Hardwired for Connection, Healing, Resiliency & Hope: A Trauma Treatment Framework

1. Hardwired for Connection, Healing, Resiliency & Hope: A Trauma Treatment Framework Presented by: Mary U. Vicario, LPCC-S St. Aloysius Orphanage Finding Hope Consulting, LLC

2. The Impact of Trauma on Brain Development, Attachment & Developmental Milestones All behavior is purposeful Sigmund Freud Strategies for disconnection are an intense yearning for connection in an atmosphere of fear Maureen Walker

3. The Importance of Relationships Human development is dependent on relational connection for: Access to resources Life –beliefs are developed through early relationships Developmental milestones Brain development are embedded in relational experiences 3

4. The Significance of Relationships to Human Development Emotional Development begins chemically in the brain at six months gestation (Schupp, 2004) The ability to trust, and the brain chemistry connected with it, begin at one month of age. 4

5. Human Brain Development and Relationships Humans are the only mammals for whom: The whites of the eyes are clearly visible 50% of brain development occurs after birth.(Experience-Dependent Maturation of Neuronal Systems) (Putnam, 2004) Synaptogenesis: The birth of the connectors (synapses) that are needed for brain development increases dramatically after birth and are dependent upon environment-stimulated activity 5

7. 7 Relational Revolution Amy Banks, MD & Mary Vicario, LPCC-S

9. Brain Growth & Interaction Why the loss of connections? Repeated use of specific connections strengthens those connections Connections that are not used atrophy; they are pruned away The brain “grows itself” from and for whatever environment it experiences (Rintoul, 1999) “What fires together wires together and what is wired together fires together” (Putnam, 2004) 9

10. Experiences which strengthen connections are:(Rintoul, 1999) Frequent, regular, and predictable Occur in the context of a safe, warm, supportive relationship Are associated with positive emotions (fun, humor, excitement, comfort) 4. Involve several senses 5. Are responsive to a child’s needs, interests, or initiative. 10

12. Growth of the Human Brain from birth to 20 years 7 years

13. Human Brain Development & Relationships (Schupp, 2004) The Cortexes are in charge of planning, organizing and executing action while regulating emotions. It performs the functions of Freud's concept of the Superego The Limbic System houses our emotions and is loosely similar to Freud's concept of the Ego. The Brain Stem is our “primitive brain.” It controls the autonomic responses of our parasympathetic nervous system and resembles Freud's concept of the Id. 13

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15. Meet The CortexesAKA: The King of it All As the Executive Control Center, the Cortexes: Read non-verbal cueslike facial expression, tone of voice, body language & posture. It’s our social navigator Control Self Regulation = the ability to regulate emotional arousal to accomplish a task or tolerate unpleasant emotional stimuli(mood stability, frustration tolerance, impulse control) Control Working Memory, Organization, Planning, Problem Solving, Sequencing 15

16. Cortex Development (Forbes & Post, 2006) It is developed by connecting the facial expression of the caregiver with what the infant is feeling at the time which because of Mirror Neurons will mirror the caregivers feelings. Pleasurable sensations develop on one type of nerve fibers and painful emotions develop another type. (Social Pain Overlap Theory or SPOT Theory) It is not fully developed until 25 years of age. It is the reason adolescences does not end until age 25 It also can be “influenced” throughout the lifespan (Neuroplasticity) 16

17. Welcome To The Limbic System (Schupp, 2004) The Amygdala: Houses emotional memory Identifies threat Sets into motion fight or flight response Decides between the need for aggression (fight) from fear (flight) Starts developing at 6 months gestation & continues until 18 months of age. The Hippocampus: Tracks memory & time Controls consciousness Maintains identity Maintains Circadian Rhythms to regulate sleep, appetite, digestion, blood pressure Self Sooths & regulates emotions Calms the Amygdala by accessing short term memory (in the cortex) 17

18. Welcome to the Brainstem The brainstem controls bodily functions: Arousal Bladder Bowl Digestion Perspiration Breathing Startle responses (Things you should not need to think about) 18

19. Brain Development (Rintoul, 1999) The Cortexes should be the largest part of the brain The Limbic system the next in size The Brain stem should be the smallest Their influence on functioning should be in a ratio that resembles an upside down pyramid.(Perry, 1993) 19

21. Brain Chemistry & Trauma When the amygdala discerns there is a life threatening event, it signals the hypothalamus which releases epinephrine, norepinephrine & cortisol to prepare the body to fight or flee These chemicals are so strong that repeated exposure to them damages the brain. (Schupp, 2004) 21

22. Brain Chemistry & Trauma Over time with repeated release of fight or flight chemicals (Schupp, 2004) The cortexes ability to plan, organ and execute action while regulating emotions is damaged. The amygdala is damaged & no longer accurately recognizes danger The hippocampus no longer effectively tracks memory, controls consciousness, identity or circadian rhythms The brainstem misfires causing enuresis, encopresis, digestive issues, impulsive aggression from an over active startle response 22

23. What Do You See? When the cortexes no longer effectively: plan organize execute action regulate emotions 23

24. What Do You See? When the amygdala is no longer accurately recognizes danger responds to danger 3. Self soothes When the hippocampus no longer effectively tracks memory controls consciousness maintains identity Regulates sleep & appetite 24

