“Floaties on the Bus” is my favorite to help my clients understand their unique survival style. While survival styles can be categorized as types, in real life it is usually a nice mix of styles with your own spin and a scattering of triggers like landmines that at first only the subconscious seems to be aware of. 

In my practice, the survival style “features” I frequently see are self-blame, robust inner critics, perfectionism, and overriding one’s own boundaries. This gets wrapped right around BFRBs such as Trichotillomania and Skin Picking, or any numbing or soothing behavior really. De-selfing, pleasing, masking, over achieving: more survival styles than fashion styles are available. 

As sessions go on and that dilemma of knowing better but not doing better develops, self sabotage is one psychobabble version of this, my clients tend to cruelly criticize themselves. “Why can’t I just…?!?!” “You dumb B%^**$ you F$^*^&$* again!” Those are good clues a survival style is at work. 

So here is Floaties on the Bus:

Imagine you as a child learning to swim. Except in this scenario you are really not getting it and truly need your floaties to stay safe in the water. Maybe the water was treacherous, maybe you didn’t have appropriate or patient adults helping you learn to swim. Maybe the adults are oddly missing and on your own you just are not going to survive teaching yourself to swim in that body of water. So those floaties help you survive the water. Those floaties make sense. Those floaties are the best you could manage to cope with being in water. You feel safe with them on. You get pretty good at navigating the water with floaties. Floaties become very familiar. 

Well, fast forward 30 or so years. You are in a new city, very different from your hometown. To get around you must learn to navigate a confusing bus system. The schedule is outdated and inaccurate. The directions are incomplete or even in other languages. The crowds seem to intuitively just get it, going fast and friendly but not exactly able to hold your hand through it for more than a brief piece of advice.

So, to help you feel safe navigating this overwhelming, new environment, you wear your floaties. On the bus. They worked so well in the water back then! Floaties help even when you go back and visit that water. So, why not here? Oh yeah, because you get some weird looks when you are the one wearing floaties on a city bus. This is not a beach town by the way.

That is How Survival Styles Work. 

Whatever your circumstances were as a baby, child, and teen, odds are you came across something that cued you to develop a method of coping and managing people, stress, self worth, learning curves, grief, hurt…you know, LIFE. The human condition in the best cases. Possibly periods of neglect or abuse. Or just unfortunate, chaotic, or overlooked times that as a tiny human you had to figure it out. 

This is not a bad thing. This is how we survive. Look how alive you are right now! It worked. Go gentle with yourself. When something works so well for us, our reptile brain doesn’t let go of lightly.

The thing is, as an adult, you have more options that were not available as a kid. No one has to take away your floaties. I doubt they could if they wanted too. They are yours. And keep them tucked safely should the need arise. But when navigating a bus system, maybe you can pause and then choose other methods from an array of adult learned strategies.  Newer, more applicable, and aligned with your values as a whole, grown up person. An adult body does not have survival on the line in relationships in the same way a child does.

Survival Strategies are Not Pathology.

The floaties are not something wrong with you. And you may choose to explore new ways of navigating life, that’s ok too. 

The post Floaties on the Bus: How Survival Styles Work appeared first on Courage Counseling, PLLC.

Please check your judgement. This is a very vulnerable time. Before you judge someone, act out and/or make accusations, know that

judgmental attitudes and thoughts come from avoiding your own vulnerability. Before you just in to “help” in a harsh and shaming way, please consider other possibilities of how they may be doing the best they can, despite it being below your standards and capabilities. The list below is for your consideration of how you may show more kindness to others.

1. If someone isn’t Wearing a Mask: They may have PTSD triggered by covering their mouth. Wearing a mask may completely render them unable to function, thrown instantly into flashbacks or panic attacks when a mask is put on.

2. If a person Passes or Stands Too Close: First, do you know how far 6-feet is? Many are assuming it is much farther than it actually is. Also, they may be neuro-divergent, thus unable to keep track of a social context. This very new boundary rule may not stick, and although informed, may keep falling out of their working memory. For many with ADHD or on the Autism spectrum (not all) staying compliant with social distancing, despite their best efforts is not much different than demanding someone in a wheelchair climb stairs.

