Court Specialty Conference - Oklahoma

Court Specialty Conference - Oklahoma

Court Specialty Conference The Primary Destabilizing Factor for the Traumatized Jon Allen PAST TRAUMA afraid & alone SENSITIZED NERVOUS SYSTEM CURRENT STRESS Reminders of trauma, life events, lifestyle UNBEARABLY PAINFUL EMOTIONAL STATES

RETREAT isolation dissociation depression SELF-DESTRUCTIVE ACTIONS substance abuse eating disorders deliberate self-harm suicidal actions DESTRUCTIVE ACTIONS

aggression violence rages Bessel van der Kolk I would say the foundation of all effective treatments involves some way for people to learn that they can change their arousal system. The issue of self-regulation needs to become front and center in the treatment of traumatized people. Thats number one Step twoIts more than tolerating feelings and sensations. Actually, it is more about knowing that you, to some degree, are in charge of your own physiological system

10 5 Window of Tolerance Optimal Arousal Zone 0 Sympathetic Activation.child (or adult) responds with fear, fight, flight states A R O U

S A L Window of Tolerance (no development) Parasympathetic Activationor child (or adult) becomes submissive, checked out, depressed, non-responsive (freeze, dissociative states) Overshooting the Window 10 5

0 Affect Dysregulation----------Hyperarousal (preoccupied & disoriented) No Vegal Brake Sympathetic Dominant 10 5 0 Undershooting the Window

Affect Dysregulation----Hypoarousal (dismissing & disoriented) To much braking Parasympathetic Dominant AFFECT DYSREGULATION All gas no brakessympathetic nervous system dominant AAAA Emotional management can varysadness, disappointment, fear, shame, joy, etc All brake no gasparasympathetic nervous system dominant

Overshooting and Undershooting The Window of Tolerance Hyperarousal: too much arousal too integrate Emotional reactivity Hypervigilance Intrusive imagery Obsessive/cyclical cognitive processing Tension, shaking, ungrounded Window of Tolerance Optimal Arousal Zone

Hypoarousal: too little arousal to integrate Flat affect Inability to think clearly Numbing Collapse (tonic immobility Regulation Self-regulation is an essential organizing principle. the best description of development may come from a careful appreciation of the brains own selforganizing operations. Cicchetti and Tucker 1994 and this self-organization of the developing brain occurs in the context of a

relationship with another brain. Schore, A. (2003) Affect Dysregulation and Disorders of the Self W. W. Norton & Company, Inc. New York, NY The essential task of the first year of human life is the creation of a secure attachment bond of emotional communication between the infant and the primary caregiver. Attachment Status Ainsworth et al. Strange Situation1978 Leeds, A. Strengthening the Self (2002) Santa Rosa, Ca: Andrew Leeds, PhD

Secure majority of infants cry, miss mother during her absence in Strange Situation (SS), are quickly comforted on reunion. Insecure: Avoidant infants show little or no distress during separation from mother in SS, & actively avoid contact on her return. Mothers reject attachment behavior at home. Insecure: Ambivalent- infants are highly distressed during separation, on reunion are not quickly soothed by mothers who are unpredictably available & intrude on exploration. Insecure: Disorganized - result of frightened or frightening parental behavior which may be a result of unresolved parental grief or parental

PTSD (Liotti, 1992). Bowlby Bowlby saw attachment as a behavioral system that is activated by perception of danger and feelings of fear Leaving the attachment system to play a major role in how we cope w/frightening experiences Children are not resilient, children are malleable. Bruce Perry, M.D. The functional capabilities of the mature brain develop throughout life, but the vast majority of critical structural and functional organization takes place in childhood. Indeed, by 3 years of age the brain has

reached 90% of adult size, whereas the body is still only about 18%.Schore, R: Rethinking the Brain: New Insights into Early Development. New York, Families and Work Institute, 1997 70% of our genetic structure is added after birth. Schore, A. N. (1994). Affect regulation and the origin of the self. The neurobiology of emotional Development. Hillsdale, NJ:Erlbaum. SEQUENTIAL NEURODEVELOPMENT Dr. Bruce Perry The brain is underdeveloped at birth

The brain organizes from the bottom up brainstem to cortex and from the inside out Organization and functional capacity of neural systems is sequential Experiences do not have equal valence throughout development Solomon, M. and Siegel, D. (2003) Healing Trauma W.W. Norton & Company, Inc. New York, NY

