Neuroception – scanning for safety

Neuroception – scanning for safety

Once triggered…

When we encounter something really frightening, we react in ways that are both common to all mammals, and definitive to humans. Our initial response to the frightening situation will be governed by the limbic/mammalian part of our brain, which triggers the fight, flight or free response to mitigate the danger. But after the event we do something that animals do not – we think about it. And this begins to create anxiety. Strangely, even though anxiety is often referred to as ‘fear of the future’, and we experience it as being afraid of something that’s going to happen, all the psychotherapists and analysts from Freud onward suggest that anxiety actually relates to fear attached to something that has already happened. We are being triggered by something in the environment that brings out an intense fear, as though we’re in danger, but while the fear may be triggered by something in the environment, we may not actually be in danger. So how does this happen?

When we survive a traumatic event, and experience the intense adrenaline rush or sudden freeze response, something else happens – our brain takes a series of ‘snap shots’ of what’s happening. These provide our brain with all the information from the environment when the event took place, including not just the important details (such as someone’s face or a car numberplate) but also all the incidentals, such as a red coat, bunch of yellow flowers, or deep puddle of water, for instance.

Seemingly irrational behaviour has rational roots

In one documented case, a woman was calmly putting petrol in her car at a fuel station one day when she suddenly found herself whirling around wildly, spraying petrol everywhere. People rushed to help her, and she quickly calmed down. But afterwards she was at a loss to explain what had happened to create this extreme change in her behaviour. During psychotherapy, she realised that as she was filling the car with fuel, a man wearing a red baseball cap started to walk across the petrol station in her direction. In an ‘aha!’ moment, she remembered that a few years earlier, when she had suffered a physical attack, the man who mugged her was wearing a red baseball cap. The fact that the two men (the innocent man today and the mugger from yesteryear) looked nothing like each other in any respect did not matter to the part of the woman’s nervous system, which was constantly on the look-out for any environmental element that matched the earlier attack.

Stephen Porges has come up with a name for this unconscious scanning of the environment for danger. He calls it ‘neuroception’ and refers to it as ‘detection without awareness’ (1). He describes neuroception as a neural circuit in the brain that evaluates risk in the environment from a variety of clues. Most importantly, it operates outside our conscious awareness, because that’s faster. If you’re walking through a forest and there’s a wiggly thing on the forest floor, it’s not helpful to start wondering about the many things that could be. It’s safer for your body to jump now and wonder about it later. so the response comes from the lightning-fast unconscious part of the mind, not the slower, conscious, reasoning part. But here’s the downside – when prompted by neuroception to react, we move immediately without knowing why. So we may find ourselves feeling acutely anxious for apparently ‘no reason’.

Is this what causes anxiety and panic attacks?

Neuroception can trigger us into a state of defence as a result of external stimuli, but it responds to internal factors too. As humans, we have capabilities that are not present in other animals, including the ability to imagine past and future in our minds. This means that we are also able to use our minds to create internal representations of threat – either future ones (such as making a work presentation that we feel sure we’ll mess up) or past ones (dwelling on a frightening situation in our past). When we do this, our bodies respond to the imagined (internally represented) threat in the same way as a real, physical-world threat, and we move into a heart-pounding fight/flight defence, or a shutting-down frozen response, just as we would if the actual threat were being experienced in the present.

On experiencing these defensive states as intense anxiety and panic, people sometimes say that they think they’re ‘going mad’, because the anxious state seems ‘illogical’ to the conscious mind, which registers the present environment as safe. However, neuroception means that both internal events (such as thoughts or feelings) or external conditions (cues in the environment) can trigger the defence cascade, and all outside of our conscious awareness.

Can we reprogram the system?

Luckily, as Porges points out, we also have recourse to a ‘social engagement system’ (2). This is the system we use to judge that people and environments are safe. It is also automatic, and takes account of various signs of safety such as the intonation of a speaker’s voice and facial expressions. When a person speaks so us using a range of pitch (rather than speaking in a monotone voice), and looks at us with an expressive face and with eyes open, we unconsciously pick up the sense that they are relaxed and we experience them as ‘safe’. As we begin to relax in response to these ‘safe’ signals, some tiny muscles in our middle ear also begin to contract, making it easier to hear a human voice from among many background sounds. (This inner-ear ‘danger or safety’ response may explain why people experiencing high levels of anxiety find that they cannot hear what people are saying.) The social engagement system lowers the sense of threat, also unconsciously, in a way that matches the unconscious firing of danger signals via neuroception. it means that when two people meet and talk in a state of open expressiveness and goodwill, they recognise it in each other and the central nervous system (of both people) becomes calmer and less reactive.

