Tag Archives: Attachment Theory

Orange County CA First Child Trauma Meeting a Big Success

On April 27, “HIMAG3259 Cherokee El, 5-2-14, James,KB, Dana w. bikeealing Orange County from Childhood Trauma” held its first meeting in Mission Viejo, CA at a local restaurant from 6 to 8 pm. We posted it on Meetup.com as the founding meeting of Orange County (CA) ACEs Connection.  I was honored to co-create the meeting with my dear friend Dana Brown, Southern California director for ACEsConnection.com.

We felt awe as three education activists, six professional trauma therapy providers, individuals suffering child trauma and a total of 12 people already acting as leaders in Trauma-Informed Care and resilience building, filled our table to overflowing.  An additional 15 folks who couldn’t attend due to schedule conflict signed up. That’s a total of 27 compassionate people, all glad to hear that finally there’s action to get ACEs child trauma out of the closet in the upscale, but down in-denial, OC.  My earlier blog on Trauma-Informed Care is here: http://attachmentdisorderhealing.com/trauma-informed-care/

We were all so excited we forgot to take a group photo — in lieu of which above are LA education leader James Encinas, myself, and Dana Brown in May 2014 at San Diego’s model Trauma-Informed Care school Cherokee Point Elementary: https://acestoohigh.com/2013/07/22/at-cherokee-point-elementary-kids-dont-conform-to-school-school-conforms-to-kids/

Everyone requested and donned name tags as we began by asking each to self-introduce.  Folks got so involved that they began asking each other questions around the table and networking on the spot. Soon we were really getting to know each other for more than an hour.

Next, Dana gave an overview of ACEsConnection and the ACE Study. Nearly two-thirds of Americans experience childhood trauma, according to the CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study, she said, and suffer chronic disease, depression and other illnesses because of it. Here’s the short video we posted on the invite (full text of invite is below): http://www.acesconnection.com/blog/ace-study-co-founders-tell-story-on-dvd-here-s-an-intro/

Dana then announced that we’re forming Orange County (CA) ACEs Connection, and asked everyone to please join ACEsConnection.com and then the Orange County group. You are welcome to go to ACEsConnection and join us here: http://www.acesconnection.com/g/orange-county-ca-aces-connection

I stressed that ACEsConnection will be the organizing platform for communication and future meetings; we’re just advertising on Meetup.com like posting an ad in the local paper.

Finally I introduced myself as author of a book and website on the incredible prevalence of attachment disorder and developmental trauma in the US:  http://attachmentdisorderhealing.com/the-silent-epidemic-of-attachment-disorder/

I have the ACE Pyramid linking to ACEsConnection on every page of my website, I said, because ACEsConnection is action-central on the facts about and the healing methods for trauma.

Then all the participants began sharing their eagerness to expand our reach and include many more Orange County residents into the process of bringing hope and healing to our neighborhoods.  One educator proposed a screening of the key documentary on trauma healing “Paper Tigers” at Dana Point’s high school; a professor wants to organize a screening at her university in Irvine; a therapist wants to show it at her trauma clinic; another practitioner wants to screen it at her church.

The group asked unanimously for a second meeting, hopefully on the third or fourth Wednesday of the month, or perhaps in odd-numbered months as the founding group did in San Diego. Three activists volunteered locations for the next meeting; others proposed that ads be put in the local Penny-saver leaflet and/or county paper Orange County Register to build the next meeting.

One leader said publishing a schedule of speeches on specific trauma topics and healing modes is a great way to build meetings. The group was so positive that we may try to create a speakers steering committee at our next meeting to draw up such a list of topics and speakers from among us.

Everyone  was invigorated and looking forward to our next gathering.  Dana and I  will be in touch with everyone for more information on next steps.

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Here’s the text of our Meetup.com advertisement that’s drawn 27 interested participants to date (and growing). Feel free to use it!

Nearly two-thirds of Americans experience childhood trauma, according to the CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study, and suffer chronic disease, depression and other illnesses because of it. Here’s a short video about it: http://www.acesconnection.com/blog/ace-study-co-founders-tell-story-on-dvd-here-s-an-intro/

Is that you, your child, your friend or family member, your student, patient, or client?  It’s likely.

Come meet us to learn how childhood adversity can last a lifetime — but it doesn’t have to.

It’s our first meeting of ACEsConnection in Orange County, CA, part of a growing movement now 8,000+ strong nationally and internationally on the social network http://www.acesconnection.com/

We’d love to see you and hear your story, whether you’re an individual suffering trauma, a service provider, educator, community organizer, concerned parent, or any compassionate human being. By listening, we can see how we might help one another in building resilient communities in Orange County.

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

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Comments are encouraged with the usual exceptions; rants, political speeches, off-color language, etc. are unlikely to post.  Starting 8-22-16, software will limit comments to 1030 characters (2 long paragraphs) a while, until we get new software to take longer comments again.

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Readers Defend Van der Kolk

Bessel van der Kolk pic Trauma CenterI had the most comments ever last week, as readers spoke up to defend Dr. Bessel van der Kolk (left) and his ideas about somatic (body) healing for trauma, after the sideswipes against science by the New York Times May 22.  But the comments section got buried under all the footnotes I had to put in my letter to the Times to document their ignorance, so I’m posting the comments here where they’re easy to find.

 

Barbara Findeisen | June 7, 2014
Thank you, Kathy, you speak for many of us.  Did you see the “60 Minutes” show that Sunday? Most of my friends in the field do not think cognitive (therapy) is the way to go.

Some do. I have a hunch it is because they are afraid of their own trauma and need to be in control. As I am sure you know it an be messy when you are back in that pain and terror.

Kathy | June 8, 2014
Dear Barbara,
I’m grateful for your work on somatic healing and attachment trauma at Star Foundation (www.starfound.org).  A transcript of the May 25 “60 Minutes” show on PTSD is here.  Personally I was horrified by the VA forcing vets to do cognitive talk therapy, retelling their trauma over and over.
Not only Dr. van der Kolk but also somatic therapy experts Dr. Peter A. Levine, Dr. Pat Ogden, Belleruth Naparstek, Janina Fisher, and others with extensive vet experience warn that “just talk” about trauma only makes victims relive the trauma.  So it gets worse.
That’s why I took Dr. Levine’s somatic book “Healing Trauma to my therapist; he’s an attachment expert, but into cognitive talk therapy.  I said: “Sorry you’re not familiar with somatic work, but I got traumatized before I was 3 and had a thinking brain, so the trauma’s baked down into my body parts, where talk and cognition can’t get at it. This book is what we’re going to do.”  Our results were spectacular.  Levine’s results with vets are also spectacular.

Cheryl Sharp | June 9, 2014
While the coverage of van der Kolk’s work looked good on the surface, the innuendos throughout left me feeling that it was more of an attack.

It would have made much more sense for the article to go further and talk about why the way he works with people actually works, such as follow up with Bruce Perry’s work.

Only when people understand how the brain gets stuck and that the only way to that part of the brain is through the body, will they understand that healing and recovery is a real possibility.

Kathy | June 9, 2014
Amen when it comes to healing!  Dr. Bruce Perry, MD, Dr. Dan Siegel, MD, Stephen Porges and show that trauma shuts down higher brain functions like cognition. Instead, body parts and the primitive brain stem get “stuck” repeating bodily feelings from the past trauma events. Without higher brain functions, we can’t put the past trauma events into long-term memory. Instead, our body is reliving the past, now.
Siegel also says trauma memories can get so fragmented that we can’t gather them into a working picture at all; they sit scattered around the nervous system and body.
Perry says  “rhythmic regulation” by body movement can get the brain stem to calm long enough to let the higher brain functions come on line.
The Times ignores all this and repeats Richard McNally’s 2005 insistence that all trauma is remembered — though many said at the time that his work lacked proof. Lisa Najavits called McNally “disappointing… landing too forcefully on one side…by no means an end to the debate.”

Jane | June 9, 2014
Kathy, thanks for this informative post.  Several parents in my online support group have been discussing this very issue – body work to heal trauma – this past week.

Kathy | June 9, 2014
Thank you Jane!  Bruce Perry, Dan Siegel and others show even a normal child’s brain has no capability to remember much from conception to 36 months of age. Memories come in as discrete packets of sensory data from the eyes, ears, nose, etc., and sit in the body and primitive brain stem.
Only when the higher cognitive  functions like the hippocampus kick in around age 3, can we create real long term memory.
But if developmental trauma occurs from conception to 36 months, the primitive brain stem gets so traumatized that it harms the development of the higher brain lobes — which are outgrowths of the brain stem. The hippocampus, our ability to create long term memory, and many other higher brain functions can be badly damaged.
So we physically can not “think our way out” as van der Kolk says.

Rebecca | June 7, 2014
Excellent. Glad you wrote a defense. Have you heard back from them??

Kathy | June 8, 2014
No, nothing yet; frankly I didn’t expect anything.
They’re like King George or Marie Antoinette… They think they are Royalty at The Most Important Newspaper In The World – so they can just print anything they like, and the rest of us peons must cower.
Like I said, I grew up in New York and I’m not impressed.
When Thomas Edison invented the light bulb, they literally wrote an editorial denouncing him as a charlatan. I don’t have a copy of it anymore but maybe you can find it on the internet?

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Kathy’s news blogs expand on her book  “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

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In Defense of Van der Kolk

Bessel van der Kolk portrait by Matthew WoodsonThe New York Times May 22 spotlighted Dr. Bessel van der Kolk MD’s idea that to change the way we heal a traumatized mind, start with the body (as noted last week). (Van der Kolk portrait by Matthew Woodson for the Times, left.)  But the Times had its own slant, some of it not cricket.

So here’s the letter I wrote to the Times about the gnarly
innuendos they also threw in — against Dr. van der Kolk.
These are innuendo against the science of how the human
organism deals with trauma and how widespread trauma

Some 50% of Americans have insecure attachment trauma
and roughly 50% of us suffer one or more types of Adverse Childhood Experience (ACE) trauma.  But the Times isn’t sounding the alarm about that.  Instead they’re damning the scientists trying to sound the alarm, with faint praise and innuendo.

I grew up in New York; I’m not impressed by Their Majesties.  I don’t care to let the Times’ arrogance stand.

