What does it mean to ‘heal’ trauma? (Part II)

THEORETICAL FRAMEWORKS FOR UNDERSTANDING TRAUMA
While the purpose of this series is not to detail all the possible theoretical frameworks for understanding trauma and trauma healing, it will be useful to briefly cover the frameworks I have synthesized as part of my research and intended application for practice. For the sake of efficiency, some of what I offer below comes from previous writings. The theoretical frameworks I have integrated include Homeostatic Theory (“HT”) as outlined by Antonio Damasio; the Polyvagal Theory (“PVT”) through the writings of Stephen Porges, Deb Dana, and Bonnie Badenoch; Interpersonal Neurobiology (“IPNB”) through Dan Siegel and Bonnie Badenoch; and Emotion Theory (“ET”) through IPNB and Karla McLaren.

Homeostatic Theory
Homeostatic Theory (“HT”) as postulated by the work of neuroscientist Antonio Damasio offers the concept that we have a fundamental drive he calls the “homeostatic imperative,” which relies on our feelings and emotions to find the ways in which we can both survive and thrive (Damasio, 2019). The theory offers that homeostasis is for everything from single cell bacteria to sea turtles to sharks, and it is for everyone from celibate monks to violent vigilantes to World Cup soccer stars.

What is homeostasis? According to Damasio, homeostasis is defined as, “The collection of coordinated life processes required to execute life’s unthought and unwilled desire to persist and advance into the future, through thick and thin…. The continuous attempt at achieving a state of positively regulated life is a defining part of our existence” (Damasio, 2018, pp. 34, 36). Damasio also counters the notion I originally thought applied to homeostasis from my studies in middle school and high school biology – that of “balance.” Damasio rejects this notion and offers instead that the idea of homeostasis as balance, “conjures up stagnation and boredom! For years, I used to define ‘homeostasis’ by saying that it corresponded not to a neutral state but to a state in which the operations of life felt as if they were upregulated to well-being. The forceful projection into the future was signified by the underlying feeling of well-being” (Damasio, 2019). In other words, the theory suggests that humans are hard wired to not only find ways to “persist and advance into the future,” but also to strive for what Damasio terms “viable, upregulated life states that tend to produce flourishing” (Damasio, 2018, pg. 46).

This felt sense of flourishing is a fundamental component of homeostatic theory. All life, including human life, is constantly humming with the process of homeostasis. This “hum” is felt. Our feelings are the “sentinels” of homeostasis (Damasio, 2018). The regulation of life is happening constantly and automatically, in the background. While we are often not consciously aware of it, the feeling state of our body is always present, and we are extremely sensitive to changes in that state. Changes in state capture our attention through feelings, and these feelings motivate us to take action that helps ensure our ability to survive — and flourish — into the future.

For example, we experience shifts in our state when we become sick, if we lose our jobs, if we lose or gain a meaningful relationship, and more. The state shifts are felt, and these feelings motivate us to take actions that our systems intuitively feel will best ensure our ability to survive and thrive. We take actions to heal illness, we get a new job, file for unemployment, or ask others for financial support, and we make efforts to repair or find new relationships. All of these actions are underpinned by the homeostatic imperative, which harnesses our feelings to govern choices.

Trauma impacts one’s felt sense of safety and ability to survive and thrive. It disrupts and frustrates the imperative’s fundamental purpose: to persist, ideally while feeling good. This disruption of the felt sense of safety is a crucial element of our ability to recover and heal.

Polyvagal Theory
Our ability to pursue choices that we believe — and feel — will ensure a future of up-regulated well-being depends on our feelingsafe to do so, and our Autonomic Nervous System (ANS) is responsible for safety. The most critical component of the ANS’ function is the vagus nerve, distributed throughout the body in the vagal complex. Its role in helping protect and regulate the human system is detailed in the PT, which is comprised of three fundamental ideas: neuroception, three predictable pathways of response, and co-regulation is self-regulation. The theory “… provides an understanding that feeling safe is dependent on autonomic state and that cues of safety calm our autonomic nervous system. The calming of physiological state promotes opportunities to create safe and trusting relationships, which in themselves expand opportunities to co-regulate behavior and physiological state” (Porges, 2017, pp. 50-51).

