Dr Richard Bolstad is Transformations Principal Trainer

Resilience, Recovery and Chronicity

Creating A World Worth Living In

Trauma and Human Resilience

When a traumatic event occurs, a neural network is set up in the brain with memories of the event (VAKOGAd), instructions about attempted responses (K), a time/place coding (Hippocampus) and an emergency rating (Amygdala). If the emergency rating is low enough, a pattern of Resilience occurs, where the person is distressed by the event but able to keep functioning normally. If the rating is high enough then at least for some time a PTSD-style response will occur and the person will have severe difficulty performing normal daily functions. The neurotransmitters which connect the new neural network are those present at the time, which is likely to include a lot of transmitters such as noradrenaline and adrenaline. The aim of the Amygdala connection is so that in any future similar events, the neural network will have override priority and be able to stop the Frontal Cortex (Conscious Goalsetting etc) from endangering life by thinking through a planned response. While this mostly saves lives, occasionally it results in a panic response which is triggered accidentally by sensory stimuli that are themselves not dangerous. In that case most people will gradually edit the neural network over the next couple of months so that it no longer interferes with everyday functioning, a pattern called Recovery. Some people have a pre-existing thinking style which makes recovery difficult (eg a pattern of constantly checking in case something bad is about to happen again) and they will then continue to have problems long term, a pattern called Chronicity. Which of the 3 patterns will occur is determined by the pre-existing thinking style and model of the world, previous experience of similar trauma, the severity of the current traumatic events, and the social support available at the time of the current trauma.

"Epidemiological studies estimate that the majority of the U.S. population has been exposed to at least one traumatic event, defined using the DSM--III criteria of an event outside the range of normal human experience, during the course of their lives. Although grief and trauma symptoms are qualitatively different, the basic outcome trajectories following trauma tend to form patterns similar to those observed following bereavement. Summarizing this research, Ozer et al. (2003) recently noted that "roughly 50%--60% of the U.S. population is exposed to traumatic stress but only 5%--10% develop PTSD" (p. 54). However, because there is greater variability in the types and levels of exposure to stressor events, there also tends to be greater variability in PTSD rates over time. Estimates of chronic PTSD have ranged, for example, from 6.6% and 9.9% for individuals experiencing personally threatening and violent events, respectively, during the 1992 Los Angeles riots (Hanson, Kilpatrick, Freedy, & Saunders, 1995), to 12.5% for Gulf War veterans (Sutker, Davis, Uddo, & Ditta, 1995), to 16.5% for hospitalized survivors of motor vehicle accidents (Ehlers, Mayou, & Bryant, 1998), to 17.8% for victims of physical assault (Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993). Although chronic PTSD certainly warrants great concern, the fact that the vast majority of individuals exposed to violent or life-threatening events do not go on to develop the disorder has not received adequate attention. It is well established that many exposed individuals will evidence short-lived PTSD or subclinical stress reactions that abate over the course of several months or longer (i.e., the recovery pattern). For example, a population-based survey conducted one month after the September 11th terrorist attacks in New York City estimated that 7.5% of Manhattan residents would meet criteria for PTSD and that another 17.4% would meet the criteria for subsyndromal PTSD (high symptom levels that do not meet full diagnostic criteria; Galea, Ahern, et al., 2002). As in other studies, a subset eventually developed chronic PTSD, and this was more likely if exposure was high. However, most respondents evidenced a rapid decline in symptoms over time: PTSD prevalence related to 9/11 dropped to only 1.7% at four months and 0.6% at six months, whereas subsyndromal PTSD dropped to 4.0% and 4.7%, respectively, at these times (Galea et al., 2003)." -- Bonanno, 2004

Bonanno, G.E. "Loss. Trauma and Human Resilience" American Psychologist, January 2004, Vol. 59, No. 1, pages 20--28 (Quote from page 24)

Patterns of Resilience and Recovery

The American Psychological Association says research suggests "10 Ways to Build Resilience", which are:

(1) maintaining good relationships with close family members, friends and others;
(2) to avoid seeing crises or stressful events as unbearable problems;
(3) to accept circumstances that cannot be changed;
(4) to develop realistic goals and move towards them;
(5) to take decisive actions in adverse situations;
(6) to look for opportunities of self-discovery after a struggle with loss;
(7) developing self-confidence;
(8) to keep a long-term perspective and consider the stressful event in a broader context;
(9) to maintain a hopeful outlook, expecting good things and visualizing what is wished;
(10) to take care of one's mind and body, exercising regularly, paying attention to one's own needs and feelings and engaging in relaxing activities that one enjoys.