3. If they Buy what You Think is Too Much: They may be making their single outing for a month, reducing risk of more errands. They may be buying for multiple families and at-risk persons who are unable to get out to the store. Delivery right now is unreliable and can take more than a week’s notice to plan, usually more expensive, and can require implementation that not everyone is capable of doing. This is especially if it requires technology that many do not have or are not familiar with how to use.

4. If they seem Amped up or Irritable: Maybe they are sensitive to their asthma or rhinitis medications. These medications are often steroids that when on top of anxiety or caffeine, hijack their whole nervous system. Especially sensitive persons. So, it may not be about you; they may be thinking the kindest thoughts. But their jitters, shaky hands, voice intensity or speed, or being quick to be annoyed may simply be a product of them keeping their airways open during not only this respiratory system threat but central Texas’s Oak blooming season.

5. Be Patient, Plan Ahead, give the Benefit of the Doubt: Everyone is feeling differently right now. Many are grieving. Many are disoriented leaving their homes so rarely and entering a surreal public setting. Prepare in a way so you feel like you’re in a hurry.

6. Set Boundaries with Tact: Assertiveness and Compassion can coexist. Practice being clear and concise without being harsh. We are learning together and from each other.

7. Visit your own Vulnerability: When you are judgmental of others, it usually means there is some vulnerable emotion that you are avoiding. Maybe you know it’s there, maybe it’s so, very well hidden. I am not asking you to drown in this emotion or runaway with an unpleasant thought. Visit it. Sit with it for a moment. Let it percolate with a soft lens while taking a daily walk. Name it. Identify the message within this feeling. Admit to yourself what you may be fearing or grieving. Find healthy ways to flow through this vulnerability, share it with someone you trust, and nurture yourself the way you would a dear loved one.

Be Kind. To other others and yourself.  We are physically distanced, but not socially disconnected. Get support. Be support if you have bandwidth. Our well-meaning survival brain can interrupt this sometimes. Courage Counseling is still offering telehealth services, so please don’t hesitate to reach out if I can be of support to you.

The post 7 Ways to Stay Kind During COVID-19 appeared first on Courage Counseling, PLLC.

So if you are having a hard time understanding:

• Why am I Anxious?
• Why do I space out and shut down?
• Why am I so sensitive to sounds?
• Why am I different after trauma?
• Why didn’t I run away or fight back?

Please take the time to watch this and understand why it’s not your fault. This is the big picture of your hard wiring.  Effective and compassionate PTSD treatment must include a trauma informed approach that addresses the nervous system as well as psychology. Body AND mind.

To read more about trauma treatment click here

The post Your Nervous System- Trauma, Anxiety, and Relationships appeared first on Courage Counseling, PLLC.

A whirlwind of perfectionism and “should” thoughts are a fast track to sabotage your meditation goals. While there may be certain meditation methods that hold some requirements, ultimately all you need is a regular mindfulness practice to lead to the healing brain changes you are looking for. So drop the word “should” from your vocabulary and start on a very bumpy road of the learning curve. You will be bad at it at first- for some time really, and that is OK!

What matters in a mindful meditation is:

• Intending where your Attention is directed
• Attendance to the Here and Now
• The act of coming back when you wander off from the above two. Let us be real, this one happens a lot and is exactly where many people give up.
• Some consideration of body or senses

The Metaphor

 I think everyone has that one drawer in their house, usually in a kitchen or rarely used office, which is just full of miscellaneous things that we might need, do need, or have long forgotten about.  You go into it regularly looking for that 1 thing, maybe your neighbor’s key to feed their cats. And you have to dig through, touching each random item while saying “not that” as you filter past koozies from old memories, cold paper clips, and sharp edges of that broken gadget you will fix one day. It is easy to get off track, forgetting about the cat entirely and taking on some new “should do” organization project or mindlessly wandering off on a tangent thought. But you are a functioning adult and eventually find that key and be a good neighbor.

