MANAGING TRIGGERS

by Carolyn Spring

BEING TRIGGERED Then it is minutes later, maybe even

hours – time has no meaning, and my
I am walking towards the Post Office
brain is scrunched up inside my skull
with humdrum thoughts roiling in my with weariness and confusion. What just
head of things I need to do, wondering happened? It was a man with a camera,
if I’ve got everything I need for tea, a dog, a child crying … I don’t know what
pondering a response to an email: it was. But I was triggered by something
the flip-flop ordinariness of everyday and it’s seriously messed up the last few
worries and concerns. Nothing unusual, minutes or hours or even days of my
nothing remarkable. And then. And then. life and I feel indignant and huffy with
I can’t even tell you what happened next myself for it happening, and in roll the
accusations and the razor-like mental
because it’s snap-click-snap, in a moment,
barbs … You’re stupid, why did you have to
in an instant, and I’m not conscious of it
react like that, what’s the matter with you,
happening at all. But my heart wants to you’re pathetic, get a grip, this is ridiculous
burst like ‘Alien’ out of my chest, there is and then, like glaze on the top, the despair
a rage of energy rippling up my legs and I … I’m never going to change, I can’t do life
can feel myself falling inwards and losing like this, this is hopeless. And, possibly just
1 touch with myself. for good measure, a dollop of panic … I’m

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never going to get my work finished now, almost anything I can to avoid triggers
everything’s going wrong today, I can’t cope and other reminders of my trauma. In fact,
with all of this!!! a very straightforward way of looking at
dissociation is that it’s primarily about
BEATING OURSELVES UP FOR
avoidance: of the trauma we suffered, of
BEING TRIGGERED
reminders of that trauma, of feelings, of
One of the hardest things I found in intimate relationships, and even of other
dealing with triggers was the aftermath:
parts of ourselves.
the shame, the self-blame, the sense of
failure and powerlessness that once again
I have reasoned with myself for a long
something had happened that I’d had no
time that life would be fine if I could just
sense of control over. Learning to manage
my critical self-talk and self-soothe keep that avoidance going. But triggers
rather than lacerate myself after being are like little psychic explosions that crash
triggered was a key waymarker on my through that avoidance and bring the
journey of recovery. When I felt ashamed dissociated, avoided trauma suddenly,
and powerless, I would set myself up for a unexpectedly, back into consciousness
double-dip and trigger myself again with – complete with all the bodily reactions
my own self-directed abusiveness. But and emotions that we would have had
once I realised that triggers made sense, at the time. In the blink of an eye we are
that my reactions were automatic and had catapulted into a fight-flight-or-freeze
been hard-wired into my brain, I began response and that trauma (that was so
to be able to take control of my triggers overwhelming that we had to dissociate
and reduce my self-hatred for being
from it at the time just to survive)
afflicted by them. In this article I want to
envelopes us like a king-size duvet around
explain what triggers are, what happens
an ant. Not surprisingly, therefore, we can
in our brain when we are triggered, and
end up orchestrating our life in order to
why they’re not therefore our ‘fault’ or
an appropriate source of self-blame, and avoid triggers. But that has its own long-
what we can do about them. term and damaging impact: life becomes
constricted as if we are living surrounded
DISSOCIATION IS PRIMARILY by a million unknown landmines and we
ABOUT AVOIDANCE must step very carefully in case one blows
Like most people with a dissociative up in our face. It’s little wonder that we
2 disorder, I hate being triggered. I will do are so often so stressed!

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 MANAGING TRIGGERS
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THE POSITIVES OF TRIGGERS WHAT ARE TRIGGERS?

But there were a couple of things on my
therapeutic journey that I learned about
triggers which at first surprised me. The
first is that they can be managed – our
brains don’t have to be our enemies but
can instead be our friends, and we can
tap them for their genius rather than
just being hijacked by them. And the
second is that triggers can actually be
helpful – because they are clues, scraps of
information, precious insights about what
we’ve dissociated. They can therefore
become guides on our therapeutic
Triggers are internal or external stimuli
journey to discover what we have
which remind us of past traumatic
segregated or kept separate from our experiences. Trauma is the root
main consciousness, and what it is that experience of dissociative disorders,
we need to process and resolve so that and even though we may have kept our
we can recover and heal. Triggers provide traumatic experiences safely locked away
these essential clues to the source of our (or ‘dissociated’) in another part of our
post-traumatic response where we can minds, it is still there, however much we
resolve the underlying cause so that we have tried to forget it or push it away. A
don’t have to live this ‘split’ life any more ‘trigger’ is like pressing a button on a jack-
of multiple parts of our personality – parts in-the-box so that suddenly the memory
or re-experience of that trauma pops out
that know, and parts that don’t know
again – except it’s rarely as innocent and
about the trauma. Rather than avoiding
fun as a multi-coloured clown causing us
the trauma, we can face it. And rather
to giggle with delight.
than being overwhelmed by it or stuck in
it, we can process it. Triggers provide key Paul Dell (2006) says that dissociative
information that we can use as a starting phenomena are ‘unbidden, jarring
point to conquer the trauma that haunts intrusions into one’s executive functioning
3
us. and one’s sense of self.’ And this is what

