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Perception's Impact on Trauma and Mental Health with Ryan Soave

November 19, 2020
All Points North Lodge

Narrator:

Hello and welcome to iCAAD Online. The next presentation you're about to watch is with Ryan Soave, and it's called the power of perception, what virtual reality is teaching us about trauma.

Ryan Soave:

Hi, my name is Ryan Soave. I'm the director of program development for All Points North Lodge, a behavioral health facility in Vail, Colorado. For the past several years, I've also been working as a consultant for a neuroscience lab at Stanford University. We've been utilizing virtual reality as a tool and an experiment to really understand what's happening with stress, fear, and anxiety in the body. Today, I'm going to be using that as a backdrop to discuss my topic. First, I just want to say I'm super grateful to be here. It would have been really great to be in person in London in May. We all know the world has changed. There's a lot of negative that's come along with that. What I've been finding is it's so great to be able to connect with people around the world in a way that maybe I haven't been able to or we haven't been able to do before. So I'm just very grateful to be here and have this discussion with you today.

So the objectives for this presentation, first, we're going to discuss this virtual reality in the Stanford experiment that I just discussed. We're going to explore the power of perception, how it can hurt us, how it heals us. And then we're going to talk about understanding how we can utilize experiential therapy and mind's eye work as reparative experiences in the healing process. And before we dive in, I want to share with you my first experience with virtual reality. It was not as a tool for an experiment, it was not as an intervention for healing and therapy. I was just at a friend's house in Malibu in his den, and he had a virtual reality game set up.

And in this game, people had the goggles on, they were standing in this room with books all around them, they knew they were in this room. But the game put us on top of a building, and I'm going to share a little video to show just how this game went. And as you watch it, I just want you to notice while you may be sitting at your home or in your office, notice what you're experiencing in your body just as you watch this video of a virtual reality game.

Speaker:

Oh my God, oh my God.

Ryan Soave:

I don't know about you, and even though I knew what was going to happen and what that video was because I put it in this presentation, even watching that as they fell off or were standing on the plank, I could feel that sensation in my bod like I was looking off the top of a tall building. And when I was doing this in my friend's den, the first people I watched do it were actually falling down in the room because they couldn't bring themselves to stand on that plank. And when it was my turn to get on, I went in there, and I was standing on this, it almost felt like I could feel the wind as I was looking down over this abyss. And I actually, and this may explain some of my neuroses, but I actually jumped off to see what would happen.

And in the game jumping off it, as I was falling down, it literally felt in my body like I was falling. And this really got me thinking about how this could intersect with the work that I was doing with people with trauma and addictions. My second experience with it was a few months later, I was actually working in China and I was walking through a market with my interpreter. And we looked over and saw this open place where they had some video games. And it looked like they had a virtual reality experience. And in this, there were people sitting on these chairs, and these chairs were hanging about two feet off the ground so your feet were about two feet off the ground. And as I watched the people in the game, the chairs moved forward a couple of feet and backward a couple of feet. And they had a fan blowing on them and virtual reality goggles on.

So as I'm watching this, it looked silly like, why were they even doing that? But because I'd had this other experience with VR, I looked at my interpreter and I said, "Let's try this." And she and I both got in it. And she was sitting next to me and we had our virtual reality goggles on these chairs that I knew were only going to move a couple of feet forward and back and only a foot or two off the ground with this fan blowing on us. And in this game, we were in a pirate ship that was at a fair or a carnival. And it was one of those ones that go back and forth. And eventually, it went all the way around. And in this game as I looked over at my interpreter, part of it was animated, part of it looked real. She was an animated person. And when she looked at me, I was animated.

So I knew I was oriented to being present just in this market in China, but I also knew I was in this game. And when it started going, it went back and forth, and I started feeling my body move. And eventually, it went all the way upside down. And how my body was reacting even though I knew I was just in this market, how my body was reacting you couldn't convince a part of me that I wasn't all the way upside down. And when we got off that thing, I almost fell down, we were dizzy. And it felt like we'd been in a ride that was going all the way around. And this just got me thinking even more. Not long after that, I had a discussion with a good friend of mine who's a neuroscientist at Stanford, Dr. Andrew Huberman who was then to become a colleague.

And he'd had a similar experience that you'll see in a moment in a video I'm going to share. But it got us starting to think about how we could utilize this to understand better what's going on in the body. And I'm going to let him tell you a little bit about it. I ended up becoming an advisor on this experiment and developed some protocols that they use that we'll talk about after you see this video. So the experiment is ongoing at Stanford University at the Huberman Lab. They're still having subjects go through, but they're getting some findings. And I'm going to let Dr. Huberman tell you a little bit more.

Speaker:

It will attack and devour anything. It is as if God created the devil and gave him jaws.

Dr. Andrew Huberman:

Fear is an adaptation that is good. You want to be afraid of fast-moving cars and of heights and things like that, that's what keeps us alive. However, there are many cases in which we have pathological fear. Post-traumatic stress comes after the trauma when the trauma is no longer there, that's what makes it pathologic. So having stress and fear in response to something that's happening that's truly threat inducing, that's good. We certainly are not interested in curing fear, we're interested in alleviating pathologic fear.

Dr. Andrew Huberman:

We have subjects come in, we wire them up to a number of different things in order to measure their body and brain responses. And then we provide these different states, fear states in particular by placing them into virtual environments. We measure people's stress response or analyzing the status of the brain and the body through measures like heart rate and sweating, pupillometry, the size of the pupils which is a readout of autonomic arousal or the level arousal or anxiety inside the brain and body.

