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Tired of Being Tired
After traveling to do trainings and lectures in Russia, Taiwan and Thailand last spring, I was diagnosed with a rare pneumonia that was not treatable with antibiotics. The treatment was more horrifying than I could have possibly imagined: REST. Rest is a four-letter word which sounds a lot like rust if said with enough dismay. Apparently, rest does not include home renovations or gardening. The good news is that I became fascinated with the difficulty we have in resting as a culture and began to research the neuroendocrine and immune system requirements for rest, as well as the dysregulation that occurs without it. Out of the research, a lecture called “Tired of Being Tired: Neuroendocrine and Immune System Dysregulation” was formulated (I had a lot of time on my hands). We presented the lecture in Edmonton earlier this year and will be presenting it in Vancouver on September 16. The lecture in Edmonton was co-sponsored by Dr. Ganz Ferrance, president of Alberta PsychSystems Incorporated (APSI) who is training all of his psychologists in Fort McMurray and Edmonton in Self Regulation Therapy®.
During my research, I had the good fortune to be introduced to the work of Dr. Myron Wentz, an immunologist and microbiologist who is a pioneer in the use of human cell-culture technology for the diagnosis of viral and other infectious diseases. He developed the definitive test for the Epstein Barr virus. In order to do his research, he needed to keep cells alive in a petri dish for months on end. He studied the requirements for optimal cell health and discovered that most products on the market were mislabeled and extremely deficient in providing what is needed for optimal cell health. With the proceeds he received for this major scientific discovery, Dr. Wentz set out to develop a nutritional line aimed at creating optimal cell health and wellness. He wanted to develop vitamin supplements that addressed the major chronic degenerative illnesses of our time: heart disease, diabetes, cancer, stroke, obesity, chronic fatigue, arthritis and Alzheimer’s. He founded Usana in 1992 to undertake his dream and in 2004 his Essentials (daily vitamins) was rated as the #1 daily vitamin supplement out of 1000 supplements in a study commissioned by Health Canada and authored by Lyle McWilliams. The vitamins are pharmaceutical grade and for this reason are the only vitamins listed in the Physicians Desk Reference and can be prescribed by physicians. Usana’s skin care line has absolutely no preservatives and is made from pure plant extracts. It is so pure that it is recommended by oncologists for cancer patients as it does not increase their toxic load.
Usana has agreed to let the CFTRE, which is a registered Canadian charity, act as a Usana distributor. We have been looking for years for an alternative source of funding for our research projects and this seems like a good fit. Our research shows that a multi-factorial approach is necessary for healthy functioning of the neuroendocrine and immune system. This means that the autonomic nervous system needs to be resilient and flexible in the face of novelty or threat which is achieved through Self Regulation Therapy. In addition, to keep the immune and neuorendocrine systems running smoothly, the body needs micronutrients that are no longer available in our food, and anti-oxidants to deal with stress and environmental toxins which is addressed through vitamin supplementation and antioxidants. Reducing internal inflammation by choosing alkaline forming foods over acid forming foods is crucial to achieving and maintaining health. We also need rest, stimulation that involves joy (play and contact with humans) and a spiritual practice for maximum health benefits.
Our basics picks for neuroendocrine and immune system health: Essentials (Multimineral and Mega AO which is multivitamin and antioxidant that is highly bioavailable and in a synergistic combination most easily utilized by the body) and BiOmega -3 (double- molecular distilled fish oil necessary for brain and nervous system health, is anti-inflammatory, regulates metabolism and has been shown in studies to prevent heart attacks and strokes). Optimizers to consider: Active Calcium (for bone and joint health and nerve health), CoQuinone (CoQ10 for heart health and immune system booster), Proflavanol 90 (powerful anti-oxidant, anti-inflammatory, and immune system booster). If you are interested in supporting the research and efforts of the CFTRE around the world and get the best nutritional supplements at 10% below wholesale cost, contact Tracee Andrews at 250-860-8860 tracee@cftre.com. For more information on USANA products go to USANA.com.