Arising from the field of psychophysiology, PT expanded our understanding of how humans respond to shifts in perception of safety. The theory offers insights that may demystify human behavior in response to perceived threats, including the symptoms of trauma, and provides us with an effective framework for helping those whose perception of safety is challenged. As Porges states, “Polyvagal Theory leads to an understanding that to connect and co-regulate with others is our biological imperative. We experience this imperative as an inherent quest for safety that can be reached only through successful social relationships in which we co-regulate our behavior and physiology” (Porges, 2017, pg. 51).

The first pillar of PT is neuroception, a term coined by Porges to describe our ongoing, background process of scanning the environment for cues of threat or safety, and for sustaining or changing states of the body to respond to various stimuli  (Porges, 2011). What Porges is essentially arguing is that neuroception is the mechanism by which the human organism carries on the homeostatic imperative. It is neuroception that is actually tracking stimuli, including feelings that arise to motivate behavior based on the constantly changing perception of our environment (including the body). This includes both events that occur that cause trauma, as well as the trauma symptoms themselves which the process of neuroception tends to interpret as threats to safety, and motivates us to take actions to restore the safety and integrity of our being.

The second pillar is three predictable pathways of response. In brief, the vagus nerve has multiple branches (thus the term “poly”-vagal). The ventral branch innervates organs above the diaphragm such as the heart, as well as the face, eyes, and larynx. The dorsal branch innervates the organs below the diaphragm, especially the digestive tract including the stomach and intestines. When we are in a “ventral vagal state,” the heart is effectively controlled by the operations of the ventral branch of the vagus nerve, and corresponds with feelings of openness, creativity, social connection, mate seeking, meaning, purpose, hope, love, and play. Our breathing and heart rates are slightly slower (due to the influence of the ventral branch of the vagus nerve, sometimes referred to as the “vagal brake”), and blood flow to the brain and digestive tract are optimized. If we perceive a potential threat to our safety, the ventral branch releases its influence on the heart, naturally inducing an increase in heart rate as well as faster breathing. If the threat requires fight or flight, our HPA axis releases hormones into the bloodstream, shifts blood flow away from executive systems in the brain and into the body’s extremities such as the arms and legs, providing us with energy crucial for a confrontation or escape. This state shift is called “mobilization” or “sympathetic activation” in PT. If sympathetic activation fails to create safety, the body has a third predictable pathway of response called dorsal vagal activation, which induces what is known as the “freeze” response. The freeze response causes a massive collapse of the overall system. Blood flow to executive centers of the brain sharply reduce, causing fogginess, lapses in memory, and what is often experienced as cognitive impairment. It also increases the body’s pain threshold through a sense of “numbing” that includes both physical and emotional responses. It can also include the experiences of depression, dissociation, losing consciousness, as well as reducing or eliminating memory processing.

Finally, PT includes the pillar that to co-regulate is to self-regulate (Badenoch, 2018). This is a crucial dimension of PT in that it argues that our ability to self-regulate depends on our ability to connect with others. The degree to which an individual can regulate their own feeling state and emotional experience, not to mention healing the impact of traumatic experience, has a direct correlation to their relationships with others. We need others to not only survive and thrive, but also to heal.

Attachment Theory
The field of attachment theory arose from the work of John Bowlby and Mary Ainsworth. It has since expanded through the work of many others, including Mary Sullivan and Allen Schore – but its findings are significant – that there is an unusually high correlation between attachment styles and the ability to predict future outcomes, especially related to health. It is also worth noting that whatever one’s early attachment relationships, it has been demonstrated that these experiences can be healed.

The key ideas of AT include the significance and impact of early attachment relationships; the formulation of attachment experiences and categories as children (e.g., secure/insecure); the formulation of attachment styles as adults, as well as “earned” attachment styles (e.g., “earned secure”); the high correlation between health outcomes and attachment relationships as demonstrated through the development of the Adult Attachment Interview, or “AAI”; and the notion that we are both hurt and healed in relationship.

The only aspect I will cover here is the formulation of attachment styles in both children and adults. In children, experiences with primary caregivers results in the two broad categories of “secure” and “insecure” attachment styles. There are three types of insecure attachment styles: anxious-ambivalent, disorganized, and avoidant. For adults, there are also two broad categories (secure/insecure), and the subtypes of insecure styles are anxious/preoccupied, avoidant/dismissive, and disorganized/fearful-avoidant.

For people who had an insecure attachment style as a child, and developed an insecure attachment style as an adult, it is possible to develop what is referred to as an “earned-secure” attachment style in which healing experiences in meaningful adult relationships counteracts, repairs, and restores one’s sense of trust, safety, belonging, connection, and possibility within relationships. This is another perspective on the idea of co-regulation is self-regulation. Through healing experiences in relationship, we can change the patterns of behavior that are a result of trauma.

