Let’s look at compassion and affective touch in turn, then we’ll turn our attention to trauma and how it can be healed.
Compassion
Compassion is most simply defined as the human quality of understanding suffering, combined with a motivation to address that suffering. It’s one of the most important human qualities.
Compassion has many elements including empathy, non-judgment, an attitude of loving kindness, a willingness to tolerate painful feelings, and a desire to help the other.
When we experience distress or pain we long for empathetic care but many health professionals view emotional connection with patients as unprofessional, or a risk for burnout, favouring clinical detachment instead. While intended to prevent distress, this approach often leaves patients feeling a lack of warmth from, their doctor or nurse, and discourages them from expressing their feelings.
However recent scientific studies and ancient wisdom are in agreement that the practice of compassion – as opposed to empathy alone – is supportive to both giver and receiver. Compassion taps into an infinite well of human connection and love.
What is the difference between empathy and compassion?
Simply put, empathy is a skill that allows us to understand others, to intuit their emotional state, and to understand the story of their difficulties. Empathy has no inherent moral value and can equally be used to support someone or hurt them, such as a conman who makes you believe they are your best friend – through the use of empathy – and then steals your money.
If you are at the airport and your flight has been cancelled at the last moment, the ticket agent at the airline desk shows positive empathy when she says, “I can understand why you feel angry and upset when you might miss your daughter’s wedding. Let’s see if we can find a way to get you there in time.” She is noticing your emotional state and also conveying her understanding of your situation.
While empathy is deemed important in health professional practice, health professionals who empathise with patients’ pain and distress are at risk of burnout unless the empathy is transformed to compassion. This switch from empathy to compassion was studied by the neuroscientist Tania Singer at the Max Planck Institute, using functional MRI scanning, which shows what regions of the brain are active at any given moment.
She asked Tibetan Buddhist monks to empathise with someone who was suffering and showed that they truly felt the pain of the other – their pain circuits ‘lit up’ in the brain scans. Empathy for pain engages a network of brain areas centred around the anterior insula and anterior mid-cingulate cortex, areas associated with negative feelings. The experience for the empathetic person is aversive and creates a motivation to turn away.
On the other hand, when the monks were asked to bring compassion to the suffering person, they activated parts of their brains concerned with love and human bonding, the medial orbitofrontal cortex and ventral striatum. They experienced feelings of warmth, connection, and positive affect, and they were drawn towards the other person, not motivated to turn away.
Empathy is transformed to compassion by an attitude of loving kindness and a desire to alleviate the suffering in the other. Compassion is protective to the practitioner; while they can understand and feel the pain of the other, their predominant feeling is one of love and connection. They also have satisfaction that their compassionate connection is healing for the client or patient.
There is a lovely description of the research here.
When we feel compassion – as both giver and receiver – we increase our levels of the neurotransmitter oxytocin, which is implicated in human bonding such as the loving connection between a mother and baby. Oxytocin makes us feel loved and comforted and it reduces our fight/flight stress response and lowers stress hormones, such as cortisol. A large body of research shows that hospital patients experience less pain and recover more quickly from injury or illness when treated by compassionate health professionals.
Empathy and compassion are personal qualities that we can develop over time. As we listen to the life stories of those less fortunate than ourselves, we tend to lessen our judgment and have greater compassion for their painful struggles. We can cultivate feelings of loving kindness through meditation and other practices. We all know people who are extraordinarily kind, caring and compassionate and they can serve as our positive role models.
Affective touch
Simple observation of people interacting will reveal the enormous importance of touch. Mothers hold, cuddle and stroke their babies and young children. Lovers caress each other’s faces. When we see someone distressed or crying, we instinctively rub them on the upper arm, in a gesture of compassion. Long-lost friends will hug each other in the arrivals hall of the airport, rubbing each other’s backs in gestures of love and affection.
Only recently have scientists become curious about the biological basis of this loving touch and how it changes our brain function and stress responses. Research in the last ten or fifteen years described a new class of specialised nerves in the skin, the c-tactile afferents. Found in areas of the skin such as the arm and the face, these nerves have only one function: to detect a soothing touch.
If the skin is stroked too quickly or slowly, the nerve doesn’t respond. But a soothing stroke, taking about a second from the shoulder to the elbow, elicits the maximal nerve signals. These nerves are also temperature sensitive – preferring the warmth of a human hand – but a rub to the upper arm also works when the skin is clothed.
