Adverse Childhood Experiences and Trauma Part 2

So let's think about or let's talk about how these behaviors make sense from the perspective of somebody who's experienced abuse, neglect, abandonment and insecure attachment basically is what it comes down to. Starting with the first one, avoidance and withdrawal. You know, we talked about that a little bit on the prior slide that people who hypervigilant to threats in the environment especially may have difficulty filtering out stimuli. So being around other people, being around in, in, in new situations can be extremely overwhelming and extremely exhausting for them. So it may be self preservatory to just withdraw, to stay at home, to be in an environment where they're not bombarded. So one of the things that we want, we may want to look at well with addressing these issues is helping the person desensitize or start being able to feel safer so they don't have to, so they don't feel like they have to be on guard all the time. Feeling detached from others makes sense. When you grow up in an environment where there's abuse, neglect and or the caregiver is emotionally unavailable, you may not have learned, or the person may not have learned how to attach to others so they may feel detached. They may also have developed that as a protective mechanism. Just detaching from those caregivers, detaching from anyone not caring about other people because it's too dangerous. People that you care about hurt you or disappoint you or abandon you. So it's easier to just not attach at all. Chronic empty feelings. Kind of goes back to that flatness when people are stressed for a long time. When that HPA axis is dysregulated. Not only is it harder to have enough, you know, dopamine and cortisol and glutamate to get angry or anxious, it's hard, hard to have enough of those excitatory neurochemicals to really care about anything. So there's a flatness. There's also a sense of emptiness that in, in a lot of people that they just don't know what they want to do. They don't know what's going to make them happy. Well, that makes sense because it's so hard for them to feel anything. Substance misuse. Well, substance misuse is an artificial way, it's an exogenous way to increase those excitatory neurotransmitters. You use alcohol, you use opioids, you use stimulants, you're going to increase the levels of dopamine and as well as other neurochemicals in the system which can contribute to feeling, you know, not necessarily just feelings of pleasure, but feeling. Going from that state of feeling empty and flat and numb and apathetic to feeling something. Emotional ability goes back to that dysregulation. The HPA axis has a real hard time controlling itself, regulating itself anymore. If you've ever been stuck in the mud, maybe this analogy will make more sense. And you know, you think you're getting a little bit of traction and you're just, you're stuck, you can't go forward, so you're flooring it and all of a sudden you peel out. That is what we're talking about with the flat and the furious. That is what we're talking about with emotional ability sometimes because people who've experienced childhood trauma or trauma often don't feel unsafe or don't feel safe. They often have a lot of undercurrents of stress. So they may be able to feel happy ish if they can. They may be able to put on this facade that things are going okay most of the time. But when something goes wrong, it is a big deal. It is a huge, you know, dump. All of a sudden they are peeling out of that mud puddle. There's a pervasive negative emotional state or apathy. Well, we talked about that. When you are, when you are hyper vigilant to negative stimuli in the environment, think about the mood you're going to be in. I mean, just makes sense. Persistent and elevated negative evaluations about yourself, others and the world. Remember when a lot of these happen, these adverse childhood experiences happened, the person was it that at an age where they tended to think concretely, where they tended to be self referential, personalizing a lot of what was going on. So they may have internalized I must have done something wrong, I must be bad. But also as they get older and they start having more advanced forms of thinking, think your Piaget development developmental stages. They start also recognizing that others are scary, are dangerous, or even malicious. There can be elevated self blame or blame of others as a result. Difficulty concentrating. You need norepinephrine and dopamine to concentrate. If your body has already decided, you know what, no, we can't, we're, we're not going to be, we're not going to pay attention to the dopamine and the norepinephrine that, that are trying to get through because we need to protect ourselves then that the normal amount of dopamine and norepinephrine that's going through a person's brain isn't going to Produce enough down downstream, if you will, to allow the person to concentrate and focus. So this is why you start seeing issues like adhd, which is a dysfunction mainly they're finding now in norepinephrine, but with a little bit of dopamine involvement, sometimes concentration. Dopamine and norepinephrine are your two big neurochemicals there. Impulsive or self destructive? Well, if you have a lot of emotional ability, impulsivity may be a reaction to protect yourself. You know, getting angry and throwing something, hitting something in for children, you know, they may bite or, you know, be unkind to other children on the playground. Self destructive behavior. Let's look at what