Melis Balban:

At a Society for Neuroscience conference, I saw a demo by one of the VR vendors that triggered a fear of heights actually. And I tried it on, and it was very, very effective. And so then that's where I decided, okay, this is the way to put humans in a box. And if we can just put some sensors on them too, they can measure their reactions.

Dr. Andrew Huberman:

The first time I put on the virtual reality goggles, which allow you to look up and down and behind you and actually see different things. The environment that I was experiencing was actually a virtual platform, many, many meters off the ground, and which I was required to step off. But what I found was that my body was actually resisting stepping off the platform. And that when I did, I got the physical sensation of falling. In virtual reality terms, I got presence, which is my brain thought that I was in the virtual environment. And at that moment, I realized that virtual reality was going to be an immensely powerful tool for probing the relationship between emotion and visual perception. And so we took it upon ourselves to learn something about the technology. And then we decided that we needed some scary experiences. So we employed a tree climber to climb very high up into a tree that was swaying in the wind.

Speaker:

What do you think? It's a nice view up here. Want to go a little higher.

Dr. Andrew Huberman:

We also have a stimulus in which we worked with a professional dog trainer to have a dog attack you in the virtual environment.

Speaker 8:

Ouch, don't hurt me.

Dr. Andrew Huberman:

And then perhaps one of the more unusual and exciting ones was diving with great white sharks.

Speaker 9:

Are you ready to go deeper?

Melis Balban:

It would be accurate to say that we are crafting fear. So in that sense, we are craftsmen of fear. But of course, we're doing more than that with the ultimate goal of understanding how our bodies and mind respond to fear and what are the parameters that change when somebody has a mental condition.

Dr. Andrew Huberman:

What I'm very interested in and what the lab is interested in are purely mechanical acts that you can perform mainly in the form of specific patterns of breathing and specific patterns of eye movements, non-meditative practices so that when we place that subject back into a virtual environment where typically or previously they had a very heightened stress response, they can maintain a calm demeanor and make better behavioral decisions.

Melis Balban:

We're still in the building phase of this platform, but it's really exciting to see a lot of similarities between subjects as well as very interesting differences. So we're excited to move forward and explore these more.

Dr. Andrew Huberman:

The ultimate goal of this project is to understand the origins of anxiety. If we can understand how anxiety and fear are coupled to sensations and perhaps develop, ideally develop new strategies for intervening with our own states and anxiety under conditions where we don't want to feel anxious. Because if we can do that, then we really can shift away from reactivity and suffering and toward proactive coping.

Ryan Soave:

And I actually found myself on a boat a couple of hundred miles off the coast of Mexico as we were filming those great white sharks. In that experiment, you actually are in the cage in virtual reality seeing yourself swim outside of the cage next to these sharks. And just thinking about that again, it throws me back to the moments of being around those huge animals. And what my role in this has been other than advising is actually helping develop some of the protocols that they utilize when the subjects come out of the fear experiences the first time. And we put them in things that help them build capacity in their parasympathetic nervous system where they can be better relaxed and go back into another fear state and perform tasks. And we're starting to see, not all the data is back, that they're performing much better than they did before.

Ryan Soave:

The virtual reality, in this case, is not used as an intervention, it's actually used as a way to more deeply understand what's going on in the brain and the body. And as we were developing this or they were developing and I was supporting and having discussions, and then talking about some of the subjects that were being in there and experiencing it myself, I really started seeing the parallels to the clinical work that I've done that we do around PTSD and unresolved trauma and addictions. So in order to kind of illustrate that a little more using the experiment as a backdrop, just want to look a little bit at the diagnosis of PTSD. In the DSM-5, the first criteria is that the person was exposed to death, threatened death, actual or threatened injury, serious injury, actual or threatened sexual violence. So it's actual or threatened. And what that means is if we were actually experiencing something that was painful or could hurt us, our body responds in a certain way. But if we're threatened that we think it's going to happen, our body may also respond in the same way.

Ryan Soave:

In the DSM-4, it said that serious injury or death was real or perceived. Again, if it was really happening, we're going to react in a certain way, most cases going into a fight or flight response. And if we perceived it was going to happen, we may react in the same way. And this is specifically important I think in our work in behavioral health when we look at the lifespan. As a 44-year-old man, what was threatening to me, actually threatening to me as a four-year-old or a four-month-old boy may not be actually threatening to me now. If when I was four months old, my mom left me alone in the woods or in the yard for a month with nobody to attend to me, most likely I'd be dead.

Ryan Soave:

Now, I'm a 44-year-old man. And the joke is if my mom left me alone for a month, we get along better. It's not the same experiences then. But if I had been abandoned or neglected at that age and I wasn't in that intense way, but if I was abandoned and neglected in that way as a child or if a child is and that continues to happen and becomes a pattern that's never resolved, they may be a 44-year-old man or woman who when they just think someone might leave them or abandon them or neglect them or they're not going to get their needs met, they may react in the same way that this child reacted. Maybe it's the child needed to scream and yell just to get fed. And now this adult, and we see this all the time, just at the sense that someone might not meet their needs or they might leave them, they throw a tantrum.

And it might not be in the same way, it may be in the same way as the child did, but it may be a little bit different. It may be more polished over time, but they might get very controlling or they might retreat. But they're reacting in a way that is based on that previous experience. But there's a felt sense in the body that's saying, you know what, I'm not okay. We're going into survival mode, into a fight or flight mode in situations where we may not need to go into it.

