16.J. C. Nemiah and P. E. Sifneos, “Psychosomatic Illness: A Problem in Communication,” Psychotherapy and Psychosomatics 18, no. 1–6 (1970): 154–60. See also G. J. Taylor, R. M. Bagby, and J. D. A. Parker, Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness (Cambridge: Cambridge University Press, 1997).
17.A. R. Damásio, The Feeling of What Happens: Body and Emotion and the Making of Consciousness (Random House, 2000), 28.
18.B. A. van der Kolk, “Clinical Implications of Neuroscience Research in PTSD,” Annals of the New York Academy of Sciences 1071, no. 1 (2006): 277–93. See also B. K. Hölzel, et al., “How Does Mindfulness Meditation Work? Proposing Mechanisms of Action from a Conceptual and Neural Perspective,” Perspectives on Psychological Science 6, no. 6 (2011): 537–59.
19.B. K. Hölzel, et al., “Mindfulness Practice Leads to Increases in Regional Brain Gray Matter Density,” Psychiatry Research: Neuroimaging 191, no. 1 (2011): 36–43. See also B. K. Hölzel, et al., “Stress Reduction Correlates with Structural Changes in the Amygdala,” Social Cognitive and Affective Neuroscience 5, no. 1 (2010): 11–17; and S. W. Lazar, et al., “Meditation Experience Is Associated with Increased Cortical Thickness,” NeuroReport 16 (2005): 1893–97.
CHAPTER 17: PUTTING THE PIECES TOGETHER: SELF-LEADERSHIP
1.R. A. Goulding and R. C. Schwartz, The Mosaic Mind: Empowering the Tormented Selves of Child Abuse Survivors (New York: Norton, 1995), 4.
2.J. G. Watkins and H. H. Watkins, Ego States (New York: Norton, 1997). Jung calls personality parts archetypes and complexes; cognitive psychology schemes and the DID literature refers to them as alters. See also J. G. Watkins and H. H. Watkins, “Theory and Practice of Ego State Therapy: A Short-Term Therapeutic Approach,” Short-Term Approaches to Psychotherapy 3 (1979): 176–220; J. G. Watkins and H. H. Watkins, “Ego States and Hidden Observers,” Journal of Altered States of Consciousness 5, no. 1 (1979): 3–18; and C. G. Jung, Lectures: Psychology and Religion (New Haven CT: Yale University Press, 1960).
3.W. James, The Principles of Psychology (New York: Holt, 1890), 206.
4.C. Jung, Collected Works, vol. 9, The Archetypes and the Collective Unconscious (Princeton, NJ: Princeton University Press, 1955/1968), 330.
5.C. Jung, Collected Works, vol. 10, Civilization in Transition (Princeton, NJ: Princeton University Press, 1957/1964), 540.
6.Ibid., 133.
7.M. S. Gazzaniga, The Social Brain: Discovering the Networks of the Mind (New York: Basic Books, 1985), 90.
8.Ibid., 356.
9.M, Minsky, The Society of Mind (New York: Simon & Schuster, 1988), 51.
10.Goulding and Schwartz, Mosaic Mind, p. 290.
11.O. van der Hart, E. R. Nijenhuis, and K. Steele, The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization (New York: WW Norton, 2006); R. P. Kluft, Shelter from the Storm (self-published, 2013).
12.R. Schwartz, Internal Family Systems Therapy (New York: Guilford Press, 1995).
13.Ibid., p. 34.
14.Ibid., p. 19.
15.Goulding and Schwartz, Mosaic Mind, 63.
16.J. G. Watkins, 1997, illustrates this as an example of personifying depression: “We need to know what the imaginal sense of the depression is and who, which character, suffers it.”
17.Richard Schwartz, personal communication.
18.Goulding and Schwartz, Mosaic Mind, 33.
