The Meadows Blog

By:  Brad J Kammer, MA, MFT, SEP

After Hurricane Katrina devastated the Gulf Coast, I had the great fortune to travel down to the area as part of a trauma outreach team, training local crisis workers on how to use the basic principles of Somatic Experiencing (SE) to help them manage the trauma that was now overwhelming the remaining residents. I had been following the news reports post-­‐Katrina, and vividly remembered the horror stories of looting and violence, particularly those coming out of the New Orleans Superdome - like stories out of Lord of the Flies - with reports of gang attacks, rapes and murder. Having worked in refugee camps on the Thai-Burma border amidst civil war, I understood how trauma could so immediately overwhelm people and communities that they would turn against each other in violence. But what I also understood was that in our most overwhelming crises, people also come together for protection, safety and healing. It happened in those first few days after 9/11 in New York City and elsewhere, and as I traveled down to the Gulf Coast region, I imagined that despite all the news reports to the contrary, it must have happened there too.

What I found when I arrived was almost exactly opposite of those news reports I had been following. All over southern Louisiana, individuals, families and communities had come together to support one another. I heard countless stories of strangers helping strangers, taking families into their homes, and other acts of selfless giving. The most startling story I heard, however, had to do with the New Orleans Superdome. I was talking with a woman who had been on the clean-­‐up crew after the last few hundred refugees were evacuated from the Superdome, expecting her to share horrifying images of what she observed. Instead, she shared with me the image of folding chairs placed in circles, all throughout the Superdome, stating that folks had come together to share stories, food, laughter and comfort.

In my years of teaching about stress and trauma, I have found that nearly everyone is familiar with the "fight and flight" survival response. However, very few people are aware of the "tend and befriend" survival response. In Somatic Experiencing, we turn to animals in the wild to understand how despite constant predator-­‐prey dynamics, wild animals are able to manage life-­‐threatening experiences and not develop the symptoms of post-­‐traumatic and other chronic stress disorders. We have carefully studied how wild animals are able to recover from high stress states by completing their fight/flight responses and thereby discharging the high arousal associated with threatening experiences. We have also understood the nature of the freeze response, which comes on-­‐line when we cannot successfully fight or flee from a life threat, and how in humans, going into freeze predicts the onset of developing PTSD and other chronic stress disorders. In Somatic Experiencing, we have developed strategies and tools to help individuals move out of freeze and restore the feeling of being in control, balanced, and capable of meeting further life challenges.

But what about this tend and befriend response? What is this all about? And how does this relate to recovering from trauma? If we look back to the wild animals, we see that there are numerous examples of herds of animals that when threatened or attacked, form protective circles. I've watched videos of zebras, elephants, sheep, and other animal species who on initial response to threat, do not immediately fight or flee, but come together as bands - and if we look closely enough, we see this beyond just mammalian herd behavior, we see this with flocking of birds, shoaling of fish, and the swarming behavior of insects.

Now let's look back to the Katrina refugees, huddled in shock, terror and confusion, locked in the Superdome with thousands of other shocked, terrified and confused refugees. These individuals were in a life-­‐threatening situation, and their very survival was at stake. It is true that there were instances of violence, most likely instigated by erratic attempts at fight or flight, but we cannot overlook the majority of individuals who bonded together with others for safety and comfort. In many ways we can see this in the various social institutions we've created as well, from national armies to gangs to families - we join together with others to protect and secure safety.

When threatened, our first biological response is to orient to the danger. Our senses are heightened and we will scan the environment for the source of threat. Maybe this has happened to you late at night while you're sleeping. You hear a noise downstairs and immediately startle, sitting up, and using your senses (ears, eyes, possibly even smell) to locate the source of the noise. I live in the country and see this happen frequently with deer. I'm walking on a trail and observe a deer some 30 yards ahead, standing still, but with probing eyes and shifting ears, attempting to evaluate if I am a source of threat. If I continue to walk closer, they will immediately run away (flight).

However, part of this orientation - often overlooked due to the rapid firing of these instinctive survival responses - is an orientation to the herd. Before the deer run away, they are also orienting to the other deer. And before you get out of bed to check the noise downstairs, you might wake up your sleeping partner to check in with them. If others are there for us, we will come together in numbers to better assure protection and safety. And if not, we will move rapidly into fight, flight or freeze responses. These are not well thought-­‐out plans, these are instinctual, biological and genetic programs that are activated in the face of danger and threat. As humans, we are programmed to connect and collaborate for survival: this is the tend and befriend survival response.

