Focusing and Health- some Psychobiological Perspectives

By Bruce Nayowith MD

Overview:
I) Introduction
II) Acute Stress and the Body
III) Stress and the creation of state-dependent memories, learning and behavior 
IV) Effects of State-dependent Processes on Physical and Emotional Health
V) General Principles of working with state-bound symptoms
VI) Guidelines for accessing State Bound Memory, Learning, and Behavior for healing purposes	
VII) Implications of psychobiology to Focusing in particular

Introduction:

	Until the last two decades, the field of psychobiology was generally limited to studies showing associations between mental and emotional conditions and physical health. Respect for the field was limited by the lack of hard data regarding exactly how and why the mind was able to influence the body in these ways. More recent research findings have clearly articulated many of the cellular pathways of the mind-body link. These have been quite brilliantly summarized and articulated by Ernest Rossi in his book, The Psychobiology of Mind-Body Healing (W.W. Norton 1993). He elaborates on what was once called “the mind-gene hypothesis” – the biochemical pathways through which mental events influence the expression of certain genes on the cellular level. Much of this hypothesis has been validated by further research.
	In this article, I have elaborated and revised my original post.  Much of the first part of this article is taken from Ernest Rossi’s work. (All quotes and page numbers are from his book.) It is my hope that this information will offer three things to the readers:
-	to better understand, and explain to others, some of the cellular pathways that generate stress-related mental and physical illnesses
-	some of the particular strengths of Focusing from the perspective of psychobiology
-	a deeper appreciation of the valuable work that Focusing practitioners are doing. 

Acute stress and the body:

	Some of the first studies into the effects of acute stress and the body described the “fight or flight” response of massive sympathetic nervous system discharge.  This is initially mediated by adrenaline and noradrenalin, and followed by other hormones, such as cortisol. Activation of the nervous system and release of hormones into the body act to increase heart rate, blood pressure, muscle tension, increase alertness and memory, open the bronchioles in the lungs, and constrict blood vessels in areas of the body not necessary to help fight or run away (abdominal organs, skin), and increase blood clotting ability.  [For the body-feel of this response, simply recall and experience of having been startled or very anxious.] 

	Another reaction to intense situations has been called the “possum” response. This is a massive parasympathetic release, suppressing most of the body systems. Blood pressure and heart rate drops, fainting may occur, muscles relax, stomach secretes more acid…

	The key determinant as to which of these two pathways will be activated in response to a major challenge depends on one’s (unconscious) interpretation of the situation. If it seems that fighting or running away is possible, the fight or flight response will be elicited. If one feels powerless to fight, escape, or alter the situation, then the possum response is more likely to occur.

	Because these “archetypal” responses to stress are survival oriented, they tend to be quite powerful and intense. They do not come without a price- a significant demand on many of the body’s cells and organs. From an evolutionary standpoint, this is still a bargain. Most situations which threaten the survival of animals last under 20 minutes. If the animal survives the challenge, there usually follows a relaxation/ recovery period – damages are minimal, and the body is able to renew itself. 

Unfortunately for humans, some form of inappropriate overactivity of the stress response may persist for prolonged periods of time. Persistent states of fear and hostility (sympathetic) or powerlessness and despair (parasympathetic) can lead to imbalances in the endocrine, immune, or nervous systems, with resultant physical and or psychological disturbances. 

	Then why is it that the negative effects of certain stressors may continue long after the initial stressful situation has passed? One key aspect of this is related to the dynamics of state-dependent learning.

Stress and the creation of state-dependent memories, learning and behavior:
	Our minds and bodies are linked through a network of communication systems mediated by various messenger molecules. These messenger molecules are produced and transmitted by the brain, peripheral nervous system, immune system, endocrine system, and gastrointestinal tract. Many of these molecules are conveyed through the blood stream. Others diffuse between or within cells. They influence receptor sites on specific cells of the body, and help regulate every function of the body- including behavior, learning, metabolism, and growth.	There are many levels of information exchange and feedback loops to promote a stable environment, which can respond quickly to challenges and changing conditions.
Cell biology, habit patterns, and memory are in a state of continual growth and flux. Processes of learning and adaptation are continuously occurring within the cells of our bodies- this is how we learn and grow.
But there is something different about the learning that occurs in intense emotional/ physical states. The learning and encoding of memories and behaviors associated with these episodes may be state-bound.

