Alternative Therapies of Trauma By: Daryush Parvinbenam, LPCC-S

Alternative therapies for trauma
Daryush Parvinbenam,
LPCC-S

Disconnection
 Hallmark of complex trauma is disconnection
neurobiological / psychological systems
personality / self system
relational system
spiritual system
 “Dissociation” is a key symptom of complex trauma or
DESNOS

Neurobiological system:
The Brain’s Hierarchical Organization
Levels Structures Understanding
of Environment
Functions
Cognitive Neocortex Concrete
Abstract
Declarative
Conscious
Thought
Info. Processing
Self-Awareness
Emotional Limbic Feelings
Procedural
Affiliation
Learning/ Memory
Emotional Reactivity
Sensorimotor
Arousal
Diencephalon
Brain stem
Instinctual
Tendencies
Survival
Sexual Behavior
Motor Regulation
Arousal &
Homeostasis

Brain: Hierarchical Functioning
Lower Level Higher Level
Fixed Action Sequences Greater Plasticity
Reflexive Action Voluntary Control
Instinct Logic/ Planning
Unconscious Conscious
More Rapid Response Slower Response
Each level has its own understanding of the environment and responds
accordingly
Depending on circumstances, one level may dominate others
In daily adult life (except for emergencies), higher levels generally override lower
levels

How Neural Systems Develop
 Neural networks change in a “use-dependent” fashion
 Patterned, repetitive activity changes the brain
 Healthy organization of neural networks depends upon
the pattern, frequency, and timing of key experiences
during development
 Fear and chaos will result in persistent, repeated
activation of the stress response systems in the brain
(Perry, 2006)

Brain: Stress Response Cycle
 Perception of danger arouses sympathetic nervous system,
signals adrenal medulla to increase output of stress hormones –
leads to fight/flight/freeze responses
 Hypothalamic-pituitary-adrenal system activated leads to
increased levels of cortisol (a glucocorticoid released from
adrenal cortex)
 Abnormally high, chronic levels of cortisol can damage the
hippocampal neurons
 Adrenal hormones depress immune system; contribute to
hypervigilance; decrease ability to regulate autonomic responses
to internal or external signals; decrease ability to respond
appropriately to emotional signals (amygdala)

Traumatic Stress Related Disconnections
in the Brain
 Top-Down Neural Connectivity Affected
Hierarchical functioning – Bottom-up
“highjacking”
 Lateral Neural Connectivity Affected
Right-Left Lobe splits – Symbol/meaning-
making & visual spatial imagery
Disconnections impede flexibility and integration; result
in biphasic, dissociated brain functioning patterns

Brain: Action Systems & Tendencies
Evolutionarily prepared, psychobiological systems,
represented by neural circuits, associated with certain
feelings, sensations
Interdependent, interrelated but unique, often
complimentary
Exist to protect and promote daily life functioning
Need higher-order brain integration to experience
simultaneous combinations of these systems
Also called: behavioral systems; motivational systems

Brain: Action Systems
 Attachment Foundation of all others
 Defensive
Under traumatic stress or high threat, these two action
systems are activated; the others may not be consistently
available
 Energy Regulation
 Caregiving
 Sociability
 Play
 Sexuality

Disconnecting Effects of Trauma on
Brain Functioning
Central Aspects of Self System are impacted:
 Affect / Arousal Modulation
 Defensive Action System
 Orientation, Attention, Information Processing
 Memory & Learning

Affect / Arousal Modulation
Hyperarousal
_________________
Window of Tolerance
_________________
Hypoarousal

Affect /Arousal Modulation
 Window of Tolerance – the intensity of emotional and
physiological arousal which can be processed w/o disrupting
modulation
 When individual outside Window of Tolerance, prefrontally
mediated capacity for responsive flexibility is temporarily shut
down & replaced with reflexive functioning (subcortical
dominance)
 Width of Window determined by threshold for arousal response
 Traumatized individuals – functionally narrowed windows of
tolerance - unusually low or unusually high thresholds (biphasic,
“bottom-up highjacking”)

