ARC

1. ARC Attachment, Self Regulation and Competency “Children, Trauma and an Introduction to the ARC Model”

2. Overview • Why ARC • Brain discussion • ARC pyramid explained • Other ARC Information • Discussion • Questions

3. Why ARC? How does the child’s behavior make sense? Given that how can we help? How do I keep going? How do we as a team stay strong?

4. When its not working • Little S*** Syndrome - At the store screaming “you’re the worst parent in the world, I hate you”, cutting up mom’s new dress, punching classmate Suzy for no apparent reason… etc • Ungrateful Little S*** Syndrome - We work really hard… • Little S*** and Big S*** Syndrome - Blaming each other

5. Brain … • How the brain works • The Alarm System • Complex vs. simple trauma • Developmental neglect • Effects of trauma on the brain • Snowball effect

6. Evolution of the BrainNeuroplasticity The reason to have some brain knowledge is: • To help direct therapy • To help the system or parts of the system hold still through the bad weather and the long journey through the seemingly trackless forest

7. The brain is an architectural organ • Bottom to top, inside to outside • Interconnected hierarchical regions • Architectural snowball

8. The brain is an historical organ • Neurons that fire together wire together – Donald Hebb 1949 • Taxi drivers in London - hippocampus

9. The brain is a relational organ - Failure to thrive - Developmental Neglect The brain is a plastic organ - Younger, more plastic, more vulnerable, more amenable to therapeutic re-organization - Older…

10. Neurosequential model of therapeutics • What were the adverse events? • How severe? • How old was the person? • Relational history – How stable and protective?

11. Brain/body:The Alarm System (Paraphrased from Buddha’s Brain – the practical neuroscience of happiness, wisdom and love by Rick Hanson) Triggering Event • Amygdala • Sounds the alarm • Thalamus (relay station in the middle of the brain) • sends wake up signal to brain stem

12. Brain Stem • Releases norepinephrine (adrenaline) throughout the brain • Sympathetic nervous system (SNS) • Sends signals to major organs and muscle groups getting them ready for fight, flight or freeze. Primary regulator of the endocrine system • Alerts pituitary gland

13. Pituitary Gland • Sends signal to adrenal gland • Adrenal Gland • Releases stress hormones epinephrine (adrenaline) and cortisol All this has taken one or 2 seconds after the initial alarm. The brain is on red alert, the SNS is lit up like a Christmas tree, stress hormones are washing through the body and it is ready for action.

14. Adrenaline and Norepinephrine • Heart rate up • Pupils dilate • Blood is directed to large muscle groups • Bronchioles of lungs dilate

15. Cortisol • Suppresses immune system • Revs up stress reaction • Causes brain stem to stimulate amygdale which then activates the SNS and the HPAA (Hypothalamic/pituitary/adrenal axis) which produces more Cortisol. • Suppresses hippocampol activity (which normally inhibits the amygdale). This takes the brakes off the amygdala which then produces more cortisol. • Shuts down the reproductive (sex drive) system • Digestion slows way down – salivation decreases, peristalsis slows down (dry mouth and constipation).

16. Emotions • Emotions intensify – mobilizing, organizing and focusing the whole brain for action SNS/HPAA • SNS/HPAA arousal stimulates the amygdala which is hard-wired to focus on negative information and react intensely and to it. (Sets us up for fear and anger)

17. Runaway Car • As limbic and endocrine system rev up the relative strength of the prefrontal cortex goes down. Now we have a car with a stuck accelerator and the driver has less control over it. Attribution • Appraising situations and attributions of other’s intentions are pushed to the negative. “Now the driver of the careening car thinks that everybody else is an idiot.”

18. ARC • Developed by… • Why does ARC work for treating complex trauma? • Main Ideas, 10 building blocks and the ARC pyramid • Fitting it into YOUR practice, staying true to the inner therapist

19. Attachment, Self- Regulation, and Competency framework ARC Developed by • Kristine M. Kinneburgh, LICSW • Margaret E. Blaustein, Ph.D. • The Trauma Center at JRI * 2 day ARC training with Margaret Blaustein on October 18th and 19th at Lake Morey Blaustein & Kinneburgh, 2010; Kinneburg & Blaustein, 2005

20. Trauma Experience Integration Dev’tal Tasks Dev’tal Tasks Executive Functions Self Dev’t & Identity Affect Expression Affect Identification Affect Modulation Routines and Rituals Caregiver Affect Mgmt. Attunement Consistent Response 10 Building Blocks

21. Treating Complex Trauma Requires an intervention that: • Addresses a continuum of exposures (layers of chronic and acute), which includes ongoing exposure • Is embedded in a social/contextual framework • Is sensitive to individual developmental competencies and deficits, and flexible in its approach • Addresses individual, familial, and systemic needs and strengths Blaustein & Kinneburgh, 2010; Kinneburg & Blaustein, 2005

22. ARC Framework: Key Components • 3 Core Domains key to healthy development • 10 Foundational Building Blocks • Flexible/ creative implementation • Child, family, and system specific goals • Active involvement of caregivers and larger system • Collaborative/ transparent intervention • Sleep, Nutrition and Exercise – Hierarchy of Needs Blaustein & Kinneburgh, 2010; Kinneburg & Blaustein, 2005

23. Questions ???