These nerves relay into various brain regions including the hypothalamus and amygdala, regulating stress reactions, and affective regions such as the obitofrontal cortex and medial prefrontal cortex, which govern emotional responses. Affective touch induces feelings of connection, safety and love, it rapidly dampens stress responses and changes the levels of hormones such as oxytocin and cortisol.
For a recent scientific review of affective touch and stress regulation see here.
Further research shows that when specific areas of the skin are stroked – the upper arms, the face, and the palms of the hands – the brain generates high levels of very slow brain waves called Delta Waves, which are implicated in memory change. For a link to this research see here. Delta waves occur during deep sleep, which is crucial for healing and regeneration. Delta waves are associated with many different health benefits, including synaptic homeostasis (regulation of nerve connections), cellular energy regulation, clearance of toxic proteins, cognitive performance, mood, and neuronal plasticity. Delta waves allow us to connect to the subconscious mind and are involved in transcendental states and spiritual experiences.
Thus the combination of compassion and affective touch creates the conditions for difficult life events and painful feelings to heal in a natural way, through highly evolved brain mechanisms. We all intuitively know this. When a three-year-old boy falls off his bike and comes to us crying, we intuitively hug the child, rub their back and their arms, and murmur our words of empathy and support. Within a minute or two, the hurt is forgotten.
A crucial aspect of affective touch is the perceived intention of the toucher. If the person offering the touch is felt to be caring and compassionate, then strokes to the arm or face generate the positive neural changes and outcomes. In contrast, if the perceived intention of the person touching is manipulative or abusive, then these same forms of touch generate an aversive response. That is why the combination of compassion and affective touch is so important.
It is tragic that these natural ways of connection and healing have been banned from professional practices in mental health. Counsellors, psychologists, psychotherapist and psychiatrists are taught never to touch their clients or patients, although some compassionate practitioners will break the rules and offer a kind touch or a hug.
However, by taking back power and putting healing in the hands of all of us, not just the domain of professionals with their restrictive practices, we can tap into very powerful, intuitive and innate healing mechanisms.
What is trauma?
Most of us think of horrifying life events, such as a car crash that left us injured, or a physical or sexual assault. We notice that these events somehow get ‘stuck’ in our mind and can be re-triggered to generate unwanted fear reactions, even years after the original event.
But even seemingly minor events, especially in childhood, may leave us with a lifelong social phobia, never feeling good enough, or undeserving of love. That’s the nature of trauma: it gets permanently stored in the brain and can be subconsciously triggered to cause unwanted feelings and stress reactions.
Why do we survive some difficult life events, leaving them firmly in the past, while other events become stored as trauma and continue to haunt us? How can we recognise the traumatic events that shape our lives?
The PolyVagal Theory
Trauma can most easily be understood by referring to the Polyvagal Theory advanced by Stephen Porges, PhD, a renowned professor of psychiatry and a pioneer in the research linking psychology and physiology.
Many of us are familiar with the ‘fight or flight’ reaction to threat, associated with increased activity in the sympathetic nervous system and circulating adrenaline. It’s a state of arousal that rapidly prepares us to face a threat by accelerating our cardiovascular system, quickening the breathing and the heart beat, increasing energy supplies, and a host of other physical changes. It’s a state of stress, which protects us in the short term but is harmful if continually activated.
The opposite state is activation of the parasympathetic nervous system, associated with relaxation, wellbeing, social connection, optimal digestion and enhanced immune function. This healthy, relaxed state is activated by the vagus nerve, a large cranial nerve that runs from the brain stem to our internal organs. A signal in the vagus nerve slows our heartbeat and activates our gut.
During health, the sympathetic and parasympathetic nerve systems are in balance and allow us to respond optimally to our changing environment, minute by minute. The sympathetic nervous system is also involved in states of arousal, such as excitement.
The important contribution of Stephen Porges was recognising that the vagus nerve actually has two branches with very different functions. The ventral branch of the vagus nerve is responsible for the health-giving effects of relaxation. But the dorsal branch creates a lesser-known reaction to threat, which is the collapse response.
If we are overwhelmed by threat, and can no longer fight or flee, our final defence is to freeze. When someone faints from severe shock, that’s the dorsal vagus nerve in action. Our heart dramatically slows and even stops for a few seconds, which is why we become unconscious during a faint. The dorsal vagal state is one of collapse, hopelessness, numbness, dissociation and a feeling of being trapped and helpless. Our thinking brain, the prefrontal cortex, goes offline and we can’t problem-solve.
