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Trauma Informed Treatment: Applying Neuroscience Fairfax, VA October 18 th , 2012

Trauma Informed Treatment: Applying Neuroscience Fairfax, VA October 18 th , 2012. Jan Beauregard, Ph.D., LPC, CSAC www.ipivirginia.org (703) 385 9667 Ext. 1. How a Healthy Brain Develops:. An infant is born with the brain stem fully intact and capable of primitive, subcortical

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Trauma Informed Treatment: Applying Neuroscience Fairfax, VA October 18 th , 2012

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  1. Trauma Informed Treatment:Applying Neuroscience Fairfax, VAOctober 18th, 2012 Jan Beauregard, Ph.D., LPC, CSAC www.ipivirginia.org (703) 385 9667 Ext. 1

  2. How a Healthy Brain Develops: • An infant is born with the brain stem fully intact and capable of primitive, subcortical reflexes like fight, flight, freeze, attach At 10 months, there is significantly more genetic material due to interactions with the primary caregiver and the environment Schore, 2007

  3. Brain Development: • At about 10 months we see that the prefrontal cortex comes on line and by age 2 the brain actually doubles in size. • For a healthy brain to develop certain kinds of experiences are critical – especially social experiences. “Cells that fire together wire together and those that do not DIE together.” (Porges, 2007; Siegel, 2007)

  4. Left and Right Brain Functioning Left Right Left Brain CEO Right Brain: The Survival Brain Problem solver nonverbal Analytic language Rational Conceptual perception of emotion, facial Task Master- expression Carries on no matter sensation what happens instinctive Verbal/narrative survival response Memory Emotional/Implicit Sensory memory imagistic

  5. Adverse Childhood Experiences (ACE) Adverse Experiences: emotional, physical neglect, physical, emotional, sexual abuse, domestic violence, Mental illness, substance abuse, divorce, incarcerated Family member, mental illness in family www.acestudy.org/files/ACE_Score_calculator.pdf ACE Score of 4 or More: 2 x as likely to smoke 12 x more likely to attempt suicide 7 x more likely to become alcoholic 10 x more likely to inject street drugs Increased Health Risks: heart disease, obesity, liver disease, lung cancer, asthma, autoimmune disease Fellitti, 2003

  6. Co-regulation With Primary caregiver • There are emotional and neurochemical effects that the mother-child diad have on each other: Hormones released in the mom impact the genome (oxytocin, endorphins, cortisol) and this psychobiological interaction of primary caregiver and child affects overall mental and physical health over the lifespan. Karr-Morse, 2012; Porges, 2006

  7. Attachment Styles In Children • Secure – 65% (UTUBE) • Avoidant/Dismissive – 20% • Preoccupied/ambivalent/anxious -5% • Disorganized/Disoriented – 10 % Attunement has a neurocorrelate – shoving own state into the state of the infant. Parents who gain insight into their own attachment style will be better parents. Tatkin, 2006 – Attachment Interview for Parents (AAI) Fraley, 2011 www.web-research-design.net/cgi-bin/crq/crq.pl Seigel, 2006 - Mindfulness, mirror neurons (Bowlby, 1973)

  8. In Secure Attachment: Good enough psychobiological interaction in parent/child diad (must be appropriate, consistent and predictable) will imprint the right brain resulting in the development of: Trust Self esteem Empathy Control of aggression Ability to self regulate unpleasant emotions Provide the network that fosters our ability to connect to others in future relationships

  9. Insecure Attachment – Impact on Brain • Abuse, neglect, under-stimulation and prolonged shame: • Reduces the level of dopamine • Reduces the levels of endorphins • Reduces the size of the hippocampus (8%) *** • Increases stress hormones like cortisol and noradrenalin • Results in a smaller corpus collosium (bridge) • Changes in brain grey matter and white matter • Dendritic burnout • Elevated resting heart rate in children a consistent • sign of early attachment trauma (Cozolino, 2006)

  10. Disorganized Attachment: Usually at the root of symptoms we associate with the diagnosis of BPD. A better name for this condition would be “disorganized attachment disorder.” This attachment style makes it difficult to assess incoming stimuli appropriately. The amygdala (fire alarm for the brain) is especially important for assessing and processing a number of emotions (fear, sadness, anger) accurately and is overactive in traumatized individuals.

