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

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

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


1
Trauma Informed TreatmentApplying 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 Conceptu
al 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/cg
i-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/wat
ch?VMD5MI-EAC10
12
When Attachments are in Peril
Education needs to begin before
parenting (Psychoeducation, Adult Attachment
Interview) Treat the whole family a parents
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?vapzxGEbZht0)
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.co
m/watch?VQTsewNrHUHU Bowlby, John Father of
Attachment Theory www.utube.com/watch?V
apzxGEbzht0 Porges, Stephan Affective
Neurobiology www.utube.com/watch?vLpu4hKG8WOA Fi
sher, J. PsychoeducationalAids for Working With
Psychological Trauma (Flipchart) DrJJFisher_at_aol.co
m
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 High activation
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 ToleranceOptimal Arousal Zone
Hypoarousal-Related Symptoms Flat affect, numb,
feels dead or empty, not thereCognitively
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
  • Louisianas 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 youd 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_at_aol.com
  • Corrinne Krill, MA, RTY-200
  • Sun and Moon Yoga
  • Infoheartandsoulyogava.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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