Escolar Documentos
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Cultura Documentos
AND TRAUMA
BY
DR. NADER KORHANI
Neuropsychology of Stress and Trauma
• Neuropsychology:
The study of the relationship between behavior, emotion, and cognition; Brain
development and function; and the dynamics of how both sides influence each-
other.
• Stress:
Stress is your body's way of responding to any kind of demand or threat. When you
feel threatened, your nervous system responds by releasing a flood of stress
hormones, including adrenaline and cortisol, which rouse the body for
emergency action.
• Psychological Trauma:
A type of damage to the mind that occurs as a result of a severely distressing event.
Trauma is often the result of an overwhelming amount of stress that exceeds
one's ability to cope, or integrate the emotions involved with that experience. A
trauma can be result of a single event, or repeating events of being
overwhelmed over a period of time of various length.
What are the stress mechanism?
Adrenomedullary Response - SAM
Occurs through the activation of the sympathetic-adrenal medulla
(SAM) complex:
• Perception of stress causes the hypothalamus (via nervous
connection) to activate sympathetic fibers
• Sympathetic fibers activate the adrenal medulla
• Adrenal medulla secretes the catecholamines: epinephrine &
norepinephrine
This causes:
• Increased heart rate, blood pressure, breathing rate & blood
glucose levels
• Shuts down digestive system
• Rapid, short-lived response to stress
Sympathetic Response to Stress
Hypothalamus causes:
Increases arousal in the sympathetic nervous system
• Increased heart rate & blood pressure
• Constriction of peripheral blood vessels
• Respiration rates increase
• Bronchial tubes dilate
• Pupils dilate
• Digestive processes decrease
Sympathetic activation prepares the body for intense
motor activity
Parasympathetic response to stress
Early Brain
Environmental Physiology
Experiences Behavior
Our experiences or “nurture” can have long-
term effects on our brain and behavior
Early Brain
Environmental Physiology
Experiences Behavior
oocyte transcription/translation
postnatal
sensory stimulation,
maternal frequency & stability of care
behavior
Parental Experience
OFFSPRING Influences Offspring
DEVELOPMENT Development
Programming of Fetal Stress
Response
maternal fetal
risk of prematurity
lower birth weight
Stress
increased stress response
risk of depression & anxiety
Genes Altered in the Rat Placenta Following Chronic
Variable Exposure to Stress
Gene Gene Function Stress Effect
11BHSD-2 metabolizes corticosterone Decreased
DNMT1 maintenance DNA methyltransferase Decreased
• Failure to Thrive: children can die from not being touched, spoken to,
looked at, etc. Even if their basic needs are attended to, the studies of
Romanian orphanages showed that children died due to the lack of
human attachment (Spitz).
• Maltreatment before the age of 18 had greater impact than later abuse.
Summary:
•Limbic electrical irritability can produce symptoms of aggression,
exasperation, anxiety, self-destructive behavior and increased risk for
suicide.
•“If our society were truly to appreciate the significance of children’s emotional
ties throughout the first years of life, it would no longer tolerate children
growing up, or parents having to struggle, in situations that cannot possibly
nourish healthy growth.”
Stanley Greenspan, M.D., Child Psychiatrist and Former Director, Clinical
Infant Development Program, [U.S.] National Institute of Mental Health (As
cited in Mate, 2008).
Negative feedback loop of stress
• Recent studies pointing out the mind and body feedback
loop when early childhood stress and developmental
disturbance may in turn lead to activation of genes that
cause oversensitivity to later stressful stimulus which
sequentially leads to greater susceptibility to physical health
problems resulting in more stress that may eventually
develop into a more permanent pattern of chronic stress,
mental health problems, and/or long term physical health
problems as result. They explained the early life experience
of the excessive and cumulative stress will lead to
compromised immune system and over the years, it will
eventually manifest itself in form of long term physical health
problems and disease in adulthood such as Diabetes and
Cushing disease. Honkoff, Boyce, and McEwen (2009)
Neurobiology of Trauma
Trauma can be conceptualized as stemming from a failure of the
natural physiological activation and hormonal secretions to
organize an effective response to threat. Rather than producing
a successful fight or flight response the organism becomes
immobilized.
(Clinical Implications of Neuroscience Research in PTSD)
BESSEL A. VAN DER KOLK
•Depression
•Aggression
•Low Self-Esteem
•Identity Confusion
•Difficulties in Interpersonal
Relationships
•Guilt
Key Principles for Therapeutic Interventions
•Judith Herman recognized three general stages of recovery
from trauma.