Over the past 20 years, thanks to the emergence of incredible brain imaging technology, we can now map the brain and body like never before. These studies show us that the regulators of our minds and bodies are embedded in relationships. This goes beyond the realm of mere survival into the realms of understanding illness, health, and resilience. Research suggests that in terms of health and healing, social support is more powerful than anything besides genetics. And when there is an absence of appropriate social interactions, when individuals retreat into social and/or emotional isolation, substitutions are made in the form of such things as food, alcohol, drugs, sex, TV, computer and video games. Meanwhile, chronic stress builds in the nervous system which leads to a host of symptoms and chronic disorders. There is plenty of information showing us that isolation and lack of social engagement can make us sick. And yet, we live in a world where we retreat more and more, creating alternate realities and identities on digital screens, whispering messages of loves through text taps, and flirting with emoticons. Contrary to what we may believe, these forms of engagement are not bringing us closer together nor are they triggering the hard-­‐wired mechanisms in our brain and bodies that are required for supporting health and well-­‐being.

Some years ago, oxytocin, the "love" chemical, was discovered in the brain. Scientists observed that this chemical was released in both mothers and their babies during labor and birth, and during bonding between parents and their children. This chemical is released to support the loving feelings necessary for healthy bonding and attachment. As we have learned through studying bonding, the mother's presence and loving attention helps to regulate the newborn's not yet fully-­‐developed nervous system. Studies have shown that when there is an absence or oxytocin release, bonding suffers and proper infant development is threatened. For the baby, then, along with food, water and oxygen, the ability to feel connected assures their very survival.

But interestingly, oxytocin also shows up in the human body during times of close social connection including romantic encounters, trusted friendships, and even the comforting pat on the back or rewarding high-­‐five. Being a big basketball fan, I enjoyed reading a research study on the National Basketball Association (NBA) a few years back which compared the performance of a team with the number of times during a game players on that team use supportive touch with one another - anything from a handshake to a chest bump to a bear hug. This study demonstrated that there is a strong correlation between successful teams and the frequency of contact, with the Boston Celtics and LA Lakers, the two teams that met in the 2008 NBA Finals, being the two "touchiest" teams.

As scientists continued to research this neurochemical, they realized that not only does oxytocin coordinate social behavior with bonding, healthy development, and improved performance, but it also supports physical health. It acts to lower the neurochemicals associated with stress and anxiety, is analgesic (blocks pain), and anti-­‐inflammatory (aids in healing). Maybe this accounts for why children run to their parents when they fall off their bicycles and scrape their knees - maybe their mother's embrace actually triggers pain-­‐reducing, healing mechanisms in the skin. Maybe this is why being with friends and family during tragedy can help us stay balanced and sane. Maybe this is why all the Katrina refugees joined together in circles at the Superdome.

Many ancient cultural and religious rituals serve this very function. For example, in the Jewish tradition, close family and friends come together to mourn a loved one's death for seven days following their passing. This practice of "sitting shiva" allows for grieving family members to be supported by their community as they manage the intense emotions associated with the loss of a loved one, possibly inoculating them against the effects of depression and illness reactions. More recently, social, self-­‐help and therapeutic groups have served a similar function in our modern society. An informative research study from Stanford University was done with 50 women diagnosed with metastatic breast cancer. They followed two groups of women - one consisted of women who joined cancer support groups and the other were women who did not join any support groups. The results demonstrated that the women who joined a support group lived twice as long as the women who did not join a support group. Not only that, those women who joined a support group also reported a higher quality of living, including 50% less pain than those not in a support group.

When working with individuals dealing with trauma, many are so engaged in managing the energy of their basic survival - which can be observed in such behaviors as conflict, avoidance and isolation, and such emotional states as rage, anxiety and depression - that their ability to be present and available for meaningful relationships suffers. This means that the most primary survival response - tend and befriend - goes off-­‐line, leaving individuals vulnerable to further effects of trauma and chronic stress disorders.

When working with Somatic Experiencing, we are focused on the unresolved dysregulation of the brain and nervous system, those neuro-­‐circuits which became dysregulated through our incomplete responses to danger and threat. In other words, a life experience overwhelmed our capacity to cope, leaving our brain and bodies disorganized and unbalanced. For example, what if upon waking in the middle of the night to that noise downstairs, you register that a hurricane had hit your home. You survive the environmental assault on your home, but your body might have not returned to the balance you experienced before this event. Now every time you hear a loud noise, you startle, or maybe you've even lost your ability to fall asleep and sleep restfully throughout the night. Unbeknownst to you, your body might be frozen in that past experience, still stuck in an incomplete fight/flight state, thereby creating a dysregulated nervous system.

