By Deborah Antinori, MA, RDT, FT, LPC

 

Orienting is a constant process of our relationship to our own internal bodily sensations, emotions and perceptions, and to the environment. Our experience and interpretation of these internal and external assessments involves multi-faceted processing. It begins with automatic reflexes in the mid- and hindbrain interfacing with learned assessments and perceptions, all of which are based on survival.

We orient to our environment as a basic part of our survival driven by millions of years of evolution. The earliest reptiles date back 315 million years ago, and earliest mammals to 200 million years ago (web references). The evolution of the primate brain has encompassed 53 million years of evolution including the reptilian and mammalian parts of the current human brain (Craig, 2015). In order to survive, we need to know where to look to locate food, shelter and to sense with whom it is safe to engage. We have the same neurobiology as our early ancestors living in caves, on the plains or in the jungle. Our systems are programmed to react, even to overreact to internal and external stimuli (Cozolino, 2011). It is better to assess a shape similar to a bush or a bear as a bear – better to have the tribe laugh at you running away from a juniper bush than to end up as the bear’s lunch! Those who reacted/overreacted lived to have their genes carry on. We are descended from those ancestors who had more highly reactive nervous systems – who tended to orient to their sensing in a “worst case scenario” manner.

Our reptilian and mammalian brains are instinctual. It is good to keep this in mind as we go through the material on orienting and trauma. I find that normalizing for clients what they are experiencing can be very helpful for them. To know that our nervous systems are aptly named – they are, in fact, nervous systems – can be helpful to those struggling with, or even ashamed of how they have been affected by trauma. To know that your brain/body has been constructed in a certain way, dictated by millions of years of conservation in evolution, can be a great relief to those suffering with the effects of trauma and who also may have a particularly high strung instrument.

In Frank Corrigan and David Grand’s first article, “Brainspotting: Recruiting the midbrain for accessing and healing sensorimotor memories of traumatic activation”, adaptive orientation is described as a sequence: “arousal, activity arrest, sensory alertness, muscular adjustments, scanning, locating in space, identifying, evaluating, taking action and reorganizing” (Ogden, et al., 2006). Because our complex brains have one quadrillion possible synaptic connections as well as intricate looping sequences through various areas of the brain for optimal functioning, this full sequence of adaptive orienting can become truncated at any point due to trauma (Corrigan, Grand, 2013) (Corrigan, et al., 2015). Orienting to danger is survival, it is making survival successful – we lived. Events occur so quickly in many cases of trauma, that the brain cannot possibly integrate all parts of the effects of that trauma on the individual (Corrigan, et al., 2015). This leaves the residue of trauma. However, activation around these residues is really a resource – the individual survived as the original orientation to that trauma produced continued survival, not death. Currently, rather than activation, David Grand is using the term “access” as the more precise description of what that phenomenon really is. Residues of trauma give us access to the original orientation to the threat which produced a successful result – survival. This makes the access/activation a resource and is the essence of BSP being a resource model (Grand, 2015).

With Brainspotting Therapy, we are looking to create the environment for adaptive orientation to the trauma by finding the relevant eye position to the trauma. We look for the Brainspot as a function of the natural tendency of humans to orient to what is salient in the environment, as stated in the paragraph above, orienting to what gives the best possible shot at survival. “A brainspot is a stored oculomotor orientation to a traumatic incident which has failed to integrate” (Corrigan, Grand, 2013). It reminds me of the famous line in the movie Cool Hand Luke, “What we have here is a failure to communicate.” I suppose we could say that areas of the brain are failing to communicate with each other when there is a trauma. To repeat, the outcome of the original threat has been survival – the individual has been successful. However, the experience of that fact has not been fully connected in the brain.

The following is my basic understanding of Corrigan and Grand’s 2013 article as it explains orienting. This article is the reference for the statements in quotes that follow here (except where indicated by other authors and their dates of publication). The elements I highlight here can never cover all the exquisite detail of what is occurring in the brain as Corrigan and Grand have described, but rather attempt to capture the meaning of a portion of this extensive article that would hopefully make sense to a client, therapist or other interested party regarding Brainspotting Therapy and orienting.

A certain sequence of brain activity occurs as a result of trauma and is described as “frozen maladaptive homeostasis” (Grand, 2013). In a BSP session, access to this maladaptive homeostasis through identification of bodily felt sense (and/or reflexive facial and body movements) in relation to the trauma connects to that network which is floundering, looking to complete the sequence of orienting begun by the trauma, yet left unfinished. Somatosensory disintegration in the brain/body can result in PTSD, dissociation and other distressing or painful body sensations and emotions.