1. Central task of the first stage is to establish safety.
2. Central task of the second stage is remembrance
and mourning.
3. Central task of the third stage is reconnection…”
(Trauma and Recovery1992)
An Interpersonal Neurobiology
- Daniel Siegel
• Conditioning
• New Conditioning
• Re-Conditioning
• De-Conditioning
Conditioning
• Experience causes neurons to fire
• Repeated experiences, repeated neural firings
• Neurons that fire together wire together
• Strengthen synaptic connections
• Connections stabilize into neural pathways
• Secure
• Insecure-Avoidant
• Insecure-Anxious
• Disorganized
Attachment Styles - Secure
• Parenting is attuned, empathic,
responsive, comforting, soothing,
helpful
• Attachment develops safety and
trust, and inner secure base
• Stable and flexible focus and
functioning
• Open to learning
• inner secure base provides buffer
against stress, trauma, and
psychopathology
Insecure-Avoidant
• Parenting is indifferent,
neglectful, or critical, rejecting
• Attachment is avoidant of
people and emotions,
withdrawn, compulsively self-
reliant
• Stable, but not flexible
• Focus on self or world, not
others or emotions
• Rigid, defensive, not open to
learning
• Neural cement
Insecure-Anxious
•Parenting is inconsistent,
unpredictable
•Attachment is clingy,
needy, compulsive
caregiving
•Flexible, but not stable
•Focus on other, not on self-
world,
•Less able to retain learning
•Neural swamp
Disorganized
• Parenting is frightening or
abusive, or parent is
“checked out,” not “there”
• Attachment is paralysis,
fright without solution
• Lack of focus
• Moments of dissociation
• Compartmentalization of
trauma
Attachment –Based Treatment (Phil Rich)
• Conditioning
• New Conditioning
• Re-Conditioning
• De-Conditioning
Pre-Frontal Cortex
• Memory de-consolidation –
re-consolidation
• “Light up” neural networks
• Juxtapose old negative with
new positive
• Neurons fall apart, rewire
• New rewires old
Modes of Processing
• Focused Attention
– Tasks and details
– Deliberate, guided change
– New conditioning and re-conditioning
• De-focused Attention
– Default network
– Mental play space – random change
– De-conditioning
An Interpersonal Neurobiology
• Default network
• De-focusing, loosens grip of attention
• Creates mental play space, free
association
• Can drop into worry, rumination
• Can drop into plane of open possibilities
• Brain makes new links, associations
• New insights, aha!s new behaviors
EMDR EYE MOVEMENT DESENSITIZATION REPROCESSING
EMDR can be
described as an eight
phase treatment for
PTSD and many other
psychological issues
including grief,
anxiety, substance
abuse, and depression.
Exposure and
cognitive components
is an important part of
this technique as it is
combined with lateral
eye movements.
EMDR
• 5.Installing and strengthening the positive cognition
Client is encouraged to check emotional and cognitive reactivity on a ten point scale.
• 6. Body scan
Client is asked to check body and sensations. Many of the Trauma symptoms such as Stomach problems,
Intestinal problems, Gynecological problems, Weight gain or loss Chronic pain (back, neck, pelvic area in
women), Headaches, Skin rashes and other problems shows a strong physical component associated
with PTSD. It is therefore, reasonable that expect clients to have experiences that manifest themselves
physically or in form of sensations as they go through the exposure process of EMDR. This also helps
client to become more aware of the link between their psychological arousal and physical sensations both
during the arousal and when it decreases and becomes less intense.
• 7.Closure
The therapist validates client’s effort and helps them to set up plans to cope with uncomfortable feelings and
thoughts after the session. The therapist also goes over different techniques of guided imagery and
relaxation (e.g. creating and using safe place imagery) with client to ensure that appropriate coping skills
are applied if needed. This include an explanation of how to cope with triggering of any unpleasant
experiences.
• 8.Re-evaluation
The therapist evaluates and assesses client’s experience and progress after last session. The goal at this
point is to determine the best direction for continuing this process and supporting client with becoming
more skilled at evaluating their-own progress and building hope and confidence.
Dialectical Behavioral Therapy
• Reverie, daydreams
• Imagination
• Guided visualizations
• Guided meditations
• Brain “plays,” makes own
associations and links,
connect dots in new ways
• Reflect on new insights