1 min read3rd Aug 201915 comments
This is a special post for quick takes by Unreal. Only they can create top-level comments. Comments here also appear on the Quick Takes page and All Posts page.

New to LessWrong?

18 comments, sorted by Click to highlight new comments since: Today at 5:16 AM

#trauma #therapy

My working definition of trauma = sympathetic nervous system (SNS) activation + dorsal vagal complex (DVC) activation

The SNS is in control of fight or flight responses. Activation results in things like increased heart rate / blood pressure, dilated pupils, faster breathing, and slowed digestion.

The DVC plays a role in the freeze response that exists in many vertebrates. In vertebrates, the freeze response results in immobility. In humans, the freeze response is associated with de-activated language centers in the brain (based on MRI research on trauma flashbacks). From my own extrapolations, it also seems associated with dissociation / depersonalization (sometimes) and lessened ability to orient to one's surroundings.

The dorsal branch of the vagus originates in the dorsal motor nucleus and is considered the phylogenetically older branch.[3] This branch is unmyelinated and exists in most vertebrates. This branch is also known as the “vegetative vagus” because it is associated with primal survival strategies of primitive vertebrates, reptiles, and amphibians.[3] Under great stress, these animals freeze when threatened, conserving their metabolic resources.
https://www.wikiwand.com/en/Polyvagal_theory

The vagus systems acts by inhibiting the SNS.

In other words, a traumatic incident involves "fully pushing the gas pedal while simultaneously fully pushing the brake." On the one hand, the body is trying to engage fight or flight, but in cases where neither fighting nor fleeing feel like options, the body then tries to engage freeze.

a) This releases a bunch of stress hormones.

So, according to The Body Keeps the Score, cortisol is a hormone that signals the body to STOP releasing stress hormones. In people with PTSD, cortisol levels are low. And stress hormones fail to return to baseline after the threat has passed, meaning they experience a prolonged stress response.

b) This helpless freeze response becomes a learned response in similar situations in the future.

The concept of "learned helplessness" is very likely related to the experience of trauma. (Interestingly, the Wikipedia article doesn't even mention the word "trauma.")

From the "Early Key Experiments" section on the Learned Helplessness Wiki page:

American psychologist Martin Seligman initiated research on learned helplessness in 1967 at the University of Pennsylvania as an extension of his interest in depression.[4][5] This research was later expanded through experiments by Seligman and others. One of the first was an experiment by Seligman & Maier: In Part 1 of this study, three groups of dogs were placed in harnesses. Group 1 dogs were simply put in a harnesses for a period of time and were later released. Groups 2 and 3 consisted of "yoked pairs". Dogs in Group 2 were given electric shocks at random times, which the dog could end by pressing a lever. Each dog in Group 3 was paired with a Group 2 dog; whenever a Group 2 dog got a shock, its paired dog in Group 3 got a shock of the same intensity and duration, but its lever did not stop the shock. To a dog in Group 3, it seemed that the shock ended at random, because it was his paired dog in Group 2 that was causing it to stop. Thus, for Group 3 dogs, the shock was "inescapable".
In Part 2 of the experiment the same three groups of dogs were tested in a shuttle-box apparatus (a chamber containing two rectangular compartments divided by a barrier a few inches high). All of the dogs could escape shocks on one side of the box by jumping over a low partition to the other side. The dogs in Groups 1 and 2 quickly learned this task and escaped the shock. Most of the Group 3 dogs – which had previously learned that nothing they did had any effect on shocks – simply lay down passively and whined when they were shocked.[4]

It seems very likely they ended up traumatizing the dogs in that experiment by caging them up and then electrocuting them. The dogs subsequently don't "flee" even when the cage is open. They've ingrained their freeze response.

Similarly in humans, traumatized people become trapped within their own mental constraints when faced with a triggering situation. They rationalize why they can't change things, but the rationalization is likely "after-the-fact". They're frozen on a nervous-system level (which happens first), and they're justifying the freeze with stories (which happens after).

Not to say that the stories are irrelevant or don't affect things. I think they do.

c) In future similar situations, the "body" believes it's still stuck in the past / that the traumatic incident is still happening in some way. It tries to recreate the original pattern over and over.