 State-dependent memories are dependent on and limited to the psychophysiologic state in which they were acquired.  One can remember or access this type of learning and memories only when in a certain state, or when linked with a symbol or association to that state.  Many studies have demonstrated that if something is learned while relaxed, one recalls it more fully while relaxed - if learned on mind-altering substances, then better recalled when on the same drugs. State-bound learning also occurs during intense physical and emotional states – it is more difficult to access the memories, learning and behavior once back in normal operating modes.

Here are Rossi’s words (p. 57):
“A psychological or physiological shock/stress can lead simultaneously to:
immediate state-dependent encoding of strong classical Pavlovian associations to traumatic events due to stress release of adrenal hormones
impaired ability to do something about it (as is typical of learned helplessness) due to the inhibition of instrumental learning under the same conditions.”

A simple example of how certain symbols or associations can access memories (for those of us old enough to remember) is how the question: "Where were you when JFK died?" may release a flood of memories.  Those words are able to access the state-bound memories that were encoded during the stress-induced (the shock of hearing about the assassination) altered cell metabolism. 

On a more serious level, certain stimuli associated with a trauma (sights, sounds, words,…) may suddenly evoke intense physical and emotional responses, often without any understanding or memory as to why this is occurring. If memories are evoked in this process, one may feel powerless to stop the flood of memories, sensations, and emotions from flooding into consciousness and running its course. 

Stanislav Grof has called this set of physical, emotional, mental and symbolic experiences all linked together through state-bound learning a COEX-a system of COndensed EXperience  [similar to what are called “engrams” in Dianetics.]

I would like to set forth a very abbreviated summary of the cell biology of this process of encoding for state-dependent memories, learning, and behavior:
 Certain intense states and situations trigger the release of messenger molecules such as steroids, adrenaline, and various neuropeptides. Some of these messenger molecules have the ability to pass through the membranes of body cells and gain direct (or indirect) access to the cell nucleus. Once in the nucleus, they can modulate the expression of certain genes. It is almost as if these messenger molecules uncover and activate certain genes that were previously quiescent; they stimulate the cellular DNA to produce certain proteins and new messenger molecules. These proteins are the biochemical equivalent of memories, associations, habitual behaviors, and emotions. 

After the crisis has passed, the initial stress hormones and other messenger molecules are no longer secreted in such high quantities. These previously-released substances are rapidly metabolized and removed from proximity to the cells. The cellular environment again approaches a more normal state, and the aspects of the genes that were “uncovered” by these substances are “covered back up again”.

Adrenaline for example, not only activates the fight-or-flight response, but also modulates the retention of memory. This is one reason that stress- related memories and events are so deeply “learned” or ingrained into one’s being. It also explains why one’s memories of a very agitated situation may begin to become fuzzy soon after the event. As the cellular milieu returns towards normal, one’s ability to access the memories becomes more difficult.

The more intense (or repetitive, which accumulates intensity) the event/ stimulus, the deeper the state-dependent patterns may become ‘imbedded’ into one’s cellularity.

How State-dependent Processes Affect Physical and Emotional Health:

Even though one’s ability to access the encoded material is state-dependent, protein synthesis for these emotions and patterns of behavior may continue even after one has returned to a more normal emotional and physical state.  Cells may be continuing to generate neuropeptides that code for patterns of distress- patterns of tightening, fear, or withdrawal.  When the initial stress has abated, the extracellular hormone environment returns to normal, and it is not possible to access or unlearn these behaviors from normal consciousness and emotionality. What has been called repression may actually be a form of state-bound memories – truly inaccessible from normal awareness without some way to access them (more on this later). 

The familiar sense of:  “I don’t know why I feel ------, but I do…” is often a manifestation of this state-dependent amnesia. The pattern generating the feeling is not accessible to ordinary memory access.

