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Acupuncture, Chinese Medicine, Dissociation, Dissociative Disorders, Embodiment, Post-Traumatic Stress Disorder (PTSD), Trauma

The vagus nerve, emotions and the difficulty with mindfulness practices

“Now, many people who don’t know a lot about trauma think that trauma has something to do with something that happened to you a long time ago. In fact, the past is the past and the only thing that matters is what happens right now. And what is trauma is the residue that a past event leaves in your own sensory experiences in your body and it’s not that event out there that becomes intolerable but the physical sensations with which you live that become intolerable and you will do anything to make them go away.”

Last week, during a two-day deep cleaning/paint prep binge (see the kitchen ceiling to the right!), I listened to a recorded talk by Bessel van der Kolk given at the May 2011 22nd Annual International Trauma Conference. The title of van der Kolk’s title is a mouthful: “Putting neuroplasticity into clinical practice with neurofeedback: rewiring the brains of children and adults who lack safety, self-regulation, capacity for play, and executive functioning.” The lecture in itself was interesting enough to keep me attentive for its length, but what particularly captured my interest is the manner in which he described the relationship of the vagus nerve to our emotions.

As I remembered from anatomy, the vagus nerve (cranial nerve x) innervates the diaphragm but what failed to register in class is that the vagus nerve also innervates much of our viscera – in fact all of our internal organs with the notable exception of the adrenal glands. It supplies parasympathetic fibers to these organs, meaning that the vagus nerve is a “rest and digest” nerve, not a fight or flight nerve. Van der Kolk quotes from Darwin’s work, “the heart, guts and brain communicate intimately via a nerve” – the pneumogastric or vagus nerve – “the critical nerve in the expression and management of emotions in both humans and animals…. When the mind is strongly excited it instantly affects the state of the viscera.” This is, of course, why our guts react strongly to our emotional state.

Van der Kolk continues with the statement that grabbed me: “what makes life unbearable is not emotions but physical sensations.”

“When you have a persistent sense of heartbreak and gutwrench, the physical sensations become intolerable and we will do anything to make those feelings disappear. And that is really the origin of what happens in human pathology. People take drugs to make it disappear, and they cut themselves to make it disappear, and they starve themselves to make it disappear, and they have sex with anyone who comes along to make it disappear and once you have these horrible sensations in your body, you’ll do anything to make it go away.”

“If these sensations last long enough, your whole brain starts fighting against emotions. And what happens in the long range is that traumatized people who continuously have a state of heartbreak and gut wrenching feelings learn to shut off the sensations in their bodies. And they go through life not feeling their physical presence.”

He then touches on a very important point and one that strongly resonates with me – “it’s a beginning of understanding why traumatized people have such a hard time with mindfulness and why mindfulness in principle doesn’t work for traumatized people because they cannot feel.” Van der Kolk had sent many of his highly traumatized patients to do mindfulness exercises with Jon Kabat-Zinn and found that many of them were returning in a state of upset and agitation.

“As they became silent and started to pay attention to themselves, they get overwhelmed with the physical sensations and they would flee, because being mindful means that you get confronted with your internal world.” In other words, the sensations of the internal world can be so intense that, lacking the tools to work through those sensations, people dissociate during mindfulness exercises. This is not limited to mindfulness exerces but happens in other types of movement, meditative, or healing practices, such as qigong, yoga or massage.

What van der Kolk has found to be a useful tool for moving through this difficulty is neurofeedback, which helps individuals learn to self-regulate by utilizing a feedback tool very similar to a video game that rewards the user for achieving target states such as relaxation, alertness, or focus (for more information on neurofeedback, see http://www.eeginfo.com/). While neurofeedback is a very useful tool and may be a major breakthrough in trauma recovery, it is not always easy to access. Although I am less familiar with them, there are other therapies such as Hakomi method and SomatoEmotional Release that help individuals work with the emotions and physical sensations that often trigger dissociation. A major focus of my studies at this point is to understand better how Chinese/Traditional East Asian medicine works with trauma and the emotions. I suspect that many different modalities can be useful for learning to be present and integrated with our bodies, but also argue that the role of the practitioner and power of intention are key ingredients in the process.

I also believe that bodywork and somatic re-education (acupuncture, massage, tuina, qigong, sotai, et) are essential components to releasing and restoring function to tissues and organs that have lost mobility due to years of fleeing from those physical sensations that van der Kolk describes. We may learn to stay present with our physical sensations, but if the diaphragm is hypertonic (or too tight, just like your shoulders) or the stomach can’t move properly in the abdominal cavity, we will have to work really hard to achieve calm presence when we could instead work to unblock stagnation and release tissues. However, the issue is often truly much more complex than this and healing for many people occurs not by a magic button but through many interwoven processes that may include acupuncture, movement work, EMDR, neurofeedback, nutritional counseling, talk therapy, and meditation or mindfulness practices.

I’ve been unable to get Van der Kolk’s talk out of my mind. Although none of the concepts are unfamiliar to me, there is a sense that I’m missing something or that this visceral-emotional relationship needs to be more closely explored. In Traditional East Asian Medicine (TEAM), the emotions closely affect and are affected by the viscera but I have yet to truly explore the many classical references to this relationship. Spending some time sitting with the classics may help shed some light on how and why acupuncture, moxibustion and other TEAM modalities have been known to treat trauma and shock. A worthwhile topic to explore next.

About Tracy A. Andrews

Tracy Andrews lives in Portland, Oregon where she practices acupuncture and Chinese herbal medicine as well as craniosacral and visceral therapies, gentle bodywork methods that help the body remember how it most likes to be. Her various adventures in the working life have taken her searching for marbled murrelets in the Coast Range of Oregon, into social service agencies providing services for homeless and displaced youth, crafting raw sauerkraut and blank books for small Portland entrepreneurs, fabricating sheet metal for SMWIA Local 16, and writing on trauma healing through Chinese medicine as a research assistant. Her most exciting adventure this year was hiking 125 miles on the John Muir Trail in the Sierra Nevada mountains of California.