When the caregivers emotional availability, responsiveness, and reflective capacities are compromised, often as a result of her own trauma and loss, dyadic affective regulation cannot proceed optimally. The more the childs emotions trigger the caregivers fear, shame, helplessness, or guilt, the more (the child) will disengage emotionally. Desperate to maintain and restore the attachment bond, the child resorts to the defense exclusion of whichever emotions produce aversive reactions in the caregiver, regardless of how vital they might be to (the child). The chronic reliance on defenses against emotional experience (used) to compensate forlapses in the caregivers affect-regulatory capacities produces adaptations which are categorized by the attachment classification (these classifi

cations are) affective functional strategiessecure attachment involves the capacity to feel and deal without the need to resort to defense mechanismsthe strategy of dealing by not feeling is avoidant attachment, and the strategy of feeling (and reeling), but not dealing is resistant/ambivalent attachmentwhen even defensive efforts are overwhelmed by disruptive emotionswe (develop) disorganized attachment. The only way both self and relationship can be maintained is through momentary immobility-the (child) can neither feel (dissociation) nor deal (paralysis), Bartholomew (1991) four-Category Model of Adult Attachment Leeds, A. Strengthening the Self (2002) Santa Rosa, Ca: Andrew Leeds, PhD Secure: (secure infant) it is easy for me to become emotionally close to others. I am comfortable depending on others and having others depend on me. I dont worry about being alone or having others not accept me. (50%+)

Dismissing: (avoidant infant)I am comfortable without close emotional relationships. It is very important to me to feel independent and self-sufficient, and I prefer not to depend on others or have others depend on me.(15% -20%) Preoccupied: (ambivalent/anxious infant)I want to be completely emotionally intimate with others, but I often find that others are reluctant to get as close as I would like. I am uncomfortable being without close relationships, but I sometimes worry that others dont value me as much as I value them.(15%) Disoriented or Unresolved Trauma or Grief: (disorganized infant) I am uncomfortable getting close to others. I want emotionally close relationships, but I find it difficult to trust others completely, or to depend on them. I worry that I will be hurt if I allow myself to become too close to others.(5%-15%) Human beings of all ages are found to be at their happiest and to be able to deploy their talents to best advantage when they are confident that,

standing behind them, there are one or more trusted persons who will come to their aid should difficulties arise. John Bowlby, 1973 The Polyvagal HierarchyStephen Porges Ogden, Pat, Minton, Kekhuni, and Pain Clare (2206) Trauma and the Body A Sensorimotor Approach to Psychotherapy. New York, NY: W.W. Norton & Company, Inc. The polyvagal theory describes three hierarchically organized subsystems of the autonomic nervous system that govern our neurobiological responses to environmental stimulation and is an attempt to explain the evolution of affective regulation. 1. ventral parasympathetic branch of the vagus nerve social engagement system (most evolutionarily recent and sophisticated of the subsystems is the ventral vagal complex originates in the nucleus ambiguous in the brainstem, one of the tiny patches of specialized

neurons that make up the reticular activating system). Provides an inhibitory or calming influence on sympathetic arousal. This system allows us to modulate autonomic arousal in a prosocial manner and controls the muscles of our eyes, face, mouth, and inner ear in the service of social communication . 2. sympathetic system mobilization 3. dorsal parasympathic branch of the vagal nerve immobilization; bodily shutdown and depends on parasympathetic processeshumans share this with most other vertebrates. Each of these subsystems corresponds to one of the three arousal zones of the modulation model: The social engagement (vental vagal) system correlates with the optimal arousal zone, the sympathetic system with the hyperaroused zone, and the dorsal vagal system with the hypoaroused zone The Traumatized Brain Threat perception system is enhanced

The filter system becomes dysregulated The self-sensing system gets blunted SOCIAL ENGAGEMENT SYSTEM AT WORK Three Types of Emotion Regulation System Interactions between different types of emotional regulation systems Paul Gilbert, PhD Driven, excited, vitality Content, safe, connected Incentive/resourcefocused Non-Wanting/

Affiliative focused Wanting, pursuing, achieving, consuming Safeness-kindness Activating Soothing Threat-focused Protection and Safe-seeking Activating/inhibiting Anger, anxiety, disgust

Three Types of Emotion Regulation System Interactions between different types of emotional regulation systems Paul Gilbert, PhD Driven, excited, vitality Content, safe, connected SAFE DRIVE THREAT actual or perceived

Anger, anxiety, disgust Three Types of Emotion Regulation System Interactions between different types of emotional regulation systems Paul Gilbert, PhD Driven, excited, vitality Content, safe, connected safe DRIVE DRIVE

