Resilience: The Biology of Stress and the Science of Hope

Listen to my radio interview reflecting on the documentary “Resilience”, the Adverse Childhood Experiences study (ACES), and my thoughts on how to heal from trauma and child abuse.

Click here: http://kcbx.org/post/resilience

aces pyramid 2

“The child may not remember, but the body remembers.” Resilience: The Biology of Stress and the Science of Hope is a one-hour documentary that delves into the science of Adverse Childhood Experiences (ACEs) and the birth of a new movement to treat and prevent Toxic Stress. While the original research was controversial, experts now consider the findings to have revealed one of the most important public health findings of a generation. Understood to be one of the leading causes of everything from heart disease and cancer to substance abuse and depression, extremely stressful experiences in childhood can alter brain development and have lifelong effects on health and behavior.

Join host Kris Kington-Barker as she speaks with guests Nisha AbdulCadar, an M.D., F.A.A.P. and Pediatrician with Martha’s Place Children’s Assessment Center and Ron Huxley a LMFT who provides faith-based, trauma-informed therapy for individuals and families about the upcoming movie screening and research behind “Resilience,” a powerful documentary film by James Redford and Karen Pritzker that reveals, toxic stress can trigger hormones that wreak havoc on the brains and bodies of children which can put them at a an increased risk for disease, homelessness, prison time, and even early death. Join the conversation and listen to how trailblazers like these in pediatrics, education, and social welfare are using cutting-edge science and field-tested therapies to fight back against the effects of toxic stress and greatly improve the health of our future generations.

Central Coast Voices is sponsored by ACTION for Healthy Communities in collaboration with KCBX and made possible through underwriting by Joan Gellert-Sargen.

2017 Child Abuse Prevention Academy

Please join us for the 9th Annual Child Abuse Prevention Academy, a training for students, professionals, and community members.

Participants will:

  • learn how to report incidents of suspected child abuse,
  • understand what occurs after a report,
  • understand the role and funtion of the brain in Trauma-Informed Care
  • learn to recognize the effects of trauma on the brain, behavior and development
  • explore primary strategies for healing trauma in the lives of children and adults.

Presenter: Lisa Fraser, Executive Director, Center for Family Strengthening, the San Luis Obispo County Child Abuse Prevention Council

Guest Speaker: Ron Huxley, LMFT will share,
The Beautiful, Wonderful, Broken Brain: Understanding Trauma-Informed Care.

Noted child and family therapist, speaker, and blogger Ron Huxley has worked in several systems of care, including community-based mental health, child therapy clinics, wraparound, County mental health, private psychotherapy practice, and faith-based counseling/coaching services. He has certifications in various clinical evidence-based and promising practices: EMDR, Incredible Years, Family Wellness, Love & Logic, S.T.E.P. (Systematic Training for Effective Parenting), TheraPlay, Love After Marriage, and Developmental Dyadic Psychotherapy (attachment-focused family therapy).

Student participants are urged to attend and will receive a Certificate of Participation. 

The training is free, but preregistration is required.

register now

When

Friday April 28, 2017. 9:00am – 12pm
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Where

Cuesta College Student Auditorium – #5401
 CA-1, San Luis Obispo, CA, CA 93403

Free Parking  Lot #2

Contact

Center for Family Strengthening
805-543-6216
support@cfsslo.org  

  Brought to you in partnership with Center for Family Strengthening and Cuesta College        

   

 

Click here to Register Now!

 

Abused Children Similar to War Vets

Children who have been abused or witnessed violence suffer similar trauma to war veterans…

LONDON (Reuters) ­ Children exposed to family violence show the same pattern of activity in their brains as soldiers exposed to combat, scientists said on Monday. In a study in the journal Current Biology, researchers used brain scans to explore the impact of physical abuse or domestic violence on children’s emotional development and found that exposure to it was linked to increased activity in two brain areas when children were shown pictures of angry faces.

Previous studies that scanned the brains of soldiers exposed to violent combat situations showed the same pattern of heightened activity in these two brain areas ­­ the anterior insula and the amygdala ­­ which experts say are associated with detecting potential threats. This suggests that both maltreated children and soldiers may have adapted to become “hyper­aware” of danger in their environment, the researchers said. “Enhanced reactivity to a…threat cue such as anger may represent an adaptive response for these children in the short term, helping keep them out of danger,” said Eamon McCrory of Britain’s University College London, who led the study.

