::On screen - CE Slides with the following information:
LOGO in upper left corner: Anne & Henry Zarrow School of Social Work. Continuing Education - The University of Oklahoma

Virtual CE The Effects of Trauma on the Brain, Tuesday January 23rd, 2024

Slide 3: For Those Seeking CE Credits: instructions to verify attendance
Slide 4: We Want to know your thoughts - online evaluation https://bit.ly/48GS5P1::

[Caitlynn Land]
Hello everyone, I want to welcome everyone today to our Lunch and Learn. This Lunch and Learn is brought to you by collaboration

::Attendees visible::

between Oklahoma Human Services, University of Oklahoma Anne and Henry Zarrow School of Social Work, and the Oklahoma Adoption Competency Network. We appreciate everyone joining us during your lunch and noon hour, and we wanna get started so we can make sure to respect everyone's time and get the great information being discussed today. First, um, let us go over a few housekeeping things for our time together this afternoon. We are recording this information. Uh, we are recording this meeting. Um, by participating, you are giving your consent to be recorded. Help us reduce distractions so that we can all focus, participate. We have muted everyone to make it possible for everyone to hear the speakers. We want you to express your thoughts and questions. Please utilize the chat for this purpose. We will monitor the chat and questions will be touched upon during our Q&A time during the last 15 minutes of the webinar. We wanna see you. So if you're willing and you can, please go ahead and turn on your video. If you are unable, that is fine also. To receive information about other post-adoption events, please list your name and email in the chat and we'll make sure to add you to our contact list. Remember confidentiality. It is vital that we protect confidential information, so we will not share specifics, names, details, et cetera about adoption cases, people, or children. CEUs are now available professionals for this training. So foster parents attending um, this training will also receive one hour of training credit for the 12 hours of in-service training that you need each year. Please indicate in the chat if you would like to claim the CEU by posting your name and email. We will send you a certificate of attendance and participation. Now I'm gonna hand everything off to our speaker today, which is Ms. Katie.

[Katie Stewart]
Good afternoon everyone. Gimme a second while I get my presentation going. Oh, on. I just realized that I did not Um, so my name is Katie Stewart and I work for the Department of Human Services, uh, in the post-adoption department.

::Slide - Trauma & The Brain::

So I am a, um, I'm an LMSW and I am under supervision for my clinical license. Um, and I am working with DHS in our new direct services program. So I'm providing clinical services to post-adopt families in their homes. Um, and so today we are gonna talk about trauma, um and its effect on the brain and the body.

::Slide - Quote::

So we're gonna focus particularly today on the effect that trauma has on our nervous system and how it functions. The bulk of the research for today's training is from the work of Dr. Bessel van der Kolk. Um, I'm going to open with a quote from his book called "The Body Keeps the Score," and it states, "We've learned that trauma is not just an event that took place in sometime in the past. It's also an imprint left by that experience on mind, brain, and body. This imprint has ongoing consequences for how the human organism manages to survive in the present. Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think." So I want us to keep this quote in mind as we go through the presentation today. Um, and as the quote says, experiencing trauma physically changes the brain structure as well as the way that our brain and body communicate through our nervous system. This leads to a variety of unintentional and uncontrollable physiological responses that show up in difficult and often confusing behaviors in our kiddos.

::Slide - Trauma & Brian Development::

So, to understand how trauma affects our brain and body, we first need to look at how they develop and communicate normally. So the brain develops from the bottom up. The first part that, uh, develops is our brainstem, which is, if you think of the brain as a closed fist, you might have seen this concept before. Um, it's that part at the very bottom. Um, and it controls our basic functions, breathing, heart rate, blood pressure, et cetera. All those functions that your body normally does automatically. And this part is fully firm-- formed at birth. The second area of the brain to develop is our limbic system. And this is sometimes called the emotional brain. Um, it includes a lot of different areas, including the amygdala, hippocampus, and hypothalamus. And these areas are really important in processing and responding to emotions, memory, storage and retrieval and attachment. And then the last part of our brain that develops is called the cortical brain, which includes our prefrontal cortex. This is the part of the brain that's right behind our forehead. This area of the brain controls all our higher level thinking skills like impulse control, critical thinking, being able to relate actions and consequences, thinking through hypotheticals, et cetera. This process of brain development is sequential and it is also dependent on our environment.
So what we see in trauma is that parts of the brain, [background noise] especially those higher level, 

[crosstalk] 
someone like him in a situation like --

[Katie] 
are underdeveloped compared to similar-aged peers who have not experienced trauma. So as our brain is developing, it's building pathways through what we call synaptic connections. And these connections determine how the brain --

[crosstalk]
through my middle school--

[Katie]
As well as how our brain and body communicate with one another. These connections grow stronger the more that they're used. And on the flip side, they can weaken and die off if they're not used. Early childhood is a particularly important in this regard because between the ages of zero and three, our brains are making 1 million synaptic connections per minute. So this is a huge capacity for growth, but also a huge capacity for those repeatedly used pathways to become automatic and integral to our brain structure itself.

