Van der kolk - Childhood adversity and attachment disruptions: Restoration by establishing synchrony

Sam was referred to our program because he was having a very very hard time in preschool his behavior was aggressive every day toward children and toward teachers and his teacher told me when he called to make the referral that Sam literally could not go from the gate where his mother dropped him off to the door of the preschool without knocking down at least one child every day without fail and so one of the early things I did and my work with the family was get permission from Elizabeth and from the teacher to go to school with Sam and hang out with him and see what was happening and see if I could understand what was going on so one morning very early in our work together I met Sam at the gate when his mother dropped him off and I walked across the yard with him and I went into the school with him and I spent the morning but the most interesting thing happened on our trip across the yard we were walking along and Sam didn't know me very well at the time but I'd been with him a few times and so you know I I'd been with him with his mom he he knew that he you know that I was okay with her he didn't have any at any trouble coming up to me going walking with me across the yard and so we were walking and talking a little bit and I was looking down at him and I noticed that his hands had formed into fists so I reached down and I touched his hand and I said what's gonna happen and he pointed across the yard to a child who was walking toward us and said that that kid's gonna hit me and I thought well maybe I don't know you know I don't know that child so I told Sam listen I'm bigger than anyone on this ground except your teacher I'm not gonna let anyone hit you I'm bigger than that kid I'm gonna protect you I'm not gonna let anyone hit you let's just let's just keep going and see what happens so we started to walk again and we were chatting and pretty soon I noticed Sam's hands clenching into fists and his arms coming up and the little boy is coming closer and closer to us and I said again relax I'm not gonna let anyone hit you and the child walked right by us to a child who was behind us on the playground with whom he intended to play and with whom he began to play and he didn't look at us we were totally not on his radar but Sam's attention bias to threat in the real world was such that every approach seemed dangerous to him every approach led to the possibility that he would be hurt that was what his internal working model told him happened between people they hurt each other and I get to welcome dr. Bissell Vander Kolk clinician researcher and teacher in the area of post-traumatic stress his work integrates developmental neurobiological psychodynamic and interpersonal aspects of the impact of trauma and its treatment he is president of the trauma center and trauma Research Foundation in Boston Massachusetts past president of the International Society for traumatic stress studies and professor of psychiatry at Boston University Medical School he regularly regularly teaches at universities and hospitals around around the world he is also the author of the 2014 New York Times bestseller the body keeps the score brain mind and body in the treatment of trauma which I know that many of you in the audience have read in the book he shows how these areas can be reactivated through innovative treatments including neurofeedback mindfulness techniques play yoga and other therapies no less importantly dr. van der Kolk was Patricia's colleague and friend and we are delighted and honored to have you here today well thank you very much for inviting me that's quite a big deal are you Patricia particularly close to her friend Alicia liberal and great supporters of each other's word for all these years it's also an honor to be invited to Israel it's always interesting there people look to America to give you advice on how to treat people we're not doing so well over there in case you haven't noticed we have some troubles we are no longer the city of the hill that which nothing but good things come forward but indeed the field of Temari says to something we did come from us strangely enough and it is particularly fertile in Boston Massachusetts of all places somehow in there in the 70s we got together and we did something that academics really do particularly Judy Herman and myself where we decided to don't mess with each other not compete with each other we decided to actually support each other even though we came from very different fields and for the first 15 years of this field it's an extremely collaborative field where people will you share things closely together I hope you guys in this wonderful complex of buildings who achieved the same thing each better than competing with each other you'll put your resources together one of the things that emerged very early on is that we put his diagnosis of PTSD together because we were working with soldiers and very quickly we realized that there was another group of traumatized people who were quite different in some ways from soldiers and rape victims and these were people who were traumatized by their own caregivers as children and it's very clear that the greatest source of danger for children is their own parents and the greatest for a danger for women is their own intimate partners and some hardest issue of attachment has never been officially integrated in the issue of trauma and but I also hear people say is that the relationship is everything and I wish that were true because then love could cure all thousands VD so some years ago I went to the Museum in Oslo of Lynch and we all know that picture and when you go to the museum there's some interesting pictures there that may be illustrated by moosh despite of obvious honours and how deeply loved he was never really did very well was always a very unhappy person he was four years old his mother died of tuberculosis he was six years old his sister died of tuberculosis leaving her home alone to be taken care of his dead and he never believed covered from the pain of the loss of his primary caregiver and so the issue of loss and grief and caregiving all sort of fits together and continues to be not very well studied so the way that we started to study it is that Judy Herman and I got together at some point I've always been very interested in neurobiology in the brain Judy was very much a feminist person we started to talk to each other how it appeared like most patients who we had who carried the diagnosis of portal and personality disorder had childhoods histories of trauma I mean Luke's in the suture and nobody ever said that and we talked about it to our colleagues and they said Oh haven't you met Otto Kern Burke it's and Melanie Klein is all about his genetic inclination to bite depressed and to aggress against sources feed you has nothing to do with reality and he said could be let's find out so we happen to have a database of every single person in the Cambridge Hospital one of the Harvard teaching hospitals that has very good therapy and we got a hold of oldest records and people had asked all the right questions except it had forgotten to ask about it childhood trauma and attachment patterns because that seemed to be irrelevant in how people turned out to be so Judy