Presentation on theme: "Will I Ever Be Normal Again"— Presentation transcript:
1Will I Ever Be Normal Again Will I Ever Be Normal Again? How Healthy Attachment Can Reintegrate the Traumatized BrainJoshua Straub, Ph.D.
2objectives Understand the various brain functions affected by trauma Learn strategies utilized in helping clients integrate traumatic experiences with their emotions and beliefsDevelop an effective strategy for helping trauma victims gain attachment security and therefore engage in healthy relationships with their family and God
3a range of disciplines Neurobiology Developmental psychology TraumatologySystems theory
4factors to traumaIdentified risk factors of early adverse life experiencesPeritraumatic dysregulation (hyperarousal and dissociation)Posttraumatic social support difficulties
5The Johns Hopkins’ RESISTANCE, RESILIENCE, RECOVERY An outcome-driven continuum of care Create Resistance Enhance Resiliency Speed Recovery Assessment Assessment Assessment Intervention Intervention Intervention Evaluation Evaluation Evaluation [Kaminsky, et al, (2005) RESISTANCE, RESILIENCE, RECOVERY. In Everly & Parker, Mental Health Aspects of Disaster: Public Health Preparedness and Response. Balto: Johns Hopkins Center for Public Health Preparedness.
6BrainCorpus Callosum – A bundle of nerves that integrates the right and left sidesHypothalamus – Receives information through senses and sends it to other parts of brain for processingHippocampus – Involves memory and encoding new information—controls emotional response by taking senses and sends to other parts that control behaviorFrontal Cortex—functions as the supervisor of all systems
7Prefrontal CortexProblem solving – state a problem, range of solutions, select one, and then monitor how it worksCognitive FlexibilityLanguage Processing—what they want, what they feel, in concise way
8Prefrontal CortexEmotion Regulation – handle emotions in way that can solve problems and accomplish goalsSocial Skills- ability to negotiate and collaborate and stay in problem solving situationBehavioral Control
9exposureType I: short term, unexpected event, limited in duration (i.e. car accident, rape, bank robbery, etc.), leads to typical PTSD with symptoms of intrusion, avoidance, hyperarousal.Those with type I exposure tend to recover more quicklyType I trauma can create a recapitulation of traumatic experiences from early in life.Type II: prolonged events (i.e. Nazi camps, Iraq war, etc.), lead to extreme stress…eventual character problems.
10complex traumaBegins early in development (often within first 5 to 7 years)Involves various forms of traumatic relationship experiences (physical abuse, sexual abuse, family violence, etc.)Most destructive is what is known as “attachment trauma”When attachment trauma occurs repeatedly throughout childhood it sets the stage for a many psychological, emotional, spiritual, and even physical maladies
11dose-response relationship Severity of the trauma, in terms of its intensity, frequency, and duration, is one of the most important determinants of a stressor’s potential to induce subsequent PTSD. Clinical observation and research show a “dose-response” relationship between degree of stress and the likelihood, chronicity, and severity of PTSD symptoms. Specific characteristics of the traumatic stressors are important, such as degree of violence involved and whether sexual victimization occurred.
12traumatic homesEmotionally overwhelmed caregiver. (child cannot achieve a secure base and therefore is in a constant state of hyperarousal)With no secure base the child struggles with developing a healthy sense of self-esteem.Trauma and abuse do not occur every moment of every day, but the threat is always thereChild is faced with a relational paradox (dissociation and other types of unhealthy coping behaviors manifest in this environment)
13traumatic stressorsQualities of intensity, frequency and duration of stressor severityUnpredictability and uncontrollability of the stressorPresence of life threatBodily injuryTragic loss of a significant otherInvolvement with brutality or the grotesqueDegree of violence involved, particularly violence of a criminal natureSexual victimization
14attachment theoryHow relationships shape our brains ability to regulate emotion and learn to participate in close, intimate relationshipsEmotion regulation is the ability to tolerate and manage strong negative emotions and to experience the wide range of positive emotions as wellKey question: Is this world I’m living in a safe or dangerous place?Forms basis for what Bowlby described as Internal Working ModelHow that question is answered tells the brain how to wire itself for safety or danger…once the wiring gets laid down it is setting the baseline emotional toneBaby’s limbic system (sometimes referred to as the emotional brain) is beginning to wire itself for either safety or danger. It is also formulating a network of basic assumptions about self and other…
15core relationship beliefs OtherSelfAre you reliable?Are you accessible?Are you capable?Are you willing?Am I worthy?Am I capable?These core beliefs were programmed into the brain through emotionally charged relationship experiences; the only way the can be modified is in relationship experiences that disconfirm these beliefs.
