“Mom, there’s a monster in the closet” - attach.org · dimensions of development: (Pia...

“Mom, there’s a monster

in the closet”How do attachment, trauma and anxiety disorders interact ?

Doris D’Hooghe www.traumacentrum.be

2

Early Attachment Trauma

Consequences

Link between EAT and anxiety

disorders

Therapeutic tools

© Traumacenter Belgium-

www.traumacentrum.be - Doris D'Hooghe

http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwizlpjK2qrQAhXFzRoKHflLC3MQjRwIBw&url=http://micheleconnolly.com/traumatized/&psig=AFQjCNH-GegeT8u6soyJRF5KQbuMViP9Qg&ust=1479297217153443

Agenda

• Ice breaker activity

• Theory

• Interactive component

• Questions and answers

• Positive note


www.traumacentrum.be - Doris D'Hooghe3

Learning objectives

• Be able to recognize, identify and categorize early attachment trauma

• Be able to define the developmental impact of early attachment experiences.

• Recognize the clinical symptomatology of EAT and the relationship with the development of anxiety disorders

• Be able to integrate the presented treatment possibilities in the daily practice



Ice breaker activity



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj9rsLj2arQAhUB6xoKHRAQDrgQjRwIBw&url=http://www.funnyjunk.com/funny_pictures/1471527/Traumatized/&psig=AFQjCNH-GegeT8u6soyJRF5KQbuMViP9Qg&ust=1479297217153443

Ice breaker activity



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwi3tqT1wv3bAhVPEVAKHbMLDnEQjRx6BAgBEAU&url=http://www.ahaparenting.com/parenting-tools/attachment-parenting/attachment-basics&psig=AOvVaw1Vb02OH22CsEX08PC1OkEq&ust=1530521332546905

Theory



http://entrevistadepsicologiauvm.blogspot.com/2015/05/el-entrevistador-ideal.html



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwj9spb2uu_bAhVFJFAKHezlD_IQjRx6BAgBEAU&url=http://soulcareservices.org/services-2/&psig=AOvVaw2zN0e32UJ_v0P6OD8um_Yl&ust=1530037973240975

Trauma?

• The classic vision of trauma

• from the perspective of a traumatizing event

• characteristics

9© Traumacenter Belgium-


Impersonal stressors



https://www.google.be/search?biw=1920&bih=911&tbm=isch&q=natuurrampen+tornado&sa=X&ved=0ahUKEwix64PT3q_QAhWM7hoKHVjvBtMQhyYIGg

https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj1yYWj3q_QAhVL5xoKHUNmCRMQjRwIBw&url=https://ejbron.wordpress.com/2012/08/07/een-jaar-voor-de-olympische-spelen-toen-londen-in-brand-stond/&psig=AFQjCNFaP5PetP9yxNPddXAMAYYhyn1b5A&ust=1479470221596365

Personal stressors



Attachment trauma



Attachment



https://www.facebook.com/events/2473602206198966/

Attachment

• Attachment is a deep and enduring emotional

bond that connects one person to another

across time and space (Ainsworth, 1973; Bowlby, 1969).

– Persistent and ongoing (from the cradle to the

grave)

– Directed toward a specific person

– Emotionally significant

– Characterized by seeking security, comfort and

pleasure



THE ABC OF ATTACHMENT

(Siegel & Hartzell, 2004)



Attunement



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiVw_am-u7QAhULMlAKHULfCcoQjRwIBw&url=http://www.lionswhiskers.com/2011/10/hard-wired-to-care-you-matter-in-moral.html&bvm=bv.141320020,d.ZWM&psig=AFQjCNHFI9L8qsZhm3CHmBKklWXrKVe8fQ&ust=1481642363404878

Attunement

• Sensitive responsiveness

• Mentalization

• Reflective functioning

• Containment

• Shared pleasure/ play



Sensitive responsiveness

Ainsworth and others (1974)

• The infant’s point of view

– Four essential components:

• Her awareness of the signals

• An accurate interpretation of them

• An appropriate response to them

• A prompt response to them



http://whywebecamehuman.com/the-ascension-of-the-human-spirit-2-from-sex-to-attachment-enveloped-by-spirit-and-then-the-covenant/

Mentalization

Peter Fonagy

• A theory of mind

(internal world)

