Articles

The Physiological Affects of Trauma and the Benefits of Tomatis-Based Sound Stimulation

INTRODUCTION – DEFINITION OF TRAUMA
There is no conclusive definition for trauma, only physical and emotional responses that are as varied as the human personality. However, the one overwhelming characteristic of trauma is that it renders us powerless. Trauma is triggered by the inability to have control over our physical self or our environment in the face of perceived danger.

Each person’s response to trauma is different. There are two sisters, who when they were children they would sit at the top of the stairs after their bedtime and listen to their parents fight. To this day, one of the sisters can repeat those arguments verbatim and the other sister doesn’t remember being there.

Research now shows that trauma and stress can occur in the womb. For example, some infants are born with ulcers—age is inconsequential. The causes of trauma are widespread. In Peter Levine’s book, Waking the Tiger: Healing Trauma, he lists several examples of life trauma which I have modified slightly: fetal trauma (intra-uterine); birth trauma; loss of a parent or close family member; illness; high fevers; accidental poisoning; physical injury (including falls and accidents); sexual abuse, especially by those in positions of trust or authority (family members, priests and clergy, therapists, care givers, etc.); physical and emotional abuse (including verbal abuse, especially over a period of time); neglect (including severe abandonment or beatings); witnessing violence; suicide attempts; extremely loud noises; natural disasters such as earthquakes, fires, and floods; certain medical and dental procedures; and surgery (particularly tonsillectomies with ether, operations for ear problems and operations for so-called "lazy-eye").

In an effort to further define trauma I have described its physiological consequences. I also discuss the use of Tomatis-based sound stimulation, the Dynamic Listening System™, as a part of treatment for the physiological and emotional effects of trauma.

PSYHOLOGICAL CONSEQUENCES OF TRAUMA, PTSD, Fight or Flight
In Mozart’s Brain and the Fighter Pilot, Richard Restak, M.D. states: "Military veterans with PTSD (Post Traumatic Stress Disorder) that resulted from their war experiences still expressed elevated CRF ([corticotrophin releasing factor] a body chemical that induces the pituitary gland to secrete ACTH [adrenocorticotropic hormone]) levels when tested a quarter of a century later! And when adults who had been abused as children experience stress, their ACTH (a hormone that instructs the adrenal glands to secrete cortisol and adrenalin) overreacts, suggesting that their early life traumas have forced both CRF and ACTH into permanent overdrive." Simply put, many years later trauma victims’ bodies are still in a "fight-or-flight" pattern, creating anxiety often referred to as PTSD. One Vietnam veteran described coming back after the war and being afraid to pick up a can of food off a grocery store shelf for fear that it would blow up — and even to this day he can have those feelings. This illustrates how chemically induced feelings haunt us long after the trauma occurs. The reality of the situation for this man: The facts that many years have passed, the war is over, and he is in a safe environment, are irrelevant.

In the article "No, Sexual Abuse Survivors Don’t Just Get Over It" (Oregonian, May 3, 2002), Rachel Brown describes the effects of her abuse in terms of PTSD: "My abuse came at the hands of a family member. I recognized the desperate coping mechanisms in the stories of other survivors. Some turn to drugs and openly rebel, striking outward. But many, like I did, numb themselves in different ways; manic, hyper-alert, overachieving and ever vigilant, eager to present a façade of normalcy and keep the devil at bay. I regularly thought I was going crazy, heart thumping and racing. I worried constantly about losing it —going nuts — in front of my classmates."

The body’s "fight-or-flight" reaction is a built-in survival response that bypasses the conscious brain in real or perceived dangerous situations. During this response, adrenalin is secreted, which increases the blood flow to the heart, lungs and large muscles (especially of the arms and legs), away from the digestive system and the brain. This blood flow insures a greater dispersal of electrolytes to the membranes of these muscles so they can contract — preparing us to fight or flee. This response pattern can save our lives and is beneficial in emergencies; but if the body stays in this pattern for an extended period of time, the result is stress, chronic high anxiety or PTSD.

Overproduction of CRF and ACTH in trauma can eventually result in physical illness affecting the heart, adrenal glands and muscles; and contributing to chronic headaches, disturbed sleep patterns and more. Stress can also lead to emotional illness: depression, anxiety disorder, panic disorder, etc. It can cause memory loss and inability to concentrate or focus. Stress causes the muscles of the body to be chronically tight and flexed; in the fight-or-flight pattern, the muscles stay ready for action, in anticipation of danger. In other words, stress creates a chronic hyper-vigilant state of body bracing through the release of two hormones, adrenalin and cortisol, secreted by the adrenal glands as a result of the overproduction of CRF and ACTH.

