This article contains detailed information and accounts of suicidal ideation & behavior. If you or someone you know may be considering suicide, get help now.

To continue to discuss the very different types of experience people have with depression, this is one that most people don’t experience, but is important to address, since some do. Suicide is not in this case a tool to get people to do or feel what the suicidal person wants; it’s simply the ultimate way to make unrelenting emotional pain stop.

I believe people’s experience of the emotional pain of life varies tremendously. Some of this is due to genetically influenced brain chemistry and resilience, but much of it is due to how much trauma and emotional hurt, loss, injustice, abuse, and other painful experiences people have experienced. We have beta endorphins in our brains to numb pain and create euphoria, so we can handle both physical and emotional pain. But people are born with varying amounts and life events can influence our supply as well. For people with very little of this chemical, life is much more painful. (more…)

This article is part II of a three-part series. Part I introduced the first phase of healing, the safety phase.

As you pass out of the first phase of healing, you may feel as though you have a new lease on life and want to step out of your healing journey.

While you have more than every right to do this, the first phase is ultimately not sufficient to bring whole and complete healing. The real and perceived safety that you established within the first phase of healing—within yourself, with the people in your life, and in your physical environment—becomes the foundation that allows you to grow into the second phase of healing. In this second phase of healing, the actual traumatic experience is grappled with through remembering and mourning.

Integrating Traumatic Events into Your Personal History

Remembering allows you to address your trauma story by placing the event, or events, into your life history. This is giving your memories temporal dimensions. Due to the physiological processes that are “online” during a traumatic experience, the subsequent memories can seem to float outside of time and space rather than being rooted in the timeline of your life. To truly heal and integrate the reality of your traumatic event, the experience needs to settle into your life history.

To achieve this, a therapist can work with you to review your life before the traumatic event, the circumstances that led up to the trauma, and life after the trauma. Such a life review includes looking at others’ reactions, as well as acknowledging and healing from secondary wounding experiences.

By engaging in this emotional work, you transform the traumatic event from something that was done to you into something that is a part of your life experience. Rooting the traumatic event into your collective life history enables you to reclaim yourself—not the trauma—as the main character in your life, and allows your personal meaning of the trauma to come to the surface.

Reconstructing Trauma Memories

Once the experience of trauma is rooted as a part of your life experience—as an event that has a sense of time and space—the next step is to reconstruct the traumatic event. This is not memory recovery work: no memory is created where there is none. Instead, your therapist will work with whatever memory you have, regardless of length or detail. The purpose is to transform the trauma memory from a frozen moment of terror into a memory that reveals your feelings about and interpretation of the event.

This work is done one small piece at a time, with the guidance, support, and assistance of a competent professional. Despite the therapist being “the expert,” you, the survivor, have the final say about the pace of this work. The end result for most survivors is that their trauma story is no longer one of humiliation and shame, but rather one of virtue and dignity.

Remembering the traumatic event or events and connecting them to words and emotions enables you to mourn what you have lost. While trauma may or may not result in physical loss, it always results in psychological losses. Emotionally connecting with your losses is a courageous act. It can feel scary or even terrifying, because this acknowledgment can confirm the finality of the losses.

Moving Beyond the Second Phase

For many, the work of remembering, mourning, and grieving feels endless, regardless of the actual amount of time this phase encompasses.  Keep in mind that there is no set time limit to this phase. Every survivor spends a different amount of time in this second phase of healing, but it cannot be skipped nor rushed.

Survivors will know that they are nearing the end of the second phase of healing when, as Dr. Judith Herman states, “It occurs to the survivor that perhaps the trauma is not the most important, or even the most interesting, part of her life story…when the patient reclaims her own history and feels renewed hope and energy for engagement with life. Time starts to move again…the traumatic experience truly belongs to the past. At this point, the survivor faces the tasks of rebuilding her life in the present and pursuing her aspirations for the future.”

“It feels heavy right here,” Rebecca* said, crying and touching her chest, “like a huge rock is sitting on me. It’s like that old cartoon, where a boulder would fall off a cliff and pin the roadrunner to the ground—it feels like I can’t move.”  Rebecca, a 32 year-old successful marketing professional whose older sister had recently been diagnosed with a psychotic condition, had come to see me last year. She seemed lost in grief. Fluctuating bewilderment, sadness, fear, anger, tenderness, and love were tying knots in every part of her.

I thought that untying some of the knots in her body, with the help of mindfulness practices, might help her begin to lift the boulder.

Growing up, Rebecca’s sister had provided unconditional loving support which protected Rebecca from demanding, neglectful, and painfully critical parents. She had always relied on her sister to guide and comfort her; they had always been best friends. She said that now it felt like she was standing at the edge of the ocean, watching her sister sit on a raft drifting out to sea. She had been crying uncontrollably off and on for days. What made things even harder was that her sister sometimes acted like her old self, then became delusional again. Rebecca’s emotions were rising and crashing along with her sister’s state of mind.