::Slide - Limbic System::

So now we're gonna take a look at how our brain communicates with our nervous system through our limbic sys-- through our limbic system. Um, the pieces we're gonna talk about here are the thalamus, the amygdala, and the prefrontal cortex. So the thalamus is like our data analyst. It's taking in information from the environment constantly, analyzing it and sending it off in two directions to the amygdala and to the prefrontal cortex. So the amygdala is the emergency alarm in this system. Um, this pathway from the thalamus to the amygdala is often referred to as the low road. And it only takes about eight to 10 milliseconds for a message to get through this pathway. And the amygdala responds to the information whether there is a real threat or a perceived threat, it's going to respond.

[crosstalk]
Turn this up superstar.

[Katie]
Um, it does this by mobilizing our nervousness and sending our body into fight or flight mode. Now, the prefrontal cortex is like mission control for your brain. Again, it's where all those higher level critical thinking skills live, but the time for the message to get from the thalamus to the prefrontal cortex is several milliseconds slower than the low road pathway. So mission control is gonna take the information from the thalamus and it's gonna analyze it and decide if it's a real threat or not, and respond accordingly. 
So lemme give you a quick, uh, real world example of how this works. So, um, I'm a person who is afraid of snakes. Um, I have a local walking trail where I live, and um, I walk there a lot, very familiar with the pathway, but it's in a wooded area. Um, and so let's say I, walking there one day, and a snake comes across my path. My body is going to, or my brain is going to see the snake, take in that information and it's gonna send that straight to my amygdala and my nervous system's going to react. So my heart rate's gonna increase. I might start sweating, my muscles are gonna tense. I'm gonna get a shot of adrenaline 'cause I'm ready to run, get out of there. And then the snake is gonna go off the path, and my mission control is gonna shut down that, um, alarm system because I'm now safe. So now let's say I'm walking, um, in that same area a few weeks later and I see a stick in the grass, what's gonna happen? I'm gonna have that same initial reaction. My thalamus is gonna take in that stick and send a danger signal to my amygdala. And so I'm gonna get that same increased heart rate, sweating, that rush of adrenaline, and then a few milliseconds later, my prefrontal cortex is gonna say, "Hey, that's a stick. We're good." And so it's gonna calm my system down. This is how our limbic system should work when it's developed in its normal, healthy way. Um, we should be able to, uh, see what's in our environment and then our, even if our, um, fight or flight mode is starting to be triggered by our amygdala, our mission control can shut that down once it realizes that we are in fact safe.
So unfortunately, in a traumatized brain, this system doesn't work the way that it's supposed to. So if a child is living in a, um, environment that's unsafe, so whether it's domestic violence, um, or, um, drug use, whatever's going on, their thalamus is constantly sending, constantly getting information from the environment that they're not safe and is constantly sending danger signals to the amygdala. And so this pathway becomes really, really well developed and over-reactive. So then what we see, even when we take a child out of that environment, when they're safe, even years down the road, that pathway is still there, it's still well developed, and it's still over-responsive. So what happens is we get overreactions to minor stressors in everyday life. This can look like excessive anger, irritability, um, a really excessive startle reflex, or extreme fear or withdrawal. And this is known as toxic stress.

::Slide - Our Nervous System::

Okay, so now that we've looked a little bit at how the brain normally develops and how trauma can affect our limbic system, we're gonna watch a short video that looks at our nervous system in a little more detail.

::Video - Trauma and the Nervous System: A Polyvagal Perspective::

Okay, let me know if you guys can't hear it. [Video plays; thunder rolls]

