Trauma Informed CareTrauma Informed Care

Dr. Amanda EvansDr. Amanda Evans

What is Trauma Informed Care?

• National trend related to intervening effectively with many populations, including children.

• Is a paradigm shift– Our intervention changes from:g

• What’s wrong with you? TO• What happened to you?

Advances in studies on Advances in studies on brain developmentbrain development

• In the past, it was theorized that the brain developed on a genetic/molecular level.

• In the past, it was theorized that the brain developed on a genetic/molecular level.p g

• New science reveals cerebral metabolism, blood flow & electrical activity influence brain

p g• New science reveals cerebral metabolism,

blood flow & electrical activity influence brainblood flow, & electrical activity influence brain development.

• Measures of neuroanatomy & neurochemistry

blood flow, & electrical activity influence brain development.

• Measures of neuroanatomy & neurochemistry• Measures of neuroanatomy & neurochemistry indicate development is on a neural and behavioral level

• Measures of neuroanatomy & neurochemistry indicate development is on a neural and behavioral levelbehavioral level.behavioral level.

Advances in studies on brain development

Neurological development is hierarchical in nature – it develops from the simple to the complex.

H lth d l t f l f th b i

Neurological development is hierarchical in nature – it develops from the simple to the complex.

H lth d l t f l f th b iHealthy development of more complex areas of the brain depends upon the quality of development in the earlier, less complex systems.

Healthy development of more complex areas of the brain depends upon the quality of development in the earlier, less complex systems. p y

Evidence suggests the brain has the ability remain plastic and responsive to new experience throughout life, however early childhood experience is particularly significant

p yEvidence suggests the brain has the ability remain plastic and

responsive to new experience throughout life, however early childhood experience is particularly significantearly childhood experience is particularly significant because the organization of the neuro-network and structure of the brain are still in its formative stages.

early childhood experience is particularly significant because the organization of the neuro-network and structure of the brain are still in its formative stages.gg

The Human Brain is designed to make it

The Human Brain is designed to make it possible for us to survive, procreate, and possible for us to survive, procreate, and become caregivers. The primary function of any become caregivers. The primary function of any species brain is to ensure the continuation species brain is to ensure the continuation of our species.of our species.

The Role of NeurotransmittersThe Role of Neurotransmitters

The only thing that a neurotransmitter

The only thing that a neurotransmitter does directly is to trigger one or more types of receptors.

does directly is to trigger one or more types of receptors.types of receptors. The effect of on the postsynaptic cell depends entirely on

types of receptors. The effect of on the postsynaptic cell depends entirely ondepends entirely on the properties of the receptors.

depends entirely on the properties of the receptors.

NeurotransmittersNeurotransmitters

Glutamate: used as a trigger in over 90% of the synapses in the brain Plays an

Glutamate: used as a trigger in over 90% of the synapses in the brain Plays anof the synapses in the brain. Plays an important role in memory, vision, & learning

of the synapses in the brain. Plays an important role in memory, vision, & learninglearning.

GABA: used in 90% of the synapses that don’t se gl tamate GABA circ its

learning.GABA: used in 90% of the synapses that

don’t se gl tamate GABA circ itsdon’t use glutamate. GABA circuits reduce anxiety & relax musclesdon’t use glutamate. GABA circuits reduce anxiety & relax muscles

Are you in the mood?Are you in the mood?

Neurons and Neurotransmitters

Di H lthDiscovery HealthNeurons & Neurotransmitters

Site address: http://www.youtube.com/watch?v=DF04XPBj5uc&feature=related

LEARNING or "Making Memories”LEARNING or "Making Memories”

To create a memory (or to learn something) 3 things need to happen

To create a memory (or to learn something) 3 things need to happensomething) 3 things need to happen:

1. We have to “sense” an experiencesomething) 3 things need to happen:

1. We have to “sense” an experience2. We have to “process” the experience3. We have to “store” the experience2. We have to “process” the experience3. We have to “store” the experience3. We have to store the experience3. We have to store the experience

Sensing “Information”g

• The senses help keep us alive. The brain uses the sensory organs (eyes, ears, nose, tongue, skin) to alert us to our surroundingsalert us to our surroundings.

