The Body Keeps the Score

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The Body Keeps the Score Page 52

by Bessel van der Kolk MD


  22.There are three different ways in which people deal with overwhelming experiences: dissociation (spacing out, shutting down), depersonalization (feeling like it’s not you it’s happening to), and derealization (feeling like whatever is happening is not real).

  23.My colleagues at the Justice Resource Institute created a residential treatment program for adolescents, The van der Kolk Center at Glenhaven Academy, that implements many of the trauma-informed treatments discussed in this book, including yoga, sensory integration, neurofeedback and theater. http://www.jri.org/vanderkolk/about. The overarching treatment model, attachment, self-regulation, and competency (ARC), was developed by my colleagues Margaret Blaustein and Kristine Kinneburgh. Margaret E. Blaustein, and Kristine M. Kinniburgh, Treating Traumatic Stress in Children and Adolescents: How to Foster Resilience Through Attachment, Self-Regulation, and Competency (New York: Guilford Press, 2012).

  24.C. K. Chandler, Animal Assisted Therapy in Counseling (New York: Routledge, 2011). See also A. J. Cleveland, “Therapy Dogs and the Dissociative Patient: Preliminary Observations,” Dissociation 8, no. 4 (1995): 247–52; and A. Fine, Handbook on Animal Assisted Therapy: Theoretical Foundations and Guidelines for Practice (San Diego: Academic Press, 2010).

  25.E. Warner, et al., “Can the Body Change the Score? Application of Sensory Modulation Principles in the Treatment of Traumatized Adolescents in Residential Settings,” Journal of Family Violence 28, no. 7 (2013): 729–38. See also A. J. Ayres, Sensory Integration and Learning Disorders (Los Angeles: Western Psychological Services, 1972); H. Hodgdon, et al., “Development and Implementation of Trauma-Informed Programming in Residential Schools Using the ARC Framework,” Journal of Family Violence 27, no. 8 (2013); J. LeBel, et al., “Integrating Sensory and Trauma-Informed Interventions: A Massachusetts State Initiative, Part 1,” Mental Health Special Interest Section Quarterly 33, no. 1 (2010): 1–4;

  26.They appeared to have activated the vestibule-cerebellar system in the brain, which seems to be involved in self-regulation and can be damaged by early neglect.

  27.Aaron R. Lyon and Karen S. Budd, “A Community Mental Health Implementation of Parent–Child Interaction Therapy (PCIT).” Journal of Child and Family Studies 19, no. 5 (2010): 654–68. See also Anthony J. Urquiza and Cheryl Bodiford McNeil, “Parent-Child Interaction Therapy: An Intensive Dyadic Intervention for Physically Abusive Families.” Child Maltreatment 1, no 2 (1996): 134–44; J. Borrego Jr., et al. “Research Publications.” Child and Family Behavior Therapy 20: 27-54.

  28.B. A. van der Kolk, et al., “Fluoxetine in Post Traumatic Stress,” Journal of Clinical Psychiatry (1994): 517–22.

  29.P. Ogden, K. Minton, and C. Pain, Trauma and the Body (New York, Norton, 2010); P. Ogden and J. Fisher, Sensorimotor Psychotherapy: Interventions for Trauma and Attachment (New York: Norton, 2014).

  30.P. Levine, In an Unspoken Voice (Berkeley: North Atlantic Books); P. Levine, Waking the Tiger (Berkeley: North Atlantic Books).

  31.For more on impact model mugging, see http://modelmugging.org/.

  32.S. Freud, Remembering, Repeating, and Working Through (Further Recommendations on the Technique of Psychoanalysis II), standard ed. (London: Hogarth Press, 1914), p. 371

  33.E. Santini, R. U. Muller, and G. J. Quirk, “Consolidation of Extinction Learning Involves Transfer from NMDA-Independent to NMDA-Dependent Memory,” Journal of Neuroscience 21 (2001): 9009–17.

  34.E. B. Foa and M. J. Kozak, “Emotional Processing of Fear: Exposure to Corrective Information,” Psychological Bulletin 99, no. 1 (1986): 20–35.

  35.C. R. Brewin, “Implications for Psychological Intervention,” in Neuropsychology of PTSD: Biological, Cognitive, and Clinical Perspectives, ed. J. J. Vasterling and C. R. Brewin (New York: Guilford, 2005), 272.

