tag:blogger.com,1999:blog-64139906713098576012024-03-13T09:03:27.220-07:00Bill Maier LCSWWorkshop June 6 & 7, 2019http://www.blogger.com/profile/00067610828934997234noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-6413990671309857601.post-31832786235627654902014-12-30T18:35:00.000-08:002023-11-03T20:08:20.709-07:00Understanding sleep<br />
<br />
Sleep is a multi-system brain/body cascade effect. It may be best understood in deep sleep with Rapid Eye Movement associated with dreaming. The wave patterns are smooth and rhythmic. Dreaming happens during this time. A sufficient amount of coordination between sections of the brain/body are required to achieve deep sleep. Two of the brain sections I know about related to sleep are the frontal lobe and the limbic system. The lack of coordination between these two sections seems to be at the root of sleep problems with many of the patients I have had with anxiety problems.<br />
<br />
One type of medicine prescribed to help sleep is Benzodiazapines. The psychoactive component of these drugs is a frontal lobe suppressant. When taken at an effective dose, this dampening of activity in the frontal lobe can help the observing part of the brain not react to stimuli generated from the limbic system. Anxious people have an exaggerated sense of endangerment, which sends an exaggerate signal to the frontal lobe. For optimum healthy sleep anxious people need to include the frontal lobe inhibitory effect on the limbic system. 90% of the function of the tissue in the pre-frontal cortex is designed to inhibit impulses coming from the brain stem. Including the frontal lobe is easier said than done. When sleep gets compromised frontal lobe activity is challenged to stay coordinated; therefore, inhibiting fear impulses is not as effective. When fear impulses aren't modulated the frontal lobe can get more active. The tireder the system gets the more this coordination can be impaired.<br />
<br />
Benzodiazapine can allow at least some level of sleep and dreaming. This can be a tremendous benefit to breaking long-standing sleep deficits. The trouble with this is Benzodiazapines compromise the very part of the brain we need to influence to lower brain/body fear impulses that are interfering with sleep.<br />
<br />
Quality of life and continued improvement in sleep hygiene are how to make decisions about using medicine for sleep. Many of the patients I have worked with have two choices; 1) Do not take Benzodiazapines and have a continually decreasing ability to get refreshing sleep, or 2) Use Benzodiazapines and strengthen their frontal lobe abilities to modulate impulses in their waking life. Either way enhancing the ability to see fear stimuli and soothe the multi-systems needs to be the target. These medicines will soothe the frontal lobe and maybe enough to not need ever increasing doses. I don't view Benzodiazapines as physically very addicting, however it is easy to become dependent on them in ways that aren't useful. Close coordination with a competent medical person is mandatory. Having someone like me who has a lay understanding of these processes can help make decisions more likely to be useful.Workshop June 6 & 7, 2019http://www.blogger.com/profile/00067610828934997234noreply@blogger.com0tag:blogger.com,1999:blog-6413990671309857601.post-59952470246663792482013-04-02T13:44:00.001-07:002023-11-03T19:55:34.772-07:00PTSD The Approach/Avoidance Disorder<br />
<h2>
PTSD The Approach/Avoidance Disorder<o:p></o:p></h2>
<div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;">
<span style="font-family: "arial" , "helvetica" , sans-serif; text-align: left;">As I look at each
symptom of PTSD in this section I will repeatedly bring that symptom back the
varying attachment dynamics that can be precursors to the approach/avoidance
strategy.</span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: left;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: left;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">B-1) Recurring distressing
recollections of the traumatic event or events. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: left;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: left;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">This symptom is more
inclusively stated by saying; having an over-powering need to talk to someone
about an intrusive, distressing memory, along with the seemingly intuitive sense it will be painful to relive it.
