Behaviours Archives - Khiron Clinics

The Disease To Please – Hypervigilance Around Others’ Needs

Araminta — Fri, 25 Feb 2022 06:00:41 +0000

Hypervigilance is not a mental health condition on its own, although it can be symptomatic of one. Being hypervigilant often means that people are sensitive to their environment, but it can also mean being extremely sensitive to other people’s emotions.

Hypervigilance Defined

Hypervigilance is characterised by an extreme sensitivity to the environment. Hypervigilant people are often on high alert and constantly on the lookout for hidden dangers and potential escape routes. It can be exhausting to deal with and can interfere with work and personal relationships.

Hypervigilance is commonly a symptom of post-traumatic stress disorder (PTSD) and can also be a symptom of panic disorder and generalised anxiety disorder.^[1] Other experiences that can cause hypervigilance include being a survivor of domestic or childhood abuse, a war veteran, or surviving sexual assault. Symptoms of hypervigilance include:

Quick, shallow breathing
Rapid heart rate
Severe anxiety
Avoiding social interactions
Increased fear
Overreacting to environmental and emotional stimuli

Additionally, hypervigilance can be defined by four features:

Avoidance of perceived threats – depending on where an individual sees a threat, they may avoid those places or scenarios. People may also develop agoraphobia, an intense fear of places and situations in which they may be trapped.
Startle reflex – everyone startles at loud noises occasionally, but in cases of hypervigilance, people can jump or flinch at sudden movement, noise, and surprise. This is also called hyperekplexia.
Overestimating a threat – hypervigilance causes people to constantly be prepared for threats, to the point where they will take any precaution to prepare themselves. This can include sitting with their back to a wall or near an exit so that they can escape easily.
Epinephrine-induced physiological symptoms – also known as adrenaline, epinephrine is a stress hormone that can impact our fight-or-flight response. Hypervigilance can release more epinephrine than needed to prepare for threats, which causes increased blood pressure, a rapid heart rate, and dilated pupils.

Hypervigilance may be mistaken for paranoia. Although there are similarities between the two, there are also marked differences:

Present and future – paranoia is characterised by a belief that someone is trying to hurt them in the present. In contrast, hypervigilance is marked by intense anxiety about bad things happening in the future.
Being on guard – hypervigilant people are consistently on guard, but those struggling with paranoia suffer from delusions that someone or something is out to get them.
Insight – paranoid people are often unaware that they are suffering from delusions. However, hypervigilant people know that they may be irrational but still find it difficult or impossible to relax.

Emotional Hypervigilance

Hypervigilance is often a response to trauma, childhood abuse, assault, or surviving an accident or natural disaster. For those hypervigilant due to abuse, they may be especially vigilant with the needs of others, constantly going out of their way and out of their comfort zone in an attempt to keep them happy.

This can also play into attachment theory. Those with an anxious-insecure attachment style are constantly sensitive to their partner’s moods and emotions. As they are terrified of abandonment, they can be increasingly hypervigilant to their partners’ needs and wants. However, this behaviour can lead to resentment on behalf of the hypervigilant person, as they strive to cater to their partner’s wants, but their partner may not do the same.

Hypervigilance can also affect relationships, both romantic and platonic, in many ways:

Identity issues – those constantly hypervigilant to their partner’s moods and needs may neglect their feelings and needs and lose their sense of identity.
Clinginess – those coping with trauma and an anxious-insecure attachment style can become incredibly clingy to their partners out of fear they will leave. They are hypervigilant to their partners’ needs to try and discourage them from leaving.
Emotional outbursts – hypervigilance can cause people to have trouble regulating their emotions, leading to intense emotional outbursts.
Trust issues – hypervigilance leads to people constantly scanning their surroundings for threats. These threats can include people, and even in relationships and friendships, people can struggle with trust issues.

In addition, those struggling with hypervigilance can overreact to their partner’s or friends’ tones or expressions and overanalyse every situation. This can damage their relationships as their partners may take offence to their reactions and not understand why they behave the way they do.

Coping With Hypervigilance

If you notice that hypervigilance affects your life, there are several ways to help. As being intensely hypervigilant is linked to anxiety disorders and PTSD, it is wise to contact a mental health professional to see if there is an underlying cause.

An effective treatment for hypervigilance is exposure therapy. This form of treatment focuses on exposing people to specific triggers and fears to help individuals recognise what causes them to react so they can take steps to limit their responses. Therapy can also provide many tools for coping with hypervigilance, including:

Relaxation techniques – your therapist may incorporate relaxation aids such as yoga and breathing exercises into your treatment.
Mindfulness – learning how to be mindful of behaviour can help those struggling with hypervigilance become more aware of what they think and feel in the moment and reduce their reactive behaviour.
Communication -therapists can incorporate communication techniques into treatment to help those struggling with hypervigilance communicate what they need and how they feel to the people around them.

Conclusion

Hypervigilance is a symptom of conditions such as PTSD and several anxiety disorders. It is characterised by the intense fear and avoidance of threats, with those struggling with hypervigilance taking extreme measures to avoid potential adverse outcomes.

Many people struggling with trauma or an avoidant-insecure attachment style can be incredibly hypervigilant to the needs of others. They worry that if they don’t cater to the needs of people around them, their friends and partners will reject them and leave, so they take extreme steps to meet every need of their loved ones; however, this can come with a range of negative consequences and can actively damage relationships. With the help of therapy and healthy coping mechanisms, hypervigilance and its causes can be treated effectively.

If you have a client or know of someone struggling with hypervigilance, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential programme and outpatient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For more information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources:

^[1] Kimble M, Boxwala M, Bean W, et al. The impact of hypervigilance: Evidence for a forward feedback loop. J Anxiety Disord. 2014;28(2):241-245. doi:10.1016/j.janxdis.2013.12.006

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The Need for Boundaries in Relationships

Araminta — Fri, 19 Nov 2021 05:04:48 +0000

All healthy relationships need boundaries. Boundaries don’t mean you’re closing yourself off to your partner, friend, or parent. Instead, they suggest that you’re setting down firm rules of what you need and expect from that relationship.

Boundaries can help you to get close to others and improve your relationship. It isn’t about keeping people at arm’s length at all times – it means that you’re putting measures in place to protect your sense of identity and your mental health.

Types of Boundaries

Anne Katherine, the author of Where to Draw the Line, defines boundaries as “a limit. By the limits you set, you protect the integrity of your day, your energy and spirit, the health of your relationships, the pursuits of your heart.”^[1]

Boundaries can look different depending on each person’s needs. You can also set professional boundaries regarding your work life. It’s essential to clearly communicate the boundaries you might need to ensure that there is minimal miscommunication. Here, it is beneficial to define exactly what you need, want, or expect.

Examples of some healthy boundaries that you might want to set include:

Asking permission, for example, to share your thoughts and feelings after a long day
Showing respect
Giving one another space when asked for
Setting a firm cut off point for finishing work

When setting boundaries, something to be aware of is that they can often turn into an attempt to control someone. For instance, a healthy boundary may require both partners to respect when the other says “no”. However, an unhealthy boundary can grow when one partner does not accept this and tries to pressure or coerce the other partner into accepting or doing something that they do not want to.