[Narrator]
Over half of us have a chronic disorder such as high blood pressure or autoimmune disease. Rates of anxiety, depression, PTSD and addiction are skyrocketing. Why? The roots of these issues and more can often be traced to trauma, adverse childhood experiences, chronic stress, and ultimately nervous system dysregulation.
Meet your autonomic nervous system, let's call it ANS. ANS takes care of a lot of your automatic functions like your heartbeat, digestion, and body temperature. ANS also manages your survival and stress response, working to keep you alive when your life is in danger. ANS functions as our built-in detection system, constantly scanning our environment for cues of safety and cues of danger. 
As ANS scans the environment, it has three general responses or states: safe -- You feel calm, relaxed, and connected to those around you. Mobilized -- When ANS detects danger, it sends a command and your heart rate and breathing increase. Adrenaline and cortisol are released and blood rushes to your muscles so you can handle the threat. This is our fight/flight response. Immobilized -- When ANS detects that the danger is so great that you can't fight or run, it shuts you down. In this state, our heart rate, blood pressure and body temperature decrease and pain numbing endorphins are released. 
ANS does all of this automatically without us thinking about it. ANS doesn't just use these states for survival, it uses them to navigate through the world each day. When ANS functions well, it moves fluidly from one state to another, one minute mobilized and ready for action, and the next resting and recovering. ANS will often blend states together. When we play, ANS combines the mobilized and safe states. And when we are intimate with loved ones, it combines immobilized and safe states. When ANS can stay flexible and fluid like this, it helps us manage and become resilient to stress and negative events, we're able to bounce back and move on.
Unfortunately, when we experience trauma and chronic stress, it can keep ANS from functioning in a healthy, regulated, and resilient way and can keep us stuck in states of survival. A friendly get together can become frightening. A simple meeting at work can become threatening for those with a history of trauma and chronic stress. The ANS detection system often becomes faulty, constantly signaling danger even when we are safe. It's like ANS is an alarm system constantly signaling fire even when there's no smoke and no flames. Consistently living in these survival states can be debilitating. And we often develop adaptive strategies like using drugs, alcohol, food, work, or sex in an attempt to bring regulation and temporary relief.
Understanding how trauma impacts us is critically important. There is a whole spectrum of experiences that can be traumatizing and adversely impact ANS like accidents, assaults, and natural disasters, which are often called "shock traumas." There is also developmental or relational trauma. When we experience chronic adversity, abuse, neglect, and lack of safety while growing up, many other experiences can be traumatizing, including chronic stress, medical procedures and adverse community environments like poverty, discrimination, and violence. Additionally, new research in epigenetics shows us that trauma can get passed down genetically at least three generations. In the past, we've thought about trauma as events that happen to us. We now know that trauma is an experience, not an event. It's what happens inside of us as a result of what happens to us. it  --
[Video ends]

[Katie]
Okay, so like that video clip explained, our nervous system is designed to be flexible and respond to the input that it receives throughout our everyday life. It's designed to naturally move between those three states, the green safe, the orange immobilized, and the, or the orange mobilized and the blue immobilized. However, much like we talked about with our limbic system, where we can get pathways in our brain that are overactive as a result of trauma, our nervous system can also get faulty wiring as a result of trauma. So let's look at that a little bit more.

::Slide - Trauma's Effect::

So in thinking about how our nervous system is affected by trauma, we're gonna talk a little bit about how our body records a traumatic event. So we often think of trauma as a specific event saved as like a verbal narrative in our memory, but they're actually encoded by our brains as emotional and sensory experiences rather than narratives. When we experience trauma, it enters our brain through our senses, right? Our eyes, ears, nose, sense of touch, et cetera. That information's then sent to the limbic system for interpretation and appropriate response, like we talked about earlier. Um, in childhood, our number one job is to attach to our caregiver. However, when our caregiver is the unsafe person or creating an unsafe environment, we get faulty wiring in our nervous system, right? This person is supposed to be keeping us safe. They're the person we're supposed to go to when we don't feel safe, for comfort and care. Um, but we can't do that. And so our nervous system wires incorrectly. All that sensory information coming in, we can't respond to it in the way that we normally would. 
So intimacy and connection begins to feel unsafe. And this continues even when we are moved to a new environment where we have safe caregivers and have healthy adults in our life. This wiring still remains. And we as humans are designed to connect with one another. That is our whole setup. We're designed to have healthy relationships. Um, we're designed to form attachments and we need that. But when we've had this faulty wiring, we might unconsciously reject others' attempts to connect with us, even though it's really what we want and need. Their nervous system doesn't allow it because instead of that desire and need for connection, it's been replaced by a need for protection due to the trauma that they've experienced.
Again, with complex childhood trauma, this experience pathway in our brain and our nervous system is activated over and over again. And so your nervous system gets stuck in that immobilized or mobilized states, again meaning you re-- overreact to minor stressors in everyday life or act out in ways that don't make sense, like pushing away connection when that's really what you need and want. Uh, another important thing to note about trauma is again, it's not encoded as like a nice clean narrative in our memory, but it's a sensory experience. And it's important to note that this part of our brain, that that takes in sensory information from our environment, can't tell time. So when a person is triggered by something in their environment, a sight, sound, uh, body posture, a smell, et cetera, it's, they're not reacting as if they're remembering something that happened to them in the past. They are literally reliving the physical experience in the present, and their nervous system is telling them that the threat is here and now, and it is real. So we have to keep that in mind, um, when we're responding to kids when they're triggered in this way.

