Friedemann Schaub: technique to "Declutter Your Mind"/ Técnica simples de desbloqueio mental

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Trauma Complexo

Está Incluído, em inglês, na designação de Complex PTSD definindo-se (vide citação de J. Briere em baixo) como um quadro de perturbações psicofisiológicas, em larga medida derivadas de estratégias de sobrevivência adaptativas a situações de perigo e ameaça permanente. Na vanguarda de quem trabalha sobre estas questões (alguns mencionados neste blog, quer nos posts quer nos favoritos) enfatiza-se a reabilitação que a neuroplasticidade, mediante a estratégia adequada, permite e adopta-se a palavra “response” (resposta, repercussão) em vez de “disorder” (Post-Traumatic Stress Disorder- PTSD) ou, português, “perturbação” (i.e Perturbação Pós-Stress Traumático - PPST ou, no Brasil, “transtorno”) que remete para a “patologização” do traumatizado. Esta surge assim como portador de uma (ou múltiplas) “injury”, lesão/ferida/dano infligido e passível de recuperação:

"When an individual has experienced multiple, severe forms of trauma, the psychological results are often multiple and severe as well; a phenomenon sometimes referred to as complex posttraumatic disturbance. Complex trauma can be defined as a combination of early and late-onset, multiple, and sometimes highly invasive traumatic events, usually of an ongoing, interpersonal nature. In most cases, such trauma includes exposure to repetitive childhood sexual, physical, and/or psychological abuse, often (although not always) in the context of concomitant emotional neglect and harmful social environments (Briere & Scott, 2006; Cook, et al., 2005). As described in Chapter 1, the impact of complex trauma  include anxiety and depression; dissociation; relational, identity, and affect regulation disturbance; cognitive distortions; somatization; "externalizing" behaviors such as self-mutilation and violence; sexual disturbance; substance abuse; eating disorders; susceptibility to revictimization; and traumatic bereavement associated with loss of family members and other significant attachment figures".(p. 2)

Neste texto enumeram-se algumas estratégias apropriadas ao contexto terapêutico com pacientes de trauma complexo. Não as vou enumerar aqui mas indico as referências no final deste post. Anteriormente publicamos aqui um video de Briere  sobre esta questão : https://www.youtube.com/watch?v=KL82kN4kPAc Mais uma pequena citação do mesmo texto dá-nos, porém, a medida das capacidades requeridas aos terapeutas para lidar com a questão:a

"Because this is a multi-modal, comprehensive treatment model that takes into account a range of psychological, social, and cultural issues, its effectiveness rests on the therapist’s previous training, skill, sensitivity, creativity, and openness to the client. Although specific interventions and activities are described, this is not a structured, “how-to” manual. Instead, this guide offers a semi-structured approach that can be adapted on a case-by-case basis by the therapist to meet the youth’s specific developmental level, psychological functioning, and cultural/ethnic background."
  

John Briere, Ph.D. and Cheryl Lanktree, Ph.D.,

Integrative Treatment of Complex Trauma for Adolescents (ITCT-A):

 A Guide for the Treatment of Multiply-Traumatized Youth,

MCAVIC-USC Child and Adolescent Trauma Program, National Child Traumatic Stress Network Final draft, August 2008

 http://www.johnbriere.com/Adol%20Trauma%20Tx%20Manual%20-%20Final%208_25_08.pdf

Medicina Integrativa articulada com reprogramação cognitiva, neurológica e emocional  

Friedemann Schaub MD, PhD

How to Declutter Your Mind Video Series

http://www.cellularwisdom.com/healing-resources.shtml

Part 1 - Introduction

Part 2 - What is Mind Clutter?

Part 3 - Subconscious Beliefs

Part 4 - Subconscious Baggage

Part 5 - Symptoms and Causes of Mind Clutter

Part 6 - Empyting the Subconscious

Part 7 - Directing the Subconscious

Part 8 - How to Stop Mind Racing NOW!

Part 9 - How to Open Your Mind

Part 10 - Conclusion

"There is no reality only perception"

"Não se querer libertar"!

"Get over it"!

"Está preso à dor"!

Assim se acrescenta o insulto à injúria.
Não, não estamos a falar do mesmo: já ouviu falar de memória implicita? 

Sem empatia não há cura, não há recondicionamento da neuroplasticidade. Aqui vai um chavão 

"neurons that fire together wire together". 