This need to tell gets stronger over time if not expressed, with a felt sense of attunement from the listener. The sufferer believes the memories will get less
intense over time. This phenomenon has
some components similar to a frog not noticing the difference in
temperature increases in a pan of water until they boil to death. If you drop frogs into boiling water they
jump out so fast their skin hardly gets scalded. As the person fights off the memories it is
hard to notice they are getting more emotionally intense. It seems natural and intuitive to expect them
to lessen. This “hallmark” symptom of
re-experiencing thoughts and feelings of the traumatic event may also seem to
stand alone to the sufferer. When he or
she finds out this symptom has lend to the rest of the symptoms it is a great
relief for most people. <o:p></o:p></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: left;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">I use the example of
how compelled you feel to tell anyone you can find about the big fish you have
caught. The compulsive need to tell about experience outside the usual
range of human experience is natural. We seek out people who are likely
to attune to our feelings, either by knowing us or knowing what it is like to
catch a big fish. After about the twelfth telling the need to tell the
story has diminished. Now drop yourself in the middle of
a desert where you don't know anyone and they have almost no experience with
fish. The compulsion to tell someone may not get satisfied. Without
the telling it is likely, and healthy to continue have the need to tell “the
big fish story” no matter how long you are in the desert.<o:p></o:p></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: left;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">The need to tell is
somewhat centered in our body-based sense of ourselves. Developmentally
it is the child rushing into the living room saying to her parents, "Look
at me! Look at me!" Healthy parents make sure the child knows they
attended to her. She goes away from that experience knowing it is natural
to express feelings stronger than usual. If instead the parents ignore
her she eventually bottles up the need to tell someone her feelings. If
these two girls go through the same traumatic event their probability of
seeking soothing from outside themselves is very different. In one of
them the need to tell about the trauma resurfaces and is expressed until it is
relatively exhausted. With the other girl the need to tell only shows up
when she can't stop the compulsion to tell. Even if she does tell someone
who could be attuned to her, she has learned to not look for cues of someone
attuning to her. With one girl the story of the trauma becomes integrated
inside her with the felt sense of being attuned to by her support system.
With the other girl the need to tell about the trauma wars with the known
fact of feeling more alone with the story if she does ever tells someone. <o:p></o:p></span><br />
<br />
<div align="center" style="margin-bottom: .0001pt; margin-bottom: 0in; text-align: center;">
<br /></div>
<div style="margin-bottom: 0.0001pt; text-align: left;">
<span style="font-family: "arial" , sans-serif;">Consider a
19 year old medic in Vietnam in 1967. His training
is condensed into eight months. In his first three months he
has the need to perform two tracheotomies, both of whom die. On the
second one he remembers some subtlety of his training he wasn't doing.
Even if his saves 100 soldiers through performing great tracheotomies the
next nine months, the part of him that feels less than others fixates on the
two deaths. <o:p></o:p></span></div>
<div style="margin-bottom: 0.0001pt; text-align: left;">
<span style="font-family: "arial" , sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: left;">
<span style="font-family: "arial" , sans-serif;">When a person’s
developing psyche comes upon an extreme life event there is a tendency to
retreat to an earlier survival based coping strategy. The younger the
disturbing situation the more problematic the reactions to it can be. The
infant or toddler who learned to survive the lack of an attuned response to
their affective states may develop a strategy to compensate for the lack of
attunement. When later life traumas happen the individual will likely use
the same coping mechanism as they did in their youth. There may be a
short term gain to this strategy, however in the long run it is necessary to
seek and find affective attunement to the disturbing feelings. PTSD has
been proven to be developed from the lack of an attuned response, rather than
the effects of the trauma.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: left;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: left;">
<span style="font-family: "arial" , sans-serif;">There is an
accumulation of factors bringing a client into my office for distress from
symptoms of PTSD. These factors need to be observed from the perspective
of representing strengths in the individual’s ability to hold their identity
together. An example would be a combat veteran who was physically abused
as a very young child by their parent. He may develop a Disorganized
Attachment, because the person he needs to be soothed by is the one who is
causing the distress. Soothing means a felt sense of attunement.