::Slide - How To Help::

So now that we've talked about what trauma does to our brain and our nervous system, we're gonna talk about different ways that we can help re-regulate a nervous system. So the first thing that we're gonna talk about is the importance of relationships. So like I mentioned earlier, we are designed for connection and relationship with other people. Um, and this is part of a concept called co-regulation. Um, so co-regulation is the idea that, um, you know, when kids are little, we help them co-regulate, right? If they're, um, a toddler and they're upset, they can't handle those big emotions. So we come alongside them as the adult and we help them to calm their body down and help them to understand how their body is feeling. And that's co-regulation. And this is something that our, um, body naturally does throughout our lifespan. So we have these things in our brain called mirror neurons, and their job is to literally mirror the states of those around us. So if we're around people who are stressed out, who are angry, um, who are anxious or depressed, that's gonna make our nervous system feel worse, um, because we're mirroring the states around them. On the other hand, if we are around others who are calm and who are attuned to our needs, um, and who are safe, then we are going to feel better just by being around them. And that initial connection, um, and co-regulation is going to allow us to do the work that we need to, to process the trauma and to, uh, work at re-regulating our nervous system. So again, healing happens in relationships. Of course, this is, um, our informal relationships, parents, caregivers, teachers, coaches, friends, et cetera. But it's also within our professional relationships, with our counselors and other service providers.  Um, so when thinking about, uh, helping the nervous system in regards to trauma as a professional, um, the first thing, um, is to understand and keep in mind that the most important thing is to be a safe space for connection. Whether this is individual or group work, um, the pat-- the client, so the kiddo, needs to be able to feel safe, um, to open up and process feelings that they haven't dealt with yet.
So earlier we talked about how you get stuck in that survival mode. So when that trauma is occurring, when your brain and body are in that survival state, you're not stopping and thinking about "What am I feeling right now and how should I process that feeling?" Right? Like, imagine if you're out camping in the woods and a bear comes across your campsite, like you're not thinking, you're not processing how you're feeling, you're focused on survival, and then you process the event after it ends. And this is true of kids with complex trauma histories. Um, they often don't have, um, the space and the feeling of safety to dig into those feelings. Additionally, with, um, trauma, we often hold onto, um, really negative feelings and thoughts about ourselves. So guilt, shame, defeat, powerlessness, et cetera. Um, and so those things are hard to dig into. Um, so in addition to having a really safe space to connect, um, we also need to promote the idea of self-compassion to our kiddos who are trying to process these feelings, um, because it's hard to deal with those and to talk about them and to process them.
Um, some specific modalities that have been shown, um, to work with trauma, particularly again with a focus on our nervous system, is EMDR and neurofeedback. So EMDR is Eye Movement Desensitization and Reprocessing. Um, it's the concept of recalling the trauma, envisioning what happened in the past while, um, activating both sides of your brain. So this is done in different ways. It can be done by, um, watching something move back and forth, tracking it with your eyes, um, or holding something in your hands that vibrate back and forth. Um, and what this does, um, the concept of activating both sides of your brain while, um, pro-- while thinking about the trauma and talking about it, it actually changes the circuitry of your brain. Um, and so you can interpret the trauma from a different angle so it doesn't erase, of course, the trauma that happened or the feelings that go along with it, but it allows you to have control over the reactions when you're triggered or when you're thinking about the trauma. So it gives the person a level of control over the, uh, trauma memories.
Um, and then the other one is neurofeedback. Um, this is something that's very specific. Um, you put electrodes on your head that measure brainwaves, um, and you, uh, it's hooked up to a visual screen, so like a video game. And so you focus on making, um, brainwaves that are calm and then you get a reward within the game set up. Um, so it helps you let, um, be able to, um, strengthen those brainwaves or those connections in your brain that are calming and focusing. 
In addition to the concepts of connecting with others and traditional, um, psychotherapy work, research is also showing several non-traditional types of activities that have a big impact on rewiring our nervous system and helping us heal from trauma. Um, and Dr. Bessel van der Kolk focuses a lot on these activities in his research.
Um, so first we're gonna talk about movement and role playing. Um, and so this is the idea of, uh, playing a different role. So getting you out of your body and mind and into a different perspective. So when you play different roles, like if you, for example, are in a theater camp, um, and you have a character that you're playing, you're really focusing on getting into the mind and the body of that character, right? How would this character walk? How would this character think or respond to that? Um, and while it might seem like a minor thing, what this does is it gives you, again, the ability to, uh, explore different personalities in a really physical way. So again, uh, I mentioned that trauma survivors often carry, um, really, uh, defeated, um, emotions or feelings about themselves. So again, guilt, shame, powers-- powerlessness, helpless, et cetera. Um, and so giving them the opportunity to role play a different character gives them the opportunity to feel powerful and to feel like they have purpose and to feel creative on a really, uh, visceral and basic level. In a slightly different way, things like yoga, martial arts, tai chi, meditation, um, those kinds of activities are also movement that's focused on, um, developing your relationship with your body. So, um, right, in all of these activities, you're really focusing on how your body is feeling, manipulating your body into different positions, different stretches. Um, and so you're really focusing on, um, understanding and recognizing how your body is feeling and, um, processing different sensory input that you're getting. Um, so it really teaches you to pay attention to your body and also control your body through things like breathing, um, muscle tension and relaxation, et cetera.
