In the second part of this blog we cite and use excerpts from an excellent article (1) on how 12 step group participation helps with Post Traumatic Stress Disorder (PTSD).
“Treatment of Complex Post-Traumatic Stress Disorder with Addictions, Utilizing a Twelve-Step Program as an
Adjunctive to Psychotherapy
by Judy McLaughlin-Ryan
“…Many clinicians working with CPTSD/A have firsthand clinical experience of just how difficult taking action can be for this CPTSD/A population. When patients experience dysregulating symptoms, sometimes another person must literally be present to activate the patients’ initiating responses. If a patient has a flashback, is dissociated or immobilized in the freeze response, in a reactive fight response, or obsessed with using alcohol or drugs, proactive behavior may be improbable and/or neurobiologically impossible without an interaction with another. Patients with CPTSD/A are frequently unable to read their bodily cues or alarms, and when misread, may take life extinguishing actions in response to an internal cue, when, in fact, the cue was telling the patient to reach out for help, receive comfort from another, or something about his or her bodily needs.
Interoception, defined by Cameron (2001), is the psychosomatic process of the brain’s influence on bodily functions and afferent sensory input to the central nervous system. It affects behavior, cognitive function and emotions. It is the mechanism of visceral sensory psychobiology, including internal organs in the abdominal cavity, and affects the viscera, resulting in an intuitive experience. As seen above, interoception is short circuited in patients with CPTSD/A. The basic tenet of interoception is that it is the interchange between the body and the brain. As Cameron states: Bodily changes follow directly the perception of the exciting fact, and that our feeling of the same changes as they occur IS the emotion . . .
With those who have CPTSD/A, emotions are often not read at all, reacted upon appropriately, or often not utilized for life supportive, action-oriented behavior…
Van der Kolk (2006) discussed the necessity for the patient with PTSD to learn how to take effective action. For example, after one is stressed, the reaction to run towards a loved one for comfort and safety is a predictable response. With those who suffer from PTSD, this mobilization response may be impossible. Because many with PTSD experience chronically overwhelming emotions, they often lose their capacity to use emotions as guides for effective action.
“Unable to gauge and modulate their own internal states, they habitually collapse in the face of threat or lash out in response to minor irritations….(p. 282). He described the necessity in treatment to address and pay sufficient attention to “the experience and interpretation of disturbed physical sensations and preprogrammed physical action patterns (p. 282). In other words, before one can take an effective action, one must have a sense of what is going on inside of his or her body and develop the capacity to act upon these sensations appropriately and not only from the perspective of the traumatic response. This awareness is a precursor to subsequent life supportive, action-oriented responses.
Those with CPTSD/A may not be aware of typical affective and state bodily functions such as hunger, tiredness, physical illness, loneliness, and many others. This awareness is a precursor to life supportive action taking. Many patients with PTSD are overwhelmed by focusing on internal sensations and deny having an inner sense of themselves. Self-awareness may initially result in a retraumatizing experience (van der Kolk, 2006). The patient may leave the here and now in response to the self-awareness and interpret the sensation or awareness as the trauma reoccurring once again…
Ogden and Minton’s (2000) work in the Sensorimotor Psychotherapy Institute addresses approaches that…suggests the integration of sensorimotor processing with cognitive emotional processing in the treatment of trauma, with the therapist interactively regulating clients’ dysregulated states as clients build their awareness and understanding of their inner bodily sensations. For this awareness or interoceptive experience to occur, patients need to learn to identify their physical sensations and translate their emotions and experiences into communicable language (van der Kolk, 2006)…
Patients’ increasing internal awareness, while learning to understand themselves, metabolizes the activation of the capacity to look for and/or find a safe place to go (van der Kolk, 2006)…
…Without a safe place, the patient could experience further reenactment of the original trauma, where one was left unprotected, without any reregulating interactive experience. The point of cultivating this internal understanding in the patient is to assist the patient in the process of engaging, or as Siegel (2007) stated, a process of enhancing compassion and empathy, while experiencing authentic connections with consideration and more reflection.
Providing the patient with a safe harbor and interactive figures that serve as interoceptionists is vital to the treatment of CPTSD, and increasing a community experience should be a part of the treatment goals. The exclusive therapeutic relationship can provide only a piece of the therapeutic puzzle, especially because the therapist cannot be available at all times to all of his or her patients, when they are having a triggered reaction or the compulsion to use drugs or alcohol in a destructive manner as a means to mediate their tension.
