Panelists: Margo DeMont, Ph.D. Cynthia Lemp, M.S.W. Kimberlie Warren, Ph.D.

1. 14th ANNUAL TRAUMA SYMPOSIUMRacing Pulse, Toxic Stress, Shock: The Effect of Trauma on the Brain Panelists: Margo DeMont, Ph.D. Cynthia Lemp, M.S.W. Kimberlie Warren, Ph.D.

2. The Effect of Trauma on the Brain Presentation Objectives The Learner will be able to: • Describe the effect of stress on the brain • Explain how to alter emotions to minimize the “flight or fight” stress response • Identify at least three symptoms of post-traumatic stress disorder • Describe two physiological changes resulting from using Acute Trauma Incident Processing with a patient

4. Bi-directional communication between the brain and the body via Autonomic nervous system (ANS)

8. ALLOSTATIC LOAD

9. Amygdala Hijacking

10. The CEO is out of commission!

12. Emotionally traumatic effects • “Multiple conflicts, wars…and personal trauma from accidents, abuse, disaster, bullying…large numbers of individual psyches and family systems have been traumatized. The emotional devastations come from the same emotions that can be powerful emotional catalysts for healing.” (www.energeticinstitute.com.au)

14. Reptilian versus Thinking Brain Reptilian and limbic, sub-cortical areas mediate emotional life. Healing and rewiring emotional responses and defenses occurs in older brain areas.

15. The heart – brain connection

16. EMOTIONS AS ENERGY SOURCES Energetic frequencies Positive (high), negative (low)

17. Emotions and Heart Rhythms Institute of HeartMath

18. The heart signals especially affect the brain centers involved in social and situational awareness, the capacity to care, and the ability to self-manage. Heart Rhythms Directly Impact Physical and Mental Performance IncoherenceInhibits BrainFunction CoherenceFacilitates BrainFunction Institute of HeartMath

19. Impact and outcomes of chronic/toxic stress Accelerated aging Brain cell death Impaired memory or learning Alzheimer's Hypertension Heart disease Obesity Cancer Diabetes

20. Stress – cognitive inhibition Vitality – cognitive facilitation

21. Synchronize the Autonomic Nervous System http://assists.blogspot.com/

22. Emotional Landscape Autonomic Nervous System – Sympathetic Pathway High Arousal - Adrenaline Angry Hostile Resentful Judgmental Frustrated Worried Anxious Afraid Joyful Happy Energized Excited Creative Productive Appreciative Caring Cortisol DHEA Stress Zone Hormonal System Positive Emotions NegativeEmotions Stress / ‘Belly Fat’ Hormone Vitality /Anti Aging Hormone Stress-Free Zone Tolerant Calm Centered Reflective Compassionate Satisfied Serene Forgiving Content Exhausted Bored Withdrawn Apathetic Shamed Depressed Despaired Hopeless Burned Out Low Arousal - Acetylcholine ANS - Parasympathetic Pathway Relaxation

23. EMOTION REGULATION Negative to neutral, to positive.

24. Cortisol DHEA

27. TRAUMA • (photo collage) Little t - BIG T

28. Jeffrey Brenner, M.D.Medical Director of the Urban Health Institute at Cooper University Healthcare • More than 15 years ago . . . • Better care at lower cost in America • The largest and most valuable health study ever done.

29. Adverse Childhood Experiences: A Chronic Public Health Disaster

30. Adverse Childhood Experiences Study - the Largest Public Health Study You Never Heard Of

31. Adverse Childhood Events • Kaiser Permanente (1997) • Center for Disease Control and Prevention (2009 publication; on-going) • St. Joseph County Community Health Needs Assessment (2012)

32. What Are ACEs? • Abuse • Dysfunctional Family • Neglect

33. Prevalence of Adverse Childhood Experiences

34. Early Death Disease, Disability & Social Problems Adoption of Health-risk Behaviors Social, Emotional, & Cognitive Impairment Adverse Childhood Experience ACEs Research: >37,000 Subjects Death Scientific Gaps Conception

35. Implications Those with four categories of ACEs • 240% higher risk of hepatitis • 390% higher risk of COPD (emphysema or chronic bronchitis) • 240% higher risk of STDs • Twice as likely to smoke • Twelve times as likely to have attempted suicide • Seven times higher risk to be an alcoholic • Ten times higher risk of injecting street drugs

36. Trauma, Toxic Stress and the Brain • Orbitofrontal Cortex • Pathological Aggression • Amygdala • Fear • Anxiety

37. Executive Function

39. Reversing the Trajectory • Post Traumatic Stress Disorder • Eye Movement Desensitization and Reprocessing

40. Post-Traumatic Stress Syndrome • Reliving • Avoiding • Increased Arousal

41. Eye Movement Desensitisation & Reprocessing • Introduction to EMDR

43. Acute-Trauma Intervention and Processing Crisis Management Impact of Event Scale 53 subjects randomly assigned Immediate/Wait-list Self Reported Distress from Trauma was statistically significant at p=< .001

44. Adult Adversity Incarceration Victim of Intimate Partner Violence Drug/Alcohol Mental Illness Divorce Parenting Adults with ≥5 ACE 14 TIMES more likely to have two or more conditions that make ACEs for kids Court-Involved Youth Higher ACE Scores Among those with ≥4: 51% special ed. (vs. 33% 0-1) 74% below 2.0 GPA (58%) 85% suspended by 2nd(71%) 33% re-offend in 2 years (13%) High School Youth 42% ≥ 3 ACEs Work injury- illness Homelessness Disability Poverty Health limits activity Unemployment Elementary Children 12% ≥ 3 ACEs 1. Health, attendance, behavior 2. Academic failure

45. Community Partnerships to Build a Network for ACEs Intervention and Prevention We are committed to Trauma-Informed Care: Proving a safe environment that promotes healing and recovery

47. EMDR in Practice Demonstration Cynthia Lemp, MSW, LCSW Memorial Hospital of South Bend Trauma Center Social Worker