How to Live with AD/HD

Topics included:

• What Accelerated Resolution Therapy Is
• How ART Supports Trauma Healing
• Who Benefits from ART
• What a Session Looks Like
• How to Begin Therapy at KKJ

In Dr. Bessel van der Kolk’s book, The Body Keeps the Score, his expertise on trauma uncovers the research of different treatment paths. He emphasizes an important first step in recovery: feeling calm and focused. Although the actual trauma cannot be undone, psychologists can begin working on the marks that trauma has left behind.

This blog will cover a few of the prominent trauma treatments as discussed by Dr. van der Kolk in his book.

Yoga
Yoga is a great way to ground people in the present moment. The act of yoga combines breathing exercises, stretching, meditation, and various poses that create a smooth rhythm between tension and relaxation. Yoga teaches individuals to pay attention to which muscles are currently being used and to focus on the safety of their current environment in different, sometimes vulnerable, positions. Research has found that both yoga and meditation increase traumatized women’s brain regions related to self-regulation. If you are interested in learning more about yoga and trauma, try reading Yoga and the Quest for the True Self.

Mindfulness-Based Stress Reduction (MBSR)
Since the core to recovery is self-awareness, MBSR integrates different mind-body exercises into one 8-week treatment path. It includes yoga, meditation, and working on thought patterns to heal both the body and the mind. Research has shown that MBSR boosts immune response and lowers both blood pressure and cortisol levels. MBSR has also been found to positively affect your brain regions related to emotional regulation, body awareness, and decreased activity of your amygdala and potential triggers.

Social support
Dr. van der Kolk speaks about the single most powerful protector against severe trauma: social support. Much of our brain’s wiring is devoted to human connection. A study done on the children affected by the German bombing during WWII in London found that children who were removed from their parents during the bombing to a safer location suffered worse long-term effects than the children who endured the bombings alongside their parents. We can feel safe when we are assured someone is there to help protect us and get us to safety. Strong social support is a great tool in treating and preventing trauma.

Bodywork/ somatic therapies
Trauma robs us of feeling in control and of feeling safe in our own skin. In order to recover from trauma, it’s important to look into mindful, physical techniques for our bodies. Therapeutic massage is one way to begin bodywork therapy that allows people to discover unknown tensions they’ve been holding in their body. Joining other groups like kick-boxing, self-defense, or Pilates can allow your therapist to begin healing the marks trauma has left behind on your body. Somatic therapies allow patients to feel safe in their skin again by relocating themselves in the present moment.

Medication
It’s important to know that medication cannot cure trauma. Medication aims to decrease the symptoms caused by trauma, but taking medication does not create long lasting change. Serotonin reuptake inhibitors (SSRIs) can help patients feel calmer and more in control, which can help their willingness and ability to engage in therapy. Other medications used to aid in trauma recovery include drugs that target the autonomic nervous system, like clonidine which decreases reactivity to stress, tranquilizing drugs, anticonvulsants, mood stabilizers, and antipsychotic medications. There are some medications that can help reduce nightmares as well.

Writing to yourself, art, music, and dance
Language is essential to healing. Through writing, people can access their inner world of emotions and thoughts they might not yet be ready to talk about. Research has found that patients who wrote about their trauma and their emotions had a drop in doctor visits and improved both their mood and optimism. Writing about personal trauma improves immune function as it helps people to process and recover from stressful events. When it comes to artistic expressions for therapy, less research has been done to understand the logistics of how art, music, or dance aid in trauma recovery. Some research has shown that expressive movement in dealing with trauma gave students better physical health and had an increase in grade point average. These artistic therapies allow people to express the speechlessness of their trauma in a way that is interpretive and meaningful. Writing and artistic expression go hand in hand to help patients deal with traumatic events they have buried deep within themselves.

