slide1 l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
NEW THEORIES OF DISSOCIATION: APPLICATIONS TO THERAPY AND HEALING ROBERT SCAER, M.D. scaermdpc@msn traumasoma PowerPoint Presentation
Download Presentation
NEW THEORIES OF DISSOCIATION: APPLICATIONS TO THERAPY AND HEALING ROBERT SCAER, M.D. scaermdpc@msn traumasoma

Loading in 2 Seconds...

play fullscreen
1 / 48

NEW THEORIES OF DISSOCIATION: APPLICATIONS TO THERAPY AND HEALING ROBERT SCAER, M.D. scaermdpc@msn traumasoma - PowerPoint PPT Presentation


  • 325 Views
  • Uploaded on

NEW THEORIES OF DISSOCIATION: APPLICATIONS TO THERAPY AND HEALING ROBERT SCAER, M.D. scaermdpc@msn.com www.traumasoma.com. THE ROOTS OF TRAUMA. A THREAT TO LIFE IN THE FACE OF HELPLESSNESS THE FIGHT /FLIGHT / FREEZE RESPONSE. THE FREEZE RESPONSE. NUMBING THROUGH ENDORPHINS

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'NEW THEORIES OF DISSOCIATION: APPLICATIONS TO THERAPY AND HEALING ROBERT SCAER, M.D. scaermdpc@msn traumasoma' - sandra_john


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1
NEW THEORIES OF DISSOCIATION:APPLICATIONS TO THERAPYAND HEALINGROBERT SCAER, M.D.scaermdpc@msn.comwww.traumasoma.com
the roots of trauma

THE ROOTS OF TRAUMA

A THREAT TO LIFE

IN THE FACE OF HELPLESSNESS

THE FIGHT /FLIGHT / FREEZE RESPONSE

the freeze response
THE FREEZE RESPONSE
  • NUMBING THROUGH ENDORPHINS
  • VAGAL (PARASYMPATHETIC) TONE
  • BIMODAL SYMPATHETIC /

PARASYMPATHETIC CYCLING

(ACCELERATOR / BRAKE

ANALOGY)

hypnosis
HYPNOSIS

-FREUD:“…a paralysis produced by the influence of an omnipotent person on a defenseless, impotent subject”

- PAVLOV: ANIMAL HYPNOSIS - “…a self-protecting reflex of an inhibitory nature”

- PERSISTANCE OF REFLEX MOTOR POSTURES IMITATING THE LAST POSITION OF THE LIMBS BEFORE HYPNOSIS ENSUED

freeze immobilization and survival
FREEZE/IMMOBILIZATIONAND SURVIVAL

BABY CHICKS

NOT

IMMOBILIZED IMMOBILIZED IMMOBILIZED

SPONTANEOUS FORCED

RECOVERY RECOVERY

BEST INTERMEDIATE WORST

DROWNING DROWNING DROWNING

SURVIVAL SURVIVAL SURVIVAL

animals that do not discharge the freeze
ANIMALS THAT DO NOT DISCHARGE THE FREEZE
  • ZOO ANIMALS
  • LABORATORY ANIMALS
  • DOMESTIC ANIMALS
  • HUMAN ANIMALS

Q: WHAT DO THESE ANIMALS HAVE

IN COMMON?

A: THEY ALL LIVE IN A CAGE!

memory in trauma
MEMORY IN TRAUMA
  • TRAUMATIC STRESS: A LIFE THREAT WHILE IN A STATE OF HELPLESSNESS
  • THIS LEADS TO THE FREEZE RESPONSE
  • DISCHARGE OF THE FREEZE RESPONSE ALLOWS “COMPLETION” OF ESCAPE OR DEFENSE IN PROCEDURAL MEMORY, EXTINGUISHES CONDITIONED SOMATIC CUES
conditioning in trauma
CONDITIONING IN TRAUMA
  • LACK OF “COMPLETION” IMPRINTS THE CONDITIONED ASSOCIATION OF:

- THE THREAT

- ITS SENSORIMOTOR EXPERIENCE

(OR TRAUMATIC CUES)

- AND THE STATE OF AROUSAL

WITHIN PROCEDURAL MEMORY!