[ My use of the word "body" is a bit shifty here. I might mean something like System 1 (Kahneman) or Self 2 (Inner Game of Tennis) or whatever part of you stores "feeling beliefs" (Bio-Emotive) or "core beliefs / belief reports" (Connection Theory). When I say "body" in quotes, this is what I mean. Whatever I mean, it probably involves the limbic system. ]

I don't fully understand what's going on here, but here's a couple super-bad made-up stories with a bunch of missing gears:

Story #1: The "body", feeling trapped, keeps trying to relive the experience in an effort to "finally find some way out". Similar to the function of dreaming, which is to try to "rehearse" some event but try out a bunch of variations quickly.

Often, reliving trauma doesn't actually end up with a different outcome, however. In many cases, the traumatized person ends up reinforcing the original trauma narrative.

Somatic Experiencing is a therapy modality that tries to relive a trauma with a new narrative where the person is not helpless, and it does it by engaging the "body" (rather than the intellect).

Story #2: The "body" has a bunch of trapped "energy" from the original trauma, and the "energy" needs a way to release.

The person usually fails to find a way to release the energy without the help of therapy or ritual or some kind of processing technique.

The Bio-Emotive process releases "energy" in the form of sobbing and vocalizing. It engages the emotional system through simple language ("I feel sad and helpless"). It engages the meaning-making / narrative system through simple story ("He left me to die"). There can be a large, loud emotional and physical release from this process.

( Lots of approaches have been developed for dealing with trauma, but I'm mentioning two as direct examples of how my Stories might fit given current practices. )

---

I've been thinking about this lately because I'm about to give a talk on trauma, so I've been re-reading sections of Waking the Tiger and The Body Keeps the Score.

I highly recommend the latter book as a pretty comprehensive view of where we are on trauma research lately. The former book is by Peter Levine, who developed Somatic Experiencing therapy and figured out a lot of stuff through trial-and-error with his clients. His language is less "science-y sounding" or something, but it contains helpful exercises and the correct "mindset" for being with trauma.

This is great. I like it for explaining both Trauma (in the PTSD sense) and trauma (in the sense where I am triggered by certain situations, but to a much lesser degree).

It also explains why memory reconsolidation techniques like the two you mentioned are so effective at dealing with trauma quickly. I tend to think that techniques based around "experiencing emotions that you didn't process" are actually doing a memory reconsolidation thing but explaining it as unexperienced emotions.

When I talk about "model-building skill" I think I mean three separate skills:

Skill A) Model-building skill proper

Skill B) Introspection skill

Skill C) Communication skill

There are probably a lot of people who are decent at model-building proper. (Situation #1)

I'm imagining genius-level programmers. But then when you try to get some insight into what their models actually are or why they do things one way vs another, it's opaque. They don't know how to explicate any of it. They get annoyed by having to try to verbalize their models or even know what they are—they'd rather get back to coding and are frustrated having to "waste time" convincing other people.

Then there are other people who might be decent at model-building and introspecting on their models, but when they try to communicate their models to you, it comes out as gibberish (at least to your ears). And asking them questions doesn't seem to go anywhere. (Situation #2)

Then there's the situation where people are really articulate and able to communicate very clear, explicit, verbal models—but when it comes to implementing those models on a somatic-emotional level, they run into trouble. But it sounds like they have the model-building skill because they can talk about their models and share genuine insights about them. (Situation #3)

An example is having a bunch of insightful theories about social dynamics, but when actually in a situation where they could put those theories into practice, there is some kind of block. The models are not acting like felt models.

...

I've been in Situation #3 and Situation #1 before.

Overcoming Situation #3 is a scary thing. Being able to see, make sense of, and articulate models (from afar) was a way of distancing myself from reality. It was a preemptive defense mechanism. It helped me feel superior / knowledgable / satisfied. And then I continued to sit and watch rather than participate, engage, run experiments, etc. Or I'd play with "toy models" like games or structured activities or imaginings or simulations.

To be fair to toy models, I learned quite a lot / built many useful models from playing games, so I don't regret doing a lot of that. And, there's also a lot to be gained from trial by fire, so to speak.

For Situation #1, the solution mostly came from learning to introspect properly and also learning to take myself seriously.

Once I honestly felt like I had meaningful things to share with other people, it became easier to bother trying. (It's hard to do this if you're surrounded by people who have high standards for "interesting" or "useful." Being around people who were more appreciative helped me overcome some stuck beliefs around my personal worth.)

I also had a block around "convincing other people of anything." So while I could voice models, I couldn't use them to "convince people" to change anything about their lives or way of being. It made me a worse teacher and also meant my models always came across as "nice/cool but irrelevant." And not in a way that was easy for anyone to detect properly, especially myself.