• Oneself and others as psychological

• Mirroring

• Sense of self



https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwitupaCt-DTAhWKIlAKHaD6AK0QjRwIBw&url=https://www.nationalelfservice.net/mental-health/personality-disorder/mentalization-based-treatment-for-borderline-personality-disorder-a-pragmatic-trial-but-with-statistical-uncertainty/&psig=AFQjCNFrA7Ewji9Nb4p9_4RZu5aEbzGKMw&ust=1494337462101889

Reflective functioning

• Reflect upon their own history (trauma, attachment)

• Influence

• Trigger

• “Ghosts in the nursery” (Selma Fraiberg)



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwim7OCOuODTAhUILFAKHQ15DuAQjRwIBw&url=http://gardener.blogg.se/category/stockholm-2010.html&psig=AFQjCNEiFrih4S31vaWsrU5ked4RpQ3jGQ&ust=1494337736116868

Containment

– (Bion, 1959)

• Receive and understand

• Without being overwhelmed by it

• Communicates back



https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjPv93QueDTAhXNK1AKHaAdBmMQjRwIBw&url=https://locallocale.wordpress.com/2012/02/16/back-to-the-basics-pt-ii-hold-that-baby-parenting-advice-cro-magnon-parenting/&psig=AFQjCNFufxnJtMnKpGCSIpxevdJ1hwR1rQ&ust=1494338086190095

Shared pleasure/ play



Confidence, trust, security

Communicate and connect

Reduce stress

Strengthens attachment

22

https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwi1_oDyteDTAhVSPFAKHcgJBFcQjRwIBw&url=https://www.pinterest.com/pin/186125397073964544/&psig=AFQjCNHAUe6qXC5dd82LY2fuEGdM5qO0Ug&ust=1494336992978449

Balance



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj_xb7usu_QAhXJCBoKHSipB2cQjRwIBw&url=http://www.vanessa-pooley-bronze-sculptures.com/mother-and-child.html&psig=AFQjCNFxGhNANp9QyMgPFAFbp4fHfdGvCQ&ust=1481657595038626

Balance

Mother as external regulator

growth-facilitating emotional environment

a child to develop an internal system

adaptively regulate

arousal psychobiological states (affect, cognition, and behavior)



Coherence



https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiO8bXrt-_QAhWHWBoKHa7JDjoQjRwIBw&url=https://tealswan.com/shop/paintings/pleiadian-coherence-lightwork-model/&bvm=bv.141320020,d.d2s&psig=AFQjCNEAX4n9yvabsSzWIhvsn13jN7pINQ&ust=1481658942168001

Coherence

Sense of selfThe availability of a reflective caregiver

Secure attachment

Facilitates the development of theory of mind

"She thinks of me as thinking and therefore I exist”

Child "find itself in the other”

"giving back to the baby the baby's own self" (Winnicott, 1967)



“Invisible” Attachment Trauma



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiczNrFt-_TAhXDJMAKHYv5DRoQjRwIBw&url=http://www.bbc.co.uk/nature/21320626&psig=AFQjCNENLJmNz1M7chriG5gqOF8aNzyzFg&ust=1494852864438170


The form of traumatization

Child’s experience of threat

Totally dependable on his caregiver

limited behavioral and cognitive coping capacities




Experiences of threat

include the threat of

separation having little

from the caregiver response to

the signals of distress.




In the interaction between child and caregiver

Not an obvious event

Caregiver’s Caregiver’s unavailibility inability to

modulate the affective dysregulation



Early attachment trauma

31

Stressful events in the relationship:

Pre- natal trauma



https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwi8tIzRmO_TAhUJIMAKHc9fADEQjRwIBw&url=https://www.incontri18.it/donne/ad14089-28enne-elegante-e-raffinata&psig=AFQjCNGj_D-h7iv2EZYFnSSva0IIBl6GMw&ust=1494844649166016

Stressful events in the relationship:

Birth trauma

• C-section/ long or short labor/life threateningexperiences/ vacuum extraction etc.



