The Body Keeps the Score: the Insula

 

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Almost every brain-imaging study of trauma patients finds abnormal activation of the insula.
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This part of the brain integrates and interprets the input from the internal organs—including our muscles, joints, and balance (proprioceptive) system—to generate the sense of being embodied.
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The insula can transmit signals to the amygdala that trigger fight/ flight responses.
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This does not require any cognitive input or any conscious recognition that something has gone awry—you just feel on edge and unable to focus or, at worst, have a sense of imminent doom.
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These powerful feelings are generated deep inside the brain and cannot be eliminated by reason or understanding.
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Being constantly assaulted by, but consciously cut off from, the origin of bodily sensations produces alexithymia: not being able to sense and communicate what is going on with you.
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Only by getting in touch with your body, by connecting viscerally with your self, can you regain a sense of who you are, your priorities and values.
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Alexithymia, dissociation, and shutdown all involve the brain structures that enable us to focus, know what we feel, and take action to protect ourselves.
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When these essential structures are subjected to inescapable shock, the result may be confusion and agitation, or it may be emotional detachment, often accompanied by out-of-body experiences—the feeling you’re watching yourself from far away.
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In other words trauma makes people feel like either some body else, or like no body.
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In order to overcome trauma, you need help to get back in touch with your body, with your Self.
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There is no question that language is essential:
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Our sense of Self depends on being able to organize our memories into a coherent whole.
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This requires well-functioning connections between the conscious brain and the self system of the body—connections that often are damaged by trauma.
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The full story can be told only after those structures are repaired and after the groundwork has been laid:
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after no body becomes some body.
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Daily Tools, Daily Work: Gratitude

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The mind is the most complex, powerful thing on earth. Its capabilities are beyond our comprehension as neuroscience keeps documenting new discoveries.
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This small complex mind is programmed best with a simple, concrete, immediate tasks.
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What fires together wires together is the basic building block of neuroscience. Where we place our attention grows and where we withdraw our attention withers and dies.
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So simple, concrete, repetitive actions become habit over time.
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Let me emphasize this again: So simple, concrete, repetitive actions become habit over time.
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Let’s plug gratitude into this equation.
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Take inventory of your life and write down everything you are grateful for. Small things, the warmth of the sun, a beautiful flower, a sunrise, a hot shower, your health, your ability to laugh, communicate, be free or just smile.
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Record your list and listen to your own voice giving thanks.

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How does it feel to hear yourself giving thanks, being positive and grateful?
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Anytime we get distracted, feel needy, feel depressed or anxious pull out your list or play the recording. Takes no effort to press play.
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Remember simple immediate, concrete tasks become habit.
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Being grateful brings desires and needs into proper perspective.
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Real happiness is an internal way of being, a calm, present moment awareness of the mundane, not a life chasing pleasure or avoiding the awkward or unpleasant.
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After gratitude calms our needs a big opportunity arrives, our ability to give to others, to journey together on this path.
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Practice daily with constant application during the day.
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The Body Keeps the Score: DEALING WITH HYPERAROUSAL

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Over the past few decades mainstream psychiatry has focused on using drugs to change the way we feel, and this has become the accepted way to deal with hyper-and hypoarousal. I will discuss drugs later in this chapter, but first I need to stress the fact that we have a host of inbuilt skills to keep us on an even keel.
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In chapter 5 we saw how emotions are registered in the body. Some 80 percent of the fibers of the vagus nerve (which connects the brain with many internal organs) are afferent;
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that is, they run from the body into the brain.
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This means that we can directly train our arousal system by the way we breathe,
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chant,
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and move,
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a principle that has been utilized since time immemorial in places like China and India,
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and in every religious practice that I know of,

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but that is suspiciously eyed as “alternative” in mainstream culture.
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In research supported by the National Institutes of Health, my colleagues and I have shown that ten weeks of yoga practice markedly reduced the PTSD symptoms of patients who had failed to respond to any medication or to any other treatment.
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Vet Who Sought VA Help Was Told To Come Back In 3 Months. He Killed Himself Instead.

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A veteran who had sought help from a Department of Veterans Affairs clinic in New Jersey killed himself in front of the building after his mental health needs were neglected, an investigation has found.

