I love to study neuropsychological treatments for trauma, and the importance of emotional integration in the therapeutic process. I am a big fan of the neuropsychologist Dr. Dan Siegel and Brain-Wise therapist, Dr. Bonnie Badenoch, from which I obtained the information I am presenting in this article.
When a person is not properly attuned to as a child, secure attachment and healthy connection do not occur. This trauma leads to the painful consequence of interrelational disconnection. The goal in therapy for a person, who has suffered from the effects of trauma, abuse, lack of attunement, neglect, or some other form of emotional disregard, is to help that person find emotional regulation through the process of differentiation, with the ultimate goal of emotional integration.
In terms of neuropsychology, when a person is integrated, emotional regulation is established. This occurs when the neural firing within an individual’s nervous system is in sync with his brain’s middle prefrontal areas, coordinating and balancing the diverse firing patterns. When integration is present, the acronym FACES can be used to identify the elements that will be in place within the individual. That is, an integrated individual will be Flexible, Adaptive, Coherent, Energized, and Stable (Siegel, 2010). A person lacking in integration will display symptoms of chaos and/or rigidity. Trauma hinders integration and unresolved trauma contributes to persistent chaos and rigidity and inflexibility to adapt to the circumstance of present interactions.
When a person experiences unresolved trauma (i.e., unintegrated trauma), his mind is incoherent, and his brain experiences panic and chaos and/or excessive vigilance and rigidity. In order to detect and resolve this unresolved trauma, it is necessary to explore the ways in which the person’s memory has been impaired in its integration.
Memory is the key to integration. There are two types of memory – implicit and explicit. Implicit memory is perceptual, emotional, interactive, sensory, mental modeling, and priming. It is not aware of time. When a person experiences an implicit memory it feels as if it is happening in the now, not in the past. When an implicit memory is retrieved in a pure, non-integrated state, it is experienced as happening now; there is no internal sensation that something is being recalled from the past. The amygdala plays a critical role in the process of implicit memory, while the hippocampus is not involved at all. The hippocampus is the brain organ that puts history to a memory. Implicit memory lacks the sensation of something being recollected from the past. This is how PTSD works. A person with PTSD is “reminded” of something from a past, traumatic event, and the visceral sensations experienced feel as if they are happening in the present, and are not connected to a past memory. The hippocampus is not involved in the circuit.
The hippocampus helps with explicit memory, which is the memory that adds factual memory, awareness of time, and conscious attention. When explicit memory is experienced, the person realizes that something is being recalled from the past. When a person’s perceptual interpretations are based on an unresolved trauma and only implicit influences are involved, without the autobiographical and factual aspects of explicit memory, then incoherence results. Explicit memory can help with retrieving memories with intention, organization, and categorization, through the process of autobiographical narrative.
Studies have been conducted which demonstrate that the middle prefrontal cortex and ventrolateral prefrontal cortex are activated when a person can name an emotion accurately. This internal labeling has been found to be related with diminished amygdala firing. This happens because an organ in the middle prefrontal circuit releases inhibitory transmitters that diminish firing of the lower limbic amygdala during reactive states. Siegel (2010) calls this process, “name it to tame it” (p. 189). Recall that the amygdala is the alert system in the brain, which screens all incoming perceptual input deciding if it is “dangerous” or not. The amygdala screens incoming data to detect if it is something similar to a past list of circumstances, and if a condition is similar to a past trauma the amygdala increases attention to the noticeable aspects of the current event. Thus, the amygdala is in charge of a person experiencing anxiety.
The good news is that our nervous system has neuroplasticity, which means that we need not remain stuck in a dysfunctional relational pattern. Attuned, empathic relationships are what can aid in rewiring broken neural circuits. As our brains experience new relational patterns of attunement, we are relieved of our distress as our brains rewired into healthy patterns of expectation. Attuned interpersonal connection heals.
Sometimes the ongoing adaptation to trauma persists, not as just moments of incoherence, but as lasting habits of being. Doing the work of integration deeply alters their (these adaptations) ways of entrapping people with trauma. Integration is accomplished within the context of a relationship; this is where a therapist can help. A therapist can revisit the traumatic memories with the person, within the context of healing and attunement, helping find the meaning for the experience (differentiation), and providing a new, healthy narrative for the suffering individual (integration), bringing the implicit and explicit memories together until the individual experiences the attributes of integration (remember the acronym FACES) – flexibility, adaptability, coherence, energy, and stability.
References:
Badenoch, B.. (2011). The Brain Savvy Therapist’s Workbook. New York, NY: W.W. Norton & Company, Inc.
Siegel, D. (2010). The Mindful Therapist. New York, NY: W.W. Norton & Company, Inc.