As we begin the process of physically locating the Brainspot, we encounter the first assistant in the brain to help with orienting – “the Superior Colliculi (SC) in the midbrain are “first responders” for orienting, they control shifts of gaze and also shifts of attention. The SC directs movements towards or away from a stimulus…Saccadic activation (eye movement) and gaze fixation are connected with memory…to the SC….(releasing) gaze fixation neurons in the SC….the sustained gaze holds the brainstem bookmark.” Additionally, Antonio Damasio (2010) finds that the SC “engenders ‘core consciousness’ in all mammals” and he suggests this as the beginnings of the self. Panksepp (2008) adds, “Fundamental healing of deep wounds to the self will only occur when the treatment acts at the midbrain level.”

While other therapies may engage the midbrain, it is usually coincidental to the theory and clinical practice of that therapy. In BSP, this midbrain engagement is fundamental to how we work with the client. It is understood that we are looking to drop down the client subcortically, since that is where we understand that the brain functions which bring about optimal homeostasis and adaptive orienting lie (Grand, 2015). “The gaze fixation used in BSP immediately involves the SC in the midbrain and this neurobiological aspect of the Dual Attunement model is specific to BSP.” This is an important fact regarding BSP – we intentionally employ clinical methodology to access the client’s midbrain. We are deliberately looking for the midbrain access via the visual field and informed by the sensing in the body (Inside Window) and/or reflexive body and facial movements (Outside Window) (Grand, 2015).

One of the reflexive body signals we look for in Outside Window technique in BSP is blinking. Looking at blink research (Nakano, et al, 2012), spontaneous blinking leads to activation of the anterior and posterior cingulate cortex and to the insula with their memory and integrative functions – “insular cortex…cingulate cortex…are paired homeostatic components of the homeostatic sensorimotor hierarchy” (Craig, 2015). These parts of the brain were previously not “online” according to the blink research fMRI studies, but now they are actively functioning – “…disruption of focused attention during blinking is allowing assimilation of the emotional and somatic experience by facilitating the emotional and memory functions of the cingulate and insular cortices… When blinking is observed in the Outside Window technique, it is picking up the momentary heightening of the internal experience that follows the spontaneous tendency to focus the gaze on what is salient.” Brainspotting accesses the very networks in the brain that can begin to naturally restore somatosensory integration and provide for adaptive orientation.

Within the Corrigan and Grand article, very complex looping sequences are described that enable optional functioning of the brain as a self-orienting, self-scanning organ. These functional looping sequences in the brain are disrupted by trauma. When we don’t have full adaptive orienting, we have somatosensory disintegration – not all parts of the brain are functioning in their intended manner for homeostasis. If we were to see the fMRI of a person with PTSD we would see certain parts of the brain light up that are not the best areas for effective integration of traumatic material. We would see areas of the brain which signal sympathetic activation of the autonomic nervous system with hyperarousal emotionally, hypervigilance, elevated cortisol levels and flight/fight/freeze responses. Contrast this to an fMRI of someone meditating, and we will see other parts of the brain light up that are working in synchrony to produce oscillations in the brain that indicate parasympathetic activation – the part of the autonomic nervous system that allows for restoration, recuperation, rebuilding, and social affiliation (Porges, 2011).

This brings to mind the dissociation or trauma capsule about which Robert Scaer (2013) has written. As Scaer describes it, the trauma has become a procedural memory, not an episodic memory with a sense of time (past, present, future), and a story with a beginning, middle and end. The trauma remains fragmented and in the present tense within our brain/body. The trauma capsule makes for looping in a dysfunction manner in our brain – not the functional brain looping to facilitate adaptive orientation to the trauma. Procedural memory develops when we learn to ride a bike or drive a car. After one has put in hours of conscious learning and motor sequences to effectively drive, they no longer have to consciously think to put the key in the ignition, put their right foot on the gas, etc. A sequence of procedures to get the car going and drive occur without a person having to think of the disparate elements to do so. This is what Scaer tells us happens with the response to the traumatic event – it quickly gets a “life of its own” and has the same automatic qualities as procedural memory.

To sum up the aspects I am highlighting in Corrigan and Grand’s article so far, the SC in our midbrain are our “first responders” for what is salient in the environment and guide our eye movements (saccades) while we are scanning, looking for the Brainspot. With the reflexive activity of spontaneous blinks, the anterior and posterior cingulate and insula come into play with memory and integrative functions. Our brainstem bookmark is held in place by the original engagement of the SC and the sustained gaze. This gives us an excellent platform for deep and lasting healing as posited by Damasio and Panksepp, healing that occurs at the midbrain level.