It is the social engagement system, according to Porges, that holds the key to recovery from trauma and helps people return to a state of greater equilibrium and a renewed sense of safety. For this reason it is now recognised as a key and effective part of psychotherapeutic approaches to trauma, and guarantees you will always receive a warm welcome into the counselling room.

 

References

1 Porges, Stephen in conversation with Buczynski, Ruth, published as ‘The Polyvagal Theory for Treating Trauma’. The National Institute for the Clinical Application of Behavioral Medicine.

2 Porges, Stephen (2011). The Polyvagal Theory.  New York: W.W. Norton.

 

 

Don’t know why you’re anxious? Your primitive brain may have the answer.

Don’t know why you’re anxious? Your primitive brain may have the answer.

Cognitive psychologists, who like to think of us humans as very logical and rational, say that anxiety is useful because it sends a signal to the brain saying “change direction!” whenever we’re doing (or about to do) something dangerous. In this way, it acts in a similar way to pain. Pain itself is not the real problem but a signal that there is one – it might be indicating a bone fracture or appendicitis, for example. Pain gets our attention, and anxiety acts in a similar way to indicate that there’s something wrong.

Aaron Beck, the father of cognitive therapy (and grandfather of CBT), said that we are constructed “in such a way as to ascribe great significance to the experience of anxiety”, so that we’ll feel compelled to do something about it. It’s such an uncomfortable feeling, in other words, that we’ll stop doing whatever is causing anxiety, and so remain safe.

But this isn’t always the case. It’s entirely possible to experience anxiety but be unable to identify its cause. In fact, many people suffering from high levels of generalised anxiety don’t know why they feel this way, and may feel bad about themselves for this perceived incompetence. So what’s happening in these cases?

Our primitive brain decides

As the great trauma expert Peter Levine pointed out, there’s a difference between anxiety designed to produce a volitional response (e.g. stop driving so fast) and one that’s designed to produce an involuntary response or reaction. And here lies the answer for the more mystifying types of anxiety – they stem from an area of the brain that controls all our involuntary actions (such as breathing and heart rate). This is the sub-cortical section of the brain, which also houses our basic animal instincts, including the supreme instinct to survive. When this part of the brain is triggered into perceiving a survival threat, it causes an instant, non-volitional reaction. It’s super-fast, because it’s not a good idea to be wondering about whether that car heading straight for you might swerve at the last minute. You see it coming, and you’ve leaped out of the way before thinking about it. This is very different to the volitional anxiety that Beck was talking about, which might make you carefully step back from a cliff.

The fast-reacting, involuntary kind of response that sees us jump away from a snake comes from the primitive, sub-cortical part of our brain that we share with other mammals. It assesses any threat in the environment and forces us into taking involuntary action if survival demands this. But our animal brain (the ‘reptilian’ and limbic parts of the brain) does more than this – it also immediately assesses whether we can escape or fight back, or are trapped and can do nothing.

This unconscious decision – about whether to fight, take flight or freeze – becomes known to us through our reaction to the threat. If our animal brain has decided we can fight this or make a run for it, we may experience symptoms such as a tightening sensation across the neck, shoulders, arms and legs, rapid heartbeat, and a feeling of being ‘ready for action’. We have an active pattern of coping, and a set of actions that can arise and be completed.

But if our animal brain has decided that fighting or running won’t work, what happens is that our active forms of defence (fight/flight) are aborted. They arise but are quickly switched off – and it is this incompletion of the active coping mechanism that causes anxiety to follow from the event. We freeze, which is one of the last defences of any animal, and lock down any movements that we would wish to make to save ourselves. These incompleted responses, such as running or punching, are denied and locked down. Anxiety that seems to have ‘no reason’, is essentially the energy wrapped up in these unrealised defensive responses. The anxiety stems from times when we wanted to fight or run, but were trapped or overwhelmed, and had to contain our active defences, instead falling back on passive ones (the freeze response or even thanatosis, where the body appears to be dead).

