Tracking
Developing Sensorimotor Awareness and Literacy
Graphics courtesy of Amen ClinicsOpens in new window
Most children do not have the vocabulary to describe and understand their sensorimotor reactions. During the preparation phase of EMDR therapy and the skill-building phase (Gomez, 2006), games to develop sensorimotor literacy might be used. In addition, Sensorimotor Psychotherapy techniques such as: Tracking, contact statements, boundaries, physical action, sensorimotor sequencing and the use of micromovements, among others, can assit EMDR clinicians working with children with affect dysregulation. In Sensorimotor Psychotherapy, tracking is a fundamental skill that refers to the moment-by-moment observation of how experience is encoded in the body. Ogden, Minton and Pain (2006) define tracking as follows: Tracking refers to the therapist’s ability to closely and unobtrusively observe the unfolding of nonverbal components of the client’s immediate experience: movements, physical signs of autonomic arousal or changes in body sensation. Somatic signs of emotions (moist eyes, changes in facial expression or voice tone) and how beliefs and cognitive distortions that emerge from the client’s narrative and history affect the body (such as the thought “I am bad” correlating with tension and looking down at the floor) are also tracked.” (p. 189) The clinician resonates and notices (tracks) the body throughout the session. Not only trauma responses, such as bracing, loss of postural integrity or the shaking of a dysregulated nervous system, but resources and physical evidence of proficiency and empowerment are noticed, such as a deep breath, lengthening of the spine, relaxation of the shoulders, etc. The child is also invited to track his or her body from the inside by using directed mindfulness with the assistance of the therapist, which cank increase the child’s ability for focused attention (Ogden, 2009; Ogden et al., 2006). When teaching children to track their bodies, a playful atmosphere becomes an important element that not only facilitates tracking, but also activates the child’s play and the social engagement systems (Ogden et al., 2006). The use of the “feelings detector” or the “body compass” may add a playful component to the mindful exploration of bodily states (Gomez, 2006). When using the “body compass” or the “internal camera” with “zoom in,” “zoom out” and “slow down” features (Gomez, 2006), the child is invited to create one of these special imaginary devices inside to check what is happening in the body and detect any body signals. The “internal camera” can also “slow down” any movement or sensation as well as zoom in and out to experience it closer or from a distance. The child is invited to do “detective work”, (Chapters 3 and 4), but this time the detective work is directed toward listening to the body. Once the child becomes aware of a somatic reaction, the child may be invited to track it internally with the feeling finder or the body compass, curiously following the sensation to see where it is going or where it wants to go. The nonverbal tracking and expression of internal bodily states can be used to help the child develop body awareness. This initial work is followed by labeling bodily states and emotions, with the intention of engaging the cortex and left brain. Since most children will not have a well-developed sensorimotor literacy, the clinician can help the child develop his or her repertoire of sensation words by providing a “sensation vocabulary menu.” We may say, “I wonder what kind of feeling it is … maybe it’s tingly, shivery, shaky, or warm. Or maybe it feels like a pressure pushing out or in.” This gives a child options to choose from, and, whether the clinician’s guesses are accurate or not, they will spark the child’s own words to describe his or her body (Ogden et al., 2006). As the child develops somatic and interoceptive awareness, information on resources, current eliciting stimuli and past experiences of adversity may surface that can be placed in the child’s targeting sequence (Shapiro, 2010). The following list (Ogden, 1997; Ogden et al., 2006) provides examples of sensorimotor vocabulary that may be used with children:
Children may also come up with their own words, as have children in treatment with one of the authors: spaghetti-like, needle-like, earthquake-like, butterflies. When a traumatic event occurs, it is often accompanied by strong negative feelings and dissociation. Recall of the traumatic event is thereafter linked with the strong negative emotionsOpens in new window that accompanied the actual event. EMDR is a technique to reprocess the traumatic memory while disconnecting it from the associated negative emotions and thoughts. EMDR contains elements of other therapies including psychodynamicOpens in new window, cognitive-behavioral (CBT)Opens in new window, interpersonalOpens in new window, experientialOpens in new window, and body-centeredOpens in new window therapies. The key component in EMDR is the use of bilateral (two-sided) stimulation. The bilateral effect is provided by having the client visualize