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3. tia epl week 3
- 1. Integrating a Trauma-Informed Approach in Behavioral Health Settings
- 2. The Effect of Trauma on the Body and Brain Week 3
- 3. Week 3 Topics •Trauma’s effects on the brain and body •Trauma and memories •Trauma triggers •Polyvagal Theory
- 4. Self Care is Important
- 5. Week 2 Learning Activity - Discussion How can you and your organization begin to build a sense of safety and trust with individuals experiencing trauma and SUD’s from various cultures and other forms of diversity? Preventing ACEs Online Training for Mental Health Care Providers Module Lesson 1.1 “The Role of Culture and Diversity in Working with Families” https://www.youtube.com/watch?time_continue=296&v=6s__KSlFxNc Letter from Ameena
- 6. DISCUSSION – Culture & Diversity • What are some aspects of culture and diversity do you recognize in your setting that could be featured as a result of viewing Preventing ACE’s Training for Mental Health Care Providers?
- 7. Autobiographical Soup – van der Kolk This Photo by Unknown Author is licensed under CC BY-NC • Danger in life is normal – the brain is in charge of detecting it and organizing our response • Sensory information (eyes, nose, ears, skin) have responses through the thalamus • Each person’s brain takes in the information and integrates the experience (what is happening to them) and is passed to the amygdala, deep in the brain and to the frontal cortex • Thalamus processing can break down and the encoding can end up as isolated, dissociated fragments – normal processing disintegrates • Time freezes – so that present danger feels like it will last forever.
- 8. Kolk MD, Bessel van der. The Body Keeps the Score (p. 60). Penguin Publishing Group. Kindle Edition.
- 9. Messages about the Sensations are then Passed on in Two Directions… Amygdala Rapid but imprecise Frontal Lobes Slower but more precise
- 10. Is This Situation Relevant to Survival?van der Kolk, p. 60 Amygdala Hippocampus This Photo by Unknown Author is licensed under CC BY-SA
- 11. This Photo by Unknown Author is licensed under CC BY-SA-NC
- 12. HPA Axis This Photo by Unknown Author is licensed under CC BY-SA
- 13. Meanwhile….the frontal lobe wonders…. This Photo by Unknown Author is licensed under CC BY
- 14. Words vs. Behaviors • Broca’s Area • Difficulty identifying/naming internal state • Difficulty managing or regulating strong feelings • May blame their emotions on others • May express emotions through behaviors
- 15. Typically: Stressor SNS Activated Increased Energy HPA Axis Activated Cortisol slows SNS Cortisol slows HPA Axis
- 16. Average Person: 20-30 activations of the HPA axis daily
- 17. DISCUSSION •What are a few examples of how this might happen in an average day?
- 18. Frequent Fear and the Brain – Bruce Perry • Routinely operate in survival mode • Shutting down • Watching for danger • Expectation to fight or flee • Heightened levels of arousal and emotional response • Difficulty self-regulating emotions • Overdeveloped fear response
- 19. PTSD = Lower levels of cortisol: Stressor SNS Activated Increased Energy HPA Axis Activated Cortisol slows SNS DANGER Cortisol slows HPA Axis
- 20. PTSD = Lower levels of cortisol: Less cortisol to dampen effects of the catecholamines Stressor SNS Activated Increased Energy HPA Axis Activated Cortisol at lower levels Epinephrine Enhances Memory Consolidation
- 21. Traumatic Memories • Bessel van der Kolk – “Traumatized people simultaneously remember too little and too much” • More adrenaline secreted = more precise memory • Engraves the memory in our minds but may also dissociate • Some brain areas necessary for proper storage and integration are shut down – e.g. hippocampus and thalamus • Rather than being organized in coherent, logical narratives, memories are stored in fragmented sensory and emotional ways (images, sounds, physical sensations, etc)
- 22. Traumatic Events
- 23. Trauma Memories Where were you and what were you doing when you learned of the Twin Towers being attacked? The plane crash that accompanied it? The attack on the Pentagon?
- 24. Flashbulb Memories Hypothesized that these memories are so emotionally important to us that they're laid down as vividly, completely and accurately as a photograph. This Photo by Unknown Author is licensed under CC BY-NC
- 25. Flashbulb Memories • Dr. Hirst & 15 others - largest study of 9/11 memories – 40% of the time people misremember some aspect, especially emotions, “You tend to project your current feelings about 9/11 on what you felt then” • Talarico and Rubin (2007) - People had already changed their stories of how they heard about the attacks over just a few days, “Because at that point you've told 35 people how you heard about it, and it's been solidified in your memory the way you're telling it, not necessarily how it really happened” • Both studies found they do appear to be more vivid than other memories, “at least people certainly perceive them that way”
- 26. Phelps and Sharot (2008) This Photo by Unknown Author is licensed under CC BY • Marked difference between participants who were in downtown Manhattan, close to the towers, and those who were farther away, in midtown • fMRI – amygdala lit up in the brains of those downtown (emotional memory) • "The amygdala trains your attention on this emotionally arousing information to the exclusion of everything else around you“ (Phelps)
- 27. This Photo by Unknown Author is licensed under CC BY-NC Culturally specific traumatic events
- 30. Robert Scaer Conditioned by early trauma experiences • Current emotions and physical symptoms may be based more on childhood experiences than those in adulthood • Old emotions and sensations reawakened • Exaggerated response based on meaning of past experience
- 31. All of our bodies have a bias to see Basic of the reptilian brain – survival and adaptation
- 32. Misinterpreting Current Situation as Dangerous
- 33. Snake or hose
- 34. Mannequinns This Photo by Unknown Author is licensed under CC BY-SA This Photo by Unknown Author is licensed under CC BY-NC-ND
- 35. Triggers •Situations •Depression/anxiety •Money •Certain people •Interactions •Time of day •Thought •Emotions •Holidays, celebrations, etc.