Another example is the rape survivor who was ignored as a child, especially
when in distress. She may develop an Avoidant Attachment imagining she
will never be attuned to. Both examples create internal tension with no
avenue for action. For the Avoidant person they can predict their
environment won’t attune to their distress. The Disorganized person keeps
finding attunement in people who feel abusive to him. </span><span style="font-family: "arial" , sans-serif;">We are
neurologically organized to seek out attachment. It requires massive
energy to block the need to feel soothed.<span style="font-size: 9pt;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: left;">
<span style="font-family: "arial" , sans-serif;"><br /></span></div>
</div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: left;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">This is the
"hallmark" symptom of PTSD. The other re-experiencing symptoms
can almost always be related distressing to memories and thoughts of the
trauma, or distressing memories and thoughts of the other re-experiencing
symptoms developed after the traumatic experience. We know a lot about
healthy expression of distress over critical life events of loss. We call
it the grieving process. Depending on the degree of attachment, suddenness of
the loss and the temperament of the griever the intensity, frequency
and duration of out-pourings of distress take place. It is healthy for
these out-pourings to continue with decreased frequency, intensity and duration
for at least a year. The anniversary of the loss is a particularly likely
time for the feelings to re-surface. Two years is not considered overlong
to feel swept up in the feelings of a critical life event.<o:p></o:p></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: left;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">In the original
description of PTSD the stressful event needed to be something as life
threatening as a bullet hitting the wall behind your head. Integrating
the experience of being centimeters away from sure death into your self-story,
requires you to relinquish fantasies of immortality
and omnipotence. Freud and I agree we all harbor these
fantasies. In a sense, those healthy parents responding to the "Look
at me" are perpetuating the child's fantasy of their felt sense of
importance in the world. This healthy nugget, around which the developing
psyche organizes itself, is highly challenged by the stark reality of the
dangers of the world. It takes the time and the processing of the
internal tension of the felt sense of increased endangerment. PTSD can
only be diagnosed when the felt sense of endangerment remains exaggerated
for a long enough time and leads to distress for the client.
Reconciling the infantile sense of being omnipotent with the mature
realization of the dangers of the world is part of growing up. Retreating
to an earlier strategy for coping with distressing feelings is the opposite of
maturation. The earlier the strategy
developed the less likely we are to know we are using it. It feels intuitive to isolate and push away
the distressing memories. The fact that
we blow up easily or can’t sleep does necessarily feel related. Short-term it works better to deny the
memories access to our consciousness.
Long-term we want to be able to access the memories and feelings when we
want to and not be over-powered by them. Learning when we are capable of allowing the
feelings to go through us is maturity.<o:p></o:p></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: left;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Another internal
tension that we all carry which feeds into feeling an exaggerated sense of
endangerment is "rapprochement". This is the tension between a
desire for independence and a desire for dependence. It is exemplified in
the moment the exploring toddler notices his mother walking out of the room.
Does the child respond to his internal need to explore, or the internal
need to have mother caring for him. If either he or his Mom is omnipotent
he thinks he will be okay. As the reality sets in that she can't be two
places at once, or join him in all his explorations, a sort of disbelief in the
parameters of his existence sets in. This really never gets reconciled in
us. Therefore, when a traumatic event happens in life there is more fuel
for this tension. The subliminal dialog might go something like this:
"I can't survive without someone taking these horrible feelings away from
me", or "I have to be able to hold onto these horrible feelings by
myself".<o:p></o:p></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: left;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">PTSD recovery is
allowing the person's development to take place. This requires the person
developing a felt sense of being attuned to in their most challenged states.
The states of coming to terms with the immediate, practical dangers of
the world, and the irreconcilable needs for independence and
dependence are two of these ongoing challenges. If you have ever been the care
giver for a child going through a tantrum you have experienced some of what a therapist
needs to be able to do. The client's emotional expression is seldom as
dramatic as a childhood tantrum. The client does need a feeling of having
survived an "affect storm" in the presence of another. This
survival of self and the therapy (therapist as respecting other) is essential
for the integration of memories that are outside of the parameters of what we
have learned to expect from our world.<span style="font-size: 9pt;"><o:p></o:p></span></span><br />
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /></span></div>
</div>
<div>
<div style="text-align: center;">
<div style="text-align: left;">
<br /></div>
</div>
</div>
Workshop June 6 & 7, 2019http://www.blogger.com/profile/00067610828934997234noreply@blogger.com0tag:blogger.com,1999:blog-6413990671309857601.post-32553811707090535952013-03-22T12:27:00.002-07:002023-11-03T19:56:24.707-07:00Anxiety Attacks<br />
<h2 align="center" style="text-align: center;">
<o:p> </o:p></h2>
<h2 align="center" style="text-align: center;">
Panic Attacks—Most of the clients I
have seen have had at least one Anxiety Attack in their lives. They find tremendous relief in the first
session finding out what is physically happening to them. (see section on A
Handy way to see the Brain). My job is
to be sure the client knows they are experiencing an activation of the Flight,
Fight, Freeze and Flop (FFFF) response. Prior
the 1995 revision of the Diagnostic and Statistical Manual (DSM-IV) two types of
acute anxiety reactions were differentiated. I still find the difference useful
because of the likely difference in the recovery process. A Panic Attack generally comes on quickly,
lasted from 1-20 minutes and ends abruptly.