and I started to think about how do you actually take a trauma history and we very quickly realized we're not stupid that you cannot go up to somebody and say will you ever raped the only reasonable answer to let's go to hell does none of your business so you need to be the go there gently and my favorite saying there is WH Auden as a poem that says truth like love and sleep presents approaches that are too intense as our duty and I put a questionnaire together we called it American students questionnaire that we still use as a trauma center for intake forms and we ask people interview with people we know nothing else about where do you live who do you live with who does the cooking who does the cleaning who does shopping who paid the bills very simple things some people gave us very strange answers but beer researchers we just don't decision but you in trouble who do you allow you for practical help bring your trouble who do you go to we can talk to quite a few people said I can't my dog sometimes my therapist that's not so great if your therapist - the only person I can talk to um and then we ask people hopper train great little who did a cookie who did the cleaning who made the bed who did a shopping who was there for you when you came home from school and we started to get really interesting answers and then we started to ask the real nasty questions you said buster anybody who recognized you as a special person and then we asked a killer question which to my knowledge nobody had ever asked before plus to anybody who felt safe with growing up and one out of three bases in the psychiatric hospitals said I do not remember feeling safe at anybody problem that's a very big deal and that continues to be a very big deal here then we asked a bunch of other questions here's another one of my favorite ones also for us to think about it who made the rules of enforced a discipline at home what pretty fat rolls liking your family how did you predict gets disciplined with hitting spanking verbal abuse physical object how are you parents off the disagreements very severe aggression how do your parents off your dare disagreements how do you solve your disagreements with your spouse they hit each other while out of the house you disappear you vent letters do you break things you jump out of the window at many times we have asked all these detail questions people are curious about themselves and we get the stories and I will put it all together end of scene and it turns out that 87 percent of all people who are diagnosed with borderline personality disorder had serious histories of early childhood abuse and neglect starting before age 7 when this paper gets quoted people always leave out starting before age 7 but that's a very important thing because there is such a thing as critical periods of brain development that determine how your brain matures I'll talk a little bit about it in a second other personality disorder we're not related to job to job there's a study number one but another study that came out of this projection he was much closer to my heart and that is that I've I've always been intrigued with self-mutilation people who burn themselves with cigarettes and say I'm feeling so much better now or when I cut myself at various parts of my body I actually feel better I've never tried it myself but they don't think that would work for me and so I think these people have a different biology and how do people get these different biologies and I've always hang out with neuroscientists like young punks type people like that who studied these things in young animals and they tell us what happens in the brain that might be responsible for that in terms of opiate receptors and stuff like that and so we do the study of who in the hospital is doing self-destructive behavior now turns out that suicide attempts are highly related to childhood hysteresis sexual abuse physical abuse abandonment neglect cutting sexual abuse abandonment of physical abuse eating disorders not quite as one-to-one but high correlations and then the interesting study camera is very relevant to the work that we do today and that is that this is a very is a very good Hospital to this day it's still very good Hospital people got trained to be very good psychotherapists and so we had a chance to look at what's happened to these patients and who got better in psychotherapy and who did not get better so what you're about to see is the sample of patients who did not improve with very good psychotherapy and the people who did not get better where the people said who said I cannot remember feeling safe as anybody growing up I cannot remember being a special person and so much shut up man there's a finding is actually quite important for psychotherapists is that if people don't drink the milk of human kindness when they're small the receptor for milk for human kindness may not develop and maybe psychotherapy based on the relationship may not be families all that useful there's a hard thing for psychotherapists to to actually embrace a therapist that I know refuse to actually pay attention to this data and they obviously donation ship will make people better people continue to believe that until they adopt kids art of orphanages and then it sink these kids who didn't get love out there in Russia or Vietnam or China when they come to live with us I know if the tempest of it in Israel it was a lot in our neighborhood in Boston that these kids don't respond to the milk of human kindness a very large part of our population are kids whose foster parents adoptive parents are desperate because these kids don't know people to love and kindness and live in their own little world so how do you deal with people who do not respond to human kindness now stuff is an anecdote IAM and the anecdote is we had somebody the other interesting part about our neighborhood is the most highly educated neighborhood in all of north america says both eight couples massachusetts was the first state in america that legalized gay marriage or the side effect of legalizing gay marriage I never expected that because I'm not gay turned out to me that gay couples who love each other would like to have a family and then they start adopting children to have a family together it dusty and it turns out it a lot of these very loving couples both kids and the kids were very often wall so temper tantrums it did don't respond to kindness it did not respond to limits they did very badly aside one point we get a cup of things and kids was a four-year-old kid adopted from China a year and a half before who has been mute ever since they bring it to us the famous trauma center they say can you help us and we say of course we can create the trauma center we can do anything and we get to work and three months later this kid is mute as is ever been and the good thing about outfits our hope he ever - you have team meetings aft maybe somewhat to discuss our successes but mainly discuss to discuss our failures because you learn so much more from feeling your stuff from successes better for ego but there's a science if you're trying to figure things out and so we present the case at one of our group member says you know if this is not working but there's this group across town they do sensory integration with kids and these kids welcome balance beams and sit