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjK2vf0mu_TAhXIAcAKHaWkBYMQjRwIBw&url=http://www.vaccinationinformationnetwork.com/birth-trauma-and-the-dark-side-of-modern-medicine-jeanice-barcelo/&psig=AFQjCNEu09AHbhDRGWf4R9FpZvb5hQYZNA&ust=1494845047153995

Disruptions in the attachment bond

Physical inaccessibility



https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwivrsTcse_TAhVM1hoKHT31BUUQjRwIBw&url=https://pimminag.com/tag/heaven/&psig=AFQjCNG1D3GKgbLkLut59pEAqZpcAdU8Rg&ust=1494851218418784

Disruptions in the attachment bond

Emotional inaccessible/ unavailable



https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwje8eP-su_TAhXT0RoKHSJyDEAQjRwIBw&url=https://www.someecards.com/usercards/viewcard/MjAxMi03NTI5ZWFmZTkwNjE4MWIz/&psig=AFQjCNFl16HIVDg0MnXIWpzvffDWG9TIsA&ust=1494851607437413

Quality of the attachment

relationship



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjezIilhIHUAhXCbFAKHVl0BMsQjRwIBw&url=http://trauma.blog.yorku.ca/2013/03/a-war-vets-best-friend-cutting-the-cost-of-ptsd-service-dogs/attachment-parenting-feature-pic/&psig=AFQjCNFMHAvMY0b1zGB87SKTCo3C2crlhQ&ust=1495457511262625

The quality of parenting

– Attunement

• Sensitive responsiveness

• Reflective functioning

• Mentalization

• Containment

• Play

– Balance

• External regulation



Features of EAT ?

• Early attachment trauma?– Caregiving relationship

– Early

– Repetitive

– Chronic (over time)

– Multiple

• EAT and the overlap with complex trauma– Interpersonal stressor

– Multiple

– Repeated

– Cumulative

– Developmentally vulnerable times

39

Developmental Consequences of

EAT

• Developmental immaturity along five core

dimensions of development: (Pia Mellody)

– self esteem (less than versus better than),

– boundaries (too vulnerable versus invulnerable),

– reality issues (bad/rebellious versus good/perfect)

– dependency (too dependent versus

needless/wantless)

– moderation (too little versus too much self-control)

40

Consequences of EAT

• Affectregulation

• Attachment style ( IWM)

• Body

• Neurobiology

• Sense of self

• Cognition

• Dissociation

41

EAT and affectregulation



https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiIk7HY5a3SAhVIshQKHT17BUsQjRwIBw&url=https://eatdrinkfilms.com/2015/06/26/inside-out-emotional-regulation-101/&bvm=bv.148073327,d.d24&psig=AFQjCNEGQ4bOM9CFMvuiQoqrqhHKBm0e1Q&ust=1488199582362231

EAT and affect regulation

• Jaak Panksepp (1998, 2009) Affective Neuroscience – 7 emotional circuits at birth

– Subcortical neurocircuitry of the mammalian brain

– Environmental experiences.

– EAT ➔the circuits don’t flow

– EAT ➔ no integration ➔ dissociated states

– EAT ➔ no self

– EAT ➔ no embodiment

43

EAT and Internal Working Model



EAT and Internal Working Model

– Internal working model (IWM)

• Memories of attachment interactions →accessibility

• Mental representations of self/others

• Cognitive structure

• Typical emotions

• Implicit memory

• Open to modification

45

EAT and cognition



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiN8dfdla7SAhVcFMAKHZVqCPoQjRwIBw&url=http://cognitivebridges.com/category/cogblog/&bvm=bv.148073327,d.bGs&psig=AFQjCNHtmRGcH_DZtFlgtxSOLD-ol3zSXA&ust=1488212388739748

EAT and cognition

• Negative IWMs of self:

– Increased appraisals of normal life circumstances as

threatening

– Difficulty in suppressing thoughts

– A tendency to devalue oneself in threatening situations

• Negative IWMs of others:

– failure to suppress when the individual is

experiencing high cognitive loads

47

EAT and the body



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwi9yIb4lK7SAhWpJ8AKHYI7CNsQjRwIBw&url=http://bigvoicepictures.com/blog/2016/02/18/healing-the-whole-body-for-abuse-and-trauma-survivors/&bvm=bv.148073327,d.bGs&psig=AFQjCNFOaTKaAzJPqIdCR8oa9ymFDveTiQ&ust=1488212142823864

EAT and the body

• Attachment dynamics play out at the physical level

• Via the body-to-body communication

• The nature and quality of the attachment relationship.

• Ways in which a mother relates to

and responds to her own physical and bodily needs

• The child relate to his own body.