Kids put in institutions have different brain compositions than kids in foster care

In new research published in the journal JAMA Pediatrics, researchers looked at brain differences between Romanian children who were either abandoned and institutionalized, sent to institutions and then to foster families, or were raised in biological families.

Kids who were not raised in a family setting had noticeable alterations in the white matter of their brains later on, while the white matter in the brains of the children who were placed with a foster family looked pretty similar to the brains of the children who were raised with their biological families.

Researchers were interested in white matter, which is largely made up of nerves, because it plays an important role in connecting brain regions and maintaining networks critical for cognition. Prior research has shown that children raised in institutional environments have limited access to language and cognitive stimulation, which could hinder development.

These findings suggest that even if a child were at a risk for poor development due to their living circumstances at an early age, placing them in a new caregiving environment with more support could prevent white matter changes or perhaps even heal them.

More studies are needed, but the researchers believe their findings could help public health efforts aimed at children experiencing severe neglect, as well as efforts to build childhood resiliency.

Source: 

http://time.com/3683071/neglect-brain-development/

Child Abuse Pediatricians Recommend Basic Parenting Classes to Reduce Maltreatment and Neglect | TIME.com:

Child abuse is a persistent problem in this country. Research published in February in Pediatrics found that child abuse kills 300 kids under 18 each year and accounts for 58.2 hospitalizations of babies per 100,000 births — more than the annual rate of SIDS. Another recent study made the case that child abuse sets the stage for future mental illness.

For a pediatrician, it can be dicey sussing out whether a child came by a broken bone or a bruise naturally or whether the injury was inflicted by an adult. As of 2009, there is an entirely new specialty devoted to making those types of assessments: the board-certified child abuse pediatrician, who focuses on identifying child maltreatment and neglect.

Read more: http://healthland.time.com/2012/04/04/child-abuse-pediatricians-recommend-basic-parenting-classes-to-reduce-maltreatment-and-neglect/


Exposure to Intimate Partner Violence, Peer Relations, and Risk for Internalizing Behaviors

Exposure to Intimate Partner Violence, Peer Relations, and Risk for Internalizing Behaviors

A Prospective Longitudinal Study

  1. Kathleen Camacho1
  2. Miriam K. Ehrensaft1
  3. Patricia Cohen2

  1. 1John Jay College of Criminal Justice, New York

  2. 2Columbia University, New York State Psychiatric Institute, New York
  1. Miriam K. Ehrensaft, John Jay College of Criminal Justice, 445 West 59th street, New York, NY 10019 Email: mehrensaft@jjay.cuny.edu

Abstract

The present study examines the quality of peer relations as a mediator between exposure to IPV (intimate partner violence) and internalizing behaviors in a sample of 129 preadolescents and adolescents (ages 10-18), who were interviewed via telephone as part of a multigenerational, prospective, longitudinal study. Relational victimization is also examined as a moderator of IPV exposure on internalizing behaviors. Results demonstrate a significant association of exposure to severe IPV and internalizing behaviors. Relational victimization is found to moderate the effects of exposure to severe IPV on internalizing behaviors. The present findings suggest that the effects of exposure to IPV had a particularly important effect on the risk for internalizing problems if the adolescent also experienced relational victimization. Conversely, the receipt of prosocial behaviors buffer against the effects of IPV exposure on internalizing symptoms in teen girls.

Ron Huxley Relates: This study simply backs up our belief that witnessing domestic violence has a negative effect on children. This article focuses specifically on teens and how one’s peer group can help to buffer those negative effects. Apparently, teen girls have reduced effects when they have a strong peer network. Perhaps all that texting is good for them? OK, maybe that goes to far but it does support another belief that group therapy, formally or informally, can help our adolescents who have been victimized in this way.

The Moral Life of Babies and Some Thoughts on Parenting

Ron Huxley’s Rant: I came across this very comprehensive article on the moral life of babies. I didn’t repost the entire article here because, well, it’s quite long and could get a bit boring. If you like that sort of thing I would encourage you to click the nytimes.com link above. Here’s the basic premise: Babies do come into the world with a bit of a moral compass. It is our job as parents to give it some refinement. This premise moved me to consider how are parenting philosophy and techniques are based on how we think about babies. 