on swings and like under heavy blankets and they lie in pastures log balls on top of them all sensory input and sensory integration let's give it a try and we said this kid over there I'll after a few weeks they start talking you say that's interesting and there's something there and then Liz this Warner was a member of our staff Oh sometimes these tapes disappear don't buy the latest Apple they make your slides go into the cloud never to be found again I have to download them that's pretty good okay so this is Liz I was so I just checked out before we started okay so this is a psychologist who used to work with autistic kids and she says this is really interesting let's set up a sense of integration lab at the trauma center so because you can see we're very wealthy Clinic was very fancy equipment and one of the things that we discover is that if you get a little trampoline that kids idolize these videotapes I mean kids jump up and down a trampoline something changes in the perception of time before the distance I really screwed up and it just filled with emotion or being shut down and when they start jumping the sense of time comes to mind for me as a neuroscientist very interesting because the sense of balance here is your cerebellar vestibular area the brain is the talking center in of your brain is in the left anterior freefall too low so by changing the balance exists in the brain you activate a different part of your brain so when kids start so here's the equipment that we all should get it no temple leans he talks about tomorrow and I'm a very body oriented person I really had the time to talk about stuff I would talk about your body and also about synchrony and it is interesting that they I talk a lot of group to groups like this how you don't notice it by yourself but your little bit like a shawl or fish when one person moves a lot of person moves you see people move very subtly it's very rare to see an audience like this somebody make movements at the outer sink with anybody else it's very striking dramatis people tend to make movements that are physically out of synch with their environment that means a lot I could talk a lot about everyone and so they see here is that this kid's mom comes out of the corner and moves in a way that's really not in sync with Harless boy and these are talking to deserve a traumatized boy a very messed up kid a very behavior consultant and we still have a trauma focused everything oh who put what into but orifice who beat this kid up what happens to this kid because sathi does how people think about trauma and as you'll see it's something very different so mom comes out of the corner making a movement that's artistic for the best and then she says something that again is out of sync with whatever else is happily and be human leaves being in sake being a very well functioning person means you're in sync with your surroundings anybody saw a muscle arm beverage you just saw how this the diagnosis a real diagnosis this means that in our family only one person gets to talk at the time and there's no room for anybody else so you can look at the trauma to interview interface but as I'll show you in the course of my lecture it is usually not what the trauma is but who was in sync with you there was there feel with the primary this kid is suicidal if whenever self I threw a ball somebody opened my mouth and Titus's and people to completely ignore me I'd want to kill myself also so maybe that's what it's all about not being seen not being paid attention to not being resonated with it so everybody's complete the art of two minutes everybody and that is the pathology of this family answer that Liz spent some time really getting them to deal with but to my mind is the most important piece of equipment in doing psychotherapy is called the beach ball the beach ball is a wonderful saying you should all get one and you can tell six back and forth and you can sync with each other about the great things as you will see where you get in sync with each other you cannot help but giggle and giggling is actually a very important human activity which never gets mentioned in any textbook of Social Work or psychotherapy except for mine as you just heard the first meaningful sound in this whole movie the sound of pleasure the word pleasure has continuously ignored in our field but life as people in tel-aviv now is about pleasure and of course mom was a terribly trauma test big kids yourself who has never beaten tune and it touches anybody they just gets this deep sense of joy or finally be in sync with her kid at Emma's is and so just slowly evolves into our smart program or sensory integration program core programs and trauma center very we help some just people they get in sync with each other in the tumors each other and for the past 30 years I've done an annual conference in Boston and this year there will be many presentations on attachment by people like that tronic and Beatrice baby dr. bill would also be a very big component on sensory integration so he's about to come to Boston to feeling but you put your teeth into really his motoric synchronous actions that can actually help people to get it together is very important this is very much bolstered by the piece of work that my colleague Lucas Nadya's and her Student Survey inheres Orion we're doing in that note we also do your science stuff and brain stuff Emmet keeps showing up in the brain is the cerebellum I must keep showing up abnormalities in the precipitous system and everybody's always dismissing that because psychotherapists are into talking and making meaning turns out that early childhood trauma leads to major deficits in the sensory integration areas of the brain which beth horon take follow we'll talk about a little bit also and that if we really want to help children and grown-up children with Dharma to actually pay attention to sensory integration I'm a PC is we suck maybe we should stop paying attention to this balancing system and this core regulatory system in equity brain default the brain changes I hope to end up with that because the findings are really quite interesting so so one thing that is very important for us the traumatized people is to do sensory integration we have various options bodywork movement touch traveling music martial arts and you know feedback all things that none of you learn in school as being healthy techniques and oftentimes things that are derided as not being respectable treatments but it's a cheap McKee to do in order for things to work and the reason that I'm here is because Alicia Lieberman says those people in Jerusalem need to hear about a body and the important thing about working with the body in order for kids to recover from trauma so here's another taper hope this works better yeah it does this is tape from the lab of my good friend ed tronic who just down the street and that sonic has done a very simple thing with his life very hope our life was as simple as that he studied a very simple thing called this still faced technique but he does he sits a lab as a mom and a baby play moms of various backgrounds drug-addicted mom moms take cocaine's dramatise moms and he looks at the interaction between these moms and their babies and what she done does at a certain moment is he asked mom to freeze her face so that the interaction the