Apr 23, 2015

Wilderness: A Powerful Intervention in the Treatment of Complex Trauma

photo of Mirasol clients backpacking by a stream in a canyonWilderness therapy is proving to be a powerful intervention in the treatment of complex trauma. Several of the unique features of adventure therapy address the dis-regulation that occurs in the individual’s neurological process from varying degrees of attachment rupture. Wilderness can directly impact resiliency by providing clients with the opportunity to access a sense of safety in a novel way.

Adventure therapy often inspires a high degree of perceived risk or threat, similar to the heightened awareness that accompanies complex trauma. Moving through the experience with peers, solving problems, receiving feedback and practicing neural self-regulation allow participants to develop confidence and a set of skills that translate directly into real-world recovery.

In this setting, the opportunity to connect appropriately, challenge old beliefs, receive support and relate to others allows clients to move forward and deepen their commitment to their own process. Clients are both responsible for their own process and for the experiences of their peers.

Kinesthetically, the physical engagement of the activities encourages clients to develop a new appreciation for, and connection to, their bodies. The immediate need to fuel and care for the needs of the body creates new opportunities for clients who have been emotionally divorced from their physical selves. Nature provides a continuous backdrop of beauty, challenging and nurturing clients to a deep sense of belonging.

Adventure therapy has been shown to increase the effectiveness of other therapeutic interventions, and to improve receptivity to treatment in general. Mirasol is excited to continue the exploration and research of wilderness therapy as a potent intervention in the treatment of trauma and eating disorders.

Watch the video of Mirasol’s first backpacking trip with clients

Apr 22, 2015
Andréa Copeland

QEEG Neurofeedback in the Diagnosis and Treatment of PTSD

Andrea CopelandQEEG guided neurofeedback has given us the ability to diagnose and treat serious disorders such as PTSD through concrete evidence of neural activity.

Post Traumatic Stress Disorder (PTSD) may occur in individuals who have been victims of traumatic events that are outside the range of our usual human experience. The trauma may be the result of physical or sexual abuse, serious accidents or combat. Individual who suffer from PTSD often live in a world of extreme hyper-vigilance, anxiety, and isolation and may suffer from disturbing nightmares and flashbacks.

Conventional treatment for PTSD typically involves long-term psychotherapy and continuous use of medications that may mask symptoms rather than addressing the root cause. All too often, clients become discouraged and end therapy prematurely before they are truly able to resolve their trauma and recover a sense of safety and contentment. This is where QEEG guided neurofeedback comes in, by locating and addressing the areas in the brain that are not preforming optimally.

Neurofeedback can be used to display a continuous stream of information from the client’s brain. This information is shared with the clients, so that they can train themselves to achieve a more desirable state of being. Knowing they can learn to relax themselves at will provides a tremendous sense of empowerment. As a result they will also notice they are able to rest easier and feel calmer and more confident.

Neurofeedback for PTSD typically consists of 20 to 30 training sessions. During these sessions, clients may begin to recall forgotten details about the traumatic events that caused the disorder. They develop a new ability to tolerate these memories due to improved emotional resilience and sense of ease offered by neurofeedback training.

Neurofeedback can also be used in conjunction with other treatment modalities to measure their effectiveness and determine what types of treatment are most effective for the client.

For more information, see High Tech That Heals: The Use of Neurofeedback in the Treatment of Eating Disorders

Apr 21, 2015
Marion MacDonald

Treating Eating Disorders with Co-Occurring Trauma and PTSD

In this video interview, Executive Director Diane Ryan and Trauma Therapist Ann Twilley describe how and why Mirasol Eating Disorder Treatment Centers developed its specialization in treatment of eating disorders with co-occurring complex trauma and PTSD.

“Years ago most eating disorder treatment centers — Mirasol included — did not include trauma as part of their treatment programs. In fact, people were turned away if they reported significant trauma before we admitted them,” says Ryan.

“So it became evident that that was not going to work, we were not going to be able to take care of people if we weren’t willing to address the traumatic issues in their lives because it was too closely tied in with the eating disorder.”

