Theme: Neurobiology and Mindfulness with Jinji Eika Willingham (U.S.A.) and Dr. Prawate Tantipiwatanaskul (Thailand). Jinji focused on how she translates and incorporates mindfulness into Buddhist-based psychotherapy for clients with trauma/PTSD through implicit or explicit awareness of neurobiology, systems. She supports clients to develop the experiential practice of self-regulation and co-regulation (neuroception) to maintain connection with others. Dr. Prawate will focus on the neurobiology of trauma, how the brain and memory process in trauma, and how mindfulness helps in the healing process.
Presentation by Jinji Willingham
(clinical psychotherapist and Buddhist chaplain from Austin, Texas, U.S.A)
- The three pillars of her work are: Buddhism, Neurobiology, and Systems Theory. She uses these to translate and re-describe mindfulness into a dharma-based psychotherapy for clients who have distress, trauma, and PTSD. Her goal is to help clients develop and resource themselves through mindfulness. She helps them to learn the experiential practice of self-regulation and relational mindfulness or co-regulation (a.k.a neuroception). Clients thus learn to regulate each other through relational connection so that they can stay in relationship and not end up in isolated stress.
- She incorporates Buddhist teachings with secular terminology, skillfully using translated versions of teachings like the Four Reminders that can turn people toward the dharma, the Four Noble Truths, the Teaching of the Second Arrow, and the Satipattana Sutta as the origin of mindfulness, etc.
- In her talk, she outlined the stages of modern psychology and psychotherapy from:
1) the early forms of modern psychoanalysis that are now seen as privilege-based, patriarchal, and therefore quite exclusive.
2) behavioral therapy looked to evidence-based medical models (EBM) and “scientific” methods that lead to the over-institutionalization, and was primarily a diagnostic-orientation and a medicalized view and treatment of patients.
3) Cognitive Behavioral Therapy (CBT) which emerged in the 1980s and 90s as the gold standard for psychotherapy through “shifting perception”, which appears very Buddhistic. However, it is not a relational system and can feel dismissive for people suffering from trauma by telling them that positive thinking and an attitude change can solve their problems. CBT initially did not take into account that trauma is also stored in the body, something which Buddhist meditation does incorporate along with its focus on the mind.
4) Present day incorporation of new layers and understandings of trauma in family systems and other micro and macro scales. This includes Polyvagal theory (poly- “many” + vagal “wandering”) introduced in 1994 by Stephen Porges. The vagus is a cranial nerve that forms the primary component of the parasympathetic nervous system. Polyvagal theory identifies a third type of nervous system response beyond the traditional view of the sympathetic nervous system, which is more activating (“fight or flight”), and the parasympathetic nervous system, which supports health, growth, and restoration (“rest and digest”). Polyvagal theory includes the “social engagement system”, a hybrid state of activation and calming that plays a role in our ability to socially engage (or not). This has led to the development of interpersonal neurobiology that involves the dynamic field of relationship, so that 1+1=3. Porges focuses on “change of state” rather than change of perspective or attitude as in CBT.
- So many new approaches today thus incorporate mindful awareness of the body and mind, which incorporates deeper layers of the brain, such as the reptilian brain where trauma leads to dissociation, freezing up, and disconnecting from social engagement. The emphasis now is to create new vagal or brain circuits through inter-relational interaction. Basically, staying in connection is the healthiest way to stay in connection. However, such connection need not be so verbal, and Jinji tries to make therapy quieter and less verbal using mindfulness techniques with clients practicing together. Thich Nhat Hanh may be famous now for this kind of “don’t worry, be happy” formulation of mindfulness, but his teachings have also talked about “returning to our basic or indwelling nature” and the practice of a wider more expansive form of mindfulness, or rather “awareness.” Meta-awareness or meta-processing is noticing the process of reflecting.
- In this way, she tries to apply mindfulness/awareness not as a practice to achieve something, like enlightenment, but rather to return to ourselves and to get involved in our dukkha directly, i.e. the practice of the 1st Noble Truth. There has been a trend among therapists to change the question, “How do you feel?”, to ask “What are you noticing in your body?” However, clients who are not in touch with their bodies cannot answer this question as well. The challenge, Jinji feels, is how can we get beneath words and work on psycho-physiology?
- She has thus asked her clients to approach this as a “field report” of what they are observing at different times of day doing different things. Such as, how is the body experienced through posture, jaws, eyes, shoulders, throat, breathing? Explore internal processes like body temperature, tone, texture, stomach, tension. This is very similar to the classic Buddhist meditation practices of sati-pattana and ana-pana-sati in which body (kaya), visceral feeling (vedana), mind (citta), and reality (dhamma) are explored. She finds it easier to help a client down-regulate or calm down rather than up-regulate or lift someone out of an immobilized, depressed state.