• Sense of bodily sense

49

EAT and dissociation



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiYgLqFlq7SAhWqJsAKHcSPA-8QjRwIBw&url=http://keywordsuggest.org/gallery/805216.html&bvm=bv.148073327,d.bGs&psig=AFQjCNGU-nwK7lZJQczUxluGdmwoeLuC5g&ust=1488212579044103

EAT and dissociation


Attachment insecurity

Disorganized attachment

Dissociation

51© Traumacenter Belgium -

www.traumacentrum.be- Doris D'Hooghe

Dissociation

• Liotti’s:

“Failure in organizing multiple and incongruent

models of the self and other

into unitary mental states and coherent

behavioral states

rahter than an intrapsychic defense against

unbearable pain and severely traumatic

experiences”



EAT and needs

• Babies require a constant stream of “emotional, spiritual, psychological, and physical inputs” (Mary Jo Barrett )

• Left without this input stream learns that its own hard-wired biological needs are terrifying.(Dr. Daniel Siegel)

• Babies are also hard-wired to be flooded with stress chemicals when those needs are not met, (Dr. Bruce Perry)

• The emotional pain and terror are so intense that the child will do anything to distract itself from those needs

• The fight-or-flight stress chemicals flood the bloodstream at a level which feels so terrifying.



54

http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjgwP_op6PRAhWDOlAKHRAPAU8QjRwIBw&url=http://herb.co/2016/02/27/if-you-get-anxiety-when-smoking-you-need-to-watch-this/&psig=AFQjCNHhaR1burjXC9J9A7IgMzj23NjenQ&ust=1483440668284098

Anxiety

• “Anxiety” and “fear”

• Separate entities in the neuroscientificcommunity.

• Fear is the physiological reaction to something in our external or internal environment.

• Anxiety on the other hand is the psychological and emotional reaction to the afore mentioned environmental stimulus.

• Anxiety is the conscious worry and sense of subconscious unease

55

Consequences of EAT resulting in

anxiety disorders• Affectdysregulation➔Affectphobia

• IWM ➔Social Phobia/ Fear of failure

• Cognition ➔OCD

• Body ➔Hypochondria/ Health anxiety

• Dissociation➔Anxiety disorders



EAT ➔Affectdysregulation ➔

Affectphobia



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwi2v6LCyOLSAhUKPhQKHSTRDbAQjRwIBw&url=http://relatie.blog.nl/aantrekkingskracht-2/2010/04/06/hoe-jouw-lijf-laat-weten-dat-je-hem-wel-ziet-zitten&bvm=bv.149760088,d.ZGg&psig=AFQjCNGHmePPVWJBmRCttRTyzAOHkISmqw&ust=1490012810546878


Affectphobia• Affect regulation

– awareness of the feeling

– identifying what it is/ name it

– the modulation of that affective experience

• When not achieved

the arousal generated by that affect remainsunmodulated as well

Anxiety




Affectphobia

• EAT = lack of contingent and responsive

mirroring

• Affectdysregulation

• Emotions are feared

• Anxiety prompts an defensive reaction

• Defense push the feeling back down

• Safety is restored




Affectphobia

• Triangle of conflict



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiX87ONrpLRAhWZcVAKHfPiAYkQjRwIBw&url=http://www.dynamictherapysouthbay.com/&psig=AFQjCNGnFKeU928WNUIINyjFSBy4hf5GYg&ust=1482858537074853

EAT ➔ IWM ➔Anxiety



https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjfidzcx-LSAhUDwxQKHe1vBOQQjRwIBw&url=https://www.theodysseyonline.com/poems-read-anxiety&bvm=bv.149760088,d.ZGg&psig=AFQjCNHiBllORWMPBbBCk9buJ5RMQhPHHw&ust=1490012593945600

EAT ➔ IWM ➔Anxiety

62

• Dismissive style and anxiety= dealing but notfeeling

Sacrifies his affective life

Minimize the importance of the relationship

Fear of closeness

Suppressing his emotional charge



EAT ➔ IWM ➔ Anxiety

• Preoccupied style and anxiety = “ feeling but not dealing”

Cannot let go relationnaly

Cannot modulate own affect

Relational maintenance

Cost his independent functioning and exploration

To much anxiety

Separation anxiety

Grief, anxiety and defensive exclusion of anger



EAT ➔ IWM ➔ Anxiety

• Fearfull style and anxiety= “not feeling not dealing”

Intense anxiety

Rupture the organization of:

➔cognition

➔ Behavior

Fragment the integrity of the self

Dissociation and splitting

Prevent more dis- integration





https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiN0Yyj9-vPAhXH0RoKHfDvBsQQjRwIBw&url=https://quotesgram.com/funny-quotes-about-anxiety/&bvm=bv.136499718,d.d2s&psig=AFQjCNEZrqu9i_sq-xEugq-awBkxBHHtFQ&ust=1477140437036203