Um, so to illustrate this a little bit, uh, we're gonna do a really quick, um, guided meditation. This is designed to be used with kids. Um, so just keep that in mind when we're going through it. Um, it has a lot of focus on, um, visuals 'cause that helps kids understand how to position their body. And so I invite you guys all, feel free to leave your cameras on or turn them off if you want. Whatever is comfortable, you can, um, close your eyes or keep 'em open, and it's just gonna be about five minutes or less as we go through this. So, um, feel free, again, to turn off your camera or just get yourself in a comfortable position. Um, either soften your gaze or close your eyes. 
And we're gonna sit really tall like a tree. So we wanna be comfortable, but we're gonna focus on making our spine really straight and sitting tall like a tree. And then we're gonna extend our hands out like they're branches, and we're gonna focus on making them as long as they can. And we're gonna stretch our fingers out as long as we can. And then we're gonna squeeze our fingers together really, really tightly. And then we're gonna let go and we're gonna let our fingers wiggle and we're gonna feel them wiggling back and forth like they're blowing in the wind. And now we are gonna be like the wind. So let's focus on taking some really deep, slow breaths. We're gonna breathe in and then breathe out like we're blowing out the wind. We're just gonna keep doing that, breathing in and out. And while we're breathing like the wind, we're gonna imagine that the sun is shining above us. So we're feeling our body breathing, we're feeling our stomach moving back and forth as we breathe, and then we're gonna feel the warm sun on our face, and it's high up in the sky, it's bright, and it's warming up our tree and the whole world around us, and we can also warm the world with our kindness. So now I want you to think of someone in your life who can use a little kindness: your sister, brother, friend, teacher. As you think of that person and imagine them in your mind, I want you to just wish them happiness for their day. And then I want you to think about how you deserve happiness too. So after you wish happiness for the person that you're thinking of, I want you to think, "I can be happy. I wish myself happiness for today." And then I want you to give a big smile like the sun. So we're smiling like the sun. We're feeling our body sitting tall like a tree, feeling our fingers wiggle, like leaves in the wind, and we're feeling our breath blowing in and out like the wind. And then we're gonna gently bring our hands back in to our laps and we're gonna open our eyes and look around.
So that's just a really, um, short example of a meditation that can be done with kids. Again, you'll notice it focuses on imagery so that kids can understand how they're supposed to be moving their body. Um, and you can also see how we are teaching them to be aware of how their body is feeling by breathing, wiggling the fingers, et cetera. And also, um, sprinkling in positive thought processes throughout that whole process. Um, and these are very simple. You can find them all over. Um, I got this one off mindful.org. So these little meditations, as well as yoga videos, are pretty easy to find nowadays, um, on YouTube and Google.
Um, so the last thing we're gonna talk about today is stimulating our vagus nerve. So our vagus nerve is part of our nervous system, and it's also referred to as the wandering nerve because it's a nerve that starts up here in our nervous system, like the base of our brain, and it wanders throughout our entire body. Um, just like the rest of our nervous system, it can get stuck in a survival state, but it also has a restful state, and we can use specific techniques to try and activate that restful side. So some things that, um, activate that are humming or singing in a low tone, like at the back of your throat, because the vagus nerve runs right here along either side of your neck and the act of vibrating it can help trigger that restful side. Similarly, uh, deep breathing, like we just did in the meditation, like you often do in yoga videos, can also help to stimulate the vagus nerve because it wanders through our diaphragm. And so the, uh, exaggerated moving up and down of your diaphragm while you're doing deep breathing can help to activate, um, our, the restful side of our vagus nerve. And then lastly is, um, reflexology massage. So there are specific pressure points in our hands, feet and ears that activate, um, the vagus nerve. Um, and so you can relax through that. You can do this, of course, you can, um, look it up online. Um, you can also, uh, work with massage therapists that are trained in reflexology massage.
Um, but I have a simple one that you can do, uh, on your own, um, that we're gonna try really quick. So I want you to take your, um, index and thumb, and I want you to put them just inside the lobe of your ear on both sides. You're not gonna squeeze or anything, you're just gonna put them in there gently. And then you're going to make little forward circular motions and you're gonna count to 15. And then we're gonna stop and we're gonna go backwards. So just really gentle forward circular motions, and then we're gonna stop and we're gonna go backwards for 15. Okay? So that's just another example of how you can act-- um, activate your vagus nerve. So the, again, the vagus nerve runs along the side of the neck and it also runs up into the outer edges of the ear.
Um, it's important to note that while there's research supporting all these non-traditional, um, therapies or treatments like yoga, et cetera, it's not a one size, one size fits all situation. So, for example, that ear massage thing may really have relaxed you. It may work really well, but it might not do anything for someone else because we all respond differently. So it is a bit of a trial and error to figure out what works best for your body.
Um, one last point I wanna chat about is, uh, the concept of medication. So of course medication can be a really great tool to use anytime you're dealing, um, with, um, symptoms and effects of trauma, it can be a really helpful tool. However, there's a lot of research showing that children who've been through, um, the child welfare system are really often overmedicated. So medication is used, um, much more than similar aged peers with similar presenting symptoms. Um, so this is just important to know and keep in your mind, um, to use it when it's helpful, but to be careful not to overuse it, right? Because the point of medication is to assist with problem symptoms. We wanna get rid of symptoms, um, so negative feelings as well as behaviors. However, if we shut everything down, then the person doesn't have the ability to do that work of going into the feelings that they haven't processed yet and working through that. And it can also shut down, uh, our things that we want to be present. So capacity to feel joy and pleasure, which can also inhibit, um, their daily life as well as their ability to process what's happened to them. So it's a really great tool, but we just need to use it, um, with caution and to really focus on not just fixing the symptom, but what is the root cause and how can we get at that root issue.

