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The Neurobiology of Touch and Trauma Somatic Experiencing from Dysregulation to Coherence Mike Changaris, Psy. D. This work is copy written under the creative commons attribution license you may use this work as a whole or adapt it as long as you site this author as the source.
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The impact of touch on emotion regulation development and in psychotherapy.

Aug 23, 2014

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Mike Changaris

Touch plays a powerful role in human development and emotional regulation. Despite this fact it is not used effectively in therapy. This talk explores current research into the biological and psychological effects of touch and how to use touch to increase emotional regulation skills.
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Page 1: The impact of touch on emotion regulation development and in psychotherapy.

 The Neurobiology of

Touch and Trauma

Somatic Experiencing from Dysregulation to Coherence

Mike Changaris, Psy. D.

This work is copy written under the creative commons attribution license you may use this work as a whole or adapt it as long as you site this author as the source.

Page 2: The impact of touch on emotion regulation development and in psychotherapy.

A Mother’s Touch… ‘Kangaroo care’

‘Kangaroo care’ An infant is held skin-to-skin to their mother or father, generating heat for the newborn much like a baby kangaroo receives in its mother’s pouch.

http://today.msnbc.msn.com/id/38988444/ns/today-parenting

“We’d resigned ourselves to the fact we were going to lose him; we were just trying to make the most of those last precious moments.”

“We thought, ‘What a blessing, we get to see his eyes before he passes away,’ ” Kate said. “But they stayed open!”

Page 3: The impact of touch on emotion regulation development and in psychotherapy.

Embodied Arrival

Invitation to orient... To room, To others, To skin contact with chair

Top Down and Bottom UpThe Brain Story: Insula, Anterior

Cyngulet, and the Orbital Frontal CortexMindful Self Massage

Page 4: The impact of touch on emotion regulation development and in psychotherapy.

OverviewBegin to understand the role of touch in the

communication of emotion and in affect regulation.Understand key brain regions involved in trauma,

touch, pain and emotion regulation. Review some of the recent literature on the

psychophysiological impacts of touch treatments.Recognize affect dysregulation and key neural

structures involved. Begin to understand how to incorporate touch

treatment in to a treatment plan.

Page 5: The impact of touch on emotion regulation development and in psychotherapy.

Who we are is created through touch…

Page 6: The impact of touch on emotion regulation development and in psychotherapy.

Touch is Communication…Touch is one of the most understudied senses, yet it can

be a profound communicator of emotion.Recent studies have found that people can identify

multiple emotions through physical touch such as anger, fear, disgust, love, gratitude, and sympathy via touch with a high degree of accuracy. (Hertenstein, Holmes, McCullough, & Keltner, 2009)

People can decode emotional information communicated by touch by simply watching touch on a film. (Hertenstein, Holmes, McCullough, & Keltner, 2009; Keysers, Wicker, Gazzola, Anton, Fogassi & Gallese, 2004)

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Page 8: The impact of touch on emotion regulation development and in psychotherapy.

Touch Interventions for TraumaTouch can be used in several ways to reduce the symptoms

of trauma. 1. To re-establish the regulation of the autonomic nervous

system.

2. To desensitize individuals to trauma triggers.

3. To increase the ability to attend to interceptive cues from the body.

4. To reduce fight/flight activation

5. Support the growth of emotion regulation centers in the brain.

Page 9: The impact of touch on emotion regulation development and in psychotherapy.

Affect RegulationFour Main Types of Affect Regulation.

Cognitive regulation is deciding to use an affect regulation skill.

Co-regulation the regulation through the interaction with another person or animal.

Auto-regulation the internalized regulation or automatic regulation processes.

Self-Regulation the integration of the above types of affect regulation.

Page 10: The impact of touch on emotion regulation development and in psychotherapy.

Cognitive Regulation and TouchAny touch based skill some one

uses consciously to regulate their emotional response.