Interpersonal Neurobiology
As we will explore the framework of IPNB in more depth in the healing section below, I will only provide a high-level summary of the primary components here.

Starting with the central tenet of IPNB, health equates to integration (Siegel, 2018). Integration is conceptualized as a dynamic balance of differentiation and linkage, in which we are appropriately differentiated from others while also remaining linked. The framework’s creator, Dan Siegel, describes it as a salad not a smoothie. Integration is not blending everything together so there is no more difference. It is including and respecting difference, while also being in healthy relationship. This includes all the various components of an individual’s system (e.g., differentiation and linkage among the various parts of the brain, such as brainstem, prefrontal cortex, and amygdala), as well as social relationships.

Another tenet is the “triangle of wellbeing,” in which our health derives from the integration of mind, brain, and relationships. Thinking of this in terms of trauma healing, we can imagine how trauma disrupts all three parts of the triangle, and healing is needed for the individual parts as well as the whole.

Next, IPNB posits the flow of life as a “river of integration” (Siegel, 2012). The river helps us to notice the dynamic, ever-changing flow of life events and experiences, including moment to moment states of consciousness, thoughts, and feelings. The flow of the river itself is thought of as the ideal flow of integration, in which our systems are self-organizing all experience and self-regulating our reactions to events and experiences. However, if our experiences become overwhelming to what we can integrate and tolerate at a given moment, we strike against the banks of the river, resulting in states of chaos and rigidity. Chaos can be related to the PVT conceptualization of sympathetic activation or mobilization, where we react with hyperarousal. Rigidity relates to states of dorsal vagal activation where we become hypo-aroused, resulting in states of collapse, freeze, or shutdown. As trauma often results in increased sensitivity and reactivity, trauma healing can be thought of as increasing one’s “window of tolerance,” increasing one’s ability to tolerate and integrate feelings and experiences without shifting into states of chaos or rigidity.

Finally, IPNB posits humans as beings with self-healing systems (Siegel, 2018). The river of integration is flowing, and feelings and emotions are motivating us to take actions that restore our sense of integrity and wholeness. Just as our bones and skin know how to mend when broken, our minds and nervous systems have a natural push towards health, which becomes impeded by trauma. By developing and applying interventions that promote differentiation and linkage, that support the triangle of wellbeing and one’s window of tolerance, our the natural “push” towards integration (the homeostatic imperative!) can be optimal and result in spontaneous feelings of health, wholeness, connection, purpose, and possibility.

Emotion Theory
The primary ideas behind emotion theory as I understand it are as follows: emotions have a feeling state in the body that have been named as “emotions” through culture (e.g., anger, rage, anxiety, love) (McLaren, 2010). The changes in feeling states and corresponding emotions are felt in the body, capture the attention of awareness, and provide opportunities to take action. Each feeling state is a message, and it is the language of the body; or, as Karla McLaren puts it in her seminal book The Language of Emotions, these feelings are the body’s way of communicating what it needs. These feelings capture our attention through varying degrees of intensity, or what is sometimes referred to as emotional valence. More intense feelings such as terror obviously have a higher valence and a more pressing urgency. Less intense feelings such as annoyance are often tolerable, but still correspond with a felt state that desires a change in our environment.

The key to this theory within the idea of healing trauma is that healing does not equate with getting rid of feelings or emotions. Feelings are integral components of human experience, all feelings are natural outcomes of experiences, and the way the body communicates as it has experiences (which is all the time). For example, in McLaren’s framework, anger occurs when there has been a perceived boundary violation, or when something of value is threatened. The purpose of anger is to protect and restore boundaries and bonds. Sadness is the feeling when something of value to us has to be released or let go. Depression is the body’s way of slowing everything down so that we spend appropriate time with something important to pay attention to, learn, or process before anything else can be taken on or done. Terror is the body’s way of providing a massive amount of energy to survive. Anxiety is the body’s way of saying that something is important, so here is the energy and mental focus to plan and complete the actions necessary to make sure what is important succeeds. Suicidal feelings are the body’s way of demanding that something stop and change at once. The body is saying, “I will die if this does not end now.”

