Practical Brain Science - Amazon S3 · cognitive approaches for treating trauma, developmental and attachment issues. She’s also the author of a groundbreaking book, Trauma and

Practical Brain Science

Transcript of: How Neurobiology Changed the Way We View Trauma Treatment

withRuth Buczynski, PhDand Pat Ogden, PhD

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How Neurobiology Changed the Way We View Trauma Treatment 2

The National Institute for the Clinical Application of Behavioral Medicinewww.nicabm.com

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How Neurobiology Changed the Way We View Trauma Treatment

ContentsHow the Body Influences the Mind and the Brain . . . . . . . . . . . . . . . . . . . . . . 3

What We Know about the Brain Impacts How We Treat Trauma . . . . . . . . . . . . 4

“Taking a Picture” of Trauma from a Brain and Body Perspective . . . . . . . . . . . . 5

A Case Study: Patient, Therapist, and Psychoeducation . . . . . . . . . . . . . . . . . . 6

The Role of Memory in Trauma and PTSD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Brief Interventions for Responding to an Emotional Upset . . . . . . . . . . . . . . . 11

How Relationships Change the Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

How Embedded Relational Mindfulness Affects the Brain . . . . . . . . . . . . . . . . 14

The Sensorimotor Psychotherapy School of Thought . . . . . . . . . . . . . . . . . . . 15

Elements of a Good Story . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

How the Narrative Activates the Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

About the Speaker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18



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How Neurobiology Changed the Way We View Trauma Treatment

with Ruth Buczynski, PhD and Pat Ogden, PhD

Dr. Buczynski: Hello everyone and welcome back. I am Dr. Ruth Buczynski, a licensed Psychologist in the State of Connecticut and the President of the National Institute for the Clinical Application of Behavioral Medicine. I’m so glad that you’re here.

My guest will be Dr. Pat Ogden. She is a pioneer in somatic psychotherapy. She’s the co-founder of the Hakomi Institute as well as the founder and director of the Sensorimotor Psychotherapy Institute.

That is an internationally recognized school, and it specializes in training psychotherapists in somatic and cognitive approaches for treating trauma, developmental and attachment issues.

She’s also the author of a groundbreaking book, Trauma and the Body: A Sensorimotor Approach to Psychotherapy.

She is also the author of The Body as a Resource: Sensorimotor Interventions for the Treatment of Trauma.

Pat, welcome – it’s great to see you. I’m glad to have you here.

Dr. Ogden: Thank you, Ruth. It’s nice to see you, too.

Dr. Buczynski: You might be wondering: why do we have a body specialist when we’re talking about the brain?

But, as I was working with all the experts to help me decide who should be in the program this year, they were saying over and over again, “You really have to integrate the brain and the body because the one affects the other – you can’t treat the brain necessarily with left-brained treatments – with the talking treatment.

You really need to get someone that uses the body as well as thoroughly understanding the brain” – and they all said the expert on that is Pat Ogden. So that’s why we’re here!

How the Body Influences the Mind and the Brain

We’ll get started right away by saying…brain science is a really hot area, but it’s important that we keep the body included in that brain science.

Tell me, just for an opening starter, your big-picture thoughts on how the body influences the mind and the brain.

Dr. Ogden: First of all, the brain/mind/body is all part of one system. They can’t really be separated – the brain exists in the body, and the mind exists in the body.

As a clinician, we can speculate moment by moment what is going on in the brain, but we can’t really see the brain.



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We can see the effects of the workings of the brain and the mind on the body – the movement, the eye contact and the prosody; we can see how a person is sitting and how they’re relating to the therapist.

We see the effects – and that is what we can work with.

It’s also very important to remember that the brain and the body are experience-dependent, so as the brain develops through the attachment relationships, the body’s patterns are also developing.

How we move, how we engage with another, how we use our voice – all that is developing along with the functions of the brain, the connectivity between the cortical and subcortical areas.

You mentioned that we can’t really resolve trauma by working with the left brain, and that’s because the early experience registers in the right brain.