(11) Learning from the past and
(12) Maintaining flexibility and balance in life ... are also cited.

In the research below, Japanese ancestry Americans had only 14% of the incidence of PTSD that European ancestry Americans had. That beats any PTSD treatment success rate I've read about! Polynesian (in the research, specifically Hawaiian; in many ways the same culture as New Zealand Maori or Samoan) ancestry also reduced PTSD rates to 35%. Resilience is pretty much the core successful human response to disaster that NLP seeks to remedially create (in fact NLP goal-setting, reframing and dissociation are all listed in the 10 points above). Note that research show that resilience is not a set personality trait so much as a set of actions you can choose to take. Also note that in the same research, a past history of being a survivor of violence almost doubles the risk of PTSD (177%). Good relationships buffer us from harm, bad ones signal a need for extra support.

Schnurr, P.P., Lunney, C.A., and Sengupta, A. "Risk Factors for the Development Versus Maintenance of Posttraumatic Stress Disorder", Journal of Traumatic Stress, Vol. 17, No. 2, April 2004, pp. 85--95

Chronicity Strategies

Adapted From Andy Austin's Patterns of Chronicity

These strategies or patterns of thinking may seem innocuous during easy times, and then create Chronicity during traumatic times. To the person, they seem normal ways of approaching challenges, and it can help to show them how these patterns ensure that positive change is impossible. Having done that it becomes possible to install more resilient patterns, for example installing new key questions.

The Big "What If..." Question
"Yes, but, what if... which means...(an impossible to manage scenario)?" The positive intention of negative "What if?" questions is to attempt to anticipate and find solutions to future challenges, but by running it on impossible scenarios, the person is locked in panic.

The Big "Why...?" Question
"Why did this happen to me?" The positive intention of past-related "Why?" questions is to find new meanings, but the person rejects each possible future-oriented meaning and keeps searching as if trying to find a meaning which can change the traumatic event or recreate the past.

The Big Maybe Response
When asked to scale their current experience of an emotion, or give any report on their internal experience, the person says they are not sure, or prefaces their answer with "Maybe". The positive intention of "Maybe" responses is to avoid mistakes such as false hope, but by refusing to commit to any specific data, the person can never measure change and can never experience success.

Testing for Existence of The Problem Rather Than Testing for Change
Even though 99% improvement might be made, if the person with chronicity is able to locate just 1% of the problem existing, this will generally be seen as representative of 100% of the problem existing. The positive intention of "Can I still do it?" responses is to detect and respond to danger effectively, but by failing to notice improvement the person continuously reinstalls the entire problem.

Negative Nominalisations
The person talks about their traumatic responses as if they were "things" rather than actions. "I have Trauma", "I have PTSD", "I have a Wounded Inner Child", "I have a Clinical Depression.". The positive intention of Negative Nominalisations is to explain what is happening by labelling it, but the result is that the processes being discussed seem permanent, damaged and even become personified as malevolent, and so are unable to be simply changed.

Being "At Effect" rather than "Being At Cause"
By being "at effect" the person experiences emotional problems happening to them, rather than being something that happens by them. A person "at effect" will seek treatment rather than seek change. Questions such as "Will this work for me?" or statements such as "It didn't work for me." And "It worked for a day and then the problem came back." Presuppose that the problem and the NLP process are 100% responsible and the person themselves is 0% responsible for their own results. The positive intention of "At Effect" responses is to explain what is happening without being at fault, but by not allowing for the possibility of their responses affecting their internal experience, the person makes it impossible to change their experience.