19.A. W. Evers, et al., “Tailored Cognitive-Behavioral Therapy in Early Rheumatoid Arthritis for Patients at Risk: A Randomized Controlled Trial,” Pain 100, no. 1–2 (2002): 141–53; E. K. Pradhan, et al., “Effect of Mindfulness-Based Stress Reduction in Rheumatoid Arthritis Patients,” Arthritis & Rheumatology 57, no. 7 (2007): p. 1134–42; J. M. Smyth, et al., “Effects of Writing About Stressful Experiences on Symptom Reduction in Patients with Asthma or Rheumatoid Arthritis: A Randomized Trial,” JAMA 281, no. 14 (1999): 1304–9; L. Sharpe, et al., “Long-Term Efficacy of a Cognitive Behavioural Treatment from a Randomized Controlled Trial for Patients Recently Diagnosed with Rheumatoid Arthritis,” Rheumatology (Oxford) 42, no. 3 (2003): 435–41; H. A. Zangi, et al., “A Mindfulness-Based Group Intervention to Reduce Psychological Distress and Fatigue in Patients with Inflammatory Rheumatic Joint Diseases: A Randomised Controlled Trial,” Annals of the Rheumatic Diseases 71, no. 6 (2012): 911–17.
CHAPTER 18: FILLING IN THE HOLES: CREATING STRUCTURES
1.Pesso Boyden System Psychomotor. See http://pbsp.com/.
2.D. Goleman, Social Intelligence: The New Science of Human Relationships (Random House Digital, 2006).
3.A. Pesso, “PBSP: Pesso Boyden System Psychomotor,” in Getting in Touch: A Guide to Body-Centered Therapies, ed. S. Caldwell (Wheaton, IL: Theosophical Publishing House, 1997); A. Pesso, Movement in Psychotherapy: Psychomotor Techniques and Training (New York: New York University Press, 1969); A. Pesso, Experience in Action: A Psychomotor Psychology (New York: New York University Press, 1973); A. Pesso and J. Crandell, eds., Moving Psychotherapy: Theory and Application of Pesso System/Psychomotor (Cambridge, MA: Brookline Books, 1991); M. Scarf, Secrets, Lies, and Betrayals (New York: Ballantine Books, 2005); M. van Attekum, Aan Den Lijve (Netherlands: Pearson Assessment, 2009); and A. Pesso, “The Externalized Realization of the Unconscious and the Corrective Experience,” in Handbook of Body-Psychotherapy / Handbuch der Körperpsychotherapie, ed. H. Weiss and G. Marlock (Stuttgart,Germany: Schattauer, 2006).
4.Luiz Pessoa, and Ralph Adolphs, “Emotion Processing and the Amygdala: from a ‘Low Road’ to ‘Many Roads’ of Evaluating Biological Significance.” Nature Reviews Neuroscience 11, no. 11 (2010): 773–83.
CHAPTER 19: REWIRING THE BRAIN: NEUROFEEDBACK
1.H. H. Jasper, P. Solomon, and C. Bradley, “Electroencephalographic Analyses of Behavior Problem Children,” American Journal of Psychiatry 95 (1938): 641–58; P. Solomon, H. H. Jasper, and C. Braley, “Studies in Behavior Problem Children,” American Neurology and Psychiatry 38 (1937): 1350–51.
2.Martin Teicher at Harvard Medical School, has done extensive research that documents temporal lobe abnormalities in adults who were abused as children: M. H. Teicher et al., “The Neurobiological Consequences of Early Stress and Childhood Maltreatment,” Neuroscience & Biobehavioral Reviews 27, no. 1–2) (2003): 33–44; M. H. Teicher et al., “Early Childhood Abuse and Limbic System Ratings in Adult Psychiatric Outpatients,” Journal of Neuropsychiatry & Clinical Neurosciences 5, no. 3 (1993): 301–6; M. H. Teicher, et al., “Sticks, Stones and Hurtful Words: Combined Effects of Childhood Maltreatment Matter Most,” American Journal of Psychiatry (2012).
