1

SASH

The Society for the Advancement of Sexual Health

National Conference

Boston, MA - September 30 - October 3, 2010

Taruno SteffensenICADAC - International Certified Alcohol and Drug Abuse Counselor

SEP - Somatic Experiencing Practitioner

tsteffensen@themeadows.org

Trauma and the Challengeof

Sexual Addiction

Trauma and the Challengeof

Sexual Addiction

2

Core Assumption I

Fisher, 2007

In the context of trauma, sexual addiction arises not as a pleasure-seeking strategy but as a survival strategy:

• To self-soothe and self-regulate

• As a way to numb hyperarousal symptoms: intolerable affects, reactivity, impulsivity, obsessive thinking

• In the service of walling off intrusive memories

• As a way to combat helplessness by increasing hypervigilence and feelings of power and control

• To “treat” hypoarousal symptoms of depression, emptiness, numbness, deadening

• In the service of facilitating dissociation

• As a way to function or to feel safer in the world

3

Core Assumption II

Fisher, 2007

How the addictive behaviors have helped trauma patients to survive: that is, which trauma symptoms are they attempting to treat through their drinking, drugging, eating disorders, and sexually acting out behaviors. We need to know this information for a number of reasons:

• First, we need to know because these are precisely the symptoms that will increase once the patient becomes sober or abstinent

• We need to know, too, so that we can begin to anticipate other coping strategies they will need in order to deal with those symptoms as they erupt and threaten to overwhelm them

• Furthermore, we need to be able to predict when and how the symptoms may potentially trigger a behavior relapse so that we can help them strengthen the addictions recovery program they have chosen

• And finally, we also need to know so that we can help the survivor appreciate their courageous attempts to cope with the effects of the abuse and, from that recognition, develop sufficient compassion and self-respect to counteract the shame and guilt that is the inevitable byproduct of their addictions and trauma history

4

What is Trauma?

“Trauma is experiencing too much, too fast, too soon.”

5

What is Trauma cont?

Trauma is perhaps the most avoided, ignored, belittled, denied, misunderstood, and untreated cause of human suffering. Although it is the source of tremendous distress and dysfunction, it is not an ailment or a disease, but the by-product of an instinctively instigated, altered state of consciousness. We enter this state - let us call it survival mode - when we perceive that our lives are being threatened. If we are overwhelmed by the threat and are unable to successfully defend ourselves, we can become stuck in survival mode. This highly aroused state is designed solely to enable short-term defensive actions; but left untreated over time, it begins to form the symptoms of trauma.

Peter Levine

6

Somatic Experiencing

7

Trauma and the Brain

8

“The imprint of the trauma is in the limbic system and in the brainstem: in our animal brains, not our thinking brains”

Bessel van der Kolk

9

The Triune Brain

x

10

• “[Traumatized] patients ... are [repeatedly] continuing the action, or rather the attempt at action, which began when the thing happened, and they exhaust themselves in these everlasting recommencements.”

• 1919/25, p. 663

Pierre Janet1859-1947

11

“Bottom-up, The Hi-Jacked Brain”

Janina Fisher, 2007

Everyday experiences connected to the trauma will trigger instinctive survival responses: fight, flight, freeze, collapse

and numbing, dissociation, re-enactment behavior. The client’s animal brain takes over, the ability to think goes “off

line,” & sexually acting out behavior takes place without conscious intention or judgment, even without awareness!

12

Normal Response

Trauma Response

Amygdala

Fight, Flight or Freeze Response

Visual Cortex

Trauma vs. Intimacy

13

“Trauma originates as a response in the nervous system, and does not originates in an event. Trauma is in the nervous system, not in the event.”

Peter Levine

14

The Polyvagal Theory

by

Stephen Porges, PhD

www.stephenporges.com

Brief Overview of theBrief Overview of theAutonomic Nervous SystemAutonomic Nervous System

15

The Parasympathetic Nervous System The Sympathetic Nervous System

Trauma may result in the PNS staying “on”, which causes it to superimpose shutdown over the hyperarousal of the SNS, rather than discharging its energy.

The SNS gets our whole body ready for action. It regulates arousal. It increases activity during times of stress and arousal – whether positive or negative. It is active when we’re alert, excited, or engaged in physical activity. It prepares us to meet emergencies and threat.

The Parasympathetic branch acts like the brake pedal for our nervous system. It helps us to relax, unwind and ultimately discharge the arousal of sympathetic activation.

The Sympathetic branch is like the gas pedal of our nervous system. It gives us energy for any action we plan, and it helps us prepare for threat.

16

The Polyvagal TheoryBy Stephen Porges

The Vagus Nerve in three parts, all working

simultaneously:

Ventral Vagal System: Is part of the Parasympathetic Nervous

System (Social Engagement/frontal cortex)

Sympathetic Nervous System:(Fight/Flight, Freeze - Limbic Brain)

Dorsal Vagal System: Is part of the Parasympathetic Nervous

System(Freeze/Immobility/Brainstem)

17

18

Social Engagement

Fight, Flight, Freeze

Immobility

Safe

Danger

Life Threatening

Ventral

Vagal

Sympathe

ticNervous System

DorsalVagal

System

19

Edvard Munch“Scream”

20

Sympathetic Hyperarousal

Parasympathetic Hypoarousal

Autonomic Arousal is Designed to Adapt to Environmental Demands

Window of Tolerance

feelings can be tolerated, able to think and feel

easy charge

easy discharge

sympathetic

parasympathetic

Foundation of Human EnrichmentOgden and Minton (2000)

AROUSAL

21

Parasympathetic Hypoarousal

Stuck on “ON”

Stuck on “OFF”

• Hyperactivity• Panic• Rage• Hypervigilance• Elation/Mania

• Depression• Disconnection• Deadness• Exhaustion

Foundation of Human EnrichmentFisher, 2006

Window of Tolerance

Optimal Arousal Zone

Autonomic Adaptation to a Threatening World

AROUSAL

Sympathetic Hyperarousal

22

Parasympathetic Hypoarousal

Foundation of Human EnrichmentFisher, 2006

Window of Tolerance

Optimal Arousal Zone

How Sexual Addiction Modulates and “Medicate” Complex PTSD to attempt Self-Regulation

Sexually Acting out

Sexually Acting in

AROUSAL

Sympathetic Hyperarousal

23

Treatment must address the relationship between the trauma and the addictive behavior: the role of the addictive behavior in “medicating” traumatic activation, the origins of both in the traumatic past, and the reality that recovering from either requires recovering from both

The Challenge of Trauma and Sexual Addiction

Fisher, 2007

• Van der Kolk, Bessel, (1996) Traumatic Stress. New York: The Guilford Press.

• Ogden, Pat, (2006), Trauma and the Body. New York: W.W. Norton & Company, Inc.

• Fisher, Janina, (2008), Addictions and Trauma Recovery

• Porges, Stephen, 2006), How your nervous system sabotages your ability to relate. www.nexuspub.com

• Levine, Peter, (1997), Waking the Tiger. Berkley, CA, North Atlantic Books.

24

Bibliography