Healthy Children Start with Healthy Mothers

As we approach another Mother’s Day, it seemed like a good opportunity to reflect on research findings that suggest our understanding of infant development cannot be separated from the impact of the child’s interactions with the primary caretaker. This “transactional model” views development of our brains as initially driven by genetically programmed processes that are then modified by exposure to environmental experiences. These experiences can either facilitate or inhibit the expression of the developing child’s potential.

Because human beings are born almost completely dependent upon others, the infant’s emerging social, psychological and biological capacities must be understood within the context of the mother-child interactional relationship. The early sensory experiences of a mother looking into her infant’s eyes, touching skin to skin, her scent and voice are stimulating patterned neuronal activity in the infant’s rapidly developing brain. The quantity, quality and rhythms of these sensory experiences activate temporary mental states in the infant. When certain experiences occur with enough repetition the probability of that pattern of activation will be increased and the temporary state becomes a consistent trait. Those early associated sensory experiences become organized into our core sense of self, others and the world. They influence whether the child sees himself or herself as a competent, capable small person who is excited about exploring a benevolent world as opposed to an inadequate, damaged individual who struggles to feel safe in a dangerous world. Because our brains are in an incredible growth spurt starting from the third trimester of pregnancy and continuing into the third year of life, early experiences have a disproportionate impact throughout a child’s life.

  

Whether or not an expectant mother is well-supported, well-nourished and receiving good medical care can have a profound impact on the developing child. Pregnant women who are suffering from mental or physical illness, are in unsafe or unsupportive relationships, or are too young or developmentally immature to care for their child will be greatly challenged in their efforts to create a growth facilitative environment. Children start off with equal genetic capacities, but not all have the exposure to experiences that allow them to express that potential.

  

A culture’s commitment to child protection cannot be separated from the values, policies and practices created to protect and care for mothers. Dr. Bruce Perry repetitively reminds us that “the success of any society depends upon the health and well being of its children.”  We can never have healthy and well-developed children without healthy and well-cared for mothers.

Happy Mother’s Day!


Your comments and questions are welcome. Please feel free to post below or to contact me directly at jerry.yager@denvercac.org

The Adolescent Brain – A Major Remodeling Project

Yes, there is a biological reason for some of your adolescent’s actions! Adolescence has been described as a time in which the brain is going through a major remodeling project.  On the front end of puberty (approximately 11 years for females and 12 for males) there is a genetically driven growth of neural connections, increasing the number and density of synapse and dendrite in several areas of the brain. This period of growth is followed by a process of elimination of non-essential connections that is probably influenced by both genetics and experiences that adolescents are exposed to in their daily lives.  The sensory, emotional and cognitive experiences that adolescents are exposed to with frequency or intensity will become wired into their central nervous systems.  Therefore, the types of experiences, both intellectual and relational, that adolescents encounter can have a profound impact on their developmental trajectory. Exposure to community and relational violence, drugs and self-destructive behaviors during this developmental period can have significant long- term consequences for the developing brain.

Understanding how the brain develops and functions allows caregivers to support adolescents from the perspective of what these youth need developmentally from adults in their lives, rather than reacting solely to how they behave or make us feel. We know that socially adolescents separate from their family and begin to explore a much larger social environment. Physical changes in size and strength allow them to feel that they can now compete in an adult world, but their knowledge and experience lag behind these physical changes. Connections with peers become much more influential during this time period.  Hormonal changes are stirring sexual attractions, increasing interest in intimate relationships, and destabilizing moods. All of these changes create both excitement and anxiety for parents, teachers and the other adults who interact with developing youth.

The most important thing adults can do is to provide healthy relational and developmentally sensitive experiences prior to adolescence to create the scaffolding that will support everyone through this transitional period. The balance between respecting adolescents’ drive toward independence, with their need for monitoring and guidance is a constant challenge for adults. Over the last few decades, science has uncovered some important findings related to changes occurring in the brains of adolescents that has added to our understanding of development. The hope is that with increased understanding of the strengths and vulnerabilities of adolescence, as a society we can begin to create age appropriate support to facilitate the successful transition from childhood into adulthood.