These unhealthy boundaries can take many forms, including:

Oversharing personal information, for instance, with people who you are not close to
Banning your partner from going out with their friends
Withholding communication or affection after conflict

How to Set Healthy Boundaries

Knowing how to set healthy boundaries in relationships can be intimidating, but there are a few ways that you can make it easier:

Communicate – Communication is key for all aspects of life. When setting boundaries, sit down with your loved one free from any distractions and discuss what you want to see in your relationship and how you can both achieve this. Although it might feel awkward, the rewards you’ll see in your relationship will be well worth it.
Start early – Setting healthy boundaries in romantic relationships works best when set early as this gives both parties the chance to settle in around the boundaries and get used to them. This isn’t to say that boundaries can’t be set later on during a relationship. They may just be harder to adapt to as both partners will be used to certain habits that could be difficult to break.
Be careful with your wording – When discussing boundaries, finding the right words to use can be tricky. If you use phrases such as “when you” or “you always do”, it can come across as though you’re blaming the other person. In turn, they may become defensive which often causes communication to break down. Try using “I” statements, such as “I feel” or “I don’t like”. In doing so, you and your partner will have the ability to focus on what you want and need within that moment.

When discussing boundaries, it’s important to remember that they are not always set in stone. You can choose to come back and review them with your loved one after a set amount of time and adjust them as needed. However, it is also important not to be too flexible with your boundaries – don’t give in to pressure if someone wants to violate a boundary you have set.

Stating that “boundaries are sometimes permeable, and sometimes they’re not. Sometimes they’re physical and sometimes they’re geo-political, so this idea is more fluid”^[2] Meredith Gore, an Associate Professor at the University of Maryland, advises people to ‘think like a geographer’ when it comes to setting boundaries.

The Benefits of Setting Boundaries

Setting healthy boundaries can come with a host of benefits that enhance many relationships. Healthy boundaries can:

Reduce conflict – Having clear boundaries that both people respect and adhere to can reduce the amount of conflict within any relationship. From a lack of respect for privacy to a lack of effective communication, continuous conflict may arise within a relationship from anywhere. However, healthy boundaries that target these issues can reduce the conflict that can arise from them.
Decrease resentment – Resentment can stem from many places, such as if you feel your partner is taking advantage of your generosity or time or taking you for granted. By setting boundaries that ask your partner to respect your time and feelings, resentment can be reduced, and your relationship improved.
Improve happiness – Studies have shown that blurred boundaries between work and life can negatively affect lifestyle and wellbeing.^[3] The prevalence of communication technology also means that those who work from home can struggle to separate their work and life balance. Unfortunately, this can increase conflict within families.^[4] Setting a firm boundary and prioritising your downtime can improve your happiness and prevent emotional exhaustion.

Conclusion

Boundaries are an essential need in all relationships. They help us remain independent in our relationships and ensure that we can still enjoy close companionship and preserve our mental health and identity. Although people may feel guilty for setting boundaries at first, especially if they are not used to prioritising themselves, they can vastly improve wellbeing.

As well as setting your own firm boundaries, always be respectful of the ones that others set. Respect is a two-way street, and if you respect the boundaries of others, they are likely to respect yours in return.

If you have a client or know of someone struggling to with their mental health, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and outpatient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For more information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources:

^[1] Katherine, Anne. Where To Draw The Line. Simon & Schuster, 2000, p. 14.

^[2] Phipps, Emma. “Meredith Gore – Boundaries In A World Striving For Work-Life Balance #Womeninscience”. Science & Research News | Frontiers, 2021, https://blog.frontiersin.org/2021/08/26/meredith-gore-boundaries-in-a-world-striving-for-work-life-balance-womeninscience/.

^[3] Pluut, Helen, and Jaap Wonders. “Not Able to Lead a Healthy Life When You Need It the Most: Dual Role of Lifestyle Behaviors in the Association of Blurred Work-Life Boundaries With Well-Being.” Frontiers in psychology vol. 11 607294. 23 Dec. 2020, doi:10.3389/fpsyg.2020.607294

^[4] Yang, Jing et al. “Work-Family Segmentation Preferences And Work-Family Conflict: Mediating Effect Of Work-Related ICT Use At Home And The Multilevel Moderating Effect Of Group Segmentation Norms”. Frontiers In Psychology, vol 10, 2019. Frontiers Media SA, doi:10.3389/fpsyg.2019.00834. Accessed 8 Nov 2021.

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Trauma and Neurodiversity – Understanding the Struggle and Meeting the Needs

Araminta — Wed, 15 Sep 2021 12:16:49 +0000

The most common metaphor used to describe our brains is a supercomputer. Both can crunch vast amounts of data, run on complex circuits, and transport data using electrical signals. However, this comparison does the organ between your ears a huge disservice – it’s much more complex than that.

Neuroscientists disagree on precisely how many neurons our brain is comprised of – some say over 80 billion, while others have claimed over 100 billion. Either way, it’s a staggering number.

People generally don’t question when others have different physical features, and it is often assumed that everyone’s brain is more or less wired the same. For years, medical science thought the same thing – people had regular neurological wiring, or different wiring, which insinuated some sort of problem. However, as we move towards a more inclusive and accepting world, scientists have come to realise that no two brains are wired up precisely the same. We’re all a little bit different, and this is where the idea of neurodiversity comes into play.

What Is Neurodiversity?

As with many fields of neuroscience, there isn’t an exact definition of neurodiversity. Originally coined in 1988 by Judy Singer in her Sociology honours thesis, the idea is now the subject of many different scientific papers and studies.

Neurodiversity refers to differences between human brains that affect sociability, learning, mood, attention, and other mental functions. It challenges the view that any deviation from the norm is pathological and a disability, instead suggesting that societal barriers are the main contributing factor that disables people. Originally used to describe those on the autism spectrum, it now encompasses a huge range of conditions from ADHD to Parkinson’s disease.

Neurodiversity and Trauma

Trauma occurs in response to events where we feel unsafe, threatened, or distressed. People often associate extreme events such as witnessing death, serious injury, war, or natural disasters as common sources of trauma, and they’re right. Instances such as these can leave a lasting imprint on our nervous system.

However, we are all different, and as a result, so is our response to the world. This means that trauma is highly subjective – what might not register for one person could be life-changing for another. Anything that puts us under sufficient levels of stress can be potentially traumatic and could range from feeling unheard to not having our educational needs met in school.^[1]

As such, when considering trauma treatment, we must pay close attention to how the individual in question experiences the world rather than how we would. We need to validate each individual’s unique response if we are to make trauma treatment as inclusive as possible. Below, we explore just a few of the many ways in which neurodivergent people may experience trauma.

Traumatic Sensory Overload

People with differing sensory experiences often find the world a hard place to inhabit. For most of us, the sound of a fire alarm, leaf blower, or a crisp packet crackling wouldn’t even register; we’d forget about it the minute it passed. However, these sounds can be completely overwhelming for those prone to sensory overload, causing their nervous system to move into fight, flight, or freeze.^[2]

This is compounded by the fact that these experiences are often invalidated or not accommodated by others around them. As a result, people often learn to mask their threat response because they don’t want to show fear or embarrass themselves, which does not allow the nervous system to complete the threat cycle.

Bullying and Social Isolation

Unfortunately, certain neurodivergents experience bullying and isolation to a far higher degree than the rest of the population.^[3] It goes without saying that bullying is an incredibly distressing experience and is enough to cause long-term trauma and PTSD.