• Everything we experience is filtered by our senses. When a signal is received by one of our senses• When a signal is received by one of our senses (sound, sight, taste, touch, smell), a surge of processes occur in the brain that alter brain structureprocesses occur in the brain that alter brain structure and function.

• The more frequently a certain pattern of neuralThe more frequently a certain pattern of neural activation occurs, the more indelible the memory becomes.

Processing InformationProcessing Information

• Once our sensory organs have detected physical or chemical information from the outside (or inside) world, this set of signals travels up into the brain to be

• Once our sensory organs have detected physical or chemical information from the outside (or inside) world, this set of signals travels up into the brain to bethis set of signals travels up into the brain to be processed.

• Sensory information enters the central nervous system

this set of signals travels up into the brain to be processed.

• Sensory information enters the central nervous system at the level of the brainstem and midbrain.

• As this primary sensory input arrives, it is matched against previously stored patterns of activation

at the level of the brainstem and midbrain. • As this primary sensory input arrives, it is matched

against previously stored patterns of activationagainst previously stored patterns of activation. • If the pattern is unknown, or is associated with previous

threat, the brain will activate a set of responses that are

against previously stored patterns of activation. • If the pattern is unknown, or is associated with previous

threat, the brain will activate a set of responses that are designed to help promote survival. designed to help promote survival.

How the brain processesHow the brain processespp

• The brain doesn’t like surprises. • Present and future experiences are matched to memories

t d t i i ht d ll t t d

• The brain doesn’t like surprises. • Present and future experiences are matched to memories

t d t i i ht d ll t t dconnected to various sights, sounds, smells, tastes, and movements.

• All unknown or unfamiliar information is judged to be

connected to various sights, sounds, smells, tastes, and movements.

• All unknown or unfamiliar information is judged to beAll unknown or unfamiliar information is judged to be threatening until proven otherwise.

• What we know as “safe and comfortable” has only become th h i

All unknown or unfamiliar information is judged to be threatening until proven otherwise.

• What we know as “safe and comfortable” has only become th h iso through our experience.

• Something in your “safe and comfortable” present moment matches the associated stored memories of previous safe

so through our experience. • Something in your “safe and comfortable” present moment

matches the associated stored memories of previous safematches the associated, stored memories of previous safe, pleasing, or rewarding experiences. matches the associated, stored memories of previous safe, pleasing, or rewarding experiences.

Storing InformationStoring Informationgg

• Storing internal representations of the external world is essential to our survival

• Storing internal representations of the external world is essential to our survivalneurobiology. These are what we know as memories. neurobiology. These are what we know as memories.

• Neuron and neural system changes are "use-dependent“.

• Neuron and neural system changes are "use-dependent“.p

• They only change if a new or extreme situation forces them “Nothing changes

p• They only change if a new or extreme

situation forces them “Nothing changessituation forces them. Nothing changes until something changes”situation forces them. Nothing changes until something changes”

The Mind/BodyThe Mind/Body Connection

• Our perception of the world and our interactions define our realitydefine our reality.

• Our brain processes messages based on our perceptions and responds accordinglyperceptions and responds accordingly.

Behaviors

Th St RTh St RThe Stress ResponseThe Stress Response• When the brain senses threat the body

responds automatically.• When the brain senses threat the body

responds automatically.• The adrenal gland releases a chemical

weapon called cortisol. Too much cortisol• The adrenal gland releases a chemical

weapon called cortisol. Too much cortisolcan prevent the brain from laying down a new memory, or from accessing already can prevent the brain from laying down a new memory, or from accessing already existing memories.

• The hippocampus is the area of the brainexisting memories.

• The hippocampus is the area of the brainThe hippocampus is the area of the brain most damaged by too much cortisol.The hippocampus is the area of the brain most damaged by too much cortisol.

STRESS & BABOONSSTRESS & BABOONSSTRESS & BABOONSSTRESS & BABOONS

• Dr. Robert Sapolksyhttp://www.youtube.com/watch?v=sPS7GnromGo

• Dr. Robert Sapolksyhttp://www.youtube.com/watch?v=sPS7GnromGo

Fight, Flight, or Call a Gi lf i d?

