Interpersonal Neurobiology of Poverty and Trauma Informed Care

Interpersonal Neurobiology of Poverty and Trauma Informed Care Trish Thacker, MSW, LICSW Program Director Minneapolis Harbor Light Center For more information or to schedule a training please contact: Trish Thacker 763 -913 -1914 trish. white. thacker@gmail. com

Introductions Trish Thacker, MSW, LICSW Program Director, Salvation Army Harbor Light Center Clinician for 17 years Advanced training in: IPNB, trauma, EMDR, forensics, narrative therapy, addictions Who’ s here today? What are you hoping to get out of today’s session?

Expectations for today I encourage you to: 1) Ask questions write down questions or raise hand ask…will also have q & a before break and before session ending 2) Take care of yourself…stand etc if needed

Complexity Disclaimer This is a simplified presentation, whittled down to core concepts. What is presented today provides a basic structure. A blueprint. A framework of understanding. This presentation illuminates a process and is merely a place to begin …

Hand Model of the Brain

Interpersonal Neurobiology Primer DEFINITIONS Interpersonal: of or relating to relationships or communication between people Neurobiology: the anatomy and physiology of the nervous system The Nervous System: The system in the body that controls internal functions of the body and receives, interprets, and responds to stimuli

Interpersonal Neurobiology Primer DEFINITIONS THE MIND: • the emergent, self-organizing process that shapes and directs how energy and information flow across time • shaped by the interaction of experience and gene expression • Represents a complex system • Characteristics of a healthy, complex system: • F - flexible • A - adaptive • C - coherent • E - energized • S - stable • Therefore, an individual with “good” mental health will generally exhibit these characteristics

Interpersonal Neurobiology Primer DEFINITIONS • Mirror Neuron system: • fires both when a person acts and when the person observes the same action performed by another • Wiring which allows for attunement, empathy , and connection • Attunement: • to bring in to harmony; the feeling of being “at one” with another human being • Shared emotional states • Powerfully influences others

Interpersonal Neurobiology Primer CONCEPTS Attachment: • a deep and enduring emotional bond that connects one person to another across time and space …”feeling felt” • Defines and effects how we perceive people and the world • Tends to be determined by the attachment style or strategy of the primary care giver • Every child grows up in a different family • Same parent can have different attachment style with each child

Concepts • Types of Attachment: • Secure – earned secure • Insecure • anxious/ambivalent • dismissive/detached • disorganized/traumatic

Interpersonal Neurobiology Primer CONCEPTS Secure - earned secure attachment • Contingent communication • perceive cues • interpret accurately • respond appropriately • in a timely manner • most of the time • Auxiliary containment – foundation for later integration • When injury occurs, the repair is made

Interpersonal Neurobiology Primer CONCEPTS • Insecure – anxious/ambivalent attachment • Parent with “unfinished business” – past intrudes into present • Available inconsistently • Insecure – dismissive/detached • Relationships as tasks and people as roles – few memories, • Unavailable • Insecure - traumatic/disorganized • Biological conundrum – drive toward and away • Parent is a source of fear or pain

Interpersonal Neurobiology Primer CONCEPTS How does this work? ? Influences perception and interpretation Mirror neurons Developing mind World is good and I’m ok World is unpredictable and I’m nervous World is cold/unhelpful and I’m separate World is scary and I’m unprotected Attunement with other Attachment style Integration and containment Intermittent integration/containment Rigid/unavailable integration/containment Fragmented/sparse integration and intrusion/no containment

Interpersonal Neurobiology Primer CONCEPTS • We are influenced by, and we influence, people and environments • Our minds will filter/define experience and perception based on our history to date (this is not static) • We will act/respond in accordance with our self-defined experience and perception • Our interaction with people and environments will effect which genes are turned on and which are turned off (gene expression) • Our life experiences influence genetic coding and the wiring in our brains and bodies (epigenetics)

Interpersonal Neurobiology Primer Side Bar Emerging field of Epigenetics refers to external modifications to DNA that turn genes "on" or "off” without changing the DNA sequence Epigenetic change is a regular and natural occurrence but can also be influenced by several factors including age, the environment/lifestyle, and disease state. This is especially interesting when we consider intergenerational poverty and the transmission What epigenetic changes may have occurred that influence the generation that follow? Ex: childhood abuse and/or neglect leave markers in the hippocampus that remain in the next generation and increase risk for mental illness and suicide What about chronic stress, poor nutrition, no time for play etc?

