The Neurobiology of Trauma By Matthew Carter, MFT

Acute Trauma versus Developmental Trauma

(The National Child Traumatic Stress Network) A 2003 Survey of 2,200 abused and/or neglected children found that… 77.6% had experienced Multiple-Event or Chronic Trauma 19.2% had experienced a Single Event or Acute Trauma (The National Child Traumatic Stress Network)

Interpersonal Neurobiology …the brain organizes in a ‘use-dependent’ way, mirroring the pattern, quality and quantity of the experiences of the infant. (Perry, ChildTraumaAcademy.org) Experience determines which genes will be expressed and when. (Siegel, The Developing Mind) Neurons are (then) created by (these) genes and sculpted by experience. (Siegel, The Mindful Brain) The physical organization of the brain directly reflects (the child’s) experiences. (Stein, Psychological Trauma and the Developing Brain)

Attachment Attachment directly influences right brain development (Ziegler, Traumatic Experience and the Brain),   (especially) the R- orbital frontal cortex, which is central in affect regulation. The OFC coordinates the activation and balance of the sympathetic and parasympathetic branches of the autonomic nervous system. (Cozolino, The Neuroscience of Psychotherapy) Disorganized attachments lead to severe OFC pruning (and subsequently, difficulties with affect regulation). (Kagen, Rebuilding Attachments) Most symptoms thought of as post-traumatic are, in fact, related to loss of secure attachment. (van der Kolk)

The Neurobiology of Trauma

“Normal” system.

The Neurobiology of Trauma Traumatic and neglectful experiences during childhood cause abnormal organization and function of important neural systems in the brain, compromising the functional capacities mediated by these systems. (Perry, ChildTraumaAcademy.org) Trauma freezes the integrative processes of the brain The brain’s first response to threat is to shut down the frontal cortex. (Perry, The Boy Who Was Raised as a Dog) L-Brain functions are inhibited. (Siegel, The Developing Mind) Heightened threat also results in the inhibition of hippocampal function. (Siegel, The Developing Mind)

“Fast” system.

As a result… (The brain is) not able to contextualize the somatic, sensory, and emotional memories (associated with the traumatic event) within networks of autobiographical memory. (Cozolino, The Neuroscience of Psychotherapy) Trauma is (instead) encoded as abnormal form of memory, encoded as images and sensations. (Herman, Trauma and Recovery) …largely stored in the R and lower brain areas. (Cozolino, The Neuroscience of Psychotherapy)

The Body’s Response to Trauma Adaptive Response REST VIGILANCE FREEZE FLIGHT FIGHT Hyperarousal Continuum RESISTANCE Crying DEFIANCE Tantrums AGGRESSION Dissociative AVOIDANCE COMPLIANCE Robotic/detached DISSOCIATION Fetal Rocking FAINTING Regulating Brain Region NEOCORTEX Cortex CORTEX Limbic LIMBIC Midbrain MIDBRAIN Brainstem BRAINSTEM Autonomic Cognitive Style ABSTRACT CONCRETE EMOTIONAL REACTIVE REFLEXIVE Internal State CALM AROUSAL ALARM FEAR TERROR From Bruce Perry, MD

Regulating Brain Region Adaptive Response REST VIGILANCE FREEZE FLIGHT FIGHT Hyperarousal Continuum RESISTANCE Crying DEFIANCE Tantrums AGGRESSION Dissociative AVOIDANCE COMPLIANCE Robotic/detached DISSOCIATION Fetal Rocking FAINTING Regulating Brain Region NEOCORTEX Cortex CORTEX Limbic LIMBIC Midbrain MIDBRAIN Brainstem BRAINSTEM Autonomic Cognitive Style ABSTRACT CONCRETE EMOTIONAL REACTIVE REFLEXIVE Internal State CALM AROUSAL ALARM FEAR TERROR

Regulating Brain Region Adaptive Response REST VIGILANCE FREEZE FLIGHT FIGHT Hyperarousal Continuum RESISTANCE Crying DEFIANCE Tantrums AGGRESSION Dissociative AVOIDANCE COMPLIANCE Robotic/detached DISSOCIATION Fetal Rocking FAINTING Regulating Brain Region NEOCORTEX Cortex CORTEX Limbic LIMBIC Midbrain MIDBRAIN Brainstem BRAINSTEM Autonomic Cognitive Style ABSTRACT CONCRETE EMOTIONAL REACTIVE REFLEXIVE Internal State CALM AROUSAL ALARM FEAR TERROR