The researchers conducted several experiments demonstrating that children experience empathy and have sense of right and wrong from the earliest moments of their lives. Their solutions to moral problems (how two children will share one toy that both believed they had their eye on first) may be limited due to their cognitive limitations and lack of social guidance but their innate understanding that some injustice has occurred is right on. Astute parents have witnessed their children getting their feelings hurt by the most innocent of situations. I once looked at a baby wrong and she tightened her face up into a silent scream and then exploded into tears. This reaction doesn’t come without some moral frame of reference, however limited.

I am not sure why we like to believe children are “perfect idiots” or full of “blooming, buzzing (moral) confusion” as a couple of leading thinkers in the field have described them. My fear is that when we hold the idea that children are narcissistic sociopaths, we will respond to them in very adverse, punitive ways. I think this has definitely been the case historically. The parenting idea of “spare the rod and spoil the child” has lead too many parents to the point of physical and emotional abuse. In my career many parents that had their children removed really that they were doing the right thing by their child. So much of our beliefs about parenting is governed by social constructs. How would parenting styles differ if we thought of babies as already equipped with a moral center, full of goodness and mercy? I know this sounds a bit preachy, but really, how would we parent differently? Would it change how we prioritize our schedules during the day? Alter educational standards? Give a new approach to discipline?

Let’s have a conversation, with other parents, about how parenting methods might change if our first thought is that babies are smart, nice and loving creatures and not budding sociopaths in need of parental toughness. Share your thoughts here or post on Facebook and Twitter.

What 9/11 has taught us about trauma

Scientific American has a useful piece on how the immediate treatment of psychological trauma has changed since 9/11. The issue is interesting because recent progress has turned lots of psychological concepts on their head to the point where many still can’t grasp the concepts.

The article notes that at the time of the Twin Towers disaster, the standard form of treatment was Critical Incident Stress Debriefing – also known as CISD or just ‘debriefing’ – a technique where psychologists would ask survivors, usually in groups, to describe what happened and ‘process’ all the associated emotions by talking about them.

This technique is now not recommended because we know it is at best useless and probably harmful – owing to the fact that it seems to increase trauma in the long-term.

Instead, we use an approach called psychological first aid, which, instead of encouraging people to talk about all their emotions, really just focuses on making sure people feel secure and connected.

Although the article implies that 9/11 was a major turning point for our knowledge of immediate post-trauma treatment, the story is actually far more complex.

Studies had been accumulating throughout the 90s showing that ‘debriefing’ caused harm in some, although it wasn’t until around the turn of the century that two meta-analyses sealed the deal.

Unfortunately, the practice of ‘debriefing’ by aid agencies and emergency psychologists was very hard to change for a number of interesting reasons.

A lot of aid agencies don’t deal directly with the scientific literature. Sometimes, they just don’t have the expertise but often it’s because they simply have no access to it – as most of it is locked behind paywalls.

However, probably most important was that even the possibility of ‘debriefing’ having the potential to do damage was very counter-intuitive.

The treatment was based on the then-accepted foundations of psychological theory that said that emotions always need to be expressed and can do damage if not ‘processed’.

On top of this, for the first time, many clinicians had to deal with the concept that a treatment could do damage even though the patients said it was helpful and were actually and genuinely getting better.

This is so difficult to grasp that many still continue with the old and potentially damaging practices, so here’s a quick run down of why this makes sense.

The theoretical part is a hang-over from Freudian psychology. Freud believed that neuronal energy was directly related to ‘mental energy’ and so psychology could be understood in thermodynamic terms.

Particularly important in this approach is the first law of thermodynamics that says that energy cannot be created or destroyed just turned into another form. Hence Freud’s idea that emotions need to be ‘expressed’ or ‘processed’ to transform them from a pathological form to something less harmful.

We now know this isn’t a particularly reliable guide to human psychology but it still remains hugely popular so it seemed natural that after trauma, people would need to ‘release’ their ‘pent up emotions’ by talking about them lest the ‘internal pressure’ led to damage further down the line.