 Effects of chronic hyperarousal:
reactive, impulsive behavior; elevated blood pressure, heart rate;
state dependent memory retrieval (fragments of perceptual
experiences recur as symptoms – flashbacks nightmares); can’t
do “reality” checks
 Effects of chronic hypoarousal:
losses in memory, affective functions & somatosensory
awareness; somatoform dissociative symptoms (motor weakness;
paralysis; ataxia; numbness); psychoform dissociative symptoms
(amnesia; fugue states; deficits in attention; interference with
thinking)

 Clinical Implications:
Clients can only process traumatic events effectively within
window of tolerance
Counselors must help clients increase window of tolerance &
increase integrative capacity
Modulate hyperactivity by becoming aware of sensations of
hyperarousal and learning to apply mindfulness practices to
modulate; increase social engagement
Modulate hypoarousal by sensorimotor actions in therapeutic
context (social engagement); increase energy & arousal

Arousal / Defensive Action System
 Hierarchy of arousal, defensive responses:
1)central parasympathetic branch of vagus nerve
social engagement, attachment
2) sympathetic branch mobilization / fight/flight
3) dorsal parasympathetic branch
immobilization / “feigning death”

Defensive Action System
 Series of relatively fixed sequential sensorimotor reactions – Ex:
startle response, fleeing danger
 Ability to amend fixed action tendency – make voluntary, top-
down, conscious decisions while under command of an action
tendency – is an attribute unique to humans
 Failure of defensive responses to assure safety
Traumatic reactions: “when no action is of avail”
 When overwhelmed, components of ordinary response to
danger tend to persist in altered, exaggerated state
 Their dissociation from other aspects of self keeps them
separate and unintegrated from present life experiences

 Effects of ChronicTrauma :
1) chronic failure of social engagement results in
dysregulated, dissociated (biphasic) arousal
2) top-down regulation is compromised: Driven by
bottom-up highjacking, often can’t modulate responses;
access top-down thinking
3) meaning-making is biased by inaccurate
perceptions of danger :Traumatized get stuck in
particular repetitive action tendencies of defense
evoked at time of trauma (and evoked again by
current cues)

Failed defenses can be rediscovered and revitalized by
giving attention to the body & establishing a sense
of mastery and competence
Mindful observation of defensive tendencies through
awareness of body can help put a gap between
triggers and defensive action tendencies

Orientation, Attention & Information Processing
 Fundamental to learning and cognitive functioning
 Overt: visible physical actions toward stimulus
 Covert: mental shift in attention
 Top-down orienting: determined by planning, goal
setting
 Bottom-up orienting: reflexive action to assure survival;
occurs very fast; involuntary, automatic
 Adaptive attention: alert, top-down control, balanced,
sustained

 Sensitization: orienting reflex evoked with discrepancy between
stimulus and individual’s expectations
 Habituation: stimuli that have become familiar or ordinary do
not evoke orienting reflex
 Chronic trauma exposure overhabituated and oversensitized;
biphasic, dissociated response patterns
 Traumatized individuals have difficulty integrating overt and
covert orienting responses and sorting out relevant cues from
inconsequential cues

Counselors need to help clients practice changing their
orienting process on a sensorimotor level rather
through discussion
Treatment should be oriented toward specific stages in
orienting response where clients are stuck: arousal;
activity arrest; sensory alertness; muscular adjustments;
scanning; location in space; identification and appraisal; action;
reorganization
Counselors help clients slow down and become mindful
observers of their orienting and attentional processes to
increase awareness of how and toward what they focus
attention

Memory & Learning
 Explicit Memory: conscious, willful, sequential
contextual mediated by hippocampus
 Implicit Memory: unconscious, intrusive, fragmented,
acontextual mediated by amygdala
 “Stress hormones & neurotransmitters that permeate the brain during a
trauma supercharge the brain’s ability encode new memories and
simultaneously interfere with its ability to sequence and contextualize those
memories”
(Lisak, 2008)

Ancient cultures and recent
brain research
Treatment Implications for
traumatized clients

Ancient “secrets” of survival
 In deed, the secret for survivals of many ancient
culture, could be their ability to devise many
creative methods of dealing with stress and
trauma within their own spiritual practices and
rituals. In recent years research on neurobiology
of trauma has provided considerable evidence
for effectiveness of these Alternative practices
to heal the negative long terms of trauma.

