Somatic Methods for Affect Regulation

A Clinician's Guide to Healing Traumatized Youth

Kimberley L. Shilson

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781351819688
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Somatic Methods forAffect Regulation is a unique resource that presents a variety of approaches for working somatically with youth. Chapters provide an overview of the relevant neuroscience research with a specific focus on affect regulation. The somatic techniques showcased in the book are evidence-based and illustrated with case studies showing their impact. Importantly, the chapters are also chock full of practical information, including strategies for working with dysregulated youth, information for collaborative and cooperative care, and an appendix with checklists and worksheets to help clinicians plan, guide, and assess their work.

Part I

Theory and Somatic Approaches

1Brain Development, Trauma, and Affect Regulation

An understanding of the neurobiology of trauma may further enhance our conceptualization of the long-term sequelae of trauma and help guide our therapeutic efforts toward increasing the accuracy and specificity of clinical interventions.

(Pat Ogden, 2006, p. 139)

Research in the field of neurobiology has shown that the capacity for self-regulation depends on early experiences with an attuned caregiver. Moreover, recent research has identified specific brain regions and mechanisms impacted by child abuse and neglect. Before a child is born, the brain and body are creating crucial connections. Through processes of use-dependent growth and pruning of dendrites and neuronal networks, the early brain takes shape. Siegel has expanded the use-dependent notion to “use-expectant” (Siegel, 2007). At birth, the infant already has over 85 billion neurons, and the first couple of years are critical to optimal development.

Clinical experts and researchers in neurobiology have written about the bottom-up development of critical areas and functions of the brain. That is, the more primitive parts of the brain responsible for unconscious processes, such as respiration, breathing, and heart rate, are the first to develop. As reflected in the opening quote, the work of Pat Ogden and other somatic healers recognizes that trauma work must consider neurobiology, and that interventions tailored to the individual from a bottom-up approach may have the greatest impact. Bruce Perry’s diagram (see Figure 1.1) offers a visual representation of neurodevelopment and the key functions of these areas. Structured akin to an upside down pyramid, with greater mass and complexity on the upper layers (cortex), basic functions are on the bottom and, as the brain grows based on maturation and life experience, the capacities for more intricate processes (e.g. problem-solving, decision-making) are at the top. This is simplistic as there is interconnection between the areas; however, the important fact is that the development of higher functions depends on the development of the lower level areas.

Figure 1.1Bottom-up Brain Development

Source: Bruce D. Perry (2017). Image used with permission.

Even more simplistic is Canadian neuroscientist Paul MacLean’s triune brain model (see Figure 1.2 below). According to the triune brain model, the human brain is composed of three interconnected areas that MacLean referred to as the reptilian brain (brain stem and cerebellum), the limbic system (also referred to as the emotional brain), and the neocortex (also referred to as the thinking brain). These areas develop in a bottom-up, use-dependent manner. From the brain stem up, patterns are formed and capacities are developed. If development is impeded at a lower area, upper areas can be profoundly impacted. Regions within the limbic system, such as the amygdala and hippocampus that are involved in functions such as memory and emotions, may not develop optimally if there is trauma or insufficient experience to facilitate growth of the lower regions. Another important concept in brain development is the well-known expression what fires together wires together. This concept, known as Hebbian theory, was introduced in Donald Hebb’s 1949 book The Organization of Behavior: A Neuropsychological Theory. Hebb’s theory provided an explanation about learning as a product of neuronal firing patterns and continues to be referenced in the works of current neuropsychological theorists (Cozolino, 2006; Heller & LaPierre, 2012; Siegel, 2003).

Figure 1.2The Triune Brain

From a trauma perspective, if the child experiences neglect that impedes the development of his capacity to self-soothe, he may encounter difficulties in areas such as learning, social interaction, and mood disturbances. If the neglect continues over years, the resultant complex trauma might manifest in the use of substances or self-injurious behaviors as attempts to regulate, difficulties in the ability to form close, trusting relationships, or early dropout from school due to inability to focus and retain material. The ACEs study, discussed later in this chapter, illuminates the long-term, far-reaching vicissitudes of childhood trauma.

What promotes optimal development of these early connections? Much has been written on the role of attunement in early brain development (Ford et al., 2013; Perry, 2009; Sroufe, 1995; Stein & Kendall, 2003). Attunement during the child’s first relationship, with the primary attachment figure, is crucial to brain development. Through mimicking or mirroring the baby’s state, whether the baby is distressed or happy, and accurately responding to the baby, and recognizing whether the baby’s cry is a call for connection, hunger, to soothe, or to change a diaper, the caregiver calms the baby’s nervous system and instills a sense of safety. As the caregiver regulates the infant, she learns that it is acceptable to have needs and that she can reach out (i.e. proximity seeking) to have those needs met. She also learns that she is worthy of the love and affection that she receives from her caregiver. Of course, there will be times when the caregiver is misattuned or unable to meet the infant’s need immediately, but through sequences of rupture and repair the infant develops tolerance and trust that her needs will be met. This is moving into attachment theory so we will move on to other factors that promote crucial neurobiological development.

Gaskell and Perry state:

The crucial regulatory neural networks involved in the stress response (and multiple other functions) are themselves modulated through patterned, repetitive, and rhythmic input from both bottom-up (i.e., somatosensory) and top-down (i.e., cerebromodulatory) systems.

