"To move through trauma often means going back to what was too much. Often we need to be with someone who is with us saying ‘I’m here. You’re safe. It’s okay to feel it now.’”

In this episode of the Numinus podcast, Dr. Joe speaks with David Treleaven. David is a trauma professional, mindfulness teacher, and educator. He is also the author of Trauma-Sensitive Mindfulness: Practices for Safe Healing. After struggling through symptoms of secondary trauma on a meditation retreat, he developed the Trauma-Sensitive Mindfulness (TSM) approach.TSM helps trauma survivors avoid the risks they face when practicing meditation. TSM has been taught to veterans, prisoners, healthcare professionals, first responders, and many others.

Through workshops and online courses, David teaches mindfulness providers the tools of TSM, so that they can meet the needs of people struggling with trauma. More information on his online training can be found here.

David has worked with organizations like Search Inside Yourself Leadership Institute (developed by Google) and the University of Massachusetts Medical School by bringing them the tools and techniques of TSM to their staff and programs. He is also a visiting scholar at Brown University.

He is the host of The Trauma-Sensitive Mindfulness Podcast. He has had guests on like Sharon SalzbergRick Hanson, and recently Dr. Joe Flanders!

 

In this interview Joe and David explore:

  • Challenges with the definition of the word trauma
  • Is there such a thing as COVID trauma?
  • Why some people are more resilient in the face of difficult experiences
  • Neurobiological models of Post Traumatic Stress (PTS)
  • Diagnosing PTS
  • Approaches to treating PTS
  • The implications of collective trauma from COVID-19

 

Here is more information on subjects mentioned in this episode:

 

More quotes from David from the interview:

“Post-traumatic stress can be the impact of two different impulses acting at the same time.”

 

“Sometimes I think of trauma as us living through impossibility, and then the costs of that.”

 

“The further away I get from academia, I find myself less interested if we count a hundred people and we talk about all of their stories, whether or not we’re going to qualify their experience for being traumatic or not. What I’m most interested in is what, in a very practical way, are going to be the interventions that are going to support this person to have less pain and suffering in their life.”

 

“To move through trauma often means going back to what was too much. Often we need to be with someone who is with us saying ‘I’m here. You’re safe. It’s okay to feel it now.’”

 

“In my experience with people when they’ve really moved through or integrated that trauma is that they’re on the other side of a pretty big emotion or discharge through the body, they say, ‘Oh, it’s finally over. It’s been trapped inside of me for a long time. And now I’m integrating it in a different way.'”

 

Here are some highlights from their conversation:

 

COVID might refer to a specific viral entity, but it means so many other things. And I guess there’s a diversity of experiences that people have had. And I don’t know, you tell me, do we want to talk about–what was your distinction there, like traumatic experiences people have had in the pandemic era or or just like some kind of collective trauma that we’ve all experienced living through this? 

Well, there’s so much to say here. I’ll talk about how I’ll define trauma here which would be a response to actual or threatened death, serious injury or threat to physical integrity. And I think it’s important to at least start here and see if we’re on the same page because trauma as it’s become more of a popular mainstream term has become slightly diffuse.

And I’d say the definition has been watered down and there’s been some concept creep in the humanities more generally around trauma, which yes, again, there’s a double edged sword here. Where it’s great that people are talking about trauma and unhelpful in some ways to just generalize.

So I’d like to talk about trauma as an input or a situation that is a threat to life and limb where our survival and our fundamental safety is on the line. And COVID cuts both ways here, where definitely it has been a significant threat and it has been an actual material threat to family. I mean, people, families, communities or people are literally dying or their well-being has been threatened. And then there’s been a whole range of more generalized threat that people could say has been traumatic.

But I’d actually challenge that where I think it’s actually just been more a challenge in adversity and where it got murky and it was confusing about, ‘Is my life in danger here, even though I’ve been triple vaxxed,’ for example. So there’s a whole other place where trauma has happened. And then I think there’s been a massive period of adversity collectively that we’re trying to sort out and maybe we’ll be talking about it here in the conversation.

 

Let’s come back to that very evocative story about the child that gets pulled out of the way of an oncoming car. That seems like a pretty good example of a threat to the child’s life, their safety and that child’s nervous system probably goes into some kind of fight or flight reactivity. And then if I’m extrapolating a little bit, the mother is basically communicating through her reaction, ‘shut that emotion down.’ And the child is basically saying to themselves, if I want to stay connected to mom here, which feels really important right now because I’m kind of freaked out, I have to put that emotion away, inhibit it in some way.’ That sounds to me like an example or a mechanism around how things get stuck. 

I wonder if you can say more about why would that be in evolution that certain really intense experiences get trapped? And even what the hell does that mean for something to get trapped in our nervous system? Can I know exactly what that means experientially and sort of working with clients?

The metaphor that’s worked for me I learned from Babette Rothschild, who’s a trauma writer. She wrote a book called The Body Remembers. Yeah, all the best trauma books are like, ‘The Body Keeps Score of the Body.’ But she’s great. She’s awesome. When she’s training people around trauma and is trying to capture what you’re saying, what’s the essence of it? Why does that stuckness happen? Like, what’s the stuckness?