And from the therapists’ point of view, the patients said the intervention was helpful and were genuinely getting better, so how could it be doing harm?

In reality, the psychologists would meet with heavily traumatised people, ‘debrief’ them, and in the following weeks and months, the survivors would improve.

But this will happen if you do absolutely nothing. Directly after a disaster or similarly horrible event people will perhaps be the most traumatised they will ever be in their life, and so will naturally move towards a less intense state.

Statistically this is known as regression to the mean and it will occur even if natural recovery is slowed by a damaging treatment that extends the risk period, which is exactly what happens with ‘debriefing’.

So while the treatment was actually impeding natural recovery you would only be able to see the effect if you compare two groups. From the perspective of the psychologists who only saw the post-trauma survivors it can look as if the treatment is ‘working’ when improvement, in reality, was being interfered with.

This effect was compounded by the fact that debriefing was single session. The psychologists didn’t even get to see the evolution of the patients afterwards to help compare with other cases from their own experience.

On top of all this, after the ‘debriefing’ sessions, patients actually reported the sessions were useful even when long-term damage was confirmed, because, to put it bluntly, patients are no better than seeing the future than professionals.

In one study, 80% of patients said the intervention was “useful” despite having more symptoms of mental illness in the long-term compared to disaster victims who had no treatment. In another, more than half said ‘debriefing’ was “definitely useful” despite having twice the rate of postraumatic stress disorder (PTSD) after a year.

Debriefing involves lots of psychological ‘techniques’, so the psychologists felt they were using their best tools, while the lack of outside perspective meant it was easy to mistake instant feedback and regression to the mean for actual benefit.

It’s worth saying that the same techniques that do damage directly after trauma are the single best psychological treatment when a powerful experience leads to chronic mental health problems. Revisiting and ‘working through’ the traumatic memories is an essential part of the treatment when PTSD has developed.

So it seemed to make sense to apply similar ideas to those in the acute stage of trauma, but probably because the chance of developing PTSD is related to the duration of arousal at the time of the event, ‘going over’ the events shortly after they’ve passed probably extends the emotional impact and the long-term risks.

But while the comparative studies should have put an end to the practice, it wasn’t until the World Health Organisation specifically recommended that ‘debriefing’ not be used in response to the 2004 tsunami [pdf] that many agencies actually changed how they went about managing disaster victims.

As well as turning disaster psychology on its head, this experience has dispelled the stereotype that ‘everyone needs to talk’ after difficult events and, in response, the new approach of psychological first aid was created.

Psychological first aid is actually remarkable for the fact that it contains so little psychology, as you can see from the just released psychological first aid manual from the World Health Organisation.

You don’t need to be a mental health professional to use the techniques and they largely consist of looking after the practical needs of the person plus working toward making them feel safe and comfortable.

No processing of emotions, no ‘disaster narratives’, no fancy psychology – really just being practical, gentle and kind.

We don’t actually know if psychological first aid makes people less likely to experience trauma, as it hasn’t been directly tested, although it is based on the best available evidence to avoid harm and stabilise extreme stress.

So while 9/11 certainly focussed people’s minds on psychological trauma and its treatment (especially in the USA which is a world leader in the field) it was really just another bitter waymarker in a series of world tragedies that has shaped disaster response psychology.

So unusually for a psychologist, I’ll be hoping we’ll have the chance to do less research in this particular area and have a more peaceful coming decade.
 

Link to SciAm piece on psychology and the aftermath of 9/11.

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This isn’t a typical piece for a parenting blog but seeing as how I work with so many traumatized children and since today is 9/11 it seemed appropriate to share a couple thoughts.

One of the first things I teach my clinical interns is that you have to “stabilize” before you can do “interventions.” As therapists and parents we want to help a child talk about their traumas and get it all out. As the article explains above, this is an out dated and incorrect hypothesis about how to manage trauma. What children need FIRST is to know that they are safe and connected to others. This is the first law of attachment if you will and the very thing that so many traumatized children lack. Think about it: trauma destabilizes your sense of safety, so what would be the best intervention? Recreating safety.

It is a common problem for new therapists to want to talk it out. I get social workers and parents pressing me to do this all the time. The fact is that it is the worst thing for the child at first. Before working out issues, let’s create safety and stability at home and school. Build more support system. Give more hugs. Stay longer in the room at night and read that extra book or two. Be more tolerant of the meltdowns and resistance to changes in routine. Follow a routine if you don’t have one. Give back rubs and an extra scoop of ice cream.

