Being Present - The Therapy of Being Lost in The Process

WHAT DOES IT MEAN TO BE PRESENT?

How many times a day do you think you are fully present? Completely absorbed in a moment without any consideration for what happened earlier today or what you need to do later?

The recognition that these moments are rare has spiked a huge movement for Westerners to adopt the Eastern practice of Mindfulness.

Mindfulness is the dispassionate, moment-by-moment awareness of sensations, emotions and thoughts. (1)

This is typically achieved through meditation practices originating from Buddhist spiritual traditions (2)

Activities can also facilitate being present, when we achieve a state known as flow (3). Flow is a state of mind characterized by focused concentration and elevated enjoyment during intrinsically interesting activities (4)

Flow experiences have been considered to characteristically occur under conditions of “perceived challenges, or opportunities for action, that stretch (neither over- matching nor under-utilizing) existing skills (4)

Several characteristic features of flow experience include “Intense and focused concentration on what one is doing in the present moment”, the “Merging of action and awareness”, the “Loss of reflective self-consciousness" (4)

BEING PRESENT, THE BRAIN AND PTSD

PTSD causes negative changes in the size and activation of the Default Mode Network (DMN), Medial Premotor Cortex (mPMC), Temporal Lobe, Hippocampus, Basal Ganglia and Amygdala. As discussed below research has shown that both meditation and flow states induce physiological changes in all of these regions of the brain.

Default Mode Network

The Default Mode Network (DMN) is a group of regions in the brain that generate ruminating thoughts (5). Rumination is strongly and consistently correlated with depression(5) and impaired DMN connectivity in individuals with PTSD has been related to childhood trauma (6). Furthermore decreased DMN functional connectivity strength has been found to be associated with increased PTSD symptom severity (7). This “default network” is deactivated when we are absorbed in goal-directed activities (8) ie when we are in 'flow'. Many studies have found reduced Default Mode Network activation during meditation (9).

Medial Prefrontal Cortex

The Medial Prefrontal Cortex (mPFC) is located in the frontal lobe just behind your forehead. The mPFC is designed to (10)

• Regulate attention and awareness

• Make decisions about the best response to a situation

• Initiate conscious, voluntary behavior

• Determine the meaning and emotional significance of events

• Regulate emotions

• Inhibit or correct dysfunctional reactions

The mPFC appears to be  smaller and less responsive in persons with PTSD (11). Meditation is associated with increased activation in the mPFC (12) while stimulation of the prefrontal cortex during video game play has been shown to increase the experience of flow states (13)

Temporal Lobe

The medial temporal lobe is is central to emotion, motivation, and memory (14). The lateral temporal lobe is believed to be crucial to self-processing, self-location, and perceived spatial unity of self and body (14). Lateral temporal lobe dysfunction is therefore likely implicated in dissociation characteristic of PTSD (14). A history of abuse is associated with reduced right temporal volume (15) and exposure to trauma-related cues may provoke temporal lobe activation in traumatized populations (16). Meditators have significantly greater cortical thickness in the temporal areas of the brain (17) and the medial temporal lobe has been implicated in flow states (18)

Hippocampus

Located within the temporal lobe, the hippocampus is vital for learning, memory, and spatial navigation (19) and people with chronic PTSD have decreased hippocampal volumes (20). Meanwhile meditators have significantly larger volumes of the right hippocampus (21) and the act of building the 'muscle memory' required to enter flow states implicates the hippocampus (18)

Basal Ganglia

The “basal ganglia” are responsible primarily for motor control, motor learning, executive functions and behaviors, and emotions (22). Compared to trauma-exposed controls, regions of the basal ganglia are deferentially active in PTSD patients (23) It has been shown that when meditators sit down to start meditating, their basal ganglia activate (24). The motor control for the implicit skill-based knowledge required for flow states means the basal ganglia are also central to flow (4)

Amygdala

The amygdala modulates fear, triggering our fight or flight response (25). Amygdala responsiveness is positively associated with symptom severity in PTSD  (11) and there is clear evidence of an association between smaller amygdala volume and PTSD (26). If your amygdala remains active after trauma, if stays stuck in hyper-vigilant mode, that is when you're likely to develop PTSD (27). Meditation down-regulates amygdala activity  (28). Researchers have yet to investigate a specific connection between frequently engaging in flow states and amygdala regulation. Given the similarities in being present in flow states and meditation, flow likely induces the same benefit. Furthermore, habitual physical activity (running) has been show to effect the amygdala by both increasing happiness and decreasing fear (29)

TEACHINGS FROM TRAUMA SENSITIVE YOGA

In Trauma Sensitive Yoga (TSY), being present is always linked to interoception and the body (30).

As I have said, meditation is the dispassionate, moment-by-moment awareness of sensations, emotions and thoughts (1).

Despite the incredible research describing the benefits of meditation on the brain regions implicated in PTSD, focusing on sensations, emotions and thoughts (1) can be distressing for complexly traumatized patients (30).

If your frontal lobe doesn't know that your thoughts are just thoughts and not reality then meditation can bring up thoughts and accompanying bodily sensations that cause you to relive the trauma (30).

This can be retraumatizing for some patients (30).

By making the body, not the mind, the object of mindful focus, we can help clients practice being present with less thoughts about trauma (30).

BEING PRESENT WHILE KICKBOXING

In Trauma Informed Kickboxing we alternate between being present by being absorbed in goal oriented activities and being present by practicing interoception

The clear distinction between TSY and trauma informed kickboxing is that we do have goals. While we are always focused on the person rather than the performance, kickboxing is a set of skills that we are working to develop. My clients and I work together in an environment that encourages curiosity about how to facilitate power.

Let's use the example of the trauma informed way to teach a push kick.

The push kick, (also known as the teep) primarily uses the quadriceps and hip flexor muscles.

At the start of class participants are invited to try Hip Stretch 1 and Leg Lift variations 1 and 2 from TSY (30).

We have a discussion around what they feel during these movements. Can they feel their quadriceps and hip flexors activate or burn or stretch? If not, can they change the stretch or movement to elicit a feeling in these areas? Participants are reminded it is OK not to feel anything and that the act of asking their body what they feel is starting to form new neural connections.

Once we have settled on a kickboxing stance, participants are given a simple invitation:

If you like, you could try pushing someone away with your foot.

While we are all practicing the kick some participants will be watching me to copy my movements. Some will be thinking back to the videos. Some will use the cue and imagine they are pushing someone away with their foot.

In all of the above, participants are fully absorbed in a goal-oriented activity. They are being present.

Now I might suggest:

Perhaps you could think back to the beginning of class. What muscles did you notice then? Can you notice those same muscles working now? Maybe you notice different muscles working now?

This prompts participants to shift their attention from the task to their bodies. Still they are being present.

Next I might suggest:

If you like, you could experiment with kicking faster or slower. You might notice how changing the speed feels in your body.

Now the focus is on the technique and themselves: how fast do I want to go? In this way we also bring choice related to right now (being present) into the session.

Many women on my podcast have said that Martial Arts gave them an escape. An hour of being completely focused on the task at hand, not worrying about their past trauma.

At The Fight Back Project I make being present not just a side effect of the nature of the activity, but a central goal of the session. I choose activities that require the right amount of concentration, we practice them for the right amount of time (to avoid boredom) and I consistently prompt to encourage interoception.

This formula has enabled both myself and my clients to be much more present in an hour of kickboxing than we could ever hope to be in a hour of cross-legged meditation.

References

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30. Emerson, D. (2015). Trauma-sensitive yoga in therapy: Bringing the body into treatment.