PDF NMT150 PSY Lecture Wk2 (1).pdf

WEEK 2 RECOGNIZE AND ASSESS PSYCHOSOCIAL PATTERNS: TRAUMA, ACES, AND HEALTH OUTCOMES TRAUMA AS DISCONNECTION FROM SELF Historically, trauma was considered as a one-time event that fell outside of the expectations of daily reality– things like a natural disaster or an act of extreme violence or w...

WEEK 2 RECOGNIZE AND ASSESS PSYCHOSOCIAL PATTERNS: TRAUMA, ACES, AND HEALTH OUTCOMES TRAUMA AS DISCONNECTION FROM SELF Historically, trauma was considered as a one-time event that fell outside of the expectations of daily reality– things like a natural disaster or an act of extreme violence or warfare. What we know today is that trauma is not an event; it is an experience. Trauma is an internal response that occurs when we experience strong, frequent, or prolonged adversity without adequate support. It overwhelms our ability to cope, and without support, our nervous system shifts into survival patterns. Changes result in mind, body, and behavior. We begin to disconnect from our gut feelings, our emotional/behavioural range becomes restricted, and physical symptoms/medical issues can arise. Chronic pain, sleep disturbances, GI issues, headaches, cardiovascular issues, diabetes, asthma, auto-immune conditions, and arthritis are some of the conditions most commonly associated with traumatic experience. The impact of developmental trauma is amplified due to its effects on a child’s developing brain and body LETS TALK ABOUT TRAUMA THE IMPACT OF TRAUMA AND TOXIC STRESS HOW CHILDHOOD TRAUMA AFFECTS HEALTH ACROSS A LIFETIME https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_ affects_health_across_a_lifetime?language=en TED talk by Dr, Nadine Burke Harris (16 min video) **for additional learning, clear explanations + recent research findings: https://acestoohigh.com/aces-101/ www.developingchild.Harvard.edu Source: Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health. Dec 2020. ACEs are strongly associated with nine of the 10 leading causes of death in the US: heart disease cancer accidents/unintentional injuries chronic lower respiratory disease stroke Alzheimer’s disease or dementia Diabetes kidney disease suicide Source: Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health. Dec 2020.  "Connectedness has the power to counterbalance adversity." Bruce Perry's Reflections: "Human beings are social creatures, and because of that, we are neurologically designed to be in relationships with other people. When you see another person and they send a signal that you belong, or they smile and give you a gentle touch, that literally changes the physiology of your brain and body in ways that lead to a more regulated stress response system, healthier heart, healthier lungs, and literally it will influence your physical and mental health." RELATIONSHIP MATTERS Let’s remind ourselves of how significant the relational experience we can provide to patients can be: On being a safe space: social engagement, active listening, and compassionate presence à What supports this process for you as an individual? What gets in the way of it? REFLECTION FOR BREAKOUT ROOMS: à How have the 3 realms of ACES (household, community, environment) influenced us as individuals? à What is important for us as NDs to consider re: toxic stress, ACES, and other forms of “invisible trauma” when we are with our patients? à How can we become aware of the stress our patients may experience within the 3 realms: household, community, and environment? à What are some ways that we can support patients who carry the imprints of adverse life experiences and toxic stress? TO LEARN MORE: Check out the book, What Happened to You by Oprah Winfrey and Bruce Perry…. “Healing must begin with a shift to asking “What happened to you?” rather than “What’s wrong with you?” Through this lens we can build a renewed sense of personal self-worth and ultimately recalibrate our responses to circumstances, situations, and relationships. It is, in other words, the key to reshaping our very lives.” And also check out this set of 8 short quotations and 1-2 min video clips (several ppt slides are drawn from here, they all add to our understanding on the subject) https://www.oprahdaily.com/entertainment/books/a36213501/oprah-bruce-perry-quotes-what-happened-to-you/ ATTACHMENT SECURE – INSECURE: ANXIOUS, AVOIDANT, DISORGANIZED  "Each of us creates a unique worldview shaped by our life’s experiences." Bruce Perry's Reflections: "The human brain is a meaning making machine. It gets information through our senses and as you develop, it starts to integrate and organize sights, and sounds, and smells so that you create a unified image and representation of the world you live in. And that process is very much front loaded. So early in life, the experiences that you have are most influential in shaping that world view. So if you have consistent, predictable, nurturing caregiving, your brain starts to feel that the world is safe—that people are kind and trustworthy. On the other hand, if you have inconsistent, unpredictable, chaotic interactions with the people who are caring for you, your brain starts to view the world as an unsafe place. In that situation, it starts to create a whole set of protective adaptations that will in the moment be appropriate for the infant. But as you get older will be maladaptive for the developing child and adult." SECURE VS INSECURE ATTACHMENT AND ADAPTATIONS OF SELF attachment as the foundation of subconscious perceptual systems attachment = meeting discomfort and distress with reliable, loving care so as to soothe the baby/young child and establish CNS patterns of trust, security, and comfort. It's not about just one behaviour (eg: responding in 1 second when a baby cries) but about providing consistent and kind response that regulates and entrains emotional health and a healthy stress system. A securely attached relationship completes the natural stress cycle, alleviates toxic cortisol, and is a predictor of lifelong health outcomes (biological, social, psychological). 