Mental Health

What effect does practising yoga have on emotional and stress responses?

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In the first part of our Q&A with Dagmar Härle, she discusses her background as a therapist, and how those who have been affected by, or experienced trauma, can improve emotional and physical well-being by participating in ‘trauma-sensitive’ yoga. Click here to read part 2 of the Q&A.

 

What led you to become a yoga teacher and a trauma therapist? What inspired you to combine the two?

I practiced yoga for many years and eventually I wanted to learn more, and get a deeper understanding of yoga and its philosophy. Therefore, I completed first a kundalini and later a Hatha yoga teachers training course and began teaching yoga classes. It was a perfect combination and helped me to stay balanced and resilient in my work as a coach and therapist, and I learnt mindful tools that I could teach to my clients.

 

I started trauma therapy training about 15 years ago in somatic experiencing, as I had so many clients who suffered from various symptoms due to trauma (especially trauma beginning in childhood), and I realised that I needed tools to work with clients who had such experiences. My studies of psychotraumatology at the University of Zurich deepened my knowledge and experience of working with those with trauma, but still there was a missing piece. So many patients couldn’t tolerate trauma exposure – they either dissociated or reacted with overwhelming sensations and emotions.

 

Yoga is a perfect training for the nervous system because there exists calming as well as activating poses and breathing techniques, and it has become obvious to me that yoga is a perfect tool to support patients in self-awareness, self-efficacy and self-control. I started with mindful yoga groups for patients and then I eventually brought yoga into therapy. Going to the Trauma Center and learning from David Emerson and Jenn Turner the TCTSY (Trauma Sensitive Trauma Center Yoga),

I was reassured in my way of using choice as an important way of supporting self-control and self-efficacy to the patients. In practice, for instance, you can execute a side bend with both arms stretched or one arm stretched while the other arm may hang loose or you sit on a chair and bend forward putting your hands on your knees or you go deeper perhaps until your hands reach the floor. It`s always the choice and under control of the patient.

 

What effect does practising yoga have on emotional and stress responses?

Yoga offers asanas-postures as well as pranayama-breathing techniques to either calm down or activate the nervous system, or in other words, activate either the parasympathetic or the sympathetic branch of our nervous system. Understanding that trauma survivors suffer from both – overwhelming sensations and emotions (sympathetic branch) as well as dissociation and shut down (parasympathetic branch, or more exact, the dorsal vagal part of it) helps to let clients know that they can benefit from yoga because we can offer them the tools for both. Learning the tools to stop dissociation and to be able to handle overwhelming emotions and sensations has an important effect on self-efficiency and self-worth.

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What is the effect of maternal stress in pregnancy?

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To celebrate the release of An Integrative Approach to Treating Babies and Children, edited by John Wilks, we have released an extract from the book.

Click here to read the extract

 

The extract is taken from chapter one, which discusses pregnancy and fetal-placental development in light of new research on maternal stress.

 

Click here to read more about the book, or to purchase a copy.

Discover more titles by John Wilks here.

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T.O. Walker on ‘Not My Shame’, Victim Blaming and Helping Survivors

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In this Q&A, T.O. Walker discusses ‘Not My Shame‘, the media’s responsibility on reporting sexual violence and how creativity can aid recovery in sexual violence survivors.

 

What is unique about the graphic novel format that makes it an appropriate platform for highlighting issues such as trauma and child sexual exploitation?

It felt fitting to communicate experiences from childhood using the format I would have used as a child. When we remember traumatic childhood experiences, we remember them from the perspective of a child not that of an adult, and it felt important to communicate this. Showing the reader the experience through images is also more powerful than describing it because images communicate emotions directly, and this makes it harder for the reader to distance themselves or deny what they are seeing which felt important for ‘Not My Shame’.

Graphic novels are a great medium for both showing and telling a story at the same time. I wanted to immerse people in parts of my experience and emotions, but I also wanted to have a voice and comment on the experiences I was sharing, as this encourages people to reflect on what they are seeing. A graphic novel is also an excellent medium for distorting time and perception: through the images, how they are framed and the order of the panels. Given the nature of traumatic memory, this was very useful.

Finally, I wanted to create something which would be accessible to people who wouldn’t sit down and read a text only book.

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Not My Shame: Extract

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To celebrate the release of Not My Shame by T.O. Walker, we are releasing an extract from the book – please click here to view it.

This striking graphic novel gives an insider’s view of the trauma caused by childhood sexual exploitation. It tackles complex issues, including victim-blaming, traumatic memory and dissociation, but is ultimately hopeful, showing how victims can be good parents and come to terms with their past through therapy, art and caring relationships.

