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1 Hardwired for Connection, Healing, Resiliency & Hope: A Trauma Treatment Framework Presented by: Mary U. Vicario, LPCC-S St. Aloysius Orphanage Finding.

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Presentation on theme: "1 Hardwired for Connection, Healing, Resiliency & Hope: A Trauma Treatment Framework Presented by: Mary U. Vicario, LPCC-S St. Aloysius Orphanage Finding."— Presentation transcript:

1 1 Hardwired for Connection, Healing, Resiliency & Hope: A Trauma Treatment Framework Presented by: Mary U. Vicario, LPCC-S St. Aloysius Orphanage Finding Hope Consulting, LLC

2 2 The Impact of Trauma on Brain Development, Attachment & Developmental Milestones All behavior is purposeful Sigmund Freud Strategies for disconnection are an intense yearning for connection in an atmosphere of fear Maureen Walker

3 3 3 The Importance of Relationships Human development is dependent on relational connection for:  Access to resources  Life –beliefs are developed through early relationships  Developmental milestones  Brain development are embedded in relational experiences

4 4 4 The Significance of Relationships to Human Development  Emotional Development begins chemically in the brain at six months gestation (Schupp, 2004)  The ability to trust, and the brain chemistry connected with it, begin at one month of age.

5 5 5 Human Brain Development and Relationships Humans are the only mammals for whom:  The whites of the eyes are clearly visible  50% of brain development occurs after birth. (Experience-Dependent Maturation of Neuronal Systems) (Putnam, 2004)  Synaptogenesis: The birth of the connectors (synapses) that are needed for brain development increases dramatically after birth and are dependent upon environment-stimulated activity


7 Relational Revolution Amy Banks, MD & Mary Vicario, LPCC-S7 7

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9 9 9 Brain Growth & Interaction Why the loss of connections? Repeated use of specific connections strengthens those connections Connections that are not used atrophy; they are pruned away The brain “grows itself” from and for whatever environment it experiences (Rintoul, 1999) “What fires together wires together and what is wired together fires together” (Putnam, 2004)

10 10 Experiences which strengthen connections are: (Rintoul, 1999) 1. Frequent, regular, and predictable 2. Occur in the context of a safe, warm, supportive relationship 3. Are associated with positive emotions (fun, humor, excitement, comfort) 4. Involve several senses 5. Are responsive to a child’s needs, interests, or initiative.

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12 12 Growth of the Human Brain from birth to 20 years 7 years

13 13 Human Brain Development & Relationships (Schupp, 2004)  The Cortexes are in charge of planning, organizing and executing action while regulating emotions. It performs the functions of Freud's concept of the Superego  The Limbic System houses our emotions and is loosely similar to Freud's concept of the Ego.  The Brain Stem is our “primitive brain.” It controls the autonomic responses of our parasympathetic nervous system and resembles Freud's concept of the Id.

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15 15 Meet The Cortexes AKA: The King of it All As the Executive Control Center, the Cortexes:  Read non-verbal cues like facial expression, tone of voice, body language & posture. It’s our social navigator  Control Self Regulation = the ability to regulate emotional arousal to accomplish a task or tolerate unpleasant emotional stimuli (mood stability, frustration tolerance, impulse control)  Control Working Memory, Organization, Planning, Problem Solving, Sequencing

16 16 Cortex Development (Forbes & Post, 2006)  It is developed by connecting the facial expression of the caregiver with what the infant is feeling at the time which because of Mirror Neurons will mirror the caregivers feelings.  Pleasurable sensations develop on one type of nerve fibers and painful emotions develop another type. (Social Pain Overlap Theory or SPOT Theory)  It is not fully developed until 25 years of age. It is the reason adolescences does not end until age 25  It also can be “influenced” throughout the lifespan (Neuroplasticity)

17 17 Welcome To The Limbic System (Schupp, 2004) The Amygdala:  Houses emotional memory  Identifies threat  Sets into motion fight or flight response  Decides between the need for aggression (fight) from fear (flight)  Starts developing at 6 months gestation & continues until 18 months of age. The Hippocampus:  Tracks memory & time  Controls consciousness  Maintains identity  Maintains Circadian Rhythms to regulate sleep, appetite, digestion, blood pressure  Self Sooths & regulates emotions  Calms the Amygdala by accessing short term memory (in the cortex)

