Neurobiology of Kindness

Transcription

1 Maggie Bennington Davis MD Creating a Safe Place Neurobiology Kindness WHAT S THE BIG DEAL ABOUT TRAUMA? When When people people are are exposed exposed to to trauma, trauma, violence, violence, overwhelming overwhelming chronic chronic stress, stress, particularly particularly as as children, children, both both bodies bodies brains brains are are affected. affected. These These experiences experiences call call forth forth a a range range responses, responses, including including the the easy easy triggering triggering fight/flight/freeze, fight/flight/freeze, intense intense feelings feelings fear, fear, loss loss trust trust in in others, others, chronic chronic hypervigilance, hypervigilance, a a decreased decreased sense sense personal personal safety, safety, feelings feelings guilt guilt shame, shame, difficulty difficulty engaging engaging in in relationships. relationships. TRAUMA SHATTERS OUR EXPERIENCE OF REALITY AND SHATTERS THE SENSE THAT WE CAN UNDERSTAND, MANAGE, AND FIND MEANING IN OUR WORLD Traumatization occurs when both internal external resources are inadequate to cope with external threat. Van der Kolk,

2 Context Matters Impact depends on: Single vs. repeated trauma Age when trauma occurs Agent natural vs. human Nature the trauma accidental vs. purposeful Environmental/social supports Political/economic context Philosophical/religious/spiritual context The other things going on reserve Innate resilience Trauma informed services take into account an understing trauma in all aspects service delivery place priority on the individual s safety, choice, control. Such services create a treatment culture nonviolence, learning, collaboration. Utilizing a trauma informed approach does not require disclosure trauma. Rather, services are provided in ways that recognize the need for physical emotional safety, as well as choice control in decisions affecting one s treatment. TIP is more about the overall essence the approach, or way being in the relationship, than a specific treatment strategy or method. Trauma informed practice guide BC Provincial MH & Substance Use Planning Council Here s how patterns develop Brains are built from the bottom up 700 new neural connections/ second Brain development most rapid in early months; continues through age 22 The brain needs safe experiences to live. It grows, is pruned learns It forms connectomes Sra Bloom, MD 50 trillion 1000 trillion 500 trillion 2

3 Most neural network development occurs after birth Childhood environment determines basic brain architecture Biological Regulation Moral Development Emotional Development Social Development Cognitive Development Sra Bloom, MD Disruptions in which an attachment figure is perceived as unavailable as the result a substantial, repetitive or unplanned separation Child maltreatment Illness, injury Divorce Military service Imprisonment Mental illness Substance abuse Family violence Community violence Allostatic Load Traumatic Toxic Tolerable Positive Sra Bloom, MD 3

4 Between Stimulus Response State high alert Cortex Action, not thought Inability to think clearly Extreme thoughts Hippocampus Slower Attention to threat Intense prolonged anxiety Sensory Thalamus Very Fast Amygdala Drive to take action S Stimulus A DISASTER WHEN THIS BECOMES CHRONIC Sra Bloom, MD Response (LeDoux, 1996) Between Stimulus Response Between Stimulus Response Cortex Cortex Hippocampus Slower Hippocampus Slower Sensory Thalamus Very Fast Amygdala Sensory Thalamus Very Fast Amygdala S Stimulus S Stimulus Response Response (LeDoux, 1996) (LeDoux, 1996) 4

5 Between Stimulus Response HYPERVIGILANCE Cortex Hippocampus Slower Changes the way you view the world literally Hypervigilance is an enhanced state sensory sensitivity accompanied by an exaggerated intensity behaviors whose purpose is to detect threats. Sensory Thalamus Very Fast Amygdala S Stimulus Response (LeDoux, 1996) Changing gears a little Physiologic changes during F/F/F Increased heart rate Increased BP Increased respiration Do you run because you are afraid or are you afraid because you run (Kohut) Stress Research from Jerusalem Ariah Shalev at Hadassah Medical School Survivors suicide bombers Following ER treatment Those that do not develop stress symptoms are able to decrease heart rate, calm, quiet their bodies Those that do develop stress symptoms still have hyperarousal, high heart rates, high blood pressure Regulated states appear to be correlated with decreased likelihood to develop stress syndromes 5

6 Play Play Fear In Panksepp JP (1998): Affective Neuroscience: The Foundation Human Animal Emotions, Oxford, New York In Panksepp JP (1998): Affective Neuroscience: The Foundation Human Animal Emotions, Oxford, New York What we see Disengagement Aggression loss impulse control in the face novel situations Immediate deterioration into power control struggles Aggression, fear, quick to anger Minor events precipitating catastrophic reactions 6

7 The Questionnaire Thee types abuse Five types family dysfunction Two types neglect Surveys given Review first results: I wept because all the suffering, I wept Results 2/3 had experienced one or more types adverse childhood experiences Of those, 87% had experienced two or more Direct link between childhood trauma risk adult onset chronic disease, mental illness, doing time in prison, work issues Linear relationship with medical, mental, social problems Tobacco Percent currently smoking or more Number ACEs 7

8 Chronic Obstructive Pulmonary Disorder Alcohol Percent with COPD or more Number ACEs Percent with alcoholism or more Number ACEs Felitti, 2004 Felitti, 2004 Injected Street Drug Use 4 Percent who have injected drugs or more Number ACEs Felitti,

