I am a medical doctor and psychiatrist who has studied many western and eastern methods of healing for over forty years, and conducted PTSD research for ten years as a Clinical Assistant Professor of Psychiatry at the University of Washington, Seattle. Since beginning my medical career, I’ve searched for healing methods that are safe, simple and empowering to pass onto my patients. I am writing this with no financial investment or expectation of financial benefit in the future from my encouragement that you read on. As a clinician focusing on PTSD and trauma recovery therapies it is clear to me that helping patients carefully re-inhabit their interoceptive capacity at an individualized pace, and learn to apply this in everyday stress management is a critical, but until now missing piece. Jessica Schaffer’s Nervous System RESET process offers this essential piece, and I find the program exceptional both conceptually and methodologically.
–Charles E. Thompson, MD, Board Certified in Psychiatry & Neurology,
Clinical Assistant Professor in Psychiatry at the University of Washington
Letter of Introduction from Charles Thompson, MD
edical science has recently made a great leap forward in its ongoing explorations of both the body and the brain. Brain imaging studies have allowed us to watch the brain in action as it deals with many processes of learning, perception, contemplation, problem solving, relationship building and trauma recovery. This careful study has recently revealed that the old idea that the body only carries the brain around in its head and has no influence on thoughts, emotions, feelings, intuition, decision making and strategy formation is completely wrong.
This insight has been shedding light on the the already recognized influences flowing to the brain through sensations from outside the body (sight, hearing, smell) referred to as exteroception, from the body surface and muscles (touch, pain, pressure, stretch, vibration) known as proprioception, and more recently on our understanding of the sensory pathway from the deep interior of the body organs themselves. The latter, referred to as interoception (sensing the state of wellness and shifts of sensation from the inside of the body), is the new discovery that is a game changer for modern medical and mental health fields. It is now known that this natural sensory ability can be subdued by unhealed trauma, chronic pain, serious medical illness, substance abuse, medication side effects, and the long term effects of adverse childhood experiences.
When blunted, the absence of awareness of this flow of vital interceptive information leads to interpersonal relationship problems, poor risk management and self protection, substance abuse, anxiety, depression, obsessive ruminations, low self-image, poor stress resilience and loss of a creative meaningful approach to daily life. In pediatrics this is referred to as “failure to thrive.” The term applies directly to adults and adolescents in whom interoceptive ability is blunted or undeveloped.
The good news about interoception is that even when there is blunted access to this critical source of awareness, we can learn to cultivate a renewed sense of connection to the body. Through careful and sequential training of our sensory awareness, we can rebuild our interoceptive ability and our internal perception of biological “safety.” The Nervous System RESET process does exactly that, and it is the best program I have found to date. It is exceptional in both its conception and its methodology.
The following collection of research and review papers is only a portion of the rapidly growing scientific data that clearly supports the practical and lasting value of what lies at the heart of the Nervous System RESET approach and process.
Charles E. Thompson MD
Board Certified in Psychiatry & Neurology
Relevant Research on the Importance of Interoceptive Awareness:
- Kanbara, K. & Fukunaga, M. (2016). Links among emotional awareness, somatic awareness and autonomic homeostatic processing. BioPsychoSocial Medicine, December 2016, 10:16.
Both emotional and interoception awareness deficits are directly connected to problems with emotional well-being, inter-personal relationship difficulties, self-image and stress resilience. The resultant dysfunctioning of the of the fight/flight/freeze system is the basis for disorders of anxiety, depression and insomnia among many others. Learning interoception and emotional awareness skill is essential for human biological and mental health.
- Paulus, M. & Stein, M. (2010). Interoception in anxiety and depression. Brain Structure and Function, June 2010, Volume 214, Issue 5–6: 451–463.
When interoceptive ability is blunted (chronic pain, serious medical illness, substance abuse, adverse childhood experiences, serious injury, inter-personal assault) we are unable to purposefully recall positive self-affirming and resilience fostering memories, let go of past traumas, successfully avoid physical and emotional harm, limit negative self-talk and disabling catastrophic ruminations, negotiate relationship challenges without aggressive acting out or immobilizing collapse. Interoceptive ability training must be considered as a valuable means to improve quality of life.
- Price, C.J. & Hooven, C. (2018). Interoceptive Awareness Skills for Emotional Regulation: Theory and Approach of Mindful Awareness in Body-Oriented Therapy. Frontiers in Psychology, May, 28 2018; 9: 798.
There is compelling evidence demonstrating links between disrupted awareness of sensory information, or interoceptive awareness, and difficulties with emotion regulation. This paper outlines a framework, based on psychological and neurobiological research, for understanding how interoceptive awareness facilitates regulation and an integrated sense of self, thus contributing to overall health and well-being.
