The Psychology and Physiology of Trauma.docx

The Psychology and Physiology of Trauma.docx

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ThePsychologyandPhysiologyofTrauma

ThePsychologyandPhysiologyofTrauma

TheAlarmReaction

Thehumanbodyandhumanmindeachhaveasetofveryimportantandverypredictableresponsestothreat.Threatmaycomefromaninternalsource,suchaspain,oranexternalsource,suchasanassailant.Onecommonreactiontodangerorthreathasbeenlabeledthe"fightorflight"reaction.Intheinitialstagesofthisreaction,thereisaresponsecalledthealarmreaction.

Thinkaboutwhathappenswhenyoufeelthreatened.Yourracingheart,sweatypalms,nausea,andsenseofimpendingharmareallsymptomaticofthisalarmreaction.

Whenapersonperceivesathreat,theinitialstagesofacomplex,total-bodyresponsewillbegin.Thebrainorchestrates,directs,andcontrolsthisresponse.Themorethreatenedanindividualfeels,thefurthertheirbrainandbodywillbeshiftedalonganarousalcontinuuminanattempttoensureappropriatementalandphysicalresponsestothechallengesofthethreat.Thecognitive（thinking）,emotional,andbehavioralfunctioningoftheindividualwillallreflectthisshiftalongthearousalcontinuum.

Duringthetraumaticevent,allaspectsoftheindividual'sfunctioningchange,includingfeeling,thinking,andbehaving.Forinstance,someoneunderdirectassaultabandonsthoughtsofthefutureorabstractplansforsurvival.Atthatexactmoment,allofthevictim'sthinking,behaving,andfeelingisbeingdirectedbymoreprimitivepartsofthebrain.

Afrightenedchildinathreateningsituationdoesn'tfocusonthewordsbeingspokenoryelled;instead,heorsheisbusyattendingtothethreat-relatedsignalsintheirenvironment.Thefearfulchildwillkeyintononverbalsignsofcommunication,cuessuchaseyecontact,facialexpression,andbodyposture,orproximitytothethreat.

Theinternalstateofthechildalsoshiftswiththelevelofperceivedthreat.Withincreasedthreat,achildmovesalongthearousalcontinuumfromvigilancethroughtoterror.（Seetheabovegraphfordifferentpossibleresponsescenarios.）

TheArousalContinuum

Thearousalcontinuumischaracterizedbymanyphysiologicalchanges.Underthreat,sympatheticnervoussystemactivityincreasesinagradualfashion.Heartrate,bloodpressure,andrespirationarealteredduringthearousalresponse.Glucosestoredinmuscleisreleasedtopreparethelargeskeletalmusclesofyourarmsandlegsforeitherafightoraflight.

Thesechangesinthecentralnervoussystemcausehypervigilance;underthreat,thechildtunesoutallnon-criticalinformation.Theseactionspreparethechildtodobattlewithorrunawayfromthepotentialthreat.

Thistotalbodymobilization--thefight-or-flightresponse--hasbeenwellcharacterizedanddescribedingreatdetailforadults.Theseresponsesarehighlyadaptiveandinvolvemanycoordinatedandintegratedneurophysiologicalresponsesacrossmultiplebrainareas,includingthebrainstemnucleiresponsibleforautonomicnervoussystemregulation.

WhatDoesHyperarousalReallyMean?

Hyperarousalisamulti-dimensionalprocesscharacterizedbybothmentalandphysicalchanges.Theseincludeanincreaseintheactivityofthosepartsofthecentralandperipheralnervoussystemresponsiblefortheperceptionandprocessingofpotentiallythreateninginformation.Thisgradedresponsealsoinvolvesaction.

Duringthehyperarousalprocess,manyphysiologicalsystemsrequiredforsurvivalareactivated（e.g.,stressresponsehormonessuchascortisolandadrenaline）.Themanyphysiologicalchangesduringhyperarousalwillinfluencethewayapersonthinks,feels,andacts.

Thefight-or-flightresponseisawell-characterizedreactiontodanger,aswe'vealreadydiscussed.Asecondcommonreactionpatterntothreatisdissociation.Dissociationisthementalmechanismbywhichonewithdrawsattentionfromtheoutsideworldandfocusesontheinnerworld.

Itisincreasinglyclearthatresponsestothreatcanvarytremendouslyfromindividualtoindividual.Thissecondmajoradaptationresponsetothreatinvolvesanentirelydifferentsetofphysiologicalandmentalchanges,yetdoesnotfallundertheheadingofeitherfightorflight.

Manycommonand"normal"mentalandemotionalstatessuchasanxiety,dissociation,orangerareexperiencedbymostofustosomedegree.Whenanyoneofthesebecomespervasiveandever-present,however,itbeginstointerferewiththerestofone'slife.Thiscanhappenwithdissociationandanxiety.Whenitdoeswecharacterizethisasadisorder.

Becauseoftheirsmallsizeandlimitedphysicalcapabilities,youngchildrendonotusuallyhavethefight-or-flightoptioninathreateningsituation.Whenfightingorphysicallyfleeingisnotpossible,thechildmayuseavoidantandpsychologicalfleeingmechanismsthatarecategorizedasdissociative.