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Subject: J. Interlandi 5-22 Van der Kolk feature
From: Kathy Brous   Date: Thursday, May 29, 2014
To: Letters@nytimes.com, “Sheila Glaser” <sfglaser@nytimes.com>
Cc: “Jeneen Interlandi” <jeneeni@yahoo.com>

Re:  “A Revolutionary Approach to Treating PTSD” by Jeneen Interlandi, May 22 New York Times Magazine

Dear Editors,

I appreciate Ms. Interlandi’s  allowing Dr. Bessel van der Kolk the space to explain that “to change the way we heal a traumatized mind, start with the body.” It’s especially true that standard “cognitive” treatments often don’t work, “patients are still suffering, and so are their families. We need to do better,” as van der Kolk says.

Of 208 reader comments, I only found two that didn’t hail his work; the two attacked van der Kolk for stating that “repressed memories” are possible.

But so, in effect, does the Times – and more. Which I found alarming.

“In the 1990s, van der Kolk served as an expert witness in a string of high-profile sexual-abuse cases that centered on the recovery of repressed memories, testifying that it was possible… for victims of extreme or repeated sexual trauma to suppress all memory of that trauma and then recall it years later in therapy,” Ms. Interlandi wrote.

Then, as if seamlessly, she segued into this next sentence: “In the 1980s and ‘90s, people all over the country filed scores of legal cases accusing parents, priests and day care workers of horrific sex crimes, which they claimed to have only just remembered with the help of a therapist… But as the claims grew more outlandish — alien abductions and secret satanic cults — support for the concept waned… Harvard psychologist Richard McNally called the idea of repressed memories ‘the worst catastrophe to befall the mental health field since the lobotomy ‘.”

Bessel website pix vanderKolkportrait1I loathe witch trials; I was alarmed.  Is van der Kolk a butcher?  So I did an extensive internet search, and found zero evidence that van der Kolk personally had anything to do with the fraudulent cases.  Let alone aliens or cults.

Then I realized that the Times doesn’t have a single footnote to show it either. Is it all innuendo?

In my search, the worst van der Kolk’s worst critics could do, was to condemn him for repeating his clinical findings that repressed memories are possible. Period. [1]  Yes it’s horrible that there was a witch hunt in the 1980s-90s. It’s horrible that others distorted van der Kolk’s findings and as a result, innocent people were jailed.

But it’s just as much of a distortion to accuse him of doing the witch hunting. Is Edison responsible for everything ever done under electric lights?

The Times doesn’t report any of that.

The Times also doesn’t report this: since Richard McNally, Elizabeth Loftus and others flatly declared repressed memory to be impossible in 2002-2005, several peer reviewers have concluded that they were (flatly) wrong. The American Psychological Association website now states that while most traumas are remembered, “repressed memories” are also often reported and quite possible — and far more research is needed before anything can be dismissed. [2]

I appreciate Ms. Interlandi for covering trauma and van der Kolk, and at such length. I appreciate she seeks balance. But was that balance?

She also describes a follow-up visit she made to the Iraq vet with PTSD, whom van der Kolk treated using group therapy in the article’s opening passages. She concludes the article by reporting that the vet has no idea whether it worked or not. This leaves readers thinking: “Hmm. Van der Kolk?  His stuff doesn’t work.”

Without any review of what van der Kolk’s actual recovery rate might be?  Why the innuendo?  Where are the facts?

The Times also doesn’t report another key fact: according to Veterans Administration chief PTSD authority Dr. Matthew Friedman and several other studies, only 10-15% of veterans who experience war trauma incidents, come down with enduring full-blown PTSD. The rest heal within a relatively finite period. [3]

Traumatized little boyThe problem is the “invisible elephant” on the national mental health lawn: child trauma.

Child trauma is a topic Dr. van der Kolk discusses constantly, but which the article only mentions in passing, by way of asking whether it can be remembered or not. Yet the ACE Study has already shown that roughly 50% of us suffer one or more types of childhood trauma.

Those 10-15% who get PTSD? They are almost always survivors of some unrelated childhood trauma, which damages memory during brain development, such that yesterday’s events continue to be experienced as today’s events. That means the Iraq vet in the article, who has enduring PTSD, very likely had childhood trauma, a huge topic in itself.  [4]

To address child trauma — and what it would really take to fully heal this vet — would require giving Dr. van der Kolk the space for a whole other article. Which more than 200 of your readers would welcome.

Unless there’s a reason why not?

Unless we instead might have an article by those who allege that van der Kolk promoted the fraudulent cases — if, that is, they can show proof? And please: proof means footnotes and documentation.

Kathy Brous, Dana Point, CA
http://attachmentdisorderhealing.com/blogs/

Footnotes (provided in letter to the Times)

FN1  The False Memory Syndrome Foundation (FMSF) (www.fmsfonline.org), the premier site exposing fraudulent accusations based upon false trauma memory, has dozens of references to Bessel van der Kolk testifying on the science. Yet it never mentions that he supported any particular therapy, therapists, false memories or particular cases at all.  It certainly never connects him to anything to do with aliens or satanic cults.

FN2  The American Psychological Association’s 2007 “Working Group on Investigation of Memories of Child Abuse” presented findings mirroring those of the other professional organizations. The Working Group made five key conclusions:
“1. Controversies regarding adult recollections should not be allowed to obscure the fact that child sexual abuse is a complex and pervasive problem in America that has historically gone unacknowledged;
“2. Most people sexually abused as children remember all or part of what happened to them;
“3. It is possible for memories of abuse that have been forgotten for a long time to be remembered;
“4. It is also possible to construct convincing pseudo-memories for events that never occurred;
“5. There are gaps in our knowledge about the processes that lead to accurate and inaccurate recollections of childhood abuse.”
– Source: Colangelo JJ, “Recovered memory debate revisited: practice implications for mental health counselors,  PRACTICE, Journal of Mental Health Counseling, 2007

The American Psychological Association’s website www.apa.org/topics/trauma/memories.aspx?item=1 currently adds:
“Q: Can a memory be forgotten and then remembered? Can a ‘memory’ be suggested and then remembered as true?
“A: Experts in the field of memory and trauma can provide some answers, but clearly more study and research are needed. What we do know is that both memory researchers and clinicians who work with trauma victims agree that both phenomena occur.
“However, experienced clinical psychologists state that the phenomenon of a recovered memory is rare (e.g., one experienced practitioner reported having a recovered memory arise only once in 20 years of practice). Also, although laboratory studies have shown that memory is often inaccurate and can be influenced by outside factors, memory research usually takes place either in a laboratory or everyday setting. For ethical reasons, researchers do not subject people to a traumatic event to test their memory. Because it has not been directly studied, we can not know whether a memory of a traumatic event is encoded and stored differently from a nontraumatic event.
“Some clinicians theorize that children understand and respond to trauma differently from adults. Some furthermore believe that childhood trauma may lead to problems in memory storage and retrieval. These clinicians believe that dissociation is a likely explanation for a memory that was forgotten and later recalled. Dissociation means that a memory is not actually lost, but is for some time unavailable for retrieval. That is, it’s in memory storage, but cannot for some period of time actually be recalled. Some clinicians believe that severe forms of child sexual abuse are especially conducive to negative disturbances of memory such as dissociation or delayed memory. Many clinicians who work with trauma victims believe that this dissociation is a person’s way of sheltering him/herself from the pain of the memory.
“Many researchers argue, however, that there is little or no empirical support for such a theory.”

FN3  “We know that if a hundred people are exposed to a traumatic episode…that most of them will not develop PTSD… The pre-traumatic risk factors are things you really can’t do anything about: whether your parents were well adjusted or had a mental health history, whether you were previously exposed to a disruptive household – your father was an alcoholic or that you were very poor and there was a lot of deprivation, or there was physical or sexual abuse during your childhood.”
– Source: Dr. Matthew Friedman, “Psychological First Aid: Diagnosis and Prevention of PTSD,” June 8, 2011 webcast, National Institute for the Clinical Application of Behavioral Medicine, www.nicabm.com
Dr. Matthew Friedman recently retired from the position of Executive Director and now serves as Senior Advisor at the U. S. Dept. of Veterans Affairs National Center for PTSD. Source: www.ptsd.va.gov/professional/continuing_ed/presenters/matthew-j-fri… [Dated March, 2014]

FN4  “The purpose of this study was to compare rates of childhood abuse in Vietnam veterans with and without combat-related posttraumatic stress disorder (PTSD).
“Results: Vietnam veterans with PTSD had higher rates of childhood physical abuse than Vietnam veterans without PTSD (26% versus 7%). The association between childhood abuse and PTSD persisted after controlling for the difference in level of combat exposure between the two groups.
“Conclusions:These findings suggest that patients seeking treatment for combat-related PTSD have higher rates of childhood physical abuse than combat veterans without PTSD. Childhood physical abuse may be an antecedent to the development of combat-related PTSD in Vietnam combat veterans.”
– Source: Bremner JD, Southwick SM, Johnson DR, Yehuda R, Charney DS, “Childhood physical abuse and combat-related posttraumatic stress disorder in Vietnam veterans,”.Am J Psychiatry. 1993 Feb; 150(2):235-9.  http://www.ncbi.nlm.nih.gov/pubmed/8422073

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Kathy’s news blogs expand on her book  “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

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“Heal trauma? Start with the body”

Bessel van der Kolk by Matthew Woodson, NYT 5-22-14“Bessel van der Kolk wants to change the way we heal a traumatized mind — by starting with the body,” reports Jeneen Interlandi in the New York Times Magazine May 22. (Dr. van der Kolk in session drawn by Matthew Woodson for the Times.)

It features Dr. van der Kolk’s new approaches to healing trauma by group therapy, yoga, meditation, EMDR, and “rhythmic regulation.”  I’ve reported on this in these recent posts: http://attachmentdisorderhealing.com/developmental-trauma/  and http://attachmentdisorderhealing.com/developmental-trauma-3/

“Trauma has nothing whatsoever to do with cognition,” van der Kolk says. “It has to do with your body being reset to interpret the world as a dangerous place.” That reset begins in the deep recesses of the brain with its most primitive structures (brain stem), regions that, he says, no cognitive therapy (frontal cortex) can access.

“It’s not something you can talk yourself out of.”

It’s a great Friday read: “A Revolutionary Approach to Treating PTSD” by Jeneen Interlandi, New York Times Magazine, May 22, 2014 at: http://www.nytimes.com/2014/05/25/magazine/a-revolutionary-approach-to-treating-ptsd.html?smid=tw-share&_r=2#permid=11865712

OK, it’s a bit off my topic. The Times doesn’t mention attachment trauma, although van der Kolk talks about that constantly. As to healing, it focuses on adult war PTSD. It only speaks to child trauma by debating what a child abuse victim can and can’t remember (not much of a call to heal child trauma).