Understanding the avenues of resolving the fight, flight and freeze states is essential in effective trauma treatment, but I remind my students to be on the lookout for the disrupted tend and befriend states as well. My work centers around supporting people in social engagement. I recognize that without social connection - when tend and befriend are off-­‐line we miss out on the healing process this behavior promotes. Part of this healing is to return to the feeling of one's sense of self before a traumatic experience disrupted one's life. To many cultures, the loss of connection with others equates to the loss of one's self.

A memory comes to mind of sitting around a refugee camp in Asia with my Burmese friends, eating good food, laughing at our poor language skills, and singing along to the guitar playing Burmese freedom songs. I was moved by the moment and by

their inspiring resiliency. I was curious as to what techniques or rituals they had in their culture to help them deal with the unrelenting trauma of social oppression. So I asked my friends what helped them deal with the brutal trauma they were experiencing. They looked at me puzzled, and finally Ko Yee Zaw, a dear friend, said "this". Right in front of my eyes, between us there that evening, safety was being established and healing promoted. Despite the very best efforts from international organizations and providers to equip the Burmese people with the technical, medical and educational support they needed to survive, my friends recognized the inherent support they already had with them - social connection.

What I've learned since is that safety translates to biology, meaning that if we trigger states of well-­‐being through personal connection, we can promote both psychological and physical health. Amidst unspeakable acts of human and environmental destruction, what I discovered in the refugee camps of Southeast Asia and the parishes of southern Louisiana was that relationships might just be the best medicine.

Brad J Kammer, MA, MFT, SEP is a Psychotherapist, Somatic Experiencing Practitioner and Assistant Trainer, and has been involved in bringing SE to various communities and cultures. Brad lives and works in Ukiah, California, but also has a private practice in San Francisco. Brad is an adjunct psychology instructor at Mendocino College and National University. To contact Brad or learn more about his work and teaching: www.body-­mindtherapy.com.

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Clients frequently ask me if their mental and emotional struggles are a result of their genes or their environment. My answer is always the same - "yes". Of course, my simplistic response refers to the interaction between genes and environment that characterizes nearly all mental health conditions, but it clearly belies the centuries of debate on this fundamental and contentious topic. In recent decades, the Cartesian dualism that has traditionally dominated the nature-nurture debate has given way to scientific theories that describe complex, bi-directional relations between genes and environment. These theories of human development have also furthered our understanding of "neural plasticity" the exciting notion that our brains are more malleable and open to change than we once thought.

First, a brief historical regression may be helpful. In the early part of the twentieth century, psychoanalysis was the dominant perspective in psychology and its guardians were particularly keen on environmental influences. In fact, parents of the baby-boomer generation were likely told that schizophrenia was entirely caused by cold, unresponsive mothering (i.e., so-called "schizophrenigenic mothers"). Behaviorism, which rose to prominence in the early-to-middle part of the century, saw human development as a process of learning based on stimulus-response interactions between an organism and its environment. By the nineteen-sixties, the "cognitive-revolution", with its emphasis on internal mental states and the promise of neuroscience advances, largely eclipsed these theories, but still had relatively little to say about the role of genetics.

In the second half of the twentieth century, geneticists began conducting large twin and adoption studies and found that a number of psychiatric conditions showed evidence of genetic heritability. For example, studies showed that schizophrenia occurs in 1% of the general population, but this increases to 6% if a parent is affected and 48% if an identical twin is affected. Findings such as these clearly showed that genetics play a role in many forms of mental illness. However, by the end of the twentieth century, the pendulum had swung too far in the direction of genetic influence, with some researchers claiming that single genes could be wholly responsible for complex phenomena like depression, violence and even suicide (e.g., one research group claimed to have found "the suicide gene").

At the turn of the twenty-first century, genetic theories relying on simple one-to-one relations between a single gene and a psychiatric condition were supplanted by "diathesis-stress" models, which posited that genetic diatheses or "vulnerabilities" could interact with environmental stressors to produce deleterious outcomes. The most prominent study of this genre was published by Caspi et al. in 2002 and showed that the relation between childhood maltreatment and later-occurring antisocial behavior was much stronger for individuals who had the less efficient form of the MAOA gene (a gene that improves the function of nerve transmission in the brain). In other words, genetics alone didn't predict poor outcomes; it was the combination of a genetic predisposition and the stress of childhood maltreatment that led to an increase in antisocial behavior.