16internal working models A set of conscious and unconscious rules that organize attachment experiences and act as filters through which an individual interprets relational experiences (Main et al., 1985)Self – AnxietyOthers – Avoidance(Bartholomew & Horowitz, 1991)
17attachment versus close relationships Secure Base – ExplorationSeparation Proximity SeekingSafe HavenLoss GriefHere is where all of this is formulated.
18measuring attachment beliefs SELFPositive View Low AnxietyNegative View High AnxietySECUREComfortable with intimacy and autonomyPREOCCUPIEDPreoccupied with relationships and abandonmentDISMISSINGDownplays intimacy, overly self-reliantFEARFULFearful of intimacy, socially avoidantPositive View Low AvoidanceOTHERNegative View High AvoidanceFigure 1.Bartholomew’s model of self and other
19attachment and feelings Secure AttachmentFull rangeGood controlSelf-soothesShares feelingsOK with others’ feelingsAvoidant AttachmentRestricted affectFocus is on controlUses things to self sootheKeeps feelings buriedDoesn’t share feelingsAmbivalent AttachmentPoor controlCan’t self sootheShares feelings too muchOverwhelmed by others’ feelingsDisorganized AttachmentFull range, but few positive feelingsCan’t self-sootheCan’t really share with othersDissociatesEmotions are gas with a purposeDrives behavior, organizes behaviorAdaptive, God given
20caring for trauma victims Intrusive recollections are why people seek treatmentAffect regulation is at core of treating PTSD and other trauma related symptomsConditioned Emotional Responses (external, internal, and relational events)When traumatic events cannot be appropriately processed people resort toAvoidanceDissociationTension Reduction Behavior:
21tension reduction behavior Becomes addictive (substance abuse, cutting, sexual promiscuity, self harm, etc.)Releases endogenous opiods (body’s equivalent to morphine)Defensive behaviors become overwhelming, not flashbacks themselvesRight side of brain stays in the nowLeft side of brain needs to go back and put story to it
22caring for trauma victims Encouraging hippocampus to activate.Implicit memory to explicit memory which activates left hemisphere and the prefrontal cortex.It’s about the extinction of fear responsesPTSD has been called the “disorder of recovery” by Shalev and BriereThe amygdala enables the encoding of fearThe involvement of the prefrontal cortex has been found to help the majority of individuals recover from acute trauma.
23two core issues Capacity of emotion regulation Ability to mentalize Traumatized people have trouble with what they feel and why they feel that wayThey have psychodynamic conflicts –afraid of intimacy (leads to autonomy and clinginess)The earlier the trauma the more difficulty in skill deficits
24core issuesHow you go about helping clients will be determined by where they are in their skillsMore psychoeducational for secureInsecure don’t know how to know their deficits of intimacy when trying to find a secure base
25systematic desensitization ExposureActivation of EmotionDisparity—nonreinforcement of CER (feared outcome)Counterconditioning—get them to relax in event (safety)Extinction of CER“Avoidance of pain is cause of all neurotic pain” – Jung
26main stages of treatment Pre-treatment assessmentWith attention on diagnosis in the posttraumatic/ dissociative spectrum, safety, and comorbidity (substance abuse, medical illness, eating disorders, and affective disorders)Complete all five axes of the DSMEmphasize current stressors and available resources for use in the development planManaged care options, health care resources, etc.
27main stages of treatment Early stage of safety, education, stabilization, skill- building, and development of the treatment alliancePerhaps most important stageSets foundation for client to functionSkill building (boundaries, safe relationships, assertiveness, self-care, emotional regulation, strategies to contain trauma symptomsMedications?Stress management and exercise
28main stages of treatment Middle stage of trauma processing and resolutionIntegrating traumatic material with associated, but avoided emotionGraduated exposureCognitive processingCognitive restructuringNarrative exposure
29main stages of treatment Late stage of self and relational development and life choiceSelf esteemRelational skillsVocationIntimacy“Survivor mission”