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POETRY THERAPY: POETRY AS Rx 

POETRY THERAPY: POETRY AS Rx 

There is research that those experiencing PTSD reported improved well-being in response to poetry therapy. This might be the case because a hallmark of having experienced trauma is the subsequent difficulty processing the experience, which results in avoiding and suppressing associated emotions/memories.

Poetry therapy has provided an outlet for those suffering with PTSD to start to integrate many of these feelings, and even more so, to start to reframe the traumatic experience.

Poetry therapy itself is a bit abstract to describe, but there are a few ways to engage with it. Here is a multi-model poetry therapy practice developed by Nicholas Mazza, the founding and continuing editor of the Journal of Poetry Therapy.

According to Mazza’s model, poetry therapy involves three main components:

  1. Receptive/prescriptive: This part of therapy involves the clinician/therapist reading a poem out loud, and then subsequently encouraging the client to react to it, either verbally, non-verbally, or both. The therapist might even prompt: “Is there a particular line in the poem that resonated with you?”, or “I noticed you started to become teary-eyed when I read this line…”
  2. Expressive/creative: This entails actual creative writing. The therapist promotes stream of consciousness writing that might aid in discovering blocked emotions, parsing felt emotions, or retrieving memories that are difficult to articulate. The therapist might offer a prompt to help someone get started.
  3. Symbolic/ceremonial: This includes working with metaphor/simile to help further explain emotions that are hard to describe in a more literal sense. The ceremonial part may consist of writing a letter to someone they may have lost and then burning it.

 

The efficacy of poetry therapy is still being studied. Most of the empirical evidence for its effectiveness comes through James Pennebaker’s (a pioneer in the field of Positive Psychology) work in the therapeutic use of expressive writing. His studies have indicated that the use of expressive writing, even for as little as 15 minutes over the course of 4 days, resulted in positive health effects. In addition, his initial work dealt with the use of expressive writing to heal wounds from traumatic stressful events.

One case in point is that in the aftermath of 9/11, poetry was utilized as a healing mechanism. According to a New York Times article on October 1, 2001:

“In the weeks since the terrorist attacks, people have been consoling themselves—and one another—with poetry in an almost unprecedented way … Improvised memorials often conceived around poems sprang up all over the city, in store windows, at bus stops, in Washington Square Park, Brooklyn Heights, and elsewhere. …”

In some ways poetry gives us the way to speak about the unspeakable. It is more and more common for those suffering with medical challenges to write their story, many times in poetic form, to aid in their own healing. As always, it is crucial to note that just like with mindfulness approaches to trauma, poetry therapy is most often used in conjunction with other therapies.

On a personal note, I’m particularly drawn to this type of therapy and recently started studying for my MFA at Queens College. I am touched by the profound pain that is both individually and collectively felt, how this pain can displace someone from others and their selves, and yet, the profound capacity for resilience, healing, and growth. Aside from writing my own work, I hope to employ poetry as a technique to help my clients say what they couldn’t otherwise say.

Here’s an example of a poem that I recently published in the British Journal of Medical Practice in this vein:

This is part 3 of a 4-part series of excerpts from the latest 2018 edition of Dr. Wolkin’s PTSD Packet

Repost: Your Two-Brain Lifestyle: How to Heal Mind, Brain and Gut

Repost: Your Two-Brain Lifestyle: How to Heal Mind, Brain and Gut

This blog post originally appeared in The Huffington Post.

huffpopost

Less might sometimes be more, but two brains are most definitely better than one! How extraordinary then that research continues to confirm a second brain that resides in our guts.

Yes, our gut has its own neural network, the enteric nervous system (ENS). Our ENS doesn’t wax philosophical or make executive decisions like the gray shiny mound in our skulls. Yet, in a miraculously orchestrated symphony of hormones, neurotransmitters, and electrical impulses, both of our “brains” communicate back and forth.

