  “Love is an emergent property of an ancient cocktail of neuropeptides and neurotransmitters.”
For hundreds of years, humans have struggled to define “love.” From Shakespearian tragedies to poetic declarations of desire, there are millions of ways to express the feelings of romantic love. While the above quote by Larry J. Young is not the most elegant description of love, it explains the biology behind love, and why we as humans are programmed to experience the joys and pains of romantic partnership. According to a team of researchers at Rutgers University, romantic love can be divided into three main categories: lust, love, and attraction. Within each category are specific chemical reactions in the body, and these reactions influence what we socially define as love. Let’s start with lust. Frequently referred to as one of the “seven deadly sins” in Christianity, lust is the biological basis for reproduction and the evolution of the human species. Lust is driven by the evolutionary need for sexual reproduction and is one of the main reasons why so many species, humans included, spend a significant amount of energy and time pursuing a romantic interest. Hormones such as estrogen and testosterone begin to rise when we come across a person we find arousing. Think back on your first encounter with your significant other or a person you found attractive; perhaps your heart began to pound in your chest, your palms became clammy, and you stumbled over an awkward introduction. All these visceral responses to lust are a part of the normal, physiologic response to deeply engrained biological processes that have allowed humans as a species to flourish. Closely related to lust is attraction. Attraction and lust are grouped into the same category in social and psychological definitions of love, but true attraction to another person originates in a different part of the brain with a unique set of neurotransmitter activity. Once we decide to pursue a romantic partner and label them as “attractive”, the brain begins to release dopamine, a neurotransmitter. Dopamine is associated with the reward system in the brain, and produces feelings of euphoria, excitement, and pleasure. As we spend more time with our romantic interest, the brain associates the attraction with an increase in dopamine. This biological process explains why we often feel as though we must spend significant amounts of time with a romantic partner, especially in the early stages of a new relationship. Increased levels of dopamine are also associated with a reduction in appetite and sleep: essentially, this means you can be so in love that you cannot eat or sleep… As relationships progress out of the initial “honeymoon” phase, a new set of neurotransmitters and hormones take over. This final category is defined by the idea of attachment and is a predominant factor in the stability of long-term relationships. While lust and attraction are associated with romantic love, attachment can also span into other types of love and relationships with family members and friends. Attachment is highly linked to the release of oxytocin, another neurotransmitter. Oxytocin is sometimes referred to as the “cuddle hormone” and is released in large quantities during activities of bonding (such as sex, holding a baby, and yes, cuddling). As romantic relationships mature and move past basic physical attraction and lust, deeper, more stable bonds begin to form. From an evolutionary perspective, lust, attraction, and attachment are all means to a single end: reproduction and the advancement of the human species. Each of these categories play a key role in the overall goal of reproduction, but unfortunately, these raw scientific definitions of love just scratch the surface of the ups and downs everyone goes through on the journey to a long-term relationship. In reality, lust, attraction, and attachment can be broken down further and reveal deeper social and psychological needs, and as many Hollywood romance movies can attest, the pathway from lust to long-term attachment can be a difficult voyage. The initial stages of lust seem simple: a gentle touch, lingering eye contact, or telling a friend about your new crush leads to a rush of dopamine that begin the spiral of “falling in love.” From here, though, how the relationship progresses becomes increasingly complex. Fear of rejection, fear of commitment, or being overly needy are frequently called out as some of the main reasons why a relationship may not progress further. In many cases, psychological predispositions and past experience with various types of relationships can profoundly impact the bonds formed with a future romantic partner. Research in this area tells us the initial bonds formed within a new romantic relationship are almost always influenced by the very first relationship we ever experience: the relationship with our parents. These early bonding experiences with our parents in infancy and toddlerhood shape how we perceive relationships and define what we view as a positive attachment. This Freudian approach to love and attachment may sound rudimentary, and many other researchers in the field argue that there are other explanations for the success of healthy attachment and how we define love. For example, a popular psychological theorist, Dr. Robert Sternberg, has proposed a whole new set of categories that define the stages of love. His initial work, published in 1986, presents the Triangular Theory of Love, which consists of intimacy, passion, and commitment. His love triangle (so to speak) is shown as the following model: From this diagram, we can see the various combinations of different types of love, and how they are intertwined and related to one another. Unlike the pure biological basis of love described earlier, Dr. Sternberg presents the idea that love is a combination of different emotions that can occur simultaneously and is not only dictated by hormones and neurotransmitters. His ideas are rooted in the psychosocial construct of love, and he relies on the human need for social connection to describe various types of love. The scientific definition of love and Dr. Sternberg’s definition of love are both right in their own respects. Simply describing love from a biological perspective does not fully encapsulate the intricacies of relationships and describing love exclusively from a psychosocial point of view does not consider the hard-wired evolutionary programming all humans are born with. As with all complex human constructs, the true meaning love is likely a combination of both definitions presented. With a deeply engrained biological need for sexual reproduction driven by hormones, combined with the need for social attachment and companionship, humans are capable of deeply emotional, romantic bonds that are unrivaled by other species. Perhaps this is why love stories are the focal point of tales told throughout generations and are highlighted in great literary works and screenplays. Love, and the idea of love, often dominate many aspects of life and the successes and failures in the search for everlasting affection and attachment. It is no surprise that many of life’s greatest celebrations and deepest heartaches are born out of love. Many often joke about the idea of Valentine’s Day being a “Hallmark” holiday and just a way for people to spend unnecessary money or time on fancy gifts or acts of affection. However, Valentine’s Day can also serve as a reminder to think about what love means to you. In your own relationships, whether romantic or otherwise, how do you define love? We would like to hear from you about what love means to you and continue to add on to the definitions presented here. Please feel free to share your thoughts on our website’s blog page or reach out to us on social media!
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 Welcome to 2022! It is hard to believe the New Year holiday has already come and gone. As with every new year, the buzzword of the month is “resolution”; you may have already been asked by friends or family “What is your New Year resolution for 2022?”