To read more about the book, or to purchase a copy, please click here.

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Striker, Slow Down! – Colouring Page

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To celebrate the release of Striker, Slow Down!, we have released a downloadable colouring page to help children use mindfulness to control their emotions.

Striker, Slow Down! tells the story of Striker the cat, who is unstoppable! He thinks that there is too much fun to be had, and no matter what his mama tells him, he never slows down. One day, a bump to the head brings this busy cat to a standstill. Will Striker finally listen to his mama and learn to make time for a little calmness?

You can use our colouring page with your children or pupils and you can share your finished pages with us on Facebook or Twitter.

To download the colouring page, please click here.

The Making of ‘Dad’s Not All There Any More – A Comic About Dementia’

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Alex Demetris is an illustrator, cartoonist and maker of comics. He completed an MA in Illustration in 2012, which resulted in a comic based on his family’s experience of coping with his father’s dementia: Dad’s Not All There Any More – A Comic About Dementia. Here he shares a little about the process of creating the comic and some of his pre-publication sketches (click to enlarge the images). Alex also co-authored Grandma’s Box of Memories: Helping Grandma to Remember. Continue reading →

The Thinking Behind ‘Take it as a Compliment’

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Bringing together the voices of males and females of all ages, the stories in this collective graphic memoir, Take it as a Compliment, reflect real life experiences of sexual abuse, violence and harassment. In this blogpost, Maria Stoian explains the thinking behind this important graphic memoir, published by Singing Dragon.

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TAKE IT AS A COMPLIMENT by Maria Stoian – NOW AVAILABLE!

Before I can talk about Take it as a Compliment, I feel I should introduce the project which preceded it. It was a short comic called The Elephant in the Room, which I made during my undergraduate degree. It was a fictional story exploring how the trauma of sexual assault might affect a person’s perception of reality and how they might deal with it in their daily life – which is to say that they probably would not talk about it, but instead bottle it up.

The project ended up being something I talked about all the time, and, as a consequence, the subject of sexual violence came up frequently. One day, I mentioned a comment I had read online which said, “When I finally plucked up the courage to tell my mother about my rape, the first thing she did was ask me what I was wearing.” I thought this was a horrifying response, in its words and also in how common the sentiment it expressed is. Instead of being appalled, however, one of the girls I was with said, “Well, a woman is responsible for her dignity.”

I couldn’t believe that the testimony of this girl wasn’t enough to convince this girl – that it didn’t say enough. I thought, “This happens to so many people, how have you missed this?”

The much more common response to my project was that people started sharing their stories with me. There was a lot of, “Oh, this happened to me too” or, “This reminds me of something else I’ve experienced” or, “I haven’t talked about this before, but now i feel like I can.””

All this made me think that if I were to draw up all these stories and put them in a book, it would speak to people when they read it. It would speak to them so loudly, and so clearly that it couldn’t be ignored by people who thought that the source of the problem was women’s lack of “dignity.”

When I started collecting stories, it was definitely a group effort. I didn’t have a very prominent web presence, so my friends helped me get the ball rolling when they told their friends about the project, and when the feminist society at uni posted a link sending people to the project’s blog, that was a huge help as well. I ended up with anonymous Tumblr messages, emails, and even a few interviews.

TiaaC Press release imageEach story is stylistically a bit different as a result of each voice being different. I received stories that were several pages long, and some that were only a couple of sentences. There are chapters where the narration is there, word for word, and there are also stories that only include dialogue. I found the responsibility of telling the story as truthfully as possible – often without knowing the protagonist – to be a bit difficult. Some people were very frank about what had happened to them, to the point where they were just recalling a series of events. Others talked about how they felt, and that was when I had to decide whether to show it, or use their words.

I also thought a lot about how I would be designing the characters. I had never met most of the people who shared their stories with me, and the people I did know needed to not look like themselves, while still being themselves. I didn’t want the audience to read the characters incorrectly; I wanted to convey the sense that they were all just everyday people.

To make a point about how I was thinking about the problem, I simplified it in a little exercise for my classmates. I made a small activity book and among the questions I had prepared, I asked the readers to make judgements about the characters I drew, to assign personalities to them, and to label them as heroes or villains. The idea was that, in real life, there are no guaranteed visual signs for what a person is like, and any interpreted signs are based on what we have been taught by culture and the media. The responses I got were that it was difficult to say which character was what, because they all appeared neutral – and yet there were clear patterns in how people judged the faces. After I explained, “Of course they just look neutral, that’s what real life is like, that was the point.” I was advised to draw the characters more “good” or “bad.”