She’ll bring a bottle of soda up on stage and she’ll start shaking it up, and she’ll basically be talking about how the stuckness is the cap. And her metaphor is saying, ‘now what would happen if we just open this soda right now?’ And of course, it would fly. It’s too much for someone. So in Babette’s work, it’s been a lot about–and in a lot of trauma work, it’s about kind of cracking that soda top and allowing some of the pressurized gas.

But let’s back that up even further, because I think it answers your question. The reason I think that metaphor works is that when it comes to trauma, like with that child, there is some kind of activation. I said factory loaded some kind of deep survival response, often referred to as fight flight. So the sympathetic nervous system and the autonomic nervous system just hit the accelerator. We have the survival response. We don’t have to think about it. It just happens automatically. Flood of adrenaline pupils dilate to try to protect us. And then that’s the moment that I think you’re pointing to. That gets very interesting.

Why the cap? There’s lots of stories about different mammals who are able to shake and discharge that activation. You know, a classic example is the deer who shakes it off. It gets really frozen and then shakes it off, moves on like nothing happened. But what’s happening for humans?

You gave the example around attachment. I’d say, ‘yes, I’m faced with the choice of either being disconnected from my caregiver, which is fundamentally threatening. So let me basically cap that energy through locking my jaw so I can stay connected.; And then in other situations, there’s a legitimate freeze, the intense parasympathetic arousal sometimes known as tonic immobility. Which will come and cap or trap that activation of fight flight in the nervous system that can’t discharge over time.

So it has deep evolutionary roots about why we had that freeze, for example, playing dead like the possum. If you’re a gazelle, you’re dragged to a cave, you might freeze. The predator thinks that you’re dead and won’t actually attack you. There are many different inherited reasons that we have that–but it can create tremendous amounts of suffering in an ongoing way for people because we can’t uncap that freeze and it gets really frustrating.

PTSD or post-traumatic stress can be the impact of two different impulses happening at the same time. So for example, the impulse to run and the impulse to freeze, they’re both happening. They’re both legitimate survival strategies. And that combination of the two creates that charge. And you could say that stuckness.

And I wanted to link it here to what’s happened to a lot of health care workers or even family members. Where I heard stories of people saying I was on one impulse was to hold the line around safety in hospitals around who could come in and out of a ward, for example. And then there’s an equal impulse to, of course, let a family member come and be with someone, that loved one or a family member. And so it creates these impossible situations.

And so sometimes I think about trauma as us living through impossibility. And then the costs of that.

 

I think that I probably learned this vocabulary from you, but maybe I can just ask you, describe it, this notion of like pendulum motion. And there’s another term that I find really useful, like titration. 

Titration?

Exactly. I think these are great tools for people to know. Can you describe those? 

Yes, it doesn’t come from me, but Peter Levine. It comes from Somatic Experiencing, which is a really popular psychotherapeutic approach to trauma or healing. And I don’t receive any money for that. I just trained in it a long time ago and the core principle–this actually gets right back to the soda bottle or the pop bottle.

So imagine that bottle of carbonated water being shaken up, and you could think of that as a traumatized system that there’s a tremendous amount of sympathetic activation fight flight in the container. So the accelerator slammed the ground. But there’s also tonic immobility. So it’s capped and that if you imagine the feeling of the accelerator and the brakes slammed down, that’s often what trauma can feel like or post-traumatic stress. It’s really painful, uncomfortable, and dysregulating.

So the idea behind pendulation and titration in this work around trauma–the idea is you’re going to pendulate your attention, so basically go back and forth between areas of where you feel more trauma and areas where you feel more resourced. And in doing so, you’re doing what’s known as titrating. Which is actually an old concept in chemistry where you’re opening the soda bottle, but only to the degree that a little bit of the carbonation is released and then you’re turning it back.

If you opened it all at once, that’s not titration. It’ll cause an explosion. Someone gets flooded. It’s too much. And we all know this. I think intuitively that we can take only so much until we need to take a break because our systems can’t tolerate it all at once. So the essence of a lot of trauma work is to go back and forth in order to titrate and not have it over, not have trauma overwhelm.

 

I wonder if you’d agree with this statement that at least this might be just one among many qualities. But this is the quality or the expertise of a trauma therapist that might be sensitive to the pace and to not go at it full speed right away because one has to work very carefully with that limit. And if you went to a therapist that doesn’t have that training, they might not know how to work with that. Is that a fair statement? 

That is the essence to me of trauma training. That is why one would train to know how to work with a combustible process. It’s because more is not going to be better when it comes to working with trauma.

Let me give an example of that. So I was trained as a somatic therapist where the main question I had was, ‘Where do you feel that in your body? It’s all I had. I was like, ‘Well, where do you feel that?’ And if you just keep driving someone towards intensity to your point, that actually can be too much for them. Now that can be confusing because when you’re working in any kind of mental health work, I think when you see emotion, you think you’re doing a good job. Someone’s crying. I’m like, ‘I must be doing something right.’ And then I’m trying to amplify it because I think we’ll go deeper. ‘That’ll be great.’ And sometimes that’s true.

But when it comes to trauma, right to your point, it’s not. It’s that you need to have a more nuanced approach and you’re learning to track someone’s mind and body in a really nuanced moment to moment way.

 

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