Overall negative impact of
trauma
 The primary negative impact of trauma is
DISSOCIATION, that manifests in many different
forms of DISCONNECTIONS in all domains of
human experience.
 These disconnections are layered and hierchrical
 Neurobiological and neuropsychological
 Intrapersonal (Self)
 Interpersonal (Others)
 Transcendent (universe, God, higher power, Etc)

Neuropsychological effects
 Affect Dysregulation
 Anxiety and fear
 Anger
 Depression
 Alexthymia (difficulty with experiencing and
expressing feelings)

 Dissociation
 Neurobiological disintegration
 Disconnection from bodily experiences
 Different forms of Amnesia and Dissociative fugue
 Depersonalization
 Derealization
 Dissociative Identity Disorder

 Trauma Re-enactments
 Substance abuse
 Violence and abuse of others (Emotional, Physical, and
Sexual)
 Self injury
 Repeat of traumatic bonds with perpetrators
 Repeats of Multiple traumas over the life time
 Difficulty with essential self care
 Difficulty with taking effective actions to manage their lives
(futile people)

Interpersonal and personality effects
 Interpersonal issues
 Managing trust issues in long term relations.
 Setting appropriate boundaries (The boundaries are
either too rigid or too fluid).
 Difficulty with appropriate assertiveness (aggressive
or passive).

Interpersonal and personality effects
 Personality issues
 Combination of attachment issues, and trauma tends
to lead to Personality Disorders.
 Trauma issues are more apparent within cluster “B”
personality disorders, specially Borderline and
Antisocial.

Spirituality and Meaning
 Spirituality and Meaning
 Traumatized individuals have a difficult time to
create a coherent history of their lives with
meaningful context for different events in their lives.
 They feel lost and disconnect from larger picture,
and universe.

Spirituality and Meaning
 They feel spiritual bankrupted, and do not
understand why “God” allowed bad things happen
to them.
 They could end up in a rigid and controlling Cult
that plays into their trauma re-enactment dynamics.

Common healing factors of the
alternative practices
 These practices create connections on all levels
of human experience:
 Neurobiological integration (Biological)
 Intrapersonal (self)
 Interpersonal (others)
 Transcendent (universe, God, higher power, Etc)

Common practical elements
 Irrelevant of their cultural origin, these practices
share common characteristics such as:
 1- Purposeful movement of the body that is:
 Bi-lateral
 Rhythmic
 Repetitive
 Done with other people and in community

Common practical elements
 2- Single minded attention and Mindfulness
 3- Commune with members of society in a meaningful
fashion that is out of the ordinary methods of interaction.
These practices are done within religious, cultural, and/or
spiritual systems of meaning. These practices could include:
 Dancing
 Chanting and meditation
 Music/Drumming
 Singing
 Breathing
 Body awareness and energetic techniques
 Etc

How do alternative practices
enhance trauma healing?
 Increase neural integration with the brain.
 Increase positive affects- Joy, compassion, and feelings
wholeness, and etc.
 Increase arousal modulation, and reduce hyper
activation of posterior part of the brain that is related
to fear and chronic trauma response.
 Impact neurotransmitters and hormonal balance.

Increase neural integration
 Areas of brain most related in
processing/mediating ( these parts that are
related to trauma and recovery from trauma)
trauma are:
 medial prefrontal cortex
 anterior cingulate and posterior cingulate
 Insula

Middle prefrontal cortex
 The activity of sympathetic and parasympathetic is
monitored by middle prefrontal cortex of the brain.
Therefore, this part of the brain plays an important role
in the interactional processes that are essential for social
communications and self observation.
 Middle Prefrontal cortex is made up
 Ventral prefrontal cortex
 Medial prefrontal cortex
 Orbitofrontal prefrontal cortex

Orbitofrontal cortex
 1.Orbitofrontal cortex Inhibits inappropriate
action, and helps postpone reward seeking.
 Area of brain where shame is located.
 First thing that comes on-line with babies

Dorsolateral pre-frontal cortex
 Dorso-lateral pre-frontal cortex:
 formulates action plan base on client’s past
experience.
 It is the problem solving part of the brain Things
are held in mind and manipulated to form plans and
concepts.
 Helps set priorities. It is about time and sequences.