  11. Dr. Alan Schore - Psychiatrist Affective Regulation in Infancy www.utube.com/watch?V=MD5MI-EAC10

  12. When Attachments are in Peril: Education needs to begin before parenting (Psychoeducation, Adult Attachment Interview) Treat the whole family – a parent’s understanding is critical to undo the legacy of intergenerational trauma (Marvin, 2002) Treatment begins with safety and containment and affect regulation tools Therapy (and other secure attachments) with appropriate attunement can reverse damage

  13. Still Face Experiment: Tronick (Utube: www.utube.com/watch?v=apzxGEbZht0) This rupture in attachment could occur in many situations. Consider a caregiver who: Has unresolved trauma Is a substance abuser Has an anxiety disorder Is depressed Is dealing with complex grief Is a victim of domestic violence Is living with chronic stress due to unemployment or under employment Has a serious mental illness

  14. Teaching Tools: Ainsworth, Mary : A Strange Situation www.utube.com/watch?V=QTsewNrHUHU Bowlby, John – Father of Attachment Theory www.utube.com/watch?V= apzxGEbzht0 Porges, Stephan – Affective Neurobiology www.utube.com/watch?v=Lpu4hKG8WOA Fisher, J. PsychoeducationalAids for Working With Psychological Trauma (Flipchart) DrJJFisher@aol.com

  15. Trauma Informed Therapy Treatments: Sensorimotor Psychotherapy (Ogden) Somatic Experiencing (Levine) Mindfulness (Siegel) and Meditation (Zinn) DBT (Linehan) and some protocols from EMDR ARC (Kinniburgh & Blaustein) Attachment, Self Regulation and Competency Trauma Sensitive Yoga (Cimini, Emerson, Weintaub) Expressive Therapies: art, music, dance

  16. Why is the Body Important? Clients often relive the trauma through the body somatically because the material is inaccessible to verbal recall. If not processed from the bottom – up, the material remains unintegrated and unaltered over time leading to a variety of disruptive symptoms and poor coping tools. (Van der Kolk, 1991). Explicit Memory – verbally accessible, factual Implicit Memory – nonverbal memory ** Often results in repair to attachment system

  17. Trauma Responses are Autonomically Driven Hyperarousal-Related Symptoms: Highactivation resulting in impulsivity, risk-taking, poor judgment Chronic hypervigilance, post-traumatic paranoia, chronic dread Intrusive emotions and images, flashbacks, nightmares, racing thoughts Obsessive thoughts and behavior, cognitive schemas focused on worthlessness and dread Hyperarousal “Window of Tolerance”*Optimal Arousal Zone Hypoarousal-Related Symptoms:Flat affect, numb, feels dead or empty, “not there”Cognitively dissociated, slowed thinking processCognitive schemas focused on hopelessnessDisabled defensive responses, victim identity Hypoarousal Ogden and Minton (2000); Fisher, 2006 *Siegel (1999)

  18. Trauma Informed Treatment: Looks at behaviors as a result of what happened instead of a symptom of what is wrong. When the prefrontal cortex is “off line” treatment MUST begin with attention to the body. The first objective is to restore the feeling of safety and to help the patient/client get back into the present moment.

  19. Basic Tools: Safety & Containment • Physical/Mental Grounding (Najavitits, 2002; Rothchild, 2002; Ferentz, 2000) • Breathing techniques to engage the parasympathetic nervous system • Orienting Response - client moves head as he/she describes objects in the environment • Interrupt to switch focus …pause, what helped you through this? When did you first realize that you were safe? (Retrospective Mindfulness… slow down the story) Pendulation – going from high activation to low activation and back (Beauregard, 2012)

  20. Focusing and Calming: • Deep breathing – exhalations longer One hand on heart, Other below the navel • Frozen lemons/limes • Handwarming • Detachment – gestures to distance affect • Hold feet • Something in me….. • Trauma sensitive yoga (Daitch, 2007; Linehan, 2000; Ogden, 2006)

  21. Activating and Engaging: • Trauma sensitive yoga: • Bellows Breath, pulling • Prana • 2. Asanas – Lum, Vum • Rum, Yum, Hum, Om • Movement • Crosswalks • Orienting Response • Ball toss • 7. Tasper (EMDR) Emerson, Porges, Weintaub)

  22. Sensorimotor Psychotherapy & SE Sensorimotor Psychotherapy is a body based, bottom- up approach to processing trauma developed by somatic pioneer Pat Ogden, Ph.D. Somatic Experiencing (SE) is another body oriented bottom-up approach developed by Peter Levine to treating trauma. Both programs require extensive training to use effectively

