Treatment and Recovery

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Plan for today

Neurological impact of trauma

Sequalae
Co-regulation/attachment
Principles of Treatment
Interventions

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Stress and the brain

The High Road
Abstract reasoning,
Thalamus:
relay making
center
flexible
decision

Sensory Information

Hypothalamus
The Low Road
Instinctive, rapid
response

Amygdala
Responsible for automatic
Thefunctions
bodys alarm
center
(sleep,
appetite), and
the
Triggers
much of theresponse
stress
fight/flight/freeze
response
Also stores memories of fear

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The Stress Response

3-5 seconds
Elapsed time: 30-60
milliseconds
minutes
Sympathetic-Adreno-Medullary
(SAM) Response
Arousal
Sympathetic
Branch
of the
Initiated
Vigilantby
Appraisal
nerve
transmission
heart rate, breathing,
Autonomic
Nervous
System
(messages
Body
freezes
sent
250mph)
muscle tone
The Sympathetic
is
Hypothalymic-Pituitary
Dumps
Focused
adrenaline/noradrenaline
attention system
Adrenal
the the
bodys
accelerator
into
Rapid
shifts
bloodstream.
inResponse pedal.
(HPA)
Causesresponse
profound
changes
Increased
attention
heartrate,
respiration
Slower
initiated
Cortisol
also
initiates
the by
throughout
theresponse
body.
Parasympathic
Opens
Higher
up
cognitive
bronchii
chemical
signals,
for prolonged
of the
Autonomic
Increased
functions
shut
hearing
down
acuity
danger
(3-5
minutes)
Nervous
System, the
bodys
Dilates
Quick reactions
pupils
if the
Dumps
Cortisol
into
brake
pedal.
Constricts
necessary
blood
flow
bloodstream,
which
.loop,
.to
. signals
Through
a feedback
extremities
(cold
toto
hands),
dilates
the
.Rapidly
. . signals
dump
stored
brainreturn
toliver
shut
off
the stress
bloodflow
normal ifinto
theres
to large
no
muscle
Glucose
thethe
bloodstream
response
when
danger
groups
threat.
passes.
Stops
If theregrowth,
is a threat
inhibits
. . . digestion
Dry mouth, sinking feeling
in stomach

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Trauma & Memory

The High Road
Abstract reasoning,
flexible decision making

Prefrontal Cortex

Amygdala
The Low Road
Instinctive, rapid
response

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The Stress Response

Chronic
HealthHyperarousal
Problems
Emotional problems
HPA dysfunction
Reactive Anger

Immunosuppresion
leads to . . .
Anxiety/fears
Increased
illness
Behavioral
Problems
Frequent
discharge of glucose
Impulsivity
use) leads to . . .
(without
Aggression
Type II
Diabetes
Cognitive
Problems
Inattention/rapid
shifts
in attention
Suppressed
growth
leads
to . . .
Hypervigilance
Development Problems
Problems inblood
executive
functioning
Heightened
pressure
(planning,
leads
to . . . organizing)
Over
time,
intellectual and
Heart
Disease
academic problems

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The Stress Response

Chronic Hypoarousal
Emotional problems
Chronic Dissociation
Depression
Behavioral Problems
Avoidance/Withdrawal
Helplessness

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The Stress Response

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Sequalae of Child Abuse

Physical
ACEs studies

Cognitive
Executive Function
IQ
Academic

Emotional
Axis I Disorders
Interoception

Social
Boundaries

Social support,
engagement
Peer relationships
Empathy
Romantic
Relationships
Victimization

Self
Concept/coherence
Reflective
capacity/insight
Worth

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Self Harm

Early Death

Risk and Outcomes: Connecting the Dots

Ongoing Mental
Health Problems
(Depression, Anxiety,
Anger and Poor
Coping

Unhealthy
Lifestyle

Medical
Problems

Criminality
Substance
Abuse

Peer Problems

Depression
Anxiety
Anger

Negative
Beliefs
-Esteem
-Efficacy
-Others
-Future

Inflexible/
Controlling
Aggression/
Conflict
Withdrawal/
Apathy

Peer
Rejection or
Victimization

Anti-social
peers

Extreme
attachment

Maladaptive
Peer

Problems in
persistence

Relationship
violence

Relationships
Early Sex/
Promiscuity

Classroom
Behavioral
Problems
SelfRegulation
Problems
-Emotions
-Attention

Gangs

Lack of school
engagement

Achievement
Problems,
Lower IQ,

Poor Job
Performance

Early/
Unplanned
Pregnancy

Poor
economic
attainment,
poverty

ACEs Studies

Some of the best studies examining the

effects of childhood trauma are the
Adverse Childhood Experiences
Studies(ACES).
17,000 patients of Kaiser Permanente In
San Diego
The sample is solidly middle-class, 3 out of 4
subjects had college degrees
Despite this, difficulties in childhood are prevalent,
2/3rds had at least on ACE
If they had one ACE, there was an, 87% another
ACE was present

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ACEs Studies
Tracked the following ACES:
Abuse
Emotional recurrent threats, humiliation (11%)
Physical - beating, not spanking (28%)
Contact sexual abuse (28% women, 16% men; 22% overall)

Household dysfunction

Mother treated violently (13%)

Household member was alcoholic or drug user (27%)
Household member was imprisoned (6%)
Household member was chronically depressed, suicidal,
mentally ill, or in Psychiatric hospital (17%)
Not raised by both biological parents (23%)

Neglect
Physical (10%)
Emotional (15%)

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Mental Health
Sleep
disturbances
Hallucinations
Attempted
Suicide

1
2

Depressive
Episode in last
year

Struggle with
Depression
Panic Symptoms
Struggle with
Anxiety
0%

100%

200%

300%

400%

500%

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500%

450%

Problems in affect regulation

400%

350%

300%

250%

4
3
2

200%

1
150%

100%

50%

0%

High levels of stress

Difficulty controlling anger

Risk of perpetraing partner

violence

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1000%

Risky Behavior

900%

800%

700%

600%

500%

4
3
2

400%

1
300%

200%

100%

0%

Alcoholic

Ever used
drugs

Injected
Drugs

50+
Ever STI
First
Intercourse
intercourse
Partners
<15yrs old

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350%

300%

Increased Health Risk

250%

200%

150%

4
3
2

100%

50%

0%

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Trauma Recovery
The High Road
Abstract reasoning,
flexible decision making

Prefrontal Cortex

Amygdala
The Low Road
Instinctive, rapid
response

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ProblemFostering Resilience
solving
skills

Mastery
Motivation

Child
Strengths

Selfregulation
skills

(facilitated in
treatment)

Beliefs that
life has
meaning

Positive
beliefs
about the
self

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