January brings an opportunity to start a new year with new desires, new plans, and yes, new “resolutions.” You now have 365 days to write 12 chapters of your life, and this can seem overwhelming with possibilities. The word resolution means “to do something or not to do something” and while it is a versatile word, the idea of a “New Year resolution” can sometimes be more harmful than helpful. According to a study published in 2016, 50% of people who made a New Year resolution failed at their resolution after three months. In the United States, the three most common resolutions are to lose weight, exercise more, and save more money. If you subscribe to social media or watch television, you are likely being bombarded by ads for gym memberships and weight loss programs. They say the best time of year to own a gym is January, after all. Society caters to the idea of resolutions as a time to “be a new you” and really make some positive changes in your lifestyle. While good intentioned, there are deeper psychological reasons why 50% of resolutions fail. Perhaps one of the most apparent reasons why resolutions fail is the motivation behind the resolution. Why are you setting this goal? There are two types of goals to discuss here – extrinsic and intrinsic goals. Extrinsic goals are the ones we buy into because family, friends, and society agree they are good goals to have. The common resolutions like weight loss, diet, and exercise are often extrinsic – society defines what a healthy weight and diet should look like. They appeal to our need to fit in with social norms and ideals (hence those annoying gym membership commercials with picture perfect models). Of course, being at a healthy weight and eating well are important generally speaking, but if the resolution is set to match a societal expectation, individual failure is almost certainly inevitable. Extrinsic resolutions are frequently things we feel we should do – not what we want to do deep down. On the other hand, intrinsic goals are ones that “reflect our inner selves and truest aspirations.” These types of goals are more personal and may have been building over time. Intrinsic goals are often not as flashy, either. While things like weight loss and muscle gain are visible to others, intrinsic goals that lead to real change may be only notable by you. Perhaps these are deeper psychological changes that need to be prioritized through individual choice, without the influence of other’s opinions. When we establish intrinsic goals, we also build resilience. Intrinsic goals are more resilient to failure because we are the ones in control. When we fail at an extrinsic goal, we can place blame on external factors. If we fail at an intrinsic goal, we have only ourselves to hold accountable. Another reason why most resolutions fail by springtime is due to the timeline in which we set our resolutions. Statements such as “I will lose 15 pounds in 30 days” or “I will save an extra $500 per month” sound great on paper but may not be realistic. If the most weight you have ever lost at a given time was 5 pounds, or your credit card payments are regularly $500 more than you expected, you will probably fail at your resolution by February. We tend to think that setting a resolution gives us a magic wand to drastically change from who we were last year. Particularly around the New Year holiday, we psyche ourselves up for lofty goals compared to other times of the year. Instead of setting goals through a rose-colored perspective, ask yourself if the goal is realistically attainable. Perhaps remove the timeline altogether or shrink the goal down to a more digestible size. Statements like “I will lose 15 pounds” or “I will try to save an extra $100 each month” are still aiming at the same resolution but provide flexibility. Speaking of flexibility, another reason resolutions often fail is due to the nature of their rigidity. Similar to the timeline issue, setting resolutions with a finite end may lead to inevitable disappointment. Take the statement “I will lose 15 pounds in 30 days.” What happens when you reach day 30 and you only lost 8 pounds? Technically, you failed your resolution because you did not meet the timeline. Setting yourself up to be flexible in your resolution is critical. By day 30, you are already halfway to your goal – so why not take another 30 days to meet the goal? Allow flexibility and accept that life circumstances can alter the timeline of a goal. With these ideas in mind, what are some ways to make a goal for 2022 and truly succeed? Write the goal down Studies suggest that thinking about a goal is not as powerful as writing it down. Grab a pen and sticky note and literally stick your goal in a place where you will read it multiple times per day. Or write down individual steps to take each day that hold you accountable. Sign up for a workout class ahead of time or write out a healthy grocery list before going into the store to help you stay on track. These intentional, daily habits lead to a larger overall change. Differentiate between short-term and long-term goals Set up realistic and appropriate timelines for your resolution. Depending upon your goal, there may be small but necessary steps that simply take more time than we’d like. Make sure you possess the skills to achieve your goal and pushing goals out to the long term is not something to be ashamed of. Establish analogous goals If you have thought of more than one resolution this year, make sure they play well together. For example, if your goal is to lose weight and save more money, perhaps buying an expensive gym membership isn’t the best solution. While you may achieve one goal, the other one is likely to fail. Instead, establish goals that work together and as you progress in one area, you progress in the other as well. Expect setbacks Unfortunately, normal life can intrude on our resolutions. Even the most thought-out and well-planned goals can be impacted by a few days of illness or an unexpected bill. Acknowledging the possibility of setbacks speaks to the idea of flexibility mentioned earlier – a setback does not immediately mean your resolution failed. Pick up where you left off and keep moving in the direction of your goal. Reward progress Sometimes we can be so wrapped up in the fantasy of the end goal that we forget to relish in the small steps. Remember that big changes contain consistent and persistent work and often, real change comes from an adjustment of small, daily habits. If all you had time for today was a walk around the block instead of an hour-long gym session, you still exercised for the day which continues to lead to a weight loss goal. All-or-nothing thinking is a resolution killer. Instead of setting a 2022 New Year resolution, what are some intrinsic goals you would like to work toward this year? Perhaps the goal is fitness or health related, or maybe the goal is something more spiritual or psychologically rooted. Whatever your desires are for this year, you have the power to set change in motion. If you find yourself needing some extra guidance with intrinsic goal setting, the counselors at the practice of Hilary Morris would be delighted to facilitate you along your journey. As a current patient of ours, please bring up ideas for 2022 goals in your sessions. If you would like to establish yourself as a patient with our practice, please contact us on our website!  The holidays are just around the corner, and they always seem to sneak up quickly. While this season often sparks happiness and excitement, it can also bring stress and a nagging feeling of trepidation. During this season, it is easy to get caught up in family gatherings, travel, finishing up end-of-the-year work responsibilities, and of course, holiday themed parties. In the midst of such festivities, mental and physical health often take a back seat on the holiday to-do list. However, it is especially important during this time to self-reflect and consciously make decisions that support health and well-being. If you have created mental or physical health goals by yourself or with help from a therapist this year, now is the perfect time to push those goals to the finish line and practice skills to maximize your growth.