What Happens Inside the Adolescent Brain

Developmentally, emerging functions are built upon earlier more simple functions. Two significant regions undergoing change during this developmental period are the pre-frontal cortex (PFC) and the cerebellum. The PFC which mediates such functions as working memory, body regulation, emotional regulation, empathy, insight, fear modulation, abstract thinking, problem solving and morality, is being modified during this period. The number and strength of the connections both within this area and between the PFC and regions lower in the brain and the body allows for improved integration of information. There is also an increase in the insulation of the connections that allows for information to travel much faster. These changes will result in improvements in top down, cortically modulated control and a decrease in automatic, habitual behavioral and hormonal patterns of reacting to stressful environmental demands. However, just like any remodeling project, functioning temporarily gets less efficient before the benefits can be enjoyed.

The cerebellum is also being remodeled during this developmental time period. This region coordinates physical movement, but is also important in recognizing social cues. Important information flows from the body to the lower parts of the brain and then get integrated in the higher brain regions. The modifications occurring in these neural pathways may initially mean that the adolescent may focus on some important social cues and miss others. Lacking a more comprehensive understanding of a social interaction may cause the adolescent to react in an irrational, illogical manner. In addition to the changes in the wiring of this region there is a change in the rhythmic release of the neurotransmitter, dopamine. Dopamine is a chemical important to attention and motivation. These chemical changes, most influential in the early period of adolescence, cause youth to be motivated to a greater extent by short-term gains rather than concerns about long-term losses.  (The thrills outweigh the risk of injury and death.) As the release of dopamine stabilizes, around the age of 14 or 15, the ability to weigh the long term consequences of our actions begins to improve, but top-down regulation does not fully mature until the mid 20’s.  This research suggests that it might be helpful to involve younger teens in activities that give them short-term personal gratification and then work on self- regulation and delayed gratification goals later in adolescents.

It is important to understand that it is not that adolescents cannot think like adults, but more that their cognitive equipment is not working as efficiently during this developmental period. When they are thinking they may not be feeling, and when they are feeling they may not be thinking. Stress plays a significant role in how adolescents are affected by these neurological changes.

The Impact of Maltreatment on the Brain’s Remodeling

Many of the templates we use to guide us in the relational world are established in the first two years of life and influence us outside of our awareness.  As the teenager separates from the home environment and faces complex social demands, the social neural networks - both conscious and unconscious - are activated.  If the foundation of these templates contains fragments of sensations, feelings, images and perceptual biases formed by maltreatment this makes the developmental journey for an adolescent more difficult to negotiate. Experiences of prolonged, chronic abuse, neglect or exposure to other forms of violence divert resources away from cortical regions and predispose an individual toward action rather than thought. Maltreatment affects brain development throughout childhood, but becomes a much larger issue during adolescence. It is one thing to manage an aggressive, impulsive, irrational five-year-old, but another thing entirely to manage those same behaviors in a 16-year-old who is bigger, more mobile, and has increased opportunity to engage in unsafe activities in the community. Adults who have to deal with these difficult-to-manage adolescents often misattribute their reactivity to their character, “bad seeds,” rather than an outcome of their adverse developmental experiences earlier in life.

Know Your Teenager Inside and Out

Everyone wants to feel understood and validated for who they are. Even though it may sometimes feel as if your teenager doesn’t care what you think, remember that your child is in fact greatly concerned about your love, respect and your opinions. Staying relationally connected to teenagers is very important to their development. Most children and families are able to successfully negotiate this period without major conflicts.  For those parents, foster parents, teachers or other caring adults who are dealing with troubled youth, remember that their behavior is an indication they are having difficulty coping with what they are experiencing internally and externally and it is not about you personally. Here are a few tips to think about to guide you through the remodeling of your adolescent’s brain.

• Try and focus on what they are thinking and feeling inside instead of always focusing on their behavior. Work on seeing the world through their eyes before expecting them to see the world through yours.
• Teenagers often want to control the social interaction. They seem to talk most when you are not trying to get them to talk. Create opportunities when you are just with your teenager and you will be surprised by how much they might share. Go out for a ride in the car, take walks, shot a basketball around, have dinner together or just sit in the same room reading. 
• Teenagers need clear expectations and structure plus validation and support - not one or the other. Teenager trust adults who can act like adults and respect them as teenagers, not someone who wants to be their friend or wants to control them.
• If you find that your teenager is creating a high level of internal distress for you - generating feelings of shame, helplessness or powerlessness - look first inside yourself for what unresolved issue might be reactivated from your past. The best way to stay connected to your teenager is to first stay connected to yourself.  Self-awareness is your greatest asset. 
• Help teenagers to use all of their brain in order to solve problems.  Ask them how they feel. What they think. Try to help them see issues from someone else’s perspective, in order to generate multiple solutions.  The goal is not just finding the solution, but teaching them to integrate sensations, feelings and thoughts into a more comprehensive, coherent picture of the world in which they live and the relationships they develop.

