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Might direct neurofeedback reduce impulsive behaviors?

The symptom of impulsivity can be found listed under several mental/behavioral health diagnoses, including but not limited to intermittent explosive disorder, substance abuse, OCD, PTSD and binge eating disorder.  When the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5™) was published in 2013 and included binge eating disorder, I finally felt validated and, at the same time, gratitude for discovering yoga, which helped to reduce my anxiety and my out-of-control eating, especially in light of the fact that I didn’t want to start taking any prescription medications.

My relationship with food has been a long and winding road.  I have memories when I was 4 or 5 of sitting at my kitchen table by myself, long after everyone else finished eating and was allowed to move on, because I was not allowed to leave the table until I finished everything on my plate, including those horrible green vegetables.  I tried every trick in the book, including slipping some to the dog under the table and putting some in my mouth, wiping my mouth with a napkin and spitting what was in my mouth into the napkin.  I also hear my parents in my mind saying “Eat your food!  There are people starving in Africa” and thinking to myself “Great, send them my food!”.

From there, after my parents got divorced, food became scarce for most of my adolescence.  My parents’ divorce and subsequent relationship was very contentious, pushing me into the land of anxiety.  I began to worry about where my next meal would be coming from and if it would be enough.  The pattern that grew from there involved eating large amounts of food (even if I wasn’t hungry) when food was available and eating very quickly (to ensure I got enough before it disappeared).  I also have memories as a young adult where I would eat my meal very quickly and then eat what was left by others on their plates.

As time passed, my relationship with food changed when my weight began to increase.  At this point, I would not allow myself to eat anything until the end of the day, after I had taken care of everyone else’s needs on my list.  Only then, almost like a reward for completing my “To Do” list for others and my sense of self-restraint or control, would I allow myself the indulgence of fulfilling one of the most basic human needs.  What didn’t change at this point though, was the speed in which I ate and the amount of food I would eat!

I then ventured into the many ‘diets’ being promoted.  My weight began to yo-yo.  My life felt so out-of-control as did I!  It wasn’t until I discovered yoga that I found myself in a space to really confront this unhealthy relationship I had with food, facing the fears lying beneath my journey in the land of anxiety.  And even with the support of my yoga practice (and a boost from some hypnotherapy), it took me many more years to see food as simply a source of energy for my body, like gas or electric for a car.

So how excited was I when I read the recent promising research on using direct neurofeedback (i.e., transcranial direct current stimulation or tDCS) to reduce impulsive behaviors!  Although it is not exactly clear how it does so, a positive effect was found in 74 out of 92 research studies.  It warms my heart to learn that there is an alternative to prescription medications, something that specifically supports the brain’s innate ability to reorganize itself towards health, and does so relatively quickly.

If you would like to read a little more on this research, click on the box below:

5 Intention-setting Ideas to Bring More Joy Into Your Life

This time of year can be stressful for most of us to say the least!  For some, including myself, it might also bring up memories of loss, family discord, and unfulfilled dreams.  So I did a little research on tools that have been shown to shift us into a space of joy and, when integrated into a regular practice, can make that joy more sustainable and available to us any time of year (also see my Reflections below on Positive Psychology).

To take a deeper dive, perhaps consider saving this website (https://itsallgoodhere.com/) in your Favorites and set a new year intention to explore these tools more.

In the meantime, consider the following intention-setting ideas to try this month:

  1. Positive Moments.  Consider setting an intention to identify at least one positive moment each day in the month of December.  You may consider it small, even insignificant, such as the first sip of your morning coffee or tea on a cold morning or climbing under the warm blankets at the end of your day.  It doesn’t matter.  What matters is that you take time to reflect on that moment and hold the experience in your awareness, perhaps for 10 to 20 seconds.  Then, consider sharing that positive moment with someone.  If you do this at night and would prefer, you can share it on Social Media.  The act of sharing allows the positive moment’s effects to linger for longer, inviting a deeper level of positivity into the body and mind.
  2. Personal Strengths.  Another option to consider for setting an intention for the month of December is to identify one of your personal strengths and then think about how you used it today or within the last couple of weeks.  You can stay with one of your personal strengths all month and challenge yourself to identify multiple times/ways you used it or challenge yourself to identify a new strength each day, along with an example of how you applied it in your life.  Or it can be a combination of both, it is all good!
  3. Set a Goal!  Perhaps start by simply reflecting on how you felt the last time you accomplished something you set out to do.  Can you remember the feelings that come with accomplishment, such as satisfaction, peace, motivation, joy?  From there, consider setting one small, attainable goal each day this month with a further intention to track your progress.  It can again be something simple like making your bed, finishing that book that you started awhile ago or reaching out to a friend that you haven’t connected with recently.  The key is to track your progress, specifically to reflect on how many times you met your goal that day.
  4. Reframe Negative as Positive.  This intention-setting idea might be a little more tricky – looking for the ‘silver lining’ in what our culture might label as negative.  When we are able to discover some benefit from an experience that brought us some level of aggravation or upset in the moment, we are doing what is called a ‘positive reappraisal’.  How do we do this?  Well, it starts with identifying something, whether an event or a routine activity that we find distasteful, for whatever reason.  Perhaps it is doing the dishes or getting stuck in traffic.  From there, we search for how these things might provide us with some positive outcome that we simply have been ignoring or have refused to consider in the past.  So, for the dishes, we might reframe it as now I have dishes ready for the next meal or the kitchen looks more welcoming.  For getting stuck in traffic, consider that you have more time to listen to your favorite podcast or music.  The more you practice this skill, the easier it gets and you tend to discover multiple positive aspects to every situation!
  5. Random Acts of Kindness.  Honda does not have to have the corner on this market!!  And it doesn’t have to cost you a thing!  During this season of connection, consider doing something kind for someone else each day this month.  It can simply be offering a genuine smile as you pass them walking by, opening a door for someone, or helping someone carry their bags in or out of their car.  Remember to take a moment to reflect on what you feel afterwards, sensing how the joy you feel inside is spreading out and touching others!

2020 Monthly Film Viewing and Reviewing Parties

Come join the party on the last Sunday of each month starting in February, 2020!

Doors will open at 6:30 pm so that you can get some popcorn and hot tea before the movie starts.  Doors will close when the movie starts at 7 pm.

After each movie, a discussion will be facilitated so consider bringing a journal to take note of what you took away from the film or what you learned from other film critics.

Might integrating trauma-informed yoga into group psychotherapy be helpful in healing and health?

As a trauma-informed yoga teacher and holistic psychotherapist, I’m always on the outlook for new ways to integrate these two (East meets West) healing modalities, better supporting the alignment of the body, mind and soul (think spirituality).  Research continues to emerge in support of integrating both with positive effects.  As we continue to expand our understanding, we are learning that treating the mind (psychotherapy) separately from the body (yoga) limits the healing benefits.  Just as we are learning that treating the body (medical health) without considering the mind (mental, emotional health) limits healing.  Yet, as I have written about in a previous Blog, there are many yoga style options.

What makes trauma-informed yoga different?  A central tenet of such an approach is choice.  As such, the language used to guide students is specific to creating a choice-based environment and reminds them that they are always in control of their practice.  Certain words are used to empower participants to make choices that feel comfortable and invite a more gentle compassionate approach.  The teacher’s role is to be a supportive and non-judgmental presence.  They are aware of how their own movements and interactions are perceived, demonstrating predictability and consistency to create and maintain safety.  In maintaining such healthy boundaries, they model those boundaries, which includes no physical assisting as such assisting may be triggering to someone recovering from trauma.  Trauma-informed teachers ‘invite’ participants to draw their awareness to the sensations in their bodies to guide them in their choices of shapes and timing of their movements, not ‘tell’ them what to do and when.  Even the guidance around how to breathe in such a class is a suggestion to find a supportive breath that invites comfort.  So no focus on holding the breath is offered.  If you are interested in reading more about trauma-informed yoga, I would suggest checking out Zabie Yamasaki’s website here.

Trauma-informed yoga is new.  In fact, in 2017 the Trauma Center’s trauma sensitive yoga (TCTSY) became the first dedicated yoga program in the world to be listed as an evidence-based program/practice of psychological trauma.  So how excited was I to read the emerging research on integrating trauma-sensitive yoga into group psychotherapy for at-risk groups, such as survivors of intimate partner violence.

