Touch plays a powerful role in human development and emotional regulation. Despite this fact it is not used effectively in therapy. This talk explores current research into the biological and psychological effects of touch and how to use touch to increase emotional regulation skills. Link to Book By Author: http://www.amazon.com/Touch-Neurobiology-Health-Healing-Connection/dp/094079506X Link to Webpage: http://www.touch-neuroscience.com/

1. The Neurobiology of
Touch and Trauma
Somatic Experiencing from Dysregulation to Coherence
Mike Changaris, Psy. D.
This work is copy written under the creative commons attribution license you may use
this work as a whole or adapt it as long as you site this author as the source.

2. A Mother’s Touch…
‘Kangaroo care’
 ‘Kangaroo care’ An infant is held skin-to-skin to their mother or father,
generating heat for the newborn much like a baby kangaroo receives in
its mother’s pouch.
 http://today.msnbc.msn.com/id/38988444/ns/today-parenting
 “We’d resigned ourselves to the fact we were going to lose him; we
were just trying to make the most of those last precious moments.”
 “We thought, ‘What a blessing, we get to see his eyes before he passes
away,’ ” Kate said. “But they stayed open!”

3. Embodied Arrival
 Invitation to orient... To room, To others, To
skin contact with chair
 Top Down and Bottom Up
 The Brain Story: Insula, Anterior Cyngulet,
and the Orbital Frontal Cortex
 Mindful Self Massage

4. Overview
 Begin to understand the role of touch in the communication
of emotion and in affect regulation.
 Understand key brain regions involved in trauma, touch, pain
and emotion regulation.
 Review some of the recent literature on the
psychophysiological impacts of touch treatments.
 Recognize affect dysregulation and key neural structures
involved.
 Begin to understand how to incorporate touch treatment in to
a treatment plan.

5. Who we are
is created
through
touch…

6. Touch is Communication…
 Touch is one of the most understudied senses, yet it can be a
profound communicator of emotion.
 Recent studies have found that people can identify multiple
emotions through physical touch such as anger, fear, disgust,
love, gratitude, and sympathy via touch with a high degree of
accuracy.
(Hertenstein, Holmes, McCullough, & Keltner, 2009)
 People can decode emotional information communicated by
touch by simply watching touch on a film.
(Hertenstein, Holmes, McCullough, & Keltner, 2009; Keysers, Wicker, Gazzola,
Anton, Fogassi & Gallese, 2004)

8. Touch Interventions for Trauma
 Touch can be used in several ways to reduce the symptoms of
trauma.
1. To re-establish the regulation of the autonomic nervous
system.
2. To desensitize individuals to trauma triggers.
3. To increase the ability to attend to interceptive cues from
the body.
4. To reduce fight/flight activation
5. Support the growth of emotion regulation centers in the
brain.

9. Affect Regulation
 Four Main Types of Affect Regulation.
 Cognitive regulation is deciding to
use an affect regulation skill.
 Co-regulation the regulation through the interaction
with another person or animal.
 Auto-regulation the internalized regulation or
automatic regulation processes.
 Self-Regulation the integration of the above types of
affect regulation.

10. Cognitive Regulation
and Touch
 Any touch based skill some one
uses consciously to regulate
their emotional response.
 Lineahan: Soothing in the 5 senses. (dbtselfhelp.com)
 For Example:
 Placing one’s hand on one’s heart
 Tapping
 Standing in a warm shower
 Massaging one’s feet/ self massage.
 Taking a bath
 Progressive muscle relaxation.
 Chi Gung Slapping

11. Co-regulation Regulation and Touch
 Co-regulation is regulation of emotions through the
interaction with another person or animal.
 Co-regulation through indirect mirroring.
 Requires the ability of the individual to tolerate,
mirror and contain the affective state of the other.
 Sub-cortical dialog of “neuroception”
 Individuals w/ Antisocial Personality lack this ability
to modulate w/ another. (Research on pupil dilation).
 Listening w/ the hands
 Co-regulation provided through conscious intervention.
 Placing of a hand on the back of some one upset.
 Increasing one’s positive affect and then contacting the
other.
 Client and therapist negotiating where contact would feel
supportive and providing that contact.