Ann Twilley, trauma therapist and prior director of Mirasol’s aftercare program, observed the same phenomenon.

“When we were trying to work on the eating disorders, we kept bumping into the trauma, so we absolutely had to do something different,” says Twilley, “and we knew that treating the symptoms wasn’t working, so we had to treat the underlying issues, and a lot of that was about trauma.”

Most treatment centers use a variety of narrative therapies for trauma treatment, but Mirasol clinicians do not believe that this is the most effective strategy.

“We found that people telling their story in a group or even in an individual setting was really re-traumatizing,” says Ryan, ”so we needed to find another approach.”

Twilley notes that many Mirasol clients had already experimented with cognitive behavioral therapy or cognitive behavioral therapy, but it hadn’t worked for them. “It wasn’t sufficient, it wasn’t deep enough work for them, and so that’s how we started going where we went.”

“The gold standard for trauma treatment has always been EMDR (Eye Movement Desensitization and Reprocessing), so that was the first training that we pursued,” says Ryan, “and since we at Mirasol have always emphasized experiential therapy and believed in healing through the body, we then pursued training in some somatic therapies as well.”

“There are a lot of ways you can address trauma through wilderness therapy and similar experiential interventions such as psychodrama, so we began putting more emphasis on training in those areas.”

Over the next several years, Mirasol clinicians obtained training in not only EMDR, but also EFT (Emotional Freedom Techniques) and TRE (Tension and Trauma Release Exercise).

“EFT is something that can be really self-empowering for the client because we can teach the skill,” says Twilley, “and we offer a monthly online alumni group that has been very supportive for clients years after they complete treatment at Mirasol.”

The additional trauma modalities complemented Mirasol’s already comprehensive integrative eating disorder treatment program including polarity therapy, Reiki, cranial sacral therapy, acupuncture, dance-movement therapy, yoga, adventure therapy and neurofeedback.

And tying it altogether, according to Twilley, is Mirasol’s pioneering work in neurofeedback.

“Neurofeedback is the science that supports a lot of the work that we do. Neurofeedback shows us that the client’s brain is changing. That’s really exciting for them to see, and really exciting for us to see.” Neurofeedback can be used in conjunction with other treatment modalities to measure their effectiveness and determine what types of treatment are most effective for the client.

“We’ve developed a strategy that really works for just about any client in terms of teaching them how to master the reactions of their own nervous systems,” according to Ryan.

She notes that Mirasol has recently expanded its adventure therapy program to include backpacking.

“A lot of research has been done about wilderness and what happens in the wilderness to people who have been traumatized, so this creates yet another way to address trauma in a way that is safe and supported and that helps them heal.”

Apr 20, 2015
Dawn Bantel

The Physiology of Trauma

PTSD BrainMost therapists are familiar with the presentation of someone that is suffering from post-traumatic stress disorder (PTSD). The individual is likely struggling with nightmares, flashbacks, dissociation, anxiety, or panic attacks. The symptoms can vary from person to person. They are generated by experiencing, witnessing or being aware of a traumatic event and/or neglect. For some, this could be a one-time event such as being in a car accident. It could also result from repeated exposure, for example, if a child has been subjected to continual abuse.

Our brains store both unconscious and conscious memories. The conscious ones are the ones that we can access at will. Our unconscious memories — the ones that we aren’t aware of — have a strong link to the emotional center of our brains. If a traumatic memory is stored here and the memory is triggered, the brain can process the experience as if the person was still in the traumatic situation.

A flight-or-fight state is an inherent form of self-preservation in a threatening situation. For those suffering from PTSD, this sympathetic nervous system response goes into overdrive and can result in long-lasting physiological symptoms. Trauma in childhood can result in brain damage and affect gene expression.

A whole-person team approach can be effective in the treatment of trauma. Mindfulness techniques help the individual to recognize and challenge his or her brain’s reactions. Some therapies such as Eye Movement Desensitization and Reprocessing (EMDR), Emotional Freedom Technique (EFT) and somatic experiencing can assist with the release of the physiologic response to a traumatic event. Yoga and bodywork, such as massage and acupuncture, help soothe the sympathetic nervous system.