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In a report released Wednesday by the VA’s Office of Inspector General, investigators determined that Charles Ingram III, a 51-year-old veteran who fought in the Gulf War, died by suicide last year after receiving inadequate care from the clinic. Missteps by the facility included a lack of communication between the patient and medical professionals and a lack of proper followup. Perhaps the most egregious incident was when Ingram, trying to schedule an appointment, was told he couldn’t be seen for more than three months.

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Ingram ultimately took his own life in March 2016 by setting himself on fire in front of the clinic, shortly before his scheduled appointment.

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The investigation came at the request of New Jersey Sen. Cory Booker (D), Sen. Robert Menendez (D) and Rep. Frank LoBiondo (R), who wanted the inspector general to “assess concerns that a patient’s insufficient access to timely mental health care may have contributed to the patient’s suicide.”

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Ingram, a seven-year veteran of the U.S. Navy, had been going to the Atlantic County Community Based Outpatient Clinic in Northfield for several years, primarily to treat obsessive compulsive disorder. In late 2015, he was told it would be more than three months before he could get another appointment with a mental health professional. He had not been seen by a medical health professional for 11 months prior to his death, according to the report.

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Investigators also found that clinic staffers “failed to follow up on clinic cancellations, patient no-shows, and appointments for approved care in the community, leaving the patient without follow-up appointments and refills for prescribed medications.”

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Across the country, VA programs suffer from delayed provision of health care and backlogged disability claims. As recently as March, photos showed a man lying on the waiting room floor at a veterans hospital in North Carolina. Another waiting veteran was slouched over in a wheelchair, shaking with pain. The photos prompted an internal investigation.

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Prior to Ingram’s death, both family members and psychologists who had spoken to him did not think he was suicidal. During appointments from 2014 to 2015 with a psychologist, “it was noted he denied suicidal thoughts or ideas,” according to the investigation.

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But while Ingram waited for his next appointment, he was “facing serious life stressors including a divorce and the loss of his job,” the report states. During this time, investigators said, Ingram did not try to contact VA staff to get an earlier appointment.

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The veteran had also told family that staff at the clinic “did not return calls and were rude,” but investigators said they found no evidence of complaints filed with the facility.

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Approximately 12 percent of Gulf War veterans have post-traumatic stress disorder in a given year, according to the Department of Veterans Affairs.

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The inspector general’s office said schedulers at the New Jersey clinic have received more training, along with new supervisors and managers.

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The Body Keeps the Score: Introceptive Pathways

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We can get past the slipperiness of words by engaging the self-observing, body-based self system, which speaks through sensations, tone of voice, and body tensions.
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Being able to perceive visceral sensations is the very foundation of emotional awareness.
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If a patient tells me that he was eight when his father deserted the family, I am likely to stop and ask him to check in with himself:
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What happens inside when he tells me about that boy who never saw his father again?
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Where is it registered in his body?
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When you activate your gut feelings
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and listen to your heartbreak
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when you follow the interoceptive pathways
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to your innermost recesses—
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things begin to change.
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The inner world

 

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When we are in survivor mode (fight or flight firing) our ability to differentiate time and perspective is compromised. Our ability to integrate sounds, images and sensations of trauma is also handicapped.
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This is why we continue to be terrified by each trigger firing, our own body mechanism.
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For many of us, our abuse is decades old and carries no real danger anymore.
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Since we do not see a beginning, a middle and end to our storyline, trauma persists and actually gets worse with time.
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A daily mindfulness practice makes it possible to tolerate our fear while staying present.
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The parts of our mind usually offline, engage and integrate our trauma to the present moment.
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We let the storyline alone and explore our inner world of vibrations, sensations, twitches and gyrations.
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PTSD makes us strangers to our inner world, our true self thus we suffer for years.
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The only way we can consciously access the emotional brain is through self-awareness,
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by activating the medial prefrontal cortex,
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the part of the brain that notices what is going on inside us and thus allows us to feel what we’re feeling.
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Sit today, focus intently on the breath, let go of judgment and thought, peer inward calmly.
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The Body Keeps the Score: treatment in the Military

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“A 2010 report on 49,425 veterans with newly diagnosed PTSD from the Iraq and Afghanistan wars who sought care from the VA
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showed that fewer than one out of ten actually completed the recommended treatment.
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As in Pitman’s Vietnam veterans, exposure treatment, as currently practiced, rarely works for them.
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We can only “process” horrendous experiences if they do not overwhelm us.
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And that means that other approaches are necessary.”
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