50 years of gentle psyche-soma regulation and reorganisation
By Anita Ribeiro Blanchard © 2019
Calatonia, created by Pethö Sándor (1969), goes beyond the regulation of the autonomic nervous system (ANS) to encompass proper whole brain regulation, and the rebooting of motivational and appetitive systems – the drive to explore. Calatonia fosters self-regulatory mechanisms of the psyche-soma unity to improve wellbeing and long-term psychophysical stability.
The protocol starts with a supine position (fMRI resting-state), which activates the resting-state network (RSN) connectivity. The novel findings of cognitive neuroscience research have proposed that a balance between global and local networks within a specific rhythm (brain chrono-architecture) corresponds to an aspect of brain self-regulation. Similar to blood pressure and heartbeat measures, the brain appears to have its optimum “pulsation” and “state of readiness”: this rhythm has been shown to be compromised in mental illness (Blanchard, in preparation). Thus, balancing the ANS without facilitating the modulation of cortical oscillation (brain synchronisation and metastability), may not lead to the regulation of the whole organism.
Calatonia proposes a quiet, non-task-orientated approach in resting-state functional connectivity, coupled with a steady, slow-paced influx of unusual passive stimuli. Thus, it provides the appropriate environment in which both ANS and brain self-regulation may occur, during a state of awareness in which there is less demand from the executive network connectivity. This approach complements very well other approaches in which there is functional demand of the executive network connectivity.
There are many more key findings from neuroscience about the neural substrates through which Calatonia operates. These findings are summarised in the newly released book, “Calatonia: A Therapeutic Approach that Promotes Somatic and Psychological Regulation” (Blanchard, Rios, & Seixas, 2019). They are fully discussed in the soon-to-be released book “Integrating Calatonia in to Psychotherapy and Trauma Therapy: Novel Insights from Neuroscience” (Blanchard, in preparation), both publications are supported by exciting and updated references. Below follows a “preview” of the elements discussed in both publications. Calatonia engages (concomitantly) with:
- Dyadic regulation in resting-state neural connectivity (RSN; Deco, Kringelbach, Jirsa, & Ritter, 2017). RSN leads to increases in the synchronisation and metastability of large-scale networks, such as the Default Mode Network (DMN; Smallwood & Schooler, 2015). The DMN is of essence to psychotherapeutic processes as it facilitates specific mental states in which individuals can access spontaneous and pertinent self-reflective mentation and theory of mind (the perspective of others). The dyadic regulation can be enhanced by the tactile stimulus proposed in Calatonia, because touch is always reciprocal. Thus, a fine-tuned, non-verbal, inter-brain synchronisation is established between patient and therapist during Calatonia. Inter-brain synchronisation (between two people) has been identified as a natural occurrence that impacts interpersonal communication (Cacioppo et al., 2014; Dumas, Soussignan, Marinerie, & Garnero, 2010; Hove & Risen, 2009; Hu, Hu, Li, Pan, & Cheng, 2017; Mu, Guo, & Han, 2016). Working consciously to achieve a fine-tuned inter-brain synchronisation is useful in the treatment of trauma, attachment and many other dysfunctions;
- Cortical-subcortical large-scale networks, which act to modulate global brain connectivity and synchronisation patterns through the rhythmic segregation and integration of neural populations acting in concert to code for complex stimuli and concepts (Bell & Shine, 2016; Goldberg, Harel, & Malach, 2006; Gollo, Zalesky, Matthew Hutchison, Van Den Heuvel, & Breakspear, 2015; Hari & Parkkonen, 2015; Park & Friston, 2013; Santangelo, 2018). Calatonia puts thelarge-scale networks, also known as the “Rich Club” (Csigi et al., 2017; Gollo, Zalesky, Matthew Hutchison, Van Den Heuvel, & Breakspear, 2015) to “listen”to the feeder networks in RSN connectivity, thus facilitating interoceptive awareness and spontaneous introspective mental states (DMN). Brain synchronisation has been identified as an aspect of brain self-regulation and has been proposed as a neuro-marker of psychological health (Collin, Scholtens, Kahn, Hillegers, & van den Heuvel, 2017; Forcellini et al., 2018; Goldberg, Harel, & Malach, 2006; Kaiser, Andrews-Hanna, Wager, & Pizzagalli, 2015; Santangelo, 2018; Wang et al., 2019);
- The orienting reflex (OR; Bradley, 2009) affects mostly bottom-up attentional, appetitive and motivational patterns, whilst it decreases startle and aversive reflexes, by fostering interest for the stimulus instead of avoidance of it. Neutral stimulus has been found to attract more attention of the insula than aversive or pleasant stimuli (Rolls, 2010). Motivation and resilience should be understood as concepts of similar importance in trauma work and psychotherapy. Dysfunctional motivational and appetitive processes are implicated in depression, trauma, etc. (Bernstein, 1979; Blackford, Buckholtz, Avery, & Zald, 2010; Block et al., 2017; Bonnet et al., 2015; Bradley, 2009; Bradley, Keil, & Lang, 2012). Sándor’s method takes into consideration the fact that “motivation” is of an autonomic, instinctual nature, and can be fostered by an Orienting Response, thus, his creative idea of generating ORs in his somatic work;