THIS ASSOCIATION LEADS TO FEAR CONDITIONING, OR TRAUMATIZATION

charcot and the salp tri re

CHARCOT AND THE SALPÊTRIÈRE

THE STUDY

OF HYSTERIA

AS A

NEUROLOGICAL SYNDROME

janet and dissociation
JANET AND DISSOCIATION
  • “FIXED IDEAS”: THE SPECTRUM OF SYMPTOMS IN HYSTERIA
  • SOMATIC, EMOTIONAL, PERCEPTUAL SYMPTOMS TRIGGERED BY TRAUMA
  • “ABSENT MINDEDNESS” AND ABULIA- THE INABILITY TO INITIATE ACTION
  • TRIGGERING OF HYSTERIA BY CUES IN THE ENVIRONMENT
the age of hysteria
THE AGE OF HYSTERIA
  • BREUER, THE “TALKING CURE”, AND “REMINISCENCES”
  • FREUD, INCEST AND “THE AETIOLOGY OF HYSTERIA”
  • FREUD AND BREUER: RECANTATION
  • JANET: PROFESSIONAL OSTRACISM
lessons from ww i
LESSONS FROM WW I
  • THE HELPLESSNESS OF TRENCH WARFARE AND THE PREDOMINANCE

OF DISSOCIATIVE SYNDROMES

(SHELL SHOCK)

  • FERENCZI (1919): “..TIC..AN OVERSTRONG MEMORY FIXATION ON THE ATTITUDE OF THE BODY AT THE MOMENT OF...TRAUMA”
  • HYSTERIA AND MALINGERING
  • LOW PTSD INCIDENCE IN PILOTS AND OFFICERS
neuroimaging in conversion disorder
NEUROIMAGING IN CONVERSION DISORDER
  • fMRI STUDIES IN HYSTERICAL MOTOR PARALYSIS AND ANESTHESIA, WITH CHRONIC PAIN REVEAL:

- REDUCED SUPRASPINAL RESPONSES IN HYSTERICAL PARALYSIS

- REDUCED ACTIVATION OF BRAIN SENSORY PATHWAYS WITH STIMULATION OF THE HYSTERICALLY NUMB LIMB

i.e.: IMPAIRED BRAIN MESSAGE TRANSFER IN CONVERSION DISORDER

neuroimaging in conversion disorder17
NEUROIMAGING IN CONVERSION DISORDER

HYSTERICAL PARALYSIS AND SENSORY LOSS (CONVERSON DISORDER) IS ASSOCIATED WITH OBJECTIVE,

LONG-STANDING DYNAMIC CHANGES IN

REGIONS OF THE BRAIN THAT PROCESS SENSORIMOTOR INFORMATION

i.e.: CONVERSION “HYSTERIA” IS PHYSIOLOGICAL,

NOT “PSYCHOLOGICAL”

manifestations of dissociation
MANIFESTATIONS OF DISSOCIATION
  • DEREALIZATION
  • DEPERSONALIZATION
  • DISTORTED TIME PERCEPTION
  • DISTORTED SENSORY PERCEPTION
  • AMNESIA
  • FUGUE STATES
  • CONVERSION REACTION
  • DISSOCIATIVE IDENTY DISORDER
dissociation psychobiology
DISSOCIATION PSYCHOBIOLOGY
  • SCHORE (2005):…”vagal outflow from the dorsal vagal nucleus …is the psychobiological engine of …dissociation”
  • …”early trauma expressed as emotional neglect and abuse…predict…dissociation.”

i.e.: IMPAIRED ATTACHMENT AND RIGHT O.F.C. DEVELOMENT LEADS TO AUTONOMIC DYSREGULATION, AND THE EMERGENCE OF DORSAL VAGAL FREEZE / DISSOCIATIVE STATES

the dorsal vagus nerve
THE DORSAL VAGUS NERVE
  • THE DORSAL VAGAL COMPLEX (DVC)