"Implicit/sensory memories

Frequently, memories of especially traumatic events, including severe child abuse, are reexperienced later
in life on a sensory level, for example as “flashbacks.”  This is thought to be due, in part, to the fact that those brain and psychological systems responsible for directing the encoding and early organization and processing of explicit, narrative memory material may be flooded (or at least bypassed) by overwhelming emotional input during severe abuse or trauma -- resulting in less integrated, primarily sensory (as opposed to verbally/autobiographically mediated) recollections upon exposure to trauma-reminiscent stimuli (Metcalfe & Jacobs, 1996; Siegel, 1999; van der Kolk, McFarlane, & Weisaeth, 1996).   In addition, traumatic experiences that occurred prior to the child’s acquisition of language necessarily will be nonnarrative, typically sensorimotor in nature.
As opposed to narrative memories, implicit, sensory recollection is generally devoid of autobiographic material, and is often experienced as an intrusion of unexpected sensation (e.g., sights or sounds of an event) rather than of remembering, per se.  Although sensory reexperiencing is often accompanied by the associated emotions that were involved at the time of the abuse, the sensory memory of the maltreatment experience and the affects conditioned to the memory (i.e., CERs) are likely to be separate phenomena (Davis, 1992; LeDoux, 1995).  In many cases, sensory memories become the stimuli that release strong CERs, which can, in turn, reinstate enough of the context of the original abuse to trigger additional reexperiencing.  As will be described below, the combination of triggered sensory memories and associated negative affects is often characteristic of posttraumatic stress".

John Briere

Treating adult survivors of severe childhood abuse and neglect: 

Further development of an integrative model

file:///C:/Users/fernando/Downloads/John%20Briere%202.pdf

Kindness

Before you know what kindness really is
you must lose things,
feel the future dissolve in a moment
like salt in a weakened broth.
What you held in your hand,
what you counted and carefully saved,
all this must go so you know
how desolate the landscape can be
between the regions of kindness.
How you ride and ride
thinking the bus will never stop,
the passengers eating maize and chicken
will stare out the window forever.
Before you learn the tender gravity of kindness,
you must travel where the Indian in a white poncho
lies dead by the side of the road.
You must see how this could be you,
how he too was someone
who journeyed through the night with plans
and the simple breath that kept him alive.
Before you know kindness as the deepest thing inside,
you must know sorrow as the other deepest thing. 
You must wake up with sorrow.
You must speak to it till your voice
catches the thread of all sorrows
and you see the size of the cloth.
Then it is only kindness that makes sense anymore,
only kindness that ties your shoes
and sends you out into the day to mail letters and purchase bread,
only kindness that raises its head
from the crowd of the world to say
it is I you have been looking for,
and then goes with you everywhere
like a shadow or a friend.

Naomi Shihab Nye

Compassion & Empathy  

Joan Halifax: Compassion and the true meaning of empathy

Joan Halifax não pronuncia nem uma única vez a palavra "empatia". 

Porque será? 

"So we can ask: What is compassion comprised of? And there are various facets. And there's referential and non-referential compassion. But first, compassion is comprised of that capacity to see clearly into the nature of suffering. It is that ability to really stand strong and to recognize also that I'm not separate from this suffering. But that is not enough, because compassion, which activates the motor cortex,means that we aspire, we actually aspire to transform suffering. And if we're so blessed, we engage in activities that transform suffering. But compassion has another component, and that component is really essential. That component is that we cannot be attached to outcome."

http://www.ted.com/talks/joan_halifax 

ADD - Défice de Atenção!

É, radica mesmo em TRAUMA. 

Entrecruza-se com ALERGIAS e INTOLERÂNCIAS ALIMENTARES:

http://www.feingold.org/BLUEBOOK2012.pdf
http://www.feingold.org/DOCS/WhenMoreThanOneAdditive.pdf

COMPASSION WITH THE TRAUMA CLIENT - John Briere, Ph.D.

What is Complex PTSD and How can it be Managed? (+playlist)

Radical Acceptance

Marsha Linehan PhD desenvolveu  um modelo terapêutico designado por  Dialectical Behavioral Therapy - DBT ou, em português, Terapia Comportamental Dialética.  O modelo construiu-se a partir do da CBT (Cognitive Behavioural Therapy - Terapia Cognitivo-comportamental) e dos seus "pontos fracos" na terapia de indivíduos com perturbação emocional intensa. Entre as estratégias e princípios propugnados encontra-se o de "radical acceptance". Esta estratégia é dupla: para o "paciente" implica a aceitação da situação e realidade tal como ela é se apresenta pela prática das Brahmavihāras budistas, em particular da  Equanimidade. Para o terapeuta implica uma postura de aceitação e validação tanto da experiência, sentimento e legitimidade do sofrimento como das competências  do paciente como capacitadores da mudança: 

"HOW IS DBT DIFFERENT FROM REGULAR COGNITIVE BEHAVIORAL THERAPY?