This dorsal vagal freeze state creates the conditions for trauma to be encoded and permanently hard-wired in the brain as a traumatic memory. It’s the most severe reaction to stress. It can occur in many different circumstances. When our car skids out of control we are powerless to stop the impact and we freeze. If we are physically overpowered by violence, we become a helpless victim. When we are humiliated, we are made to feel useless and have no means to fight back. As a child, we are helplessly dependent on the love and goodwill of our parents; if that safety is threatened, we may become traumatised.
In order to get out of trauma, we need to take our power back. If we can fight off a threat, or escape, then we don’t usually get traumatised. Thus, if we managed to correct the skid of our car and avoid a collision, we get a fright but we are not traumatised; if we can fight off a bully we will feel hurt and angry but not traumatised. We break a leg in an accident but the hospital provides care and we are confident in our body’s ability to heal. These are the difficult life events that don’t become a trauma and they are left safely in the past.
But when we find ourselves in a threatening situation, especially when we are feeling vulnerable rather than resilient, and we have no power to make the situation better, then the event gets ‘hard-wired’ into our brain as a traumatic memory and can affect us for the rest of our life.
This traumatic memory has many sensory triggers so finding ourselves in a similar situation may create subconscious fear and stress reaction, which we can’t prevent. For example, a person who was bullied and excluded by friends at school may develop a significant social phobia. Being with a crowd of people in adult life subconsciously reminds the person of the school-time bullying and so the person feels anxious, unconfident and is motivated to withdraw or avoid being with people.
We can rewire the memory of trauma to make it safe
Fortunately, the brain has a mechanism that allows us to re-write traumatic memories in a way that gives us back power, thus healing the trauma. In fact, every time a traumatic memory is reactivated, it can either be strengthened or weakened, depending on our emotional state at the time, and how much support we have.
If we are feeling stressed and vulnerable, because of recent life events, we may strengthen a traumatic memory and develop a new phobia because the unconscious triggers now eliciting a more powerful fear reaction. For instance, a businessman in his 60’s had a severe panic reaction after boarding an aircraft. He had flown for many years with no anxiety but recent life stresses had amplified an old traumatic memory of being trapped in a confined space and panicking, thirty years before. Being confined in the aircraft subconsciously trigger his trauma.
Conversely, if we recall a traumatic memory at a time we are feeling supported, safe and relaxed – for instance, while receiving somatic compassion – then we can weaken or even erase our traumatic memory and reduce our emotional and stress reactions. A process like this was used to heal the businessman’s original trauma and then his fear of flying vanished.
All kinds of memories, both ordinary memories and traumatic ones, are regularly re-evaluated and re-written. When the memory is strengthened, a molecular reaction causes more receptors to be expressed in the synapse, which is the signalling junction from one nerve to another. When a memory is weakened, the number of receptors is reduced. The slow brain waves called Delta Waves are strongly implicated in the this process of memory change, which occurs within minutes.
The combination of compassionate presence from another, plus the affective touch – somatic compassion – rapidly changes our brain function and allows us to feel safe, relaxed, loved and connected. It gets us out of the dorsal vagal state of powerlessness, either to take back power through anger and determination (sympathetic activation) or to problem-solve from a relaxed state. Also, the particular forms of affective touch used in somatic compassion help the brain generate Delta Waves, which are strongly connected with memory change.
We can engage our mind, do creative problem solving, tap into our strengths, and take back our power. Thus it create the ideal conditions for us to process difficult life events and lessen their impact.
In the trauma clinic we celebrate when a person who felt trapped and helpless suddenly feels angry for the first time. They feel a sense of indignation or outrage that they were treated that way and suddenly have the motivation to find their way out of the threatening situation, equipped with greater mental capacity and problem-solving ability.
We can understand the shift in physiology, by reference to the polyvagal theory, as the person shifts from the dorsal vagal state of collapse into the sympathetic state of activation, which includes anger. Ultimately, the person completely escapes from the threat and returns to the ventral vagal state of relaxation and wellbeing.
Don’t worry about the theory!
The wonderful thing is that the brain will often then solve the problem subconsciously, and the traumatic memory spontaneously changes, without any effort. The memory might become blurry, distant, or a new scene might appear, which is innocent or even funny.
That’s what happened in the story I shared about the friends Jessaica and Sarah in ‘Get Started‘. Sarah’s bullying boss became a pathetic weasel character!
What you can do is notice the changes in people as you support them. Recalling the memory of a difficult life event or stressful situation will create visible signs of stress and emotional upset. As the trauma dissolves away, you will notice how the person you are supporting becomes relaxed, lighthearted and even laughing with relief.