We asked a few therapists to share their tips on how to best navigate through the holidays, and how to prioritize all aspects of well-being this season. Read on for some of our favorite ways to thoroughly enjoy the holidays! Plan ahead - make a schedule of important events ahead of time Whether you are traveling across the country to see family and friends or cozying up close to home, planning effectively (and in advance) is an excellent way to manage anxiety and stress. Using a calendar application on your phone, a journal, or a day timer are great resources to organize schedules and ensure appointments do not overlap. These tools are fully customizable, and you can add as much or as little detail to each event to capture important reminders and to stay organized. In addition, remember to allocate down time for yourself. After a busy day shopping for gifts or a hectic workday, pencil in time on your calendar to relax on the couch, read a good book, or go to bed early. These little breaks can do wonders for an overwhelmed mind. Get physical – remember to move your body Physical exercise is important all year round, but with the addition of holiday treats it is even more essential. A brisk walk with the dog, a morning spin class, or even a few runs down a ski slope all count! When we exercise, our bodies release endorphins (the “feel good” hormones) and norepinephrine, which aid in the regulation of the central nervous system to improve mood and cognitive abilities. Another added benefit of physical exercise is improved sleep. Activities that increase heart rate and body temperature help the body to regulate more efficiently and once bedtime rolls around, the body and mind are ready to count sheep (or reindeer). Establish a budget – for money and your time For many of us, holiday shopping, gift giving, and entertaining friends and family can quickly impact finances. Of course, we want to buy the perfect gifts for those we love, but it is important to keep gift giving realistic and within a budget. Before the endless advertisements for Black Friday and holiday savings events start to infiltrate all aspects of life, set a budget for how much you can realistically spend on gifts this year. Using a budget application on your phone or even a pen-and-paper breakdown can visually help to plan accordingly. For example, set an overall budget and then break it down into categories for friends, family, coworkers, etc. When it’s time to capitalize on those holiday deals, bring your budget and shopping list with you to help stay on track. We often think of budgeting in relationship to money and spending – but time is also a valuable currency. If you are spending time with loved ones or hosting guests from out of town, remember that you, your presence, and your time are precious. Set a “time budget” for yourself and do your best to stick to it. Spreading yourself too thin and forgetting to replenish your tank only add to the holiday stressors. Manage expectations – things may not go perfectly according to plan The holidays bring an element of excitement, and we often reunite with loved ones during this season. Especially over the past two years living through a pandemic, many of us may have not seen friends or family for a long time. This anticipation can lead us to build up an idea in our minds of how perfect our reunions will be or how great it will feel to reconnect. However, it is critical to manage expectations and understand that plans may not perfectly pan out. Cancelled flights, winter weather, and delayed packages are all unfortunate events that tend to occur this time of year. It is certainly acceptable to be upset by these glitches but remaining optimistic and having flexible expectations is a must to maintain a positive attitude and reduce stress. When something does not go according to plan, remember to take some deep breaths and remain calm; there are always ways to solve a problem and sometimes great things can come from spontaneous changes in plans. Practice gratitude Hundreds of research articles have been published on the benefits of practicing gratitude. This powerful exercise has the ability to physically change neural pathways in the brain and improve overall mental health. In one study performed at UC Berkley, researchers asked two groups of study participants to lay in an fMRI machine to view blood flow activity in the brain. The first group were instructed to write “gratitude letters” and the second group did not. Each group were then imaged in the fMRI machine and during the scan, were asked to complete a task. For the task, each participant was given money and asked to “pay it forward” to a worthy cause, and they could decide how much money to give. The group of participants who started the study by writing gratitude letters were more likely to give more amounts of money and researchers noticed increased activity in their medial prefrontal cortex (responsible for learning and informed decision making) compared to the other group. Researchers concluded that even small acts of gratitude can impact how the brain functions and improve decision making and overall satisfaction. During the holiday season, we tend to focus on things we don’t have – gifts we want for ourselves or gifts we want for friends and family. Practice writing a gratitude list or a journal entry. Encourage others in your family to write about gratitude and create a new habit. Before getting out of bed in the morning, think about one thing you are grateful for that day. Gratitude reverses our priorities to help us appreciate the people and things we already have. We hope these tips help you to navigate through the holidays this year and to truly enjoy all the wonderful things that happen during this season. Remember to stay present with yourself, with your friends, and with your family. At the practice of Hilary Morris, LPC, we are grateful for all our patients and colleagues and wish you a wonderful holiday season. We hope you are able to relax, unwind, and reconnect with loved ones, and we are here to continue to provide the support you may need this season.  " Knowing your unique blueprint for how you experience panic episodes in your mind (cognitive narratives), body (somatic presentations), and the length of time it lasts helps you shift these patterns to create room for alternative coping strategies. "  A panic episode is one of the most frightening events we experience. Panic attacks are so disruptive because they pull us out of the present moment and into a chaotic realm of overwhelm, fear, terror, and hypervigilance! An estimated 4.7% of adults have experienced a panic disorder at some point in their lives. According to the DSM-5, a panic disorder is a type of anxiety disorder. A panic disorder involves the repeated occurrence of panic attacks. It begins with a rapid onset of intense fear or discomfort which inhibits overall functioning. According to the DSM-5, a panic attack involves 4 or more of the following sensations:
The highly dysregulating event causes us to incorrectly believe we are dying or in immediate threat. Sometimes, panic episodes become so frightening and confusing, individuals seek out emergency medical attention to find relief. A study measuring emergency room (ER) visits in the United States from 2009-2011 found 1,247,000 anxiety related ER visits. This represents .93% of total ER visits. The most common form of treatment for these visits was benzodiazepine treatment. To effectively treat panic disorder, psychiatric medications, cognitive behavioral therapy, desensitization therapy, exposure therapy, and mindfulness-based stress reduction therapies are clinically appropriate modalities of choice. Below are additional strategies to manage and overcome episodes of panic. Ride the Wave Face the panic rather than running from it. During a panic episode, we may feel like we are going to die, but in most cases, there is no immediate danger to the body. Staying with the panic episode actually leads to more rapid resolution. Breathing through the uncomfortable sensations helps the body and the nervous system down regulate the panic response. “Riding the wave” of the panic attack teaches your body to stay with the reactions (sweating, heart palpitations, chest construction) rather than getting overwhelmed by them and entering into a dissociative (where you "leave" or disconnect from your body), fight, or flight response. When practiced over time, this method improves overall stress tolerance. The clinical term for this concept is desensitization. Mindfulness Viewing the panic attack from an objective perspective diminishes its power. Instead of the panic episode throwing you into a whirlwind of unending panic and anxiety, you observe it as an event with a start and an end. Shifting the mental narrative from “I’m panicking” to “I’m noticing panic” externalizes the panic episode and creates distance between you and the panic. Mindfulness also helps explore triggers, precursors, and antecedents to panic episodes. There may be a theme to when, where, and why you experience these episodes. Recognizing this helps create a plan to apply appropriate interventions. Cognitive Reframing By recognizing what thoughts arise during a typical panic response, you can intentionally redirect them. Common thoughts during a panic episode include, “I’m dying” or “I’m out of control.” Knowing your unique blueprint for how you experience panic episodes in your mind (cognitive narratives), body (somatic presentations), and the typical length of time it lasts helps you shift these patterns to create room for alternative coping strategies. Positive coping statements minimize emotional distress during a panic episode. Examples include:
Physical Activity Moving the body provides relief during a panic episodes. Physical activity in the following ways can help improve emotional control during a panic episode:
Engage Your Frontal Lobe During a panic episode, the limbic system of the brain creates a fight or flight response. Engaging the frontal lobe creates focused concentration and a distraction from the source of panic. Completing a task, writing a narrative, or talking to another person improve activity in the frontal lobe. Diaphragmatic Breathing Diaphragmatic breathing, or “deep belly breathing” uses the whole stomach and abdomen to breathe. To begin this process, breathe inward for 5 seconds and breathe deep into the stomach and abdomen. Before breathing out, pause for 2-3 seconds. Then slowly breathe out for 5 seconds. Repeat this cycle for 5 minutes. This technique provides relief to the nervous system. Closing your eyes during this practice also filters out excess visual stimulation and deepens the practice. Bilateral Stimulation Bilateral stimulation activates interhemispheric communication in the brain. Multiple regions of the brain communicate with one another and down regulate the limbic system (anxiety center in the brain) and nervous system in times of panic, hypervigilance, and anxiety. Eye-movement desensitization reprocessing (EMDR) is an evidenced-based method used in the treatment of post traumatic stress disorder (PTSD). It uses bilateral stimulation through eye movements, tactile sensations, or auditory tones to reduce physiological activation and emotional distress around traumatic memories. Other examples of bilateral stimulation include:
Environmental Shifting Shifting your physical environment can also help diffuse the panic episode. A new environment creates new stimuli for the body and brain to adjust to. If your panic episode occurred in a building, getting outside can be a great way to reset. Smelling a flower, taking a drink of water, or touching the grass can also help. Reach Out For Help If you are having trouble managing your panic attacks on your own, you may require the help of psychiatrist, psychologist, or psychotherapist. Talking about these episodes is the first step to overcoming them! Hilary Morris, LPC and her team teach clients to manage and find relief from their panic episodes. They use evidenced based methods to help patients gain control over their panic, feel confident, and get back to living their lives! They use cognitive behavioral therapy, exposure therapy, desensitization therapy (EMDR and Brainspotting), biofeedback, and stress inoculation training to provide their patients with relief. Their clients become stronger than the sources of panic in their lives and improve overall confidence! To learn how they can help, contact them to set up an initial consultation.   How would you define “counseling” or “therapy?”