12. Auto-regulation and Touch
 Auto-regulation is the internalized
pattern of affect regulation.
 Automatic Thoughts, Schema’s and Cognition
 Patterns of cognition, self talk, and beliefs
 Situational triggers
 Interaction between cognitive and emotional systems
 Automatic Emotions: Loops of emotions…
 Cingulet Gyrus: Can replay emotional events of the past as
if they are happening and plays a role in depression.
 Daniel Hughes – Story of Katie
 RIG’s – Representation of interactions generalized.

13. Self-Regulation and Touch
 Self-Regulation is the integration of auto-regulation,
patterns of co-regulation, and one’s cognitive regulation
skills.
 As a person becomes more integrated these types of
affect regulation work together to allow the individual
to tolerate a range of stressors, different emotions and
even exceeding their current affective auto-regulation
capasity with comfort.

14. Touching Emotions
1. Brake up into dyads
2. Decide who will be the receiver first.
3. The partners let each other know where they feel safe receiving touch (e.g. shoulders,
upper back etc.).
4. Receiver sits in a chair and chooses an emotion they will evoke through (memory of
emotion, evoking the felt experience in the body etc.).
5. Negotiate contact
6. Giver: Attempt to listen with the hands and see if they can identify the emotion being
communicated.
7. Then switch roles.
8. Share in dyads. Share in larger group.

15. Instructions
1. Choose partner.
2. Choose who gives touch
first.
3. Negotiate contact
(be safe).
4. Receiver: Choose
emotion.
5. Giver: Listens with
hands to attempt to
identify the emotion.

16. Neurobiology of Affect Regulation
HPA-Axis and Thalamus
 Hypothalamus Pituitary Adrenal-axis (HPA--
axis): Is made up of the hypothalamus, pituitary gland, and
adrenal cortex. Its main task is to mobilize a powerful en
ergetic defense when a person is threatened and to return
to rest when the threat is gone. The HPA--
axis triggers cortisol secretion. Touch based interventions co
uld help restore regulation to this system. Touch treatment
been shown to reduce cortisol levels.
 Thalamus: Is a relay station for the brain. A damaged
thalamus can result in a
coma. Sensory information from touch reaches the cortex th
rough connections in the thalamus It plays a role in modul
ating levels of arousal. The thalamus may be the seat of
human consciousness.

17. Neurobiology of Affect Regulation
HPA-Axis and Thalamus
 Hypothalamus Pituitary Adrenal-axis (HPA--
axis): Is made up of the hypothalamus, pituitary gland, and
adrenal cortex. Its main task is to mobilize a powerful en
ergetic defense when a person is threatened and to return
to rest when the threat is gone. The HPA--
axis triggers cortisol secretion. Touch based interventions co
uld help restore regulation to this system. Touch treatment
been shown to reduce cortisol levels.
 Thalamus: Is a relay station for the brain. A damaged
thalamus can result in a
coma. Sensory information from touch reaches the cortex th
rough connections in the thalamus It plays a role in modul
ating levels of arousal. The thalamus may be the seat of
human consciousness.

18. Neurobiology of Affect Regulation
Hippocampus
 The hippocampus Is found in the medial temporal lobe.
 The three major theories used to explain hippocampus f
unctioning are that the hippocampus is involved in: beh
avioral inhibition, declarative memory consolidation, and
sense of place. In those with PTSD
hippocampus declines have been noted.
 Dissociative Identity Disorder (DID), one study found a 26%
decline compared with controls. No studies were found linking
hippocampal growth with touch therapies.
 However, touch reduces cortisol production and high levels of
cortisol.
Hippocampal declines can be reduced through reregulatio
n of cortisol.

19. Neurobiology of Affect Regulation
Hippocampus
 The hippocampus Is found in the medial temporal lobe.
 The three major theories used to explain hippocampus f
unctioning are that the hippocampus is involved in: beh
avioral inhibition, declarative memory consolidation, and
sense of place. In those with PTSD
hippocampus declines have been noted.
 Dissociative Identity Disorder (DID), one study found a 26%
decline compared with controls. No studies were found linking
hippocampal growth with touch therapies.
 However, touch reduces cortisol production and high levels of
cortisol.
Hippocampal declines can be reduced through reregulatio
n of cortisol.

