This chapter focuses on the modulatory role of the neuropetides in attachment as well as autonomic regulation, discussing sympathetic and parasympathetic arousal, particularly dorsal vagal and ventral vagal regulation as suggested by polyvagal theory. The probable role of the endogenous opioid system in the modulation of oxytocin and vasopressin release is discussed with a view toward the elicitation of both relational and active defensive responses are reviewed. Porges’ Polyvagal Theory delineates two parasympathetic medullary systems, the ventral and dorsal vagal. Brain circuits involved in the maintenance of affiliative behavior are precisely those most richly endowed with opioid receptors. Avoidant attachment is commonly associated with parental figures that have been rejecting or unavailable and refers to a pattern of attachment where the child avoids contact with the parent. The similarity of severe posttraumatic presentations to autism suggests that the research with regard to social affiliation in autism spectrum.
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This chapter focuses on identifying and working with dissociative symptoms and dissociative disorders in a therapeutic context, providing a road map to assist with the pacing and planning of clinical interventions. Rapid eye movement (REM) sleep can be conceptualized as a household strength processor that can accommodate the usual processing requirements of daily life. Posttraumatic stress disorder (PTSD) has been historically defined as requiring a trauma that is outside the range of normal human experience. Hypoarousal and parasympathetic activation that are an intrinsic part of dissociative symptoms are much more difficult to assess. The original painful memories live on in flashbacks and nightmares as well as in reenactments of the unconscious dynamics captured from the family of origin’s enactments of perpetration, victimization, rescuing, and neglect. Excessive sympathetic nervous system activation is easily construed to be an indicator of psychopathology.
This chapter focuses on educational purposes for the promotion of research. It helps the practitioners to study the available evidence and use professional discretion in their prescribing decisions, being fully aware of known potential risks as well as benefits. The literature describes the use of opioid antagonists in a number of different disorders, some of them traumatic stress and attachment-related disorders, as well as dissociative disorders. Self-injurious behavior is common in the more severe traumatic stress syndromes. It also happens to be one of the diagnostic criteria of borderline personality disorder (BPD), a diagnosis that has been associated with childhood abuse and attachment conflicts. Pathological gambling is thought to provide rewards through endogenous opioid effects on the mesolimbic dopamine system. Fibromyalgia is a chronic pain disorder that is thought to result from the type of autonomic system dysfunction to which traumatic stress disposes.
- Go to chapter: Alexithymia, Affective Dysregulation, and the Imaginal: Resetting the Subcortical Affective Circuits
Alexithymia, Affective Dysregulation, and the Imaginal: Resetting the Subcortical Affective Circuits
This chapter focuses on the strategies that use neocortical resources of imagery to increase affective mentalization as well as, possibly reset them to allow increased adaptive, relational, and intersubjectivity capacity. Brain organization reflects self-organization; and human emotions constitute the fundamental basis the brain uses to organize its functioning where parent-child communication with regard to emotions directly affects the child's ability to organize his- or herself. Alexithymia and affective dysregulation play a significant role in that they constitute profound barriers for the effective treatment of traumatic stress syndromes and dissociative disorders by directly interfering with emotional processing as well as contributing to emotional destabilization. Traumatic stress and early childhood trauma has been associated with alexithymia, affective dysregulation, and deficits with regard to affective mentalization. Mentalization has been described as the ability to read the mental states of others through the brain’s mirror system.
This chapter suggests that multiple animal models are relevant to our understanding of the phenomenology of traumatic dissociation. It includes the literature of learned helplessness (LH), stress-induced analgesia (SIA), as well as tonic immobility (TI). The opioid-mediated stress response is evident in all humans, though the extent and severity of it ultimately determines to what extent structural and pathological dissociation arises. The peritraumatic opioid activation is a probable functional mechanism for the development of phenomena related to pathological dissociation, structural dissociation, and somatoform dissociation. The endogenous opioid system is part of a stress-response mechanism that has its origins in the invertebrate nervous system. Prolonged stress appears to exacerbate the organism’s response to endogenous opioids. Catalepsy is a phenomenon related to immobilization that can be induced by emotional shock. The autonomic nervous system will respond to stress with both sympathetic and parasympathetic activation.
This chapter describes different approaches to fractionating and titrating trauma processing to facilitate efficient information processing. Fractionation in the treatment of dissociative disorders specifically refers to the direction of attention to aspects of traumatic experience to attenuate the intensity of abreaction. In eye movement desensitization and reprocessing (EMDR) parlance, refers to setting up a "target" for trauma processing specifying the image, cognitions, affect/emotions, and sensations associated with the traumatic memory. A strategy in somatic work involves oscillation between the traumatic state and the resourced state. Bottom-up processing is characterized by an absence of higher level direction in sensory processing, whereas top-down processing reflects higher level neocortical processes such as cognitions. TOTEMSPOTS uses channels as described in the approaches noted earlier to fractionate an intense traumatic memory, to make it more manageable. Somatosensory processing is bottom-up, as it is suggested that sensation is foundational to the experience of emotion.
- Go to chapter: Dissociation, EMDR, and Adaptive Information Processing: The Role of Sensory Stimulation and Sensory Awareness
Dissociation, EMDR, and Adaptive Information Processing: The Role of Sensory Stimulation and Sensory Awareness
Working toward an understanding of the nature of information processing, as purported to occur in eye movement desensitization and reprocessing (EMDR) can ultimately enhance our understanding of traumatic stress syndromes and dissociative disorders. Impaired information processing reflects the inability of the brain to recognize and integrate external stimuli. The hyperpolarization of the thalamus is likely associated with profound effects on brain wave activity. The adaptive information processing (AIP) model is a neurobiological heuristic based on the notion of neural networks and represents a paradigm shift from psychological theory toward neuroscience. Shapiro argues that pathology results when traumatic or stressful events interfere with information processing and the forging of connections between different neural networks. This chapter reviews the literature on sensory stimulation and suggests that sensory stimulation and associated sensory awareness are involved in modulating oscillatory activity in the brain, which has been linked to information processing.
This chapter suggests neurobiological mechanisms to account for dissociative symptoms in general and structural dissociation in particular. Peritraumatic dissociation (PD) is associated with the release of endogenous opioids and other anesthetic neurochemicals that alter communication between lower and higher brain structures. MacLean's triune brain model provides a structure for the understanding of emotional functioning and dissociation. The integration of brain functioning both horizontally and vertically at different levels of the brain is at the core of information processing. The thalamus also plays a role in cortical oscillations, a phenomenon that has been related to cognitive-temporal binding and information processing, thus affecting cortical connectivity. The corpus callosum is the largest connective pathway in the human brain, constituted of nerve fibers that connect the left and right hemispheres, thus facilitating interhemispheric communication. Disruption of thalamocortical communication is a key component of anesthetic-induced unconsciousness.
This chapter focuses on how to effectively integrate somatic interventions during the different stages of trauma treatment, such as stabilization, trauma processing, and reconnection, and how to integrate their use to maximize the effectiveness of eye movement desensitization and reprocessing (EMDR). Ventral vagal connectedness between and within people is the name of the game to enhance association and integration. The EMDR standard protocol integrates cognitive, emotional, and sensory information. Information processing breaks down, likely due to significant peritraumatic dissociation (PD) that co occurs with the apparent hyperarousal. Social engagement reflects a ventral vagal response that results in increased self-regulation and calming, thereby decreasing the likelihood of a dorsal vagal response. To facilitate both dual focus and body mindfulness, both exteroceptive and interoceptive awareness are required. Olfactory pathways travel directly to the limbic system and amygdala, and from there olfactory information is likely conveyed to lower brain structures.