What this research suggests is that it may not only have positive effects for clients in Group Therapy, but also for the care providers!  If you would like to read more about this research, click the box below:

Is direct neurofeedback safe and effective for depression when pregnant?

I believe most of us want to do what is best for our health, such as eating well, exercising, getting enough sleep and staying connected with friends and family and I imagine maintaining our health and wellbeing takes another step up on our list of priorities when we think about getting (or are) pregnant.  If we smoke, we might consider stopping.  If we drink alcohol, we again might consider stopping.  However, if we experience a mood imbalance (think anxious and/or depressive symptoms), do we consider stopping any medications we are taking that are currently supporting our experience of more balance in our moods?  And what happens if we begin to experience some of these symptoms for the first time during our pregnancy, do we consider taking medications while pregnant or try to tough it out?

It is not uncommon for physicians to encourage women to stop such mood management medications as the side effects can be premature birth and low birth weight, similar to the impacts of smoking and drinking during pregnancy.  Where does this leave moms-to-be that are either taking such medications or might experience antenatal anxiety and/or depression?  There is research that shows babies have higher levels of the stress hormone cortisol when moms experience untreated depression, which increases the risk of that baby developing anxiety, depression, and other mental and behavioral challenges later in life.  So it is well known that depression in pregnancy negatively affects both mom’s and her baby’s health, so is there any other option?

A recent pilot randomized controlled research trial shows hope for a non-invasive, non-medication brain stimulation treatment option, specifically transcranial direct current stimulation (tDCS), also referred to as direct neurofeedback.  The results of this trial reflect the feasibility and acceptability of such an option along with encouraging preliminary effectiveness and no serious adverse (i.e., side) effects in this under-treated population.  The effects even lasted a month after delivery!  The results of this pilot study supported the next step to a definitive random controlled trial to evaluate tDCS for antenatal depression.

If you might be interested in reading more about this treatment option, either for yourself or someone you know that is struggling with such a decision, please click on the link below to learn more:

Do emotions have a role in healing childhood trauma?

I sense that most of us are aware that our brain, especially the rational part (i.e., prefrontal cortex) does not reach full development until age 25 or so, which implies, by default that until that age, we tend to operate more from the emotional parts, such as the amygdala.  And, as our brains develop, the connections between the two (emotional and rational) centers are still developing as well.  What we may not be so aware of is the impact of childhood trauma on such connections.  We also may not be fully aware of many of the situations that are now understood to be traumatizing to children.

Let me start with the latter.  Extensive research has been ongoing since the original group of participants were recruited for the Adverse Childhood Experiences Study between 1995 and 1997 in California.  Although the study ended in 1997, most states continue to collect such information through the Behavioral Risk Factor Surveillance System.  The information collected focuses on child abuse and neglect and other household challenges, including intimate partner violence, substance abuse and mental illness in the household, parental separation or divorce, and if a household member was incarcerated. This research has resulted in the inclusion of a new diagnosis of Complex posttraumatic stress disorder, also referred to as developmental PTSD, within the International Classification of Diseases, 11th Edition, recently officially endorsed by WHO’s World Health Assembly and set for implementation outside of the US in 2022.

This is a HUGE step forward in identifying the underlying cause of most challenging symptoms to mental health, including anxiety and depression, and how these symptoms link to most chronic physical diseases, such as heart disease and cancer!  I have been known to say we don’t need a Diagnostic and Statistical Manual (DSM) of Mental Disorders, we simply need The Book of Trauma.  When we all can embrace the idea that there is nothing wrong with us and instead can understand it is what happened to us when we were little that makes it so difficult to live a life full of joy and meaning today, there will no longer be any stigma to seeking support and we can begin the process of healing by shedding the shame and suffering we have been carrying.