The right brain is online at birth; the attachment relationships, the “implicit relational knowing,” as Dr. Karlen Lyons-Ruth (Professor of Psychology Harvard Medical School and Director: Family Studies Lab) said – is all registered there in the right brain.

When we’re working with the body, we’re working with the effects of all the experience that we can actually see.

What We Know about the Brain Impacts How We Treat Trauma

Dr. Buczynski: Would you say that all the work that has come out on the brain recently also has an impact on how we treat trauma?

Dr. Ogden: I think it does, especially for therapists who are psychodynamically trained, who have been taught a top-down approach to therapy – that we can heal trauma by talking about it and making interpretations and working with insight.

We know that emotion is a subcortical process. We know that instinct is a subcortical process. We know that both are also a part of this implicit system – they can’t be directly addressed in language.

But they can be addressed through working with the body, the emotion, and the cortex. Integration is there between cortical and subcortical processes.

We can speculate that there will be more integration and regulation also in the brain – I think Dan Siegel calls that a vertical integration.

In working with implicit processing, we’re also working with right-brain phenomena. Even though we’re working with the body and the emotions, we’re still talking and bringing it to language – we’re also working with the left brain.

“Integration is there between cortical and subcortical processes.”

“We can see the effects of the workings of the brain and the mind on the body.”

“When we’re working with the body, we’re working with the effects of all the experience that we can actually see.”



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All that information can come up through the right hemisphere and hopefully be transferred over through the corpus callosum to the left brain.

“Taking a Picture” of Trauma from a Brain and Body Perspective

Dr. Buczynski: Let’s take a picture of the occurrence of trauma. Let’s say you experience a trauma – it might be severe or minor – can you take us through that? What is happening to the individual from a brain or a body perspective?

Dr. Ogden: When we experience trauma, it stimulates our survival responses. It activates our right amygdala, which sounds the alarm to fear – some action needs to be taken.

Of course, this organizes our actions much quicker than if it went through the cortex and we had to think about what action we were going to take.

When we have the experience of being threatened and being in danger, we respond instinctively through our bodies.

The amygdala is lit up and the brain is wired for survival. When that happens, often the thinking brain is just not active – it shuts down.

Some trauma survivors re-experience this phenomenon over and over by traumatic reminders – their subcortical instincts are triggered along with the shutting down of their frontal lobes.

Many patients say, “I can’t think clearly. When my trauma comes up, I feel crazy, and I can’t think. I’m in an emotional state. I have a lot of body sensations that I don’t understand.”

It’s very difficult for our patients to make sense of this and what is happening to them when their trauma is re-stimulated.

This is where brain science can be helpful clinically. Just a little bit of psychoeducation to a patient can help a patient feel, “Oh, I’m not crazy; this is normal; this is natural; there’s nothing wrong with me.

We just have to work with increasing the flow of information so my frontal lobes and my left hemisphere can help organize and regulate these subcortical responses.”

Dr. Buczynski: As I take it, then, when you’re working with someone you might talk to them a little bit about what goes on in their brain as a result of the trauma?

Dr. Ogden: Yes, exactly, and I keep it simple. I often show them a diagram of the triune brain and how our instinct and trauma responses live in the subcortical areas of the brain and how this is our body trying to keep us alive and trying to protect us.

“When we have the experience of being threatened and being in danger, we respond instinctively through our bodies.”

“Just a little bit of psychoeducation to a patient can help a patient feel,

‘Oh, I’m not crazy; this is normal...’”



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It’s about that old saying, “It’s better to mistake a stick for a snake than a snake for a stick.” That is how the brain works: it is better to be alert to potential trauma than not be alert to trauma because then you might really not survive.

We might talk a little bit about the right amygdala and how that is so easily triggered when the person feels endangered, but has lost the capacity to evaluate if the danger is real or is a traumatic reminder.

A Case Study: Patient, Therapist, and Psychoeducation

Dr. Buczynski: Pat, I wonder if a patient comes to mind that you could share with us. Is there a person you worked with and talked to about some of this?

Dr. Ogden: I’m thinking of a young man who had a lot of abuse, especially from his father. He’s a brilliant young man and a college student.