So How do I Start Meditating?

So today I talk to you about what I call the “Junk Drawer Meditation.” How it works is that you observe your here and now state, be it bodily sensations, thoughts, five senses, or emotions. In this mediation we are looking for “coherence,” Coherence is the body’s signs of feeling OK, safe, and flowing with some degree of health. The “not that’s” that we are filtering past are pain, illness symptoms, urges to pick your skin,  compulsions to pull a hair out, thoughts of any sort. We touch and briefly feel each thought we find, just long enough to give it a label and continue digging for what you KNOW is in there. Coherence: a sensation that is not pain. Coherence: a moment of calm, a fiber of strength. It is in there somewhere! Keep looking. Get off track and back on again. And when you find it, observe it curiously as long as you can. Then, watch for more coherence to come into awareness. When you drop it, start digging again, “not that, not that, not that…AHHHH! There it is.”

But Where? When? I’m busy!

You may not have a serene setting or even a quite space. You may be washing dishes or speed walking on your way to the next thing on your list. Maybe sitting in a functionally parked car on the highway waiting for traffic to move. The here and now is not always sexy, it is where you actually are in your real life. Start today and make it a daily habit. A few moments, then build up as it works well for you. The research says 7 minutes is where you start to see significant changes on brain scans. Buddha says that everyone needs to meditate 10 minutes a day, and if you are too busy for that than you need an hour! You may wake up early before the house starts to rustle. Or fall asleep meditating at the end of the day. I have even heard of making a habit of meditating every time you sit on the toilet. Waiting for the perfect time and place will just lead to waiting forever.

So give mindfulness a try. Meditate badly. Then meditate again. And again.

Oh yeah. And don’t forget to feed the cat!

The post Junk Drawer Guide to Meditation appeared first on Courage Counseling, PLLC.

◦     Orienting to 5 senses. This is a meditation practice that involves slowly and mindfully noticing each of your five senses. Spend about a minute each observing what you see, hear, feel, taste, and smell. Move your neck slowly as you look all the way around you. Notice what bodily sensations come up as you become more present in the moment and environment. This process communicates to your nervous system that you are safe now, grounding you in the present moment. Can be done still, walking, or while engaging in any pleasant activity.

◦     Sensory tracking. Non-judgmentally notice various sensations in your body: tightness, softness, textures, temperatures, urges to move, breath, stomach, pressure, etc. Observe how the sensations evolve as you name them. Try this in joyous time and when relaxed just as much as the hard times. If noticing sensations becomes disturbing, please bring these concerns to a trauma-informed therapist.

◦     Resourcing. Self care is essential, so engaging in both our internal and external resources regularly is a lifelong intervention that makes you more resilient. When you are in difficult moments, struggling with a trigger or simply stressed out, bringing these resources to mind can help settle your nervous system and help you cope.

◦     Journal with Sensations. If you keep a journal, make a note of the bodily sensations that came up before, during, and after the events describe as well as thoughts, emotions, images, and behaviors

◦    Trauma First Aid. These are simple, structured exercises that you can do to integrate your nervous system. Sit in a calm and safe space with both feet on the floor. Start noticing the sensations in your feet and really feel the contact with the ground. Body part by part, work your way up scanning your body and trying to put words to describe the sensations you feel. Feel the support of the chair under you. Feel the air in your lungs. Imagine a color that represents your current state.

◦     Breathing with a Stretchy Object. Each breath serves our body the way it needs to in that moment. Paying close attention to your breath can help your nervous system settle and calm down when activated. Trying holding a stretchy fidget to represent your airways and lungs. Stretch it with each inhale and relax it with each exhale. Try to keep it in sync with the rate and depth of your breath, and watch how your breath naturally slows down and gets so very deep. Spontaneous breath comes on its own, and washes over you with an indescribable calmness.

◦     VOO. This is a breathing exercise comparable to an “Om” in yoga. The vibrating waves created by making a deep, fog horn like projection of the sound “Voo” over the length of your exhale give your vagus nerve a gentle massage, restoring flow and releasing historical gunk. The vagus nerve is the longest nerve in your body and regulates key functions such as social engagement, digestion, alertness/consciousness, and emotional regulation.