For many people, we start by thinking about the standard therapy setting: a cozy room with a chaise lounge, a large chair, soft lighting, and inspirational quotes framed on the walls. We then picture a therapist sitting in that large chair, with a pen and notepad nodding thoughtfully along with your story, as you lay on the couch looking at the ceiling and contemplating where life went wrong. If you have ever seen a counselor or therapist in a TV show or movie, this scene is easy to picture. We often think of counseling in the way it is portrayed in the movies. The quintessential “how does that make you feel” question rarely helps the counselor, or the patient, make much progress. Outside of the fictional world of counseling in the movies, there are multiple schools of thought and theories counselors learn to best aid their patients. While counselors are known to ask a lot of questions, there are methods behind how those questions are asked that can help clients see problems through a new perspective or tie pieces of their story together. Among these theories are “evidence-based” practices, which are tried-and-true methods that statistically lead to positive outcomes for the patient. In addition, evidence-based practices are often more likely to be reimbursed by medical insurance and have been used in mental health research for decades. Within the umbrella of evidence-based practices is a counseling theory called “cognitive-behavioral therapy”, or CBT. CBT has been shown to be effective across a range of mental health diagnoses, including depression, anxiety, post-traumatic stress disorder, and substance abuse. This therapeutic approach is also backed by years of scientific and clinical research to demonstrate its efficacy in diverse populations of patients and conditions. But what is CBT, and why is it effective? To start, let us break down the name itself into its components:
CBT was founded on three core principles, defined by the American Psychological Association:
As simple as it sounds, CBT is a process and a journey - unique to each patient. The therapeutic process takes time and effort, but CBT offers a gateway into the complexities of human thought and behavior. Let’s take a straightforward example to discuss the effectiveness of CBT. Imagine a professional basketball player. This basketball player has been playing since he was in elementary school and has had a successful college career and is now playing professionally. But playing for a professional team is a whole new ball game (pun intended). There are new stressors, added pressure to perform at his best, and not to mention the financial benefits he may earn by being a star athlete. He has never experienced stress like this before, and anxious thoughts begin to enter his mind: “am I good enough?”, “will I cause the team to lose this game?” So on and so forth. At the beginning of his first big professional game, these intrusive thoughts occupy his mind. The cheering crowds, bright lights, and screams from the team coach and captain only seem to make things worse, as though the whole stadium is focused on him and his ability to perform. The player is then tasked with a free throw, and this basket could either make or break the game for his team. Instead of focusing on the task at hand, the player thinks to himself “I am a horrible player, there is no way I’ll make this shot.” And not surprising, he misses the basket and the crowd sighs and boos. The player walks off the court defeated and begins to truly believe that he is a bad player and is not talented enough to play professionally. To the outsider reading this story, you may be thinking to yourself “well of course he missed the basket, it was a self-fulfilling prophecy.” He told himself he couldn’t do it, so he didn’t make it. Now imagine this scene happens over and over again. All of the sudden, the player’s behavior starts to change, and he becomes withdrawn from the team, depressed, anxious, and stressed. As his behavior changes, his negative beliefs about himself strengthen until he truly believes that he is a bad professional basketball player. This is the power of negative thinking. A talented athlete with all of the skills to make it as a professional basketball player turns into a self-deprecating, depressed person who may decide to quit the team all together. Overtime, our basketball player’s behavior also begins to reinforce his negative thoughts. This creates a feedback loop: negative thought à negative behavior à negative thought. This cycle becomes extremely detrimental to mental health and is often hard to break. This is when counseling and CBT can become instrumental in regaining control of our narrative and shifting our negative beliefs about ourselves into positive ones. Let’s imagine a different situation when he stepped onto the court for the game changing free throw. Instead of saying to himself “I am a horrible player there is no way I’ll make this shot”, he could say “this is a tricky shot, but I am good, and I can make it.” Do you think he will be more likely to actually sink the ball into the hoop this go around? You are probably right. This is the beauty of CBT and why it is so effective. Yes, it is simple, but often times the simplest answer is the correct one. Through the process of counseling with CBT, patients learn how to constructively change their negative beliefs about their abilities. For example, writing down positive statements about oneself on a sticky note or on a bathroom mirror aids this perspective shift. By challenging those negative beliefs, patients learn to trust in themselves which leads to self-confidence. As a result, behavioral changes occur. When we feel confident and capable, our personalities shine through, and we become better versions of ourselves. Overtime, triggers that made us anxious or depressed become less impactful on our day-to-day functioning and those intrusive thoughts have less of a hold on our minds and bodies. CBT is a simple and straightforward therapeutic approach and while it may be easy to understand at face value, implementing strategies to change negative thoughts and beliefs takes courage and determination. This is when a counselor steps in to help navigate through the growing pains of becoming the best version of yourself. With unconditional support and positive regard, a trained counselor will be with you every step of the way throughout the journey. CBT is an effective approach to overcome many of the challenges we face in life. At the private counseling practice of Hilary Morris, LPC, all counselors are trained in CBT and routinely integrate it into therapy sessions. If you are engaged in therapy with us, you may even pick up on some questions or ways of thinking that remind you of our basketball player’s story. If you are not currently working with a counselor but this topic resonated well with you, please reach out to us with questions or if you are interested in becoming a patient with our practice.   Trauma can take on many forms and can occur at any point in one’s life. Whether physical or emotional, trauma leaves behind scars that influence the decisions people make throughout their lifetime. But what is trauma exactly? There are hundreds of ways to describe trauma, and each individual defines it in their own way based on deep, personal experiences.