Lineahan: Soothing in the 5 senses. (dbtselfhelp.com) For Example:

Placing  one’s hand on one’s heartTapping  Standing  in  a  warm  shower Massaging  one’s  feet/ self massage.Taking a bathProgressive muscle relaxation.Chi Gung Slapping  

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Co-regulation Regulation and TouchCo-regulation is regulation of emotions through the

interaction with another person or animal.Co-regulation through indirect mirroring.

Requires the ability of the individual to tolerate, mirror and contain the affective state of the other.

Sub-cortical dialog of “neuroception” Individuals w/ Antisocial Personality lack this ability

to modulate w/ another. (Research on pupil dilation). Listening w/ the hands

Co-regulation provided through conscious intervention. Placing of a hand on the back of some one upset. Increasing one’s positive affect and then contacting the

other. Client and therapist negotiating where contact would

feel supportive and providing that contact.

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Auto-regulation and Touch

Auto-regulation is the internalized pattern of affect regulation.

Automatic Thoughts, Schema’s and CognitionPatterns of cognition, self talk, and beliefsSituational triggers Interaction between cognitive and emotional systems

Automatic Emotions: Loops of emotions… Cingulet Gyrus: Can replay emotional events of the

past as if they are happening and plays a role in depression.

Daniel Hughes – Story of KatieRIG’s – Representation of interactions generalized.

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Self-Regulation and Touch

Self-Regulation is the integration of auto-regulation, patterns of co-regulation, and one’s cognitive regulation skills.

As a person becomes more integrated these types of affect regulation work together to allow the individual to tolerate a range of stressors, different emotions and even exceeding their current affective auto-regulation capasity with comfort.

Page 14: The impact of touch on emotion regulation development and in psychotherapy.

Touching Emotions 1. Brake up into dyads

2. Decide who will be the receiver first.

3. The partners let each other know where they feel safe receiving touch (e.g. shoulders, upper back etc.).

4. Receiver sits in a chair and chooses an emotion they will evoke through (memory of emotion, evoking the felt experience in the body etc.).

5. Negotiate contact

6. Giver: Attempt to listen with the hands and see if they can identify the emotion being communicated.

7. Then switch roles.

8. Share in dyads. Share in larger group.

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Instructions1. Choose partner.

2. Choose who gives touch first.

3. Negotiate contact (be safe).

4. Receiver: Choose emotion.

5. Giver: Listens with hands to attempt to identify the emotion.

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Neurobiology of Affect RegulationHPA-Axis and Thalamus Hypothalamus  Pituitary  Adrenal- axis  (HPA- axis):  Is  made  up

 of  the  hypothalamus,  pituitary  gland,  and  adrenal  cortex.   Its  main  task  is  to  mobilize  a  powerful  energetic  defense  when  a  person  is  threatened  and  to  return  to  rest  when  the  threat   is  gone.  The  HPA- axis  triggers  cortisol  secretion.  Touch  based  interventions  could  help  restore  regulation  to  this  system.   Touch  treatment  been  shown  to  reduce  cortisol  levels.

Thalamus:  Is  a  relay  station  for  the  brain. A damaged thalamus can result in a coma. Sensory  information  from  touch  reaches  the  cortex  through  connections  in  the  thalamus  It  plays  a  role  in  modulating  levels  of   arousal.  The  thalamus  may  be  the  seat   of  human  consciousness.

Page 17: The impact of touch on emotion regulation development and in psychotherapy.

Neurobiology of Affect RegulationHPA-Axis and Thalamus Hypothalamus  Pituitary  Adrenal- axis  (HPA- axis):  Is  made  up

 of  the  hypothalamus,  pituitary  gland,  and  adrenal  cortex.   Its  main  task  is  to  mobilize  a  powerful  energetic  defense  when  a  person  is  threatened  and  to  return  to  rest  when  the  threat   is  gone.  The  HPA- axis  triggers  cortisol  secretion.  Touch  based  interventions  could  help  restore  regulation  to  this  system.   Touch  treatment  been  shown  to  reduce  cortisol  levels.

