Treating Childhood Trauma: Mind vs. Body Approaches

1. By Matthew Carter, MFT Treating Childhood Trauma: Mind vs. Body Approaches

2. Grounding

3. What is a “mind” approach? • Center around changing thoughts and perceptions • More concerned with cause and effect (why), logic (evidence), and cognitions (positive/negative) • Values self-regulation as a conduit to learning (psychoeducation and insight). • “Left brain” and “higher brain” approaches

4. Examples • Psychoeducation • CBT • Narrative • Psychoanalytic/psychodynamic (interpretation) • Solution Focused • Strategic Family Therapy

5. What is a “body” approach? • More concerned with moment-to-moment emotions and sensations • Centers on emotional/sensory activation and expression (“processing”) and building regulation • More relational/attachment based • “Right brain” and “lower brain” approaches

6. Examples • Play and Art Therapy • Music and Movement • Psychoanalytic/psychodynamic (catharsis) • Gestalt (role plays) • Somatic therapies • Structural Family Therapy (enactments)

8. So which one(s) is better?

9. Depends on who and what you are treating. • The traumatized brain has a distinctly different physiology from a non-traumatized brain. (Levine, Trauma Through a Child’s Eyes) • Research suggests that a traumatized child’s brain works less efficiently. (Stein, Psychological Trauma and the Developing Brain)

10. How Trauma is Stored in the Brain • Experience is processed and stored explicitly (consciously and “top-down”) or implicitly (outside of conscious awareness, “bottom-up”). • Emotions and emotional memories are largely stored in the right brain. Semantic memory is largely stored in the left brain.

11. The consolidation of explicit memory is largely mediated by the hippocampus. • Extreme stressors will cause over-activation of the amygdala, inhibiting the function of the hippocampus. • …when hippocampal functioning is stunted, memories are largely stored (implicitly) in the R and lower brain areas, (Cozolino, The Neuroscience of Psychotherapy).

12. These implicit memories (images and sensations) are stored without a sense of time or completion, thus the brain/body remains hyperaroused and hypervigilant for any stimulus (“trigger”) that might even vaguely resemble the original threat.

13. What results is a chronically overactive stress response system, which can interfere with the child’s capacity to regulate their arousal levels and predispose them to overreactions and impulsive behavior. (Perry, ChildTraumaAcademy.org)

14. From Bruce Perry, MD

18. Because these trauma-related symptoms originate in the lower parts of the brain (Perry, ChildTraumaAcademy.org), the treatment of these symptoms must entail activating and re-organizing these areas.

19. Coping vs Building Capacity • Reducing suffering vs building capacity to tolerate suffering (consciously vs unconsciously) • When to pendulatevs when to deepen • “Mind” approaches generally utilize self-regulation to move through the trauma narrative. • Body oriented interventions build the body’s capacity to manage distress.

20. Mind vs. Body Interventions

21. Watching for Markers of Physiological Activation • Wetness in the eyes • Shaking foot/leg • Swallowing • Gasps • Eyebrows • Holding the breath • Posture

22. What did you just experience? • What happens when you just focus on that? • What are you noticing now?

23. Raising Activation • Raising stress (e.g. frustration) • Changing posture/movement • Focusing on the images and sensations of a traumatic memory • Making statements vs asking questions

24. Changing Patterns • Changing posture • Changing fixations • Asking the client to engage in movement (e.g. neck, arms) • Stretches- abdominals, chest, etc.

25. Example • C: “My foster mom is mean” • T: “Who does she remind you of?” • C: “My mom, she always used to blame for everything.” • T: “That’s tough. How does that make you feel when you get blamed?” • C: “Bad.” • T: “Like a bad kid?” • C: “Yea”

26. T: “Do you think you’re a bad kid?” • C: “Sometimes.” • T: “What are the things you do that are bad.” • (client lists a number of benign misbehaviors) • T: “Let’s look at the things you do well.” • (therapist lists a number of things client does well) • T: “Sometimes good kids do bad things, that doesn’t mean they are bad.”

27. VS • C: “My foster mom is mean” • T: “That’s messed up. Let me see if I can help her be less mean. Help me understand how she’s mean. Play her for a little bit so I can better understand.” • (client role plays foster mother telling him he’s doing something wrong) • T: “Oh. OK, let me play her a little bit and you tell me if I got it right. • (therapist role-plays hypercritical caregiver) • T: “I noticed your eyes get big when I did that. Being mean is kinda scary huh?” • C: “Kinda”

28. T: “Let’s play a little game, a game that will help me help foster mom be less mean and you be less scared of her.” • C: “OK” • T: “I’m gonna play her again and you tell me what is going on inside, like if your hands get tight, or your face gets hot, or your stomach gets sick.” • C: “OK” • (therapist again role-plays hypercritical caregiver) • T: “What do you feel”

29. C: “Mad” • T: “Where in your body?” • (client clinches hands) • T: “Good. Lets do that again, this time instead of doing that (clinching), try this (pushing motion).” • (Therapist again plays hypercritical) • T: “OK, did the anger get bigger or smaller.” • C: “Smaller.” • T: “Good, so it’s like back-off. But what if she keeps going?” • C: “I’d leave.”

30. T: “So your feet want to run?” • C: “Yea.” • T: “Do you sometimes want to run out of therapy?” • C: “Yea.” • T: “OK, one last time, this time plant your feet on the ground, imagine you are Iron Man and don’t need to run away from mean people.” • C: “OK” • (more role-playing)

31. T: “Wow you are strong, what was different that time?” • C: “I felt strong.” • T: “Good. This week, whenever someone is being mean to you, I want you to keep your hands relaxed, but imagine yourself as Iron Man, with legs strong on the ground. If you can do that just once this week, I’ll give you a prize next time I see you.” • C: “What kinda prize?....”