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triggers are – something which causes me who hurtled back to there-and-then

these sudden, unasked-for, jarring and our trauma amongst trees. That part
intrusions of the trauma of the past to of me was panicked and disoriented and
clatter right back, unwelcomed, into the was lost for several hours. It was only
present. A flashback – that immersive, when this had happened several times
it’s-happening-right-now memory that that I began to recognise that there was
is experienced not as a past event but as a clue here, and gradually in therapy
a present re-experiencing – can often be we traced this trail of breadcrumbs
caused by a trigger, one of these current- back to its source and the trauma I had
day reminders of something from the past. experienced in some woods near a farm.
We might be consciously aware of what Similarly, I didn’t know that babies were
these triggers are, or they could affect us triggering, a reminder of my own direct
at an unconscious level so that we react trauma with infants when I was a child
and then a teenager. And I didn’t know
but we don’t even know why. A trigger
that communion was triggering – until on
might be a sight, a sound, a taste, a smell,
more than one occasion I went to church
a touch – in other words, some form of
and found myself throwing up in the
sensory input – or it might be something
toilets during this part of the service for
about the situation we’re in (such as being
no apparent reason.
powerless, being in some way ‘in trouble’),
a location, even a body position (such as
Triggers were everywhere and caused
lying down) or a body movement (like
massive destabilisation in my life. I felt
bending over).
that I was ‘going mad’ constantly as I was
MY EXPERIENCE OF TRIGGERS tripped into a highly agitated state by
normal, everyday things. But before my
During my most difficult period of time a sudden, life-altering ‘breakdown’ in 2005,
few years ago, after the ‘breakdown’ that it was as if I’d had solid walls in my mind
turned my ‘apparently normal’ life into a that were strong and stable enough to
daily trek for psychological survival, I was keep the trauma at bay, so none of these
being constantly triggered. I didn’t realise triggers managed to penetrate through
that trees were triggering until I was to my consciousness. As a result I was
walking through some local woods one ‘apparently normal’ and got on with life,
day and then suddenly I was elsewhere with my career and with my marriage. But
and time had fallen down a rabbit hole: I then in 2005, literally overnight, there
4 had switched to a much younger part of was this sudden, total collapse, as if the

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walls in my mind had crumbled under up the music louder and louder to drown
the weight of too much pressure over out his knocks! I began to make progress
too many years. A build-up of factors only when I opened the door and opened
over at least a decade had chipped away the ominous package with my name on it.
at my walls until eventually there were
too many gaps and breaches, and these Of course we have to do this at a pace and
‘unbidden, jarring intrusions’ were able to in a way that we can manage – we cannot
get through. have a reckless, ‘gung-ho’ approach to life
and act as if there are no triggers or that
TRIGGERS ARE MESSENGERS they won’t affect us. That’s just another
At the time, of course I viewed it very form of denial and avoidance. But if we
negatively. These flashbacks, these states have been living with a certain trigger
of intense dysphoria and distress, were for a while and we are building our life
ruining my life and I wanted them to stop! around avoiding it, then we need to see
I was ashamed of my inability to control that, like the postman knocking on our
them, and terrified of what might happen door, we are in fact allowing ourselves to
in a public place. But I now understand be held prisoner. It takes a lot of energy to
that they were the trauma trying to heal, organise our life around avoiding triggers
giving me clues about what it was that was and reminders of trauma all the time,
hidden in my unconscious. Unfortunately, and eventually we will get to the point
while I viewed the flashbacks and triggers where we realise that the cost of facing it
as the enemy, I didn’t hear what they were outweighs the cost of avoiding it.
trying to say to me, and I missed the signs
that could have eased my work in therapy. IDENTIFYING TRIGGERS
Over a number of years, I had to work
The more I avoided the trauma, the more hard to identify my triggers, and learn how
I worked to edge carefully around every to manage them, as well as how to resolve
potential trigger – staying indoors in case them. That work of resolution is what
I came across dogs and trees, isolating is often referred to as ‘phase two’ work
rather than engaging with people and in therapy – processing trauma. That,
their babies, for example – the more these for me in relation to triggers, is the end
triggers and reminders kept plaguing me. goal. But in the meantime we can learn
They were like a very insistent postman to manage them, as we put in place the
who was knocking on the door trying to first phase of our work in therapy which is
deliver a message, and I was just turning ‘safety and stabilisation’. There are many 5

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 MANAGING TRIGGERS
by Carolyn Spring

triggers that no longer have any impact psychoeducation is probably the single
on me because I have opened the package most helpful thing that I have learned
– the dissociated trauma – and so the over the last few years, because with
‘postman’ has stopped knocking. In this dissociative disorders a large part of the
case, traumatic memories have become problems we face is caused by a lack of
‘associated’ rather than ‘dissociated’ – connections (or ‘associations’) between
they have linked up again with the rest of different parts or structures of the
my autobiography, my personal narrative, brain. Trauma causes damage to many
my view of my self and the world, and my aspects of our brain functioning. For
feelings. But on a daily basis there are still
example, the pathway between the right
some things which catapult me back to 30
and left hemispheres of our brain, the
years ago, and while I’m still working to
corpus callosum, is ‘eroded’ by trauma
‘associate’ that trauma, I’ve had to learn
– brain scans show that it is less dense
to manage triggers so that I don’t have
in trauma survivors. That may explain
to avoid them altogether and remain a
prisoner in my own home. at least in part why many of us have
reduced ability to integrate left-brain and
TWO PARTS OF THE BRAIN right-brain processes and why certain
So I’ve had to learn what triggers are all therapeutic interventions that include
about, what is going on in the brain when ‘bi-lateral stimulation’ such as EMDR
they happen, and how I can use my brain (Eye Movement and Desensitisation
to manage my brain. The basis for that Reprocessing) can be effective in treating
is what I and other people, for the sake trauma. We also tend to have fewer
of simplicity, often refer to as the ‘front’ connections between our thinking ‘front’
brain and the ‘back’ brain. This piece of brain and our survival-based ‘back’ brain.