Quick break to: think breathe stand etc

Definitions of Poverty • Poverty results when the lack of basic security simultaneously affects several aspects of people’s lives, when it is prolonged, and when it severely compromises people’s chances of regaining their rights and reassuming their responsibilities in the foreseeable future • Poverty describes those who are poor and have little or no mobility. • Chronic poverty occurs when people experience several forms of disadvantage at the same time. These combinations keep them in poverty and block off opportunities for improving their livelihoods.

Dynamics of Poverty Difference between being impoverished and being part of a culture of poverty Those experiencing poverty often carry a sense of: Being marginalized Helplessness Dependence and resulting powerlessness Not belonging, separateness, singled out Reduced sense of history due to survival behaviors

Poverty and Attachment • Research indicates: • Poverty and related chronic stress can biochemically dampen maternal motivation and sensitivity • Increased stress due to lack of financial resources, reduced social support, and risky home and neighborhood environments directly affects parenting efficacy • Poverty is associated with an up to 22 -fold increase in risk for child abuse and neglect • Chronic and acute stress from the basic lack of security that defines poverty causes increased limbic/amygdala maternal functioning that causes the mother to perceive their child’s need as hostile

Poverty and Chronic, Acute Stress • Because the negative effects of deprivation on human development tend to be cumulative, individuals with greater exposure to poverty during childhood are likely to have more difficulty escaping poverty as adults • Chronic stress deposits an epigenetic biological marker of cumulative wear and tear on the body that is caused by the mobilization of multiple physiological systems in response to chronic environmental demands. • childhood poverty is inversely related to working memory in young adults • The greater the number of years spent living in poverty, the more elevated was overnight cortisol and the more dysregulated was the cardiovascular response

IPNB and Poverty The more poverty related stress the individual experiences, the less capable they are to effectively manage stress, which contributes to keeping them in the chronically stressed environment

IPNB and Poverty What happens to the brain when experiencing the conditions associated with poverty?

IPNB and Trauma What is trauma? Individual trauma results from an event, series of events, or set of circumstances that is experienced, or witnessed, by an individual as physically or emotionally harmful or threatening Trauma overwhelms/surpasses our current ability to cope Trauma can be singular and/or cumulative Traumatic reactions occur when action is of no avail

IPNB and Trauma What happens in the brain and body when trauma occurs?

IPNB and Trauma What can we expect from traumatized people and people groups? Flipped lid - Brown-out/black-out state Triggered reactions vs considered responses Can be physically reactive Can be dissociated “loop” of conversation Disorganized/chaotic behavior (doesn’t make “sense”) Elaborate back-story explanations Learned helplessness

IPNB and Trauma What can we expect from homeless/traumatized people and people groups? Unaware - ness of other people, ideas, causal relationships False dichotomies – black and white thinking Rapid shifts in emotional state Difficulty making decisions All manner of presentation of fight-flight-freeze behaviors The “sprint” mentality (vs marathon) which increases long-term suffering Exercising control in counterproductive ways (posturing, blame casting, etc)

IPNB, Trauma, and Poverty The acute and chronic stress experienced by those in poverty elicits the same brain response as trauma And People experiencing poverty have fewer physiological and socioeconomic resources available to them to resolve the trauma …. . We are working with a population of people who are in various states of acute and chronic trauma

Trauma-Informed vs Trauma-Specific Trauma Specific Care = the care, the treatment itself Trauma-specific intervention programs generally recognize the following: The survivor's need to be respected, informed, connected, and hopeful regarding their own recovery The interrelation between trauma and symptoms of trauma such as substance abuse, eating disorders, depression, and anxiety The need to work in a collaborative way with survivors, family and friends of the survivor, and other human services agencies in a manner that will empower survivors and consumers Includes: Seeking Safety, DBT, EMDR, narrative exposure therapy, somatic experiencing, stress inoculation training, etc

Trauma-Informed vs Trauma-Specific Trauma informed care = how care is delivered and involves management of environment, program, and staff Realizes the widespread impact of trauma and understands potential paths for recovery Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; Responds by fully integrating knowledge about trauma into policies, procedures, and practices AND Seeks to actively resist re-traumatization

Trauma Informed Care Effective trauma informed care functions like: The insulation around an electrical cord Noise canceling head-phones lifeguarding on a beach: talk through guide out throw a flotation device go out and get It contains and off-sets the negative effects of trauma

Trauma Informed Care Trauma informed care is about how care is delivered Services delivered in a manner that supports integration of brain functions