18 18 Welcome to the Brainstem The brainstem controls bodily functions: Arousal Bladder Bowl Digestion Perspiration Breathing Startle responses (Things you should not need to think about)

19 19 Brain Development (Rintoul, 1999)  The Cortexes should be the largest part of the brain  The Limbic system the next in size  The Brain stem should be the smallest  Their influence on functioning should be in a ratio that resembles an upside down pyramid. (Perry, 1993)

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21 21 Brain Chemistry & Trauma When the amygdala discerns there is a life threatening event, it signals the hypothalamus which releases epinephrine, norepinephrine & cortisol to prepare the body to fight or flee  These chemicals are so strong that repeated exposure to them damages the brain. (Schupp, 2004)

22 22 Brain Chemistry & Trauma Over time with repeated release of fight or flight chemicals (Schupp, 2004) The cortexes ability to plan, organ and execute action while regulating emotions is damaged. The amygdala is damaged & no longer accurately recognizes danger The hippocampus no longer effectively tracks memory, controls consciousness, identity or circadian rhythms The brainstem misfires causing enuresis, encopresis, digestive issues, impulsive aggression from an over active startle response

23 23 What Do You See? When the cortexes no longer effectively: 1. plan 2. organize 3. execute action 4. regulate emotions

24 24 What Do You See? When the amygdala is no longer accurately 1. recognizes danger 2. responds to danger 3. Self soothes When the hippocampus no longer effectively 1. tracks memory 1. controls consciousness 2. maintains identity 3. Regulates sleep & appetite

25 25 What Do You See? When the Brainstem misfires autonomic responses (things you do not think about) like: Arousal Bladder Bowl Digestion Perspiration Breathing Startle responses

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29 29 Clients with PTSD will need help with:  Transitions AKA Shifting cognitive set = The ability to shift from one mind-set to another.  Requires the coordination of the Amygdala and the Cortex  Since trauma causes a transition from safety to danger all transitions become associated with danger  Problem Solving = the ability to organize a coherent plan  The amygdala can interfere with this when it sets off the flight or fight response  The flight or fight chemicals released by the amygdala (corticosteroids) damage the cortex which is needed to plan for transitions & problem solve.

30 Interventions Transitions: 5 – 10 minute warning using a timer that shows the time passing with color not sound Visual Schedules Replace “No & Stop” with “Yes you can (when) & “Pause” “Hold that thought” Problem Solving: “Bored” box Homework/Chore/ Play Cards the child can organize in any order they want. Red, (Orange) Yellow, Green cards to indicate need for assistance Red & Green snack cards

31 31 Violence in Children’s Lives By The Percent of Children Exposed in the United States per Year (US Dept. of Health and Human Services, 1997 & 2010) 1997  Exposure to domestic violence – 5 to 16%  Violent crime victimization – 5.6%  Physical Abuse – 1.2%  Sexual Abuse – 0.12%  Victim of bullying at school – 7.9%  Teen suicide attempt – 8.8%  Fighting with peers – 33.2% 2010  Physical Abuse - 0.16%  Sexual Abuse -.08 %

32 32 Violence in Children’s Lives  According to Schupp (2004) 40 million women in the United States reported sexual abuse prior to the age of 18 which is equal to one out of three girls which = 33%  The statistic for boys has reached one out of five which = 20%

33 33 Additional Factors ( Additional Traumatic Factors (Adapted from: Pynoos, Steinberg, Goenjian, 1996)  Exposure to direct life threat  Injury to self – extent of physical pain  Witnessing of mutilating injury/grotesque death (especially to family or friends)  Hearing unanswered screams or cries of distress  Being trapped or helpless  Unexpectedness or duration of the experience  Number and nature of threats during episode  Degree of violation of physical integrity of child  Degree of brutality and malevolence

