EFFECTS OF

TRAUMA/
STRESS ON
BRAIN
DEVELOPMENT
EFFECT OF TRAUMA/STRESS
ON BRAIN DEVELOPMENT

HOW OUR EARLY EXPERIENCES

SHAPE OUR PHYSICAL AND MENTAL
HEALTH

Kathleen C Gaffney PMHCNS, CPNP, PMHS-BC

 LEARNING OBJECTIVES
Upon completion of this lecture, you should be able to:

1. Identify areas of the brain that are affected

by trauma/stress
2. Identify behaviors for each age group that
are related to brain changes secondary to
trauma/stress
3. Define Allostasis and Allostatic load
4. Recognize the relationship between
common medical problems and brain
changes from Trauma/stress
5. Identify methods to effect change
 Areas of the brain affected by
trauma/stress

 Activation of sympathetic nervous

system (flight, fight, freeze response)
 Suppression of parasympathetic system
 Increase in cortisol levels affects brain
cell differentiation
 HPA Axis (Hypothalamic-pituitary-
adrenal axis)
2000-2009 American Health Assistance Foundation
 LIMBIC SYSTEM:

 Hippocampus
Amygdala > regulate emotions
& memories
 Corpus Callosum-integrates information
from the right and left hemispheres
 Cerebellum – Complex information
processing system involving verbal
working memory, attention, language
and predictions based on experience
EFFECTS OF TRAUMA/STRESS
ON THE BRAIN
 SMALLER INTERCRANIAL AND
CEREBRAL VOLUME
 SMALLER CORPUS CALLOSUM – less
integration between hemispheres,
language centers and emotional
memories not connected (PTSD)
 CHANGES IN THE CEREBELLAR VERMIS
 DYSREGULATION OF MULTIPLE
NEUROTRANSMITTERS
 LONG TERM EFFECTS OF
CHRONIC TRAUMA/STRESS
 ALLOSTASIS-
 Mc Ewan defines this as “the ability to achieve
stability (homeostasis) through change”
 ALLOSTATIC LOAD-
 Cumulative load on the body as it attempts to
adapt physiologically to the stresses in one’s
life.
 Physiological toll on the neurobiological/
neuro-endocrine systems

 McEwen,B.C.(2000)
 Aggressive behaviors as
related to Trauma/ Stress
Poor
Attachment/
abuse/neglect
Reacts negatively
due to faulty Chronic Stress/
interpretation, trauma affects
negative world view Brain
and faulty brain Development
development
Fight/ fight or
freeze response
=aggressive Hypervigilent
responses Interprets Stimuli
Negatively
 AREAS OF IMPAIRMENT IN
CHILDREN EXPOSED TO TRAUMA
ATTACHMENT
AFFECT REGULATION
BIOLOGY
BEHAVIORAL CONTOL
COGNITION
DISSOCIATION
SELF CONCEPT
 Symptoms in School aged
children
 Attention and learning problems
 Decreased interest in school
 Nervous with inability to concentrate
 Anger, rage, regressive behaviors
 Irritability and hyperarousal
 Somatic complaints
 Adolescents
 Same as school aged children
 Increased risk taking behaviors
 Substance use and abuse
 Oppositional behavior
 Aggression, poor impulse control
 Continued difficulty managing feelings
(poor affect regulation)
 Adults
 Depression
 Suicide attempts
 Alcoholism and substance abuse
 Smoking
 Overeating
 Increased risk factors for leading causes
of death
 The adverse childhood
experience (ACE) study

Study done by Kaiser-Permanente in from

1995-97
 17,000 participated

 Relationship between negative

childhood experiences and risk factors
for leading causes of death in adults
 RESULTS: The more exposure to
childhood abuse/dysfunction > the
more risks for poor health outcomes
 Adverse Childhood
Experiences (ACE) Study
The ACE Study is perhaps the largest scientific research study
of its kind, analyzing the relationship between multiple categories of
childhood trauma (ACEs), and health and behavioral outcomes later in
life. Growing up experiencing any of the following conditions in the
household prior to age 18 :
 Recurrent physical abuse  Someone who is chronically
depressed, mentally ill,
 Recurrent emotional abuse
institutionalized, or suicidal