However, what is often not discussed is the trauma of feeling different. Humans exist within certain societal behavioural norms, and we often shun people who break those perceived norms. As a species, we crave connection with other people, and this is no less true for neurodivergents than it is for the rest of society.

If people cannot feel they can form meaningful bonds with their peers, it can leave them feeling misunderstood, dejected, and distressed. This can also lead to people masking their neurodiversity in an effort to fit in, further exacerbating the feeling they can’t embrace their true selves.

Difficulty Communicating

We need to be able to convey our feelings to others in order to feel safe and to have our needs met. However, navigating the landscape of social communication can be difficult for neurodivergent people.

This is especially true for those who struggle with uncertainty. What might come across as a neurodivergent being inflexible, rigid, or stubborn could very well be them attempting to remain in a state where they feel safe. This can result in misunderstandings and people being labelled as difficult and can also be a barrier to receiving proper treatment and care.^[4]

Conclusion

While this is by no means an exhaustive list of the ways in which neurodivergent people can be more susceptible to trauma than the rest of the population, it can provoke thought and reflection.

If we are to make trauma treatment and recovery as comprehensive as possible, we need to not only consider an individual’s circumstances, but the unique way in which they perceive said circumstances.

If you have a client or know of someone struggling with any of the issues discussed, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and outpatient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For more information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources

^[1] van der Kolk, Bessel A. “The Body Keeps The Score: Memory And The Evolving Psychobiology Of Posttraumatic Stress”. Harvard Review Of Psychiatry, vol 1, no. 5, 1994, pp. 253-265. Ovid Technologies (Wolters Kluwer Health), doi:10.3109/10673229409017088. Accessed 18 July 2021.

^[2] Scheydt, Stefan et al. “Sensory overload: A concept analysis.” International journal of mental health nursing vol. 26,2 (2017): 110-120. doi:10.1111/inm.12303

^[3] Zablotsky, Benjamin et al. “Risk factors for bullying among children with autism spectrum disorders.” Autism : the international journal of research and practice vol. 18,4 (2014): 419-27. doi:10.1177/1362361313477920

^[4] Autistic People May Not Receive Treatment For PTSD | LDT”. LDT, 2021, https://www.learningdisabilitytoday.co.uk/autistic-people-may-not-receive-treatment-they-treatment-they-need-for-likely-ptsd.

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Unhealthy Bonds and What Binds People to Them

Araminta — Fri, 16 Jul 2021 04:58:12 +0000

From the outside, it can be hard for those of us in relatively conventional relationships to understand why someone stays with an abusive partner, family member or boss, when placed in the same situation; we would turn on our heels and run as far as possible in the other direction. The simple answer is that far from being simple, it is an extremely complex and multifactorial issue that spans past experience in both the abused and the abuser. Mental health issues that arise from that experience and a whole cocktail trolley of hormones that get served up in different scenarios and serve to feed the co-dependency of harmful and unequal bonds keeps people stuck when they should in fact, twist.

One of the best-known examples of unhealthy bonding occurred in Sweden in 1973 and was coined “Stockholm Syndrome” (Bejerot 1974). Despite surviving the trauma of having dynamite strapped to their bodies and being held hostage for 131 hours during the course of a bank robbery, the hostages defended their captors (one even mounting a legal defence on their behalf) and one later becoming engaged to one of them. Stockholm Syndrome is described as “an unconscious emotional response to the terror of being captive” and that “protection is entirely in the hands of the abuser”, placing them in complete control. [1] This is an extreme example of what is often referred to as a Trauma Bond but this type of attachment challenges reason and is also extremely hard to detach from.

Unhealthy bonds can occur in a variety of settings, sometimes even intentionally such as in the case of military training but are most often seen in everyday life in the example of children of abusive parents or in intimate or workplace relationships (basically anywhere there is the opportunity to abuse a position of authority and exercise control). [2]The relationship is characterised by an unshakeable attachment built on the foundations of recurrent physical, emotional or psychological abuse, peppered by sporadic positive reinforcement, affection and all too rare good times. The cycle is an unhealthy merry-go-round of trauma, often predicted by unresolved childhood trauma. According to trauma authority, Dr Bessel van der Kolk, “The absence of strong, healthy early attachments robs people of the security necessary to interrupt the inner or social isolation that keeps them stuck in repetitive patterns.” This response is not because they are weak but because the early trauma creates psychological and biological disturbances which include “physical addiction to abusers; hyperarousal states that are alleviated by violence against self or others”. [3] The intensity of the connection is reinforced by the fact that it is physical as well as emotional and psychological, with the sufferer awash with hormones that dictate their response to the abuser in a similar way to that of substance users.

How Life Creates the Perfect Storm & the Making of an Equally Perfect “Hostage” Candidate

Unresolved past trauma, especially in childhood, can compromise our capacity for developing and maintaining positive relationships (family, romantic, friendship and work) and from engaging in appropriate social exchange. Trauma for a child means an event or events that outweigh its ability to cope, which often leads to mental health issues like anxiety and depression, avoidant or addictive behaviours, mercurial moods and emotions or even Borderline Personality Disorder or Narcissistic Personality Disorder. Traumatic episodes have a tendency to shift people into survival mode, which is either to fight, flee or freeze and in the case of trauma and unhealthy bonds, it’s almost always the freeze option.

Because of this childhood abuse (eg domestic or sexual), the person often has no real sense of “self” and may have been prevented from developing a good support system by way of friends, extended family etc. This inhibits resilience and fosters a poor coping style. Other indicators which place trauma sufferers at risk of continuing to be abused in subsequent relationships are:

Learning difficulties / poor academic performance
Substance abuse
Poverty / debt / Unemployment
Low self-esteem
Exposure to the trauma of others
Negative or positive reaction of others to their trauma (can make them feel deserving of bad treatment or the sympathy can furnish them with good feelings)

Why Doesn’t (S)he Just Leave? – The Chemical Equation of Unhealthy Attachment

The body’s reaction to stress causes activity in the parts of the brain that activate what is referred to as “motivated behaviours” (those which are directed toward or away from particular stimuli such as hunger or sex) which require activity and effort. The reptilian brain which includes the sympathetic and limbic systems which are involved in self-preservation – eating, fighting, fleeing and reproducing – takes over when we are stressed, shutting down the parts of our brains that help us to make good decisions and plan for the future. This is because the brain has just one aim at this point, to help us survive and this is where it gets really interesting. In the situation of unhealthy attachments, the brain associates the abusive person with safety, even if it is they who are the cause of the trauma because it is also the abuser who is intermittently providing comfort and sporadically repenting. The brain latches onto this and processes it as positive reinforcement and because the prefrontal cortex has taken a back seat to the sympathetic part of the brain, it is not able to think about the long-term consequences of being in the situation. The body is at the same time in a state of high alert because of the amount of cortisol being released, which when not “discharged” can create feelings of exhaustion, dissociation and lead to a PTSD-like state. [4]

To exacerbate things, the chemicals in the brain cease to be effectively modulated in abusive relationships, with the brain becoming addicted to the feel good hormones (dopamine and oxytocin) associated with the “loving” behaviour which is at times shown by the abuser. If we liken it to dieting, it feels like eating a box of chocolates after surviving on cabbage soup for a month; so good that it makes up for the cabbage so we just want more. We associate the chocolaty good vibes with the person who gave it to us, even if it’s the same person that keeps force-feeding us the watery, unpalatable soup. Psychologists and law enforcers both describe the common occurrence of abused and beaten women who refuse to press charges or defend their partners at the point of rescue by police or other interveners as logic having left them. They instead feel an inappropriate range of feelings, from a need to protect them to even feeling a misplaced sense of gratitude (victims have often been “groomed” and “rescued” from homelessness or other unsatisfactory situations) and that they need them because they have suffered in their own lives or wanting to please the abuser by placating them so in effect, facilitating the abuse.

