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Trauma & the Body:Mapping Autonomic Responses for

Assessment and Intervention in Mental Health

presenter:Saj Razvi M.A.

The Trauma Dynamics Program at

Learning Objectives• Learn how to better navigate through your client’s

PTSD by developing an overarching, coherentunderstanding of post traumatic stress

• Understanding the memory systems involved in PTSD

• Be able to map the 5 major autonomic nervous systemstates associated with stress and trauma

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Level of EvidenceEtiology:

• Underpinnings based in memory systems and biological response to threat (autonomic nervous system) research, literature is well established in these areas

Theoretical model: • Has not been falsified in 40 years, continues to explain more current research

findings

Clinical: • No modalities built off of this theoretical model have received the evidence based

designation (somatic modalities not part of mainstream funding and research)• Partially validated with a successful yet uncontrolled pilot study conducted in

partnership with CU Denver• Thousands of anecdotal cases that appear to validate theoretical model• Ultimately, research shows early, positive results. Evidence and validity however

are limited based on limited research trials.

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Imagine a plane flying low over a city and buildings

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What did you have for lunch a week ago today?

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Episodic Memory• Captures significant events in a timeless state (positive or

negative)• Different pathway for encoding and storing memories • Stored as primarily an experiential and visceral “snapshot” of the

event• Can be accessed through verbal means but is fundamentally an

image or experience, may or may not be conscious • Leads to creation of triggers: elements of the event (diesel fuel

for vets) calls forth the entire memory and consequent reactivity• Primary memory system involved in stress and trauma reactions• Primarily responsible for relapse

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Cohen NJ, Squire LR: (1980) Preserved learning and retention of pattern-analyzing skill in amnesia: Dissociation of knowing how and knowingthat. Science 210, 207-209

Procedural Memory• Memory of processes (tie your shoelace, play a

musical instrument, language, character, boundaries)• Non-conscious • Non-verbal• Requires time and repetition to learn, time and

repetition to unlearn• 90% to 95% of character is procedural in nature• Coping mechanisms, self care, self soothing (or lack of

self soothing), attachment style, relapse are all procedurally learned processes

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Cohen NJ: (1984) Preserved learning capacity in amnesia: Evidence formultiple memory systems. In LR Squire & N Butters (eds.)Neuropsychology of Memory. New York: Guilford Press.

Semantic Memory

• Context free factual information• Verbal• Analytic process• Explicit / conscious memory

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Cohen NJ, Squire LR: (1980) Preserved learning and retention of pattern-analyzing skill in amnesia: Dissociation of knowing how and knowingthat. Science 210, 207-209

Memory Systems & Personality

Semantic (declarative)Episodic: (declarative)

Executive functionSelf-observational capacity

Procedural (non-declarative)

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Grigsby J, Hartlaub G: (1994 ) Procedural learning and the development andstability of character. Perceptual and Motor Skills, 79, 355-370

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Research into the nature of traumaticmemories indicates that trauma interferes withdeclarative memory (i.e., conscious recall ofexperience) but does not inhibit implicit, or non-declarative memory, the memory system thatcontrols conditioned emotional responses,skills and habits, and sensorimotor sensationsrelated to experience.

van der Kolk, BA: (1994) The Body Keeps the Score: Memory and Evolving Psychobiology of Posttraumatic Stress. Harvard Rev Psychiatry. Volume 1, Number 5

Trauma Accessed Through Non-declarative Memory

Procedural Memory: Behavioral approachesDBT skill development90 meetings, 90 dayssponsorship, meditation, self regulation skills

Semantic Memory: Talk therapies, insight and self awareness, step work, life coaching, cognitive therapy

Episodic Memory: Accessed via sensation, emotion (autonomic nervous system), experiential therapies (Gestalt), somatic therapies, exposure therapies

Stress & trauma are a bottom up processes occurring in mostly in non-verbal, experiential memory systems

Right Tool for Right Job

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Sensorimotor impulses and nervous system responses are part of episodic memory.

When episodic memory is triggered, sensations and impulses that were part of a past event will feel like symptoms (anxiety, tension, fear, irritation, depression, hopelessness, numbness) in the present moment.

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The Role of the Body

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What is the autonomic nervous system?