THREAT actual or perceived Anger, anxiety, disgust TONING DOWN THE THREAT SYSTEM From The Competitive Mentality From the Caregiving Mentality Self Soothing Dialogues

Self-critical Dialogues Maintains Compassionate imagery SENSE OF CURRENT THREAT Ends actual or perceived

SHAME Compassion Safety TONING DOWN THE THREAT SYSTEM From The Competitive From the Caregiving Mentality Mentality Self Soothing

Dialogues Self-critical Dialogues Maintains SHAME Compassionate imagery SAFETY Ends

Compassion Safety Theres an art to knowing when Never try to guess Toast until it smokes Then 20 seconds less Babette Rothschild Solutions DAILY Disciplines Psychoeducationincludes basic brain knowledge, understanding of emotions, how

emotions present in our bodies, and how we construct meaning Neurofeedback Music (Jana Stanfield) Anchors, healthy distractions (notice in therapy) Visualizations (Belleruth Naparsek) The art of hushing Forgiveness: Understanding Triggers (implicit memories) Self and Others Perceived fear or Actual fear??? Apps:

Breath work Stop, Breath, and Think Mindfulness EMDR Safe relationships My Calm Beat, etc. Animal therapy Tapping Yoga

Narrative Shift Aerobic Body Scan (dose) Nutrition EMDR Journalingfocusing on integration Gratitude Lists (easy does it) Progressive-Counting Massage Compassionate Letters to the Internal Community

Practicing Compassion Container exerciser (Levine) Dance 12 Step Meetings Chanting etc., etc., etc. Richard SchwartzInternal Family Systems Exiles the part of the survivor that was initially hurt and then abandoned Managers tries to manages our relationships, our appearance and our productivity Firefighters go immediately into action to take us away from the pain, shame, and terror

Protective parts Managers and Firefighterswhat they are protecting are the exiles. Training Our Minds in, with and for Compassion. An Introduction to Concepts and Compassion-Focused Exercises Paul Gilbert, et al (2010) Training Our Minds in, with and for Compassion. An Introduction to Concepts and Compassion-Focused Exercises Paul Gilbert, et al (2010) Bremner, J. D. (2002). Does Stress Damage The Brain? New York: W. W. Norton & Company, Inc. Briere, J. (1992). Child Abuse Trauma: Theory and Treatment of the Lasting Effects. Newbury Park, CA: Sage

Briere, J. (1996). Therapy for Adults Molested as Children. Second Edition, Expanded and Revised. New York: Springer Publishing Co. Burdick, D. (2013). MINDFULNESS SKILLS WORKBOOK For Clinicians & Clients. Eau Claire, WI: PESI, Inc. Greenwald, R. (Summer 2015). From the Cutting Edge: Trends in Trauma Practice International Journal of Trauma Research and Practice Volume II, Issue 1 Hanson, R. (2009). the practical neuroscience of Buddhas Brain happiness, love & wisdom. Oakland, CA: New Harbinger Publications, Inc. Frewen, P. and Lanius, R. (2015). Healing the Traumatized Self CONSCIOUSNESS NEUROSCIENCE TREATMENT. New York: W. W. Norton & Company, Inc. Leeds, A. Strengthening the Self (2002) Santa Rosa, Ca: Lee, D. (November 3-5, 2011). Using compassion to Work with Shame Based Flashbacks in PTSD. International Society for Traumatic Stress Studies (ISTSS). Baltimore, Maryland Ogden, P., Minton, K., and Pain, C. (2006). Trauma and the Body A Sensorimotor Approach to

Psychotherapy. New York, NY: W. W. Norton & Company, Inc. Rothschild, B. (2000). The Body Remembers. New York, NY: W. W. Norton & Company, Inc. Schore, A. (2003). Affect Dysregulation ad Disorders of the Self. New York, NY: W.W. Norton & Company, Inc. Schwartz, R. (1995). Internal Family Systems Therapy. New York: Guilford Press. Siegel, D. (1999). The developing mind: How relationships and the brain interact to shape who we are. New York: Gilford Press. Siegel, D. (2007). The mindful Brain: Reflection and attunement in the cultivation of wellbeing. New York, NY: W. W. Norton & Company, Inc. Siegel, D. and Bryson, T. (2012). The Whole-Brain Child. New York: Bantam Books Solomon, M. and Siegle, D. (2003) Healing Trauma. New York, NY: W.W. Norton & Company, Inc. Van der Kodlk, B. (2014). The Body Keeps The Score. New York, New York. Penguin Group

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