Saturday, 30 March 2019
When the Body Says No: Mind/Body Unity and the Stress-Disease Connection
Plenary Address: Gabor Maté, MD
Stress is ubiquitous these days — it plays a role in the workplace, in the home, and virtually everywhere that people interact. It can take a heavy toll unless it is recognized and managed effectively and insightfully.
Western medicine, in theory and practice, tends to treat mind and body as separate entities.
This separation, which has always gone against ancient human wisdom, has now been demonstrated by modern science to be not only artificial, but false. The brain and body systems that process emotions are intimately connected with the hormonal apparatus, the nervous system, and in particular the immune system. Emotional stress, especially of the hidden kind that people are not aware of, undermines immunity, disrupts the body’s physiological milieu and can prepare the ground for disease. There is strong evidence to suggest that in nearly all chronic conditions, from cancer, ALS, or multiple sclerosis to autoimmune conditions like rheumatoid arthritis, inflammatory bowel disease or Alzheimer’s, hidden stress is a major predisposing factor. In an important sense, disease in an individual can be seen as the “end point” of a multigenerational emotional process. If properly understood, these conditions can provide important openings for compassion and self-awareness, which in turn are major tools in recovery and healing.
Dr. Maté’s presentation includes research findings, compelling and poignant anecdotes from his own extensive experience in family practice and palliative care, and illuminating biographies of famous people such as athlete Lance Armstrong, the late comedienne Gilda Radner, or famed baseball legend Lou Gehrig. The presentation is based on When The Body Says No, a bestselling book that has been translated into more than ten languages on five continents.
Sunday, 31 March 2019
The Emergence of Polyvagal-Informed Therapies in the Treatment of Trauma
Plenary Address: Stephen W. Porges, PhD
The Polyvagal Theory provides a new perspective to explore how autonomic nervous system function relates to social behavior, emotional regulation, and health. The Polyvagal Theory links the evolution of the autonomic nervous system to affective experience, emotional expression, facial gestures, vocal communication, and contingent social behavior. The theory, by being informed by the phylogeny of the autonomic nervous system, expands our understanding of normal and atypical behavior, mental health (e.g., coping with stress and novelty), experiences (e.g., dissociative states), and psychiatric disorders (e.g., autism, anxiety disorders, PTSD). The theory emphasizes that the core deficits in behavioral and affective regulation associated with several psychiatric disorders is related to neural regulation of the autonomic nervous system. By incorporating a developmental perspective, the theory explains how traumatic experiences can disrupt and ‘retune’ the neural regulation of autonomic function to form a neural “platform” upon which the trauma survivor will have challenges in establishing safe and trusting relationships. The theory explains how the nervous system evaluates risk in the environment, without awareness and often independent of a cognitive narrative, through a process labeled “neuroception.” Neuroception attempts to support adaptive behaviors by matching autonomic state with the neuroceptive state of risk (i.e., safe social environment, danger, and life threat). Abuse and trauma may reset neuroception to protect the individual from others when there is no “real” danger resulting in defensive and often aggressive responses to friends and caregivers.
This presentation will focus on how Polyvagal Theory provides a plausible model to explain how therapy can support mental and physical health during compromised states frequently associated with the consequences of trauma. The Polyvagal Theory informs therapists by providing a strategy to understand the neural mechanisms and processes that are embedded in therapies to improve social engagement behaviors and to enhance the regulation of bodily and behavioral state. The theory provides insights that bridge therapy to the neural regulation of the autonomic nervous system and health outcomes. Polyvagal-informed therapies have two important components: 1) the context of the therapeutic session including the interpersonal relationship between therapist and client that promote feelings of safety and trust, and 2) the functional ‘neural’ exercises that are involved in the specific therapy. The Safe and Sound Protocol will be described as an example of an intervention that incorporates these two components.
Monday, 1 April 2019
The Growth-Promoting Role of Right Brain Mutual Regressions in Long-term Psychotherapy of Relational Trauma
Plenary Address: Allan N. Schore, PhD
In line with the current two-person relational trend in psychodynamic theory Dr. Schore will discuss the critical role of transient synchronized clinical regressions, defined as the process of returning to an earlier stage of development, in the psychotherapy of early relational trauma. Although the paradoxical process of regression may reflect a clinical deterioration it may also represent a creative return to fundamentals and origins that can facilitate a potential reorganization leading to better integration, healthy individuation, and increases in the adaptive capacity of intimacy. Drawing from his next two Norton volumes, Right Brain Psychotherapy and The Development of the Unconscious Mind, Dr. Schore will present interpersonal neurobiological models and case examples of mutual regressions embedded in clinical re-enactments of attachment trauma.
Current neuroscience now documents the critical role of the early developing right brain in attachment mechanisms, intense traumatic dysregulating emotional states, the dissociative defense, connections into the autonomic nervous system, social-emotional functions, interpersonal trust, and implicit affect regulation. The right brain thus needs to be activated in both the patient and the empathic therapist in working with relational trauma. Synchronized mutual regressions initiate an implicit shift from the left to right brain, allowing the therapist to remain intersubjectively connected to the patient as she experiences the subjective bodily-based aspects of relational trauma. Dr. Schore will describe how in heightened affective moments of the session, especially during ruptures and repairs of the therapeutic alliance, the psychobiologically attuned therapist implicitly instantiates a regression, a “reversible dominance of the left over the right hemisphere.” The creative clinician, sensitive to even low levels of the patient’s shifts into and out of affective states, learns how to fluidly synchronize this shift in hemispheric dominance with the patient shifts, thereby increasing safety and trust in the therapeutic alliance. This right lateralized interbrain synchronization allows for the communication and regulation of not just conscious but unconscious affects.
In this expansion of regulation theory Dr. Schore will explicate the central role of the character defense of dissociation (as opposed to repression) in working with regressions in not only symptom-reducing but growth-promoting psychotherapy, on both sides of the therapeutic dyad. He will offer a model for working with defensive coping strategies embedded in clinical regressions, especially those involving unconscious dissociated affect in spontaneous mutual regressions. In line with contemporary psychodynamic theory and interpersonal neurobiology he will argue that the communication and interactive regulation of affect and not interpretation and cognitive insight are central change mechanisms with early traumatized patients. Utilizing case vignettes, he will also elaborate the unconscious neuropsychoanalytic processes that are expressed in these mutual regressions. In deep psychotherapy these long-term changes in the patient’s right brain may underlie the structural psychotherapeutic transformation of the patient’s unconscious attachment internal working model, allowing for an integration of the personality and more adaptive and complex social-emotional functions.