- Schulz, S. (2016). Neural correlates of heart-focused interoception: a functional magnetic resonance imaging meta-analysis. Philosophical Transactions B Royal Socity, Nov. 19: 371 (1708).
Interoception plays a key role in managing emotional experience of all kinds, making decisions in daily life, and problems with interoception are commonly found in anxiety and depression. The regions of the brain most involved with these functions are reported. The importance in mental health of being able to perceive internal sensory shifts cannot be under-estimated.
- Kuehn, E., Mueller, K., Lohmann, G, & Schuetz-Bosback, S. (2016). Interoceptive awareness changes the posterior insula functional connectivity profile. Brain Structure & Function, April, 2016. 221(3): 1555-71.
Brain scans during interoception versus external perception show marked changes in several regions of the brain known to be of central importance in stress and mental health. The ability to shift awareness intentionally from outside to inside signals is learnable and worthy of our attention to enhance psychological wellbeing.
- Sze, J., Gyurak, A., Yuan, J., & Levenson, R. (2010). Coherence Between Emotional Experience and Physiology: Does Body Awareness Training Have an Impact? Emotion, Dec, 2010. 10(6): 803–814.
This study showed that if sensations emanating from bodily responses are primary constituents of subjective emotional experience, then subjective emotional experience should more closely track and be coherent with physiological responding for those who are more aware of their bodily responses. Awareness of the body sensations and emotions play key roles in physical and mental health. Mindfulness based training that increases awareness of visceral sensations (interoception) and dance training that increases awareness of somatic sensation of the musculoskeletal-skeletal system can both result in long-lasting physical and mental health benefits. Brain imaging studies have shown the interoception training has the stronger effect.
- Hanley, A.W., Mehling, W.E., & Garland, E.L. (2017). Holding the body in mind: Interoceptive awareness, dispositional mindfulness and psychological well-being. Journal of Psychosomatic Research, August 2017, 99:13-20.
Both interoception accuracy and ability to choose responses to challenges mindfully result in enhanced psychological well-being and relationship stability. Training that increases both of these life skills has the potential for significant quality of life improvements.
- Dunn, BD, Galton, HC, Morgan, R., Evans, D., Oliver, C., Meyer, M., Cusak, R., Lawrence, AD, & Dalgleish, T. (2010). Listening to your heart. How interoception shapes emotion experience and intuitive decision making. Psychological Science, 2010 Dec; 21(12):1835-44.
How one thinks and how one feels emotionally and physically are strongly influenced by body sensation feedback through interoception. How well one perceives bodily responses to choices and challenges is critical for successful adaptation to life’s everyday challenges. Training to improve this Interoception ability is an important quality of life enhancer.
- Herbert B.M., & Pollatos, O. (2012). The body in the mind: on the relationship between interoception and embodiment. Topics in Cognitive Science, 2012 Oct; 4(4):692-704.
Interoception, the intentional embodiment of awareness, has profound impact on the thinking functions and emotional well-being.
- Ernst, J., Böker, H., Hättenschwiler, J., Schüpbach, D., Northoff, G., Seifritz, E., & Grimm, S. The association of interoceptive awareness and alexithymia with neurotransmitter concentrations in insula and anterior cingulate. Social Cognitive and Affective Neuroscience, 2014 Jun;9(6):857-63.
The ability to feel core bodily sensations and recognize ones emotions are the cornerstones of emotional health and stress resilience. When that ability, Interception, has become suppressed this vital function becomes inaccessible. The brain chemistry changes (GABA, Glutamate) associated with this state are described.
- Murphy, J., Brewer, R., Catmur, C., & Bird, G. (2017). Interoception and psychopathology: A developmental neuroscience perspective. Developmental Cognitive Neuroscience, 2017 Feb; 23:45-56.
Low interceptive ability limits our ability to accurately know our own emotions and successfully manage them internally and inter-personally. In adolescents abnormal interoceptive ability increases risks for risky behaviors, decreased growth of social-emotional competence, successful career development and healthy peer and family bonding.
- Wiebking, C., Duncan, NW, Tiret, B., Hayes, DJ, Marjaǹska, M., Doyon, J., Bajbouj, M., & Northoff, G. GABA in the insula – a predictor of the neural response to interoceptive awareness. NeuroImage, 2014 Feb 1;86:10-8.
