Lecture Three Attachment, Trauma, and PTSD Student Version

Attachment

• A deep and enduring emotional bond connecting one person to another.

• Originates in infancy (or earlier) between a caregiver and child.

• Shapes an individual's ability to form emotional connections throughout life

Roots of Attachment Theory

• Developed by John Bowlby in the 1950s and 1960s.

• Influenced by psychoanalytic theory and ethology.

• Mary Ainsworth's "Strange Situation" experiment expanded and operationalized Bowlby’s concepts.

Four Primary Attachment Styles

• Secure Attachment

• Avoidant (Dismissive) Attachment

• Ambivalent/Anxious/Preoccupied Attachment

• Disorganized/Disoriented Attachment

Characteristics of Secure Attachment

• Comfortable with intimacy and independence.

• Typically, positive view of themselves and others.

• Reliable ability to engage with and seek support from caregivers.

Avoidant (Dismissive)

Values independence, avoids closeness.

Ambivalent or Preoccupied (anxious)

Seeks closeness and is anxious about abandonment

Disorganized

No clear strategy, a mix of avoidant and anxious behaviors

Implications of Attachment in Adulthood

• Early attachment has an influence on all adult relationships (romantic esp.)

• Impacts one's ability to form and maintain friendships.

• Shapes emotional regulation, resilience, and coping mechanisms.

Trauma - Gabor Mate

The wound that you sustained as a result. Trauma is not what happens to you. Trauma is what happens inside you as a result of what happens to you

Trauma

Emotional, psychological, and sometimes physical responses to distressing events that overwhelm coping abilities.

Types of Trauma

Big T and small t

Big T

Significant events (e.g., war, natural disasters, severe abuse, life-threatening incidents).

Small t

Everyday distressing events (e.g., interpersonal conflicts, minor accidents, feelings of invalidation)

Impact of Trauma

Both types can affect mental health, behavior, and overall life experience.

Adverse Childhood Experiences (ACE) Scale

a tool developed to quantify the cumulative effects of different types of childhood traumas. The scale assesses exposure to ten types of adversity in childhood, ranging from emotional, physical, and sexual abuse to various forms of household dysfunction.

The 10 types of adversity in childhood

ACE is defined as experiencing any of the following categories of abuse, neglect, or loss prior to age 18:

• Physical abuse by a parent

• Emotional abuse by a parent

• Sexual abuse by anyone

• Growing up with an alcohol and/or substance abuser in the household

• Experiencing the incarceration of a household member

• Living with a family member experiencing mental illness

• Domestic violence

• Loss of a parent

• Emotional neglect

• Physical neglect

Background of ACE

The ACE study originated in a collaboration between the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente's Health Appraisal Clinic in San Diego.

3 Main ACE categories

Abuse: emotional, physical, and sexual
Neglect: Emotional and Physical.
Household Dysfunction: This encompasses challenges such as having household members who were incarcerated, mentally ill, substance abusers, or if the respondent witnessed domestic violence, or lost a parent due to separation, divorce, or other

ACE Scoring

• Each type of adversity encountered scores one point.

• ACE scores range from 0 to 10; higher scores indicate greater exposure to childhood adversities.

ACE Health Outcomes

• Numerous studies show a graded dose-response relationship between ACEs and negative health outcomes in adulthood.

• As the number of ACEs increases, the risk for health problems also increases, including:

  • Heart disease

  • Diabetes

  • Substance misuse

  • Mental health conditions

Broader Implications of ACE

• The ACE score aids medical professionals, therapists, and other practitioners in understanding the health and social impacts of adverse childhood experiences.

• This insight highlights the importance of early intervention and prevention efforts to address the root causes of many health and social issues.

In children under the age of 6, trauma may manifest as…

Regression, language disruption, reenactment, separation anxietyc

Regression

Returning to behaviours like bed-wetting after learning to use the toilet.

Language Disruption

Forgetting how or being temporarily unable to talk due to stress.