PHYSIOLOGICAL CONSEQUENCES OF TRAUMA — Cortisol, Adrenalin
Cortisol is a stress hormone whose effects on the body are described by Carla Hannaford, Ph.D. in her book Awakening the Child Heart. "It blocks efficient metabolism of glucose and breaks down tissue, including bone, increasing the danger of osteoporosis…. It inhibits the uptake of proteins by as much as 70 percent, leaving decreased protein for building strong muscles and nerve networks…. It causes the release of fat into the blood, which under chronic conditions isn’t used for the action of fight or flight but accumulates, especially around the waist and hips, resulting in obesity…. It causes nerve cells, especially of the hippocampus (the brain area that helps to formulate memory after receiving input from other brain regions), to lose their dendritic branches and spines and eventually die off, resulting in poor memory, fuzzy thinking, and lack of creativity…. It depresses the immune system, lowering immunoglobulin levels, and has been deemed the most violent immunodepressant known to man. Chronic stress elevates cortisol levels while decreasing the levels of dehydroepiandrosterone (DHEA), which plays a key role in our immune system. High cortisol and low DHEA levels are found in people with major diseases such as MS, diabetes, cancer, coronary artery disease, and Alzheimer’s disease."

Cortisol also "causes the blood cells responsible for clotting (platelets) to become stickier to protect from blood loss in the case of wounding. Heart attack occurs because increased blood pressure causes a crack to develop in the artery lining that covers fatty plaque. Then platelets, drawn to the site, instantly adhere in their stickier state to the artery wall and aggregate, choking off blood flow to the heart."

Furthermore, she notes that cortisol "is especially high in children with parental loss: longstanding emotional separation from parents or insecure relationships with their parents [when the parent is at all emotionally or physically unavailable, such as parent(s) in chemically or behaviorally addictive patterns, or who are depressed, chronically ill or elderly — if the child has a fear of the parent dying before they are grown.] This causes a weakening of young children’s biological stress-response systems.

Finally, Carla notes that cortisol "leads to depression, fatigue, muscle pain, high blood pressure, ulcers, short stature, and fertility problems. It is described as a form of slow physiological suicide. A high cortisol/low DHEA ratio leads to premature aging." Cortisol is actually more dangerous than adrenalin (the other stress-inducing chemical) when it continues to be secreted from the adrenal gland long after the danger subsides. However, adrenalin also causes anxiety and produces negative physical effects.

Adrenalin causes the heart to beat faster and to divert blood to the big muscles of the arms and legs for fight or flight. This constant alertness causes all the muscles of the back of the body to be chronically tight which in turn causes the whole structure to go too far forward on the feet, creating chronic tension in the calves, back pain, sore feet, temporomandibular joint dysfunction (TMJD), neck pain and shoulder pain. Overproduction of adrenalin interferes with the secretion of gastric juices, leading to digestive disorders.

Adrenalin also affects the eyes, according to Carla Hannaford, PhD in her book Awakening the Child Heart. "It dilates them to take in maximal light and focus laterally (turning outward) to enable someone to view a threat in the periphery. The outer muscles of the eye become over tight so the inner eye loses its integrity, making it harder for them to converge properly for activities such as reading. Now the dominant eye scans the periphery for danger and the non-dominant eye focuses on the close objects." Once the eyes lose their coordination and integrity, the two sides of the visual cortex (the two lobes in the upper part of the back of the skull) lose their integration, resulting in a tilt of the head that causes a rotation and collapse on the side of the body where the non-dominant eye turns and goes down to see printed words. The other eye will stay in an alert position, scanning the environment for danger, causing the corresponding side of the body to be overly tense.

VISION — Misalignment
As an Alexander Technique teacher working with body structure and as a student of natural vision work, this misalignment is readily apparent to me. If you look closely at a person’s face, often you can see one eye sunken into the skull and higher up than the other eye. The other eye is rotated forward and sits lower on the face. If you look down the body you realize it is a whole-body pattern. It doesn’t actually begin at the eyes, but in the upper part of the visual cortex at the back of the head. So, on the side where the eye sinks back into the skull and is higher you can also observe that the hip and shoulder rotate back and up. On the side where the eye is forward and down the hip and shoulder will also be forward and down. You can also observe that the head is tilted. If you are unable to see this pattern, look at the neck from the back and notice which side is shorter — that is the side where the eye is lower.