In criteria D, talks about what we're left with after experiencing trauma, real or perceived again, actual or threatened. And just touching back on that actual or threatened in the US at least, in our legal system, we even recognize this. Someone can be arrested for battery, which means that they've gone and they've actually hurt somebody physically, they've attacked them. But they can also be arrested and serve jail time for assault, which is threatening to do that. Even in our legal system in the US, we're recognizing that we have these reactions. And when we look at it in how our clients experience trauma or difficult experiences from the past, it's the same way. So in criteria D, it says, once we've experienced these things especially over a pattern of time, we're left with often these negative beliefs and expectations about ourselves for the world. It gives the example here, I'm bad, the world is completely dangerous. Maybe it's I'm not good enough.

As a child, maybe I was ... The child is in an experience where the world is dangerous, or let's say they had a perpetrator that was a man, and they made a decision that men are dangerous. And they needed to survive because the men that they were in relationship with or the man that they were was dangerous. And they needed to have that belief in order to survive that situation, they couldn't keep letting the person in. The problem with that is when that belief becomes fixed and carries over into adulthood as a fixed belief. Because if I have a fixed belief that men are dangerous even when I want to be in a relationship with a man as a friend that's intimate and vulnerable and connected, there's going to be a wall up. And I might feel that as I get in toward those relationships or if it was a woman into a relationship with a man too.

So when we're left with these fixed beliefs, they can impact us in adulthood. And we don't want to go the other way and then just go, "Well, I want to heal, so all men are safe." That's not going to serve either because sometimes we're going to come across men in the world that are dangerous. And sometimes, we're going to come across men in the world who are safe. And we want to be able to develop in a way that we can use our history to support us and inform us that we can make a decision utilizing discernment in the present moment to decide this person is safe or this person is dangerous and then go into survival mode if we need to. Also, beliefs about oneself. If I have a belief that I'm bad or I'm not good enough, and that becomes a fixed belief, that can be pervasive in anything I do.

Now, let's say I did do something that wasn't good enough. I was going to meet a friend for lunch, and I told them I was going to be there and I didn't show up. Now, in that scenario, I didn't meet the expectation that I set out and they set out, and it might be good for me to recognize I made a mistake there and I can go fix it. But if I have this fixed belief about myself that I'm bad or I'm not good enough, that experience may throw me into a spiral of shame that doesn't allow me to recognize that I can correct that, that I can have a corrective experience in relationships. So these fixed and kind of negative limiting beliefs start to create a reality that we choose from.

It also talks about persistent distorted blame of self or others, that again comes up, like the shame and guilt of just my existence based on these past experiences. And it doesn't allow me in many ways to have an experience in the presence that is about the present. In that video, Dr. Huberman said it helps us get presence. Now, the question isn't are we present because we can only live in the present moment. The question is, what are we present to? Am I present to what is actually happening here, or am I present to what happened in the past, and therefore what I think may happen now, and then projecting out into the future? So this becomes where there's this persistent or distorted blame that doesn't allow me to see what's happening as it is, it's more as I was.

And then persistent negative trauma to related emotions, fear, horror, anger, guilt, and shame. And all of these emotions have a place. Again, shame and guilt have a place for me if I do something wrong to give me the energy to go correct it. But in here, we're talking about this almost existential guilt and shame, or almost that I need to be in a fear state all the time, which as Dr. Zimmerman was talking about, fear is helpful, but pathological fear isn't. When I'm in a fear state when there's not something to be afraid of, that causes problems.

This quote, creation gave us instincts for a purpose. Without them, we wouldn't be complete human beings. If men and women didn't exert themselves to be secure in their persons, made no effort to harvest food or construct shelter, there would be no survival. If they didn't reproduce, the earth wouldn't be populated. If there weren't any social instincts, if men cared nothing for society or one another, there would be no society. Yet these instincts so necessary for our existence often far exceed their proper functions powerfully, blindly, many times subtly they drive us, dominate us and insist upon ruling our lives. Our desires for sex, for material, and emotional security, and for an important place in society often tyrannize us. When thus out of joint, man's natural desires cause him great trouble, practically all the trouble there is.

For me, this is one of the best descriptions of post-traumatic stress disorder that I've ever seen. I see in here that when he talks about instincts, he's talking about survival because survival instincts are survival-based. And he's talking about these instincts that we need. We need all of them. It's when they're overactive or underactive that they become a problem. Having sex is not a problem until it becomes something that that's all I'm focused on. Eating food is not a problem until that's all I'm focused on doing either too much or too little. Having a place in society, having significance is important. It's one of the hierarchy of needs that Maslow talks about. But when that becomes all-encompassing, it drives us and dominates us. It drives our unconscious automatic behaviors in a way that doesn't allow us maybe to interact in the present with relationships in the way that we want.

And what I think is so awesome about this description and this writing that I think is really kind of talking about PTSD is also really talking about what we see now as process addictions, food, sex, our place in society, which could be work or like that. This was not written by a psychologist, a medical provider, a therapist, and it was written long before PTSD was even a term. And some of you know who this is, it was written by a drunken stockbroker who'd been sober for several years. It's Bill Wilson the founder of Alcoholics Anonymous. This is on the first page of the fourth step in the book, the Twelve Steps and Twelve Traditions, what came out many years, more than 15 years after this first group got sober. And now they'd been sober, they'd solved the problem of drink, but all these other things they saw were taking place. And that people were maybe eating, going into food addiction or sex addiction, that they didn't even call that then. But they had these instincts that were kind of gone awry and driving them and dominating them.