◦     Safe Place Meditation. This is a therapeutic daydream that gets developed overtime. Create an imagined place with great vividness. Fill out the details of all 5 sense and how your body feels in that setting. It may be inspired by a real place or fully fantasy, there are no rules other than it is safe, only yours, and how you get there remains secret. The grounding experiences and intentional focus in the imagined place is what differentiates this from a dissociation or avoidance.

The post 8 Self Help Tips from Somatic Experiencing Trauma Therapy appeared first on Courage Counseling, PLLC.

The letters SEP mean that a health professional has completed all 216 hours (over the span 3 years) of in class didactic and experiential training to learn this powerful yet gentle trauma treatment method taught directly by faculty of the Somatic Experiencing Training Institute. It also means that the professional has staffed dozens real life cases with Somatic Experiencing (SE) experts individually and in group, to assure the professional is understanding and applying SE with the utmost care, accuracy, and effectiveness. Finally, it means that the professional has sat in the client’s role in the care of a very experienced SEP to learn first hand what it is like to experience and heal from SE.

In the years since beginning my journey to become an SEP I have been consistently amazed by SE’s effectiveness to bring clients relief, joy, trust, and true healing that they had long lost hope was ever possible. It is such a joy and privilege to both live the benefits of this program and witness the progress in my clients every day. While this method was designed to resolve trauma specifically, since it is ground in neuroscience, its function frequently exceeds its original purpose. Everyone has a central nervous system and science continue to explain the role of a unregulated nervous system in many mental and physical conditions.

Learn more about Somatic Experiencing and the Somatic Experiencing Training Institute here: http://traumahealing.org/

The post SEP? What is a Somatic Experiencing Practitioner? Trauma Treatment appeared first on Courage Counseling, PLLC.

This post focuses on that overwhelming sense of fear and urgency that seems to come out of no where, even though rationally we know there is no “reason” to be anxious. The parts of the brain that are responsible for detecting danger are not rational parts. They don’t even touch the rational prefrontal cortex. Since safety is its job, it has to work very fast, there is no time to seek extra information to rule out alternatives causes for what triggered our anxiety. Speed can be a truly good thing. If a building is on fire, we need to get out as fast as possible, not sit down and map out a decision making flow chart.

Here is a metaphor to explain what is happening in your brain during those unsettling moments. Your amygdala works like the smoke detector in your kitchen. When it detects danger it screams so loud that your hippocampus cannot do its data management job, processing new information, organizing, and retrieving  memories. The hippocampus starts getting sloppy, can’t find what it needs, and mixes new memory files up. When the danger is pasts, the alarm stops, and hippocampus settles down and hopefully resumes normal functioning. Of course, mistakes it make while the alarm was on still exist and may need to be cleaned up later. One of the functions of psychotherapy and Somatic Experiencing is cleaning up those disorganized files.

Back to the smoke detector metaphor. For some people, their smoke detector goes off fairly rarely and usually only when danger is present. And they may bounce back pretty quickly. But for others, we get many false alarms, and are therefore anxiety much too frequently. Imagine your smoke detector is installed directly over that old toaster with too many crumbs burned to the bottom. Whenever you use that toaster, even though there is no fire, the smoke alarm screams so loud it can’t be ignored, scaring everyone in the house. Yet, when you clearly see that ITS JUST THE TOASTER and not real danger, you are able to take reset the smoke detector and restore peace and quiet right away. Then maybe even enjoy your breakfast.

My point is to introduce a neuroscience informed affirmation, a mantra that can help you restore peace during your own false alarms. This means taking a moment to step out of the chaos of reacting to the false alarm, seeing when there is no actual threat to you or your loved ones safety, and sighing a deep relief, “Its just the toaster.”

To read more about trauma treatment click here

The post “It’s just the Toaster.” Your Brain’s False Alarms appeared first on Courage Counseling, PLLC.