The frustration that people felt when the characters didn’t fit into neat two-dimensional boxes was something I thought might come out of Take it as a Compliment. While I wanted each story to have its own individuality, and show each character’s humanity, I also wanted it to have a certain level of neutrality, a sense of this individual human being and their unique experience being one of many. I learned that statistics didn’t say as much to people as I thought they would. It seemed everyone already knew the 1 in 6, 1 in 4, 1 in 3 estimates from this study and that one. Somehow it wasn’t enough, it didn’t translate perfectly that the 1 was a human being. And equally, that what happened to them was caused by another human being. Survivors and perpetrators of sexual violence are real, everyday people.

As it turned out, the anonymity ended up not being that important to all that many people, tumblr_n5et4x7qE61sklb5to1_1280what with there being interviews and emails sent. Not only did people choose to approach me without anonymity, some people even signed their names to their stories. One person introduced themselves in their written story by name, saying, “And that’s my REAL name, because these things happen to REAL people.”

All throughout its creation, I thought of Take it as a Compliment as being for two groups: For survivors and for bystanders. For the survivors, I’d hoped that the act of telling their stories would be part of a sort of healing process for them. And for bystanders, it was a message to be active in the discussion and to take action regarding the issue.

I don’t know how much personal benefit the survivors in the stories got from sharing, but it was clear that many of them did it not for themselves, but out of a concern for other people. Almost every contributor prefaced their story with something along the lines of, “People need to know this is a very real, and a very common occurrence.”

I think one of the most exciting things about the book getting published is that the survivors who did choose to remain anonymous have a chance to see that it became a real thing, and that it’s part of a conversation. Before Take it as a Compliment was picked up by Singing Dragon, it really was just all the stories, back to back. That was the main thing that needed to change. The publisher really felt – and I agree – that there needed to be a conclusion. A lot of people might get through the book and feel a lot of anger, and rightfully so. They might also feel helpless. But there is a lot of power in the discussion. There are a lot of us out there who are aware of the issues and who are eager to make changes.

My hopes for Take it as a Compliment going forward would be for it to keep doing what it’s been doing, which is to keep the conversation going. Even after the project was finished, and it was on display at my university’s grad show, I was approached by an older woman who said, “I really connected with your project because I’ve also been raped. Thank you.”

When we stand up and talk about these experiences, we can make more of an impact together, than we can by suffering in silence on our own.

 

Maria Stoian is a graphic designer and illustrator based in Scotland. She is interested in the way illustration and games can be a non-aggressive way of encouraging people to recognise when they might be biased. Take It As A Compliment was Maria’s Master’s project at Edinburgh College of Art.

Stoian_Take-It-As-A-Co_978-1-84905-697-7_colourjpg-printTake it as a Compliment  by Maria Stoian is AVAILABLE NOW

Price: £14.99

ISBN: 978-1-84905-697-7

 

 

Memory in Trauma by Steve Haines

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In this article, Steve Haines shares his thoughts on memory and trauma, and how important it is to recall past memories. Steve Haines is the author of medical graphic book Pain is Really Strange. His new book Trauma is Really Strange will be available on the 21st December.

 

The old primitive brain is shown in blue and red: the limbic system, brain stem and cerebellum.

The old primitive brain is shown in blue and red: the limbic system, brain stem and cerebellum.

Some Thoughts On Memory

Where are memories stored? In order to heal trauma, how important is it to remember what happened? These are common questions that often come up working with clients and teaching on trauma.

There are folklore phrases such as ‘muscle memory’ and ‘cellular memory’ that can be very useful but need to be applied carefully. They speak to the importance of information stored in the body. However it is essential to understand that for the information to be available to our awareness, our brain needs to be involved in processing the patterns of information flow happening in the body. Where the information is processed – in the primitive brain (unconscious) or in the cortex (conscious) – determines whether or not the memory is explicit.

I have a favourite old pair of jeans right now, some holes are on the second round of stitching. The wrinkles and folds in the material are a memory of sorts, the jeans mould to my body like no other pair of trousers. The fascia researcher Gil Hedley (2005) talks about fascia as ‘fuzz’. The fuzz accumulates and represents time. A certain stickiness and alignment of the fibres in the tissues holds the joints in more habitual ways.

Imagine a small child being shouted out by her father. Her shoulders tense, her neck tightens and there is a surge of fear related hormones and activity in the body. If this happens continuously the pattern of ‘shoulders tense and neck tight’ becomes a deep ‘action pattern’ (Kozlowska et al 2015).

