Treating Trauma and Addiction with the Felt Sense Polyvagal Model

A Bottom-Up Approach

Jan Winhall

• Éditeur: Routledge
• Année: 2021
• ISBN:
  9781000405415
• Édition: 1
• Sujet: Psychologie
• Sous-sujet: Sucht in der Psychologie

In sharp contrast with the current top-down medicalized method to treating addiction, this book presents the felt sense polyvagal model (FSPM), a paradigm-shifting, bottom-up approach that considers addiction as an adaptive attempt to regulate emotional states and trauma.

The felt sense polyvagal model draws from Porges' polyvagal theory, Gendelin's felt sense, and Lewis' learning model of addiction to offer a graphically illustrated and deeply embodied way of conceptualizing and treating addiction through supporting autonomic regulation. This model de-pathologizes addiction as it teaches embodied practices through tapping into the felt sense, the body's inner wisdom. Chapters first present a theoretical framework and demonstrate the graphic model in both clinician and client versions and then teach the clinician how to use the model in practice by providing detailed treatment strategies.

This text's informed, compassionate approach to understanding and treating trauma and addiction is adaptable to any school of psychotherapy and will appeal to addiction experts, trauma specialists, and clinicians in all mental health fields.

1 Early Days: The Initiation of a Trauma Therapist

Addiction: It helps you in the short term,

hurts you in the long term,

and you can’t stop doing it. – JW

As far back as I can remember I have been curious. I wondered about all kinds of things, mostly to do with feelings and relationships. How could some people that I love hurt me so much? How could others be so kind? What made people so different, and how was I going to find my way in this kind of world? When I look back now, it feels like I was a born psychotherapist, questioning the nature of relationships from the beginning. I spent much of my life exploring ways to find answers to these questions. This exploration led me to run an incest survivor group for young women in their twenties. Here I found many more questions, and many experiences that were like mine, and not like mine. These relationships accelerated my search. I became particularly curious about how the body responded to such horror. The myriad of ways that these young women were poking and prodding themselves both fascinated and repelled me. They described how these ways helped them and how they became addicted to them. Out of this experience I came up with this definition: Addiction is something that helps you in the short term, hurts you in the long term, and you can’t stop doing it.

Addiction as Behavioural Affect Regulation: A New Frontier

I felt an urgency to help, but how? The answers I was searching for evolved over time. In reading trauma treatment books by Van der Kolk (1996) and Herman (1992), I came to understand that these self-destructive behaviours were common to all survivors of trauma as ways to manage affect regulation. Herman noted that such heightened states of attack could not be managed by ordinary means. “Abused children discover at some point that the feeling can be most effectively terminated by a major jolt to the body. The most dramatic method of achieving this result is through the deliberate infliction of injury” (p. 109). She went on to say that while self-injury is the most “spectacular” soothing mechanism, children find many other ways to induce major alterations in affective states. “Purging and vomiting, compulsive sexual behaviour, compulsive risk taking or exposure to danger, and the use of psychoactive drugs become the vehicles by which abused children attempt to regulate their internal emotional states” (p. 109).

It is only within the past decade that we see researchers begin to discuss these actions as behavioural or process addictions. Prior to this, we viewed addiction as substance related, and therefore self-injury was not viewed as an addiction. However, while not all self-injury is addictive, all addiction is self-injurious. It helps you and harms you. What many of us hear in our offices is that because these behaviours are so needed and effective, they become compulsively repeated as powerful mechanisms of comfort. Thus, habit-forming behaviours can become addictive when they are needed to survive.

The understanding of behavioural or process addictions has emerged at the same time as, and perhaps because of, a current technological revolution. We now have access to neurobiological information about the body that is guiding us in our broader understanding of psychological struggles. Since the decade of the brain in the 1990s, the field of trauma has been greatly enhanced by the use of modern imaging technologies such as fMRI and PET. We can now see the impact of traumatic experience on brain functioning. Lewis (2015) states, “The neural consequences of behavioural addictions indicate the same cellular mechanisms and the same biological alterations that underlie drug addiction” (p. 23). New theories are emerging as we learn more about trauma and the brain.

Finding Interpersonal Neurobiology (IPNB)

IPNB, as it is called, was created by Dan Siegel (1999) in the 1990s. It draws from 40 different academic disciplines. The beauty of the theory is its emphasis on consilience. Wilson (1998) defines consilience as “the discovery of common findings from independent disciplines” (p. 7). Thus, we can learn to appreciate and integrate findings from branches of the natural and social sciences, and the humanities. We will see in Chapter 2 a new and fresh way to integrate these disciplines called thinking at the edge (TAE). This way comes from Gendlin’s philosophy of the implicit (2018). The concept of the felt sense is central to this philosophy. A felt sense is a bodily knowing that can be subtle at first but opens up more and more as one gently attends to it. The central importance of attending to the felt sense has been widely adopted in trauma and therapy circles. It also forms an integral part of the felt sense polyvagal model (FSPM) of addiction that forms the central idea for this book.

IPNB provides a view of mind, brain, and relationships that seeks to bring a more strength-based approach to mental health. This theory suggests that well-being is a state of integration, and that states of suffering are difficulties with emotion regulation. Siegel views these states on a continuum from an emotionally flooded, chaotic response at one end, to a numb and rigid response at the other. Integration is the linkage of differentiated parts. Without integration, a person will cycle between chaos and rigidity. Linkage creates integration of left and right hemispheres and of top-down and bottom-up processing, and this helps a person stay away from the extreme ends of the continuum.