But Ms. Interlandi does let van der Kolk speak to his charge that there is a lot more trauma than we think, and that standard “cognitive” treatments are not working. “Patients are still suffering, and so are their families. We need to do better,” van der Kolk says.

“Van der Kolk says he would love to do large-scale studies comparing some of his preferred methods of treatment with some of the more commonly accepted approaches,” she points out. “But funding is nearly impossible to come by for anything outside the mainstream. In the wake of the Sept. 11 terrorist attacks, he says, he was invited to sit on a handful of expert panels. Money had been designated for therapeutic interventions, and the people in charge of parceling it out wanted to know which treatments to back.

To van der Kolk, it was a golden opportunity. We really don’t know what would help people most, he told the panel members. Why not open it up and fund everything, and not be prejudiced about it? Then we could study the results and really learn something. Instead, the panels recommended two forms of treatment: psychoanalysis and cognitive behavioral therapy.

“So then we sat back and waited for all the patients to show up for analysis and C.B.T. And almost nobody did.” Spencer Eth, then medical director of behavioral health services at St. Vincent’s Hospital in Manhattan, (later) gathered data on the mental-health care provided to more than 10,000 Sept. 11 survivors.

The most popular service by far was acupuncture. Yoga and massage were also in high demand. “Nobody looks at acupuncture academically,” van der Kolk says. “But here are all these people saying that it’s helped them.”

Out of 208 reader comments to the Times, I only found two that weren’t deeply grateful for his approach, as I am.  These two didn’t mention healing either.

Enjoy reading about Dr. van der Kolk today, but read carefully – the Times, ever a bit arrogant, puts in some gnarly innuendos I didn’t like, which the two comments made worse. So I had to do further research on this one.  My results to come next week…

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

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Bruce Perry: No Empathy, No Survival

Dr. Bruce Perry, MD, “Born for Love:
“Why Empathy is Essential – and Endangered”
Address to The National Council for Behavioral Health
Washington, DC, May 4, 2014  – Click link or photo for video
https://www.youtube.com/watch?v=M6kDeBaJi0M

“Empathy is what makes us human,” says brain scientist Dr. Bruce Perry, MD  –  but this has not sunk in for Americans.  If simple kindness isn’t enough, what about the minor fact that it’s brain science?  Or that by ignoring this basic fact, we’re violating biology, so we’re dying as a species?

To let Dr. Perry make his point, today I’ve just got a few quotes from his May 4 Washington DC address, to provoke you to watch the video kindly posted by the National Council for Behavioral Health.

”From birth, we seek intimate connections, bonds made possible by empathy — the ability to love and to share the feelings of others,” Perry begins. But “our  policies routinely violate the biological reality of empathy, and that’s destructive…

“For example, we pass on to the next generation explicit choices that we’re going to teach math — but not music…We don’t care if everyone learns to read and perform music or not, but they’ve got to do arithmetic…  We have extensive rules for all the things everyone has to learn to drive a car… but we don’t do the same for raising a child!  We don’t make any systematic recommendations, or ensure that everybody who’s about to have a child has the fundamental knowledge of what’s necessary for the child…

“We’re exposing our children to levels of violence as a problem solving technique, at rates that are at least 50 times greater than alternate methods of problem-solving…

“We have invented ourselves into a corner with technology… into models of child rearing, education, and building communities that is fundamentally disrespectful of two of the greatest (biological) gifts our species has:  the fundamental malleability of the human brain in early life, and the fundamental relational (empathic) nature of human beings…. As a result we are much more vulnerable to mental health, social health, cognitive health, and physical  health  problems.

Humans Need Humans Around to Live

Perry another headshot“Human beings are biological creatures with genetic gifts… The only way we survived was by forming relationships, collaborative relationships…  Human beings are neurobiologically meant to be connected to others: to live, work, hunt, play, invent, and die in groups.

“We use the word ‘independent’ a lot — but the truth is there’s not a single human on this planet, ever, that’s been independent.  All of our physiology is designed to connect to others, we have huge parts of our brain designed purely to respond to the non-verbal cues of others… it’s in the way our face is oriented, our facial configuration is forward, looking at people… We have sensory apparatus on our skin that’s meant to be touched… so that we can feel somebody caress us…

“Our brain is a social organ; we are social animals. We don’t have any natural body armor, camouflage, stinging other things. We form groups!  Human beings are ‘meat on feet’ to the natural world!  The only way we survive is by forming collaborative groups, by sharing what we hunted and what we gathered with everybody else in our group.  And the typical living group was a developmentally heterogeneous, multi-family, multi-generational group: 40 to 50 people.

“And in that group…  the ratio of developmentally more mature individuals who cared for you, protected you, nurtured you…  was four to one.  But now, we think it’s an incredibly enriched early child care environment if there’s one caregiver to six kids!  That’s 1/24  the relational density the brain benefits from…

“Today, the whole organization of society flies in the face of this… In the last census, one third of American households were one person.

“On top of which, now… the typical American spends 11 hours a day interacting with digital devices, and not with fleshy objects!  And I want to talk about the consequences of this for how we end up expressing our ability to be compassionate (or not)…. You see it all the time, complaints in the psychological literature about the disconnectedness of multi-tasking constantly with our phones… but we do it ourselves…  You’re talking to someone, then your phone will vibrate — and it pulls you away from them.

” It breaks the rhythm of social contact, of empathic engagement– and the truth is: those things are physiologically meaningful.”

Again, click here for video:
https://www.youtube.com/watch?v=M6kDeBaJi0M

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

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What Trauma-Informed Care Means to Me

IMAG3258 James, kid, bike“Rider for Change” James Encinas arrived by mountain bike at San Diego’s Cherokee Point Elementary May 2 to the delight of some hundred students, and visitors from around southern California. James, a career LA school teacher, is riding 3,000 miles from Sacramento to Philadelphia. He’ll take the southern route through Texas and Louisiana, then follow the Underground Railway by which African Americans escaping slavery crossed north to freedom.

James is riding to draw national attention to the need for “trauma-informed schools,” key to the movement for “Trauma-Informed Care (TIC)” in education, health, and all public systems. But what is Trauma-Informed Care, and what’s a trauma-informed school ?  (Hint: all the pix in this blog are from Cherokee Point).

“In medicine, a patient is sent to hospice when all medical procedures have failed, and they’re going to die. That says: we give care and comfort only when nothing else works,”notes Dr. Christopher Germer, psychology prof at Harvard Medical School and co-editor of Mindfulness and Psychotherapy.  Pretty crazy right there, if you consider. Been in a hospital lately? Often you’re a widget; they take your clothes away, don’t tell you what’s happening, and so on. [FN1]

IMAG3250 James, Dana Mom w. FoodBut when treating the real human being, “Care Equals Cure,” says Dr. Germer. If a therapist doesn’t care, he’s not going to cure his client. But it’s also true in any dealings with humans. “Care IS the practice of non-resistance to suffering which dismantles emotional suffering,” says Germer. “It means opening to emotional pain more fully, instead of trying to bypass it. Compassion opens the heart, reveals inner suffering, and makes the suffering available for transformation.” (Above: James and activists carry food donated for kids.)

“So the message is:  Stop fixing,and start caring,” Dr. Germer concludes. In fact, it’s brain science. Comfort, care, compassion reduce so much of a human’s fight-flight reflex, even in major medical pain, that this has been shown to heal surgeries faster. Pain and bodily trauma create enough fight-flight that the brain stem often shuts down the immune system, for one.  Compassion helps it come back online. “Let a wounded soldier talk to his mom and he’ll require 50% less pain meds,” says Dr. Bruce Perry, MD.

But could it be necessary or work well in schools?

History of Trauma-Informed Care (TIC)

IMAG3253 Dana w. Youth LeadersTIC goes back to 1994 when the federal Substance Abuse and Mental Health Services Administration (SAMHSA) began to study the remarkably high rate of women in the mental health system with histories of physical and sexual abuse trauma. It became clear that, since such clients came in already pre-traumatized, providers should be mindful lest their own practices and policies put the women in danger, physically or emotionally, or lead to re-traumatization. (Activist Dana Brown with youth leaders.)

These and related studies next showed high rates of earlier life trauma in clients seeking services for substance abuse, domestic violence, child welfare and many other areas. In 2005 SAMSHA created the National Center for Trauma-Informed Care (NCTIC) to assist all public programs to implement Trauma-Informed Care, not only in mental health, but in all services including criminal justice and the education system. [FN 2]

“NCTIC seeks to change the paradigm from one that asks, “What’s wrong with you?” to one that asks, “What has happened to you?” says SAMHSA. “Trauma includes physical, sexual and institutional abuse, neglect, inter-generational trauma, and disasters that induce powerlessness, fear, hopelessness, and a constant state of alert…often resulting in recurring feelings of shame, guilt, rage, isolation, and disconnection.”

It’s impossible to successfully  treat human beings in that condition without recognizing this and at least following the principle of “Do No Harm.”  “When a program becomes trauma-informed, every part of its organization and service delivery system is assessed… to include a basic understanding of how trauma affects the life of an individual,”  SAMHSA notes.

IMAG3271 Kids Raise HandsSchools are key, since all Americans are supposed to spend 13 years there. “If fixing school discipline were a political campaign, the slogan would be ‘It’s the Adults, Stupid!’,” says Jane Stevens, founder of ACEsConnection;  “More than three million kids are suspended or expelled each year” in the U.S., 3.4  million in 2006 according to the National Center for Education.  “But punishment doesn’t change behavior; it just drops hundreds of thousands of  kids into a school to prison pipeline.” (Above: Kids ask James questions.)

“Instead of waiting for kids to behave badly then punishing them,  trauma-informed schools are creating environments in which kids can succeed,” she says. It’s about re-training the adults to drop their fears and assume that kids are basically good, but something traumatized them, so they act out. Bad behavior isn’t accepted and it is corrected – by a dialog with kids to hear what’s hurting inside, and show them how to address it. “Focus on altering behavior of teachers and administrators, and kids stop fighting and acting out in class. They’re more interested in school, they’re happier and feel safer,” Stevens says. [FN3]

See the Grade or see the Person?

As SAMHSA began trauma studies in 1994, the Adverse Childhood Experiences (ACE) Study (1994-98) documented a shocker:  about 50% of Americans have significant child trauma. The 17,421 HMO clients studied were privileged to be mostly college-educated, have jobs and good health care. Yet more than half had two of ten types of childhood trauma: physical abuse; sexual abuse; alcoholic or drug addict parent; family member in jail; battered mother; parent with mental illness; loss of a parent; physical neglect, emotional neglect;  or verbal/emotional abuse.

