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Healing Our Heroes: Treatment Techniques to

Support Family Resiliency Naturally - Part 1

1This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family

Readiness Policy, U.S. Department of Defense under Award Numbers 2014-48770-22587 and 2015-48770-24368.

Connecting military family service providers

and Cooperative Extension professionals to research

and to each other through engaging online learning opportunities

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MFLN Intro

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Patricia Gerbarg, M.D.

• Assistant Clinical Professor in Psychiatry, New York Medical College

• Practices Integrative Psychiatry, combining standard and complementary treatments

• Research focuses on mind-body practices for reducing the effects of stress and trauma, particularly in survivors of mass disasters

Richard P. Brown, M.D.

• Associate Professor of Clinical Psychiatry at Columbia University College of Physicians and Surgeons

• Has authored over 100 scientific articles, books, and book chapters on pharmacological treatments, clinical studies, and complementary and integrative treatments in psychiatry

• Developed a comprehensive neurophysiological theory of the effects of yoga breathing on the mind and body, particularly its benefits in anxiety, depression, and post-traumatic stress disorder (PTSD).Research Interest

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Today’s Presenters

Copyright

• The slides and content of this presentation are under copyright and may not be reproduced, copied, transcribed, recorded, distributed, posted or published without written permission from the authors, Dr. Patricia Gerbarg and Dr. Richard P. Brown.

Neurobiology and neurophysiology of breath practices, clinical studies and use in military and mass disasters

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Richard P. Brown, MDAssociate Professor in Clinical Psychiatry

Columbia University College of Physicians and Surgeons

Patricia L. Gerbarg, MDAssistant Professor in Clinical Psychiatry

New York Medical College

Professional Disclaimer

• Dr. Richard P. Brown and Dr. Patricia L. Gerbarg receive payment for publication of books on

Integrative Psychiatry as well as reimbursement for travel expenses, workshops, and honoraria

when lecturing. They receive no payment for lecturing the APA or for this Healing Our Heroes

Presentation.

• They received research funding for a study of breathing practices for relief of stress following the

Horizon Gulf oil spill from the Dept. of Mental Health of Mississippi.

• NCCAM grant for Brain GABA in depression study.

• They are co-authors on citations in this presentation.

• Dr. Brown consults on a research project for Humanetics and holds a patent on the use of 7-keto

DHEA for treatment of PTSD.

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The Autonomic Nervous System is the Foundation of our Mind-Body-Spirit

Sympathetic System

• Threat seeking & response approach (reward/fight), avoidance (flight), burns energy

• Dopamine

Parasympathetic System

• All safe, relax & recover, emotional regulation, bonding, restores energy reserves, calm, heal, recharge

• Serotonin/Norepinephrine

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Behavior & Emotion

(Gray’s Motivational Theory, Beauchaine, T., 2001)

Breath and Emotion

• Bi-Directional

• Specific emotions induce breath patterns

• Voluntary changes in breath pattern induce specific emotions

(Philippot P & Blairy S. 2003)

8©Brown_Gerbarg

Activation of the Parasympathetic System (PNS)

• Vagus nerve: main pathway of PNS

• Vagus nerve is bidirectional

• Breathing activates afferent pathways that stimulate vagusnerve

• Voluntary change in pattern of breath can alter the activity of vagus nerve

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Vagal Activity

• 20% of the vagus nerve pathways regulate heart, lungs, digestion, glands, immune function (efferent)

• 80% of vagus nerve pathways carry messages from the body up to the brain (afferent)

10©Brown_Gerbarg

Vagus Nerve Involved In:

• Social bonding

• Empathy & love

• Gut feelings & instincts

• Perception & observation

11©Brown_Gerbarg

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Nucleus Tractus Solitarius

Vagus Nerve

Limbic System

Amygdala

Hippocampus

Slows

Heart Rate

Calms and slows Gastrointestinal

Tract

Corpus Callosum

Thalamus

Cerebral Cortex

Slows

Respitory

Rate

Hypothalamus

Parabrachial Nucleus

©Brown_Gerbarg

Coherent Breathing

• Coherent Breathing: gentle breathing at 4.5-6.0 breaths per minute

• With equal inhalation and exhalation

• In and out through the nose

• Without force or pressure

14©Brown_Gerbarg

Heart Rhythm Varies With Breathing Rhythm

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Heart rhythm at 5 breaths per minute