- The engagement of cross-hemispheric communication via the corpus callosum, which facilitates integrative higher-order neural network processes, implicated in the ability to verbally identify, interpret and communicate emotions (Compton et al., 2008; Compton, Feigenson, & Widick, 2005; Hearne et al., 2019; Roland et al., 2017; Skumlien, Sederevicius, Fjell, Walhovd, & Westerhausen, 2018). Because the touch in Calatonia is unusually subtle, bilateral, simultaneous, and sustained for over one minute, it involves complex encoding, and as such, it engages neural connectivity via the corpus callosum: its complexity imposes a cross-hemispheric communication to analyse the stimulus;
- The “grooming” system in the mammalian nervous system, primarily composed of C-tactile mechanoreceptors (CT receptors; Brauer, Xiao, Poulain, Friederici, & Schirmer, 2016; Iggo, 1960; Iggo & Muir, 1969; Olausson et al., 2002; Olausson, Wessberg, Morrison, McGlone, & Vallbo, 2010), and recently identified as part of the human social-affective system. The stimuli in Calatoniaactivate polymodal C-receptors (low-threshold unmyelinated free nerve endings and nociceptors) as well. These receptors are implicated in the modulation of pain (Monroe, 2009) and they are sensitive to subtle (low threshold) touch and are slow to conduct their information to the brain, carrying sensory information of an affective-emotional quality as well;
- The discriminative-spatial system, associated with Merkel’s cell-neurite complex receptors and the Ruffini corpuscle, a type of skin proprioceptor (Blanchard, 2019). Both are low-threshold (sensitive to light touch) and slow-adapting (keep responding to the stimulus) lightly myelinated nerve endings (Birznieks, Macefield, Westling, & Johansson, 2009; Ciaunica & Fotopoulou, 2017; Ebisch et al., 2016; Grion, Akrami, Zuo, Stella, & Diamond, 2016; Macefield, 2005; McGlone, Wessberg, & Olausson, 2014; Mountcastle, 2005). These are the most sensitive fibres responsive to subtle touch, more so than the CT receptors. They conduct medium-speed impulse to the brain while remaining slow to inhibit the activation of “noticing” stimuli, as they “stay focussed” on the stimulus to investigate its perceptual features (ex. location, direction, pressure). The combined stimulation to these two very different systems, the discriminative and the affective, facilitates the integration and regulation of emotional and cognitive processes;
- The combination of attentional systems engaged in processing the location and quality of touch delivered in Calatonia. These systems are activated independently from the global networks, via connections with the thalamus, one of them being the parietal attentional system, known for its highly associative function with other areas of the brain (Daffner et al., 2003; Goldberg et al., 2006; Rushworth, Paus, & Sipila, 2001);
- Engagement of cutaneous nerves, which are not sensory per se, but regulate the endocrine system both locally (within the dermis ) and globally (via the Hypothalamus, Pituitary and Adrenals, HPA axis; Slominski et al., 2012), as well as aspects of the immune system. The engagement of cutaneous nerves during Calatonia may explain the frequently observed re-setting of the endocrine system to healthier homeostatic values following a series of applications (within as few as ten sessions) of Calatonia.
Like music, the “ensemble” of all the above elements is performed within a “tempo”, a rhythm based on sustaining each point of contact (touch points) for approximately three minutes. This ‘tempo’ creates compatibility between the patient’s rhythm and the therapist’s rhythm, a harmonisation that is conducive to dyadic regulation, and strengthens the naturally occurring interpersonal synchronisation, on a therapeutic level of fine-tuned non-verbal communication.
The importance of establishing a conscious pace in therapeutic relationships cannot be emphasised enough (Koole & Tschacher, 2016; Schore, 2009; Siegel, 2012), because our physiology follows rhythms (heartbeat, breathing cycles, brainwaves, pace of walking, and so on) and “rhythms are a prominent signature of brain activity” (Jones, 2016), a new concept that has been called brain chrono-architecture.
Lastly, in Calatonia, the modulation of cortical oscillation via paced somatosensory stimuli also facilitates integration of the basic notion of selfhood. From early infancy to adulthood, selfhood is built through physical contact and proximal interaction with others via skin-to-skin interactions, before one develops the ability to share mental states in distal face-to-face interactions (Ciaunica & Fotopoulou, 2017;Hallam et al., 2014; Naruse & Hirai, 2000; Szirmai, 2010).
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