Remodeling can be messy and disruptive, but the end result is generally worth the effort!

I welcome your comments and questions. Please don't hesitate to post them here, or to contact me directly by email at jerry.yager@denvercac.org.

New Year's Resolutions: A Complex Challenge for the Brain

Setting goals for the New Year is a ritual that dates back at least as far as 2000 B.C. It began with the Babylonians and was later enthusiastically taken up by the Romans. The month of January is named after the Roman deity Janus, who had two faces, one looking toward the past and one toward the future.

The ability to set and implement goals is one of the brain’s most sophisticated capacities. Goal setting is mediated by the prefrontal cortex, the last region of the brain to fully mature.  In order to set and achieve a goal, a person has to hold onto what they have learned and experienced in the past, and then integrate that information with what they desire for the future. An individual has to resist reacting to current environmental stimuli and instead be guided by an internal representation of the future. The ability to achieve the desired outcome will depend upon accessing long-term memories, focusing attention on stimuli in the environment related to achieving the desired outcome, delaying short-term gratification, inhibiting old patterns of response, and planning the steps and sequences for new responses.

How do our brains accomplish these complex tasks? We use the cortical executive functions: Working memory, cortical modulation and cognitive flexibility.

• Working memory consists of a workspace in which information can be temporarily stored and mental work can be carried out. Neuroscientist Joseph LeDoux uses the computer to illustrate these cognitive capacities. The operating system of a computer is responsible for moving information from permanent storage (ROM) to a central processing unit with active memory (RAM). The executive function operates in a similar fashion by selecting appropriate environmental stimuli and then moving relevant information from storage throughout the brain into this workspace to process and direct behavioral responses. These executive functions allow for problem solving, decision making, and choosing a particular course of action.
  
  
• Cortical modulation is a higher brain function that allows individuals to inhibit impulses, resist temptations, and disrupt automatic habitual ways of behaving. This capacity allows us to make choices—to stop and think before we act.
  
  
• Cognitive flexibility allows individuals to shift their attention, adjust to changing environmental demands, and understand rules that govern behavior in different situations. For example, in the home a child is told to share his toys with other children, but on the soccer field he is instructed to steal the ball from a peer. In life there are exceptions to many rules that demand flexibility in our thinking and actions.
  
  

Developmental perspective

This ability to intentionally direct our behavior, and inhibit or modulate automatic, habitual patterns of reacting is not a skill we are born with, but one that must be developed over time. As people mature, they become less impulsive and reactive, allowing them to be more thoughtful and deliberate in their responses. These expanding behavioral capacities are a reflection of the underlying maturation and organization of the brain.

The developing child depends upon adults to provide structure and predictable routines to support the emergence of the brain’s executive functions. By matching the environmental demands to children’s developmental capacities, adults allow the child to experience the repetition of challenges, frustration and success as they work on tasks. This builds strong neural networks, allowing children to begin to integrate sensations, feelings and thoughts into a goal-directed action. These same abilities will foster the capacity for children to wait their turn, stay focused on tasks, and to remember and follow instructions when they enter the complex social environment of a school setting. These social/emotional capabilities are what make children “school ready,” not just the ability to understand numbers and letters.

The impact of trauma on executive functions

Early exposure to developmental insults affects the emergence of executive functions. Prenatal complications such as substance abuse, exposure to environmental toxins, illness, and high levels of maternal stress can disrupt the intrauterine environment and impact the fetus’s developing brain. Abuse, neglect and exposure to chaotic, unsafe environments can interfere with the regulation of important biochemicals resulting in modifications of brain architecture and functions. Exposure to adverse early experiences not only interferes with the child’s current functioning, but also alters the developmental pathway and can result in profound age expected deficits in working memory, cortical modulation and cognitive flexibility.

Hope

Don’t get discouraged because science tells us there is hope for children whose brains have been impacted by trauma. The developing brain’s capacity to be influenced by environmental stimulation presents us with the possibility of altering children’s developmental trajectory by exposing them to effective developmentally sensitive interventions. Research demonstrates that the brain remains plastic throughout life, meaning it is able to change in response to environmental input. However, the brain overproduces neurons early in life, and then chisels away those cells that are not used while strengthening the connections between pathways that are repetitively activated. Therefore, the earlier the intervention, the more adaptable the brain is to developmentally appropriate stimulation. It takes less energy and resources to create change in a system that is still being organized than it does to disrupt a system and then reorganize it. A system once organized will work to maintain itself.