The ACE Study compared their childhoods, to whether they later developed life-threatening physical conditions and/or addictions.  “It found that those 10 types of severe and chronic childhood traumas up the risk of adult onset of major diseases. But it also  increases the chances of being violent, a victim of violence and becoming chronically depressed,” Stevens reports in a terrific post on  Cherokee Point El.  “Brain research revealed one reason: the toxic stress of trauma damages the structure and function of a child’s brain. Kids get anxious and can’t sit still; get depressed and withdraw; get angry and fight; can’t focus and stop learning. They cope with anxiety, depression, anger by drinking, smoking, drugs, fighting, stealing, overeating,  and/or becoming overachievers on their way to being workaholics.”

What about not-so-privileged kids?  Child trauma and its mortal results must affect a far higher percentage of kids in low-income areas with less access to nutrition, health care, and on and on.  A huge percentage of American children suffer trauma, bigger than 50% if we knew the real national average.

IMAG3293 Big GroupMeanwhile many of us privileged middle class kids grow up to be teachers,  administrators, and so on. If we’re traumatized ourselves, we can’t feel our feelings– so we believe that considering “feelings” is idiotic.  Instead, we set up schools as a place to tell kids things.  Because adults talked at us, we think it’s adult to talk at kids. We tell kids they are there to listen to information and repeat it back as we want it, ie. “get the grade,” or face trouble. Enough to put anyone into fight-flight. (James Encinas, left, with students, Principal Godwin Higa, activists.)

I’m from that privileged middle class. I often say, “Nobody beat me or raped me; what’s wrong with me?”

IMAG3306 Higa & Crane AOn Feb. 25 this year, I heard Ruth Beaglehole, founder of Echo Parenting and Education, address Echo’s annual Los Angeles meeting. Urging the 150 professionals present to get passionate about raising awareness of child trauma, she said,  “Kids have to live in the real world? Make the real world non-violent and trauma-sensitive!  What about creating places where children can seek safety, where children can come home to people who open their arms, attune to them, and say ‘Tell me what happened today’. ” (Above: Principal Higa helps Cherokee students make origami cranes for charity.)

“Some people define that as a report card and demand, ‘I want to see your grades.’  Enough of these bloody grades!” Ruth said, to audience laughter, including mine. “Why do we accept this?  Why do we accept that that’s the definition of a person — their grades?”

Suddenly out of nowhere I began violently sobbing at my table full of therapists, about 20 feet from the podium.  “I see you,” Ruth said, looking straight at me. “You don’t have to hold it back.” She saw the real person I am, she didn’t need me to fake anything. She was willing to simply be with me in the pain, as Chris Germer said: “Stop fixing, start caring.” Boy did that feel good. [FN4]

I knew I always hated having to go out and get that grade, and it better be above 90 “or else.”  So I did it, but I lived in fear.  They didn’t see me.  I was a widget who had to produce results or there’d be trouble.

Back story? On Feb. 8, 2011, I’d just heard I might have a thing called “attachment disorder.” Late one night I dragged myself to the sink to wash, listening to a CD by Dr. Henry Cloud. He joked about a lady who didn’t like her husband to go bowling: “She’s not old enough to be dropped off at school.”  But it wasn’t funny.  [FN5]

“That’s it: I wasn’t old enough to be dropped off at school,” I journaled, “I was just dumped off.”  Terrified, I slumped in a heap sobbing, clutching a stuffed dog and a soggy toothbrush.  Rising an hour later, I couldn’t even brush my teeth without holding the dog. “I’m really frightened because I don’t know if this hole under my feet ever ends,” I muttered into my pocket recorder.

I didn’t know last February but read later that Ruth was born in New Zealand to prestigious academic parents who didn’t see Ruth, either.  “I baby-sat since age 12, trying to give to vulnerable children what I didn’t get,” she says.  So she took a BA in early childhood ed, moved to LA, got a Masters in family therapy, and grew Echo Parenting into an agency of 23 staff that trains 100 professionals a year in service.

IMAG3308 Trauma SignWhat if Ruth’s right? What if a school’s whole mission were to look at each child and say “I see you”?  “I see you as a human being, I care how you’re feeling today, and I care what feelings and fears you’re bringing in the door.  I care if you feel threatened even before you walk in the door.  I want to get to know you, the real you who is.  That way we can make you feel safe to be here in school.  And then, you’ll really want to learn!”  (One of many posters students did for James Encinas.)

———————————
Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN1  Christopher Germer, PhD, “Open Heart, Open Eyes: Self-Compassion,” speech to 20th Annual Conference on Psychology of Health, Immunity and Disease, National Institute for the Clinical Application of Behavioral Medicine (NICABM), Hilton Head SC, Dec.2008
Dr. Germer [http://www.mindfulselfcompassion.org/ and http://www.centerformsc.org/ ] is a founding member of the Institute for Meditation and Psychotherapy, a clinical instructor in psychology at Harvard Medical School, author of The Mindful Path to Self-Compassion, and co-editor of Mindfulness and Psychotherapy. His meditation MP3 are here: http://www.mindfulselfcompassion.org/meditations_downloads.php   “Why Self-Compassion is Becoming a Psychotherapist’s Best Between-Sessions Tool,” Dr. Chris Germer interview by  Dr. Ruth Buczynski, Sept 13, 2009 is at http://www.nicabm.com/nicabmblog/can-self-compassion-become-a-portable-between-session-tool/

FN2  The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. Websites on TIC:  http://www.samhsa.gov/nctic/ ; http://www.samhsa.gov/nctic/trauma.asp

FN3  Jane Stevens, ACEsConnection.com and ACEsTooHigh.com:  http://blogs.psychcentral.com/organizations/2014/04/5-reasons-we-struggle-to-be-trauma-responsive-and-why-the-struggle-should-continue/
http://acestoohigh.com/2012/05/31/massachusetts-washington-state-lead-u-s-trauma-sensitive-school-movement/
http://acestoohigh.com/2013/03/20/secret-to-fixing-school-discipline/

FN4 Ruth Beaglehole, founder of Echo Parenting and Education, address to Echo’s annual Los Angeles meeting “Developmental Trauma: Changing the Paradigm,” Feb. 25, 2014

FN5  Dr. Henry Cloud, PhD, “Character Discernment for Dummies, Part 2,” CD, Dec. 6, 2010, www.CloudTownsendResources.com

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Perry: Rhythm Regulates the Brain

Perry another headshotDr. Bruce Perry, MD is taking his healing for trauma to Washington in a May 4 program for the National Council for Behavioral Health.

And the doc’s got rhythm.  In fact, he and other trauma experts are reporting revolutionary success with treatments using yoga, meditation, deep breathing, singing, dancing, drumming and more.

These principles are so fundamental to our brains they go back to the dawn of man; the Vedas were sung before 5,000 BC (likely with yoga and meditation.)  My book describes how yogic chant and meditation saved my life in 2010, before I ever read a word about brain science.

One California county is trying to cancel such programs, insisting on Cognitive Behavioral Therapy (CBT) which relies on the thinking brain.  But Perry and many experts say talk therapy alone can re-traumatize trauma survivors.

Perry says we need “patterned, repetitive, rhythmic somatosensory activity,” literally,  bodily sensing exercises. Developmental trauma happens in the body, where pre-conscious “implicit memory” was laid down in the primitive brain stem (survival brain) and viscera. Long before we had a thinking frontal cortex or “explicit memory” function. [FN1]

The list of repetitive, rhythmic regulations used for trauma by Dr. Perry, Dr. Bessel van der Kolk, Dr. Pat Ogden and others is remarkable. It includes singing, dancing, drumming, and most musical activities.  It also relies on meditation, yoga, Tai Chi, and Qi Gong, along with theater groups, walking, running, swinging, trampoline work, massage, equine grooming and other animal-assisted therapy…. even skateboarding. Click here for Perry’s web page on interventions.

“I am asked how hip hop and skateboarding can help a child with depression or ADHD,” reports Dr. Sarah MacArthur of the San Diego Center for Children. “Yet 70% of the children showed improvement in symptoms of depression, anxiety, and PTSD.” [FN2]

The Brain Stem Rules

Perry simpler 4 brain from web“The brain organizes from bottom to top, with the lower parts of the brain (brain stem/diencephalon aka “survival brain”) developing earliest, the cortical areas (thinking brain) much later,” Perry says. “The majority of brain organization takes place in the first four years.

“Because this is the time when the brain makes the majority of its “primary” associations… early developmental trauma and neglect have disproportionate influence on brain organization and later brain functioning… When a child has experienced chronic threats, the brain exists in a persisting state of fear… and the lower parts of the brain house maladaptive, influential, and terrifying pre-conscious memories… ”  [FN3]

“People with developmental trauma can start to feel so threatened that they get into a fight-flight alarm state, and the higher parts of the brain shut down,” says Perry. “First the stress chemicals shut down their frontal cortex (thinking brain).  Now they physically can not think. Ask them to think and you only make them more anxious.

“Next the emotional brain (limbic brain) shuts down. They have attachment trauma, so people per se seem threatening; they don’t get reward from emotional or relational interaction.

“The only part of the brain left functioning is the most primitive: the brain stem and diencephalon cerebellum. If you want a person to use relational reward, or cortical thought – first those lowest parts of the brain have got to be regulated,” Perry concludes.

We must regulate people, before we can possibly persuade them with a cognitive argument or compel them with an emotional affect.

“The only way to move from these super-high anxiety states, to calmer more cognitive states, is rhythm,” he says. “Patterned, repetitive rhythmic activity: walking, running, dancing, singing, repetitive meditative breathing – you use brain stem-related somatosensory networks which make your brain accessible to relational (limbic brain) reward and cortical thinking.

“Cognitive behavioral therapy (CBT) is great if you have a developed frontal cortex – but we’re talking about a five year old kid who’s so scared to death most of the time that it’s shut down his frontal cortex ’cause he just saw his mother get shot,” Perry told an audience of therapists. “You’re going to do 20 sessions of CBT and expect change? That’s a fantasy.”  [FN4]

6 R’s for Healing Trauma

Perry NMT Bar Chart from webDr. Perry does separate developmental “maps” of each person (left) using his “Neurosequential Model of Therapeutics” (NMT). Each individual is so unique that using NMT needs training;  this blog is meant only to point you toward it. For an overview of NMT, click here for Perry, B.D. and Hambrick, E. (2008), “Neurosequential Model of Therapeutics.  Click here for training in NMT and Somatosensory Regulation.

