Monday, June 27, 2016

Van der Kolk on feeling safe and treating trauma.

Being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives. 
– Van der Kolk
There's an interview with Bessel van der Kolk here. Van der Kolk is a Dutch psychiatrist noted for his research in the area of post-traumatic stress since the 1970s. He's also introduced as the medical director and founder of the Trauma Center at Justice Resource Institute and professor of psychiatry at the Boston University School of Medicine in an interview with psychotherapy dot net.

He talks about his work, and how his research posits that talk-therapy alone cannot treat trauma.
Of course, talking can be very helpful in acknowledging the reality about what’s happened and how it’s affected you, but talking about it doesn’t put it behind you because it doesn’t go deep enough into the survival brain.
He goes on ...
But there is a mistaken notion that trauma is primarily about memory—the story of what has happened; and that is probably often true for the first few days after the traumatic event, but then a cascade of defences precipitate a variety of reactions in mind and brain that are attempts to blunt the impact of the ongoing sense of threat, but which tend to set up their own plethora of problems. So, trying to find a chemical to abolish bad memories is an interesting academic enterprise, but it’s unlikely to help many patients. It’s a too-simplistic view in my opinion. Your whole mind, brain and sense of self is changed in response to trauma.
In the long term the largest problem of being traumatised is that it’s hard to feel that anything that’s going on around you really matters. It is difficult to love and take care of people and get involved in pleasure and engagements because your brain has been re-organised to deal with danger.
It is only partly an issue of consciousness. Much has to do with unconscious parts of the brain that keep interpreting the world as being dangerous and frightening and feeling helpless. You know you shouldn’t feel that way, but you do, and that makes you feel defective and ashamed.
Instead, Van der Kolk discusses other helpful methods to incorporate, including EMDR and body awareness (he uses Yoga in a lot of his work, and claims in 8-week yoga trials people felt significantly better):
Traumatised people often become insensible to themselves. They find it difficult to sense pleasure and to feel engaged. These understandings force us to use methods to awaken the sensory modalities in the person.
When asked about what research he's found promising lately, he highlights a few new areas of research:
Learning how to interpret quantitative EEGs allowed me to actually visualise what parts of the brain are distorted by traumatic experiences, and this can help us target specific brain areas where there is abnormal activity and where the problem actually is.

In another example, the frontal lobes of traumatised people often have activity similar to that of kids with ADHD, which makes it difficult to attend with the subtlety that we need to lead nuanced lives.
There is still so much work to be done regarding new treatments. Treatment is still being tested and quantified. There are different camps touting their own methods, and accessing any of it isn't always possible. I find it promising, and that's not nothing.

* The Establishment also has several articles on trauma and PTSD that were published today. *

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