25. What Do You See? When theBrainstem misfires autonomic responses (things you do not think about) like: Arousal Bladder Bowl Digestion Perspiration Breathing Startle responses 25

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29. Clients with PTSD will need help with: Transitions AKA Shifting cognitive set = The ability to shift from one mind-set to another. Requires the coordination of the Amygdala and the Cortex Since trauma causes a transition from safety to danger all transitions become associated with danger Problem Solving = the ability to organize a coherent plan The amygdala can interfere with this when it sets off the flight or fight response The flight or fight chemicals released by the amygdala (corticosteroids) damage the cortex which is needed to plan for transitions & problem solve. 29

30. Transitions: 5 – 10 minute warning using a timer that shows the time passing with color not sound Visual Schedules Replace “No & Stop” with “Yes you can (when) & “Pause” “Hold that thought” Problem Solving: “Bored” box Homework/Chore/ Play Cards the child can organize in any order they want. Red, (Orange) Yellow, Green cards to indicate need for assistance Red & Green snack cards Interventions

31. Violence in Children’s LivesBy The Percent of Children Exposed in the United States per Year (US Dept. of Health and Human Services, 1997 & 2010) 1997 Exposure to domestic violence – 5 to 16% Violent crime victimization – 5.6% Physical Abuse – 1.2% Sexual Abuse – 0.12% Victim of bullying at school – 7.9% Teen suicide attempt – 8.8% Fighting with peers – 33.2% 2010 Physical Abuse - 0.16% Sexual Abuse - .08 % 31

32. Violence in Children’s Lives According to Schupp (2004) 40 million women in the United States reported sexual abuse prior to the age of 18 which is equal to one out of three girls which = 33% The statistic for boys has reached one out of fivewhich = 20% 32

33. Additional Traumatic Factors(Adapted from: Pynoos, Steinberg, Goenjian, 1996) Exposure to direct life threat Injury to self – extent of physical pain Witnessing of mutilating injury/grotesque death (especially to family or friends) Hearing unanswered screams or cries of distress Being trapped or helpless Unexpectedness or duration of the experience Number and nature of threats during episode Degree of violation of physical integrity of child Degree of brutality and malevolence 33

34. Resulting Belief Systems from Trauma Attachment Abuse destroys trust Instills a feeling of hopelessness Jeckle and Hyde themes Connection is dangerous. We are all in this alone. Why children hold themselves responsible Overwhelming feelings, especially shame, influence development Cannot face reality of vulnerability to malevolent caregivers Limitations of Pre-operational thought 34

35. Trauma Induced & Co-occurring Disorders Everything an abused child does after the abuse is designed to give them a sense of safety Eliana Gil

36. PTSD vs. Complex PTSD(Herman, 1992) PTSD = Perceived life threatening situation with intense fear response Intrusive, avoidant, and hyper-arousal symptoms present Complex PTSD = A history of prolonged or repeated totalitarian control with resulting Alterations in Affect regulation Consciousness Self perception Perceptions of the perpetrator Relations with others Systems of meaning 36

40. The Cycle of Abuse Bonding with the Aggressor AKA The Stockholm Syndrome(Rawlings & Carter, 1977) The Impact of Defenses (Denial, Dissociation, Minimizing, Manipulation) Partnering with or becoming an abuser 40

41. Child Abuse & School Problems(Dawud-Noursi, Lamb & Sternberg, 1998) Greater than 50% of abused children have significant school problems (including conduct problems) Greater than 25% of abused children require special education programs Several studies suggest CAN decreases IQ CAN victims 2 X's more likely to be unemployed as adults 41

42. Trauma-Related Psychopathology (Rossman et al, 2000) Affect dysregulation (depression, mood swings, panic attacks, affect liability) Use and abuse of substances to regulate mood, sense of self, and behavior A History of Child Abuse or Neglect is the single best predictor of alcohol or other substance abuse in women Attentional problems (ADHD Symptoms, impulsivity, hypervigilence) 42

43. The Effects of Fear on Behavior What the search for safety can look like? How to use it to promote healing? 43

45. Biologically Based Fear Responses (Forbes & Post, 2007) Manipulating Lying Stealing Hording Aggression Defiance/”Button Pushing” Poor Eye Contact Food issues Gorging Starving Purging Sleep issues Enuresis Encopresis Self harm 45

46. The Top 5 Things to Remember When Addressing Biologically Based Fear Responses Irritation Equals Fear (Forbes & Post, 2007) All behavior is purposeful (Sigmund Freud) Everything an abused child does after the abuse is designed to give them a sense of safety (Gil, 1991) Connect Limits with safety (Use the Phrase that Pays) 1. The one whose amygdala is calm wins! (Forbes & Post, 2007) 46

47. Manipulation(The Consolation Prize of the Disenfranchised) Is nothing more than a survival skill learned by those who do not have direct access to the resources they need to survive. To address manipulation, teach clients to: directly seek what they need when it is safe to do so and teach the significant others in their lives to respond directly. 47

48. The Safety Script: “ This is a safe place, and I won’t let anyone _________ you, so I can’t let you ____________ because this is a safe place.” 48

49. Lying is Learned When Reality is not allowed to be real The truth is what you need it to be to get the job done 49

50. Interventions for Lying Identify their goal – their perceived need for the lie. To Avoid Punishment? To access a perceived need? To solve a problem 50