Best Practices Working With Trauma -- GPBH Conference 2017
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Trauma by definition is unbearable. Intolerable. Overwhelming. Out of control. In fact for many people, the memory of trauma is so upsetting that they will try to push it out of their minds, move on, act as if nothing happened. Trauma affects not only those who are directly exposed to it, but also those around them. Wives of men who suffer from PTSD tend to become depressed, the children of depressed mothers struggle with anxiety and insecurity. Having been exposed to violence as a child makes if difficult to establish trusting relationships as an adult. Not just and event that took place sometime in the past, it is an imprint. …a trauma imprint that leaves traces on our mind, body, and brain. This imprint of trauma has ongoing consequences for how we manage to survive in the present.
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Best Practices Working With Trauma -- GPBH Conference 2017
- 1. Presented by: Tami De Coteau, PhD Licensed Clinical Psychologist DeCoteau Trauma-Informed Care & Practice, PLLC www.decoteaupsychology.com
- 2. What Is Trauma? Posttraumatic Stress Disorder – variety of symptoms following exposure to a traumatic event. Clinical presentation varies among individuals and may include: Fear-based re-experiencing, emotional, and behavior symptoms. Anhedonia or dysphoric mood and negative thoughts. Arousal Dissociation Combination of all of these Other Trauma- and Stressor-Related Disorders Reactive Attachment Disorder – relationally inhibited and emotionally withdrawn Disinhibited Social Engagement Disorder – socially disinhibited
- 3. What is Trauma? Violence and betrayal in our own lives, as well as on our histories and cultures. Unbearable. Intolerable. Overwhelming. Out of Control. Trauma has direct and indirect effects. Imprint on the mind, body, and brain. Traces of trauma remain in our minds, emotions, and biology.
- 5. Neuroplasticity Neuroplasticity has a clear age-dependent determinant Although plasticity occurs over an individual’s lifetime, different types of plasticity dominate during certain periods of one’s life and are less prevalent during other periods. In other words, there are “windows of opportunity” for full acquisition of skill to occur The environment plays a key role in influencing plasticity. The brain is shaped by the characteristics of a person’s environment and by the actions of that person
- 6. Brain Development Bottom Up – from primitive to most complex Brain development is sequential. More complex systems are dependent on development of less complex systems. For normal brain development to occur there must be specific patterns of activity at specific times during development = sensitive periods Experiences (positive or negative) during sensitive periods organizes brain systems. Therefore, trauma during early childhood can effect all future functional capabilities!
- 7. Activity Across Brain Regions Brain Region Functions Critical Period Experiences needed Functional Maturity Cortex Thinking, Planning, Reasoning, Creativity, & Sensory Integration 3 - 6 years Complex conversations, social interactions, exploration, safe, fed, secure Adult Limbic Emotion, Attachment Memory, & Sensory Integration 1 - 4 years Complex movement, social experience, narrative Puberty Diencephalon Sensory Motor & Sensory Processing : 6 months - 2 years Complex rhythmic movement, simple narrative, affection Childhood Brain Stem State Regulation & Sensory Processing In utero – 9 months Rhythmic, patterned input, engaged caregiving Infancy
- 8. Trauma Leads to Problems with Sensory Integration The more effective our brain is at processing sensory input, the more effective our behavioral output will be. 90% of children with trauma have sensory difficulties.
- 9. Hippocampus Part of the limbic system Fully mature by age 3 Primary role is short-term and long-term memory Also plays important role in spatial navigation
- 10. Cerebral Cortex Outer layer of neural tissue Fully mature at age 20 If it is not nurtured it does not mature Primary function is higher brain function such as thought and action Where “true personality” is held
- 11. Secure Vs. Insecure Attachment General Population
- 12. Secure Vs. Insecure Attachment Foster/Adopted Children Secure
- 13. Trauma Leads to Problems with Attachment Attachment is a system in the brain that that develops to ensure infant safety and survival The comfort, pleasure, and calm and balanced attuned interaction between the infant and caregiver creates a sense of safety within the infant Forms the basis for: all future relationships sense of self-worth resilience to stress ability to regulate own emotions make sense of life create meaningful connections with others
- 14. In Normal Youth: the brain mirrors what is being projected by the caregiver In Traumatized Youth: The mirror becomes inaccurate Hypersensitive and highly reactive to negative nonverbal cues Over-perceive negative behavior to mean presence of threats Inability to recognize feelings Difficulty with empathy Mirror Neurons
- 15. Amygdala Part of the limbic system Limbic system is active in- utero. Therefore infant is born with feelings! Primary role is processing of memory, decision-making and emotional reactions Important role in expression and modulation of aggression Survival based “Boss” of the limbic system
- 16. Fight, Flight, or Freeze
- 17. How Trauma and Neglect Impact the Brain Overbuilding stress reactivity + Underdeveloped cortex = primitive, immature and violent responses
- 18. Trauma & Visceral Feelings
- 20. Trauma & Left-Right Brain Left side rational brain Facts Statistics Sequence Right side emotional brain Sensory experiences Nonverbal signals
- 21. Problems of Traumatized Youth Impulsivity Hyperactivity Distractibility & Inattention Dysphoria Emotional Numbing Social Avoidance Dissociation Sleep Problems School Failure Anger Eating Difficulties Relationship Difficulties Aggression/Violence Substance Abuse Disrespectfulness Refusal to attend school Refusal to follow instructions Regressed or delayed development Sensory Issues
- 22. Trauma-Informed Care Amygdala is overactive in traumatized children Goal of TIC is to de-activate the amygdala when it is over-firing When the amygdala is de-activated, compassion is activated TIC rebuilds the child’s brain!
