"Neurons that fire together, wire together"
A common and largely misunderstood phenomena in bodywork is the idea of the emotional release. We are probably familiar with expressions such as "butterflies in your stomach" or "a broken heart" but what does that really mean to hold emotional pain and how do we let it go? Part of the problem in understanding this phenomenen lies within our understanding of the mind and brain as being distinct and separate entities. Increasingly however, more and more clinicians, both working in mental health and with physical ailments such as pain and musculoskeletal dysfunction, are utilising a more Eastern perspective of the mind and body being both one and the same in the search to find more efficient ways of creating meaningful change in peoples lives. So what is the thread that links the two?
Neurons that fire together, wire together
Interoception and how we feel inside
Interoception is basically the sense of what we feel is going on inside our bodies. The cravings for food and the urge to relieve our bowels are interoceptive messages that come from neural pathways within our body that are processed by our brains and inform necessary behaviour. Importantly though, we can also relate to internal sensations triggered by emotional stimuli. "Butterflies in our bellies" or being "scared stiff" are internally felt and perceived responses to things that threaten our inner sense of wellbeing. The importance of this connection to what we feel inside is being proven to be an incredibly useful resource in the management of stress, anxiety, bulimia, and many other forms of psychological distress that were once exclusively seen within the domain of cognitive based approaches such as counselling or CBT. Interoceptive practice is actually embedded within many systems of bodywork, as well as spiritual and meditative traditions, particularly found in the East. Yoga and taichi are brilliant ways of training interoception and proprioception (kinaesthethic awareness) through sustained awareness of breath and bodily sensations alongside dynamic to more subtle alterations of bodily movement.
"One of the clearest lessons from contemporary neuroscience is that our sense of ourselves is anchored in a vital connection with our bodies. We do not truly know ourselves unless we can feel and interpret our physical sensations; we need to register and act on these sensations to navigate safely through life. While numbing (or compensatory sensation seeking) may make life tolerable, the price you pay is that you lose awareness of what is going on inside your body and, with that, the sense of being fully, sensually alive."
Bessel Van Der Kolk
A brief understanding of trauma and Porges hierarchical survival response
When we face a threat to our safety our body makes a snap decision as to whether we can use our skills of verbal and bodily communication to get away from trouble. This first response is called our Social engagement system. A sign of a healthy social engagement system is being able to synchronise and engage smoothly with others body language, voice tone and verbal cues. When people are scared and this system is challenged you can observe a change in voice tone, posture and often see an increase in the speed and volume of their talking. However, if this fails to work or we have already bypassed this step, then we instinctually employ the physiological survival mechanisms that are hardwired into the most primitive parts of our neural circuitry. When we activate our primal survival resources, it feeds straight into the limbic system and the brain stem. This is why trauma will often effect the most basic bodily functions such as eating, sleeping, defocating and breathing. Interventions focussing on the frontal lobe and cognitive processing are at best limited in these cases.
The first system to occur after the social engagement system is the fight or flight system governed by sympathetic activation (SNS) of the autonomic nervous system (ANS). This causes a surge of adrenalin and then cortisol into the system which increases our heart rate and speeds up breathing whilst our pupils dilate to spot danger and our digestive processes slow down. It is very common to see people who are running on chronic SNS activation. A lot of my clinic time involves bringing people back into their bodies and calming this system in order to work at a deeper and more therapeutic level.
Perhaps though, we may experience a scary and overwhelming experience that we can't fight or run away from. This, "freeze" or feign death" response", is another primal survival mechanism that you can see in many animals that become trapped and unable to escape the danger. This survival response can be seen when a cat catches a mouse. Often the mouse will instinctually play dead which fools the cat into losing interest in it's dinner and leaving the motionless mouse alone. Once the danger has passed the mouse will spring back into life and make a speedy getaway. The freeze response will also often cause people to suddenly lose control of their bowels, hence the commonly heard phrase of "being scared shitless".
What the trauma researchers have recently shown us is that these trauma states can become chronically activated, thus hijacking our ability to operate smoothly at neo-cortical levels that are crucial to building successful, loving and trusting relationships to others and, indeed, to ourselves. When we are activated into these survival states, the inability to inhibit activation into more primitive neural networks means that we may not be able to give a very detailed account of what might have happened to us. What we do find though is that we will still have ingrained implicit memories of the sensory experience. This means that we may powerfully recall the odours, sounds and sensations of the trauma without being able to deliver a coherent sense of the timing and order of the events. These lucid, sensory memories may re-activate the horrors of the experience at a later date when we experience similar sensory experiences. This is called state dependent recall in PTSD. An ex soldier becoming going into a sweat and having a sudden sense of a panic attack at a firework display that triggers an implicit traumatic memory of being in a warzone would be an example of this. Trauma can also be through physical injury as well as emotional overwhelm.