Anxiety doesn’t arise from dangerous situations, but from a feeling of being unable to cope with them and take action to get out of them. Levine says that “ultimately we have only one fear, the fear of not being able to cope, of our own un-copability. Without active, available, defensive responses, we are unable to deal effectively with danger and so we are, proportionately, anxious”. And that anxiety does not go away over time. It remains in the mind and body.

This kind of anxiety can either erupt occasionally in the event of being triggered, or operate as a kind of background hum all the time.

It also can be said to result from trauma – which involved a feeling of being overwhelmed and unable to escape. But we’d remember that, wouldn’t we? Confusingly, not always. Sometimes the trauma occurred many years ago, in childhood (such as being bullied at school or frightened by an angry parent) or stemmed from an event that we remember but don’t realise has affected us in a very deep way (such as caring for a loved one when they were dying). Traumatic memories are different: they are not processed fully or correctly at the time (because they were too overwhelming to the system) and so they are inadequately processed and maladaptively stored. Instead of fitting into the autobiographical memory of our everyday lives, they remain ‘unfiled’ in some way, and continue to intrude, unbidden, into our lives at odd moments.

Which means that it’s quite possible to feel highly anxious, while not knowing why. But the not-knowing does not mean that the fear is illogical or unreachable, or that the sufferer is behaving stupidly in some way. Quite the opposite – the person suffering from this form of anxiety has had to be immensely brave at some point in their lives. This is where therapy can play a vital role, in helping someone to realise and release the emotions and actions that were put aside for survival, and genuinely let go.

‘A person suffering from this type of anxiety
has had to be incredibly brave at some point in their lives’

 

 

Maybe you are actually something special.

It’s amazing how many of us suffer from Imposter Syndrome – meaning that every time we achieve something we assume that the authorities missed something, or gave us a free pass. It seems almost impossible that maybe we are genuinely capable human beings. Somewhere along the line we learned or decided that we were stupid, unworthy, ‘less than’ everybody else. But this blog post has a moment of pure epiphany – a sudden realisation that a long and deeply held belief about oneself can be completely wrong. And it changes everything.

James is Trying

I cried in the middle of a class. Again. That’s happened more than I would’ve expected in my life. This time, it was a Friday morning, before a really important exam.

In medical school, we have these yearly exams to make sure that we kind of know what we’re doing when it comes to patient care. They’re called the OSCEs, pronounced Oss Skeez, (Objective Structured Clinical Examination). We go from room to room with “standardized patients” (actors) who pretend they have some disease and we have to diagnose them by asking the important doctorly questions or performing the right physical exams or we have to deliver a difficult diagnosis, depending on which room we’re in. This happens while 1 or 2 real doctors stare at us with judging eyes and clipboards where they make notes of all the things we messed up and all the reasons why we shouldn’t graduate…

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How to control your reptilian brain

How to control your reptilian brain

In the simplest of terms, the human brain is made up of three parts that evolved at different times over millions of years. This is the theory of the Triune Brain, developed by Paul MacLean in the 1960s, and it may be the most useful brain theory for those of us without a degree in neuroscience who nevertheless want to understand something about how the brain works and why we act like we do. It also holds the key for learning how to regain calm from a state of high anxiety or even panic.

In MacLean’s model, the oldest part of the brain is known as the reptilian brain. This developed in animals over 100 million years ago, and not only does that ancient brain still operate in our nervous system, it’s often running the show. Which is not always useful, given that this part of the brain is instinctive, automatic, lightning fast, and hell-bent on survival (it’s the part that will make you swerve away from a falling object before you’ve even consciously noticed it). The reptilian brain controls the involuntary systems of the body (breathing, heartbeat, organ functioning, body temperature) and it’s also responsible for triggering our fight/flight/freeze responses. It gets scared or angry fast. It’s territorial, aggressive and horny – it wants to stay alive and to reproduce. It’s obsessive, compulsive, and easily scared (its job is to keep us alive), so it not only holds us back from applying for new jobs or pursuing our dreams – it can keep us held in a state of anxiety.

Which means that if you’re struggling with anxiety, the reptilian brain needs soothing. But to know how best to do this, it’s necessary to know something about the other two evolutionary parts of the brain: the limbic system and the neocortex.