©Brown_Gerbarg

Heart rhythm at 7.5 breaths per minute

Heart rhythm at 15 breaths per minute

Heart rhythm at 30 breaths per minute

©Brown_Gerbarg

“The purpose of breathing practices is to induce the tenderness of a new-born babe.”

Lao Tzu, Tao Te Ching

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Coherent Breathing OutSlowly lower hands while gently breathing out. OUT ……… 2 …..… 3 ……. 4 ….….

©Brown_Gerbarg

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Coherent Breathing OutSlowly lower hands while gently breathing OUT. Turn palms out and DOWN.

OUT ……. 2 ……. 3 ……. 4 …….

• Improving autonomic nervous system balance may mitigate adverse effects of sympathetic dominance and its associated conditions.

• However, this requires:• Conscious control of respiratory rate

• Conscious control of respiratory depth

• Relaxation

19©Brown_Gerbarg

Increase Vagal Afferent Stimulation

20©Brown_Gerbarg

• Slow breathing 3-6 bpm

• Increased airway resistance – Resistance Breathing• Laryngeal contraction: Ocean Breath, Ujjayi

• Pursed lips

• Duration of exhalation > inhalation

(Cappo & Holmes, 1984; Telles & Desijaru, 1992; Calabrese, 2000; Gozal, 1995)

• Imbalance in stress response systems

• trauma memories (subsymbolically encoded) eg. physical

sensations, emotion dysregulation, distorted body perceptions

• Disruption of bonding, disconnectedness, loss of meaning,

emotional numbing

• Difficult to access with verbal or cognitive therapies

• Instead, access by helping the body send signals to brain through

neural networks

(Gerbarg PL: Yoga and Neuro-Psychoanalysis, in Bodies in Treatment: The

Unspoken Dimension. Ed. FS Anderson. The Analytic Press, Inc. 2008, pp.127-150.)

21©Brown_Gerbarg

Traumatic Experiences

Stress, Trauma, & Neglect Affect Stress Response systems

• Autonomic Nervous System

• Hypothalamic Pituitary Adrenal Axis

• Emotion dysregulation: Anxiety, depression, insomnia,ANGER, PTSD

• Stress-related medical conditions: gastrointestinal, metabolic syndrome, high blood pressure, cardiovascular, cerebrovascular

• Mind-body practices have the potential to correct stress-related disorders

©Br

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Social Engagement + Social Bonding =Co-Regulation

• Safety – Proximity – Contact – Bonding

• Mammals: Regulators of physiology are embedded in

relationships

• Phase I: face-to-face interactions (eye contact)

• Phase 2: physical contact while immobilizing without fear

requires trust, safety, love

Porges, S. W. (2009). The polyvagal theory: New insights into adaptive reactions of

the autonomic nervous system. Cleveland Clinic Journal of Medicine, 76 S2, S86-90.

Porges, S. W. (2003). Social Engagement and Attachment. A Phylogenetic

Perspective. Ann NY Acad Sci. 1008:31-47.23

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Trauma: Disrupts Connectedness

26©Brown_Gerbarg

• Distorts social awareness

• Defensive reactions displace social engagement• Fight/flight

• Immobilization (dissociation) with fear

• Interferes with healthy reciprocal co-regulation of physiological state• Cannot feel safe or establish trusting relationships

• Difficulties being close, touched, or touching others

• Unable to self-soothe

©Brown_Gerbarg

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ANS: 3 Developmental Stages

• Stage 1: Primitive unmyelinated vagus: immobilization (dissociation)

• Stage 2: Sympathetic Nervous System (SNS): fight/flight behaviors

• Stage 3: Myelinated mammalian vagus enables social interactions to regulate physiology, promote health, growth and restoration of balance between

