Trauma, Brain and Relationship Helping Children Heal
From NEURONS TO NEIGHBORHOODS
Second Annual Conference
Interview with Don Dorsey, Ed.D.
DR. DORSEY, CAN YOU PROVIDE SOME EXAMPLES OF TRAUMA AND EXPLAIN THE NEUROLOGICAL EFFECTS?
One example of a change in brain structure is a part of what's called the limbic system, the emotional survival part, of the brain is literally smaller in people who have been traumatized. That's a critical part of the transformation of memory. The people who have been traumatized have less capacity to transform memory. What's called rapid eye movement sleep, during sleep, is also very critical in the transformation of memory. People who have had a post-traumatic stress disorder generally demonstrate about 50 percent of the rapid eye movement sleep as normal people. I'm working with somebody right now who has only 8 percent of rapid eye movement sleep. You get a lack of capacity to transform memory in a self-healing kind of way, because the brain has been impacted in a way that it's less capable.
Another kind of critical thing is if children, infants, are not soothed, repeatedly not soothed by their parents when they're in distress. That impacts the chemical systems in the brain, what's called the cortisol system. The cortisol system is a natural neural hormone for calming arousal down, calming distress down. If an infant's not soothed, then they increase their cortisol levels to try to make up for the lack of soothing by their parents. Then because high levels of cortisol are dangerous to brain tissue, it resets a thermostat. As a result through the rest of their life, until recently we thought it was permanent, the thermostat is set so that they have less cortisol and less capability of handling distress. So they're more prone to getting upset, and more prone to staying upset once they get upset. Some very significant parts of the brain, the part of the brain that holds time, could be depressed.
Bruce Perry talked about what happens if there's not attunement in infants that affects a part of the brain that's called the orbital frontal cortex that exerts a modulating effect on the emotional parts of the brain. It's also the part of the brain that's very responsive in interpersonal effectiveness. All of these changes add up to not making the person less capable, but making them more prone to being retraumatized later.
WHAT IS YOUR SPECIALTY, DR. DORSEY? AS A SPECIALIST HOW DO YOU HEAL ALL THIS?
Let me take one other thing and then come back to the healing, because the core of trauma is a part of the limbic system called the amygdale, which interprets incoming sensory data around issues of survival and nurturance. It makes six different decisions and it uses prior experience, the memory of prior experience, to make those decisions. So they have what are called episodic sensory memories that are held like a template to evaluate new incoming experience. That part of the brain gets the new experience before what we think of as our mind gets the experience. When there's a person's who has been traumatized those sensory templates, a snapshot of the experience, is converted into long-term memory. So it's held as the semi-permanent way of evaluating incoming experience.
For example, with the Northridge earthquake, people who were traumatized will have a record of vibration, of sound, of movement, different kind of things held in that part of the brain. At Cal State Northridge where I teach, after the earthquake somebody would push an audio/visual cart down the hall. I wouldn't even notice it, and you would have a quarter of the class diving under the desk just from the slight vibration. That part of the brain is trained to overreact if there's 10 or 20 percent of the same context that says, "Here it comes again." Our brain's about 50,000 years old, and it was designed to protect us from saber-toothed tigers. So that part of the brain responds before our thinking part of our brain even knows anything is happening. People who have been traumatized, they have automatic reactions that are initially preconscious and they're locked in. That tends to make them less effective.
About one-third of children are childhood trauma survivors and they're carrying that into adulthood. The people I work with are people who have been traumatized as children. Generally they can range from everything from intimacy problems, at a more normal range, to what's called dissociate disorder. About 40 percent of people don't even remember that they'd been traumatized, even when they were old enough to have memory, because it was the only way they could protect themselves. What they found is that there are several different ways of working with trauma. Trauma's held in the right side of the brain. Ordinary talking psychotherapy works with the left side of the brain. So, it's at best inefficient in working with trauma. Cognitive behavioral therapy is right brain. Certain kinds of children's therapies like play therapy are right brained.