music between mom and baby stops and the kid is after for himself the main reason why I'd like to show this tape is not so much for you to pay attention to what happens on the screen but most of all to pay attention to your internal sensations this is really my way of inviting people to pay attention to their mirror neuron system which is of course the critical system that we need as psychotherapists to pick up the sensations that the people we are with are experiencing and oftentimes our bodies are much better and picking up what's really going on with their patients and our minds is because a mirror neuron system is an exquisitely sensitive system that allows us to be sensory and tune with each other I said night she has a Buccaneer here as you're told don't respond to you again who says mommy is me does anybody feeling you see your body these days sir all but the most heartless people in this room have a mirror neuron system that's responsive is a-- and you feel what that little boy is feeling very remote system is mirroring the sensation assisted by him boy two minutes odd nothing happened you hope that's the worst thing is if I had a fella ever happened to this boy and in fact you can make a very good case that this is a very good seat for this boy anybody who deals with little kids knows how little kids gets very distressed on a regular basis and he gets this trust he knows that before too long his mom will be there for them very good for you to development the limbic system that has a map of what to expect in the brain at his penis I will become really distress as sooner or later mom will be there for me and make me feel better and that makes for object constancy as the kids whose parents don't response don't develop that if tofu is honest about their constancy are more likely to develop portal and personality disorder but it don't know that you can feel really upset so most of us do from time to time but it will come to an end that doesn't mean that this event has no impact six months later his little boy goes to visit his mom who's a post doctoral student in tonics lab and II who come up to the cannula and he enters in this room this little blip in his serum cortisol is something in the back of his brain it's no cognition whatsoever it's just an automatic animal-like reaction that says this is not a nice place and you'll say I'd rather be in that room and the psychotherapists will say why do you prefer that room over that room and the kid bill making up an explanation because human beings making explanation for everything I don't think there's ever been a tribe in the world and then they asked him why does the Sun rise in the east and west that they say I don't know people make up an explanation for everything particularly psychologists and most of our explanations are wrong humming here's another go people from that will laugh at the explanations we have today but we are merely making people we have to make many artisans but you do have a little imprint in your body and so what you see in this tape is the importance of the physical relationship and that particularly with rhythmic relationships very carefully studies by Coleman traversing let's call him who's peeled up this is about mother and infant talking to each other so maybe maybe we do our psychotherapy training but we should train people in his voices and faces because that's how we communicate with each other and I don't do verbal psychotherapy because I don't believe a word about my students will tell me because we're in capable of accurately reporting on our own and other people's behavior need to see it need to see people's tone of voice need to see how people move their bodies together need to see what people's faces look like when they talk to each other to avoid about what people say is served almost maybe to these important or maybe not the important season so how do kids process traumatic experiences the first study on that as far as I know was done by Anna Freud and her friend Dorothy Burlingame anybody knows their studies yet enough to ignore it and so they were done in 1946 1947 in London because Jordan is Second World War the Nazis were bombing London were causing enormous devastation kill toddlers of thousands of people at these nice longer says this is very traumatic for our kids that ship our older kids that began off to the countryside to be safe and live in bucolic surroundings and when the war is over and it will come back home and they'll just be fine all of her sex was one of those people anybody here's an Oliver Sacks fan anybody read all of her sexes autobiography the Ben but he says the second most traumatic event in his life was being shipped off the countryside the most imp traumatic event is when he told his mom that he was gay and his mom said I curse the day that you were born don't do this to your killed children because you will never be able to take that back be very careful what you say so Oliver Sacks was not these people has very traumatic and so for the Burlingame did he studies on these kids who had done to save Smarties and these kids who stayed in London were just fine and the kids who were separated from their caregivers were really messed up and depressed so did the attachment issue Trump's the trauma not in the DSM but in not a psychiatry but in real life it does so here's an example this little boy now a grown-up boy his cold norm so he happens to be the son of some people you know mr. parelle son Jackson and Noah was five and a half years old when he started first grade in PS 234 in Manhattan school that's right underneath the World Trade Center and so on September 11th he goes to school at court and I'm mourning his death Jack's drops drops him off and seven minutes later he witnesses this miss classroom only closer by than what we see here his dad runs back and they become fifty thousands of 250,000 people who start burning down 7th Avenue running away from the disaster what's interesting to me is when I show this movie to psychotherapists and I say but do you see here the response almost invariably is I see very scared people I see panicked people because you're training education works your perceptions all of us but you see here it is people running but because running is not an important part of how we think about trauma or the mind we ignored it about the running piece as those in your review yesterday heard me talk about quite a bit probably at the core of trauma his physical immobility the inability to do anything and to move away and activate your fight/flight response talked a lot about yesterday but the issue of being able to take action had to do something is probably the single most important protector against becoming traumatized a response to a terrible event that's not part of our discipline and something else I saw my colleagues are hardly acted very very interested in bringing back into this world there's a long story but just like that make very certain that we have all these meetings to talk about things and in one of our meetings or my colleagues shows this particular picture of the Brooklyn Bridge they say this interesting so when people are under stress they start running and they start running a particular direction they don't start running randomly I bet there was nobody from New Jersey on the Brooklyn Bridge that day