20. Neurobiology of Affect Regulation
The Insula
 The insula is a part of the limbic cortex.
 The insula has been postulated to be involved in the felt
experience of introceptive cues from the body, viscera, appetit
e, and addiction and plays a role in the integration of body se
nsation of the primary emotions (such as anger, sadness, happiness,
and disgust).
 It has connections with the amygdala and the orbital frontal cortex
through connections with the thalamus.
 Touch in combination with the individual’s attention has been shown
to activate the insula in fMRI studies.
 The insula registers both painful touch and pleasant touch.

21. Neurobiology of Affect Regulation
The Insula
 The insula is a part of the limbic cortex.
 The insula has been postulated to be involved in the felt
experience of introceptive cues from the body, viscera, appetit
e, and addiction and plays a role in the integration of body se
nsation of the primary emotions (such as anger, sadness, happiness,
and disgust).
 It has connections with the amygdala and the orbital frontal cortex
through connections with the thalamus.
 Touch in combination with the individual’s attention has been shown
to activate the insula in fMRI studies.
 The insula registers both painful touch and pleasant touch.

22. Neurobiology of Affect Regulation
Cingulate Gyrus
 The cingulate gyrus is often referred to as the limbic cortex.
 At three to nine months of development, the infant grows the abilit
y to modulate social engagement through immobility and withdrawing
(noradrenalin) and active protection through fight/flight
(dopamine), monitors internal and external behavior, attends to mistak
es, and modulates behavior for more successful outcomes.
 The anterior is discussed here and is related to autonomic homeostasis,
reward anticipation; heart rate, decision-making, emotions, and modeling
the emotions of others.
 It plays a central role in integration of bottom up and top down neural
processes.
 The cingulate gyrus is involved in the limbic touch circuit.

23. Neurobiology of Affect
Regulation: the Amygdala
 The Amygdala is often known as the fear
center of the brain. Although it could be
better conceptualized as a smoke detector.
It notices changes in the insula, and other limbic structures.
 The amygdala is involved in classical conditioning and emotional
memory. Likely involved in “flash bulb” memories).
 The amygdala becomes nearly fully developed by the age of one
year.
 Early in life it plays a role in the infant’s indiscriminant impulsive
drive to social interaction.
 Touch has been shown to have strong links to the amygdala, the
insula, and other limbic structures.

24. Neurobiology of Affect Regulation
Basal Ganglia… Septal Nucleus
 Basal Ganglia (BG): Is
central to the modulation of movement, emotional set, anticipation of mov
ement, eye movement, motivation, and reward. Physical touch increases ne
urotransmitter production key for basal ganglia functioning.
 Septal Nucleus: Plays a role in pleasure, relaxation and rest. It has an inhibitory
effect of cortisol.
 In early development, the amygdala pushes the infant toward indiscriminant social
contact.
 As the child develops, the septal nucleus provides regulation for amygdalar
impulses.
 Stressful touch to rats increased the septal nucleus secretion of dopamine and
activation of the hypothalamic circuits.
 In rat pups, a damaged septal nucleus leads to increased aggression and loss of
maternal behaviors.

25. Neurobiology of Affect Regulation
Basal Ganglia… Septal Nucleus
 Basal Ganglia (BG): Is
central to the modulation of movement, emotional set, anticipation of mov
ement, eye movement, motivation, and reward. Physical touch increases ne
urotransmitter production key for basal ganglia functioning.
 Septal Nucleus: Plays a role in pleasure, relaxation and rest. It has an inhibitory
effect of cortisol.
 In early development, the amygdala pushes the infant toward indiscriminant social
contact.
 As the child develops, the septal nucleus provides regulation for amygdalar
impulses.
 Stressful touch to rats increased the septal nucleus secretion of dopamine and
activation of the hypothalamic circuits.
 In rat pups, a damaged septal nucleus leads to increased aggression and loss of
maternal behaviors.

26. Neurobiology of Affect Regulation
Orbital Frontal Cortex
 Orbital Frontal Cortex:
“emotion and reward” area of the prefrontal cortex
.
 This is likely the most abstract area of emotional pro
cessing.
 It is also the last to mature.
 It reaches full maturity in the early twenties.
 It is involved in decision making and expectation.
 Pleasant touch increases activation in the OFC.