is going on. What is the function of this behavior? Is it helping the person feel something? Is it helping the person, you know, get some of those neurochemicals going? Or is it serving to protect the person in some way? Efforts to avoid real or imagined abandonment. Okay, we already talked about that. A compulsive desire for attention. Well, that goes along with efforts to avoid abandonment. If the child feels fearful that they're going to be abandoned by their caregivers, then they may do whatever they need to do to try to ingratiate themselves, to try to get that caregiver's attention, to get that caregiver's love, to avoid abandonment. Because abandonment to a two year old means destruction. I mean, a two year old cannot pay the rent and make their own meals. Hypersensitivity to criticism. Well, it makes sense if you fear abandonment. If you've got a compulsive desire for attention, usually positive attention, and efforts to avoid real or imagined abandonment, then criticism is the antithesis. Criticism is the exact thing that you might be afraid is going to cause abandonment. So people become hypersensitive, manipulative behavior. Well, children can learn this. And a lot of times the manipulative behavior, it's not. They're not overtly thinking, how can I manipulate this person to make them do what I want? They learn that if, if I do X, then they do Y and it's a automatic sort of process. If I throw a temper tantrum in the store, then we get to go home. They've experienced the reward that they want from that. Ergo they're going to engage in that behavior again to try to get the same result. The child doesn't think, you know, how can I manipulate mom? The child may think, if I throw a tantrum we get to go home. Unstable and extreme interpersonal relationships. When you're in a relationship with somebody who is Fearful, frantically trying to avoid abandonment, compulsively needs attention and reassurance, is hypersensitive to criticism, and may engage in inadvertent manipulation. It's probably going to put a strain on relationships. And those relationships can be extreme because of the fear of abandonment. They may perceive them as more intimate than they really are, just hoping that this person is going to love them. Chronic pain. Well, we already talked about how stress can cause increases in pain. We've also talked about how stress and trauma can cause increases in inflammation, and inflammation causes pain. So there you go, sleep disturbances. If you don't feel safe, if your stress response system, if your HPA axis is constantly kind of on in the background, you're not probably going to get good quality sleep. If you're not getting proper nutrition, you're probably not going to make enough serotonin to make melatonin to get good quality sleep. So there's sleep disturbances when you don't feel safe. It's difficult to get sleep if you are. And a lot of people may not understand why they don't feel safe or why they have a hard time relaxing. And that's something we can help them explore. What does that mean? Inability or unwillingness to empathize. And, you know, a lot of times in diagnosis diagnostic areas, it talks about unwillingness to empathize. I, I like to look at it as potentially inability. You know, if somebody grows up in an environment in which they are just overwhelmed by the negativity and the powerful emotions of their caregivers and everyone around them, it may be they may never have learned how to empathize because it was too dangerous. If they opened them up, open themselves up and tried to empathize, it was just too overpowering. So it's like, nope, I just, I, I gotta set these really rigid emotional boundaries that can prevent them from being vulnerable in future relationships. And they may. We have to learn how to empathize. It's not something we're really born with and, and, or comes along, but we really nurture it in children. And it, it's helpful if, when children are egocentric, we help them learn to take other people's perspectives. So thinking about all of these, if you look at them, if you think back to your dsm, these are the criteria for a fair number of personality disorders as well as substance misuse and mood disorders. So I think it's important to recognize that a lot of our behavioral health issues that we see in the DSM as well as some physical issues like sleep disturbance and chronic pain and you'll learn later today obstructive sleep apnea can actually be caused by or exacerbated by trauma. Welcome to the All CEU's education channel where you will find long form counselor education training videos as well as shorter overview videos geared toward the general public. We have over 900 videos so using the search function that is underneath the subscribe button on our homepage can help you find the videos that you really want to watch. You can also find an alphabetized set of some of my most popular playlists@allce.com YouTube playlists I absolutely love hearing from you, so keep those comments coming. We actually do read all of them and try to respond within a few days. Have a fabulous day and don't forget to click subscribe and the bell if you haven't already so you can be notified when I release new videos Videos so what do we do? Interventions. We want to create safe, stable, nurturing relationships because those are a pillar for health. People need others. Trauma informed intergenerational practices are needed in clinical early care, like early childhood care, daycare, those sorts of things. Educational and community contexts. So think about how can we