• Neuroception of danger, safety, or life threat trigger adaptive neural circuits

28©Brown_Gerbarg

Safety

Parasympathic

Myelinated Vagus

↑ HRV

↓ Defensive

↑ Social Engagement

Immobilization

without fear

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Danger

Sympathetic Nervous

System

↓ HRV

↑ Defensive

↓ Social Engagement

ImmobilizationBehavioral activation/Behavioral inhibition

Life ThreatUnmyelinated Vagus

↓ HRV

↑ Defensive

↓ Social Engagement

Immobilization

with fear

Approach-AvoidEmotion dysregulationHypervigilenceOver reactivityAnger, fear

Freeze

DisconnectDissociateNumbing

Flexible, AdaptiveEmotion regulationBond, connect, loveIntimacy, soothe, heal, Cooperate, empathy

Perceived Environmental Condition

• Combat requires that soldiers disconnect from their emotions and from other people

• Combat requires a defensive mental state

• Being in this state becomes a problem when soldiers return home if they are unable to shift back into a non-defensive mental state

• The defensive mental state can severely impair the soldier’s ability to experience normal feelings and to feel emotionally connected to others, leading to feelings of not ‘belonging,’ isolation, frustration and anger

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Mental States in Combat

©Brown_Gerbarg

Using the Breath to Change the Physiological State of the Organism

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Stimulus

Stressors

Organism Response

PerceptionEmotion

CognitionBehavior

InteroceptiveMessaging

Breath

©Brown_Gerbarg

Integrating Mind-Body Practices into Clinical Practice

• Precautions, contraindications

• PTSD Case illustrations

• Interoception and Emotional Awareness

• Neuroanatomical Model

• Polyvagal Theory

• Vagal-GABA Theory of Inhibition

• Bonding, PTSD, Disconnection

32©Brown_Gerbarg

Slow Coherent Breathing is Generally SafeRapid forceful breathing - Contraindications

• Avoid rapid, forceful breathing or breath holds–Pregnancy, seizure disorder, recent surgery, severe cardiac

disease, uncontrolled hypertension

–Panic Disorder - panic attacks

–PTSD – flashbacks

• Modify breath practices for asthma or COPD

• Bipolar I – rapid yoga breathing can trigger mania

• Bipolar II – if stable on medication, compliant, not prone to mania may do slow Coherent but not rapid breathing

33©Brown_Gerbarg

Clinical Studies of VRBPs Voluntarily Regulated

Breathing Practices

1. Schizophrenia: Cognition, Epigenetic2. Inflammatory Bowel Disease3. Southeast Asia Tsunami Survivors4. Australian Vietnam Veterans with PTSD5. Generalized Anxiety Disorder6. 9/11 World Trade Center Attacks7. Mississippi Healthcare Providers8. South Sudanese Survivors of War & Slavery9. Depression & MRS Brain GABA Levels

34©Brown_Gerbarg

Effects of Yoga on Cognition, Psychiatric Symptoms, and

Epigenetic Changes inChronic Schizophrenic Patients

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Robert C. Smith, Sylvia Boules, Lawrence Maayan, Patricia Gerbarg, Richard Brown, Elizabeth Visceglia, Henry Sershen, Abel Lajtha, James Auta,

Merlyn Mathew, John M. Davis, Alessandro Guidotti

National S. Kline Institute for Psychiatric Research, Dept. of Psychiatry New York University Medical School

Breath Practices, Yoga, & Qigong

• Open study 12 weeks 3 groups (total n = 35) chronic schizophrenic outpatients

• 1 hour sessions 3 times/week

• All Groups: Coherent Breathing at 5 bpm 15-25 min.• 15-25 min. movement and postures

• Groups 1 & 2: yoga postures

• Group 3: Qigong movements

• 5-10 min. supine rest and guided meditation

• 5-10 minutes of group processing

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37©Brown_Gerbarg

The Effect of Breathing, Movement, and Meditation Practices on Quality of Life Indices in Patients with Inflammatory Bowel Disease