Trauma Informed Care Trauma informed care is about how care is delivered Five principles of Environment and Program Management: 1) Safety: Ensuring physical & emotional safety; “do no harm” 2) Trustworthiness: Maximizing trustworthiness, making tasks clear, maintaining appropriate boundaries 3) Choice: Prioritizing consumer choice & control over recovery 4) Collaboration: Maximizing collaboration & sharing of power with consumers 5) Empowerment: Identifying what they are able to do for themselves; prioritizing building skills that promote recovery; helping consumer find inner strengths needed to heal

Trauma Informed Care Effective trauma informed care takes into consideration the “contagion” effect of emotional states… therefore …trauma informed care must include care for the other AND care for self

IPNB Care of Self Intentionally do those things that fill me up in order to stay well ex: gratitude practice, exercise, meditation, safe people, alone time, etc Self-attunement Alignment with values Intentional boundary management Playground example Not contributing to the chaos around me protects me and clients Face/address my own feelings/experiences of helplessness Do my own work Get my emotional and significance needs met apart from work Anything that is unresolved in me will get triggered in this environment If I don’t, I risk working out my own issues at the expense of clients

Interpersonal Care of Other It’s all about who you are in the room Eye contact - attunement Listen to the story ask if they feel heard vs proving you’ve heard It’s not about what’s wrong, it’s about what happened It’s not about the event. It’s about the experience of the event Consistency Fairness Professional transparency The process IS the product In creating conditions of safety, the roadblock is often myself…

References Ainsworth, Mary. Patterns of Attachment: A Psychological Study of the Strange Situation. Psychology Press. London, England. 1979 Bloom, Sandra. Restoring Sanctuary: A New Operating System for Trauma-Informed Systems of Care. Oxford Press. 2013. Bowlby, John. Attachment: Second Edition. Basic Books. New York, NY. 1983. Bowlby, John. Separation: Anxiety and Anger. Basic Books. New York, NY. 1976. Bowlby, John. A Secure Base. Routledge. New York, NY. Re-issue 2005. Bretherton, Inge. The Origins of Attachment Theory: John Bowlby and Mary Ainsworth. Developmental Psychology (1992), 28, 759 -775. Clark, Carrie. Treating the Trauma Survivor: An Essential Guide to Trauma-Informed Care. Routledge Publishing. 2014. Cloud, Henry. Changes That Heal. Zondervan Publishing. Grand Rapids, MI. 1992. Cozolino, Louis. The Neuroscience of Psychotherapy: Healing the Social Brain. W. W. Norton and Company. New York, NY. 2010. Evans, Amanda. Trauma-Informed Care: How neuroscience influences practice. Routledge Publishing. 2014. Levine, Peter. In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. North Atlantic Books. 2010 Levine, Peter. Waking the Tiger. North Atlantic Books. 1997.

References Main, Mary. Intergenerational Transmission of Attachment. PBS Series. 1995. Main, Mary and Hess, Erik. Disorganized Infant, Child, and Adult Attachment: Collapse in Behavioral and Attentional Strategies. Journal of the American Psychoanalytic Association, 48: 1097 -1127. 2000 Scaer, Robert. The Body Bears the Burden. Routledge Publishing. 2014. Siegel, Daniel. Mindsight: The New Science of Personal Transformation. Random House, NY. 2010. Siegel, Daniel. Pocket Guide to Interpersonal Neurobiology. Norton Publishing. NY, NY. 2012 Siegel, Daniel. The Neurobiology of "We": How Relationships, the Mind, and the Brain Interact to Shape Who We Are (Sounds True Audio Learning Course). 2010. Siegel, Daniel. The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being. W. W. Norton and Company. New York, NY. 2007.

References Siegel, Daniel. The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are. The Guilford Press. New York, NY. 2001. Siegel, Daniel. The Mindsight Institute Conference on the IPNB of Attachment. UCLA. Los Angeles, CA. 2010 Siegel, Daniel. Toward and Interpersonal Neurobiology of the Developing Mind: Attachment Relationships, Mindsight, and Neural Integration. Infant Mental Health Journal Vol 221 (1 -2), 87 -94. 2001. Siegel, Daniel and Hartzell, Mary. Parenting From the Inside Out. Tarcher Press. Los Angeles, CA. 2004 Sutherland, Carol. Inner Relationship Focusing: Strengthening Attachment and Interpersonal Neurobiological Integration. Focus Training. Cape Cod, MA. 2005. Thompson, Curt. Anatomy of the Soul: Surprising Connections between Neuroscience and Spiritual Practices That Can Transform Your Life and Relationships. Salt. River Publishing. New York, NW. 2010 Townsend, John and Cloud, Henry. How People Grow. Zondervan Publishing. Grand Rapids, MI. 2004 Van der Kolk, Bessel. The Body Keeps the Score. Viking Publishing. NY, NY. 2014