Anxiety and the reptilian brain

We share the reptilian brain with reptiles and birds, but the limbic system (sometimes called the ‘limbic brain’) is the part we have in common with mammals like dogs and horses. This evolutionary addition emerged in the first mammals, bringing a huge increase in brainpower and the ability to feel emotions, experience motivation, store long-term memory and be able to learn. It contains the amygdala, which is sometimes referred to as the ‘fear centre’. The limbic system is tightly connected to the newest part of the brain – the neocortex.

The neocortex evolved in primates around 40,000 years ago, which is a blink of the eye in evolutionary terms. This is the ‘clever’ part of the brain – it allows us to do complex things that mammals and reptiles can’t manage, such as advance planning and intricate social interactions. The neocortex is often referred to as the ‘executive functioning’ part of the brain, because it figures things out, makes reasoned judgements, calculates and handles complex concepts. It also provides us with imagination and creativity. Our neocortex is three times larger than would be found in a similar-sized primate, which perhaps explains why we’re top of the food chain and have populated the entire globe, while monkeys and chimps are still swinging from trees.

And here’s the thing: the neocortex can temper the reactive response of the reptilian and limbic brains.

When your reptilian brain leaps off the path after seeing a coiled something, your neocortex checks it out, realises it’s a rope not a snake, and sends out ‘it’s ok!’ signals to the whole nervous system. The neocortex can help us to reason our way out of an anxious or fearful feeling. The reptilian brain might get jumpy in the dark, but the neocortex checks for time, place and contex, and says ‘It’s just 3 a.m. and you’re in bed at home – everything is fine’. It’s this cognitive ability that is used in CBT (Cognitive-Behavioural Therapy) to reduce constant worrying and high levels of anxiety through examining thoughts and changing unhelpful thought patterns and associations.

The CBT isn’t working! I’m still anxious!

The reason that CBT is often unable to help in a state of high anxiety is this: once our reptilian brain is triggered into ‘thinking’ there’s a survival threat, the neocortex effectively goes off-line. This is because it is not helpful to be wondering whether that’s really a rope or a snake on the forest path – you need to act. Fast. In a survival threat situation, the reptilian brain leaps into action and saves us, effectively shoving the neocortex and its slower thinking out of the way. Which means that we lose the capacity for careful, reasoned judgement, and now we’re acting instinctively. Like an animal.

If you find yourself living in a permanent state of fear, anger or very high stress, your mind and body will be reading this as a struggle for survival. And when that’s the interpretation of your current situation, control will veer between the reptilian and mammalian (limbic) parts of the brain. You won’t have access to your human, reasoning part, the neocortex. You may not be able to process emotions either, while the reptilian brain is screaming ‘RUN!’ (which may not be helpful in the middle of a work appraisal). In this situation, the world may be experienced as overwhelming, out of control and full of danger. What you need, in this situation, is to use one of the reptilian brain’s own tools.

Consciously taking hold of an involuntary process

The reptilian brain controls all our involuntary body processes, such as our heartbeat. And most of these are beyond our control, so they’re operating in a one-way system – they automatically (unconsciously) control parts of our bodies and we cannot consciously gain control over them. Except for one thing – the breath. Breathing is a function of the reptilian brain that we can take conscious control over, and as we do so, we can affect the other involuntary systems that the reptilian brain is controlling. The fight/flight/freeze response will show up in many ways, including fast, shallow breathing from the high chest area. But if you consciously take hold of the breath and change it – making it slower and deeper – you will be taking hold of the entire fight/flight/freeze response.

Slow the breath and you’ll slow the heartbeat. Slow that, and you’ll begin to bring the fight/flight system under control. This calms the limbic brain and allows the neocortex (which disengaged during the survival response) to come back online. Now you’re in a position to see where you are and what’s actually happening – you can assess the real level of danger. You can think clearly again.

The breath is a tool that’s always with you and it’s inconspicuous to use. You could be standing on a train packed with passengers and bring the breath into use to calm the reptilian brain without anyone noticing. You may even use this system unconsciously at times already to relieve stress, such as when you let out a huge sigh or a long deep breath when things begin to feel stressful.

