Neuroscience and Ethics of Trauma-Informed PracticeNASW Provider # 886580997-9477 Lunch provided by
Mindsight • the ability for one person to perceive the mental state of another.
“Mindsight depends on linking together widearrays of neural input – from throughout theentire body, from multiple regions of thebrain, and even from the signals we receivefrom other people.” Dan Siegel
Brain Stem (“reptilian brain”) • Controls body’s energy levels (i.e., regulating heart rate and respiration) • Moves information from the body proper to the brain (i.e., nauseas, hair on the back of your neck, nervous feeling, rapid heart beat) • Influences response to flee, fight, or freeze in the face of overwhelming situation
Brain Stem (i.e., “reptilian brain”) • “Giving” and “receiving” love are the same • Working together, the brain stem and limbic areas– o Push toward deep drives (i.e., food, shelter, reproduction, safety) o Influences states (i.e., drive toward vs. satiated) of arousal (i.e., sexual and appetite)
• Emotional center of the brain• Attributes meaning to feelings (i.e., feelings have meaning)• Motivates us to act in response to meaning we assign (i.e., emotions evoke motion)• Mammalian lineage – our drive to connect with others
Hypothalamus • Secretes hormones (i.e., cortisol) to help regulate the body (i.e., sexual organs, thyroid) • Small amounts of cortisol enhance functions such as memory • Overwhelming situations with which we can’t cope lead to chronically elevated cortisol.
Hypothalamus – High Cortisol Over Time • Sensitizes limbic reactivity so that minor adversities spike cortisol. • Interferes with brain growth and damages neural tissues • Self-soothing activities (i.e., meditation, walks in nature) that draw on higher areas of the brain are critical to create a “cortical override”
Amygdala • Fear response • Emotional states can be created without conscious awareness • Remembers any and all dangers and generalizes (i.e., attacker, man who looks like attacker, to man, etc)
Hippocampus • Organizes explicit memory • Compares different memories and make inferences • Late maturation
Cortex• Abstract and symbolic thought• Understand concepts such as self, time, others• Executive planning, social functions• Consciousness, perception, attentionMiddle Prefrontal Cortex• Integrates cortex, limbic and brain stem
Left-right integration enables us to: • Put feelings into words • Think about feelings
Memory At birth – • Hippocampus (memory and learning) not well developed • Implicit memory (memories without a “sense” of recollection) • Implicit memory enables development of mental models i.e., transferring felt experience of pacifier with nubs to visually recognizing it
Memory Cont’d Implicit memory • begins in the womb • predominates through early life • enables creation of mental models of the way the world works – no effort on our part • can continue to shape who we are without our awareness
Mirror Neurons • Hardwired from birth to detect sequences, make maps of other’s intentions • A neuron that mirrors the behavior of others, as though the observer were doing the behavior. • Fires when observing intentional behavior • Same neuron fires when conducting the behavior • Cross-modal (i.e., vision, touch, smell, etc.)
Resonance Circuit • A neural network called insula (i.e., information superhighway) runs from mirror neurons to limbic area which sends messages to the brainstem and body, then back to middle prefrontal cortex. • This process informs the cortex of our state of mind (i.e., energy and information flow).
Resonance Circuit Cont’d • This enables us to resonate physiologically with others; our respiration, blood pressure, heart rate changes with other’s internal state. • When we sense our own state, it is easier to resonate with others.
Resonance Circuit Cont’d • We come to know our own mind (i.e., energy and information flow) through interaction with others. • It is the awareness of our own body signals that help us understand the difference between me and you. • It is important to track distinction between me and you, lest we become flooded with others’ feelings, leading to quick burn out.