34 34 Resulting Belief Systems from Trauma Attachment  Abuse destroys trust  Instills a feeling of hopelessness  Jeckle and Hyde themes  Connection is dangerous.  We are all in this alone. Why children hold themselves responsible  Overwhelming feelings, especially shame, influence development  Cannot face reality of vulnerability to malevolent caregivers  Limitations of Pre- operational thought

35 35 Trauma Induced & Co-occurring Disorders Everything an abused child does after the abuse is designed to give them a sense of safety Eliana Gil Eliana Gil

36 36 PTSD vs. Complex PTSD (Herman, 1992) PTSD = Perceived life threatening situation with intense fear response Intrusive, avoidant, and hyper-arousal symptoms present Complex PTSD = A history of prolonged or repeated totalitarian control with resulting Alterations in  Affect regulation  Consciousness  Self perception  Perceptions of the perpetrator  Relations with others  Systems of meaning

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40 40 The Cycle of Abuse  Bonding with the Aggressor AKA The Stockholm Syndrome (Rawlings & Carter, 1977)  The Impact of Defenses ( Denial, Dissociation, Minimizing, Manipulation)  Partnering with or becoming an abuser

41 41 Child Abuse & School Problems (Dawud-Noursi, Lamb & Sternberg, 1998)  Greater than 50% of abused children have significant school problems (including conduct problems)  Greater than 25% of abused children require special education programs  Several studies suggest CAN decreases IQ  CAN victims 2 X's more likely to be unemployed as adults

42 42 Trauma-Related Psychopathology (Rossman et al, 2000) Affect dysregulation (depression, mood swings, panic attacks, affect liability)  Use and abuse of substances to regulate mood, sense of self, and behavior  A History of Child Abuse or Neglect is the single best predictor of alcohol or other substance abuse in women  Attentional problems (ADHD Symptoms, impulsivity, hypervigilence)

43 43 The Effects of Fear on Behavior  What the search for safety can look like?  How to use it to promote healing?

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45 45 Biologically Based Fear Responses (Forbes & Post, 2007) 1. Manipulating 2. Lying 3. Stealing 4. Hording 5. Aggression 6. Defiance/”Button Pushing” 7. Poor Eye Contact 8. Food issues 1. Gorging 2. Starving 3. Purging 9. Sleep issues 10. Enuresis 11. Encopresis 12. Self harm

46 46 The Top 5 Things to Remember When Addressing Biologically Based Fear Responses 5. Irritation Equals Fear (Forbes & Post, 2007) 4. All behavior is purposeful (Sigmund Freud) 3. Everything an abused child does after the abuse is designed to give them a sense of safety (Gil, 1991) 2. Connect Limits with safety (Use the Phrase that Pays) 1. The one whose amygdala is calm wins! (Forbes & Post, 2007)

47 47 Manipulation (The Consolation Prize of the Disenfranchised)  Is nothing more than a survival skill learned by those who do not have direct access to the resources they need to survive.  To address manipulation, teach clients to: directly seek what they need when it is safe to do so and teach the significant others in their lives to respond directly.

48 48 The Safety Script: “ This is a safe place, and I won’t let anyone _________ you, so I can’t let you ____________ because this is a safe place.”

49 49 Lying is Learned When Reality is not allowed to be real The truth is what you need it to be to get the job done

50 50 Interventions for Lying Identify their goal – their perceived need for the lie. 1. To Avoid Punishment? 2. To access a perceived need? 3. To solve a problem

51 51 Kitchen Set & Toy Food Food = Love (AKA Nurturance)  Neglect will be acted out through stealing and /or hording of food  Sexual Abuse will be acted out on food  They will use food to have a sense of power  Cooking, in play or at home, with a parent is very healing

52 52 Interventions for Food Issues 1. Discuss favorite foods 2. Plan menus 3. Have caregiver or positive person do steps 1 & 2 and go shopping for the food with client 4. Make placemats 5. Identify what they would like to talk about over dinner 6. Prepare & enjoy a meal together 7. Plan ways to have weekly if not daily meals with positive people (Resilience factors 1 & 2) 8. Plan birthday parties or other celebrations