  36.T. M. Keane, “The Role of Exposure Therapy in the Psychological Treatment of PTSD,” National Center for PTSD Clinical Quarterly 5, no. 4 (1995): 1–6.

  37.E. B. Foa and R. J. McNally, “Mechanisms of Change in Exposure Therapy,” in Current Controversies in the Anxiety Disorders, ed. R. M. Rapee (New York: Guilford, 1996), 329–43.

  38.J. D. Ford and P. Kidd, “Early Childhood Trauma and Disorders of Extreme Stress as Predictors of Treatment Outcome with Chronic PTSD,” Journal of Traumatic Stress 18 (1998): 743–61. See also A. McDonagh-Coyle, et al., “Randomized Trial of Cognitive-Behavioral Therapy for Chronic Posttraumatic Stress Disorder in Adult Female Survivors of Childhood Sexual Abuse,” Journal of Consulting and Clinical Psychology 73, no. 3 (2005): 515–24; Institute of Medicine of the National Academies, Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence (Washington: National Academies Press, 2008); and R. Bradley, et al., “A Multidimensional Meta-Analysis of Psychotherapy for PTSD,” American Journal of Psychiatry 162, no. 2 (2005): 214–27.

  39.J. Bisson, et al., “Psychological Treatments for Chronic Posttraumatic Stress Disorder: Systematic Review and Meta-Analysis,” British Journal of Psychiatry 190 (2007): 97–104. See also L. H. Jaycox, E. B. Foa, and A. R. Morrall, “Influence of Emotional Engagement and Habituation on Exposure Therapy for PTSD,” Journal of Consulting and Clinical Psychology 66 (1998): 185–92.

  40.“Dropouts: in prolonged exposure (n = 53 [38%]); in present-centered therapy (n = 30 [21%]) (P = .002). The control group also had a high rate of casualties: 2 nonsuicidal deaths, 9 psychiatric hospitalizations, and 3 suicide attempts.” P. P. Schnurr, et al., “Cognitive Behavioral Therapy for Posttraumatic Stress Disorder in Women,” JAMA 297, no. 8 (2007): 820–30.

  41.R. Bradley, et al., “A Multidimensional Meta-Analysis of Psychotherapy for PTSD,” American Journal of Psychiatry 162, no. 2 (2005): 214–27.

  42.J. H. Jaycox and E. B. Foa, “Obstacles in Implementing Exposure Therapy for PTSD: Case Discussions and Practical Solutions,” Clinical Psychology and Psychotherapy 3, no. 3 (1996): 176–84. See also E. B. Foa, D. Hearst-Ikeda, and K. J. Perry, “Evaluation of a Brief Cognitive-Behavioral Program for the Prevention of Chronic PTSD in Recent Assault Victims,” Journal of Consulting and Clinical Psychology 63 (1995): 948–55.

  43.Alexander McFarlane personal communication.

  44.R. K. Pitman, et al., “Psychiatric Complications During Flooding Therapy for Posttraumatic Stress Disorder,” Journal of Clinical Psychiatry 52, no. 1 (January 1991): 17–20.

  45.Jean Decety, Kalina J. Michalska, and Katherine D. Kinzler, “The Contribution of Emotion and Cognition to Moral Sensitivity: A Neurodevelopmental Study,” Cerebral Cortex 22 no. 1 (2012): 209–20; Jean Decety, C. Daniel Batson, “Neuroscience Approaches to Interpersonal Sensitivity,” 2, nos. 3-4 (2007).

  46.K. H. Seal, et al., “VA Mental Health Services Utilization in Iraq and Afghanistan Veterans in the First Year of Receiving New Mental Health Diagnoses,” Journal of Traumatic Stress 23 (2010): 5–16.

  47.L. Jerome, “(+/-)-3,4-Methylenedioxymethamphetamine (MDMA, “Ecstasy”) Investigator’s Brochure,” December 2007, available at www.maps.org/research/mdma/protocol/ib_mdma_new08.pdf (accessed August 16, 2012).

  48.John H. Krystal, et al. “Chronic 3, 4-methylenedioxymethamphetamine (MDMA) use: effects on mood and neuropsychological function?.” The American Journal of Drug and Alcohol Abuse 18.3 (1992): 331-341.