Peter Grunwald is an Alexander teacher and a Bates teacher (The Bates method teaches people how to restore vision naturally). In working with his own self to recover his vision, which he lost at an early age, he developed the Eye-Body Reflex Pattern® now know as the Grunwald Method™. He discovered that each individual’s unique eye pattern has a direct effect on the body structure. In his article "The Eye-Body Reflex Patterns" in Direction magazine (1999), Peter states that "squints [in America we call this "cross-eye"], often seen in young children, may develop at prenatal stages, during birth (a forceps delivery or a quick birth, where the occiput [is] not fully released) or during development stages, particularly during crawling. It is often found alongside hyperopia [farsightedness] or myopia [nearsightedness]. Visual aspect: One or both eyes squint inwards or outwards…. More often than not the child missed the cross-crawling stage of development." (A baby normally advances from unilateral crawling to cross-crawling — employing opposite arm and leg — before learning to walk.) It can be observed that the position of the eyes affects the visual cortex at the top and back of the head, which affects the whole body structure.

During the fight-or-flight response, the peripheral vision is activated and the eyes lose light to the nasal side of the retina. If this response is ongoing or chronic, the body loses its integrity through the hips and legs as a result of losing the visual information on the nasal side of the eyes. I have begun to ask people whom I have treated for trauma about the condition of their eyes. They are always surprised that I would ask about their vision in relationship to their trauma. There is always a corresponding story of visual deterioration following the trauma and they are surprised to relate the two events. My observations, while not a scientific study, are very consistent.

Trauma affects the ears as well as the eyes. When the optic tract divides, it terminates respectively in the superior colliculus of the midbrain and the lateral geniculate body of the thalamus. The cochlear root of the inner ear also has synapses in the colliculus and geniculate body. The colliculus located in the brain stem is involved in reflexes. In trauma, both the eyes and the ears bypass the conscious brain and send information directly to the nervous system, signaling the body to go on alert. Dr. Alfred Tomatis, an ear, nose and throat physician from Paris, believed that trauma can cause a switch in ear dominance that can result in learning disabilities, depression, stuttering, chronic exhaustion and high anxiety. He believed that the ear is designed to filter sounds and send them to the correct part of the brain to be processed, and to act as a battery to the brain. A person in trauma switches from the dominant right ear (which has a shorter nerve and sends information to the left side of the brain where the speech and language centers are located), to the left ear. The left ear tracks the surrounding environment; it has a longer nerve and is connected to the viscera as well as the brain. A person who has experienced trauma may sleep with the right ear down in order to listen with the left ear for danger.

During a traumatic event, the body shuts down any function unnecessary for survival. Blood flow is slowed down to the left side of the brain, where the speech and language centers are located, rendering higher thinking such as reflection and reasoning inconsequential in the face of danger. In survival situations the left ear becomes dominant. Positron Emission Tomography (PET) scans, which take images of the lobes of the brain, show less activity on the left side of the brain when a person has been traumatized. This situation makes learning very difficult since the speech and language areas are on the left side of the brain. When sound enters primarily through the left ear, it goes first to the right side of the brain and then back to the left side; in other words it must cross over the corpus callosum twice instead of once. Also, because the left cochlear nerve is longer than the right one, there is a further delay in processing speech and language following a trauma.

AUDITORY – Tomatis, Speech and Language, Bone Conduction
Another possible effect of trauma is that a person may shut down the hearing psychologically and begin to use bone conduction as a primary source for hearing sound. This is an unconscious attempt to protect oneself in trauma by damping down both ears and taking in sound from the bones. Bone is a very good conductor of sound and we all listen to some extent with our bones, but they should not be the prime source of sound. When bone becomes the primary conductor of sound, the sound is no longer filtered by the ear; so much of the sound comes in at once and indiscriminately. This causes the ear to be inundated with sound. There is no ability to focus on one specific sound and put other sounds in the background. So in a classroom or office, all the sounds take on equal attention: The person trying to have a one-on-one conversation with you, papers rustling, the pencil sharpener and the conversation next to you all come in at once. When everything heard has the same intensity, a person can become overwhelmed, confused and anxious. In addition, fatigue and exhaustion can occur because the ear is what charges the brain and gives us energy. When there is switched ear dominance or when the bone becomes the primary conductor of sound, there is usually an underlying exhaustion.

RETICULAR ACTIVATING SYSTEM
Dr. Tomatis believed that the first function of the ear is to "charge" the brain and body with energy that translates into thought, reflection, and creativity. When the ear loses the ability to charge the brain, the higher forms of thought are affected. This happens through the vestibular system, the entryway to the brain through the ear. It is through the ear that the vestibular system sends information to the Reticular Activating System (RAS) in the brainstem.

