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Biological Implications of Trauma

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Catie Bainbridge

on 29 June 2016

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Transcript of Biological Implications of Trauma


Treatment
Implications
The biomedical model of care emphasizes pharmacological treatment (medication) to address chemical and structural brain imbalances
(Davis, 2014).
Individual Perspectives
Trauma and the Brain

References
Biological Implications of Trauma
Definitions
Prefrontal Cortex
Structure responsible for:
Hippocampus
Amygdala
Catie
http://www.nimh.nih.gov/health/educational-resources/brain-basics/brain-basics.shtml
Parcilla
Michelle M.
Maggie

Monika
Annie C.
Anterior Cingulate Cortex
Long Term Effects of Trauma
Conclusion

Interpersonal vs. Impersonal
Single Incident Trauma
Complex Trauma
Developmental Trauma
Intergenerational Trauma
Historical Trauma

Trauma can occur in many dimensions, magnitudes, complexities, frequencies, durations, and at internal and external levels.
Trauma can alter certain areas of the brain
Single Incident Trauma
Complex Trauma
Developmental Trauma
Intergenerational Trauma
Historical Trauma
Re-occurring events causing physiological and emotional distress

By Catie, Monika, Annie, Michelle, Maggie, and Parcilla
Stress
Positive Stress
Tolerable Stress
Moderate and short-lived, causing brief increases in heart-rate or mild changes in stress hormone levels.
Positive stress can include meeting new people, learning to share, and dealing with frustration.

Positive Stress is regarded as an important and necessary aspect of healthy development.


Is severe enough to disrupt brain architecture if unchecked, but is buffered by supportive relationships that facilitate adaptive coping mechanisms and prevent damaging affects.

Sources of intolerable stress can include death or serious illness, parental divorce, or natural disasters.
Toxic Stress
Jack Shokoff argues that, "early life experiences are literally built into our bodies, for better or for worse. This is a fundamental principle of biology. What happens early on forms biological memories in our brain..."
It is important to distinguish between the different types of stress to better understand the long-term developmental effects.
Is severe and prolonged in the absence of the buffering protection of supporting relationships.
Sources include physical and emotional abuse, chronic neglect or family violence.

Toxic Stress can disrupt brain architecture and lead to lifelong problems in learning, behavior and both physical and mental health.
Stanford CPI. (2010).
The Impact of Early Experience on Childhood Brain Development: Jack Shonkoff.
[Video File]. Retrieved from www.vimeo.com/11666627
Interpersonal
VS.
Impersonal
Structure responsible for:
Most severe
Least severe
Occurrence
Once: Strangers
Repeated, Chronic, Escalates: Family/Caregiver/Significant role
Occurrence
Once (usually): Random, "Act of God", disaster
Most Common Types
Child Abuse: physical, sexual, emotional, neglect
Most Common Types
Accidental (eg. motor vehicle),
Natural Disaster (eg. earthquake)
Deliberate
Accidental
(Courtois, 2014), (BCMHSAPC, 2013)
Critique: Pat Capponi argues that the biological determinants of mental disorders are limiting; they reduce experience to biological brain imbalances and are largely rooted in a capitalist regime focused on the profit from pharmacological drugs
(Davis, 2014, p. 8)
The biological implications of trauma can illuminate the cost of childhood stress on our bodies and psyches over time. Combined with other perspectives of trauma, this lens can be incredibly valuable in the mental health field. It is important to recognize the resilience of individuals to adapt to these effects of trauma over time with the support of trauma-informed care initiatives. I recently came across research by Dr. Rick Hanson that touches on our individual power to restructure the brain and how it responds to stress. For further information watch his Ted Talk!

Ted Talks. (2013).
Hardwiring Happiness: Dr. Rick Hanson at TEDxMarin 2013.
[Video File]. Retrieved from www.youtube.com/watch?v=jpuDyGgleh0
decisions, judgement, fear conditioning, behavior inhibition, working memory, and self-regulation (Raine, 2011 )
regulating emotional responses triggered by the amygdala (Bremner, 2006)
the consolidation of explicit memories, simple learning processes and emotion regulation (Maté, 2012)
Because the left hemisphere (explicit memories) is less active in trauma, Williams (2006) suggests creative treatment methods to address the implicit memories (emotional sensations) located in the right hemisphere of the brain. For example: imagery work, movement, film, drawing, play, and drama
(Williams, 2006).
Anatomy:

contains receptors for the stress hormone cortisol
(Kolb & Whishaw, 2013)
"For those habituated to high levels of internal stress since early childhood, it is the absence of stress that creates unease ... People may become addicted to their own stress hormones, adrenaline and cortisol, Hans Selye observed."

-Gabor Maté,
When The Body Says No
BC Provincial Mental Health and Substance Abuse Planning Council [BCMHSAPC]. (2013).
Trauma Informed Practice Guide
. Retrieved from http://bccewh.bc.ca/wp-content/uploads/2012/05/2013_TIP-Guide.pdf

Bremner, J. D. (2006). Traumatic stress: effects on the brain.
Dialogues in Clinical Neuroscience, 8
, 4, 445-461. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181836/?tool=pmcentrez

Courtois, C. A. (2014). Understanding complex trauma, complex reactions, and treatment approaches.Retrieved October 7, 2015, from www.giftfromwithin.org/html.cptsd-understanding-treatment.html

Davis, S. (2014). Community mental health in Canada: Theory, Policy, and Practice. Vancouver, BC: UBC Press.