  49.Mithoefer, Michael C., et al., “The safety and efficacy of±3, 4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study.” Journal of Psychopharmacology 25.4 (2011): 439-452; M. C. Mithoefer, et al., “Durability of Improvement in Post-traumatic Stress Disorder Symptoms and Absence of Harmful Effects or Drug Dependency after 3, 4-Methylenedioxymethamphetamine-Assisted Psychotherapy: A Prospective Long-Term Follow-up Study,” Journal of Psychopharmacology 27, no. 1 (2013): 28–39.

  50.J. D. Bremner, “Neurobiology of Post-traumatic St
ress Disorder,” in Posttraumatic Stress Disorder: A Critical Review, ed. R. S. Rynoos (Lutherville, MD: Sidran Press, 1994), 43–64.

  51.http://cdn.nextgov.com/nextgov/interstitial.html?v=2.1.1&rf=http%3A%2F%2Fwww.nextgov.com%2Fhealth%2F2011%2F01%2Fmilitarys-drug-policy-threatens-troops-health-doctors-say%2F48321%2F.

  52.J. R. T. Davidson, “Drug Therapy of Post-traumatic Stress Disorder,” British Journal of Psychiatry 160 (1992): 309–314. See also R. Famularo, R. Kinscherff, and T. Fenton, “Propranolol Treatment for Childhood Posttraumatic Stress Disorder Acute Type,” American Journal of Disorders of Childhood 142 (1988): 1244–47; F. A. Fesler, “Valproate in Combat-Related Posttraumatic Stress Disorder,” Journal of Clinical Psychiatry 52 (1991): 361–64; B. H. Herman, et al., “Naltrexone Decreases Self-Injurious Behavior,” Annals of Neurology 22 (1987): 530–34; and B. A. van der Kolk, et al., “Fluoxetine in Posttraumatic Stress Disorder.”

  53.B. Van der Kolk, et al., “A Randomized Clinical Trial of EMDR, Fluoxetine and Pill Placebo in the Treatment of PTSD: Treatment Effects and Long-Term Maintenance,” Journal of Clinical Psychiatry 68 (2007): 37–46.

  54.R. A. Bryant, et al., “Treating Acute Stress Disorder: An Evaluation of Cognitive Behavior Therapy and Supportive Counseling Techniques,” American Journal of Psychiatry 156, no. 11 (November 1999): 1780–86; N. P. Roberts et al., “Early Psychological Interventions to Treat Acute Traumatic Stress Symptoms,” Cochran Database of Systematic Reviews 3 (March 2010).

  55.This includes the alpha1 receptor antagonist prazosin, the alpha2 receptor antagonist clonidine, and the beta receptor antagonist propranolol. See M. J. Friedman and J. R. Davidson, “Pharmacotherapy for PTSD,” in Handbook of PTSD: Science and Practice, ed. M. J. Friedman, T. M. Keane, and P. A. Resick (New York: Guilford Press, (2007), 376.

  56.M. A. Raskind, et al., “A Parallel Group Placebo Controlled Study of Prazosin for Trauma Nightmares and Sleep Disturbance in Combat Veterans with Post-traumatic Stress Disorder,” Biological Psychiatry 61, no. 8 (2007): 928–34. F. B. Taylor, et al., “Prazosin Effects on Objective Sleep Measures and Clinical Symptoms in Civilian Trauma Posttraumatic Stress Disorder: A Placebo-Controlled Study,” Biological Psychiatry 63, no. 6 (2008): 629–32.

  57.Lithium, lamotrigin, carbamazepine, divalproex, gabapentin, and topiramate may help to control trauma-related aggression and irritability. Valproate has been shown to be effective in several case reports with PTSD, including with military veteran patients with chronic PTSD. Friedman and Davidson, “Pharmacotherapy for PTSD”; F. A. Fesler, “Valproate in Combat-Related Posttraumatic Stress Disorder,” Journal of Clinical Psychiatry 52, no. 9 (1991): 361–64. The following study showed a 37.4 percent reduction in PTSD S. Akuchekian and S. Amanat, “The Comparison of Topiramate and Placebo in the Treatment of Posttraumatic Stress Disorder: A Randomized, Double-Blind Study,” Journal of Research in Medical Sciences 9, no. 5 (2004): 240–44.