He came to me because he wanted a relationship with women. He wanted to be able to ask a girl out. He said he had very dramatic responses in his own body that he didn’t understand.

For example, he told me the story of a girl that he liked, and they did an activity together and they had a good time – but then she gave him a hug at the end and he literally fainted.

He said, “I didn’t know what was going on – it made me crazy! She was very nice, but I was so confused!”

We talked a little bit about the dorsal vagal response that can really stimulate that reflex of fainting and how that is a survival response.

That was very reassuring to him – it was something he could learn and then mitigate. He could learn to keep his social engagement system online when he was with this girl.

We’re really talking about Steve Porges’s polyvagal hierarchy.

With this young man, his trauma was so severe that as intimacy became a reality in terms of that hug, his arousal just plummeted – the dorsal vagal system tone increased so that he literally passed out.

Learning about this was very helpful to him.

We talked also about mindfulness and how, if he could be aware of his reactions inside, that would put a gap between his reactivity and his environment.

He started to learn how to observe what was going on inside, which keeps the frontal lobes online.

Mindfulness is like the observing part of the brain – you can watch what is going on inside.

“We talked a little bit about the dorsal vagal response that can really stimulate that reflex of fainting and how that is a survival response.”

“It is better to be alert to potential trauma than not because then you might really not survive.”

“He started to learn how to observe what was going on inside, which keeps the frontal lobes online.”



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As he began to notice his reactions, he began to learn about them rather than to have them take him over.

It’s very interesting. One of the gestures we worked with was a reach out and beckon – just a reaching and a beckoning action.

It is a very basic movement of reaching toward another and then asking them to come toward you. It is a proximity-seeking action, and in his history, proximity-seeking actions were dangerous.

Dr. Buczynski: Were you asking him to ask you to come toward him?

Dr. Ogden: Yes, and he literally could not make the movement. He would start to do it, but then it would turn into a push away – a “keep away” motion.

Dr. Buczynski: Where did you go with that? Help us be there with you. What did you do then?

Dr. Ogden: I asked him to try, and he said that he did, but he really couldn’t do it. It turned into, if you can see my hand, what looked like a fight invitation. It was a motion that said, “Get over there.”

What’s interesting is that he’s a fighter – he learned how to box in order to help himself feel safe. He said this is what he would do if he was challenging somebody to a fight – but it wasn’t an invitation.

He literally could not make the motion. It was too dangerous for him. But yet he could say he felt this emotional need in his chest – he really longed for connection with others.

As he even thought about asking me to come closer, he heard this voice inside saying, “What are you doing? What are you doing? You’re going to get hurt.”

Just that little exercise we did started to bring some of the implicit processing of the right brain and his subcortical survival responses into his awareness.

Before we talked, he wasn’t aware of what was happening inside – he just knew he had a hard time asking a girl out. He wasn’t aware of how powerfully those implicit processes were affecting him.

Dr. Buczynski: Where did you go after that? Were you thinking about a Gestalt kind of approach with an empty chair? What exactly did you do then?

Dr. Ogden: No, we didn’t do an empty chair. But if we think about integration, we can think about it on many levels: integration in the body, integration in the brain, vertical integration, and left/right integration. In a body approach, that also includes emotion of course – we want to find gestures and movements that are integrated.

Dr. Beatrice Beebe has done research on children. She found that babies of mothers with unresolved trauma don’t touch themselves as much as babies of secure parents.

“One of the gestures we worked with was a reach out and beckon.”

“We started to bring some of the implicit processing of the right brain and his subcortical survival responses into awareness.”



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As this young man was feeling a longing in his heart, but the inability to even make a proximity-seeking gesture, I just asked him to place his hands over the part of him where he felt the emotional need.

Now, all repair happens in relationship – I’m sure that in talking with Dan Siegel, he talked about interpersonal neurobiology and how our neurobiology is shaped by relationship and what he would call the “flow of energy and information.”

So, it wasn’t only the young man doing this himself – connecting with this part of him – I was also doing it.

This is a part of body therapy, and I was demonstrating it to him – touching my own heart with tenderness and with gentleness.