Infant Care-Giver Dyads –Prelude to AttachmentNeurobiology for Clinical Social Work, Applegate and ShapiroNeuroscience of Psychotherapy, Cozolino • Brain structure and processes affected by microexpressions in infant-caregiver dyads • Synapses are programmed to receive certain microexpressions • If the expected experiences are not experienced, neurons die • Death of neurons leads to a smaller volume amygdala and hippocampus (Glaser)
Infant Care-Giver Dyads –Prelude to Attachment Cont’d • Microexpressions occur via verbal and nonverbal responsive communication such as: o Voice pitch, tone, rhythm o Pupil dilation o Movement of eyebrows o Degree of eye openness o Fullness or terseness of lips o Level of muscle tension in the face o Other verbal and nonverbal communication
Infant Care-Giver Dyads –Prelude to Attachment Cont’d • Prolonged mutual gazing increases infant’s metabolic activity and neural growth • Reflexive smiling evokes positive feelings which stimulates brain development • Infant and caregiver adjust to each others’ gestures, behaviors, and sounds in a song and dance fashion
Infant Care-Giver Dyads –Prelude to Attachment Cont’d • A responsive song and dance (i.e., exchange of microexpressions) sets children up to experience secure attachments. (Cozolino) • Good-enough parenting
Attachment Patterns &Emotional Regulation Attachment patterns arise as a result of infant caregiver interactions and establish neural networks: • Secure attachment sets the stage for integrated neural networks. • Insecure attachments sets the state for unintegrated neural networks.Behavioral Videos Neurobiology Videos(7:15) Avoidant (2:04)•Secure http://www.youtube.com/watch?v=qgYJ82kQIyg&feature=result•Insecure/Avoidant s_video&playnext=1&list=PL1A32ED7EF5F192F2Ambivalent Ambivalent (1:56)http://www.youtube.co http://www.youtube.com/watch?v=nGhZtUrpCuc&feature=relatedm/watch?v=PnFKaaOS Disorganized (4:48)Pmk http://www.youtube.com/watch?v=zovtRq4e2E8&feature=related
Attachment Patterns Summary Secure – • Uses caregiver as a secure base for exploring. Insecure – • Unable to use caregiver as a secure base (true for ambivalent and disorganized) • Little distress on departure, little response to return • Little effort to main contact. Low attachment equals low affect, low self-esteem. • Parent has little response to distressed child.
Attachment Patterns Summary Ambivalent – • Seek contact upon return but reluctant, or angrily resistant when contact is achieved. • Children are more anxious. Parent is inconsistent with dismissive and attentive responses. Disorganized – • Freezing or rocking. Contradictory, disoriented behaviors such as approaching but with the back turned. • Parent likely violent, intrusive, role confusion, negativity, contradictory affective communication.
How Trauma Affects Emotions • Early deprivation or chronic stress increases the chances of damage to the brain, deficits in memory, and prolonged use of primitive defenses. • Through the connect-disconnect-reconnect pattern, our experience with a “good-enough” parent establishes the neural networks for healthy affect regulation (i.e., being able to tolerate negative affect).
How Trauma Affects Memory Two primary implicit/explicit response patterns 1. Recall what happened and separate physical, emotional sensations • Describe traumatic event in matter-of-fact w/o making implicit body memories explicit 2. Inability to recall what happened (i.e., explicit memory) yet retain physical, emotional senses) • i.e., abusive childhood isn’t a problem, yet person is profoundly negative, critical, etc./acting out their implicit memories
How Trauma Affects Memory Cont’d • Inability to recall traumas that occurred in infancy, may lead children to internalize the somatization of their implicit memories and conclude they are bad. • Ambiguous stimuli (i.e., silence) activates implicit memory • Smaller hippocampus (i.e. responsible for memory and learning) due to chronically high cortisol levels, toxicity and cell death
Responses to Trauma Lack of vertical neural integration • Affect dysregulation i.e., inability of the cortex to process, inhibit and organize information from brainstem and limbic system such as reflexes, impulses, and emotions. • Trauma or living in an “emotional desert” leads to being cut off from bodily sensations, leading to poor judgment, lack of wisdom.
Responses to Trauma Cont’d Lack of horizontal neural integration (i.e., one side dominating) leads to: • Inability to put feelings into words • Somatization (i.e., manifestation of emotional conflicts into bodily illnesses) • Loss of creativity, richness, and complexity that results from integration • Inability to understand the nonverbal world of self and others
Healing Trauma: Strengthening NeuralIntegration Interpersonal Neurobiology Series (Cozolino, Siegel) Restoring neural integration requires simultaneous reregulation of networks on vertical and horizontal planes. This may occur through: • Strength of the therapeutic alliance • Moderate levels of stress • Narrative which involves emotion and cognition • Mindsight (i.e., ability to perceive the mental state of another person) These same factors are at work across psychodynamic, systems, and cognitive approaches to treatment.
Healing Trauma: Narratives and NeuralIntegration Narratives are powerful tools for high-level neural integration because they contain: • Linear storyline and visual imagery, woven with • Verbal and nonverbal expressions of emotion
Healing Trauma: Narratives and NeuralIntegration Cont’d Narratives facilitate neural integration by using circuitry from: • Left and right hemispheres • Cortical and subcortical networks • Amygdala and hippocampus
Healing Trauma: Narratives and NeuralIntegration Cont’d Narratives facilitate • Integration of neural networks • Combining sensations, feelings and behaviors with conscious awareness • Individuals placing themselves in alternate points of view
Hope is Present! • Based in neuroplasticity research, Dr. Siegel explains in this video explains how “making sense of what happened to us as a child” is more important than actually what happened. • “Become a Better Parent” http://www.youtube.com/watch?v=JNNT7loaQAo&feature=bf_prev &list=PL1A32ED7EF5F192F2&lf=results_video