because New Jersey is over there so when people under stress their bodies start moving to a particular place all be talking about it already we have the GPS Bob is no part of GPS part in our brain that says went beyond the stress our body is want to go home it goes over cities you had clawed jumped up here a few years ago and clawed chant of the devii search in New York Google traumatized turned out almost nobody in New York of traumatized except the people who were married to mentally ill traumatized domestic violence type situations so as long as when home was not safe people go traumatized and so as long as you can move as long as you have a safe place to come home you're probably going to be okay that's true for children that's two finals and then as all this going on with your work I have a flashback to the last page of my anatomy textbook to medical school which is something you probably also frequently hear in this colony versus last page of letters techno pronounced music he really nailed it I mean you can traumatize your body gets activated to flee to fight it to get away with something and what our research has shown which I talked about yesterday know is that when you get so attached to your frontal lobe terr shuts down and you take leave of your senses nobody is rational when you feel under stressful that's seen for you place like this where people are always under stress because it makes it harder for you to be bashed off because you always feel threatened and your limbic system takes over having your limbic system takes over it just makes your body move and so my definition of to manage stress is when the body gets stuck in the limbic mode of fear and terror so maybe the first thing you do with challenges people is to make their bodies feel safe and how do you make their bodies feel safe by reuniting them as people who didn't love people who hold him doing things like yoga and other things to make their bodies feel safe and it's not a cognitive issue it's a body issue and the bunnies do feel safe and as I talked about yesterday it's oftentimes extremely difficult to make the bodies of traumatized kids and adults feel safe and calm and that becomes a great challenge the slider girls of Steven Porges mela of course I didn't leak all blood you idiot I'm a reptile we all become reptiles when BR on the threat so this is a picture I took in New York and so after disaster I'm sure it happens in Israel also people tend to pull very close together people tend to become very nice to each other after a disaster because evolutionarily we know that we need to be good to be more traumatized if because if we don't they'll bite us in the ass because they will stay in their trauma and become aggressive that means as some more societies become very calm and safe and of course not always as terrible disasters and I think that's what we deserves just that you treat here as kids who cannot be helped to be feel feel safe after terrible things happen because I never their parents are too traumatized disrupted mentally ill or disorganized to actually provide a sense of safety for them and that means that you have to do it so um the story here is that Esther Perel and Jack her husband I walk through the pit of the World Trade Center on September 13th they knew some of the people cleaning up there and we come back home around 9 o'clock evening and no one shows me this picture and I say to no man no man can I have that picture that's just an amazing picture he says no and they say you know I'm writing a book and I really want this picture to be my book and so are you give it to me he said no he said I'll sell it to you how much $400 I said that something keyless nobody ever bid on the laws for time performing to 5 year old kid he says take it or leave it that's resilience so I I peel the ha those are my talking to give it to him he says boy that's an easy hunter box he lives two blocks in the World Trade Center he makes a lot of pictures of what he saw that day and he urged his entire college tuition selling has been does had us dealing with trauma really that's the American Way maybe this very video so why was I so desperate to get his picture those are this he's a five and a half year old drawing what he saw plane flying in the World Trade Center people jumping out firefighters telephone booth and doraga work I say so what's that he says you know when the plane hit versus fireball and the heat of the fireball came through the window and I thought we've got to get burned up I think yeah that's how people remember as a sensation it's not a story it's an image anybody who have seen who escaped from the World Trade Center fuses in that body feels the sound they get triggered by some people with nice attributes are triggered by smells or by touch so it's a particular sensation and I say so it's that over here he says oh that's a trampoline and they say what's the trampoline doing there he says sir there's been people jump out of the World Trade Center they can catch them and they will be ok they go home our president has come on TV two days before and his opening line is people killed him dead or her life and I go oh my god the leader of the free world is Olympic man who responds like a dog who has been upsetting there is no intervening from the Loeb action of how else you can do don't be like that you shall fall to Loeb guys because the world people get destroyed if you don't use your frontal lobe and so here's this five and a half year old kid who has a frontal lobe and the visa I wanted this picture is because being a dramatist your imagination goes and that sounds means you're getting raped that image means that you're gonna die so this is no lack of intervening response all good trauma therapies evolve imagination imagining new realities as many ways of doing it you need to see how things are different I happen to personally love theater I love sensorimotor psychotherapy I love sancho therapy I love JK Rowling was a terrible trauma history and the escapes like creating Harry Potter stories and made Britain grow blessings to the whole world by her imagination life is about imagining new possibilities good luck imagining how Israel and Palestine can solve the issues my imagination fails me I hope yours doesn't so next chapter in 1999 I got a phone call from a foundation that says dr. Falco great be following your work and we'd like to fund you to do a study on how trauma affects learning I say poor nobody's ever called to offer me money is fantastic this is a good idea of my life but have you had the work of Dante chickadee who has written extensively about it but they say no have you learned about how much truth they said no have you bet Frank button and they say no so I said you know we don't need more studies on who how trauma affects learning we need to actually have a system where people learn all that stuff that we know already even the last two days a whole bunch of people kept up this great research ideas and yeah some for a good work on that dung by about 15 different so maybe if you read the literature you can actually move to field further rather than views and and so I say to make these wonderful thunders you know very nice I'd like to do another study but it would really be a waste if nobody beats the study at once again so the issue is not that we don't know