Experiential Response to Siegel’s IPNB Model

When I first read about the chaos/rigidity continuum, I recognized how it was helpful in understanding the women in my group. Because of trauma, they were all swinging back and forth from chaos to rigidity. They were seldom able to experience a grounded state because they felt so unsafe in their bodies.

The whole demeanour and physicality of the women’s presence changed depending on where they were on this emotional continuum. If they were flooding in chaos, they were anxious, fidgety, distracted or sometimes irritable and rageful. If they were numbing, they presented as rigid, lost, depressed, dissociated. How they viewed the world was also determined by their state. If they were in a chaotic/angry state, the world was a boxing ring. If they were in a shut down, depressed state, the world was boring, grey, deadened. This dramatic shifting of states was a key to my future understanding about the nature of the autonomic nervous system.

Discovering the Missing Links: The Polyvagal Theory

It was when I discovered Porges’ (2011) work on the polyvagal theory that I really began to make headway into a deeper understanding of the mysterious behaviours of the women in group. Polyvagal theory is the study of the autonomic nervous system (ANS), the linked, massive network of nerve fibres that keenly monitors our needs for survival without our conscious awareness. The vagus nerve is the primary focus of the theory. It is the tenth cranial nerve, connecting brainstem areas to several visceral organs.

Polyvagal theory has had a huge impact on the field of trauma. This book takes it into the field of addiction, challenging the disease model by providing a radical paradigm shift. Through this lens addictive behaviours that I saw in my women’s group are adaptive attempts to regulate the ANS. The central goal of the healing journey is to support autonomic regulation through embodied practices.

Origins of the Felt Sense Polyvagal Model of Addiction (FSPM)

Over 40 years of keeping my clients company, I have developed a model to understand what I saw and heard as I sat with their stories and ways of managing their intense experiences. As I began to learn about polyvagal theory, I realized that I was applying the theory as I explored the field of addiction. The theory enhanced my understanding of what I knew intuitively: Clients were using addictive behaviours to propel themselves from a state of sympathetic arousal to a dorsal vagal response of numbing, and vice versa. Through understanding how the ANS operates, we see these behaviours as adaptive. They have developed over time to help the addicted person survive when enough safety isn’t available.

I now saw Siegel’s continuum of emotional chaos and rigidity as reflective of the ANS. Chaos is the sympathetic state, and rigidity is the parasympathetic shutdown the body experiences when the dorsal vagus is activated. Thinking back to Brigette in the women’s group, it became clear that her vaginal cutting was an adaptive response to intolerable experience. It propelled her from the overwhelming flooding of anxiety, terror, and ensuing chaos characteristic of sympathetic arousal, to the tunnelling, funnelling journey down into a place of floating oblivion and rigidity, which is a dorsal vagal response. This cutting behaviour became her addictive, adaptive response to trauma.

Addictive/Adaptive Responses Often Tell a Detailed Trauma Story

Another part of the mystery is the way in which the addictive response may tell a story about the client’s trauma history. Sometimes the chosen addiction points to the source of the trauma. For example, some studies show that 80 per cent of sex addicts have a history of sexual abuse (Carnes, 2001). Another example is dysregulated eating, which can be a response for those with a trauma history around food.

Sometimes clients reenact specific behaviours that take place during the addictive experience that link back to early childhood abuse. The reenactment tells a piece of the story, hence puts the client in touch with the feelings, without directly making the link. The dissociated, fragmented story is held in the body.

Van der Kolk (2014) was curious about re-enactments. He asked the question, “Why are so many people attracted to dangerous or painful situations?” He found a paper written by Beecher (1946) entitled, Pain in Men Wounded in Battle. Beecher was a surgeon working with soldiers wounded on the Italian front. He observed that 75 per cent of the severely wounded did not request morphine. He then speculated in this paper that if emotions are strong enough, they can block pain.

Van der Kolk and some colleagues conducted a study with eight war veterans who agreed to watch violent scenes from the film Platoon (1986) and at the same time take a standard pain test. They measured how long the veterans could keep their hands in a bucket of ice water. They then repeated the process with a calm and peaceful movie scene. Seven of the eight veterans kept their hands in the freezing water 30 per cent longer during the violent movie. He states, “We then calculated that the amount of analgesia produced by watching fifteen minutes of a combat movie was equivalent to that produced by being injected with eight milligrams of morphine, about the same dose a person would receive in an emergency room for crushing chest pain” (Van der Kolk, 2014, p. 33).

In clinical settings it is apparent that clients’ addictive behaviours of traumatic re-enactment – that is, re-exposing themselves to painful, humiliating, dangerously abusive experiences – activates a dissociative, dorsal vagal response. This response is often activated at the beginning of the addictive cycle, the phase of pre-occupation, and endures for hours after the event. Clients report that it brings them a powerful sense of relief and often the ability to sleep.

Now, it all begins to make sense through an ANS lens. The primary responsibility of the ANS is to ensure safety and hence survival, and the shift in states facilitates this mandate. Without safety, our body will automatically resort to survival mode, although our ancient survival mechanisms are not always the best response in the modern world.

Addictive behaviours are adaptive strategies for survival that kick in when there is no sense of safety. A sense of safety is a prerequisite for the ventral vagus to support a socially engaged state. Addiction occurs in isolation, during avoidance of social engagement. Instead of regulating our nervous system in safe connection with self and others, in addiction we regulate with objects, behaviours, drugs, alcohol, food, and with relational reenactments. Porges (2017) states, “When individuals have difficulty regulating s...