The Abuser Profile

There is a strong correlation or comorbidity between Narcissistic Personality Disorder, Psychopathy and people who tend to be the abuser in these types of intense and co-dependent relationships where the power-balance is skewed toward the exploitative party. As is often the case, no matter how the disorder presents itself in the abuser, the subject is adept at ingratiating themselves with the object of their imprisonment and getting them to sympathise with them by regaling them with tales of their hard-done by history including childhood abuse. They also use it as grounds when pleading for forgiveness and promising that it will never happen again etc. etc. Conversely, the abuser (or captor) shows their captive no such empathy (as they’re not actually capable of feeling it) and instead seeks to isolate and devalue them in order to remove them from any existing support networks, if there are any which allows them to exercise complete control. It is the ultimate example of manipulation and these people are arch manipulators; at the same time, the good and bad guy. In the extreme, they can even employ torture and sensory deprivation.

Breaking Free

Many factors, apart from those listed, can impact the ability for the abused party to break free. These can include financial dependence, usually carefully constructed by the abuser as a means to make leaving difficult if not seemingly impossible and the presence of children, which ties into the financial component, as there is no means for the abused party to support them. Advice from van der Kolk is that “in contrast with victimized children, adults can learn to protect themselves and make conscious choices about not engaging in relationships or behaviours that are harmful”. They can be assisted via the following safeguarding measures which can build resilience:

Learning positive behaviours, coping and problem solving skills
Being in employment which can provide independent means
Being part of a community such as a special interest, support, church or school group
Continuing education
Having a support system in place (friends and/or family)

If you are concerned that someone is entering into an unhealthy relationship, some signs to look out for are the break-neck speed at which the relationship is moving whilst they are simultaneously losing contact with friends and family and becoming all-consumed by their new relationship. Tell them that you’re concerned about this pace and let them know that you are there for them should they need you. You cannot be responsible for another person but reminding them that they are not alone may be helpful at such time as they realise they are in trouble. If things have progressed too far, sometimes it can be necessary to physically remove the person from the situation to help their body reset so they can wake up to the dysfunction of their situation but this comes with its own challenges and moral issues. If it is possible, they say that a change is as good as a holiday and this could be the best holiday they ever have.

If you have a client, or know of someone who is struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

Sources:

[1] Logan, Matthew H. “Stockholm Syndrome: Held Hostage By The One You Love”. Violence And Gender, vol 5, no. 2, 2018, pp. 67-69. Mary Ann Liebert Inc, doi:10.1089/vio.2017.0076. Accessed 12 July 2021.

[2] Williams, Jason et al. “Unit Cohesion, Resilience, And Mental Health Of Soldiers In Basic Combat Training”. Military Psychology, vol 28, no. 4, 2016, pp. 241-250. Informa UK Limited, doi:10.1037/mil0000120. Accessed 13 July 2021.

[3] van der Kolk, Bessel A. “The Compulsion To Repeat The Trauma”. Psychiatric Clinics Of North America, vol 12, no. 2, 1989, pp. 389-411. Elsevier BV, doi:10.1016/s0193-953x(18)30439-8. Accessed 12 July 2021.

[4] Stovall-McClough, K. Chase, and Marylene Cloitre. “Unresolved Attachment, PTSD, And Dissociation In Women With Childhood Abuse Histories.”. Journal Of Consulting And Clinical Psychology, vol 74, no. 2, 2006, pp. 219-228. American Psychological Association (APA), doi:10.1037/0022-006x.74.2.219. Accessed 13 July 2021.

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Mental Health and the Menopause

Araminta — Fri, 09 Jul 2021 05:47:17 +0000

Menopause, and perimenopause, bring changes to a woman’s body with various physical symptoms, but the years leading up to it, and the transition itself, also affect the mind and a person’s mental health.

During menopause, mood changes such as sadness, lack of concentration, irritability, lack of motivation, aggressiveness, and stress are common and cause emotional strain.^[1] These mood changes combined with distressing physical symptoms can result in the onset of mental health disorders such as depression and anxiety.

Additionally, if an individual has a pre-existing mental health condition, menopause is known to potentially exacerbate symptoms.

In this article, we will uncover the connection between menopause and mental health, the most commonly associated conditions, and tips to help cope with this transitory time in a woman’s life.

Effects on Mental Health

Menopause is defined as marking the end of the menstrual cycle, twelve months after a woman’s last menstrual period. Perimenopause is the time leading up to menopause when estrogen and hormone levels drop. Perimenopause can last anywhere between four and twelve years.

The key hormones which control the female reproductive system are estrogen and progesterone. These hormones are produced in the ovaries. During menopause, these hormones – particularly estrogen – drop, while the levels of follicle-stimulating hormone (FSH) and luteinising hormone (LH) increase.^[2]

The fluctuations in the hormone levels cause biochemical changes to the brain and nervous system, resulting in various physiological and psychological symptoms. These symptoms can be mild or acute and may be emotionally distressing.

Symptoms include:

Physical Symptoms: insomnia, hot flushes, fatigue, night sweats, and memory loss.
Mood changes: sadness, lack of concentration, irritability, lack of motivation, aggressiveness, and stress.
Mental Health Disorders: depression and anxiety.

Women may experience similar symptoms due to hormone fluctuations through premenstrual syndrome (PMT), premenstrual dysphoric disorder (a severe form of premenstrual syndrome), and postpartum depression. All these conditions are driven by hormonal changes in the body.

Decreased estrogen levels are particularly significant in affecting mood changes as estrogen modulates neurological processes related to our stress response, cognition, and emotional regulation.

Most women transition without experiencing mental health issues; however, an estimated 20%^[3] of women experience psychological difficulty.

It is rare for someone with no history of mental health disorders to develop a severe mental health issue during this time. Most women who experience significant mood difficulties have suffered from a similar issue in the past.^[4]

It is important to note that midlife, when menopause typically occurs, is a time of flux and stress for many women that may contribute to the onset of depression and anxiety. Women at this time in their lives may feel burdened with life changes, which could include:

caring for children
caring for aging parents
grown children leaving home or returning home
career changes
changes in romantic relationships
concerns about the health of a partner or family member
growing older

Menopause and Depression

Women appear to be vulnerable to depression during perimenopause and in the years after menopause. Clinical trials are yet to find a clear link between depression and menopause; however, research shows that rates of depression significantly increase during these years.^[5]

Women with a history of clinical depression, postpartum depression, or severe PMS in their younger years are more likely to experience a relapse of these symptoms during these years.

In rare instances, the estrogen changes and associated menopausal psychosocial stresses can contribute to the vulnerability of developing major depressive disorder (MDD).^[6]

Menopause and Bipolar Disorder

Research suggests that hormones play a role in the development of bipolar disorder. The hormone fluctuations during menopause have been shown to increase the severity of symptoms in some women. One in five women already suffering from bipolar disorder reported severe emotional distress as they transitioned.^[7]

Research has additionally demonstrated that it is usually the depressive episodes, rather than the manic, which become more pronounced and acute during menopause. This is most likely due to the decrease in estrogen levels.