People report the end being so sudden it takes their breath away. An Anxiety Attack comes on gradually, lasts
up to two hours and slowly loses its force. People reporting Panic Attacks almost always
say they felt like they were going to die. Both types of episodes have residual
effects.<o:p></o:p></h2>
<h2 align="center" style="text-align: center;">
The worst part of Anxiety Attacks is
their chronicity. People become worn-out from the effects of the last one and fear of the next one. The worst part of a Panic Attack is its
intensity. Sufferers will be exhausted
afterwards and may remain afraid of the next one for years or decades. The sudden onset of a Panic Attack often
gives us an advantage of having a recognizable set of circumstances we can help
the client illuminate. Recognition at an
ever earlier moment is the primary part of recovery. When the client can notice precursors and
relax before the Frontal Lobe turns itself off, they have a much greater likelihood
of the FFFF response not being initiated.<o:p></o:p></h2>
<h2 align="center" style="text-align: center;">
With all forms of Anxiety Disorders
the thinking leading up to and during the episode will include a declarative
internal statement of: “I can’t________, but I must___________”, or “ I have to________,
but I don’t want to_________”. The most
frequently reported place people experience this trap in their thinking is in
the grocery store. The etymology of the
word Agoraphobia (one of the types of
Anxiety Disorders in the Diagnostic Manual) is fear of the market place. I always imagine a herder coming over the
rise to see the longed-for market place.
He has been alone with his animals and thoughts. On many levels he wants to go into the market
place. His business and resupply need to
be done there. He wants involvement with
people. On the other hand he is afraid of being taken advantage of, or be ridiculed or criticized. The worst fear comes if he has experienced
some type of anxiety reaction in the past. His biggest fear is he will have an attack. The modern day person has to go get their
groceries to survive. It is a perfect setup for an Anxiety or Panic
Attack. “I have to <u>go to the store, </u>but
I can’t<u> do it if I have a Panic Attack”.</u>
If they don’t go they increase their desperateness and add more tension
to the next attempt. If they do go and
have an attack they get nothing accomplished they increase their desperateness
and add more tension to the next attempt.
The word, “but” is used here as a contradiction. The only way out of this dilemma is to consciously
choose one side of the equation or the other.<o:p></o:p></h2>
<h2 align="center" style="text-align: center;">
If the herder chooses to not go into
the market he will slowly starve to death, besides becoming less capable of
being around people. If he prepares by
relaxing himself thoroughly and survives the encounters with others he can
repeat this ritual the next time. Most exaggerated
fear of endangerment is built by avoiding the repetition of historical
situations and feelings leading up to an episode of exaggerated fear of
endangerment. This self-fulfilling cycle
only gets interrupted when the sufferer becomes aware of the cycle and relaxes.<o:p></o:p></h2>
<h2 align="center" style="text-align: center;">
Anti-anxiety medications have cause
as much trouble as they have provided relief for anxiety. They are a class of medicines called Benzodiazepines. Benzodiazepine is the depressant chemical
released when alcohol is broken down in the body. It is particularly active as a Frontal Lobe
depressant. The Frontal Lobe will have
diffuse activity and less over-all activity.