Trauma healing, says Perry, requires 6 R’s; it must be:
Relational (safe)
Relevant (developmentally-matched to the individual)
Repetitive (patterned)
Rewarding (pleasurable)
Rhythmic (resonant with neural patterns)
Respectful (of the child, family, and culture)

“To change any neural network in the brain, we need to provide patterned, repetitive input to reach poorly organized neural networks involved in the stress response. Any neural network that is activated in a repetitive way will change,” Perry explains.

“The rhythm of these experiences matter. The brain stem and diencephalon contain powerful associations to rhythmic somatosensory activity created in utero and reinforced in early in life. The brain makes associations between patterns of neural activity that co-occur.

“One of the most powerful sets of associations created in utero is the association between patterned repetitive rhythmic activity from maternal heart rate, and all the neural patterns of activity associated with not being hungry, not been thirsty, and feeling ‘safe’ (in the womb).

“Patterned, repetitive, rhythmic somatosensory activity… elicits a sensation of safety.  Rhythm is regulating.  All cultures have some form of patterned, repetitive rhythmic activity as part of their healing and mourning rituals — dancing, drumming, and swaying.

“EMDR and bilateral tapping are variations of this patterned, repetitive rhythmic, somatosensory activity… We believe that they are regulating in part because they are tapping into the deeply ingrained, powerful permeating associations created in utero.”  [FN5]

For each child, the NMT develops a unique, personalized “map” (see above) of what the specific neurological damage has been, how far development has come (or not), and where the child needs to go. Next it creates “a unique sequence of developmentally-appropriate interventions,” says Perry. “While many deficits may be present, the sequence in which these are addressed is important. The more the therapeutic process can replicate the normal sequential process of development, the more effective…

“The first step in therapeutic success is brain stem regulation… Start with the lowest undeveloped/ abnormally functioning set of problems and move sequentially up the brain as improvements are seen…

“An example of a repetitive intervention is positive, nurturing interactions with trustworthy peers, teachers, and caregiver… using patterned, repetitive somatosensory activities such as dance, music, movement, yoga,  drumming or therapeutic massage…  This is true especially for children whose persisting fear state is so overwhelming that they cannot improve via increased positive relationships, or even therapeutic relationships, until their brain stem is regulated by safe, predictable, repetitive sensory input.” [FN6]

Sound like your family doctor saying “Go calm down in the gym” ?  I thought so – until I tried it.  It works, big time.  My story is here: “Dr. Perry: Music Makes Your Case.”

———————————

Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN1  Perry, Bruce D., MD,  “Born for Love: The Effects of Empathy on the Developing Brain,” Annual Interpersonal Neurobiology Conference “How People Change: Relationship & Neuroplasticity in Psychotherapy,” UCLA, Los Angeles, March 8, 2013 (unpublished).
Library of articles on interventions, trauma, brain development: https://childtrauma.org/cta-library/
Training in NMT Method and Somatosensory Regulation, Power of Rhythm — Individual and Site Training Certification Programs, DVD/streaming training, and online training: http://www.ctaproducts.org
Dr. Perry’s latest research and key slides: “Helping Children Recover from Trauma,” National Council LIVE, National Council on Behavioral Health, Sept. 5, 2013 at www.thenationalcouncil.org/events-and-training/webinars/webinar-archive/  (scroll down to Sept. 2013.)
Dr. Perry’s YouTube channel with educational videos in depth: https://www.youtube.com/channel/UCf4ZUgIXyxRcUNLuhimA5mA?feature=watch

FN2  MacArthur, Sarah,PhD., “Wellness Innovations Transform Children,” San Diego Center for Children, June 2013, http://www.centerforchildren.org/live-blog/87-wellness-innovations-transform-children/

FN3  Perry, B.D. and Hambrick, E. (2008), “The Neurosequential Model of Therapeutics (NMT),” Reclaiming Children and Youth, 17 (3) 38-43;  and
Dobson, C. & Perry, B.D. (2010), “The role of healthy relational interactions in buffering the impact of childhood trauma in “Working with Children to Heal Interpersonal Trauma: The Power of Play,” (E. Gil, Ed.), The Guilford Press, New York, pp. 26-43
Both at: http://childtrauma.org/nmt-model/references/

FN4  Perry, Bruce D., “Born for Love,” op. cit. FN1

FN5  MacKinnon, L. (2012), “Neurosequential Model of Therapeutics: Interview with Bruce Perry,” The Australian & New Zealand Journal of Family Therapy, 33:3 pp 210-218, http://childtrauma.org/cta-library/interventions/

FN6  Perry & Hambrick, op. cit. FN3

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Bruce Perry: Attachment and Developmental Trauma

BrousBlog9a Perry head shotDr. Bruce Perry, MD (left) documents the brain science of how attachment problems can cause developmental trauma to a fetus, infant, or child – just when the brain is developing.

And he’s taking his “attachment first” approach to Washington.  In “Trauma Impacts the Brain: Healing Happens in Relationships,” Perry leads a full-day Pre-conference University on Sunday May 4, to kick off  the National Council for Behavioral Health’s Annual Conference ’14 on May 5-7 (click here for details).

“Experiences profoundly influence the development of young children. Adverse Childhood Experiences (ACEs) shape the brain’s organization, which, in turn, influences the emotional, social, cognitive, and physiological activities,” the conference website notes.

“So often, trauma happens in relationships, but it is also in relationships that healing occurs. Explore the latest research and clinical treatment with trauma researcher, treatment visionary, and bestselling author of The Boy Who Was Raised as a Dog, and Born for Love:  Why Empathy is Essential and Endangered, Dr. Bruce Perry.”

Dr. Perry’s relationship and attachment theory healing model first assesses each child as an individual, using his  Neurosequential Model of Therapeutics (NMT).  He emphasizes that there is no one label for child trauma. Rather, “there are very individualized patterns of exposure to trauma (all with unique timing, nature, and patterns)… So we don’t call ‘it’ anything,” he wrote me recently. “We describe it — and try to ‘illustrate’ each individual’s trajectory separately” with the NMT’s individualized brain mapping technique. [FN1]

Dr. Perry recommends his books above as the best summaries of his work.  His latest research and key slides are online from his National Council webinar last fall, “Helping Children Recover from Trauma,” National Council LIVE, Sept. 5, 2013 (scroll down to Sept. 2013.)  I really recommend this – and it will only be online through August 2014.

Click here for an overview video:   [FN2]

Survival Brain Develops First

BrousBlog9c Perry Slide1 Brain 4 PartsDr. Perry says we’ve got to learn about the neuro-biological growth of the brain in order of time sequence from  conception to later development in infancy and childhood.

His “Four Part Brain” slide (above) shows the time sequence from the bottom up: first the brain stem develops (pink); then the diencephalon cerebellum (yellow); they make up our primitive reptilian “survival” brain.  Next develop the emotional limbic brain which only mammals have (green), and finally the thinking brain aka frontal cortex (blue).

The fetus’ “survival brain” develop first, because infants require breathing, heart beat, and other survival functions at birth, Dr. Perry told a March 2013 UCLA conference. The rest of the brain develops largely after birth and as an outgrowth of the brain stem. [FN3]

So injury during brain stem development in the first 45 months harms development of the entire brain, the neurons around the viscera, and most of the body.

Dr. Perry next details three key threats to an infant’s developing brain:  Trauma in utero (intra-uterine insult); post-birth attachment trauma; and other post-natal trauma – all before the thinking brain comes on line around age 3.

A fetus in utero is designed to develop in nurturing oxcytocin and other “reward” chemicals released by a mother supported by her family, all joyous a baby is coming. Intra-uterine insult occurs when the mother instead uses substances, or is under stress so that her stress hormones impact the fetus’ developing brain. This can be visible stress to the mother: domestic abuse, work stress, violence.

A fetus, however, can also be subject to stress chemicals with no visible external stress to the mother, as in mothers who are anxious, themselves victims of attachment disorder, don’t want a baby, etc.  Often these mothers have no steady pattern to their heart rate, and since a baby’s brain grows according to the mother’s heart rate rhythm, the baby’s brain develops dysregulated.

All these “causes a cascade of mental and physical problems in every part of the body and brain,” Perry says. “Every part of the whole brain these neurons enervate will be dysregulated.”

Birth: the Mother of All Stress

Attachment trauma occurs easily because birth is incredibly stressful to a baby: suddenly there’s lack of oxygen, blinding light, shocking cold, terrifying noise, and pain. This floods a baby with stress hormones — which is essential because now it’s not having needs met as in the womb; thus it’s got to protest so someone comes. “If animals in the wild didn’t feel the stress of hunger they’d just lie around and die of starvation,” Perry notes.

Mom Smile Baby If all goes as designed, an attuned mother meets the baby’s needs, feeds it, swaddles it, turns down the lights, so the baby feels safe and is flooded with reward optiates like oxytocin. If animals didn’t feel opiate rewards when they get up and eat just what they need (not dirt, for example), they’d not get up.

Then they wouldn’t survive, so the stress hormones and the reward opiates are linked. “At the relief of hungry-thirsty-cold stress, we feel pleasure,” Dr. Perry says. An attuned mother “has a well-organized neurobiology to create a healthy organized neural network for the infant of attachment and regulation…

“And in the arms of that caregiver, that is that magic moment literally weaving together the neurobiology of all these different systems. The biology of attachment is that a baby learns by thousands of good experiences that this stress is tolerable because it leads to reward, and this pleasurable outcome is cathexsized to a person, Mom… Ultimately just seeing or hearing Mom makes you feel safe and pleasurable. Let a wounded soldier talk to his mom, he’ll need 45% less pain meds.”

Or not.

If mom instead is under too much stress herself to meet needs, has too many children and no support, or herself was raised by a mis-attuned mom, “she doesn’t get reward from responding to her baby’s distress,” Perry continues. “So the pull to respond isn’t there.”

Even if no stress to the mother is visible, “if she merely meets physical needs, without involving her own pleasure systems, then the weaving together of meeting needs and the reward/safety system is weak or absent. So her baby learns that stress can be life-threatening, that stress is terrifying,” Dr. Perry concludes. [FN3 op. cit.]

The “Or Not” baby’s brain learns: “that’s all she wrote.”