::Wrapping Up::

So to sum up today, we talked about how our nervous system has three states. It has the safe, mobilized, and immobilized, and it's supposed to switch between them fluidly as needed. However, when we experience trauma, particularly complex childhood trauma, that affects our brain and nervous system's ability to move and have the flexibility that it should, and it gets stuck in that survival mode, which causes overreactions to normal stressors in our life. And also rejection of connecting with others. Some ways to help this is to have co-regulation from calm, attuned healthy relationships in our life so we can feel safe while we learn to regulate our own nervous system. Um, we can work on helping our nervous system in both traditional therapeutic spaces as well as non-traditional activities. But the key is to have space to feel what is happening in our body, learning why those reactions are occurring and how to control and manage it in a healthy way.
Okay, and looks like we're a little ahead of the schedule, but um, I am open for any questions or concerns.

::Attendees visible::

[Speaker]
I have a question. Yeah. Okay. So I was listening to a podcast yesterday and it was, you mentioned EMDR. What is the difference between EMDR and ISI as far as the approach?

[Katie]
I'm not familiar with ISI. Bonni, are you on here?

[Speaker 1]
Um, I can, so ISI, um, therapy can help clients identify and work through their different parts, including those that are holding onto trauma memories and emotions. And then EMDR therapy can then be used to desensitize. So is that like, I, I was just trying to understand it, um, it to the two different things as far as the EMDR approach versus that, or, but it's not something that you are familiar with.

[Katie]
I'm not, I'm not familiar with ISI, um, I can try and explain a little bit more. Um, again, EMDR, um, you are sitting and, um, focusing. So it's like, um, think about this event. What are you noticing? So it's, um, focusing on, um, recalling the trauma and what are you noticing that you're feeling in your body? So where, you know, are you feeling a stomach ache, are you feeling it in your chest, et cetera. And while you're doing that process, um, you're using, again, either eye tracking or buzzers, like little vibrators in your hands back and forth. Um, and it's the act of doing that back and forth activation, um, that allows the trauma memory to be stored in a different way in your brain. So then in the future, like you successfully complete EMDR, um, the trigger still comes up, but you immediately recognize that that is what's happening and you're able to shut that down like your prefrontal cortex should. So your prefrontal cortex should shut down the fight or flight response when there's not a real threat. And EMDR allows reprocessing to do that.

[Speaker 1]
Okay. Okay. Thank you. Yep.

[Speaker 2]
I know when I've had the EMDR treatment, the um, doctor that I worked with built a real positive experience so that it had a place in the brain and then I processed that negative part, uh, and kind of overlaid that in such a way. So there may be even different ways that they do the EMDR that help to assimilate and do that. I know the one I worked with, he worked with Vietnam vets. And so, um, it, it's very, very powerful and it's amazing that that doesn't get as much tout as it should in, in healing communities, uh, for families and, and children. 'cause it's a real easy way instead of the medication and everything. Thanks for bringing that up today.

[Katie]
Yeah, no problem. Um, I've got a couple requests, um, for the research that I've used. I'm gonna, um, put the name in the chat. So Dr. Bessel van der Kolk is, um, where the research is from, and I'm gonna put a link. He has a, uh, research foundation. Um, he does a lot of trainings and different things. Um, and then he also has a book called "The Body Keeps the Score." So I put all of that in the chat for you guys.

[Grace Cameron]
I think a couple people were also wanting, um, to know where you got the meditation exercise.

[Katie]
Oh, yes. Right. That was from, um, mindful.org. And I'll, I can drop that in the chat too.

[Speaker 3]
What age does MDR like become appropriate? When can they start that?