How to calm the reptilian brain

In a moment of crisis, when you feel triggered into jumpy over-reactivity, stop what you’re doing and take your mind off your current stream of thought. Direct all your thinking to the breath and take control of it. Breathe in and out very slowly, drawing the breath right down to the belly, so that it expands (as though you’re blowing up a balloon in your belly). Breathe in through your nose (over a count of about four seconds), hold the breath for one or two seconds, then very slowly breathe out again, over a count of six to eight seconds. Breathe out through your mouth as though you’re cooling hot soup on a spoon by your mouth. Slowly and smoothly.

Notice the difference in any shakiness you were feeling, as you bring the fight/flight/freeze response under control. Keep breathing like this until you notice that you are able to think more clearly again (a sign that the neocortex has reconnected). In a case of real danger, like an oncoming train or tiger, we need to disengage the slow-responding, “hmm, wonder what that is?” type of thought that the neocortex engages in, but for daily life, we benefit from its consideration. This is our higher, human brain, that allows us to function happily and healthily in a complex world. So if the reptilian brain gets triggered into driving the system, simply move it gently into the back seat again by using one of its own tools – the extraordinarily effective breath.

Why happiness can trigger anxiety

This insightful post from Let’s queer things up explains why and how happiness can trigger anxiety in people with a history of developmental trauma. If happiness was often the precursor to a storm of verbal or physical abuse in your childhood, happiness and joy will have become associated in your mind, and you may find that it’s just when you’re most happy that you begin to feel really anxious. (Thank you, LQTU!)

Being happy makes me a little crazy. And if you’ve ever thought you were the only one, I assure you – it’s actually a really common thing.

via Let’s Talk About Self-Sabotage. — Let’s Queer Things Up!

If I’m so smart, why would I need therapy?

This blog post comes from US counsellor and consultant Paula Prober, who specialises in counselling gifted young people and adults. I’m sharing it here because she makes a great point – counselling isn’t a sign of weakness or of ‘something being wrong’ with a person – but when the world feels crazy or ‘too much’, it’s time to focus your attention on one place. And the best place to start is yourself.

Things are looking kinda crazy these days. It’s hard to know what to think, what to do, or how to be. There are so many issues worldwide that need attention. So many. What should super-sensitive, empathetic, insightful, emotional humans do? Well. Being the obsessed-with-psychotherapy psychotherapist that I am, you can guess what I’m about to say. Hang […]

via If I’m So Smart, Why Do I Need Psychotherapy? Part Two — Your Rainforest Mind

Living With a Borderline Parent

Three days ago I read this moving account of what it’s like to live with a parent who has borderline personality disorder. Hayley Iannantuoni’s writing perfectly captures the child’s mystification – why can’t I ever make her happy? Why can’t I ever love her in the way she wants me to? Why am I such a disappointment to her? Her account of the fierce, tempestuous, confusing and frightening relationship, and the way in which a diagnosis helped her to understand what was going on has an extraordinary clarity. Many thanks, Hayley, for giving us permission to share the article here.

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Dear Mom, It’s Not You, It’s Me

When I was a little girl I did not have a favorite teddy bear, pacifier, or blanket that I brought with me everywhere, instead I treasured a photo album. This album was filled with pictures of me and mom with ear to ear smiles, dirty faces, and countless matching mother daughter outfits. I would look through the pictures every night before I went to bed.These pictures gave me something that I didn’t have growing up, and that was the love from my mom.

I could never understand why I failed to make her happy and carefree like she was in the pictures I have engraved in my memory. I could never clean the house good enough to keep her from yelling when she came through the door after work. Nor was I able to be responsible enough at 12 years old to be left home alone so she could go out, even though I desperately wanted her to stay with me. Most importantly, despite the hundreds of pictures I drew for her, bubble gum machine rings I got her, or how many times I told her “I Love You,” I could never love her the way she desired.

As a teenager I came to accept the fact that I would never have the traditional mother daughter relationship that I had desired for so long, and that I would always be a disappointment in her eyes. I knew that my mother’s love was conditional based on what I could do for her. Many times I had to be the shoulder for her to cry on, forcing me to grow up much faster than any child should. I began to blame myself for her behavior, I was her problem. I was the reason I didn’t have the ‘John and Kate Plus Eight’ family I dreamed of.