- THE DORSAL VAGAL NUCLEUS

- PRIMITIVE, REPTILIAN

- LOW O2 UTILIZATION

- THE DIVE REFLEX (APNEA, BRADYCARDIA)

- THE FREEZE RESPONSE, THE

RISK IN MAMMALS, AND

“VOODOO DEATH”

slide21
BUT! THE DORSAL VAGUS / FREEZE THEORY DOES NOT EXPLAIN THE OCCURRENCE OF HIGH SYMPATHETIC-DOMINANT DISSOCIATVE STATES:
  • HOMICIDAL DISSOCIATION
  • “BERSERKER” BEHAVIOR IN COMBAT
dissociation structure
DISSOCIATION STRUCTURE

A CAPSULE, COMPARTMENT

OR STATE OFPERCEPTION COMPOSED OF THE VARIED PROCEDURAL MEMORIES

OF THE EXPERIENCES

OF A PAST TRAUMATIC EVENT

WHERE A FREEZE RESPONSE OCCURRED WITHOUT A FREEZE DISCHARGE

the dissociation capsule is composed of
THE DISSOCIATION CAPSULE IS COMPOSED OF:
  • SOMATOSENSORY MESSAGES AND MOTOR ACTIONS
  • AUTONOMIC STATES
  • EMOTIONS
  • ENDORPHINERGIC ALTERATION OF PERCEPTION
  • EMOTION-LINKED DECLARATIVE MEMORY

ALL SPECIFIC TO

THE TRAUMATIC EXPERIENCE

features of the dissociative capsule
FEATURES OF THE DISSOCIATIVE CAPSULE

CAPSULES CONSIST OF

PROCEDURAL MEMORIES

FOR THE PAST TRAUMA,

BUT ARE PERCEIVED AS BEING PRESENT,

AND ARE THEREFORE DISSOCIATIVE

examples of capsule procedral memories
EXAMPLES OF CAPSULE PROCEDRAL MEMORIES
  • PAIN, NUMBNESS, DIZZINESS,
  • TREMOR, TICS, PARALYSIS
  • NAUSEA, CRAMPS, PALPITATIONS
  • ANXIETY, TERROR, SHAME, RAGE
  • FLASHBACKS, NIGHTMARES OR INTRUSIVE THOUGHTS
slide26

THE DISSOCIATIVE CAPSULE IS BROUGHT INTO CONSCIOUS AWARENESS(THE PRESENT MOMENT) BY EXTERNAL REPRESENTATIVE CUES OR INTERNAL KINDLEDMEMORIES

slide27

THE SIZE, SPECIFICITY AND STRENGTH OF A DISSOCIATIVE CAPSULE DEPENDS ON THE INTENSITY OR REPETITIVE EXPERIENCE OF THE TRAUMA THAT CAUSED IT

slide28
THE NUMBER OF ONE’S DISSOCIATIVE CAPSULES IS DETERMINED BY THE SUM TOTAL OF ONE’S CUMULATIVE LIFE TRAUMAS
slide29
THE MORE THE NUMBER OF DISSOCIATIVE CAPSULES, THE LESS TIME ONE IS ABLE TO SPEND IN CONSCIOUSNESS (THE PRESENT MOMENT)
the present moment
THE PRESENT MOMENT
  • 1-10 SECOND PERIOD OF AWARENESS OF “NOW”
  • A “LIVED STORY”
  • BACKGROUND FEELINGS FROM THE BODY
  • AUTOBIOGRAPHICAL MEMORY
  • CHANGING INTERNAL AND EXTERNAL PERCEPTIONS
  • CONCEPTS OF TIME, INTENTIONALITY, SHIFTING EMOTIONAL TONE
  • A MEASURE OF CONSCIOUSNESS
  • OUR CHANGING SENSE OF SELF
the self

