1. Neuroscience of Trauma

2. Trauma genesis
Repeated activation of threat-response system that drives REACTIVE ADAPTATION & MITIGATION
Nervous system becomes CHRONICALLY activated and CHANGES its structure and function
Activation does NOT require abuse, abandonment, physical or sexual hurts—just the REPEATED perception of threat or a stress filled environment is adequate
There are behaviors that are common and predictable when the survival system is dominant (usually seen as WRONG or BAD vs. ADAPTIVE
Rhoton R. & Gentry E. 2016

3. Developmental Trauma Disorder
A. Exposure 1. Multiple or chronic exposure to one or more forms of developmentally adverse interpersonal trauma (abandonment, betrayal, physical assaults, sexual assaults, threats to bodily integrity, coercive practices, emotional abuse, witnessing violence and death). 2. Subjective Experience (rage, betrayal, fear, resignation, defeat, shame).
Bessel A. van der Kolk, MD

4. Developmental Trauma Disorder
B. Triggered pattern of repeated dysregulation in response to trauma cues Dysregulation (high or low) in presence of cues. Changes persist and do not return to baseline; not reduced in intensity by conscious awareness. •Affective •Somatic (physiological, motoric, medical) •Behavioral (e.g. re-enactment, cutting) •Cognitive (thinking that it is happening again, confusion, dissociation, depersonalization). •Relational (clinging, oppositional, distrustful, compliant). • Self-attribution (self-hate and blame)
Bessel A. van der Kolk, MD

5. Developmental Trauma Disorder
C. Persistently Altered Attributions and Expectancies •Negative self-attribution •Distrust protective caretaker •Loss of expectancy of protection by others •Loss of trust in social agencies to protect •Lack of recourse to social justice/retribution •Inevitability of future victimization
Bessel A. van der Kolk, MD

6. Developmental Trauma Disorder
D. Functional Impairment •Educational •Familial •Peer •Legal •Vocational
Bessel A. van der Kolk, MD

7. Abused Brain

10. Figure 1A schematic of the human brain illustrating how the limbic system is involved in posttraumatic stress disorder (PTSD). The prefrontal cortex (PFC) and the hippocampus both have dense connections to the amygdala, which is important for conditioned fear and associative emotional learning. The PFC is thought to be responsible for reactivating past emotional associations and is decreased in both responsiveness and density. The hippocampus is thought to play a role in explicit memories of traumatic events and in mediating learned responses to contextual cues; in PTSD, the hippocampus is decreased in volume and responsiveness to traumatic stimuli. The top down control of the amygdala by the hippocampus and PFC might result in the increased activation of the amygdala, as is observed in subjects with PTSD. The end result of these neuroanatomical alterations is increased stress sensitivity, generalized fear responses and impaired extinction. Other regions including the anterior cingulate cortex, the orbitofrontal cortex, the parahippocampal gyrus, the thalamus and the sensorimotor cortex also play a secondary role in the regulation of fear and PTSD.

11. Window of tolerance

12. HEALING OF TRAUMA: RESEARCH & BEST PRACTICES
Emotion regulation strategies
Narration of trauma memory
Cognitive restructuring
Anxiety and stress management (imaginal exposure, etc.)
Interpersonal Skills (therapeutic alliance)
Psychoeducation
Meaning making
Rhoton R. & Gentry E. 2016

13. Common elements trauma approach (ceta) “ACTIVE INGREDIENTS”
Relaxation: learning specific ways to calm the body
Cognitive-Emotive Coping: learning how thoughts, feelings, and behavior are interconnected.
Exposure-Trauma Memories/In-Vivo: process trauma in a SAFE PLACE
Cognitive Restructuring: learning how to change “stuck thoughts” that are keeping distress going
Behavioral Activation: planning and participation in pleasurable activities
Problem Solving: learning specific way to come up with realistic solutions to problems
Rhoton R. & Gentry E. 2016

14. Rhoton R. & Gentry E. 2016

15. The empowerment & resilience structure: an active ingredients approach
Preparation & Relationship
Psychoeducation & Self-Regulation
Integration & Desensitization
Post-Traumatic Growth & Resilience
Rhoton R. & Gentry E. 2016

16. The empowerment & resilience structure: an active ingredients approach
Preparation & Relationship
Orientation and Acculturation around therapy process
Discovering capacities and strengths while instilling faith and hope in the therapy process. GIVING CHOICES throughout treatment
Formal and informal assessments used to increase relationship and connection (e.g. Adverse Childhood Experiences, also PCL,
Assessing patterns and developing global goals that will be fine-tuned through the process
Rhoton R. & Gentry E. 2016

17. The empowerment & resilience structure: an active ingredients approach
II. Psycho-Education and Skills Building
Teach mechanics of the Threat-Response System
Creating a common language to enhance ease of discussion and relational connection
Teach impact of environment
Convert discussions of anger, sadness, fear, etc. to physiological dysregulation
Normalize internalize negative messages, perceptions of self, others and the world
Normalize relationship, emotional and cognitive patterns
Explore meaning of behavior
Self-Regulation skills
Rhoton R. & Gentry E. 2016

18. The empowerment & resilience structure: an active ingredients approach
III. Integration & Desensitization
Use of various models: from EMDR to Somatosensory, EFT, Experiential & Creative/Art Therapies
Elements
Explain that in the beginning it is your JOB as the clinician to keep the BRAKES ON so that things don’t go too FAST. Titration is KEY.
Creating narratives that can be expanded as needed and in the process lessen the reactivity to the events
Normalize difficulties, unwanted emotions, thoughts, behaviors and beliefs
Focus on discovering and highlighting strengths and capacities
Mourning and working through grief
Rhoton R. & Gentry E. 2016

19. The empowerment & resilience structure: an active ingredients approach
IV. Post-Traumatic Growth & Resilience Work
Use of various models: from EMDR to Somatosensory, EFT, Experiential & Creative/Art Therapies
Elements of Post-Traumatic Growth
Consolidate change in the Perception of SELF
Consolidate change in the Interpersonal Relationship
Consolidate change in the Philosophy of Life
Core Features of Resilience
Relating Others, reconnecting or creating new connections
Exploring New Possibilities
Intentional Applications of Personal Strengths
Spiritual Change or Re-Orientation
Appreciation of Life even when faced with stressors
Rhoton R. & Gentry E. 2016

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