alter the current systems, the educational system, the daycare system, the community. I don't know what to call it. The community system where children are raised until they start going to daycare or or school. How can we alter these systems to help everyone recognize realize the widespread impact of trauma and the multiple paths of recovery? Some people need to get their physical stuff under control first and then work on their behavioral health. Others need to work on behavioral health and physical at the same time. You know, we want to look at that. Not everybody is going to display trauma in the same way. Some people may dis display trauma as an autoimmune disorder. That doesn't mean it's not they didn't experience trauma. But their path for recovery is going to look very different than someone whose primary presenting diagnosis is PTSD for that early childhood trauma or adhd. You know, we know that it can contribute to adhd. We want to think about how can we help people in the community. Teachers, clergy, daycare workers, parents, pediatricians, you know, counselors. How can we help people recognize the signs and symptoms of trauma in individuals and others involved in the system? And then once we recognize it, what do we do with it? I work with a lot of clergy here in Tennessee and you know, they do a lot of counseling. I mean that's a big part of their job. And they interact with people on the daily who have experienced trauma. And a lot of times they don't recognize how all of the person's physical as well as mental health issues and spiritual issues might all be connected once they start recognizing that these may be signs of trauma. A lot of times, a lot of clergy that I've worked with don't feel like they have the tools to be able to fully help somebody process, you know, PTSD or other trauma related issues. Some of them do, but some of them don't. And so how do we respond to those things? If Sally experienced trauma as a child and she's now having difficulty with parenting and her relationship with her spouse, and she's experiencing, you know, and she has fibromyalgia, you know, let's just. And she goes to her pastor and says, pastor Bob, you know, I'm really struggling right now and this is everything that's going on. Well, Pastor Bob may not see the connection between those two, but if he does, then what is the policy? Does Pastor Bob know who he can refer to? Does Pastor Bob know what the next step might be in order to help Sally process the what's causing all of this stuff? And four is resists retraumatization. And that really comes from two words, safety and empowerment. Which takes us to the six key principles. We want to make sure that people feel safe, respected in whatever environments they're in, whether it's school, daycare, church, community organizations, work wherever, jail. We want to make sure that people feel respected. When they don't feel safe, they are going to tend to be more emotionally reactive and they're going to tend to probably experience more dysregulation because that HPA axis goes into overdrive. In order to help people feel safe and empowered, we have trustworthiness and transparency. We need to make sure that we say what we mean and we mean what we say, and we're as transparent as possible about what we're doing and why. And that goes for medical professionals as well as, you know, everybody else, and, and medical professionals, unfortunately, is one of the areas that, that I see some of the least trauma, informed behavior, which is really unfortunate. Peer support. It's important that people feel connected to others who've experienced similar things when they're going through the recovery process. Now, not everybody is going to acknowledge or identify that what happened when they were five is impacting them today. And that's okay. That's part of the empowered. We can educate, but then we need to let the client lead. But if they are struggling with fibromyalgia, for example, peer Support can be very helpful because that can help them integrate what's going on. Collaboration and mutuality. Again, helping the person feel respected is important. We don't want to tell them what to do. We don't want to tell them what we are going to do with them. We want to ask them, you know, is it okay if I would it feel okay if I, what would you think if we, we really want to get their input and in anything involving them we want to get permission. We don't want to be doing things to them because a lot of times that is part and parcel of their prior trauma. Empowerment, voice and choice kind of goes along with collaboration and mut mutuality. These six key principles came from samsa. So you know, I'm, I'm trying to stick to them, to fidelity. But we do want to make sure that people feel empowered to collaborate with us and participate in their treatment planning, participate in creating an environment that feels safe and cultural, historical and gender issues. Paying attention to how different cultures view depression, trauma, parenting. You know, there are a lot of cultural differences that need to be taken into consideration. Likewise, we need to consider how much that person is, has embraced any particular culture. They may be from Panama. It doesn't necessarily mean that they have fully embraced that culture. They may be acculturated to a different culture. So we need to communicate and give voice to the client to help them figure out or communicate to us what would be the most helpful course of action for them. And, and to your question Sheila, I am not sure about the