Thalamus:  Is  a  relay  station  for  the  brain. A damaged thalamus can result in a coma. Sensory  information  from  touch  reaches  the  cortex  through  connections  in  the  thalamus  It  plays  a  role  in  modulating  levels  of   arousal.  The  thalamus  may  be  the  seat   of  human  consciousness.

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Neurobiology of Affect RegulationHippocampusThe hippocampus Is  found  in  the   medial  temporal  lobe.  

The  three   major  theories  used  to  explain  hippocampus  functioning  are   that  the  hippocampus  is  involved  in:  behavioral  inhibition,  declarative  memory  consolidation,  and  sense  of  place.  In  those  with  PTSD hippocampus  declines  have  been  noted.  

Dissociative Identity Disorder (DID), one study found a 26% decline compared with controls. No studies were found linking hippocampal growth with touch therapies.

However, touch reduces cortisol production and high levels of cortisol. Hippocampal  declines  can  be   reduced  through  reregulation  of  cortisol.  

Page 19: The impact of touch on emotion regulation development and in psychotherapy.

Neurobiology of Affect RegulationHippocampusThe hippocampus Is  found  in  the   medial  temporal  lobe.  

The  three   major  theories  used  to  explain  hippocampus  functioning  are   that  the  hippocampus  is  involved  in:  behavioral  inhibition,  declarative  memory  consolidation,  and  sense  of  place.  In  those  with  PTSD hippocampus  declines  have  been  noted.  

Dissociative Identity Disorder (DID), one study found a 26% decline compared with controls. No studies were found linking hippocampal growth with touch therapies.

However, touch reduces cortisol production and high levels of cortisol. Hippocampal  declines  can  be   reduced  through  reregulation  of  cortisol.  

Page 20: The impact of touch on emotion regulation development and in psychotherapy.

Neurobiology of Affect RegulationThe Insula The  insula  is  a  part  of  the  limbic  cortex.

The  insula  has  been postulated  to  be  involved  in  the  felt experience  of  introceptive  cues  from   the  body,  viscera,  appetite,  and  addiction and  plays  a  role  in  the  integration  of  body  sensation  of  the  primary  emotions (such as anger, sadness, happiness, and disgust).  

It has connections with the amygdala and the orbital frontal cortex through connections with the thalamus.

Touch in combination with the individual’s attention has been shown to activate the insula in fMRI studies.

The  insula  registers  both  painful  touch  and  pleasant  touch.

Page 21: The impact of touch on emotion regulation development and in psychotherapy.

Neurobiology of Affect RegulationThe Insula The  insula  is  a  part  of  the  limbic  cortex.

The  insula  has  been postulated  to  be  involved  in  the  felt experience  of  introceptive  cues  from   the  body,  viscera,  appetite,  and  addiction and  plays  a  role  in  the  integration  of  body  sensation  of  the  primary  emotions (such as anger, sadness, happiness, and disgust).  

It has connections with the amygdala and the orbital frontal cortex through connections with the thalamus.

Touch in combination with the individual’s attention has been shown to activate the insula in fMRI studies.

The  insula  registers  both  painful  touch  and  pleasant  touch.

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Neurobiology of Affect RegulationCingulate  Gyrus

The  cingulate  gyrus  is  often  referred  to  as  the   limbic  cortex.  

At  three  to  nine  months  of  development,  the  infant   grows  the  ability  to  modulate  social  engagement  through  immobility  and  withdrawing  (noradrenalin)  and  active  protection  through fight/flight (dopamine),  monitors  internal  and  external  behavior,  attends  to  mistakes,  and   modulates  behavior  for  more  successful outcomes.

The anterior is discussed here and is related to autonomic homeostasis, reward anticipation; heart rate, decision-making, emotions, and modeling the emotions of others.