EMDR
EMDR- Eye movement desensitization and reprocessing therapy is based on the finding that psychologist Francine Shapiro had one day: that rapid eye movements relieved her from the distress of painful memories. EMDR allows patients to heal from their trauma without talking about it and allows them to integrate their traumas into a larger context or perspective. Through EMDR treatment, patients allow their trauma to become a story instead of something immediate and anxiety inducing. Research has shown that EMDR increases prefrontal lobe activation. Another 8-month long study showed that 60% of patients reported being completely “cured” after EMDR treatment. EMDR regulates trauma’s intense memories through restoring a sense of agency and ownership of one’s body and mind.

Overall, trauma therapists use techniques that calm their patient, lay their traumatic memories to rest, and reconnect their patient with other important social connections. Trauma does not have to define anyone’s life, and through research like Dr. van der Kolk’s, we can discover how trauma affects the mind and the body and how to best treat each individual case.

Trauma, at its essence, is something intolerable and unbearable. While people can react to traumatic events differently, trauma can create a physical change, rewiring the brain’s alarm systems and increasing the release of stress hormones. In Dr. Bessel van der Kolk’s New York time’s Bestselling book The Body Keeps the Score, he dissects the science behind trauma. Dr. van der Kolk is one of the world’s top experts on trauma, having spent over three decades working with survivors. His work reveals how trauma literally reshapes the brain, the mind, and the body.

Understanding how trauma affects the brain is something many researchers are working to uncover. Previous research studies with Rorschach tests revealed that traumatized people tend to superimpose their trauma on everything. Other research on brain scans showed that when a flashback was triggered for traumatized patients, the area of the brain responsible for speaking (the Broca's area) was inactive. This literally meant there was a physical inability to put their feelings into words.

The amygdala is an important brain structure that is usually affected by trauma. The amygdala is like a smoke alarm; it takes incoming information and identifies its relevance in terms of survival. The amygdala sends an instant message to other structures to orchestrate a whole-body response. The frontal lobe (in charge of decision making) may be able to restore balance by letting you know you are responding to a false alarm. However, people with trauma may lack this ability and misinterpret many things as a direct threat to their survival. When triggered, the amygdala will activate the release of chemicals like cortisol and adrenaline which causes a constant feeling of agitation and arousal. During trauma, when individuals are unable to escape danger, their brain will continue secreting stress chemicals in vain.

Psychologist Stephen Porges introduced the Polyvagal theory. The theory focuses on the body’s vagus nerve and its influence on trauma. The vagus nerve connects the brain with other important organs like the lungs, heart, and stomach. Focusing on this nerve and the body’s regulation of arousal, the Polyvagal theory suggests there are three fundamental states for our bodies.

The first is social engagement which means, when humans are in the face of danger, we will first reach out for help and support. When social engagement does not work, we enter the second state of fight or flight. This state causes a change in our ventral vagal complex (VCC) which is in charge of social engagement and remaining calm. When we are unable to fight or flee, we are left with the third physiological state: freeze/collapse. This third state activates the dorsal vagal complex (DVC) which reaches down into the stomach and kidneys and causes the heart rate and metabolism to drop. The DVC’s activation is the ultimate emergency system as people will disengage, collapse, and freeze in the face of danger and their inability to escape from it.

The way in which we are able to interact with our trauma may change the behaviors we display after the event or influence our reaction to future traumas. If you were able to fight or flee, you might become overall more anxious and on edge. If you were trapped and unable to act during the traumatic event, you may dissociate and shut down to numb yourself and prevent your body from registering any emotional or physical pain.

Trauma breaks down important functions in our brain that change our entire way of living. Brain studies reveal that for some traumatized patients, there is no distinction between the past or the present. Traumatized patients have an inactivation of their dorsolateral prefrontal cortex, creating a lost sense of time. Additionally, Dr. van der Kolk began to realize that many of his patients could not physically feel whole areas of their bodies. Trauma created a disconnection between their mind and their body.

Not only were their sensory perceptions altered, but research also shows how trauma affects people’s sense of self and self-awareness. Some patients weren’t able recognize who they were in a mirror. A study focused on the ‘default state network’ (when people actively think of nothing), found that individuals will activate areas of the brain related to the self even in the default state network. However, the same was not true for traumatized patients.

