Resilience PHASE based approach for the treatment of ... · PDF fileResilience PHASE based...

Developing Compassionate Resilience

PHASE based approach

for the treatment of Complex PTSD?

Attachment ruptures

Abuse

Massively Inappropriate parenting

Dr Deborah Lee 2013 Newcastle

ISTSS Expert reference definitions

PTSD symptoms •Intrusion •Avoidance •Hyperarousal

Self regulating capacities --- threat system - attachment •Emotion regulation difficulties •Disturbances in relational capacities •Alterations in attention and consciousness •Adversely affected belief systems •Somatic distress or disorganisation


Preparing the mind the work with trauma memories

Phased based Approach Lee 2012

TFCBT/NET/EMDR Psychoeducation Compassionate

resilience

Phase I Phase II Phase III

Reclaiming life

Phase IV

Recovery

CI

SI

MI

SB MI


The need for Compassion

CFT model (Gilbert, 2005) • Ability to access positive affiliative emotions

– vital role in regulating negative or threat-based emotions

• Self compassion – reduced self criticism and depression increase positive affect, curiosity, optimism life satisfaction agreeableness – Neff, 2003, Neff, Kilpatrick & Rude, 2007,Neff, Rude & Kilpatrick 2007

• People who are less able to generate positive affiliative emotions are ?? more vulnerable to psychological difficulties. – (early experiences of neglect or trauma, care giving and attachment

relationships may be highly threat-focused)

• Are they less able to benefit for CBT – cant feel reassured by what they

know


Types of Affect Regulator Systems (Paul Gilbert)

Incentive/resource

focused

Seeking and behaviour

activating

Dopamine (?)

Affiliative focused

Soothing/safeness

Opiates (?)

Threat-focused

safety seeking

Activating/inhibiting

Serotonin (?)

Anger, anxiety disgust

Drive, excite, vitality Content, safe, connect


Compassion within healthy attachments

Inner abilities that allow us to maintain a cohesive and coherent sense of self (Pearlman & McCann, 1994)

1. To maintain an inner sense of positive connection with others-

AFFILIATION

2. To maintain a sense of self as viable, benign and positive – LOVABLE

3. To experience, integrate and tolerate feelings

COMPASSIONATE self soothing to regulate affect

4. Have experiences of internalised loving others COMPASSIONATE IMAGERY – inner working recipricol roles


Underdeveloped self compassion as a consequence of poor attachments

• Difficulty with the connection with internalised others • Difficulty with self soothing, expression of profound isolation,

experience of self as oddly different, hiding self from others • Development of internal compassionate images?

• Underdevelopment of self worth? • Self denigrating statements, lack of self care, substance abuse,

isolation • Development of compassionate self talk, compassionate

problem solving, compassionate motivation to care

• Underdevelopment of affect tolerance? • Dissociation, self harm, aggressive behaviours, substance

abuse, affective lability, numbing • Developing of compassionate feelings, compassionate

problem solving


Mary Background

• Lack of parental care

• Lack of maternal protection and warmth

• Physical violence – self and parents

• Early exposure to trauma

• Sexual assault

• Emphasis on achievement

• Not emotionally cared for, not loved, not protected, deliberately hurt

• Letting family down – family shame, internal & external shame

I DON’T MATTER –THE WORLD ISNT SAFE – OTHER PEOPLE ARE DANGEROUS


Does Mary have self compassion?

Can she regulate shame based experiences in helpful ways?


Compassion within healthy attachments

Inner abilities that allow us to maintain a cohesive and coherent sense of self (Pearlman & McCann, 1994)

1. To maintain an inner sense of positive connection with

others- AFFILIATION Mary has an absence

2. To maintain a sense of self as viable, benign and positive – LOVABLE

Mary has an absence 3. To experience, integrate and tolerate feelings

COMPASSIONATE self soothing to regulate affect Mary has an absence

4. Have experiences of internalised loving others COMPASSIONATE IMAGERY – inner working recipricol roles Mary has an absence


Underdeveloped self compassion as a consequence of poor attachments

• Difficulty with the connection with internalised others • Difficulty with self soothing, expression of profound isolation,

experience of self as oddly different, hiding self from others • Development of internal compassionate images?

• Underdevelopment of self worth? • Self denigrating statements, lack of self care, substance abuse,

isolation • Development of compassionate self talk, compassionate

problem solving, compassionate motivation to care

• Underdevelopment of affect tolerance? • Dissociation, self harm, aggressive behaviours, substance

abuse, affective lability, numbing • Developing of compassionate feelings, compassionate

problem solving


Self critical

Dialogues

Shame

Compassion/

Safeness

Self soothing

Dialogues/

Compassionate

imagery

Maintains Ends

Turning off the threat system From the care giving mentality

From the competitive mentality


Phased based Approach Lee 2012

TFCBT/NET/EMDR Psychoeducation Compassionate

resilience

Phase I Phase II Phase III

Reclaiming life

Phase IV

Recovery

CI

SI

MI

SB MI


Compassionate insight

Compassionate motivation

Compassionate feelings

Compassionate mind sets to problem solve


4 sessions


You are doing the best you to cope with living a life you didn’t intend and its causing you to suffer

• A reality check • Role of evolution • Old brain new brain social brain • Not your fault • One version of you • The formulation Taking responsibility for your life It’s not your fault but sadly its your problem and you can take charge of the changes you want to make in your life by facing your pain and suffering with care and kindness.