Menopause and Schizophrenia

Estrogen has antidopaminergic properties, which are the main qualities of any antipsychotic medication. The decrease in estrogen levels during menopause effectively removes this protective aid and can aggravate or trigger psychotic conditions such as schizophrenia.^[8]

Schizophrenia is typically diagnosed in young adulthood; however, there is a second peak in diagnosis among women around menopause. Those with pre-existing schizophrenia may experience an increase in symptoms or a deterioration of their illness and may require a new level of treatment.

Coping with Mood Changes

As well as the fluctuating hormone levels, physical health changes are common during the menopause years, and these can additionally contribute to our mental health. Here are some tips to help protect your mental health during the perimenopause and menopause years:

Remember it is temporary – the physical and physiological shifts during menopause can be frightening. It would be easy to think that they will not pass; however, the symptoms will fade over the years and not be present all the time.
Be aware – mood changes are likely linked to hormone levels, a lack of sleep, stress, or other co-occurring health issues.
Making lifestyle changes – eat a healthy, balanced diet, increase exercise, sleeping well, socialise with positive peers, and control stress levels. All are factors that can help to reduce potential symptoms.
Ask for help – talk to friends and family to share your challenges and receive support if you are struggling. If the symptoms are severe and persistent, speak to your GP or a medical professional, as numerous treatments are available to help alleviate symptoms.

Menopause is a period which all women go through as they reach mid-life. Menopause affects all women differently, with a range of symptoms ranging from mild to acutely distressing. If you or a loved one is suffering from mental health issues during menopause, do not struggle alone – seek help today.

Sources:

[1] “How Can Menopause Affect Your Mental Health? – Mental Health UK”. Mental Health UK, 2021, https://mentalhealth-uk.org/blog/how-can-menopause-affect-your-mental-health/.

[2] “The Reproductive Endocrinology Of The Menopausal Transition.”. Reference.Medscape.Com, 2021, https://reference.medscape.com/medline/abstract/21419147.

[3] “Menopause And Mood Disorders: Overview, Pathophysiology, Etiology”. Emedicine.Medscape.Com, 2021, https://emedicine.medscape.com/article/295382-overview#a1.

[4] “Menopause And Mental Health – Harvard Health”. Harvard Health, 2020, https://www.health.harvard.edu/womens-health/menopause-and-mental-health.

[5] Bosworth, H. B. Depression Increases In Women During Early To Late Menopause But Decreases After Menopause. 2021.

[6] Albert, Kimberly M., and Paul A. Newhouse. “Estrogen, Stress, And Depression: Cognitive And Biological Interactions”. Annual Review Of Clinical Psychology, vol 15, no. 1, 2019, pp. 399-423. Annual Reviews, doi:10.1146/annurev-clinpsy-050718-095557. Accessed 6 July 2021.

[7] “Women With Bipolar Disorder”. Webmd, 2021, https://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-women.

[8] Gupta, Rina et al. “Menopause And Schizophrenia”. Menopause International, vol 18, no. 1, 2012, pp. 10-14. SAGE Publications, doi:10.1258/mi.2012.011116. Accessed 6 July 2021.

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Emotional Breakdowns – What is Really Happening?

Araminta — Fri, 02 Jul 2021 05:09:45 +0000

People often say they’re having a breakdown. The Rolling Stones even had a transatlantic hit about a girl whose 19th Nervous Breakdown was imminent, and in times of acute stress, pressure, or both, it can feel that way. In the 21st Century, that term is thankfully outmoded and unacceptable, but the human stress response has not correspondingly evolved beyond the state that gave rise to the term.

Most of the time, we can forge on, dust ourselves off and prepare for the next “crisis”, but in some cases, an emotional breakdown is a very real and much more serious affair.

Physical and psychological symptoms may present as:

panic attacks
difficulty breathing
hallucinations
excessive fear
paranoia
extreme mood swings
unexplained outbursts
detachment from reality (and self)

People exhibiting signs of emotional suffering need support to help them return to a more balanced state and function normally in day-to-day life without a sense of crippling overwhelm.

What Are the Signs?

In Western cultures, some early indicators may be:

increased absenteeism from work or other appointments
lack of attention to personal hygiene
disturbed sleep and eating patterns
trembling or shaking
muscle tension
gastrointestinal and cardiovascular symptoms
dry mouth
lack of focus or recall
unexplained aches and pain

Some people might comfort eat, while weight will seem to fall off others as they are unable to eat due to stress and worry, and at the more extreme end of clinical markers, people can experience suicidal ideation.

What is Really Happening?

This kind of response often indicates an underlying and often undiagnosed co-morbidity with other mental health conditions such as depression, anxiety, or PTSD, with signs varying from person to person and many things potentially being at the root of an episode. Relationship breakdowns, especially in the young, are “one of the greatest harms” that can occur for most humans, with the concept of “Love Trauma Syndrome” being introduced by Richard B. Rosse in 1999.^[1]

Most of us have experienced the feeling of having a broken heart. We have witnessed the phenomenon in others, with each person experiencing and exhibiting symptoms in differing ways and for varying durations. This is just part of the natural process of healing and the human condition, but in some, what has come to be the standard practice of processing these emotions becomes maladapted and can go on for what is considered to be an excessive time period, spilling over onto the unhealthy end of the scale for the sufferer.

Things can become so bad that standard treatment methods like Cognitive Behavioural Therapy are rendered ineffective, and more complex and multi-disciplinary treatment protocols are required. As with many emotional and mental disorders, the root cause of self-regulatory behaviour can be found in childhood or adolescence, driving automatic and unhelpful thought responses and patterns such as perfectionism throughout life.

The Cult of Personality

“Personality has the power to uplift, the power to depress, the power to curse, and power to bless.”

– Paul Harris

Studies have shown a correlation between personality type and attachment styles and a higher likelihood of depression and emotional breakdown.^[2] Often, those with a more robust concept of self who have been on the receiving end of parental and other support network-derived positive affirmation are predisposed to having a stronger personal identity and are less dependent on others for their own sense of security and happiness.

Perfectionism also plays a role in more than its fair share of mental health issues and can lead to burnout and other forms of emotional and physical breakdown. A study undertaken on athletes showed that multiple disciplinary athletes were less likely to exhibit stress and burnout than those who specialised or who were effectively fixated on one particular activity, which can become obsessional in and of itself.^[3] Those with perfectionist personalities can obsess over details and never feel a sense of satisfaction or a job well done, which can compound over time, leading to a catalogue of unhelpful emotional responses, including breakdown.

Emotional Rescue

Understanding that the prolonged habits and behaviours which led to the breakdown in healthy functioning is the key to producing meaningful and lasting results in treatment or, to quote the Rolling Stones again, emotional rescue is paramount.

The simplest explanation is that a “breakdown” is the culmination of an inability to deal with and clear the trauma held by the body, particularly the parasympathetic nervous system, as a response to any or all of the underlying conditions mentioned earlier. These unfinished stress cycles need to find completion with the help of new generation psychotherapeutic treatments informed by neuroscience and developed in America.

This ground-breaking treatment will not re-trigger traumatic events and can help to create a healthy internal voice in the sufferer’s mind to enable them to move forward and break any unhealthy cycles they are stuck in.

