Resources for Treatment and Management of PTSD

Clinical Implications of Neuroscience Research in PTSD

Bessel A. Van Der Kolk, 1996

Sensory input can automatically stimulate hormonal secretions and influence the activation of brain regions involved in attention and memory.

Reminders of the past automatically activate certain neurobiological responses = trauma survivors are vulnerable to react with irrational-subcortically initiated responses that are irrelevant and even harmful in the present:

They often blow up in response to minor provocations, freeze when frustrated, become helpless in the face of trivial challenges.
There is an increase in blood flow in the right medial orbitofrontal cortex, insula, amygdala, and anterior temporal pole (emotional brain).
Relative deactivation in the left anterior prefrontal cortex—Broca’s area (the expressive speech center in the brain).
Activation of brain regions that support intense emotions
Decrease activity of brain structures involved in the inhibition of emotions and the translation of experience into communicable language.

TARGETS FOR EFFECTIVE INTERVENTION

The capacity to respond to the environment in a flexible manner develops slowly and is easily disrupted. Children only develop autonomy when they start developing a prefrontal cortex. This allows them to appraise their internal states and to execute action necessary to restore disturbances in homeostasis.

Emotionàl reactions result from increased activation of subcortical brain regions and reduction of blood flow to frontal lobe.

Traumatized individuals have problems with sustained attention and working memory, which causes difficulty performing with focused concentration and being fully engaged in the present. This probably results from dysfunction of frontal-subcortical circuitry and deficits in corticothalamic integration.

Target:

1. (fight/flight/freeze) Immobilization vs taking action using arousal modulation and control of the ANS (breathing exercises, progressive muscle relaxation, guided imagery, meditation).

2. Mindfulness and Interoception (body oriented therapies: Somatic Experiencing Therapy)

Bring awareness to body: Physical self experience and self awareness,
As trust is established, it is critical to create a physical sense of control and safety,
By working with body boundaries, exploring ways of regulating physiological arousal,
(breath and body movement, yoga), focus on regaining a physical sense of being able to defend and protect oneself.

3. Eye Movement Desensitization Response (EMDR). Your therapist will use EMDR therapy techniques to address targeted memories. This happens in four stages:

Desensitization. You’ll focus on that negative thought, memory, or image. At the same time, you’ll be guided through bilateral stimulation (BLS), which might involve making specific eye movements, tapping, audio tones, or blinking lights. Then, you’ll let your mind go blank and notice any thoughts and feelings that come up spontaneously. After you identify these thoughts, your therapist may have you refocus on that traumatic memory or move on to another, if that memory no longer triggers unwanted emotions.
Installation. You’ll “install” a positive self-belief or image to replace the unwanted one you identified in phase 3. You’ll focus on this belief through another repetition of BLS.
Body scan. Your therapist will ask if the targeted memory prompts any uncomfortable physical pain or sensations. If it does, they’ll lead you through another repetition of BLS.
Closure. After each session, your therapist will explore your progress and suggest relaxation techniques and other coping strategies that can help you maintain improvements.

Neurobiology of trauma
Attachment theory
Understanding trauma in developmental context
Complex and acute trauma
Dissociation and memory
Stabilization
Trauma Processing: Cognitive, Expressive, Mind-Body, EMDR
Play therapy with traumatized children
Trauma and resiliency
Vicarious trauma and self-care
Ford, J. (2005). Treatment implications of altered affect regulation and information processing following child maltreatment. Psychiatric Annals, 35(5), 410 – 419.

Readings:

De Bellis. M.D. (2001). Development and Psychopathology: Developmental Traumatology: The Psychobiological development of maltreated children and its implications for research, treatment, and policy. 13, 539-564. Cambridge University Press: Printed in the United States of America.

Pynoos, R., Steinberg, A. & Piacentini, J. (1999). A developmental psychopathology model of childhood traumatic stress and intersection with anxiety disorders. Biological Psychiatry, 46, 1542 – 1554.

Cahill, L., Kaminer, R. & Johnson, P. (1999). Developmental, cognitive, and behavioral sequelae of child abuse. Child and Adolescent Psychiatric Clinics of North America, 8(4), 827 – 843.

Bessel van der Kolk M.D. , Complex Trauma

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., deRosa, R., Hubbard, R., Kagan, R., Liautaud, J., Mallah, K., Olafson, E., & van der Kolk, B. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35(5), 390 – 398.

van der Kolk, B., Roth, Pelcovitz, D., Sunday, S., and Spinazzola, J. (2005). Disorders of Extreme Stress: The Empirical Foundation of a Complex Adaptation to Trauma. Journal of Traumatic Stress, 18(5), 389–399.

van der Kolk, B.A. (2002). Assessment and Treatment of Complex PTSD. In R. Yehuda, Treating Trauma Survivors with PTSD. American Psychiatric Publication.

10/20/08 Margaret E. Blaustein Ph.D.Trauma in Context: The Attachment System

James, B. (1994). Handbook for Treatment of Attachment: Trauma Problems in Children (1-23). New York: The Free Press.

American Academy of Child and Adolescent Psychiatry. (2005). Practice parameters or the assessment and treatment of children and adolescents with reactive attachment disorder of infancy and early childhood. Journal of the American Academy of Child and Adolescent Psychiatry, 44(11), 1206-1219.

Carlson, V., Cicchetti, D., Barnett, D., & Braunwald, K. (1989). Disorganized/disoriented attachment relationships in maltreated infants. Developmental Psychology, 25, 525-531.

Bessel van der Kolk M.D. Brain, Body, and the Self

van der Kolk, B. (2003). The Neurobiology of Childhood Trauma and Abuse. Child and Adolescent Psychiatric Clinics, 12, 293-317.

Glaser, D. (2000). Child abuse and neglect and the brain: A review. Journal of Child Psychology and Psychiatry, 41(1), 97 – 116.

Howell, E. (2005). Dissociation: A model of the psyche. Ch 1 in The Dissociative Mind (pp 14-38). Analytic Press. Schwartz, R.C. (2001). Introduction to the Internal Family Systems Model. Pp 3-20, 69-81,83-95.

Kinniburgh, K., Blaustein, M., Spinazzola, J. & van der Kolk, B. (2005). Attachment, Self-Regulation, and Competency: A comprehensive framework for intervention with childhood complex trauma. Psychiatric Annals, 35(5), 424-430.

Gelinas, D. (2003). Integrating EMDR into Phase-Oriented Treatment for Trauma. Journal of Trauma & Dissociation, Vol. 4(3) 91-135.

Korn, D. L., & Leeds, A. M. (2002). Preliminary evidence of efficacy for EMDR resource development and installation in the stabilization phase of treatment of complex posttraumatic stress disorder. Journal of Clinical Psychology, 58,(12), 1465-1487

Healing Trauma: Attachment, Mind, Body, and Brain [Hardcover] Daniel J. Siegel (Editor), Marion F. Solomon (Editor), Marion Solomon (Author) 2003

The Healing Power of Emotion: Affective Neuroscience, Development & Clinical Practice (Norton Series on Interpersonal Neurobiology) [Hardcover]Diana Fosha (Editor), Daniel J. Siegel (Editor), Marion F. Solomon (Editor) 2009

The Personality Disorders Through the Lens of Attachment Theory and the Neurobiologic Development of the Self: A Clinical Integration – Hardcover (Jan. 10, 2006) by James F. Masterson.