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Jill Roberts Center for Inflammatory Bowel DiseaseNew York Presbyterian Medical Center

Dr. Ellen Scherl, Dr. Laurie Stevens, Dr. Richard Brown, Dr. Brian Bosworth, Dr. Patricia Gerbarg

DBRCT 30 patients: inflammatory boweldisease

• Study group: BBMW + weekly follow up BBM sessions

• Control group: educational seminar + weekly follow up educational sessions

• 6 week: significant improvement in breathing group over the educational group control (p=.02)

• 6 month: significant improvements in breathing group vs control group in symptom control Brief Symptom Inventory (BSI, p=.01), Perceived Stress (PS, p=.01), Inflammatory Bowel Disease Quality of Life (IBDQ, p=.04)

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Breath-Body-Mind Workshop as Adjunctive Treatment in Patients Suffering from Generalized Anxiety Disorder (GAD) with or without Comorbidity

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Martin A. Katzman, Monica Vermani, Patricia L. Gerbarg,

Richard P. Brown, Dina Tsirgielis, Christina D’Ambrosio

Inclusion Criteria

• 20 Outpatients (aged 18-65 years) with primary diagnosis of GAD (DSM-IV)

• Minimum 8-week history of treatment with an appropriate dose of a standard anxiolytic

• Baseline Score of:

– Clinical Global Impressions-Severity of Illness (CGI-S) score of 5-7

– HAM-A total score 20

– HAM-A anxious mood and tension items; including a score of >2

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Baseline prior

to BBM

intervention

Immediately

after BBM

intervention

6 months after

BBM

ntervention

F, p

Scale M SD M SD M SD

BAI

BDI-II

ASI

PSWQ

26.05

24.75

33.80

64.45

14.380

11.832

12.146

9.248

7.75

12.05

20.75

42.75

7.468

9.870

14.011

23.344

13.40

15.05

18.00

41.80

16.064

15.007

18.834

32.778

15.827,< 0.001*

15.412,< 0.001*

12.281,<0.001**

6.588,<0.01***

Scores for BAI, BDI-II, ASI, and PSWQ Significance of mean differences between Baseline and immediately after BBM session reported as (F-value)

•Significant Significant after Huynh-Feldt corrections **

2-DAY 12-hr Breath-Body-Mind Intervention

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•Significant after Greenhouse-Geisser adjustment for violation of sphericity*** ASI= Anxiety Sensitivity Index; BAI= Beck Anxiety Inventory; BDI-II= Beck Depression Inventory-II; PSWQ= Penn State Worry Questionnaire

Effects of a Yoga-Breath Intervention Alone and in Combination with an Exposure Therapy for PTSD and Depression in Survivors of the 2004 Southeast Asia Tsunami. Acta Psychiatr Scand 2010.

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Teresa Descilo, Patricia Gerbarg, A Vedamurtachar, D

Nagaraja, BN Gangadhar, R Damodaran, Beth Adelson,

Laura Braslow, Sue Marcus, Richard Brown

Severely Traumatized Population

• Refugees from the most severely damaged coastal villages in Nagapattinam

• Living in 5 refugee camps

• Out of 8018 deaths in the state of Tamil Nadu, 6065 (75%) occurred in Nagapattinam district

• 75% buildings destroyed

44©Brown_Gerbarg

Study Design

• 183 subjects

• 3 equal groups assigned by camps

• BWS: BWS + 10-minute SK

• B+T: BWS followed 3 days later by TIR (Traumatic Incident Reduction)

• CON: 6-week wait-list control group

45©Brown_Gerbarg

P < .001

Mean Scores PTSD Checklist PCL-17

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Mean BDI Scores

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P < .0001

Multi-component Yoga Breath Based Program Reduces PTSD in Vietnam War Veterans J Carter, PL Gerbarg, RP Brown, R Ware, et al.