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THE ‘BACK BRAIN’ and by using the simplistic term ‘front

brain’ I am in particular referring to the
The ‘back’ brain refers to two
frontal lobes that are involved in learning,
evolutionarily-distant parts of the brain
thinking and planning – all the sensible
known as the reptilian brain and the
stuff! Just this simple distinction between
mammalian brain, also known as the
an automatic, survival-based ‘back brain’
limbic system. The reptilian brain deals
and a thoughtful, reasoning, reflective
with automatic, instinctual functions such
‘front brain’ can help to explain a lot of
as making our heart beat, keeping our
our behaviour when we are triggered
lungs breathing, and regulating our blood
and also give us strategies of how to
pressure, hormones and digestion. It’s not
manage better when we are tripped up by
a thinking part of the brain at all – it just
traumatic reminders.
responds at quite a distinctly biological
level to ‘instructions’ and stimuli. The THE AMYGDALA – THE
mammalian brain sits on top of this and is BRAIN’S ‘SMOKE ALARM’
our emotional and body memory system
which helps us to survive threat. So the
‘back brain’ is unconscious, automatic,
and based around keep us alive.

THE ‘FRONT’ BRAIN

The ‘front’ brain by contrast refers to the
neo-cortex which largely consists of the
folds of grey matter that we typically think
of as the ‘brain’. A baby is born with very
little ‘front brain’ and the first five years is
a rapid development and growth of these
neurons and synapses: the neo-cortex
grows and forms connections almost The brain takes in a wealth of sensory
entirely in response to its environment – information all the time and most of
as a result of the experiences it has. The this incoming ‘data’ is streamed to the
‘front’ brain controls many aspects of thalamus, and from there it goes to a
our conscious life including movement, tiny almond-shaped area of the brain
co-ordination, speech and thoughts. It is called the amygdala (‘amygdala’ is the
our learning, thinking, self-aware brain, Latin word for almond). The amygdala is 7

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part of the limbic system, the emotional We don’t think at all! The body sets off
alarm system of the brain: the ‘back the sympathetic nervous system to be
brain’. And the amygdala’s function ready to respond before we have even
revolves around our fear response and it had a chance to think about the danger.
acts, in metaphorical terms, as a kind of
‘smoke alarm’. When incoming data from THE AMYGDALA ASSUMES
our environment is channelled to the THE WORST
amygdala, it is a first line of defence: in the This is a very good system that has meant
blink of an eye – in around 7 thousandths that for thousands of years we have
of a second – it scans this information been designed to be alert to danger and
for threat or danger. It does this outside to respond instantly in order to survive.
of conscious thought because this is the But unfortunately, if we have suffered a
‘back brain’ – not the thinking-based lot of trauma, especially during our early
‘front brain’. years when our brains are at their most
impressionable, then our amygdala – our
If the amygdala senses threat, it sets off an ‘smoke alarm’ – becomes oversensitive.
alarm in the body and initiates the body’s The amygdala is a very basic bit of brain
fight-or-flight system, the sympathetic kit – it doesn’t think, it doesn’t spend long
nervous system. Within moments our processing incoming information, and it’s
hearts start beating faster, our lungs are not smart. It is just a smoke alarm – it only
gulping in more air, our blood pressure is responds to what it perceives to be smoke.
increased to squirt blood at a greater rate So it cannot tell the difference between
around our body and the bloodstream is burnt toast and the house being on fire.
flooded with sugar for energy: everything Or between a snake-shaped stick on the
we need for an instant and energetic path ten metres ahead and a real snake.
physical response. And when this happens And the more traumatic experiences
– when the smoke alarm sounds – the we’ve had, the more our amygdala is
‘back brain’ becomes very active, and the wired towards assuming the worst.
‘front brain’ shuts down. And this is what
is happening when we are triggered – A MALADAPTIVE RESPONSE
outside of conscious thought, the body is That might seem inconvenient now, but
ramped up for immediate evasive action. at the time, as a child, this was ‘adaptive’
We don’t sit around thinking, ‘Oh, maybe – it helped us to survive a threatening
in a minute this dog might bite me, so environment. By being sensitive, even
8 maybe I ought to do something about it.’ over-sensitive, the amygdala gave