that they don't know the issue is that nobody beats this stuff and there is no discipline where people learn about the effect of trauma on learning so he said let's have a qualification with members of the Senate Ted Kennedy's health care advisors some other senators some high muckety-mucks any governments to some some my friends who were a good trauma has gel Serapis including flow gentle veterans part of that also we get together for three days and we decided to set up a National Child traumatic stress Network we tell every go to Congress in America which at that time used to be functional they actually did things at a time and they fund 40 million dollars per year to fund a child's National Child traumatic stress Network which now is all over the US and all these different places talking to each other somewhere over there is us and so but at first like to talk about but do we actually know all this stuff that already was there and so the first person to mention is dr. chicory how many people have read down to Jionni how many people have read Sigmund Freud we don't educate him so Dante was in in my junior faculty member at Harvard when I was there also and don t is a beautiful man who is a spirit in his spare time a fashion designer whose hair falls down to his boss if you go for that he's a beautiful man he does amazing work when he comes up for tenure the faculty at Harvard sinks he's not our type so he doesn't get tenure even though he is actually one of the great men of my generation what does he do he such a bird school cat summer cabin with abused kids and normal kids and he videotapes their behaviors he videotapes their learning patterns they video a video tips their play patterns I started really talking about how developmentally traumatized kids are different from other kids then he gets to see how P relationships a difference our learning things are different our sensory integration takes a difference and then he also shows that at the time that the time that the trauma happens has a very different impact on the long term effect something that I never hear traditions talk about but we talk about these things if you want to develop really effective treatments we need to be much more precise in our characterization of the deficits of the things that we try to cure that person I need to make mention is my colleague event Carlin lies Ruth who's also in my hometown and it starts with this starter something that I believe resonates miss namely when I was in medical school I delivered about 13:30 children to 14 and 15 year old two single girls and that's quite a little growth experience for a young bored about really bothered me is how these girls didn't seem to have any visitors so I said to them in my innocence of the way I've noticed that nobody has come to visit you how do you think you go to basis little baby and their answer was horrifying they said don't worry about it doc I've always wanted half a baby and we'll go home and we'll take care of each other and there's a funny four-year-old boy I knew that the old babies don't take care of their mothers and this was a setup for disaster so that's just a sort of question that got carlin really interested in what would have happened to discus so two years later she makes home visitation and it turns out an 86 was undies kids are very troubled kids mainly off the aggressive variety in the u.s. maybe not in Israel if you're a two year two and a half year old Baden years kid the likelihood you'll ever get off that trajectory is extremely slim this is pretty much of contempt for a lifetime of dysfunction so Carla looks at the literature and she identifies the most single most effective therapeutic intervention dr. mankind namely home visitations where you help mothers to hold and respond to their kids and to be a witness each other the masses of David's olds in the year 2000 Jon Hackman won the Nobel Prize for analyzing that particular treatment and he discovered for every dollar debt to society invests mother-child interaction therapy the society harvests $7 it benefits the long range of people finishing school become taxi bitings taxpaying citizens don't go to jail and stuff like that so he Carlin basically tries to teach her mother's to be like one of my favorite people to be really in tune and in touch and synchronous with their babies I always thought crying massive I miss that guy so she does this for her half a year and then after having year the kids are so much better and then suddenly happens to her that does happen to every single one of my really innovative friends the rug gets pulled out father Neath her as she loses her funding it's happened to me a bunch of times happen to Frank but then I could mention just one long list of people who are terrific innovators and somebody doesn't like the work deputy I'll leave it up to your own paranoid ideas why that is so Carlin loses her funding has never done anything wrong she's a little bit of money left continues to this small sample at the end her kids after year and a half are almost as well as the controllers so very effective treatment but what's even more interesting part Connors work is that she takes videotapes and those videotapes for me are stunning video because they tell me something about what happens here so she does his very main type attachments tapes were kids playing mom comes in the room you videotape the mom you see moms have eager to show what a good mom she has picks up the kid if you look really carefully but most of us have misses you see the me mum just being a little bit out of touch with the kid and the kid moving back a little bit but nothing worried so six months later mom comes to the room give us kids playing baby looks up looks away mom picks the kid up and the kids move surf moves back not good six months later mom comes in room baby looks up starts smiling falls on the ground mom picks the baby up and it gave me baby flock flops back there go that's how it starts I've always been intrigued how people get to abuse their children because child abuse is against the law of God and men and Darwin and everything about it is not normal to abuse your kids there's something really just really messed up about it how do people get to amuse the kids and in this video tips you see that because of these kids these mom and the kids are so out of tune at this born that amount that kids have come to see their moms as traumatic triggers the kids try to avoid the mom the moms are probably Travis's people on their own right so they say my kid makes me feel even worse about myself that I feel already and then this stuff starts so that's and then life is all about politics and the very interesting thing happens that 13 years after gonna lose our funding the priest abuse scandal that you in Israel probably don't know all that much about as the rest of the world breaks out in Boston it turns out there were 298 pedophile priests in the Archdiocese of Boston who were molesting kids and all hell breaks loose my boss for example at the time who suggested priest who has tried to cover things up for the Cardinal so my clinic is closed down and all kind of disasters happen everywhere but bar the results of this this whole piece of a scandal is that this sub money becomes available for people seeing maybe abuse may not be good for kids even though