Brain imaging studies demonstrate that adequate levels of the calming neurotransmitter GABA are necessary for accurate interoception. The brain region Insula is the key area supporting this ability so essential for mental health and stress reliance. High stress levels lower GABA lelvels in the Insula, thus blunting interoceptive ability. This is strongly correlated with increased risks for loss of hope and depression. The implication is that combining training of interception with stress reduction skills will reduce these mental health risks.
- Seth, A.K. (2013). Interoceptive inference, emotion, and the embodied self. Trends In Cognitive Science, 2013 Nov;17(11):565-73.
The brains ability to predict outcomes of current challenges of any kind depends upon full and accurate interoceptive awareness. This is described to encourage further study of this vital source of therapeutic method development.
- Sokol-Hessner, P., Hartley, CA, Hamilton, JR, & Phelps, EA. (2015). Interoceptive ability predicts aversion to losses. Cognition and Emotion, 2015;29(4):695-701.
The ability to perceive shifts of internal body-mind states strongly influences ability to avoid errors in risk associated decision making. This study demonstrates that a healthy level of interoceptive ability correlates with increased ability to avoid financial decisions that are too risky.
- Maister, L., Tang, T., & Tsakiris, M. (2017). Neurobehavioral evidence of interoceptive sensitivity in early infancy. eLife, 2017 Aug 8;6.
Interoception, the sensitivity to visceral sensations from the gut, heart, lungs and blood vessels, plays an important role in homeostasis and guiding wisely motivated behavior. It is also considered to be fundamental to self-awareness. Despite its importance, the childhood developmental origins of interoceptive sensitivity remain unexplored. We here provide the first evidence for implicit, flexible interoceptive sensitivity in 5 month old infants using a novel behavioral measure, coupled with an established cortical index of interoceptive processing. These findings have important implications for the understanding of the early developmental stages of self-awareness, self-regulation and socio-emotional abilities, and for child-rearing.
- Grabauskaitė, A., Baranauskas, M., & Griškova-Bulanova, I. (2017). Interoception and gender: What aspects should we pay attention to? Consciousness and Cognition, 2017 Feb;48:129-137.
Interoceptive ability, which strongly affects the occurrence of both somatic and mental health disorders are different in men than women. Women tend to notice bodily sensations more often, better understand relations between bodily sensations and emotional states, more accurately recognize state of mind changes in others (especially off-spring), worry or experience more emotional distress with sensations of pain or discomfort and see the body as less safe than men. The implication is that interoceptive accuracy training paired with emotional self-regulation training is worthy of consideration for quality of life improvement.
- Couto, B., Adolfi, F., Sedeño, L., Salles, A., Canales-Johnson, A., Alvarez-Abut, P., Garcia-Cordero, I., Pietto, M., Bekinschtein, T., Sigman, M., Manes, F., & Ibanez, A. (2015). Disentangling interoception: insights from focal strokes affecting the perception of external and internal milieus. Frontiers in Psychology, 01 May 2015.
Sensory information flowing from the surface of the body (pain, touch, etc.) and from outside the body (visual, auditory, smell) are joined in the brain region Insula with interoception sensory flow from inside the body (heart, lungs, blood vessels especially in the gut). Damage to Insula from stroke can severely alter this critical ability to know ones’ state of body and mind. This is an area of stroke rehabilitation that may benefit from combing interoception training with standard occupational and physical therapies.
Sources of Inspiration for Jessica. . .
The Nervous System RESET process teaches the following:
- How to cultivate greater resiliency and adaptability in response to life stressors
- How to use simple somatic practices to gradually quiet and settle the nervous system and down-regulate arousal levels over time
- Increased body awareness and ability to define a sense of safety or settling in the body
- How to stay inside of a comfortable window of tolerance in your exploration so that you stay connected to an inner sense of safety
- How to notice and track body sensations with curiosity and openness without bracing against them, pushing them away or being overwhelmed by them
- How to follow sensory cues to read whether the nervous system is activating or settling
- How to explore sensation in small amounts always orienting back towards a felt experience of safety in the body
- How to recognize the tendency or pattern of overriding body signals and how to trust body signals and work with them in new ways
- How to build effective self-care and containment strategies
People often ask me what the sources of inspiration are for the Nervous System RESET approach. The honest answer is that this work has been an intuitive unfolding being birthed through me over the past 20 years as I have had the privilege of holding space for my clients in their deep and personal healing processes. And along the way, I have been deeply impacted by the work of many. Among those who have inspired me are the following:
The field of ACE research, trauma-informed care and Donna Jackson Nakazawa, author of Childhood Disrupted:
The original ACE (Adverse Childhood Experiences) study (conducted by Vincent Felitti and Robert Anda) and subsequent research has unequivocally impacted our understanding of how early adversity and overload changes the neurological development of a child and can lead to disruptions in their physiological, emotional and behavioral regulation throughout life.