Dorsolateral pre-frontal cortex
When this part of the brain is gone, people go into
their trauma and re-live their experience. It is
important to keep this part of the brain activated.
That is what keeps people in here and now.
 The task of therapy is to keep Orbitofrontal
cortex and dorsolateral prefrontal cortex
working together.

Cingulate gyrus
 Cingulate gyrus functions as an integral part of
the limbic system, which is involved with
emotion formation and processing, learning, and
memory. Also, executive control needed to
suppress inappropriate unconscious priming is
known to involve the anterior cingulate gyrus.

Insula
 Insula is the vehicle which information is
transferred to and from outer cortex and inner
limbic (amygdala, hippocampus, hypothalamus)
and bodily areas

Neural integration
 Neural integration is the linkage of anatomically of functionally
differentiated neural regions into an interconnection of widely
distributed parts of the brain and body proper.
 The interconnections take the form of synaptic linkage
structurally, and create a form of coordination and balance
functionally (Daniel Siegel).
 Neural integration likely creates optimal functioning by the way
this coordination and balance of neural activation.

Interpersonal VS Intrapersonal
 Secure attachment is co-related with
development of Middle part of prefrontal
cortex, and also Mindfulness practices. It may be
that Mindfulness practices creates intrapersonal
attunement that creates similar results to secure
attachment.

Body and mindfulness
 In many of the mindfulness practices, we are
focusing on an aspect of body experience. This
engages prefrontal cortex and Insula, which are
clearly play an important role in neural
integration.

Studies on meditation and yoga
 Sara Lazar’s studies-Studied the thickness of
cortex of meditators VS Non-meditators by use
of fMRI.
 Sarah Lazar’s studies showed; subjects who meditated and
practiced Yoga had larger medial prefrontal cortex than
non-meditators. This brain regions associated with
attention and sensory processing, and how much a person
can modulate effects of outside stimuli (affect tolerance).

Studies on meditation and yoga (con)
The enlargement was particularly more evident in
region of the brain called Insula (Acts like a
switch board connecting brain regions involved in
emotions with those involved in thoughts and
decisions).
This connection could contribute to stress
reduction.

Increases positive affect
 Monk under fMRI.
 Significant difference in left prefrontal cortex
activation compared to right prefrontal cortex.
 Difference as high as 3 standard deviations above
the “norm”.

Monk under MRI.
 There is a strong relation between activity of
right prefrontal cortex and positive affects such
as joy and compassion.

Mindfulness and arousal modulation
 According to Van Der Kolk, key to arousal modulations is:
1- befriending internal sensations, and allowing oneself to experience
one’s internal process.
2- gaining awareness of transitory nature of all sensory experience.
These key issues are main focus of many ancient spiritual practices such as;
Zen Buddhism
Vipassana (school of Buddhism)
Many schools of yoga
Sufism
Tai Chi
etc

Reduce hyper activation of posterior
part of the brain
 The vagus nerve, is one of the 12 cranial nerves,
serves as the body’s “information highway”
connecting the brain to many major organs.
 It is considered part of the parasympathetic
branch of the autonomic nervous system. That
means it’s involved in relaxation and calming the
body down—the opposite of the “fight or
flight”

Vagus Nerve
 Vagus nerve is the only nerve that starts in the
brainstem (within the medulla oblongata) and
extends, through the jugular foramen, down
below the head, to the neck, chest and abdomen,
where it contributes to the innervation of the
viscera.
 Activation of the vagus nerve typically leads to a
reduction in heart rate, blood pressure, or both.

Vagus Nerve
 Researchers have already found that children
with high levels of vagal activity are more
resilient, can better handle stress, and get along
better with peers than children with lower vagal
tone.
 Research also suggests; Vagus nerve has direct
impact with increased heart rate variablity that
has strong correlation with PTSD.

