Emotional Dysregulation, Trauma, and Paths to Recovery Mel Pohl MD
Disclosure â€˘ Nothing to Disclose
Learning Objectives • Describe fundamentals of pain and suffering • Review the neurobiology of pain and trauma • List non-medication treatments for chronic pain
Emotional Abandonment Abandonment When you have to hide a part of who you are in order to be acceptable/ to protect self. When you have to hide: —Your mistakes/ vulnerabilities — Your feelings — Your needs — Your accomplishments/ success
Emotional Abandonment -- cannot live up to expectations -- attack whole being, worth, and value versus action -- you are to be an extension of another’s dreams. -- you are responsible for another’s feelings, thoughts, and behaviors. -- parents’ esteem is derived through child’s behavior. -- children are treated as peers with no parent child distinction.
Damaged Inadequate Damaged goods
Stupid Not good enough
Trauma â€œstress that causes physical or emotional harm from which you cannot remove yourselfâ€? Larke Huang (SAMHSA)
Greater likelihood of addiction
Greater number of Traumas
Greater likelihood of multiple addictions
Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: Adverse Childhood Experiences (ACE) Study --Childhood abuse, neglect, and exposure to other traumatic stressors = ACE Almost two-thirds of study participants reported at least one ACE more than one in five reported three or more ACEs. short and long-term outcomes of these childhood exposures ďƒ health and social problems. CDC and Kaiser Permanente, San Diego
As the number of ACEs increase, the risk for the following health problems increases in a strong and graded fashion: • Alcoholism & alcohol abuse • Chronic obstructive pulmonary disease (COPD) • Depression • Fetal death • Health-related quality of life • Illicit drug use • Ischemic heart disease (IHD)
• Liver disease • Risk for intimate partner violence • Multiple sexual partners • STDs & HIV • Early initiation of smoking • Suicide attempts • Unintended pregnancies
Finally, as the number of ACEs increases, the number of co-occurring or “co-morbid” conditions increases.
Pain Switchboard GENETICS N O C I C E P T I O N
P A I N
Patient with Pain Pain
Patient with Pain Suffering Pain
“…When touched with a feeling of pain, the ordinary uninstructed person sorrows, grieves, and laments, beats his breast, becomes distraught. So he feels two pains, physical and mental. Just as if they were to shoot a man with an arrow and, right afterward, were to shoot him with another one, so that he would feel the pains of two arrows…” The Buddha
Emotional Intensifiers • • • • •
Guilt Anger – Resentments Loneliness Helplessness Fear
Cycle of Uncontrolled Pain and Fear Avoidance Behaviors Pain
Decreased Mobility FEAR
Altered Functional Status
Reversal of Cycle of Fear and Pain
Pain Pearls • Conditioning Increases Pain. • Pain Patients Are A Pain. • Secondary Gain Prevents Getting Well.
Trauma Pain Addictions
Trauma Addictions Pain
Trauma Addictions New Trauma Pain Addiction Worsens Pain Worsens
Addiction Trauma Pain Medications Addiction Worsens Pain Worsens
Pain Recovery – Develop Balance • • • •
Mental Emotional Physical Spiritual
RESULTING CHANGES – Relationships – Positive actions and behaviors
Non-Medication Treatments at LVRC • • • • • • • • • •
Exercise – Physical Therapy Chiropractic Treatments Therapeutic Massage Reiki Acupuncture EMDR Equine therapy Mindfulness-Based Stress Reduction (Kabat-Zinn) Yoga - Chi Gong Individual + group therapy
Research confirms that drugs give the same benefits as yoga !!!
Halasana Excellent for back pain and insomnia.
Balasana Position that brings the sensation of peace and calm.
Savasana Position of total relaxation.
References • • • • • • • • • • • •
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