Reenactment

Acting out the traumatic event during playtime as a way to process the experience.

Separation Anxiety

Becoming unusually clingy with a parent or caregiver, reflecting a need for security

In teenagers, trauma may manifest as…

Withdrawal, risk-taking behaviours, mood swings, difficulty concentrating, somatic complaints (key considerations: cognitive development & need for autonomy)

The influence of traumatic experiences

• Early traumatic events can disrupt the development of secure attachment.

• Abuse, neglect, or loss can lead to anxious, dismissive, or disorganized attachment styles.

• The absence of a consistent, responsive caregiver post-trauma exacerbates insecure patterns.

neurological implications of trauma

• Chronic stress and trauma can impact the amygdala, hippocampus, and prefrontal cortex.

• Heightened stress response and difficulties in emotional regulation.

• The brain becomes wired for survival rather than connection.

Trauma attachment and regulation

• The "window of tolerance" refers to the optimal zone of arousal where an individual can function effectively (Dr. Dan Siegel)

• Trauma and insecure attachments can narrow this window.

• Leads to hyperarousal (fight/flight) or hypoarousal (freeze/dissociate) outside this window.

The Power of Secure Attachments in Trauma Recovery

• Secure Base: Provides safety and fosters resilience.

• Therapeutic Relationships: Can "rewire" attachment patterns and offer corrective emotional experiences.

• Social Support: Community, friendships, and mentorships play a crucial role in recovery.

Post-Traumatic Stress Disorder (PTSD)

Can develop after experiencing a shocking, scary, or dangerous event

Normal Fear Response

Fear is part of the body's natural "fight-or-flight" response, helping us avoid or respond to danger.

Natural Reactions

It is common to feel afraid during and after frightening situations, and most people recover from their symptoms over time.

PTSD Diagnosis

Those who continue to experience symptoms beyond the normal recovery period may be diagnosed with PTSD.

Common Groups - who develop PTSD

• Combat veterans

• Individuals who have experienced or witnessed:

  • Physical or sexual assault

  • Abuse

  • Accidents

  • Disasters

  • Terror attacks

  • Other serious events

Secondary Trauma

Not everyone with PTSD has directly experienced a dangerous event; learning about trauma affecting a relative or close friend can also lead to PTSD.

About ___ in every 100 people will experience PTSD in their lifetime

10

_____ and ______ are more likely to develop PTSD

Women and BIPOC

Specific aspects of a traumatic event as well as some _____ and social factors (i.e., attachment history, genetic history) make some people more likely to develop PTSD.

biological

What are the Symptoms of PTSD?

• Onset: Usually begin within 3 months of the traumatic event but may emerge later.

• Duration: Symptoms must last more than 1 month and interfere with daily life (relationships, work).

• Cause: Symptoms should not be caused by medication, substance use, or illness.

• Recovery: Some recover within 6 months; others may have symptoms for a year or longer.

Symptoms of PTSD and Co-occurring Conditions

• Co-occurring Conditions: PTSD often occurs with depression, substance use, or anxiety disorders.

• Detachment: After trauma, it's common to feel detached, as though observing the event.

• Diagnosis: A psychiatrist, psychologist, or clinical social worker can assess if symptoms meet PTSD criteria.

Criteria for PTSD Diagnosis

• Symptoms must last at least 1 month and include:

  • At least 1 re-experiencing symptom

  • At least 1 avoidance symptom

  • At least 2 arousal and reactivity symptoms

  • At least 2 cognition and mood symptoms

Re-experiencing Symptoms (PTSD)

• Flashbacks: Reliving the traumatic event (physical symptoms like a racing heart or sweating).

• Reoccurring Memories or Dreams: Related to the event.

• Distressing Thoughts: Triggered by reminders.

• Physical Stress Signs: When recalling the trauma.

• Triggers: Words, objects, or situations can cause these symptoms.