Three Stage Abreaction Process
The person has a "nocebo" ("I will harm"; the opposite of placebo) response to NLP processes where they have an "uncontrollable" negative response to all interventions designed to actually help them change, although they permit interventions which maintain their problem. The positive intention of "Abreaction" responses is to protect the person from feared results of the change process, but they block all change.
Stage 1. Signal (Implied Threat of Emotion) eg "This is making me feel ill."
Stage 2. Increased Amplitude of Signal (direct Threat of Emotion) eg "Now I really feel sick. Your process is harming me. Stop or I will start screaming!"
Stage 3. Abreaction (Punishment of the Practitioner) eg vomiting, convulsing, running out of the room screaming, uncontrollable crying.
Arthur Barsky, a psychiatrist at Boston's Brigham and Women's Hospital gives a profile of the kind of patient likely to experience the nocebo effect from medical treatment - worse side effects and poorer outcomes - on a given drug. The patient has a history of vague, difficult-to-diagnose complaints and is sure that whatever therapy is prescribed will do little to solve their problem. Barsky notes that about 20% of patients taking a sugar pill in controlled clinical trials of a drug spontaneously report uncomfortable side effects - an even higher percentage if they are asked. This is quite likely the medical version of the effect we are seeing with chronic NLP clients who have negative effects such as headaches and sudden emotional flooding from NLP sessions which are usually positive and change producing.

Adapted from: Austin, Andrew, Integral Eye Movement Therapy Practitioner DVD Set, IEMT, London, 2010

Key Questions

Deciding what you'll ask of life!
Adapted from Steve Andreas (Core Questions)

1. Resourceful state; Rapport

2. Ask them what situation, or what context they want to find the core question for. (eg. "at work" "my relationship with my kids" "dealing with a client/student")

3. "As you think of that situation, imagine stepping back into your body there. Notice what you see through your eyes there, what you hear, and what you feel in your body. Be aware of how you are deciding what actions to take."

4. "If there were a question that quietly guided all your behaviour in this context, what would it be?"

5. "Now think of that question. Check that when you say that question to yourself, it reminds you of the situation." (You're checking it has the same submodalities; ie feels like thinking of that situation itself).

6. "If you knew, what is your unconscious mind's positive intention in asking this question in this situation?" If the person tells you a negative intention (like "to get me worried") ask "And if it gets you that fully and completely, what even more important thing will you get through that?"

7. "Is there a question that would be even more effective in getting you the positive benefits you want in that situation?"

8. If there is, say "I'd like you to step back into your body in that situation, and say the new question to yourself -actually say it aloud now, as you imagine being in that situation. Notice that when you're in that situation now, the new question is quietly at the back of your mind, guiding your behaviour, and check that that feels much more enjoyable! Imagine a future time, when you'll be in that situation again, and check how asking that new question changes the way it feels."

Verbal First Aid In A Disaster

First Things First. Call emergency services. Get person to medical help. Use first aid as per manuals.

Establish alliance. Let them know you are here to help. "I'm [name] and I'm going to help you."

Get contract. Ask them to help you. "Will you relax and stay here while I help?"

Be realistic. Truthful simple reassurance. "The worst is over. Your body is already healing itself, and help is coming."

Pace. Touch the person and verbally pace their state. "I can imagine this has been scary."

Distract from pain. Shift their attention elsewhere. "I can see your [body part] needs attention. Can you check the rest of your body to tell me how it feels here... and here... and here?

Ask for their help. Give them something to do (anything). "Can you hold this phone while I bandage your arm." "As I move this arm can you breathe deeply."

Ericksonian suggestions for healing. Say suggestions clearly and firmly, using Ericksonian language. "As you holdM my hand you may notice the tingly feeling that lets you know healing is happening, and you can realise that the emergency services are on their way and you can relax." "As we have now cleaned up the wound, your body will stop the blood flow here, and you can begin to notice which way to position yourself to feel more comfortable." "Perhaps it has already occurred to you to think of a place where it would be nice to be resting right now, perhaps cooling this arm in a nice mountain stream, or relaxing in a warm bath."

From "The Worst Is Over" by Judith Acosta and Judith Simon Prager, Jodere Publishing Group, San Diego 2002

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