It plays a central role in integration of bottom up and top down neural processes.

The  cingulate  gyrus  is  involved  in  the  limbic  touch  circuit.

Page 23: The impact of touch on emotion regulation development and in psychotherapy.

Neurobiology of Affect Regulation: the Amygdala

The Amygdala is  often  known  as  the  fear  center  of  the  brain.  Although  it   could  be  better  conceptualized  as  a  smoke  detector.  It  notices  changes in the  insula,  and  other  limbic  structures. The amygdala is involved in classical conditioning and emotional

memory. Likely involved in “flash bulb” memories). The amygdala becomes nearly fully developed by the age of one

year.

Early in life it plays a role in the infant’s indiscriminant impulsive drive to social interaction.

Touch has been shown to have strong links to the amygdala, the insula, and other limbic structures.

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Neurobiology of Affect RegulationBasal Ganglia… Septal Nucleus Basal  Ganglia  (BG):  Is central  to  the  modulation  of  movement,  

emotional  set,  anticipation  of  movement,  eye  movement,  motivation,  and  reward.  Physical  touch  increases  neurotransmitter  production  key  for  basal  ganglia  functioning.

Septal Nucleus: Plays a role in pleasure, relaxation and rest. It has an inhibitory effect of cortisol. In early development, the amygdala pushes the infant toward indiscriminant social

contact.

As the child develops, the septal nucleus provides regulation for amygdalar impulses.

Stressful touch to rats increased the septal nucleus secretion of dopamine and activation of the hypothalamic circuits.

In rat pups, a damaged septal nucleus leads to increased aggression and loss of maternal behaviors.

Page 25: The impact of touch on emotion regulation development and in psychotherapy.

Neurobiology of Affect RegulationBasal Ganglia… Septal Nucleus Basal  Ganglia  (BG):  Is central  to  the  modulation  of  movement,  

emotional  set,  anticipation  of  movement,  eye  movement,  motivation,  and  reward.  Physical  touch  increases  neurotransmitter  production  key  for  basal  ganglia  functioning.

Septal Nucleus: Plays a role in pleasure, relaxation and rest. It has an inhibitory effect of cortisol. In early development, the amygdala pushes the infant toward indiscriminant social

contact.

As the child develops, the septal nucleus provides regulation for amygdalar impulses.

Stressful touch to rats increased the septal nucleus secretion of dopamine and activation of the hypothalamic circuits.

In rat pups, a damaged septal nucleus leads to increased aggression and loss of maternal behaviors.

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Neurobiology of Affect RegulationOrbital  Frontal  CortexOrbital  Frontal  Cortex: “emotion  and  reward”

 area  of  the  prefrontal  cortex. This  is  likely   the  most  abstract  area  of

 emotional  processing.   It  is  also  the  last  to   mature.   It  reaches  full  maturity  in  the  early  twenties. It  is  involved   in  decision  making  and

 expectation. Pleasant  touch  increases  activation in the OFC.

Page 27: The impact of touch on emotion regulation development and in psychotherapy.

Neurobiology of Affect RegulationOrbital  Frontal  CortexOrbital  Frontal  Cortex: “emotion  and  reward”

 area  of  the  prefrontal  cortex. This  is  likely   the  most  abstract  area  of

 emotional  processing.   It  is  also  the  last  to   mature.   It  reaches  full  maturity  in  the  early  twenties. It  is  involved   in  decision  making  and

 expectation. Pleasant  touch  increases  activation in the OFC.

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4 Types of Neuroplastic Changes Experience Independent: Changes driven entirely by genetic

determination. (e.g. Layered Structure of Brain: Brain Stem, Limbic, Cortex)

Experience Expectant: Changes that are biologically determined and need only be activated by life events. (e.g. language formation, facial recognition and attachment)

Experience Dependant: Changes that are individual idiosyncratic and are dependent on the specific environmental event occurring. (e.g. The first month of the year is January, there are six degrees between any one and Kevin Bacon).