Discussion

9 thoughts on “The vagus nerve, emotions and the difficulty with mindfulness practices

  1. This is a great post. I suppose my question after reading is what makes something like neurofeedback preferable or more effective for some trauma patients than MBSR? Because to me, it seems that both approaches have awareness as the major therapeutic goal. I would also like to get more context for the quote from Dr. van der Kolk saying that, “it’s a beginning of understanding why traumatized people have such a hard time with mindfulness and why mindfulness in principle doesn’t work for traumatized people because they cannot feel,” specifically, what the basis for the word “cannot” is.

    Posted by Jason Lay | 18 August 2011, 1:10 pm
    • Later in the talk, van der Kolk goes on to discuss using neurofeedback as a way that someone can reach a state in which they can begin mindfulness or other work. My interpretation is that an individual in a hypo- or hyper-aroused state cannot begin mindfulness work because it is the process of feeling from which they have fled. This began as an adaptation to the trauma and has become maladaptive; if being in a state of hypervigilance is how you survive, and to feel something threatens your ability to stay in that hypervigilant state or is simply too overwhelming because there is a backlog of months, years or decades, then mindfulness is perhaps not the best place to start. But I will be happy to listen to that section of the lecture again and bring in some more context for you, Jason.

      Posted by Tracy A. Andrews | 18 August 2011, 1:27 pm
  2. You quoted that becoming silent and turning inward in mindfulness practice/therapy aroused powerful (overwhelming) physical sensation in traumatized people which to me seems to contradict that they cannot feel. Perhaps they have “shut off” their ability to be aware of emotions per se, but the physical correlate is still there and accessible. I would love to know what neurofeedback might be doing differently. I have a friend who is a neurofeedback therapist who I could ask so I’ll share whatever insights he might have.

    Posted by Jason Lay | 22 August 2011, 8:55 pm
    • I agree with you that it is not that people are incapable of feeling, but rather that we learn not to feel as a coping mechanism in the absence of other tools to process the feelings as they arrive. In many traumatized people, there is often a high level of “fight/flight/freeze” that keeps an individual in a survival state – to sink down into one’s feelings is to leave oneself vulnerable to threats, including threats that will not be threatening to someone who has worked through their trauma.

      Settling into mindfulness practices requires a certain letting go and letting down one’s guard – it is not something that you can do by trying harder – and yet the dominant “fight/fright/freeze” primarily knows how to survive by working hard and staying hypervigilant. I am not sure that I really understand how the “freeze” mode interacts with mindfulness practices and so I won’t try to speak to that just yet.

      One way that neurofeedback works is that it teaches people how to be present and stay within a certain state, the parameters of which are determined by the frequency of brain waves coming from different parts of the brain. By learning to reach and then maintain a certain state (relaxation, calm focus, etc), a participant can learn to regulate their own state when they become hypo- or hyper-aroused. In my own experience working with a neurofeedback therapist, I learned to pull my head up above the clouds or back down to the ground. Then when I started to feel the onset of anxiety, I could rein in my thought patterns to keep myself in my body rather than fleeing my body to avoid the feelings. When I started to practice qigong I began to recognize that I could, at times, use certain forms or moves to create an effect similar to neurofeedback.

      In a nutshell, neurofeedback has the potential to teach people to become sufficiently stable so that they can pursue further healing from a safer place. Does that help bring any more insight to the question?

      Posted by Tracy A. Andrews | 22 August 2011, 9:48 pm
  3. Oh, and can I get a link to that talk?

    Posted by Jason Lay | 22 August 2011, 9:00 pm
  4. I’m also an acupuncturist exploring this link between trauma and the viscera, meridians. What I have been meditating on recently is that the trauma and freeze exist in an electric field around certain areas of the body, and that as acupuncturists we dissipate that charge. This can bleed off excess charge, which I find to be more of a mental energy, or yang. However, there’s also a need to ground the charge back into the emotional energy, the yin. Most times, there is an imbalance in the yin, and we must come in and supply the correct structural matrix for the yin to become a stable home for the yang. Hari, a style of Japanese acupuncture does this with “Seki”, which is a process of needling that brings in tonification energy into the organ, it has been described as crystalline in nature. I’ve also found the modality Source point Therapy holds this structure, this may be what is referred to as Zheng Qi, or upright Qi.

    Posted by Kent | 19 April 2013, 7:51 am
    • I have been practicing and teaching mindfulness for many years and am also a counsellor working with people with various trauma issues, as well as people with many other difficulties.My experience is that mindfulness can almost always be used and can be helpful in reconnecting people to traumatic emotions stored in the body and then allowing their processing and release. And in most cases this approach is helpful, but the mindfulness needs to be adapted and titrated according to the individual client situations. People might begin to be mindful of the other senses to begin with – what they can see, hear, smell etc this can be very “grounding” rather than going to their internal states straight away. It might be that they then try to bring mindfulness to their feet on the floor, or their hands and arms. Always being reminded that what they are experiencing is in the “present” and not a re-experiencing of the past trauma. So we tiptoe with them in the shallows, deepening at their own pace, always with a view to keeping them in contact with their resources – inner and outer – in the sessions and outside of the sessions to help them feel safe. And the process described above might take many, many sessions. Often when comment is made about the use of mindfulness it is thought of in monolithic terms – but mindfulness can be practiced and taught in very nuanced and refined ways. It need not be about whether or not to use it, but how and when. It is not an either/or situation. At least this is my experience.

      Posted by steve | 22 April 2013, 8:15 pm

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