He talks about it again about these instincts in the sixth and seventh step, which talks about the character defects that drive people into their drinking and then into their behaviors after. I think it's just a beautiful description. The response to trauma, to threat, is instinctual just like I talked about or Bill Wilson talked about in that writing. It helps us live and survive. It's a survival mechanism, and it's absolutely necessary. We don't want to get rid of it. The problem is when we operate out of survival mode when we don't need to be in survival mode. And I believe that is one of the main problems for us as human beings that either causes a lot of our behavioral health issues or exacerbates them. We go into survival mode when we don't need to be in survival mode.

When we look at the neuroscience of it, there's a part of our brain that somehow we perceive we're a threat, the animal brain takes over and we go into fight or flight. And again, we don't want that to go away. If I'm standing out in the street and a car is about to hit me, it's barreling down at me, I don't want to sit down and meditate or try to get calm or find perspective. I want to get out of the way as fast as possible. And if there's anybody else there, I want to be pushing them so they're safe too. I want to be in complete reaction to the time it takes to get out of that actually threatening moment.

The problem happens when my wife says something to me, or we have interaction, and I get triggered by it, and I feel like she might abandon, neglect, not meet a need, or I'm just upset or scared or sad, and I react to her like she's a car about to hit me. That's where the problem comes in when we go into survival mode when we don't need to be in survival mode. And that's where Bill Wilson was talking about these things drive us subtly and dominate us, blindly and subtly.

So coming back from the experiment as I start to contextualize this, I see that we kind of life in virtual reality. That often especially when we're triggered, we have these virtual reality goggles on that has me have a certain perception of what's happening that may be very different from what you are. And I would also assert that this is happening all the time. We have these brains that are amazing, they're kind of like our personal computers that are more powerful than any personal computer that's ever been developed. Yet, they're all programmed by our individual past experiences. The programming is all different. Even if I'm sitting with a bunch of people that I know that I'm friends with and we're like-minded when we have an experience together, we can all have a different perception of what went on. And so it's like we're living in our own virtual reality in an almost automatic unconscious way.

And what we're going to talk about is how when we can recognize this, we can take it off sometimes, that we can actually come to presence, that it's not unhelpful these virtual reality goggles, but that we can take our past. And this is a lot of what we do with behavioral health, with therapy, with trauma work is helping us take our past and moving it from this kind of liability that drives us automatically and unconsciously to an asset that informs us so that maybe sometimes we need these goggles on. But we can take them on and off as we need if we're in situations that aren't actually threatening. If I'm in a situation that's actually threatening, I want to be in complete reaction just like I talked about a moment ago.

So we're going to do a little exercise. And if you're sitting at home or in your office or somewhere, please follow exactly along. If for some reason you're driving, listening to this presentation, please don't do everything I ask you to do. Maybe you can come back to it later. But if you're sitting somewhere safe, I'd like for you to just place both feet on the ground, kind of sit up like you would almost in a meditative position, let your body begin to relax. Drop your shoulders, place your hands on your thighs, and just begin to slowly deepen your inhale and lengthen your exhale. Allow yourself to relax. And with your next inhale, begin inhaling through your nose and gently exhale with softly pursed lips as if you're softly and slowly breathing out through a straw relaxing with each breath. And slowly returning to a normal breathing pattern, but just keeping it deep and full. With a relaxed body, just begin to look at the screen where you see the lemons.

And really get a good picture of these lemons. In a moment, I'm going to have you close your eyes. But as you have them open, really get a good picture of these lemons, especially the one that's cut in half, it's ripe and juicy. And then close your eyes with a picture of that lemon. And with your eyes closed, I want you to imagine that that lemon, that half lemon is in your hand. You're in your mind's eye now and you're envisioning that lemon in your hand. And then envision yourself slowly bringing that lemon up to your mouth. And as you bring that lemon up to your mouth, take a bite of it, suck on it, squeeze the juices into your mouth. Just imagine that the juices of the lemon are in your mind. And as these juices are in your mouth, just notice what you're experiencing.

Notice the saliva in your mouth or not. Notice any sensation in your body. Notice if you have a facial expression or not, just notice. And then on one of your next inhaling breaths, just slowly open your eyes coming back to this moment. And if I were in the room with you, I'd be asking you what you experienced. I've given this part of this presentation many times in front of large and small audiences. And as I'm in front of them, what I'm usually seeing is a big chunk of the audience making these faces like a tart lemon is in there. And most people tell me that they experienced some saliva in their mouth. Some people say they could smell the lemon. Some people say they could taste it in their mouth. Some people really don't like the taste of lemon and they felt kind of repulsed. Some people love it, and they felt really good.

I had a woman in Chicago once told me that she had a cut on her arm, and she could actually feel the cut burning as the lemon juices, these mind's eye lemon juices came down over her arm. Now, I'm assuming that everybody that maybe had a reaction to this has also had an experience with a lemon. You've tasted a lemon, you bit into one, you've had lemon juice, something like that. Most people have. And in this moment though, you didn't actually have a lemon there. This was perceived lemon, this was a threat of lemon. Now, lemon isn't necessarily a trauma. If you were allergic to one, it might be or if it was involved in a trauma you had in your history, it may be. But for most people, it's not a significant trauma. But I use this to show that there's a relationship in your history that you have with lemon that most people who do this exercise bring that relationship into this moment and your body actually responds as if lemon is there.

And I assert that this is happening all the time. Now, I asked you to slow down, I asked you to get a present, I asked you to relax, and I asked you to notice what was happening. Maybe if I hadn't done that and you looked at these lemons, you wouldn't have experienced it that intensely or at all, maybe you would have. I can tell you I've done this particular exercise a couple of hundred times, and my mouth is still salivating. But there was perceived lemon, and it actually had the body react. And again, asserting that this is happening all the time mostly unconsciously, mostly automatically when we hear a sound, a smell, someone's voice reminds us of something else. We see a person or have an interaction like someone from our history, we have a sensation that throws us back into our past.