Although this particular gene-environment interaction has been replicated a number of times, some researchers have questioned whether the diathesis-stress model tells the whole story. In the last decade, researchers began noticing that when individuals with a genetic "vulnerability" experienced lower levels of environmental stress, they often fared better than those with individuals with the "favorable" form of the gene. For example, in the graph from the Caspi (2002) study (see above), under conditions of no childhood maltreatment, individuals with the "inefficient" form of the gene (red line) actually had lower levels of antisocial behavior than individuals with the "efficient" form of the gene (blue line). In the Caspi study, this difference wasn't statistically significant, but it raised questions about whether it could be a significant finding if studies were designed to see the phenomenon more clearly.

Jay Belsky, a professor of mine at the University of California at Davis, was one of the first to propose that particular genes (like MAOA) may confer risk or benefit, depending on the environment. Instead of thinking of certain genes as merely a liability, he argued that these genes might increase susceptibility to environmental conditions, "for better or for worse". Belsky and colleagues" theory of "Differential Susceptibility" is rooted in an evolutionary argument that, under circumstances where the future is uncertain, it makes sense to have some offspring that are less sensitive, and other offspring that are more sensitive, to environmental conditions. Like a well-diversified financial portfolio with some money in conservative, robust holdings and some money in high-risk stocks that can respond dramatically to market swings (too close to home for some of us), differential susceptibility posits that some people have a more "fixed" genetic makeup that is less vulnerable to environmental conditions, while others have a more plastic or malleable genetic makeup that is more susceptible to the environment, whether it be positive or negative.

Of course, this theory comes with the exciting possibility that reducing environmental stress (e.g., child maltreatment and relational trauma) may be particularly meaningful for individuals with genetic susceptibilities. In a study published in 2008, Bakermans-Kranenburg and her colleagues tested this hypothesis by investigating 157 families with toddlers who showed elevated levels of externalizing problems (e.g., hyperactivity, oppositional behavior, aggression, etc.) They found that their Positive Parenting and Sensitive Discipline intervention program was most effective in reducing externalizing behaviors in those children who had a version of the dopamine gene (DRD4) that has been linked to externalizing behavior and attention-deficit hyperactivity disorder. That is, children who would have traditionally been thought of as carrying a dopamine-related genetic "vulnerability" were in fact most responsive to the positive environmental changes associated with the parenting intervention program.

The results of this study, and many others like it, suggest that improving environmental conditions during childhood can drastically enhance developmental outcomes, especially for those children who are genetically susceptible to environmental influences. However, these findings might also apply to adults - especially considering recent research showing that the brain remains plastic or malleable well into adulthood. For adults with adverse life experiences who are recovering from conditions like depression, addiction, and post-traumatic stress, the genetic susceptibilities that previously contributed to their sensitivity to adverse environmental conditions may also facilitate their responsiveness to the positive changes associated with recovery treatment. In other words, by improving environmental conditions, what was once considered a vulnerability may actually become the very means for plasticity and growth.

As the Serenity Prayer suggests, it takes courage to improve our environmental conditions and there is much of our day-to-day circumstances that remains beyond our control. However, even when we cannot change our external environment, we can always alter our perspective of it. Approaching ourselves, our fellow beings, and the world with a greater measure of acceptance and compassion can literally change the subjective experience of our environment, and in many cases it can also lead to objective changes in the environment. This shift in perspective is bound to feed back into the biology of our being, perhaps most noticeably for those individuals who at one time may have been considered genetically vulnerable, but who might actually be predisposed to resiliency, especially if the right environmental conditions are established.

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The Meadows is pleased to announce that Sean Walsh has joined The Meadows as Executive Director. An extensive search was conducted to find a leader that would honor the trauma and addiction treatment work that is done at The Meadows.

For the last 16 years Walsh has committed his work towards giving back and helping people heal, including positions as CEO and COO for two treatment programs. Prior to his executive leadership roles, Sean has worked in several clinical service and leadership positions, including launching two successful programs specifically designed to meet the unique needs of young adults. Walsh retains a post as an adjunct faculty member at Rio Salado College in Tempe, Arizona, teaching two different chemical dependency seminars on street drugs and adolescent substance abuse. His industry experience and passion for the field make him uniquely qualified to assume day-to-day leadership of The Meadows Wickenburg campus and improve The Meadows services to meet the growing demand from the young adult patient population.