Vagus Nerve
 In his laboratory, Keltner has found that the level of activity in
people’s vagus nerve correlates with how warm and friendly they
are to other people.
 Interestingly, it also correlates with how likely they are to report
having had a spiritual experience during a six-month follow-up
period.
 Keltner’s study suggests; vagal tone is correlated with how much
compassion people feel when they’re presented with slides
showing people in distress, such as starving children or people
who are wincing or showing a facial expression of suffering.

Vagus Nerve
 In the nervous system, afferent neurons--
otherwise known as sensory or receptor neurons
carry nerve impulses from receptors or sense
organs toward the central nervous system.
 Afferent neurons communicate with specialized
interneurons. The opposite activity of direction
or flow is efferent.

Vagus Nerve
 In the nervous system, efferent nerves – otherwise
known as motor or effector neurons – carry nerve
impulses away from the central nervous system to
effectors such as muscles or glands (and also the ciliated
cells of the inner ear). The opposite activity of
direction or flow is afferent.
 Vagus nerve has both afferrent and efferent quality.

Vagus Nerve
 Dorsal vagus is related to
 Parasympathetic
 Acetocholine
 breathing/digestion/reproduction
 Ventral vagus: It is related to being social and in the
community. It inhibits certain actions, and helps people
to calm down. It is connected to the heart, lungs, voice
box (tone of voice) and most of the facial muscles.

Neurotransmitters and hormonal
balance
 Meditation has been linked with increase
production of:
 Serotonin that is related to modulation of affect and
behavior. Many of the new anti-depressants enhance
presence of serotonin within nervous system.
 Melatonin that is related to regulation of sleep, and
may have anti-carcinogen and immune system
enhancing effect.

Impact of Mindfulness practices
 Body regulation
 Attuned communication
 Emotional balance
 Response flexibility
 Empathy
 Insight and Self-Knowing
 Fear modulation
 Intuition
 Morality

Application and
treatment issues

Counseling relationship
 All counseling occurs within therapeutic relationship,
and building therapeutic alliance should not be ignored,
and specially with trauma clients managing relational
complexities is essential.
 Relational traumas always happens within the context
of power differentials, therefore counselors must be
very aware of the inherent power differential dynamics
within counseling, and transference issues related to
this power differential

 It is also important to remember, techniques are
always built on therapeutic alliance, and it is
though this alliance that clients find motivation,
energy, and zest to engage in counseling and its
relevant therapeutic recommendations, including
practices that will be discussed, or have already
been mentioned.

 In order for the clients to be fully engaged in the
process, they must understand the interventions and
purpose of these interventions prior to their practice.
An orientation to Alternative practices must be the
initial step prior to recommending/practicing.
 This is even more important for clients who have
already been in traditional talk therapies, and over time
have built a certain expectation about what “should”
occur in counseling.

Treatment considerations
 Our current understanding of neurobiological
and multiple layers of dissociation that justifies
inclusion of a somato-sensory approach to
trauma.
 This implies adaption of healing principles of
ancient spiritual practices in a culturally relevant
and appropriate format for treatment of trauma.

Treatment considerations
 The subtle attention to self impacts integrative parts of
the brain that are indicated as being affected by long
term trauma.
 All of the meditative practices of ancient cultures
demand non-judgmental self observation and
introspection.
 Many of these practices use the body, and movements
to create the circumstances for self observation
through non-judgmental observations of bodily
sensations, reactions, and desires as arises during the
practice.

Drumming for healing
 In a study that was done with traumatized Israeli
solders by Moshe Bensimon (2008), and his
colleague After sixteen drumming sessions they
reported;
 The solders had increased sense of openness,
togetherness, sharing, closeness, connection, and
intimacy.

Drumming for healing
 Group drumming facilitated an outlet for rage, and
an acceptable way of anger expression
 Drumming created a sense of relief from pent up
tension and anxiety, and created a sense of
satisfaction and empowerment.
 The solders were able to gain a sense of control and
self confidence by playing RHYTHMIC, and
synchronized patterns in a group.

Context of healing movements
 Effectiveness of movement exercises without
appropriate cultural context would be minimal on its
own, only within Socially engaged collaborative
relationship increase in client’s social engagement,
information processing capacity and growing ability to
maintain optimal arousal even in the face of trauma
related stimuli.
 This is even more relevant in the practices that involve
dance as a form of therapy.