Regulating Brain Region Adaptive Response REST VIGILANCE FREEZE FLIGHT FIGHT Hyperarousal Continuum RESISTANCE Crying DEFIANCE Tantrums AGGRESSION Dissociative AVOIDANCE COMPLIANCE Robotic/detached DISSOCIATION Fetal Rocking FAINTING Regulating Brain Region NEOCORTEX Cortex CORTEX Limbic LIMBIC Midbrain MIDBRAIN Brainstem BRAINSTEM Autonomic Cognitive Style ABSTRACT CONCRETE EMOTIONAL REACTIVE REFLEXIVE Internal State CALM AROUSAL ALARM FEAR TERROR

Regulating Brain Region Adaptive Response REST VIGILANCE FREEZE FLIGHT FIGHT Hyperarousal Continuum RESISTANCE Crying DEFIANCE Tantrums AGGRESSION Dissociative AVOIDANCE COMPLIANCE Robotic/detached DISSOCIATION Fetal Rocking FAINTING Regulating Brain Region NEOCORTEX Cortex CORTEX Limbic LIMBIC Midbrain MIDBRAIN Brainstem BRAINSTEM Autonomic Cognitive Style ABSTRACT CONCRETE EMOTIONAL REACTIVE REFLEXIVE Internal State CALM AROUSAL ALARM FEAR TERROR

The After Effects of Trauma (Since) brain states that “work” (are) reinforced and strengthened, (Siegel, The Developing Mind) The defense that the child used to keep her safe during and after the trauma will thus be reinforced and likely utilized again. (van der Kolk, Traumatic Stress)

Regulating Brain Region Adaptive Response REST VIGILANCE FREEZE FLIGHT FIGHT Hyperarousal Continuum RESISTANCE Crying DEFIANCE Tantrums AGGRESSION Dissociative AVOIDANCE COMPLIANCE Robotic/detached DISSOCIATION Fetal Rocking FAINTING Regulating Brain Region NEOCORTEX Cortex CORTEX Limbic LIMBIC Midbrain MIDBRAIN Brainstem BRAINSTEM Autonomic Cognitive Style ABSTRACT CONCRETE EMOTIONAL REACTIVE REFLEXIVE Internal State CALM AROUSAL ALARM FEAR TERROR “Behavioral symptoms are the diagnostic indicator of how trauma has impacted the mental and emotional processes of the child.” (Ziegler, Traumatic Experience and the Brain)

Dysregulation In an effort to predict and control future trauma, the brain/nervous system raises it’s baseline level of arousal (to match the level of perceived threat) and remains hypersensitive to any stimulus that might even vaguely resemble the original trauma.

Regulating Brain Region Adaptive Response REST VIGILANCE FREEZE FLIGHT FIGHT Hyperarousal Continuum RESISTANCE Crying DEFIANCE Tantrums AGGRESSION Dissociative AVOIDANCE COMPLIANCE Robotic/detached DISSOCIATION Fetal Rocking FAINTING Regulating Brain Region NEOCORTEX Cortex CORTEX Limbic LIMBIC Midbrain MIDBRAIN Brainstem BRAINSTEM Autonomic Cognitive Style ABSTRACT CONCRETE EMOTIONAL REACTIVE REFLEXIVE Internal State CALM AROUSAL ALARM FEAR TERROR Baseline for “normal” child.

Regulating Brain Region Adaptive Response REST VIGILANCE FREEZE FLIGHT FIGHT Hyperarousal Continuum RESISTANCE Crying DEFIANCE Tantrums AGGRESSION Dissociative AVOIDANCE COMPLIANCE Robotic/detached DISSOCIATION Fetal Rocking FAINTING Regulating Brain Region NEOCORTEX Cortex CORTEX Limbic LIMBIC Midbrain MIDBRAIN Brainstem BRAINSTEM Autonomic Cognitive Style ABSTRACT CONCRETE EMOTIONAL REACTIVE REFLEXIVE Internal State CALM AROUSAL ALARM FEAR TERROR Baseline for traumatized child.