EAT ➔ IWM ➔Social Phobia

• EAT

• Lack of appropriate response when the child is

– Frightened

– Threatened

– Seeks proximity

• World = threathening and unsafe

• Self = incompetent in different life domains




• Attachment anxiety• Negative feelings about the self

– Low self esteem/Worthlesness

– Incompetence

– Danger

– Shame/ Quilt

• Negative feelings about others– Others will lack acceptance and support

– Give rise to perfectionism• Perfect social performance

– To assure acceptance

– To ensure loss will not happen

• Hypervigilance to threat




• IWM:

– Feelings

– Thoughts

• Projection of feelings and thoughts to anotherperson

• Believe the other feels/ think that way aboutyou

• Causes anxiety

• Withdrawal and avoidance



EAT➔ Insecure attachment➔

Fear of failure



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjh5tHjspLRAhWWN1AKHQ3vB04QjRwIBw&url=http://anxietytobik.blogspot.com/2015/01/anxiety-definition.html&bvm=bv.142059868,d.d2s&psig=AFQjCNGLUIyOCXPkuEDDWxZGa46q-wK43A&ust=1482860025370092

EAT➔ Insecure attachment➔

Fear of failure

• Lack of secure base

• Ongoing concerns about attachment security

• The caregiver not being available, accepting orunconditionally responsive

• Not safe enough to explore

• Avoidance of danger

• Avoidance of failure

• Fear of failure



EAT➔ Parent-child role- confusion



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiR-u2unJDUAhXIblAKHf5mCJAQjRwIBw&url=http://mediationtea.com/dialogue/question-of-the-day/parentification/&psig=AFQjCNHr6_OFBjyagHodEdcZatP9HhN07w&ust=1495979367955059

EAT➔ Parent-child role- confusion

➔ Fear of failure

72

• EAT

• Lack of secure base

• Disorganized attachment

• Role reversal (the child behaves like a parent towards the caregiver)

– Punitive behavior

– Caregiving behavior

• e.g., the child assists, guides, encourages, soothing, or is overly cheerful or solicitous

• Failure experiences



EAT➔ Parent- child role-

confusion➔Phobia

• EAT

• Withdrawn behavior caregiver

• Child as parent

• Stay close to the parent

• To comfort, guide, soothe…

• Social phobia

• Schoolphobia



EAT and health anxiety



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj18tzQs6PRAhWCdVAKHfxhDf0QjRwIBw&url=http://8ballpoolforum.miniclip.com/discussion/4162/fun-to-look-at-funny-happy-images-no-political-conspiracy-of-any-kind/p21&psig=AFQjCNFW4YTB447qiA2SUrqiqkNf2WN6dQ&ust=1483444463447334

EAT and health anxiety

• Caregiver not securely attached to his body

– Negative body image with rejection

– Neglecting the body needs

• Child is deprived of the safety, security, and containment

• Physical needs left unattended

• Resulting in an insecure body attachment

• Vulnerability to concerns about bodily functioning

• A way to seek help from those who were unresponsive ( “attachment cry”)



EAT and Obsessive Compulsive

Disorder (OCD)

• OCD➔ Intrusive thought

➔appraised as dangereous or threathening

➔ need to be neutralized

➔ obsession

• Attachment is fundamental in formation of

IWM of self and others.

• May influence the development of obsessive

beliefs



EAT and Obsessive Compulsive

Disorder (OCD)• IWM :4 domains

– Self- esteem:• I’m bad

• I’m worthless

– Competence• I’m a failure

• I can not do it

– Safety• I’m in danger

• I will die

– Responsibility• It is my fault

• I am guilty





http://potentialz.com.au/narrative-therapy/

Anxiety treatment = Trauma

treatment• Phase-oriented:

– Stabilization phase

– Confrontation phase

– Integration phase

• Anxiety = 4 levels– Physiology: Heart rate/ fatique/ stomach pain/ muscle

tension/ numbing/ nausea

– Cognitive: Self- critical/ fearful/ catastrophizing/ forgetfullness/ concentration

– Emotional: Fear/ worry/ anger

– Behavioral: Avoidance/ impulsivity/ trembling voice/ avoiding eye contact/ fiht- flight- freeze



Case

• Child ( 8 years) was referred to me for:

– anxiety especially in his room with nightmares and

frightening dreams

– Another aspect of the anxiety was fear of failure

which manifests itself in the school

– separation anxiety, he doubt whether his mother

loves him



Phases of the treatment model

Case- conceptualization


• Stressful events in the relationship:– birth trauma

– disruptions in the attachment bond

• Quality of the relationship:– quality of parenting

– dismissive attachment style of the mother

• Events outside the relationship:– traumatic childbirth mother

– relationship problems

– absence of the father

– loss experiences

Stabilization



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjSxfek-NXRAhXI1hoKHcBKDHwQjRwIBw&url=http://www.mystock118.com/2015/12/23/chinas-earliest-economic-indicators-show-signs-of-stabilization/&bvm=bv.144686652,d.d2s&psig=AFQjCNHJAP5Gy_-ToaRYLkNfTFk7INLazQ&ust=1485180939343650

Therapy: Calming the physiology

• Recognizing the anxiety symptoms in the

body.

• Write down what you feel in your body when

experiencing anxiety.



Therapy: Calming the physiology



https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiIx86A-7bQAhWDtBoKHWmDDeIQjRwIBw&url=https://mossavi.wordpress.com/tag/my-feelings/&psig=AFQjCNEwQVp1iTGNR4zHHQev_EWhtwMMJA&ust=1479717455015998

FAFA: First aid for anxiety

• Grounding

• Breathing

• Here and now

• Dual awareness

• Safe place



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwjF2OW9svjbAhUQ16QKHaBwC-sQjRx6BAgBEAU&url=http://www.elvingtonscoutgroup.org.uk/?tribe_events=cubs-first-aid-badge&psig=AOvVaw1_XwwgD0L-7MxgRDxZbyFB&ust=1530345175651138

Therapy: calming the physiology

• Grounding:



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjgsemC7JbRAhXPM1AKHY61C-AQjRwIBw&url=http://www.wikihow.com/Ground-and-Center&bvm=bv.142059868,d.d2s&psig=AFQjCNGKNTdEACdx2mKerzK2gASDEUOsVA&ust=1483012782354972

http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj96cDZ7JbRAhXYIFAKHVGUCVsQjRwIBw&url=http://www.alustforlife.com/soul/compassion/ways-to-ground-yourself-to-inner-calmness&bvm=bv.142059868,d.d2s&psig=AFQjCNGKNTdEACdx2mKerzK2gASDEUOsVA&ust=1483012782354972


• Diafragmatic breathing



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj2kYWN65jRAhUDeFAKHSunCUYQjRwIBw&url=http://mygospelworkers.org/mgwministry/health/eight-doctors/pure-air/&psig=AFQjCNGRolJFch4Wp5nDwvasGluDm7o6Qg&ust=1483081219610857


• Diafragmatic breathing



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj6i5_9pvHSAhUL1RQKHeM8ADAQjRwIBw&url=http://zoom.nl/foto/portret/bellen-blazen.2393835.html&psig=AFQjCNGJbxX9-jX8EgfDBIEBdTSLnEwinQ&ust=1490519223065538

http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjg05uwp_HSAhVElxQKHfBHCowQjRwIBw&url=http://www.zavelput.be/peuterklas/category/thema/page/3/&bvm=bv.150729734,d.ZGg&psig=AFQjCNEWVQcORPLpOzXNzpLJMEcOMxeZew&ust=1490519280884061




http://notsalmon.com/2016/04/06/quotes-about-anxiety-and-lowering-stress/


• Grounding: the tree exercise



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj_xKWk65bRAhVXIFAKHYD2DS4QjRwIBw&url=http://balancedwomensblog.com/tag/grounding/&bvm=bv.142059868,d.d2s&psig=AFQjCNGKNTdEACdx2mKerzK2gASDEUOsVA&ust=1483012782354972


• Grounding:

– Eat or drink something

– Nature

– Chewing gum

– Gardening

– Cooking

– Drumming



Dual awareness



https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwiCr5WWsp7RAhUZMFAKHUOhDU8QjRwIBw&url=https://www.tumblr.com/tagged/frequently+experienced&psig=AFQjCNGthbZzlkf3unHhMzw7viJPb1NRaQ&ust=1483272333299648

Safe place



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwi1prXwgcXMAhUE6xoKHW_jCugQjRwIBw&url=http://www.psycho-consult.nl/rdi.html&psig=AFQjCNF7ic_8rDQAyoD0sZ3GIgN4XaOaDQ&ust=1462609143308956

Safe place script

• Image an Actual or Imaginary place with positive associations, where s/he feels safe, comfortable, peaceful or calm.