THE SELF

ANTONIO DAMASIO:

“THE EMBODIED MIND”

SOMATIC SENSATIONS (FEELINGS)

OF THE PRESENT MOMENT SUPERIMPOSED ON OUR AUTOBIOGRAPHICAL MEMORY

slide32

PROCEDURAL

MEMORY CUES

- SOMATOSENSORY

- LIMBIC/EMOTIONAL

- AU TONOMIC

- EMOTION-LINKED

DECLARATIVE MEMORY

THE STRUCTURE AND RELATIONSHIPS OF DISSOCIATIVE CAPSULES

  • PROCEDURAL
  • MEMORY CUES
  • SOMATOSENSORY
  • LIMBIC/EMOTIONAL
  • -AUTONOMIC
  • - EMOTION-LINKED DECLARATIVE MEMORY

AUTONOMIC CUES

SOMATOSENSORY CUES

INJURY

MVA

LIMBIC CUES

THE PRESENTMOMENT

  • PROCEDURAL
  • MEMORY CUES
  • AUTONOMIC
  • LIMBIC/EMOTIONAL
  • EMOTIONA-LINKED
  • DECLARATIVE MEMORY
  • PROCEDURAL MEMORY
  • CUES
  • - SOMATOSENSORY
  • LIMBIC/EMOTIONAL
  • AUTONOMIC
  • - EMOTION-LINKED
  • DECLARATIVE MEMORY

DEATH OF PARENT

PROCEDURAL MEMORY

CUES

- AUTONOMIC

- LIMBIC/EMOTIONAL

- EMOTION - LINKED

DECLARATIVE MEMORY

INCEST

SHAMING,

GRIEF

what implications does the dissociative capsule have for healing trauma

WHAT IMPLICATIONS DOES THE DISSOCIATIVE CAPSULE HAVE FOR HEALING TRAUMA?

TO HEAL TRAUMA

WE MUST EXTINGUISH POSTTRAUMATIC PROCEDURAL MEMORY CUES

slide35

CEREBRAL CORTEX

HYPOTHALAMUS

HPA AXIS

ORBITOFRONTAL

CORTEX

ORGANIZES RESPONSE

TO THREAT

SENSORY

INPUT –

HEAD AND NECK

ANTERIOR

CINGULATE GYRUS

MODULATES

AMYGDALA

HIPPOCAMPUS

DECLARATIVE MEMORY

COGNITIVE MEANING

AMYGDALA

EMOTIONAL

CONTENT

LOCUS

CERULEUS

EARLY WARNING

the key ingredient in healing trauma

THE KEY INGREDIENT IN HEALING TRAUMA

EXTINGUISHING THE

DISSOCIATIVE CAPSULE

CONTENTS

BY

DOWNREGULATING/

INHIBITING THE AMYGDALA

DURING IMAGINAL EXPOSURE TO ITS CONTENTS

trauma therapy theoretical considerations
TRAUMA THERAPY:THEORETICAL CONSIDERATIONS
  • EXTINCTION OF CONDITIONED CUES: IMAGERY WHILE INHIBITING THE AMYGDALA

- THE POWER OF RITUAL

- INTEGRATING THE CEREBRAL HEMISPHERES

- EMPOWERMENT THROUGH AFFIRMATION

  • RECONSOLIDATION OF MEMORY
  • “COMPLETION” OF DEFENSE/ESCAPE: THE “DISCHARGE”
  • RESTORING HOMEOSTASIS
  • TRANSFORMATION AND WISDOM THROUGH MEANING
the dilemma of pharmacotherapy
THE DILEMMA OFPHARMACOTHERAPY
  • SRI’s, ANTICONVULSANTS, BENZODIAZEPINES, ANTIPSYCHOTICS, BETA BLOCKERS
  • TREATING A BIPOLAR SYNDROME
  • RECIPROCAL SIDE EFFECTS
  • SIDE EFFECTS AS TRAUMATIC EXPERIENCES DUE TO NEUROSENSITIZATION
  • NARCOTICS IN CHRONIC PAIN
trauma therapy
TRAUMA THERAPY
  • PSYCHOTHERAPY

