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Psychotherapy Is ‘The’ Biological Treatment

Author: Robert A. Berezin, MD

Private practice, Lexington, Massachusetts

March 16, 2018

Medscape Psychiatry

Neuroscience surprisingly teaches us that not only is psychotherapy purely biological, but it is the only real biological treatment. It addresses the brain in the way it actually develops, matures, and operates. It follows the principles of evolutionary adaptation. It is consonant with genetics. And it specifically heals the problematic adaptations of the brain in precisely the ways that they evolved in the first place. Psychotherapy deactivates maladaptive brain mappings and fosters new and constructive pathways. Let me explain.

The operations of the brain are purely biological. The brain maps our experiences and memories through the linking of trillions of neuronal connections. These interconnected webs create larger circuits that map all throughout the architecture of the cortex. This generates high-level symbolic neuronal maps that take form as images in our consciousness. The play of consciousness is the highest level of symbolic form. It is a living theater of “image-nation,” a representational world that consists of a cast of characters who relate together by feeling as well as scenarios, plots, set designs, and landscape.

As we adapt to our environment, the brain maps our emotional experience through cortical memory. This starts very early in life. If a baby is startled by a loud noise, his arms and legs will flail. His heart pumps adrenaline, and he cries. This “startle” maps a fight-or-flight response in his cortex, which is mapped through serotonin and cortisol. The baby is restored by his mother’s holding. Her responsive repair once again re-establishes and maintains his well-being, which is mapped through oxytocin. These ongoing formative experiences of life are mapped into memory in precisely these two basic ways.

These two basic modes underlie the mapping of the entire play into memory. A play written through positive attachment and emotions will promote authenticity and love. One written from trauma can generate a darker narrative and psychiatric symptoms. A problematic play affects the very sense of self of the child, his self-worth, and value. It also warps the quality of relatedness with other people to one of distrust, emotional removal, and anger.

It is our individual genetic temperament that determines the form of psychiatric symptoms, whether depression, anxiety, phobias, hyperactivity, obsessions, compulsions, or psychosis. Deprivation and abuse in one individual may generate depression, while a similar trauma in another may generate a phobic state. One’s temperament is the genetic component in the formation of psychiatric conditions.

Repairing the Brain

The process of psychotherapy specifically and biologically repairs the damage done to the play of consciousness. To introduce how we map our experience and how to affect brain change, I’ll use a simple example of neuromuscular learning. This example is about learning to play the guitar. Neuromuscular learning is similar to other musical instruments, sports, dance, or any learned physical activity.

What happens in the brain as you learn to play the guitar chord B7? It requires total attention to separate your fingers in a precise way in order to hold down the strings within certain frets. When you first attempt it, you can’t do it. You have to slowly place each finger on the right fret. The muscles don’t feel like they could get there, hold the position, or get sound out of the strings. And it hurts. It initially requires seconds to finalize the correct hand position. Each finger needs to be placed individually.

As you continue to practice playing B7, it gets a little easier. After a night’s sleep, you try it again, and it is still very clumsy. You still need full conscious attention to get your fingers correctly onto the frets. The sound begins to come out better. But getting it is still very slow. The chord is not, as yet, usable. After 3 days of working at it, you can finally play the chord. Your fingers don’t hurt anymore, and there is better coordination for the hand position. Your hand now operates as a whole unit, without much conscious effort. You no longer have to think about it. You have now mastered the chord. You have established a neuromuscular B7 map in your cortex.

Let’s say you learned the chord using a scrunched-up hand position, and now you want to correct it. In order to do so, you first have to force yourself to stop using the old hand position. Once again, you have to give full conscious attention to holding your fingers and hand differently. This takes you back to muscular pain, clumsiness, slowness, inability, and frustration, just as it did the first time but not quite as bad. This is required for you to establish a new and different neuromuscular B7 map in your cortex. Once this is established, it operates by using the new map, which will allow you play automatically. The process of brain change involves deactivation—disuse, not using the old brain map; and then creating a new neuromuscular experience to create a newly mapped B7 chord, which is activated.