Now, the mirror neurons in his brain are firing because he sees me make that action. He imitates it and makes contact with that emotional need in himself. In a sense we’re both making contact with that need.

In that process, we’re hoping – we’re thinking of the brain – that there is some integration going on with his limbic system and his connection with his emotions and his ability to integrate that deep, emotional need.

If I can say just one more thing about it: what he felt as he did that, because the imagery that comes up is an indication of the severity of the trauma and the severity of dysfunction in the brain from the trauma, but as he contacted that emotional need, he said, “It’s like putting gauze down on a wound.”

He said, “It’s as if your throat has been ripped out and you’re just trying to stop the bleeding.”

That was a very, very powerful image, then, that we could integrate. It represented the part of him with emotional need, which was all implicit – his trauma was very young.

What we worked through here gives you a little flavor of how to approach a case with trauma.

Based on this intervention, we can then speculate and hope, as he connects with himself and he connects with me – and we do this together, that the amygdala won’t fire so much.

And, indeed, he reported that he was able to make more connections with women – although not yet to the one he was really attracted to – but it had an effect.

Dr. Buczynski: Conceptually, it sounds like you’re using vertical integration – the top-down/bottom-up kind of thinking – as well as horizontal integration – left/right brain thinking…. Did I get that right?

“As he connects with himself and he connects with me - and we do this together, the amygdala won’t fire so much.”

“As this young man was feeling a longing in his heart, but the inability to make a proximity-seeking gesture, I asked him to place his hands over the part of him where he felt the emotional need.”

“The mirror neurons in his brain are firing because he sees me make that action. He imitates it and makes contact with that emotional need in himself.”



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Dr. Ogden: Yes. I think that’s true.

Dr. Buczynski: Then ideally, we want both in order to have health and healing from trauma?

Dr. Ogden: In terms of the right and left brain, the fMRI studies have shown that the right, especially the posterior, of the brain lights up with trauma and PTSD patients.

When people remember non-traumatic incidents, that area of the brain doesn’t light up – it’s more that they are working out of biographical, organized memory.

This is an idea from Dr. Allan Schore – he’s on the clinical faculty of the Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, who describes the impact of early traumatic experiences on the development of the right brain, arguing for early intervention and prevention programs.

He says that when we’re dealing with trauma, one of the ways to bring the information up is through the right hemisphere where it can cross over to the left brain, so there could be some cognitive integration as well.

That’s very important. If you’re working with implicit phenomena through the body and through the emotions, it is a left-brain function to find the words and the language for them, and in my mind, this starts to integrate the left and the right.

A lot of this is still so speculative: fMRI imagery has taught us a lot about what happens and where in the brain, but it doesn’t tell us what is happening in a three-year-old brain when that little girl gets sexually abused by her stepfather. It doesn’t give us all the information.

The Role of Memory in Trauma and PTSD

Dr. Buczynski: You alluded to this just a moment ago – let’s get into the role of memory in trauma and PTSD.

Dr. Ogden: Memory in trauma has often been called a “flashbulb memory” – it is a lived memory; it is not in the past.

Trauma survivors’ memories are what Dr. Chris Brewin (an internationally recognized expert on trauma), would call situationally dependent; there’s a certain situation, like with my patient, where the thought of wanting to seek proximity implicitly reminded him of his trauma and he went into a defensive response.

It’s different if you think about a happy memory. You don’t have that same response where the subcortical brain takes over. So the memories are stored very differently.

“If you’re working with implicit phenomena through the body and through the emotions, it is a left-brain function to find the words and the langauge for them, and this starts to integrate the left and the right.”

“Memory in trauma has often been called a ‘flashbulb memory’ - it is a lived memory; it is not in the past.”



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Dr. Buczynski: Are memories stored in different parts of the brain or just stored in different ways?

Dr. Ogden: I would say in different ways. There are so many different ways to think about memory.

In my work, memory is procedural – I think more about the habits.

When we’re looking at habits rather than facts, we’re starting to look at phenomena that organize our lives, our histories, and our futures.