Now to expand on the awareness of the impact such developmental PTSD has on the growing connections between the emotional and rational parts of a child’s brain.  When we are little and presented with trauma (as defined above), the emotional input to the brain is overwhelming to the point where we only ‘feel’ and are unable to ‘think’ because the developing rational part of the brain is hijacked by the emotional part, cutting off the connections that encourage a more balanced perspective.  The most familiar and natural fear responses of ‘fight or flight’ in many cases may not be an option for children.  Therefore, the ‘freeze’ response may be the most accessible, especially in young children.  The freeze response is used when the presenting danger cannot be escaped or beaten down, and if either were to be attempted, might actually increase the risk of harm.  The freeze response is a survival response that encourages stillness and silence to avoid being seen and offering a mental escape instead.  What this normal response to danger also does is narrow the range of emotional awareness to flavors of fear and shuts down the development of a more diverse range of emotions, including engagement, joy, comfort, confidence, empowerment and enthusiasm.  When the freeze response helped us to survive the traumas of our childhood, it also stunted our emotional intelligence (aka alexithymia), locking us in a world where danger lurks around every corner, even as adults.

So what can we do to unlock the door to the fear chamber and open it up to a safer, more peaceful existence?  In order to facilitate improvements in trauma-specific symptoms, such as anxiety, depression, dissociation, impulsivity, and interpersonal problems, emotions need to be welcome to express themselves.  Working with a therapist that embraces the intelligence of emotions, through perhaps using Emotionally-focused therapy, can address the emotional challenges associated with alexithymia and thus, begin to resolve issues of childhood trauma.

To read a little more of the research on how working with emotions heals childhood trauma, click on the link below:

 

 

Can Stimulating the Prefrontal Cortex Calm the Default Human Survival Flight/Fight Response?

When humans encounter situations that they perceive as threatening, the parts of the brain responsible for our survival (i.e., amygdala, hippocampus) kick in to determine if running away from the threat is possible, to fight if not, and if neither is possible to stand still, hold our breath to be quiet and ultimately faint.  This flight/fight/freeze/faint response is not only the default position of our brains, it can be so activated over time from trauma and stress that it stays turned on even when we are not in harm’s way.

As someone that grew up in a home that would now be described as chaotic, I found myself in a series of situations that I either ran away from or fought, with a few where I found myself frozen in fear.  As a young child we don’t understand how these experiences are effecting our development, we just do what we have to – anything to survive.  As a young adult, I began to sense the amount of pressure I held in my body and used that energy to drive myself forward, sometimes to the point of exhaustion.

Through several years of psychotherapy, I discovered that the survival response in my brain, when activated (which happened to be most of the time), reduced my access to the parts of my brain that helped me to focus and communicate.  I subsequently learned that this is referred to as ‘amygdala hijacking’ and I describe it as the amygdala literally turning off the light switch leaving it in the dark to fend for itself without being able to see that there is access to support, specifically the prefrontal cortex.  And when you can’t access this part of the brain on a consistent basis, it loses its ability to offer a more balanced perspective of life.  Remember that saying “If you don’t use it, you lose it”, well it applies here too.

When I discovered yoga, I found a way to keep these two parts of my brain connected and when I did, it reduced the level of anxiety in the moment and began to strengthen the bridge that allows space to response, instead of react.  One of the most powerful tools that I learned from my time on the yoga mat was deep belly breathing, which was the first tool that I took off of the mat and into my everyday experiences.

Research has shown that practicing such breath techniques has neurophysiological impacts through respiratory vagus nerve stimulation.  The vagus nerve is the main part of our parasympathetic autonomic nervous system that is responsible for rest and digest processes and when stimulated is closely associated with emotional balance, mental flexibility, empathy and attachment.  It does this through decreasing hippocampal activity among other things, reducing the reactivity in the fear center of our brain, making access to the prefrontal cortex easier.  Now, what I have to admit is that I practiced such breath techniques for years until I began to consistently experience the emotional balance I so craved.  So, from personal experience I know it works, yet it can take time.

So how excited was I when I read the recent research in the Journal of the American Medical Association (JAMA) Psychiatry that looked at this bridge from a different perspective – stimulating the prefrontal cortex in order to allow it to stay online and calm the fear center of the brain when experiencing threatening circumstances, reducing anxiety.  This research looked at the effects of transcranial direct current stimulation, such as used in direct neurofeedback, of the prefrontal cortex on amygdala threat activity in people who experience chronic anxiety.  Neuroimaging was used to assess the impact and the results reveal a direct connection between the ability of the prefrontal cortex to regulate the fear response in the amygdala.  These findings offer more support to the neurocognitive mechanism contributing to the positive effects of direct neurofeedback and offer much hope to more directly and quickly reduce anxiety through such a non-pharmaceutical treatment option.