And this is not always bad, it's our body's way of preparing for what it's predicting is going to happen. This was your body's way if you experience something of getting ready for lemon, bringing the saliva there so that you could absorb it. And that maybe what's happening all the time. However, if we've experienced, if an individual has experienced a lot of complex trauma over a lifetime, this can take effect when it's not helpful; That when they're having a sense that something is going to become intimate, not even sexually intimate, but a relationship is going to start to become closed, their body actually will go into a reaction because that was dangerous in their history.

Again, perceived lemon, the threat of lemon. So trauma or even we could expand it beyond really high-impact trauma, we can expand it to relational trauma. We could even expand it just to some of our history-shaping events. But I'm going to say the word trauma creates a virtual environment that when we get triggered, we return to. And if we're not aware of that, we return to it in a way that will make what happened in the virtual environment happening now. For those of you are clinicians, I know that you've had times where you're talking to a client in a room, especially one that might've been, let's say, had a significant trauma history or PTSD that when you say something, the way they're reacting, and there may be some transference going on, but the way they're reacting, you can recognize that they're hearing something completely different than what you said or experiencing something entirely different than when you get across than what you're trying to get across.

And I would say that trauma's created this in a virtual environment that we return to when triggered. That's not necessarily again a bad thing because we needed it at a certain point. We needed it to survive. These behaviors, this returning to that environment allowed us to survive, and we need it. We want to return to it in survival based situations when there's an actual threat. Again, and I can't stress this enough, the problem happens when there's not an actual threat, and we go into that environment and we stay there. Now, in the healing process, we're going to see, and for those of you who are clinicians, you see over time that it's not bad that we go there, but it's about recognizing that we've gone there so that we can get out if it's appropriate to be out so that we can be fruitful in the relationships that we want and be present to the things that we want.

The survival response is an appropriate response just at an inappropriate time. What time are we present to? Am I present to what's happening now or am I present to what happened before? It's an appropriate response in an inappropriate time. And we can help our clients understand that this appropriate response is just at an inappropriate time, that we can work through, we can start to release some of this shame. And we can help them see that this virtual environment was created, and they get triggered and they're going into it. We can start reducing some of the shame and guilt and stigma around it and help them see that these are tools, these are pathologies that you might need some time if you're ever in survival. But we can help you start to identify how to use discernment. What are the practices we can put in place? What are the therapies and modalities that we can use to help release some of that stress and traumatic stress and trauma that's held in the body that throws us into that virtual environment?

And when I say virtual environment, I know it's from a real experience. There was a real experience just like the sharks for me, for Dr. Huberman, and for the other people with us was a real experience. But when they're coming back to us on the land in a lab at Stanford University, it's a virtual environment based on a real experience that we had. And so people come to treatment, people come to personal development, people come to outpatient and inpatient therapy because there's something in their behaviors that isn't working. I think it's safe to say that. And maybe they've identified it or their families and friends have identified it, something's not working. People rarely come to a long-term inpatient facility because everything's working great. They have a history that's a little complex, but everything's going well.

It's the same reason that people go to a self-help section at the bookstore if bookstores exist anymore, I guess, or maybe the bookshelf behind me or if we looked on Amazon. But people will go to because maybe they're feeling like they're overweight or something's not working in relationships. And they look for a book or a strategy to support them in changing that so that then they're okay. The problem though is it's like the top line issue is the behavior. What's underneath the behavior as we see in this diagram are the emotions. And we're going to talk about the emotions that are mostly in the realm that would most people call negative. So shame, fear, guilt, and this is pathological shame, fear, guilt, anxiety, stress that's kind of just taking us over and driving us.

So there's emotions underneath that people are experiencing that then we can say the behaviors that they're doing, they're utilizing to calm those emotions. For people who've come in for alcoholism or drug addiction, that's a behavior that needs to be worked on. Of course, we need to intervene on that behavior. But when we can understand the emotions, let's say they're in constant fear, that behavior isn't really the problem for them. It is problematic, don't get me wrong, but that behavior is actually their solution. It's their medicine to help them feel okay to regulate. They're not self-regulating, they're using a behavior, a process, a substance, alcohol in order to regulate those emotions.

But when we can understand the emotions, these kind of pathological negative emotions, when we can really understand them, we can understand the behaviors. Again, it doesn't make the behaviors, okay, but we can make sense of them. Sometimes even the craziest pathological behaviors we can understand when we understand the emotions that are underneath them. But underneath the emotions, what's driving them is a set of beliefs. And I don't mean beliefs that work for us or spiritual beliefs necessarily, I'm talking about these kinds of negative pathological fixed limiting beliefs like we talked about in the diagnosis of trauma in the DSM. These kinds of fixed limiting beliefs that say the world is this way, I'm this way, people are this way, my place in it is this way. And these are usually things that keep people very small.

If I have, and this is actually something I've worked on for a long time, it's not something that drives me anymore. But if I had very active right now this belief that I'm not good enough, and it's fixed. It doesn't matter that I'm speaking to people and have been asked to speak or I have people who trust me to design programs or work with their family members. It won't matter because no matter what, sorry, alcohol or accolade, what accolade I could get, it's not going to be good enough because I'm not good enough. And placed scenarios like this speaking to you, the fear could be overwhelming. And then it's going to enact behavior that is going to quell that fear. If I didn't have any work around that, and I'm not saying that never comes up, of course, it does.