A child who has missed out on certain academic knowledge will be much more capable of benefiting from academically focused remedial interventions than a child who has deficits in self-regulatory functions. Our child welfare and educational systems must radically rethink the way they treat children with learning and behavioral problems.  Interventions must be focused on stimulating the development of lower brain functions before attempting to address higher cortical mediated functions.  This can be accomplished by balancing exposure to somatosensory, emotionally meaningful and cognitive activities throughout the child’s day.  The timing, intensity and duration of each of these interventions should be sensitive to the child’s capacity to process the experience. To be effective, interventions must challenge children, but not overwhelm them. Children will naturally seek to explore their environment when they feel safe. The process of discovery and learning becomes pleasurable.  Pleasure will increase the likelihood of repetition, and repetition will create long-term changes in the brain that the intervention is designed to accomplish.

As a society, instead of labeling children who struggle to negotiate developmental demands, we must all become more developmentally sensitive, encouraging, and responsive. Our long-term goal is to help facilitate the development of citizens who can collaboratively function in a social group, delay gratification of immediate needs, and work toward the achievement of individual, family and community goals. Both for our children and for ourselves, we should strive to emulate the qualities of Janus—the ability to learn from the past and to develop strategies in the present, in order to achieve a desired outcome in the future.

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Dr. Jerry welcomes your questions! If you'd like additional information on any topic discussed or suggestions for future entries, please let us know!

Holidays and Memories

I was driving across the state two weeks ago and enjoying the fall colors as I headed over Vail Pass. My radio playing, the road ahead, and the beautiful scenery put me into a very nice, calm state of mind. Then the radio station announced that the next hour would be commercial-free and they were going to play music from “The British Invasion.” Songs from the Beatles, Stones, Animals and many more famous groups from that time began to play. I found myself singing songs I didn’t even realize I remembered the words to. Memories from my younger years came back along with many emotions. Memories of friends, girlfriends, parties, school teachers, and family rose into conscious awareness. All the time I was rocking out and reminiscing, I was flying down the highway at 80 miles an hour. What an amazing organ the brain is to allow me to engage in such a complex skill as driving, while I enjoyed my surroundings and revisited my past!

Brain Processing

Our brains are made up of 100 billion neurons, each forming connections with thousands of other neurons. This complex network of cells allows for the flow of information and energy through the organ. The nervous system converts sensory stimuli from the external environment into patterned electro-chemical signals. These signals have the capacity to modify the efficiency of communication between neurons and to change the actual architecture of the neurons themselves. The ability of neurons to change in response to stimuli is called plasticity. Plasticity is the mechanism that allows for learning, memory and development.

Our brains process environmental signals by modifying the connections between neurons and generating an internal representation of the external world. This is the foundation of memory. Our memories are not stored in just one place, but in various pieces throughout the brain. Visual information is stored in one area, auditory information in another, and emotions have a separate area. However, they are all connected through neural networks.
The way the brain categorizes information is by creating associations between stimuli. So when you hear barking you automatically envision a dog. This capacity to associate allows us to experience the present, compare it to the past and then anticipate the future, which increased our chances of survival. Imagine if we heard the roar of a lion, but had to wait until the lion appeared before reacting. Being so slow and weak as a species, anticipation became a real asset.

Multiple memory systems

Nature has a way of sticking with old designs and then building new functions on top of them. Memory is not a single system, but is composed of different systems that work together—when the system is functioning well. The memory system most of us recognize easily is the verbal system or declarative memory. These are memories that we are conscious of and can declare to ourselves and others.

A second memory system records experiences in sensations, images, emotions and behaviors. These memories function outside our conscious awareness but influence our actions on a daily basis. Information stored in this memory system is not expressed in words, but through internal or external actions. It is in this lower memory system that the procedures for driving are activated and occur without conscious attention.

