Recently published by San Diego Trauma Therapy. All articles were written by Dr. Jeffery Smith, MFT.

The Benefits of Drama in Relationships​

Is there a benefit from drama in relationships? Even more so with those who have Borderline Personality Disorder (BPD)?

If we do what we do for a reason, then, what is the reason for all the emoting?

Is it possible that the drama actually serves a productive purpose?

From the outside looking in, there seems to be no good reason to act out and throw a tantrum – could we be missing something?

Might there be alternatives to reach the same end-state without the drama? – this is a concept that Dialectical Behavioral Therapy is based on.

If we cannot offer alternatives or other options to reach a desired end state, then we can fully expect the drama to continue. It becomes habit -- automatic activation of thought, feeling and accompanying negative behavior.

Recent studies on brain activity using fMRI brain imaging have revealed the end state that various activities have on our brain -- everything from listening to different kinds of music to smelling different smells, meditation, prayer, worship, sleep and thinking about pleasant and unpleasant thoughts. Brain imaging confirms what we have long known: our thoughts, actions and behaviors either stimulate the brain or sedate it.

These images, along with blood samples taken before, during and after specific activities have led us to greater understanding of why people do what they do. We have learned that people struggling with Bulimia-Nervosa do not binge and purge for the sake of body image or avoiding weight gain as much as they do for the end state of becoming calm following the violent activity of purging. Vomiting creates a large release of enzymes, hormones and neurotransmitters that have a powerful sedating effect on the body and the mind. The binging and purging, in effect, offer a way to calm the emotions in our mind – we have been falsely led to believe it is about food or body image.

Domestic Violence (DV) creates a similar end state – believing circumstances are out of control, the anger addict or abusive person is prone to strike both emotionally and verbally toward their victim – believing there is some real or justifiable reason for the violence. The real reason is the sedating effect that is experienced following the storm. This person has learned how to calm their brain and has a sense of being able to control some aspect of their world which cannot really be controlled. Of course we want to offer them alternatives to reach calmness without the need for hostility.

Cutters believe they cannot control their emotions, so they learn to not feel. Over time this learned behavior of not feeling (land of the lost) becomes intolerable and radical measures are explored to generate “some feeling”. The physiological sensation of cutting provides comfort by confirming that they are still able to feel something. This thought, in turn, provides emotional comfort and the end-state is one of being more in control and having a sense of being more calm. Doing something out of control to gain control – is an illusion of course and short lived, raising a pain threshold and pain tolerance to ever increasing frequency and severity The brain produces opiates and endorphins to ease the physical pain of the self-inflicted injury. The brain does not care who caused the pain, it simply responds to the pain in a predictable fashion that the cutter comes to rely on. These same chemicals produced by the brain in response to the pain also have a calming effect on the emotional part of the brain. Physical sensation is felt and controlled by the Parietal lobes and cortical surfaces of the brain. Right next door and underneath the cortical surface of the brain is the limbic structure that governs and regulates our emotions. So in essence, when the cutter is overwhelmed with not feeling, they cut and the brains response to the injury creates a two fold experience of easing both the physical and emotional discomfort.

As people with trichotillomania pull their hair out (could be hair on the scalp, or facial hair: eye lashes, eyebrows or nose hair), they unconsciously and unknowingly create a small production of opiates (natural pain killers) in response to the very concentrated area of pain. These natural pain killers that soothe the physical pain also soothe the emotional pain or discomfort that is experienced as anxiety – this may be more sub-conscious or unconscious distress than conscious anxiousness. This response to physical pain is the genesis to ongoing and repetitious behaviors known as obsessive compulsive behavior. The solution to avoiding unnecessary hair loss is to bring the behavior into awareness and connect it to the emotional state at the time or just prior to the hair pulling. Once the emotion can be identified we can then offer an alternative action to remediate the anxiousness. People after all, simply want to feel content and want to believe that they have the ability to promote stability in their life and get their needs met. When we do not think or believe we have this ability, we resort to behaviors that do – regardless of the negative impact or long term consequences.

Skin and scab picking, nail biting, hair twisting & twirling, nose picking, lip licking, and repetitive scratching all have in common, the end state of a very small production of self soothing chemicals that hit our pituitary gland (bottom center of the Limbic Structure – emotional core of the emotional network of the brain) that give us a sense of wellbeing. As we become aware of this behavior by being willing to be more present in our thought life, we can then ask ourselves what is troubling us to the point of needing to do something that will not really help or solve the deeper issues. If we do not work toward solving these unresolved deeper issues, they will increase in magnitude, sending a stronger signal of emotional discomfort (which also spills over to physical discomfort and eventual pain). If an action or behavior can produce a combination of chemicals (enzymes, hormones and neurotransmitters) that can bring physical and emotional soothing, then a different combination of chemicals can also produce physical and emotional pain – it has to work both ways. We want to become aware of this process – eliminate exposing ourselves to negative thoughts and negative environments that generate these upsetting chemical responses – that tell us to run away, move away, avoid or stay away from the cause or source of the pain.

Next to our motor neurons in our brain, (that gives us kinesthetic sensation and motor skills) lay our “mirror neurons”. The mirror neurons allow us to feel other’s emotions and give us some insight into what people around us are experiencing. If we do not have good boundaries and we allow our mind and body to be in toxic exposure, our mind will create a supply of chemicals to soothe the emotional injury just the same way it will to relieve physical injury. This sounds like a good thing – but used too often – it is not. It works and people come to depend on feeling better by first having to feel bad – emotionally and or physically – it matters not, because the brain responds to both the same way.