27. Neurobiology of Affect Regulation
Orbital Frontal Cortex
 Orbital Frontal Cortex:
“emotion and reward” area of the prefrontal cortex
.
 This is likely the most abstract area of emotional pro
cessing.
 It is also the last to mature.
 It reaches full maturity in the early twenties.
 It is involved in decision making and expectation.
 Pleasant touch increases activation in the OFC.

29. 4 Types of Neuroplastic Changes
 Experience Independent: Changes driven entirely by genetic
determination. (e.g. Layered Structure of Brain: Brain Stem,
Limbic, Cortex)
 Experience Expectant: Changes that are biologically determined
and need only be activated by life events. (e.g. language
formation, facial recognition and attachment)
 Experience Dependant: Changes that are individual idiosyncratic
and are dependent on the specific environmental event
occurring. (e.g. The first month of the year is January, there are
six degrees between any one and Kevin Bacon).
 These types of development interact. Extreme events (chemical,
physical, and learning) can alter any of these developmental processes
(This Presenter’s Personal Conjecture Based on the Eval of Current Lit).
 Shifts in functional relationships between structures (see dysregulation).

30. Clinical Story
 The Story of the two guards at the cave…
 When you call up a memory it calls the pattern of
neuronal behavior up and often it is in a “plastic state.”
 Using touch to help support witnessing presence to
remain connected to sensation long enough for the new
possibility to integrate.

31. Two Main Types of Affective
Dysregulation
 Developmental: Developmental dysregulation occurs when
there are either disruptions in the developmental
environment or physical systems of the brain leading to
altered growth in the cortical structures, hormones,
neurotransmitters, or the relationship between structures.
 Incident Driven Dysregulation: In a catalyzing event, through
which the brain and self undergo fundamental functional
alterations. (Most PTSD Research and treatment focus on this
type of dysregulation)

32. Developmental Dysregulation
 Example: If a child misses the processes that lead to the
maturation of the septal nucleus, that child could display
impulsivity and tendency to socialize indiscriminately, and the
cortical structures that myelinated after the development of the
septal nucleus could display disruptions functioning as well.
 More the 60% of children who have been traumatized (developed
PTSD after an event) display major to moderate disruptions in
multiple neuocognitive abilities (e.g. Memory, Language, Spacial
reasoning, Attention/Concentration etc..)
 A disruption in a key neurocognitive domain can lead to
disruptions in all the developmental processes that rely on these
domains to develop.

33. Developmental Dysregulation
 These children tend to be improperly diagnosed, receive
improper treatment, and their educational needs not
attended to.
 Effects more then 3,000,000 children per year in America
alone.
 Although, there has been a call for the diagnosis of
developmental trauma by Bessel Van Der Kolk and others, it is
yet to be included in the DSM-V.
 Write the committee!

34. Incident Driven Dysregulation
 This is the main focus of the current PTSD liturature.
 Two main forms of dysregulation (These types are not
exclusive but people show a predominance in a direction)
 Hyperactivation: Reflects an upregulation of stress hormone
production and an underactivation of emotion regulation
centers. Display increased Cortisol and Heart Rate when read
a trauma script. (70% of sample)
 Hypoactivation: Reflects an under-activation of stress
response and an over activation cortical structures, which
regulate stress. Displays a decreased Cortisol production and
Hear Rate when read a trauma script. (30% of sample)

35. Dysregulation
 The body and mind are full of rhythms functioning
coherently… From the daily rhythm of sleep to waking, to the
diurnal pattern of cortisol secretion.
 Dysregulation occurs when the normal coherent relationship
between these patterns is disrupted in such a way that the
brain or mind has difficulty returning to its normal
homeostatic range (Liberzon, Taylor, Fig, & Koeppe, 1998).
 Post-traumatic stress disorder (PTSD), there is an
upregulation of the threat system such that it triggers a
dissociative shutdown, it over-produces stress hormones,
reacts too intensely to triggers, or it is triggered too easily to
produce stress hormones.

