The Effects of Trauma on Brain and Behavior BY ELI DEHOPE, PH.D., LCSW, BCD What is Trauma? Trauma results from an event or a series of events that subsequently causes intense physical and psychological stress reactions. The individual’s functioning and emotional, physical, social, and spiritual health can be affected. Trauma can be caused by a physical assault, emotional assault, developmental situations and environmental considerations THE KEY! UNDERSTANDING IS THE KEY TO WORKING WITH HUMAN BEINGS And what about the brain? DR. ELI DEHOPE Major Components of the Brain Brain Stem / Spinal Cord – Primal functioning – components to keep you alive Cerebellum – Basic functioning - coordination of movement, posture, and balance. Cerebrum – Higher functioning part of the brain - (lobes of the brain) DR. ELI DEHOPE PARIETAL LOBE ◦ Located behind the frontal lobe ◦ Concerned with perception of stimuli related to touch, pressure, temperature and pain. Parietal Lobe, Right - Damage to this area can cause visuo-spatial deficits (e.g., the patient may have difficulty finding their way around new, or even familiar, places). FRONTAL LOBE Parietal Lobe, Left - Damage to this area may disrupt a • Located at the front of the brain patient's ability to understand spoken and/or written language. • Concerned with reasoning, decision The parietal lobes contain the primary sensory cortex making, planning, parts of speech and which controls sensation (touch, pressure). Behind the movement (motor cortex), emotions, primary sensory cortex is a large association area that and problem-solving. controls fine sensation (judgment of texture, weight, size, shape). • This area determines personality and allows for us to create relationships • Called THE BOSS! DR. ELI DEHOPE TEMPORAL LOBE ◦ Located to the side of the brain ◦ Concerned with perception and recognition of auditory stimuli (hearing) and memory (hippocampus). There are two temporal lobes, one on each side of the brain located at about the level of the ears. These lobes allow a person to tell one smell from OCCIPITAL LOBE another and one sound from another. They also ◦ Located at the back of the brain, behind help in sorting new information and are believed to the parietal lobe and temporal lobe. be responsible for short-term memory. ◦ Concerned with many aspects of vision. Right Lobe - Mainly involved in visual memory (i.e., memory for pictures and faces). Not only is the occipital lobe mainly responsible for visual reception, it also Left Lobe - Mainly involved in verbal memory (i.e., contains association areas that help in the memory for words and names). visual recognition of shapes and colors. Damage to this lobe can cause visual deficits DR. ELI DEHOPE Emotions DR. ELI DEHOPE Memory DR. ELI DEHOPE Brain Development is Amazing! The development of synapses occurs at an amazing rate during a child’s early years, in direct response to the young child's experiences. Some of these synapses are strengthened and remain intact, but many are gradually discarded. This process of synapse elimination—or pruning—is a normal part of development Myelin is the white fatty tissue that insulates mature brain cells by forming a sheath, thus ensuring clear transmission across synapses. Children process information slower because they lack the needed Myelin. Brain development continues throughout the lifespan. This allows humans to continue to learn, remember, and adapt to new circumstances What About Trauma and the Brain???? The Amygdala is a small almond-shaped structure located deep in the middle of the temporal lobe. The amygdala is designed to: ◦ detect threats in the environment and activate the “fight or flight” response. ◦ activate the sympathetic nervous system to help you deal with the threat. ◦ helps you store new emotional or threat-related memories. The Prefrontal Cortex regulates attention and awareness and is designed to: ◦ make decisions about the best response to a situation. ◦ Initiate conscious, voluntary behavior. ◦ Determine the meaning and emotional significance of events. ◦ Regulate emotions. ◦ Inhibit or correct dysfunctional reactions. Studies of response to threat in people with PTSD show: ◦ a hyper reactive amygdala. ◦ a less activated medial PFC. In other words, the amygdala reacts too strongly to a potential threat while the medial PFC is impaired in its ability to regulate the threat response. The Brain Changes over a Person’s Lifetime Brain Development and External Events Attachment Human brains function best when they are adequately stimulated but simultaneously protected from overwhelming stress. For people, Trauma this explains a need for order, safety and protection. Poverty and hunger Homelessness Synapses, Myelins and Plasticity DR. ELI DEHOPE Perception and