- In the West, depersonalization is considered a disorder but a certain level of depersonalization is exactly what happens to seasoned meditators. In some traditional cultures, disorders like schizophrenia, ADD etc. are seen as spiritual endowments. However, in more modern contexts, these disorders may be experienced as fundamentally suffering.
- Somatic work may be an important corrective to modern psychology and psychotherapy that was overly focused on the mind. However, in Buddhism, a skilled teacher is able to see where a student is stuck. Some students may be overly focused on the body or somatic areas and use meditation to sink into the body to bypass emotional or psychological trauma. A good teacher will guide them into these neglected areas and develop a balance between head-heart-gut. To be skillful, clinicians must be able to discern between Buddhist “emptiness” or equanimity and a client’s tendency to dissociate and shut down (a form of immobilization). It’s important to establish a “secure base” or sense of stability prior to a neutral state of non-identification. In other words, there is a difference between Depersonalization Disorder and the Buddhist awareness of emptiness or equanimity.
Presentation by Dr. Prawate Tantipiwatanaskul
(Psychiatrist & President of the Satir Institute of Thailand)
- Jon Kabat-Zinn defined the term mindfulness in a clinical context as, “paying attention in a particular way; on purpose, in the present moment, and non judgmentally.” This had a transformational impact on it being adopted by clinicians in the West.
- In general, trauma overwhelms the brain processing systems, and this creates a “trauma capsule”. Traumatized people cannot differentiate between what they experienced in the past and what is happening in the present. Because of unprocessed material, one can easily regress back to the mental state of when the trauma occurred, which cannot be controlled by the will. When we have accidents, different pieces of information are spread throughout the brain, these are frozen in time and space by the brain.
- The brain is broken down into three basic layers: reptilian, mammalian, and human or neo cortex. The reptilian brain is the most influential for our whole cognitive process. A major limitation in talk therapy, what is considered the foundation of modern psychology, is that it cannot access experiences lodged in these deeper parts of the brain. This is especially true for those who experienced trauma at a young age when the brain was beginning to form. In this way, adult PTSD is easier to heal than childhood trauma. The good news, however, is that the brain is capable of neuroplasticity and neurogenesis. [Working on how the mind processes experience before the cognitive and linguistic mind is activated is found in the Buddha’s practice of dependent co-origination (paticca samuppada) in which one cultivates mindfulness (sati) to become aware of how sense object (rupa), sensory door (nama or ayatana), and their coming together in sense contact (phassa) create sense consciousness (vinyana), followed by visceral feeling (vedana) and perception (sanya) before cognitive mind (sankhara) begins.]
- It is important to create a sense of safety in the body, but this is much more than just making the client sit in a comfortable chair or couch. Grounding exercises, body scanning, breathing exercises, yoga, tai chi, chigong, etc. contribute to calm. It has been found that yoga has can have the same effect as antidepressants for people who have experienced certain kinds of trauma. In a person’s “window of tolerance”, when experiences becomes too much they may shift into hyperarousal, getting worked up and hysterical, or into hypoarousal, shutting down and becoming depressed. A person who is traumatized will have a small window of tolerance and can get triggered easily. So he practices with clients to expand the window of tolerance by creating emotional space and self-regulation.
- Acceptance from a Buddhist standpoint involves facing the reality and the facts of life, such as our own bodies, personal characteristics, and childhood experiences. Mindfulness practice involves slowing down and becoming mindful of each experience, moment to moment. In this way, we become more vigilant and don’t get caught in the trap of reactivity. To practice this, we need some sense of security inside. By practicing dharma, we can develop a sense of courage and acceptance. Then, with a sense of purpose and direction, we are less bothered by minor things. It is not enough to be just scared into changing your situation, just trying to escape suffering. One needs to be actively moving in a direction of transcendence. A transcendent orienting principle is important for meaning.
- In terms of the helpfulness of religion or not, Prawate has found that faith and spiritual connectedness can help create this important sense of safety. However, the process always must be client centered and only approach religion if they are interested. A principal goal of chaplaincy is to bring meaning to life, sometimes through prayer or the reading of sutras. It can be important to see that being religious or speaking in religious ways is simply another type of language. Most world religions are expressed through mythic language, yet can be translated into modern, secular and psychological ways—and vice versa. Buddhism is perhaps popular today because it is an ancient world religion that easily speaks in a modern psychological way. In this way, perhaps the term “karma” is an ancient expression for “trauma”.