But if it was something that dominated and drove me that I'm not good enough, that then the fear came in that was so overwhelming that I'm going to fail, that you're not going to like me, then the behavior would be, you know what, I'm just not going to do it. I'll sign up, I'll figure a way to get out of it, I'll back out. Maybe in a history drank or used something, those aren't the things that I would use anymore. And obviously, because I'm here, it's not driving. But I could understand what's happening there, we can understand what's happening with our clients when we understand what belief they have about themselves and the world. If they believe even in a room that is safe that they're unsafe, their emotions are going to be in alignment with unsafe, and then their behaviors are going to be in alignment with that.

So our behaviors are almost always in alignment with our emotions and our limiting beliefs about ourselves. And those beliefs are driven by our perceptions. And our perceptions somewhat distinct from our senses, our bodily senses, but they drive from that. So I'm always sensing everything in my body. My friend, Dr. Huberman says this, we're always sensing everything, but we're not always perceiving things. The perception is kind of the conscious awareness of what we're sensing. However, when we're kind of people who've been traumatized, have a history of difficulty. That perception that we're conscious of isn't always correct. I'll have a sense in my body, and I'll perceive that I'm not safe. Now, that may be true or have been true at a certain time.

But right now in this room even if you didn't like me, even if I was getting thumbs down on a screen or something like that, I'm not at actual threat. I may have that sense in my body. And when that's unchecked, it can then drive the beliefs which drive the emotions, which drive the belief. When people come in for treatment, let's say they come in for substance use disorder or alcoholism, that behavior we need to intervene on. We're not going to get underneath it if they continue to drink or hurt themselves in the way that they are. We need to intervene in that in some way. So coming to treatment, going to detox, that's an intervention on that, we're helping with that behavior. Now, like many people who drink or use drugs when we stop the drugs or alcohol, it doesn't make life emotionally better right away.

Oftentimes, it makes it worse because, remember, we're taking away the solution or the medication. So we can stop that behavior, but that doesn't change everything else, the stuff underneath is still driving it. We talk about that as the trauma, as the underlying issues in 12-step recovery talking about the causes and conditions are still underneath very alive and well. So in treatment, we need to work to intervene on the behaviors and then support people in building the capacity to experience difficult emotions. The sympathetic nervous system is often well and good in people who are coming to us for treatment, they're constantly in fight or flight. We need to help build capacity in the parasympathetic nervous system to help them be able to experience difficult emotions when they're not actually a threat. I believe the work that I do, the work that we do as clinicians and treatment facilities in which we probably couldn't put this on the website because people might not want to come on our websites is we're teaching people how to feel bad. Learning how to have these difficult emotions, understanding that when they're not a threat, they can experience those.

And then being able to make decisions that aren't driven by the difficult emotions, but rather driven by the way that they want to live. Maybe it's on a set of principles or a set of directions that they've decided is this is the way they want to live. So we intervene on the behavior, help build capacity around the emotions so they can have difficult experiences. And then we can start getting underneath that to help them challenge some of these limiting beliefs. Challenge the fixed I'm not good enough or the world is dangerous or people are bad, or I'm unsafe, the fixed version of it so that they're not stuck in the state that creates a reality that has them having being driven into these emotions and these behaviors. And we can help them understand and work with their perception around this, that in the moments of being triggered, we can recognize when we're being triggered.

We can recognize when we're being thrown back into that virtual environment that's creating this perception of danger. Know recovery or healing work is not about finding some state to be in everything is okay, that there's bliss all the time. I really believe it's about being able to learn. Let's say I'm looking for peace, when I'm out of peace sooner, recognizing that sooner and having tools to return to it quicker, to recognize when I'm in a trauma reaction or age aggression or I'm triggered and be able to have that recognition sooner and have the tools in place to return to the state that I want to be in quicker. And at first, we need to use other people to support us with that, maybe for a long time. But over time, that's a regulation. How am I going to regulate from this state back to a more centered state? We can start to build practices and understanding to get to self-regulation.

So our perception then creates our reality. And when we talked to so many of our clients, they're living in a reality that doesn't seem to be in alignment with the reality that everybody else sees or their family sees, or we see for them. And it's not just about us telling them that their reality is wrong because it's been very real. In fact, denying the reality of a child can be very impactful for them in a negative way. If your child is saying, there's a boogeyman in the closet, we don't have to agree that a bogeyman is there. But if I just tell them they're wrong for thinking the boogeyman is there, that denies this real fear and anxiety that they may be having. And it can really set up confusion, and this is hard. My son is almost 13. And about two years ago, my wife and I picked him up from school. I think he was in sixth grade at the time, about 11-years-old. And I was on the phone.

And I got off the phone and I could tell he was having a bit of an attitude with my wife. When he that, that brings up stuff for me, and I start getting annoyed. And it takes a lot for me to come to the center. And I asked I said, "What's going on?" And my wife said that something like there was a permission slip that was sent home from school that he didn't have us sign, and it was to watch a movie. And I said, "Well, why didn't you have us sign it?" And he was talking about this one teacher who's actually a real champion of his that he likes that always is telling him she believes in him. So he likes this teacher and he said, "She wants me to watch a movie about the Holocaust, and I'm not going to watch a movie about the Holocaust." But the way he said it was this real kind of almost teenager negative way.

And I said, "Okay, Josh, you don't have to watch the movie, but were you talking to your teacher like this?" And he said, "Yes." And I said, "Well, we can talk to her about you not watching the movie, but I think you need to apologize to her." At which he said, "You could drag me to the ends of the earth and I would not apologize to that woman." And I thought, "Whoa, first, where did he learn that? I think maybe for me." But he had this level of stubbornness and reaction around it that was very intense. And that started bringing up for me, and at this point, I'm ready to take away his video games, he's never going to see friends again. And I'm feeling the blood boil in me because it's not okay for him to be acting like this. And I'm ready to take this all away.