• Randomized, wait-list controlled trial

• 25 Australian Vietnam Veterans with chronic,

treatment resistant PTSD• Clinician Administered PTSD Scale (CAPS)• Mini-Plus, AUDIT, PCLM, CES-D• baseline, pre-, 6 week-post, 6-month post(J Traumatic Stress Disorders & Treatment. 2013. 2(3):1-10)

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Outcomes Over 6 Months: CAPS

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Results after 6 Weeks

• Intervention Group Caps scores (adjusted for baseline CAPs) decreased 14.2 (95%CI: 4.6 to 23.7; P=.007)

• Control Group: no decline

• The Effect Size of the difference in CAPS scores is 0.91

• Vietnam veteran, “If we’d gotten this when we came back from Vietnam, we wouldn’t have lost 30 years of our lives.”

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1st & 2nd Trials Breathing, Movement, &

Meditation for relief of PTSD, Depression, & Anxiety Related to

September 11th NYC WTC Attacks.

RP Brown, PL Gerbarg, M Vermani, MA

Katzman

51https://www.flickr.com/photos/gcattiaux/2603608239

1st Trial: Breath~Body~Mind Workshop

12 hour workshop taught over 2 days

1.Resistance + Coherence Breathing (5 bpm) + Breath Moving2.QiGong: Gentle movements with Resistance Breath

• QiGong breathing: counts & holds 4–4–6–2

3.Open Focus meditation: improves flexibility of attention (Les Fehmi)• First focus on internal spaces of the body.• Connect internal spaces with space in environment.• Increases alpha brain wave synchrony.

4.Group Processes

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1st Trial: T-Test Results

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Pre vs Post Scores df t Significance

Anxiety Sensitivity Index 16 5.33 .001

Beck Anxiety Inventory 13 4.02 .001

Beck Depression Inventory 16 7.38 .001

Penn State Worry Questionnaire 15 3.18 .006

Sheehan Disability Index Social

Life

15 3.44 .004

Bonferroni t-tests significance 0.05/9 = .006 n = 17 subjects

©Brown_Gerbarg

2nd Trial - September 11th Experience

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N

First Responder 6

Fireman 4

Worked with or affected by 9/11 4

Emergency Health Care Provider 2

Worker at Ground Zero (post attack) 6

Resident Living near World Trade Center 10

WitnessedAttack 8

Family member of a first responder 1

Escaped from World Trade Center 2

Note: Total N = 27 participants

2nd Trial: Number of Participants Meeting Criteria for a Clinical Disorder

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Clinical Disorder N

Major Depressive Disorder 12

Generalized Anxiety Disorder 14

Post Traumatic Stress Disorder 23

Panic Disorder 16

Agoraphobia 9

Note: Total N = 27 participants

2nd Trial: T-Test Results

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Pre vs. Post df t Significance

Anxiety Sensitivity Index 21 3.93 .001

Beck Depression Inventory 20 4.01 .001

Beck Anxiety Inventory 21 3.09 .005

Penn State Worry Questionnaire 19 1.95 .066 (ns)

Treatment Outcome PTSD Scale 18 1.63 .120 (ns)

Bonferroni t-tests significance 0.05/5 = .01 n = 27

Breath~Body~Mind Training for Stress Relief after Gulf Oil Spill

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(Mississippi State DMH Grant) Assisted by Mississippi Cares & Serving Those Who Serve

Chris StreeterBoston University Medical Center

Patricia Gerbarg

New York Medical College

Richard P Brown

Columbia University College of Physicians & Surgeons

ttps://pixabay.com/en/oil-rig-explosion-fire-disaster-618704/58

Breath-Body-Mind Teacher Training for Stress Relief Post Disaster

• Trained 153 health care providers

• 84 participated in study: social workers (31%), counselors (15%), teachers (10%), psychologists (8%), case workers (5%)

• Mississippi counties affected by Gulf Oil Spill

• 3-day 18-hr Train-the-Trainer

• Pre- and post- Exercise Induced Feeling Inventory (EIFI)

• Perceived Stress Scale (PSS)

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©Brown_Gerbarg

Perceived Stress Scale

• Baseline mean PSS scores (n=84) were high (17.7 6.9) compared to norms for males (12.1 5.9) and females (13.7 6.6).