Mindfulness of the Body: Body Scanning and Stretching

The first foundation of mindfulness is mindfulness of the body. It is cultivated with body scanning and movement practices, like yoga and walking meditation, anchored in feeling the sensations of breathing. A body scan involves directing one’s attention to different areas, one at a time, and focusing on the sensations in each place. A scan can begin with feeling the moisture on one’s skin, sensations of warmth or coolness, pressure or tingling. Then we scan the interior of the body, noting muscle tightness or ease near the surface and going deeper, where emotions express themselves as inner physical sensations.

Building brief body scans into a sustained stretch can begin to soften tight muscles—created from strong emotions—and release the mind from thinking for a while.

Prior to entering therapy, Rebecca had taken an 8-week course in Mindfulness-Based Stress Reduction (MBSR) from me. MBSR is based on the work of Jon Kabat-Zinn at the University of Massachusetts, and is taught in hundreds of hospitals, corporations, and schools in the US and around the world. Rebecca had done many body scans as part of the course. She knew how to locate and identify the physical sensations accompanying her emotional states. The following intervention was natural to offer, and easy to do with her.

Untying Knots in the Body

As Rebecca continued to cry, we talked about the benefits of recognizing and allowing her grief. But after 20 minutes of repeated bouts of intense sobbing, she asked me to help her stop. I asked if she would like me to guide her through some breathing and mindful stretching; she immediately said yes. We did a four- or five-minute sequence of stretches, while she remained seated on the couch. I guided her to stretch gently, to her limit, with each pose, holding it for 20+ seconds, and remembering to breathe. While holding each stretch, she scanned, place by place throughout her entire body, for unnecessary tension—inviting it to soften (without insisting) wherever she found it.

“Psychotherapeutic approaches that utilize mindfulness offer well-developed non-verbal exercises that enable the individual to dip into direct sensation beneath the veil of words that may often conceal the mind’s pain. This sensory immersion enables the individual to disengage from those bottom-up enslavements at the root of suffering….” (Siegel, 2007)

“Our poses can strongly influence our emotional states. For instance, because of the expansive inhalation and opening of the chest, backbending, traditionally a stimulating practice, can elevate a low mood. Exhale-intensive poses such as forward bends tend to calm an agitated mind. In any balance practice, both inhale-oriented and exhale-oriented postures are executed in order to create equilibrium in the body and breath and to gain emotional
harmony.” (Gerstein)

Untying Knots in the Mind and Heart

This practice creates a state of non-thinking in the midst of strong feelings. Non-thinking helps release habitual, reactive thought patterns as attention is redirected to the body—what is called the neutral ground of attention. If, in the heat of raw emotion, we give free rein to thinking or emotions, our familiar and deeply grooved cascades of mental and emotional activity take their usual course, often intensifying the emotions, or cordoning them off from awareness. Instead, if we direct ourselves to notice “what am I feeling in my big toe right now?” the cascade slows, or even stops, for a while. Awareness remains intact, and new, more balanced, and less distorted thoughts have a chance to arise.

When she sat up again after her last slow, deep forward bend, Rebecca’s face had softened, her breathing was quiet, and she said “it’s gone, the heaviness is gone.” She said she felt sad, but less afraid and overwhelmed. She began to speak with compassion for herself and her sister, while remaining more relaxed for the duration of the session.

Before ending, we rehearsed the practice again: she brought the feelings back into her awareness on purpose, then, increasingly independently, guided herself through stopping, breathing consciously, body scanning, and stretching/releasing tension.

Rehearsal increased the chances that she would remember to use breathing and stretching in the days ahead. Later, she reported with some relief that she had remembered and been able to stop and practice, and that it had helped sometimes. Directing focus away from thinking, and into the body, gave her a sense of independence in calming herself, and also helped her to use her considerable intelligence to understand her sister’s situation, and to face the frightening challenge of becoming independent of her sister for the first time in her life.

Practices like these are not intended to offer an easy fix for difficult emotions or life experiences. Mindfulness, at its core, involves observing things as they are and not fighting them. One formula used is Pain x Resistance = Suffering (PxR=S). Paradoxically, allowing ourselves to be with our pain, sadness, fear, or anger, frees us to go beyond them for a while. And, according to Daniel Siegel, when practiced enough, “… an intentionally and repeatedly created state can become an effortless trait of our being.”

Is prior training required for this intervention to be effective?

A person must be open to locating and feeling different body sensations. Not having this training is a limiting factor. In my experience, however, the breathing, stretching and scanning practice can lead to a similar shift in people who are receptive, regardless of having prior training in mindfulness.

*Names and identifying information have been changed for privacy

Resources:
Center for Mindfulness—Stress Reduction Program
Jon Kabat-Zinn’s Guided Mindfulness Meditations site

http://drdansiegel.com/

References:

1. Gerstein, Nancy. (n.d.). How Yoga Affects Emotions. OmPlace.com. Retrieved from http://www.omplace.com/articles/Yoga_Emotion.html
2. Siegel, Daniel J., M.D. (2007). Reflections on the Mindful Brain. New York: W. W. Norton & Company
3. Siegel, Daniel J., MD. (2010). The Mindful Therapist: A Clinician’s Guide to Mindsight and Neural Integration. New York: W. W. Norton & Company