Ask Dr. Rick About:

Trauma

What can I do if I get flooded with thoughts or painful feelings, even traumatic ones, when I try to meditate?

It’s important to build up inner resources for meditating. Buddha’s Brain focuses on inner resources, especially the fourth chapter on taking in the good.

A quick suggestion would be to find something that is reliably comfortable and peaceful in your experience – such as the breath, or an object of beauty, or a saying – and use that as your meditation anchor. Maybe while standing or walking, to reduce the dissociation. And keep disengaging from painful thoughts; don’t fight them, ignore them. And from time to time look at them categorically; in other words, see their nature, the nature of all experience, all phenomenology: transient, made of parts, arising and passing away due to causes, insubstantial, an unreliable basis for lasting happiness; seeing them in this way, they have less weight.

How can one express, feel and process ``negative`` emotions associated with an experience thoroughly and not create and strengthen ``negative`` neural pathways associated with those experiences at the same time?

Basically, three things are simultaneously true:

  • Being with and letting go of an experience – in a mindful way, spacious, disidentified way – does not reinforce it and in fact helps to release it. “A healthy cry” is a beautiful, vastly important thing
  • Being identified with our negative reactions and marinating in them reinforces them
  • Positive experiences are not “learned” efficiently so it’s useful to deliberately sustain and internalize them

The points you raise are right at the intersection of key questions in working with trauma: does revisiting the material reinforce it or release it? Check out my slides and talks about the  ways to work with the mind.

I've experienced emotional abuse, a serious brain injury, PTSD, anxiety, and depression – and I find it hard to meditate. Any suggestions?

In terms of things that might help, I’m assuming you have done sensible standard things like therapy. In terms of some options that might be helpful, you could look into:

  • Neurofeedback
  • Sensorimotor training (e.g., Baniel Method, Feldenkrais)
  • Functional medicine type assessment of your overall physiology, and then systematically optimizing it as best you can
  • Using an emotionally positive and stimulating object of attention for meditation – such as love for others, contentment, gratitude, bliss after pranayama – and marinating in happiness, both to help steady the mind and to potentially help tip your brain more toward positivity

And of course, keep knowing and feeling your own obvious goodness.

How would you recommend dealing with repurcussions of trauma?

I recognize the issue you raise and usually speak about it in workshops with therapists. Some people need to resource themselves initially (e.g., greater mindfulness, self-soothing, distress tolerance) before deliberately activating and installing enjoyable experiences. Of course, people can use the methods of positive neuroplasticity in Hardwiring Happiness to accelerate the internalization of these foundational resources.

I suggest moving away from the word “good,” which I’m doing more and more myself in my languaging of this material. I use “beneficial” or “useful” or “experiences of an inner strength.”

How do people who have experienced trauma as a child practice with the ``child-like state``?

The essence of this practice for me is an attitude of sweetness and gentleness toward the younger parts of myself. It’s not so much that I imagine a complete, younger personality inside myself, but that there is a tenderness, understanding, encouragement, and good humor aimed at my softer, younger, needier, more vulnerable, more child-like layers deep down in my psyche. This attitude/feeling is aided sometimes by visualizing or remembering myself as a boy, but that act of imagination is more a way to call forth the sweetness I’m trying to cultivate than the presumption of a coherent little kid deep in my psyche.

Integrating more playful, child-like tones or qualities into your adult life, plus finding compassion and respect and caring for the younger parts in yourself will serve you well!

If a childhood trauma was the root cause of a current source of behavioral anxiety, then how do I deal with unlocking it?

Let’s start by presuming your insight about the root experience/trauma is accurate. There could also be other factors, such as a general inclination toward anxiety, or not much internal sense of protectors or other resources to deal with threats that might “get you.”

In addition to obvious other resources (e.g., psychotherapy), in terms of what I might suggest, you should try the first three steps of HEAL (see my free online resources and/or Hardwiring Happiness) for this, including “key resources” such as feeling protected, sense of grit, seeing threats accurately, and so on.

Building on cultivating inner resources for this issue with just the HEA (Have, Enrich, Absorb) steps, you could try the Link step, in which you hold in awareness at the same time both a relevant “positive” resource (e.g., feeling protected, sense of grit) along with some of the “negative” material (e.g., fear of being injured). Remember to keep the positive bigger in your mind and drop the negative if you get sucked into it. This Link step could be especially useful.

Could focusing on the resiliency of a person be similar to bringing up a positive experience and pairing it?