To offer an analogy, intense situations (because of the physiological alterations created during the stress response,) “open the flap to the control panel” that controls access to some of the genes in the cells.                                                                                         Once “open”, new programs are written and activated (for certain new learning, memory, and behaviors. Incorporated into these programs are associations as well as the emotional and physical tone of that state.)  This ‘control panel access door’ then closes after the body has moved away from these states, and is no longer possible to gain access (through normal waking consciousness and body state) to stop these programs from running. The body’s natural healing mechanisms can correct the dysfunctional programs only by first “re-opening the panel” to gain access to the control mechanisms.

Some of these programs are inactive until a trigger (association to the situation) is encountered. (These triggers may be visual, auditory, kinesthetic, mental or emotional cues directly involved in the initial stressful situation, or a symbol, (which later becomes associated to one of these cues, and thereby becomes a part of the COEX.) Exposure to these triggers automatically “runs the program”, and elicits the state–dependent feelings, memories, and body responses- a Pavlovian type response. Phobias and triggered flashbacks are good examples of this.

Other programs may be continuously producing inappropriate physical, mental or emotional responses.
The generalized, continuous unease and tension experienced by many with post-traumatic stress disorder is an example of this.

Describing this without the biochemistry, it is as though certain stresses (especially those that induce some form of trance or dissociation) can cause ‘something inside of us’ to open, into which the psychological/ emotional tone of that moment is ‘injected’ into some of the cells, along with other accompanying associations. 

If there are sufficiently intense components of fear, abuse, hatred, loneliness, etc., they may literally become part of one’s body chemistry.  After the intense experience has passed, many aspects of one’s life may feel more normal, but something inside may not seem normal, not right…  

While this is part of the body on one hand, it may feel foreign to one’s normal sense of self. It may be experienced as: “something inside me that has a life of its own”, and, in a way, it is. 

 Its effects are experienced by normal waking consciousness, but the “core” of the state-bound system is not accessible.  We can further carry this idea of how negativity can become incorporated into one’s body cells and self-image. 

If certain statements were expressed during intense states (like “you are no !*$@@!  good!”   or “don’t you ever…..!”  ), they may become associated into the state-dependent  COEX. 
Those statements may even come to feel as if they are an integral part of one’s identity or being – a felt conviction that “THAT (negative judgment) is who I really am”.

Likewise, one would expect that experiences of warmth, kindness, and connectedness could also become incorporated into the body.

(The limited ability for “positive self-talk” and affirmations repeated in alert waking consciousness to unlearn or reprogram state-bound material will be explained in a later section.)

 Even if one feels relatively stable emotionally in the present, it is possible for these patterns, learned in the past, to be contributing to suboptimal health. The following are a few examples of physical conditions that can be related to stressors:

Chronic muscle tension from persistent patterns of muscle guarding
Chronic oversecretion of hormones
	cortisol – diabetes, decreased immune response
	regulators of stomach acid – ulcers, gastritis, reflux
Adrenaline and noradrenaline – elevated blood pressure and strain on heart
	sex hormones – altered menstruation, ovulation, endometriosis
Alterations in immune system functioning
	increased susceptibility to infections
Increased allergic responses (food allergies, hay fever, asthma…)
	autoimmune diseases (lupus, rheumatoid arthritis,…)
	increased risk and/or progression of cancer
Altered contraction of smooth muscle in body
	asthma
	irritable bowel syndrome
	spastic bladder
Chronic constriction of blood flow to an area
	recurrent infections
	poor healing from wounds or fractures

In some people, the above symptoms may be linked directly to state-bound material, and may become unlearned (healed) during a felt shift.  A personal example was my experience with recurrent sore throat and fever that developed whenever I was under stress and lost some sleep (see personal account in earlier pages of this Folio). 
This state-bound system encoded a pattern of chronic constriction of blood vessels and/or immune suppression in the area of my throat. This resulted in an increased susceptibility to infections which persisted until a felt shift (with emotional, physical, biographical and dream components) occurred while Focusing.

Another example was that of my first wife. After many months of good health, symptoms of endometriosis (which in previous years had led to a hospitalization and several operations) developed rapidly after an experience that had symbolic association to a very distressing past experience. Healing occurred in association with a felt shift later on.