[Katie]
Uh, that is a great question. Um, and I don't actually know the answer to that. Um, I'm familiar with MDR, but I'm not certified in it myself. I don't know if Bonni or someone else on here knows?

[Speaker 3]
That's okay. I was just thinking that would be probably something useful in the future for my foster daughter, but right now she's, she's too wiggly. She probably couldn't, you know,

[Katie]
I do know, um, I think it's like, I would say probably like five, age five and up. Um, oh, Bonni, the question was age that EMDR is appropriate to start?

[Bonni Goodwin]
Yeah, there, um, there are different types, uh, for different ages. Um, there's some ad-- adapted for younger ages. Um, I would, I would agree, Katie, I think probably around five, you have to be able to sit still. Um, and there are some adaptations, like I've said, that have like handheld devices or things that you can stick in shoes that, um, don't require the, the focus of the concentration of eye-to-eye movement or side-to-side eye movement. Um, but most of the time it is our older, older ages. [reading] It looks like, uh, John said adolescents, teenagers, and adults of all ages can benefit from the treatment.

[Delinda]
Katie, it's Delinda, we, when I was trained in Austin, they would let us go to four. But again, it, like she said, it was kind of depending on their ability to stay focused and set still.

[Christina]
I have a question for Katie. In your experience, um, is there a particular population or demographic that, that you're hesitant in presenting, like the neurobiology of trauma and the brain, um, as a way to kind of like psychoeducation? Is there any like group or demographic that you find it challenging to present it that way? Or is everyone kind of receptive to that kind of explanation?

[Katie]
Yeah, so I didn't mention this in my intro, but I actually spent, um, the bulk of my career thus far has been as a caseworker with foster and adoptive, um, parents. That's what led me into the clinical side. Um, so I have done a lot of psychoeducation, um, with my clients and I found it, um, I think it really, it depends on the personality. I have found it overall beneficial. Um, I haven't found a particular demographic where it's just not helpful at all or where it's harmful. Um, I think the degree to, um, how helpful it is depends on personality and temperament of the people that you're doing the psychoeducation with, as well as how you're doing it. Um, so being able to do it in a conversational way, um, as well as a, "Hey, look at this, you know, cool information," versus "I know more than you do and you need to know what I do." Does that make sense? Um, so really approaching it, um, as a, I'm coming alongside you with this cool information that might be helpful versus coming from a, um, more authoritative, um, concept has been really helpful in my experience.

[Christina]
Thank you. And I'm graduating with MSW up this upcoming semester, so I'm, I'm on my way.

[Katie]
Congratulations.

[Tonya]
I work with adult cancer patients. And so I'm just curious, I know you're presenting more on childhood trauma, but how this might apply as well to adults who have a trauma like having, uh, cancer.

[Katie]
Yeah, so, uh, medical trauma is a real, uh, real thing. Um, I've actually experienced that, uh, personally with my kiddo, um, recently. And so, uh, again, while that's, um, he's a child, it's still that concept of shock trauma versus what we've been talking about more, which is the complex trauma. So the concepts are all the same. So trauma, any kind of trauma at any age still affects how our brain is functioning, particularly in regard to that nervous system. So as an adult, you know, they might have a normally developed brain if they didn't experience trauma before their cancer diagnosis, but that cancer diagnosis and everything that comes after it is trauma in and of itself. And so, um, their nervous system is still going to have that same, can still have that same reaction of getting stuck in fight or flight mode. Particularly if you think about with cancer patients, um, they have the same kind of, um, or similar experience of, um, okay, I beat this, but there's that possibility of relapse and they have to have scans coming up and all those things are triggering again, that same unsafe feeling. So that part, um, is all the same of our limbic system, sending those inaccurate messages and then our nervous system getting stuck in the, um, fight, flight, or immobilized mode. So I think, um, absolutely it's relevant to that population. And things like the same kinds of things of, um, you can do EMDR for, um, shock traumas as well. It's not just for childhood traumas. Uh, Dr. Bessel van der Kolk actually talks about it in regards, um, to veterans, um, and traumas as an adult. So that's where his research actually started. Um, and all those things like yoga and meditation and those other like non-traditional activities we talked about can also help them regulate their nervous system in the same way.

[Tonya]
Thank you. That was helpful.

[Grace]
We had one question that said, "What would you re-- what would be recommended for a five-year-old who cannot sit still?"

[Katie]
Um, that's a good question, Bonni, you wanna jump in and assist?

