Institute Inbrief - 15/12/2015
Welcome to Edition 238 of Institute Inbrief! What happens to the brain during trauma? The neurobiology of trauma is the focus of this edition’s featured article.
We’d like to take this opportunity to wish you and your loved ones a Merry Christmas and joyful festive season! Whether or not you celebrate the occasion, it's a great time to acknowledge the presence of loved ones in our lives, and the importance of the human bond – whether it is gained through our families, communities, workplaces, and/or other relationships.
Also in this edition:
- Latest news and updates
- Articles and CPD information
- Wellness and counselling practice tips
- Social media review
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When Destructive Behaviour Makes Biological Sense
Studies in social science and psychology have shown people whose early existences are largely defined by a lack of resources, instability, and violence often live foreshortened lives filled with risk-taking and even crime. Vladas Griskevicius, a social psychologist at the University of Minnesota’s Carlson School of Management, wants to change the way we think about those people, and the seemingly senseless choices that they make.
The Neurobiology of Trauma and the Therapeutic Window
Trauma, stress, and the Autonomic Nervous System
With exposure to stress or trauma, the Autonomic Nervous System (ANS) comes under direct fire. It is comprised of the Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System (PNS). Under normal “at rest” conditions – meaning, when not under stress – the PNS is tasked with maintaining normal physiological activity: decreasing the heart and breathing rates, while increasing the blood flow to the digestive system (thus it is said to be involved with “rest and digest” functions).
The SNS, meanwhile, is the adaptive system. Designed to protect the body when there is a perceived threat to survival or body integrity, the SNS activates the “fight, flight, or freeze” response. When this response is activated:
- Adrenalin and cortisol levels increase dramatically, producing hypervigilance and hyperarousal
- The body is prepared to fight or run from danger through:
- Constricted blood vessels and pupils
- Decreased blood flow to the digestive system
- Increased perspiration
- Increased heart and breathing rates
- If fleeing or fighting is impossible, the body is prepared to “freeze” through dissociation:
- The individual feels numb and disengaged
- The individual may faint
- Time is suspended
- Derealisation may occur, theoretically preparing the body for camouflage, increasing chances for survival through compliance with the attacker, or creating conditions in which death is not as painful if the attacker does not go away (Bicknell-Hentges & Lynch, 2009)
Clearly, the SNS stress response is critical for survival. The problem comes when the SNS is stimulated too often; harmful effects occur to the body. Because the autonomic stress response is triggered in the same way by both physical and emotional pain, people who continually perceive danger in their environments will engender a constant autonomic response of alertness. This could range from mere vigilance to terror. Whether the individual has actually been exposed to a traumatic event or is “only” experiencing an ongoing stress does not matter; either way the ANS response causes serious damage to the individual’s health (Bremner, 2002).
Hippocampal damage to memory formation
The hormones of adrenalin and cortisol are released during stressful times, soaking the parts of the brain involved in memory and response to stress. Receiving the hormones mobilises these brain systems to respond to danger, and so is critical for survival, but excessive or repetitive activation of this response can result in long-term changes to just these same areas of memory and stress response. For example, studies have shown that cortisol may cause damage to the hippocampus, impairing memory formation (Sapolsky, 1996).
Increased physiological response to all stimuli
Individuals exposed to intense or prolonged trauma may have a more intense physiological response to all stress. In a study comparing individuals with PTSD to non-traumatised controls, those with PTSD responded to reminders of trauma with significant increases in blood pressure, heart rate, and skin conductance (Pitman, Orr, Forgue, De Jong & Claiborn, 1987). Studies have also demonstrated that chronic SNS arousal increases other physiological responses, including irritability in the limbic system. This irritability means that almost any excessive stimulus – such as loud noises, strong odours, or flashes of light – stimulates the fight-or-flight response. Each time such an individual is re-stressed, the sensitivity of the response is increased, as is the individual’s vulnerability to anxiety and depression (Scaer, 2005).
Chronic SNS arousal can negatively impact higher brain functions
Self-soothing disrupted
During the first three years of life, brain growth is predominantly in the right hemisphere of the brain, which processes nonverbal signals and communications, including facial expression of feelings, perception of emotion, and regulation of the autonomic nervous system. If a child is exposed to significant stress or PTEs during this time, the critical function of self-soothing (regulated by the right hemisphere) is unable to develop properly (Siegel, 2003).
