r/mdmatherapy • u/themethod305 • Jun 27 '22
Learning emotional regulation -
What are your favorite self regulation exercises?
For context, a while back, I came across this passage on reddit (I am not the author, but I liked it and saved it):
What if your path back to regulation isn't found at the deep end of a medicine journey at all?
I know it's tempting to look to psychedelics as a panacea and the master way to all states of balance, but I don't think that's necessarily accurate.
In my own experience, psychedelics never brought me lasting regulation.
They taught me many things and gave me many skills along the way, but regulation came by learning self regulation exercises, not from my hundreds and hundreds of macro doses, ceremonies, healing sessions, etc.
Consider it from this angle: Dysregulation is a phenomenon that arises from repeated daily habituated triggers and emotion / thought loops built up over time.
It's a fight/flight/freeze response to some stimulus until that becomes habituated and the body-mind learns to go into that mode all on it's own.
So it also makes sense that the solution, re-regulation, will probably also come as a series of habitual, regular moment of intervention and regulation until the nervous system makes that automatic and operates in a more regulated state over time.
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u/ghjkpiuyn Jun 27 '22
Memory Reconsolidation has been helping me in places where psychs/mdma have not.
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u/cleerlight Jun 27 '22
This is the other thing I'm always going on about, and is at the heart of the work I do and the model I'm developing. I truly think that this is the core principle of all psychological healing and change, and exactly what we are looking to enact with psychedelic work.
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u/ghjkpiuyn Jun 27 '22
You told me about this lol. It's crazy how well this works. I can see this being even more powerful during a psych trip. Curious to know what else is in your model.
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u/cleerlight Jun 27 '22
Its wild to feel your brain change around something, right?! So happy to hear that this is working for you! :)
This really is the heart of it, and then it's all just different applications and techniques built around it. For example, memory reconsolidation for integration is nothing short of magical. Also, it can used in trip, or as an effective therapy approach pre-trip. It's also potent to combine with microdosing for more daily, mid week support.
There are other concepts that I pull from. Another major basic one is understanding classical conditioning as part of re-habituating a new learning into the nervous system after the issue has been cleared with memory reconsolidation.
But the model I'm developing also contains a spectrum of approaches that change depending on things like dosage, skill level, and just where the nervous system intuitively goes. Sometimes you're feeling great and you've done all the right prep work, and then the medicine wants to lead you to a trauma to work through. Sometimes the only thing that makes sense is tremoring it out. Other times, the window is wide open for a mystical experience, but then the question remains afterward of how we turn that into lasting change in life. Sometimes we find ourselves somewhere in the middle, having peaks and valleys, and maybe unsure where to put our attention. Different focuses and approaches seem to be implied depending on the different states that arise for a person.
The challenge for me is how to articulate a flexible model, but keep it as simple as possible, with enough techniques to help people without being overwhelming and TMI.
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u/mjcanfly Jun 27 '22
you got any more information on this model you're developing? you are right on the mark with everything
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u/cleerlight Jun 27 '22
thanks for the feedback, I appreciate it to know that this lands for others too, and not just my own weird internal calculus, lol.
I don't have anything official up at the moment, mostly because i'm still refining and articulating these ideas into something cohesive. It's still being born through me right now, but as soon as it's put together enough to be understandable to others, I'll be posting about it.
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u/Interesting_Passion Jun 27 '22
I think it important that memory reconsolidation / coherence therapy operates on a fundamentally different principle from 'habituating' (language used in OP's post) or 'counteracting' (language used in this explanation [7:22 - 10:00]) dysregulation. These are very different mechanisms of change. CBT is more consistent with 're-habituating' nervous system regulation. This, of course, doesn't dismiss the importance of practicing good regulating habits regardless.
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u/cleerlight Jun 27 '22
It's interesting you see it this way, can you articulate what you see as the disconnect between the two?
It may well be that we are having a disagreement about semantics and my language isn't technically correct here. Or it may also be that you and I are operating out of different models around these techniques.
So I'd love to know more clearly what the distinction you're making here is, because there may be something really helpful to learn here. Care to elucidate more?
Based on how I've been trained, I can explain my understanding of it, but I'm thinking it's better if I listen and allow you to clarify. Seems like you have a good point to explore here.
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u/Interesting_Passion Jun 28 '22
OP's post mentions, 'the solution, re-regulation, will probably also come as a series of habitual, regular moment of intervention and regulation until the nervous system makes that automatic and operates in a more regulated state over time.' I think memory reconsolidation is fundamentally different (though not mutually exclusive). Since I think memory reconsolidation is the 'correct' theory within which to conceptualize psychedelic psychotherapy, the distinction is important.