Before we dive into how trauma and the brain interact, lets remember our cast of characters from our previous posts: the pre-frontal cortex (PFC) and the limbic system. These two characters are responsible for the harmonization between our emotional and rational selves. The PFC is the part of our brain that helps us problem solve, make rational decisions, and perform many of the tasks we are required to do in our day to day lives at work or at school. The limbic system is a complex network of smaller structures that aids in our fight or flight response, allows us to connect to other humans on an emotional level, and is responsible for our emotional responses to stressors. Both the PFC and the limbic system are connected in the brain through “highways” of neuronal connections and send a constant stream of information to each other. This communication enables humans to have both an emotional and a logical response to a problem. We will come back to our characters in a moment. For now, lets break down the word “trauma” and understand how the word will be defined in this post. The Oxford Dictionary defines trauma as “a deeply distressing or disturbing experience” and an “emotional shock following a stressful event or a physical injury, which may be associated with physical shock and sometimes leads to long-term neurosis.” While these definitions are correct, they leave quite a bit of gray area and are open for various interpretations. In this post, we will define trauma using some of the descriptors from the Diagnostic and Statistical Manual of Mental Disorders. The DSM-5 describes trauma as an “exposure to a traumatic event” such as war (as a combatant or civilian), threatened or actual physical assault or sexual violence, being kidnapped, taken hostage, terrorist attack, natural or man-made disasters, and severe motor vehicle accidents. This is certainly not an exhaustive list; however, it begins to identify some of the common traumatic experiences many people are exposed to. So, what happens when a person experiences one of these events? From a biological level, a response to a traumatic event is the same as a response to a “stressor.” A stressor, simply put, is an event or situation that brings about feelings of overwhelm, anxiety, worry, fear, or sadness. This response is systemic; the entire human body, not just the brain, responds to the stressor. A surge of hormones and neurotransmitters instruct our body on how to respond. Muscles tense, the heart beats faster, breathing rate increases, pupils dilate…and the flood of adrenaline prepares our bodies to fight, flee, or freeze. While our bodies prepare to respond to the stressor, the brain fires on all cylinders with one goal in mind: self-preservation. In a matter of milliseconds, the brain processes information from the five senses and decides what needs to be done to protect us from harm. In these few moments, the brain coordinates an entire action plan, and we operate out of pure survival mode. Here is an example: you are driving along the highway, listening to your favorite song on the radio. Out of nowhere, a truck in front of you blows a tire, and the tread comes flying down the road right in front of you. All of the sudden, you swerve your car out of the way, somehow missing the car in the lane next to you. You swerve back into your lane as the truck pulls out of the way. In less than three seconds, you are driving down the highway again and tune back in to the next verse of the song without missing a beat. Once you realize what just happened, you feel the adrenaline rush and think to yourself “wow, that could have been bad!” Perhaps you take a few deep breaths to calm down your heart rate, and in a few more minutes, its as if nothing happened. However, in those three seconds, your brain and your body seem to have taken over all conscious thought. Was it really you who maneuvered the car every so skillfully to avoid a collision? Sometimes it feels as though another power takes over in these moments; your body is just along for the ride and time passes more slowly. In those split seconds, the human brain enters into self-preservation mode. This is where the PFC and limbic system characters make their entrance. The PFC, again, is responsible for logical, rational decision making. But the PFC is slow. He takes time to process through every situation, every outcome, every positive or negative ending to a decision. During the example of the car and narrowly avoiding an accident, the PFC was nowhere to be found. In this situation, the PFC does not have the time to undergo his normal deliberation process. By the time the PFC made up his mind to swerve left or right, the tread hit the car, causing the car to spin and crash into the median. But instead, the driver used just the right movements to steer the car out of harms way. While the PFC sits with his play-by-play game cards, the limbic system has already processed hundreds of outcomes and chose the correct set of instructions to self-preserve. But how does the limbic system know what to do that quickly? In order to answer this question, we need to dive deeper into the limbic system itself. The limbic system is divided into multiple sub-structures, including the thalamus, hippocampus, cingulate cortex, and the amygdala. Each structure has its own role and function, but for this topic, we will focus on the amygdala. This almond-shaped, small structure is commonly thought of as the “core system for processing fearful and threatening stimuli…including detection of threat and activation of appropriate fear-related behaviors in response to threatening or dangerous stimuli.” Based on this definition, it is no wonder why the amygdala, and its surrounding limbic system, is the main character in the face of trauma-inducing events. The amygdala’s power resides in its ability to make split-second choices and send instructions to the rest of the body. Going back to our car example, the amygdala knew how to send signals to the right muscles to turn the wheel in a certain direction at a certain angle, calculate the near miss of the car in the next lane, and ensure the truck who blew the tire remained far enough way. These steps are a combination of memory and experience that the amygdala relies upon. In prior life situations, the amygdala learned what muscles control the fine movements required to operate a steering wheel and put them to action. The amygdala also tapped into memory storage to recall that a few seconds before the potential accident, there was another car in the driver’s blind spot seen during a routine side-mirror check. The combination of all of these little details led to the amygdala’s role in self-preservation and avoiding a traumatic accident. Now there is a problem: the amygdala can sometimes make a mistake, or a traumatic event is inevitable. Recall the DSM-5 description of traumatic events. For example, a military combatant is ordered to charge into gunfire, or a large tornado desolates a town and its inhabitants. In both of these examples, the stressor/traumatic event is unavoidable. The solider is doing his or her job and has no choice but to face the stressor head on, regardless of the threat to his or her own safety. The town members cannot outrun a tornado but do their best to take shelter and hope that they and their loved ones survive. In these cases, the amygdala, and the rest of the brain and body for that matter, have no choice but to fight, flee, or freeze. The amygdala does its best to communicate with the rest of the limbic system and the PFC to aid in self-preservation. But often times in such traumatic situations, there are lasting effects that leave survivors with emotional scars. When the amygdala and limbic system are unable to self-preserve and a traumatic outcome occurs, these two systems can become “stuck” in a cycle of processing and re-processing the events that transpired. In day-to-day life, humans experience the manifestation of trauma-related symptoms in many forms: nightmares, panic attacks, sensitivity to certain stimuli (hypervigilance), withdrawal from people or places that remind them of the trauma, and even physical symptoms such as loss of appetite or fatigue. In the mental health and psychology world, professionals frequently classify these symptoms as indictors for post-traumatic stress disorder (PTSD). Following a traumatic event, the amygdala becomes overly taxed, and the normal fight or flight response is elevated. As the amygdala failed once before, it tries to avoid any situation that could cause additional harm. Let us take a war veteran as an example. While overseas, the solider was ordered to charge into oncoming artillery fire to aid in a rescue mission. During the charge, the solider was exposed to loud gunfire, smoke, fellow soldiers being shot and killed, and fear of being shot himself. While the mission may have been an overall success, the soldier lost a friend who he was unable to save on the field. A few months later, the solider is safely back home and trying to host a