 Mother is treated violently

 Contact sexual abuse
 One or no parents
 An alcohol and/or drug abuser in
the household
 Emotional or physical neglect
 An incarcerated household
member
http://www.acestudy.org/
 Health declines with increased
Adverse Childhood Events(ACE)
•alcoholism and alcohol
abuse
•chronic obstructive
pulmonary disease (COPD)
•depression
•fetal death
•health-related quality of life
•illicit drug use
•ischemic heart disease
(IHD)
•liver disease
•risk for intimate partner
violence
•multiple sexual partners
•sexually transmitted
diseases (STDs)
•smoking
•suicide attempts
•unintended pregnancies
ACE Pyramid
 Follow up Studies on ACEs

 2009- Five states reported on a

randomized study
 population-based representative sample
from multiple states stratified by
demographic characteristics, including
sex, age, education, and race/ethnicity.
 26,229 individuals interviewed by phone
 Results of 2009 study
 59.4% of respondents reported having at
least one ACE, and 8.7% reported five or
more ACEs.
 this study found that ACEs were common
among all racial/ethnic groups
 Limited study: Only 5 states involved
 Continued study needed but intervention to
prevent ACEs is crucial
 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5949a1.htm
 Summary
Trauma in Childhood
1. Affects brain development
2. Causes social, emotional and cognitive
impairments
3. Affects behavior due to changes in brain
and impairments
4. Leads to multiple medical and psychological
problems
5. Early death- 20 years off life expectancy
(American Journal of Preventative Medicine,Nov,2009)
 How to effect change
 Holistic view of patients- awareness of the role
trauma/stress from the past affects our patients in the
here and now

 Therapy –Irvin Yalom, “The Gift of Therapy”- therapy

is a new/reparative relationship, a healthy attachment

 Education – teaching patients self care and self

advocacy
 Medications- biological method to correct dysregulated
neurotransmitters
 EFFECTING CHANGE
 Therapeutic Relationship
 CBT: Cognitive Behavioral Therapy
 DBT: Dialectical Behavior Therapy
 TF-CBT: Trauma focused CBT
 Mindfulness Therapy
 Resilience skills :
http://resiliencetrumpsaces.org/non_m
enu.cfm?ID=46
 EDUCATION
 Teaching Self Care
 Behavioral Coping Skills
 Self-Soothing Techniques
 Setting Healthy Boundaries
 Incorporating an Internal Locus of
Control
 Self Regulation Skills through games
with children
 MEDICATIONS
 Medications used judiciously to target
the dysregulated neurotransmitters
 SSRIs
 SNRIs
 Mood Stabilizers
 Medications to correct the metabolic
disorders caused by either the faulty
coping mechanisms or the body
responses to the stressors
 References
 Perry, Bruce http://childtrauma.org/
 Schore, Allan http://trauma-pages.com
 Siegal, Daniel
 Teicher, Martin Scars That Won’t Heal
(March,2002) Scientific American Inc.
 Yalom, Irvin, D, The Gift of Therapy
(2002) Harper Collins Publishers
 References
 Allostasis and Allostatic Load:
Implications for
Neuropsychopharmacology,McEwen,B.
S.,NEUROPSYCHOPHARMACOLGY 2000-
Vol 22,No2 (retrieved Nov 2, 2009)
 http://www.cdc.gov/nccdphp/ACE/findi
ngs.htm
 ADDITIONAL RESOURCES
 www.childtrauma.org
 www.nctsn.org
 www.oprah.com/sideshow/oprahshow/2
0081016-towa-danielle/2
 Cohen, J, Mannarina A.P.,Deblinger,E.,(2006)
Treating Trauma and Traumatic Grief in
Children and Adolescents, New York, The
Guilford Press
 MORE RESOURCES

 Gil, E., Helping Abused and Traumatized

Children,(2006) New York, The Guilford Press
 Levine., Kline, M., (2007) Trauma Through a
Child’s Eyes, Berkeley, CA, North Atlantic
Books
 Ogden., Minton, K., Pain, C. (2006) Trauma
and the Body, A Sensorimotor Approach to
Psychotherapy, New York, WW Norton &
Company
 And More Resources

 http://resiliencetrumpsaces.org/
 http://resiliencetrumpsaces.org/providers
.cfm?id=8
 http://www.trauma-
pages.com/trauma.php
 http://health.oregonstate.edu/synergies/
2013/the-importance-of-early-
development-for-later-success/