  58.G. Bartzokis, et al., “Adjunctive Risperidone in the Treatment of Chronic Combat-Related Posttraumatic Stress Disorder,” Biological Psychiatry 57, no. 5 (2005): 474–79. See also D. B. Reich, et al., “A Preliminary Study of Risperidone in the Treatment of Posttraumatic Stress Disorder Related to Childhood Abuse in Women,” Journal of Clinical Psychiatry 65, no. 12 (2004): 1601–1606.

  59.The other methods include interventions that usually help traumatized individuals sleep, like the antidepressant trazodone, binaural beat apps, light/sound machines like Proteus (www.brainmachines.com), HRV monitors like hearthmath (http://www.heartmath.com/), and iRest, an effective yoga-based intervention. (http://www.irest.us/)

  60.D. Wilson, “Child’s Ordeal Shows Risks of Psychosis Drugs for Young,” New York Times, September 1, 2010, available at http://www.nytimes.com/2010/09/02/business/02kids.html?pagewanted=all&_r=0.

  61.M. Olfson, et al., “National Trends in the Office-Based Treatment of Children, Adolescents, and Adults with Antipsychotics,” Archives of General Psychiatry 69, no. 12 (2012): 1247–56.

  62.E. Harris, et al., “Perspectives on Systems of Care: Concurrent Mental Health Therapy Among Medicaid-Enrolled Youths Starting Antipsychotic Medications,” FOCUS 10, no. 3 (2012): 401–407.

  63.B. A. Van der Kolk, “The Body Keeps the Score: Memory and the Evolving Psychobiology of Posttraumatic Stress,” Harvard Review of Psychiatry 1, no. 5 (1994): 253–65.

  64.B. Brewin, “Mental Illness is the Leading Cause of Hospitalization for Active-Duty Troops,” Nextgov.com, May 17, 2012, http://www.nextgov.com/health/2012/05/mental-illness-leading-cause-hospitalization-active-duty-troops/55797/.

  65.Mental health drug expenditures, Department of Veterans affairs. http://www.veterans.senate.gov/imo/media/doc/For%20the%20Record%20-%20CCHR%204.30.14.pdf.

  CHAPTER 14: LANGUAGE: MIRACLE AND TYRANNY

  1.Dr. Spencer Eth to Bessel A. van der Kolk, March 2002.

  2.J. Breuer and S. Freud, “The Physical Mechanisms of Hysterical Phenomena,” in The Standard Edition of the Complete Psychological Works of Sigmund Freud (London: Hogarth Press, 1893). J. Breuer and S. Freud, Studies on Hysteria (New York: Basic Books, 2009).

  3.T. E. Lawrence, Seven Pillars of Wisdom (New York: Doubleday, 1935).

  4.E. B. Foa, et al., “The Posttraumatic Cognitions Inventory (PTCI): Development and Validation,” Psychological Assessment 11, no. 3 (1999): 303–314.

  5.K. Marlantes, What It Is Like to Go to War (New York: Grove Press, 2011).

  6.Ibid., 114.

  7.Ibid., 129.

  8.H. Keller, The World I Live In (1908), ed. R. Shattuck (New York: NYRB Classics, 2004). See also R. Shattuck, “A World of Words,” New York Review of Books, February 26, 2004.

  9.H. Keller, The Story of My Life, ed. R. Shattuck and D. Herrmann (New York: Norton, 2003).

  10.W. M. Kelley, et al., “Finding the Self? An Event-Related fMRI Study,” Journal of Cognitive Neuroscience 14, no. 5 (2002): 785–94. See also N. A. Farb, et al., “Attending to the Present: Mindfulness Meditation Reveals Distinct Neural Modes of Self-Reference,” Social Cognitive and Affective Neuroscience 2, no. 4 (2007): 313–22. P. M. Niedenthal, “Embodying Emotion,” Science 316, no. 5827 (2007): 1002–1005; and J. M. Allman, “The Anterior Cingulate Cortex,” Annals of the New York Academy of Sciences 935, no. 1 (2001): 107–117.

  11.J. Kagan, dialogue with the Dalai Lama, Massachusetts Institute of Technology, 2006. http://www.mindandlife.org/about/history/.