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us the maximum possible amount of

time to respond to threat – to respond
with fight, flight or (if all else fails)
freeze. The problem is that this level
of responsiveness isn’t so adaptive or
helpful as an adult. If the abuse is behind
us, if we’re living in a world that is at least
relatively safe, then we don’t need to have
such quick responses to guard against
threat: we don’t need such a sensitive
smoke alarm. But having been in repeated
fires in childhood, many of us have been
left instead with a smoke alarm that reacts
to the merest whiff of smoke as if it’s an
inferno. And sometimes it goes off just not just what happened, but where
in case – better safe than sorry! It’s this it happened and when, and what the
oversensitivity that can plague our lives – context for it was. However, when the
why we can be so tense and stressed, why amygdala (smoke alarm) has been set off
we can react so dramatically to triggers, because of high levels of stress such as
and in everyday life be jumpy and irritable trauma, the hippocampus shuts down.
and even aggressive. Memories of traumatic events may
therefore be encoded or stored without
THE HIPPOCAMPUS their full context. This partly explains why,
There’s another part of the ‘back brain’ after the event, memories of abuse may
that is important and that is a seahorse- be so fuzzy and indistinct – why we’re
shaped structure called the hippocampus. not quite sure whether they happened or
This is concerned with short-term memory not, or when and where they took place.
processing, organising, sequencing, and It is as if they float free of anchors in our
mental maths, and is heavily involved in minds, and it makes them very difficult to
the processes of memory storage and bring into verbal, narrative memory.
retrieval. In this latter role it acts as a
kind of ‘context stamp’, providing data So when something traumatic happens,
such as time, location and context. So the smoke alarm goes off and that
it ‘tags’ memories with this additional deactivates the hippocampus. The
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information, allowing you to remember memory of that traumatic event may then

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a chance to think about it. When the

amygdala smells smoke, the front brain
switches off and the back brain switches
on. This back brain alarm floods the body
with stress hormones like adrenaline and
cortisol which gear us for instant action,
to fight or flee. They make us tense,
pumped up, aggressive, so we end up with
lots of overreactions to tiny reminders of
the trauma, and a generalised ‘stressiness’
that is hard not just for us but for the
be encoded or stored without information
people around us too.
about the context for what just happened.
Imagine that our attacker was wearing At the same time as this is happening,
the colour red. If that colour information however, the front brain – the thinking
is detached from the overall context, then part – has decreased bloodflow and shuts
‘red’ may be stored as a ‘trigger’ in the down. At a survival level, there is a good
future – a smoke warning sign that there’s reason for this, because if we’re about to
imminent danger. The hippocampus didn’t be attacked by a tiger, we need lightning-
get to ‘tag’ the memory with contextual quick reflexes and to be ready to run or
information to show that the ‘red jumper’ fight. We don’t need to be slowed down
wasn’t a key part of what happened, so by our ponderous thinking brain which
‘red’ becomes a conditioned response wants to weigh up all the options and
to the trauma: it becomes a trigger, figure out what kind of tiger it is and scroll
something that will set off the smoke through all the associations we’ve had
alarm. with tigers in the past. While we’re still
weighing up those options and recalling
FRONT BRAIN OFF / BACK the differences between Bengal tigers and
BRAIN ON Siberian tigers, we’ll already have been
All of this presents a huge challenge to us eaten! So when it’s a matter of threat and
as trauma survivors. There is a cascade of survival, the back brain fires up and pours
processes that happens in our brain and stress hormones into our bloodstream
body when the amygdala detects a threat, ready for action, and our front brains are
10 and it all happens before we’ve even had switched off to stop us faffing.

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BROCA’S AREA It’s what Judith Lewis Herman calls the

‘wordless terror’ of trauma.
We are all familiar with the effects of
adrenaline – the surge of energy, the
But the flipside is that if we can get
pounding heart, the tensed muscles, ourselves talking, or focusing on words
clenched fists, alert attention. And many such as through puzzles like wordsearches
of us will also be familiar with the effects or crosswords, or by reading or
of high levels of stress: it may be less journalling, we will be coaxing our brain
exotic than being hunted by a tiger, but to restore its bloodflow back to Broca’s
public speaking has a similar impact on area again. And by doing that, it will start
our autonomic nervous system! It is often to turn on the front brain as a whole
touted as the number one fear because again. When a therapist gets you to talk
the very thing that we are supposed to be about the weather, or football, or what
doing – speaking, and thinking about what you had for tea last night, it’s not because
we are going to say next – is inhibited by they can’t cope with your flashback or
the stress response as our front brains re-experience of your trauma – they’re
shut down and we can’t get our minds into getting you out of a back-brain, triggered
gear. state by turning your front brain back on
again. Some therapists are smarter than
There is another area of the brain that they look!
is relevant here, called Broca’s area. It is IT’S NOT MY FAULT
concerned with language and speech –
So when we are triggered, a very simple
with words. Like the hippocampus, it is
but powerful process is at work. Before
also shut down when the smoke alarm is
we have even had a chance to think about
sounding. That is why in a state of terror,
it, within 7 milliseconds, our ‘smoke
like a flashback of trauma, it is so difficult
alarm’ has detected smoke, and has set
to get our words out. In a situation such off a bodily alarm system to pump stress
as public speaking, at the moment that hormones into our bloodstream to enable
we most need to speak fluently, our mind us to take immediate evasive action. The
goes blank and we literally cannot think front brain switches off so we can’t think
of anything to say. This isn’t some random and the back brain switches on so all we
occurrence – it is caused by Broca’s area want to do is act. To me, that suddenly
having reduced bloodflow in moments made sense of how I can be so rational, so
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of high stress and so being ‘turned off’. normal, so competent some of the time

