5 discussion questions

Trauma and the Brain Andraé L. Brown, PhD, LMFT

Why Look at Trauma? • 40 to 60% of youth in foster care have

mental health problems vs. only 20% in the general population.

• Common traumatic experiences: – Abuse and severe neglect – Exposure to domestic violence – Separation from natural family

Why Look at Trauma? (cont.) • One study that looked at trauma in foster

children found PTSD in 64% of sexually abused children, 42% of physically abused children, and 18% of non-abused children.

• Trauma appears to be a chronic problem for these individuals: – PTSD in adults who were in foster care in childhood is

nearly five times higher than in the general population (22% vs. 5%).

– They may not recover from PTSD as well as the general population.

Central Nervous System (CNS) • In order to understand trauma, we need some

understanding of how the brain (and spinal cord) develops and functions. – The CNS is the primary way we process, make sense

of, and respond to threatening situations in the environment.

– The CNS mediates how we experience trauma via our senses (what we see, hear, feel, smell, or taste); how we understand the event (threatening vs. not); and what we do or don’t do in response to the event (fight-flight).

Brain Development • Several important areas of development

are dependent on the brain, including: – Social and emotional development

• Attachment – Cognitive development

• Mental activities such as thinking, language, memory

– Physical development • Growth, puberty, muscle coordination

Brain Development • Basic survival

– Brain stem and spinal cord

– Breathing, heart rate, body temperature, and sleep-wake cycles

• Reflexes and motor coordination – Cerebellum – Sucking, blinking reflexes

Brain Development (cont.) • Emotions and memories

– Limbic system • Complex brain

functions, including reasoning, planning, decision making, language, and behavioral control (develop last) – Cerebral cortex – Development continues

into young adulthood

Brain Development (cont.) • Social and emotional

development – The early caregiver-child

relationship is critical to: • Healthy brain “wiring”

(brain cell connections) • Associated with

emotional competence

Brain Development (cont.) • Social and emotional development

– Early attachments provide a context for children to learn to understand emotions and to learn to regulate them

– Early relationships teach children about: • Themselves à What am I feeling? Can I deal with

problems? Am I a good person? • Others à Can I trust others to help me? • Relationships à Do good experiences come from

being close to others?

Brain Development (cont.) • Social and emotional development

– Caregivers who are sensitive and responsive to their child’s needs tend to have children who develop:

• Better emotional and behavioral control • Better language skills • Better interpersonal skills

The Adolescent Brain • The adolescent brain is

still a work in progress • The frontal lobe is still

developing (prefrontal cortex)

• This is the part of the brain responsible for: – Decision making – Planning ahead – Inhibition – Social understanding

The Adolescent Brain (cont.) • Problems seen in adolescence that result

from an immature frontal lobe (prefrontal cortex): – Making poor and impulsive decisions—not

thinking things through – Significant problems taking other people’s

perspective—being very self-oriented – Risk-taking

The Adolescent Brain (cont.) • What else is going on in there?

– Teens have a “conflict” between social- emotional networks of the brain and cognitive- control networks.

– The social-emotional networks are more active than cognitive-control networks; in the end, feelings often override logic.

Stress Response • We’re all equipped with a natural stress

response mechanism. • “Fight-flight” response:

– Stress causes certain hormones to be released in the body that prepare you to deal with a temporary “threat” (short-term response).

– After the threat has passed, the body goes back to its normal state.

– However, extreme (toxic) stress causes physical and psychological problems (traumatic experiences, constant exposure to stress for long periods of time).

Stress Response (cont.) • Prolonged exposure to stress can lead to:

– Headaches, muscle tension, pain in neck or back

– Upset stomach – Chest pains, rapid heartbeat – Difficulty falling asleep or staying asleep – Fatigue, sluggishness – Loss of appetite or overeating (“comfort

foods”) – Increased illness

Stress Response (cont.) • (continued):

– Poor concentration or focus – Memory problems, being forgetful – Feeling jittery – Irritability – Short temper – Anxiety

What’s Trauma? • Is there a difference between stress

and trauma? – Psychological trauma is a particular type

of stress – Extreme or “toxic” stress

What’s Trauma? (cont.) • Trauma “occurs when a sudden,

unexpected, overwhelming intense emotional blow or a series of blows assaults the person from outside. Traumatic events are external, but they quickly become incorporated into the mind.”

—Dr. Lenore Terr

What’s Trauma? (cont.) • We become traumatized “when both

internal and external resources are inadequate to cope with external threat.”