These types of development interact. Extreme events (chemical, physical, and learning) can alter any of these developmental processes (This Presenter’s Personal Conjecture Based on the Eval of Current Lit).

Shifts in functional relationships between structures (see dysregulation).

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Clinical StoryThe Story of the two guards at the cave…

When you call up a memory it calls the pattern of neuronal behavior up and often it is in a “plastic state.”

Using touch to help support witnessing presence to remain connected to sensation long enough for the new possibility to integrate.

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Two Main Types of Affective DysregulationDevelopmental: Developmental dysregulation occurs

when there are either disruptions in the developmental environment or physical systems of the brain leading to altered growth in the cortical structures, hormones, neurotransmitters, or the relationship between structures.

Incident Driven Dysregulation: In a catalyzing event, through which the brain and self undergo fundamental functional alterations. (Most PTSD Research and treatment focus on this type of dysregulation)

Page 32: The impact of touch on emotion regulation development and in psychotherapy.

Developmental Dysregulation Example: If a child misses the processes that lead to the maturation

of the septal nucleus, that child could display impulsivity and tendency to socialize indiscriminately, and the cortical structures that myelinated after the development of the septal nucleus could display disruptions functioning as well.

More the 60% of children who have been traumatized (developed PTSD after an event) display major to moderate disruptions in multiple neuocognitive abilities (e.g. Memory, Language, Spacial reasoning, Attention/Concentration etc..)

A disruption in a key neurocognitive domain can lead to disruptions in all the developmental processes that rely on these domains to develop.

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Developmental DysregulationThese children tend to be improperly diagnosed, receive

improper treatment, and their educational needs not attended to.

Effects more then 3,000,000 children per year in America alone.

Although, there has been a call for the diagnosis of developmental trauma by Bessel Van Der Kolk and others, it is yet to be included in the DSM-V.

Write the committee!

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Incident Driven DysregulationThis is the main focus of the current PTSD liturature.

Two main forms of dysregulation (These types are not exclusive but people show a predominance in a direction)

Hyperactivation: Reflects an upregulation of stress hormone production and an underactivation of emotion regulation centers. Display increased Cortisol and Heart Rate when read a trauma script. (70% of sample)

Hypoactivation: Reflects an under-activation of stress response and an over activation cortical structures, which regulate stress. Displays a decreased Cortisol production and Hear Rate when read a trauma script. (30% of sample)

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DysregulationThe body and mind are full of rhythms functioning

coherently… From the daily rhythm of sleep to waking, to the diurnal pattern of cortisol secretion.

Dysregulation occurs when the normal coherent relationship between these patterns is disrupted in such a way that the brain or mind has difficulty returning to its normal homeostatic range (Liberzon, Taylor, Fig, & Koeppe, 1998).

Post-traumatic stress disorder (PTSD), there is an upregulation of the threat system such that it triggers a dissociative shutdown, it over-produces stress hormones, reacts too intensely to triggers, or it is triggered too easily to produce stress hormones.

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HyperactivationThe hyperactivated individual floods with information from

the body and has less capacity to regulate the intense sensation.

Ruth Lanius Found in an fMRI Study… Over activation in the insula (bringing extreme amounts of

information from the body’s interceptive cues) Under-activation of the anterior cingulate cortex (ACC) (area

needed to regulate the body sensations brought up from the insula)

Under-activation medial prefrontal cortex (mPFC) (area needed to regulate the body sensations brought up from the insula)

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HypoactivationFor the hypoarousal type, only a small amount of

interceptive cues get into the limbic cortex and are quickly squelched by cortical structures, leaving the individual feeling disconnected, emotionally flat, and dissociated.

Ruth Lanius Found in an fMRI Study…Down regulation of physical sensations from the insula

cortex.Hyperactivation activation in the anterior cigulet cortex

(ACC). Hyperactivation in the medial prefrontal cortex mPFC.