 

DBT is a modification of standard cognitive behavioural treatment. As briefly stated above, Marsha Linehan and her team of therapists used standard CBT techniques, such as skills training, homework assignments, symptom rating scales, and behavioral analysis in addressing clients’ problems. While these worked for some people, others were put off by the constant focus on change. Clients felt the degree of their suffering was being underestimated, and that their therapists were overestimating how helpful they were being to their clients. As a result, clients dropped out of treatment, became very frustrated, shut down or all three. Linehan’s research team, which videotaped all their sessions with clients, began to notice new strategies that helped clients tolerate their pain and worked to make a “life worth living.” As acceptance strategies were added to the change strategies, clients felt their therapists understood them much better. They stayed in treatment instead of dropping out, felt better about their relationships with their therapists, and improved faster.

The balance between acceptance and change strategies in therapy formed the fundamental “dialectic” that resulted in the treatment’s name. “Dialectic” means ‘weighing and integrating contradictory facts or ideas with a view to resolving apparent contradictions.’ In DBT, therapists and clients work hard to balance change with acceptance, two seemingly contradictory forces or strategies. Likewise, in life outside therapy, people struggle to have balanced actions, feelings, and thoughts. We work to integrate both passionate feelings and logical thoughts. We put effort into meeting our own needs and wants while meeting the needs and wants of others who are important to us. We struggle to have the right mix of work and play.

In DBT, there are treatment strategies that are specifically dialectical; these strategies help both the therapist and the client get “unstuck” from extreme positions or from emphasizing too much change or too much acceptance. These strategies keep the therapy in balance, moving back and forth between acceptance and change in a way that helps the client reach his or her ultimate goals as quickly as possible. 

In http://behavioraltech.org/downloads/dbtFaq_Cons.pdf

  

Os efeitos do trauma complexo (complex PTSD) na saúde, nas perturbações nervosas, e cognitivas (por ex. défice de atenção) e em particular no desregulamento do eixo hipotalámico-hipofisario-adrenal (HPA Axis) está sobejamente comprovado. Síndrome de fadiga crónica, fibromialgia, perturbações gastrintestinais, asma, alergias, disfunções hormonais, etc.  estão entre as sequelas mais comuns.   O desregulamento do EHHA tem consequências "inflamatórias" em todos os sistemas corporais incluindo no cérebro perpetuando o trauma original pela debilitação das funções vitais. Tendo esta questão já sido amplamente estudada esta questão é incontroversa.

Vamos então continuar a medicar os sintomas? 
A partir o ser "às fatias"? 
Praticar  "medicina forense"? 
Autopsiar os vivos? 

A resistência de prestadores de cuidados médicos é assumida por Gabor Maté aqui: 

Gábor Máté MD Attachment = Wholeness and Health or Disease, ADD, Addiction, Violence: https://www.youtube.com/watch?v=Earq-eR3MQI 

Maté, Gabor. 2003. When the body says no: understanding the stress-disease connection. Hoboken, N.J.: J. Wiley.

http://restorativemedicine.org/wp-content/uploads/2013/03/5.-Addiction-Childhood-Trauma-Stress.pdf 

Ader, Robert. 2007. Psychoneuroimmunology: Vol. 1-2. Amsterdam;Boston: Elsevier/Academic Press. 

Se há

paralização, bloqueio  

sentimento persistente de desamparo

falta de foco e/ou défice de atenção

autodestrutividade

há Trauma.

"What to Do When There is Trauma

When stress is layered upon previous trauma, the dissociated and unconscious trauma memories can block the speedy resolution of present day stress without our even knowing why.  Uncovering un-integrated memories of previous trauma often works best with the skillful collaboration of a therapist trained in healing trauma ."

Linda Graham in http://lindagraham-mft.net/resources/published-articles/skillful-ways-to-deal-with-stress-and-trauma/

Stress vs Empathy

Stress vs Empathy

"What is empathy? 

Empathy is an appreciation of  another person's situation and experience".