Naturopathy targets ways to tonify the nervous system by addressing lifestyle, nutrition, and endocrine or other physiological imbalances. For example, caffeine can reduce one’s ability to manage anxiety, and or eating habits will impact blood sugar regulation.

Cortisol, the stress hormone, can be measured by salivary testing. Nutritional supplements can be used to reduce elevated levels or increase resilience to stress. Nervine herbs such as passion flower, kava kava, lavender and valerian help tonify the nervous system, while amino acids such as L-theanine and gaba can assist with calming neurotransmitters.

Validation and education about the body’s trauma response can be extremely helpful. It helps individuals suffering from PTSD or trauma make sense of an experience that may seem irrational or overwhelming. With treatment, the individual can increase his or her resiliency and experience relief from the symptoms of trauma and PTSD.

Apr 19, 2015
Marion MacDonald

First Backpacking Trip with Mirasol Clients

trail-bossThere were those of us — myself included — who doubted it would be possible to incorporate backpacking into a residential eating disorder treatment program. Executive Director Diane Ryan, Admissions Director Carol Magee and I began talking about expanding Mirasol’s adventure therapy program to include backpacking in October, 2014. The challenges seemed overwhelming. First of all, since clients obviously don’t come to treatment outfitted for backpacking, we needed to purchase all the equipment from tents, sleeping bags and sleeping pads to flashlights, hiking poles and utensils. Over the next six months we patrolled eBay and Craigslist for good used equipment, and picked up additional items at sales. Friends got wind of the project and stepped forward with gear to loan or donate.

We took a leap of faith and purchased 10 wilderness permits in January. The timing was tricky, since we needed to make sure that any clients participating in the program were medically and emotionally stable and that they had arrived at a point in their treatment where a wilderness experience such as this could provide a significant boost to their recovery.

Of course the biggest challenge was the food. In retrospect, it’s hardly surprising that food would be an issue for an eating disorder treatment program. But I had not anticipated the difficulty of balancing the need to comply with each client’s carefully tailored meal plan with the need to maintain pack weight and bulk appropriate for a beginning backpacker. Our heartfelt thanks go out to Chef Dee O’Leary, who went way above and beyond the call to prepare hearty, backpack-friendly meals and snacks for our brave beginners!

The day before the hike was pandemonium, while we packed and repacked between checking the weather and trying to figure out how to transport staff and gear from three locations to a single departure point. We were nearly two hours behind schedule when we set out Thursday morning, but it was a gorgeous spring day with temperatures in the mid-70s and a cloudless sky.

Over the next three days, we shared the magic of a sparkling stream that threads its way between walls of red conglomerate and yellow volcanic tuff in the Galiuro Mountains. There’s no real trail, so we wandered back and forth across the stream in the shade of giant Fremont cottonwoods and Arizona sycamores. We made camp on a sandy beach where there was a nice deep pool warm enough for a refreshing dip and with sun-baked rocks where we could stretch out like the many lizards we saw along the trail.

Evenings we shared our experiences from the day and stories of how we all came to be huddled around a crackling campfire deep in a canyon in the heart of southern Arizona.

I cannot say enough good things about the hard work and dedication of Executive Director Diane Ryan, Primary Therapist Katie Klein and Counseling Assistant PeiDong Zhang, who provided loving and tireless support to all the members of our group.

Only time will tell if this daring experiment produces lasting results. But the obvious delight of the clients who participated was an inspiration to us all.

As one of them remarked, “I always wanted to experience an outdoor adventure like this, but I didn’t think I could. Now I have the confidence to continue exploring my own.” May that confidence stay with you and sustain you and you move forward in your recovery!

Thanks for a memorable weekend, and a very big “wu gong*” to all of you!

*”Wu gong” became our favorite all-purpose expletive after PeiDong identified a large scary bug using his digital dictionary. For example, you might exclaim, “wu gong!” if a giant centipede was crawling down your back.