It develops in a state of perpetual stress in which the stress chemicals simply do not stop and the reward chemicals never or seldom come. In this state, fight/flight cortisol flood eventually leads to “freeze” dissociation, Judith Herman reported back in 1992. [FN4]

More Perry slides at: http://attachmentdisorderhealing.com/how-your-brain-works-101/

———————————

Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN1 Perry, B.D. and Hambrick, E. (2008), “The Neurosequential Model of Therapeutics (NMT),” in Reclaiming Children and Youth, 17 (3) 38-43;  and
Dobson, C. & Perry, B.D. (2010), “The role of healthy relational interactions in buffering the impact of childhood trauma in “Working with Children to Heal Interpersonal Trauma: The Power of Play,” (E. Gil, Ed.) The Guilford Press, New York, pp. 26-43
Both at: http://childtrauma.org/nmt-model/references/

FN2  Bruce Perry MD, Daniel Siegel MD, et.al, “Trauma, Brain & Relationship: Helping Children Heal,” www.youtube.com/watch?v=jYyEEMlMMb0 – introductory video on Attachment Disorder and development trauma. Copies at www.postinstitute.com/dvds.

FN3  Perry, Bruce D., MD,  “Born for Love: The Effects of Empathy on the Developing Brain,” Annual Interpersonal Neurobiology Conference “How People Change: Relationship & Neuroplasticity in Psychotherapy,” UCLA, Los Angeles, March 8, 2013 (unpublished).
Library of articles on interventions, trauma, brain development: https://childtrauma.org/cta-library/
Training in NMT Method and Somatosensory Regulation, Power of Rhythm — Individual and Site Training Certification Programs, DVD/streaming training, and online training: http://www.ctaproducts.org
Dr. Perry’s latest research and key slides: “Helping Children Recover from Trauma,” National Council LIVE, National Council on Behavioral Health, Sept. 5, 2013 at www.thenationalcouncil.org/events-and-training/webinars/webinar-archive/  (scroll down to Sept. 2013.)
Dr. Perry’s YouTube channel with educational videos in depth: https://www.youtube.com/channel/UCf4ZUgIXyxRcUNLuhimA5mA?feature=watch

FN4  Herman, Judith, “Trauma and Recovery,” Basic Books, New York, 1992

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Developmental Trauma: What You Can’t See…

Bessel van der KolkWhat you can’t see, can hurt you.

Dr. Bessel van der Kolk, MD (left) and leaders in brain science and attachment are calling for a hard look at developmental trauma.  Developmental Trauma Disorder (DTD) was identified by van der Kolk in 2005, but the psychiatric Powers That Be deny it exists. [FN1]

“Clearly our field would like to ignore social realities,” Dr. van der Kolk said recently, “and study genes…”

He’s also shown it’s at the root of borderline personality disorder and bipolar disorder. He implies (I’m sure it’s true) that it’s at the root of most cases mis-diagnosed as  ADHD/ADD.  See van der Kolk video: http://www.acesconnection.com/clip/bessel-van-der-kolk-childhood-trauma-affect-regulation-and-borderline-personality-disorder-69-min

I dubbed it “trauma since the sperm hit the egg” when I realized I had it.  Dr. Allan Schore calls it “trauma in the first 1000 days, conception to age two.”  It used to be called “complex PTSD” (C-PTSD) or “Early Trauma” (ET).

Developmental trauma starts in utero when we don’t have much more than a brain stem, and goes on during the pre-conscious years. It can continue until 24 or 36 months depending on when the thinking brain (frontal cortex) comes on line.  That’s up to 45 months living in general anxiety to non-stop terror — before age 3.  A very long time to an infant.

DTD occurs as a continual process, not discrete incidents, while a baby has not developed a thinking brain able to recall incidents.  Frequently it occurs before there are any discrete incidents.

“No one can see it” means “it never happened.”  As I’ve said, “No one beat me or raped me. What’s wrong with me?”  Try getting that treated.

Neuroscientists Dr. Daniel Siegel, MD, Dr. Bruce Perry MD and others detail how attachment failures cause developmental trauma in this video: www.youtube.com/watch?v=jYyEEMlMMb0 [FN2]

Insecure Attachment as the Cause

Allan Schore 2DTD is a “Relational Trauma, trauma in the context of a relationship” as Dr. Allan Schore (left), father of attachment theory in the U.S., identified it in the 1990s. [FN3] Only relational processes can explain DTD, not incidents.

Yet all the American Psychiatric Association (APA) can fathom is Post-Traumatic Stress Disorder (PTSD) — since it’s caused by a visible incident such as war injury or rape. Developmental trauma has no incident. It’s ingrained in brain and visceral tissue, with no obvious “big bang,” so some call it “little ‘t’ trauma,” as opposed to visible PTSD “Big ‘T’ Trauma.”

Insecure attachment and attachment disorder generally are the cause of developmental trauma, not vice versa, Dr. van der Kolk details in his May 2005 Psychiatric Annals pdf  noted above and in FN1.  He emphasized this again in a terrific May 10, 2013 speech at Yale on child trauma, borderline personality disorder and bipolar disorder (click for video).  He lists DTD’s symptoms as relational and chronic: inability to concentrate or regulate feelings, chronic anger, fear and anxiety; self-loathing; aggression, self-destructive behavior. [FN4A]

Working with the National Center for Child Traumatic Stress Complex Trauma Network (NCTSN), van der Kolk reports that he ran a survey of 40,000 children nationally being treated for multiple traumas. Most of them  “do not meet the criteria for PTSD… (as) the majority of issues are not specific traumas, but issues in their attachment relationships,” he says.

Van der Kolk describes studies by his colleague Dr. Marylene Cloitre, on attachment problems as the cause of DTD.  “Marylene looked at chronic complex trauma symptoms, then she did child attachment interviews, Dr. Mary Main’s interviews, in which I hope all of you have been trained, because they are very very helpful to see what were peoples’ experiences of their childhoods,” he said [referring to the Adult Attachment Interview (AAI)]. [FN4B]

Dr. Cloitre found “that pure PTSD symptoms are a function of specific traumatic incidents, but the other symptoms she identified – affect dysregulation, mood regulation, anger expression, chronic suicidality, self-injury, disturbance in relations with self and others… do not occur in PTSD.  They are rather a function of a disturbed attachment relationship,” van der Kolk repeated.

Yet psychiatry, he says, “is not good at treating attachment difficulties. There is very little treatment” of it.  Innovative somatosensory healing programs at van der Kolk’s Trauma Center in Boston using “theater programs, yoga, martial arts for kids, etc. — to get them inter-personally attuned — are not standard treatment even though we do statistical research and publish it,” he notes.

The Body Keeps the Score

Bessel Book bodykeepsscoreBecause DTD happens before we have a thinking brain, the body is forced to store all the memories as somatic trauma. “There is somatization. The body keeps the score,” he says, the title of his latest book, “this is a somatic experience, and you become a terrified organism. Your immune system changes, your stress hormone system changes and your perception of your body changes.”

PTSD’s existence was hard to get recognized at first, too. It took Dr. van der Kolk and friends a chunk of the 1970s and ’80s to get the government to stop insisting that war trauma didn’t exist. Doctors finally established the diagnosis PTSD by showing that Vietnam vets were re-living discrete terrifying incidents from the past.

But “in fact there was no basis for any opinion about the prevalence” of any childhood trauma, even of childhood sexual abuse, before the 1995-1998 Adverse Childhood Experiences (ACE) Study,  study co-director Dr. Vincent J. Felitti, MD, notes. “That’s because such information is almost completely protected by shame and secrecy, by families, and by individuals.  Doctors also have been inhibited by our own ignorance and major gaps in our training, from asking into certain areas of patient history.” [ FN5]

In 1995 Felitti ran an obesity program at Kaiser Permanente in San Diego. But he had a 50% drop-out rate, just when those quitting were losing up to 100 pounds.  “As we interviewed almost 300 of the dropouts, every other person spoke of having childhood sexual abuse; most of them seemed to have been waiting to tell someone after hiding it for years,” Felitti said. “They also often mentioned verbal and physical abuse and other traumatic experiences such as watching their mother being beaten.

“We were amazed. I thought, ‘This can’t be true. People would know if that were true. Someone would have told me in medical school.’  [FN6]

“We wanted to know: to what degree does this happen in the whole population?  That’s how we created the ACE Study.  We took at first 8 and later a total of 10 categories of traumatic childhood experiences which we’d heard about from our obese patients, then found 17,421 average, middle-class adults who agreed to interviews.

“We were astonished to find that the percent of the general public who suffer from traumatic experiences in childhood and adolescence is far higher than imagined… Two-thirds (64-67%) of middle class subjects had one or more types of childhood trauma, and 38-42% had two or more types. One in six had an ACE Score of 4 or more; one in nine had an ACE Score of 5 or more.”  In less privileged populations the numbers are far higher.

Similarly, Dr. van der Kolk describes a patient in the 1980s who could not recall if she were sexually abused, yet drew portraits of her family with menacing genitals. “So we went to the textbook — Freedman,  Kaplan, & Sadock’s  ‘Comprehensive Textbook of Psychiatry’ — with which I sat for my board exam in psychiatry.  It said:  ‘Incest is very rare; it happens in 1 out of 1.1 million women.’   At the time there were about 200 million Americans, so I thought, ‘Hmm… About 100 million women, 110 women are incest victims; how come 47 of them are in my office?’/” [FN4 Yale video.]

“The text says it is also very benign,” he went on quoting it: ‘There’s no agreement about the role of father-daughter incest as a source of psychopathology. The act offers an opportunity to test a fantasy whose consequences are found to be gratifying and pleasurable…In many cases it allows for a better adjustment to the external world.  The large majority of them are none the worse for the experience ’. ”  [FN7]

Developmental Trauma: Psychiatrists Still in Denial

Shrink knitting my brainBut even today, until DTD is in the APA’s official Diagnostic and Statistical Manual of Mental Disorders (DSM), most mental health professionals will not diagnose or treat it, and no insurance company will cover it.

So in 2012 Dr. van der Kolk’s NCTSN network submitted data on 200,000 children around the world to the APA to document DTD.  He spoke on DTD before the National Association of State Mental Health Directors, which treats 6.1 million patients a year with a $29 billion budget, and they wrote to the APA urging that DTD be included in the next DSM-5 in 2013.

But the APA refused and in June 2013, issued DSM-5 without mention of developmental trauma. Van der Kolk in his Yale video ridicules the APA for asking only two questions on child trauma in preparing DSM-5: “1. Can we assume life was pretty good growing up? and  2. Was anyone in your family a drug addict or an alcoholic?”

“Clearly our field would like to ignore social realities,” van der Kolk responds, “and study genes or biological functions — because for us to actually find out how the environment shapes the brain, would get us into very difficult situations.”