The strategy that I use most is called EMDR, which is a strategy that uses bilateral stimulation, partly to keep the person grounded in the present, so that part of them is reliving a distressing experience and part of them is right here. It also generates a crossover from right to left hemisphere. So healing of trauma is movement of information, or memory, from right hemisphere to left hemisphere where then it's converted into a more normal kind of memory that holds an awareness of time, the world around us, and positive experiences and so forth.
Children who have had a lot of trauma, the emotional part of the brain, the survival part of the brain, doesn't even process positive experiences. It's only looking for the damage. They found EMDR is the approach that is the only one so far that's been able to demonstrate robust changes in the brain physiology. Before EMDR, when somebody was reliving the trauma, essentially only the right limbic system was activated on a spec scan, on a brain scan. The left hemisphere where our analytic functions, language, sense of time and all of that are functioning is turned off. It's turned off so that you can focus on the survival, and it doesn't get in the way. You know, when the saber-toothed tiger is coming at us, we don't want to say, "What's its speed, should I go to the left first, go to the right?" We want to react. So out of that 50,000-year-old brain, we have this mechanism that protects us nicely against saber-tooth tigers, but can create problems with social emotional kinds of experiences.
EMDR jumpstarts that self-healing process again, and reactivates the left hemisphere. There's very recent research that suggests EMDR increases the cortisol level. That needs to be replicated. There's just one study. But I'm working with somebody now who is diagnosed with dissociate disorder, what used to be called multiple personality disorder, whose cortisol level was off the scale. It was so low, and she just came into the normal range now of cortisol. Now she has more ability to calm herself down when she gets upset.
The main thing that EMDR does is change the episodic memory. For example, with the earthquake I was talking about, vibration takes on different meaning. Very common with EMDR is the visual image changes. It changes its context and it becomes much more vague. The person no longer sees them self in that picture. It's not like they forget the experience, but they're not holding this traumatic memory in the same kind of way.
The most direct effect of the EMDR is you're apparently facilitating this self-healing process that transforms that memory from the locked-in state that it was, that constantly led the person to be prone to being retriggered, to normal memory. The person can say as a child I had these terrible experiences, and they were very painful at the time, but now I'm an adult, so I have time, I have an awareness of my capability, and I'm not being constantly triggered.
They're using EMDR extensively with children now. It's done in a different format than with adults. There are at least four books written on EMDR with children, down to about 15 months of age. It looks like, if anything, it's probably more effective. There are only three research studies with children. But the children seem to be very responsive to it, particularly if the intervention is near the time of the trauma rather than years later.
HAVE YOU HAD ENORMOUS SUCCESS WITH EMDR AND ADULTS WHO WERE TRAUMATIZED AS CHILDREN?
Yeah. I've only had, as far as I know, one failure in the last maybe ten years where it was not effective. I use it about 80 percent of the time. There's a percentage of maybe 10 percent of people who don't seem to be responsive to EMDR. For some people it's not the best way to go. I use what's called Somatic Experiencing, too, with people. There are a few people I do more straight relationship therapy with them, because that's what fits where they are at that moment. But about 80 percent of the people I'm working with I use EMDR as the primary treatment approach. Generally what you're trying to do is locate their strategies for locating what the genesis of the current reaction was, what fed it. You go back, and most of the time, treat that first, then drop that out and then come up to the present and work with what are called the triggers in the present and desensitize those.
WHAT DOES EMDR STANDS FOR?
EMDR stands for eye movement desensitization and reprocessing. It's a misnomer. The person that originally developed it, Francine Shapiro, said if she could redo it and drop the name-it's kind of too late, it's been around close to 15 years now-she would call it accelerated reprocessing therapy. With the majority of people that I work with, I don't even use eye movements. You use some form of bilateral stimulation-tapping, sounds-something that triggers both hemispheres going across and also keeps the person grounded in the present. There's some indication that it replicates the rapid eye movement dream state, so that that may be what facilitates the transfer. There are a couple other physiological changes that happen in the brain that are a result of EMDR that I didn't mention, too.
THANK YOU, SIR. YOU'RE TERRIFIC.
(END OF INTERVIEW)
Stan Tatkin, Psy.D. - Psychotherapist
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