In Childhood Disrupted: How Your Biography Becomes Your Biology and How You can Heal, Donna Jackson Nakazawa has written an informative, accessible book chock-full of good references to sound research in the field of ACE impacts, child development and epigenetics. I always recommend this book as a resource for folks wanting to know more about the impact of ACE’s.
And the field of ACE research and trauma-informed care are at the heart of how I work with people and why I developed the Nervous System RESET process to begin with. Because we know that early adversity is prevalent in our society, we must assume that trauma is more widespread than we might have imagined. We cannot afford to work with the body or the nervous system or the psycho-emotional self without first putting into place certain safeguards that support us doing that work in a gradual way so that we make sure the client is working inside of an authentically comfortable and accurate window of tolerance at all times.
The way that I accomplish this is to teach people how to track body sensation and cues of safety / lack of safety that are registering at the body level as the basis for any other work that we aim to do. This is the foundation that the Nervous System RESET process gives people: helping them learn to track and monitor body cues signaling safety and settling or lack of safety and activation, while learning to work with those very same sensory pathways to gradually down-regulate hyper-arousal in the autonomic nervous system. In this way, clients are taught how to become active participants in the process of their own well-being.
For more information on Donna Jackson-Nakazawa, visit www. donnajacksonnakazawa.com
For more information on ACE’s, visit www.acesconnection.com
Stephen Porges and Polyvagal Theory:
Distinguished university scientist at the Kinsey Institute and a Research Professor in the Department of Psychiatry at the University of North Carolina, Stephen Porges and his Polyvagal Theory has been essential to our understanding of how the nervous system and its adaptive responses work. Porges has completely transformed our understanding of how we respond to obstacles, adversity, stress, and trauma, and his insights have transformed our approaches to treating everything from trauma to autism. Porges provides us with a foundational, neurophysiological understanding of what constitutes safety (i.e., safety as it is registered in our body and not just at a cognitive or conscious level), and demonstrates that when we have better physiological state regulation or autonomic regulation, other therapeutic interventions can have improved outcomes.
This idea of a cultivating a neurophysiology of safety is the core component of what I am teaching in the Nervous System RESET approach. Having an understanding of how to read our nervous system responses (through tracking body sensations) allows us to work with these adaptive responses and shift them over time.
For a sense of Porges research check out this citation:
Zero to Three (J), v24 n5 p19-24 May 2004. Neuroception: A Subconscious System for Detecting Threats and Safety. Porges, Stephen W.
The author describes recent findings on the neurobiological mechanisms involved in perceptions of risk and safety depend upon accurate healthy interoception ability. The term “Neuroception” describes how neural circuits distinguish whether situations or people are safe, dangerous, or life threatening. Neuroception explains why a baby coos at a caregiver but cries at a stranger, or why a toddler enjoys a parent’s embrace but views a hug from a stranger as an assault. The author explains the Polyvagal Theory, which posits that mammals–especially primates–have evolved brain structures that regulate both social and defensive behaviors. The Polyvagal Theory describes three developmental stages of a mammal’s autonomic nervous system: immobilization, mobilization, and social communication or social engagement. A neuroception of safety is necessary before social engagement behaviors can occur. Infants, young children, and adults need appropriate social engagement strategies in order to form positive attachments and social bonds. Faulty neuroception might lie at the root of several psychiatric disorders, including autism, schizophrenia, anxiety disorders, depression, and Reactive Attachment Disorder.
Dan Siegel and the field of Interpersonal Neurobiology (IPNB):
IPNB is a working model that looks at human development as an interwoven dynamic between body and mind in the context of social relationships. Rooted in attachment theory, this approach is often thought of as relational neuroscience.
As with Stephen Porges’ Polyvagal Theory, the tenants of IPNB inform the relational component of my work with clients. With all clients, there is a foundation of mentoring that starts with co-regulation: I am helping them to learn how to manage and negotiate their body sensations and nervous system responses of activating or settling while they are simultaneously learning how to safely do that for themselves. The whole goal is to help clients gain mastery of tracking and negotiating their body sensations, what we can call an ability to accurately self-regulate, so that they come into an empowered relationship with their bodies rather than feeling like they are at the mercy of their body responses or dependent on a professional to help them manage those experiences.