The Drive

So you see that my driving activated my non-verbal, procedural memory system allowing me to operate the car while the music served as a cue to my declarative memory system to activate the neural pathways connecting the music to lyrics, past experiences and the many emotions connected to those experiences. However, when all of those memories came back to awareness they were changed because now in the future those songs and memories will be associated with that drive through the mountains on a sunny autumn day. Each time we retrieve our memories, they are modified by the current context in which they are recalled. Memories are not like photographs, but are evolving estimates of what actually occurred in the past.

Adverse Experiences

Memory systems function best when we experience a balance between stimulation and recovery. Under these conditions the brain works in an integrated manner allowing information and energy to flow both horizontally and vertically. Physical sensations, emotions, and cognitions are combined with information from the past and anticipated future to direct an adaptive behavioral response. Under adverse conditions, such as neglect or abuse, memory does not function so well.

From a biological perspective, neglect is the lack of developmentally required stimulation and abuse is exposure to prolonged, severe levels of arousal. For many of our clients who have had adverse childhood experiences, the traumatizing event may have taken place prior to the verbal system maturing.  This means that their memories cannot be consciously recalled or communicated verbally. For older children, the adverse event may have interfered with the integration of these systems so memories not only cannot be shared with others but cannot even be verbally declared to the self. These systems are dissociated from each other. The only way to express memories is through body sensations, images or behavior.  For these children, past events are not understood as memories from the past but rather experiences in the present. Our clients tell their stories by the relational situations they recreate.

Holiday Celebrations

This holiday season we should all be aware that for traumatized children and their families, association to the rituals connected to this season (songs, lights, foods, gifts) may trigger feelings of distress, frustration, abandonment and pain. Many of their memories cannot be expressed in words but only re-experienced in relational interactions. The greatest gift that caregivers, teachers, caseworkers, and other professionals involved with this population can give to a child is to be present, attentive, attuned and responsive to their developmental need for both stimulation and soothing. By having a different relational experience this holiday, where others truly hear, validate and respond, will allow vulnerable children to use their past memories in a way that begins to incorporate new meaning for the future.

Keys to a Safe Holiday Season

• Awareness: “What are my associations to the holidays and how might they be different than those of the children in my care?”
• Stay connected to your children so that you can monitor their arousal levels
• Know your children’s stress tolerance levels and structure recovery times before they get overwhelmed. Just because it is a special time of year our stress tolerance levels don’t change. 
• Try and structure quiet relational times to verbally process the day’s events.
• As much as possible try and communicate any upcoming change in structure so your children can anticipate transitions.
• Develop a safety plan so your children can signal you if they are getting overwhelmed, or you can signal them if you see them getting overwhelmed and what steps can take place to find space to recover.
  

All of these steps can be worked on collaboratively and put in place before the holidays begin. Your goal is to create a safe, positive experience for yourself and the children in your care.

Happy Holidays!

Is It Ten Years Already? Seems Like Yesterday.

November 22, 1963—I am nine years old, home sick from school, watching television when the news flashes across the screen that John F. Kennedy has been shot.

April 19, 1995—I am sitting in my office reading reports, when a co-worker tells me to turn on the radio because of the Oklahoma City bombing. Who can forget the sight of that fireman holding the infant outside the federal building? 

April 20, 1999—I am working with teenagers at the Denver Children’s Home when another child tells me that two students attacked other defenseless students at Columbine High School right here in Colorado.

September 11, 2001—driving into work, my car radio informs me that a plane has hit the World Trade Center. I arrived at work shortly after the radio announcement and turned on the television to watch in disbelief as the towers collapsed.

Images of all of these events have been seared into my memory. I viewed the events multiple times on those historic days, the same way I find myself drawn to look at a car accident on the highway. They scared and angered me and yet I couldn’t turn away. When something in our environment is perceived as threatening it is difficult to disengage. Each of these events altered my perception of the world and my personal sense of safety and security. Memory researchers call these “flashbulb” memories. Memories of events that are highly emotionally significant that the brain records them more vividly and we believe we recall them more accurately then other less significant events.

That day—September 11, 2001—normal activities were not an option and I wanted to make contact with people I cared about. Everyone I interacted with shared what they were thinking and how they were personally impacted. Our cognitive templates didn’t account for such catastrophes. When threatened, our biological directives cause us to seek proximity to each other and begin circling the wagons.  It is amazing how tragic events seem to draw people closer together. We all shared something painful and we all felt soothed by our relational connections. However, when we huddle together that means everyone outside the circle is a danger.  Nobody wants to say anything that might get them kicked out of the circle. In times of danger, we must present a united front to our perceived enemies.