• Enhancement– What do you see/ hear/smell/taste/feel

• Say: “I know that I’m save”

• Say: “ I feel safe”

• Which sensations do you experience in your body right now?

• Cue word




Long term

• Meditation

• Relaxation

• Yoga

• Safe touch

• Sports/ movement



Therapy: Affectregulation



https://www.google.be/imgres?imgurl=http://cdn.24.co.za/files/Cms/General/d/1285/1050e0bbecf44955ab533cffd4e677f4.jpg&imgrefurl=http://www.parent24.com/Baby/Sleeping/6-reasons-why-your-baby-wont-sleep-20120726&docid=hol7EuPtcXluDM&tbnid=M6BW3L_aP1Dk9M:&vet=1&w=300&h=300&bih=911&biw=1920&q=affect regulation&ved=0ahUKEwiDtObk-NXRAhXFChoKHSvfBX44yAEQMwgIKAYwBg&iact=mrc&uact=8

Affectregulation: Awareness of the

feeling/ name it



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=0ahUKEwj_jPTAuZLRAhXaN1AKHRgpBywQjRwIBw&url=http://findyourinnerhappy.com/the-ultimate-emotional-survival-guide-for-empaths-hsps/&bvm=bv.142059868,d.d2s&psig=AFQjCNHlqA19jvJswSB7FAYmPQbpYe8wfQ&ust=1482861921592443

Emotional flooding



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwidx4GJuZLRAhXZclAKHclpAP8QjRwIBw&url=http://www.express.co.uk/news/uk/418914/Flood-plan-to-stop-city-swamping&bvm=bv.142059868,d.d2s&psig=AFQjCNHa5kDnRK-KLAP6rVRH42JdAEjaOQ&ust=1482861794553306

Down regulation

• Perceive bodily signals (interoceptive

sensitivity)

• Use reappraisal

• Name the emotion

• Increase the opposite feeling

• Changing our bodies ( rest)



Emotional blocking



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjk5Pi8u5LRAhXUc1AKHdBcAqwQjRwIBw&url=http://www.dupre.co.uk/high-speed-internet/beat-the-freeze-on-new-internet-orders/&bvm=bv.142059868,d.d2s&psig=AFQjCNGrtJvVVeBzAeFXHPaLbA-1EPr2_g&ust=1482862472867268

Up- regulation

• Focus on humor

• Think about a positive experience

• Focus on a certain aspect of the situation

• Express positive feelings

• Share your feeling with others

• Build on positive experiences

• Increase the number of pleasant things

• Focus on goals

• Build a life worth living

• Changing our appraisals of a situation.

• Modulating our responses in the situation.



Therapy: Cognition



https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwidj4bs-dXRAhVJVhoKHXNfCnMQjRwIBw&url=https://www.psychologytoday.com/blog/the-athletes-way/201403/eight-habits-improve-cognitive-function&bvm=bv.144686652,d.d2s&psig=AFQjCNE3yzwiGN9Gt2hO2SL9g4dVua_Hrw&ust=1485181239369951

Therapy: Cognition

• Stop!

• Container exercise



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjWyLT3vb_SAhXG1RQKHR0RAD0QjRwIBw&url=http://www.armoonbourse.com/%D8%A7%D8%AE%D8%A8%D8%A7%D8%B1-%D9%88-%DA%AF%D8%B2%D8%A7%D8%B1%D8%B4-%D8%A8%D8%A7%D8%B2%D8%A7%D8%B1/ArtMID/15393/ArticleID/200/%D8%AA%D9%88%D9%82%D9%81-%D9%87%D8%A7%DB%8C-%D8%A7%D9%85%D8%B1%D9%88%D8%B2&psig=AFQjCNE8lg6qVayenXFJgrpP36uppmnGVg&ust=1488807253585889

http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiKhrzsvr_SAhWE1hQKHbiODcwQjRwIBw&url=http://www.merford.com/en-gb/markets/maritime-ports/container-handling/&bvm=bv.148747831,d.ZGg&psig=AFQjCNHhr8sQYukGtENIzET0jChgwoVCGg&ust=1488807551390538

Sorrow eater



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjD4e6ls_fTAhUFY1AKHV3UBgAQjRwIBw&url=http://mybaba.com/an-interview-with-gerd-hahn-inventor-of-sorgenfresser/&psig=AFQjCNGsgS7xKHwTCQesFqoES8DXGBooyQ&ust=1495126743129459

Therapy: Cognition

• Distraction (do something!)

