Thursday, July 03, 2008

Notes from the Trauma Conference: Emotional Awareness

I have recently returned from Bessel van der Kolk and the Trauma Center at JRI’s ( annual conference ( It is my second year attending, and again I found it a fascinating and rewarding experience. The overall theme was trauma and the body, with a heavy emphasis on understanding the brain, the roles of various parts, and the impact of trauma. The JRI group are becoming more and more convinced of the importance of including body work in therapy for traumatized patients, and have recently received an NIMH grant to study the use of yoga in trauma treatment. They also recommend EMDR, dance, drama, art and other non-verbal therapies.

One concept stressed by many of the speakers that seemed important to our work is the concept of emotional self-awareness. Regulation of emotions is not possible unless you are aware of emotions.

Trauma causes people to become disconnected from their bodies and numb to their emotions. People keep active, display symptoms, engage in risky behavior, all in the service of not feeling what they are feeling, as they only associate feelings with intolerable pain.

Lane and Schwartz have identified stages of emotional awareness- awareness of:
Physical sensations
Action tendencies
Single emotions
Blends of emotions
Complex emotions

The higher stages recruit higher levels of the brain.

Emotions are felt as bodily sensations. The vagus nerve carries information from the body to the brain, however it is two-way. Therefore you can change how you feel by moving your body. Thus the efficacy of dance and rhythmic movement in helping change our emotions.

How do we become emotionally aware? Through a securely attached relationship with other human beings. Through attuned interactions in which the other person names emotions, recognizes them, expresses them in sync but with a little twist. Through small ruptures in attachment which are soon mended. Through caring others connecting our bodily sensations with the names of emotions and with the suggested action steps. Through people validating our emotions, exploring them, paying attention to them. Through valued others taking our emotions- and theirs- into account when making decisions. Through these complex and oft-repeated processes, we develop the ability to notice our feelings, to name them, to reflect on them, to use our higher brain (pre-frontal cortex) to inhibit our immediate emotional responses when necessary, and to take effective action.

We do incorporate many of these processes in treatment. Most therapists have a feelings chart, for example. But I think we could be much more deliberate and conscious about it. If we understand that one of the basic problems our clients face is the lack of emotional self awareness, we can purposefully incorporate this training into all aspects of our interactions. This can be done through naming emotions we observe, validating, asking for the bodily sensation, teaching Wise Mind (DBT concept), feelings charts and thermometers, and many other ways. Treatment teams could discuss clients in terms of this skill (the first step in the Risking Connection® feelings management skill) and make plans as to specific actions to take for each client.

We cannot teach emotional regulation until the clients can recognize an emotion when they see one.

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