In order to modulate impulses from the brain stem, like anxiety, concentrated
Frontal Lobe activity is required. The
benefit of these medicines comes because it is harder to be aware of brain stem
impulses if you are compromised in your Frontal Lobe.<o:p></o:p></h2>
<h2 align="center" style="text-align: center;">
Valium was the first developed
benzodiazepine. It had a half-life of
longer than a day. A person took it to
go to the grocery store and had a depressed Frontal Lobe for the rest of the day. Xanax, one of the later developed
benzodiazepines, has a much shorter half-life, which may mean the next dose needs to be taken sooner. The ability to observe an exaggerate sense of endangerment returned
fairly abruptly. People tended to need
to take the fast dissipating benzodiazepines more frequently, or face the same
feelings they avoided a few hours ago. This cycle can lead to a type of
dependency. Any prolonged use of a benzodiazepine
challenges the Frontal Lobe’s inhibitory function of anxiety. In the short-term, seven to ten days, benzodiazepines
allow a person to not notice the anxiety welling up from their brain stem.<o:p></o:p></h2>
<h2 align="center" style="text-align: center;">
Recovery is definite if you are treated
by a knowledgeable practitioner. At the
bare minimum the client will learn the phrase, “This too shall pass”. Hippocrates, the father of medicine, wrote
about Anxiety Attacks. In all our document history since, no one has
died yet of a Panic Attack. People do
build-up fatal musculature around their hearts because of the rapid heartbeat
of FFFF. Either type of attack is a built-in survival mode to deal with a life-threatening situation. This built-in reaction won't kill you. It is very unfamiliar and if you are afraid of it, it gets magnified.</h2>
<h2 align="center" style="text-align: center;">
In a psychoanalytic sense
anxiety is caused by a lack of an attuned response to a felt sense of
endangerment. By feeling attuned to by a
therapist who seems to understand their anxious feelings, the client is no
longer alone with the unbearable affect.
The “I can’t, but I must” situation can be looked at objectively. Recovery is about make a choice of which side of
this contradiction to act on. The beauty
of the recovery process is related to the repetitive nature of the problem. If
the client can develop a realistic response to thinking they are trapped, they can
use the same response in many other situations.<o:p></o:p></h2>
Workshop June 6 & 7, 2019http://www.blogger.com/profile/00067610828934997234noreply@blogger.com0tag:blogger.com,1999:blog-6413990671309857601.post-78889647358277730872013-03-20T15:07:00.006-07:002023-11-03T19:57:36.231-07:00DEPRESSION & THE CINGULATE GYRUS<h2>
</h2>
<h2 style="text-align: center;">
</h2>
<h2>
<span style="font-size: 18pt; line-height: 150%;"> </span></h2>
<h2>
Depression---Anger turned inward—cingulate gyrus<o:p></o:p></h2>
<div class="MsoNormal">
In between the left and right and just below hemispheres of
the human brain is a group of nervous about as long and thick as a hotdog. Its primary purpose is to switch our focus
from one thing to another. When we are
focusing on a client we are accessing many areas of our memories of them, our
disciplines as therapists, their histories and the current session’s interactions.
If they ask us about the plant we have in the office our Cingulate Gyrus will
quickly activate to gather relevant data of the history of our plant. The Cingulate’s job is meant to be
short-lived, like a switch. I point to the light switch. It turns the attention
to the plant, then stops functioning until we want to switch back to our clinical
awareness. The Cingulate Gyrus is
located above the Limbic Cortex and Corpus Callosum. It is high enough up in
the brain to utilize language, however when it operates the brain reduces the
use of the frontal lobe. The logic
circuitry isn’t nearly as important as the complex process of creating memory
images. <o:p></o:p></div>
<div class="MsoNormal">
This is all well and good, however what does it have to do
with anger turned inward? The Cingulate
has the capability of having a thought over and over again without the need to
filter it through the logic circuitry. Thought distortions are what David
Burns, MD, in his 1980 book <u>Feeling Good</u>, called the core of being
depressed. There is some hopeless,
helpless exaggerated thought that resonates with the feelings in the Limbic
System. Without regulation from the Frontal
Cortex the emotional low brain/body and repetitive thought re-enforce
one-an-other. The more we think our
situation is hopeless the more it feels hopeless. The more we feel hopeless the more we think
the hopeless thought over again. This
Cingulate Gyrus/Limbic Cortex feedback allows the impulse centers of the brain/body
to operate without the modulation the Frontal Cortex is responsible for. <o:p></o:p></div>
<div class="MsoNormal">
If we experience anger toward ourselves or others while we
are thinking and feeling hopeless we are compromised in our ability to modulate
those feelings and thoughts. As the
seconds and moments develop into days and weeks a feeling of lethargy sets in.