- COGNITIVE/BEHAVIORAL THERAPY: MOST THOROUGHLY EVALUATED

- EXPOSURE THERAPIES:

- IMAGINAL EXPOSURE

- IN-VIVO EXPOSURE

- SYSTEMATIC DESENSITIZATION

BEST FOR AROUSAL AND ANXIETY,

LESS EFFECTIVE FOR AVOIDANCE AND DISSOCIATION; ? LONG-TERM EFFICACY

trauma therapy40
TRAUMA THERAPY
  • RECONNECTING WITH THE BODY

- SOMATIC DISSOCIATION AND THE FELT SENSE

- THE USE OF MOVEMENT THERAPY:

YOGA, DANCE, BALANCE, EQUESTRIAN THERAPY

- THE USE OF THERAPEUTIC BODY WORK AND EXERCISE

- THE USE OF ARTISTIC MEDIA

- BIOFEEDBACK

guided imagery
GUIDED IMAGERY
  • USED IN ALMOST ALL TECHNIQUES
  • DERIVING THE SUD’s SCALE
  • ACCESSING THE MEMORY TO BE EXTINGUISHED
  • MANIPULATING THE MEMORY THROUGH IMAGINAL REVERSAL
  • FACILITATING THE FELT SENSE
somatic experiencing
SOMATIC EXPERIENCING
  • ACCESSING THE FELT SENSE
  • TRACKING AND TITRATION THROUGH “PENDULATION”
  • ELICITATION OF SOMATIC SENSORIMOTOR RESPONSES: THE FREEZE DISCHARGE
  • AUTONOMIC RESPONSES
  • CONCEPTS OF COMPLETION, UNCOUPLING, EXTINCTION
energy psychology
ENERGY PSYCHOLOGY
  • THOUGHT FIELD THERAPY (T.F.T.), EMOTIONAL FREEDOM THERAPY (E.F.T.), HEALING TOUCH

* USE OF SUD’s SCALE

* AFFIRMATIVE STATEMENTS, MERIDIAN TAPPING, SINGING, VOCALIZATION, EYE MOVEMENTS AND IMAGERY

* EMPOWERMENT, HOMEOSTASIS, INTEGRATING THE HEMISPHERES, RITUAL, EXTINCTION

slide44
EMDR
  • USE OF SUD’s SCALE
  • ALTERNATING EYE MOVEMENTS,

AUDITORY OR TOUCH STIMULI LINKED

TO IMAGERY OF THE TRAUMA

  • POSITIVE AND NEGATIVE COGNITIONS
  • THE REM CONNECTION:

- PROCESSING AROUSAL MEMORY

- MEMORY RECONSOLIDATION

- CEREBELLAR – CINGULATE CONNECTION

  • AFFIRMATION, RITUAL
neurofeedback
NEUROFEEDBACK
  • DRIVING THE BRAIN INTO THE PRESENT MOMENT
  • ALPHA/HIGH THETA ENHANCEMENT
  • COMPARISON TO DEEP MEDITATION
  • APPLICABLE CONDITIONS:

- ADD/ADHD, OCD

- ADDICTIONS

- CRIMINAL BEHAVIOR

- FIBROMYAGIA/CFS

- MOOD DISORDER, PTSD, ANXIETY

- SOMATIZATION

- MTBI

transformation and wisdom
TRANSFORMATION ANDWISDOM
  • 1. THE RECOGNITION AND MANAGEMENT OF UNCERTAINTIES
  • 2. THE INTEGRATION OF AFFECT AND COGNITION
  • 3. THE RECOGNITION AND ACCEPTANCE OF HUMAN LIMITATIONS, INCLUDING THE FINITUDE OF LIFE

i.e.: LIFE IN THE PRESENT MOMENT