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and then, when I’m triggered, I become UNDERSTANDING TRIGGERS

a jumpy, rabbit-caught-in-headlights,
Understanding that being triggered is
speechless wreck. And understanding
automatic and not my fault therefore
that, that it’s an automatic process based
helped me to become kinder towards
around survival, and that it happens
myself, and by soothing myself and
outside of conscious thought within
speaking kindly to myself after a triggering
the blink of an eye, made the world of
incident, I improved my ‘recovery time’.
difference to me: it’s not my fault. It’s not
Over a period of months I therefore
because I’m attention-seeking, or pathetic, noticed that I was getting triggered less
or just plain ‘bad’. It’s my brain with its often, and – just as significantly – when I
automatic wiring trying to keep me safe. I was, it wasn’t taking me so long to come
am more easily triggered by other people back to a state of balance and equilibrium.
because I have an oversensitive smoke It was the start of a new way of relating
alarm from being in way too many fires to myself based not on the old models
as a child, not because there’s something of attack-and-abuse but based on the
intrinsically defective about me. new models I was learning in therapy of
comfort-and-accept.
Armed with this new knowledge, I stopped
beating myself up when I got triggered. It So triggers aren’t our fault, but they still
didn’t prevent me from being triggered, need to be managed. How do we do that?
but it diverted the backlash afterwards, And how can we turn down the sensitivity
the tornado of critical thoughts and of the smoke alarm over time, so that it
accusations that would make a bad doesn’t sound the alarm when the toast
situation even worse. And gradually I has been burnt?
realised too that this self-blame, this tirade
of self-denigration, was in itself triggering HELPLESSNESS
– that my own abusiveness, even though Of course, the first and most important
it was only ever voiced in my head, also thing to realise is that we can actually
smelled ‘smoky’ to my amygdala. So I was do something. I believe that the core
triggering myself with my own self-hatred essence of trauma is helplessness – it
– and that in itself had been spinning me is being overwhelmed and powerless
time and again into a vicious circle of being where there is absolutely nothing that
triggered and then triggered again by my we can do to stop what is happening to
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own disgust at having been triggered. us. For many of us who have gone on to

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develop a dissociative disorder, that night, we rely on prescription medication

sense of helplessness lives on in a very or other drugs, or alcohol, to try to
powerful but often unconscious way, numb things down. But the good news is
infecting everything that we do with a that although triggers happen within 7
sense that we can’t. It is a habit that our milliseconds, we can be ready for them,
brains developed in childhood because we can develop a strategy for managing
chronically, over years and years, perhaps them, and we can even begin to turn
hundreds or even thousands of times, we down the sensitivity of our ‘smoke alarm’
experienced traumatic events where we over time so that we are less likely to be
experienced intense helplessness. Our triggered in the future. The net result, of
brains grow and develop in response course, is that life then starts to become
to our experience, especially repeated a whole lot easier and we can concentrate
experience. And so quite without any on more than just surviving an hour at a
sense of choice, most of us developed a time.
chronic sense of learned helplessness: this
can become a default state that we are
triggered back into, either when we are
reminded directly of our original trauma
or when we are hit by a circumstance in
the here and now that renders us helpless
again.

And being triggered – being hit by

an automatic body-brain response
where adrenaline is pumped into our
bloodstream, our thinking brains shut
down and our survival-based back brains
THREE PARTS OF THE FRONT
light up – can also make us feel helpless!
BRAIN
After all, it all happens outside of our So what therefore can we do when we
control, without our permission, even are triggered? I believe that we need a
when we are doing our best to stop it. So ‘go to’ strategy, something that is easy to
it is easy to believe that there is nothing remember even when our front brains
that we can do about it, and we can start are screeching to a halt, and something
to restrict our life to cater for it – we give that works in a variety of settings. What
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up work, we don’t bother to try to sleep at I developed for myself was something

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that came out of understanding a little it. There are many survivors of complex
bit about the front brain, and how three trauma who have great, even highly-
general areas of the front brain, with developed front left brains – we love
their own particular characteristics and knowledge and information and facts,
peculiarities, can be engaged to help and the more the better! And it is this
us get back in control again when an part of the brain that gets ‘switched on’ by
unexpected trigger knocks us off course. doing even just low-level mental activities
such as counting or maths, logic puzzles,
The three parts of the front brain that I factual quizzes, Sudoku.
am referring to are:
• the front left brain: the dorsolateral Doing those kinds of things turns on the
prefrontal cortex front left brain, and because the front and
• the front right brain: the right orbital back brain operate like a kind of see-saw,
prefrontal cortex just by turning your front brain on you
• and the front middle brain: the medial will be turning your back-brain off. All too
prefrontal cortex. often we fight hard, by some huge effort
of the will, to try to ‘calm down’. In fact
Of course this is a simplification, and is we may be more successful if we don’t try
looking at the brain in metaphorical terms hard to calm down – which often upsets us
rather than strictly neuroscientific terms more as we become frustrated that we’re
– because the aim is not precise brain not succeeding! – but if we just focus our
surgery, but to understand generalised attention instead on switching our front
differences in the way that our front left brain on. Conversely, of course, that
brains work which we can then tap into to is why it is hard to concentrate when
manage triggers better. we’re stressed and panicky. And that’s
why something that doesn’t matter,
THE FRONT LEFT BRAIN
something like Sudoku or a puzzle game
So firstly, there’s the dorsolateral on a smartphone, can help get our front
prefrontal cortex: the front left brain. brains more active again without even
This is the part of the brain that holds really trying.
information as facts: that Paris is the
capital of France, that Shakespeare wrote That is also why work is so often a
Macbeth, and that I am safe here – the stabilising factor for many trauma
logical, factual part of that statement, survivors – work that isn’t too complex
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not the emotional, experiential part of and stressful and full of relational conflict