people say Moses abuse is called by a false memory syndrome of therapists implanting false memories in their patients minds and so Carly get some money to follow up her kids and to see what happens and she tries to locate him in the Department of Mental Health social services in jail it turns out that about half of our kids are there now and it turns out that these kids have all kind of problems and the main problem is the Association these kids cannot feel they have borderlines features there have effect this regulation they don't feel their bodies they don't have a sense of pleasure they don't have a sense of agency and they are major behavioral problems just like against that you see now as a quote from Winnicott that's very much also goes with it because what turns out is that the lack of responsive 'ti and synchrony at age 2 predicts these behaviors at age 16 and 17 years kids and then at the same time a student of mine does this research that shows indeed that if you have this early childhood trauma stuff that the areas of your brain has has to do with the self-awareness knowing who you are knowing what you are what you stand for actually gets severely damaged so early childhood trauma when you have no resonance and no mirror asset neural system that's reflected by others leads to very severe brain damage I hope to talk about it so what time do I have on the half-hour so I have till 3:30 I think I'll go to 3:45 they have love good stuff to show if that's okay okay good so it's insulin carding correlates the behavior of these teenagers and she sees that the big behavior predictor of borderline artificial behavior there is 1617 his lack of verbal comforting engagement of the home and emotional and physical toll on the home and then does she does another study very interesting having a researcher you should never be married to your results because she shows had the data that Judy Herman and I came up with about borderline personality disorder were fundamentally wrong always nice research shows you the things are different so but as Connie shows is that these symptoms that be blamed on trauma and neglect but Carla state prospective data show it's all the result of lack of a tournament between the mother and the child and if you're not being a - - as a kid then you're more likely to also have trauma episodes but the trauma observed a secondary the lack of having it attuned relationship to your parents I think that's sort of important information because it has something to do is how do we help people to feel the - to ultimately to be known that cetera etc and then we do study I was the header day he is M for PTSD committee and but just study shows is that kids PTSD symptoms are due to Chalmers as specific events but all the other stuff that we see in our practice anger expression suicidality Snarf's injurious behavior difficulties relationships with others cumulative victimization the somatic complaints are all a function of the attachment system of broken attachment systems then there's Frank Putnam and 'days Allen's shrew forgave all these prospective studies and then we have covent of arson who starts to study a very important thing they did her brain is shaped by the experience that we have early on and if we are being seen and known and acknowledged exactly the part of the brain that allow you to know yourself come online having feelings for others come online and having feelings for yourself and so then there's a new piece of research that comes aligned mainly from my friend Marty tiger also in my home town who starts looking at how different forms of abuse at different ages have different effects on brain development very important if we as as clinicians must have developed the most effective treatments we should be much more precise diagnostically in what is going on here and how can i precisely change this system let me just quickly show what the cumulative evidence is of chronic abuse and neglect in children defects the amygdala search engine sure it's fat detection everybody know it also affects your ventral prefrontal cortex the capacity doesn't die in my book I called the ventral prefrontal cortex the watchtower the part of your brain that knows what goes in on the inside of you make atomic tests you don't know what's happening inside of you you have no internal self-awareness this is called alexithymia for those of you who are followers of envy crystal or y'all psychoanalysts it also affects the orbital prefrontal cortex orbital prefrontal cortex is the part of your brain that if you've wake up at 3 o'clock in the morning and you have a really angry thoughts about Australian Prime Minister and I want to tweet him you put your good cellphone back on the desk and you put your hands on your bias bomb and go back to sleep but if you don't have an orbital be fault the cortex you cannot inhibit yourself you have to do that sort of stuff very well events to the work that we do very relevant for juvenile justice I'm sure that in Israel like in America all juvenile justice programs are based on finger wagging if you keep doing this terrible things will keep happening to you know it's that way not that way but but when you're a juvenile delinquent who has been abused and neglected you don't have a finger wagging receptor no matter how often you warn people that bearable things will happen to you it doesn't come in you cannot control that and as I talked about yesterday maybe martial arts or boxing might be helped a lot more effective ways of building up an inhibitory system in your brain and the medial prefrontal cortex then any psychological known to mankind and America I'd like to say if any of you have a trust fund I would love to do a study comparing tango dancing as cognitive behavioral treatments are certainly capoeira with CBT for traumatized kids and have a pretty good hypothesis about which Bumble work better because bunch in the heart of brain works you know that cognition or get you there you cannot get there by understanding and insight dorsolateral prefrontal cortex part of your brain gives you a sense of time that's off line everything that's bad happens to you it feels like this but lasts forever that you'll not be over and lastly very central to my thinking and the work that I do and the research I do is tear your cingulate which allows you to understand what is relevant and what's evelopment and trauma really messes up the part of your brain that tells you what is worth paying attention to actually I hope to have a minute to talk about it at the end so that's stuff stuff stuff all these differences is happening in the brain and then beyond all these wonderful C's for monkeys this is Steven Sumi who were who got Harlow's monkeys and so if you have a safe mom you have a completely different biology than if you have a mom who is scary all very well worked out all very well worth reading some degree has summarized in my book and then we start a National Child traumatic stress Network and we had finally have a chance to see how we can treat travel test kids and but but the network is about a surfer race of who can develop the people that look and get the most money and research grants the first thing get good yes develops is single incidence drama CB team and I think to myself that's not my be set up the network the network was really