One other study evaluated how brains react to eye contact from another individual. In individuals who did not experience trauma, when making eye contact, they activate their frontal lobe and mirror neurons which allow for rational thinking and understanding others’ intentions. However, in traumatized individuals, they did not have any activation of the frontal lobe and instead had an activation in a region of the brain in charge of self-protective behaviors. Trauma disconnects the brain from activating regions needed for healthy social engagement as well as self-sensing areas.

Trauma is very difficult to understand, however it should be emphasized that having strong social support and true reciprocity in your relationships is a very powerful tool in protecting against stress and trauma. Trauma affects us at our core and leaves a mark on our brains and our bodies. According to Dr. van der Kolk, “for real change to take place, the body needs to learn the danger has passed and to live in the reality of the present.”

Avoidance is usually seen as a maladaptive response to feared things or situations. For example, if you’re scared of elevators, you’ll probably go out of your way to find the stairs. Avoiding things can create barriers and worsen people’s anxiety of what they fear. However, some scientists argue that avoidance can sometimes act as a positive response by enhancing people’s perception of control.

Firstly, it’s important to note that avoidance is a key behavior in most anxiety disorders. By looking deeper into its benefits and negatives, we can see when avoidance is maladaptive and when it can promote psychological health. When it comes to treating anxiety disorders, exposure therapy is known as the most effective form of treatment. Avoidance and exposure seem to be opposites- so how could avoidance be good for people dealing with anxiety disorders?

Avoidance is a good skill to use when you are actively avoiding harmful stimuli. Avoidance is an issue when people continue to avoid things even though the harmful stimulus is gone. When people rely so heavily on avoidance to feel in control, it can become a habit so ingrained in their daily lives that it becomes a maladaptive hindrance.

It’s also important to note the importance of feeling in control to reduce anxiety. To a certain degree, avoidance helps patients struggling with anxiety gain control and begin to face their fears. When avoidance is used to stop exposure to harmful situations, it’s viewed more as a successful coping skill. Combining a healthy amount of avoidance with exposure in a safe environment can allow individuals to feel in control while also facing their fears. According to clinical psychologists Stefan Hoffman and Aleena Hay, some avoidance strategies give clients in the early stages of therapy a greater sense of control “without sacrificing treatment gains.” They also say that avoidance coping can help promote the effects of exposure therapy and can be adaptive in the short term (Hofmann & Hay, 2018).

When discussing coping mechanisms and whether they are causing impairment or creating healthy psychological growth, it’s important to consider the context they are used in (Fischer et al, 2021). Therefore. when thinking of avoidance, it’s not always a “bad” thing and not always a “helpful” tool. The effectiveness of avoiding things depends on the situation it’s used in and how it affects a person’s well-being.

When it comes down to it, avoidance is not always a bad trait to have. Avoidance behaviors can give people a sense of control that, when paired with exposure therapy, can better allow patients to fully confront their fear.

When a client goes to a mental health provider, they may often wonder if they will be diagnosed with a mental health disorder. For some people, a diagnosis can make them feel better because it provides an explanation for their suffering, while others may be concerned about the stigma and impact of a particular diagnosis. It's important to remember that for mental health professionals, a diagnosis is a tool to ensure the next steps for treatment are effective for the client. It is also a way for providers to communicate with one another in the event of the need for a referral or collaboration.

Having a diagnosis can be empowering. Identifying areas for growth, and underlying resilience to support that growth, sets up the path for what comes next. A diagnosis allows mental health providers to accurately refer a patient elsewhere for medication or for more effective treatment. For students, diagnoses offer proper accommodations in classroom settings that will create a better learning environment. Additionally, having a diagnosis can help parents better understand their child’s behaviors instead of assuming their child is just willfully being difficult.