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and high risk, but work that engages our So the front left brain can be viewed as
front brains to come online and stay the facts-based, information centre of the
online. We really shouldn’t underestimate thinking brain. However, even though the
the role that work plays in keeping our front left brain can say, ‘I know I’m safe
front brains on and keeping us stabilised. here,’ have you ever noticed how your
Certainly my worst time after my therapist can tell you until he or she is
breakdown in 2005 was during 2008 blue in the face that you’re safe now, but
when I gave up work – because I felt I you still don’t feel safe? This is because
couldn’t cope any more – and without the the front left brain has very few direct
demands of work to keep my front brain connections to the smoke alarm, the
online, things actually got a lot worse for amygdala, which is the part of the brain
me very quickly. I went through a period as we have seen that makes that initial
of several months where I was what I assessment of risk and danger.
might call ‘back brain activated’ most of
the time, and where I was resorting to So the lack of connections between the
medication and self-harm as my principal front left brain and the amygdala means
methods of self-regulation. that although we can use the front left
brain to turn down our panicky, survival
It was when I started work again at a low- back brain response once we have been
level and on a voluntary basis that I was triggered, just relying on cognitive
able to activate my front brain for several facts won’t make any difference to the
hours a day, which had the automatic see- sensitivity of the smoke alarm over time.
saw effect of turning down my back brain. In other words, it helps in the short term
That was then a turning-point for me from but not in the long term. Two other parts
which I was able to move forwards, and it of the front brain are much better for that.
is something that I am still very conscious
of nowadays. I know that after a therapy THE FRONT RIGHT BRAIN
session, I need to get my front brain online Firstly, there is what we can call the front
again by doing something menial like filing right brain, the right orbital prefrontal
or checking the bank statement. I can’t do cortex. This is the region of the brain
anything very complicated or creative, that is involved in attachment, in human
but even Sudoku or putting books back relationships, especially between a
in alphabetical order is better and safer mother and her baby. Attachment theory
than descending into a back-brain fuelled is critically important to understanding
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dissociative state of crisis! and recovering from dissociative

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disorders, and I cover it in detail in my have developed in childhood – the ability

Working with Relational Trauma training of the front brain, in effect, to down-
course, but suffice to say here that the regulate and modulate the activity of the
front right brain is switched on during back brain, and intentionally ‘practising’
what we might call ‘attachment moments’ this relational soothing can have a
– times when a mother soothes her tremendous impact over time. Many
baby with touch, with eye contact, with
writers talk about the importance of
a reassuring tone of voice. And these
‘affect regulation’ – the ability to manage
‘attachment moments’ can be replicated
difficult or strong emotions – and how
by a partner – someone with whom you
this can develop over time as the therapist
have a close emotional bond – as well
as the therapist who acts as a soothing and client form a ‘dyad’ which closely
presence to their client during times of resembles, in neuro-developmental
hyperarousal or agitation. We all know terms, aspects of the relationship
how powerful it is to have someone who between a mother and a baby.
cares about us come alongside us when
we are triggered and help us to down- This is what I have experienced a thousand
regulate again, coaxing us to breathe times in therapy sessions when my
more slowly, to come into tune with their feelings have suddenly hijacked me and
calm presence rather than our terrified I have been triggered into a high-anxiety
state of panic. And it is this right orbital state. Together with my therapists, I
prefrontal cortex that is being activated (or another part of me) have gradually
during these moments. learned to be able to turn the volume
down on those feelings so that they are
The front right brain also has quite good
not deafening me anymore. My therapists
links to the amygdala, meaning that
have mirrored calmness to me, breathing
human contact – especially at the level
slowly and deeply together (‘Just sigh!’ as
of an attachment relationship – can help
Janina Fisher puts it), so that I have been
to turn down the sensitivity of the smoke
alarm over time. If there are repeated able to manage the spikes of emotion
soothing moments, a neural network can when triggered. Over time this has helped
develop in the brain and the front right to form a neural network between my
brain can in effect ‘inhibit’ the smoke front right brain and my amygdala, to turn
alarm, making it less likely to go off at just down the sensitivity of the smoke alarm
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a whiff of smoke. This is what we should over time.