[Bonni]
[laughs] Yeah, so I'm, I'm guessing the question is asking what type of treatment or intervention would be appropriate for, um, those kiddos that we were talking about earlier that might not be able to sit through, um, EMDR. And really I think, um, a lot of that is going to, there, I mean, there's a whole bunch of different directions where you could take that treatment possibility. Um, one would be looking at, um, some parent -- lot of the therapeutic parent training programs to support parents, um, in handling in a therapeutic response with, um, what's going on with the kiddo in the home and behaviors and emotions that that child might be, um, holding and displaying. And then in the processing, um, I think there's some, some things that that could be done with. Uh, it depends on, on the, the situation, right? I think it depends on the doing a full assessment of what all is, uh, playing a role in this child's experience and what's going on. Is there sensory processing? Um, could there be an evaluation for occupational therapy to hand to, you know, address some of the sensory processing challenges that might be a part of the impact of trauma. Um, so there's, at that age and, and in that situation, I think there'd be a lot of, um, yeah, neuro-- biofeedback might be, uh, potentially, um, a conversation. 
But you're gonna be looking at, in fact, this is a really good time to, to say to this whole group. Um, I know at the beginning you were given the information that this is, uh, presented to you from the perspective of the adoption, uh, competent, um, network -- Oklahoma Adoption Competent Network. So really the population and focus that we're talking about is the adoption competent mental health approach, um, to serving this population and adoption and foster care. So what, what my recommendation would be would be doing a full, uh, family approach and family systems assessment to see how to support parents with that. If there's any other assessments that need to be, um, a part of the, the process with this five-year-old, and it might be that the actual trauma processing piece is something that you get to as the child ages.
Um, there's TFCBT is a, is another excellent, um, trauma processing approach. Um, that's evidence-based and highly rated. So five-year-old, struggling with some of that stuff, I would, I'd probably sit back and do a little bit some of the, the other assessments to look and see what might be, um, a good approach from a holistic perspective with really supporting the family and the parents and trying to understand, um, the context. What is this child's story? Uh, five years old is really one of those times with our kiddos, whenever they start hitting that real, you know, a little bit more processing of their own story, um, when the, the losses, the, that they've experienced, the grief, um, can come to the table with some of that, uh, starting school for the first time. Um, you know, lots of changes around age five. So I don't, that's kind of a general, general response to that question, but would cover, um, what, what my recommendations would be for how to respond.

[Valerie]
I'm the one that asked that question. Um, I'm a adoptive parent of the five-year-old,

[Bonni]
Hi Valerie.

[Valerie]
Hi. We're, we're in OT already, but I just don't know where to go from here 'cause I think we need more than just occupational therapy. So I was just trying to get some recommendations. I don't even know where to start.

[Bonni]
Ah, Valerie, thank you so much for unmuting and sharing that context. Um, yeah, I think, um, probably another next good step would be, um, I don't know if you're connected to also an adoption competent therapist who might be able to do, um, and other assessments and, and talk more in depth about, um, your child's specific story and experience. Um, one thing you could, you've got lots of people putting some stuff in, in chat for you with child-parent psychotherapy, which is another evidence-based treatment that's high rated. And, uh, for our littles, zero to six, yeah, PCIT, which is another one. Um, but all of those different types of treatment, um, have different, different, uh, approaches and different ways that that fit really well once you're able to sit down with an adoption competent therapist and really talk about the whole context. So there's lots of possible things out there to be able to do as a next step. So, um, Valerie specifically, I would love for you to, I'm gonna put my email in the chat, so if you wanted to talk more about being able to find an adoption competent therapist, do a full assessment with you and talk about good next steps, please reach out to me and we'll see if we can either get connected, um, get you connected or have you connect with one of our, um, clinical social workers, which Katie is one of our, uh, workers on our team.

[Valerie]
Thank you so much.

[Bonni]
Yeah.

[Sarah Antari]
I also -- I also put my contact in there. I'm Sarah Antari, an, uh, Post Adoption Outreach Supervisor. Um, so if you wanna reach out to me, it, my contact is in there too, and we'll, we'll find, we'll find something for you.

[Katie]
Any last minute questions or thoughts?

[Bonni]
Katie, thank you so much for an excellent, excellent job today. We appreciate this presentation and, and how you've given it to us. You have lots of good feedback in the chat of how clear and organized it's been, so we appreciate the act-- the activities to, to join in with you. I know that was a, a bright spot in my day as well, so thank you, thank you. Thank you everyone for coming. Um, really appreciate this is a, the, a great turnout. Um, please continue to connect with us, the Oklahoma Adoption Competency Network. Um, we would love to continue to have these excellent thoughts and, um, perspectives and expertise, um, as we continue to serve the population of adoption, foster care, families and children. So thank you so much and I hope you have a wonderful, wonderful day.

[Silence]

::Repeating CE Slides from beginning: 
Title Slide: The Effects of Trauma on the Brain - Presented by: Katie Stewart (LMSW) on Zoom - Tuesday January 23rd, 2024
Slide 1: Thank you for joining us today.
Slide 2: Continuing Education Certificates will be emailed 12-14 business days after completing the Post-Event Evaluation Survey.::