This describes simple neuromuscular learning and change. In the emotional sphere of the play of consciousness, change and growth are far more complicated. Because the play is written through the amygdala and the limbic system, change has to proceed through feeling. The process of change is called mourning.

In psychotherapy, the patient mourns the pains of his life in the context of emotional trust with the therapist. The patient mourns the abuse and deprivation of his life and faces the pain anew in order to deactivate negatively linked brain mappings. Elisabeth Kübler-Ross’s five stages of grief accurately describe the processes involved in relinquishing the old play to accept and inhabit a new one. One must go through the following stages: challenge and denial—to be willing to open and feel the pain again. Then one feels the anger at the real source of the abuse, and one feels the sadness at losing old problematic sources of security or feels the pain deprivation itself, and finally acceptance of no longer inhabiting one’s old familiar identity. The trauma has to be mourned in order to move on to something new and better. Trauma is the hardest of all attachments to mourn.

The old play that generates symptoms and suffering was written from trauma, neuronal mappings involving serotonin and cortisol activity and influence in the limbic system, which is involved in the emotional experience. Traumatic attachments need to be mourned for them to lose their power and then to be relegated to deactivated memory. In the context of the safe harbor of the therapist, one slowly digests, deactivates, and lays to rest the mappings of the old play; the symptoms and suffering generated by the old play disappear. During the therapy, the patient writes and inhabits a new play of trust and positive emotions and attachment. Here oxytocin is the mediator, rather than serotonin. The process of mourning in psychotherapy specifically repairs the brain in the very way that the original play was constructed.

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3 Common Holiday Stressors—and How to Cope

Holidays are a time for coming together with loved ones to celebrate seasonal festivities. And yet, the holidays can be one of the most stressful times of year for many people. Pressure to spend money, time, and energy on things that society deems important can leave you feeling overwhelmed, exhausted, and fearful of what may happen if you don’t keep up with the Joneses. This is a great article by  Tris Thorp that I would love to share…

Most Wonderful Time of the Year?

“It’s the most wonderful time of the year,” sang Andy Williams originally in 1963. As children, it’s likely that the holidays were a time of excitement, anticipation, wonder, and cookies! Things were so much simpler when you didn’t have to work long hours and worry about being spread thin from the cost of gifts, décor, and travel. You were free from planning the guest list and the menus, and you didn’t have to fret about challenging family dynamics.

Stressors Increase During the Holidays

As adults—both young and seasoned—you’re now aware of all that goes into holiday expectations and the guilt associated with not following through with what society has deemed appropriate. As if life hasn’t become busy enough, you’re now faced with how we’re going to manage everything from our finances to finding extra time to plan, shop and entertain, and the ensuing exhaustion. For some, the holidays may bring up emotions of sadness or loneliness from the loss of a loved one or not having that special someone to share them with. Regardless of your individual stressors, there is a percentage of people who would rather pull the covers over their head for two months and sleep through all of the end-of-year celebrations.

According to a 2015 survey conducted by Healthline, a consumer health information site, 62 percent of respondents described their stress level as “very or somewhat” elevated during the holidays, while only 10 percent reported no stress during the season. Three of the biggest holiday stressors are finances, time, and energy. Let’s explore how the effects of stress in these three areas can show up.

Stressor: Money and Finances

It should come as no surprise that money tops the list of holiday stressors. According to a 2012 Holiday Stress Report from the American Psychological Association, stress has a major impact on lower-middle-class citizens who feel “the weight of stress from work plus the seasonal rush to find time to get everything done. In addition, their worries about money are heightened by the commercialism of the season and the pressure to spend a lot of money.” Commercialism plays a huge role in holiday stress with in-your-face pressure to spend, spend, spend!

Stressor: Time

The holidays can increase your stress when it comes to your time and how it’s spent. Some people get generous holiday leave from their careers while others find themselves working up to the last minute and having to return again the day after.