• Another thought



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiwt9ixv7_SAhWB8RQKHUmvC6oQjRwIBw&url=http://www.trickntrick.com/2014/03/easy-way-to-make-money-online-listening-to-music/&bvm=bv.148747831,d.ZGg&psig=AFQjCNHnUBxKNgcwCpn8aVy7QTK3SLuCBQ&ust=1488807772927019

https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiE99Hev7_SAhVIvhQKHf5pDcQQjRwIBw&url=https://www.theodysseyonline.com/books-are-valuable&bvm=bv.148747831,d.ZGg&psig=AFQjCNHMxgqawkeY3P3lABFMAoMxOMLeEg&ust=1488807863142277

http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwib_bGI1L_SAhWFqxoKHbHsAmEQjRwIBw&url=http://www.coolmath-games.com/0--sudoku&bvm=bv.148747831,d.ZGg&psig=AFQjCNGWT7NIO_Fy4lqQ_pEC8PXFqqRDuA&ust=1488813307249449

https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiN_dbv1L_SAhXE7hoKHbxXAGUQjRwIBw&url=https://openclipart.org/detail/223115/multiple-thoughts-man-line-art&bvm=bv.148747831,d.ZGg&psig=AFQjCNEruHWM_c3lD-GZNstgmSoC_69rgg&ust=1488813441594123

Restructuring the internal

working model: Dis-identification

108

http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwibven0vMDMAhXHaRQKHYmoCPkQjRwIBw&url=http://ikweetnietmeerwatikwil.nl/blog/2014/05/22/leer-jezelf-kennen-mediteer/&psig=AFQjCNGBMETIoP2WcBvcXSGRx9b3zG2EGg&ust=1462453082657950

Dis- identification

• I have a body, but I am more than my body. I am the one who is aware: the self, the center. My body may be rested or tired, active or inactive, but I remain the same, the observer at the center of all my experience. I am aware of my body, but I am more than my body.

• I have emotions, but I am more than my emotions. Whether I feel excited or dull, I recognize that I am not changing. I have emotions, but I am more than my emotions.

• I have an intellect, but I am more than my intellect. Regardless of my thoughts and regardless of how my beliefs have changed over the years, I remain the one who is aware, the one who chooses--the one who directs my thinking process. I have an intellect, but I am more than that.

• I am a center of pure awareness. I am the one who chooses. I am the self.



Reconnecting with the body



http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiLr9nh_dXRAhWIMhoKHcQGA4cQjRwIBw&url=http://www.sparklebox.co.uk/6631-6640/sb6633.html&bvm=bv.144686652,d.d2s&psig=AFQjCNHzbt_AOfvHi4mBx36aJAoaD2zWdA&ust=1485182368258816

Reconnecting with the body

• Safe touch

• Bodyscan

• Chacrawork

• Peter Levine

• Pat Ogden



Reconnecting with the body/ Peter

Levine

• The goal of Self- Holding:

– To calm the nervous system

– Bring the Self back into the body

– Develop more body awareness

– Train one’s own nervous system to remember what

normal is like.



Somatic experience/Peter Levine

• Self- holding



http://www.new-synapse.com/aps/wordpress/wp-content/uploads/2013/09/soothing-hand_background12.jpg

http://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj-jJvCj67SAhVGcRQKHSN5AksQjRwIBw&url=http://www.new-synapse.com/aps/wordpress/?p=207&psig=AFQjCNG_SPnnaZsm5Y4Mjikupf4Q8uKoTQ&ust=1488210823904758

Somatic experience/ Peter Levine

• Self hug

• Goal: To feel the body as container. To

develop our container.



http://www.new-synapse.com/aps/wordpress/wp-content/uploads/2013/09/p_levine_selfholding-border.jpg



https://www.google.be/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjly8_1-OvPAhUH1BoKHTqDB2UQjRwIBw&url=https://www.pinterest.com/explore/funny-quotes/&bvm=bv.136499718,d.d2s&psig=AFQjCNF_tkPJlmmvUAOUKSRF77Iaj2aIiA&ust=1477140784300520

“Mom, there’s a monster in the closet” - attach.org · dimensions of development: (Pia...

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