• PSS mean scores at the 6-week follow-up (n =30) were 12.14.6, a significant decrease of - 4.66.4 from pre-training scores (t = -3.92, df= 29, p<0.001).

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©Brown_Gerbarg

Mean Scores Perceived Stress Scale compared to norms for women and men

Pre- and 6 Weeks Post- Training

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16

18

20

Pre 6 weeks

Normed Female

Normed Male

(Gerbarg PL, Streeter CC, Whitfield T, Brown RP. Poster presented at SYTAR,

Stockbridge, MA. Sept. 23-25, 201).

Exercise Induced Feeling Inventory (EIFI)

• Highly statistically significant improvements

• Positive Engagement: mean ↑ 2.19 ± 3.26 (t = 4.04, df = 35, p < 0.001).

• Revitalization: mean ↑ 3.94 ± 3.41 (t = 6.95, df = 35, p < 0.001)

• Tranquility: mean ↑ 3.42 ± 2.99 (t = 6.86, df = 35, p < 0.001)

• Physical Exhaustion: mean ↓ 2.67 ± 4.28 (t = - 3.74, df = 35, p < 0.001)

(Streeter C, Gerbarg P, Brown RP unpublished data 2012)

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Adapting Mind/Body Practices for Mass Disasters and Military-Related Trauma

• Few teachers serve large groups• Simple techniques, easy to learn and teach• Rapid relief• Safe for everyone regardless of trauma, physical condition, or

age (3 to 100 years old)• Tailor programs for different cultures: easily understood and

accepted.• No equipment, electricity, buildings, or supplies• Low cost

• Sustainability: train healthcare workers, chaplains, officers,

parents, school teachers, community leaders to teach the

practices at school, work, home, on tour

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©Brown_Gerbarg

Breath-Body-Mind.com

Chemung County Department of Mental Hygiene supports healthcare professionals and educators in the acquisition of this model. These techniques will be a tremendous asset in the treatment of individuals suffering from PTSD, mood disorders, anxiety, ADHD, and life stress." Brian Hart, Director of Community Services, Chemung County Department of Mental Hygiene, Geneva NY

Dr. Brown & Dr. Gerbarg are not paid to teach workshops for this demonstration project in Chemung County, NY

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©Brown_Gerbarg

Counsellor and School Teacher

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• “ …inspired, excited, hopeful, relieved (that there’s a way to slow myself, stress-less, be happier, be more calm and focused)…”

• “I found a side of myself I lost sight of over the past decade, I feel more at ease with myself and look forward to practicing at home to help decrease stress and practice self-care. I am also eager to teach my children.”

©Brown_Gerbarg

Girl with Breathing Buddy

After school program at a Community

Center

66©Brown_Gerbarg

2010 Haiti 1 week after earthquake – Gretchen Wallace Steidle Leads Coherent Breathing – GlobalGrassroots.org

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War and Slavery in South Sudan

• It is estimated that tens of thousands of South Sudanese who were captured during the last two decades of wars remain in slavery in North Sudan.

• $100,000 worth of bovine vaccine purchases freedom for one of these slaves.

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Sudanese Survivors of War and Slavery Program Evaluation

• Short form of Breath~Body~Mind practices

• 3 Qigong movements and 20 minutes of Coherent Breathing with the clinic staff 5 days a week for 18 weeks.

• VAS Mood Scale and VAS PTSD Scale.

• 19 South Sudanese women

(Gerbarg PL, Wallace G, Brown RP. Mass disasters and mind-body solutions: Evidence and field insights. International Journal of Yoga Therapy. 2011. 2(21):23-34.)