Dance and movement therapy
 Historically ceremonial dance has played

Application for treatment
 Clients can be taught to observe their internal
experience with out judgment, therefore increase
affect/sensation tolerance, and increase capacity for
self observation.
 This increases intrapersonal contact and neural
integration.
 This can be done through breathing practices that do
not triggers clients traumatic memory.

Breathing practice
 Traumatized individuals tend to hold their
breath, and maintain a shallow breathing pattern.
 This form of breathing was adopted over in
order to maintain dissociation, and therefore
avoidance of body oriented traumatic memories
and pain connected to this memory.

Breathing practice
 These client’s “natural” tendency for holding their
breath could be used to create somatic engagement, and
self observation without triggering their body oriented
traumatic memories.
 This is accomplished by guiding the client to take a deep and
slow breath, and then hold his/her breath for a few second,
and then slowly exhale. Initially this intervention should take
place only in the therapist office, and with the instruction of
the therapist. After a few sessions clients will be able to do it
at home on their own.

Breathing practice II
 It is possible to isolate the focus of the breath to
certain parts of the body that does not trigger
traumatic memories, but the client still is able to
become mindful of the breath to engage
parasympathetic nervous system, and reduce affect
dysregulation, and increase self awareness, and change
structure and bio-chemical function of the brain.
 This is a Vipassana technique that can be directly
adopted, without a revision.

Breathing practice II
 This technique should also be practiced at the therapists
office before client is directed to practice it on their own.
 Client will take a breath, and become observant of the breath
within their Nostril. Initially they may not notice anything,
but this is completely acceptable and understandable. It is
important to be reminded to maintain non-judgmental
attitude, and when their mind wonders off, bring their
attention back to their nostril without emotional reaction it.
Observation is the key word

Managing dissociative symptoms
 Many of the trauma clients struggle with psychological
dissociation, which its symptoms include; Amnesia,
Depersonalization, and Dissociative Identity Disorder.
 Tapping has been a very useful tool to help the client to
move out of dissociative states prior to full switch, but
first these clients must develop effective “awareness”
skill to recognize these s symptom when they just start
to manifest

Referral for Adjunct therapies
 Many of the spiritual practices of ancient
cultures are currently adopted as holistic and
health oriented way of life for Americans and
Europeans.
 Words like meditation, Yoga, Tai chi, Martial
arts, and Zen are not unfamiliar word for many
westerners.

Referral for Adjunct therapies
 It is important for all trauma therapists to have a basic
understanding of these practices, and their potential
benefits for their clients. For example; Tai chi and yoga
tend to be effective tools for affect regulation, while
harder styles of martial arts could help the client to feel
their own body, and its power.
 It is also important to remember many of these adjunct
therapies have multiple benefits, and all of these issues
should ne considered and negotiated with the clients.

References
Lisak, D. (June,2008). The neurobiology of trauma (2005 ppt presentation)
Perry, B.D. (2006). Applying principles of neurodevelopment to clinical work with
maltreated and traumatized children. In N.B. Webb (ed.), Working with traumatized youth
in child welfare (pp 27-52), New York: Guilford.
Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to
psychotherapy. New York: Norton.
Siegel, D. J. (2007). The mindful brain: Reflection & attunement in the cultivation of well-being. New
York: Norton.
Solomon, E. P. & Heide, K.M. (2005). The biology of trauma: Implications for treatment.
Journal of Interpersonal Violence, 20 (1), 51-60.
Van der Kolk, B. A. (2002). Beyond the talking cure: Somatic experience and subcortical
imprints in the treatment of trauma. In Shapiro, F., EMDR as an integrative psychotherapy
approach (pp 57-83). Washington, D.C.: APA Press.

References
Van der Kolk, B. A., & Fisler, R. (1995). Dissociation and the fragmentary nature of
traumatic memories: Overview and exploratory study. Download: http//www.trauma-
pages.com/vanderk2.htm

Alternative Therapies of Trauma By: Daryush Parvinbenam, LPCC-S

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