36. Hyperactivation
 The hyperactivated individual floods with information from
the body and has less capacity to regulate the intense
sensation.
 Ruth Lanius Found in an fMRI Study…
 Over activation in the insula (bringing extreme amounts of
information from the body’s interceptive cues)
 Under-activation of the anterior cingulate cortex (ACC) (area
needed to regulate the body sensations brought up from the
insula)
 Under-activation medial prefrontal cortex (mPFC) (area
needed to regulate the body sensations brought up from the
insula)

37. Hypoactivation
 For the hypoarousal type, only a small amount of
interceptive cues get into the limbic cortex and are
quickly squelched by cortical structures, leaving the
individual feeling disconnected, emotionally flat, and
dissociated.
 Ruth Lanius Found in an fMRI Study…
 Down regulation of physical sensations from the insula
cortex.
 Hyperactivation activation in the anterior cigulet cortex
(ACC).
 Hyperactivation in the medial prefrontal cortex mPFC.

38. Porges: Poly-vagal Theory
 Autonomic Nervous System Regulates:
Stress, Arousal, Heart Rate, Breath
Rate, Digestion etc…
 Autonomic Nervous System has Two
Branches….
 The Sympathetic Branch: Fight and
Flight response.
 Parasympathetic Branch: Two Systems…
Rest and digest, and Freeze.

39. Porges: Poly-Vagal Theory…
Two Parasympathetic Branches
 Evolutionarily Newer (VVC): Rest and digest or Social
Engagement System. Functions when we feel safe.
 Evolutionarily Older (DMNX): Freeze Response… Functions
like a circuit braker to shut down the nervous system under
extreme threat of death. A time dependent physiological
process.
 A feed back loop is possible (Lizards from the 1900’s):
Injection of the stress hormone adrynilyn can maintain the
freeze response indefinantly.

40. Poly-Vagal Theory
The way it works…
V.V.C. Brake Disengages
Sympathetic Nervous
system Engages
V.V.C Brake Engaged
at rest and Socially
Engaged.
DMNX Engages
Shutting Down
Consciousness

41. Somatic Experiencing Theory
 Fight, Flight are defensive strategies…
 They are time limited aimed at removal of a threat.
 Freeze response is a defensive strategy…
 It is time limited and follows a predictable pattern of
behavior.
 Often the freeze response can not complete because of its
multi-sensory association with the fight or flight response
(coupled in the felt-experience of the event).
 Overactive fight/flight response leads to maintianance of the
freeze response indefinantly.

42. Somatic Experiencing Theory
 Psychological adaptations to trauma occur when the
individual develops strategies to co-opt other neurological
systems to override the need to access states that could re-
trigger traumatic experience.
 In SE theory, the return of social engagement behavior can
indicate a re-regulation of the nervous system.
 Some indications of social engagement are: The inner ear
tuning to the range of the human voice, breathing becoming
slow and smooth, orienting towards the therapist, and the
individual growing curious about his or her environment.

43. Video Demo…

44. Four major touch pathways
Type AAlpha - Quick myelinated pathway mediating
proprioception from skeletal muscles.
Type A Beta - Slightly slower myelinated pathway mediating
skin touch, hair follicle endings, and deep touch.
Type A Sigma - Slower thinly myelinated pathway mediating
temperature and pain.
Type C - Slow unmyelinated pathway mediating pain,
temperature and itch.

45. Three Pain Touch Pathways…
1. Spinoreticular tract
“Ouuuch!”
2. Spinothalamic tract
“I Hurt My Arm!!!”
3. Spinomesencephalic tract
“I feel better now…”

47. Touch Pain Pathways:
Spinoreticular track
 The philogentically oldest of these pathways.
 It goes from the spine to the reticular activating system (RAS).
 The RAS is a major body regulator of level of conscious arousal.
 This pathway mediates the emotional arousal aspects of pain and
the motivation to stop the pain.
 When a person stubs her toe, this information is read by the
brain as, “ouch.”

48. Touch Pain Pathways
Spinothalamic tract
 Runs from the spine and to the thalamus.
 It conveys information to the brain about specific areas
of pain, sensation, and temperature.
 This area can localize the pain to a given region.
 This area is the one that makes a person say, “I cut my
arm!”

49. Touch Pain Pathways
Spinomesencephalic tract
 This tract, through communication, is responsible for
modulating and reducing the pain response.
 Through activating the Para Ventriculate nucleus (PVN)
serotonin and opiates produced endogenously. These
chemicals signal the body to interrupt the pain
response.
 When this area comes on line, one might state, “My arm
feels better.”

