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The Neurobiology
of Regulation and Resiliency




Presented by:
Sophia Deborah Erez, MS, LPC, MFT

Shared Hope International
November 30, 2011



 Slide by Sophia Deborah Erez © 2008   520.302.5859
The Triune Brain

                                      •   Neo cortex
                                          Thinking - Cognition, language,
                                          thought, speech

                                      •   Limbic Area
                                          Emotional - Expression and
                                          mediation of emotions and feelings,
                                          including emotions linked to
                                          attachment

                                      •   Reptilian Brain
                                          Survival/Instinctual - Digestion,
                                          reproduction, circulation, breathing,
                                          and the execution of the "fight or
                                          flight"



Slide by Sophia Deborah Erez © 2008                                 520.302.5859
The “unthinking” response




Slide by Sophia Deborah Erez © 2008   520.302.5859
Stages of the Arousal Cycle

Stage 1: Prepare for Defensive Action
                Muscles tense, orient to source of threat

Stage 2: Mobilization
                Production of Adrenalin and Cortisol in order to provide energy
                 needed to defend

Stage 3: Release of Energy through Fight or Flight
                Running, Defensive Responses, Vocalizations

Stage 4: Return to Central Nervous System Equilibrium
                Parasympathetic responses-Homeostasis



 Slide by Sophia Deborah Erez © 2008                                      520.302.5859
Autonomic Nervous System

           Sympathetic                 Parasympathetic
      Prepares for ACTION               Prepares for REST

 The SNS controls organs during       The PSNS controls the body
        times of stress                      during rest

            Breathing rate                  Breathing rate
               Heart rate                      Heart rate
             Pupils Dilate                 Pupils Constrict
            Blood Pressure                  Blood Pressure
               Sweating                        Sweating
           Stress Hormones                 Stress Hormones

                Digestion                     Digestion
                 Saliva                        Saliva


Slide by Sophia Deborah Erez © 2008                       520.302.5859
Autonomic Nervous System

Sympathetic - prepares for action


                                      Release
   charge
                                                                         charge



                       Parasympathetic - prepares for rest




                                                     THE NERVOUS SYSTEM Miller-Karas.
                                                      *adapted from a slide by Elaine AND TRAUMA
                                                                       Trauma Resiliency Model
Slide by Sophia Deborah Erez © 2008                                       520.302.5859
Nervous System Dysregulation
                        Hyperactivity
                        Hypervigilance       Stuck on “High”




                                                                               Normal Range
                        Elation/Mania
                                             Hyper arousal




                                                                                Window of
                        Anxiety/Panic




                                                                                Tolerance
STRESS                  Rage




                                         Depression
           Stuck on “Low”                Disconnection
                                         Deadness
           Hypo arousal                  Exhaustion
                                         Numbness
                                                   *adapted from a slide by Elaine Miller-Karas.

Slide by Sophia Deborah Erez © 2008                                         520.302.5859
Functional Priorities


                                        We do not have
                                      access to our higher
                                       cortical functions if
                                       our more primitive
                                         needs are not
                                             secure.



Slide by Sophia Deborah Erez © 2008                  520.302.5859
Trauma and Affect Regulation




Slide by Sophia Deborah Erez © 2008          520.302.5859
Nervous System Dysregulation
                        Hyperactivity
                        Hypervigilance       Stuck on “High”




                                                                               Normal Range
                        Elation/Mania
                                             Hyper arousal




                                                                                Window of
                        Anxiety/Panic




                                                                                Tolerance
STRESS                  Rage




                                         Depression
           Stuck on “Low”                Disconnection
                                         Deadness
           Hypo arousal                  Exhaustion
                                         Numbness
                                                   *adapted from a slide by Elaine Miller-Karas.

Slide by Sophia Deborah Erez © 2008                                         520.302.5859
Window of Tolerance

                                           Hyper arousal - too much arousal to integrate
      A
      R
      O
      U                                                                                 Perceived Safety
      S
      A
      L
                                        Hypo arousal - not enough arousal to integrate

Adapted from Empowering the body in the treatment of trauma: The role of Sensorimotor Processing in trauma, by P. Ogden, 2006. Paper
   presented at the conference: The Embodied M ind: Integration of the Body, Brain, and M ind in Clinical Practice, Los Angeles, CA.
        Slide by Sophia Deborah Erez © 2008                                                                 520.302.5859
Therapeutic Goals
Help client develop the ability to stay within
   their “Window of Tolerance”.
           Self regulation


Help client expand their “Window of Tolerance”.
           Positive and negative affect tolerance
           Build a bigger container




Slide by Sophia Deborah Erez © 2008                 520.302.5859
Learning to shift to a resourced state
 helps clients experience a sense of
control over their body and traumatic
              memories.