"Beginning in utero, the RAS ‘wakes up’ the neocortex, increasing excitability and responsiveness to incoming information from the environment. This 'wakeup' by the RAS gets us ready to take in and respond to our environment, and to learn. This connection between the vestibular system and neocortex as well as the eyes and core muscles is highly important to the learning process. When we don’t move and activate the vestibular system, we are not taking in information from the environment," according to Carla Hannaford in her book Smart Moves: Why Learning Is Not All in Your Head. It is the RAS, the arousal system, that keeps us awake, sends us the messages to sleep, and activates every state in between. People whose vestibular systems have been damaged through trauma suffer extraocular muscle dysmetria, or unbalanced activation of the muscles which control movement of the eyes, causing them to overshoot or undershoot their position when reading, resulting in dyslexia. The dyslexic must concentrate so much just to read the words and sentences that concentration, focus and memory are difficult.

Other problems that RAS system dysfunction can cause include states of hyper-activity or hypo-activity. When both states are activated simultaneously, spurts of hyper-activity are followed by spurts of hypo-activity, causing exhaustion and sleepiness. When the ear is not functioning correctly and there is no nourishment to the brain from sound, a person may try to self-stimulate through hyper-activity, compulsive and/or addictive behaviors. Almost anything can be turned into a compulsion — from compulsive talking, to hand washing, obsessive thinking, sexual activity such as masturbation, computers, food, television, cleaning, exercising, sleeping, working, shopping, ritualizing behaviors, and hording. All of us perform some compulsive or ritualistic behaviors as a way to calm ourselves down or energize ourselves; in other words it’s a form of self- medicating and can help us to function in our daily lives. However, the line may be crossed from engaging in a nondestructive behavior to having a full-blown compulsion or addiction. This is defined by a state where more and more of one’s life is taken over by an activity or combination of activities which start to interfere with one’s social, family or, work life or participation in one’s own life. It is good to examine where you are getting your energy. If you are not engaged in a specific activity or behavior, are you walking around exhausted or in high anxiety or both? I had an acquaintance that would arrive in town for a visit and play two rounds of 18-hole golf back-to-back while waiting for his friends to get off from work to visit with him; this would be an example of hyper-activity for an adult.

In children it manifests as constant movement unless they are asleep. Children and adults can receive treatment and stop negative behaviors, but the physiological effects of trauma (the fight-or-flight pattern of the PTSD sufferer) are difficult to treat without working with and affecting the brain in the way that Tomatis work does. Tomatis work affects the brain through the ear (vestibular system) to recalibrate the RAS, and helps with many of these symptoms.
When the ear/vestibular system is not charging the brain, some of the other symptoms include: inability to understand the body in space, loss of balance and coordination, being accident prone, moving constantly or the opposite — no energy to move, invading people’s space without knowing it, and poor posture with the inability to actually stand up in the structure so there is a collapse in the body (Carla Hannaford calls this "noodling"). All of these characteristics can start in childhood and do not resolve themselves without some form of treatment. They grow worse with time and we become depleted.

MEMORY & LEARNING
There are three areas of the brain that are involved in the storage of memory and learning: the amygdale, hippocampus and basal ganglion. The amygdale is linked to thinking, sensory processing and bodily states of emotions (facial expressions and body language). It also formulates memories related to fear and anxiety. The hippocampus uses sensory input coming through the thalamus and emotions in the hypothalamus to form short-term memory. Short-term memory, with nerve net activation in the hippocampus, can then enter permanent storage as long-term memory. The basal ganglion helps to control body movements to convey emotional states to others; in learning, it helps with motor-based memory like the memory required in learning to play the piano. In trauma many of the brain processes that deal with memory, learning, conscious information processing, focus and attention become secondary. This is a direct result of trauma setting off the fight-or-flight pattern. The left side of the brain where the speech and language centers are located; as well as the neocortex or any other part of the brain that is used for planning, creativity, insight, memory, and higher non-survival functions; lose blood and oxygen to the right side of the brain, which then becomes dominant. This explains "test anxiety", where a person can recite all of the required material but once put into the stressful testing situation, is unable to perform.