Even with thinking, I tend to look at the habits of thinking that a person engages in – the emotional habits and of course the physical habits.

But the way we think is also experience-dependent. You’ll have clients, for example, where they think in terms of support. Everything is translated into, “Am I getting the support I need? Is this person not supporting me?” You can hear them talk in those patterns of thinking.

Dr. Buczynski: What are your thoughts about a client like that?

Dr. Ogden: I’m looking at the way the patterns of thinking relate to the emotions and relate to the instinctual responses.

If I have a patient who says, “My husband is not supportive. He’s working all the time. I don’t get enough time with him. I need somebody who’s more supportive….”

I want to look at how that pattern is reflected in her body and also reflected in her emotions – when she feels that she’s not getting support, what pattern of emotion does she go to – anger, sadness, grief, defiance? What is the pattern of emotion?

In our model, we loosely correlate levels of information processing – cognitive, emotional and sensorimotor – with those levels of the brain.

Dr. Buczynski: Can you go through that with us just a little bit?

Dr. Ogden: Sure! Dr. Paul MacLean in the 1980s came up with this idea of the triune brain and he identified three basic areas of the brain.

There’s the reptilian brain. That is the seat of instincts and vegetative functions and arousal – it regulates our digestion and our breathing.

Then there’s the limbic system – the emotional brain, and the third basic area is the cortex, which is the thinking brain.

Loosely, that correlates with cognitive processing, emotional processing, and bodily processing.

Even MacLean said in the eighties, “These three levels of the brain – these levels of information processing – don’t always work well together.”

“When we’re looking at habits, we’re starting to look at phenomena that organize our lives, our histories, and our futures.”

“The triune brain...correlates with cognitive processing, emotional processing, and bodily processing.”



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He went on to say, “My traumatized clients will often say, ‘Well, I know I’m safe’ – this is the cortex speaking – ‘but I’m frightened all the time and my body’s shaking’ – that is the limbic and the reptilian brain being over-stimulated.” The triune brain is not in sync and it’s crazy-making.

So we look at how to help the information processing sync-up, and in terms of neuroscience, we’re finding that you can’t address those lower-level phenomena purely by thinking about them. The left hemisphere can’t tell the right amygdala to quiet down and stop…

Dr. Buczynski: In other words, to chill out.

Dr. Ogden: Yes…But we can create a shift. We can say, “Okay, let’s take some deep breaths. Let’s feel your feet on the floor.”

We can work in ways, physically and relationally, that start to quiet our response and help the body and the brain to catch up to present time.

Brief Interventions for Responding to an Emotional Upset

Dr. Buczynski: One thing I wanted to bring up – and I’ll ask you this again probably toward the end – but just a bit ago we were talking about the patient, the boxer, the young man who fainted when the girl gave him a hug. You talked about having him put his hand on his chest and you did as well.

We have a lot of people on the call who aren’t psychotherapists – they’re parents perhaps, or they’re physicians, or nurses, or in other professions. They’re not in the “fifty-minute hour” session that you and I are so used to.

While this is helpful for everyone to hear how the brain and the body work together and are involved in trauma, are there some simpler ways to respond? Are there simpler interventions that we might want to think about using?

When you think about a nurse or even a parent who is responding to somebody who’s having an emotional upset, are there brief interactions we can have that would communicate what the person, patient or child might need?

Dr. Ogden: This is a lot of what our book is about – it’s full of little interventions.

The most important thing is to be present in the relationship and to watch the effect of whatever you are doing on the person that you are with. For example, some people need a lot of empathic contact. Some children need a lot of physical contact to help them bring high levels of arousal into their window of tolerance.

Some people, especially if they have a history of early relational trauma, can get dysregulated by too much connection with another person because it stimulates needs that they’re not yet ready to integrate.

“We can work in ways, physically and relationally, that start to quiet our response and help the body and the brain to catch up to present time.”



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But staying present and tracking your response is really most important. If your child is having trouble, just holding them is important. Physical contact can be regulating and reassuring – helping the lower brain to quiet down and helping the amygdala to cease its firing.

I’m hesitant to say that physical contact is the answer for all. (There was a child I was working with) who gets more dysregulated when he is touched.

