14 th annual trauma symposium racing pulse, toxic stress, shock: the effect of trauma on the brain...

14th ANNUAL TRAUMA SYMPOSIUM

Racing Pulse, Toxic Stress, Shock: The Effect of Trauma on the Brain

Panelists: Margo DeMont, Ph.D. Cynthia Lemp, M.S.W. Kimberlie Warren, Ph.D.

The Effect of Trauma on the Brain Presentation Objectives

The Learner will be able to:

Describe the effect of stress on the brain

Explain how to alter emotions to minimize the “flight or fight” stress response

Identify at least three symptoms of post-traumatic stress disorder

Describe two physiological changes resulting from using Acute Trauma Incident Processing with a patient

Bi-directional communication between the brain and the body via Autonomic nervous system (ANS)

ALLOSTATIC LOAD

Amygdala Hijacking

The CEO is out of commission!

Emotionally traumatic effects

• “Multiple conflicts, wars…and personal trauma from accidents, abuse, disaster, bullying…large numbers of individual psyches and family systems have been traumatized. The emotional devastations come from the same emotions that can be powerful emotional catalysts for healing.” (www.energeticinstitute.com.au)

Reptilian versus Thinking BrainReptilian and

limbic, sub-cortical areas mediate emotional life.

Healing and rewiring emotional responses and defenses occurs in older brain areas.

The heart – brain connection

EMOTIONS AS ENERGY SOURCES

Energetic frequencies

Positive (high), negative (low)

Emotions and Heart RhythmsEmotions and Heart Rhythms

17Institute of HeartMath

CoherenceFacilitates Brain

Function

Heart Rhythms Directly Impact

Physical and Mental Performance

The heart signals especially affect the brain centers involved in social and situational awareness, the capacity to care, and the ability to self-manage.

IncoherenceInhibits Brain

Function

Institute of HeartMath

Brain cell death Accelerated aging

Impaired memory or learningAlzheimer's

Hypertension Heart disease

CancerObesity

Diabetes

Impact and outcomes of chronic/toxic stress

Stress – cognitive inhibition

Vitality – cognitive facilitation

http://assists.blogspot.com/

Synchronize the Autonomic Nervous System

Emotional LandscapeAutonomic Nervous System – Sympathetic Pathway

High Arousal - Adrenaline

Hormonal System

Low Arousal - AcetylcholineANS - Parasympathetic Pathway

Relaxation

Stre

ss Z

one

Stress-Free Zone

Cortisol DHEA

AngryHostile

ResentfulJudgmentalFrustratedWorriedAnxiousAfraid

JoyfulHappy

EnergizedExcitedCreative

ProductiveAppreciative

Caring

TolerantCalm

CenteredReflective

CompassionateSatisfiedSerene

ForgivingContent

ExhaustedBored

WithdrawnApatheticShamed

DepressedDespairedHopeless

Burned Out

Neg

ative

Emoti

ons

Posi

tive

E

moti

ons

Vitality /Anti Aging HormoneStress / ‘Belly Fat’ Hormone

Negative to neutral, to positive.

EMOTION REGULATION

Cortisol

DHEA

TRAUMA

(photo collage)Little t - BIG T

Jeffrey Brenner, M.D.Medical Director of the Urban Health

Institute at Cooper University Healthcare

More than 15 years ago . . .

Better care at lower cost in America

The largest and most valuable health study ever done.

Adverse Childhood Experiences:

A Chronic Public Health Disaster

Adverse Childhood Experiences Study -

the Largest Public Health Study You Never Heard Of

Adverse Childhood Events

Kaiser Permanente (1997)

Center for Disease Control and Prevention (2009 publication; on-going)

St. Joseph County Community Health Needs Assessment (2012)

Abuse

Dysfunctional Family

Neglect

What Are ACEs?

Prevalence of Adverse Childhood Experiences

Substance abuse 27% Parental sep/divorce 23% Mental illness 17% Battered mother 13%

Adverse Childhood Experiences Are Com m on

Household dysfunction:

Criminal behavior 6%

Abuse: Psychological 11% Physical 28% Sexual 21%

Neglect: Emotional

15%

Physical 10%

ACEs Research: >37,000 Subjects

Adverse Childhood Experience

Social, Emotional, & Cognitive Impairment

Adoption of Health-risk Behaviors

Disease, Disability & Social Problems

Early Death

Scientific Gaps

Death

Conception

Implications

Those with four categories of ACEs 240% higher risk of hepatitis 390% higher risk of COPD (emphysema or

chronic bronchitis) 240% higher risk of STDs Twice as likely to smoke Twelve times as likely to have attempted suicide Seven times higher risk to be an alcoholic Ten times higher risk of injecting street drugs

Trauma, Toxic Stress and the Brain

Orbitofrontal Cortex Pathological Aggression

Amygdala Fear Anxiety

Executive Function

Reversing the Trajectory

Post Traumatic Stress Disorder

Eye Movement Desensitization and Reprocessing

Post-Traumatic Stress Syndrome

Reliving

Avoiding

Increased Arousal

Eye Movement Desensitisation & Reprocessing

Introduction to EMDR

Acute-Trauma Intervention and Processing

Crisis ManagementImpact of Event Scale53 subjects randomly assignedImmediate/Wait-list

Self Reported Distress from Trauma was statistically significant at p=< .001

Elementary Children

12% ≥ 3 ACEs

1. Health, attendance,

behavior 2. Academic

failure

Court-Involved

YouthHigher ACE ScoresAmong those with

≥4:51% special ed. (vs.

33% 0-1)

74% below 2.0 GPA (58%)

85% suspended by 2nd (71%)

33% re-offend in 2 years (13%)

Adult AdversityIncarceration

Victim of Intimate Partner Violence

Drug/Alcohol Mental Illness

Divorce

Parenting Adults

with ≥5 ACE

14 TIMESmore likely to

have two or more conditions that make ACEs for

kids

Work injury- illness

HomelessnessDisabilityPoverty

Health limits activity

Unemployment

High School Youth42% ≥ 3 ACEs

Community Partnerships to Build a Network for ACEs Intervention and

Prevention

We are committed to Trauma-Informed Care:

Proving a safe environment that promotes healing and

recovery

EMDR in Practice

Demonstration

Cynthia Lemp, MSW, LCSWMemorial Hospital of South

BendTrauma Center Social Worker