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14th ANNUAL TRAUMA SYMPOSIUM Racing Pulse, Toxic Stress, Shock: The Effect of Trauma on the Brain Panelists: Margo DeMont, Ph.D. Cynthia Lemp, M.S.W. Kimberlie Warren, Ph.D. The Effect of Trauma on the Brain Presentation Objectives The Learner will be able to: Describe the effect of stress on the brain Explain how to alter emotions to minimize the “flight or fight” stress response Identify at least three symptoms of post-traumatic stress disorder Describe two physiological changes resulting from using Acute Trauma Incident Processing with a patient Bi-directional communication between the brain and the body via Autonomic nervous system (ANS) ALLOSTATIC LOAD Amygdala Hijacking The CEO is out of commission! Emotionally traumatic effects • “Multiple conflicts, wars…and personal trauma from accidents, abuse, disaster, bullying…large numbers of individual psyches and family systems have been traumatized. The emotional devastations come from the same emotions that can be powerful emotional catalysts for healing.” (www.energeticinstitute.com.au) Reptilian versus Thinking Brain Reptilian and limbic, sub-cortical areas mediate emotional life. Healing and rewiring emotional responses and defenses occurs in older brain areas. The heart – brain connection EMOTIONS AS ENERGY SOURCES Energetic frequencies Positive (high), negative (low) Emotions and Heart Rhythms Institute of HeartMath 17 Heart Rhythms Directly Impact Physical and Mental Performance Incoherence Inhibits Brain Function Institute of HeartMath The heart signals especially affect the brain centers involved in social and situational awareness, the capacity to care, and the ability to self-manage. Coherence Facilitates Brain Function Impact and outcomes of chronic/toxic stress Brain cell death Alzheimer's Accelerated aging Impaired memory or learning Hypertension Heart disease Obesity Cancer Diabetes Stress – cognitive inhibition Vitality – cognitive facilitation Synchronize the Autonomic Nervous System http://assists.blogspot.com/ Emotional Landscape Exhausted Bored Withdrawn Apathetic Shamed Depressed Despaired Hopeless Burned Out Negative Stress / ‘Belly Fat’ Hormone Joyful Happy Energized Excited Creative Productive Appreciative Caring Emotions Hormonal System DHEA Vitality /Anti Aging Hormone Positive Cortisol Emotions Angry Hostile Resentful Judgmental Frustrated Worried Anxious Afraid Tolerant Calm Centered Reflective Compassionate Satisfied Serene Forgiving Content Low Arousal - Acetylcholine ANS - Parasympathetic Pathway Relaxation Stress-Free Zone Stress Zone Autonomic Nervous System – Sympathetic Pathway High Arousal - Adrenaline EMOTION REGULATION Negative to neutral, to positive. Cortisol DHEA TRAUMA (photo collage) Little t - BIG T Jeffrey Brenner, M.D. Medical Director of the Urban Health Institute at Cooper University Healthcare More than 15 years ago . . . Better care at lower cost in America The largest and most valuable health study ever done. Adverse Childhood Experiences: A Chronic Public Health Disaster Adverse Childhood Experiences Study the Largest Public Health Study You Never Heard Of Adverse Childhood Events Kaiser Permanente (1997) Center for Disease Control and Prevention (2009 publication; on-going) St. Joseph County Community Health Needs Assessment (2012) What Are ACEs? Abuse Dysfunctional Family Neglect Prevalence of Adverse Childhood Experiences Adverse Childhood Experiences Are Common Household dysfunction: Substance abuse Parental sep/divorce Mental illness Battered mother Criminal behavior 27% 23% 17% 13% 6% Abuse: Psychological Physical Sexual 11% 28% 21% Neglect: Emotional Physical 15% 10% ACEs Research: >37,000 Subjects Death Early Death Disease, Disability & Social Problems Adoption of Health-risk Behaviors Social, Emotional, & Cognitive Impairment Adverse Childhood Experience Conception Scientific Gaps Implications Those with four categories of ACEs 240% higher risk of hepatitis 390% higher risk of COPD (emphysema or chronic bronchitis) 240% higher risk of STDs Twice as likely to smoke Twelve times as likely to have attempted suicide Seven times higher risk to be an alcoholic Ten times higher risk of injecting street drugs Trauma, Toxic Stress and the Brain Orbitofrontal Cortex Pathological Aggression Amygdala Fear Anxiety Executive Function Reversing the Trajectory Post Traumatic Stress Disorder Eye Movement Desensitization and Reprocessing Post-Traumatic Stress Syndrome Reliving Avoiding Increased Arousal Eye Movement Desensitisation & Reprocessing Introduction to EMDR Acute-Trauma Intervention and Processing Crisis Management Impact of Event Scale 53 subjects randomly assigned Immediate/Wait-list Self Reported Distress from Trauma was statistically significant at p=< .001 Adult Adversity Elementary Children 12% ≥ 3 ACEs 1. Health, attendance, behavior 2. Academic failure High School Youth 42% ≥ 3 ACEs CourtInvolved Youth Higher ACE Scores Among those with ≥4: 51% special ed. (vs. 33% 0-1) 74% below 2.0 GPA (58%) 85% suspended by 2nd (71%) 33% re-offend in 2 years (13%) Incarceration Victim of Intimate Partner Violence Drug/Alcohol Mental Illness Work injuryDivorce illness Homelessness Disability Poverty Health limits activity Unemployment Parenting Adults with ≥5 ACE 14 TIMES more likely to have two or more conditions that make ACEs for kids Community Partnerships to Build a Network for ACEs Intervention and Prevention We are committed to Trauma-Informed Care: Proving a safe environment that promotes healing and recovery EMDR in Practice Demonstration Cynthia Lemp, MSW, LCSW Memorial Hospital of South Bend Trauma Center Social Worker