Regulating Brain Region Adaptive Response REST VIGILANCE FREEZE FLIGHT FIGHT Hyperarousal Continuum RESISTANCE Crying DEFIANCE Tantrums AGGRESSION Dissociative AVOIDANCE COMPLIANCE Robotic/detached DISSOCIATION Fetal Rocking FAINTING Regulating Brain Region NEOCORTEX Cortex CORTEX Limbic LIMBIC Midbrain MIDBRAIN Brainstem BRAINSTEM Autonomic Cognitive Style ABSTRACT CONCRETE EMOTIONAL REACTIVE REFLEXIVE Internal State CALM AROUSAL ALARM FEAR TERROR Baseline for traumatized child.

Regulating Brain Region Adaptive Response REST VIGILANCE FREEZE FLIGHT FIGHT Hyperarousal Continuum RESISTANCE Crying DEFIANCE Tantrums AGGRESSION Dissociative AVOIDANCE COMPLIANCE Robotic/detached DISSOCIATION Fetal Rocking FAINTING Regulating Brain Region NEOCORTEX Cortex CORTEX Limbic LIMBIC Midbrain MIDBRAIN Brainstem BRAINSTEM Autonomic Cognitive Style ABSTRACT CONCRETE EMOTIONAL REACTIVE REFLEXIVE Internal State CALM AROUSAL ALARM FEAR TERROR Baseline for severely traumatized child.

Regulating Brain Region Adaptive Response REST VIGILANCE FREEZE FLIGHT FIGHT Hyperarousal Continuum RESISTANCE Crying DEFIANCE Tantrums AGGRESSION Dissociative AVOIDANCE COMPLIANCE Robotic/detached DISSOCIATION Fetal Rocking FAINTING Regulating Brain Region NEOCORTEX Cortex CORTEX Limbic LIMBIC Midbrain MIDBRAIN Brainstem BRAINSTEM Autonomic Cognitive Style ABSTRACT CONCRETE EMOTIONAL REACTIVE REFLEXIVE Internal State CALM AROUSAL ALARM FEAR TERROR Baseline for severely traumatized child.

A chronically overactive stress response system… …interferes with the child’s (own) capacity to regulate their arousal levels. (van der Kolk, Traumatic Stress) Which is why traumatized kids often overreact to minor stressors and have trouble calming themselves.

(This) loss of the ability to regulate the intensity of affect is the most far-reaching effect of early traumatic abuse and neglect. (Solomon/Siegel, Healing Trauma)

Treatment “Effective treatment needs to involve…” Learning to tolerate feelings and sensations by increasing the capacity for introception Learning to modulate arousal Engaging in effective action (van der Kolk)

Talk therapy is of little initial value for the traumatized child because the receptive and expressive language regions of the brain required to carry on a conversation are controlled in the neocortex, which is bypassed during traumatic experience. (Ziegler, Traumatic Experience and the Brain) Tx must be in the language of trauma (reliving and picturing rather than narrating and analyzing). (Solomon/Siegel, Healing Trauma) Refrain from “why” questions…(and) interpretations, (which) invite the child to engage the higher brain. (Levine, Trauma Through a Child’s Eyes)

Self-Regulation Establishing safety begins with focusing and restoring control of the body. (Herman, Trauma and Recovery) Key to arousal modulation is “befriending” internal sensations, and gaining awareness of transitory nature of all sensory experience. Teach clients …to become aware of bodily states, and learn techniques for increasing the speed at which clt. can recover from “triggered” states. (Siegel, The Developing Mind)

Teach and Practice… Mindfulness Coping Skills Proper breathing Mindful breathing Body scan Tracking changes Coping Skills Proper breathing Verbalizing their feelings Walking away

Corrective Experiences Parts of the brain cannot be changed if they are not activated. (Perry, ChildTraumaAcademy.org) The client must have opportunities for new experiences that will allow the brain either to break false associations or to decrease the overgeneralization of trauma-related associations (corrective responses).

Traumatized kids need to have physical & sensory experiences to: Unlock their bodies, Activate effective fight/flight Tolerate their sensations, Befriend their inner experiences, Cultivate new action patterns. (van der Kolk)