Dysregulation is a hallmark of trauma. If we are regularly exposed to frightening situations and we aren’t able to process, understand or gain comfort for our fears, our bodies can become sensitized and wired for overreactions. We go from zero to ten and ten to zero with no speed bumps in between, we shoot from numbness to overreaction, from shut down to hyperarousal and hyperintensity and the reverse. Both extremes are, in a sense, overreactions and emotional sobriety is somewhere in between. This see-sawing back and forth of one’s inner experience is part of the trauma boomerang effect. Whenever I see a client moving between emotional, psychological or behavioral extremes, I explore the possibility that some form of unresolved trauma may be at the base of it.
Traumatized people can have trouble living in four, five, and six; that middle ground where thinking feeling and behavior operate as a fairly integrated whole.
In Twelve Step rooms the phenomenon of dysregulation is intuitively referred to as “black and white thinking.”
Chronic stress can get us stuck in a fight or flight mode that is generally accompanied by the release of the stress hormone cortisol, which has some serious and long-term effects on our brain and body. Too much cortisol tends to shut down the hippocampus, the part of the brain that helps us to accurately perceive and read our environment. When the hippocampus is not functioning properly, we have trouble interpreting signals in our environment. Cortisol also impairs the cortex’s ability to regulate fear signals coming from our fear center, the amygdala. So at the same time that we are being over sensitized to stress, we lose some of our ability to regulate our fear and anxiety and put into proportion and context what’s going on around us.
To complicate this overreaction further, when the hippocampus is impaired, the prefrontal area is unable to modulate and accurately interpret signals from the overreacting amygdala. The result is that the amygdala starts reading everything as scary or threatening, and as the hippocampus mistakenly perceives too many triggers for our fear, our fears get generalized. We become hypervigilant, waiting for the other shoe to drop. As we’ve become convinced that our fears are very real, we have trouble distinguishing between real and imagined or “generalized” fears. This condition of hypervigilance and overreactivity is part of posttraumatic stress disorder (PTSD) reaction. PTSD then might be understood as a failure of the brain to regulate arousal in both the central and autonomic nervous systems, leading to extreme fluctuations in state, both emotional and physical.
Because of this loss of self-regulation, the therapist needs the skill set to meet the client anywhere along the trauma continuum from numbness and shutting down to high intensity. The trauma extremes of shut down and high intensity do not necessarily respond to words. What they do respond to is a method that can both meet them in their frozenness or their overpowering urge to act. When someone’s emotions become triggered during the course of therapy, those emotions need to somehow travel a path towards completion. Emotions need to be felt, processed, and brought to some form of closure; thoughts need to be brought back into alignment so that they are about what is actually being experienced rather than racing ahead, obsessing or disengaging. Hungers need to be moved through so that the urge and intention to act doesn’t remain frozen in the body.
The prefrontal cortex needs to be restored to its rightful place as the part that reasons, assesses, and thinks about what is happening. The feeling mind needs to be restored to its right size so that it is neither explosive nor stunned and mute. Behavior needs to brought under conscious control so we do not act without thought or foreclose on our feelings.
Neuropsychodrama and psychosocial metrics act as safe triggers that can allow the trauma-related memories to come forward in a way that takes into account that those recollections will be spotty and vague at times, even though they might have very intense emotions associated with them. As I mentioned previously, I find it effective to slow the process down and allow the protagonist to move through this state trusting that awareness will dawn as they do. Having PTSD-related emotions triggered through psychosocial metrics or confronting figures from the past who have hurt us can mobilize deep feelings. Clients who are caught in this fear vortex have done all they can do to simply stand in this moment of reliving their own internal over reactions. At this moment, clients may well be standing with others who are also experiencing memories. Because they have internalized the process of choosing a feeling or symptom they identify with, sharing and listening, they can use the safety of identification and sharing as a safe container in which to reexperience these emotions.
This is why Relational Trauma Repair (RTR) is quite sufficient on its own and offers many contained moments of healing. Clients slowly regulate their own emotions by feeling and sharing them as others do the same. They are able to take a new, more mature look at an old emotional reaction and they do not feel isolated as they do this, rather they feel connected. Healing takes place through many incremental moments where feelings are “triggered” in a therapeutic context, felt, translated into words, shared, and then integrated and regulated.