- 23. Trauma & The Brain
- 24. Trauma-Informed Care The greater the intensity, frequency, and duration of the child’s trauma, then the greater the intensity, frequency and duration of the intervention TIC must have breadth and depth Must include sensory, relational, therapeutic, etc. Strategies Some research shows that 1 month of intensive intervention is required for every year of life
- 25. Trauma-Informed Care Every misbehavior is an attempt to fulfill an unmet childhood need Must look to understand the meaning behind the behavior Relationship trauma can only be healed by relational interventions
- 26. 3 Pillars of Trauma-Informed Care S A F E T Y C O N N E C T I O N S M A N A G I N G E M O T I O N S
- 27. Citations Karen, R. 1998. Becoming Attached: First Relationships and How They Shape Our Capacity to Love. Oxford Press, New York, NY. Perry, B. 2009. Examining Child Maltreatment Through a Neurodevelopmental Lens: Clinical Applications of the Neurosequential Model of Therapeutics. Journal of Loss and Trauma, 14:240-255. Trevarthen, Colwyn, & Kenneth J. Aitken. 2001. Infant Intersubjectivity: Research, Theory, and Clinical Applications. Journal of Child Psychology and Psychiatry 42, 3 – 48.
Editor's Notes
- According to the Diagnostic and Statistical Manual Fifth Edition Fear based...flashbacks Emotional and behavioral Arousal – such as anxiety or panic Dissociation – a sort of Splitting off or detaching from out thoughts, memory or physical sensations These types of labels describe the clinical presentation required to meet the criteria for a diagnosis of a trauma-related disorder. But they don’t really described to us the deeply distressing and disturbing experience of trauma.
- Trauma by definition is unbearable. Intolerable. Overwhelming. Out of control. In fact for many people, the memory of trauma is so upsetting that they will try to push it out of their minds, move on, act as if nothing happened. Trauma affects not only those who are directly exposed to it, but also those around them. Wives of men who suffer from PTSD tend to become depressed, the children of depressed mothers struggle with anxiety and insecurity. Having been exposed to violence as a child makes if difficult to establish trusting relationships as an adult. Not just and event that took place sometime in the past, it is an imprint. …a trauma imprint that leaves traces on our mind, body, and brain. This imprint of trauma has ongoing consequences for how we manage to survive in the present. Following a traumatic event, the traces of trauma remain in our minds and emotions….impact our capacity for joy and intimacy. The traces of trauma impact even our biology and impair our immune systems. Trauma literally impacts how our DNA is coded, which is then passed to our offspring.
- For example, Language must be learned during early childhood in order for language skill to be fully acquired.
- Attachment is an interactive process involving non-verbal communication. It is an evolutionary fact that our brains are structured to connect to one another. Attachment is a system…. The comfort….. Secure attachment….. Attuned – make receptive or aware Mutually attuned – receptive or aware of one another Attachment forms the basis for all future relationships…..
- Show upside down triangle of health development vs. upright triangle of unhealthy development.
- Trauma is a visceral feeling. When something is visceral you literally feel it in your gut. It’s intuitive. So Trauma is a sensation in the body. The vagus nerve connects to the brain stem, also known as the 10th cranial nerve, part of the downstairs brain. When the Vagus nerve senses safety, it signals down to our heart and lungs, slowing HR and breathing. And we feel calm, relaxed. When the vagus nerve senses threat, it sends an alarm signal that increases heart rate and breathing and sends us into a flight or flight response. It also produces gut-wrenching feelings and heartbreak.
- But not everyone responds to trauma in the same way. Whenever we feel threatened our first line of defense is to call out for help and comfort from the people around us. But if no one comes, our system second line of defensive is the fight or flight response, a much more primitive survival method. We fight, we run. However, if this fails, we are trapped, held down and cannot escape, the body tries to preserve itself by shutting down. We are then in a state of freeze or collapse. The result is a feeling of numbness of not being present or alive. They may not even register pain. For many people the fight or flight response is preferred. Which explains why so many people with trauma seek chaos and danger. It may also explain why people with trauma are prone to cutting,
- The left and right sides of the brain process memories in dramatically different ways. The left brain is often referred to as the “rational brain”. It remembers facts, statistics, and the sequence of events. The right brain is referred to as the “emotional brain”. It stores the memories of sound, touch, smell and the emotions these senses evoke. It automatically reacts to voices, gestures and facial features, and places we’ve experienced in the past. The right brain is intuitive Under ordinary circumstances these two sides of the brain work together. However, most of the imprints of trauma are stored in the emotional brain. So when something reminds a person of their traumatic past, their right brains reacts automatically, as if the trauma is happening in the present. Without the capacity of left brain sequencing we cannot determine cause and effect. We react without knowing why or what caused our reaction. Afterwards, they may look for somebody to blame for their reaction.
- We all want to move beyond our trauma, but the part of the brain that ensures our survival, otherwise known as the downstairs brain, is not very good at denial. Long after trauma is over, the downstairs brain still reacts to the slightest hint of danger and secretes massive amounts of stress hormones. These stress hormones are responsible for the unpleasant emotions and intense physical sensations associated with trauma, such fear, panic, racing heart, sweating, paranoia, and feeling as though your outside your body looking in.
- Connections are central – Safety comes from connection; Managing emotions comes from connection Therefore, Healing comes from connections.