answer to that in terms of whether autism spectrum disorders are related to adverse childhood experiences, but I will certainly look that up on the next break. Mindfulness based mind body approaches have been shown to reduce trauma related presenting symptoms by over 30%. That's a lot. And the good thing is it doesn't require you going to any sort of two week training and certification and anything else. So that is a good thing. It's something that we can all implement pretty, pretty quickly. What we're looking at is mindfulness, purposeful moment by moment presentation and self awareness of breathing, body sensations, emotions and thoughts in a non judgmental manner incorporated into something like biofeedback. You know, let's practice watching your heart rate as you pay attention to your breathing and your body sensations. Notice how when you feel a certain way, what does your pulse do? And it can either be just feeling their pulse or it can be with an activity tracker or a heart rate monitor strap, whatever, but people will start seeing how different things actually impact them. One of the activities I have, some of my clients do is wear a chest strap that, from that, that monitors their heart rate. And they set the upper and lower bounds on their watch. So when their heart rate goes below or above that zone, they get alerted by, by the phone, by the watch. And the interesting thing is that a lot of times they don't realize how much heart rate variability they've got during the day. They don't realize how many stressors they actually experience until their wrist is buzzing constantly throughout the day. So it's an interesting activity for people who may not be as, as self aware of some of these things. And it really forces them into kind of not constant mindfulness, but brings them to a place where they need to be mindful. When that thing starts buzzing, they need to breathe and slow their breathing down to lower their heart rate to get it back into that whatever zone it was that we set them at. And I usually, I find their resting heart rate, whatever that is. And then the upper bound, I have them, you know, walk around my office just at a leisurely pace like they would walk around the office. And whatever that heart rate is, I tack five beats a minute on top of that just to give a little bit of wiggle room. And that's what I use for the upper and lower bounds. I obviously don't want it going off when they're just walking to get some coffee or something, but I want it going off if they are experiencing a trigger, if you will, of their HPA axis. I find that one can be very effective for a lot of people to start becoming more aware of the different things going on. Guided imagery can also be very helpful if people are noticing their breathing during guided imagery. Yoga or yoga, or even meditation, that can be super helpful. Greater self awareness is one of the benefits of mindfulness because people can start acting proactively instead of waiting. Like people who have anger management issues. Instead of waiting until they're enraged, when they start to become more mindful, they start to notice when their heart rate is starting to climb, when their blood pressure is starting to go up, when they're starting to grind their teeth, whatever their triggers or cues are. And they can intervene earlier and be more proactive instead of waiting until the, the culminating event and only acting reactively. Additionally, being more mindful can help people develop strategies to reduce HPA axis hyperactivation so they can start noticing, oh, you know, every time I have to go into my boss's office, my heart rate goes through the roof. Okay, well that's something that we can work on. So when you interact with your boss, you don't have that theoretically unnecessary hyperactivation of your HPA axis. More than 60% of people have experienced ACEs. It's believed that the rate of exposure to ACEs has increased significant significantly in the past five years. Now, just kind of think about what's been going on in the past five years. Now, there are other times, like during the Vietnam war, Korea, other times when there's been a lot of social unrest where there were a lot of aces going on. But, you know, there, there's been a lot. And there's been, well, we'll get to moral injury later. But a lot of, well, a lot of people who are children right now, their parents may have experienced trauma and moral injury that contributed to them developing mental health issues and having difficulty being responsive to their children. Not everyone who experienced ACEs will to develop traumatic injury. Injuries related to ACE trauma include the development of personality disordered behaviors like especially borderline histrionic, antisocial and dependent. If you look at the characteristics of those and couch it from the perspective of how would this make sense? How would these behaviors make sense to help someone survive? And a traumatic childhood, mood disorders, ptsd, addictions, autoimmune issues, including ibs, Crohn's disease, diabetes, heart disease, cancer, chronic lung disease, liver disease, increased in difficulty in interpersonal relationships because of the above issues and increased risk to become a perpetrator. I don't like that word. But of ACEs, people who develop ACEs and develop some of these issues may end up being the caregiver in that environment, that is has emotional ability and can be verbally abusive or has a mood disorder or an addiction. So you can see how there may be an intergenerational transmission of ACEs.