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At first I felt frustrated at being triggered evidently absent right brains, many of
during therapy, that I was wasting us will however manifest some degree
precious minutes by just ‘getting upset of underdevelopment. And we see the
again’ and therefore somehow messing up impact of this in our difficulties with
the session. But I eventually realised that relationships and especially attachment
‘getting upset’ in the session was a good relationships, as well as our struggles
thing, because through the coaching of with managing our emotions. And this
my therapists I learned how to calm down, is why we can’t just ‘get better’ or ‘snap
and by doing so I have been laying down out of it’ as many of us will have been
new patterns in my brain, new neural exhorted: we’re actually ‘brain-damaged’
networks that have meant that over the or at the very least ‘brain-missing!’ That is
long-term I am less likely to fly into a panic why recovery can take time, because we
when I am sniffing smoke but there is no are literally trying to grow and develop
fire to be found.
these parts of our brains. That is also
why some forms of cognitive therapy
The impact of neglect on the front right
often prove inadequate on their own
brain has perhaps most strikingly been
in treating complex trauma – cognitive
seen in brain scans on the Romanian
therapies may appeal to our front left
orphanage children highlighted by
brain with its facts, logic, information and
television documentaries in the 1980s.
knowledge, but may do little to develop
These children, victims of Ceausescu’s
our front right brain with its craving for
regime, received the most minimal levels
of care and attention, many of them being human relationship and interactive affect
washed and fed but otherwise ignored regulation.
– no cuddles, no interaction, no play, no
love. On brain scans, the area of the front The good news is that attunement and
right brain that we are talking about here, empathy can actually ‘grow’ this front
the region connected with attachment right part of our brains, and that is why
and emotional regulation, was more or attachment relationships including ones
less missing: ‘black holes’ showing the with partners and with therapists are so
lack of development arising from extreme important. It also hints at why when we do
relational neglect. develop secure attachments, it positively
impacts our ability to cope better with
Although most of us with a history of adversity and manage our feelings within
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complex trauma will not have such a wider ‘window of tolerance.’

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For me personally, perhaps the greatest struggle to know what is going on inside
impact I have seen over the last few us! I suspect that some of the reason for
years has been the way in which my front that is because we are so focused ‘out
right brain has helped to turn down the there,’ being hypervigilant for threat, that
sensitivity of my ‘smoke alarm,’ meaning we have never stopped to look ‘in here.’
that I am much less often triggered And if we do, then the ‘in here’ bit is so
nowadays, and much less severely. Even often fraught with feelings of yuk and
when I am, I can use what I have learned shame and horror – we don’t want to feel
in therapy to coax myself back down to a what we’re feeling; we don’t want to think
more settled state. about what we’re thinking. And that of
course is the very essence of dissociation.
THE FRONT MIDDLE BRAIN Many of us, therefore, have ended up with
The other part of the front brain that a quite underdeveloped medial prefrontal
we can tap into and which is helpful cortex – which is a real shame as it has
for modulating the smoke alarm is the the best connections or pathways to the
front middle brain, the medial prefrontal amygdala.
cortex. You may be thinking, ‘But what
do I do when my therapist or partner
isn’t around? What do I do if I haven’t got
a therapist or partner in the first place?’
And they are very real concerns. But the
good news is that the medial prefrontal
cortex is part of the brain that everyone
can tap into, at any time of night or day.
It is a part of the brain that is concerned
with self-awareness: of emotions, of body
sensations, of thoughts. It is the part
of the brain that can reflect upon itself,
looking inside and thinking, ‘How am I
feeling? What’s going on for me? What am
APPLIED MINDFULNESS
I experiencing right now?’ The most successful emerging therapies
in working with complex trauma seem to
Research has shown that this part of the be those that employ so-called ‘applied
brain also tends to be quite depleted in mindfulness,’ such as the Sensorimotor
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chronic trauma survivors – many of us Psychotherapy approach developed by

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Pat Ogden and others including Janina just with curiosity. I began to be able to
Fisher. This has helped me enormously – develop what others have called a ‘third
at the beginning of my therapy journey I position’ or a ‘mentalising stance.’
had practically no ability whatsoever to
be able to just observe what was going on TALKING OURSELVES
in me. I was ‘in’ my physical experience, THROUGH IT
just swallowed up and consumed by it; I And perhaps most critically for me
wasn’t able in any way to stand back from personally, it meant that I had a new
it and observe it. I was ‘in’ my emotional strategy when I was triggered. When my
experience, domineered and hijacked back brain had switched on and my front
by any emotion that wanted to come brain had switched off, I began to realise
along and dictate to me, and I was utterly that I needed to talk myself through it. At
convinced that not only did I have to first I needed the support and coaching
believe what that feeling was telling me, of my therapists to do it, for them to
but that I had to obey it too. I couldn’t help direct my attention and for them
bear to sit with it. I just had to act on it. to help me to step back from myself and
just observe what was happening and to
So I was forever mindlessly reacting to name it. So I began to learn to develop
what was going on inside me, and yet a self-narrative at these moments: ‘Oh
through the practice of mindfulness and look, my arms and my legs have gone all
through Sensorimotor Psychotherapy tense. What else is happening in my body?
approaches in particular, I was able to Let’s have a look. Oh, my breathing has
begin to be able to ‘just notice,’ to ‘just speeded up and it’s gone quite shallow.
be curious,’ and to start to observe and What’s happening in my tummy? It feels
comment on what was happening, seeing like a tight ball of energy. What’s this all
that it was ‘just a thought’ or ‘just a feeling’ about? Oh, I think I’ve been triggered. This
or ‘just a sensation.’ This was revolutionary is an autonomic nervous system reaction.
for me. I began to realise that the ‘I’ that Something has tripped the switch;
I so struggled to define was separate to something has set the smoke alarm off.
the feelings of panic, the compulsion to My amygdala has detected something
self-harm, the in-wash of shame, and that that it thinks is a threat. My front brain
this I could stand back and ‘just notice’ has been shut down and my back brain
and comment on what was happening in has lit up and geared me up ready for fight
an accepting-but-detached way, without or flight. It’s not because I’m being abused
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judgement, without counter-emotion, but in the here-and-now. It’s just my body’s