Sources:

^[1] Mouchan, Razieh et al. “The Effectiveness Of Schema Therapy On Reducing Symptoms Of Emotional Breakdown”. 2016, Accessed 21 June 2021.

^[2] Moradtalab, Shahnaz, and Asghar Jafari. “Prediction Of Depression In Students With Emotional Breakdown Based On Attachment Styles And Self-Concept”. International Academic Journal Of Humanities, 2014, Accessed 21 June 2021.

^[3] Garinger, Lindsay M. et al. “The Effect Of Perceived Stress And Specialization On The Relationship Between Perfectionism And Burnout In Collegiate Athletes”. Anxiety, Stress, & Coping, vol 31, no. 6, 2018, pp. 714-727. Informa UK Limited, doi:10.1080/10615806.2018.1521514. Accessed 21 June 2021.

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Polyvagal Theory: Coregulation

Araminta — Fri, 24 Jul 2020 04:22:41 +0000

Coregulation lies at the heart of all human relationships. According to Polyvagal theory, it is the reciprocal sending and receiving of signals of safety. It is not merely the absence of danger but connection between two nervous systems; each nourishing and regulating the other in the process.

Because it is baked into our evolutionary past, it is not a desire, but a need – one developed to facilitate survival. As humans, we therefore are programmed to seek interpersonal connection: it is a biological imperative.

Neuroplasticity and Tone

Today, modern society places a premium on resilience and independence; the mastering of ones’ self. Yet just as neuroception precedes the brain, self-regulation finds its root in coregulation. The former simply cannot happen without the latter. It is why a baby or child looks to a parent for safety, and in turn they are reassured through a signal of safety such as an embrace[1]. That process of mutual reinforcement shapes the autonomic nervous system, affording the investment of trust in others[2]. And it is why healthy relationships formed in early development generally breeds a flexibility that assists the navigation of later life challenges.

On the other hand, a mistuned autonomic nervous system bears the imprint of neglect. Without connection, we may remain fixed in defensive states (mobilised or immobilised). Signals are indiscriminately received as dangerous; patterns of connections are replaced with patterns of protection[3]. Because coregulation is what we bring to our relationships, their emergence becomes difficult in its absence.

Fortunately, just as nervous systems have been shaped, so too can they be reshaped. Insights from neuroplasticity – how neural networks rewire themselves – continues to provide more detail on how this takes place. Coregulation is at its core. From this privileged position, atop the ladder, new vistas open. The entire system is regulated, tuning it to deal appropriately with the challenges ahead. It can be thought of as toning, as with any healthy muscle.

Trauma

In highly traumatic situations, the autonomic nervous system can overload with stress and shut down. Subsequent stressful events can trigger may trigger a full shut down or a modification of immobilization such as freezing with dissociation. The shutdown is mediated through the parasympathetic reaction, while the freeze is a hybrid state requiring sympathetic tone in addition to the parasympathetic reaction. A common example may be the sounds of fireworks for those suffering from Post-Traumatic Stress Disorder following military service. The nervous system is recognising a familiar and lethal cue from the past and intuiting from it what is happening in the present. It takes a protective action: a perfectly rational move within the logic of autonomic nervous system[4].

However, the system is mistuned. Yet through revisiting these painful memories whilst resisting disassociation via cues of safety and trust, powerful new patterns can be rewired. Spending time in coregulation, or ventral vagal, allows for the reshaping – or regulation – of the autonomic nervous system.

Rape victims may dissociate when reencountering their initial trauma, mirroring their protective response at the time. Dr Stephen Porges states that survivors are mistakenly shamed because they didn’t mobilise and fight[5]. But once the victim understands that this was a physiological response – hardwired into human body as evolutionary inheritance – it can rid those feelings of shame (‘why did I freeze?’) that can prevent resolution of the initial traumatic episode.

Clearing the mist of shame may also unleash anger. This is a good thing: it is a mobilising response away from numbness and disconnection. The victim is climbing the ladder. They are closer to the ventral vagal state in which unresolved issues surrounding the episode can be explored. This can also be concluded from the fact small movements whilst exploring the original trauma can also help to temper a slide to dissociation[6].

Polyvagal for Everyone

All individuals’ nervous system brings past experience to bear in interpreting situations. It is the shape of the autonomic nervous system – that accumulation of past experience – that affects how everyone digests stimuli. So understanding polyvagal theory can help all to better navigate everyday life.

Grasping how the nervous system shapes lived experience is key. Simply being able to interpret which state you are in offers a path to a different one. A systematic questioning is useful. It may go as follows.

First you must know where you are (“I am angry so I must be in a mobilised state”). How did I get here? Is it something in the environment or the way somebody talks to me that chimes with past experience? How can I get out of here? Is it a removal of the triggers? Or are there conscious mechanisms I can use to activate a ventral vagal response?

Furthermore, it may not always be a shift that is sought. Ventral vagal is where we naturally want to be. Bringing awareness to the situation helps us to savour it in its fullness. The question may arise: how can I stay here?

Sources:

[1] https://fpg.unc.edu/sites/fpg.unc.edu/files/resources/reports-and-policy-briefs/Co-RegulationFromBirthThroughYoungAdulthood.pdf

[2] Cozolino, L. (2006). The neuroscience of human relationships: Attachment and the developing brain. New York: W. W. Norton & Co.

[3] Dana, D. 2018. The Polyvagal Theory in Therapy: Engaging the rhythm of regulation. W W Norton & Co.

[4] ibid.

[5] https://www.theguardian.com/society/2019/jun/02/stephen-porges-interview-survivors-are-blamed-polyvagal-theory-fight-flight-psychiatry-ace

[6] van der Kolk, B. 2014. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin

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Polyvagal Theory: A Ladder of Nervous States

Araminta — Fri, 17 Jul 2020 04:54:48 +0000

According to polyvagal theory, shifts in the autonomic nervous system produces three elementary states: rest-and-digest (social and safe), fight-or-flight (mobilisation) or shutdown (immobilisation).

Deb Dana encourages us to think of these states as a ladder[1]. We move up or down it through activating the stimulating (sympathetic) or relaxing (parasympathetic) branches of the autonomic nervous system, based on the reception of various stimuli (neuroception).

The ladder is a predictable hierarchy: the states can only be moved through in sequence. For example, if you’re immobilised, you cannot simply leapfrog to safe and social, but must first pass through mobilisation – however briefly. It explains why a PTSD sufferer may suddenly experiencing extreme levels of stress before tipping into immobilisation. But predictability – one of the key insights of Polyvagal theory – offers a platform from which to target appropriate interventions. This, as the next article explains, has important implications for clinical application.

Because the movement through these states are anchored in our evolutionary past, the ladder also doubles as a chronological timeline. These developments have layered one on top of the last, forming the sequenced response mechanism. Freezing is the most primitive and shared with our reptilian ancestors – the defence mechanism of final resort – whilst social connection appeared latest in humanity’s evolutionary past. This is vital: it encourages a focus on the biological plumbing we all share, rather than conflating various disorder with something inherent in different individuals.

Safe and Social/Rest-and-Digest

To arrive in the safe and social state, a parasympathetic response is activated through the vagal ventral pathway (as previously stated, this dampening response takes place through the vagus nerve, of which ventral is a branch).

It is humans’ most evolutionary complex state of being. In this place, we thrive. Naturally then, individuals want to be here unless there really is an immediate threat. The safe and social rung of the ladder is also a biological imperative. It is fundamentally what makes us human.