And something in me said, "You're not really in danger, Ryan, just take a breath." And I took a deep breath. And I said, "Josh, what's the movie?" And he said, "I don't know, it's about some woman named Anne." And I said, "Anne Frank?" And he said, "Yeah." And I said, "Do you know who she is?" And he said, "Yes, she's the woman who made all the bombs in World War II, in the Holocaust that killed all the people. She made the bombs in the Holocaust that killed all the people," which is not reality. Anne Frank was hiding in her attic She was oppressed and died because of all of that and has been an inspiration for people, but he didn't know that. And then there's some other history with Josh, we live in Boca Raton, Florida or he goes to school there, and the rest of our country is maybe 3 to 5% Jewish, it's 25 to 30% Jewish there. He has friends whose families in their history were impacted by this.

He wasn't super conscious of that, but it's in his history, and his grandmother is Jewish and her relatives survived the Holocaust. And so in his epigenetic makeup, it's in there. He wasn't even aware of that consciously, but it's in there. And he's a very sensitive kid, and he doesn't like to see people get hurt. In his mind, in his reality, his teacher was going to make him watch a movie about a terrorist that was going to hurt people, and he wasn't going to do it. And so I was able to talk to him about this and understand that it wasn't the case. And he was still nervous and he apologized to his teacher, and we talked to her and she said, "Josh, you can sit next to me at the movie. And if you ever get upset, I'll help you."

And for me, that was a great lesson of understanding the reality of a child, which can be much different. I mean, I knew that, but how often might we deny that? And his perception created that. These virtual environments that we create in our minds because of our trauma and our history create this reality that we choose from. And our survival response when we're not in actual threat is logical. Again, it's an appropriate response at an inappropriate time, but it's a logical response from an illogical place. It's almost like an algorithm, an if-then algorithm that says, if this, then do this, then run away, then throw, then yell and scream. And all of the thens make sense, all of them if and then make sense except for the beginning one that says, if I'm in actual threat, if I'm in actual danger, somebody around me is in immediate physical danger or I am, then do this.

These emotional responses all make sense except for the first one. They make sense based on our history but not based on what's happening right now. So something I work with people on and something I was using myself in that car is the question becomes, am I or is someone around me in immediate physical danger? And first off, if you have the ability to ask yourself this question, chances are you're not in immediate physical danger. But if you're able to ask yourself this and you're not, I would say there's not a negative emotion or emotional state that we can't survive.

Now, this isn't something we go right to with our clients who've been in this state for a long time because we don't want to make them feel like their responses are wrong. But over time working to help them see that, hey, I can look around and I can see that I'm not at danger. And I can build the capacity to experience these negative emotions, to experience this stuff and let it move through me because these emotional states will move. They're like weather patterns, and they'll move through, they will pass. And a lot of our healing work is about building the capacity to be able to experience that and allow them to move through us. It takes time and it takes practice.

So this brings us to different experiential therapies in the mind's eye. And the mind's eye is often utilized in many types of experiential therapies. For those of you who don't know, when I talk about the mind's eye, it would be like if I had you close your eyes and imagine something like we did with the lemon, you're in a mind's eye experience. It's almost like our own little virtual reality experience, we're not there, but we can kind of come back to it. We have these experiences often in dreams. But in dreams, it's not controlled. So it's difficult to utilize dreams for the virtual environment from which we can heal from. But with experiential therapies in the minds I work with, we can create virtual environments for healing. And those of you who do these types of work, this type of work understand this.

Now, you might not have conceptualized like it's virtual reality. But we can go back even in time and place, to people, to perpetrators, to family members even people who are gone and have reparative experiences that can allow us to heal. And how do we know we can do this? Well, we're doing it the other way all the time. We're doing it the other way where we're going into this almost virtual environment in a moment where I'm triggered and bringing my history here and then making choices based on it. But that's being driven automatically unconsciously and isn't always helpful. Might be helpful again when there's a threat, but when there's not, it's not. It actually creates more trauma for us. But we can as therapists, clinicians, treatment facilities, can create these virtual environments even without the goggles that support people in having these reparative experiences.

So experiential modalities and in mind's eye work, but the modalities really, I mean, we look at things like psychodrama where people move through experiences and have conversations and let go of stress and trauma around people by having other folks play people in their lives, situations in their lives. We actually help them get into the moment, into the picture. Now, they're really there in the moment, but they're not really there in history with the real people, it's a virtual environment. We do that with folks in EMDR even though we're helping them process whether it's through their eyes or using the tappers. We're supporting them in kind of getting present with the emotions that were there during the experience, even though they might be in our office, in somatic experiencing to moving through activation and resource. Pendulating through that in order to support folks and not diving into something like you would in exposure therapy, but it is almost like some type of controlled and regulated exposure that we're helping people go through events in their lives and release stress from it.

We'll see them actually have physical releases, post-induction therapy where there's a lot of inner child work done, which I talk about later on or confronting parents and confronting perpetrators in a virtual kind of mind's eye experience. Different types of breathwork help people get into states where they can actually have memories and move through these experiences. Meditation sometimes does this, people have physical releases in meditation because it allows them to get very relaxed. I have Yoga Nidra meditation on here because it's a Nidra, it means sleep. It's a sleep-based meditation that often can support people in a controlled way to go in that state that's almost like a dream state and set an intention and release stress around certain people or triggers that they have. IFS, Integrated Family Systems work, and Parts work, and inner-child work, and many more. I'm sorry if it's not on the list and it's something you're practicing, these are examples of we're creating these virtual environments. That people can go in their history and have these reparative and healing experiences.