Kolb, B., & Whishaw, I. Q. (2013). An introduction to brain and behaviour (4th ed). New York, NY: Worth Publishers.

Maté, G. (2012). Addiction: childhood trauma, stress, and the biology of addiction.
Journal of Restorative Medicine, 1
, 56-63. doi: 10.14200/jrm.2012.1.1005.

McFarlane, A. C. (2010). The long-term costs of traumatic stress: intertwined physical and psychological consequences.
World Psychiatry: Official Journal Of The World Psychiatric Association (WPA), 9
(1), 3-10.

National Institute of Mental Health [NIH]. (2015).
Brain basics
. Retrieved from http://www.nimh.nih.gov/health/educational-resources/brain-basics/brain-basics.shtml

Raine, A., Yang, Y., Narr, K. L., & Toga, A. W. (2011). Sex difference in orbitofrontal gray as partial explanation for sex differences in antisocial personality.
Molecular Psychiatry, 16
(2), 227-236. doi: 10.1038/mp.2009.136

Stanford CPI. (2010).
The Impact of Early Experience on Childhood Brain Development: Jack Shonkoff.
[Video File]. Retrieved from www.vimeo.com/11666627

Ted Talks. (2013).
Hardwiring Happiness: Dr. Rick Hanson at TEDxMarin 2013.
[Video File]. Retrieved from www.youtube.com/watch?v=jpuDyGgleh0

Williams, W. (2006). Complex trauma: Approaches to theory and treatment.
Journal of Loss and Trauma
, 11, 321-335.

Over production

of
cortisol

Excess cortisol
decreases
the number of
cortisol
receptors
in the
hippocampus

Cognitive treatments can also help restructure the brain to repair mental experiences of stress and trauma.
For example internalizing a positive experience for at least 12 seconds (Hanson, 2013).
Effects of Trauma:

Stress
Trauma at any period of a person's development can have implications for physical and mental health, but is particularly significant during childhood. The developing brain requires parental input in order to cope with stressors, and when this is unavailable and stress is chronic, hormonal disruptions and changes in brain structure can occur. Shonkoff (Stanford CPI, 2010) discusses how experiences in childhood are "built into our bodies," and can be reflected later in adult physical and mental health. Treatment options range from medication to address symptoms to more alternative ideas such as art and music therapy, all of which are most effectively conducted using the principles of trauma-informed care
(BCMHAPC, 2013).
Examining the biology of trauma in terms of a person's development provides an example of a case where it is difficult to separate "biological" from "psychological" factors. When researching stress and trauma, there are many examples of changes in brain structure and chemical imbalances that can occur as a result of abuse, for example. However, the solutions and prevention mechanisms seem to come back to environmental conditions, such as the three sources of adversity in childhood discussed by Shonkoff (Stanford CPI, 2013): relationships, physical environment and nutrition. This demonstrates the close link between our brain chemistry and surrounding environment, particularly in early development. It highlights the importance of providing secure and supportive conditions for children in order to prevent chronic stress and subsequent mental and emotional problems that can result when the biology of the brain is affected adversely.
http://imgarcade.com/1/acute-and-chronic-stress/
Impacts both
behavioural
and
emotional functioning
Impairment

in
creating
new
memories
(Kolb & Whishaw, 2013; Maté, 2012; NIH, 2015; Williams, 2006)
Executive Functioning
Effects of Trauma:

Causes a marked
decrease

in the volume of
the ventromedial
prefrontal
cortex
reduces
the
functional ability
of the region
results in the heightened
sense of fear
,
anxiety
, and
extreme stress responses
(Bremner, 2006; Williams, 2006)
Structure responsible for:
fear and threat responses (NIH,2015)
processing of emotions (Kolb & Whishaw, 2013)
Effects of Trauma:
causes the

hyperactivity
of the
amygdala
Throughout this course the question has been whether or not "mental illness" is a result of a psychological model, sociocultural model, biological model or a combination of any two. After researching trauma and stress it has become evident that sudden traumatic experience as well as exposure to prolonged trauma and stress in the form of verbal or physical abuse causes permanent neurological and chemical changes in the brain. These changes often result in negative consequences like difficultly developing healthy relationships,long term physical side effects due to stress, low self esteem and even a disconnect between the left and right hemisphere of the brain. This leads me to believe that there is a strong correlation between a trauma event(s), biological models and stress. I am thinking of it in terms of "cause and effect" where the traumatic experience is the cause of psychological or physiological responses and the chemical change to the brain is the irreversible result, or effect. I use the word "irreversible" because although an individual can learn to adapt to their unstable environment or go to through therapy and medicate to cope, the damage done to the brain is permanent.

