What should we do when we are not aware?
This innate capacity for awareness can be lost in situations of excessive stimulation such as experiences of trauma, either physical or psychological, during which the self-regulation circuits and the body schema are either partially deactivated or, in more serious cases of trauma, almost completely deactivated. In these situations the brain produces a very rapid automatic response to protect the person in the best possible way, based on a response model of fight, flight or freeze which, depending on the severity of the trauma, alters on a long-lasting basis the way of responding to the situations of stress. As a result the person no longer monitors his internal state, altering the homeostatic models linked to embodied awareness which ensure metabolic function and processes of development.
We can re-emerge from the period of withdrawal resulting from trauma experiencing a new sense of security, which can restore a normal capacity for absorption, involvement and repair. Repair, which is set in motion once the need for help is recognised, can happen as a result of a prolonged period of rest, sleep and/or contact with people capable of establishing harmonious relationships. This is therefore a repetition of the primitive process of interactive regulation as the key to the recovery of awareness of the Self (Schore, 2003). The combination of these elements allows us to renew our response moment by moment within our environment, abandoning the automatic way of responding that was activated by the trauma.
The loss of embodied awareness is central to the continuation of the effects of trauma, since it regulates the internal environment and our relationships with the external environment. It is not only trauma that causes a breakdown in our natural capacity for awareness: a prolonged condition of stress, from a psychophysiological point of view, can have the same disturbing effects on the perception of Self.
The question of what we should do if we lose our awareness may seem rather paradoxical. Loss of awareness is accompanied by a kind of loss of memory about what we should be aware of and by a self-referentiality which is difficult to break. Patients end up asking for help over issues stemming from discomfort - physical or psychological - as a result of which they are very absorbed or, equally paradoxically, barely aware.
Requesting help and establishing a relationship and an effective working partnership are the first conditions for beginning the journey towards awareness. A journey in which the results actually belong to the first-hand experience and the doctor is an expert guide but is not the only expert.
Fogel (Fogel, A. (2009). The psychophysiology of self-awareness: Rediscovering the lost art of body sense. The Norton Series on Interpersonal Neurobiology. NY: W. W. Norton) summarises the key elements of this journey towards embodied awareness in a table, which presents interesting ideas for reflection, and brings together the work and the influence from various authors.
MOVING TOWARDS AWARENESS
Attention to resources. By RESOURCES we mean the creation of an internal and external situation of stability, security, support. People need these resources to confront anger or feelings of threat or pain that have been suppressed. The loss of awareness is the price paid for this suppression.
Slowing down in order to learn to remain in contact for longer with our own subjective emotional experience. Embodied awareness requires a slowing-down of the cognitive processes of evaluation, or a temporary suspension. Moving from thinking to feeling what exists in the present requires time to gather our bodily sensations and develop a sense of competence regarding them and a greater tolerance of the physical or emotional sensations of discomfort.
Co-regulation. The therapist acts as an external regulator so that the person can learn to trust the exploration of his own physical and emotional experience.Learning to regulate his emotional states and becoming aware of the effects of hyperactivation and hypoactivation helps the person to come back into contact with his own inner resources. This process requires a supportive external environment which acts as a coregulator.
Verbalisation. Helping the verbalisation of our interoceptive states helps us to stay within our own subjective emotional experience. Searching for words to describe the experience encourages communication without communicating being an experience of losing contact with the body.
Connections and boundaries. Clarifying locations and connections in the body schema and the distinction between Self and Others. Locating the source of sensations in the body, opening or mobilising defensive postures, discovering the “lost areas” of the body and how they are coordinated in movement and defining connection and boundaries between ourselves and others.
Self-regulation as a way of dealing with our own recovery. Becoming the source of our own resources, developing proactive behaviour aimed at re-establishing balance.
Involving ourselves actively in maintaining our own embodied awareness. Engaging in physical activities, which sustain awareness, learning to say no to destructive or debilitating behaviour.
Letting go, or learning to distinguish between involvement and absorption, between thought and rumination. Letting go includes the ability to choose what to get involved in and to accept the reality of a loss.