So I want to do a brief exercise before we close, and I call this take the goggles off. And in a moment, I'm going to ask you again to kind of get a present like we did in the lemon exercise. And at a point, I'm going to have you imagine that you're putting these goggles on and you're going to have your eyes closed. And I'm going to ask you to bring somebody to mind that kind of triggers you or annoys you. I don't want you to bring to mind the person that most triggers you or a perpetrator or something that's very triggering, but maybe just someone at work or in your family that kind of irks you, annoys you, maybe it's in the way that they say things or the way that they come at you or they're always right, the way that they retreat, just something that kind of annoys you. In a moment, I'll have you bring that to mind.

First, just again, feet on the floor, again, if you're not driving. Begin to deepen your inhale and lengthen your exhale. Letting your body relax, letting your shoulders relax, letting your face relax. Close your eyes. And I want you to bring to mind that person that annoys you, that triggers you slightly. And as you see them in front of you, allow yourself to experience everything that annoys you about them or kind of triggers you, how they talk, their voice, how they hold themselves, how they talk to you, how they don't talk to you. Just really allow yourself to experience it? Notice even if you have sensation in your body. Even now, let them get to you. And now as you sit here, I want you to imagine that you're kind of leaning back and you recognize that you're also wearing these virtual reality goggles. And these goggles have a filter. And in this filter is everything from your history, everything from your history with this person, everything you've ever seen them do, and everything in your history with people like this or the opposite of this.

And then that's all overlaid on this person in front of you. In a moment, I'm going to have you actually reach up and imagine you're taking these goggles off. And as you do, all of the history begins to slide away and you're left with this moment. So reach out, pull the goggles off. And as you pull the goggles off, you're seeing this person as they truly are. Maybe as they are as a child with all of their wounds. And as you do this, the annoyances just slip away for this moment, that it's not all the moments in your history and their history and your history together. It's you standing in front of this new person. And on your next inhaling breath, just allow the person to disappear and gently open your eyes.

This is a very simple exercise, and hopefully, you were able to get an experience of just recognizing that your perception and your history informs what's happening now. This doesn't mean that that person isn't annoying. It doesn't mean that this person is not a problem, but it means that I can start seeing the world as it is, what's happening now not as I was or we were. Seeing the world as it is right now, seeing this person and situation as it is right now not as I was or we were together so that I can make choices and interact in a way that's not because of everything that happened in the past and projecting everything in the future. That I can actually have a discussion, maybe not take it personally, not get so triggered myself, not take it away from that moment with me, not take it home with me that day. Not then get triggered and annoyed and bring it into another relationship I have, that day or that week.

Again, that I can begin to see the world as it is not as we were or I was. And sometimes when we do this, and again, this is when there's not an actual threat. When we do this, what we think might look like this might actually be this. Sorry for exposing you to that song. I have an 18-month at a whole home, and she loves that. I thought it was appropriate to have mommy and daddy in there too because, for those of you who are clinicians, that's so much of what we're dealing with our clients. That picture of the shark before that I actually took, and it looks terrifying except I was also behind a cage. But hopefully, this helps give you an idea of what I'm trying to talk about, what we're learning in the lab and can be extended to what we understand already about psychology and behavioral health, what we already understand about trauma and addiction, and hopefully apply that going forward.

We're not using the technology part like the goggles as an intervention right now, but our therapies are a technology. So if you're using them, keep using them. If you're not, look into them. If you're someone that's looking for healing really look for something that's going to support you in healing holistically not just talking about it, but really releasing what's held in the body, what's held in our experience, and understanding our belief systems and our perceptions. Anyway, thank you so much for spending the time with me here today. Right after this, I'll be live with you to answer any questions. Please interact with me. I love questions, debates, everything. Again, just super grateful to be here. Thank you. I acknowledge you for the work you're doing and keep it up.

Thank you for attending today. I see we have a few questions. I was able to record the presentation a few days ago, and now we're live here. [Anusha 01:08:16] asked how we've been able to use VR to separate the past from the present experience. there are people using virtual reality as an intervention may be for like exposure therapy to help people work through things. What I was trying to convey here is what we're learning from the experience to really understand what's going on in the body and that we're actually creating, as I said in the end, these virtual environments in a way with our experiential therapies to support people and having reparative experiences and healing. The technology, that's the VR goggles is something that can put people, that's even being used for training people to do things and helping people learn.

It's been difficult I think to create an experience that throws somebody into their history. I think we can do that better by creating an actual environment through something that we're doing in a therapeutic environment like a psychodrama or like something in somatic experiencing where we're supporting people get there. So we create our own virtual reality that's a therapeutic technology more than just the goggles that are on. And Sam asked about it, it sounded like the beliefs that I was talking about or the convictions that you came to believe in our lives. I think the answer to that is yes, and these are more of the convictions that aren't helping us. The ones that have said, as I talked about like I'm bad, the world is dangerous that become fixed and don't support us in being able to utilize discernment in the present and make decisions based on where we want to go not just what our emotional state is and what history that emotional state is triggering.

I think the last question I have is, how could I put you through that last song? I apologize for that, but I couldn't help it. And I think that's pretty much it unless anyone types another one in. I really appreciate you coming today. I really wish I could be there with you in, well, I wish we could all be together in England without face masks on, but that's just not how the world is. We'll see what this creates as our virtual environments that we get thrown back into later on. But I'm confident we're a resilient people and we'll move forward. Thank you again for attending. I hope you have a wonderful conference, and keep up the good work.

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