(in Malchiodi & Crenshaw, 2014, p. 184)

Rhythm is built into the brain stem and occurs below conscious awareness. We are not aware of our heart beating or breathing, for example, but these rhythms are crucial to our survival and facilitate functions in higher brain regions. One need only look at an infant attempting to self-soothe though rocking side to side to witness the fundamental role rhythm plays in our lives. Rhythm is used in interactive regulation as well, when the caregiver rocks the baby or walks around making cooing sounds, for example. In addition to the rhythmic input, the caregiver’s prosody plays a role in brain development, specifically the instillation of capacity for self-regulation. The caregiver’s soothing tone and pace settles the nervous system and creates a sense of safety and well-being in the infant (Ogden, 2006). Prosody, along with movement and facial expressions, are components of implicit communication essential to optimal neurological, social, and emotional growth. Janina Fisher has described this process as interactive neurobiological regulation (Fisher, 2010).

ACEs (Adverse Childhood Experiences) Study

In 1998, Vincent Felitti and colleagues published a ground-breaking longitudinal study on the long-term, far-reaching impact of child abuse (Felitti et al., 1998). Felitti had been conducting research in an obesity clinic when he became curious about the high dropout rate of patients who successfully lost weight in the program. Upon exploration, he uncovered histories of sexual abuse that had not been addressed in treatment, primarily because the right questions were not asked. This longitudinal study, a joint project between Kaiser Permanente and the CDC, initially conducted between 1995 and 1997 with over 17,000 participants, provided evidence for a direct link between childhood maltreatment and various adult social, emotional, cognitive, and psychological problems. Adult health issues ranged from mental illness, to addictions, to medical issues such as heart disease and early mortality. The ACEs study is significant given the large sample size, the longitudinal nature of the research, and the demonstrated links between early child abuse and a vast range of adult health issues, and the results have been cited by many contemporary trauma experts.

Most alarming, the research demonstrated a cumulative effect of multiple exposures to trauma. Adverse life experiences included in the survey were items such as emotional, physical, or sexual abuse, and living in a household with mentally ill caregivers or domestic violence. Here is a sample of the staggering statistics:

• Life expectancy was reduced by 20 years, from 80 to 60, for those with six or more ACEs.
• Those with four or more ACEs were 2.2 times more likely to have heart disease than those with none.
• Individuals with four or more ACEs were 12.2 times more likely to have ever attempted suicide than responders with none.

As with most research, there are limitations to the study that are beyond the scope of this book. There is a website with an abundance of material on the study for those who wish to learn more about ACEs (www.acestoohigh.com). The ACEs study is included here because it highlights how medical professionals often overlook historical factors that may contribute to presenting symptoms reflecting dysregulation, how widespread childhood trauma is in our society, and the vast ramifications of unrecognized, untreated childhood trauma. Findings suggest a paradigm shift in how clinicians conduct assessments: ask “what happened to you?” rather than “what’s wrong with you?”

Figure 1.3 ACE Pyramid

Source: Adapted from www.cdc.gov/violenceprevention/acestudy/ACE_graphics.html.

Neuroplasticity – Hope for Healing!

As noted above, neurons that fire together, wire together. With this concept in mind, we know that with repetition and rhythm (Perry, in Malchiodi & Crenshaw, 2014) new connections can be formed and strengthened. Siegel (2007) wrote: “Neuroplasticity is the term used when connections change in response to experience.” (p. 30). Thus, there is a possibility for children who have experienced severe neglect, for example, to generate or regenerate neuronal growth in under- or undeveloped brain regions. The concept of neuroplasticity is important in work with traumatized youth and families because it gives us hope and, more significantly, offers hope to the youth and caregivers that feel hopeless about the possibility for healing.

The Burgeoning Field of Interpersonal Neurobiology (IPNB)

Moving from the Brain to the Mind

Siegel describes the field of interpersonal biology as a combination of fields, such as anthropology, education, psychology, and neurology, “into one view of the nature of being human” (Siegel & Solomon, 2013, p. 1), a view that includes the mind, relationships, human development, and general wellness. “The capacity of caregivers to modulate physiologic arousal reinforces the child’s attachment to them and allows a smooth alternation between activities that increase and reduce arousal as they go back and forth between exploring the environment and returning to their mothers” (van der Kolk, 2003, p. 295). Perry (2002) has outlined six core strengths that are sequentially developed through effective clinical work with traumatized youth:

1.attachment – the ability to form a dyadic relationship with another, typically a primary caregiver;

2.self-regulation – the ability to self-regulate depends on the earlier attachment relationship;

3.affiliation – learn how to be connected with other people, cannot be mastered without ability to self-regulate;

4.attunement – noticing others are different from oneself and learning what others are like;

5.tolerance – through learning and attunement, appreciating individual difference;

6.respect – beyond tolerating differences, recognition that the world needs diversity and we are stronger with diversity.

Based on these core strengths, the attachment relationship precipitates the capacity for self-regulation that is necessary for us to function in our social world. The youth we see in our practices have either gotten stuck or have underdeveloped attachment and self-regulation. This book focuses on ways to rewire or build these capacities through enhancing regulation.

Figure 1.4Contemporary Artwork Reflecting the Significance of the Mind–Body–Social Connection

Source: “Cognectica”...