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Porges: Poly-vagal Theory Autonomic Nervous System

Regulates: Stress, Arousal, Heart Rate, Breath Rate, Digestion etc…

Autonomic Nervous System has Two Branches….

The Sympathetic Branch: Fight and Flight response.

Parasympathetic Branch: Two Systems… Rest and digest, and Freeze.

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Porges: Poly-Vagal Theory…

Two Parasympathetic Branches

Evolutionarily Newer (VVC): Rest and digest or Social Engagement System. Functions when we feel safe.

Evolutionarily Older (DMNX): Freeze Response…

Functions like a circuit braker to shut down the nervous system under extreme threat of death. A time dependent physiological process.

A feed back loop is possible (Lizards from the 1900’s): Injection of the stress hormone adrynilyn can maintain the freeze response indefinantly.

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Poly-Vagal TheoryThe way it works…

V.V.C. Brake Disengages

Sympathetic Nervous system Engages

V.V.C Brake Engaged at rest and Socially Engaged.

DMNX EngagesShutting Down Consciousness

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Somatic Experiencing TheoryFight, Flight are defensive strategies…

They are time limited aimed at removal of a threat.

Freeze response is a defensive strategy… It is time limited and follows a predictable pattern of

behavior. Often the freeze response can not complete because of its

multi-sensory association with the fight or flight response (coupled in the felt-experience of the event).

Overactive fight/flight response leads to maintianance of the freeze response indefinantly.

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Somatic Experiencing TheoryPsychological adaptations to trauma occur when the

individual develops strategies to co-opt other neurological systems to override the need to access states that could re-trigger traumatic experience.

In SE theory, the return of social engagement behavior can indicate a re-regulation of the nervous system.

Some indications of social engagement are: The inner ear tuning to the range of the human voice, breathing becoming slow and smooth, orienting towards the therapist, and the individual growing curious about his or her environment.

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Video Demo…

Page 44: The impact of touch on emotion regulation development and in psychotherapy.

Four major touch pathways

Type A Alpha - Quick myelinated pathway mediating proprioception

from skeletal muscles.

Type A Beta - Slightly slower myelinated pathway mediating skin touch,

hair follicle endings, and deep touch.

Type A Sigma - Slower thinly myelinated pathway mediating temperature

and pain.

Type C - Slow unmyelinated pathway mediating pain, temperature and

itch.

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Three Pain Touch Pathways…

1. Spinoreticular tract “Ouuuch!”

2. Spinothalamic tract“I Hurt My Arm!!!”

3. Spinomesencephalic tract“I feel better now…”

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Page 47: The impact of touch on emotion regulation development and in psychotherapy.

Touch Pain Pathways: Spinoreticular track The philogentically oldest of these pathways.

It goes from the spine to the reticular activating system (RAS).

The RAS is a major body regulator of level of conscious arousal.

This pathway mediates the emotional arousal aspects of pain and the motivation to stop the pain.

When a person stubs her toe, this information is read by the brain as, “ouch.”

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Touch Pain Pathways Spinothalamic tract Runs from the spine and to the thalamus.

It conveys information to the brain about specific

areas of pain, sensation, and temperature.

This area can localize the pain to a given region.

This area is the one that makes a person say, “I cut my arm!”

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Touch Pain PathwaysSpinomesencephalic tractThis tract, through communication, is responsible

for modulating and reducing the pain response.Through activating the Para Ventriculate nucleus

(PVN) serotonin and opiates produced endogenously. These chemicals signal the body to interrupt the pain response.

When this area comes on line, one might state, “My arm feels better.”

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Sensory Processing Primary Sensory Motor Region: Receives raw sensory

data. If damaged leads to paralysis or muscle spasm.

Secondary: Integrates sensation with perception.Damage to the secondary sensory area can lead to: Difficulty

localizing and integrating sensory input; Losing propreaceptive input, such that the person feels lost in space.

