Midterm for Trauma

Congnitive Behavioral Therapy

Safe simulations to desensitize so the can better intergrate trauma into their lives

Drugs

Were found to allow patients to revist trauma, but without the hyperarousal paired up with psychotharapy

What is the risk of using drugs to treat trauma

There is the possibility of misdiagnosis

Benifits of confronting trauma

Gives control and starts the healing process

Self-discovery

Autobiographic (story) and moment to moment

Study with self-discovery

Those who wrote about trauma and their emotions had less doctors visits

Art, music, and dance therapies

Can process feelings in a different way (limits of language); still need responsive community

How to deal with trauma

Need to deal with reality and connect with the body

EMDR

Eye Movement Desensitization and Reprocessing

How does EMDR work?

Bilateral stimulation of the two sides of the brain by focusing on what is happening internally; don’t need to talk or have a relationship with the psychologist

What is EMDR doing

Intergrating and restoring your body to equilibrium

Exploring sleep connection

REM sleep processes memories, duel action, and activates PNS

Annie

Was stuck in fight/flight and she needed to learn how to overcome shock and numbness

Bottom up regulations

Heart Rate Variability

HRV

Controlled by the autonomic system (PNS and SNS); patients with PTSD had reduced HRV (didn’t stabilize after)

Yoga study by Dr. Van der Kolk

Found there were positive results to yoga

Subsequent yoga studies

Supported Dr. Van der Kolk’s findings

Learning self-regulation

It is hard to heal if you can’t notice what you are feeling (need introspection)

Dr. Van der Kolk’s views on yoga

It reestablishes sense of time by allowing one to safely experience the body and helps raise the feeling that there is an end to trauma

Neuroscience

Yoga is good for self-awareness because it activates the medial prefrontal cortex

Learning to communicate

Is good to find a way to communicate the trauma to start healing

Mary

Had Dissociative Identity Disorder in response to trauma (desperate to feel safe/survive)

Internal Family Systems Therapy

We are made up of different parts with may become polarized from trauma; idea is to confront them

Self-leadership

When the core self is able to lead

Mindfulness

Activates the medial prefrontal cortex and decreases the Amygdala response

Trauma

Exposure to disturbing events

Trauma can be

Acute (isolated), chronic (repeated), complex (multipule from an early age)

Impact

Emotional, behavioral, physical, developmental, cognitive, and interpersonal

Long term effects

Physical (injuries), mental (depression), behavioral (substance abuse), and future victimization

PTSD

Chronic vigilance and threat sensitivity, phisiological basis

Trauma/loss of self

Difficult to confront shame of actions or inactions

Numbing reorganizing perception

Provides insight into thoughts process (stuck in trauma) and how trauma can reorganize mind/brain perception

Midnight confessions information

Learned about high levels of stress hormomnes

Pharmalogical revolution

Drugs were being distributed to boost/maintain levels of norepinephrine and dopamine

Learned helplessness

Situations can initiate feelings of helplessness

Addicted to trauma

Some have been observed to repeat a situation to gain control over it (no proof)

Prozac

Help responces by raising seritonin levels (no whole solution; some downsides)

Imaging

PET and fMRI scans can be used to see what happens in the brain when you have flashback and memories

Brocas area

Was decreased in response to flashbacks (can’t vocalize)

Broadman’s area 19

Registers the images and flashbacks

Right vs Left

The right was activated and the analytical left side was decreased

Noam’s reaction

Found a way to process trauma of 9/11

Normal stress response

Flight, fight, freeze, or faun

Mirror neurons

Neocortex and frontal lobes have neurons that mirror other’s reactions and emotions, but this leaves us vunerable

Brain development

Develops bottom up starting with the reptilian brain (brainstem) to the mammalian brain (limbic system) and finally the neocortex (rational brain)

Thalamus

Takes in all the sensory information, shouts down when experiencing trauma

Frontal lobe

Returns body to normal state (regulates amygdla)

Dissasociation

When we relive events our dorsolateral prefrontal cortex collapses (timekeeper)

Darwin

Said that emotion were biological and help/guide behavior (can be stuck)

Pavlov’s

Conditioned response can become extinct (may be useful for trauma)

Sympathetic Nervous System

The “accelerator” that gives you energy for fight/flight

Parasympathetic Nervous System

The “break” that relaxes the body when danger passes

Polyvagal Theory

Vagus nerve (rest/digest)