Here is what I see over and over again in my counseling practice. Someone comes in for their skin picking or hair pulling problem (trichotillomania), collectively known as Body Focused Repetitive Behaviorsor “BFRBs.” As we get to know each other their story quickly reveals a whole person with a full life of struggles and successes. Someone who is so much more than a picker and a puller. My goal is to help that whole person heal their traumas without losing sight of the picking and pulling. I noticed many overlaps between what I learn about trauma and what I learn about trichotillomania and skin picking. Here I hope to share with you how sometimes trauma is related to body focused repetitive behaviors (BFRB) such as skin picking disorder and trichotillomania.

My Story

Since I was a kid I have struggled with skin picking, then I started hair pulling, around the time unfortunately trauma became all too much of an issue for me. After over 10 years of psychotherapy many things got much better, even the picking, pulling, and trauma related struggles were less severe, but I was far from the progress I hoped for. A major shift on those issues was not made until I started resolving my trauma at the nervous system level, using Somatic Experiencing (SE). SE is a body-awareness approach to therapy developed specifically to resolve post traumatic stress disorder in a gentle, naturalistic way grounded in neuroscience and ethology. The work done in SE therapy is what freed me to finally be able to use the cognitive behavioral therapy (CBT) interventions which were suggested in the past to address my BFRBs. Prior to Somatic Experiencing I was stuck, helpless, and frustrated. After a few sessions of SE, I realized there is an internal activation that I was previously unaware of, and could now identify. I feel and notice early signs that if not attended to would lead to a picking or pulling episode. Even if I find myself leaning to the mirror, which used to be a point of no return, I can now remain present in my body and back away.

Based on my own journey; geeking out over neuroscience in my post graduate education, and now over 4 years of focusing on these three issues for my clients in my professional counseling practice, I see how intricately these issues are woven together. Helping clients see and escape this web has become my passion. In several cases my clients’ trauma has been tied into or connected to their picking and pulling habits. I also see that they get stuck where I got stuck in my own treatment, until we start to use SE, and finally shifts happen. Now I introduce it from the beginning integrated with CBT.

The Myth

When a BFRB is present we cannot assume there was a traumatic event that caused it. Unfortunately, many of us (BFRB or not) have survived a trauma at some point in our lives. I am not saying that trauma causes trichotillomania or skin picking disorder. I believe that healing trauma can empower us to fight the behavior and reduce the triggers that lead us to pick or pull in our current lives.

I bring this up after a pattern of unfortunate discussions where trauma was dismissed altogether once the topic of BFRB came up. In our effort to dispel the myth that BFRBs are solely a symptom of a major repressed childhood trauma, I believe our message overcompensated a bit and overshadowed the fact that sometimes trauma is a very important piece of the BFRB puzzle. Again, I am not saying trauma is related to all BFRBs, I am saying it is worth considering on a case by case basis.

What is Trauma?

When I talk about trauma, I refer to our nervous system’s reaction as opposed to a specific event that occurred. Trauma usually impacts people when they perceive their self or a loved one is in danger. Danger may or may not actually be present, but the nervous system is not always that logical. In addition to traumatic events, the nervous system may respond to chronic stress, dramatic change, shame, betrayal, or prolonged chaos as if trauma were present.

Every person’s nervous system is different. Some of us are built with a resilient system, while others may be more vulnerable to stress, chaos, or being startled or shamed. Those with a more sensitive body/nervous system can hold onto that experience for months, years, or even decades. It is not about the event, it is about how that circumstance was internalized by this survival oriented parts of the brain. Some people will have a visceral, nervous system shifting, traumatic reaction to a being yelled at during a vulnerable time or getting into a fender bender. These events are nearly universal. When scars, wounds, and bald spots are visible to people around us, their negative responses and the resulting shame and isolation can be traumatic. Then of course the statistics behind how many people survive sexual assaults, terror attacks, and witnessing acts of violence, are truly overwhelming. The BFRB population is not immune to being a part of those events, events which become major parts of our lives.

