The Defense CascadeSteve Haines Nov 2015www.traumaisreallystrange.com

The Defense CascadeThe venn diagram attempts to summarise, in a non hierarchical way, the ‘defense cascade’ from Kozlowska et al 2015.

Threat Causes ArousalMuscle tone, metabolism, emotion, presence, focus, thinking, behaviour all change.

Predators StalkThe image beautifully shows the poised,attentive state of arousal in a predator.

Threat Causes ArousalMuscle tone, metabolism, emotion, presence, focus, thinking, behaviour all change.

Prey OrientsFor most animals threat leads to vigilance. The body stills, the head turns, and the senses sharpen. We all have an inner meer cat.

Threat Causes ArousalMuscle tone, metabolism, emotion, presence, focus, thinking, behaviour all change.

Humans ‘Tend and Befriend’ and ‘Socially Engage’Humans learn safety from caregivers. Our first response is to check the humans around us. If we perceive people acting safely, we feel safe.

Threat Causes ArousalMuscle tone, metabolism, emotion, presence, focus, thinking, behaviour all change.

All Animals Can FreezeThere can be a fixed posture, but a huge amount of internal activity. Competing defense strategies can lead to ‘freezing’ as a state of ‘flight or fight put on hold.’

Polyvagal TheoryAs the perception of threat escalateswe default to more primitive responses

Social Engagement

Immobilisation

Mobilisation

Jaw MusclesV Trigeminal

Facial MusclesMiddle Ear MuscleVII Facial

Saliva and SwallowingIX Glossopharyngeal

SCM and Trapezius MusclesXI Accessory

Heart and Lungs X Ventral Vagus

Throat Muscles X Ventral Vagus

Orientation / Social EngagementNew Vagus Off (Ventral Vagal Complex CN V, VII, IX, X, XI activity changes)Neck, face, throat and jaw muscles and oxygen control change in response to threat.

Narrow FocusFixed ThinkingGoing Quick

Breathing UpHeart Rate UpCold Hands and Feet

MobilisationSympathetic Nervous System‘Fight-or-Flight’, Adrenaline then Cortisol

Dry Mouth

Digestion Down

Stereotypical, Imprecise Action PatternsMuscles Tension Up

Libido, Immune, Growth and Repair Down

Dreamy DissociatedHard to ConcentrateSlow Thinking

Numb LimbsTingling

ImmobilisationOld Vagus (Dorsal Motor Nucleus)Dissociation, Opioids

Floating

Tonic Immobility: Stiffness Collapsed Immobility: FloppinessPassive Action Patterns

Absent BellyHard to Feel FeetBody Shape Distorted

The Defense CascadeKozlowska et al 2015 have written a very impressive review of trauma physiology. They use language and frame some concepts in novel ways (to me at least).

The defense cascade is described as a sequence, that feels a little rigid. The authors acknowledge that prior learning means that threat can trigger any one of a number of responses. The venn diagram attempts to show the defense cascade in a non hierarchical way.

Freeze is defined by Kozlowska et al in a very particular way as ‘flight-or-fight on hold’. They reserve the term immobility for last ditch, passive responses to threat. In the past I have often described immobility as dissociation and confusingly freeze (freeze as immobility is fairly common see Levine, van der Kolk and Porges).

The slides on ‘Threat Causes Arousal’ show different types of response that I put under the umbrella term Orientation. I do not feel that ‘freeze’, ‘social engagement’ or ‘tend and befriend’ completely describe the range of responses that are possible as we become aroused. Orientation covers the responses before we go into mobilisation - a full sympathetic response of fight-or-flight.

Polyvagal TheoryKozlowska et al 2015 utilise polyvagal theory in their descriptions of the defense cascade, though for me they underplay the importance of social engagement. The above slides on polyvagal theory are still my preferred simple overview of the human responses to threat. Some direct Porges quotes are below:

‘Sequence of response strategies: (1) removal of VVC (ventral vagal complex) then, (2) increase in sympathetic tone, and (3) a surge in DVC (dorsal vagal complex DMN) tone.’ Porges (2011 p165).

'In contrast, defensive behaviors could be categorized into two domains: one related to mobilization including fight and flight behaviors and the other related to immobilization and death feigning that might be associated with dissociative psychological states. Within this dichotomy of defensive strategies, freezing behavior that requires increased muscle tension in the absence of movement, such as stalking or vigilance behaviors, is categorized within mobilization. In contrast, immobilization is associated with a decrease in muscle tension and often with fainting and other features of decreased metabolic activity.' Porges (2011 p267).

'When the environment is appraised as being safe, the defensive limbic structures are inhibited enabling social engagement and calm visceral states to emerge. In contrast, some individuals experience a mismatch and the nervous system appraises the environment as being dangerous, even when it is safe. This mismatch results in physiological states that support fight, flight, or freeze behaviors, but not social engagement behaviours.’ Porges (2011 p273).

Bold added, in the second quote from Porges the text supports the ‘freeze’ concept of Kozlowska et al. However in the third quote he also uses ‘freeze’ as something different from social engagement.

ReferencesKozlowska K, Walker P, McLean L, and Carrive P (2015) Fear and the Defense Cascade: Clinical

Implications and Management. Harv Rev Psychiatry. 2015 Jul; 23(4): 263–287. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495877/

Porges, S. (2011) The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. New York: Norton

Taylor SE, Klein LC, Lewis BP, Gruenewald TL, Gurung RA, Updegraff JA (2000) Biobehavioral responses to stress in females: tend-and-befriend, not fight-or-flight. Psychol Rev. 2000 Jul;107(3):411-29.

Want more? Check bit.ly/mouse-escape-video for a video with great examples of tonic immobility, freeze and

mobilisation in a mouse surviving a cat attack.Even More? Buy ‘Trauma Is Really Strange’, a non-scary comic book about trauma by Steve Haines, art by

Sophie Standing: www.traumaisreallystrange.com

Steve Haines, 04 Nov 2015, steve.haines@mac.com