This connection is actually what accounts for those proverbial butterflies in our stomach and has vast implications on our overall health and wellness. Changes in the diversity of the trillions of bacteria that reside in our gut (called the gut microbiota) can impact upon our mental state. And on the flip side, psycho-social factors, including the way we think and feel, have been implicated in gut problems.

Given my personal experience with SIBO, and professional experience with hundreds of women suffering from depression, anxiety, and GI difficulties, I enjoy teaching about how to live what I like to call a “Two-Brain Lifestyle.”

Here are four ways to begin your two-brain lifestyle journey:

 1. Diet:

“Diet is a central issue when it comes to preserving our gastrointestinal health, because by eating and digesting we literally feed our gut microbiota, and thus influence its diversity and composition.” –– Professor Francisco Guarner (University Hospital Valld’Hebron, Barcelona, Spain)

There is more and more research linking diets to both our gut and brain health. Certain diets elicit a healthier bacterial balance. Overall, and generally speaking, a diet rich in whole, unprocessed, unadulterated, and non-genetically modified foods help to maintain a proper pathogenic gut bacteria ratio. More specifically, the following are key recommendations:

A. Probiotic Intake:

Probiotics can be found in foods such as yogurt, or kimchi, and can also be taken in supplement form. Among other benefits, probiotics keep the bacterial ecosystem in our gut healthy, which in turn helps keep us healthy overall.

The positive impact of probiotics on gut flora has been widely studied in the last few years. In a 2013 study in Gastroenterology, 12 of 25 healthy women ate a cup of yogurt twice a day for four weeks. The rest of the women ingested no yogurt. All women had pre and post brain scans while being asked to respond to a series of images depicting different facial expressions. Results indicated that the women who ate yogurt were calmer when shown various emotions than the control group. Showing that the yogurt changed the subjects’ gut microbiota, which also modified their brain chemistry.

This means probiotics are potential game changers when treating anxiety and mood difficulties.

B. Low Sugar/Low Simple Carb Diet:

It is hard to say this, given that a love for chocolate has a special place in many of our lives, but excess sugar upsets the balance in the gut by nurturing more pathogenic bacteria, which leads to increased systemic inflammation. And inflammation is a major player in the inception of chronic disease, including mental health difficulties — no good!

In a recent study, researchers fed a group of mice a diet high in sugar and then tested their mental and physical function. The sugar diet negatively impacted the mice’s gut microbiota, impaired their cognitive flexibility, and ability to efficiently adapt to changing situations. The change in gut bacteria also negatively affected the mice’s long-term and short-term memory.

Basically, sugar makes you forgetful and possibly impairs adaptability, but don’t fret, the chocolate craving can still be met: The darker the chocolate, the less sugar. Also, if you don’t want to cut sugar completely out of your diet, eating less overall can still improve wellness.

 2. Physical Exercise:

Ever feel like vomiting when you are scheduled for a job interview? That is just a crude reflection of how stress negatively impacts many aspects of our gut, but give exercise a try, it’s a well-known stress-buster!

A 2014 study found that rugby players not only have more diverse microbiota, but also a high amount of a particular bacterial species associated with decreased rates of obesity and metabolic diseases. While the study didn’t separate the effects of exercise, stress, and diet, it certainly provides evidence for exercise’s possible beneficial impact on gut microbiota diversity.

3. Therapy:

Our gut microbiota talk to the brain and impact how we think and feel, and, the way we think and feel has a profound impact upon the gut. Therefore, negative thinking styles and certain emotional states can disrupt gut functioning and even lead to dysfunction and disease.

Cognitive Behavioral Therapy (CBT) is a type of therapy geared toward identifying and reframing negative and counterproductive thought patterns. In a 2003 study of patients with IBS, a significant number reported less pain, bloating, and diarrhea after 12 weeks of CBT. Stands to reason that therapy should be part of a thorough treatment plan for chronic gut upset!

 4. Relaxation and Stress-Reduction Exercises: 

Studies have shown that stress puts us at risk for dysbiosis, a shift away from healthy gut diversity. This then strips us of a defense against infectious disease, which can potentially wreak havoc on the Central Nervous System (CNS).