The key is to bring up a rich experience – in this case of a nurturing being – whether it is someone today or someone from the past when the trauma occurred. Just remembering that someone was helpful in the past (you didn’t say this, I am just mentioning this here for clarity) would not have the same impact in implicit memory as bringing up the experience of that soothing in the past, or an experience of soothing here and now.

So I don’t think there is an inherent distinction in the power of experiences of past or present soothing/resilience: past or present could be more or less powerful depending on other details. For example, when I bring up the felt sense of people in my childhood who were really for me, even though that emotional memory is less intense than that of my wife’s support for me these days, in some ways it (the childhood memory) goes deeper since it happened when I was a kid.

My own process is to feel the pain for sure, held in a big open space of awareness when I can, but also really focus on internalizing positive resources (mainly from positive experiences); check out the material on my website on taking in the good. In other words, be with the weeds in spacious mindful awareness while also diligently planting flowers in the garden of your mind/brain. Over time, the flowers will gradually crowd out the weeds.

What suggestions do you have for recovering from a head concussion?

I am no specialist in head injury, but what I have seen myself or heard from people with more experience includes:

  • Take a concussion really seriously.
  • Avoid any further blows to head, even seemingly minor ones.
  • Work with licensed, experienced professionals who really listen to you and take the concussion seriously.
  • Explore neurofeedback.

Overall, treat your brain with kid gloves, such as minimize stress, prevent or reduce inflammation in general, eat brain health foods (e.g., refined fish oil or flax oil), avoid toxins (e.g., stand upwind when pumping gas), and encourage authentic emotionally positive experiences.

I suffer from GAD (generalized anxiety disorder) from a trauma I sustained. What can I do to calm my nervous system and activate the parasympathetic nervous system?

Overcoming trauma can be difficult and here are some options that may help (some of which you might already be pursuing):

  • Take good care of your body. When a person does mental interventions with limited results, that naturally suggests a focus on the “hardware.” Options include exercise, nutrition, “nutraceuticals” (e.g., 5-HTP), a general health check (e.g., thyroid, other hormones, anemia), and possibly medication.
  • Really really repeatedly “take in the good” of experiences of calming, relaxing, recognizing that you are alright right now, protection, safety, and support. Use the Foundations program resources, especially the Learning and Calm pillars, also my book Hardwiring Happiness. The brain needs repetition, but with repetition it really will learn and change for the better.
  • Emphasize self-compassion. Check out Kristen Neff and Christopher Germer.
  • Try biofeedback based devices/programs like Heartmath to train your body (e.g., heartrate variability, vagal tone) to be calmer.
  • Try mindfulness, including brief practices such as with Headspace.

Most of all, be reassured that you really can feel better. It will take work, but altogether what I have written here is less than half an hour a day (of course, you can give it more time if you want), plus the work itself is sweet: it feels good to do it, and you can know that you are really helping yourself along the way.

How can someone deal with cruelty, in their mind? How can one stop the mind from ruminating on horrible images of violence, without going back into denial?

First, I share your concerns about hurting other beings for one’s own pleasure.

Second, in a sense you are speaking about trauma in general and how to clear it from the mind. This is a big topic, and I’ll just say here a few things that might help:

  • When the painful imagery or related thoughts arise, willfully shift attention elsewhere, especially to things that are stimulating and engage attentions, such as jumping up and down, eating something good, or giving/receiving love.
  • Focus on the emotions and sensations of compassion, drawing awareness away from imagery or inner speech.
  • Remind oneself what one is doing to help things get better; engage attention to this in rich ways such as reviewing actions or interactions and feeling what’s good about them (not just having an idea that one has sent money to a worthy cause).
  • Have confidence that over time painful imagery does tend to fade or at least not preoccupy one, though it can still get triggered.
  • If it helps, try EMDR or related trauma therapies.
  • You might be able to get value from the Buddhist teaching about the emptiness of all experiences, no matter how wonderful or awful.

Experiences exist in some sense, but they are transient, insubstantial, made of parts, and arise due to causes, and therefore they are “empty” of absolute self-existence. In a sense, they are like clouds, not bricks.

How do I find the “right” therapist to help me overcome PTSD?