"Trauma can be defined as anything that overwhelms our resources"
Somatic emotional triggers
The clinical name for a complete lack of interoceptive ability is alexilthymia. People with a complete lack of interoceptive ability are evidently impaired in their ability to recognise emotions accurately. A very common experience found within bodywork is that people can lose connection with certain parts of their bodies. Sometimes this can be seen through an inability to accurately sense or feel what is going on within their bodies when palpated, asked verbally to track sensations or perform specific movements. It can also be picked up by the skilled practitioner as an observable and palpable area of relative inactivity, or local stagnation of fluid, blood etc. It is almost like the area of the body has been erased from the internal body map. I personally share the opinion, amongst many other practitioners, that this block of awareness is a coping strategy, put in place so we are not continually subjected to the potentially unpleasant or distressing bodily sensations that may have arised during a personally traumatic experience or overwhelming time in someones life. This sensation may form a kind of somatic trigger, that when activated through touch, movement, related external sensory input or internal awareness practice, releases the same neuro-endocrine response and consequent felt sense of emotion that was generated at that time of increased stress or single traumatic incident. If this was the case then we could begin to understand how the subconscious avoidance of somatic triggers to unpleasant guarded emotional arousal, could lead to habitual postures and movement patterns developed in clinical states such as depression and anxiety. When was the last time you saw a truly depressed person with an upright and engaged posture? This initial sensation of something more ethereal has undergone the transition to a chronically held physical state of tension or, equally possible, lack of tension.
Exposure therapy and cathartic emotional release practices
We know from studies into the de-sensitisation or exposure approach to PTSD treatment that when the patients recall their experiences through verbal triggers or even through computer generated scenes of battlefield action, for example, that their biological responses are the same as if they were experiencing the trauma at that present time. In other words, they are being re-traumatised again and again in order to numb their arousal response to the effects of their trauma. Unsuprisingly, these interventions have an extremely high dropout rate and in some cases cause patients to spiral out of control and lead to irrational and dangerous behaviour. So in this case we are initiating the same emotional and neuro-endocrine response, but this time it is through our external senses or mental processing and it is without the awareness and connection to the body.
Exposure therapy and other highly charged and emotionally challenging techniques seem to be too direct an approach to safely allow an integration between a safe and contained sense of self in the present moment with the turbulent nature of the implicit traumatic memory. If we can learn to safely activate the somatic trigger whilst maintaining a sense of the present and not becoming too overwhelmed then we may be able to push the trigger into a place of stillness where we can move on. Often it can just be as simple as first becoming aware of the interoceptive sensations that arise when in periods of emotional stress, and then going through a process of gradually befriending them. Once a level of awareness and control is established over our internal world then we can prevent these interoceptive feelings from triggering a negatively spiralling thought pattern that occur on a largely sub-conscious level. We take the leap from being governed by our feelings to taking an active role in stabilising the hold over our emotional wellbeing.
Many people working working with trauma stress the importance of working sensitively and at the right speed for the individual patient. The Chinese medicine perspective also stresses the importance of this idea of not pushing an energetic release out of the body. If either the patient or practitioner forces the process, it will just cause a stagnation in the free flow of qi. The release will happen when it is ready to. Peter Levine calls this process titration or pendulation in some of his books, (see video below) it involves first finding an anchor of safety within yourself, and then slowly re-visiting the sensations over time, without becoming too overwhelmed, in order too take the venom out of the locked emotional energy. We must also bear in mind that an overly acute interoceptive sense can also be involved in negative experiences such as anxiety disorder. Studies have shown that people with anxiety have been recorded as having a better ability to accurately sense the number of heartbeats within a given time as opposed to a control group. Whilst knowing this is clinically relevant, we must not throw the baby out with the bathwater. It is possible for people to become hypersensitive to sensations within the body such as an increased heart beat and for this to become a trigger for a negatively reinforcing thought pattern. For example, an increased heart beat that invokes a sensation of panic then triggers a cascade of associated catastrophising thought patterns that further reinforces the sensation of imminent danger and anxiety response. In this case, the physically felt sensation of increased heart beat has now become a sensitised catalyst to unpleasant emotional arousal, however by bringing our attention to neutral sensations within the body and remaining present at the point of emotional arousal we can create a more balanced perception of self that is able to navigate more safely through our internal world.
It would not be unreasonable, in my opinion, to suggest that many chronic mental and even physical illnesses are derived from dysregulated interoceptive patterns due to the effects of unresolved underlying trauma and chronic stress activation. To work skillfully with the body is to work with the mind, whether we know it or not. Some of the most inspiring people I know are naturally able to connect and bring light into peoples lives through an almost psychically perceptive understanding of human emotion. These people are often the teachers, bus drivers and baristas of our society. Not health professionals, just well intentioned intuitive souls with highly attuned mirror neurons. However, from a clinicians perspective, If we don't take the time to examine the neurobiological mechanisms of held emotional trauma and unresolved physiological survival responses then we may fail to be informed of the potential for re-traumatisation. I believe that if we can learn to integrate this exciting new knowledge of neuroscience with the rich traditions of cultivating mind body awareness that have existed and evolved over thousands of years, then we can significantly progress in our knowledge and practice.
Find your true weakness and surrender to it. Therein lies the path to genius. Most people spend their lives using their strengths to overcome or cover up their weaknesses. Those few who use their strengths to incorporate their weaknesses, who don’t divide themselves, those people are very rare.
Norm Farb interoception
Bessel Van Der Kolk