Successes with Psychogenic Non-Epileptic Seizures (PNES) using TRE®
Since gaining my certification as a Peer Support Specialist, I have been happy to see more people with mental health challenges finding their path to my services. This is an endeavor that is near and dear to my heart. Many of these people are experiencing physical symptoms due to the emotional stress they are going through. If the nervous system gets stuck in fight/flight or freeze states we can see things ranging from autoimmune dysfunction, high or low blood pressure, digestive upset, numb sensations, muscle tightness, and pain, to obesity, addictions, and eating disorders. Some of these problems seem obviously physical in nature, and others we may put into more of a psychiatric category. Yet, as we learn more about the triggers and causes of these challenges we see how understanding the connection between the body and mind is extremely important to finding ways to alleviate them. This has certainly been the case in working with Psychogenic Non-Epileptic Seizure Disorder (PNES).
Polyvagal Theory by Dr. Stephen Porges
In my training to become a TRE (Tension and Trauma Releasing Exercises) provider, I was taught the main concepts of Dr. Stephen Porges’ Polyvagal Theory of the Autonomic Nervous System. In short, if the Sympathetic Nervous System gets activated into Fight or Flight, and then shunted outside of its window of tolerance for too long, a reaction into a Dorsal Vagal Parasympathetic Nervous System state of the Freeze response can occur. Just as there are varying levels of Fight or Flight activity ranging from worry to panic, or frustration to rage, there are also varying levels of shut-down in the Freeze response. This can range from helplessness and depression to numbness, dissociation, and then to total body collapse or immobility. PNES seems to fall somewhere in the middle of this Freeze response gradient, with dissociation at the core, yet varying amounts of body rigidity and involuntary movements.
With an assessment from a neurologist, it is established that the brain of someone who is undergoing a non-epileptic seizure is not going through the kind of electrical storm that happens in a true epileptic seizure. Following from its name, PNES is psychogenic in nature, or correlated with the psychological distress of a person. Never has it been so apparent to me how the emotional and mental state of a person can affect the body, as in PNES.
So what is happening to cause this shut-down into such a dramatic freeze response? Through researching this condition and through my own observations, I have recognized that freeze and dissociation may be a coping mechanism that was learned very early in life’s circumstances. The person learned to withdraw into the self, and to push away their emotions. There may not have been anyone with whom they felt able to speak their truth while being heard and understood. The only way to communicate that distress becomes doing it through the body. The release is so needed, yet the only way the person can do it in their emotionally suppressed state, is somewhat or completely unconsciously in the PNES events.
The benefit of using TRE as a therapeutic tool for a person with PNES, is that it allows a similar type of release that the person’s body has already found to be useful. The similarity is in the shaking, or tremor response reflex, which originates from the brainstem. This is the most primitive part of the brain, and does not involve the higher level cognitive thinking parts of the brain. The shaking reflex allows for a natural release of high intensity energy in the body, as it was evolved to do. The difference is that with TRE we are keeping the person in a calm state, in high awareness of their body, and fully present while doing it. We are teaching the person to honor their needs through self-regulation, while broadening their window of tolerance in their nervous system. We are slowly opening the body up to a new expression while also creating a positive experience with another person.
In using TRE for a PNES client, I work gently and slowly, allowing for much agency and choice in all matters involved in the session. I feel it is important for the client to be actively working with a psychotherapist and a neurological specialist, to make sure that physical or psychological issues can be addressed by licensed providers. As a Certified Peer Specialist, I have been taught trauma-informed techniques that help a person to feel understood, safe, and supported. I help them to find resources and supports as they become needed. Because healing happens in connection with others, I feel that the Peer Specialist role helps that connection to happen. Corrective experiences that involve sharing feelings and being validated and supported happen spontaneously in session. The client can begin to be open to exploring their inner self and discover new possibilities in healing if they so choose.
Over time we see fewer and shorter PNES episodes. Partners feel more confident in their supportive roles, and goals for self-care spontaneously come forward. It is constantly amazing to me how TRE can help people develop their inner strength, and how it guides a person into post-traumatic growth. It will be interesting to see how TRE develops as a therapeutic tool for PNES and many other psychogenic disorders in the future. I look forward to being a part of this exploration.