Here the autonomic nervous system identifies a safe environment. We feel closeness, trusting of others and our environment and can form positive attachments. Normal bodily functions are regulated for optimisation: blood is available around the stomach for metabolization and the immune system is recharged. It explains why prolonged periods of time away from this peak state – for instance loneliness[2] – are associated with decreased life expectancy.

Mobilisation/Fight-or-Flight

A sympathetic reaction – one that mobilises energy – brings people into a fight-or-flight state. We might feel flush, perspire, or the heart beating faster. Stress and tension are detectable. Anger, anxiety or panic may be the felt experienced. The world is no longer safe, but unfriendly and dangerous. The autonomic nervous system is telling us to protect ourselves. Defensive behaviours – manifested in various way – follow.

Because the body is physiologically gearing up to fight-or-flight, internal resources –occurring independently of our conscious awareness – are redirected. Blood shifts away from the digestive system and to muscles and limbs. Cortisol is released from the adrenal gland. It is the reason highly anxious periods are often accompanied with digestive issues[3] and stressed individuals always seem to have a cold (too much cortisol diminishes the effectiveness of the immune system[4]).

Resources are not evenly spread across the body for optimal function but instead are rallied in service of survival. The nourishing functions humans need ticking away in the background are temporarily suspended.

Immobilisation/Freeze/Shutdown

Immobilisation is the most ancient mechanism of defence. When faced with a potential life-threatening situation – which the sympathetic branch cannot resolve or is simply overwhelmed by stimuli – the autonomic nervous system shuts the body down: self-preservation through the conservation of energy. The heartrate falls dramatically along with blood pressure. Movement is all but extinguished, reducing metabolism and the need for food. Pain in numbed, with only so-called vegetative process continuing in the background.

Freezing is a hybrid state with powerful adaptive benefits. In a freeze state, although being immobilized, there is sufficient sympathetic activation to maintain muscle tone and blood flow to maintain consciousness. For survivors of trauma this state is often the ‘go to’ state if there is a history of total shutdown and collapse. Under severe life threat the nervous system may shift reflexively and adaptively to a total collapse that has been described as death feigning in other mammals. This state triggers a massive activation of the dorsal vagus resulting in fainting and potentially defecation. However, the state of collapse is potentially lethal to humans, since the collapsed state many not provide sufficient oxygenated blood to our brain. Thus, our nervous system adapts and puts us in a state of freeze when experiencing the cues that had previously triggered a shutdown. Experiences of dissociation are frequently associated with freeze and freezing often serves as internal signal to ‘awaken’ a different ‘part’ of the individuals complex mental structure of self.

This is the dorsal vagal pathway of parasympathetic response. Operating through the calming vagus nerve, but separately to the ventral vagal social system, it is experienced as an extreme energy deficit[5]. The world doesn’t make sense. Depression, numbness and dissociation are commonly felt. William Styron, in his memoir of a bout of depression, captures the essential difference between this and the mobilised (fight-or-flight) survival state:

“it is, generally speaking, the antithesis of violence. It is a storm indeed, but a storm of murk. Soon evident are the slowed-down responses, near paralysis, psychic energy throttled back close to zero.”[6]

Life – it seems – is elsewhere. And this can feel hopeless. But to counter this, Deb Dana recalls a patient who telling her a simple truth: it is useful to remember that you are still on the ladder. The physiology may be against you now, but you can still climb up. When we understand neurobiological states, so too can we understand how to change them.

Sources:

[1] Dana, D. 2018. The Polyvagal Theory in Therapy: Engaging the rhythm of regulation. W W Norton & Co.

[2] Rico-Uribe LA, Caballero FF, Martín-María N, Cabello M, Ayuso-Mateos JL, Miret M. Association of loneliness with all-cause mortality: A meta-analysis. PLoS One. 2018;13(1)

[3] https://www.health.harvard.edu/newsletter_article/stress-and-the-sensitive-gut

[4] Morey JN, Boggero IA, Scott AB, Segerstrom SC. Current Directions in Stress and Human Immune Function. Current Opinion in Psychology. 2015; 5:13‐17.

[5] Dana, D. 2018. The Polyvagal Theory in Therapy: Engaging the rhythm of regulation. W W Norton & Co.

[6] Styron, W. 1990. Darkness Visible: A Memoir of Madness. Random House

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Polyvagal Theory: Neuroception – the Fundament of Feeling

Araminta — Fri, 10 Jul 2020 13:19:44 +0000

Conceived by Dr Stephen Porges, neuroception describes the body scanning our environment for cues of safety or danger. It is constantly ticking below our subconscious, although you are likely to be aware of the physiological responses it causes. They are sent to your brain, which is then tasked with making sense of it; in other words, a story. The problem is that we may be telling ourselves the wrong ones.

Pre-perception

Neuroception is observable in all living species with a nervous system. It precedes the evolution of the cortex. Evolutionary speaking, it lies in our primitive past, the reason autonomic nervous systems responses are more readily identified in animals – less muddied by awareness and perceptions. Dr Stephen Porges explains this is “why a baby coos at a familiar caregiver but cries at the approach of a stranger”, despite the immaturity of the spinal cord and brain[1]. The autonomic nervous system responds through brain structures outside the realm of cognitive awareness, functionally recognizing features of safety or threat before we think.

Whence the signals come

The senses are constantly scanning for cues of safety and danger every microsecond. Based on the signals, neurobiological mechanisms will be triggered spontaneously: either activating a parasympathetic (calming) or sympathetic (arousing) response. Deb Dana identifies the three places we receive signals from[2].

Outside

The most obvious is perhaps signals from the outside environment. The sight of fire may trigger the sympathetic system; whereas the sound of soothing music may activate a sympathetic response, relaxing tension and informing the mind and body that it is safe.

Within

The nervous system listens internally for signs of safety or danger, sensing information about your organs. Fever, pain or any physical illness can all cause a shift in our autonomic nervous system.

Between

These signals come from the interplay between nervous systems (usually humans but also mammals, given the closeness of their system). Evidently, a smiling face is a signal of safety, an angry face one of danger. In turn, they trigger reactions in our own system. When cues of safety are received, it can trigger a neurobiological reaction that transmits a safety signal back.

With mutually reinforcing cues, connection is facilitated. The physiological response is manifested in a variety of ways: facial expressions grow more animated; voice modulation and inflection increases; and ear drums zone into a range that better distinguishes human voices from background din[3]. This is coregulation in action.

Humans are ultimately social beings[4]. Spending time in this ‘between’ social state connection is essential to both our mental and physical health.

The Importance of Identifying Triggers

Sometimes we may not recognise the triggers that precede a nervous system response, even when they dramatically change our mood, such as a state shift from connection to fight-or-flight. It’s why many people often confusedly ask themselves “why did I react that way?”. From a place of calm and safety, it may seem irrational. Feelings of shame may also cloud experience, hindering proper reflection. Understanding what is really happening is the springboard for change.

The explanatory power of polyvagal theory lies in its systematisation of the three states – and the shifts between them – based on neurobiological processes[5] that have been essential to evolutionary survival. Shades of shame are alleviated when we understand behaviours as contingent on and constituted by physiological reactions: the ‘how-we-are’. Seen in its proper context, it can help us to forgive ourselves when we have perhaps overreacted.