—Dr. Bessel van der Kolk

What’s Trauma? (cont.) • “It is not the trauma itself that does the

damage. It is how the individual’s mind and body reacts in its own unique way to the traumatic experience in combination with the unique response of the individual’s social group.”

—Dr. Sandra Bloom

Post-Traumatic Stress Disorder (PTSD)

• PTSD is the point at which trauma interferes with someone’s ability to function.

• Diagnosis of PTSD requires: – Exposure to an event that involves death, serious injury, or

the threat of extreme violation to oneself or others – Person experiences intense fear, helplessness or horror

• Other criteria: – Re-experiencing event (e.g., flashbacks, nightmares) – Avoiding anything related to the trauma – Increase in negative thoughts and feelings

Post-Traumatic Stress Disorder (PTSD) (cont.)

• Increased risk for substance/chemical misuse – Marijuana, alcohol, OTC drugs, cleaning products

• Tends to be underdiagnosed – Especially when youth have substance use problems,

very poor attention, act aggressively or violently, or have sexual behavior problems

• There is also a risk of vicarious (secondary) trauma to those working with traumatized persons

Common Traumatic Experiences • Physical, sexual, psychological abuse • Abandonment • Incest • Rape • Domestic violence • Witnessing death or severe injury • Kidnapping, hostage situations • Serious accidents • Shootings in the community • Fires • Natural disasters (e.g., Super-Storm Sandy)

Complex Trauma • Exposure to multiple traumatic events over

a long period of time • Usually beginning in early childhood • Interpersonal in nature • Disrupts development

Early Trauma • How early is “early”?

– In the womb • Intimate partner violence during pregnancy • Remember: Touch and hearing come online

before birth! – During the birth process

• Maternal stress à increased chances of birth complications

– During childhood • Target of violence directly; or exposure to violence

Early Trauma (cont.) • How does early trauma impact older

youth? – Early trauma sets the stage for problems later on. – As the child grows up, he or she attempts to

understand what happened through memories and a search for meaning—and sometimes reenactment.

– Video clip: • First Impressions: Exposure to Violence and a Child’s

Developing Brain • http://www.youtube.com/watch?v=O4zP50tEad0

Traumatized Children and Adolescents

• Behavior control problems – Reenacts traumatic experiences – Poor impulse control – Aggression – Oppositional/defiant – Excessive compliance – Sleep problems (nightmares/terrors) – Eating problems – Substance use problems

Traumatized Children and Adolescents (cont.)

• Emotional regulation problems – Poor emotional control (unable to

manage feelings) – Poor recognition of own feelings

Traumatized Children and Adolescents (cont.)

• Problems with biological and physical functioning – Anxiety – Lack of energy – Pelvic pain – Asthma – Skin problems – Problems with immune system – Bedwetting may begin or get worse

Traumatized Children and Adolescents (cont.)

• Attachment problems – Poor boundaries – Isolates self – Mistrustful – Unable to give or receive affection – Poor recognition of others’ feelings

Traumatized Children and Adolescents (cont.)

• Problems with consciousness – On “high alert” all the time (hypervigilant) – Poor alertness or being “in a fog” – Complains that things don’t seem real; dream-

like state – Memory problems (amnesia episodes)

Traumatized Children and Adolescents (cont.)

• Problems with cognition – Problems with attention – Problems completing tasks – Learning problems – Problems with language – Problems keeping track of time and place

Traumatized Children and Adolescents (cont.)

• Problems with their self-concept – Low self-esteem – Body image problems – Shame and guilt – Feelings of powerlessness or helplessness

Why Do People Respond the Way They Do to Trauma?

Thoughts

BehaviorFeelings

Event

Why Do People Respond the Way They Do to Trauma? (cont.)

Traumatic Event

Thoughts (what you tell yourself)

Feelings/Emotions

Behavior (what you do about it)

Why Do People Respond the Way They Do to Trauma? (cont.)

• So keep in mind that when traumatized youth are triggered: – They tell themselves that they are in danger

(you or the situation becomes the threat). – They may suddenly feel intense anger, terror,

helplessness, or possibly nothing at all (auto- pilot).

– They may go into “survival mode,” which could be severe protest or fighting for their life.

Summary Points • Important points to remember when it

comes to trauma and brain development: – Brain development begins in the womb and

continues until young adulthood (early 20s). – The social environment is crucial for brain

development. – Toxic stress early on, such as trauma, may

have set the stage for what we’re seeing now in the children we serve.