By Matthew Carter, MFT

1. Seeing The Whole Elephant:Integrating Biologically Informed/Body Oriented Interventions into Standard Practices By Matthew Carter, MFT

3. Thoughts Feelings Behavior Environment Attachment Genes

4. The Body as “Container” • All human experience has a biological correlate. • Experiences (activation) repeated over time will become biological patterns. (states-> traits) • These patterns will organize around survival, our body’s prime directive, • and ultimately drive thoughts, feelings, and behavior.

5. Community • Family

6. Therefore, changing maladaptive thinking, feeling, or behavioral patterns requires changing the underlying biological patterns, which means changing experiences over time.

7. How Stress Alters Biology

8. Arousal Definition: The body’s level of reactivity to stimuli. Calm EX

9. Visual Thalamus Visual Cortex Amygdala Scientific American The Hidden Mind, 2002, Volume 12, Number 1 (Neuro)

10. Vigilance Calm

11. Fight or Flight Threat Vigilance Calm

12. Defensive Response . Threat Oppositional Vigilance Calm

13. Overwhelm . Threat Oppositional Vigilance Calm

14. . Overwhelm . Avoidant Threat Oppositional Vigilance Calm

15. . . Overwhelm . Aggressive Avoidant Threat Oppositional Vigilance Calm Patterns

17. Maladaptive Patterns

20. Trauma and Neglect B

21. “The traumatized brain has a distinctly different physiology from a non-traumatized brain.” - Peter Levine

22. . . Overwhelm . Aggressive Avoidant Threat Oppositional Vigilance Calm

23. Dissociation . . . Overwhelm . Aggressive Avoidant Threat Oppositional Vigilance Calm Dissociation

24. Calm . Compliance Parasympathetic Arousal

25. Calm . . Compliance Dissociation

26. Calm . . . Compliance Dissociation Dissociation fragments experience Fainting PTSD

27. Post Traumatic Stress Disorder • Trauma is encoded as an abnormal form of memory, as images and sensations… • …in subcortical areas of the brain. • Thus treating PTSD requires activating and reprocessing these memories… • …which means more direct work with the trauma narrative.

29. Other Long Term Effects of Trauma and Neglect

30. Kindling effect/ Priming Visual Thalamus Visual Cortex Amygdala Scientific American The Hidden Mind, 2002, Volume 12, Number 1

32. Normal Stress Response Overwhelm Threat Vigilance Calm

33. Lowered Tolerance Overwhelm Threat Vigilance Calm

34. Hypervigalence Overwhelm Threat Vigilance . Calm

35. Changing Biological Patterns • Promoting mindfulness • Practicing coping skills • Building capacity (raising threshold for overwhelm) • Lowering baseline arousal • Changing behavioral reinforcers

36. Promoting Mindfulness Overwhelm . Threat Vigilance . Calm

37. Orienting To the Body • Psychoeducation(e.g. stress response) • Developing a vocabulary of sensation (How do you know your are feeling what you are feeling?) • Process vs content vs activation • Working with moment-to-moment activation. EX

38. Markers of physiological changes • Wetness in the eyes • Shaking foot/leg • Swallowing • Gasps/sighs • Jaw clenching • Eyebrows

39. Shifting Biological Patterns

40. Practicing Coping Skills Overwhelm . Threat Vigilance . Calm

41. Coping Skills • Conscious breathing (focusing on outbreath) • Observation (mindfulness) • Distraction (thinking about something else, counting) • Sublimation (walking away, stretching, squeezing something) EX/B

42. Building Capacity Overwhelm Threat Vigilance . Calm

43. Overwhelm Threat Vigilance . Calm

44. Overwhelm Threat

45. Overwhelm Threat . Bio

46. Lowering Baseline Arousal Overwhelm Threat Vigilance . . Calm

47. Overwhelm Threat Vigilance . Calm

48. Changing Behavioral Reinforcers

49. Community • Family

50. Introducing New Patterns