In her book, Imagery In Healing, Jeanne Achterberg recounts the story of a woman with chronic pelvic infections for over 10 years. During a self-healing exercise, she had a spontaneous episode of imagery in which she saw (and physically experienced herself as) a Native American woman being abused by members of another tribe. This experience was associated with intense warmth in her pelvis and an immediate and permanent disappearance of her pain and infections. The physical mechanism for this (and in many experiences of “faith healing”) was postulated to be the sudden releasing of a ongoing long-standing pattern of excessive constriction of the blood supply to her pelvic organs. Decreased blood flow had impaired her body’s ability to protect against infection and heal. 

In the above examples, we could say that the Focusing and imagery approaches were able to gain sufficient access to the state-dependent pattern to allow them to unlock and end their dysfunctional physiological patterns. All were associated with cathartic felt shifts.

Some general principles of working with state-bound symptoms:

Attempting to heal state-bound material is challenging on several fronts-
1) There is amnesia (no memory) of the event from normal consciousness, so one may not even be able to make a connection between present symptoms and the initiating or sustaining events.
2) There is no direct way (while remaining in ordinary waking consciousness) through an act of will to access, unlearn, or “heal” them. 
3) The idiosyncratic nature of these state-bound patterns means that every person (and each state-bound memory in the same person) has a different composition and pattern.  The determinants and incorporation of components and “meaning” into the state-bound complex occur more by an associative process rather than by a logical, predictable one
	4) Recent brain research suggests that prolonged chronic stress may cause permanent damage to the hippocampus in the brain, which is involved in short term memory and learning. This leaves less capacity for problem solving and resolution.

The following are several guidelines for working with state-bound memories, learning and behavior:
 	
1)	One way to become free from the effects of state-dependent dysfunction is to gain access to the original (or a similar) physiological state and allow other resources of the body (conscious awareness, other self-healing processes) to enter in and restore the system to a healthier state. Re-accessing the original state “gains access to the control panel” and allows different learning, memories and processes of regulation to take place.

2) It may be possible to access state-dependent encoded information from any modality of mind-body communication that was incorporated into the COEX.
Rossi (p 93) mentions the following avenues for accessing state-dependent material:
Imagery 				Behavior 		Symbols
Sensation (perceptions)		Awareness (cognition)
Emotion				 Identity

Tending to a felt sense was not mentioned by Rossi specifically. It seems to include, but be more than the simple sum of, several of these modalities simultaneously.
[In addition, some approaches that involve acupuncture meridians have been reported to be helpful, though these do not directly access the emotionality or symbols.]

3) One very effective way into a state-bound system is by attending to the symptoms themselves.
The symptoms are seen as a gateway to healing. (analogous to Gendlin’s philosophy of the life-forward direction implicit in each felt sense)

Rossi contrasts many behavioral medicine and psychoanalytic approaches, which see symptoms as problems to get rid of, with psychobiologically-oriented approaches, which see symptoms as: 
 “maladaptive forms of information transduction that can become important signals for creative personal development. (p 292):

“Behavioral and psychoanalytic approaches both throw away valuable information by placing themselves in opposition to the problem network. Our psychobiological approach uses the data by accessing the state-dependent system that encodes the problem, and reframing them into creative functions…

“…Many types of chronic pain and recurrent physical symptoms …actually amplify the (minimal) stress signals of mind and body.”

4) The act of consciously attending to modalities associated with state-bound material facilitates healing by changing its state-bound nature.

Rossi (p 91)  “A basic premise here is that every access is a reframe. Every time we access the state-dependent memory, learning and behavior processes that encode a problem, we have an opportunity to re-access and reorganize (reframe) the problem in a manner that resolves it….
…(recent research into memory learning and cognition shows that) memory does NOT operate like a tape recorder in which we simply play back exactly what we have learned.
Memory is always a constructive process whereby we actually synthesize a new subjective experience every time we recall an event.”

Rossi (p111-112):
“to tend to a symptom is actually the most direct source to accessing its psychobiological sources encoded in the state-bound processes… 
…research into the neurobiology of memory and learning indicates that the process of accessing and recall is not simply that- accessing and recall are actually a synthetic process of reconstruction. Therefore, prescribing the symptom (voluntarily tending to it) is actually a process of reconstructing it. When we ask a person to experience a symptom voluntarily rather than resisting it, we are drastically altering the internal dynamics and state-dependent memory and learning systems that allow the symptom to flourish. We have changed it from a dissociated and involuntary action to a voluntary action; we are undoing its state-bound character.”