The human brain is the product of many millions of years of evolution – a process of conserving, modifying and adapting


New Psychologies Emerge in the World

1 million? Extended caring

Human Symbolic thought and

(2 million?) self-identity, theory of mind, meta-cognition

Mammalian Caring, group, alliance-

(120 million?) building, play, status

Reptilian Territory, fear, aggression,

(500 million?) sex, hunting


why we have complex brains and minds that are difficult to understand regulate

1. Old Brain Emotions: Anger, anxiety, sadness, joy, lust Behaviours: Fight, flight, withdraw, engage Relationships: Sex, status, attachment, tribalism 2. New Brain Imagination, fantasise, look back and forward, plan, ruminate Integration of mental abilities Self-awareness, self-identity, and self-feeling Mindful brain – choosing brain 3. Social Brain Need for affection and care Socially responsive, self-experience and motives

What happens when new brain is recruited to pursue old brain passions? Dr Deborah Lee 2013 Newcastle

Compassion starts with a deep understanding of Not our Fault

Caught in the flow of life – products of personal genes and our evolved and socially shaped mind Socially shaped mind – doing the best we can The source of deep wisdom – the archetypal and the personal in us – one version of the self The concept of ‘enlightened’ cultivation of the mind – the garden


DEVELOP A SCRIPT…….

EXERCISE IN PAIRS


Traumatised Affect Regulator Systems

Incentive/resource- focused

Wanting, pursuing, achieving, consuming

Activating

Non-wanting/ Affiliative focused

Safeness-kindness

Soothing

Anger, anxiety, disgust

Drive, excite, vitality Content, safe, connected

Threat-focused

protection and

Safety-seeking



Wanting to care/receiving care because you deserve it

FBRs

Fear of compassion 11 myths of compassion


BLOCKS AND MYTHS?

Fears


DISPELL THE MYTHS OF COMPASSION USING SCIENCE, COMMON SENSE, HUMANITARIAN KNOWLEDGE…….

EXERCISE


Developing compassionate feelings


Preparing the mind for compassion

• Compassionate smell • Mindfulness practice- ‘coming to your senses’ • Soothing rhythm breathing

Developing compassionate feelings

• Compassion flow exercises • Compassionate imagery • Perfect nurturer


Showing we care


Genuine desire to care and moved by distress of others


Distress sensitive, kind and caring


Warmth


Distress tolerant and empathy


Non judgement – we all struggle


Wisdom and strength


Caring-Compassionate Mind

Care for well-being

Sensitivity Sympathy

Distress tolerance

Empathy Non-Judgement

Compassion

ATTRIBUTE

S

Warmth

Warmth

Warmth

Warmth Dr Deborah Lee 2013 Newcastle

4 sessions


Compassion and problem solving

• State- shame and self-criticism are behaviourally paralysing, generate less effective solutions to interpersonal problems

(Covert et al, 2003)


Caring-Compassionate Mind

Imagery

Attention Reasoning

Feeling Behaviour

Sensory

Care for

well-being

Sensitivity Sympathy

Distress

tolerance

Empathy Non-Judgement

Compassion

ATTRIBUTES

SKILLS -TRAINING

Warmth

Warmth

Warmth

Warmth Dr Deborah Lee 2013 Newcastle

Trauma

Traumatised mind

Attention

Thinking Reasoning

Behaviour

Motivation Emotions

Imagery Fantasy


Using compassionate minds to work with trauma memories

Start each session with accessing the green zone through smell and

exercises


Rescripting shame memories

• Therapist: How do you want to feel?

• Gemma: Powerful, disdainful and control.

• Therapist: What needs to happen for you to feel like that?

• Gemma: I need to see him shrinking, being exterminated, looking very terrified and alone, begging – looking pathetic

• Therapist: Can you hold that in your mind’s eye?

• Gemma: Yes, he’s gone – the pathetic, disgusting little man.

• Therapist: And knowing that, how do you feel?

• Gemma: Good, I feel strong and powerful.


Types of Affect Regulator Systems (Paul Gilbert)

Incentive/resource

focused

Seeking and behaviour

activating

Dopamine (?)

Affiliative focused

Soothing/safeness

Opiates (?)

Threat-focused

safety seeking


Serotonin (?)

Anger, anxiety disgust

Drive, excite, vitality Content, safe, connect


Compassionate Rescript

• Therapist: How do you want to feel? • Gemma: Safe, that it’s not my fault, that I am not dirty. • Therapist: What needs to happen for you to feel like that? • Gemma: I need to focus of the feelings of warmth, care

and kindness I have for myself, I need to focus on the sadness of this memory and to understand how hard this was for me to endure.

• Therapist: Can you hold that feeling in your mind and body?

• Gemma: Yes, I am feeling stronger, he is going and he cant harm me now.

• Therapist: And knowing that, how do you feel? • Gemma: Good, I feel strong and soothed.


The end

•

Thank you and may your

compassion always be in your

casework


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