3.Sebern F. Fisher, Neurofeedback in the Treatment of Developmental Trauma: Calming the Fear-Driven Brain. (New York: Norton, 2014).
4.J. N. Demos, Getting Started with Neurofeedback (New York: WW Norton, 2005). See also R. J. Davidson, “Affective Style and Affective Disorders: Prospectives from Affective Neuroscience,” Cognition and Emotion 12, no. 3 (1998): 307–30; and R. J. Davidson, et al., “Regional Brain Function, Emotion and Disorders of Emotion,” Current Opinion in Neurobiology 9 (1999): 228–34.
5.J. Kamiya, “Conscious Control of Brain Waves,” Psychology Today, April 1968, 56–60. See also D. P. Nowlis, and J. Kamiya, “The Control of Electroencephalographic Alpha Rhythms Through Auditory Feedback and the Associated Mental Activity,” Psychophysiology 6, no. 4 (1970): 476–84 and D. Lantz and M. B. Sterman, “Neuropsychological Assessment of Subjects with Uncontrolled Epilepsy: Effects of EEG Feedback Training,” Epilepsia 29, no. 2 (1988): 163–71.
6.M. B. Sterman, L. R. Macdonald, and R. K. Stone, “Biofeedback Training of the Sensorimotor Electroencephalogram Rhythm in Man: Effects on Epilepsy,” Epilepsia 15, no. 3 (1974): 395–416. A recent meta-analysis of eighty-seven studies showed that neurofeedback led to a significant reduction in seizure frequency in
approximately 80 percent of epileptics who received the training. Gabriel Tan, et al., “Meta-Analysis of EEG Biofeedback in Treating Epilepsy,” Clinical EEG and Neuroscience 40, no. 3 (2009): 173–79.
7.This is part of the same circuit of self-awareness that I described in chapter 5. Alvaro Pascual-Leone has shown how, when one temporarily knocks out the area above the medial prefrontal cortex with transcranial magnetic stimulation (TMS), people can temporarily not identify whom they are looking at when they stare into the mirror. J. Pascual-Leone, “Mental Attention, Consciousness, and the Progressive Emergence of Wisdom,” Journal of Adult Development 7, no. 4 (2000): 241–54.
8.http://www.eegspectrum.com/intro-to-neurofeedback/.
9.S. Rauch, et al., “Symptom Provocation Study Using Positron Emission Tomography and Script Driven Imagery,” Archives of General Psychiatry 53 (1996): 380–87. Three other studies using a new way of imaging the brain, magnetoencephalography (MEG), showed that people with PTSD suffer from increased activation of the right temporal cortex: C. Catani, et al., “Pattern of Cortical Activation During Processing of Aversive Stimuli in Traumatized Survivors of War and Torture,” European Archives of Psychiatry and Clinical Neuroscience 259, no. 6 (2009): 340–51; B. E. Engdahl, et al., “Post-traumatic Stress Disorder: A Right Temporal Lobe Syndrome?” Journal of Neural Engineering 7, no. 6 (2010): 066005; A. P. Georgopoulos, et al., “The Synchronous Neural Interactions Test as a Functional Neuromarker for Post-traumatic Stress Disorder (PTSD): A Robust Classification Method Based on the Bootstrap,” Journal of Neural Engineering 7. no. 1 (2010): 016011.
10.As measured on the Clinician Administered PTSD Scale (CAPS).
11.As measured by John Briere’s Inventory of Altered Self-Capacities (IASC).
12.Posterior and central alpha rhythms are generated by thalamocortical networks; beta rhythms appear to be generated by local cortical networks; and the frontal midline theta rhythm (the only healthy theta rhythm in the human brain) is hypothetically generated by the septohippocampal neuronal network. For a recent review see J. Kropotov, Quantitative EEG, ERP’s And Neurotherapy (Amsterdam: Elsevier, 2009).
13.H. Benson, “The Relaxation Response: Its Subjective and Objective Historical Precedents and Physiology,” Trends in Neurosciences 6 (1983): 281–84.