  23. Why Use Sensorimotor/SE? Because the body can be used to regulate affect (breathing, movement, etc.) To prevent Bottom – Up Hyjacking – responding to false threats To learn new physical actions to challenge procedural learning (breathing, pushing, moving)

  24. Trauma, PTSD and Movement • Hurricane Katrina yielded the greatest amount of PTSD (33%) more than other natural disasters • As stress hormones got activated, the natural response would have been to move or “do something” • Louisiana’s response was to put people in one location and immobilize them After 911, The PTSD rate was documented at only 6 % because people ran, moved, dug others out, mobilized – completed the fight/flight response

  25. Experiment: • You will be shown 2 different slides • Notice the nonverbal cues (sensations, feelings) that accompany each slide

  26. Sensorimotor Psychotherapy www.sensorimotorpsychotherapy.org Pat Ogden – Founder 3 Levels of Training offered Nationally and Internationally

  27. Mindfulness and Meditation Mindfulness can be described as paying attention in a particular way; on purpose to the present moment, nonjudgmentally. (Kabat-Zinn, 1994) In mindfulness we watch the the experience of the story unfold in the present moment through changes in body sensations, moment, sensory perception, emotions and thought (Ogden,2006). Mindfulness is a part of SP, SE and DBT. Posterior Cingulate – activated when mind wanders Anterior Cingulate – activated in the here and now http://www.mindfullivingfoundation.org/meditations.html Meditations

  28. Mindfulness Questions • What do you feel in your body right now? • Where exactly do you feel that tension? • How big is the area of tension? • What sensation do you feel in your legs right • now as you talk about ______? • 6. Just notice in your body what wants to happen as • you say that… • 7. What happens inside when you get angry? • 8. What inside your body tells you that you feel safe?

  29. Mindfulness and Meditation How long is a moment? 5-8 seconds or the amount of time It takes for one in and out breath. Our minds wander 48 % of the time – the more the mind wanders the more stress increases. A recent study showed that as little as 1 minute of mindfulness meditation a day could reduce stress, improve concentration and reduce aggression Alabama Prisoners – 20 % reduction in disciplinary action for prisoners participating in mindfulness meditation course Documentary Movie: The Dhamma Brothers www.wildmind.org/blogs/news/alabama-prisoners-turn-to-meditation-forpeace

  30. Meditation: Thinking, thinking, thinking….return to the breath….. Sound, sound, sound….. Return to the breath….. Feeling, feeling, feeling…… Return to the breath….. “Let the bird fly by….do not let it nest in your head.” There are changes in the brain during meditation – the left prefrontal cortex gets activated (10 – 15 % change results in more positive emotions) Changes in the white matter and grey matter of the brain occur with as little as 1 minute of mindfulness a day.

  31. Trauma Sensitive Yoga • Effective in treating both anxiety, depression and PTSD symptoms • Yoga teacher must use permissive language and allow clients to establish the boundaries they need during the practice • Give choices (Cimini, Emerson, Weintaub, 2004)

  32. User Friendly Language • “If you’d like, you may open your mouth if it is uncomfortable to breathe through your nose…. • “Whatever feels comfortable right now….” • “If you wish, try to place your left hand on the crown of your head….” ** Yoga therapist needs to contract about touch with each client (Emerson, 2008)

  33. Trauma Sensitive Yoga Resources • Yoga Warriors – two day training with Lucy Cimini • David Emerson – Justice Resource Center Boston, MA Amy Weintaub – Yoga for Depression Training in LifeForce Yoga ** The type of yoga and the training of the instructor is important “trauma sensitive Yoga”

  34. Trauma Sensitive Yoga in VA • Heather Hagaman, MA, RTY-200 Beloved Yoga, Reston journeyfortruth@aol.com Corrinne Krill, MA, RTY-200 Sun and Moon Yoga Info#heartandsoulyogava.com

  35. IPI: Additional Training • Tools for Transforming Trauma • Sensorimotor and Somatic Techniques • Trauma Sensitive Yoga/Yoga Warriors • Using Ego State Therapy and Imagery • Expressive Therapies for Trauma Treatment • Using DBT in Trauma Treatment • Treating Complex Trauma in the Substance Abusing Client • Sexual Compulsivity and Trauma

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