His parents didn’t understand that for the longest time, but now that they have learned how physical contact affects him, they give him space and talk with him. That helps him calm down – and then he’s ready for some contact. Everybody is different.

But it’s important to know that the brain changes in relationship with others.

Dr. Buczynski: I was thinking about a physician or a nurse, and if a patient is talking about something that’s very upsetting to them, how important it is to just recognize the upset or just in that moment say, “I can see how upsetting that must be…I can hear how that must have been hard for you...or have been painful.”

Perhaps even just a gentle touching of oneself can convey that understanding of the impact – they are aware of what is happening to their patient.

Dr. Ogden: Yes, that’s right, and Dr. Vincent Felitti (who was head of the Department of Preventive Medicine at Kaiser Permanente in San Diego) did research on this with the ACE study.

His study showed that, as a physician, if you even start to ask about trauma and just be present with the person as he/she talks for a little while, that starts to lower the person’s number of doctor visits.

That has been proven. So, we know that listening can be very powerful.

Dr. Buczynski: A lot of psychotherapy, especially in the past, has been based on the idea that you can talk through your problems.

You’re saying – and different schools of thought have tried to say this in the past – that this is not necessarily so. You can’t treat trauma with a left-brain, talking-it-out kind of approach. Would you say that’s a fair way of describing your position?

Dr. Ogden: I would say that’s a little strong. In terms of efficiency – and this is where brain science really does inform us – talk therapy can be very relational.

It can be filled with empathy, interpersonal connection, and even attachment in long-term therapy – patient and therapist can get very attached to one another.

“If you ask about trauma and just be present with the person as he/she talks for a little while, that starts to lower the person’s number of doctor visits.”

“Staying present and tracking your response is really most important. I’m hesitant to say that physical contact is the answer for all.”

“The brain changes in relationship with others.”

“Talk therapy can be very relational.”



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So, in that case, talking can really resolve trauma because it’s that interpersonal connection that shapes the brain to start with. It’s through that connection that we can capitalize on the neuroplasticity – talking therapy creates new relational experiences.

I don’t know that it’s as efficient or as direct as when you’re also adding the elements of the body and movement. These are direct interventions that work with the physiology and the emotions.

In my mind, it can be more efficient if you integrate all those elements rather than just talking.

But I wouldn’t say that talking can’t work with trauma, because it can. Talking can provide us new relational experiences that can change the brain. Talking can provide those experiences.

How Relationships Change the Brain

Dr. Buczynski: Yes, that’s one thing I probably didn’t highlight enough. You said earlier on that relationships really affect the brain.

One way to change the brain is through positive relationships, but really, relationships can change the brain in either direction – negative relationships can also change the brain.

Dr. Ogden: That’s the downside of neuroplasticity: brains are very plastic but they can also change for the worse as people who have trauma later in their lives often discover.

But even in a body-therapy approach like mine, it’s very relational. I always feel that without that relational attunement, bonding, and even attachment, that the therapy can’t take place.

Even the mindfulness that we use – we’re calling it now “embedded relational mindfulness” – is not the kind of mindfulness we usually speak

about where a person is inside studying his/her own reactions or just being with the breath.

Embedded relational mindfulness is mindfulness that is extremely relational. It is mindfulness where clients are taking us in there with them as they are mindful of what is going on internally.

Dr. Buczynski: You and I have talked about that before, but I think it’s useful to go over that again for people who might not have been on that call last fall – that was part of the mindfulness series.

“Embedded relational mindfulness is where clients are taking us in there with them as they are mindful of what is goign on internally.”

“It can be filled with empathy, interpersonal connection, and even attachment in long-term therapy when you’re adding the elements of the body and movement. These are direct interventions that work with the physiology and the emotions”

“One way to change the brain is through positive relationships, but negative relationships can also change the brain.”



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Even for those on the call, I think it would be helpful to go over that again. What do you mean by “embedded relational mindfulness?” Let’s go more into that and perhaps even use a case-study example.