Although these events have many things in common, our response to them is what creates the difference. The message we received in those earlier events—before 9/11—was that the actions of disturbed individuals resulted in a terrible disaster.  However, the world was still good. The rituals, the funerals, the grieving and healing helped put meaning to the overwhelming, unimaginable experiences.

Something of a different magnitude occurred on 9/11 and changed forever the way we think, feel and behave when it comes to safety and protection. The world on that day was divided into good and evil. Our only hope of survival was to defend ourselves. As a nation we had to seek out and destroy the threat before it destroyed us. Survival was, and still is, at stake. Laws were quickly enacted and policies implemented that were designed to protect us but in reality generated increased anxiety.  Every time we travel we are reminded that the world is an unsafe place and that danger is ever present.  It is as if the very strategies that were initially put into place to keep us safe became the obstacles to healing and moving forward.

In some ways Kennedy’s assassination, the Oklahoma City bombing, and Columbine created an acute stress response, but 9/11 resulted in an entire nation suffering from Post Traumatic Stress Disorder. The diagnostic criteria for PTSD:

Exposure to traumatic event in which both the following were present

• Experienced, witnessed, or was confronted with an event or events that involved actual or threatening death or serious injury, or a threat to the physical integrity of self or other
• Response involves intense fear, helplessness or horror

The traumatic event is persistently re-experienced in one (or more) of the following ways

• Acting or feeling as if the traumatic event were recurring
• Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
• Physiological reactivity to exposure to internal or external cues that symbolize or resemble the traumatic event

Persistent avoidance of stimuli associated with the trauma

• Efforts to avoid activities, places, or people that arouse recollection of the trauma
• Efforts to avoid thoughts, feelings or conversations associated with the trauma
• Diminished interest or participation in significant activities
• Restricted range of affect
• Sense of foreshortened future

Persistent symptoms of increased arousal (not present before the trauma)

• Hyper-vigilance
• Exaggerated startle response
• Irritability or outburst of anger

Duration of disturbance more than one month

The ongoing anxiety generated by 9/11 changed the world and shattered our assumptions. The speed in which we enacted new laws and shifted power to one branch of government and eliminated certain liberties, without understanding and debating the long term impact of those decisions, suggested the level of threat we felt we were under.  The openness to go to war with a country that was not even connected to 9/11, because it presented a potential threat, suggested how reactive we were. New homeland defense measures were funded and continue to function ten years later. Our profiling of a group of people that triggered memories of the traumatic incident suggested our efforts to avoid these individuals at all costs. I don’t think we monitored the whereabouts of all white middle class teenagers after the Columbine incident. No exaggerated startle response was necessary because we portrayed those two teenagers as troubled youths, unlike other teens.

Sandra Bloom, Past-President of the International Society for Traumatic Stress Studies and author of Creating Sanctuary: Toward the Evolution of Sane Societies and co-author of Bearing Witness: Violence and Collective Responsibility, states that under severe stress, a leader rapidly emerges within a group. The process is a combination of the needs of the group, individual characteristics of the individual leader and the demands of the moment. Under these conditions humans become more suggestible to the influence of a persuasive leader who represents the best defense for the clan and has the function of binding the group’s anxiety. Decisions are made quickly with input that is colored by a pressure to conform to standards of group cohesion (Neither Liberty Nor Safety, pg. 9). 

This tenth anniversary of 9/11 is an opportunity for our nation to heal from our wounds rather than just defend ourselves from possible future threats. Research over the past decade has shed light on how exposure to life threatening adverse events changes how an individual, an organization or even an entire nation  perceives, processes, stores, retrieves and acts upon environmental stimuli that has become associated with a traumatic event.

Trauma-sensitive approaches to helping victims heal suggest that our country must find a way to redefine our definitions of “safety” and integrate our past traumatic experience into a coherent narrative that can be used to navigate a healthier vision of the future. As a psychologist who works on a daily basis with victims of trauma, I am looking to leaders who are:

• Committed to creating an environment of physical, emotional, social and moral safety, so that we can engage our higher brain regions in advancing innovative and creative solutions to the complex problems confronting our world.
  
• Communicating clearly about actual probability of a threat and not scaring people with the possibility of an attack.
  
• Determined to look inward for the solutions rather than blaming others. In some respect we are a developmentally very young nation that needs healthy, attentive, attuned, responsive caretakers to both sooth us and challenge us to express our optimal potential.
  