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©Brown_Gerbarg

Program Evaluation Data from Sudan: Response of Refugees to Breath~Body~Mind

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Mean Test Scores Change Mean Score/

% Change Mean Score

Baseline 6 wks 18 wks 0-6 wks 0-18 wks

VAS

PTSD

49.3 17.2 14.5 32.1

65%

34.8

71%

VAS

Mood

20.8 10.8 7.10 10.0

48%

13.7

66%

VAS: Visual Analogue Scale n = 19 women

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June 2011 –Dr. Richard Brown Teaches Breath~Body~Mind

to South Sudanese just freed from slavery

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Dr. Brown in South Sudan July 2015

• Medical Center in Juba

• Taught mental health staff at psychiatric unit and clinic. Very stressful environment.

• Some staff had been doing Coherent Breathing for 2 months

• Gave BBM workshop to NGO workers

• Military wounded in hospital for pain relief

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©Brown_Gerbarg

Dr. Brown is given 20 minutes to teach 400 recently liberated slaves as they cross the border into South Sudan

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Juba mental health staff and patients learn VRBPS“If I’m scared, from now on I feel less. When I have stress

I’m breathing because then I’m not stressed.”

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The Wise Woman paces breathing by tapping her

bronze bowl for the 19 women

teaching Healing Breath

Practices in South Sudan since 2011.

81©Brown_Gerbarg

Breath-Body-Mind Training for Soldiers since July 2015

• Dr. Ayuel Atong and her staff teach soldiers in military hospital and in barracks

• Why soldiers say they like the practices:

• On the front line, it saves their lives because it maximizes functioning (focus, awareness of situations, think clearly, respond effectively)

• “It saves our lives.” (wounded soldier)

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©Brown_Gerbarg

Wounded Soldiers in South Sudan Hospital commonly have no pain medication

• Soldier with AK47 gunshot wound through in his chest

• No available pain medications

• Dr. Brown taught a group 13 wounded soldiers and 25

mental health staff and medical nursing staff how to use

Breath Practices with Open Focus Attention Training and

Visualization to relieve pain without medication

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©Brown_Gerbarg

South Sudanese Pharmacist

• Since his village was attacked and burned 9 years ago, he has had recurring images while awake and asleep every day of his sister

burning to death• Learned Breath-Body-Mind with Dr. Brown• Practiced breathing 20 min/day for 7 days• Recurring images of sister stopped• “I feel free.”

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©Brown_Gerbarg

Soldiers Need to Know

• How to shift their mental state from the state of defensive disconnection that is necessary for survival during combat

• To a non-defensive state of connectedness to her own emotionsand to other people when they return home to their families

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©Brown_Gerbarg

Case 1: Disconnection Sept 11, 2001

• Cholene, former Air Force U-2 spy plane pilot, was flying for United Airlines. She was scheduled to be on Flight #93 on Sept. 11, 2001, but her connecting flight was changed. Her close friend, pilot Leroy Homer, Jr. died when Flight #93 crashed leaving her with survivor guilt and feeling helpless, angry, and disconnected from everyone and everything she had believed in.

• Hoping to find a connection to life, she did 3 tours in Iraq as an embedded journalist and 2 years of post-Katrina relief work in Mississippi.

• She was left feeling drained, joyless, and without meaning.

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©Brown_Gerbarg

Reconnection September 26, 2009 NYC breath workshop

“The breathing and the rhythm of the bells were like the tide in the Arabian Gulf. The sound of the tide and the feel of the waves rolling over me were the only things that made me feel connected to life. The breathing was that and much more powerful because I was physically and mentally connecting to a larger energy source.”

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©Brown_Gerbarg

“I found myself weeping when Dr. Brown said,‘think of those you love.’ I came away with a sense of being reunited with my life and loved ones. For the first time in years, I wanted to be connected to something besides a war or a disaster zone. After the breathing, during the meditation, I felt connected to the universe and to everyone in it.”

(Through the Eye of the Storm by Cholene Espinoza.Chelsea Green Pub. 2006)

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©Brown_Gerbarg

Questions

• How do breathing practices access and transform trauma in the mind and body?

• How do breathing practices permanently resolve physical and mental symptoms of trauma?