53 53 Interventions for Sleep Issues & Nocturnal Enuresis Before Bed: 1. Identify daily successes 2. Rewrite unpleasant parts of the day 3. Identify one challenge from the day 4. Make plans for the challenge 5. Write dreams 6. Remind child they can rewrite dreams while having them

54 54 Interventions for Oppositional-Defiance 1. Give a 5 minute warning for transitions 2. Connect the request/limit with safety 3. Use descriptive vs. evaluative directions 4. Give space (physical & emotional) for compliance 5. Pay it forward - Tell them what you know they are going to do (that is positive) 6. Use a Success Calendar to record daily something they did to accomplish something in a positive way, made the world a better place, helped someone, etc. 7. Use Descriptive instead of Evaluative praise

55 55 To tone down your buttons ask yourself: 1. Identify your implicit memories 2. Who did this to me when I was the client’s age or lately? 3. What do I expect and how did that come to be my expectation? (It’s most helpful to do this in advance of the stressor by making it a regular part of your day)

56 56 The Three R’s of Trauma Treatment The one whose amygdala is calm wins! Heather Forbes

57 57 The Three R’S of Trauma Recovery Re-experience: When the client is able to 1. processes the trauma in a realistic way experiencing whatever levels of pain, anger, loss, or other emotions are elicited by a CLEAR MEMORY (perceives the event accurately and in detail) of the event 2. Does not feel irrationally responsible for having caused the event.

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60 60 Emphasize for clients the healing power of their words  “ What you share, you can bear.” (Siegel, 2004)  “The more times you tell the story, the more power you have over it and the less power it has over you.” (Vicario)

61 61 Release: The client is able to: 1. Understand that the experience occurred in the past and does not see or react to the experience as a clear and recurring danger in the present. (This is the cognitive part of self- regulation) 2. No longer feels devastated by the memory of the event (This is the emotional part of self- regulation)

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63 63 Reorganize: The client is able to: 1. Live their life without feeling compelled to relive or repeat the traumatic event either consciously or unconsciously. 2. Define their life without the trauma being the central organizing piece of who they are and how they live their life; consciously, unconsciously, and chemically.

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65 65 Posttraumatic Growth (PTG)  PTG refers to a growth process by which survivors are profoundly affected by the traumatic experience in a way that transforms.  PTG refers to positive changes that go beyond effective coping and adjustment in the face of adversity; movement beyond pre-trauma levels of adaptation.

66 66 The Top Five Resilience Factors PTSD is a disorder of hope Bessel van der Kolk What a better way to experience hope than to help others Judith Jordan

67 67 The Top 5 Resilience Factors 5. Autonomy (Agency): When do you feel in control? How do you define power and control? How do you make things happen? How do you help others, make the world a better place, contribute to the interdependent web of life?

68 68 The Top 5 Resilience Factors 4. Self Esteem A. Sense of Self – Personal Preferences likes &dislikes B. Sense of Self – Worth When do I feel loved and valued? How do I show others they’re loved and valued? How do I give and receive The Five Good Things? C. Sense of Self-efficacy – How do I affect change in a positive way? How do I make things happen for the greater good?

69 69 The 5 Components of Mutually Enhancing Relationships Jean Baker Miller (1976) calls these the “Five Good Things” that result from “growth fostering mutually enhancing relationships.” 1. Zest 2. Clarity 3. Increased sense of worth 4. Creativity/Productivity 5. Desire for more connection

70 70 The Top 5 Resilience Factors 3. External Support Systems Friends Pets Extended Family Neighbors People at Church Even Positive Fantasy

71 71 What was Michael Jackson’s First solo #1 hit song?