Peter Levine (Waking the Tiger, In An Unspoken Voice, Healing Trauma, etc.):
Peter Levine and his body of work (Somatic Experiencing) have been influential to my approach working with clients over the years. His first book, Waking the Tiger, was published just as I was starting my bodywork practice, and his recognition of the physiological responses that underpin trauma resonated deeply with me and what I was seeing in my work for people. He was the first person to talk openly about the fact that the body has a natural discharge or release response which kicks in when the nervous system is settling and recovering from past danger or arousal signals embedded in the body. He helped us begin to understand that trembling or shaking are not signs of pathology, but rather a healthy reflex of healing and release.
Levine reminds us that awareness of body sensation and the ability to safely track sensation (interoception) is a key component to supporting a hyper-aroused or overwhelmed physiology gradually returning to balance. He recommends working slowly with building awareness of body sensation, working in small doses (what he calls “titration”), moving toward sensation and then back away again (what he calls “pendulation”) as a means for increasing awareness of the felt sense and the internal landscape of our body (“interoception”). For more research on the relevance of interoceptive awareness, please see the annotated research list above.
These are all core principles of how I work with clients, gradually teaching them through what I call “neural” exercises, simple somatic practices that invite the exploration of body sensation in small amounts and always orienting back towards a baseline of anchoring in the present moment towards safety. Some of the tracking practices I teach are adapted from Levine’s orienting exercises, but they have been modified to be as simple and streamlined as possible.
Eugene Gendlin and Focusing Work:
Anyone working through a somatic lens owes a debt of gratitude to Eugene Gendlin’s concept of bodily “felt sense.” Felt sense is the word Gendlin coined to refer to the experience of something within the body even before we can name or explain what that experience is. In his research assessing which therapies are most effective for clients, Gendlin found that the single variable that was the most essential in determining a client’s success in therapy was whether or not clients were able to reference experiences and shifts happening in their bodies.
Gendlin’s approach advocates learning how to hold space for the felt sense experience and allowing that sense to guide the client’s process of gentle self-exploration. The body is never wrong, and we can remain open and curious to what the body is revealing to us as a source of wisdom and inspiration. Although I am not a therapist and do not offer psychotherapy, this approach has been a founding principle for me in my work with clients over the years. It allows a gentle and safe container of exploration meant to empower the client in their self-discovery and self-awareness.
The 4 year period I spent as a Certification Trainer and Certified Provider for TRE® was formative to my evolution as a practitioner. In this period I honed my skills of working with the body’s natural stress release response of “tremoring,” and expanded my theoretical basis of neuroscience. Although ultimately my methodology around working with the body’s natural tremor response is very different than how TRE® approaches it, I believe the greatest gift that TRE® has brought into the world is that it introduced us to the possibility of being able to access the tremor reflex as an intentional pathway of healing. This reflex lives inside of all of us and can be used as a gateway to health and wellness as long as it is balanced with good body awareness and the ability to accurately track and monitor our physiological markers for staying inside a window of comfort and safety.
A sampling of relevant TRE® Research as listed on their global website:
- Berceli D, Salmon M, Bonifas R, Ndefo N. Effects of self-induced unclassified tremors on quality of life among non-professional caregivers: A pilot study. Glob Adv Health Med. 2014;3(5):45-48. | Abstract
- Berceli D. [Neurogenic tremors: A body-oriented treatment for trauma in large populations]. Trauma und Gewalt. 2010 May; 4 (2):148-156. German. |Download
- Berceli D, Napoli M. A proposal for a mindfulness-based trauma-prevention program for social work professionals. Complement Health Pract Rev. 2007 Oct; 11 (3):1-13.| Abstract
- Department of Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. Mind Body Skills for Regulating the Autonomic Nervous System. Published June 2011. | Download
- Johnson S. Interventions for stress and burnout of secondary school educators in high-risk schools. In: Robert M, ed. Abstracts of the 30th International Congress of Psychology; 2012 Jul 22-27; Cape Town, South Africa. Oxon, UK: Psychology Press; 2012. p. 167. | Download
- Soluções Inovadoras para a Promoção de Saúde Mental de Adolescentes na Atenção Primária | Portuguese Download
Innovative Solutions for the Promotion of Adolescent Mental Health in Primary Care | English Download
Soluciones Innovadoras para la Promoción de Salud Mental de Adolescentes en la Atención Primaria | Spanish Download
Besel Van Der Kolk (The Body Keeps Score):
Besel Van der Kolk is a psychiatrist and respected research scientist noted for his research in the area of post-traumatic stress since the 1970s. His research (especially through the use of functional MRI) has shown us that trauma is embedded in the body and that if we are not addressing the physiological shifts that occur, we cannot effectively recover from dysregulated states. His book, The Body Keeps The Score: Brain, Mind and Body In the Healing of Trauma, is an excellent resource.
In gratitude to all of these sources of inspiration,