Slide by Sophia Deborah Erez © 2008   520.302.5859
Resilient Affect Regulation
                                        “Resilient affect
                                         regulation can
                                       tolerate disruption
                                          and return to
                                         equilibrium in a
                                      timely and efficient
                                            manner”
                                            Sophia Deborah Erez




Slide by Sophia Deborah Erez © 2008                               520.302.5859
Trauma and memory




Slide by Sophia Deborah Erez © 2008         520.302.5859
Slide by Sophia Deborah Erez © 2008   520.302.5859
Slide by Sophia Deborah Erez © 2008   520.302.5859
Slide by Sophia Deborah Erez © 2008   520.302.5859
Aspects of Memory

•Sensations
•Images
•Meaning
•Affect
•Belief



Slide by Sophia Deborah Erez © 2008   520.302.5859
Nihil est in intellectu quod non fuit
                      prius in sensu:

           Nothing is in the understanding,
           which was not first perceived by
                 some of the senses.

                                      John Locke

Slide by Sophia Deborah Erez © 2008                520.302.5859
A Fear Network




Dissociation following traumatic stress: Etiology and treatment.
By Schauer, Maggie; Elbert, Thomas
Zeitschrift für Psychologie/Journal of Psychology, Vol 218(2), 2010, 109-127.

  Slide by Sophia Deborah Erez © 2008                                           520.302.5859
Triggers and Flashbacks
•Over coupling of different aspects of memory.

•When triggered, a person’s ANS responds “as if something is
happening right now.”

•Can be defused through trauma therapy.

•Bridges to the past. Can be reframed as an opportunity for
healing.

•The ability to recognize a trigger and respond differently than in
the past can be installed as a resource.


 Slide by Sophia Deborah Erez © 2008                        520.302.5859
Dissociation
                                      •Is an under coupling of
                                      different aspects of
                                      memory.
                                      •Disruption in sense of
                                      self in time and place or
                                      between ego states.
                                      •Is on a continuum.
                                      •Can be reframed as a
                                      tool that may no longer be
                                      useful.

Slide by Sophia Deborah Erez © 2008                     520.302.5859
Change is Possible!
  “What we are now learning about the brain is
that it is plastic throughout the lifespan. We do
 have the ability to nurture alternative neuronal
  pathways that will allow us to “pause” before
 reacting and access higher cognitive functions
   than our preprogrammed fear response’s.
   This gives us access to alternate, hopefully
            more appropriate reactions.”

                                 Sophia Deborah Erez


Slide by Sophia Deborah Erez © 2008                    520.302.5859
Slide by Sophia Deborah Erez © 2008   520.302.5859
Slide by Sophia Deborah Erez © 2008   520.302.5859
Resilient Memory

    “Resilient memory is the
ability to recall an event in the
   context of time and place
  while remaining wholly and
fully grounded in the present.”
                                  Sophia Deborah Erez


Slide by Sophia Deborah Erez © 2008                     520.302.5859
Trauma and Perspective




Slide by Sophia Deborah Erez © 2008           520.302.5859
Slide by Sophia Deborah Erez © 2008   520.302.5859
Slide by Sophia Deborah Erez © 2008   520.302.5859
Slide by Sophia Deborah Erez © 2008   520.302.5859
Resilient Perspective
                                      “Resilient perspective
                                      is similar to empathy.
                                      It is the ability to take
                                      responsibility for your
                                         experience while
                                       acknowledging that
                                        other equally valid
                                        points of view may
                                               exist.”
                                             Sophia Deborah Erez




Slide by Sophia Deborah Erez © 2008                                520.302.5859
Circle of Compassion

    A human being is a part of a whole, called by us
     'universe', a part limited in time and space. He
   experiences himself, his thoughts and feelings as
 something separated from the rest... a kind of optical
delusion of his consciousness. This delusion is a kind
 of prison for us, restricting us to our personal desires
 and to affection for a few persons nearest to us. Our
   task must be to free ourselves from this prison by
widening our circle of compassion to embrace all living
    creatures and the whole of nature in its beauty.
                                      Albert Einstein

Slide by Sophia Deborah Erez © 2008                     520.302.5859
Slide by Sophia Deborah Erez © 2008   520.302.5859