Avoidance Symptoms (PTSD)

• Avoiding: Places, events, or objects that remind of the trauma.

• Avoiding Thoughts/Feelings: Related to the event.

• Changes in Routine: For example, avoiding driving after a car accident.

Arousal and Reactivity Symptoms (PTSD)

• Startled Easily: Feeling tense, on edge, or on guard.

• Difficulty: Concentrating, falling asleep, or staying asleep.

• Irritability: Angry or aggressive outbursts.

• Risky Behavior: Engaging in reckless or destructive activities.

• Interference: With daily life (sleep, eating, concentration).

Cognition and Mood Symptoms (PTSD)

• Memory Issues: Trouble recalling key aspects of the event.

• Negative Thoughts: About oneself or the world.

• Blame: Distorted thoughts leading to self-blame.

• Ongoing Negative Emotions: Fear, anger, guilt, shame.

• Loss of Interest: In previous activities.

• Social Isolation: Feeling detached from friends or family.

• Difficulty Feeling Positive Emotions: Such as happiness or satisfaction.

Not Everyone Develops PTSD

Many factors influence this, some before, during, and after the trauma.

Risk Factors for developing PTSD

• Exposure to "little t" or "big T" traumas.

• Developmental Trauma: Childhood trauma.

• Intense Emotions: Feeling horror, helplessness, or extreme fear.

• Lack of Social Support: After the event.

• Additional Stress: Loss of a loved one, injury, job, or home.

• History of Mental Illness or Substance Use: Personal or family history (epigenetics).

Resilience Factors

• May reduce the likelihood of developing PTSD:

  • Social Support: Seeking help from friends, family, or support groups.

  • Self-Acceptance: Feeling okay with your response to the trauma.

  • Coping Strategies: For dealing with and learning from the event.

  • Preparedness: Responding to upsetting events, despite feeling fear.

Key Treatments for PTSD

• Psychotherapy: Talk therapy addressing emotions, thoughts, and behaviors.

• Somatic Therapy: Body-based therapy focusing on trauma held in the body.

• Medication: Often antidepressants, especially SSRIs.

Personalized Care

An experienced mental health professional tailors treatment to symptoms and needs.

Complex Cases

Those living with ongoing trauma (e.g., abusive relationships) need treatment that addresses both the situation and PTSD symptoms.

Co-occurring Conditions:

PTSD often overlaps with panic disorder, depression, substance use, or suicidal thoughts, which also need treatment.

Psychotherapy for PTSD

• Goal: Identify and change troubling emotions, thoughts, and behaviors.

• Types: Individual or group sessions, lasting 12-24 weeks or more.

• Focus: Some therapies target PTSD symptoms directly; others address social, family, or job issues.

Effective Therapies for PTSD

• EFT: Emotion-Focused Therapy.

• DBT: Dialectical Behavior Therapy.

• EMDR: Eye Movement Desensitization and Reprocessing.

• CPT: Cognitive Processing Therapy.

• Psychedelic-Assisted Therapy: Emerging treatment option.

Somatic Therapy for PTSD

• Body-Focused Approach: Based on the idea that trauma manifests physiologically.

• Somatic Experiences: Focuses on body sensations rather than just cognitive or emotional symptoms.

• Developed by: Dr. Peter Levine.

Medications for PTSD

• SSRIs: Selective serotonin reuptake inhibitors (antidepressants) commonly prescribed for PTSD.

• Benefits: Help reduce sadness, worry, anger, and emotional numbness.

• Other Medications: Can address specific symptoms like sleep problems and nightmares.

• Psychedelics: A promising new avenue for PTSD treatment.

Complex PTSD (C-PTSD)

• Definition: Arises from prolonged or repeated traumatic events, such as childhood abuse, torture, or domestic violence.

• Symptoms: Includes all PTSD symptoms plus:

  • Difficulty regulating emotions.

  • Negative self-image (shame, guilt, feelings of worthlessness).

  • Difficulty forming and maintaining close relationships.