L20: Traumatic Experience

Question 1

What is attachment trauma?

Answer 1

• significant disruptions in relationships with caregivers who provide the comfort needed to manage and regulate stress

Question 2

T/F: The amydala matures bw ages 2-3

Answer 2

• False, amygdala at birth, hippocampus at 2-3

Question 3

Categories of trauma

Answer 3

• Impersonal trauma: disasters, accidents (typically not human initiated) - Personal trauma: human initiated - A.) attachment trauma (family, partner or significant person) - B.) interpersonal (acquaintance or stranger) - C.) self-directed (self-harm and suicide) - D.) systemic (social, cultural, political, economic, religious/spiritual etc.)

Question 3

Role of physician when providing trauma informed care

Answer 3

• Ask “What’s happened to you?” vs “What’s wrong with you?” - Compassion - Create safe environment - Respect them and their journey - Empathic engagement - Concern for their ongoing safety - Appropriate referral - Ongoing advocacy

Question 4

Effects of development trauma/childhood trauma.

Answer 4

Leads to chronic and severe problems with: - emotional regulation - impulse control - altered attention and cognition - dissociation - somatic dysregulation

Question 4

What is the effect of chronic/severe stress and trauma on the hippocampus?

Answer 4

• Changes size, shape and number of neurons - Kills cells, suppresses neurogenesis - Cognitive decline, decreased ability to form declarative/explicit memory

Question 5

Characteristics of and definition of trauma

Answer 5

• Personal and subjective assessment by victims of how threatened and helpless they feel - loss of faith in order and continuity of life - meaninglessness and loss of control of one’s destiny - Trauma is when one loses sense of having a safe place to retreat within or outside oneself to deal with frightening emotions and experiences

Question 5

Which brain regions are responsible for recording, filing and remembering traumatic events?

Answer 5

• Hippocampus and amygdala

Question 6

Function of amygdala. When does it mature?

Answer 6

• matures at birth - formation of emotional memories - center of negative emotions that inform the brain of drea and fear - active while recalling a traumatic event - facilitates remembering by re-creating the emotional state of original experience - responsible for “take-over” of consciousness by emotion

Question 7

Characteristics of the worst traumas

Answer 7

• Repetitive(chronic) - Human initiated - Normal fight/flight response is not possible - Lack of emotional support

Question 7

Limbic system function

Answer 7

• Role in functions needed for self-preservation and procreation - Regulates survival behaviors: eating, sexual reproduction, instinctive defenses of fight, flight, freezing - Role in parental care and play - Regulates emotional expression - Influences memory processing

Question 8

Function of hippocampus. When does it mature?

Answer 8

• matures between ages 2-3 - contextualizes and event by giving it space and time - some emotional arousal increases hippocampal activity which facilitates memory formation

Question 8

Which structures are impaired during periods of traumatic stress?

Answer 8

• prefrontal cortex and hippocampus

Question 10

Effects of traumatic stress on brain:

Answer 10

• Traumatic stress activates: amygdala functioning causing fear level to be amplified. Implicit memory formation is strengthened - Traumatic stress impairs: prefrontal cortex’s ability to regulate fear by means of thinking and reasoning resulting in bad behavior, hippocampal storage and processing is hindered with reduced ability to contextualize experience and form explicit memories - Increases right hemisphere activity causing increased emotionality and sensitivity - Decreases left hemisphere activity causing difficulty using language and reasoning to control emotions

Question 11

Implications of psychophysiological effects of trauma on medical practice.

Answer 11

• Help pt stay in control - Thoroughly explain procedures - Inform before touching - Respect the pts signal to stop - Pt may need to re-ground

Question 13

Symptoms seen in adults abused as children

Answer 13

• Recurrent depression - Anxiety, panic, phobias - Somatic pain syndromes - Sustance abuse - Eating disorders - Relationship/intimacy difficulties - Sexual dysfunction, addiction, avoidance - Sleep disturbances

Question 15

Which structures are activated during periods of stress

Answer 15

• Amygdala and thalamus

Question 17

Adverse childhood experiences study

Answer 17

• ACE - Disrupted neurodevelopment - Social, emotional and cognitive impairment - Adoption of health-risk behaviors - Diseases, disability and social problems - Early death

Question 17

Which brain regions are responsible for regulating emotional expression?

Answer 17

• Limbic system

Question 18

At what memory level does amygdala function?

Answer 18

• implicit level

Question 19

What is precognitive emotion?

Answer 19

• Thalamus transmitting signals directly to amygdala, bypassing neocortex and hippocampus and leading to triggering of emotion before we have made cognitive how we are feeling - Emotional reaction and memories can be activated without involvement of cognitive conscious processes

Question 20

T/F: chronic trauma decreases ability to form declarative memory

Answer 20

• True

Question 21

Much of what we learn and much of the “most important” things we learn is at what level?

Answer 21

• implicit

Question 22

T/F: thalamus is necessary for weighing options for actions

Answer 22

• False

Question 23

Clinical presentation of pts suffering from traumatic experiences

Answer 23

• “done to” pts - fearful - distrustful - hypersensitive - “I’m not ok, I’m bad” - Marks of self-injury - Suicidal ideation and attempts

Question 24

Name important variables that affect impact of traumatic experiences on people

Answer 24

• Genetic vulnerability - Developmental level at time of trauma - Nature and severity of event - Frequency and duration of traumatic states - Strength and adaptiveness of defenses - Strength and clarity of one’s sense of self prior to the trauma - Extent of previous trauma history - Extent to which external protection, nurturing, soothing and social support are available - Representational meaning of trauma - Cultural implications of trauma

Question 25

Common responses to unbearable emotional states?

Answer 25

• Withdrawal - Move against self - Move against others

Question 27

What is a leading cause of physical and psychologic injuries? What type of trauma is this?

Answer 27

• Violence - Attachment trauma

Question 28

What is the function of the hippocampus and amygdala in traumatic events?

Answer 28

• Involved in recording, filing and remembering traumatic events

Question 30

Type of defenses when threat is perceived

Answer 30

• Attach / flock - Flight / fight - Freeze / submit

Question 31

Identify different types of memory

Answer 31

• Explicit (declarative): conscious, autobiographical information and facts, you are in this memory, mediated by words and cognitions, has time and space dimension, involves hippocampus, thalamus and frontal cortext - Implicit (procedural): unconscious, encoded on a non-verbal sensory level, you are not there, there are no space time dimension, level where traumatic events and early attachments are typically stores, relatively resistant to disease, unconscious skills, localized in occipital cortex, striatum and cerebellum

Question 32

T/F: chronic trauma decreases ability to form procedural memory

Answer 32

• False

Question 33

Function of neocortex

Answer 33

• oriented to outside world - problem solving, learning, discrimination of complex stimuli - helps decide what stimuli are important, which are not - necessary for weighing options for action - necessary for predicting outcomes of behavior

Question 34

Characteristics/tenets of trauma informed care

Answer 34

• Realizes widespread impact of trauma - Recognizes the signs and symptoms of trauma - Responds by integrating knowledge of trauma

Question 35

In terms of areas of brain, what do early traumatic experiences result in?

Answer 35

• Over-activity of amygdala (ctr for negative emotions) - Decreased activity of prefrontal cortex (ctr for positive feelings)