"Sean is the right person for this position because of his experience, clinical expertise and personal passion to lead a quality organization that is committed to changing lives," said Jim Dredge, The Meadows CEO.

Dredge created the Executive Director position to allow him to focus time and attention to the growth plans for The Meadows organization. Dredge is excited to expand the continuum of services offered from The Meadows so that they can reach more people in need of the healing solutions offered from The Meadows Model. Dredge will continue to have an office on the Wickenburg campus and at the Phoenix business office. He and Walsh will work closely together during the transition period.

Walsh has long admired the reputation of excellence enjoyed by The Meadows and actively sought training at the workshops and events hosted by The Meadows in the Phoenix area. "I came to The Meadows because the reputation and work at The Meadows is world class and it is an honor to join this team of skilled practitioners," Walsh said.

The Meadows is an industry leader in treating trauma and addiction through its inpatient and workshop programs. To learn more about The Meadows' work with trauma and addiction contact an intake coordinator at (866) 856-1279 or visit www.themeadows.com.

For over 35 years, The Meadows has been a leading trauma and addiction treatment center. In that time, they have helped more than 20,000 patients in one of their three centers or in national workshops.The Meadows world-class team of Senior Fellows, Psychiatrists, Therapists and Counselors treat the symptoms of addiction and the underlying issues that cause lifelong patterns of self-destructive behavior.The Meadows is a Level 1 psychiatric hospital that is accredited by the Joint Commission.

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The Meadows is pleased to sponsor a lecture by Dr. Peter Levine titled "In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness," on March 30 from 9:30am to 4:00pm (Pacific Time) at the Westin San Francisco Airport.

With doctorates in both medical biophysics and psychology, Dr. Levine, a Senior Fellow at The Meadows, is the developer of Somatic Experiencing®, a naturalistic body-awareness approach to healing trauma. In his lecture, Dr. Levine will discuss that it is possible to live robustly with pleasure and creativity even when dealing with the most devastating experiences - and deceptively trivial ones.

Dr. Levine will address the nature of trauma, how it is a condition that can be healed from, as well as how the body is utilized to make that happen. During the lecture, Dr. Levine will describe how traumatic healing can be strengthened by learning to attend to the "unspoken voice of the body." The roots of addiction in unresolved trauma, insecure attachment and habitual childhood frustration will also be explored.

Event Information:

Friday, March 30 from 9:30am to 4:00pm (Pacific Time)

Cost: $125

Westin San Francisco Airport
1 Old Bayshore Highway
Millbrae, California 94030

Registration available at http://www.regonline.com/builder/site/Default.aspx?EventID=1059970

Published in Blog
Monday, 21 November 2011 19:00

Denial by Michael Cooter

The current news coverage regarding the alleged sexual abuse perpetrated by Sandusky can potentially be activating of old memories for many men and women. Most people react with disgust, rage, and shame due to their own abuse histories that involve being sexual violated. Some others may find themselves acting out or acting in without consciousness of the trigger for their behavior. Regardless of the outcome of the Sandusky case, there is help and more importantly hope for survivors of sexual abuse. It is imperative to process thoughts and emotions regarding the abuse. Vital is for the individual to recognize that they did nothing to cause the abuse. They are not to blame. An Insidious feature of sexual abuse is for the victim to internalize and carry the shame of the shamelessness of the perpetrator. Feelings of shame and guilt are pervasive. Feelings of anger and rage often are expressed directly and indirectly to others. A classic question most, if not all, survivors ask is "what did I do to cause this to happen?" Men, in particular, have a greater propensity to express their emotions with rage, covert / hidden depression, and if the perpetrator was male - homophobia. Hope for the survivor comes with processing the abuse and engaging trauma treatment modalities such as EMDR and Somatic Experiencing to gain some resolution of what happened to them. Surviving sexual abuse, particularly from childhood experience, allows the individual to establish sanity in their lives, intimacy with loved ones. It affords the individual the opportunity to embrace the joy that can be found in life. Message to the survivor: "you did nothing wrong", "you did nothing wrong". Stepping out and accessing help in the form of counseling, peer support, or inpatient treatment is the first step in the journey of healing. You are not alone. Secrecy binds the individual to the trauma. Secrecy allows the abuse to continue. We all have a legal, moral, and ethical obligation to ensure the safety of all children. Report, report, report.

Michael Cooter, MSSW, LCSW

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