9 Some People May have tremendous exposure to adverse events especially as children that cause a wash threat detection all the time Those who serve them Have created ways thinking about perceiving people their behaviors These patterns thinking sometimes get in the way We must begin with ourselves! The wear tear on the body brain resulting from chronic over activity or inactivity physiological systems that are normally involved in adaptation to environmental challenge Extreme poverty, repeated abuse or neglect, Growing up in families facing economic hardship can produce elevated cortisol levels that may stay elevated even after conditions have improved. Even infants young children are affected by significant stresses that negatively affect their family caregiving environments Sra Bloom, MD ADAPTIVE COPING Building Resilience MALADAPTIVE COPING Sleep Exercise Good food Access to mental health treatment Support from others Relationships healthy relationships 9

10 ADAPTIVE COPING Community MALADAPTIVE COPING Substance use Addiction Avoidance triggers Anxiety, phobias, agoraphobia Friends, teachers, other adults Family Self Pain as a distraction Avoidance grief Risky behavior Controlling behavior Dissociation Empowerment through violence Self harming Depression, suicidality Addiction to trauma Alienation from others Reenactment, revictimization Criminal, antisocial behavior Personality disorder Depression Generalized anxiety disorder Panic disorder Conduct disorder Oppositional disorder ADHD ETC ETC It s not What s wrong with you? It s What happened to you? Sra Bloom, MD Sra Bloom, MD 10

11 What High Needs / High Cost Members Have Taught Us Moving from What s wrong with you to What has happened to you Formal qualitative study Adverse Life Events Health Resilience participant open ended interviews Survey now being sent to 9000 Health Share members Can we identify common pathways to high utilization? 41 Tumultuous, violent relationship between parents, unstable housing birth What we learned: Life stories with chain reactions adversity Parents split, dad got left behind Lived with multiple caretakers in various locations 5 yo 11 yo 15 yo 18 yo 21 yo 27 yo 47 yo Moves back in with mom, daily sexual abuse from stepfather Mira First pregnancy/birth, stepbrother is father Drops out school 3 children, still living in abusive household Begins heavy drug use selling Goes to to prison on on drug drug charges Age 47 6 children age No GED/diploma, no employment In recovery from severe substance use Chronic pain, cancer, multiple surgeries, no teeth or dentures Multiple psychiatric medications 3 more children born Suicide attempt Heavy alcohol use, drug relapses, cancer, car accidents Health Share Oregon 0 6 yo 30% Suffered repeated physical, sexual or emotional abuse in early childhood 47% Neglect 7 19 yo The Prevalence Adverse Life Experiences 54% struggled in school 50% dropped out school 17% Had unmet basic needs (food, clothing) 13% Livedwithanadultwith a substance use issue 17% Were separated from parents What the Numbers Tell Us Before Age 19: 63% experienced some form abuse; 52% experienced extended maltreatment 28% Ran away or left home early 30% Became teen parents 15% Became homeless at some point 46% Were substance users 30+ yo 40% Struggle with mental health 70% Describe struggling to get needed healthcare 30% Struggle to manage their medication NONE able to work 30% Describe being socially isolated yo 30% Were arrested or incarcerated at some point 52% Were substance users 26% Were homeless 74% Report job insecurity or become unable to work at all 28% Were separated from their children Lauren Brfman, Center for Outcomes Research Education (CORE) What Does This Mean For Communities? How do we get people on the same page in order to be well? 11

12 What We Are Most Trying to Prevent: Cascading adverse life events that derail a healthy life Pregnancy Birth Adult violence, SUD 3 yo Parents not able / ready to parent 5 yo 6 12 yo Poor Attachment Abuse Neglect yo Kindergarten School Failure Behavioral Problems Skill Deficits Unintended pregnancy 21 yo + Risk Behaviors Substance Use Unhealthy Relationships Chronic illness, Substance use, Mental illness, Criminality, Isolation, Disability Job Insecurity Social Deprivation Housing Insecurity Goal: A healthy, productive next generation Oregonians Pregnancy Birth Wanted Pregnancy 3 yo Healthy Mom / Child 5 yo Strong Attachments 6 12 yo Ready for kindergarten yo Academic Success 21 yo + Positive Relationships Healthy, productive adult Healthy Lifestyle HOW? A healthy start in life An absence toxic stress for families Loving relationships Safe communities A responsive environment will Facilitate physiologic calm Avoid triggering the fight/flight/freeze response Encourage thinking, problem solving, decision making, collaboration 12

13 Creating Safe Places Let s start with educating EVERYONE Reinterpret difficult behavior through the lens trauma exposure Agree on our values Let s get civilized Developing a safe environment atmosphere How? What signals SAFETY? Social Physical Moral Cultural What are universal triggers? What are universal signs welcome respect? What signals DANGER? Social Physical Moral Cultural Building Communities Community: A group people sharing a common interest set values Nonviolence Emotional Intelligence Democracy Social Learning Open Communication Social Responsibility Growth Future Intentional Communities: Creating Culture Language Traditions rituals Welcoming newcomers Overt norms values The lens from which we see 13

14 Where are the places we are in community, how can we be intentional about our experiences there? Early childhood Schools Social public services Everyday life Trauma Informed Universal knowledge about trauma, adversity, their effects Policies practices in place to minimize damage maximize opportunities for health growth development Interventions that specifically acknowledge the impact toxic stress exposure restore the person/family/community to safety relationship "I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel. Maya Angelou Resilience: Humans thrive on love connection Brains can be protected nurtured Brains can be re wired Brains can heal All in the context enriched human interaction 14

15 Be kind, for everyone you meet is fighting a great battle --Aristotle 15