a distressing scene or memory while the therapist stimulates rapid back-and-forth eye movements, alternates right and left hand taps, or alternates sounds between the right and left ears. During the visualization, the client brings to mind thoughts and feelings related to the distressing memory (Rubin, 2003). The term EMDR comes from the idea that eye movements (or other bilateral stimulation) while reprocessing a traumatic memory can lead to desensitization of the anxiety associated with the memory. EMDR goals include anxiety reduction, elicitation of positive affect (emotion), changes in beliefs, insights, and behavioral shifts (Shapiro, 2002). A course of treatment may consist of 12 or more sessions over a period of several weeks, depending on the client’s needs and response to treatment. EMDR is usually administered on an outpatient basis (Bisson et al., 2007). Since Dr. Shapiro’s (1989) first article on EMDR was published, over 30,000 mental health practitioners have been trained in EMDR. In the early 1990s, EMDR was depicted by the popular media and early proponents as a miracle cure for a wide range of problems. The dramatic results of early EMDR studies were misinterpreted as implying that a single EMDR session could lead to long-lasting resolution of distress associated with traumatic memories in posttraumatic stress disorder (PTSD)Opens in new window and that clinicians could anticipate success rates as high as 80 or 90 percent. PTSD may occur afer experiencing or witnessing military combat, domestic violence, sexual trauma, auto accidents, natural disasters, and other types of trauma. However, Shapiro acknowledged some of the media reports as hype and cautioned EMDR proponents not to make claims about miracle cures (Rubin, 2003). EMDR has been used to treat many conditions, including PTSD, grief, eating disorders, phobias, panic disorder, test anxiety, performance difficulties (e.g., work, sports, performing arts), conduct disorders, personality disorders, chemical dependency, marital and relationship problems, dissociative disorders, and physical pain. The most compelling evidence exists for the effectiveness of EMDR in treating PTSD. Some extreme claims have contributed to the controversy and skepticism surrounding the use of EMDR. For example, Allan L. Botkin, PsyD, claims that an offshoot of EMDR he calls induced after-death communication can help resolve the deep sadness associated with grief by helping bereaved individuals “experience what they believe is actual spiritual contact with the deceased” (Botkin, 2000, p. 181). Theories about the mechanism of action responsible for the effects of EMDR include resetting of cells in the brain’s septum (which includes the hippocampus and amygdale), disconnection between the affective (emotion) and cognitive (thought) parts of the anterior cingulated cortex, and increase in the interaction between right and left brain hemispheres. Evidence from electroencephalogram (EEG) studies suggest that brain stimulation during EMDR increases the power of a naturally occurring low-frequency rhythm in the amygdale of the brain, which processes fear. When fearful memories are recorded (encoded), the memory is closely linked to the fearful emotion experienced during the traumatic event. This low-frequency rhythm produced by EMDR stimulation causes a mechanical change in fear memory, allowing the memory to be disconnected from the extreme emotions previously associated with the traumatic memory (Harper, 2009). There has been a great deal of controversy about the effectiveness of EMDR. In a 2007 review of the research into treatment of PTSD, EMDR was found to be as effective as trauma-focused CBT, both of which were more effective than stress management, other therapies, or no treatment. Results may be affected by the populations being studied. For example, a study of Vietnam vets with PTSD showed EMDR to be less effective than a control group receiving no treatment (Bisson et al., 2007). While EMDR appears to be a well-supported treatment for adults with PTSD resulting from a single trauma, there is less compelling evidence supporting the effectiveness of EMDR to treat PTSD in children, combat veterans, or individuals who have sustained multiple traumas (Rubin, 2003). As not all individuals will benefit from EMDR, a variety of treatment approaches should be considered. Other treatment options may include alternative forms of trauma-focused treatment (e.g., CBT or exposure therapy) or psychotherapy augmented with medication (Bisson, 2007; Rubin, 2003). More research is needed to establish the effectiveness of EMDR as a treatment for various populations and conditions, to see whether beneficial effects are maintained over time, and to explore and document any negative outcomes or side effects. Side effects of EMDR may include unanticipated reactions, a temporary increase in distress (emotional or physical), or ongoing reexperiencing of traumatic material (e.g., in memories, dreams, or flashbacks) after the session has ended. For understanding or knowing that a person is in a mental state, or to reflect on one’s own mental