Dr. Ogden: Sure. Mindfulness is described by so many teachers as bringing awareness to what is happening in the present moment without judgment and being receptive to whatever comes up or to whatever emerges.

What is different about the relational – when we use embedded relational mindfulness – is that the therapist and patient together are studying and becoming aware of and learning about the patient’s internal processes as they happen in the moment.

This also is a way to think about the brain. For example, when we’re just talking about something that happened, it is very different from asking a client, like this young man, “What happens when we

together contact this place in you that is desperate for emotional need?”

When he studies what happens, he studies what happens in his body – and remember he wanted to press on his chest. He is studying the images that come up, which he said were like being in an emergency room with blood everywhere, with his throat being ripped open.

He’s reporting his thoughts, and one of his thoughts was, “I can barely keep you alive” – and he’s speaking to that emotional part of himself.

It was a highly interpersonal experience. He was sharing these phenomena with me as they occurred in the present moment. He was seeing the image of the blood; he was feeling the pressure on his chest; he was thinking about survival.

It was emotional. It was a very emotional connection between us…and it was happening in the moment. It wasn’t something that had happened in the past – it was happening right in the instant that he was sharing it.

He took me with him into that present-moment study of a stimulus – the stimulus was hands on the chest to contact this need. That present-moment study was in my presence and with me.

How Embedded Relational Mindfulness Affects the Brain

Dr. Buczynski: Conceptually, what are your thoughts on how this embedded relational mindfulness affects the brain? What do you think was happening for him?

“When we use embedded relational mindfulness the therapist and patient together are studying and becoming aware of and learning about the patient’s internal processes as they happen in the moment.”

“He was sharing these phenomena with me as they occurred in the present moment. Seeing the image of the blood, feeling the pressure on his chest, thiking about survival.”



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Dr. Ogden: First, we know that mindfulness affects the brain. We know that mindfulness stimulates empathy in the brain and helps to keep the frontal lobes online.

So, relationally – and if we talked about that instance – I could feel the empathy developing that is enhanced by the mindfulness.

When it’s relational instead of just a mindfulness exercise that you do in solitude (focusing on the breath or watching a candle), then these meditation exercises, when you add that relational component, give us repair.

This relational repair that is added to the mindfulness helps to begin to heal the influence on the brain of the early relational trauma.

I doubt that there are studies on this – I know there are a lot of studies on mindfulness and meditators, but I don’t think there are any studies with embedded relational mindfulness.

But, in adding that piece, that’s what speaks to interpersonal neurobiology – what is happening in relationship with another person.

The Sensorimotor Psychotherapy School of Thought

Dr. Buczynski: Let’s use some of our remaining time to talk about your approach.

You are the founder of the sensorimotor psychotherapy school of thought. Can you just take us through that a little bit?

What are some of the things you’d say? What does the patient need to be thinking about? What does this offer us – particularly when we’re thinking about the brain and the repair of trauma?

Dr. Ogden: We know that we can capitalize on neuroplasticity – the potential for changing our brains – through creating new experiences.

Now, that is very different from talking about something. Creating a new experience means you talk about it very differently every time, but trauma survivors tend to talk about the same thing over and over and over and over.

One of the things that brain science has taught us is that memory is reconstructed; we work with our memory every time we think about it.

With sensorimotor psychotherapy, I think about laying down new experiences, especially when working with traumatic memory, so that the memory is encoded differently in the brain and then remembered differently.

“We can capitalize on neuroplasticity - the potential for changing out brains - through creating new experiences.”

“Mindfulness stimulates empathy in the brain and helps to keep the frontal lobes online.”

“When it’s relational instead of just a mindfulness exercise that you do in solitude, these meditation exercises give us repair.”



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This can take many, many forms. A simple example – and this was one of the first times I was experimenting with this idea – was with a woman who had had a terrible physical accident and nearly died.

But, before the accident – she was just a little girl – she was dancing to Chubby Checker and having so much fun. Then, she fell through a plate-glass window.

Every time she thought about that memory, she just saw awful images of blood. Those images of blood would get retriggered

every single time.

In our approach, we go back to remembering the positive experiences that occurred throughout that whole incident – otherwise she wouldn’t have survived.