birthday party for his daughter when a party balloon pops. This loud noise sounded eerily similar to the gunfire he heard months before; the same gunfire that killed his fellow soldier and friend. Without warning, he leaps from his chair and grabs his daughter, fleeing into the other room. Other party attendees may be confused as to what happened and why he seemed to overreact to just a balloon. However, this veteran’s amygdala and limbic system are still entangled in a cycle of trauma that was unresolved months before. Only this time, there was no actual threat – just a perceived one that he instinctively reacted to in order to keep his loved one safe. The body and the brain remember the trauma long after the event occurs. This fictional example is all too real for many veterans returning home. The amygdala is still living in a world where danger can come from any direction and cannot differentiate between what happened then and what is happening now. To the amygdala and limbic system, the traumatic event is starting all over again. It is this cycle that leads to a traumatized brain. With an overreactive and exhausted amygdala, the entire limbic system is thrown into chaos. Without a properly regulated limbic system, the PFC struggles to make logical decisions and its process is frequently overridden with fight or flight instincts. In a cycle of trauma and ongoing PTSD, the PFC almost seems to take a backseat, and the limbic system has full control in the name of self-preservation. The good news is that breaking this cycle can be done. With a correct evaluation and a PTSD diagnosis, many individuals can overcome their trauma and rewire their limbic systems to live a more peaceful life. One of the most common therapeutic interventions for PTSD is called Eye Movement Desensitization and Reprocessing (EMDR) therapy. EMDR was initially developed in the 1980’s and has been used almost exclusively for PTSD. In a nutshell, EMDR works to process through memories that contain the emotions, thoughts, beliefs, and physical sensations that occurred at the time of the traumatic event. This process facilitates in fear extinction and aids memory condition - the memory can then be re-processed with lower levels of physiological arousal. During a structured EMDR therapy session, the therapist leads the patient through the traumatic memories to reprocess, relabel, and redefine the trauma. In other words, breaking the cycle. The office of Hilary Morris, LPC specializes in trauma-work and trauma reprocessing. Hilary Morris, LPC and Mary Aragon, LPC, LAC are trained EMDR therapists and have been using this evidence-based approach for many years. While EMDR is not for everyone, it can certainly be something to discuss with a doctor or mental health counselor with the appropriate training. In addition to EMDR, many patients with PTSD may try various psychiatric medications to aid in symptom management. These recommendations are given by a psychiatrist. For additional information on PTSD, please follow these helpful resources below:  In our previous blog, we discussed the brain and its various characters. As a refresher, the brain is comprised of two keys players: the limbic system and the pre-frontal cortex. The limbic system is the “animal” part of our brain; it is where our emotions originate and houses our fight-or-flight response system. The limbic system sits deep down in the center of our brain and is surrounded by the outer cortical surface of the brain called the cortex. The cortex is comprised of five major lobes: the frontal, parietal, temporal, occipital, and cerebellar areas. Each of these lobes play a distinct role in human function, but the frontal lobe, arguably, may be the most important in terms of human consciousness.
The frontal lobe is segmented into a handful of definitive areas, one of which is called the prefrontal cortex (PFC). Sitting at the most anterior portion of the frontal lobe in our forehead region, the PFC is responsible for a myriad of functions. At the top of the list, the PFC is mainly in charge of executive function (Siddiqui, 2008). Executive function includes many of the everyday tasks we need to function in society, such as an ability to pay attention, retain new information, communicate with others, and engage in goal-directed behaviors. The PFC functions at peak performance when we are listening to a teacher explain a new concept, brainstorming new ideas with our boss at work, or planning a family vacation. The PFC has also been linked to each individual’s overall intelligence level, as many IQ tests challenge the PFC’s responsibilities directly. As mentioned in the first edition of this blog, the PFC interacts with the limbic system on a constant basis. The PFC acts as the gatekeeper to our emotionally charged limbic system and ensures our emotional impulses are kept in check and our needs are being met. However, this delicate communication system can be severely compromised when the PFC becomes injured. An injury to the PFC can come about in hundreds of different ways. Perhaps of the most famous brain injuries every recorded occurred in the fall of 1848 (Garcia-Molina, 2010). Phineas Gage was born in New Hampshire and found work as a railroad constructor, taking him all the way to the western coasts of California. At the age of 25, a tragic accident occurred. Phineas Gage was standing over an area of rail line that exploded, causing an iron tamping rod to rocket out of the ground straight upwards into the left side of Phineas’ skull. The rod penetrated through his left jaw, traveled behind his left eye socket, and exited out of the top of his left frontal lobe. Shockingly, he survived, and lived 12 more years before dying of an epileptic seizure. However, those 12 years were marked by extreme personality changes for Phineas, and this dramatic injury changed the medical community’s understanding of the significance of the PFC in a person’s neuropsychological function. While the story of Phineas Gage is severe, many injuries to the frontal lobe often result from everyday occurrences. In the United States, motor vehicle accidents and slip-and-fall accidents account for over half of all traumatic brain injury (TBI) hospitalizations (Center for Disease Control and Prevention, 2021). In addition, concussions and TBI’s from sport-related accidents are also becoming increasingly concerning. Both children/adolescent and professional sports such as football, hockey, lacrosse, and soccer are gaining national media attention for athletes suffering from long-term head injury symptoms. So, what happens exactly when the frontal lobe is injured? The PFC sits in the foremost portion of the frontal lobe, directly behind the bones of our forehead. There is little space between the PFC and these skull bones. The PFC is suspended in the skull and its’ only protection from the skull bones are thin layers of tissue and membrane. During a head impact event, the delicate tissue of the PFC can be jostled back and forth, causing it to come into contact with the skull bones. Next, the brain ricochets backwards, and this forward and backward momentum continues until the brain reaches a resting point. Imagine a piece of Jello sitting on a plate: as the plate moves back and forth, the Jello jiggles front to back and side to side. Even once the plate becomes still, there may still be subtle movements of the Jello due to physics and the properties of inertia. While the brain is not quite Jello consistency, it is this movement that often results in the traditional symptoms we associate with concussions and TBIs. The U.S. Department of Veteran’s Affairs and Department of Defense defines and classifies severity of TBI using the following criteria: loss of consciousness, memory loss, altered mental state, neurological deficits, Glasgow Coma Scale, and imaging results. Common symptoms of mild TBI include:
In addition, depending upon the severity of injury, other parts of the brain’s cortex can become injured, resulting in additional symptoms that are often difficult to diagnose at face value. Injury to the PFC can greatly alter a person’s ability to function in everyday society. For many, a TBI diagnosis can have lifelong impacts and depending upon a person’s specific recovery, may or may not improve over time. However, there are many therapeutic options for TBI treatment. Perhaps one of the most helpful interventions can simply be understanding what a brain injury is and how the PFC changes after an injury. Through the use of psychoeducation, we can begin to better understand how our PFC functions post-injury and in turn, make appropriate accommodations at work, school, and home. As we learn to better understand how the PFC functions and what it needs for recovery, we can learn to give ourselves grace and the time it often takes to adapt to a new way of functioning. Living with a brain injury is challenging, but with the right resources and support from loved ones and health care providers, thriving with a brain injury is possible. The office of Hilary Morris, LPC provides psychological services and trauma therapy for those struggling with emotional symptoms following TBI or concussion. They provide psychotherapy to help clients learn to gain control over episodes of anxiety or panic. Their clients integrate changes into their daily life and make peace with their brain injury recovery process. For more information on brain injury and brain injury recovery, please refer to these organizations advocating for TBI-patient care:
 Meet the Characters
The brain is a complex organ. It controls everything humans think and feel and allows us to interact in an ever increasingly multifaceted world. But, when you get right down to it, the brain looks quite fragile and uncomplicated. So how can such a humble-looking organ cause so much distress in our everyday lives? I think this question is best answered by one of my favorite science blog writers, Tim Urban. He explained there are two forces in our brains working together (and sometimes against each other) that control every thought, every emotion, every aspect of our functioning. According to Tim, these two characters exist to keep us safe and in control of our environment, and also allow us to feel the pleasures of a fresh-baked cookie or a warm summer breeze. These characters also allow us to feel loss, grief, and emotional pain that can often shift the entire course of our lives. While our brains are not completely segmented into two characters, per se, the brain develops over time and two key biological systems work together to form human consciousness. The first character to discuss is the limbic system of the brain. Evolutionarily speaking, this is an old brain system that all mammals possess. It is the part of our brain that responds immediately to danger and sits quietly in the background when we are relaxing at home. There are few things the limbic system has to worry about – mainly our immediate safety and what we are feeling in any given moment. The human limbic system is similar to that of an animal brain: when a threat appears, the limbic system jumps into action through a rush of adrenaline, intricate muscle movements, and an increase in heart rate and blood pressure. These reactions to danger keep the animal alive for another day, and the human limbic system has helped our species survive and thrive for millennia. The next character in our brain’s development story is that of the prefrontal cortex (PFC). The PFC came along in human evolution approximately 6 million years ago and gave rise to language, emotional expression, and high-level executive functioning (Smaers, et al, 2017). The PFC helps us to rationalize situations, create imaginative scenarios in our minds, and respond appropriately to threats. Unlike the limbic system who is easily startled at every noise, the PFC can take in information from our senses to better understand the noise and whether or not our survival is at risk. Working together, the limbic system and the PFC have shaped the human brain into the machine it is today. These two characters play vital roles in our everyday functioning and also inform our life’s biggest decisions. These characters allow us to feel the thrill of a roller coaster without truly fearing for our lives. They allow us to love another person so deeply while also making logical decisions about marriage and commitments. They allow us to feel and to think simultaneously. But what happens when these characters are no longer playing on the same team? What happens when one character has more power than the other? The Limbic System vs. The PFC The interplay between the limbic system and the PFC in the brain is quite refined and delicate. When these systems start to work against each other, the destruction to human function can feel like a never-ending battle. When the PFC is in charge, things may seem reasonable on the surface. A person may appear to be logical, rational, smart, and never makes a wrong decision. With the wave of a wand, things seem to fall into place. However, bubbling below the surface, you may find a suppressed limbic system waiting to angrily take over. We often stereotype people who are run by their PFC as being cold, calculated, or having a difficult time expressing emotions. With the PFC running the show, life is done and is often successful, but may not be enjoyed to its fullest potential. On the other hand, the limbic system can just as easily run the show. When this system is in charge, a person may feel every emotion so deeply that the ups and downs of everyday life are joyous and catastrophic at the same time. A person being driven by the limbic system may even start to appear as animal-like: skittish, easily startled, shy, and wary of their environment. However, the limbic system also allows us to develop meaningful relationships, love unconditionally, and protect ourselves from danger. Pitting the limbic system and the PFC against each other can certainly be a recipe for disaster. And even though we may think the PFC is smarter, he often loses this battle…but why? The PFC often loses because he is young in terms of the evolution of the human brain. The limbic system, on the other hand, has been around for tens of millions of years (Smaers, et al, 2017). The limbic system is the human brain’s default network and when threatened, jumps in to take control. The Limbic System Runs the Show It is no wonder why humans, when exposed to an acute stressor, react before we think. This is our limbic system taking over the PFC to keep us out of harm’s way. The fight or flight network came pre-installed in humans and the PFC is like a new software upgrade. As hard as we may try, this default networking in the human brain is unchangeable. At birth, the limbic system is just about fully developed. A few weeks into life, the limbic system is in full work mode. Infants cry for everything they need; eating and sleeping are about as complex as life gets. Its not until much later into puberty that the PFC comes online. The PFC reaches full maturity around late teens to early twenties and even then, can spend a few more years developing. By the time the PFC makes his appearance and begins to fully contribute to human functioning, the limbic system has been around for more than a decade. As an example, when a stressful life event occurs when we are children, the limbic system is all we have to rely on. We may have left our trusted blanket or stuffed animal at the playground and we cry and scream that it is gone forever. The limbic system thinks that this dependable, deeply loved, and necessary item is key to our survival and we will panic until it is returned to our grasp. As the PFC is not yet in the picture, we as children have no way to understand that we are responsible for the lost blanket, and logically must retrace our steps to go retrieve it. However, even as fully developed adults with properly developed PFC’s, the limbic system can still take over and run the show. There are many ways this can happen, and in the following series, we will talk about the ways the limbic system can take charge over our functioning, leaving the PFC far behind. |
AuthorsMichaela Olson is a registered psychotherapist with over 6 years of experience working with traumatic brain injury and recovery. Archives
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