developmental trauma

what is trauma?

• result of overwhelming stress that exceeds one’s ability to cope

• or overwhelms person resources

• usually, there is enough space to absorb extra stressors

without basic needs, people cannot feel safe

• true

• without basic needs, the threat system stays activated

what do safe attachments allow us to do?

• learn about ourselves

• emotional regulation

• template for healthy relationships

• conflict resolution

what does scaffolding allow us to do?

challenging prior learning in a safe and guided way

there are multiple levels to build social resources

• true

• individual, family, friends, and culture

• each level influences each other

• need to remember that family and friends have their own culture too

during adolescence, you start learning about the needs of other people (mentalising) and understanding risks as well as adult

• true

• starting to learn about the needs of other people: mentalising

• understanding and evaluating risks as well as adults

what are the frontal lobes implicated in?

• planning

• attention

• concentration

• impulse control

• organisation

• mental flexibility

• judgement

• novel problem solving

what is the brain structure that is most sensitive during adolescence?

frontal lobes

what is mentalising?

ability to understand that others have thoughts and feelings that are different to our own

why is attachment important?

attachments early in life are how we develop an understanding of how to be in this world

attachment during our teenage years is the same to early childhood

• false

• attachments during teenage years is different to early childhood

• there is individuation from the home and peer social life

• experimentation in peer, non-home groups

what attachment changes occur from teenagehood to adulthood?

• during teen years, there is a widening of social experiences

• by adulthood, we come to a core sense of self that is more or less consistent between the home and outer social life

social connections are key to mental wellbeing

• true

• social connections, quality in particular, is related to mental wellbeing

• may buffer negative impacts of stressful events

what biopsychosocial factors are affected by trauma?

• biochemistry

• the individual’s psychology

• social context

• environmental context

trauma has impact on a biopsychosocial level

• true

• also has an effect on who you end up associating with: social and environmental

what parts of the brain reduces in activity during threat?

• prefronal cortex: thinking part of the brain

• hippocampus: sorts through facts

what parts of the brain increases in activity during threat?

the amygdala acts as the alarm system and becomes more activated during threat

what are forms of ACEs?

• maltreatment

• violence and coercion

• adjustment

• prejudice

• household or family adversity

• inhumane treatment

• adult responsibilities

• bereavement and survivorship

those with 4+ ACEs experience a myriad of health-harming behaviours, poorer mental and physical health outcomes in adulthood compared to those without

• true

• 2x more likely to binge drink and have a poor diet

• 3x more likely to be a current smoker

• 4x more likely to have low levels of mental wellbeing and life satisfaction

• 5x more likely to have had underage sex

• 6x more likely to have an unplanned pregnancy

• 7x more likely to have been involved in violence

• 11x more likely to have used illicit drugs

• 11x more likely to have been incarcerated

all individuals with 4+ ACEs will suffer detrimental impacts in adulthood

• false

• on a population level, the more things you go through, the more impact you experience

• however on an individual level, some may fare much better: individuals work differently from populations

shame is a form of internal threat

• true

• activates our threat system from the inside

• fear that the worst thing about ourselves will be revealed and no one would want to know us

• stems from the threat of potential rejection from others

what is the window of tolerance?

• a window in which we are able to cognitively and emotionally engage with what is going on around us

• cortisol and adrenaline limits this window → only threat processing becomes available (amygdala)

• hypoarousal shuts down thinking and fact sorting (PFC and hippocampus)

what are the 5 main responses to threat?

• fight

• appease (friend)

• flight/flee

• freeze

• flop

there is a dose-response effect of trauma

• true

• the more trauma, the more the impact it has on your development

what are some ways in which a small window of tolerance can impact your cognition and behaviour?

• attentional bias toward threat

• concentration difficulties

• memory difficulties

• relationship difficulties: people are scary, even safe people

• emotional regulation difficulties: using FAFFF

• impulse control difficulties: better safe than sorry

how do breakdown of resources occur in developmental trauma?

loss of healthy attachment →

fewer opportunities to learn emotional and social competencies →

lack perceived support from the community →

fewer resources to overcome adversity

a loss of healthy attachment leads to a loss of social competence

• true

• after a loss of healthy attachment, there are fewer opportunities to learn emotional and social competencies

fewer emotional and social competence can lead to compensation by developing adaptive coping strategies

• false

• fewer emotional and social competence can lead to lack of perceived support (differences in what they feel is true support vs. the support they are getting)

lack of perceived support from the community leads to fewer resources to overcome adversity

• true

• loss of healthy attachment leads to a cycle as losing perceived support and resources to overcome adversity

a sense of safety can be established even when threat responses predominate

• false

• there is no sense of safety when threat responses predominate

every experience can shape our psychology

• true

• every new experience creates new connections in the brain

• repeated experineces strenghten the connections

• unused connections disappear if not used

what effect does childhood trauma have on the threat system?

hypervigilance or excessive avoidance

what effect does childhood trauma have on the reward system?

less sensitive to rewards over time

what effect does childhood trauma have on the memory system?

• lots of negative memories

• over-generalisation of negative memories → positive ones get pushed out

why is early intervention important for preventing negative outcomes of developmental trauma?

earlier or multiple traumas have a larger impact on our life course compared to later or single event traumas

latent vulnerability

neurocognitive and biological systems adapt to early adverse environments that are adaptive in the short term but increases risk of poor outcomes in the future

what impacts do perceived lack of support from others and fewer personal resources to overcome adversity?

• learning negative things about ourselves

• negative impacts on relationships

• perceived future looks bleak

adversity is common, but becomes traumatic if we feel like we are alone

• true

• perceived lack of social support leads to lowered resouces to cope with effects of early life adversity

how should one approach treating developmental trauma?

• feeling of safety is central to treatment of trauma

• bringing into balance threat, safety, and drive

• understanding what increases sense of safety and decreases sense of threat

trauma informed care has roots in Maslow’s hierarchy of needs

• true

• it is important to establish basic needs before moving onto higher order needs

how should stabilisation be approached in developmentally traumatised individuals?

• work with multiagency colleagues

• aim to increase external and internal safeties

how should addressing distress be approached in developmentally traumatised individuals?

bringing in evidence or practice-based evidence to work with psychological distress

how should moving forward be approached in developmentally traumatised individuals?

asking how would you like to live your life if you weren’t ruled by fear

it is important to think about who is contributing to the sense of threat and safety outside of the individual

• true

• it is also important to consider how family, friends and the wider culture contribute to an individual’s sense of threat and safety

• the sense of threat and safety is impacted by not only the individual’s cognitions and feelings, but also the influences from the environment

if the person is not safe enough, you must swiftly provide support through someone the YP already trusts and direct intervention

• false

• you must establish safety first before moving onto any intervention

if the person is safe enough, move to support the YP through someone they trust and/or directly intervene via TFT and resilience building

• true

• if the person is safe enough, you must move to support the individual using support networks and direct interventions