states, one has to be able to represent that state. In order to be able to represent a state, one needs a concept of that state—that is, a rich enough theory of mind. The study of how children acquire the requisite theory of mind is therefore essential for our understanding of how children come to understand memory. Furthermore, since some memorial states are reflective or self-referential, children need a theory of mind for being in such states or having such memories. Why We Need a Theory of Mind for MemoryWe probably do not need a theory of mind for implicit (nondeclarative Opens in new window) memory, but for explicit (declarative Opens in new window) memory we do, since “explicit memory is revealed when performance on a task requires conscious recollection of previous experiences.” (Schacter, 1987). To be conscious of a fact one requires to be also aware of the state with which one beholds that fact. The higher-order-thought theories of consciousness make this their core claim (Armstrong, 1980; Rosenthal, 1986). For instance, if one sees a state of affairs X (e.g., that the chocolate is in the cupboard), then this seeing is a first-order mental state (attitude). To be conscious of this state of affairs means, according to theory, that one entertains a second-order thought about the seeing—that is, the second-order thought represents the first-order seeing. A weaker version does not require that one has to entertain the second-order thought, but only that one has to have the potential for having the second-order thought (Carruthers, 1996). That some such condition must be true can be seen from the following consideration: “Could it ever be that I can genuinely claim that I am consciously aware of the chocolate being in the cupboard, but claim ignorance of the first-order mental state by which I behold this state of affairs—that is, by claiming that I have no clue as to whether I see, or just think of, or want the chocolate being in the cupboard?” The important point of these conceptual analyses is that to be conscious of some fact requires some minimal concept of knowledge or of some perceptual state like seeing. Unfortunately, there is no clear evidence when children understand a minimal state of this sort. There is some evidence of understanding (mother’s) emotional reactions and seeing (direction of gaze) in the first year of life (see Perner, 1991, chap. 6; Baldwin & Moses, 1996; Gopnik & Meltzoff, 1997, for summaries and discussion of problems of interpretation). There is also some recent evidence that between 8 and 12 months children might be inferring people’s intentions to grasp an object from where that person looks (Spelke, Philips, & Woodward, 1995) and even between 5 to 9 months from how a person touches an object (seemingly intentional or accidentally). And by 18 months (where children’s understanding of mental phenomena seems to flourish in general) children imitate people’s intended actions even when they observe a failed attempt (Meltzoff, 1955a) and they understand differences in preferences (e.g., that someone else can prefer cauliflower over biscuits, Repacholi & Gopnik, 1997). Evidence that children distinguish their knowledge from ignorance is available at a relatively late age. Povinelli, Perilloux, and Bierschwale (1993) asked children to look for a sticker under one of three cups. Children were first trained to look under the cup at which the experimenter had pointed. After some training even the youngest were able to do this. When asked to look without the experimenter pointing, an interesting developmental difference emerged. Children older than 2 years and 4 months acted without hesitation when they knew which the cup the sticker was under, but hesitated noticeably when—in the absence of the experimenter’s poining—they had to guess where it was. Interestingly this is also the age at which children start using the phrase “I don’t know” (Shatz, Wellman, & Silber, 1983). In contrast, children younger than that showed no comparable difference in reaction time. This may indicate that young 2-year-olds do not yet reflect on what they do and do not know. So, theory of mind research is not yet able to give a guideline for when infants might develop explicit, conscious memories. Memory development may help out on this point. Meltzoff (1985, 1995b) demonstrated that 14-month-old infants can reenact a past event (e.g., they imitate the experimenter leaning forward to touch a panel with forehead so that panel lights up) after several months. Recently this has been demonstrated in 11-month-olds with a delay of 3 months. Since this is achieved from a brief observational period and does not require prolonged learning, and since patients with amnesia cannot do this (McDonough, Mandler, KcKee, & Squire, 1995), it is tempting to conclude that such enactment demonstrates explicit, conscious memory. One should, though, keep in mind that delayed imitation that is based on a single event (third-person view) is not to be equated with a memory (knowledge) of that event as a single, past event (first-person view).
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