Cortical functions unable to modulate lower brain responses
In normal individuals, brain growth and increased organisation means that the higher, more complex areas of the brain begin to control the more reactive, primitive-functioning parts of the lower brain. The sophisticated cortex enables the individual to increasingly modulate his or her impulses and behavioural responses to strong emotions. Chronic arousal of the SNS, however, impacts the development of those higher brain functions, making it difficult for the person to think logically, plan, and problem-solve before reacting. Language is also affected. Looked at another way, the more complex the survival network becomes (i.e., the more traumatised the person is), the more difficult it is for the person’s higher cortical functions to subdue the primitive parts during learning, concentration, and recall (Perry, 2001).
States become traits
Finally, persistent SNS stimulation also increases the risk that characteristics of the state of arousal become more stable traits. Chronic hyperarousal may permanently alter the SNS adrenalin system. Persistent dissociation may alter the opioid (that is, endorphins, the body’s natural morphine) system (Bicknell-Hentges & Lynch, 2009).
Trauma behaviour makes sense
Just imagine if you were lost in the forest somewhere with a group of children. As the adult, you realise that when night falls, it is you who must watch out for marauding wild animals and any human predators. The children go to sleep, but you stay up 24/7 in order to do the lookout work. Yet you cannot sleep during the day as you must use daylight to try to find your way out of the forest. The next night you face the same task, and sometimes you do have to deal with animals. It is frightening and exhausting.
Obviously, after some time of needing to be totally awake and hypervigilant, you would begin to feel anxious. As body and mind became tired and burned out from the guard duty and attempts to guide the group safely out, your memory, normally so reliable, would be struggling to remember simple things. You might begin to do increasingly bizarre things because brain changes brought on by the stress of constant vigilance would mean that your ability to regulate your behaviour and impulses would be steadily decreasing. At some stage, it would all be too much. If you continued to be saddled with ensuring safety in an unsafe environment, you might become full of despair. Certainly all of these responses, plus addictions and self-harming, could await you after the event, when you were all back safely home. And trauma experts would say that these behaviours would make sense as responses to the potentially traumatising ordeal you were enduring.
As we have described, exposure to PTEs does not bring an automatic sentence of PTSD, but the resultant over-stimulation of the autonomic nervous system does put traumatised individuals at much higher risk for constrained memory formation, decreased cortical modulation of lower brain impulses and behaviours, and eventual transitioning of temporary traits into stable (unwanted) traits. As mental health professionals, we are called upon to understand this basic neuroscience in order to better inform and guide our clients’ treatment.
This article was adapted from the upcoming Mental Health Academy’s CPD course “Working with Trauma”. For more details, visit www.mentalhealthacademy.com.au.
References
Bicknell-Hentges, L, & Lynch, J.J. (2009, March). Everything counselors and supervisors need to know about treating trauma. Paper based on a presentation at the American Counseling Association Annual Conference and Exposition, Charlotte, N.C.
Bremner, J.D. (2002). Understanding trauma-related disorders from a mind-body perspective: Does stress damage the brain? New York: W.W. Norton & Company.
Perry, B.D. (2001). The neurodevelopmental impact of violence in childhood. In Schetky, D., & Benedek, E.P. (Eds.), Textbook of child and adolescent forensic psychiatry, (221-238). Washington, D.C.: American Psychiatric Press, Inc.
Pitman, R.K., Orr, S.P., Forgue, D.F., de jong, J., & Claiborn, J.M. (1987). Psychophysiologic assessment of posttraumatic stress disorder imagery in Vietnam combat veterans. Archives of General Psychiatry, Vol 44, 970-975.
Sapolsky, R. M. (1996). Why stress is bad for your brain. Science, Vol 273, 749-750.
Scaer, R.C. (2005). The trauma spectrum: Hidden wounds and human resiliency. New York: W.W. Norton & Co.
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The social value of being an active listener
Every year my siblings look forward to the visit my husband and I make to my country of origin. They are very glad to see me, but they can’t wait to see him. Why? When he is with each one, it is as if that person is the only human being on the planet. My husband gazes at the person with unwavering interest, drawing them out, checking that he has heard things correctly, and backing up the whole encounter with congruent body language. In short, my husband has mastered the art of being interested. So many people long to be the life and soul of the party – that is, to be interesting – but let’s have a look at just how potent an asset it is to be a skilful listener instead.