5) The process and nature of state-bound learning and associations is highly individualistic.
Each person has a unique pattern of state-dependent (stress-induced) symptoms. A directive approach, where the therapist or guide tells the client what the experts say is needed to improve, will not be as effective as a more exploratory, problem focused approach, where the problem tells the client and therapist “ what it needs” at each (often illogical and idiosyncratic) step of its expression and healing.

Approaches to healing state-bound problems:

There are three general levels at which most therapies influence this process:

1)	Learn and practice newer, healthier patterns, in an attempt to override or overpower the state-dependent patterns.

A “natural” response to feeling bad is to do or tell oneself things to try to make oneself feel better. (Positive affirmations, willpower, self-talk…) While some find these helpful to a point, they do not affect the process of continuing to code for these stress-induced patterns. Some may find that “trying to feel better” actually intensifies a sense of inner conflict. Sometimes these dysfunctional state-bound patterns are interpreted and labeled as an intentional “ self-destructive tendency,” rather than recognized for what they are.

This may be a good opportunity to mention some of the suffering that can be caused by misguided applications of these insights. 

The use of willpower, affirmations, etc, is of some value in creating healthy patterns, but is unable to reverse the earlier “cellular brainwashing” (especially if these affirmations, etc. are done while in a state of normal waking awareness.) 

Yes, the dysfunctional patterns were “learned”, but they are not consciously accessible. They were not ‘chosen’. 

And it may be extremely difficult and distressing to access these state-dependent memories associated with intense states. These misinterpretations often lead to  “blaming the patient for their illness.” Now that we are aware of how state-dependent patterns are formed, let’s not contribute to adding additional guilt and suffering to people in these situations by repeating such unenlightened slogans such as:  “You choose your illness”, or “The reason that you are not getting better is because you do not want to enough.”

2)   “Derail” the associators, or triggers, that stimulate the manifestation of state-bound responses in the cells. 

 Modalities such as Neurolinguistic Programming (NLP)  are often employed to change the associations triggering the symptoms. For example, someone with a spider phobia can learn to disconnect the “spider” from the panic reaction. This will eliminate the spider as a trigger to symptoms, which is adequate for many people and situations. This has had remarkable success in phobia cures, for example.

If there is also a more generalized pattern of anxiety as well, it may not be as effective,  unless these modalities are used as a vehicle into accessing the state-dependent material rather than mere symptom removal. Otherwise, they would not unlock or unlearn the remainder of the initial negative pattern itself – the “cellular memory.”

3)	Attempt to recode for the present dysfunctional programs in the cells at the cellular level.

Present theory suggests that one very effective way to end this process at its roots is by re-accessing the initial chemical/ hormonal (usually with similar emotional and feel-quality associations) milieu under which the original learning took place. 
This allows access to the genes that are still coding for proteins since they were turned on by an earlier stress response (and have been shielded from being turned off since).  It also offers the opportunity for this earlier program to be replaced with a different one, to code for different proteins and patterns of bodily response.

There are several ways to re-access the state-dependent encoding process:
a)	attempt to re-create similar emotional conditions (and assuming the biochemistry will follow suit,)
b)	 change the quality and field of attentional focus on some aspect of the distress, 
c)	and/or attempt to reaccess this state through one of its associations. (tight area in the body, anxious feelings, dreams, memories…)  

Visualizations, Dianetics (using sentences), certain bodywork approaches, hypnosis, talking therapies (when the client focuses - connects with some physically felt quality associated with the situation!) are just a few of the possible methods that have been effective. Often there is some large cathartic emotional release and often-‘repressed’ memories that flood out during the healing process.

Healing in these states can be a very delicate matter. It is important not only for the client to open up into that emotional/biochemical condition, but also that these experiences by met with openness, kindness, acceptance, and respect… Ideally, we would desire that a new learning take place in which the stress and its associated triggers are held in an “attentional embrace of kindness and care”, so that the whole experience can become associated with “proteins and memories of kindness” rather than ‘adding another dose’ of reinforcing tightness, distress, and dis-ease into an already distressed client and their cellular milieu.