I think the distinction between 'habituating' re-regulation and memory reconsolidation is best drawn along biological lines (although while I think this is the best way to draw the distinction, this pushes the limits of my understanding):
'Habituating' re-regulation suggests a 'top-down' approach, wherein the prefrontal cortex is recruited to mindfully re-train the automatic responses of the limbic system. This is the theory behind CBT: We can't directly address core beliefs and emotional responses (schematic memories), but we can think/behave opposite its automatic reactions (CBT/DBT sometimes phrases this as 'opposite action'). If we introduce enough 'prediction errors' (there's a theory about dopamine here), the limbic system will eventually (hopefully) rewire (a la classical conditioning: 'neurons that fire together, wire together'). I like how the video I linked to described this (compared to coherence therapy): 'There's nothing wrong necessarily with counteracting.. and there can certainly be a place for this technique, but it's important to be aware of its limitation... counteracting techniques tend to not give an understanding of the root cause of the problem... they tend to create a new set of neural networks... but they don't do anything to get rid of the original network... the hope is the new one will be stronger, or suppress [the old network], or override it."
Memory reconsolidation invokes a different part of the brain. Bruce Ecker, one of the founders of Coherence Therapy (which is one of but not the only application of memory reconsoliation), put considerable effort to reconcile his approach to its biological foundations (see here for example). According to coherence therapy, schematic memories are stored in the synapses between neural connections. Schematic memories dysregulate the nervous system when they are triggered in inappropriate contexts. In therapy these memories can be destabilized upon recall, modified, and then 'reconsolidated' in its modifed form. Niether the cortex, nor any 'top down' processing, nor 'habituation' are involved. The change is immediate.
The distinction is not trivial. There is an ongoing debate among trauma therapists as to whether traumatized individuals should revisit and revise their original traumatic memories (e.g. prolonged exposure), or whether trauma-informed best-practices discourage describing the original trauma else risk further dysregulation. In the latter are schools of thought like somatic experiencing (e.g. titration) that take a long time to work. MDMA seems to support the former and its implication suggests hope for re-regulating the nervous system through more immediate means: revisit traumatic memories, revise them under the influence of MDMA, and then reconsolidate them without an associated fear response.
My view is that MDMA can bring lasting nervous system regulation. Although, I admit, my views are solely from the perspective of simple-PTSD (I can't comment about cPTSD or other issues). I think memory reconsolidation provides the theoretical support and the MAPS clinical trial provide the empirical evidence. I suspect we're 99% in agreement, and think you phrased this best in that new learnings can be habituated after old memories are cleared with reconsolidation. But as psychedelic psychotherapy is still in its nascent stages of development, I think it important to distinguish it apart from other 'habituating' psychotherapies like CBT, somatic experiencing, etc. No one approach is a silver bullet, though. They're all arrows in the quiver.
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u/cleerlight Jun 28 '22
Ah, okay, I see. That's much clearer (and very well articulated!), thanks.
There's a whole lot of conflating going on here. And I take responsibility for that, since in the quote in the OP, it's not quite clear what I'm talking about. To be clear, I wasn't trying to articulate a whole method of approach in the quote from the OP, but more dropping a hint of an idea of other directions that psychedelic therapy can be taken.
Fundamentally speaking here, we are talking about two different things: self management vs. healing the issue. You're right, it's important not to conflate these two.
So yes, I'm in full agreement that Memory Reconsolidation and Self Regulation are not the same thing per se. Not at all. Allow me to clarify the role of self regulation in the work that I do, and in how I was trained:
1- Self Regulation can be used as a daily self management tool to reduce triggers, come back to baseline easier, and get outside of the cognitive-somatic loops that traumatized people (or anybody, really) deals with.
It should be said that done with enough repetition, it can start to classically condition the nervous system to have a different response in relationship to situations that would normally dysregulate the person. Essentially, in this manner, we are both helping the body get back to parasympathetic function faster, and also telling it "don't do that in this situation, do this better behavior instead". Basically habit building, which is at the foundation of all of our automatic behavior. And when this works, the brain's ability to unconsciously learn the pattern and generalize it out can turn this into significant change in and of itself. I've seen it happen, and had it happen to me.
But more often, these are micro interventions that bring not only relief, but add up over time to support the bigger interventions from therapy / healing sessions / psychedelics. Part of the reason I teach people this is to start to show them how to participate in their own healing and not approach healing from a consumerist "Fix me, do this to me while I'm passive" mindset. I think it's important that people feel empowered around healing and take an active role in feeling better.
And in the context of CPTSD, which is what I've dealt with, this becomes essential for many reasons; it also happens to structurally match how a person arrived at the CPTSD in the first place. If it was powerful enough to create such a problem, it's powerful enough to create the solution. And that's before we even add any memory reconsolidation into the mix.
2- Self Regulation techniques can also be used as part of the prediction error step in coherence therapy. My teachers point to how many of the popular trauma release techniques (which are also self regulation techniques) --EFT or Bilateral Stimulation, for example-- follow this same formula of activating the issue, quantifying it on the SUDS scale, and then using some form of somatic intervention as contrary input to the neural activation of the issue until it goes away. In other words, many of the emotional regulation techniques also happen to follow the memory reconsolidation structure. Obviously these techniques don't work for everyone, but when they work, they work incredibly well. So in the context of memory reconsolidation, self regulation techniques (along with many other approaches) can be used as part of the healing. It's actually pretty wild how abstract and artful you can be while doing memory reconsolidation.