Another big consideration is managing the expectations of others when it comes to how you choose to spend your time. Or the expectations may be self-imposed: “I should go see my family but I’d rather sit on my couch and watch all seven seasons of Game of Thrones than travel 2,500 miles.” Or, “I’m supposed to go to the company holiday party but I have no time to shop for a new dress and shoes.”

Stressor: Energy—Mental, Emotional, Physical

Another major player in holiday stress is the mental, emotional, and physical toll it takes on you. The misconception is that you can become drained of your energy. It’s impossible to be depleted of energy. Energy is something you have an endless supply of because it’s what you are made up of, at least from a quantum-physics perspective.

However, you can be mentally scattered and defocused. You can feel emotionally overwhelmed and experience physical exhaustion. Where you are putting your attention is where your energy will flow. If you’re not monitoring where you’re directing your energy, it is possible for you to feel the effects of being pushed and pulled in several directions, giving you the impression that you’re drained of energy.

How to Cope: Find Your Place of Harmony

The biggest favor you can do for yourself and everyone around you is to find your place of harmony in the midst of all that is spiraling around you. Stress can be described as how you respond to life’s obstacles and challenges. Much of the stress you encounter during the holidays (or any other time of year) can be managed effectively by bringing your awareness to your:

  1. Perception and interpretation of what’s happening
  2. Highest possible intention or outcome
  3. Decision about how you are going to proceed

How to Cope: How Are You Perceiving and Interpreting What’s Happening?

Everything you experience is run through your internal filtering system which is where you evaluate or analyze what happened and you try to make sense of it. Your rational mind is always trying to understand, distinguish, and categorize what you experience as good or bad, right or wrong, scary or safe.

With increased awareness, you can consciously begin to shift the way you are choosing to perceive and interpret your experiences. This puts you in a position to see what’s happening through a different lens and let go of your mental and emotional conviction of what you believe is the reality of the situation. For example, “I’m not in a financial position to afford gifts for my family and friends” could be your reality. Looking at from another perspective, however, you may not have extra money this year for gifts but you can still give people the gift of your attention, love, appreciation, and affection.

How to Cope: What Is Your Highest Intention in This Situation?

As you find yourself getting caught up in the melodrama of emotions, the frenzy of “will I get everything done in time?” and the stress of feeling spun out, stop and ask yourself “What is my ultimate highest intention in this situation?” What is it that you want and need to do with your time? Is your intention to have a calm, relaxing, and enjoyable evening with friends? Do you want to move through the situation with effortless ease and grace, while deciding how you will choose to spend your time?

How to Cope: How Do You Want to Proceed?

What do you really want? How would you love things to turn out? Now it’s time to decide what action you need to take. This can be difficult for some people because it may involve enforcing boundaries with others.

At the end of the day, keep your awareness on your perspective. Stress will always be a part of life, and at the same time, there is always something to be grateful for—whether it be the tray of fudge your mom left in the fridge or the quality time off with close friends and loved ones. If you can find and focus on something you appreciate the holiday season, you’ll be well on your way to managing the stress of the holidays.

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October is domestic violence awareness month!

This subject is very near to my heart and the reason why I started Kaleidolife in the first place. We all experience our own adversities, issues, and drama in our lifetime, but when someone you love hurts you, it breaks you down so much and leaves lasting scars.

My own experiences of abuse have given me a deep understanding and so much empathy when someone has to deal with this trauma. My broken heart led me to study domestic violence and trauma counseling. I felt that I needed to spread the word that there is hope for healing and getting out of your situation.

My biggest concern is for the children who get dragged into their parent’s abuse. As adults, we make our own choices and can deal with the consequences ourselves. But, children cannot stand up for themselves and simply get out when things get bad. They are helpless and learn these negative behaviors from their parents. They carry it well into their adulthood and so the vicious circle of abuse continues.

It is difficult. I am not going to sugar coat it. Some get help and manage to break free and start a new life for themselves and some just never do.  I do not have a magic wand that I can wave around and make all your troubles disappear. But feeling overwhelmed and alone will not help you walk back to a normal, calm peaceful life.