*****An aside about Shame/Narcissism.
Even when the Frontal Lobe can get involved, it is important to remember
its default setting is to worry about what people are thinking and feeling
about us. Our shame dynamic tells us there is something wrong with us and other
people know it. During moments of
depression there IS something wrong with us, so rather than helping us become
more realistic about our thoughts and feelings, the False Self turns the reigns
back over to the Cingulate Gyrus and the Limbic Cortex. ******The diagnostic
manual for mental disorders states that an essential criterion to meet the
diagnosis of a Depressive episode is: a person must experience a feeling like
hopelessness most of the hours, for most of the days, for at least two
weeks. Many people who have come to me
for therapy have been experiencing thoughts and feelings of hopelessness almost
every day for years.<o:p></o:p></div>
<div class="MsoNormal">
So how do we get the logic circuitry back involved? This is where Dr. Burns clarified for us
Cognitive Behavioral Therapy. One,
identify the distorted thoughts. Two, determine the type of exaggeration it is.
Three, develop a realistic thought about the same thing without the
exaggeration; and practice all three steps when able to notice depressive
thoughts or feelings. This process of
recognition of the distressing component requires the observation ability that
only can come from the Frontal Lobe. 90%
of the function of the cells in the Frontal Lobe is to inhibit impulse coming
from the Limbic Cortex. By being logical
and starting an action of thinking differently, automatically the emotions are
being modulated.<o:p></o:p> This may not be powerful enough to inhibit the process of the emotions controlling the thoughts, however it is likely to be a useful component of most people's recovery from Depression.</div>
Workshop June 6 & 7, 2019http://www.blogger.com/profile/00067610828934997234noreply@blogger.com0tag:blogger.com,1999:blog-6413990671309857601.post-79889971260176394632013-02-13T13:21:00.058-08:002022-12-26T13:15:07.325-08:00Pain and psychotherapy<br />
<h2>
</h2>
<h2>
Pain
and psychotherapy<o:p></o:p></h2>
All felt pain has physical and psychological components. Sensory and emotional signals are sent up and
down the body/brain systems. Suffering and agony are fear related to pain. They are intrinsic to pain. Fear, in a deep body/brain sense, is a
requirement. It manifests as muscle guarding which tenses the muscle areas
surrounding the pain. This increased
tension can cause more mechanical pain, leading to more muscle guarding, and
more pain. I will explain pain in the brain/body, its relationship to involuntary contraction of muscle, and what to do about it to suffer less.<br />
<br />
First let me clarify the basic working components of the nervous system. I
have found my clients need this information in order to understand anxiety,
depression, <b><u>pain</u></b>, medicines, anger, and impulsive behavior.<br />
<br />
Nerves have three different types of dendrite receptors: mechanical,
thermal and chemical. The brain interprets pain signals. Psychological
processes have physical effects.
Physical processes have psychological effects. There is no separation between
psychological and biological. The cell
wall of a neuron is made up of proteins, large molecules, whose shape and content determine the character and function of each protein. The outfacing end of the long cell wall
protein can be thought of as a key hole, it is the receptor site.
Neurotransmitters are the keys that fit in these locks. Overly simplified, when a neurotransmitter
lodges in these proteins they bond changing the electrical potential of the
whole cell a tiny bit. The nerve cell
generally sets at -70 millivolts, when it reaches -40 millivolts it triggers
the cell wall proteins to flip over, bring the cell to +30 millivolts. Neurotransmitters
are discharged out of the axon end of the nerve, into the synapse between that
axon and the dendrite of the next cell.
They diffuse into the area where the dendrite end of the next nerve has
many receptor sites for them. The electrical process causes the protien to flip, (actual Sodium-Na and Potassium-K, negatively charged (-) chemicals are pushed out while Chloride-Cl, positively charged (+) is drawn in). Those two nerves
are now wired together. <div><br /></div><div>The more a pathway in the nervous system is used the more it becomes
resupplied with the necessary chemicals for it to operate. Blood veins,
arteries and the muscles that surround them are strengthened and developed. It
gets easier and easier to use that pathway.