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Sde.regulationandresiliency

  • 1. The Neurobiology of Regulation and Resiliency Presented by: Sophia Deborah Erez, MS, LPC, MFT Shared Hope International November 30, 2011 Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 2. The Triune Brain • Neo cortex Thinking - Cognition, language, thought, speech • Limbic Area Emotional - Expression and mediation of emotions and feelings, including emotions linked to attachment • Reptilian Brain Survival/Instinctual - Digestion, reproduction, circulation, breathing, and the execution of the "fight or flight" Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 3. The “unthinking” response Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 4. Stages of the Arousal Cycle Stage 1: Prepare for Defensive Action  Muscles tense, orient to source of threat Stage 2: Mobilization  Production of Adrenalin and Cortisol in order to provide energy needed to defend Stage 3: Release of Energy through Fight or Flight  Running, Defensive Responses, Vocalizations Stage 4: Return to Central Nervous System Equilibrium  Parasympathetic responses-Homeostasis Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 5. Autonomic Nervous System Sympathetic Parasympathetic Prepares for ACTION Prepares for REST The SNS controls organs during The PSNS controls the body times of stress during rest Breathing rate Breathing rate Heart rate Heart rate Pupils Dilate Pupils Constrict Blood Pressure Blood Pressure Sweating Sweating Stress Hormones Stress Hormones Digestion Digestion Saliva Saliva Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 6. Autonomic Nervous System Sympathetic - prepares for action Release charge charge Parasympathetic - prepares for rest THE NERVOUS SYSTEM Miller-Karas. *adapted from a slide by Elaine AND TRAUMA Trauma Resiliency Model Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 7. Nervous System Dysregulation Hyperactivity Hypervigilance Stuck on “High” Normal Range Elation/Mania Hyper arousal Window of Anxiety/Panic Tolerance STRESS Rage Depression Stuck on “Low” Disconnection Deadness Hypo arousal Exhaustion Numbness *adapted from a slide by Elaine Miller-Karas. Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 8. Functional Priorities We do not have access to our higher cortical functions if our more primitive needs are not secure. Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 9. Trauma and Affect Regulation Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 10. Nervous System Dysregulation Hyperactivity Hypervigilance Stuck on “High” Normal Range Elation/Mania Hyper arousal Window of Anxiety/Panic Tolerance STRESS Rage Depression Stuck on “Low” Disconnection Deadness Hypo arousal Exhaustion Numbness *adapted from a slide by Elaine Miller-Karas. Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 11. Window of Tolerance Hyper arousal - too much arousal to integrate A R O U Perceived Safety S A L Hypo arousal - not enough arousal to integrate Adapted from Empowering the body in the treatment of trauma: The role of Sensorimotor Processing in trauma, by P. Ogden, 2006. Paper presented at the conference: The Embodied M ind: Integration of the Body, Brain, and M ind in Clinical Practice, Los Angeles, CA. Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 12. Therapeutic Goals Help client develop the ability to stay within their “Window of Tolerance”. Self regulation Help client expand their “Window of Tolerance”. Positive and negative affect tolerance Build a bigger container Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 13. Learning to shift to a resourced state helps clients experience a sense of control over their body and traumatic memories. Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 14. Resilient Affect Regulation “Resilient affect regulation can tolerate disruption and return to equilibrium in a timely and efficient manner” Sophia Deborah Erez Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 15. Trauma and memory Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 16. Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 17. Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 18. Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 20. Nihil est in intellectu quod non fuit prius in sensu: Nothing is in the understanding, which was not first perceived by some of the senses. John Locke Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 21. A Fear Network Dissociation following traumatic stress: Etiology and treatment. By Schauer, Maggie; Elbert, Thomas Zeitschrift für Psychologie/Journal of Psychology, Vol 218(2), 2010, 109-127. Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 22. Triggers and Flashbacks •Over coupling of different aspects of memory. •When triggered, a person’s ANS responds “as if something is happening right now.” •Can be defused through trauma therapy. •Bridges to the past. Can be reframed as an opportunity for healing. •The ability to recognize a trigger and respond differently than in the past can be installed as a resource. Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 23. Dissociation •Is an under coupling of different aspects of memory. •Disruption in sense of self in time and place or between ego states. •Is on a continuum. •Can be reframed as a tool that may no longer be useful. Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 24. Change is Possible! “What we are now learning about the brain is that it is plastic throughout the lifespan. We do have the ability to nurture alternative neuronal pathways that will allow us to “pause” before reacting and access higher cognitive functions than our preprogrammed fear response’s. This gives us access to alternate, hopefully more appropriate reactions.” Sophia Deborah Erez Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 25. Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 26. Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 27. Resilient Memory “Resilient memory is the ability to recall an event in the context of time and place while remaining wholly and fully grounded in the present.” Sophia Deborah Erez Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 28. Trauma and Perspective Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 29. Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 30. Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 31. Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 32. Resilient Perspective “Resilient perspective is similar to empathy. It is the ability to take responsibility for your experience while acknowledging that other equally valid points of view may exist.” Sophia Deborah Erez Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 33. Circle of Compassion A human being is a part of a whole, called by us 'universe', a part limited in time and space. He experiences himself, his thoughts and feelings as something separated from the rest... a kind of optical delusion of his consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free ourselves from this prison by widening our circle of compassion to embrace all living creatures and the whole of nature in its beauty. Albert Einstein Slide by Sophia Deborah Erez © 2008 520.302.5859
  • 34. Slide by Sophia Deborah Erez © 2008 520.302.5859