Long after situations which lead us to where we are now have passed, our body and nervous system may continue to function as if it is still ongoing. Essentially our body remains on guard for danger, sustaining itself in fight, flight, or freeze mode. People respond to trauma in many ways, so they may be impacted by trauma even if they do not meet diagnostic criteria for PTSD (Post Traumatic Stress Disorder). Trauma-informed therapy help restore the nervous system for real healing. It builds resilience in our nervous system, emotions, and life functioning. Specifically, I use Somatic Experiencing as the modality for treating trauma in therapy.

Trauma significantly impacts what therapy looks like and its effectiveness for BFRB, but this lens can really help. With some time and focus spent on healing trauma, a client can begin to feel safe enough to be seen, work through shame, develop healthy ways to self soothe, and become ready for change. Therapy, especially for BFRBs, is best when the client is curious and open to the process. Yet the nervous system is only wired to allow for curious and receptive states when it knows it is truly safe. It is not just a logical process of being safe, it is the reptilian, survival mode in the brain that needs to be calm and ready.

Comprehensive cognitive behavioral therapy (ComB) as taught by the Trichotillomania Learning Center to help with BFRBs has been effective in my practice. ComB leads to the exploration of many factors related to the picking and pulling. The thoughts, emotions, sensations, and places brought up in the ComB assessment may be triggers for traumatic memories, implicit or explicit.

Neurons that Fire Together Wire Together

Basic neurobiology shows that “neurons that fire together, wire together.” (Dan Siegel, 2010).  BFRBs already appear to be hardwired in our brain, and when BFRB patterns get wired to a trauma response, it can feel powerless to take on one without the other. Somatic Experiencing calls this overcoupling. It is not uncommon for the picking or pulling to start long before any traumas. However, if the BFRB soothes when lonely, helpless, scared, worried, or angry, and you must find a way to cope with a trauma making you feel that way. Then your brain starts to link the BFRB to the a trauma. Now they are overcoupled, tied together in the brain and nervous system.

I see a pattern of clients who come in for BFRB and gradually reveal much unprocessed and un-integrated trauma, complex trauma, and/or so much chaos growing up that their nervous system had to find some way to cope. Ultimately, they found some way to self soothe and picking or pulling did the trick. It is common for clients to be unaware of this link and even deny it in the ComB assessment, but I watch as their nervous system gets activated around a traumatic topic, their hands get busy, start searching, fidgeting, or even start to engage in the BFRB.

“Studies suggest that prevalence of PTSD in trichotillomania may be higher than in general population and that more different type trauma story is related to duration of hair pulling period and location of bald area.”  (Aytac, 2017)

How do BFRBs get Uncoupled?

Research distributed through the Trichotillomania Learning Center is already supporting the push to include psychotherapy interventions with CBT, HRT, and ComB. These therapies show some effectiveness in helping clients self soothe, learn to regulate their own emotions, communicate assertively, become more mindful, and resolve major life stressors that make it really hard to focus on or make progress with the BFRB treatment. To this I add trauma-informed treatment approaches grounded in neuroscience. I am trained in Somatic Experiencing (SE), so this is the specific skill set, language, and lens through which I observe my clients and deeply impacted my own journey. When working with trauma using SE, you discover and renegotiate over coupled emotions, thoughts, images, behaviors, and bodily sensations. While it can take time, teasing out what are the past and present issues, doing so can be freeing and bring much clarity. It also takes the “umph” out of the triggers- both BFRB and PTSD.

What I see in my clients’ progress and in my own life, is that once the uncoupling has occurred, and the barriers to feeling safe enough in a helping setting are lifted, we can then use those great CBT assets to take on the picking and pulling head on. Often, I see the need to turn to those techniques dissolve significantly. Therapy can be linear, a matter of getting the trauma out of the way so we can use ComB for the BFRB, but sometimes is a process of oscillating between working with the trauma and BFRB. There have even been cases that with the resolution of the trauma we do not need to continue to use the ComB interventions beyond general coping skills, boundaries, and self care.