• Capable of reflecting upon the decisions that were made under imminent danger and evaluating the need for elimination or modification of those decisions.
  
• Willing to shift our resources away from protection toward policies of optimal growth.
  
• Open to engaging in honest dialogue about what lead up to the attack and how we reacted. This dialogue is designed not to point fingers and blame, but as a way of beginning to integrate our experience, learn from the past, and begin to create a brighter future.
  
• Ready to invest in educating our citizens about the benefits of developing healthier relationships within families and communities. Work on supporting the development of adaptive coping strategies to deal with potential threats and challenges rather than short term solutions.
  
• Motivating individuals to not only remember the tragic events but to encourage them to perform some positive, caring action in their community.

Terrorism comes in many forms and in all walks of society.  The symbols of the collapsing towers and the loss of 3000 valuable lives can serve to awaken all of us to the terrible fear and pain children in our country face every day. Millions of children are abused neglected and exposed to violence in their homes and in their communities each year. In a 2004 longitudinal study of 768 New York City teens, reported in Applied Development Science (Vol.8, No.3) and sited in an article by Tori DeAngelis (Monitor on Psychology, September, 2011), the authors compared the rate of mental health problems among those exposed to the 9/11 attack with those teens who had experienced or witnessed community violence but were not directly exposed to the attack on 9/11. These youth are exposed to assaults, domestic violence, bullying, and murders were far more likely to experience a mental health issue than those exposed to the isolated event of September 11, 2001. True Homeland defense must not exclude those most at risk.  Take this tenth year anniversary to find a way to get involved in  your community to improve the quality of life for someone more vulnerable than yourself and making the world a safer place.

“The role of elders in any society is to determine what experiences we want our children to be exposed to with enough repetition that it gets passed onto the next generation.” Dr. Bruce Perry, ChildTrauma Academy 

Stress Changes The Way We Think - Part Two

Individuals who are exposed to isolated traumatic events, such as crime, car accidents, serious injuries, or medical procedures, may have a similar reaction to mine, but more intense.  These individuals experienced a biological reaction—stress, pain, fear—and the body replays these reactions whenever something reminds them of the stressful event.  They may find themselves avoiding situations that remind them of their scary experience. They might sense a physiological stress reaction to cues that have become associated with their painful memories.

Therapeutic interventions for people exposed to single traumatic events are designed to expose them to the cues associated with their painful memories of the event, but in a predictable, moderate manner. This allows them to master the situation and integrate it into narrative story that can be used to build resilience for the future. Cognitive focused treatments, EMDR (eye movement desensitization and reprocessing) and other trauma-sensitive treatments are very effective in helping these clients recover from their exposure to an overwhelming event.

Sadly, the children referred for treatment at the Denver Children’s Advocacy Center (DCAC) are rarely the victims of a single crime.  While parents live in fear of “stranger danger,” the little girl from a happy home who experiences one vicious sexual assault on her way home from school is actually much more likely to heal from the trauma than is a child who has been repeatedly abused from infancy.

The majority of children in treatment at DCAC have a chronic history of maltreatment that has affected their development and disrupted the functioning of their regulatory systems. Current stressful events are interpreted through a lens filtered with past traumatic experiences. Their brains lose the capacity to use internal sensations and feelings as a guide to interpret current events. Everything is associated with threats from the past and perceived as dangerous.  They are in a state of perpetual stress. 

Fight or flight works well in the jungle, or in response to a single isolated emergency—the need to run for a plane, for example.  The children we see are in a state of constant high alert, with elevated heart rates and no ability to rationally evaluate threats.  If your abuser could strike at any moment, and your home—which should be a place of safety—was instead a scary place where danger lurked around every corner, you would be hypersensitive too.

Staying hyper alert and constantly scanning the environment for possible threats takes up a great deal of these children’s energy, and interferes with their healthy development.  Many of them have learning problems, sleep problems, relationship problems, mood regulation problems and behavioral control problems. All of these problems are symptoms of a poorly organized, poorly functioning regulation system.  All of these symptoms are the result of unremitting trauma over a long period of time.  The body never has the opportunity to self-regulate. For these individuals an event similar to my airport experience could have been devastating.

