Tag Archives: cognitive therapy

A leaf transcends square

What transcends square?    A leaf. Nature offers perfect symmetry in many shapes besides square.

What transcends square? A leaf.
Nature offers perfect symmetry in many shapes besides square.

The word transcend has to do with out of the box thinking in that transcend means to rise above the usual ways of thinking or doing things. Transcend can also refer to rising above the mundane problems of the real world and think from a more spiritual perspective.

Transcending the urge to self harm can be a daily struggle of self-control but it can also be a habit of thinking that helps lead one to keep searching for reasons for the unusual feelings. Transcending feelings of hopelessness and helplessness can be aided by supportive messages from others or from listening to inspiring music or reading or viewing other positive literature or art.

Optimism can be a choice that becomes a habit. It may be harder to maintain an optimistic attitude during times of stress or if survivors of trauma are somehow reminded of the trauma. Symptoms of PTSD, Post Traumatic Stress Disorder, can be triggered by reminders of the trauma. Good or bad habits can be something like a line of dominos falling against one after the other.

Transcending the negative habit patterns may take a lot of practice but cognitive therapy and Dialetical Behavior Therapy (DBT) techniques can be helpful. Psychiatric support with talk therapy and medication help can also be helpful but may be less helpful if accurate diagnoses aren’t pursued. And talk therapy and psychiatric medications may be harmful if an underlying nutrient deficiency is the actual cause of symptoms of mental illness or is exacerbating a milder mental illness.

Psychiatric medications for a person who is grieving the loss of a loved one may also be more harmful in the long run then just accepting that grief and loss can be a painful process that takes time to work through. Talk therapy might be more helpful for a grieving patient than immediately reaching for an anti-depressant. Psychiatric medications can have significant side effects and at least for some patients may cause worsening symptoms when the medication is stopped. Grieving may also become an ongoing problem when someone receives a life changing diagnosis for themselves or for a loved one or for their child.

It gets better. The show goes on; the sun rises and the sun sets, and both are beautiful.

/Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

Retraining the brain to desire healthy food

A recently released research study suggests that it is possible to retrain the reward pathways in the brain to prefer healthier food choices over more immediately pleasurable but less nutritious foods. Actual brain scans were taken of the study participants so it was a small study with only eight participants in the experimental group and five in the control group, so more research is needed to confirm the results. However it does suggest that if we stick with new dietary changes, it might become easier to stick to the new habit over time. The new habits may be replacing some of the old neural pathways so that an increased appetite might be triggered by thoughts of healthy foods instead of unhealthy foods. [link]

So thinking ourselves thin may work if we first start by practicing the healthier habits. Think the green beans look good and think the greasy fries look queasy while eating or seeing them, and soon the green beans might look better on a brain scan too and the memory of an unsettled stomach might make it easier to say no thanks to the fries.

DID and Cognitive therapy strategies

A therapist specializing in Dissociative Identity Disorder (DID) describes cognitive therapy as helping the patient to learn what not to do rather than focusing on teaching them what to do. The description is by Colin A. Ross, M.D., from the book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality. [1] The author provides an example script he developed for patients to describe what cognitive therapy is and how it might help them. The script begins with lines that suggest that our feelings are sometimes affected by what we think and that if that is true then changing how we think may be the best way to change how we feel. [p339, 1]

Incorrect beliefs can develop during childhood that may have been helpful to the child at the time but may cause problems later in life. The author discusses five false assumptions commonly believed by DID patients and he describes a few cognitive therapy techniques which he found helpful for challenging the old beliefs and guiding the patients to new beliefs.

The false assumptions are discussed within the section titled Cognitive Restructuring Techniques [pp338-345, 1]. I found the ideas helpful and combined the false beliefs into a list, with notes summarized from my understanding of the text, words in italics are quotes from the text:

  1. “Different parts of the self are separate selves.” – Which can lead to the false belief that different parts of the self (alters) actually have different bodies and cognitive therapy may address the risk of one alter causing physical harm to the host (primary personality) by tackling the alters’ false belief that there are two or more separate bodies.
  2. “The victim is responsible for the abuse.”  This false belief may occur during developmental stages in early childhood when the child believes that what happens in the world is caused by the child’s actions. Cognitive therapy  can challenge the underlying belief that “I must be bad.”
  3. The abuse happened because I am bad.” Children can’t just leave their caregivers and the need to love and feel love is also strong so it can be a common false assumption that whatever is happening is right and the child is wrong or deserving of the mistreatment. Cognitive therapy can discuss the differences between a child’s and an adult’s responsibilities in life and whether traumatic events are something other children could cause to occur or that they deserve instead of normal love and affection.
  4. It is wrong to show anger.” Cognitive therapy can help teach what healthy anger is and how to control it. Underlying false beliefs can be challenged by asking: “Who says anger is bad? How do you know that?”
  5. The primary personality can’t handle the memories.” Cognitive therapy can help the DID patient to recognize that as an adult the primary personality is older and may have more ability to cope with painful memories.