Some people may have negative associations with a mental health disorder diagnosis. For instance, a diagnosis can cause some people to overthink their mental health disorder as a label. Some people may feel anxious at the thought of being diagnosed with something. It’s important to know that you are not your disorder. There might even be a fear of judgment for having a diagnosis. A diagnosis can be overwhelming, but no one should feel ashamed of a mental health diagnosis any more than they would with a medical diagnosis. A diagnosis is simply a constellation of symptoms that explain what is happening with someone, just like symptoms explain a stomach ulcer. Yes, there may be behavioral changes that contribute to some symptoms getting better or worse, but there are also biological and situational factors that contribute to a mental health diagnosis.

People are not their mental health disorders any more than they are their medical conditions. The most important thing in your mental health journey is getting the proper treatment to lead a happy and functional life. Diagnoses help mental health professionals ensure they understand what is happening to develop an appropriate treatment plan.

Major Depressive Disorder (MDD) is one of the most common psychological disorders, with more than 7% of the U.S. diagnosed with depression. Individuals with MDD experience symptoms that are detrimental to their everyday functioning including sadness, sleep problems, and difficulty concentrating. Other common symptoms include lack of interest or pleasure in activities and low energy. Experiencing these symptoms can be overwhelming and can reinforce the inability to initiate productive habits. We can get stuck in a harmful cycle of feeling overwhelmed, unmotivated, and helpless. During the Covid-19 pandemic, anxiety and depression increased by 25%, yet psychological treatment was widely inaccessible for various reasons. So how do we start making ourselves feel better when we feel so trapped by our depression?

Behavioral Activation is a simple, evidence-based intervention that has shown substantial improvement for those with MDD. Behavioral Activation derives from the behavioral model of depression where it is believed that a lack of positive experiences contributes to the feelings of depression. The idea is that your thoughts and feelings are affected by your interactions with others and overall satisfaction of life. Using Behavioral Activation increases activities and the reward value of the activities. It works by getting your body moving and doing the things that create rewarding experiences in your day-to-day life. Eventually, initiating these positive activities becomes easier and more positive thoughts and feelings begin to emerge.

To start, Behavioral Activation prompts you to list what you used to enjoy or could potentially enjoy, motivates you to try it out, even if it feels like you are “just going through the motions,” and has you document your experience while doing it. Having a list of activities will make it easier to choose activities that a feasible in that moment and documenting the reward value will allow our mind to acknowledge the positive data. When you feel the joy brought on by these activities, your mind starts to remember how this felt and sends positive feedback to your reward center.

Try it out! To begin:

It is not uncommon for young children to express feelings of nervousness and worry in their everyday lives. However, some children face persistent and excessive feelings of worry and fear, making their day-to-day tasks difficult to get through. Parents may not be familiar with the signs of childhood anxiety or how to approach getting the appropriate help for their children suffering with an anxiety disorder. Understanding childhood anxiety and treatment options can best help teach your children how to regulate their anxiety and lead a healthier and happier life.

The most common anxiety disorder is Generalized Anxiety Disorder (GAD). GAD is defined by obsessive and persistent worry over various things in one’s life that has been prominent for at least six months and makes life dysfunctional. Childhood anxiety can affect children’s performance in school and social events, limiting their interactions and ability to calmly complete tasks.

The National Institute of Mental Health estimates that around 32% of children between the ages of 13-18 have an anxiety disorder. Although adults may not notice the signs of anxiety and wave children’s symptoms as nothing more than just nerves, anxiety disorders can severely impede one's ability to function in society.

There are usually a multitude of factors that can cause a child to develop an anxiety disorder. Some prominent factors include genetics, brain chemistry, life situations, and learned behaviors. Children with family members who have an anxiety disorder are more likely to inherit the genes that make them prone to develop anxiety. Chemical imbalances in the brain can also cause anxiety as well as certain life situations (death of a loved one, history of abuse, major illness, violence, etc.). Similarly, the way a child is raised can influence their behaviors. This is especially true when children grow up in an environment where fear and anxiety are prevalent. Children can be taught over time to respond with fear and anxiety when their home lives reinforce these feelings.