5 Intention-setting Ideas for Professional Wellness Month

When we start to attach our identity to our work, job and/or employer, we are teetering on a tight rope without a net.  Today, more than ever, it is vital to our well-being and longevity (both at work and in life) to find ways to maintain a balance between who we are and what we do!

Many employers, in an attempt to build a more harmonious work culture, encourage employees to socialize outside of normal working hours.  However, such encouragement from employers can create an internal conflict for those employees that are unable to join such social gatherings due to other commitments outside of the workplace.  It can also create a perceived sense of preferential treatment for those that do attend such gatherings versus those that don’t – or can’t – participate.

Employers would better serve their employees by supporting such things as flexible work hours, encouraging workers to go home after an 8 hour day in the office, requiring workers to take regular breaks and vacations, creating spaces in the office where workers can go for a few minutes of peace and quiet throughout the day, like a meditation room, a garden and/or a walking path, and offering regular group exercise opportunities during work hours, such as yoga, Tai Chi, or Qigong classes.

Until all employers buy into the research that indicates such things enchance a worker’s physical, emotional, and mental well-being, boosting productivity, focus, memory, and creativity, below are intention-setting ideas for you to implement for yourself, to remind yourself every day that you are so much MORE than what you do and avoid burning the candle at both ends:

  1. Walking meetings.  If you find yourself either needing to schedule a meeting with a colleague or are invited to one, ask your colleague if they would mind making the meeting a walking meeting.  Take the walk outside and, if possible, into an area that has some greenery, like trees or flowers, or near water, such as a lake or water fountain.  Perhaps you can locate a bench outside that you can stop at and sit for part of the meeting.  Even if you are able to make one meeting a week a walking meeting to start, before long this idea might catch on as others begin to feel the difference it makes in their day!
  2. Take multiple short breaks.  Consider taking a one-minute break every hour.  You can set an alarm on your phone or a reminder in your calendar.  Some ideas for each one-minute break include:  closing your eyes and taking several, long deep breaths while visualizing something that brings you joy; bringing in a jump rope and/or hula hoop and using it for one minute; doing some seated yoga poses at your desk; and/or listening to a guided meditation.
  3. Ask a co-worker for support.  If you find the support of another as motivation to hold you accountable, ask a co-worker to start an at-work health challenge with you.  It could be around the number of steps you take at work (think taking the stairs instead of the elevator) or the amount of time you hold a challenging shape, such as wall squats, plank or balancing on one leg.  It might also be eating more healthy, such as getting points for eating fresh fruit or a salad instead of a taco or hamburger.  If stress is an issue, maybe consider keeping track of the number of meditations you participate in (by taking those one-minute breaks every hour!).  Don’t forget to set a goal, perhaps the ‘winner’ at the end of the month treats the ‘other winner’ to lunch.
  4. Start a gratitude circle.  I know when I worked in the corporate world, it was very easy to get caught in the experience of complaining about work to my co-workers, whether it was about other co-workers not pulling their weight, the unrealistic work expectations, and/or the lack of communication.  Although at first it might have brought some temporary relief, such complaining did not change anything.  Therefore, consider turning complaining on its head the next time you find yourself looking for a co-worker to vent with by challenging yourself to identify something that you are grateful for from your experience at work and sharing it with another.  Better yet, start a gratitude circle with several co-workers, scheduling a 5 minute gathering at some point in the day where everyone gets to share what they felt gratitude for that day (limiting the time to 1 minute or less for the sharing).
  5. Play music.  No, not your favorite dance music or rock or rap album.  Find some music without lyrics that you might enjoy and make sure to play it at an ambient noise level to avoid disturbing your co-workers.  It might be jazz or classical or it could be nature sounds, like the ocean or the sounds of the forest.  Research has shown music to improve mood, which impacts productivity and creativity