Natural Disasters
There have been many natural disasters since the last newsletter most notably the tsunami affected areas of Thailand which I visited in April and the hurricanes on the Gulf Coast. Dr. Ed Josephs traveled to devastated areas in Alabama, Mississippi and Florida in October, November and December last year to assess the role that the CFTRE may play in recovery. Certainly the basics of food, water, shelter, and employment need to be established before trauma work will really be of benefit. The concern we have for the Gulf coast and for Thailand is that the rates of PTSD will continue to climb for years after the funding has ended, and help is no longer available. In fact the rate of death in Louisiana post hurricane is climbing in part, we think, because of prolonged dorsal vagal braking.
We have been contacted to ascertain our interest in doing an SRT training in New Orleans. Certainly it is part of our goal to train practitioners in those areas to deal with the rising numbers of individuals diagnosed with PTSD, other anxiety disorders and depression. Addiction and crime rates will surely rise as a reflection of the dysregulation in the community. Not only did many people witness the devastation of the natural disaster, many also experienced or witnessed violence, starvation, degradation and felt completely neglected by their government which results in a whole other layer of relational trauma mixed in with the trauma of the natural disaster. We will keep you posted on the development in those hard hit places. Thank you to Marilyn Stern for her help in New Orleans.
On a Brighter Note
Naomi Lepage, an Advanced SRT assistant and SRT practitioner, was recently chosen to represent Canada at the Young World Leaders Conference at the United Nations in March. She was invited to meet with the head of Crisis Prevention and Recovery at the UN who is very interested in utilizing the training programs offered by the CFTRE.
We have had the opportunity to train excellent practitioners this past year. We have had very successful SRT Foundation trainings in Edmonton, Boston and Vancouver since the last newsletter. As well we have finished an Advanced training in Edmonton and are doing an Advanced training in Vancouver and Boston. Thank you to our Foundation Level Assistants: Dr. Ganz Ferrance, Dr. Dennis Brown, and Esme Tyson in Edmonton; Dr. Kim Luzzi and Amy Yeager in Boston; Erika Moore and Bett Robinson in Vancouver. Also much thanks to our Advanced Level Assistants: Sue Diamond Potts, Naomi Lepage, Tracee Andrews and Herta Buller for their help in Edmonton , Vancouver and Boston Advanced Trainings.
We were honoured to speak on The Psychophysiology of Addiction and SRT at the Idaho State Addiction Conference in June 2005 and look forward to doing more training in Idaho. As well, we had a blast teaching the Couples Retreat in Kelowna last spring and are offering it again in May 2006.
As the seasons change and the days lengthen remember to rest throughout the day and sleep at least 8 hours and 13 minutes at night (average recommended length of nightly sleep). To further reduce the allostatic load on your immune system and neuroendocrine system, floss everyday. Research shows that flossing adds 6 years to your life because it prevents gum inflammation which activates the immune and neuroendocrine systems. Take your vitamins, walk everyday (especially outdoors) laugh, meditate or pray and imagine health. According to new research: what you imagine your future health will be, is the best predictor of your future health.
Lynne Zettl
Upcoming Events and Trainings
For more information about all of the events listed below please call 250-860-8860, toll free 866-387-3863, web: www.cftre.com, email: info@cftre.com
Couples Retreat
Kelowna May 12-14, 2006
This three-day retreat involves a didactic and an experiential component. We start with an overview of the developmental neuromuscular affective stages and a short discussion of the psychophysiological underpinnings of shock trauma. Experiential exercises with your partner to increase awareness of the psychophysiological procedures that we all fall into as couples, and how to interrupt the procedures comprise at least half of the workshop time. Past participants have found it to be a very enjoyable weekend. Couples come away with a greater understanding of each other's development and nervous system and learn to relate to each other in a completely new way.
The Psychophysiology of Trauma and SRT
Saskatoon May 31
This lecture is designed to give practitioners a deeper understanding of the neuropsychological sequelae of PTSD. An introduction to effective psychophysiological deactivation techniques is presented. A basic overview of neuroanatomy and the triune brain will be presented. In addition, the psychobiology of development including early trauma, disorders of dysregulation, and affect development will be discussed. Kindling and quenching in the autonomic nervous system and the cumulative nature of trauma will be explored. Case studies using Self Regulation Therapy with will be presented and includes a discussion of the plasticity of the brain in transforming trauma, categories of trauma, and symptoms of PTSD. A new Self Regulation Therapy Practitioner Training begins in Saskatoon in September!
