Trauma Informed Treatment:
Applying Neuroscience
Fairfax, VA
October 18th, 2012
Jan Beauregard, Ph.D., LPC, CSAC
www.ipivirginia.org
(703) 385 9667 Ext. 1
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
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)
Left and Right Brain Functioning
Left Brain
CEO
Left
Problem solver
Analytic
Rational
Conceptual
Task MasterCarries on no matter
what happens
Verbal/narrative
Memory
Right
Right Brain: The
Survival Brain
nonverbal
language
perception of
emotion, facial
expression
sensation
instinctive
survival response
Emotional/Implicit
Sensory memory
i
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
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
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/cgibin/crq/crq.pl
Seigel, 2006 - Mindfulness, mirror neurons
(Bowlby, 1973)
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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
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)
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.
Dr. Alan Schore - Psychiatrist
Affective Regulation in Infancy
www.utube.com/watch?V=MD5MI-EAC10
When Attachments are in Peril:
Education needs to begin before parenting
(Psychoeducation, Adult Attachment Interview)
Treat the whole family – a parent’s
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
Still Face Experiment: Tronick
(Utube: www.utube.com/watch?v=apzxGEbZht0)
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
Teaching Tools:
Ainsworth, Mary : A Strange Situation
www.utube.com/watch?V=QTsewNrHUHU
Bowlby, John – Father of Attachment Theory
www.utube.com/watch?V= apzxGEbzht0
Porges, Stephan – Affective Neurobiology
www.utube.com/watch?v=Lpu4hKG8WOA
Fisher, J. PsychoeducationalAids for Working
With Psychological Trauma (Flipchart)
DrJJFisher@aol.com
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
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
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 Tolerance”*
Optimal Arousal Zone
Hypoarousal
Ogden and Minton (2000);
Fisher, 2006
*Siegel (1999)
Hypoarousal-Related Symptoms: Flat affect,
numb, feels dead or empty, “not there”
Cognitively dissociated, slowed thinking process
Cognitive schemas focused on hopelessness
Disabled defensive responses, victim identity
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.
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)
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)
Activating and Engaging:
1. Trauma sensitive yoga:
Bellows Breath, pulling
Prana
2. Asanas – Lum, Vum
Rum, Yum, Hum, Om
1. Movement
2. Crosswalks
3. Orienting Response
4. Ball toss
7. Tasper (EMDR) Emerson, Porges, Weintaub)
Sensorimotor Psychotherapy & SE
Sensorimotor Psychotherapy is a body based, bottomup 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
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)
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”
• Louisiana’s 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
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Experiment:
• You will be shown 2 different slides
• Notice the nonverbal cues (sensations,
feelings) that accompany each slide
Sensorimotor Psychotherapy
www.sensorimotorpsychotherapy.org
Pat Ogden – Founder
3 Levels of Training offered Nationally and
Internationally
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
Mindfulness Questions
1. What do you feel in your body right now?
2. Where exactly do you feel that tension?
3. How big is the area of tension?
4. 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?
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-tomeditation-forpeace
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.
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)
User Friendly Language
• “If you’d 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)
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”
Trauma Sensitive Yoga in VA
• Heather Hagaman, MA, RTY-200 Beloved
Yoga, Reston
journeyfortruth@aol.com
Corrinne Krill, MA, RTY-200
Sun and Moon Yoga
Info#heartandsoulyogava.com
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