Now imagine 30 years later the adult is on your treatment table. With grounded presence and soft, safe, warm, hands you are holding her head and neck. The tissues in her neck begin to express long held contractions and tightness. A shape in her body emerges, similar to the pattern generated when she got shouted at. Your client begins to feel unease and may think about her father.

The ‘muscle memory’ is the tension and tone in the tensegrity of the neck (Ingber 2008). The ‘cellular memory’ is cellular membrane receptors on local and global cells that grew to be sensitive to the all the stress hormones, immune system signaling and inflammatory chemicals that used to be secreted in the fear response (Damasio and Carvalho 2013). The ‘action patterns’ are simple, default movement schemas held in the old primitive brain.

Sensory nerves signal the changes in tension and chemical milieu to the brain. Only with the brain involved do we have emotions, feelings and thoughts generated in awareness. They may or may not be fully integrated into cognition, but something is happening. A memory is being expressed.

Instead of explicit memories we can have implicit memories (I first heard this term from Babette Rothschild, 2000), here the activation is chiefly in the primitive brain (brain stem, cerebellum and limbic system). The client on the table becomes scared when you touch her neck and too much changes too soon, but she does not really know why she is getting upset.

As a therapist working with trauma it is important to note the surges and changes in the rhythmic activity of the body as implicit memories occur. There are some great early warning signals that something is happening.

We can then help find the right pace of change for the individual so they can learn to self-regulate. The therapist’s skillful presence can lead to co-regulation such that the individual can learn to self-regulate (Ndefo 2015). The primitive brain does not do words and concepts very well, but will respond to safety, touch and presence.

Implicit memories are coded very simply in the primitive brain. Often they are without a timeline. The amygdala – an important part of our threat detection system (LeDoux 2015) – holds lots of symbolic representations of threat. The amygdala will trigger ‘fight-or-flight’ or ‘immobility’ responses (‘defense cascade’ Kozlowska et al 2015) if it senses danger in the incoming information stream.

If the cortex gets involved then we will have explicit memory – we can pull in associated events and a timeline to contextualise the activity in the body. Explicit memories usually only emerge into awareness after the body has changed. The hippocampus and prefrontal cortex should help us say ‘That happened 30 years ago’. The skill of the therapist here is to honor the memories and stories that appear but keep orienting the client to resources in the body and environment; ‘Its not happening now’, even if your body is screaming at you be scared.

Following Dr David Berceli (2008), founder of Trauma Releasing Exercises (TRE), I am fond of saying ‘You do not need to remember or do not need to understand to heal trauma’. The goal is to overwrite the symbols in the amygdala with present time information. The body is a great source of good news that can bring you into now.

Summary

Information is stored in the tissues and cells of the body.

The threat detection systems in the primitive brain can be activated as the body changes.

The primitive brain does not do words and concepts very well, but will respond to safety, touch and presence.

If we can support change in the body and down regulate arousal we can change memories with out needing to understand or remember the trauma event.

The goal is to uncouple the charge of the defense cascade from the sensations of the implicit memory.

Notes

1 Kozlowska et al (2015) list some early signs of arousal. For flight-or-fight (their preferred order of this phrase) they list; changes in breath, furrowing of the eyebrows, the tensing of the jaw, or the clenching of a fist, narrowing of the range of attention. For immobility states they list; visual blurring, sweating, nausea, warmth, light-headedness, and fatigue. 

My favourite signs to look out for are anything going too quick (thoughts, sensations or emotions that cannot be integrated into the present moment) and anything going too slow (spacey, floaty, absence, hard to make eye contact, numbness or tingling or loss of body awareness). 

Dry mouth, sense of small or far away feet, absent belly, cold hands and a sense of someone withdrawing are all good signs to put the brakes on, whatever process is being expressed. David Berceli teaches ‘Freezing, Flooding or Dissociation’ as signs that too much arousal is occurring.

Download as pdf: memory v3 2015-10-29

References

Berceli D (2008) The Revolutionary Trauma Release Process. Transcend Your Toughest Times. Vancouver: Namaste Publishing.

Damasio A and Carvalho GB (2013) The nature of feelings: evolutionary and neurobiological origins. Nature Reviews Neuroscience, Vol 14, February 2013, 143.

Hedley G (2005) The Integral Anatomy Series. 4 Vol DVD set. Integral Anatomy Productions, LLC, 430 Westwood Avenue, Westwood, NJ 07675, USA (or check ‘The Fuzz Speech’ on YouTube).

Ingber DE (2008) Tensegrity and mechanotransduction. Journal of Bodywork and Movement Therapies 12, 198–200.