The summer before my senior year, my parents decided to get a divorce. This news was not a surprise to me due to the common background noise of yelling, screaming, and crying that filled my house everyday. I decided that I wanted to move in with my dad instead of staying with my mom. My mother did not take this news lightly, she took this news as if she had lost a limb. In a panic she locked all of my sister’s and I’s clothes and belongings in her house. She then bolted the windows shut and made it impossible for us to grab our things, and leave her. Instead of throwing us out, she decided to lock us in. I could not understand why my mom wanted us to stay with her when she was always in a bad mood and wanted nothing to do with us for days at a time locking herself in her room or leaving us to go visit her boyfriend. As soon as we told my dad what happened, he waited for her to get home and called an ambulance for her, like he had done this before.

My first day of  senior year did not include wearing my brand new shoes that I had picked up specifically for that day, nor did it include a new backpack, or fresh school supplies, those were still bolted behind locked doors. My first day of senior year included going to the guidance counselor’s office to put on a spare uniform, a plaid skirt two sizes too big, a stained white collared shirt, and a uniform pass because I did not have the right color shoes for the first day. Shortly into the day, I got called to the guidance office this time, to my surprise, my dad was waiting for me. My dad told me that we would be taking a bus to his house today after school, and with police company we would be able to go grab all of our belongings out of my mother’s house. Due to the circumstances, he also told me that I would be missing swim practice and all of my club meetings after school to go to court mandated therapy sessions with my mother once she was released from the hospital. After many therapy sessions, I understand why my mom could not hold a job for more than a few months, why she was always fighting with my dad, me and my sister, and why she pulled us away from her family and so many other things throughout our lives.

To meet a diagnosis of Borderline Personality Disorder under the DSM-V you must show: ‘a persuasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning in early adulthood and present in a variety of contexts as indicated by five (or more) of the following’ –

  1. Frantic efforts to avoid real or imagined abandonment
  2. A pattern of unstable and intense interpersonal relationships characterized by altering between extremes of idealization and devaluation
  3. Identity disturbance: markedly and persistently unstable self image or sense of self
  4. Impulsivity in at least two areas that are potentially self damaging (e.g., substance abuse, binge eating, and reckless driving_
  5. Recurrent suicidal behavior, gestures, or threats, or self- mutilating behavior
  6. Affective instability due to a marked reactivity of mood (e.g. Intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days)
  7. Chronic feeling of emptiness
  8. Inappropriate intense anger or difficulty controlling anger (e.g., frequent displays of temper, consistent anger, recurrent physical fights)
  9. Transparent, stress- related paranoid ideation or severe dissociative symptoms)

When my mother received this diagnosis, I remember the unfamiliar feeling of her crawling into my bed grabbing my hand with tears in her eyes and telling me that she suffers from Borderline Personality Disorder. After some research, I felt like everything finally made sense and I was not the only person who felt unloved and unwanted by a person with BPD. I finally understood that throughout all these years my mom drove me away in fits of rage, that was the only way she knew how to pull me closer. Additionally, I found opinions from other people with BPD, offering advice on how to “get off the emotional rollercoaster” and start focusing on yourself and distancing with love, opening a healthy line of communication. BPD researcher Marsha M. Linehan has developed a communicating style known as D.E.A.R.

D – Describe the situation as you see it without exaggerating, making judgements, or explaining how you feel about it

E – Express your feelings or opinions about the situation clearly (do some thinking beforehand to determine your exact emotions)

A – Assert your limits making them simple (remember you have decided there are limits and those are your personal preferences)

R – Reinforce the benefits of your limits, if appropriate, making it clear you are not acting against the other person, you are acting for YOURSELF.
There is nothing that can compare to the relationship of a mother and her daughter, or to a mom’s home cooked meals and phone calls just to say “I love you.” My mother and I work hard to keep in touch, and try to talk everyday but for her the intense emotions she cannot escape makes this relationship a challenge, facing more bad days than good days. Growing up with a mother suffering from a mental illness has impacted my life in so many ways, particularly, in my choice to become a social worker. Finding my passion has been something I struggled with for many years, when really the answer was right in front of me the whole time. I have my mom to thank for helping me make that decision.

By Hayley Iannantuoni, The (I’m)Possible Project
(Shared with permission from the author)