Is situation 3 more about introspection, or more generally about internal alignment? (It seems like introspection is necessary but not sufficient for that)

Yeah, I think it's more the latter.

I would classify situation 3 as a lack of the model-building skill proper, which includes having my models affect me on an alief level. Although introspection would help me notice what my aliefs are to begin with.

Short and immediate responses as I read some of this post about Leverage:

https://cathleensdiscoveries.com/LivingLifeWell/in-defense-of-attempting-hard-things

When I first encountered the group, it was clear that something different was going on. They were pretty much crap at any of the conservation behaviors that in my circles meant that you cared about improving the state of the world: they didn’t recycle, they’d turn on the kitchen sink and then walk away to go get something, they’d hold the fridge door wide open while they tried to carefully answer a question about the limited types of goals they’d seen in people’s motivational setups -- I don’t even know if they were registered to vote! But that was almost symbolic of their determination to not flinch away from the size and complexity of the problems that humanity doesn’t seem to be on track to solving: they weren’t pretending that taking public transport and reusing shopping bags would handle problems of such magnitude, they weren’t resigned to never solving them or in denial that they existed -- they were spending all their attention genuinely trying to figure out whether there might be any counterintuitive ways that they could end up successfully addressing these very real and very hard problems.

I appreciate this reframing of this behavior as being especially determined. 

I also think we might end up turning such behaviors into a kind of social signal that reads to our ingroup as focused, determined, and doing it for real. Which would be equally bad as using recycling as a social signal (since we've lost the actual good thing in favor of signaling). But this would also actually be slightly worse imo because you're hitting the 'wastefulness' button as a favorable signal, so it becomes better to waste 'noticeably' or excessively. 

What we do with our minds matters at every level. I think conspicuous wastefulness is not a good thing for a mind to train itself to do. 

Elon Musk challenging the UN to show how they could end world hunger with $6B.

Given what I'm learning about Modern Slavery, whenever more resource is injected into corrupt systems, the bottom is always just exploited for even more. You can give these people money, but if they're inside a deeply corrupt system, everything they have will be taken almost immediately. 

The root cause is human greed and hatred. Without solving these, interventions will always be bandaid solutions. 

Prospective funders reported that the bottleneck was a lack of promising projects. As far as we could tell, the lack of good projects is a result of a lack of effective, benevolent, and coordinated people.

It doesn’t seem like there’s a lack of benevolence or altruism -- there are plenty of people who want to solve these problems, but either they can’t figure out what to do, or what they try never really works, or they settle for tackling smaller issues that they think they can actually resolve.

This is extremely well stated. 

There are a few abnormally effective people: Elon Musk is the celebrity poster child of effectiveness -- love him or hate him, it’s really impressive what he’s been able to accomplish.

Yeah I just disagree. 

I think you should only count as effective if you're helping the problems of the world. I'm pretty sure he's only making them worse. There are lots of institutions and organizations that are highly effective... at making things worse. This is not that impressive to me. 

I had explored enough career paths at this point to recognize that most of my opportunities to positively affect the world were limited by the organizations or institutions that were already established or by my own ability to affect them from within, and I didn’t like my prospects. Government agencies, nonprofits with limited scope, politicians, think tanks -- I couldn’t find any employers that matched my level of ambition while also being self-reflective and self-critical and thus willing and able to adjust and pivot as they proactively learned more about the shape of the problems in the world (there are a lot of constraints out there).

An important paragraph. 

I haven't personally looked around, but it's not very surprising to me that someone would say this. 

And we also had no system for handling the work that people didn’t want to do (I didn’t buy groceries because it was my job; I went to the store because the fridge was empty and I wanted to help) or how to handle people saying that they were going to do something and then not following through.

I feel vaguely frustrated that this is such a common problem. 

Lack of Hufflepuff virtues. Shakes head. 

I find this ironic to compare to the first part you quoted.

People don't recycle, keep the fridge door open, don't register to vote... but, you know, from certain perspective this is actually great, because it shows their determination to do the actually important stuff.

The same people then also don't buy groceries, don't keep their promises...

Both of these examples signal the lack of Hufflepuff virtues. The first one is easy to rationalize; the second one has a personal impact on the author.

Yeah, it seems like ... the rationalization might be sort of a cover-story for certain bad habits or patterns that they don't want to fix in themselves. shrug. I'm not a huge fan. 

[+][comment deleted]2y30