- 36. Trauma Triggers • Stimulus that sets off a memory of a trauma or a specific portion of a traumatic experience • Some triggers can be identified/anticipated easily • Many are not and may surprise the individual • TIC – be aware of potential common triggers (e.g. UAs, signs with violence, etc.)
- 37. Polyvagal Theory • Dr. Stephen Porges This Photo by Unknown Author is licensed under CC BY-SA
- 39. Polyvagal Theory - Porges Safety • Physiology will optimize for growth, restoration and health • Engage others, eye contact, etc. (PNS) Danger • Supports mobilization – fight/flight • Sympathetic Nervous System (SNS) Life Threat • Shut down/immobilize • Freeze response • Dissociation
- 41. Quest for Safety: Emergent Properties of Physiological State – Dr. Stephen Porges Internal/External Cues from Environment Nervous System (neurocepetion) Safety Danger Life Threat
- 42. Parasympathetic Branch of the Autonomic Nervous System Rest and Restore Safety
- 43. Ventral Vagal Nerve = Brake to Allow Social Behaviors
- 44. Social Engagement – Ventral Vagal Nerve This Photo by Unknown Author is licensed under CC BY-ND
- 45. Jaguars This Photo by Unknown Author is licensed under CC BY-ND
- 47. Ventral Vagal Response • Oxytocin and other beneficial hormones released • Helps learning, critical thinking and other executive functioning • Facilitates general health and positive experiences This Photo by Unknown Author is licensed under CC BY-ND
- 48. Mohawk of Self-Awareness- Ruth Lanius in The Body Keeps The Score •Brain in idle – Default State Network (DSN) •Pay attention to ourselves – sense of self •Mohawk - Midline structure of the brain •Turns off when there is a threat •Activity sharply decreased in individuals with chronic histories of trauma Anterior Cingate – Affect regulation Posterior Cingate – Internal GPS Medial Prefrontal Cortex - Watchtower Insula – e.g. socio-emotional functioning Orbital Prefrontal Cortex - complex cognitive behavior, personality expression, decision making, and moderating social behavior
- 49. Sympathetic Response – Fight or Flight This Photo by Unknown Author is licensed under CC BY-SA
- 51. Polyvagal Theory The more danger, the primitive the response Non-traumatized individuals can better bounce between yellow and green line more easily
- 52. PNS (Rest and Restore) • Pupils constrict • Saliva stimulated • Bronchi constrict • Heart slows • Stomach, pancreas, & intestines stimulated • Relaxes bladder • Immune system regulates SNS (Fight-flight) • Pupils dilate • Saliva inhibited • Bronchi dilate • Heart accelerates • Stomach, pancreas, & intestines inhibited • Constricts bladder • Immune system inhibited • Glucose released Sympathetic vs. Parasympathetic Branches of the Autonomic Nervous System (ANS)
- 53. Dorsal Vagal Response - Freeze
- 54. The Other Brake Pedal – Freezing/Dissociation Immobilization with Fear
- 56. Dorsal Vagal Response •Preparation for death •Endogenous opioids •Dissociation •Trapped •Hopelessness/helplessness •Numbness
- 58. Richard Boyatzis – Resonant Leadership • MRI - executives as to recall past leaders • Resonant leaders attract, dissonant leaders repel • Resonant – mirror neurons activated • Resonant – Default Mode Network (social network) open to new ideas and emotions • Dissonant – areas related to focused attention were activated – while it allows us to remain focused and be persistent in a task, it closes the mind to ideas and emotions then later, leads to avoidance and negative emotions
- 60. Week 3 - Learning Activity • Read the article, “On Being Sane in Insane Places” (1973) https://digitalcommons.law.scu.edu/cgi/viewcontent.cgi?article=2384 &context=lawreview • Watch the video, “Behind Closed Doors” (2007) https://vimeo.com/2709542 • Be prepared to discuss how organizations and systems may have changed through the decades and how a trauma-informed approach could have made a difference.
- 61. Acknowledgments Kate Speck, Ph.D., MAC, LADC Pam Oltman, MS, LIMHP, LADC Mountain Plains Addiction Technology Transfer Center (MPATTC)