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The automatic nervous system

ANS governs many body processessuch as:• heart rate• breathing• metabolism• temperature

Two sub-branches:• sympathetic (fight/flight)• parasympathetic(sleep, calm, depressive, dissociation)

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All mammals share the same basic autonomic nervous system

Porges, SW: (2001) The Polyvagal Theory: Phylogenetic Substrates of a Social Nervous System. International Journal of Psychophysiology 42, 123-146

Mapping the Autonomic Nervous System

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Gellhorn E: (1957) Autonomic Imbalance and the Hypothalamus,Minneapolis : U of Minnesota Press

Levine PA: (1976) Accumulated stress, reserve capacity and disease.Retrieved from http://traumahealing.org/wp-content/uploads/2016/04levin-doctoral-thesis-1976-accumulated-stressreserve_capacity_and_disease.pdf

Wolterstorff EJ: (2003) A speculative model of how groups respond tothreats. Retrieved from https://www.researchgate.net/profileEric_Wolterstorff/publication255670786_A_Speculative_Model_of_How_Groups_Respond_to_Threats/links56e8b26b08ae9bcb3e1cdab5.pdf

Zeeman EC: (1976) Scientific American, (March).

Stress symptoms are adaptive survival responses to threats

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Threat =

Activation of the ANS

The greater the threat, the greater the ANS response

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Threat Level

Activation

0

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•Think of your nervous system as a marble on a track that is being acted on by gravity.

•ANS activation is a state of tension and requires biological energy to maintain.

•The marble seeks the most stable, relaxed, and efficient position possible.

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Marble Metaphor

Threat Level

Activation

0

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• The ANS can retain activation even when the threat has passed.

• This is due to attractor states or “resting places” built into the ANS.

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Threat Level

Activation

0

1 State 1: Mild Stress•Relatively stable•Attracts and holds the marble

State 1 : Mild Stress

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State 1 - Mild StressAdaptive ANS responses / symptoms:

• Increased energy• Fear• Anxiety• Anger• Hyper-alertness• Excitement• Irritability / annoyance• Increased heart rate and

breath speed

• Insomnia• Somatic Tension: tight

muscles, headache or other pain, sensations of heat

• Restlessness or feeling fidgety

• Speedy thoughts• Feeling Nervous

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Threat Level

Activation

0

1State 1: Mild Stress

•Relatively stable•Attracts and holds the marble

State 1 : Mild Stress

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Threat Level

Activation

0

1

2State 2: High Stress

•Maximum activation and performance•Short-duration•Unstable

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State 2 Symptoms – High Stress:Adaptive ANS responses / symptoms Include:

• Panic• Hyperventilation• Heart Racing• Sweating• Shaking, trembling• Overall body tension:

muscles contracting

• Rage• Terror• Maximum performance• Very fast thoughts• Doesn’t last very long

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Threat Level

Activation

0

1

2

State 2: High Stress

•Maximum activation and performance•Short-duration•Unstable

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Stress versus Trauma

Everything we have covered so far is stress –Not trauma.

Stress = Activation in the Fight or Flight, Sympathetic branch of the Autonomic

Nervous System

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Trauma Emerges

• Trauma emerges with overwhelm of the sympathetic system. When active fight, flight responses fail to resolve the threat (I.e when active solutions fail) passive solutions are engaged.

• A massive parasympathetic response emerges.

• Your body starts to shut down, dissociative responses emerge, fragmentation of the psyche

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Threat Level

Activation

0

1

2

Overwhelm point

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State 3: Moderate Trauma

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Stress-induced analgesia has been described in experimentalanimals after a variety of inescapable stressors such as electricshock, fighting, starvation, and cold water swim. In severelystressed animals opiate withdrawal symptoms can be producedeither by termination of the stress or by naloxone injections.

Endogenous Opioids

2 decades after the original trauma, opioid-mediated analgesiadevel- oped in subjects with PTSD in response to a stimulusresembling the traumatic stressor,which we correlated with asecretion of endogenous opioids equivalent to 8 mg of morphine.

van der Kolk, BA: (1994) The Body Keeps the Score: Memory and Evolving Psychobiology of Posttraumatic Stress. Harvard Rev Psychiatry. Volume 1, Number 5

State 3 Moderate TraumaAdaptive ANS Responses / Symptoms include:

• Lethargy• Depression• Sleepiness• Heaviness• Collapsed posture• Lessening muscle

tension• Fogginess /Dissociation

• Sensations of heavy weight

• Feeling cold• Nausea• Confusion• Slow Thoughts• Suicidality• Hopelessness

Alternate or occur simultaneously with State 1 & 2 symptoms

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The Difference between Moderate and Severe Trauma:

A possible solution that didn’t work (state 3) versus absence

of a solution (state 4)

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Threat Level

Activation

0

1

2

Overwhelm point

3State 4: Severe Trauma

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State 4 Severe TraumaAdaptive ANS Responses / Symptoms:

• Blank affect• Numbness• Feeling disconnected• Spaciness• Vision changes:

clouded or tunnel

• Feelings of unreality• Most dissociated state• Out of body

experiences• Floaty • Respite

Absence of State 1 & 2 Symptoms36

Activation

0

1

2

3

4

Hot Symptoms

Cold Symptoms

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A solution based understanding of trauma:• the presence or absence of solution determines which ANS state we went to duringthe actual event• solution also determines a great deal abouthow we process trauma now

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…A vast literature on combat trauma, crimes, rape,kidnapping, natural disasters, accidents, andimprisonment has shown that the trauma response isbimodal: hypermnesia, hyper-reactivity to stimuli, andtraumatic re-experiencing coexist with psychicnumbing, avoidance, amnesia, and anhedonia. Theseresponses to extreme experiences are so consistentacross the different forms of traumatic stimuli that thisbimodal reaction appears to be the normative responseto any overwhelming and uncontrollable experience.

van der Kolk, BA: (1994) The Body Keeps the Score: Memory and Evolving Psychobiology of Posttraumatic Stress. Harvard Rev Psychiatry. Volume 1, Number 5

Bimodal Nature of Trauma

Clinical Observation on Dual Activation & Bipolar Diagnosis

• State 3 (dual activation, hot and cold cycles) can be misdiagnosed as bipolar disorder.

• The problem: inhibiting symptoms prevents resolution.

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ReferencesCohen NJ, Squire LR: (1980) Preserved learning and retention of pattern-

analyzing skill in amnesia: Dissociation of knowing how and knowingthat. Science 210, 207-209

Cohen NJ: (1984) Preserved learning capacity in amnesia: Evidence formultiple memory systems. In LR Squire & N Butters (eds.)Neuropsychology of Memory. New York: Guilford Press.

Gellhorn E: (1957) Autonomic Imbalance and the Hypothalamus,Minneapolis : U of Minnesota Press

Grigsby J, Hartlaub G: (1994 ) Procedural learning and the development andstability of character. Perceptual and Motor Skills, 79, 355-370

Levine PA: (1976) Accumulated stress, reserve capacity and disease.Retrieved from http://traumahealing.org/wp-content/uploads/2016/04levin-doctoral-thesis-1976-accumulated-stressreserve_capacity_and_disease.pdf

Porges, SW: (2001) The Polyvagal Theory: Phylogenetic Substrates of a Social NervousSystem. International Journal of Psychophysiology 42, 123-146

van der Kolk, BA: (1994) The Body Keeps the Score: Memory and Evolving Psychobiology ofPosttraumatic Stress. Harvard Rev Psychiatry. Volume 1, Number 5

Wolterstorff EJ: (2003) A speculative model of how groups respond tothreats. Retrieved from https://www.researchgate.net/profileEric_Wolterstorff/publication255670786_A_Speculative_Model_of_How_Groups_Respond_to_Threats/links56e8b26b08ae9bcb3e1cdab5.pdf

Zeeman EC: (1976) Scientific American, (March).

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Saj Razvi M.A.

saj@traumadynamics.com

The Trauma Dynamics Program at

Slide Number 1Learning ObjectivesLevel of EvidenceSlide Number 4Slide Number 5Slide Number 6Slide Number 7Slide Number 8Slide Number 9Slide Number 10Slide Number 11Sensorimotor impulses and nervous system responses are part of episodic memory.�When episodic memory is triggered, sensations and impulses that were part of a past event will feel like symptoms (anxiety, tension, fear, irritation, depression, hopelessness, numbness) in the present moment.��Slide Number 13Slide Number 14Slide Number 15Mapping the Autonomic Nervous System�Stress symptoms are adaptive survival responses to threats Threat = Activation of the ANS��The greater the threat, the greater the ANS responseSlide Number 19Slide Number 20Slide Number 21Slide Number 22Slide Number 23State 1 - Mild Stress�Adaptive ANS responses / symptoms:Slide Number 25Slide Number 26State 2 Symptoms – High Stress:�Adaptive ANS responses / symptoms Include:Slide Number 28Stress versus TraumaTrauma EmergesSlide Number 31Endogenous OpioidsState 3 Moderate TraumaAdaptive ANS Responses / Symptoms include:�Slide Number 34Slide Number 35State 4 Severe TraumaAdaptive ANS Responses / Symptoms: �Slide Number 37Bimodal Nature of TraumaClinical Observation on Dual Activation & Bipolar DiagnosisReferencesSlide Number 41