Neurological Impact of Trauma and Attachment:

Implications for Treating Sexual Behavior Problems

Kevin Creeden, M.A. LMHCWhitney Academy

East Freetown, MAkcreeden@whitneyacademy.org

SASH Conference 2009San Diego, CA

Experience of Trauma

1. Developmental stage

2. Temperament

3. Context

4. Response / Support

Perry, 1997

Neurodevelopment and trauma

•Teicher, et al (2002)

Increased limbic iritability

Decrease left hemisphere development

Decrease left/right hemisphere integration

Limited functioning of cerebellar vermis in self-regulation

Hypothalamus: controls appetite, hormones, and sexual behavior

Amygdala:responsible for anxiety, fear and emotions

Neocortex: Site of higher cognitive functions and sensory integration

Cerebellum: seat of motor control and coordination

Hippocampus: crucial to memory and learning facts

Brain stem: responsible for sensory input and physiological responses

Brain Structure Function Impairment

Amygdala fear conditioning; aggressive behavior; triggers fight/flight

Increased arousal, impaired fear conditioning

Hippocampus Retrieval of verbal and emotional memory

Memory impairment, especially verbal memory

Left hemisphere Regulate analytical responses; mediate emotional responses; language processing

Difficulties in accurate, effective reading of situation; language processing

Corpus Collosum Communication and integration between hemispheres

Poor integration and modulation of responses to daily interactions

Cerebellar Vermis Production and release of neuro-transmitters

Problems regulating physical activity, attention, emotions

Prefrontal cortex Center for executive functions Poor organization, rigid problem solving; increased impulsivity

Domains of Impairment: Complex Trauma

I. Attachment

Distrust

Social isolation

Attunement difficulties

Boundary problems

Problems with perspective taking

Cook, Spinnazzola, et al (2005)

Attachment Theory

•Assumption: maintenance of proximity to a secure and trusted figure is needed and sought by humans throughout the lifespan and particularly during periods of perceived danger or stress

•Behaviors related to attachment seek to both engage and maintain proximity

•Goal: safety and affiliation

Attachment and Neurobiology

•Emotion operates as a central organizing process within the brain (Seigel, 1999)

•Emotional responses to caregivers must play a crucial role in the regulation of early brain development (Trevarthen & Aitken 2001)

•The development of the pre-frontal cortex depends upon relationship based experiences that become aggregated into the internal working model of attachment

(Balbernie, 2001)

•The orbitofrontal cortex acts in the highest level of control of behavior, especially in relation to emotion.

(Schore, 2003)

•The pre-frontal cortex is a convergence area that receives multimodal visual, auditory, and tactile input from the external/social environment along with subcortical information from the internal environment

(Schore, 2003)

•Persistent stressors in the first two years of life prune neural connections in the pre-frontal cortex and inhibit effective regulation of arousal

II. Biology

Sensorimotor problems

Somatization

Analgesia

Increased medical problems

III. Affect Regulation

Poor emotional self-regulation

Problems labeling and expressing emotions

Problems recognizing and describing internal states

Problems communicating wishes and needs

IV. Dissociation

Distinct alterations in states of consciousness

Amnesia

Depersonalization

Impaired memory for emotionally based events

V. Behavioral Control

Poor modulation of impulses Self-destructive behavior Aggression towards others Pathological self-soothing Sleep difficulties Eating disorders Substance abuse Excessive compliance Difficulty complying with rules Reenactment of trauma behavior

VI. Cognition

Executive functioning problems Lack of sustained curiosity Problems processing novel information Problems w/object constancy Problems understanding responsibility Problems w/ language development

VII. Self-Concept

Lack of continuous, predictable sense of self

Poor sense of separateness

Disturbances of body image

Low self – esteem

Shame and guilt

Resiliency Factors

1. Positive attachment to emotionally supportive and competent adults

2. Development of self-regulation and cognitive abilities

3. Positive self- concept

4. Motivation to act effectively

Informing Practice

•Assessment protocols should examine:

Current Trauma Symptoms: Trauma Symptom Checklist for Children (TSCC)

Executive functioning skills: Wisconsin Card Sort; Tower of London

Auditory Processing skills: SCAN:A

Assessment cont’d

Visual Organization and Processing: Bender-Gestalt Test; Rey Complex Figure Test

Memory: Weschler Memory Scales

Informing Practice

Availability of Occupational Therapy evaluations especially around sensory integration and self-regulation

Greater focus on multi-modal learning

Primary Treatment Issues

1. Establishing safety and predictabiltiy

2. Deconditioning and decreasing anxiety and arousal levels

3. Altering the way victims view themselves and their world

(Van der Kolk, et al, 1996)

Self-actualization

Artistic needs

Cognitive needs

Self-esteem

Belonging

Safety Needs

Physical Needs

Maslow’s Hierarchy of Needs

Trauma Interventions• Stabilization, deconditioning,

relationships can be re-framed as “containment”

att

ach

men

t

structure

self

-reg

ula

tion

WORKING ON TRAUMA

thinking, feeling, and talking about trauma

Allen, 2001

Treatment: Brain Based

•Different individuals have different styles of learning

•Certain brain processes will enhance or inhibit learning at different times

•Multi-modal (multiple pathway) learning will increase understanding and recall

Treatment: Brain Based

• Pre-exposure (education) increases learning and motivation

• You need the opportunity to practice what you learn in order to integrate

• Threat and stress (distress) minimize learning and creative thinking

•Integration of affect and cognition a primary goal

•Interventions can help to re-create or alter attachment experiences

•Consideration given to stimulating particular neural pathways

•Persistent attention to monitoring arousal level and learning skills to regulate