Those who have CPTSD, when in a fight, flight, and/or freeze response, in regard to a triggering event, need “a place to go,” “a place to run to,” “a place of hope.” This running towards hope metabolizes a reparative primitive response to the traumatic experience or traumatic memory. The twelve-step program offers that place to go for hope.
Members are encouraged to make contact when in distress and not to wait to do so. Many members offer telephone numbers for outreach calls and remind one another that these outreach calls help both parties involved, not simply the person in distress. Most clinicians and psychotherapeutic support groups do not offer this type of broad range availability all hours of the day, seven days a week. Therefore, while the patient is in treatment, developing the security of a place to go when in distress any time of day offers the potential for the patient to build secure attachments, learn to self-regulate, and learn to help others, which subsequently develops the potential for the patient to have the experience of compassion and attunement through identification.
A confounding treatment problem with CPTSD/A is that the dysregulatory response of flight, fight, or freeze, with added emotionally reactive responses of compulsivity and obsession, may disrupt the patient’s capacity to automatically and autonomously initiate life supportive, healthy action responses to distress. One cannot assume that the patient has had sufficient interactive attuned experiences to be independently aware of his or her own dysregulated state. Sometimes, the patient may require another’s input to make a down or up regulating response. In other words, for the patient experiencing massive dysregulatory responses, including the compulsive need for addictive behavior to mediate the stress, the execution of a plan of positive action may sometimes not be simple or even possible.
Most clinicians who have had experience working with those who have a traumatically-driven addictive responses understand how therapeutic interventions and cognitive-intellectual understanding can be massively limited for the patient when it comes to actually putting these life supportive responses into action. Because reflective thought is incompatible with the traumatic reaction, sometimes an attuned interactive experience is necessary at the time of the traumatic reaction…if the patient is developing a community of others in the twelve-step program, instructions on socially-driven action-oriented responses are more likely to be developed via the attuned interactive experiences and the availability of a safe place.
The experience of having access to another member of the program and the development of an internalized working model of a social community that models awareness of self, secure attachment bonds to mitigate states of dysregulation, the reliance on others, identifying the cause of the problem, and then taking the appropriate action to solve that problem helps the patient become aware of his or her own internal states. This development occurs through the reliance on others by seeking identifying experiences with fellow members and through faith in some power greater than oneself. Schore (2003) discusses how a regulating attachment of another not only helps regulate the dysregulated patient, but literally develops a more regulated neurobiological brain and thus a more regulated reaction. In other words, during times of this type of distress, interaction is vital. The twelve-step program members practice sharing how the program has worked in their lives, which generally involves self-regulating experiences. Members share how they found solutions to distress and/or their dysregulating experiences.
The CPTSD/A condition can interfere with some of the most basic areas of life supportive daily actions and daily functioning, such as eating, sleeping, and mood, as well as other states and affective experiences. Van der Kolk (2006) describes the basic problems that those with PTSD have with interoceptive experiences. He suggests that the therapist’s functions include being an interoceptionist or one who facilitates the patient’s learning to tolerate, understand, and finally react to internal feelings and sensations…
When traumatized individuals try to mediate these trauma-related perceptions, emotions, and sensations, they often deny the bodily experience or feel overwhelmed by it. Thus, taking any action as a result of a bodily sensation is impossible.
HALT is one example of how the twelve-step program addresses problems with interactive experiences of mindfulness regarding interoception and basic bodily physical functions, develops secure and attuned attachments, and helps regulate terrifying affective/state experiences…taken from Courage to Be Me (Alanon World Service Literature, 1996 ), “We can watch for the need to HALT and give ourselves special attention when we are feeling Hungry or Angry or Lonely or Tired” (p. 139)…”
HALT. Don’t get too hungry, angry, lonely, or tired. (this reminder to help set healthy limits perhaps never learned as a child of an alcoholic? As a case study in this article refers to ” In the past, I often believed I should be able to go for days without food or sleep. I also tested the limits of my ability to handle enormous doses of stress and isolation without tending to my own emotional needs.”
“Al-Anon has taught me a gentler, simpler way of caring for myself. I find it of great benefit to have a brief list of the most basic areas in which I neglect my own well-being: nourishment, emotional wellness, fellowship, and physical rest…”