twelve subjects received MDMA and eight received an inactive placebo. Sitting or lying in a comfortable room, they then all received two eight-hour psychotherapy sessions, mainly using internal family systems (IFS) therapy, the subject of chapter 17 of this book. Two months later 83 percent of the patients who received MDMA plus psychotherapy were considered completely cured, compared with 25 percent of the placebo group. None of the patients had adverse side effects
Body awareness puts us in touch with our inner world, the landscape ot our organism. Simply noticing our annoyance, nervousness, or anxety immediately helps us shift our perspective and opens up new options other than our automatic, habitual reactions. Mindfulness puts us in touch with the transitory nature of our feelings and perceptions. When we pay focused attention to our bodily sensations, we can recognize the ebb and flow or out emotions and, with that, increase our control over them.
The rational, analyzing part of the brain, centered on the dorsolateral prefrontal cortex, has no direct connections with the emotional brain, where most imprints of trauma reside, but the medial prefrontal cortex, the center of self-awareness, does.
. James Heckman, winner of the 2000 Nobel Prize in Economics, has shown that quality early-childhood programs that involve parents and promote basic skills in disadvantaged children more than pay for themselves in improved outcomes
have calculated that every dollar invested in highquality home visitation, day care, and preschool programs results in seven dollars of savings on welfare payments, health-care costs, substance-abuse treatment, and incarceration, plus higher tax revenues due to better-paying
The need for attachment never lessens. Most human beings simply cannot tolerate being disengaged from others for any length of time. People who cannot connect through work, friendships, or family usually find other ways of bonding, as through illnesses, lawsuits, or family feuds. Anything is preferable to that godforsaken sense of irrelevance and alienation.
A secure attachment combined with the cultivation of competency builds an internal locus of control, the key factor in healthy coping throughout life.? Securely attached children learn what makes them feel good; they discover what makes them (and others) feel bad, and they acquire a sense of agency: that their actions can change how they feel and how others respond. Securely attached kids learn the difference between situations they can control and situations where they need help. They learn that they can play an active role when faced with difficult situations. In contrast, children with histories of abuse and neglect learn that their terror, pleading, and crying do not register with their caregiver. Nothing they can do or say stops the beating or brings attention and help. In effect they're being conditioned to give up when they face challenges later in life
. The mind needs to be reeducated to feel physical sensations, and the body needs to be helped to tolerate and enjoy the comforts of touch. Individuals who lack emotional awareness are able, with practice, to connect their physical sensations to psychological events. Then they can slowly reconnect with themselves
Trauma victims cannot recover until they become familiar with and befriend the sensations in their bodies. Being frightened means that you live in a body that is always on guard. Angry people live in angry bodies. The bodies of child-abuse victims are tense and defensive until they find a way to relax and feel safe. In order to change, people need to become aware of their sensations and the way that their bodies interact with the world around them. Physical self-awareness is the first step in releasing the tyranny of the past.
Somatic symptoms for which no clear physical basis can be found are ubiquitous in traumatized children and adults. They can include chronic back and neck pain, fibromyalgia, migraines, digestive problems, spastic colon/ irritable bowel syndrome, chronic fatigue, and some forms of asthma.16 Traumatized children have fifty times the rate of asthma as their nontraumatized peers.17 Studies have shown that many children and adults with fatal asthma attacks were not aware of having breathing problems before the attacks
The elementary self system in the brain stem and limbic system is massively activated when people are faced with the threat of annihilation, which results in an overwhelming sense of fear and terror accompanied by intense physiological arousal. To people who are reliving a trauma, nothing makes sense; they are trapped in a life-or-death situation, a state of paralyzing fear or blind rage. Mind and body are constantly aroused, as if they are in imminent danger. They startle in response to the slightest noises and are frustrated by small irritations. Their sleep is chronically disturbed, and food often loses its sensual pleasures. This in turn can trigger desperate attempts to shut those feelings down by freezing and dissociation
In the past two decades it has become widely recognized that when adults or children are too skittish or shut down to derive comfort from human beings, relationships with other mammals can help. Dogs and horses and even dolphins offer less complicated companionship while providing the necessary sense of safety.
What is less well-known is that in 1924 Pavlov made another momentous scientific discovery related to trauma. The thaw in St. Petersburg during the spring of that year caused the River Neva to flood Pavlov's basement laboratory, inundating the cages of his experimental dogs who were trapped in the icy water with no means of escape. The dogs survived, but after the water receded the dogs continued to be terrified, even though they were physically uninjured. A significant proportion, though physically unscathed, "broke down" emotion- ally, behaviorally, and physiologically. Many of them laid around motionless, barely paying attention to what was going on around them. Pavlov interpreted this as a sign of ongoing terror, which had obliterated any curiosity in their surroundings. We now know that physical immobility and loss of curiosity are also typical of frightened, traumatized children and adults.
The challenge of trauma treatment is not only dealing with the past but, even more, enhancing the quality of day-to-day experience. One reason that trau- matic memories become dominant in PTSD is that it's so difficult to feel truly alive right now. When you can't be fully here, you go to the places where you did feel alive-even if those places are filled with horror and misery.
Tt's important to have an efficient smoke detector: You don't want to get caught unawares by a raging fire. But if you go into a frenzy every time you smell smoke, it becomes intensely disruptive. Yes, you need to detect whether somebody is getting upset with you, but if your amygdala goes into overdrive, you may become chronically scared that people hate you, or you may feel like they are out to get you.
The challenge is not so much learning to accept the terrible things that have happened but learning how to gain mastery over one's internal sensations and emotions. Sensing naming, and identifying what is going on inside is the first step to recovery
neuroscience research shows that very few psychological problems are the result of defects in understanding; most originate in pressures from deeper regions in the brain that drive our perception and attention. When the alarm bell of the emotional brain keeps signaling that you are in danger, no amount of insight will silence it
The neuroscientist Paul MacLean compared the relationship between the rational brain and the emotional brain to that between a more or less competent rider and his unruly horse. As long as the weather is calm and the path is smooth, the rider can feel in excellent control. But unexpected sounds or threats from other animals can make the horse bolt, forcing the rider to hold on for dear life.
Our frontal lobes can also (sometimes, but not always) stop us from doing things that will embarrass us or hurt others. We don't have to eat every time we're hungry, kiss anybody who rouses our desires, or blow up every time we're angry. But it is exactly on that edge between impulse and acceptable behavior where most of our troubles begin. The more intense the visceral, sensory input from the emotional brain, the less capacity the rational brain has to put a damper on it