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©Brown_Gerbarg

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http://bit.ly/297Rj1a

http://bit.ly/1r1ZvBhhttp://bit.ly/1I0tg2D

http://bit.ly/295Adjm

http://bit.ly/295Adjm

Resources

www.Breath-Body-Mind.comContact

Dr. Richard P. Brown & Dr. Patricia GerbargSee B-B-M Teacher page for Training Information

See Workshops/Lectures Schedule Page

Updates & Free Integrative Mental Health Newsletter

www.Coherence.com - Respire - 1 CD 2-Bells Trackwww.OpenFocus.com - Meditation CDs

www.RobertPeng.com - QiGong DVDs, meditation CDs

http://www.innerresource.org Amy B. Otzel, M.A., M.S., LPC

Military Readjustment Specialist

Level-3 Breath-Body-Mind Teacher

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Resources for Further Learning

• The Healing Power of the BreathRP Brown & PL Gerbarg (Book + CD, Shambhala, 2012)

• Non-Drug Treatments for ADHDRP Brown & PL Gerbarg (WW Norton, 2012)

• How to Use Herbs, Nutrients and Yoga in Mental HealthRP Brown, PL Gerbarg, PR Muskin (WW Norton, 2009)

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Carter, C.S. (2014). Oxytocin pathways and the evolution of human behavior. Annu Rev

Psychol. 65:17-39.

Porges, S. W. (2009). The polyvagal theory: New insights into adaptive reactions of the

autonomic nervous system. Cleveland Clinic Journal of Medicine, 76 Suppl 2, S86-90.

Porges, S. W. (2003). Social Engagement and Attachment. A Phylogenetic Perspective.

Ann NY Acad Sci. 1008:31-47.

Porges, S. W. (2001). The polyvagal theory: Phylogenetic substrates of a social nervous

system. International Journal of Psychophysiology, 42(2), 123-146

Gerbarg PL, Wallace GS, Brown RP. Mass disasters and mind-body solutions: Evidence

and field insights. Journal of the International Association of Yoga Therapists. 2011.

2(21):23-34.

Streeter CC, Gerbarg PL, Saper MD, Ciraulo DA, and Brown RP. Effects of Yoga on the

autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy,

depression, and Post-traumatic Stress Disorder. Medical Hypotheses. 2012

May;78(5):571-9.

Dissolving Pain. Fehmi and Robbins, Trumpeter Press, 2010

The Open Focus Brain, Fehmi and Robbins, Trumpeter Press, 2007.

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Recommended Reading 1

The Open Focus Brain, Fehmi and Robbins, Trumpeter Press, 2007.

Carter J, Gerbarg PL, Brown RP, Ware R, D’Ambrosio C, Dirlea M, Vermani M, Katzman

MA. Multi-component Yoga Breath Program for Vietnam Veteran Post Traumatic Stress

Disorder: Randomized Controlled Trial. Journal of Traumatic Stress Disorders &

Treatment. 2013. 2(3):1-10.

Brown, RP, Muench F, Gerbarg, PL. Breathing practices for treatment of psychiatric and

stress-related medical conditions. In Complementary and Integrative Therapies for

Psychiatric Disorders, Ed. PR Muskin, PL Gerbarg, RP Brown. Psychiatric Clin NA.

March 2013, 36(1):121-140.

Brown RP and Gerbarg PL. Yoga breathing, meditation, and longevity. In Longevity,

Regeneration, and Optimal Health, Integrating Eastern and Western Perspectives, Ed. C.

Bushness, E. Olivo, and N Theise. Annals NY Acad Sci. 2009, 1172:54-62.

Descilo T, Vedamurtachar A, Gerbarg PL, Brown RP, et al. Effects of a Yoga-Breath

Intervention Alone and in Combination with an Exposure Therapy for PTSD and

Depression in Survivors of the 2004 Southeast Asia Tsunami. Acta Psychiatr Scand April

2010, 121(4):289-300.

95

Recommended Reading 2

What is one significant thing you learned today?

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101This material is based upon work supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, and the Office of Family

Readiness Policy, U.S. Department of Defense under Award Numbers 2014-48770-22587 and 2015-48770-24368.