The first and last of the assumptions listed above are more specific to DID in that amnesia is involved; the memory of the trauma is blocked from the primary personality. However a child in a trauma situation might also develop the last assumption about other people in their lives. They might feel a need to protect family or others from information that the child might fear is too disturbing in some way or had been told by someone else to keep secret.

Less severe cases of childhood trauma may result in the child growing up believing false assumptions similar to those listed in number 2, 3, and 4 without the child also developing amnesiac memory blocks or feeling like there are parts of the self that are separate from each other.

Dissociation can be a normal coping strategy but in DID it can become disruptive for the adult even though it may have helped the child survive traumatic events. Cognitive therapy strategies can help the patient recognize that the beliefs they had developed as a child are not necessarily true at all or they are not true now that the child is really an adult. Initial recognition of false assumptions can help change old beliefs and related behaviors quickly, but it can also take months or years repeating the new beliefs to replace the old childhood beliefs.

Information from the book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality regarding the cost effectiveness of therapy for DID is reviewed in a previous post: [2] A narrative description of DID from the book Jennifer and Her Selves, [1991], is summarized in a series of excerpts in a previous post: [3]

/Disclosure: This information is shared for educational purposes and is not intended to provide individual health care guidance. Please see a health care professional for personalized health care./

 

Spiritual gardening for the dissociated soul

Trigger warning: This post is about recovery from sexual assault.

Sometimes a book can speak to you like a good friend, heart to heart, soul to soul, sharing secrets you never imagined anyone else had thought or experienced. The author wrote words many years ago but may have imagined that there would be a reader in need of the wisdom learned from hard experience.

Dissociation is a way for the mind to cope with pain or fear or with other overwhelming emotions or events. Children who experience trauma may have coped by allowing their minds to dissociate or separate from feeling the physical sensations or from being mentally present during the traumatic event. Dissociation is a natural reaction to intense experiences but it can become a lesson that is too well learned, a strategy for coping that becomes too much of a habit for the rest of life. Recovering a sense of connection to self and with the world can be difficult for the survivor of childhood trauma.

Dissociation became a habit for Karla McLaren, the author of Rebuilding the Garden: Healing the Spiritual Wounds of Childhood Sexual Assault (1997). [1] She experienced ongoing sexual assault beginning at age three. The culprit was caught but the dissociation remained for the author as a feeling of being incomplete and disconnected during her youth and young adult years.  The book grew from her personal discovery and exploration of an inner sanctuary that can exist within our minds whenever we care to imagine it and visit. She describes the inner sanctuary in terms of a garden with herself as the gardener. Sexual assault occurring during childhood violates boundaries and can take away an inner sense of self.

“Since the lasting wound of sexual assault occurs in a quiet spiritual center that no one ever mentions, it is very hard for assault survivors to understand why they don’t get better.” [page 5, 1]

The assault destroys the inner sanctuary but the survivor is not the ruined garden but is instead the gardener who can rebuild boundaries that protect and heal. Assault during childhood teaches the survivor that they have no boundaries and are open to invasion. Later in life the adult survivor may have problems relating well to others. Some survivors may be overly controlling of every aspect in their lives while others may seek stimulation and act out of control. Normal sexual relations may be difficult for some survivors.

“Many assault survivors become excellent puppeteers when sex is “happening” to them; they pull the right strings and make the right noises, but they are not present at all. They are off in a dream world, or up on the ceiling.” [page 57, 1]

Meditative relaxation is somewhat similar to the strategies described but the visualization exercises in the book delve more into the energy of the chakras and auras. The author describes the dissociated self in terms of being split. The visualization exercises are varied but aim to help the reader reconnect with their fragmented self and with the world around them.

“Not going anywhere in life, not living in peace, not truly knowing how to behave around people, relying on relationships for inner peace: these are just some of the characteristics of people who come to me for classes, and when I see them, they are often at the end of their ropes. People usually don’t come to psychic healers first.” [page 36, 1]

Seeking guidance from someone who self designates as a psychic healer may not be a first choice for most people but dissociation is the mind or psyche separating itself from the body’s present. The visualization strategies the author shares are designed to help restore a sense of an inner core that is always safe and to help reconnect to the world.

A lifelong habit of dissociation isn’t treatable with a pill. Anti-anxiety medications may be provided to help cope with anxiety if that is also present. Cognitive therapy, retraining the brain, is the most effective strategy used currently for treating people with dissociative disorders. But for that you would need an appointment with a therapist who believes in dissociative disorders. So in the meantime, there’s always Amazon. Finding an author who believes in the problem and believes that recovery is possible is at least a place to start even if it’s not a first choice. [1]

Gloriosa greets the day in the cheerful way, that daisies all share.

Gloriosa greets
the day in the cheerful way,
that all daisies share.

/Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

Talking about trauma with kids; PTSD, neural mapping, EMDR and reframing

/This article was originally posted on March 21, 2011. It is still important to have open conversations with children about traumatic events or other information they may find confusing, troubling or frightening. EMDR therapy can be helpful for adults with PTSD./
We all need comfort and we gain it from sharing our burdens, talking about troubles and letting out worries. Listening is more important than talking – let kids talk to you about trauma – we don’t know what they are thinking or are worried about until we let them talk it out. Don’t worry too much about “how to talk about it”, pause, listen, and accept – “yes, there are worries but we’ll stick together and work through it”, is a strong message for all of us to hear.
Children and all of us have “hot” emotional memories centered in the amygdala and milder long term factual memories stored more generally throughout the neocortex. Electrical activity of the brain can be recorded and associated with the topic being considered. The amygdala centered emotional memory can be tied to smells, sounds, places or people and can be unexpectedly triggered leaving the person with panic attack type symptoms unique to the individual’s memories of the early traumatic event.

Douglas Buchanon described neural mapping in his blog “Follow the Neurons – Your Life Map” [TheGatesofHorn].Neural mapping is a bit like playing with a line of toy dominos. The designers spend hours placing the dominos in line, each the perfect distance and angle from the last, carefully balanced on end and poised for any slight shock to send the entire chain tumbling down. Emotional memories may be triggered by something like a car door slamming shut. A toddler memory may be submerged regarding something as trivial as mom and dad fighting over who has to carry in the groceries and the car doors were slammed shut violently. To a toddler the words may not mean as much as the tone and the violent sounds.

After the event, immediately, and maybe later that day, the next day, the next week – the toddler may pester with questions of what is wrong and what did I do to cause that fight? The child’s world is centered around themselves – natural while young but prone to self blame. The memory can be stored with feelings of “I caused that arguement – I am a bad person – I don’t deserve attention or explanation” and so on. If their worries are left unanswered or are denied as real then the hot memory is ignored and is left unprocessed, instead it is pushed down and forgotten at the daily level. A car door slamming with a combination of shouting voices might trigger a panic attack though.

The hot memory can be toned down and moved to long term storage if time is allowed to discuss the event – and more than once. It might pop up in the toddler’s chit chat daily, and then weekly, monthly, and maybe even over the years if it was bad enough triggering event. Once the connection is made though, (negative event associated with a negative symptom) and discussed, usually the power of the slamming/shouting sound is reduced and similar events in the future may not trigger a panic attack or it might  be a milder reaction.

Children are absorbing knowledge and building their neural pathways – good habits and bad habits are learned by watching the people they love and trust. Spending a few minutes whenever possible to listen to children share their worries allows them to move the memories from the ‘hot’ button zone of the amygdala, to the mellower long-term storage of the neocortex.

Symptoms of PTSD, Post Traumatic Stress Disorder, can be effectively reframed  and reduced using cognitive therapy techniques like EMDR. A problem or trigger event is visualized and then a state of deep relaxation is reached and the memory is discussed or pondered with guidance from the therapist. New insights from the perspective of the adult framing of the situation can be considered and then the relaxation method is repeated using the new perspective.  The neural maps of the traumatic events can be reached  from a deeply relaxed state of theta waves. EMDR, attempts to help the patient reach the theta state with rapid stimulation of the right side then left side of the brain, either visually with a moving hand or object, or with sound or a vibration buzz in the palm of the hand. Children under seven are already living in this more meditative level of consciousness. In the zone – flow time – playing like a child – we could all use a little relaxed theta time these days and a chance to free a little worry from the hot zone of the amygdala.

The world is changing but denying reality never solves problems it only pushes them down to a submerged hot zone. When we talk about our troubles then we can look for solutions and change. Denying problems, denies a chance for change.

Art therapy can be a useful way to give children and anyone freedom to explore feelings – color to feel not to produce. Playdough and other free form play can help reach a relaxed state where gentle talk about hot topics can be released  as they surface. Picking at the problem with needling questions may not be as quick as open ended play time. Adults may find a walk or bike ride their ticket to free flow brain time.

___________________________________________________________________________

  1. Terrorism, and talking to kids about catastrophic mass violence, guidance sheets from The National Child Tramatic Stress Network [nctsnet.org/trauma-types/terrorism]
  2. by Carol Boulware, MFT, PhD, “EMDR Therapy, EMDR Therapists, EMDR information, PTSD,” [emdr-therapy.com/].
  3. by Carol Boulware, MFT, PhD, “EMDR-Breakthrough Therapy for Overcoming Anxiety, Stress,Trauma and Self-Sabotage,” [emdr-therapy.com].
  4. by Carol Boulware, MFT, PhD, “Do I Have Anxiety Needing Therapy?” a discussion about anxiety and PTSD focused on adults [emdr-therapy]
  5. The National Child Traumatic Stress Network [nctsnet.org/]
  6. Trauma and Your Family – a guidance factsheet from The National Child Traumatic Stress Network pdf: [nctsn.org]
  7. by Tanya Anderson, PTSD in Children and Adolescents, Great Cities Institute, GCP-05-04, November, 2005  pdf: [uic.edu]
  8. This website is a non-profit 12 step based program for the Adult Children Of Alcoholic (or Dysfunctional) Families. PTSD and neural mapping aren’t discussed but the symptom list includes similar problems: The Laundry List – 14 Traits of an Adult Child of an Alcoholic (or Dysfunctional Family) ,  [adultchildren.org]
/Disclaimer: This information is for educational purposes and is not intended to provide individual health care guidance. Please see a health professional for individual health care purposes./