Appraisal Going to a Party ◦ A person age 60 ◦ A person age 20 Safety ◦ A child who lives with his mother in a car ◦ A child who lives with his mother in an apartment in the city ◦ A child who lives with his mother in a house in the suburbs Stopped by a police officer ◦ A person who is white ◦ A person who is black What is trauma? Let’s talk physical trauma first… Physical Injuries directly to the Brain ◦ Traumatic Brain Injury ◦ Falls, Sports, Assaults, Shaken Baby Syndrome, Domestic Violence, Motor Vehicle, Blasts ◦ Anoxia – deprivation of oxygen ◦ Penetration into the skull (gun shot…) DR. ELI DEHOPE SLEEPY CABBY DR. ELI DEHOPE MILITARY DR. ELI DEHOPE SPORTS DR. ELI DEHOPE SOME BASICS THAT GET IMPACTED COGNITIVE FUNCTIONS Speed of Processing and Integration of Attention Thoughts Perseveration Confusion Concentration Executive Functions ◦ Judgment ◦ Problem solving Language Processing ◦ Decision making ◦ Inhibition Memory DR. ELI DEHOPE Drugs also affect Neurology We know that drug use and addiction is a disease that affects both brain and behavior DR. ELI DEHOPE DR. ELI DEHOPE The Brain: Basic Drives and Motivators Instinct - An instinct is an innate biological force, which commands the organism to behave in a particular way. Motivation - external inputs and drives affected behavior of organisms, in addition to the internal drives. Hunger – the desire to sustain oneself Nurturing – need to reproduce and continue the species Avoiding Pain - The behavioral consequences and responses to pain are acquired during life. Emotional Responses – Emotions drive behavior – difference between automatic vs. conscious emotions DR. ELI DEHOPE Mental Health and the Brain Thought Disorders DR. ELI DEHOPE Mental Health and the Brain – Emotional Issues DR. ELI DEHOPE Mental Health and the Brain- Behavioral These positron emission tomography (PET) scans show that patients with ADHD had lower levels of dopamine transporters in the nucleus accumbens DR. ELI DEHOPE BEHAVIOR AS RESULT OF TRAUMA Depends on age and prior The brain is physically changed experiences ◦ Some areas of the brain are hyper- charged while others are more Depends on how aware passive someone is ◦ Stress responses also change – Depends on past coping skills ability to negotiate the “new normal” But it really depends on how functional the brain is especially Emotional responses and in the prefrontal and frontal dysregulation lobes Numbing COMMON BEHAVIORAL ISSUES AFTER TRAUMA •Impulsiveness Irrationality and Illogic •Anger and aggressiveness Poor concentration •Lethargy and passiveness Emotional instability mood swings •Poor memory depression suicide ideation •Inappropriate social skills •Frustration Poor self-awareness Disinhibition and hyper-sexuality DR. ELI DEHOPE Self Awareness Developed throughout the Brain consciousness as opposed to unconsciousness knowledge of the world around us sense of self through continuity of experience using personal history to understand the present and future. DR. ELI DEHOPE Resiliency Resiliency is a dynamic process that involves Areas of Resiliency: the ability of the person to respond to stress ◦ understanding and then cope, adapt and thrive in the face of adversity, effectively balancing negative others thoughts and emotions with positive ones. ◦ understanding oneself ◦ controlling oneself While an individual’s total brain is involved with responding to stress and adversity, the ◦ the processes which main structure that appears to support occur where self resiliency is a well-functioning frontal lobe. and others meet. DR. ELI DEHOPE BIO PSYCHO SOCIAL SPIRITUAL CULTURAL Acute medical Perception and Family Organized religion Race issues Appraisal Chronic Coping response Friends Philosophy of life/ Ethnicity medical issues belief system Medications Beliefs and Community Religion of childhood Age philosophy of life organizations (if different) Neurology and Mental well-being Occupation/ job Religion or spirituality Sex Orientation the brain and mental illness difference from larger society Genetics Cognitive Leisure activities Neighborhood/ functioning and self and associations community awareness Basic Thoughts/ Feelings/ Socioeconomic Demographics Behavior status DR. ELI DEHOPE INTERSECTION OF DIFFERENCE AND EXPERIENCES OFTEN COMPLICATE THE PERSON’S ABILITY TO LIVE Race TBI Gender Sexual Orientation Drug and/or Alcohol Abuse Age Culture Developmental Challenges Socioeconomic Issues – i.e. Homelessness Family Life – i.e. Foster Care Neurologic Issues Domestic Abuse Military Experiences Assessment and Screening are Key Always consider the brain: Always consider trauma: ◦ Almost 3 million people experience a TBI every year You can always ask about their experiences – ◦ Estimates are 40% of homeless people have experienced understanding