Fight, Flight, or Call a Gi lf i d?Girlfriend?Girlfriend?

New Research on stress - Gender Differences New Research on stress - Gender Differences • Females release high levels of oxytocin

under stress. Males do as well but it is • Females release high levels of oxytocin

under stress. Males do as well but it is suppressed by testosterone.

Taylor, S.E. (2006). “Tend and Befriend”: suppressed by testosterone.

Taylor, S.E. (2006). “Tend and Befriend”: Biobehavioral Bases of Affiliation Under Stress. http://www.thecenter.ucla.edu/mindbody.htmlBiobehavioral Bases of Affiliation Under Stress. http://www.thecenter.ucla.edu/mindbody.html

The HippocampusThe Hippocampus and Memory

• The Hippocampus is critical to the process of learning. It takes short-term memory and converts it into long-term memory. V i h ( ti l) t lt hi• Various hormones (e.g., cortisol) appear to alter hippocampus synapse formation, causing actual changes in overall structure & size.

• Repeated stress inhibits the development of neurons andRepeated stress inhibits the development of neurons and atrophy of the hippocampus can occur.

The Brain, Neural Systems, & Fear

A d l th k b i i i th i• Amygdala: the key brain region in the processing, interpreting, and integration of emotional functioning.

• The amygdala processes and determines the emotionalThe amygdala processes and determines the emotional value of simple sensory input, complex multisensory perceptions, and complex cognitive abstractions. Th d l h t t th t thi ti l• The amygdala orchestrates the response to this emotional information by sending projections to brain areas involved in motor (behavioral), autonomic nervous system, and ( ), y ,neuroendocrine areas of the CNS.

Cortex where the brain subjectively interprets the quality• Cortex - where the brain subjectively interprets the quality and intensity of any emotion, including anxiety.

Recalling Traumatic Eventsg

• The brain doesn’t record a memory of a traumatic event the same way it does normal events. At th ti f f f l h i l fl d th t• At the time of fear, powerful neurochemicals flood the system. These chemicals are designed to trigger the fight or flight response.p

• The autonomic response of the brain is designed for survival, not thought processing.It i t l f i ti t h f t d i f• It is not unusual for victims to have fragmented memories of the traumatic event. The memories are often out of sequence, and filled with gaps. g p

• This knowledge is especially important in working with victims or doing advocacy work!

• The developing brain is particularly sensitive to stress/fear. (Child Trauma Academy

• The developing brain is particularly sensitive to stress/fear. (Child Trauma Academy ( ywww.childtrauma.org )

• Neural systems that are activated in a repetitive

( ywww.childtrauma.org )

• Neural systems that are activated in a repetitive fashion can change the brain in permanent ways, altering synaptic number and microarchitecture of th b i

fashion can change the brain in permanent ways, altering synaptic number and microarchitecture of th b ithe brain

• The brain is use dependent!the brain

• The brain is use dependent!

T & Child’ B iTrauma & a Child’s Brain

• The traumatized child frequently has significant impairment in social and emotional functioning. H i il t hild f tl d l• Hyper-vigilant children frequently develop remarkable non-verbal skills in proportion to their verbal skills (street smarts). ( )

• They often over-read (misinterpret) non-verbal cues.E t t i d th t f i dl t h• Eye contact is read as a threat, or a friendly touch is interpreted as an antecedent to seduction and rape. These assessments might have been p gaccurate in the world they came from.

Implications for PracticeImplications for PracticeImplications for PracticeImplications for Practice

A theory of human motivation. (1943). Abraham Maslow

Combining theory with f t d i f dfacts and moving forward

T I f d C & ChildT I f d C & ChildTrauma Informed Care & ChildrenTrauma Informed Care & Children

• Things we should know:T ti t th i l t f

• Things we should know:T ti t th i l t f• Trauma over activates the survival part of the brain.

• Trauma over activates the survival part of the brain.

• Behaviors may be a direct result of this actually “normal” according to the needs

• Behaviors may be a direct result of this actually “normal” according to the needs of the brain.

• The brain is a patterning organ -of the brain.

• The brain is a patterning organ -g gg g

P tt i & S itP tt i & S itPatterning & SecurityPatterning & Security

• Discussion…• Discussion…