A word about the brainstem bookmark here – in addition to being the brainstem bookmark, the Brainspot also inhibits excitation of saccades (eye movements) that would naturally occur by fixing the gaze on the spot. These excitation saccades might have found their endpoint in some type of discharge through natural eye movements, however, the gaze fixation forces the excitation to go elsewhere, possibly accessing a deeper internal processing or discharge in the brain itself. By inhibiting the powerful tendency to move the eyes, a deeper brain discharge is effected rather than the natural brain practice. Is this possibly what BSP does? Why it works as it does? (Grand, 2015)

Here is some further information about these key parts of the brain described in the Corrigan and Grand article and which I have highlighted here:

The Posterior Cingulate Cortex (PCC) is involved with episodic memory, internally directed thought, emotions and pain (Badenoch, 2008). Where we previously had procedural memory with its trauma/dissociation capsule, we now have the possibility of episodic memory – a story with a beginning, middle and end – the trauma now has the possibility to be located in the past and integrated into the fabric of our current day life.

The Anterior Cingulate Cortex (ACC) “…assembles cognitive and affective information to make decisions and mediates the shifting of attention.  Because streams of information containing rational and emotional cognitions converge here, it is one of the primary areas supporting neural integration” (Badenoch, 2008).

The Insular Cortex or Insula “…gathers together sensory data into an emotionally meaningful context…It mediates what the amygdala pumps out” (Badenoch, 2008). The amygdala is the organ of appraisal prior to the development of our cortex . From birth to 18 months, everything is being appraised by the amygdala – safe and warm, threatening or inviting, moving towards or away from – all is based on visceral feel by the infant.  All the preverbal memory is formed at this time in our development – most of us is subcortical (Grand, 2015). The foundation upon which the rest of the brain is built through individual temperament, brain development over time and in concert with the environment (caretakers, parents) begins with these early amygdaloid assessments of the environment. With the left dorsolateral prefrontal cortex being the adult brain executor of goals, plans, decisions and other higher order assessment, it is resting upon that early foundation with original assessment being amygdaloid, visceral. The insula is mediating what the amygdala is assessing from that early vantage point in our lives and continues throughout our lives to give that certain quality or feel – “Racy, sweaty”, says Uri Bergmann (2007) is insular.

For more on the insula, I suggest a book I am reading that Frank Corrigan has suggested by A.D. (Bud) Craig, How Do You Feel?: An Interoceptive Moment with Your Neurobiological Self (2015). Bud Craig is a functional neuroanatomist with over 30 years experience in research. He describes interoception as “sensory representation of the condition of the body” and the insula as the part of the brain that makes our subjective feelings possible based on interoceptive integration. The insula is an important part of the brain to be engaged in healing trauma since it mediates the quality of a feeling and also places it in a time context, he says, for our subjective sense of time. He goes on to say that there is evidence that “interoceptive or insular activation in the brain can be modified by biofeedback training using realtime fMRI, which could be especially useful in clinical patients”. Implicating that, he would most likely find that BSP likewise modifies insular activation since it is organic neurobiology we work with in BSP rather than technologically produced brain states the client achieves by synchronizing/controlling their brain state with a biofeedback machine. We must work on getting him a personal BSP experience!

Another finding of Craig is that the cingulate projects to the periaqueductal grey (PAG), which is the homeostatic motor structure. He goes on to state, “Accordingly, their activation corresponds with the sensory aspect (cingulate) and the affective/motivational aspect (PAG), respectively, of feelings from the body” (2015.) Corrigan and Grand have offered that the SC and PAG are of great importance to midbrain access promoting deep healing. We have a loop back from the cingulate to the PAG. It is these looping functions in the brain that functionally connect brain structures for optimal processing of feelings and information from interception (information coming in from the body) and stimuli coming in from the environment. Corrigan and Grand have much information in their article about the PAG which I have not included here, but wanted to touch upon briefly.

And so I will finish this blog article as the Corrigan and Grand article begins: “We hypothesize that the orientation to highly emotional complex information involves the basic orienting response in the midbrain tectum…we hypothesize that adaptive orientation to information of a distressing nature involves a nested hierarchy based in the superior colliculus…”.