Fight→vigilant→calm→flight→freeze

Three levels of safety

Social engagement (cortex), flight/fight (mammalian), freeze (reptilian), and the more/better it is running, the better we can assess the situation

Approaches to treatment

Social engagement activated by top down or calm by bottom up

Lacking sense of self (depersonalization)

Need to gain back the self-sensing system and agency with mindfulness

Alexithymia

Not having words for feelings

Befriending

Need to befriend the body and notice feelings and connect with others (mirror neurons and eye contact)

Brain development

We need positive interactions to form connections; negative ones can slow process and affect responses to situations and ability to grow/learn

Secure attachment

Need to bond with caretaker (if you don’t may look for disaster)

Attunement

Being able to respond to other’s needs (mirror caregiver); if have negative attachment might have a hard time interpreting emotions

Attachment styles

Secure- Confident/resilient

Anxious/preoccupied- emotional hunger

Avoidant- isolation/emotional distance

Disorganized- internal conflict, unpredictable

Disorganization

Want internal sense of security, but a lack of security can result in hostility, controlling behaviors, and lack of self regulation

Dissociation

Lacking secure base and trauma can increase dissociation (is learned early)

Terror and numbness

Marilyn’s story (autoimune disease effected her sight because her body became hypersentative)

World view

Can be distorted and one might have to try and learn to remember (flashbacks); many hate their home, but it’s still home

Replaying trauma

Having trouble sleeping or having nightmares

Nightmare theory

Is a way of trying to cope/ work through trauma

Fawning

Trying to please to avoid harm (have a hard time saying no; unconscious survival mechanism)

DSM III

Not perfect (might not encapsulate everything) but there are some benifits (current is DSM 5)

Traumatic Antecedents Questionnaire

Covers ACEs but is a little subjective

Self-harm

Linked to childhood maltreatment

Imprecision of labels

Symptoms my overlap (but different); complex PTSD and dissociative PTSD (similar but complex= WHO and Dissociative= DSM5)

When problems are solutions

Some problamatic behaviors may reveal underlying problem

Childhood abuse

Our nation’s larges public heath problem

Are there bad genes?

There is potential genetic link with PTSD that can be turned on/off (environmental)

Epigenetics

Generational trauma may be passed down

Nature vs Nurture

Early experiences have just as much impact as genes

National Child Traumatic Stress Network

Wanted to improve the standard of care

Power of diagnosis

Can get proper treatment and insurance; developmental trauma disorder was proposed

What is the most important thing for development

Healthy attachment to caregiver

Long-term effects of incest

When woman had to share their experiences, the cortisol levels didn’t increase later (but their biological clocks were sped up)

DSM5

Symptom based diagnosis (overlook issues like DTD)

Benifit of developmental trauma disorder

Would help funding and properly target the root of the problem

Memory and trauma

Memory is not always coherent, but that does not mean it did not happen

Traumatic memory vs normal

Grant study found that those with PTSD had clear/consistent memories but were fragmented

High arousal vs low arousal

High= fragmented story

Low= coherent narrative

Joan’s Story

Identified different parts to access the past (managers and firefighters and exiles)

Managers

Require a lot of energy to control emotion and protect from humiliation

Firefighters

Fight emotions from getting out and bringing out exiles (numbness)

IFS with Rumitoid Arthritis and PTSD

Goal is to accept feelings about diagnosis (RA); were measurable and immeasurable improvements (was promising for both)

Peso Boyden System Psychomotor Therapy

Use different people to create new memories and provide symbolic fulfillment of unmet needs (play the role of father, etc.)

Maria and Mark

Felt validated and safe when exploring the past and were able to experience new sensory and emotional senarios

Electrical circuts of the brain

Slower frontal lobe brain waves in “problem” children

Australian study

Found that slow waves were an indicator orf ADHD and that the frontal lobe activity in troops was similar to ADHD

Neurofeedback

Alpha training for relaxation (led back alpha waves to releave stress; first done with cats then humans)

What can neurofeedback do?

Can change habitual brain patterns because it is similar to mirroring; can help with learning disabilities (abused)

Lisa’s story

Trauma center is using neurofeedback and created new connecting patterns

Brain Waves

Delta- sleep

Theta- edge of sleep

Alpha- mindful meditation

Beta- focused

High beta- anxious

Quantitative EEG

Can show what’s going on in the grain; trauma can lead to hyperactivity and anxiety