What do you do to create safety and stability after a child experiences something traumatic?

Children of depressed mothers have a different brain: MRI scans show their children have an enlarged amygdala

ScienceDaily (Aug. 15, 2011) — Researchers think that brains are sensitive to the quality of child care, according to a study that was directed by Dr. Sonia Lupien and her colleagues from the University of Montreal published in the Proceedings of the National Academy of Sciences. The scientists worked with ten year old children whose mothers exhibited symptoms of depression throughout their lives, and discovered that the children’s amygdala, a part of the brain linked to emotional responses, was enlarged.

Similar changes, but of greater magnitude, have been found in the brains of adoptees initially raised in orphanages. Personalized attention to children’s needs may be the key factor. “Other studies have shown that mothers feeling depressed were less sensitive to their children’s needs and were more withdrawn and disengaged,” explained Drs. Sophie Parent and Jean Séguin of the University of Montreal’s, who followed the children over the years.

Scientists have established that the amygdala is involved in assigning emotional significance to information and events, and it contributes to the way we behave in response to potential risks. The need to learn about the safety or danger of new experiences may be greater in early life, when we know little about the world around us. Indeed, studies on other mammals, such as primates, show that the amygdala develops most rapidly shortly after birth. “We do not know if the enlargement that we have observed is the result of long-term exposure to lower quality care. But we show that growing up with a depressed mother is associated with enlarged amygdala.”

“Having enlarged amygdala could be protective and increase the probability of survival,” Lupien said. The amygdala may be protective through a mechanism that produces stress hormones known as glucocorticoids. The researchers noted that the glucocorticoids levels of the children of depressed mothers who participated in this study increased significantly when they were presented with unfamiliar situations, indicating increased reactivity to stress in those children. Adults who grew up in similar circumstances as these children show higher levels of glucocorticoids and a greater glucocorticoid reaction when participating in laboratory stress tests. “What would be the long term consequences of this increased reactivity to stress is unknown at this point.”

Although this study cannot clarify the causes of enlarged amygdala, the researchers note that the adoption studies have also shown that children who were adopted earlier in life and into more affluent families than others did not have enlarged amygdala. “This strongly suggests that the brain may be highly responsive to the environment during early development and confirms the importance of early intervention to help children facing adversity,” Lupien said. “Initiatives such as prenatal and infancy nurse home visits and enriched day care environments could mitigate the effects of parental care on the developing brain.” Séguin adds, “Future studies testing the effects of these preventive programs and observational studies involving children exposed to maternal depressive symptoms at different ages, and consequently for different lengths of time, should provide more insight into how this occurs, its long term consequences, and how it can be prevented.”

This study was published in the Proceedings of the National Academy of Sciences on August 15, 2011, and was financed in part by the John D. and Catherine T. MacArthur Foundation, the Canadian Institutes for Health Research, and Fonds de recherche en santé du Québec. The University of Montreal is officially known as Université de Montréal.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Montreal, via EurekAlert!, a service of AAAS.

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

As a therapist working with adopted children, I can see how this adaptation plays out in a child’s everyday life. An enlarged Amygdala allows the child to protect themselves and seek emotional “nurturance” from their environment. Unfortunately, this result in an over reaction to events and misinterpretations of hostile behavior on the part of other people in their lives. Too many children, due to severe abuse and neglect, in their early moments of life, have an inability to modulate sensory input and become labeled as “disruptive”, “reactionary”, and “attachment disordered”. While these labels are true, they brand the child into negative roles of “defiant”, “oppositional”, “manipulative”, and “damaged”.

When I am presented with these labels I simply agree with the surface description but make a point to ask why are they manipulative, etc. The goal is to dig to the root of the problem and focus on it, in collaboration with the child to work on changing this pattern of behavior. Too many labels identify the child with the problem and leave the situation feeling hopeless, even permanent. It is not permanent but lots of therapeutic effort is needed to make changes. The alternative is to place the individual into institutions where we know hope is limited and opportunities for repair, namely bonding with a healthy caregiver, is not possible.