Gabor Maté

http://www.youtube.com/watch?v=_eiiJiezRGg

Para quem ainda tem dúvidas: 

" What Is Empathy?

The term “empathy” is used to describe a wide range of experiences. Emotion researchers generally define empathy as the ability to sense other people’s emotions, coupled with the ability to imagine what someone else might be thinking or feeling.

Contemporary researchers often differentiate between two types of empathy: 'Affective empathy” refers to the sensations and feelings we get in response to others’ emotions; this can include mirroring what that person is feeling, or just feeling stressed when we detect another’s fear or anxiety. “Cognitive empathy,” sometimes called “perspective taking,” refers to our ability to identify and understand other peoples’ emotions. Studies suggest that people with autism spectrum disorders have a hard time empathizing.'"

in http://greatergood.berkeley.edu/topic/empathy/definition

Trauma Complexo

" Good therapist were those who really validated my experience and helped me to control my behavior rather than trying to control me."  testemunho de vítima in Herman, 

Judith L. 1997. Trauma and Recovery. New York: Basic Books, p. 133.  

Herman, que é psiquiatra e Professora de Psiquiatria Clinica na Harvard Medical School  e ainda membro da Victims of Violence Program, Cambridge Health Alliance, and Department of Psychiatry,é especialista em trauma e vitimologia. No seu trabalho ela elabora e fundamenta a distinção entre trauma simples (tipo I,  em inglês designado pela sigla PTSD) e trauma complexo (tipo II, em inglês CPTSD). O último não foi incluido no Diagnostic and Statistical Manual of Mental Disorders e, assim, para muitos é como se não existisse.

O trauma complexo radica frequentemente na infância e adolescência sendo, consequentemente, tangencial ao trauma de desenvolvimento  (developmental trauma disorder - DTD). 

Veja-se http://www.mentalhealthconnection.org/pdfs/ptsd-predictors.pdf

"Can Mindfulness Help Adults Who Were Abused as Children?" 

http://greatergood.berkeley.edu/article/item/can_mindfulness_help_adults_who_were_abused_as_children

É o título de um post do http://greatergood.berkeley.edu/ website em  que seguimos aqui. A resposta é, obviamente, SIM, sem ser prescrição ou remédio. 

Estas práticas de meditação e meditação ancorada no corpo a que agora se convencionou denominar genericamente “mindfulness” em boa medida por razões de marketing e dessacralização e acessibilidade do público em geral buscam conseguir uma pacificação ou complemento terapêutico dos sujeitos traumatizados.

E como encarar o sistema social e de saúde das sociedades ocidentais modernas e a sua abordagem do trauma complexo  (Complex PTSD) como é o de infância seja ele derivado do clássico abuso sexual ou do ainda mais prevalente abuso emocional e negligência?

O trabalho de Gabor Maté é aqui crucial. Para uma imersão no seu pensamento na 1ª pessoa:

http://vimeo.com/55416414

Portugal tem falta de literacia?E qualidade de vida?

Agências internacionais continuam a "dourar a pílula" de forma dissociada de descolada da realidade sob uma tónica condescendente como se pode ler no "Better Life Index" da OCDE:

"How’s Life?

Portugal has made significant progress over the last few years in modernising its economy and improving the living standards of its citizens, however the global financial crisis has surely weakened its growth. Portugal performs in only overall few measures of well-being, as shown by the fact that it ranks lower or close to the average in a large number of topics in the Better Life Index.(...)!

Então em que ficamos? Continua-se, esquizoidemente, a dizer tudo e o seu contrário. Nem os dados factuais estão actualizados nestes relatórios de show off. 

"Better Life"? "Better" para quem?

E depois continua:

"Money, while it cannot buy happiness, is an important means to achieving higher living standards. In Portugal, the average household net-adjusted disposable income per capita is 18 806 USD a year, less than the OECD average of 23 938 USD a year. But there is a considerable gap between the richest and poorest – the top 20% of the population earn nearly six times as much as the bottom 20%."

Dinheiro compra felicidade sim e compra, tambem saúde, liberdade, esperança e DIGNIDADE. 

Tudo itens de qualidade de vida em escassez por aqui. 

Mas o chorrilho de falsidades e deturpações continua:

"Having a good education is an important requisite for finding a job. In Portugal, 35% of adults aged 25-64 have earned the equivalent of a high-school degree, much lower than the OECD average of 75% and one of the lowest rates amongst OECD countries". 

É mesmo?

http://www.oecdbetterlifeindex.org/countries/portugal/#