The APA refusal letter actually made a veiled dig against the Adverse Childhood Experience (ACE) Study and denied that “childhood adverse experiences” are a “substantive” problem – which is outrageous.  Dr. van der Kolk read that letter at Yale in May 2013 and let ’em have it:

APA:  “The consensus was there was just too little evidence to include DTD in the DSM-5. There have not been any published accounts about children with this disorder.”
Dr. vdK aside: “No, because it’s not in the textbooks!”

APA: “The notion that childhood adverse experiences lead to substantive developmental reduction is more clinical intuition than a research-based fact. “
Dr. vdK aside: “We submitted research data on 200,000 children from around the world to substantiate our diagnosis.”

APA: “The statements made cannot be backed up by prospective studies.”
Dr. vdK aside: “Actually, they can.”

Dr. van der Kolk could make a lot more money as a TV comedy star, after dealing with this idiocy for a lifetime. Despite the tragedy, his psychiatrist audience also had a good laugh — the APA is that absurd.

Developmental trauma is the “invisible” part of “the Silent Epidemic of Attachment Disorder.” [FN8]. DTD can happen as a by-product when a mother or her child are beaten or sexually abused – but it also happens on a wide-spread basis with no visible incident.

Perhaps 20-40% of our population goes through life never knowing they even have DTD. That’s why many of them go on to become leaders of industry and government. That’s why Dr. van der Kolk has said that the US Congress is “dissociated,”  or they’d feel the simple human compassion to know that sending youth to war brings back a flood of PTSD suicides.  (To me that means more than 50% of Congress has attachment problems, which is why they made a career of trying to control others. ) [FN9]

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN1  van der Kolk, Bessel, MD, “Developmental Trauma Disorder: Toward a rational diagnosis for children with complex trauma histories,” Psychiatric Annals 35:5, 401-408, May 2005   www.traumacenter.org/products/pdf_files/preprint_dev_trauma_disorder.pdf
This article also details how developmental trauma is attachment-based:  “Early patterns of attachment inform the quality of information processing throughout life [11]. Secure infants learn to trust both what they feel and how theyunderstand the world…. (more),” he reports.
But “When caregivers are emotionally absent, inconsistent, frustrating, violent, intrusive, or neglectful, children are liable to become intolerably distressed and unlikely to develop a sense that the external environment is able to provide relief. Thus, children with insecure attachment patterns have trouble relying on others to help them, while unable to regulate their emotional states by themselves. As a result, they experience excessive anxiety, anger and longings to be taken care of. These feelings may become so extreme as to precipitate dissociative states or self-defeating aggression…”
Dr. van der Kolk has been Medical Director of The Trauma Center in Boston for 30 years (www.traumacenter.org).

FN2  Daniel Siegel, MD, et.al, “Trauma, Brain & Relationship: Helping Children Heal,” www.youtube.com/watch?v=jYyEEMlMMb0
Introductory video on Attachment Disorder and how development of the mind-body system can cause trauma. Copies at www.postinstitute.com/dvds.

FN3  Schore, Allan N., PhD, “Effects of Early Relational Trauma on Right Brain Development, Affect Regulation, & Infant Mental Health,” 2001, www.trauma-pages.com/a/schore-2001b.php

FN4A  van der Kolk, Bessel, MD: Video, Yale University, May 10, 2013, “Childhood Trauma, Affect Regulation, and Borderline Personality Disorder,” http://acesconnection.com/video/bessel-van-der-kolk-childhood-trauma-affect-regulation-borderline

FN4B  Cloitre, Marylene, et. al, (NYU Child Study Center, Department of Psychiatry, New York University Medical College,  marylene.cloitre@nyumc.org), “Attachment organization, emotion regulation, and expectations of support in a clinical sample of women with childhood abuse histories,”   Journal of Traumatic Stress, 2008 Jun;21(3):282-9. doi: 10.1002/jts.20339.  Abstract: Despite the consistent documentation of an association between compromised attachment and clinical disorders, there are few empirical studies exploring factors that may mediate this relationship. This study evaluated the potential roles of emotion regulation and social support expectations in linking adult attachment classification and psychiatric impairment in 109 women with a history of childhood abuse and a variety of diagnosed psychiatric disorders. Path analysis confirmed that insecure attachment was associated with psychiatric impairment through the pathways of poor emotion regulation capacities and diminished expectations of support. Results suggest the relevance of attachment theory in understanding the myriad psychiatric outcomes associated with childhood maltreatment and in particular, the focal roles that emotion regulation and interpersonal expectations may play. http://www.ncbi.nlm.nih.gov/pubmed/18553408

FN5   Vincent J. Felitti, MD;  Robert F. Anda, MD, MS;  “The Lifelong Effects of Adverse Childhood Experiences,” Chapter 10 of Chadwick’s “Child Maltreatment,” Sexual Abuse and Psychological Maltreatment, Encyclopedic Vol 2 of 3, STM Learning, Inc., Saint Louis, p.203-215; March, 2014

FN6   Stevens, Jane, “The Adverse Childhood Experience Study” — the largest, most important public health study you never heard of — began in an obesity clinic,”  ACEsTooHigh.com

FN7  Freedman, Alfred M., Kaplan, Harold I., & Sadock, Benjamin J.,  “Comprehensive Textbook of Psychiatry,” 2nd Edition, Williams and Wilkins Co., Baltimore, 1975; 2609 pages.  Now in 9th edition; known since 4th edition as “Kaplan and Sadock’s.”

FN8  Lanius, Ruth A., MD; Vermetten, Eric; Pain, Claire; Editors, “The Impact of Early Life Trauma on  Health and Disease: The Hidden Epidemic,” Cambridge University Press, 2010. “Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician,” American Academy of Pediatrics,  2012 (New York Times 1-7-12), and many more.

FN9  van der Kolk, Bessel, MD, “What Neuroscience Teaches Us About the Treatment of Trauma,” June 6, 2012 webcast, National Institute for the Clinical Application of Behavioral Medicine  (NICABM) : Most of Congress is “dissociated,” van der Kolk told this 2012 globally-televised webcast, or they’d feel the simple human compassion to know that sending youth to war brings back a flood of PTSD suicides. We already knew from Korea and Vietnam that “for every solider that will die on the battlefield, there will be 30 suicides, as is happening right now,” van der Kolk said.  But “society dissociates from the reality of it and then Congress says, ‘Oh, gosh, isn’t that amazing!’  No it’s not amazing, that’s what happens!”
Short promo clip: http://www.nicabm.com/nicabmblog/how-trauma-traps-survivors-in-the-past/
Link to buy video, mp3 audio, transcripts: http://www.nicabm.com/trauma-2012-new/
On Congress, see also http://www.theatlantic.com/politics/archive/2014/06/why-it-matters-that-politicians-have-no-experience-of-poverty/371857/

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Comments are encouraged, with the usual exceptions; rants, political speeches, off-color language, etc. are unlikely to post.  Starting 8-22-16, software will limit comments to 1030 characters (2 long paragraphs) a while, until we get new software to take longer comments again.

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How Your Brain Works 101

#2 in my News Blog series; original post September 13, 2013

BrousBlog9a Perry head shotDr. Bruce Perry just put out his latest on “How Your Brain Works 101,” in his September 5 webinar for the National Council on Behavioral Health. Perry’s revelations at Dr. Daniel Siegel’s March 8  (2013) UCLA Conference “How People Change” hit me in the solar plexus.  Now you can hear him and download his slides, (Click here and scroll all the way down to September 2013). [FN1]

You know how your car works – don’t you want to know how your brain works? Click here for an introductory  video on how Attachment Disorder causes brain trauma  [FN2]  Click for Dr. Perry’s YouTube channel with educational videos in depth: https://www.youtube.com/channel/UCf4ZUgIXyxRcUNLuhimA5mA?feature=watch

I first heard of Bruce Perry in August 2010; not his name, but his substance. I was commuting to another high-pressure defense job on the 91 freeway outside Anaheim, CA, worrying about how to pour concrete at Seal Beach Naval Base.  It didn’t look to my clients, or to me, as though I had anything wrong with my high-performance business brain.

On the car stereo was a CD by psychologist Dr. Henry Cloud. “Humans are neurologically designed, physiologically designed, psychologically, spiritually, emotionally, and cognitively designed, to be in a relationship where you are loved,” Cloud said to my shock. “You are designed to take aspects of that relationship inside of you, and they actually become a part of who you are.  My 17-month-old came into the world with nothing in her head.  A lot of need, not a lot of words, didn’t read.  Babies are all need and they cry. Adults must calm them, and the minute we put them down, they start crying again.

“But after we do that a million times, the gap for how long they can tolerate not being held gets wider and wider. They take our love from the outside, and it becomes part of them on the inside… Love becomes actual equipment that you take in and walk around with.” [FN3]  I felt sad; I couldn’t identify.

But watch how my body reacts to the right research:

Cloud went on, “We can now do scans of the brain of older kids who were in institutions and were not held, comforted or soothed, and there are parts of the brain which are dark. There’s nothing growing in there — because nothing was planted; neurologically there’s literally no brain activity. But the kids who were held and loved, those parts of the brain are physiologically growing.”

I nearly drove off the 91 overpass at 70 MPH. It hit me in the gut the minute he said it. “Oh, S#$%”, I thought, “parts of my brain are dark!”  (Go tell that to the Marines at Seal Beach.)

It wasn’t until 2 1/2 years later when some guy named Perry put up his slides at UCLA in March 2013, that I saw the pictures. It was brain scans of two children aged 3, a normal brain in grey, and one labeled “extreme neglect,” parts of which were black. In that moment, I knew Cloud had referred to Bruce Perry’s work. [FN4]

As I’ve shown in previous posts, maybe 50% of Americans have some degree of attachment disorder, neurological areas which didn’t get Dr. Cloud’s “love on the inside.”  We don’t want to go around with parts of our brain dark.

Most Primitive  Brain Develops First

BrousBlog9c Perry Slide1 Brain 4 PartsDr. Perry says we’ve got to learn about the neuro-biological growth of the brain in order of time sequence from  conception to later development in infancy and childhood.

He calls this the Neuro-sequential Model of Therapeutics (NMT).  Dr. P’s “Four Part Brain” slide above shows the time sequence from the bottom up: first the brain stem develops (pink); then the diencephalon cerebellum (yellow); they make up our primitive reptilian “survival” brain.  Next develop the emotional limbic brain which only mammals have (green), and finally the thinking cortex (blue).

Why time sequence? Our entire big Einstein brain is an outgrowth of its most primitive part: the brain stem (the knob at the top of the spinal chord), and its spin-off, the cerebellum.