Date: Wed May 31, 2006
Time: 7:00-9:30 pm
Place: 4th Floor - Birk's Building 165 3rd Ave South Saskatoon, Sk.
Cost: $25 in advance. Contact Edyta at info@cftre.com or 866-387-2862 with payment details
Psychological Anatomy: Developmental Neuromuscular Affective Integration
Kelowna, BC July 17-22, 2006 and Cape Cod , MA October 10-15, 2006
In this exciting six-day course we will explore stages of development starting in utero and extending to the teen years. The concomitant conflicts that may arise within the therapy as a result of derailments at any given stage will be discussed. The psychological function of the neuromusculature initiated within each stage will be explicated. In addition, utilizing the most recent psychophysiological research, attachment and the cognitive, and emotional aspects of stage-specific brain development, will be explored. Affective development and its centrality in the capacity to self regulate will be discussed. Therapeutic progress may be slowed or stalled as a result of unresolved developmental challenges that are often misinterpreted as resistance, attention seeking and help-rejecting behaviour, interpersonal conflict, malingering, or character disorders. These misinterpretations lead to frustration, re-wounding of the client, and ultimately premature termination. Strategies for helping clients work through developmental derailments will be presented through experiential and didactic modalities allowing individuals to integrate what they have learned directly into their work on Monday morning. This seminar integrates the work of Allan Schore, Joseph Ledoux, Bruce Perry, and other developmental neuroscientists with clinical and practical applications for professionals.
Tired of Being Tired: Neuroendocrine and Immune System Dysregulation
Vancouver Saturday September 16, 2006
This one-day seminar in Vancouver, BC will utilize current psychophysiological research to explore the potential links between trauma and negative life experiences and dysregulation of the neuroendocrine and immune systems. In addition, this seminar will introduce effective clinical approaches to help bring the autonomic nervous system back into balance and increase resiliency in the immune and neuroendocrine systems. In the past decade, there has been a significant increase in the diagnosis of Chronic Fatigue Syndrome and other diseases related to the neuroendocrine system. Recent psychophysiological literature has suggested strong links between trauma and disorders of the neuroendocrine and immune systems. The Hypothalamic-Pituitary-Adrenal axis is a major stress pathway in the nervous system and contributes to the regulation of the neuroendocrine system. Research suggests that significant or cumulative stress may alter the balance of the body’s hormonal and immune systems. Dysregulation of the autonomic nervous system, whether as a result of trauma experienced in adult life, or as a result of prenatal or perinatal trauma including abnormal maternal-infant bonding is strongly implicated in the generation of neuroendocrine and immune disorders including: fibromyalgia, chronic fatigue, hypo and hyperthyroidism, Type I diabetes, rheumatoid arthritis, systemic lupus erythematosis, Sjogren’s syndrome, Graves disease, Hashimoto’s thyroiditis, multiple sclerosis, stress-induced asthma, Epstein-Barr virus and other chronic fatigue conditions.
View Tired of Being Tired brochure on the CFTRE website.
SRT Foundation Trainings 2006
Edmonton
Apr 28-30
May 26-28
Jun 23-25
Saskatoon
Sept 29-Oct 1
Nov 10-12
Dec 8-10
Vancouver
Nov 17-19
Dec 15-17
Jan 19-21, 2007
View SRT brochure on the CFTRE website.
SRT Advanced Trainings 2006
Boston
Mar 31-Apr 2
Jun 16-18
Sept 8-10
Oct 20-22
Edmonton
Sept 22-24
Nov 3-5
Jan 26-28, 2007
Feb 23-25, 2007
View SRT brochure on the CFTRE website.
Featured Article
What’s Working?
Most students in the SRT training have heard me ask this question more than a few times, usually at the beginning of a clinical case supervision. And yet, despite their ability to anticipate the question after a few supervisions, few are prepared to address the question, and have reactions ranging from surprise to impatience (possibly tinged with irritation?) “Why are we wasting our time talking about what’s working?”, I interpret from their facial expressions. “Aren’t we here to talk about what’s not working so that you can make suggestions about how to make it work?” And further, “Why do you keep asking that question each time when you can clearly see that we don’t have many answers and don’t really like to think about it anyway?”