Studying Somatic Experiencing (SE) for trauma and ComB for BFRB’s separately yet concurrently has been very eye opening for me. The overlap between the two I find very exciting. Here we have a BFRB disorder that seems to have strong links to the brain, nervous system, body sensations, and an eclectic constellation of emotional and situational triggers unique to each person. At the same time, we have a treatment option grounded in all of those factors that is designed for trauma, an issue few of us fully escape.

Dissociation

Clients recount their experiences of suddenly looking up in the midst of a BFRB and realizing 15 minutes, 45 minutes, 3 hours, or even 10 hours have passed as if it were a in a blink of an eye. When a client loses time while engaging in a BFRB, such as reporting they “go away,” or feel “out of body,” these are signs of some level of dissociation. Dissociation can also be a symptom of trauma and is treatable with SE. What I see is that sensations leading up to this can be caught, felt, tolerated, and settled before reaching this point. If you find yourself already there, the BFRB is happening but you cannot seem to get control over your body, try some of the tips listed later in this article to ground and settle the dissociative episode.

When the survival part of the brain believes it cannot fight off the danger or flee to safety, it defaults to an immobility response. Like the opossum “plays dead,” we have a broad spectrum of dissociated states as a lingering impact of trauma. Dissociation is like a faux death, the stimulation and touch of picking and pulling lets us know we are alive. While not ideal, it is an effective way to soothe. BFRBs stimulates us to get back into our body, soothes us when overwhelmed. It can be done alone; we do not need a safe caregiver to rely on.

With bodily awareness that comes from this approach to trauma, the client develops more awareness of the picking and pulling behaviors. Even the unconscious, automatic BFRBs are more accessible. Those micro movements, thoughts, emotions, and seemingly irrelevant sensations that precede and build up to the pick or pull become a wealth of information. They serve as cues to self soothe, grab a fidget, or find a way to prevent the next pick or pull. As we know from habit reversal training, the sooner in the chain of events we intervene, the more effective we will be at stopping the next pick or pull before it happens.

Self Help Tips

Here are some ways to integrate healing your nervous system into your own BFRB journey:

◦     Orienting to 5 senses. This is a meditation practice that involves slowly and mindfully noticing each of your five senses. Spend about a minute each observing what you see, hear, feel, taste, and smell. Move your neck slowly as you look all the way around you. Notice what bodily sensations come up as you become more present in the moment and environment. This process communicates to your nervous system that you are safe now, grounding you in the present moment.

◦     Sensory tracking. Non-judgmentally notice various sensations in your body: tightness, softness, textures, temperatures, urges to move, breath, stomach, pressure, etc. Observe how the sensations evolve as you name them. Try this in joyous time and when relaxed just as much as the hard times. If noticing sensations becomes disturbing, please bring these concerns to a trauma-informed therapist.

◦     Resourcing. Self care is essential, so engaging in both our internal and external resources regularly is a lifelong intervention that makes you more resilient. When you are in difficult moments, struggling with an urge or simply stressed out, bringing these resources to mind can help settle your nervous system and help you cope.

◦     Log Sensations when tracking your BFRB. If you keep a log of your picking and pulling patterns, make a note of the bodily sensations that came up before, during, and after the pull as well as thoughts and emotions.

     Trauma First Aid. These are simple, structured exercises that you can do to integrate your nervous system. Sit in a calm and safe space with both feet on the floor. Start noticing the sensations in your feet and really feel the contact with the ground. Body part by part, work your way up scanning your body and trying to put words to describe the sensations you feel. Feel the support of the chair under you. Feel the air in your lungs. Imagine a color that represents your current state.

◦     Breathing with a Fidget. Each breath serves our body the way it needs to in that moment. Paying close attention to your breath can help your nervous system settle and calm down when activated. Trying holding a stretchy fidget to represent your airways and lungs. Stretch it with each inhale and relax it with each exhale. Try to keep it in sync with the rate and depth of your breath, and watch how your breath naturally slows down and gets so very deep. Spontaneous breath comes on its own, and washes over you with an indescribable calmness.