The social and professional benefits of active listening
Linguists claim that the greatest human achievement is learning to speak our native language. Many of us were further trained by family and school to “speak properly”, but less emphasis is typically placed on listening properly. In our digital world of abbreviated texts and 140-character limits, the focus is on quick responses, and we can lose sight of the benefits of the gracious, unhurried act of deeply listening. True listening – not just the passive act of hearing, but the active act of engaging the brain, concentrating, and adding desire to comprehend – can do all of these things:
- It shows respect for the speaker and thereby has immense capacity to build relationships, from work to social to intimate connections
- It is the key to communication of any sort, as it is half of any communicative exchange
- Being genuinely listened to is very healing for the speaker and has immeasurable power to help resolve issues
- It enhances the listener’s career, for example:
- It improves decision-making, because you gain necessary details and perspective to inform intelligent choices
- It increases the listener’s “mana” as a wise, mature, trustworthy individual: the “go-to” person for trouble-shooting
- Getting all of the available facts helps find solutions
- The capacity to skilfully listen makes you into a mentor, and that automatically boosts your organisational standing
- Deep listening allows you to auditorily “read between the lines”, so that camouflaged information can come to the fore, giving insight and understanding to an issue
- Active listening can accelerate your personal growth, as you gain self-discipline (because you aren’t jumping in with your own stuff!), empathy (because you are actively putting yourself into the speaker’s shoes), and maturity (because you stop prematurely judging people and situations).
How to cultivate active listening skills
If you’re like me (well, probably most of us), you may think, “Oh, yawn: listening skills? I’ve heard it all before!” But let’s make sure we can still pass Communication Skills 101. Here are a few of the rules:
Check your body language. Before you even hear the first sentence from the other person, take note: are you making appropriate eye contact? Sitting/standing relatively straight and oriented toward the speaker? Do you have an open body posture, conveying openness to what you are about to hear (for example: crossing arms in front of your chest is not a good look!)? The point is to communicate respect and interest.
Apply the 80/20 rule to the conversation. You listen 80% of the time and speak 20%.
Ask open questions to gain understanding. Compare these two sentences: “Did you react angrily when the boss said you were being laid off?” versus “How did you respond to the boss saying you were being laid off?” The second sentence gives the speaker much more scope to experience and reflect on his/her feelings.
Use “minimal encouragers” to draw out the speaker. This rule advocates using short phrases such as “Yes”, “I see what you mean”, “Umm”, or “Tell me more”. It shows interest and involvement and has the purpose of encouraging the speaker to keep talking. Mostly, it communicates that you as listener are on track.
Reflect back to the speaker occasionally. Few listening skills are as powerful a tool as well-used paraphrases and reflections of feeling and meaning. A paraphrase reflects back what the speaker said in a condensed, nonjudgmental version of the facts and thoughts. A feelings reflection is a deeper cut, helping the speaker clarify implicit or even conflicting feelings. Meanings reflections are an advanced tool for identifying and responding to the significance of an event or issue for the speaker. All of these reflections should be used judiciously: too soon or too often and you seem either unskilled or inauthentic, or both. Besides, you might wreck the speaker’s flow! But used well, they can really help move a discourse forward.
Reassure the speaker of confidentiality and be conscientious doing any promised follow-up. Don’t you get irritated with people who seem so understanding, but then don’t do what they said they would?
Remember what the person said. If it’s in one ear and out the other, how deeply were you listening?
Skilled communicators have written reams on the art of good listening. But I maintain, if you really want to be a hit at those Christmas parties – or anywhere else in life – it boils down to doing like my husband and aiming not so much for being interesting as being interested.
Written by Dr Meg Carbonatto B.S., M.A., and Ph.D.
This article was originally published in Asteron Life’s Balance Blog. AIPC regularly contributes to Balance’s wellbeing blog category.
E-therapy: A Look at the Benefits
Most of us would not have pursued a career in mental health helping (broadly including here counselling, psychotherapy, psychology, social work, and psychiatry) if we were not aware of and keen to extend to those in need the many benefits that the face-to-face therapeutic encounter brings. Accustomed to this format, we can easily dismiss online technologies as a viable way of delivering professional health services. But let’s look for a moment at what we would be dismissing. Note: the following list of benefits does not include those emanating strictly from interactions with clients vis-a-vis social media sites.
Loss and Grief: Why We All Grieve Differently
Grieving has as many forms as there are people grieving. It is guaranteed to be painful, hard work which sucks up a huge amount of emotional and physical energy. It is also highly individual. Like snowflakes, no two grieving paths are exactly the same, and the precise support needed varies accordingly. In this article, we look at some of the factors and circumstances which create very different experiences of grief, and also explore common characteristics of grief.
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What is Psychology?
Psychology is the scientific study of thoughts, feelings and behaviour (Weiten, 2004). Compared to biology, chemistry or physics, psychology is a young scientific field. In 1879, William Wundt established the first psychology research lab at the University of Leipzig. In 1881, the first psychology journal was established, also by Wundt. Other important early contributors to psychology include William James (“stream of consciousness”), John B. Watson (behaviourism) and Sigmund Freud (the “unconscious”) (Weiten, 2004). Traditional influences include philosophy and physiology; however, as a multidisciplinary field, psychology is now influenced by disparate areas including computer science, medicine, music, feminism and social science.
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