When dealing with an abusive partner/parent, it is imperative to realize that they do NOT have the same perspective or views of the situation than you do. They do NOT think that they are wrong or hurting you. They do NOT see themselves as the perpetrator or abuser. They do NOT understand that their behavior is destructive or abusive. And you will NOT be able to let them see otherwise. EVER! They need professional help or the cycle will continue until death.

Instead, they see themselves as strong and that they are taking charge of a situation that, in their mind, is out of control and needs to be saved by them. They feel that you “belong” to them and them alone and that this is how they show you how much they love and care for you. They feel that it is their duty as your partner/parent to teach you, keep you under control and manage your life for your own good.

They are normally very self-centered, arrogant, controlling and bombastic on the outside, but really insecure and scared on the inside. 90% of the time they have experienced abuse themselves at some point in their lives. You will never be able to change them. It does not matter how sweet and charming they are when they are trying to apologize for their behavior to win you back. The abuse will continue until you both get professional help and allow each other space away from each other to breathe and think.

As a domestic violence counselor, I am able to assist you in planning your safety plan, getting the appropriate resources for your specific area and situation.  I assist my clients in working alongside them in their plan and helping them achieve their goal to live a healthy, abuse-free life.

Building up confidence and your ability to choose what happens to you. Your self-worth and self-love are very important to prevent you from returning to the abuser, thinking that they love and care for you.

Once you have successfully removed yourself and your children from the abusive situation, I work with you through ongoing support and maintenance to ensure that you have the courage and confidence you need to start a fresh, beautiful Kaleidolife.

If you feel that you are ready to take on this transformational journey with me, contact me and set up your first appointment. If you are reading this, you know that you are not happy in your current situation. Take that very important first step today and trust your instincts. You are worth it!

If you or anybody you know is in immediate danger, please call the National Domestic Violence Hotline at 1−800−799−7233 or TTY 1−800−787−3224. Or dial 211 now.

Domestic violence counseling is done via Zoom online secure platform or at a mutual safe space. I see domestic violence clients on a sliding scale module. Please contact me at (619)-618-9439 or to set up your appointment.

Domestic violence counceling

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Massage therapy for stress relief

The American Massage Therapy Association (AMTA) notes that massage therapy can be effective for stress relief. Stress is a prevalent component in today’s fast-paced world which can negatively impact on an individual’s health and well-being. Massage therapy has been shown to be a means by which stress can be reduced significantly on physical and psychological levels. While massage therapists know from experience that massage reduces stress, there is considerable research that validates our experience.

In a study on the effect of trigger point therapy, there was a significant decrease in heart rate, systolic blood pressure, and diastolic blood pressure. Measures of oxygen consumption, blood pressure, and salivary cortisol levels were all lower after a 10 to 15-minute massage in controlled studies.

Changes in psychological states have been measured by physiological responses, the Perceived Stress Scale, the POMS Depression Scale, and the Anxiety State Scale. In these studies, all subjects in the massage group showed significant changes in emotional states and stress levels.

Stress is a response to pressure or threat. Under stress, we may feel tense, nervous, or on edge. The stress response is physical, too. Stress triggers a surge of a hormone called adrenaline that temporarily affects the nervous system.

Stress suppresses the immune system, which makes it easier for you to get sick and harder to fight off bugs. When people are stressed, they get sick. It could be a cold or cold sores, which pop up because the immune system can’t suppress the virus. These are just symptoms, but the underlying cause is stress.

It is imperative to your health to take action steps to combat the effects of stress. Like with most of our problems, stress will not just go away by itself. Long after we have sorted out a stressful situation, our bodies still feel the effects of stress. You need to be proactive in managing your stress levels and book regular stress management sessions with your therapist.

I utilize a variety of different modalities that have been proven to combat stress and its effects on our minds and bodies. Take that first step to wellness today and contact me to book your stress management consultation.

I look forward to assisting you in living a Kaleidolife!