What I ask both clients and treatment providers to hold in their awareness is that trauma may not have “caused” the BFRB, but it may very well be a vital part of recovery. I want to stress the importance of helping the whole person including their picking and pulling struggles. Somatic Experiencing is designed to be integrated into other comprehensive treatment modalities. This lens can be overlaid with the ComB model quite neatly to support our clients and their nervous systems.

For more on skin picking disorder treatment click here.
For more on hair pulling (trichotillomania) treatment click here.

Citations:

Siek, A., Makarewicz, A., Lobejko, L., Gralewska, A., Tomaka, J., Szymanska-Piekarczyk, J., …& Juchnowicz, H. K. (2017). “Pulling hair out of the head” -the importance of traumatic family events in the development and maintenance of trichotillomania symptoms-case report. Current Problems of Psychiatry, 18 (4), 367-377.

Aytac, H. M. (2017). History of Trauma adn Current Posttraumatic Stress Disorder in Trichotillomania: A Case Report. Klinik Psikofarmakoloji Bulteni, 27, 133.

Siegel, Daniel J., 1957-. (2010). Mindsight : the new science of personal transformation. New York :Bantam Books.

Stacy Nakell, A Healing Herd: Benefits of a Psychodynamic Group Approach in Treating Body-Focused Repetitive Behaviors, International Journal of Group Psychotherapy, 65, 2, (295), (2015).

Peter J. Taylor Ph.D., SEP, CGP, FAGPA, & Roger Saint-Laurent Psy.D., SEP, CGP (2017). Group Psychotherapy Informed by the Principles of Somatic Experiencing: Moving Beyond Trauma to Embodied Relationship, International Journal of Group Psychotherapy, 67:sup1, S171-S181.

Heller, L., & LaPierre, A. (2012). Healing developmental trauma: How early trauma affects self-regulation, self-image, and the capacity for relationship. Berkeley, CA: North Atlantic Books.

Click Here for a peer reviewed, scientific article about Somatic Experiencing. :
Front. Psychol., 04 February 2015 | doi: 10.3389/fpsyg.2015.00093
Somatic experiencing: using interoception and proprioception as core elements of trauma therapy
Peter Payne¹, Peter A. Levine² and Mardi A. Crane-Godreau^1*

About Priscilla Elliott, MA, LPC, SEP

Owner and Psychotherapist at Courage Counseling in Austin, Texas specializing in helping clients with BFRBs. Courage-Counseling.com

Graduate of TLC’s Virtual Professional Training Institute

Completed full certificate program of Somatic Experiencing Training Institute. http://www.traumahealing.com/

Dedicates much time to community outreach for BFRB education

The post The Role of Trauma in Trichotillomania, Skin Picking Disorder, & Body Focused Repetitive Behaviors appeared first on Courage Counseling, PLLC.

As for the part about coming out of the closet, skin pickers and hair pullers often struggle with their own closets. Hiding the wounds and bald spots, feeling as if they are the only one, blaming themselves. Coming out of that closet has the potential to empower you in so many ways and break through the shame and stigma that tries to hold the closet door shut.

http://www.upworthy.com/a-4-year-old-girl-asked-a-lesbian-if-shes-a-boy-she-responded-the-awesomest-way-possible?c=gt1&fb_source=message

For more on skin picking disorder treatment click here.
For more on hair pulling (trichotillomania) treatment click here.

The post The Brain on Hard Conversations appeared first on Courage Counseling, PLLC.

Long after the situations which lead us to where we are now have passed, our body and nervous system may continue to function as if it is still ongoing. Basically, our body remains on guard for danger or attempts to sustain fight, flight, or freeze mode. People respond to trauma in many ways, so they may be impacted by trauma even if they do not meet diagnostic criteria for PTSD (Post Traumatic Stress Disorder). Therapy can help restore the nervous system for real healing, and it can build resilience in our nervous system, emotions, and life functioning.

Here are some resources to learn more about trauma, in addition to therapy with a specially trained counseling professional: http://www.traumahealing.com/somatic-experiencing/bookstore_all.html

To read more about trauma treatment click here

The post What is Trauma? appeared first on Courage Counseling, PLLC.