Dissociationduetothreatand/ortraumamayinvolveadistortedsenseoftimeoradetachedfeelingthatyouareobservingsomethinghappentoyouasifitisunreal--thesensethatyoumaybewatchingamovieofyourlife.Inextremecases,childrenmaywithdrawintoanelaboratefantasyworldwheretheymayassumespecialpowersorstrengths.

Likethealarmresponse,this"defeat"ordissociativeresponseisgradedalongacontinuum.Theintensityofthedissociationvarieswiththeintensityanddurationofthetraumaticevent.（Rememberthatevenwhenwearenotthreatened,weusedissociativementalmechanisms,suchasdaydreaming,allofthetime.）Duringatraumaticevent,allchildrenandmostadultsusesomedegreeofdissociation.However,someindividualswilluse,orexperiencetraumathatinducesdissociationasaprimaryadaptiveresponse.

Formostchildrenandadultstheadaptiveresponsetoanacutetraumainvolvesamixtureofhyperarousalanddissociation.Duringtheactualtrauma,thechildfeelsthreatenedandthearousalsystemswillactivate.Withincreasedthreat,thechildmovesalongthearousalcontinuum.Atsomepointalongthiscontinuum,thedissociativeresponseisactivatedandahostofprotectivemental（decreasedperceptionofanxietyandpain）andphysiologicalresponses（decreasedheartrate）occur（seeFigure3-4below）.

Thefollowingpointsareanoverviewofhumanresponsetothreatandtrauma.Don'tworryifyoudon'tgraspalltheconceptsatfirstreading.Wewillbediscussingtheseissuesingreaterdetailaswemovethroughourcourse.Considerthisapreviewofsorts.

∙Thebrainmediatesthreatwithasetofpredictableneurobiological,neuroendocrine,andneuropsychologicalresponses.

∙Theseresponsesmayincludedifferentsurvivalstrategies--rangingfromfightingorfleeingtogivinguporsurrendering.

∙Therearemultiplesetsofneurobiologicalandmentalresponsestostress.Thesevarywiththenature,intensity,andfrequencyoftheevent.Differentchildrenmayhaveuniqueandindividualizedsetsofresponsestothesametrauma.

∙Twoprimaryadaptiveresponsepatternsinthefaceofextremethreatarethehyperarousalcontinuum（defense--fightorflight）andthedissociationcontinuum（freezeandsurrenderresponse）.Eachoftheseresponsesetsactivatesauniquecombinationofneuralsystems.

∙Theseresponsepatternsaresomewhatdifferentininfants,children,andadults--thoughtheysharemanysimilarities.Adultmalesaremorelikelytousehyperarousal（fightorflight）response,whileyoungchildrenaremorelikelytouseadissociativepattern（freezeandsurrender）response.

∙Ingeneral,thepredominantadaptivestyleofanindividualintheacutetraumaticsituationwilldeterminewhichpost-traumaticsymptomswilldevelop:

hyperarousalordissociative.

Exercise:

CatalogYourAlarmResponsePatterns

Thinkbacktothelasttimeyoufeltthreatenedinsomewayandyouralarmstatewasactivated.Perhapsyouwerewalkingdownadarkstreetonenightandheardfootstepsclosebehindyou.Perhapsyouwereattendingafootballgameoneafternoonwhensomebeer-swillingfansnexttoyoubeganafightwithafanoftheopposingteamseatedintherowbehindyou.

Picktwoorthreeeventsfromyourlifewhereyoufeltsomeelementofthreat.Foreach,maketwocolumns.Inthefirstcolumn,listtheemotionalandmentalchangesyouremember--forexample,asenseofunreality,intensefear,ortuningouttheworld.Intheother,listthephysicalsymptomssuchasracingheart,sweatypalms,orlight-headedness.Whatphysicalsymptomsdoyourecallemergingasyourbrainsentthesignaltoyourbodythatathreatwasnear?

Didyouwanttorun?

Didyoufeelanadrenalinsurgeinpreparationforpossibleself-defense?

Visualizeyourbodyandmakeamentallist,fromheadtotoe,ofeveryphysiologicalresponsetotheperceivedthreatthatoccurred.Thiscanillustratetwokeypoints:

1）youprobablyhadaslightlydifferentsetofadaptivechangesineacheventand2）themental（i.e.,psychological）andbody（i.e.,physiological）changesareinterrelated,interdependent,and,infact,componentsofthesameneurophysiologicalresponsetothreat.Itisnotusefuloraccuratetothinkof"psychological"vs."physical"responses.

ThePsychologyandPhysiologyofTrauma

Differentchildrenhavedifferentstylesofadaptationtothreat.Somechildrenuseaprimaryhyperarousalresponse,whileothersadaptaprimarydissociativeresponse.Mostchildren,however,adoptsomecombinationofthesetwoadaptivestyles.

Inthefearfulchild,adefiantstanceisoftenseen.Thisistypicallyinterpretedasawillfulandcontrollingchild.Ratherthanunderstandingthebehaviorasrelatedtofear,adultsoftenrespondtothe"oppositional"behaviorbybecomingangrierandevenmoredemanding.

Thechild,over-readingthenonverbalcuesofthefrust