  12.A. Goldman and F. de Vignemont, “Is Social Cognition Embodied?” Trends in Cognitive Sciences 13, no. 4 (2009): 154–59. See also A. D. Craig, “How Do You Feel—Now? The Anterior Insula and Human Awareness,” Nature Reviews Neuroscience 10 (2009): 59–70; H. D. Critchley, “Neural Mechanisms of Autonomic, Affective, and Cognitive Integration,” Journal of Comparative Neurology 493, no. 1 (2005): 154–66; T. D. Wager, et al., “Prefrontal-Subcortical Pathways Mediating Successful Emotion Regulation,” Neuron 59, no. 6 (2008): 1037–50; K. N. Ochsner, et al., “Rethinking Feelings: An fMRI Study of the Cognitive Regulation of Emotion,” Journal of Cognitive Neuroscience 14, no. 8 (2002): 1215–29; A. D’Argembeau, et al., “Self-Reflection Across Time: Cortical Midline Structures Differentiate Between Present and Past Selves,” Social Cognitive and Affective Neuroscience 3, no. 3 (2008): 244–52; Y. Ma, et al., “Sociocultural Patterning of Neural Activity During Self-Reflection,” Social Cognitive and Affective Neuroscience 9, no. 1 (2014): 73–80; R. N. Spreng, R. A. Mar, and A. S. Kim, “The Common Neural Basis of Autobiographical Memory, Prospection, Navigation, Theory of Mind, and the Default Mode: A Quantitative Meta-Analysis,” Journal of Cognitive Neuroscience 21, no. 3 (2009): 489–510; H. D. Critchley, “The Human Cortex Responds to an Interoceptive Challenge,” Proceedings of the National Academy of Sciences of the United States of America 101, no. 17 (2004): 6333–34; and C. Lamm, C. D. Batson, and J. Decety, “The Neural Substrate of Human Empathy: Effects of P
erspective-Taking and Cognitive Appraisal,” Journal of Cognitive Neuroscience 19, no. 1 (2007): 42–58.

  13.J. W. Pennebaker, Opening Up: The Healing Power of Expressing Emotions (New York: Guilford Press, 2012), 12.

  14.Ibid., p. 19.

  15.Ibid., p.35.

  16.Ibid., p. 50.

  17.J. W. Pennebaker, J. K. Kiecolt-Glaser, and R. Glaser, “Disclosure of Traumas and Immune Function: Health Implications for Psychotherapy,” Journal of Consulting and Clinical Psychology 56, no. 2 (1988): 239–45.

  18.D. A. Harris, “Dance/Movement Therapy Approaches to Fostering Resilience and Recovery Among African Adolescent Torture Survivors,” Torture 17, no. 2 (2007): 134–55; M. Bensimon, D. Amir, and Y. Wolf, “Drumming Through Trauma: Music Therapy with Post-traumatic Soldiers,” Arts in Psychotherapy 35, no. 1 (2008): 34–48; M. Weltman, “Movement Therapy with Children Who Have Been Sexually Abused,” American Journal of Dance Therapy 9, no. 1 (1986): 47–66; H. Englund, “Death, Trauma and Ritual: Mozambican Refugees in Malawi,” Social Science & Medicine 46, no. 9 (1998): 1165–74; H. Tefferi, Building on Traditional Strengths: The Unaccompanied Refugee Children from South Sudan (1996); D. Tolfree, Restoring Playfulness: Different Approaches to Assisting Children Who Are Psychologically Affected by War or Displacement (Stockholm: Rädda Barnen, 1996), 158–73; N. Boothby, “Mobilizing Communities to Meet the Psychosocial Needs of Children in War and Refugee Crises,” in Minefields in Their Hearts: The Mental Health of Children in War and Communal Violence, ed. R. Apfel and B. Simon (New Haven, Yale Universit Press, 1996), 149–64; S. Sandel, S. Chaiklin, and A. Lohn, Foundations of Dance/Movement Therapy: The Life and Work of Marian Chace (Columbia, MD: American Dance Therapy Association, 1993); K. Callaghan, “Movement Psychotherapy with Adult Survivors of Political Torture and Organized Violence,” Arts in Psychotherapy 20, no. 5 (1993): 411–21; A. E. L. Gray, “The Body Remembers: Dance Movement Therapy with an Adult Survivor of Torture,” American Journal of Dance Therapy 23, no. 1 (2001): 29–43.

 

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