2 PATHWAYS, SAME END-GOAL 1. healthy attachment = secure attachment = positive relational experience = good for your brain = adaptive coping = resilient to life challenges = better physical and mental health outcomes 2. healthy attachment = trust and security in self/other = healthy sense of self, emotional regulation, assertive behavior = resilience to life challenges = better physical and mental health outcomes Attachment is the perceptual foundation of our experience of our self and forms the basis for our life narrative. it helps us to understand default patterns re: behaviour, stress, physiology, and relationship. It is NOT just about parents and kids-- it applies to every relationship, including the dr-pt relationship. It is malleable with experience and intention, and either acts as a resiliency factor to be drawn upon or a risk factor to be aware of. Understanding attachment in another requires that we are aware of our own experience, and invites us into a process of pattern recognition.  THE MAIN PATTERNS OF RELATIONAL EXPERIENCE: Secure style: approx. 60% of people; safety within themselves and in relation; an internalized sense of security; people feel comfortable with intimacy and with independence; I’m ok, you’re ok 3 insecure styles: Anxious style: template is safety in the presence of another; people are often preoccupied with their relationships; they find safety in the immediate presence of another; they may pursue the other and tend to worry about the other person's ability to love them back; I'm not ok you’re ok: high dependence + low avoidance (poor internal model for self creates great need for relationship) Avoidant style: template is safety in disconnection from others; people learned that emotions are not safe; they tend to equate intimacy with a loss of independence and may subconsciously try to protect themselves from meaningful connection; I'm ok, you’re not ok: low dependence + high avoidance Disorganized style: there was no template for safety, resulting in chronic tension between connection and disconnection; I’m not ok, you’re not ok, but I want you anyway: high dependence + high avoidance THE COMMON DENOMINATOR The common denominator in insecure styles of attachment is an insecure sense of self, rooted in shame. SHAME à a belief that I am flawed; there is something inherently wrong with me that is not fixable; if others knew the real me they would reject me YOUR ATTACHMENT STYLE CAN INFLUENCE: Your adult relationships and behaviours in relationships Your beliefs about yourself The way you explain the events of your life Your physical health Your subconscious triggers How you perceive stress, adversity, and challenge How you react to and recover from adversity The strategies you use to cope with and adapt to adversity The role that people and relationships play in your efforts to cope with stress AND YES…. You may lean into different relational patterns in different ages/stages of life and- or different roles in life For example: you may have been raised with an anxious attachment to a primary caregiver but secure attachments to secondary caregivers. You may have had an anxious attachment with best friends in middle and high school and evolved into a secure romantic relationship as an adult For example: you may experience a tendency towards one relational style with regards to your professional relationships (for example, avoidant) and another style with regards to intimate relationships (for example, disorganized) However, most of us have a dominant style, wired in as our first perceptual system in early childhood, that we return to as a default. This was an essential adaptation to our lived experience. The good news is that we can consciously change these patterns if they no longer suit us. Relational Tensions vs Relational Security HOW THE NERVOUS SYSTEM ADAPTS EXPRESSIONS OF FIGHT-FLIGHT-FREEZE DYSREGULATION IS AN ADAPTATION ATTENDING This is an important skill for us to cultivate within ourselves, and one that we can bring to our patients. Tracking autonomic states Noticing and being able to describe the physical/sensory experience of different states- both large shifts and subtle changes AUTHENTICITY CAN HEAL TRAUMA https://www.youtube.com/watch?v=pFLS1MTreGU Gabor Mate, MD 18 min video, Nov 11/2022 “We tend to believe that normality equals health. Yet what is the norm in the Western world? Joining us live on stage in London – in conversation with filmmaker and author David Malone - the renowned physician, addiction expert and author Gabor Maté dissects the underlying causes of this malaise – physical and emotional, and connects the dots between our personal suffering and the pressures of modern-day living. Illness and trauma are defining how we live. 45% of Europeans suffer high blood pressure, and nearly 70% of Americans take at least one prescription drug. Over four decades of clinical experience, Dr Gabor Maté has found that the common definition of ‘normal’ is false: virtually all disease is actually a natural reflection of life in an abnormal culture, as we grow further and further apart from our true selves. Filled with stories of people in the grip of illness or in the triumphant wake of recovery, this life-affirming talk from the beloved physician and author will show how true health is possible – if we are willing to embrace authenticity above social expectations.” (if interested, please check out the full 1hr:22 min presentation Dr. Mate offered in London, Nov 2022 + an additional 5 part conversation series. The required video, above, is part 2 of the 5-part conversation series.) ADDITIONAL RESOURCES FOR LEARNING: https://www.youtube.com/watch?v=I3WzMpjtkrs “Trauma, Healing, and the Brain” Dr. Gabor Mate, MD (19 min video, Nov 2015) “Dr. Mate is internationally known for his work on the mind/body unity in health and illness, on attention deficit disorder and other childhood developmental issues, and his breakthrough analysis of addiction as a psychophysiological response to childhood trauma and emotional loss.”