In the first part of this article, I looked at how triggers are an everyday occurrence for many trauma survivors and what an impact they can have on us. But as well as being unwelcome intrusions, triggers are also clues to our dissociated trauma, little ‘pop-
The problem lies in the fact that our amygdala, which functions as a kind of ‘smoke alarm’ in the brain, responds so quickly and so automatically to potential threats (within 7 milliseconds and outside of conscious thought), that if we were in a lot of ‘fires’ as a child, we react without even thinking to the merest ‘whiff of smoke.’This automatic, hardwired survival response is built into every single human being, but it has become over-
THE BRAIN AND TRIGGERS
Of course our brain is a single yet highly complex organ with many interrelating parts or areas, and yet it can be helpful to think of it in terms of two separate units: front and back. As I have said before, some of the problems that we face as dissociative survivors is that the connections between different parts of our brains are not as well developed as they might be, and that is certainly true for the highway between the ‘front’ and the ‘back’ brain. Our front brain plans and considers and assesses and thinks; and our survival-
Of course, the first and most important thing to realise is that we can actually do something. I believe that the core essence of trauma is helplessness – it is being overwhelmed and powerless where there is absolutely nothing that we can do to stop what is happening to us. For many of us who have gone on to develop a dissociative disorder, that sense of helplessness lives on in a very powerful but often unconscious way, infecting everything that we do with a sense that we can’t. It is a habit that our brains developed in childhood because chronically, over years and years, perhaps hundreds or even thousands of times, we experienced traumatic events where we experienced intense helplessness. Our brains grow and develop in response to our experience, especially repeated experience. And so quite without any sense of choice, most of us developed a chronic sense of learned helplessness: this can become a default state that we are triggered back into, either when we are reminded directly of our original trauma or when we are hit by a circumstance in the here and now that renders us helpless again.
And being triggered – being hit by an automatic body-
So what therefore can we do when we are triggered? I believe that we need a ‘go to’ strategy, something that is easy to remember even when our front brains are screeching to a halt, and something that works in a variety of settings. What I developed for myself was something that came out of understanding a little bit about the front brain, and how three general areas of the front brain, with their own particular characteristics and peculiarities, can be engaged to help us get back in control again when an unexpected trigger knocks us off course.
THE THREE PARTS OF THE FRONT BRAIN THAT I AM REFERRING TO ARE:
- the front left brain: the dorsolateral prefrontal cortex
- the front right brain: the right orbital prefrontal cortex
- and the front middle brain: the medial prefrontal cortex.
Of course this is a simplification, and is looking at the brain in metaphorical terms rather than strictly neuroscientific terms – because the aim is not precise brain surgery, but to understand generalised differences in the way that our front brains work which we can then tap into to manage triggers better.
STORED INFORMATION AND TRIGGERS
So firstly, there’s the dorsolateral prefrontal cortex: the front left brain. This is the part of the brain that holds information as facts: that Paris is the capital of France, that Shakespeare wrote Macbeth, and that I am safe here – the logical, factual part of that statement, not the emotional, experiential part of it. There are many people with dissociative identity disorder who have great, even highly-
Doing those kinds of things turns on the front left brain, and because the front and back brain operate like a kind of see-
That is also why work is so often a stabilising factor for many trauma survivors – work that isn’t too complex and stressful and full of relational conflict and high risk, but work that engages our front brains to come online and stay online. We really shouldn’t underestimate the role that work plays in keeping our front brains on and keeping us stabilised. Certainly my worst time after my breakdown in 2005 was during 2008 when I gave up work – because I felt I couldn’t cope any more – and without the demands of work to keep my front brain online, things actually got a lot worse for me very quickly. I went through a period of several months where I was what I might call ‘back brain activated’ most of the time, and where I was resorting to medication and self-
So the front left brain can be viewed as the facts-
ATTACHMENT IN TRIGGERS
Firstly, there is what we can call the front right brain, the right orbital prefrontal cortex. This is the region of the brain that is involved in attachment, in human relationships, especially between a mother and her baby. Attachment theory is critically important to understanding and recovering from dissociative disorders, and I cover it in detail in my Working with Relational Trauma training day, but suffice to say here that the front right brain is switched on during what we might call ‘attachment moments’ – times when a mother soothes her baby with touch, with eye contact, with a reassuring tone of voice. And these ‘attachment moments’ can be replicated by a partner – someone with whom you have a close emotional bond – as well as the therapist who acts as a soothing presence to their client during times of hyperarousal or agitation. We all know how powerful it is to have someone who cares about us come alongside us when we are triggered and help us to down-
The front right brain also has quite good links to the amygdala, meaning that human contact – especially at the level of an attachment relationship – can help to turn down the sensitivity of the smoke alarm over time. If there are repeated soothing moments, a neural network can develop in the brain and the front right brain can in effect ‘inhibit’ the smoke alarm, making it less likely to go off at just a whiff of smoke. This is what we should have developed in childhood – the ability of the front brain, in effect, to down-
This is what I have experienced a thousand times in therapy sessions when my feelings have suddenly hijacked me and I have been triggered into a high-
NEGLECT AND TRIGGERS
The impact of neglect on the front right brain has perhaps most strikingly been seen in brain scans on the Romanian orphanage children highlighted by television documentaries in the 1980s. These children, victims of Ceausescu’s regime, received the most minimal levels of care and attention, many of them being washed and fed but otherwise ignored – no cuddles, no interaction, no play, no love. On brain scans, the area of the front right brain that we are talking about here, the region connected with attachment and emotional regulation, was more or less missing: ‘black holes’ showing the lack of development arising from extreme relational neglect. Although most of us with DID will not have such evidently absent right brains, many of us will however manifest some degree of underdevelopment. And we see the impact of this in our difficulties with relationships and especially attachment relationships, as well as our struggles with managing our emotions. And this is why we can’t just “get better” or “snap out of it” as many of us will have been exhorted: we’re actually ‘brain-
The good news is that attunement and empathy can actually ‘grow’ this front right part of our brains, and that is why attachment relationships including ones with partners and with therapists are so important. It also hints at why when we do develop secure attachments, it positively impacts our ability to cope better with adversity and manage our feelings within a wider ‘window of tolerance.’ For me personally, perhaps the greatest impact I have seen over the last few years has been the way in which my front right brain has helped to turn down the sensitivity of my ‘smoke alarm,’ meaning that I am much less often triggered nowadays, and much less severely. Even when I am, I can use what I have learned in therapy to coax myself back down to a more settled state.