A lot of modern people have been traumatized and there are now a lot of good treatments and therapists who work in this area. Here are a few criteria and suggestions for finding help with trauma issues:

  • Google searches often turn up good people. Contact a few who meet your criteria and get a call back with one or more therapists.
  • I’d want someone experienced that was smart, nurturing, aware of mindfulness, and focused on results.
  • The work of Peter Levine and Pat Ogden on healing trauma is excellent; they have trained many therapists in their methodologies.
  • Eye Movement Desensitization and Reprocessing (EMDR) is a treatment used to alleviate the distress associated with trauma. There are many therapists and psychologists trained in this method.
  • Contact the referral lines of the associations of psychologists or other kinds of licensed therapists in your county or state.
  • Also check for any underlying physiology to make sure there is not an imbalance dragging down mood and flattening the results of psychological interventions. People trained in functional medicine can offer a fine-grained assessment and evidence-based interventions.

Which is the better approach for people suffering from trauma or oppression: a “top-down,” “positive psychology” approach that deals with mind, or a “bottom-up,” “somatic” approach that deals with the body?

For sure, experience, learning, residues of racism, trauma, etc. are all stored in the body, usually involving the nervous system, often entwined with other systems (e.g., musculoskeletal, immune).

Some of this learning – broadly defined, including the acquisition of learned helplessness, internalized oppression, insecure attachment, etc. – can be clustered in meaningful ways, such as all the various internalized consequences of oppression.

We can get at that material through various psychological (i.e., mental) interventions including bringing awareness to aspects of the body. Some of these interventions will be “top down,” like focusing on unearthing needlessly self-critical thoughts. Other mental interventions will be “bottom up,” like sensing into the pelvic floor and relaxing and releasing buried tension there. We can also get at this material through behavior, in other words, through action – including moving the body, power-posing, yoga, psychodrama, etc., and through hitting the streets, demonstrating, speaking truth to power.

Mental interventions can improve the effectiveness of behavioral interventions, and vice versa. Behavioral interventions are not better than mental interventions and mental interventions are not better than behavioral interventions. And many general-purpose mental and behavioral interventions (e.g., developing self-compassion) that are not specifically targeted at a particular “cluster” or kind of material (such as the impacts of oppression) may still help develop psychological resources (inner strengths) that are useful for that particular material.

People who single out any one of these factors of healing and growth as “not as good as” another kind of factor are missing the point. For a particular individual with a particular issue in a particular situation at a particular time: a particular package of methods could well be optimal – perhaps more tilted toward mental interventions or more tilted toward behavioral interventions. But the value of those particular interventions for that particular person does not mean that there is anything wrong about the other interventions or that they are not useful.

“Positive psychology” has not systematically swerved away from dealing with oppression any more than family therapy, humanistic psychology, or psychoanalysis has swerved away. Fields of psychology or mental health or human potential or spirituality have a general focus by their nature.

Critiquing them for not focusing on a specific issue such as oppression is misguided.

To address oppression, we need to deliberately focus on it and bring to bear all the methods, all the factors, listed above, as well as many more at the level of relationships, groups, and societies. I think this is what we should focus on! Roll up our sleeves and use all the tools and get to work!

My dilemma is wanting to love my parents but being scared of them. What to do?

What I might offer is that one approach is to experience your own lovingness (compassion, kindness, benevolence) as a kind of field radiating from you that includes all beings independently of who they are or what they do. Then your lovingness can also become more individualized depending on the person – leading to more or less closeness with them. But your lovingness itself can be unconditional. Besides the benefits to others, this approach can feel very self-nurturing and uplifting.

Can you help me with the tremendous feelings of pain/guilt/helpflessness I feel because of the trauma my nation lives with?

Survivor guilt…moral injury…these terms are useful but the heart wrenching experiences you have go much deeper. I speak from lots of privilege and good fortune, so it is very respectfully that I say that I see tremendous variety in the day-to-day experiences of 7+ billion people: for some it is full of suffering, for many it is sort of OK, and for some it is full of happiness. The suffering of some does not change the happiness of others, and vice versa. If those who are happy made themselves suffer, it would not lessen the suffering of others. In fact, happiness and well-being are strengths that can be used, if one is moral, to help those who suffer.

Up to you, but for me the path combines compassion…and equanimity. And it allows each of us to find the happiness we can while we do what we realistically can to help others.

I’d like to mention a book that came across my desk recently, Healing Collective Trauma by Thomas Hubl. You might find some useful things in it.

Also, as I feel your big heart in your words, it occurs to me that shifting your attention to compassion and love when you feel heartsore about your beautiful country (distinct from its oppressive rulers), and really resting in love, taking love as a meditation object, taking love as where you dwell…well, this might be helpful too.

Dr. Ramani Durvasula is a licensed clinical psychologist, author, and expert on the impact of toxic narcissism. She is a Professor of Psychology at California State University, Los Angeles, and also a Visiting Professor at the University of Johannesburg.