This “reptilian brain” is in the back of your head at the level of the ears. It maintains rock bottom survival such as body temperature, heart rate, sleep, and breathing – all the functions you never think about which if they didn’t happen you’d be dead. Not only reptiles have the same apparatus but so do pre-bony fish like sharks. That’s humbling: our whole brain starts with something that primitive.

“During development, the brain organizes from bottom to top, with the lower parts of the brain developing earliest,” Dr. Perry says. Reptile brain better hit the ground running at birth or infants don’t breathe; the rest of the brain can and does grow in later. “The majority of brain organization takes place in the first four years of life,” he says. “Because this is the time when the brain makes the majority of its ‘primary’ associations and core neural networks organize as a reflection of early experience, early developmental trauma and neglect have disproportionate influence on brain organization and later brain functioning.” [FN4 Op cit]

What goes wrong from “conception to 36 months” can fry our reptilian brain and put it in permanent fight-flight or freeze (dissociation shutdown). Then the entire brain can be thrown out of whack starting from its first cell divisions.

As the ACE Study has shown, this results in heart, gut, and many other chronic physical diseases throughout adult life.

“The brain is an historical organ,” Perry said.  “The NMT Core Assessment’s first step is a review of the key insults, stressors, and challenges during development. Intrauterine insults such as alcohol or perinatal care disruptions (such as an impaired inattentive primary caregiver) alter the norepinephrine, serotonin, and dopamine systems of the brain stem and diencephalon that are rapidly organizing. These early life disruptions result in a cascade of functional problems in brain areas these neural systems innervate.”

Think your thinking brain’s in charge? “Think” again – we’re arrogant about how much our thinking brain can do. Fact is, it’s the new kid on the block in the brain. It has a lot less influence than we imagine on the roiling instincts and feelings in the subconscious or “downstairs” brain, as Dan Siegel calls the rest of the brain below the cortex.  Siegel says the “downstairs brain” also  includes thick clusters of neurons associated with the brain stem that form around our viscera (heart, lungs, gut etc.).  Development of all that can go wrong from the hour the sperm hits the egg. It did with me.

“When a child has experienced chronic threats, the brain exists in a persisting state of fear,” Perry says. This “makes the stress response oversensitive, over-reactive, and dysfunctional due to over-utilization of brain stem-driven reactions. Such reactions become entrenched over time, and the ‘lower’ parts of the brain house maladaptive, influential, and terrifying pre-conscious memories that function as a template for the child’s feelings, thoughts, and actions.” [FN4]

“Cognitive behavioral therapy (CBT) is great if you have a developed frontal cortex – but we’re talking about a five year old kid who’s so scared to death most of the time that it’s shut down his frontal cortex ’cause he just saw his mother get shot,” Perry told his UCLA therapist audience March 8. “You’re going to do 20 sessions of CBT and expect change?  B#$$%&! (expletive)  That’s a fantasy.”  (Wild applause).

Listening to him talk, I can feel things inside me resonating, probably things that didn’t develop right in the womb, and I can feel it healing because, finally, here is compassion for my situation. It’s a remarkable experience.

When I hear Dr. Perry and his colleagues identifying these issues, it hits me in the solar plexus and the gut. I feel like someone is telling me “You’re not crazy, this actually happened deep inside you, you don’t have to conceal the pain anymore. You can be understood, you can be accepted as who you are.

“You can say exactly how you feel for the first time in your life and we are not going to run screaming from the room. We are going to accept you, because we can say scientifically that this is the way your cells developed in the environment you were in.”

Once I feel accepted in this profound way, I literally feel the problem begin to heal.  Dan Siegel reports that it’s been proven by brain scans that this feeling of acceptance and belonging produces re-growth of damaged brain tissues. It simulates the missed environment of love, acceptance and “we’re glad you’re here” which the infant was designed to experience at birth.

“Born for Love”

BrousBlog9d Perry Slide2 Attachment,StressBruce Perry and his Attachment Theory and trauma specialist colleagues like Bessel Van der Kolk, Daniel Siegel, Allan Schore, and Mary Jo Barrett, are also overturning the American Psychiatric Association (APA) apple cart by calling this “developmental trauma.”  It starts in the womb and is continuous from there, going on in the pre-conscious years.

It differs completely from incident-by-incident based trauma such as assault, rape, school violence, or combat stress, which can hit at any age. These later “PTSD” traumas have been assumed to what trauma is, yet horrible as they are, they are just not all there is.

Many (like me) take a lot of damage in wrong therapy which treats developmental trauma as if it were incident trauma. The APA’s latest “what’s my disease” bible, the “Diagnostic and Statistical Manual of Mental Disorders (DSM-5),” just out June 2013, doesn’t even recognize the existence of developmental trauma.

How to heal? Dr. Perry lays out the brain science behind Dr. Cloud’s idea of “getting love on the inside.”

“Attachment is when the baby learns by thousands of good experiences that stress is tolerable because it leads to reward opiates such as dopamine in our body, and that this pleasurable outcome is cathexsized to a person, Mom, who consistently attunes to it about this,” Perry said at UCLA. “When the baby feels distress, the attuned Mom feels distress and gets her own pleasure rewards by responding to the baby. So the infant brain weaves together the neurobiology of what interaction with another human being is, and connects it to stress relief, pleasure and safety, when this happens repeatedly. Ultimately, just seeing or hearing Mom makes you feel safe and pleasurable. Let a wounded combat soldier talk to his mom, and he’ll require 45% less pain meds.”

“Patterned, Repeated, Rhythmic Activity”

“Because the brain is organized in a hierarchical fashion, with symptoms of fear first arising in the brain stem and then moving all the way to the cortex, the first step in therapeutic success is brain stem regulation,” Perry said.  “An example of a repetitive intervention is positive, nurturing interactions with trustworthy peers, teachers, and caregivers, especially for neglected children who have not had the neural stimulation to develop the capacity to bond with others.

“Others are dance, music, or massage, especially for children whose persisting fear state is so overwhelming that they cannot improve via increased positive relationships, or even therapeutic relationships, until their brain stem is regulated by safe, predictable, repetitive sensory input.” An hour here and there of even sensitive therapy is rarely enough, he says.

“Children with relational stability and multiple positive, healthy adults invested in their lives improve; children with multiple transitions, chaotic and unpredictable family relations, and relational poverty do not improve even when provided with the best ‘evidence-based’ therapies. The healing environment is a safe, relationally-enriched environment,” he says.

“The only way you can move from these super-high anxiety states, to calmer more cognitive states, is rhythm,” Perry emphasizes.  “Patterned, repetitive rhythmic activity: walking, running, dancing, singing, repetitive meditative breathing.  You use brain stem-related somato-sensory network regulation, which make your brain accessible to relational reward and cortical thinking.”

Dr. Perry’s ChildTrauma Academy in Houston offers courses such as “Somatosensory Regulation Plan for Dysregulated Children” and “The Power of Rhythm: Music, Movement & Language.”  Somatosensory rhythmic programs at Dr. Bessel van der Kolk’s Trauma Center in Boston feature yoga, drama, drum circles,  trampoline work, and more.

“If you want a person to use relational reward, or cortical thought,” he says, “they’ve got to be emotionally regulated first!  We must regulate people, before we can possibly persuade them with a cognitive argument or compel them with an emotional affect.  All our contingency-based models do nothing but merely escalate their negative arousal!”

Sound stupid, like your doctor saying “Scram and go cool off at the gym” ?  I thought so – until I tried it.  It works, big time. But what happened was so explosive, it’s another blog for another day.

The take-away is 1: Listen to Dr. Perry; figure out how your brain does work; see if anything he says resonates.  Call up the ChildTrauma Academy and get their materials and training on Somatosensory Regulation and the power of rhythm.

Or if you can’t wait, as I’ve said before, find a really empathic, loving therapist who knows trauma inside out, and bring him that Peter Levine book. [FN5]  That’s what I used to do somatosensory work before I heard of Bruce Perry.  You’ll need professional supervision when you do the exercises on the CD in the back of Levine’s book, and look out world.

Even if we’re 92, we can grow parts of our brain. Daniel Siegel did it with a 92-year-old lawyer using mindfulness practice. [FN6]

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Excerpts from Kathy’s forthcoming book DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment DisorderHow I accidentally regressed myself back to infancy and healed it all and related research of attachment and brain science are posted here every Friday. Watch for the continuing series of excerpts from the rest of her book, in which she explores her journey of recovery and shares the people and tools that have helped her along the way.

Footnotes

FN1  Perry, Bruce D. MD, PhD, “Helping Children Recover from Trauma,” National Council LIVE, National Council on Behavioral Health, September 5, 2013; http://www.thenationalcouncil.org/events-and-training/webinars/webinar-archive/  Scroll down to September 2013.

FN2  Bruce Perry, Daniel Siegel, et.al, “Trauma, Brain & Relationship: Helping Children Heal,” (25 Minutes) www.youtube.com/watch?v=jYyEEMlMMb0 – an introductory video on Attachment Disorder. A new understanding of how trauma effects the development of the mind-body system, and how it affects children’s behaviors and social relationships. Copies at www.postinstitute.com/dvds.

FN3  Cloud, Henry, PhD, “Getting Love on the Inside,” Lecture, April 2002 (CD), Mariner’s Church, Newport Beach CA, www.Cloud-Townsend Resources.com, [Coauthor with Townsend, John, PhD, of “Boundaries,” Zondervan, 2004]

FN4  Perry, Bruce, MD, PhD, “Born for Love: The Effects of Empathy on the Developing Brain,” Annual Interpersonal Neurobiology Conference “How People Change: Relationship & Neuroplasticity in Psychotherapy,” UCLA, Los Angeles, March 8, 2013 (unpublished).
Dr. Perry’s latest research and key slides (otherwise hard to obtain)  are in his National Council speech in FN1 above.
Key videos, articles on Interventions, Trauma, Brain Development/Neuroscience, etc. are at: https://childtrauma.org/cta-library/
“The Neurosequential Model of Therapeutics” by Perry, B.D. and Hambrick, E. (2008)  is  at: http://childtrauma.org/nmt-model/references/

FN5  Levine, Peter A., PhD, “Healing Trauma: A Pioneering Program for Restoring the Wisdom of Your Body,” Sounds True, Inc.,  Boulder CO, 2005; ISBN 1-159179-247-9

FN6  Siegel, Daniel J., MD, “How Mindfulness Can Change the Wiring of Our Brains,” National Institute for the Clinical Application of Behavioral Medicine, www.nicabm.com,  March 2011.  Check for the passage on a 92 year old lawyer code-named “Stewart.”

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