Even when the children know that their abuser can no longer harm them, it can take many months (sometimes years) to “de-program” the accumulation of years of adverse experiences.  In the assessment and treatment program at DCAC, our therapists use trauma-informed assessments and provide developmentally sensitive interventions. Many of the initial therapeutic interventions are patterned repetitive regulatory sensory stimulation within a relationally safe environment. Teaching children and adolescents how to tolerate, identify, express and integrate emotional experiences into an adaptive behavior response becomes an important treatment goal. As the children and adolescents experience a sense of safety both in their bodies and within the therapeutic relationship, work on traumatic memories becomes possible. The therapists stay attuned to their clients’ verbal and nonverbal communication, shifting back and forth between focusing on traumatic memories and regulatory exercises.  This dosing of the trauma work allows the client to re-experience past painful memories in a more predictable, safe, moderate manner.

When we are scared we move into a protective stance and survival becomes the primary objective.  Our thinking becomes more concrete, our focus is on the immediate situation and our actions are impulsive.  As a species, when we feel safe and secure, we become motivated to take risks and to explore both our internal and external environments. We become open to growth, capable of abstract thinking and effective problem solving. We develop innovative, alternative solutions and respond in a flexible adaptive manner. It is under these conditions that healing becomes a reality.

Dr. Jerry Yager

For more on our work at DCAC, including upcoming training opportunities, please visit us on the web at www.DenverCAC.org.

Stress Changes The Way We Think - Part One

Even Dr. Jerry can get overwhelmed by stressful situations and fail to make sensible decisions in the face of real and perceived threats. It’s a bit embarrassing, but I want to use two recent personal experiences to illustrate how stress works on our thinking.

I recently took a trip to Pennsylvania to give a lecture.  I was running late, I had difficulty finding a parking space, and my cell phone kept ringing.  I was in a pretty agitated state when I encountered airport security, which my mind interpreted as a threat to my survival (missing my plane).  As I passed through inspection, my anxiety must have been evident and agents identified me as a candidate for a more extensive search.  Already stressed, now I was being asked to empty everything out of my pockets and to hold my arms away from my body, while this stranger moved his hand down the inside of my pants leg and across my buttocks. This was not what I would label safe touch! 

Immediately following the completion of this uncomfortable search I picked up my items and left hastily. I tried to distance myself from this disquieting situation by running as fast as I could to my gate. Arriving with a few minutes to spare I started to calm down. After boarding the plane I relaxed and regained my sense of safety.

When I arrived in Philadelphia and attempted to rent a car, I realized I had not received my license back from security in Denver. Being without proper identification far from home is not an ideal situation, and I was annoyed with myself for having been so upset by the invasive airport security search that I’d left critical identification behind. However, in this second stressful situation I did not panic. I was able to solve my transportation needs with a train and a taxi, conduct a full-day training and get back to Denver.

In reflecting on my experiences, I was curious about how worry over missing my plane and enduring an embarrassing search had taxed my ability to think clearly, while another situation that also created great difficulty didn’t seem to interfere with my mental functioning.  The two situations, taken together, illustrate the fact that stress is not so much about what happens to you, but how you react to the situation. In one situation I felt totally out of control, while in another I felt stressed but in control.

Stress, when experienced in moderate, predictable ways, and we perceive that we can take action to effectively cope with the situation, can build resilience and improve performance.  When stress is unpredictable and we feel powerless, it interferes with our ability to function, and increases our vulnerability.

Over millions of years of evolution animals have developed a system to respond to real or perceived threats in the environment. This “fight or flight” alarm system functions automatically, with predictable neuronal and hormonal activation patterns, which results in fixed behavioral responses. 

The body’s threat response system is designed to be short-term and to mobilize the body’s resources for action.  In the event of a threat, the body:

• Shifts attention to the perceived threat
• Rapidly mobilizes energy—glucose, proteins and fats are processed and relocated away from non-essential organs
• Increases heart rate, blood pressure and respiration in order to move emergency resources throughout the system
• Halts growth, sex drive, and digestion (the body cannot focus on long-term threats to health when immediate survival is at stake
• Has a diminished perception of pain due to release of powerful endogenous opioids

The body also memorizes and documents threats, so that it will know how to respond in a similar event.  Next time I fly I will probably work hard to get to the airport early and better prepare myself for the inspection. However, I can be sure that memories of this past trip will be present and influencing my behavior. I might find myself getting anxious from the time I book my ticket until I get through security. You can be sure I will check to make sure I have my identification and ticket with me after passing through that check point. As time passes the anxiety about plane travel will probably diminish, but hopefully the lessons learned will stay with me.

(to be continued)