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73 73 The Top 5 Resilience Factors 2. Affiliation (with a cohesive supportive group that works together toward a positive goal)  System of Meaning (Rochelle Dalla, 2006)  Meaningful Work  Church Group  SPARK (Lyn Mikel Brown’s work)  Games for Change  Volunteer Work  Scouts  Sports  4 H

74 74 The Top 5 Resilience Factors Positive Experiences with positive adults, especially people in positions of authority

75 75 Top Five Resilience Factors The Top 5 Resilience Factors 5. Autonomy (What do I have control over and how to make things happen?) 4. Self Esteem Sense of Self – Personal Preferences (likes & dislikes) Sense of Self Worth – How do I give & receive love and value? The Five good things in mutually enhancing relationships 1. Zest 2. Clarity 3. Increased sense of worth 4. Creativity/Productivity 5. Desire for more connection Sense of Self-efficacy – How do I affect change – what do I have power and control over – How do I make things happen? 3. External Support Systems (Can be a person, pet, fantasy) 2. Affiliation (with a cohesive supportive group) 1. YOU! Positive Experiences with adults, especially people in positions of authority

76 76 The World is not dangerous because of those who do harm but because of those who look at it without doing anything. Albert Einstein

77 To embrace the power of relationship will change society as well as psychology ~ Jean Baker Miller

78 References Boat, B.W. (2007). “A Toxic Triad: Animal Cruelty, Child Abuse and Domestic Violence,” Child Forensic Interviewer Training, The Childhood Trust, Cincinnati, OH) April 2007. Child Maltreatment 1997: Reports from the States to the National Child Abuse and Neglect Data System. U.S. Department of Health and Human Services, Administration on Children, Youth and Families, 1997. Dalla, R. (2006). You cannot hustle all your life: an exploratory investigation of the exit process among street-level prostituted women. Psychology of Women Quarterly. vol. 30 no. 3. pp. 276-290. Dawud-Noursi,S., Lamb, M.E., Sternberg, K.J. (1998). The relations among domestic violence, peer relationships, and academic performance. IN M. Lewis and C. Feiring (eds.) Family, Risk and Competence. Mahwah, NJ: Lawrence Erlbaum Associates, Inc De Bellis, M., Kenshavah, M., Clark, D., Casey, B.J., Giedd, J.N., Boring, A.M., Frustaci, K., & Ryan, N,D, (1999). Developmental traumatology, part II: Brain development. Biological Psychiatry, 45, 1259-1284.

79 References Forbes, H.T. & Post, B.B. (2006). Beyond Consequences, Logic and Control. Orlando, Fl: Beyond Consequence Institute, LLC. Herman MD, J. L. (1992). Trauma and Recovery, New York: Harper Collins Publishers, Inc. Hudgins, K.M. (2002). Experimental Treatment for PTSD: The Therapeutic Spiral Model. New York: Springer Publishing Company, Inc. Gil, E. (1991).The Healing Power of Play. New York: The Guilford Press. Greene, R.W. & Ablon, J.S. (2005). Treating Explosive Kids. New York: The Guildford Press 79

80 References Miller, J.B. (1976).Toward a New Psychology of Women. Boston, MA: Beacon Press Mounstakas, C.E. (1959). Psychotherapy with Children The Living Relationship. New York: Harper and Row, Publishers, Inc. McCarty, M. (2006). Little Big Minds, New York: Penguin Group Putnam, F. W. (2004). The Impact of Trauma on Children’s Brain Development. Putnam, FW. (2004). Experience Dependent Maturation of Neuronal Systems. Pynoos, R.S., Steinberg, A.M., & Goenjian, A. (1996). Traumatic stress in childhood and adolescence. In Bessel A. van der Kolk, Alexander C., McFarlane, & Lars Weisaeth (Eds.), Traumatic Stress, pp. 331-358. New York: The Guilford Press

81 References Rintoul, B. (2005). Bridging the Social Synapse. Rawlings, E. I. & Carter, D.K. (1977). Psychotherapy For Women. Springfield, Illinois: Charles C. Thomas Publisher. Rossman, B.B.R., Hughes, H.M., & Rosenburg, M.S. (2000). Children and Interparental Violence: The Impact of Exposure. Philadelphia, PA: Brunner/Mazel Schupp, L. J. (2004). Assessing and Treating Trauma and PTSD, Eau Claire, Wisconsin: PESI, LLC Seigel, D & Hartzell, M. (2004). Parenting From the Inside Out. New York: Penguin Group, Inc. Wilens,T.E. (2001). Straight Talk About Psychiatric Medication for Kids. New York: Guilford Press.

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