!"#$"%!& When you change the way you look at things, the things you look at change.

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1 When you change the way you look at things, the things you look at change.!"#"$%&'("$%)*&"$+,-."$%&(-/0$)&1#2,#1.&2#13&%310'& )'31'+(1)&24&5/1& 6)&0&31)-,'&71&031&+2/8,19*&0.085#1*&"$'13.181$.1$'&0$.& "$'130+5#1& :-3&+(",.(22.&.1#1,28/1$'&+2$)'30"$)&2-3&0.-,'& 4-$+52$"$%& 6.#13)"';&0$.&'30-/0&")&+2//2$&0$.&"4&-$0..31))1.*&+0$& /-'0'1&"$'2&'29"+&)'31))<+2/8,19&'30-/0& =23/0,&)13#"+1&);)'1/)&,03%1,;&2#13,22>1.&'(1&+1$'30,& %&

2 The brain needs safe experiences to live. It grows, is pruned and learns! Emotional Regulation for infants! Maternal dyad! Repetitive, patterned interaction to hardwire self-regulation! Exploration of individual self, tentative independence, tolerating manageable separations! In[ter]dependence Neurodevelopment of Childhood, Bruce D. Perry, M.D., Ph.D., #&

3 We were prey long before we were predators! Earliest relationships critical for developing capacity to regulate states! Neglectful and traumatic early relationships set up person to respond with state dysregulation to interpersonal cues in subsequent relationships '&

4 Cortex Hippocampus Slower Sensory Thalamus Very Fast Amygdala (LeDoux, 1996) Stress! Our mind s struggle with what is! Demands outweighs resources! Lack of control! Lack of meaning.! Interaction between actual events and how you perceive! Events may not be amenable to change but you can control your perception and response! Glided by prejudices or principles. (&

5 Trauma is extreme stress brought on by shocking or unexpected events that overwhelm a person s ability to cope resulting in feelings of helplessness, and extreme fear and horror. The survivor perceives the event as bodily violation, threat of death or serious injury to self or a loved one. The event may be witnessed or experienced directly. Cortex Hippocampus Even Slower Sensory Thalamus Very, very Fast Amygdala (LeDoux, 1996)!Powerlessness!Disconnection!Devaluing!Out of Control What we see!aggression and low impulse control in new situations or with new people!power struggles and fear in the context of rule enforcement!disengagement!interpretation of safety enforcement as predatory! Minor events precipitating catastrophic reactions!&

6 ! Interferes with normal emotional & cognitive development! Emotional states too intense to handle! Reinforced by helplessness and need for control! Reset CNS: The hallmark is! HYPERVIGILANCE! Traumatic re-enactment! Aggression become chronic! Dissociation is common! Chronic hyperarousal interferes with cognitive clarity! Loss of (or failure to develop) affect modulation. (De Bellis et al., 1999) Bloom, 2001 )&

7 HYPERVIGILANCE Hypervigilance is an enhanced state of sensory sensitivity accompanied by an exaggerated intensity of behaviors whose purpose is to detect threats. Hypervigilance is also accompanied by a state of increased anxiety which can cause exhaustion. Other sx include: abnormally increased arousal, a high responsiveness to stimuli, and a constant scanning of the environment for threats. +,--./01&#22!1&/,345678&+9:;&! Changes parameters:! Affect! Thought! Behavior! Sense-of-self! Consciousness.! Shapes basic beliefs about identity, world view, and spirituality.! Symptoms are ADAPTATIONS. Loss of emotional management Lack of basic safety/trust Problems with cognition Communication problems Children and Adults Problems with authority Confused sense of justice Inability to grieve and anticipate future TRAUMA-ORGANIZED PERSON Slide from Sandra Bloom, 2014 *&

8 1.! When acutely threatened, we mobilize vast energies to protect and defend ourselves. We duck, dodge, twist, stiffen and retract. Our muscles contract to fight or flee. However, if our actions are ineffective, we freeze or collapse. -Levine 2.! In normal development, state changes are coregulated with changes in state becoming smoothed out over the course of development. -Putnam 3.! States become traits: if the neurobiology of a specific response, Hyper-arousal or Dissociation, is activated long enough, there will be molecular, structural and functional changes in those systems. -Perry! Experienced & impacted by intense adversity! Extreme behaviors within relationships can be seen as defensive or selfprotective! Respond to their trauma history in the present. They are not able to discern that the context has changed! This behavior must be seen as an attempt to master extremely difficult environments! In this way, traumatized individuals are doing the best that they can. <&