FEELINGS AND TRIGGERS
The other part of the front brain that we can tap into and which is helpful for modulating the smoke alarm is the front middle brain, the medial prefrontal cortex. You may be thinking, “But what do I do when my therapist or partner isn’t around? What do I do if I haven’t got a therapist or partner in the first place?” And they are very real concerns. But the good news is that the medial prefrontal cortex is part of the brain that everyone can tap into, at any time of night or day. It is a part of the brain that is concerned with self-
Research has shown that this part of the brain also tends to be quite depleted in chronic trauma survivors – many of us struggle to know what is going on inside us! I suspect that some of the reason for that is because we are so focused ‘out there,’ being hypervigilant for threat, that we have never stopped to look ‘in here.’ And if we do, then the ‘in here’ bit is so often fraught with feelings of yuk and shame and horror – we don’t want to feel what we’re feeling; we don’t want to think about what we’re thinking. And that of course is the very essence of dissociation. Many of us, therefore, have ended up with a quite underdeveloped medial prefrontal cortex – which is a real shame as it has the best connections or pathways to the amygdala.
The most successful emerging therapies in working with DID seem to be those that employ so-
And perhaps most critically for me personally, it meant that I had a new strategy when I was triggered. When my back brain had switched on and my front brain had switched off, I began to realise that I needed to talk myself through it. At first I needed the support and coaching of my therapists to do it, for them to help direct my attention and for them to help me to step back from myself and just observe what was happening and to name it. So I began to learn to develop a self-
And even by doing this – even by putting these things into words, we are automatically bringing our front brains online, by engaging Broca’s area, the speech and language centre. But the real key is to be able to turn our attention inwards and to observe what is going on in us so that it is just something that is going on in us: it is just a thought, just a feeling, just a sensation. It’s not the entirety of our experience. If it is something separate from us, then it need not define us or control us, or be the be-
But if the feeling is just a feeling, then I can watch it come towards me, as if hurtling in my direction on the motorway at 70 miles per hour, and I can choose to watch it go past me – I just need to wait and watch it zoom past. I can step out of the way of it. And I don’t need to make matters worse by feeling not just anxiety, but frustration at my anxiety. If I just observe the single juggernaut of anxiety and watch it roar past me, I don’t have to add on a lorry-
A Sensorimotor psychotherapist with whom I worked for a number of years used to say to me in the kind of sing-
CONDITIONING AND REPETITION IN TRIGGERS
It took many months of annoying repetition but eventually I started to be able to do it for myself. So when I had a very serious near-
So there we have then the three parts of the front brain – front left, front right, and front middle, each of them with their own characteristics and their own specific ways that we can utilise to manage triggers and turn down the sensitivity of the smoke alarm over time. And using these three metaphorical regions, I have developed three strategies for turning my front brain back online when I have been triggered:
- using my front left brain, I get myself thinking – with Sudoku or word-
searches or games on my phone, with counting backwards in 7s, with filing or reconciling bank statements, with reading and journalling.
- using my front right brain, I get myself connected – preferably to an attachment figure, such as a therapist or my husband, in order to allow them to help me be soothed and calm down.
- using my front middle brain, I get myself noticing – I turn my attention inwards and I am “just curious” and I “just notice” the feelings and the physical sensations of panic, and I name them and observe them and watch them pass by without judgement or meaning-
The important thing is to find activities that help us each personally to ground ourselves when we are triggered, but using this simple matrix of three parts of the brain and the three strategies to go with it, it can help us when our front brain has gone offline and we have become foggy with panic and we can’t remember what to do. For that purpose, quite some time ago PODS produced some laminated posters of this grounding technique that I have described here, with the three parts of the brain relating to the three strategies for grounding. They are ideal for sticking on the fridge or a kitchen cupboard or wherever you need to put them to help you through those inevitable times when, against our will, at the most inconvenient of times, we are triggered by our oversensitive smoke alarm.
But the promise is there that if we will develop these grounding activities and repeat them and repeat them and repeat them some more, then we will develop new patterns in our brain, new neural networks, that over time will reduce the sensitivity of our smoke alarm which has become over-