50. Sensory Processing
 Primary Sensory Motor Region: Receives raw sensory
data. If damaged leads to paralysis or muscle spasm.
 Secondary: Integrates sensation with perception.
 Damage to the secondary sensory area can lead to:
Difficulty localizing and integrating sensory input; Losing
propreaceptive input, such that the person feels lost in
space.
 Damage to the secondary motor area leads to loss of: The
urge to move (basal ganglia); Organized patterns of
movement; Emotional drives for movement.

51. Sensory Processing
 Tertiary: Integrates higher order abstractions and
concept formation.
 Multi-sensory Integration: Creates the seamless felt
experience of reality

52. Biology of Touch Sensory Integration
 Through the visuotactile mirroring mechanism, people
model each other’s emotions and experiences by
integrating touch and vision.
 Two Visuotactile Systems:
 Non-intentional system models Inannimate Objects
• Intentional system models relational
touch and may mediates the
experience of “resonating with
another.” (Co-Regulation)

54. Effects of Touch
in Therapy
 Touch is as vital as food
 Touch can affect multiple neurobiological systems that are
targets of anti-depressants, anxiolytic medications.
 Having one positive emotion after a stressful event or the
experience of a triggering event can speed the reduction of
cortisol levels, and reduce physiological indicators of stress.
 Soothing, safe touch can be an effective means to provide an
experience of safety, evoke the relaxation response and for
some positive emotions

55. Effects of Touch in Therapy
 Just as touch plays a profound role in the development of the child, it
can play a profound role in the regulation of the nervous system…
 Therapeutic touch has been shown to decrease cortisol production,
substance P (mediating pain responses),
 Therapeutic touch has been shown to increase dopamine, serotonin, and
oxytocin production (known to mediate maternal behaviors, attachment
and partner boding).
 In infants it has been shown to increase birth weight, cortical
development, length of the infant, reduce asymmetry between frontal
lobes (associated with depression), increase the ability to self-soothe,
and re-regulate cardiac vagal tone (an indication or autonomic
regulation).

56. Effects of Touch in Therapy
 In parents, it has been shown to increase the quality of
their relationship, infant-parent synchrony, perception
of partner support, reduce frontal lobe asymmetry, and
reduce the effects of post-partum depression.
 Massage has been shown to
reduce symptoms of depression,
state anxiety, and PTSD

57. Changes in Auto-regulation
Through Touch
 Internalization of the therapist as a safe regulator of affect
 The coupling of difficult emotional content with the safe
containment of the therapist and effects of touch the client
builds new regulatory possibilities.
 Changes occur in the ACC and its modeling and play back of
emotional events.
 The client reduces for the client the number of conflicts their
ACC needs to monitor through its conflict monitoring function
and the number of number of emotional exchanges with a
successful outcomes.

58. Changes in Auto-regulation
Through Touch
 The internalization of the therapist as a safe regulator of affect.
 As the therapist coaxes the client’s orbital frontal cortex online
through safe touch and emotional mirroring through touch, these
areas likely are strengthened.
 The safe contact with the therapist could allow for increased ability
of the client to tolerate his interceptive responses to events and thus
allows him to be available to a wider range affect without
dysregulating and be an active participant in a wider range of life
experiences.
 As a new-felt experience of contact with one’s physical form and
physical contact with a self–regulating other is internalized, the
individual has the ability to auto-regulate through touch.

59. QUESTIONS

61. Containment Through Contact
1. Brake up into dyads
2. Decide who will be the
receiver first.
3. The partners let each
other know where they
feel safe receiving touch
(e.g. shoulders, upper
back etc.).
4. Negotiate contact
5. Containment Exercise
6. Then switch roles.
7. Brief sharing in dyads

62. Containment Exercise
 Provide containing touch: Resting at the skin
 Using invetational language ask your partner to notice the
contact with your hand.
 Invite them to move their attention to a place that feels good on
the inside.
 Gently ask them to move their attention to place that feels
slightly uncomfortable,
 Invite them to move their attention back to a place inside that
feels good.
 Ask them to notice the felt experience of contact with your
hand.