The healing process itself may not be without its own traumas. The client is in vulnerable to many influences in these states (they are again open to new state-dependent learning!), and can be inadvertently retraumatized or re-programmed with less-than–healthy associations.  There are at least two stages in the healing process in which this can occur. 

1) Trauma can be inflicted during attempts to return the client to a state analogous to the original traumatic one in order to begin the healing. For example, methods based on “reliving the original experience” run the risk of reinforcing the pathology or of introducing new pathology depending on what is employed in encouraging the client to relive it. - certain stresses may be added to the mind and body by either client or healer in the attempt. This is especially true with more aggressive, directive approaches (attacking ‘the adult without’ in an attempt to help ‘the child within”). The more gentle and accepting the approach, the less likely it is to re-injure.

2) Traumas may be inadvertently incurred while actually IN the altered cellular state during the ‘healing’ experience. Some intense methods of “opening someone up and re-programming ”  (the early days of Erhart Seminar Training, certain marathon encounter groups….) may have the negative effect of “re-inoculating” one’s tender places with a different type of harshness - limiting or negating the desired healing. 

A Perspective on what Focusing offers here:

Focusing offers one powerful way to approach these difficult and tender places. By attending to the felt sense and letting it develop, one begins to access the state-bound learning on its own timing. Staying with a felt sense generates the conditions similar to those that created the initial stressful cellular environment. As the felt sense unfolds along its own uniquely encoded path in each individual, the affected cells are given the opportunity to release their original feelings, beliefs and dysfunctional patterns, and be replaced with the more positive “learning programs”- the emotions, attitudes and beliefs present during the healing moment. 

The Focusing approach is a very “organic” and non-manipulative processes. The depth and speed of “going into the problem” is regulated by the client, the felt sense itself, and the other felt senses in the body (the places that wants to go slower or are scared of another place inside are also honored rather than ”pushing through resistance”). This honors the whole body system, not just the one aspect that is pushing for healing but may be doing so at the possible expense of another part. 
Besides tending to the felt sense, a physical sense “of the whole thing”, Focusing makes space for all of the modalities able to access state-bound material – imagery, sensation, emotion, identity, behavior, language, and symbols (a handle). Including the interaction between these modalities and the cognitive mind within an environment of a relaxed, open attentional field further frees the problems from its state-boundedness. 

Even when felt shifts do not occur in a session, as “every access is (an opportunity for) a reframe”, simply taking the time to consciously attend to felt senses begins to decrease their state-dependent nature, facilitating healing.

 Tending to the life of the felt sense, and asking it what it needs, allows the encoded problems to unfold at their own healing pace and in their own way.  No forcible attempts to “recreate the situation” need be brought into the client’s body during a Focusing session. In fact, “nothing extra or unnecessary is added”. 

Tender, distressed areas are allowed to open at their own speed. There is no attempt to push or force them to open prematurely, (e.g. “If you don’t deal with this now, you will never get better!”) which is another subtle form of violence that could otherwise be introjected into one’s cells and psyche. This extreme safety also allows very tender places to drop the protective layer and let themselves be accessed – and subsequently healed.

Focusing not only allows for effective access and healing of state-bound material, but it also cultivates the development of an friendly, accepting, curious attitude and orientation towards more and more of life experience in the remainder of the focuser’s awareness.

 In addition, the qualities of allowing, respect, acknowledging the positive intention, and loving attention offered by the listener are among the most life-promoting and protecting environments one can offer to these injured and stressed places. Even when a profound physical healing does not occur, Focusing often offers the client a cellular experience of kindness, presence and mercy. This cultivates an experiential base which can be accessed and offered to oneself and to others in their times of distress.

 On a biochemical level, the proteins and learning encoded in the cells of the body in times of stress moves more and more away from patterns of distress, tightness, other armoring and withdrawal, and toward a release of kindness, empathy, compassion, and safety – both in the body and in the mind.

In this way, Love extends itself from one through others, offering healing to an ever-expanding realm of experience.