Kozlowska K, Walker P, McLean L, and Carrive P (2015) Fear and the Defense Cascade: Clinical Implications and Management. Harv Rev Psychiatry. 2015 Jul; 23(4): 263–287.

LeDoux JE (2015) The Amygdala Is NOT the Brain’s Fear Center. psychologytoday.com http://bit.ly/ledoux-no-fear-center  Accessed 2015-09-01

Ndefo N (2015) Personal communication. www.trelosangeles.com ‘Sometimes we have to co-regulate before we can self-regulate’.

Rothschild B (2000) The Body Remembers – The Psychophysiology of Trauma and Trauma Treatment. London: W.W. Norton.

Medical graphic books by Steve Haines, published by Singing Dragon

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Pain is Really Strange is a scientifically-based, detailed, and gently humorous graphic book on pain and pain management. Answering questions such as ‘how can I change my pain experience?’, ‘what is pain?’, and ‘how do nerves work?’, this short research-based graphic book reveals just how strange pain is and explains how understanding it is often the key to relieving its effects.

 

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Trauma is Really Strange is a science-based medical graphic book explaining trauma, its effects on our psychology and physiology, and what to do about it. When something traumatic happens to us, we dissociate and our bodies shut down their normal processes. This unique comic explains the strange nature of trauma and how it confuses the brain and affects the body. With wonderful artwork, cat and mouse metaphors, essential scientific facts, and a healthy dose of wit, the narrator reveals how trauma resolution involves changing the body’s physiology and describes techniques that can achieve this, including Trauma Releasing Exercises that allow the body to shake away tension, safely releasing deep muscular patterns of stress and trauma.

Trauma is Really Strange will publish on December 21st 2015.

Drawing and Writing about Anxiety

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When Anxiety Attacks is a graphic memoir about living with anxiety and finding help through a therapist. In this blog, Terian Koscik, author and illustrator, gives an inside look to her experience of drawing and writing about anxiety.

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One of the hardest parts about living with anxiety is trying to explain what it’s like to friends and family who don’t experience it. To them, it makes no sense that someone who is usually capable of making clear, rational decisions would have fears and thoughts that are totally irrational. What they don’t realize is that anxious people are often perfectly aware of how irrational our thoughts are. This doesn’t make it any easier to ignore them, though. Dealing with anxiety, beginning to understand it after going to therapy for the first time, and trying to convey my new sense of understanding to others led me to want to create a comic book about the experience.

As a child, my anxieties appeared blatantly silly and irrational to outside observers. I would panic whenever the phone rang, worried about what would happen if we didn’t answer it before it went to voicemail. What if it was an extremely important call, and they needed to talk to us right then? Or what if they thought we didn’t care?

As adults, we have a lot more in our lives to worry and panic about, and the line between what is silly and what isn’t is harder to see, especially if one’s default state is to worry. After graduating from college, my best friend from high school moved in with me, and I was distraught when she didn’t seem as enthusiastic about living together as I was. I constantly thought about what I was doing wrong when she chose to spend her time alone instead of with me, and whether I was capable of making any friends at all. I ended up going to therapy to talk about these feelings. I gradually realized that my worries were based on a general fear of being alone rather than anyone’s specific actions, that I could address them directly by asking others for help, and that there was nothing wrong with me for feeling this way.

In my book “When Anxiety Attacks,” I used dramatically different color palettes to demonstrate the way that irrational anxious thinking separates one from their usual ability to consider facts and possibilities. Other people and possibilities other than the worst case scenario do not exist in this state of mind. This makes it difficult or impossible for well-meaning loved ones to get through to us when in this state. For example, if I felt lonely, someone might remind me that I have many friends and family to turn to for reassurance. However, my anxious thinking would find a way to ignore this advice. Wouldn’t my friends and family have more important things to do than listen to me complain? Did I even deserve their attention?

Through therapy I have found that as anxious people, the best we can do is remain open to facts and possibilities, and not judge ourselves too harshly for the tendency to worry. I hope that my book will help others reach this conclusion.

Terian Koscik has been a reader of comics, a creator of comics, and an anxious person for almost as long as she can remember. Most of her work is autobiographical in nature, and deals with finding humor in feelings of loneliness, anxiety, and depression. She posts her work regularly at http://pineconedoesthings.tumblr.com/. Terian lives in Portland, Oregon with 4 humans and 2 rabbits.

Tweet in a drawing of your anxious self to @Singing_Dragon_ using the hashtag #AnxiousMe to enter the chance to win a copy of When Anxiety Attacks

Learn more about When Anxiety Attacks here