Circuitry:
critical role in conditioning of trauma
stress-induced fear and anxiety (Kolb & Wishaw, 2013)
Amygdala to Prefrontal Cortex

Amygdala to Hippocampus
amygdala
responds
to stimuli
hippocampus
encodes
response into memory
Stimuli associated with
trauma
are
processed

by
amygdala
and
accessed
by
hippocampus

(Kolb & Wishaw, 2013)
https://www.brainfacts.org
emotional stimuli
processed

in a
maladaptive way
Triggers

past traumatic
events
leads to
similar maladaptive
responses
in different situation
(Bremner, 2006 & Williams, 2006)
Structure responsible for:
When working with individuals in mental health, it is important to acknowledge the significant role biology plays in the immediate, maintenance, and long-term effects of traumatic experiences. The depth to which traumatic childhood experiences severely affect the long-term outcome of the individual is crucial. These traumatic experiences create lasting effects on the individual, which include static and permanent dysfunction. While the biomedical model, on one hand, strongly emphasizes that medication helps fix apparent permanent damage, neuroscience and cognitive development, on the other hand, allow individuals to restructure their neural pathways and cognitions in order to re-learn how to cope with stressful and traumatic experiences (Davis, 2014; Ted Talks, 2013). Although physical damage may be present, the field of neurobiology is able to aid in the treatment of traumatic experiences through the neuroplasticity of the brain (Stanford CPI, 2010).
One unpredicted event causing physiological and emotional distress



Examples: natural disaster, death of loved one, witness of an accident, involved in an accident, etc.
Re-occurring trauma in early life (infants and children) interfering with healthy development

Individual traumatic psychological experiences and coping patterns that are passed from generation to generation

Examples: Natural disaster that
destroys a family home, parental
abuse, poverty, etc.


The collective trauma experienced by a large group of people occurring across generations, often caused by a dominant, powerful group of people

Examples: Genocide, black slavery, Indigenous residential schools, Indian hospitals, etc.
Effects of Trauma:
trauma related stimuli
causes
anterior cingulate cortex to

inadequately inhibit
amygdala
hyperactivation
of amygdala
https://neuroscience.stanford.edu/sites/default/files/images/news/executive_anatomy.001.pn
The body's stress response (fight or flight) is not designed to be constantly activated from physical and emotional stressors. Prolonged activation of the stress response system becomes a biological threat to the body, compromising major biological systems.
Heart Health
Elevated heart rate for long periods of time stresses the cardio-vascular system and leads to coronary heart disease

Blood Pressure
Elevated heart rate produces more stress on the circulatory system causing hypertension and weakening artery walls

Metabolism and obesity
Elevated levels of blood sugar leads to higher incidence of diabetes
Increased levels of total cholesterol and triglycerides
Higher Body Mass Index Scores for both males and females




Major Mechanisms in the Body
(Bremner, 2006)
Examples: Abandonment, assault, abuse, neglect, etc.
mediating cognitive influences on emotion (Bremner, 2006)
controls blood pressure and heart rate during stressful events
helps motivate, stay focus, and manage emotional reactions (NIH, 2015)
Circuitry:

projects to the amygdala for emotion regulation (Bremner, 2006)
Examples: Nation at war, abuse, violence (emotional or physical)
(Mcfarlane, 2010);(Shonkoff, 2010)
Physiological Stress Response: Fight or Flight
Constant production of stress hormone: Cortisol
Shokoff, J., 2010
Shokoff, J., 2010
Shokoff, J., 200
(BCMHSAPC, 2013)
(BCMHSAPC, 2013)
(BCMHSAPC, 2013)
(BCMHSAPC, 2013)
(BCMHSAPC, 2013)
The external environment plays a significant role in
shaping the architecture of the developing brain.
Exposure to trauma during this time has detrimental
effects on the formation of neural circuits important in
regulating emotions, memories, sensations and thought
processes. As mental health workers, it is important that we recognize the impact trauma has on the biological functions of the brain. A survivor of trauma simply cannot physiologically ignore feelings of fear and anxiety. When working with these individuals we must acknowledge that recovery is a process that will take immense time.

Approaching trauma with a biological lens outlines the severity of both acute, early-developmental trauma, and long-term health implications of trauma. Persistent and complex episodes of trauma affect biological systems before altering psychological and social systems, thus proving trauma to be primarily impacting human biology (McFarlane, 2010, p.5).
In Dr. Shonkoff's 2010 lecture, he explains how the brain's architecture and circuitry is created by over-producing connections, and then pruning them over time. With 700 new synapses being produced every second in the first few years of life, it is crucial to ensure that the "biological embedding during sensitive periods" is happening in healthy environments with healthy interactions (Shonkoff, 2010).
As a mental health worker, analyzing the impact that traumatic early childhood experiences has on brain development explains how mental illness and addiction can surface later in life (Williams, 2006, p.327). With brain development being a gene-environment interaction issue, we must approach mental illness and addiction prevention strategies at pre-natal and early childhood levels. If we can form foundations for health-related behaviours and establish these patterns at an early age, we can decrease the likelihood of children developing chronic, debilitating mental and physical illnesses that submerge in adolescence and early adulthood (Shonkoff, 2010).


(BCMHSAPC,2013)
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