Damage to the secondary motor area leads to loss of: The urge to move (basal ganglia); Organized patterns of movement; Emotional drives for movement.

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Sensory Processing Tertiary: Integrates higher order abstractions and

concept formation.

Multi-sensory Integration: Creates the seamless felt experience of reality

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Biology of Touch Sensory IntegrationThrough the visuotactile mirroring mechanism,

people model each other’s emotions and experiences by integrating touch and vision.

Two Visuotactile Systems: Non-intentional system models Inannimate Objects

• Intentional system models relational touch and may mediates the experience of “resonating with another.” (Co-Regulation)

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Effects of Touch in Therapy

Touch is as vital as food

Touch can affect multiple neurobiological systems that are targets of anti-depressants, anxiolytic medications.

Having one positive emotion after a stressful event or the experience of a triggering event can speed the reduction of cortisol levels, and reduce physiological indicators of stress.

Soothing, safe touch can be an effective means to provide an experience of safety, evoke the relaxation response and for some positive emotions

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Effects of Touch in Therapy

Just as touch plays a profound role in the development of the child, it can play a profound role in the regulation of the nervous system…

Therapeutic touch has been shown to decrease cortisol production, substance P (mediating pain responses),

Therapeutic touch has been shown to increase dopamine, serotonin, and oxytocin production (known to mediate maternal behaviors, attachment and partner boding).

In infants it has been shown to increase birth weight, cortical development, length of the infant, reduce asymmetry between frontal lobes (associated with depression), increase the ability to self-soothe, and re-regulate cardiac vagal tone (an indication or autonomic regulation).

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Effects of Touch in Therapy

In parents, it has been shown to increase the quality of their relationship, infant-parent synchrony, perception of partner support, reduce frontal lobe asymmetry, and reduce the effects of post-partum depression.

Massage has been shown to reduce symptoms of depression, state anxiety, and PTSD

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Changes in Auto-regulation Through TouchInternalization of the therapist as a safe regulator of

affect The coupling of difficult emotional content with the safe

containment of the therapist and effects of touch the client builds new regulatory possibilities.

Changes occur in the ACC and its modeling and play back of emotional events.

The client reduces for the client the number of conflicts their ACC needs to monitor through its conflict monitoring function and the number of number of emotional exchanges with a successful outcomes.

Page 58: The impact of touch on emotion regulation development and in psychotherapy.

Changes in Auto-regulation Through Touch The internalization of the therapist as a safe regulator of affect.

As the therapist coaxes the client’s orbital frontal cortex online through safe touch and emotional mirroring through touch, these areas likely are strengthened.

The safe contact with the therapist could allow for increased ability of the client to tolerate his interceptive responses to events and thus allows him to be available to a wider range affect without dysregulating and be an active participant in a wider range of life experiences.

As a new-felt experience of contact with one’s physical form and physical contact with a self–regulating other is internalized, the individual has the ability to auto-regulate through touch.

Page 59: The impact of touch on emotion regulation development and in psychotherapy.

QUESTIONS

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Page 60: The impact of touch on emotion regulation development and in psychotherapy.
Page 61: The impact of touch on emotion regulation development and in psychotherapy.

Containment Through Contact1. Brake up into dyads

2. Decide who will be the receiver first.

3. The partners let each other know where they feel safe receiving touch (e.g. shoulders, upper back etc.).

4. Negotiate contact

5. Containment Exercise

6. Then switch roles.

7. Brief sharing in dyads

Page 62: The impact of touch on emotion regulation development and in psychotherapy.

Containment Exercise Provide containing touch: Resting at the skin Using invetational language ask your partner to notice the

contact with your hand. Invite them to move their attention to a place that feels

good on the inside. Gently ask them to move their attention to place that feels

slightly uncomfortable, Invite them to move their attention back to a place inside

that feels good. Ask them to notice the felt experience of contact with your

hand.