14.Tobias Egner and John H. Gruzelier, “Ecological Validity of Neurofeedback: Modulation of Slow Wave EEG Enhances Musical Performance,” Neuroreport 14 no. 9 (2003): 1221–4; David J. Vernon, “Can Neurofeedback Training Enhance Performance? An Evaluation of the Evidence with Implications for Future Research,” Applied Psychophysiology and Biofeedback 30, no. 4 (2005): 347–64.
15.“Vancouver Canucks Race to the Stanley Cup—Is It All in Their Minds?” Bio-Medical.com, June 2, 2011, http://bio-medical.com/news/2011/06/vancouver-canucks-race-to-the-stanley-cup-is-it-all-in-their-minds/.
16.M. Beauregard, Brain Wars (New York: Harper Collins, 2013), p. 33.
17.J. Gruzelier, T. Egner, and D. Vernon, “Validating the Efficacy of Neurofeedback for Optimising Performance,” Progress in Brain Research 159 (2006): 421–31. See also D. Vernon and J. Gruzelier, “Electroencephalographic Biofeedback as a Mechanism to Alter Mood, Creativity and Artistic Performance,” in Mind-Body and Relaxation Research Focus, ed. B. N. De Luca (New York: Nova Science, 2008), 149–64.
18.See, e.g., M. Arns, et al., “Efficacy of Neurofeedback Treatment in ADHD: The Effects on Inattention, Impulsivity and Hyperactivity: A Meta-Analysis,” Clinical EEG and Neuroscience 40, no. 3 (2009): 180–89; T. Rossiter, “The Effectiveness of Neurofeedback and Stimulant Drugs in Treating AD/HD: Part I: Review of Methodological Issues,” Applied Psychophysiology and Biofeedback 29, no. 2 (June 2004): 95–112; T. Rossiter, “The Effectiveness of Neurofeedback and Stimulant Drugs in Treating AD/HD: Part II: Replication,” Applied Psychophysiology and Biofeedback 29, no. 4 (2004): 233–43; and L. M. Hirshberg, S. Chiu, and J. A. Frazier, “Emerging Brain-Based Interventions for Children and Adolescents: Overview and Clinical Perspective,” Child and Adolescent Psychiatric Clinics of North America 14, no. 1 (2005): 1–19.
19.For more on qEEG, see http://thebrainlabs.com/qeeg.shtml.
20.N. N. Boutros, M. Torello, and T. H. McGlashan, “Electrophysiological Aberrations in Borderline Personality Disorder: State of the Evidence,” Journal of Neuropsychiatry and Clinical Neurosciences 15 (2003): 145–54.
21.In chapter 17, we saw how essential it is to cultivate a state of steady, calm self-observation, which IFS calls a state of “being in self.” Dick Schwartz claims that with persistence anybody can achieve such a state, and indeed, I have seen him help very traumatized people do precisely that. I am not that skilled, and many of my most severely traumatized patients become frantic or spaced out when we approach upsetting subjects. Others feel so chronically out of control that it is difficult to find any abiding sense of “self.” In most psychiatric settings people with these problems are given medications to stabilize them. Sometimes that works, but many patients lose their motivation and drive. In our randomized controlled study of neurofeedback, chronically traumatized patients had an approximately 30 percent reduction in PTSD symptoms and a significant improvement in measures of executive function and emotional control (van der Kolk et al., submitted 2014).
22.Traumatized kids with sensory-integration deficits need programs specifically developed for their needs. At present, the leaders of this effort are my Trauma Center colleague Elizabeth Warner and Adele Diamond at the University of British Columbia.
