In CRM, the body residues of the traumatic experience are rapidly metabolised through the alteration of the breathing patterns so that the memory can be reconsolidated without emotional activation and physiological arousal. The increased capacity for attention and wakefulness in response to a threat emerges when that orientation stimulates brainstem areas such as the locus coeruleus, the pedunculopontine and laterodorsal tegmental nuclei, and the raphe nuclei. These brainstem areas project to the intralaminar nuclei of the thalamus which are also receiving information from the midbrain to integrate and forward to the basal ganglia, the nucleus accumbens and the cortex. Stimulus valence and context data conferred by past experience can be acquired from the amygdala and hippocampus. Then self-relevance and autobiographical memory traces can be integrated in the cingulate cortex from where further orienting actions and autonomic responses are derived. In particular, there can be ﬁ ne-tuning of the head and body position in relation to the stimulus and complex intentional movements can be initiated. The brainstem and hypothalamus, the cingulate motor areas, the visceromotor prefrontal areas and the cortical projections back to the hypothalamus and PAG integrate autonomic, behavioural and emotional components of the complex and considered defence response. If it is completed and successful there may be no persisting damage. If it is incomplete through freezing, obstruction, dissociation or all of these, the clinical residues may be experienced long after the events or even for the rest of the person’s life. The low mood, the vigilance characteristic of an “anxiety disorder”, the intensity of a panic attack, the crippling muscular tensions, and the inﬂammatory responses – all will carry changed respiratory patterns.
The visceral alerting response consists of vasodilation in muscles; vasoconstriction in gut, skin and kidney; and an increase in heart rate and blood pressure; this can be elicited by stimulating injections into the hypothalamus (Carrive, 2011). Stimulation of the midbrain PAG can lead to uncontrolled activation, ﬁght, ﬂight and freeze responses. Both hypothalamus and PAG are activated by the central and basolateral nuclei of the amygdala and both have inputs from prefrontal cortex which are potentially modulating. Bandler et al. (2000) proposed that active defence responses were mediated by circuits including the lateral and dorsolateral PAG columns, hypothalamus and prefrontal cortex with the lateral PAG being more responsive to physical threats and the dorsolateral PAG more relevant for psychological stressors. The ventrolateral column mediated passive coping strategies which could, in the event of survival, promote healing. Fight and ﬂight strategies mediated by lateral and dorsolateral PAG columns are accompanied by increased heart rate and blood pressure with different patterns of limb vasoconstriction/vasodilatation whereas the passive coping of the ventrolateral column has a lowering of blood pressure and heart rate. Stimulation of the dorsal PAG (dPAG) in anaesthetised laboratory rats elicits the expected increase in respiratory rate and the increase is greater when the caudal, as opposed to the rostral, dPAG is stimulated (Zhang et al., 2007). The caudal dPAG mediates the ﬂight rather than the ﬁght response, so this poses some interesting questions. Do humans preparing for ﬂight breathe more deeply than those preparing for ﬁght? If the ﬂight response is unavailable, what happens to the drive to increased breathing? Does a pause allow the respiratory centres to scroll through the available options to try to match the situation with the most appropriate response?
In Sensorimotor Psychotherapy (Ogden et al., 2006; Ogden & Fisher, 2015) awareness of breathing can be used to stabilise both hyper- and hypo-arousal states, but deliberate changes in breathing sequences are used with caution for fear of destabilising the client. Emphasis on the in-breath may increase arousal whereas emphasis on the outbreath may decrease arousal. The tendency for a held breath to be associated with a freeze response is not generally focused upon in trauma memory processing. In CRM, in contrast, judicious use of the breathing sequences is used to alter the activation, whether hyper- or hypo-arousal, when the patient is in the emotional state pertinent to the trauma memory, and different breathing patterns may be suggested to ﬁnd which is most helpful at a particular time. For example, with CRM ﬁre breathing the awareness of the outbreath is increased, perhaps while the attention is focused on a high-energy tension in a part of the body. CRM earth breathing helps to return the attention to the body in a grounding, stabilising way. Heart breathing brings in compassion, or at least its body components, for a hurt or traumatised state or for the adult who is working through the trauma memories. The use of CRM ocean breathing centres and grounds while the absence of any pause between inbreath and outbreath counteracts any tendency to a freeze in the cycle being replayed. CRM is entering the brainstem physiology of the stored memory through the associated body sensations and the affects but also through the respiratory patterns that accompany it.
(Extracted from) The Comprehensive Resource Model: Effective Therapeutic Techniques for the Healing of Complex Trauma, written by Lisa Schwarz, Frank Corrigan, Alastair Hull and Rajiv Raju, published by Routledge, 2017