Head bangers, have learned this behavior by trial and error. They have resorted to this level of action in direct response to the level of emotional dysregulation they are experiencing within. Head bangers tend to be in the most pain, therefore need to implement an action that will stimulate the production of natural pain killers and create the desired numbing effect or end state.

People with Borderline Personality Disorder and Histrionic Personality Disorder resort to creating dramatic reactions to circumstantial events perceived as threatening or not getting their needs met in the way they believe they need them to be met. This drama in turn creates a high level of stimulation and antonymic nervous system activation (panic) that eventually exhausts the adrenal gland – the end result is depleted energy stores which are experienced as both physical and emotional exhaustion – generally followed by withdrawing and going into a time of recovery, rest and sleep.

We have learned that our brain is oriented toward seeking experiences of novel and curious stimulation along with stability and safety. This is best done in balance. When the mind signals the brain that balance has not been achieved, actions go into effect that then produce the right mix of chemicals to reach the desired end state of calm or relaxed. For those people who go to extreme measure to eventually reach a relaxed calm state of mind, we can offer more affective strategies with far less negative consequences physically and emotionally. The alternative choices mostly entail learning to think differently by being willing to seek the truth, uncover the lies we have all been taught to believe from childhood and resolving emotional traumas from troubling memories that are easily triggered by similar situations and events that tell our mind we are not safe, even though we really are. A place to start seeking the truth and learning new alternatives is to take the short 25 question Understanding Truth Quiz, evaluating your score, and following the suggestion offered at the end of the quiz.

Depending on the level of pain you believe you are in, you will need to seek interventions that are capable of providing relief at that level. Baby aspirin will not relieve a migraine headache. So work with a mental health professional that specializes in treating these conditions to create a solid plan that is research based and time tested. I specialize in these treatments and love to see that when they are applied, people gain the peace of mind they seek. Feel free to contact me if you would like to begin this journey. Just link to my profile page.

We want to begin the journey with the end in mind – being calm and content comes with self acceptance – something we ideally learn from our parents and if not then we learn from a “life coach” or skilled therapist. I have years of experience assisting people with the conditions described in this article, and would be happy to assist you.

Human beings identify themselves with learned self beliefs that are a product of our genetic makeup and the collection of our life experiences. We call these core beliefs - they can be both positive and negative. These experiences of "self" and their interpretations become encoded in the circuitry of our memory networks. We believe this circuitry is WHO WE ARE and we become imprisoned by our misconceptions. The process toward experiencing joy and purpose in life starts by identifying our untrue or negative beliefs, seeking the truth or...

The Strategic Counseling Model is built from the ground up on a five-tiered model for generating motion, creating action, and thus generating healthy change. The five tiers are neural (brain) science, attachment theory (intimacy), emotional trauma recovery (PTSD), spiritual awareness, and physical health (self care). The hallmark of Strategic Counseling is...

Recognizing, Living with and Resolving Trauma:
Part 1 - The Connection between Suicide & PTSD

Every event we experience directly or indirectly has an impact on our nervous system – for better or otherwise. Current research suggests that 80% of our mind is comprised of unconscious actions (impulses, urges, cravings, instincts, and drives). The remaining 20% is conscious – that which we are aware of with regard to person, place, and time.

Each of us has a different threshold of activation of our Autonomic Nervous System (which is unconscious and reacts very quickly – in some instances, fractions of a second). The ANS has 2 sub-branches, sympathetic (stimulating) and parasympathetic (sedating). We know this as the Fight, Flight or Freeze response. The ANS system allows us to quickly respond to danger and is also common to most higher functioning animal species. We need our ANS to live well.

Nature (genetics) and nurture (environment) are key factors when it comes to activating the ANS. Suicidologists report that the mind records trauma exposure much like our bodies record exposure to radiation. There is a point at which we exceed the ability to process and “shake it off” – particularly if the exposure(s) happen close together and at a young age. New PTSD studies indicate that “fear circuitry in the brain never rests.” The idea is that the more traumas the mind is exposed to, the more the fear circuitry has to keep it busy. The same way a song gets stuck on “repeat” in our head – whether or not we like the song.

We really have to be aware and careful of what we expose ourselves to regarding trauma – no different than second-hand smoke, heavy metals, sodium, and animal fats. The unconscious mind cannot distinguish between real and unreal. Only the smaller conscious part of mind has this ability. If we expose ourselves to violent or scary movies or the more mundane nightly news, our sub-conscious mind believes the unbelievable and is experiencing a level of discomfort just below conscious awareness. We can be operating just below the threshold of ANS activation due to self-induced over accumulation of bothersome information and troubling entertainment choices. We have learned that risk for suicide is higher for those with PTSD. Recall that our "fear circuitry" is responsible for processing fearful and anxious emotions and regulates sensitivity to pain and negative emotions which will increase with each additional exposure.

To make matters more complicated, repeated exposure to trauma (large or small) decreases our ability to integrate information regarding the awareness of time (past, present and future). The resultant state of confusion creates a “re-experiencing” as if it was happening again, now.

Be willing to ask yourself if you have any more room for more self-inflicted negative exposures (trauma) and what the gain would be, even if you did? We are conditioned to take in negativity (minor trauma) and think little of it. Those with a family history of depression and those who have had high exposure to traumas need to be even more aware of their small tolerance for more.

Depression is degenerative – untreated, it becomes progressively more severe and, in general, requires professional care to treat. All of us, though, would do better to reduce our exposure to undue negativity. In order to live well, we need our ANS to function well.

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