23.R. J. Castillo, “Culture, Trance, and the Mind-Brain,” Anthropology of Consciousness 6, no. 1 (March 1995): 17–34. See also B. Inglis, Trance: A Natural History of Altered States of Mind (London: Paladin, 1990); N. F. Graffin, W. J. Ray, and R. Lundy, “EEG Concomitants of Hypnosis and Hypnotic Susceptibility,” Journal of Abnormal Psychology 104, no. 1 (1995): 123–31; D. L. Schacter, “EEG Theta Waves and Psychological Phenomena: A Review and Analysis,” Biological Psychology 5, no. 1 (1977): 47–82; and M. E. Sabourin, et al., “EEG Correlates of Hypnotic Susceptibility and Hypnotic Trance: Spectral Analysis and Coherence,” International Journal of Psychophysiology 10, no. 2 (1990): 125–42.
24.E. G. Peniston and P. J. Kulkosky, “Alpha-Theta Brainwave Neuro-Feedback Therapy for Vietnam Veterans with Combat-Related Post-traumatic Stress Disorder,” Medical Psychotherapy 4 (1991): 47–60.
25.T. M. Sokhadze, R. L. Cannon, and D. L. Trudeau, “EEG Biofeedback as a Treatment for Substance Use Disorders: Review, Rating of Efficacy and Recommendations for Further Research,” Journal of Neurotherapy 12, no. 1 (2008): 5–43.
26.R. C. Kessler, “Posttraumatic Stress Disorder: The Burden to the Individual and to Society,” Journal of Clinical Psychiatry 61, suppl. 5 (2000): 4–14. See also R. Acierno, et al., “Risk Factors for Rape, Physical Assault, and Posttraumatic Stress Disorder in Women: Examination of Differential Multivariate Relationships,” Journal of Anxiety Disorders 13, no. 6 (1999): 541–63; and H. D. Chilcoat and N. Breslau, “Investigations of Causal Pathways Between PTSD and Drug Use Disorders,” Addictive Behaviors 23, no. 6 (1998): 827–40.
27.S. L. Fahrion et al., “Alterations in EEG Amplitude, Personality Factors, and Brain Electrical Mapping After Alpha-Theta Brainwave Training: A Controlled Case Study of an Alcoholic in Recovery,” Alcoholism: Clinical and Experimental Research 16, no. 3 (June 1992): 547–52; R. J. Goldberg, J. C. Greenwood, and Z. Taintor, “Alpha Conditioning as an Adjunct Treatment for Drug Dependence: Part 1,” International Journal of Addiction 11, no. 6 (1976): 1085–89; R. F. Kaplan, et al., “Power and Coherence Analysis of the EEG in Hospitalized Alcoholics and Nonalcoholic Controls,” Journal of Studies on Alcohol 46 (1985): 122–27; Y. Lamontagne et al., “Alpha and EMG Feedback Training in the Prevention of Drug Abuse: A Controlled Study,” Canadian Psychiatric Association Journal 22, no. 6 (October 1977): 301–10; Saxby and E. G. Peniston, “Alpha-Theta Brainwa
ve Neurofeedback Training: An Effective Treatment for Male and Female Alcoholics with Depressive Symptoms,” Journal of Clinical Psychology 51, no. 5 (1995): 685–93; W. C. Scott, et al., “Effects of an EEG Biofeedback Protocol on a Mixed Substance Abusing Population,” American Journal Drug and Alcohol Abuse 31, no. 3 (2005): 455–69; and D. L. Trudeau, “Applicability of Brain Wave Biofeedback to Substance Use Disorder in Adolescents,” Child & Adolescent Psychiatric Clinics of North America 14, no. 1 (January 2005): 125–36.
28.E. G. Peniston, “EMG Biofeedback-Assisted Desensitization Treatment for Vietnam Combat Veterans Post-traumatic Stress Disorder,” Clinical Biofeedback and Health 9 (1986): 35–41.
29.Eugene G. Peniston, and Paul J. Kulkosky. “Alpha-Theta Brainwave Neurofeedback for Vietnam Veterans with Combat-Related Post-Traumatic Stress Disorder.” Medical Psychotherapy 4, no. 1 (1991): 47-60.
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