Beyond utilizing exercise, which we already talked about, stress reduction and relaxation techniques, such as meditation, help bring the gut environment back to homeostasis. In a recent study from Harvard University affiliates, forty-eight patients with either IBS or Inflammatory Bowel Disease (IBD) took a 9-week session that included meditation training. The results showed reduced pain, improved symptoms, stress reduction, and a decrease in inflammatory processes.

Go with your gut

Just as the best way to boost our brain is by maintaining impeccable gut health vis-a-vis the content of our diet, so too, it might be impossible to heal a distressed gut without considering the impact of stress and our emotions.

So just remember, you are what you eat, and you are what you think, and there are ways to do both more mindfully.

Fear as Fuel: Don’t LOOSE it. USE it!

Fear as Fuel: Don’t LOOSE it. USE it!

At the end of each new intake evaluation I always ask my patients to delineate one to three concrete goals for their work in therapy. Many of them don’t even have to give it any thought, and immediately and confidently say: “I want to lose this sense of my fear, and make these symptoms of anxiety go away”.

Yet, from what I have learned through my training, mentors, and my own therapy, and what I tell my patients when they embark on a journey to rid themselves of anxiety and fear…

Not only is it impossible to rid yourself of these feelings, it is detrimental. The point of therapy isn’t to “fix” you, or to make your feelings go away, but rather to help you learn the skills to enable yourself to bring those feelings into balance, to an adaptive level, where they belong.

Fear, you see, is evolutionary. The fact that our fight or flight mechanisms arouse us to impending dangers or threats is a gift. Anxiety, which is similar to fear, but engages more of the thinking part of our brain, is also just as adaptive. If we never got anxious, we’d never go to the doctor, study for an exam, make sure we have a retirement plan in place, or pay our electric bills. In fact, anxiety is linked to conscientiousness, and conscientiousness is linked to longevity.

Yes, the inability to feel anxious can shorten your life! So, by that logic, anxiety is life-promoting!

Here is the thing to remember though. It is about working to keep the anxiety and fear at adaptable levels, and to live not in spite of these feelings, but because of them!

I personally struggle with the balance of adaptive and less adaptive anxiety all the time. Here’s just a little example:

A few weeks ago, I woke up at 4am.  I couldn’t sleep – at first, I didn’t really feel much of anything. I just lay in bed, not knowing what to do, so I just looked up at the ceiling. I finally got up and walked around, shut the light, opened the light, shut the light, got some water, went back into bed, got out of bed, and at that point I was starting to cycle through some very destructive and fear-induced thought processes.  I was starting to feel mentally and physiologically stressed, but then…

here was my moment…

I put my sneakers on and I could feel some sort of new adrenaline rush inside me, not a toxic one, but one that lifted me up (there’s a fine line between these adrenaline rushes, different mindset, but same ‘ol physiology). Whether I was excited or stressed, my fight or flight was elicited. I think the interpretation of what it means is the difference between the biophysiological and psychosocial consequences of the rush.

This rush catapulted me to the gym, finally feeling energized enough to exercise. I nearly skipped all the way there, and when I arrived the sight of sweaty people elated me – so many people alive and moving and motivated to heal and live longer by bringing their heart rate up, or combating obesity, or high blood sugar, or just general malaise, or a depressed stupor. I was inspired by this tableau, which touted the need for social milieus to act out the yearnings of the mind and body to thrive. We were all acting on our fears together.

Fear and anxiety are the human struggle, and the struggle is real. My therapist encourages me, and I in turn encourage my own patients, to embark on living a healthier life, the life they desire, by embracing their fear, without letting it cripple them. And fear, can most definitely cripple.

Many people have said, “Use fear as fuel”, and while the catchphrase might be cliché, it couldn’t be truer. There is nothing to rid ourselves of, only everything to embrace…

What has your experience been? Are you up for embracing your fear and working WITH it?

Let’s embrace all of ourselves; especially those BrainCurves :).

– Dr. Jen