While the symptoms of trauma can include many of these feelings (I have felt all of them at one time or another), healing trauma does not mean that the function of the body in communicating through anger, depression, anxiety, or panic comes to an end. While trauma may produce overreactions to stimuli, healing may entail dialing back the reactivity (increasing the window of tolerance), but not eliminating the mechanism or purpose of a feeling. Thus, healing does not mean that we will never again experience anxiety, depression, or even suicidality, even if we are considered to be recovered from trauma and would no longer be diagnosed as having PTSD. Life will always present experiences that produce feelings, and learning this “language of emotions” provides us with the ability to heal our relationship to our feelings and emotions, and understand what they are saying. When we feel anger, it may not be reactivity due to trauma. It may be natural anger that occurs because we perceive a threat to an important relationship, or are betrayed by someone who failed to come through on a promise. The anger’s purpose here is not to plague us but to capture our attention so that we take the appropriate action to protect and restore the boundary or bond. Healing trauma also does not mean that we never feel anxious again. Culturally, I argue that in the United States we have come to classify anxiety as something which is actually much closer to panic with a significantly higher intensity and valence that is disruptive of our ability to function. McLaren talks about anxiety as the body’s natural way of giving us the energy and focus needed to plan, prepare, and executes tasks of importance to us. The daily “stress” we often feel is simply the body’s physical response giving us a surge of energy and mental focus or clarity to be successful. As an anticipatory function, it is also future-oriented. Anxiety is focused on preparing, planning, and executing tasks for future anticipated goals and needs. Fear, on the other hand, is present-oriented. It is a surge in surveillance and scanning of the environment in order to evaluate whether or not a situation is safe.

With the experience of trauma, the valence of many of our feelings are supercharged, easily pushing us into states of chaos and rigidity. If we can repair our relationship to our feelings and emotions, and come to understand their purpose and language, it affords us more space to respond appropriately and work with our feelings instead of feeling besieged by feelings. In addition, trauma healing entails a shift into both greater tolerance for feelings, as well as restoring one’s natural feeling abilities to respond in proportion to circumstances, even when the appropriate response happens to be high valence emotions like panic, rage, shame, and depression.

REFERENCES

Aurobindo, Sri. (1990). The Synthesis of Yoga. Lotus Press.

Badenoch, B. (2018). The Heart of Trauma (First edition ed.). W.W. Norton & Company.

Banerji, D. (2016). Seven quartets of becoming (Second impression ed.). Nalanda International.

Blackstone, J. (2018). Trauma and the unbound body. Sounds True.

Damasio, A. R. (2019). The strange order of things : life, feeling, and the making of cultures (First Vintage Books edition, February 2019. ed.). Vintage Books.

Freud, S. (2010). Civilization and Its Discontents. W. W. Norton & Company.

Herman, J. L. (2015). Trauma and recovery. Basic Books, a member of the Perseus Books Group.

Larson, G. J. (1969). Classical Sāṃkhya (1 ed. ed.). Motilal Banarsidass.

Levine, P. A., & Frederick, A. (1997). Waking the tiger : healing trauma : the innate capacity to transform overwhelming experiences. North Atlantic Books.

Levine, P. A., & Kline, M. (2008). Trauma-proofing your kids : a parents’ guide for instilling confidence, joy and resilience. North Atlantic Books.

McLaren, K. (2010). The language of emotions. Sounds True.

Merriam-Webster. (n.d.). Heal. In Merriam-Webster.com dictionary. Retrieved November 23, 2022, from https://www.merriam-webster.com/dictionary/heal

Miller, A. (1997). The drama of the gifted child : the search for the true self, revised edition. Basic Books.

Porges, S. W. (2011). The polyvagal theory : neurophysiological foundations of emotions, attachment, communication, and self-regulation (1st ed. ed.). W.W. Norton.

Porges, S. W. (2017). The pocket guide to polyvagal theory : the transformative power of feeling safe (First edition. ed.). W. W Norton & Company.

Siegel, D. J. 1. (2012). Pocket guide to interpersonal neurobiology : an integrative handbook of the mind (First edition. ed.). W.W. Norton & Company.

Siegel, D. J. 1. (2018). Aware : the science and practice of Presence, the groundbreaking meditation practice. TarcherPerigee, an imprint of Penguin Random House LLC.

Solomon, M. F., & Siegel, D. J. 1. (2003). Healing trauma : attachment, mind, body, and brain (1st ed. ed.). W.W. Norton.

Van der Kolk, Bessel A. 1943-. (2015). The body keeps the score : brain, mind, and body in the healing of trauma. Penguin Books.