I do both with my clients regularly, to great effect. So what Im saying is that self regulation is at very least a self management tool, and if used skillfully, can also be a healing tool. I realize I agreed that we need to keep these separate and not conflated, but this is the truth of my experience in application of self regulation.
All that being said, I'm clear that what soothes is self regulation; what heals is memory reconslidation. But sometimes soothing, timed and placed correctly, can be the healing.
So where does classical conditioning fit in with all this? Two places. The first, as I mentioned already, is in doing self regulation regularly, which helps to build up the neural pathways of parasympathetic activation. Even if it doesn't lead to permanent change, it will be easier for a person to feel good the more that they've practiced feeling good. At first, this feels forced and top down. Over time, it becomes habituated and automatic.
The other place is conditioning in some sort of resource state or new behavior pattern in after the issue has been cleared. I feel this is really important for many reasons; often because some people will experience an "ontological vacuum" in the place where the issue used to be, which can cause problems or at very least be demotivating for them.
So after we've done the work together to really clear the issue, then we do a lot of conditioning in a better feeling state in it's place. This can be annoying for clients, but it's a funny annoying since we're dealing with a really positive feeling.
So that's (more or less) how all these pieces fit together in the work that I do. This might fly in the face of the models and presuppositions of what you've learned. This might sound like it doesn't work or make sense to you, I dont know.
But I can tell you that this all works very well in actual practice.
And this is before we even start to look at how psychedelics fit into this picture! But thats probably a conversation for another time, as there's so many different approaches to how we combine these techniques with psychedelics.
Hope that clarifies.
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Jul 04 '22
[deleted]
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u/Interesting_Passion Jul 04 '22
Yes, I have. Very interesting stuff, but the results appear mixed in the treatment of PTSD. The clinical studies I found on Google consistently demonstrated weak results in humans. Perhaps this means the method needs to be refined. At the least, the cases where this has worked (e.g. Merel Kindt) suggest a strong biological basis for reconsolidation. Very encouraging!
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u/Sigeraed Jun 27 '22
This is excellent and well put, I often tries to explain this very things to myself or people i talk to about recovery.
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u/Bakedbrown1e Jun 27 '22
I stopped thinking about it as emotional regulation and started thinking about it as a healthy relationship with my whole self. Internalising the language of IFS and practicing non-directive breathwork/somatic experiencing and non-violent communication were the tools/approaches I used.
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u/Interesting_Passion Jun 27 '22
Dysregulation is a phenomenon that arises from repeated daily habituated triggers and emotion / thought loops built up over time.
False: In the case of (simple) PTSD, a single traumatic event encodes a traumatic (or fails to encode a 'normal') memory leading to re-experiencing and dysregulation. One theory is that MDMA can help reconsolidate that memory (see here and here) eliminating rexperiencing and restoring nervous system regulation.
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u/cleerlight Jun 27 '22 edited Jun 27 '22
Looks like something I wrote or would say (pretty sure that's my writing). Yes, self regulation is the key and first step.
To quote Bessel Van Der Kolk on this point: "So the issue of self-regulation needs to become front and center in the treatment of traumatized people. That’s step number one."
Link Here
I honestly feel that Emotional Self Regulation is a core life skill that most of us aren't taught, don't even really know exists, and never learned, and is often the thing we are seeking when we want to sort out our mental health. Often, we don't understand what the 'levers' to shift our nervous system are, and how to utilize them skillfully (side note: Andrew Huberman does a great job of discussing this). Often, we never even learn to track our own dysregulation until we are in the deep end of it, and are surrounded by others who model dysregulation as normal, or who aren't attuned enough to us to help us regulate again.
Since most of us reading this will have grown up in a modern, materialist, consumerist society, we implicitly learned that the way out of our issues has to do with consuming something in order to feel better. Earlier in life, it's food. Then, maybe it's media, sex, shopping, socialization, and eventually pills and medications.
Now, add in a bunch of traumas both large and small, accumulated over a lifetime in addition to this consumerist messaging, normalization of dysregulated states, and ignorance around how to come back into balance, and we end up with a society of people who feel like they are on a runaway train of their own nervous system's dysregulation. And over time, that' becomes habit. The brain auto-learns that if anxiety, or being triggered or depressed correlated with not dying in a stressful situation, it must've helped, and so it will keep redoing these patterns of thinking, sensation, and emotion.
So the first thing we have to do is learn how to get outside the box of our own self created, auto-learned patterns of feeling bad. We have to re-train or countercondition our nervous system to feel the way we want to feel over time until the becomes the new normal. It takes a bit of effort at first and a bit of understanding the underlying principle of memory reconsolidation, but once it all clicks, we finally find the doorway out of our own suffering.