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automatic reaction because the memory past me – I just need to wait and watch it
of that has been triggered. Now let’s look zoom past. I can step out of the way of it.
again at what is happening in my body … And I don’t need to make matters worse
My fists want to clench. My legs want to by feeling not just anxiety, but frustration
run …’ And so on. at my anxiety. If I just observe the single
juggernaut of anxiety and watch it roar
And even by doing this – even by past me, I don’t have to add on a lorry-load
putting these things into words, we are of frustration. Too often in the past I have
automatically bringing our front brains allowed one emotion to spawn a whole
online, by engaging Broca’s area, the car-crash of others. And all the time,
speech and language centre. But the real while I’m just observing and commenting
key is to be able to turn our attention and noticing this feeling of anxiety, I
inwards and to observe what is going on in am engaging my thinking, assessing,
us so that it is just something that is going pondering, wondering front brain and the
on in us: it is just a thought, just a feeling,
just a sensation. It’s not the entirety of
our experience. If it is something separate
from us, then it need not define us or
control us, or be the be-all and end-all of
us. It can come, and it can go, and we can
be certain that it will only be temporary.
There is a difference between being
anxious and having an anxious feeling:
the latter will pass, whereas by thinking
the former, we have begun to attribute see-saw effect will mean automatically
meaning to it (‘This is who I am’), with that my back brain will be calming down.
a sense of certainty and finality and
enduringness to it. A Sensorimotor psychotherapist with
whom I worked for a number of years
THE POWER OF THE WORD used to say to me in the kind of sing-
‘JUST’ song voice that surely you can only pick
But if the feeling is just a feeling, then I can up through very many years of therapy
watch it come towards me, as if hurtling in school: ‘Just notice! Just be curious!’ It
my direction on the motorway at 70 miles was pretty annoying at first, especially
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per hour, and I can choose to watch it go when I was consumed in a back-brain

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state of red alert, with everything

screaming at me that the house was on
fire and I was imminently going to die.
But with just those two or three words
she was in effect saying, ‘It’s ok, it’s just a
false alarm. It’s just burnt toast. The house
isn’t really on fire. Don’t panic. They are
just feelings of panic, but there’s nothing
to panic about. It’s just your body’s smoke
alarm going off, that’s all. There isn’t really
a fire. Just notice what the panic feels like
in your body. Let’s just observe it. Let’s just
be curious …’

SELF-TALK IN A CRISIS
Well done me for responding so quickly
It took many months of annoying
with that adrenaline. Well done me for
repetition but eventually I started to be
releasing glucose into my bloodstream. I
able to do it for myself. So when I had a
can stay present. I can just notice and be
very serious near-miss on the motorway
curious.’ And I did, and it was one of those
some months ago, and I went into genuine
moments when I looked back afterwards
survival mode, I talked myself through it.
and realised what progress I’d made, and
‘Just notice!’ I said to myself internally (in
how a few years ago I would have been
the same sing-song voice – I’m sure the
lost maybe for hours afterwards; the
magic is in the voice), ‘Just be curious!’
And I started to recount to myself what emotional aftermath could have lasted in
was happening in my body – my shaking fact days; and worst of all, I would have
arms, my tense legs, my chest feeling beaten myself up for someone else’s
crushed like there was no breath in it, driving error, and heaped torment and
my sweating palms, my feeling of nausea, abuse on myself for someone else’s lapse
everything distant and slow and unreal. I of concentration. Instead I was able to
could feel myself being pulled off inside, stay in control; I didn’t have to switch or
to ‘check out,’ to dissociate and switch dissociate to manage the situation; and
to another part, but like staring down the aftermath was one of gratitude and
a tunnel I just kept up my self-talk: ‘It’s thankfulness that I was alive and unhurt
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just your amygdala sounding the alarm. rather than the savagery of self-blame.

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by Carolyn Spring

THREE STRATEGIES FOR

THREE PARTS OF THE BRAIN
So there we have then the three parts of
the front brain – front left, front right,
and front middle, each of them with their
own characteristics and their own specific
ways that we can utilise to manage
triggers and turn down the sensitivity
of the smoke alarm over time. And using
these three metaphorical regions, I have
developed three strategies for turning my
front brain back online when I have been
triggered:
• using my front left brain, I get myself
thinking – with Sudoku or word-
searches or games on my phone, with ourselves when we are triggered, but
counting backwards in 7s, with filing using this simple matrix of three parts
or reconciling bank statements, with of the brain and the three strategies
reading and journalling. to go with it, it can help us when our
• using my front right brain, I get front brain has gone offline and we
myself connected – preferably to an have become foggy with panic and we
attachment figure, such as a therapist can’t remember what to do. And the
or good friend, in order to allow them promise is there that if we will develop
to help me be soothed and calm down. these grounding activities and repeat
• using my front middle brain, I get them and repeat them and repeat
myself noticing – I turn my attention them some more, then we will develop
inwards and I am ‘just curious’ and new patterns in our brain, new neural
I ‘just notice’ the feelings and the networks, that over time will reduce
physical sensations of panic, and the sensitivity of our smoke alarm
I name them and observe them which has become over-reactive,
and watch them pass by without not because we’re bad or stupid or
judgement or meaning-making.The pathetic or lazy, but simply because
important thing is to find activities we were in way too many fires as
22 that help us each personally to ground children.•

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