In his article "Emotion, Memory and the Brain" (Scientific American: The Hidden Mind, August 2002), Joseph E. Le Doux distinguishes between two kinds of memory: declarative learning and emotional learning. Declarative learning is memory that comes back to mind from some earlier conscious experience. Le Doux states: "The original learning and the remembering are both conscious events and are mediated by the hippocampus and the cortex." Emotional learning that comes through trauma is not the same and operates independently of conscious awareness even though it is stored in the same areas of the brain, the hippocampus and the cortex. "Emotional and declarative memories are stored and retrieved in parallel and their activities are joined seamlessly in our conscious experience. That does not mean that we have direct conscious access to our emotional memory; it means instead that we have access to the consequences — such as the way we behave or the way our bodies feel. These consequences combine with current declarative memory to form a new declarative memory.

Emotion is not just unconscious memory — it exerts a powerful influence on declarative memory and other thought processes." One of the reasons that we may not remember traumas from early childhood is that the area of the brain that stores them, the hippocampus, had not yet matured enough at the time of trauma to consciously form accessible memories. The emotional memory system, which may develop earlier, clearly forms and stores its unconscious memories of these events. It is because of this difference that early trauma may affect thoughts and behaviors later in life although we may have no conscious awareness of the traumatic event, creating a condition of PTSD with no event to hook incongruent behaviors on. Current research shows that the amygdale is activated during fear conditioning, even in situations where the conditioned stimulus is prevented from entering consciousness, showing that fear memories can be established unconsciously. How these factors affect personality is new work; but what is clear is that trauma can dramatically affect the ability to remember, focus and learn.

TOMATIS TREATMENT
How does the Tomatis method help to lower anxiety and take in sound in such a way that it energizes the mind and body? The first part of the treatment is the listening test to determine how you listen through both air conduction and bone conduction. This is done with an audiometer. By reading this test we can determine how you listen, if there is reversed ear dominance, which frequencies are lost, if there is any actual permanent hearing loss, if you are using bone as the primary conductor of sound and if you are selectively listening. Once we have read the test we can create an individualized listening program based on the test results. You then begin your auditory reeducation program by listening to Mozart through equipment that sends the music out over a specialized head set in analog, filtered and gated specifically for your individual needs.

Why Mozart? Don Campbell states in The Mozart Effect for Children, "Clearly, the rhythms, melodies, and high frequencies of Mozart’s music stimulate and charge the creative and motivational regions of the brain. But perhaps the key to Mozart’s greatness is that it all sounds so pure and simple."

Over the 15 days of listening, we slowly begin to remove certain frequencies from the music and to play music to the right ear in order to lateralize the listening to the dominant right ear. The headset has a bone conductor that can be set to lower bone conduction as needed. The listening time is 90 minutes a day for 15 days. We try to schedule the 15 days in close proximity. Then there is a break of about three to four weeks and you return for the active phase of the work.

When you return you continue to listen but we begin to reintroduce the frequencies that were removed in the first part of the listening. Once this is accomplished, there is a process to reconnect the ear to the voice by toning, humming, singing and reading out loud into a microphone while you wear a head set so that you can make changes to your voice as well as your ear.

What kind of improvements would a listener look for? Here is our checklist:

Physical Changes:
More upright posture Increased eye contact
Positive change in sleep patterns Change in eating habits
More appropriate levels of physical activity Less nervous energy
Face and body appear more relaxed Voice softens or strengthens Sings plays more with voice (sounds) Increased clarity of speech
Can match tones more accurately Improved handwriting
Physical coordination improves More interest in physical self
More talking/communicating Change in skin tone and/or color
More touching and hugging Breathing more deeply and regularly More consistent energy level Less confusion of left and right
Better sense of rhythm Fewer headaches
Improved reflex responses Can improve vision

Psychological Changes:
More animated Less overwhelmed
More gentle with animals and/or people Healthier emotions
Appropriate social contacts/boundaries Increased sense of humor
Willing to accept nurturing Increased self-confidence
Ability to deal with conflict Increased independence
More comfortable making eye contact Change in friends
New interests More sensitive to voice tone
More sensitive to innuendo Less defensive
More responsive to the environment More expressive
More adventurous More tolerant
More thoughtful More patient
More calm and relaxed, less anxiety More affectionate
More flexible More outgoing
Improved mood

Mental Changes:
More motivated Better memory for names
Improved short-term memory Thinking before acting
Improved attention span More open-minded
Less bothered by background noises Increase in vocabulary
Improved reading skills Does not need instructions repeated Improved spelling Initiates reading
Improved socialization Improved organization
Less irritable Less anxious or tense
Math seems easier Better at starting/finishing projects Sequencing improves Better time management skills
Improved memorization skills Improved sentence structure
More inquisitive