The main reason that I ask you to consider what is working on a regular basis is to help you conceptualize a case (a practice, your life) as a whole gestalt with aspects that are functional (ie working) and aspects that are challenging (ie not working). The process of entering therapy has a strong bias towards identifying pathology (what’s not working). As a result, a therapeutic relationship is formed with a focus on how to “fix what is not working”. Problems with my relationship, my depression, my pain, my anger all have at their basis a problem that must be solved. By addressing these problems and making them the initial focus in therapy, aspects of a person’s functionality are overlooked and may seem irrelevant in light of “the problem”. Our job as therapists (as I see it), is to help a client recognize their strengths (what is working) as a tool to help address and solve their own problems. When a client can identify what strengths they had to “get them through” a difficult time, they come into a contact with a part of their brain (ventral vagal complex) that is proactive, ergotrophic and a natural problem solver.
When a therapist helps a client identify this powerful resource, clients can actually better solve their own problems. Furthermore, even if we could tell a client exactly what to do to “solve their problem” (which many therapists fall into the trap of doing), it rarely, if ever works. In the rare case that your advice does have an effect, it tends to only work for a specific situation and has as it’s legacy the beginning of a dependency. You told me what to do last time and it worked, so tell me this time, clients reason. Give a hungry man a fish and you have fed him for a day (and he’ll be back tomorrow). Teach him how to fish and you have fed him for his lifetime (and you can go and play golf).
In fact, when people are down there is much less of a tendency to look at what is working. They are drawn to what is not working and as a result continue to spiral towards futility and depression. Even though it may be difficult to help your client change his focus, and it may take awhile and some good strategies, you are really addressing the root of the problem when you help them look for what is working.
There is another reason that asking what is working is important in the therapeutic process. The “hallmark” of therapy is the “therapeutic alliance” also known as the relationship. As a client becomes attached to a therapist (and vice versa), healing and growth have an opportunity to occur. If the relationship is successful, the client will improve and the question of termination will eventually emerge. However, the idea of leaving a relationship that has become intimate, supportive and helpful is ego-dystonic to a client (as well as the therapist) particularly if the client has not experienced many close relationships in his life. As termination looks increasingly imminent, there is only one strategy that can positively save relationship- the very same one that created the relationship….”the problem”.
Thus, it is usually as termination approaches that the “problem” starts to return. Although unconscious, it is nevertheless real. “I’m starting to have those scary dreams again”, “I’ve been feeling a bit suicidal lately”, “My wife and I had a fight the other night.” If a client’s mental health fails to continue to improve, or, in fact, declines, termination is put on hold. Thus, improvement in therapy carries with it an iatrogenic trauma: separation. And the only way to avoid it is through an unconscious (or sometimes conscious) relapse into the “problem” (or new problems) that cemented the relationship from the start. However, a relationship that has at it’s roots a support of a client’s strengths (what’s working) is a different relationship. Although separation will always be bittersweet, a relationship that is formed around what is working allows the client to have a sense of their own agency in life and a way to leave therapy (you helped me, but I really had it in me all along). Planning for termination, a necessary and difficult part of therapy, commences with the first meeting when the initial conditions of what’s working are addressed.
Ed Josephs
Questions and Answers
Supervision Questions
Question #1
Can SRT be used to work with Aspergers? If so, where do I start?
Answer #1
From a neurodevelopmental perspective, individuals with Aspergers have an acute sensitivity to stimulation that has affected their ability to have contact with others and to accurately read social cues. They tend to have great difficulty modulating and expressing affective states, which implicates some derailment around the development of the right orbital frontal cortex. Start by teaching basic skills of grounding, containment, and centering that taught in Foundation Level SRT and Psychological Anatomy. Eventually, try working with gaze aversion exercise from Psychological Anatomy to help to them really slow down the stimulation coming in from contact with you, while remained connected to a resourced state. Keep in mind that you are helping to build both lateral and ventral tegmental circuits from the right orbital frontal cortex.
Question #2
My client really likes coming to therapy and we seem to have a good relationship, but I can’t seem to get her to track her sensations, at least not for long. We usually end up talking a lot, which she enjoys, but I know is doing little to change the symptom she came to see me about which is chronic low back pain. How can I get her to be more embodied?