9 ! Faulty control methods:! Over-control! Impaired! Self-blame attachments:! Passivity! Warmth by friction! Addictive behavior! Interpersonal skill! Self-harm deficits! Self inflicted injuries! Dissociation! Aggressive arousal! Avoidance! Intrusive re-experiencing! Burning and Cutting protect from vulnerable feelings! Substance Use numbing, distraction from memories; I just want to feel better.! Under eating maintain sense of control! Over or binge eating masks anxiety, compensates for feelings of unworthiness! Hypervigilance ensure safety at all times! Hopelessness avoidance of success/failure. almazarconsulting@yahoo.com Presume that every person in a treatment setting has been exposed to abuse, violence, neglect or other traumatic experiences. & Moving From What is wrong with you? to What Happened to you? & $&

10 D1,4EF03/& M$0B","';&'2&C3-)'& K05$%& G32B,1/)& L-",'&?0%1& THE EYE Shifting Sense of Self =103& 6$%13& G)1-.2E H2/81'1$+;& I$)041& G(;)"+0,& J1(0#"23)& D'10,"$%& C13323&!;"$%& A1831))"2$& D19-0,& J1(0#"23)& A0/0%1.&L22.)&!27&D1,4EK)'11/& The Center For Contextual Change, Ltd. Social Environmental Intervention Sensory Thalamus Cortex Hippocampus Psychotherapy Amygdala Neuroregulatory Intervention Response Psychopharmacology (LeDoux, 1996) is the process of encircling a person with value and empowerment by engaging with them in their natural cycles of growth. Collaboratively helping them gather resources from within a themselves, their family and their community. %2&

11 ! Awareness/Realism! Creativity! Humor! Courage/Initiative! Flexibility/ Adaptability! Faith/Trust! Social Support. Socialenvironmental intervention Neuroregulatory Intervention Traumatic State Traumatic Reminder Traumatic State Socialenvironmental Intervention Neuroregulatory Intervention %%&

12 !!!! Customizing the Relationship to Match, Adapt and Respond to:! Coping Style! Stages of Change! Expectations! Resistance Attention to the Alliance/Relational Bond Empathy! Sensitive ability and willingness to understand the person s thoughts, feeling and struggles! Positive regard! Congruence/Genuineness! Feedback! Self-disclosure Goal Agreement & Consensus on tasks (Norcross, 2005 Maya Angelou %#&

13 ! Story! Positive Asset! Restory! Action.! Normalize symptoms! Understand that trauma lives in the body! Acknowledge long term consequences of short term coping! Reframe to empower the client as smart, creative and resourceful! Encourage development of other coping strategies! Teach symptoms are not taking place in the here-and-now. janinafisher.com/resources.php %'&

14 Maya Angelou Safety: Ensuring physical, emotional, social and moral safety Openness & Trustworthiness: Maximizing trustworthiness, making tasks clear, and maintaining appropriate boundaries Participation & Choice: Prioritizing choice and control Belonging & Collaboration: Maximizing collaboration and sharing of power Citizenship & Empowerment: Prioritizing empowerment and skillbuilding (Bloom, 2001; Fallot 2008) 1.! Relationships connecting to a deep set of values that provide a meaningful vision. Collaboration/ Power Sharing/Attachment. 2.! Psycho -Educational Experiences/ Cognitive Behavioral/ Neuro-Mind- Body/ Communication/ Mindfulness/ Thought Process/Self Regulating 3.! Strength Based Guidance/ Vulnerability and Resilience 4.! Safe Context/Boundaries/Structure 5.! The Creation of Workable Realities /Hope! Set up calm and nurturing environments! Teach staff to meticulously observe for triggers when someone is beginning to move from a calm, continuous state to a discreet state of emergency! Train to caring and compassion! Meticulously interview for triggers! Adjust the environment! Adjust what we do (i.e., look at ourselves and our behaviors and actions as the key for success)! We can work to build that cognitive wedge! %(&

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