First, we remember the dancing and the movement in her body – feeling that twisting to Chubby Checker and capturing the aliveness and the energy.

We remember that flow of energy and information, as Dan Siegel would say, through her body, her emotions, and her mind. By doing that, she’s re-embodying that moment, and that alone changes the memory.

Then she remembered her father picking her up, and the look of love in his eyes, which was very rare for her – because of work, he was often absent.

She had completely forgotten about that, but as she went back into the memory through embedded relational mindfulness, we were stretching time. Instead of just that one moment of the blood, we were remembering everything around the memory, especially those positive elements.

She began to weep as she remembered and saw in her mind’s eye that look of love in her father’s eyes because, as she said, this was something she had hardly ever experienced.

And that changed her memory! That is what started to create new neural networks in connection with that memory.

So we’re working with laying down new experiences within the relationship and within the body. Emotionally, as she saw her father’s eyes, I remember her whole body just melted. It was as if she just softened and opened – and that was a new experience.

It’s funny when people say, “Well, how has neuroscience changed the way you work?”

It hasn’t changed the way I work that much because I always worked in this way.

“In our approach, we go back to remembering the positive experiences that occured throughout that whole incident.”

“As she went back into the memory through embedded relational mindfulness, we were stretching time. We’re working with laying down new experiences within the relationship and within the body.”

“With sensorimotor psychotherapy, memory is encoded differently in the brain and then remembered differently.”



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At the root of my therapy is embedded relational mindfulness. This is how I’ve worked – although we didn’t call it that – but I work with integrating the emotions and the thoughts.

Now, though, the neuroscience really helps us to make sense of why this way of working might be important.

Dr. Buczynski: The neuroscience can give us explanations for what we knew intuitively…but had no conceptual framework for it or at best, a very loose conceptual framework. We certainly didn’t know it from a brain point of view.

Dr. Ogden: Right – exactly.

Dr. Buczynski: Our understanding of the brain gives us so much more of a framework, and it can change what we thought…Not always, but sometimes…

Even the research gives us a conceptual framework – and sometimes it gives us the evidence that can be so convincing to a client…

Dr. Ogden: That’s right.

Dr. Buczynski: …or perhaps with a parent, or perhaps, if we’re in a hospital setting, with an administrator. The evidence alone from the research can be so helpful.

Dr. Ogden: Yes. Dan Siegel has co-authored a couple of books that really speak to that defense – The Whole-Brain Child and Parenting From the Inside Out.

Dr. Buczynski: Right. He was in our series earlier….and he explained how all that comes together….

I’m afraid we’re already out of time. It has gone by so fast.

I wanted to say thank you, Pat, for giving us your time and being here to share your thoughts on the brain and the body together – how important it is that we integrate both.

I so very much appreciate all that you do; you’re a true pioneer. So many people say that of you and I always experience that when I spend time with you.

Dr. Ogden: Thank you very much, Ruth, and it was my pleasure.

“At the root of my therapy is embedded relational mindfulness. I work with integrating the emotions and the thoughts.”

“The neuroscience can give us explanations for what we knew intuitively. The research gives us a conceptual framework and the evidence that can be so convincing to a client.”



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About The Speaker:

Pat Ogden, PhD, is a pioneer in somatic psychology having trained in a wide variety of somatic and psychotherapeutic approaches. She has over34 years experience working with individuals and groups in diverse populations. She is first author of the groundbreaking book, Trauma and the Body: A Sensorimotor Approach to Psychotherapy. Dr. Ogden is both founder and director of the Sensorimotor Psy-chotherapy Institute. She is a clinician, consultant, international lecturer and trainer, co-founder of the Hakomi Institute, and on faculty at Naropa University.

Find out more about this and related programs at: www.nicabm.com

Featured Books by Speaker: Pat Ogden, PhD

Trauma and the Body: A Sensorimotor Approach to

Psychotherapy

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Practical Brain Science - Amazon S3 · cognitive approaches for treating trauma, developmental and attachment issues. She’s also the author of a groundbreaking book, Trauma and

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