Answer #2
A common misperception about SRT is that it is solely focused on sensations in the body. In truth, SRT is mainly focused on bringing awareness to unconscious procedures, at the basis of which are bodily sensations. There are many people who, for whatever reasons are not ready to track sensations in their body. The reasons are too numerous to discuss here but may include a dissociative process or a general discomfort of being aware of their body with another person observing them, a process which may lead to shame for them. In fact, it is not uncommon for people experiencing chronic pain to dissociate from their body in order to get through the day. Thus, it may feel counter-productive (and quite uncomfortable) for them to sense into their body. Your mission (if you choose to take it) is to track your client’s process and help bring awareness to their process in the moment. Here are a few strategies that can help:
1. Slow down the process.
This can be achieved by actually asking the client to slow down, It can also work if you “interrupt” the client” process to ask questions or bring awareness to the process. (“You seem so proud when you talk about your daughter’s wedding”; “Don’t you get a chance for a lunch break during the day?”; “I notice how quickly you talk when we discuss your mother”). By “interrupting” or being more active in the conversation, you have the opportunity to insert time, and to take the client out of their procedure, thereby creating the possibility of noticing this moment.
2. Educate the client.
It is helpful if your client has some understanding of why it is helpful to bring awareness to their procedure and how this is related to their back pain. You may ask: “When do you have less discomfort in your back?”, “What part of your body feels relatively more comfortable (less uncomfortable) right now?” , “What do you notice now as you sense into that space?”
3. Help a client track where they do notice themselves.
People with chronic pain are often very skilled at dissociating from their pain, and hence from their body. This can be adaptive (at least in the short term) as they are able to get their jobs done, or complete daily tasks; however the result is that it also contributes to higher levels of pain later on (often in the evening or at bedtime). Some education about the normal process of dissociation (see your Foundation III manual) can be helpful to de-pathologize the process ( I often say that I would not go to the dentist if couldn’t dissociate). Then as you discuss different subjects (not just activating subjects like their discomfort, but positive subjects as well), you can interrupt and ask if they have a sense of where they notice themselves in this moment. You may help by giving a menu: perhaps you are aware of yourself a few feet above or to the side of your body, or perhaps you are aware of yourself in your thoughts (head)? It is helpful not to use the word “body” when you are tracking a dissociated state, but everything else you have learned about tracking is relatively the same. You can ask if it is comfortable or uncomfortable. You can ask about their breath. You can ask what might make it more comfortable. During this time it is also very helpful for the therapist to feel as grounded as possible. Sense into YOUR seat, track YOUR breath. Give time and let the process unfold. Remember that a dissociated state is a state of high activation, so that as your client becomes increasingly grounded she may suddenly have a strong sensation as she begins to sense her body. Education as this occurs can be very helpful, and finding a place of less discomfort to track, even if it is an earlobe or a toe is instrumental in helping a client ground and discharge some activation. If your client dissociates again ( as they often do), just continue to track where they notice themselves as before.
Question #3
My client has Chronic Fatigue Syndrome (CFS) and seems to be doing a lot of the right things but has not seen much difference in her symptoms. Is there an area I could focus on to help her see results?
Answer #3
Yes. Although CFS is a syndrome, there is one aspect that is often overlooked, or paid lip service to, and is fundamental in the successful treatment of CFS. REST. When you ask someone with CFS if they rest, they often say that they rest all the time, but what do they really mean by rest? When you check it out with them you often find that rest has many meanings, e.g. checking my emails, watching TV, going for a drive. It’s not that there is anything wrong with these activities, it’s just that they are not actually rest. CFS is likely a condition that is brought about through chronic low-level stress that keeps the HPA axis (hypothalamus-pituitary-adrenal) running nonstop and eventually affecting the immune system. It can be exacerbated by an accident, illness or trauma. There are also likely developmental issues around “pushing through”. Nevertheless, there are often issues with resting. It can be helpful experiment with resting in a session and to track “what lets go and what holds on” for the client. Often thoughts about one’s uselessness or judgements about wasting time come up (and as you have that thought, what do you notice about resting, I may say). Resting is a skill and an art form and takes practice to get proficient at. By tracking a client’s ability to rest in a session, you will notice a good deal of activation that can be discharged, allowing the client to experience a state closer to that of rest. Finally, helping a client identify good times to rest during the day (not just when convenient, or when she cannot push through any longer), good places to rest, and good strategies for resting can make a significant difference in symptoms of CFS.
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