Upload
basil-simon
View
220
Download
2
Tags:
Embed Size (px)
Citation preview
Neurological Impact of Trauma and Attachment:
Implications for Treating Sexual Behavior Problems
Kevin Creeden, M.A. LMHCWhitney Academy
East Freetown, [email protected]
SASH Conference 2009San Diego, CA
Experience of Trauma
1. Developmental stage
2. Temperament
3. Context
4. Response / Support
Perry, 1997
Neurodevelopment and trauma
•Teicher, et al (2002)
Increased limbic iritability
Decrease left hemisphere development
Decrease left/right hemisphere integration
Limited functioning of cerebellar vermis in self-regulation
Hypothalamus: controls appetite, hormones, and sexual behavior
Amygdala:responsible for anxiety, fear and emotions
Neocortex: Site of higher cognitive functions and sensory integration
Cerebellum: seat of motor control and coordination
Hippocampus: crucial to memory and learning facts
Brain stem: responsible for sensory input and physiological responses
Brain Structure Function Impairment
Amygdala fear conditioning; aggressive behavior; triggers fight/flight
Increased arousal, impaired fear conditioning
Hippocampus Retrieval of verbal and emotional memory
Memory impairment, especially verbal memory
Left hemisphere Regulate analytical responses; mediate emotional responses; language processing
Difficulties in accurate, effective reading of situation; language processing
Corpus Collosum Communication and integration between hemispheres
Poor integration and modulation of responses to daily interactions
Cerebellar Vermis Production and release of neuro-transmitters
Problems regulating physical activity, attention, emotions
Prefrontal cortex Center for executive functions Poor organization, rigid problem solving; increased impulsivity
Domains of Impairment: Complex Trauma
I. Attachment
Distrust
Social isolation
Attunement difficulties
Boundary problems
Problems with perspective taking
Cook, Spinnazzola, et al (2005)
Attachment Theory
•Assumption: maintenance of proximity to a secure and trusted figure is needed and sought by humans throughout the lifespan and particularly during periods of perceived danger or stress
•Behaviors related to attachment seek to both engage and maintain proximity
•Goal: safety and affiliation
Attachment and Neurobiology
•Emotion operates as a central organizing process within the brain (Seigel, 1999)
•Emotional responses to caregivers must play a crucial role in the regulation of early brain development (Trevarthen & Aitken 2001)
•The development of the pre-frontal cortex depends upon relationship based experiences that become aggregated into the internal working model of attachment
(Balbernie, 2001)
•The orbitofrontal cortex acts in the highest level of control of behavior, especially in relation to emotion.
(Schore, 2003)
•The pre-frontal cortex is a convergence area that receives multimodal visual, auditory, and tactile input from the external/social environment along with subcortical information from the internal environment
(Schore, 2003)
•Persistent stressors in the first two years of life prune neural connections in the pre-frontal cortex and inhibit effective regulation of arousal
II. Biology
Sensorimotor problems
Somatization
Analgesia
Increased medical problems
III. Affect Regulation
Poor emotional self-regulation
Problems labeling and expressing emotions
Problems recognizing and describing internal states
Problems communicating wishes and needs
IV. Dissociation
Distinct alterations in states of consciousness
Amnesia
Depersonalization
Impaired memory for emotionally based events
V. Behavioral Control
Poor modulation of impulses Self-destructive behavior Aggression towards others Pathological self-soothing Sleep difficulties Eating disorders Substance abuse Excessive compliance Difficulty complying with rules Reenactment of trauma behavior
VI. Cognition
Executive functioning problems Lack of sustained curiosity Problems processing novel information Problems w/object constancy Problems understanding responsibility Problems w/ language development
VII. Self-Concept
Lack of continuous, predictable sense of self
Poor sense of separateness
Disturbances of body image
Low self – esteem
Shame and guilt
Resiliency Factors
1. Positive attachment to emotionally supportive and competent adults
2. Development of self-regulation and cognitive abilities
3. Positive self- concept
4. Motivation to act effectively
Informing Practice
•Assessment protocols should examine:
Current Trauma Symptoms: Trauma Symptom Checklist for Children (TSCC)
Executive functioning skills: Wisconsin Card Sort; Tower of London
Auditory Processing skills: SCAN:A
Assessment cont’d
Visual Organization and Processing: Bender-Gestalt Test; Rey Complex Figure Test
Memory: Weschler Memory Scales
Informing Practice
Availability of Occupational Therapy evaluations especially around sensory integration and self-regulation
Greater focus on multi-modal learning
Primary Treatment Issues
1. Establishing safety and predictabiltiy
2. Deconditioning and decreasing anxiety and arousal levels
3. Altering the way victims view themselves and their world
(Van der Kolk, et al, 1996)
Self-actualization
Artistic needs
Cognitive needs
Self-esteem
Belonging
Safety Needs
Physical Needs
Maslow’s Hierarchy of Needs
Trauma Interventions• Stabilization, deconditioning,
relationships can be re-framed as “containment”
att
ach
men
t
structure
self
-reg
ula
tion
WORKING ON TRAUMA
thinking, feeling, and talking about trauma
Allen, 2001
Treatment: Brain Based
•Different individuals have different styles of learning
•Certain brain processes will enhance or inhibit learning at different times
•Multi-modal (multiple pathway) learning will increase understanding and recall
Treatment: Brain Based
• Pre-exposure (education) increases learning and motivation
• You need the opportunity to practice what you learn in order to integrate
• Threat and stress (distress) minimize learning and creative thinking
•Integration of affect and cognition a primary goal
•Interventions can help to re-create or alter attachment experiences
•Consideration given to stimulating particular neural pathways
•Persistent attention to monitoring arousal level and learning skills to regulate