 

Deborah Antinori, MA, LPC, FT, RDT has had a private practice of therapy for twenty-four years. Certified in Brainspotting, she is in the BSP Trainer Trainee group taught by David Grand and has been a member of his NY supervision group since 2009. Deborah has been a part of the Brainspotting community since its inception. She holds her Masters Degree from NYU’s Drama Therapy department and is a Registered Drama Therapist. She has a Fellowship in Thanatology from the Association for Death Education and Counseling, and holds certifications in EMDR and Pesso Boyden System Psychotherapy. Her critically acclaimed audiobook, Journey Through Pet Loss, won an Audie Award from the Audio Publishers Association and a ForeWord Book of the Year Silver Award. Originally an actress, Deborah graduated with her BFA from the Boston Conservatory of Music with a drama major/musical theater minor. You can contact Deborah by email.

 

References

Badenoch, B., 2008. Being a Brain-Wise Therapist, W.W. Norton & Co., Inc., New York, NY.

Bergmann, U., 2007. The Neurobiology of EMDR. EMDR National Conference, Dallas, PowerPoint presentation & CD series.

Corrigan, F,. & Grand, D., 2013. Brainspotting: Recruiting the midbrain for accessing and healing sensorimotor memories of traumatic activation, Medical Hypotheses, Vol. 80, Issue 6, p759-766.

Corrigan, F., Grand, D., Raju, R., Brainspotting: Sustained attention, spinothalamic tracts, thalamocortical processing, and the healing of adaptive orientation truncated by traumatic experience, Medical Hypotheses, Vol. 84, Issue 4, p384-394.

Cozolino, L., 2011. The Neuroscience of Trauma & Effective Trauma Treatment, Premier Education Solutions, Web Seminar.

Damasio, A., 2010. Self Comes to Mind: Constructing the Conscious Brain, William Heinemann, London.

Grand, D., 2013. Brainspotting: The Revolutionary New Therapy for Rapid and Effective Change, Sounds True, Boulder, CO.

Grand, D., 2015, personal communication.

Ogden, P., Minton, K., Pain, C., 2006. Trauma and the Body: A Sensorimotor Approach to Psychotherapy, Norton, New York, NY.

Porges, S.W., 2011. The PolyVagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication and Self-Regulation, W.W. Norton & Co., Inc., New York, NY.

Scaer, R.C., 2013, The Dissociation Capsule, www.traumasoma.com.

Web references, http://nature.ca/notebooks/english/coalrep.htm; http://www.earthlife.net/mammals/evolution.html

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By Jennifer Delaney, MA, NCCJenheadshot5-2015-300x300

The other day a friend was battling a migraine. She had been in the midst of some serious negotiations at work, and remarked, “It’s all coming to a head.”

“To your head?” I reflected.

She laughed. “Evidently!”

It is clear to many clinicians that bodies take the brunt of our inability to process stress and underlying emotions, especially anger and anxiety. Instead of numbing feelings with some substance, pill or comfort food, it’s always more beneficial to learn new ways to acknowledge and release emotions so that we don’t contract an array of physical ailments that cause chronic pain as well as addictions.

According to the Psychology Today website, “Some 30 million Americans suffer from some form of chronic pain.” New paradigms of pain, such as neuromatrix, nerve sensitivity, endocrine and immune responses to pain, neuroplasticity, as well as cognitive and emotional influences are all part of the recent academic conversation exploring this complex phenomenon. Continue reading Brainspotting and Chronic Pain: Physiological Messages

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By Dr. Melanie Young

 

“Let’s start at the very beginning, a very good place to start. When you read you begin with A,B,C. “ (singing from Sound of Music…).

RMBI

Melanie Young

When you spot you begin with three pillars: gazespotting, inside and outside window spotting. Everything else gets built from this. There is evolution in most types of treatment (at least we hope there is). This is true with brainspotting. There are wording changes. For example, we used to call a brainspot a “distress spot,” then an “activation spot,” and now David Grand sometimes calls it “the access spot.” Activation at the spot gives us access to what we want to work on. There are logistical and organizational changes in brainspotting as well.

There’s more articulation of activation and resource models. Activation is where the client holds activation in the body and finds the brainspot that matches that activation. The activation model is actually considered a resource model because it is done with relational attunement. One way to Resource is to find a body resource spot which is paired with the resource eye. However, most can handle more activation than we may believe, and when the process plateaus, that’s where the healing can happen.