Awareness must be brought to situations and states. Firstly, merely identifying triggers can help change reactions to them, a practice familiar in approaches like CBT. Understanding why we feel a certain way gives a sense of perspective and lifts confusion. If triggers can be viewed with clarity, the response may change. Just as our neuroception is always listening to our environment, so also should more attention be brought to listening to what the physiological states are trying to tell us and how to form a more enabling story. For instance, anger through the lens of physiology, rather than a seemingly intractable issue of psyche.

Secondly, recognising triggers as they happen enables the use of conscious coping mechanisms. An individual recognising in real-time a trigger they know will cause a sympathetic reaction could immediately ask themselves if they can do anything to provoke a parasympathetic reaction.

Thirdly, if – on reflection – the responses to triggers are not necessarily a result of a mistuned neuroception, it encourages contemplation of whether environments should be changed (whether outside, inside or between). Understanding the biological basis of responses – rather than something inherent in the psyche – can encourage individuals to be bold in changing their lives.

Looking solely at the individual for answers is limiting. Instead they must be seen in context: a collection of experience and memory, much of which is outside conscious availability. Yet that collection is instinctively known by the autonomic nervous system we all share. It is continuously shaping experience on this basis.

New experiences can either reinforce or remould how people respond to stimuli. Understanding must be brought to the autonomic nervous system needs, given its role in all lived experience. It can give us clarity on how to can stay anchored in social connection.

Sources:

[1] Porges, Stephen W.Neuroception: A Subconscious System for Detecting Threats and Safety. Zero to Three (J), v24 n5 p19-24 May 2004

[2] Dana, D. 2018. The Polyvagal Theory in Therapy: Engaging the rhythm of regulation. W W Norton & Co.

[3] Porges, Stephen W.Neuroception: A Subconscious System for Detecting Threats and Safety. Zero to Three (J), v24 n5 p19-24 May 2004

[4] Young SN. The neurobiology of human social behaviour: an important but neglected topic. J Psychiatry Neurosci. 2008;33(5):391‐392.

[5] Porges, S., 2011. The Polyvagal Theory. New York: W.W. Norton.

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Polyvagal Theory: Systems of Feeling – An Introduction

Araminta — Fri, 03 Jul 2020 04:55:25 +0000

This blog introduces the concept of Polyvagal theory. A further three articles shall explore it in the series for this month. At first it may sound inaccessible, but through these blogs, terms and ideas will be broken down and demystified.

In essence, Polyvagal theory unpacks how our nervous system responds to stimuli. It is how the body scans, evaluates and reacts to cues of safety and danger. As it is biologically active in all human experience, it also provides a rich framework for understanding why people behave the way they do.

Before Polyvagal Theory

Everybody knows the central nervous system. Polyvagal theory deals with its lesser known counterpart: the autonomic nervous system. Outside the brain and spinal cord, it connects to the central nervous system and regulates glands and internal organs[1]. Instinctive and physiological, it operates outside our conscious awareness, and necessarily so: the system must decide, at every moment, whether we are in safety or danger – whether to rest-and-digest or fight-or-flight. It is like a personal surveillance system, scanning for signs of danger and shifting our body as appropriate.[2]

Social behaviour is limited by human physiology, much of which is shared with our mammalian cousins[3]. Consider the antelope. Grazing, she is at ease. A crack of the branch, a whisper of uncertainty, and her ears are pricked. Pupils dilate, the heartbeat quickens, and glucose is pumped into the bloodstream[4]. A swathe of stimulating hormones has been released. These hormones will be required for a potential getaway.

This process of activation – or mobilisation – is a result of the sympathetic nervous system at work: the animal has readied herself for survival, fuelled by a release of adrenaline. Its opposite is the parasympathetic nervous system, acting to quell this aroused mode. The antelope has gone back to grazing; she is calm, safe and at peace in the world. Blood swells the digestive system, reserves are replenished, and the internal system recalibrates itself. These two processes – the sympathetic and the parasympathetic – form the basis of the autonomic nervous system.

Enter Polyvagal Theory

Polyvagal theory’s insight has been a matter of breadth. Before it was thought that these systems worked only in a reciprocal manner. Sympathetic readied for survival whilst the parasympathetic subdued; enabling healing, restoration and social connection.

Dr Stephen Porges’ theory identified another state of survival produced by the interplay of these two systems[5]. The dampening response (parasympathetic) not only prompts a social mood but can also impel a state of immobilisation at the other end of the spectrum. Yet both are the result of the vagus nerve at work – hence the name Polyvagal theory.

Return to the antelope. The flight has been in vain: the predator has struck. Sensing mortal danger, the animal feigns death, immobilising herself and extinguishing the aroused state. The hormones that had been released for fight-or-flight will not resolve the situation. Yet an opportunity arises when the predator’s clutch loosens. The antelope makes a break for it and escapes. That freeze-or-faint reaction – whilst perhaps not as obviously as fight-or-flight – has been critical to the antelope’s survival: it has conserved the energy needed for its deferred getaway.

Why is this relevant? Because that nervous system is also part of human neural wiring – fundamentally how we are. It shapes every lived experience[6]. Understanding those states and how shifts from one to the other occur therefore has obvious value.

The coming articles will explore three pillars of Polyvagal theory:

Neuroception – the fundament of feeling

The autonomic nervous system is constantly evaluating cues in our environment, absorbing signals beneath awareness and before cognition. It is taking place in ancient and primitive mechanisms developed in the service of survival through our evolution, detecting whether it is safe or dangerous. But neuroception can misread signals based on past experiences that may be inappropriate for understanding the present. Fortunately, the nervous system can change.

These signals come from three directions: outside (the lived environment), within (the internal organs) and between (signals of safety or danger from another living nervous system).

A ladder of nervous states

The three states form a hierarchy – or ladder. Movement through them can happen only in sequence:

i. Connection – or rest-and-digest; feed-and-breed. An impala grazing. The nervous system has told us we are safe. Social connections can be made.

ii. Mobilisation – or fight-or-flight. A kudu bolting. The nervous system has detected danger. It marshals all its energies to survive.

iii. Immobilisation – or freeze. A gazelle feigning death. The nervous system has detected mortal danger. The body shuts down, conserving energy for a potential escape.

Co-regulation

Co-regulation lies at the heart of relationships. It is the mutual reinforcement that comes from the sending and receiving of cues of safety with another nervous system. Although it is not geared to serve immediate survival needs, it assists – evolutionary speaking – survival in the longer-term. In other words, there is a biological imperative to co-regulate.

Once it is understood that all human experience has a physiological basis, people can start to understand how to identify which state they are in, and what they can do to shift to another more conducive state.

Sources:

[1] https://opentextbc.ca/anatomyandphysiology/chapter/12-1-basic-structure-and-function-of-the-nervous-system/ accessed 26/05/2020

[2] Dana, D. 2018. The Polyvagal Theory in Therapy: Engaging the rhythm of regulation. W W Norton & Co.

[3] Barré-Sinoussi F, Montagutelli X. Animal models are essential to biological research: issues and perspectives. Future Sci OA. 2015;1(4)

[4] http://www.qmedical.com/dtr_ans_overview.htm accessed 26/05/2020

[5] Porges, S., 2011. The Polyvagal Theory. New York: W.W. Norton.

[6] Dana, D. 2018. The Polyvagal Theory in Therapy: Engaging the rhythm of regulation. W W Norton & Co.

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