This is part of the way chronic pain gets habituated in the body/brain.<div><br />
As a pain sensation is felt in the body it sends a signal
of the pain to the spinal column. As the signal arrives, the spinal column
quickly makes available more receptor sites for noticing pain. The surrounding neural
dendrites are quickly tuned to receive the same pain signal. Therefore, the
signal is amplified, literally increasing magnitude of the pain signal. The brain can also send signals back down the
spinal column to interfere with the use of some of the receptor sites or add
more. After the spinal column has processed it, the pain signal heads up to the
brain. There the signal goes through an
amazing and complex matrix of receiving areas. <br /><br /></div><div>The following brain areas are some of important functions in the way we
experience pain:<br /><br /></div><div>
SENSORY CORTEX<br />
This is a strip of brain tissue on both sides of the brain about the width
of your index finger. It processes our
body sensations. How pain is felt depends on how cells in these strips are
organized. Every part of our body has an
area represented on the brain’s sensory strip. It is a mini version of our body
mapped onto our brain. The size of the
space dedicated for different body parts is related to that area’s degree of
sensitivity. Therefore the mouth, face, finger, genitals and feet are related to
much bigger areas than their physical size is.
This increased sensitivity allows us to feel two toothpicks pressed on
our fingertip a quarter of an inch apart and it will feel like one toothpick on
our backs. These areas can all get bigger or smaller depending on use. If you have chronic pain in your right elbow
the space related to it in the sensory strip enlarges and becomes more
sensitive. (In recovery from suffering from pain the reverse of this process
will be utilized. The client learns many
systems to focus on the non-painful areas of their life.) <br /><br /></div><div>
LIMBIC SYSTEM</div><div> <br />One of the first and most powerful matrixes for pain identification is located in the Amygdala. The Amygdala can
decide to pass the signal on up to more complex areas for evaluation, or the
Amygdala can take over if it determines the signal to be life threatening. If it feels life threatening all of the smooth
muscles contract to force all the blood near the heart for rapid use where
need. This creates a lot more tension
throughout the body. At the same time in
40-60 milliseconds directions are sent to the heart to speed up, lungs to work
faster using only the top parts that are closer to the heart, the stomach and
other organs to shut off, the adrenal gland to secrete adrenaline, and many other systems<br />
If a person has an exaggerated sense
of endangerment due to life threatening experiences in their past, it is easier
for the Amygdala to take over. So, when the
body sends a signal that is similar to the signal sent during an earlier life
threatening event it is more likely a fear response will be initiated. <br /><br /></div><div>
SITTING WITH THE RIGHT AMOUNT OF
PAIN</div><div><br />
So, how can we talk to someone about all of these complications with pain?
I have never explained all of these concepts to any one client. Even though several of my client knew more
about some the pain related processes in their body/brain. Many of them have been much smarter than I
am. Joining the client in where they are
at with their knowledge of their pain and their hard fought strategy for
dealing with, is the answer. In a sense
I am a knowledgeable person they are bouncing their plans off of. My job with either depression or anxiety is
to help the client relax in many layers of their organization of themselves.
When their pain coping strategies sound and feel like the way they dealt with
the deficits in their early life care-giver environment, I need to help them
soften those ideas. These defensive
strategies invariably make pain worse in the long run, so helping them see what
ideas help them and what ideas hurt them illuminates relaxing with the pain and
focusing on how they want their life to be.<br /><br /></div><div>
The problem and solution with chronic pain is neural plasticity. Nerves. being able to add new connections to
other nerves, leads to ever greater intensity, frequency and duration of
suffering. Allowing the overgrown areas
to atrophy is facilitated by growing new more dynamic connections in other
areas.<br />
<h2>
<o:p></o:p></h2>
<h2>
<o:p></o:p></h2>
<div class="MsoNormal">Knowing the overall cascade effect, that is most obviously demonstrated by the either/or bifurcated functioning of the Amygdala, (flight or fight triggered on the left; empathy and frontal lobe connection on the right) helps patientss plan ways incremental progress in many areas of pain modulation, rather than looking for a quick fix.</div>
<h2>
<o:p></o:p></h2>
<h2>
<o:p></o:p></h2>
<h2>
<o:p></o:p></h2>
<h2 align="center" style="text-align: center;">
<o:p></o:p></h2>
<h2>
<o:p></o:p></h2>
<h2>
<o:p></o:p></h2>
<h2>
<o:p></o:p></h2>
<h2>
<o:p></o:p></h2>
<h2 align="center" style="text-align: center;">
<o:p></o:p></h2>
<h2>
<o:p></o:p></h2>
<h2>
<o:p></o:p></h2>
</div></div>Workshop June 6 & 7, 2019http://www.blogger.com/profile/00067610828934997234noreply@blogger.com0