There is more emphasis on the brain based model as we learn more. (My brain model Alaine brain was introduced). Brainspotting appears to access the sub- cortex including the right brain, limbic system, and the brainstem. According to Corrigan and Grand, brainspotting is a neurological resource as it provides an attuned, focused, framed, accessing anchor to the midbrain and is grounded in the body. The sub-cortex is much faster than the neo-cortex, which is so complex, it sacrifices speed for higher performance. Brainspotting >> sub-cortex. Therapists intervening >> neo-cortex!

There is more talk about neuroplasticity (Norman Doidge) and how it applies to Brainspotting and healing. “Neurons that fire together, wire together.” (Donald Hebb)

The trauma capsule theory was developed by Dr. Robert Scaer. It’s also known as the dissociative capsule. Trauma can overwhelm the brain’s processing which leaves pieces of the unprocessed experience frozen in time or space (or even lost).

Unprocessed traumas are held in capsule form in the brain. A brainspot is believed to be an eye position that correlates with a physiological capsule that holds the traumatic experience in memory form. Corrigan talks about visual fields, and how visual information gets direct access to the midbrain. We appear to use orienting mechanisms in the brain to find the trauma capsules. Brainspotting turns the brain’s search/scan system back on its self to locate the trauma. Dr. Grand theorizes that brainspotting taps into and harnesses the brain/body self scanning to locate, hold in place, process and release focused areas that are in a maladaptive homeostasis i.e. frozen in primitive survival mode. Dr. Grand continues to emphasize less talking and intervention. “Less equals more.” There is more emphasis on the Uncertainty principle by Heisenberg. We are sitting with the client in a state of uncertainty 100% of the time. We’re in trouble when we think we know. David talks about wait, wait, and wait some more when wanting to intervene. You can’t heal the sub-cortical with neo-cortical intervention. It goes back to the idea of following the client. We are the tail of the comet following the head (client) when working in treatment.

Brainspotting constructs a frame around the client, relationally and neurobiologically. This is the definition of dual attunement. With the resource model, the therapist makes the container smaller temporarily. The frame holds the client and focuses them. It enables them to go into a state of optimal processing. However, therapists may jump in too quickly with resources, including with clients who suffer from very complex PTSD.

David Grand has expanded on the window of tolerance concept. (see John Briere and Dan Siegal)

 

Simple PTSD

Single event/1-2 trauma

 

 Complex PTSD

Childhood or protracted combat

 

 Very Complex PTSD

Close to being outside the window of tolerance but you can still use traditional brainspotting

 

 

 

Extremely Complex PTSD (DID and severe attachment disorders) is outside the window of tolerance and requires both a modified and expanded BSP resource model. The attuned presence of the therapist is the core of the advanced resource model, according to Dr. Grand.

Dr. Grand’s third day of his phase one training is focused on working with severe attachment disorders and Dissociative Identity Disorder (DID).

Subcortical countertransference can be induced in the therapist by exposure to the client’s severe trauma material. This may activate the therapist’s own trauma triggers. The therapist may experience flight, flight, or freeze reactions. Flight is our impulse to create distance from the client. Freeze can be the dorsal vagal collapse or the therapist’s extreme sense of somatic helplessness and inability to think. Fight is the therapist’s vulnerability to struggle with the client especially, with aggressive altars. A triggered therapist is likely to intervene too quickly and too frequently. Dr Grand stated that the key piece is to know it, be aware, and not overcompensate out of anxiety. For the therapist to sit in a tuned, empathic presence is the ultimate antidote!

Many DID clients can be trapped in a 24 hour flashback which is usually somatic. These clients typically have little capacity to sleep. One of the first, primary goals is to establish reestablish sleep and establish islands where there are no flashbacks.

The most powerful brainspot for clients with DID is the eye contact spot. This can be the ultimate healing aspect of the attuned presence. It is done spontaneously and in silence. It is important to be mindful of how and when your client is looking at you, and when they do, engage back with them. Let them choose what’s comfortable -for example how close or how far away.

A client in flashback will often look off in a particular direction when they go into flashback. Point this out to them. For example, I see you were looking in such and such a direction. Is it okay if I position myself there? Look right at their face. You want them to see you. When you’re in their flashback, they can begin to feel you there, and see that they are not alone. It can help them to see somebody who’s not the perpetrator. Aligning our face where the client gazes can help imprint a new image onto the flashback.

Most of this new material on Brainspotting can be found in David Grand’s new three day level 1 Brainspotting training if you are interested!

This material was originally presented in a RMBI brown bag lunch seminar earlier in 2015.

Melanie K. Young, PSYD
(303) 444-5330
Info@melanieyoungpsyd.com

 

 

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