The focus of Dr. Ramani’s clinical, academic, and consultative work is the etiology and impact of narcissism and high-conflict, entitled, antagonistic personality styles on human relationships, mental health, and societal expectations. She has spoken on these issues to clinicians, educators, and researchers around the world.

She is the author of Should I Stay or Should I Go: Surviving a Relationship With a Narcissist, and Don't You Know Who I Am? How to Stay Sane in an Era of Narcissism, Entitlement, and Incivility. Her work has been featured at SxSW, TEDx, and on a wide range of media platforms including Red Table Talk, the Today Show, Oxygen, Investigation Discovery, and Bravo, and she is a featured expert on the digital media mental health platform MedCircle. Dr. Durvasula’s research on personality disorders has been funded by the National Institutes of Health and she is a Consulting Editor of the scientific journal Behavioral Medicine.

Dr. Stephen Porges is a Distinguished University Scientist at Indiana University, Professor of Psychiatry at the University of North Carolina, and Professor Emeritus at both the University of Illinois at Chicago and the University of Maryland. He is a former president of the Society for Psychophysiological Research and has been president of the Federation of Behavioral, Psychological, and Cognitive Sciences, which represents approximately twenty-thousand biobehavioral scientists. He’s led a number of other organizations and received a wide variety of professional awards.

In 1994 he proposed the Polyvagal Theory, a theory that links the evolution of the mammalian autonomic nervous system to social behavior and emphasizes the importance of physiological states in the expression of behavioral problems and psychiatric disorders. The theory is leading to innovative treatments based on insights into the mechanisms mediating symptoms observed in several behavioral, psychiatric, and physical disorders, and has had a major impact on the field of psychology.

Dr. Porges has published more than 300 peer-reviewed papers across a wide array of disciplines. He’s also the author of several books including The Polyvagal Theory: Neurophysiological foundations of Emotions, Attachment, Communication, and Self-regulation.

Dr. Bruce Perry is the Principal of the Neurosequential Network, Senior Fellow of The ChildTrauma Academy, and a Professor (Adjunct) in the Departments of Psychiatry and Behavioral Sciences at the Feinberg School of Medicine at Northwestern University in Chicago and the School of Allied Health at La Trobe University in Melbourne, Australia. From 1993 to 2001 he was the Thomas S. Trammell Research Professor of Psychiatry at Baylor College of Medicine and chief of psychiatry at Texas Children's Hospital.

He’s one of the world’s leading experts on the impact of trauma in childhood, and his work on the impact of abuse, neglect, and trauma on the developing brain has impacted clinical practice, programs, and policy across the world. His work has been instrumental in describing how traumatic events in childhood change the biology of the brain.

Dr. Perry's most recent book, What Happened to You? Conversations on Trauma, Resilience, and Healing, co-authored with Oprah Winfrey, was released earlier this year. Dr. Perry is also the author, with Maia Szalavitz, of The Boy Who Was Raised As A Dog, a bestselling book based on his work with maltreated children, and Born For Love: Why Empathy is Essential and Endangered. Additionally, he’s authored more than 300 journal articles and book chapters and has been the recipient of a variety of professional awards.

Dr. Allison Briscoe-Smith is a child clinical psychologist who specializes in trauma and issues of race. She earned her undergraduate degree from Harvard and then received her Ph.D. in clinical psychology from the University of California, Berkeley. She performed postdoctoral work at the University of California San Francisco/San Francisco General Hospital. She has combined her love of teaching and advocacy by serving as a professor and by directing mental health programs for children experiencing trauma, homelessness, or foster care.

Dr. Briscoe-Smith is also a senior fellow of Berkeley’s Greater Good Science Center and is both a professor and the Director of Diversity, Equity, and Inclusion at the Wright Institute. She provides consultation and training to nonprofits and schools on how to support trauma-informed practices and cultural accountability.

Sharon Salzberg is a world-renowned teacher and New York Times bestselling author. She is widely considered one of the most influential individuals in bringing mindfulness practices to the West, and co-founded the Insight Meditation Society in Barre, Massachusetts alongside Jack Kornfield and Joseph Goldstein. Sharon has been a student of Dipa Ma, Anagarika Munindra, and Sayadaw U Pandita alongside other masters.

Sharon has authored 10 books, and is the host of the fantastic Metta Hour podcast. She was a contributing editor of Oprah’s O Magazine, had her work featured in Time and on NPR, and contributed to panels alongside the Dalai Lama.

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