about dealing with domestic violence and kids growing up on a quality dangerous circumstances so my group done does a survey of 22,000 children in the network and see what sort of trauma happens in American kids which is probably face similar to what happens in Israeli kids most common thing childhood emotional abuse second most common losing a parents to the war to jail to mental illness having impaired caregiver domestic violence childhood sexual abuse neglect childhood physical abuse and this being America our Senate says you need to find out how traumatized kids are by Osama bin Laden than by Muslims and it turns out that is not an issue for America's children maybe something to also in Israel to also pay attention to who are really that people weren't really dangerous to your welfare I have no opinion about it and then we look what do these kids suffer from and what they suffer from is major problems with effective circulation major problems with attention and concentration major problem is hating themselves not selling themselves major progress impulse control major problems aggressions devastating and after we connect all these data and do a survey of the literature of 200,000 people we get together and form a committee and sent a recommendation to the American Psychiatric Association to create a new diagnosis called developmental trauma disorder had kept just the reality of kids who are traumatized in the context of their intimate with their caregivers as anybody you ever see here people who were traumatized in the contact I don't anybody ever not see people who were heard this is as far as I know the bulk of what we do for a living sort of important to do that right so a month after we submit our proposal you may recognize some of the names here I give a talk to all the commissioners of mental health in the United States and they really like what I have to say and they say we are an organization of all the commissioners all different states and we spent 29.5 public mental health service dollars and we urge you to make this the most important priority in your development of dsm-5 I go but that's great that can go home and go back to actually doing work and doing stupid politics and so what is development otama disorder you have experienced terrible things in the context of a caregiving system it's not there for you that doesn't make you better and it leads to problems with affect dysregulation like an inability to modulate tolerate or recover from an extreme effect states anger shame temper tantrums immobilization you ever see anything like that in your practice disturbance it is very much I think disturb is it bodily functions eating sleeping elimination of reactive dogs if you sound and touch the minister where knows anything impaired capacity describe States second piece problem is attention and concentration preoccupation is fats impact passive free self protection habitual self-harm stuff like that and then issue of the self hating yourself hating other people being aggressive not being able to really forth intimate friendships and anybody else because the world is always dangerous and you see so we submit that and then the months later we can report from the American Psychiatric Association says this is very confusing you know all this stuff and only sinks this happier person and all these 200 papers take your submitted things to heart it's submitted but if in the next 26 days you give us a paper about the genetics of this disorder the epigenetics disorder the cultural variations of disorder the long-term prognosis of disorder the familiar patterns of disorder and five other things none of which is known for any psychotic disorder we will be considering so why is it that what a nuke answer this and then something very bad happens namely I'm sorry looking at a newspaper to buy a scuba-diving shop in Curacao I've had it but we have postdoctoral students and postdoctoral students are a mixed bag the good things about them is that there are very smart they're really know just statistics they can go nights without sleeping and work their asses off they are generally quite pleasant fairly nice to look at that's all great things the best thing is that they don't have a cynical bone in their body and think that the truth will eventually come out so there's a revolt on buyer post doctoral students assess let's do it and in 24 days we interview 20,000 children according to Jose by far the best field trial for dsm-5 and then read slow back analyzes attachment issues there is not attachment issues comes very well and then two months later we get a response from the American Psychiatric Association dsm-5 committee that says this the consensus was just a little evidence at this time it's include DTD in the dsm-5 the notion of early childhood hazards verse experiences lead to substantial developmental options it's more clinical intuition and research-based fact this statement is commonly made but it cannot be backed up a bad prospective studies even though we had submitted about 18 prospective studies or at an officer year period so what is it about our society that's unwilling to see who we treat and the real to retreat which means that we cannot study but read because it's Lawren your patients don't exist you can just give each other so anecdotal information so on the other hand we have a law of choice we can call our patients PTSD desert the mood regular is very reactive attachment disorder not so solid when the postman positions are fire covers are a black person we can call them all those things depending in America may be known Israel on what your insurance company bought the inversion for him how low have we sunk can you imagine - a going to a cardiologist will give you a diagnosis on the basis of what the insurance company will pay him for one of them what's going on with your heart but our profession and I'm astounded that clinicians are actually willing to live in la-la land and give patients diagnoses that have actually almost nothing to do with the reality of the deal with you are being Israelis who are known to be fairly opinionated and so many people I would encourage you to actually talk about these things and talk about the reality of puppetry my comfort is that at least luckily my book has been sadly missed certainly outstanding the dsm-5 that's good so why is it important it's very important because we need to define but what we need to do and need to define what works we need to do affect regulation use sensory integration do it how are you funded did was executive functioning how do you deal with traumatic reenactments how do you deal with interpersonal how do you deal with foreign bodies how do you deal dissociative disorder and a self injurious behavior and how we deal that people switched between very different states from time to time these are all different aspects all of which need to be addressed separately and people say the relationship will work I have some data I almost shot in here of most of us when we meet somebody with a kind face and a sweet voice our brains calm down I have some nice videos some brain scans about how traumatized people with childhood trauma look at the current face on his feet voice and what lights up is the periaqueductal gray the part of the brain that are called a cockroach brain the terrified part of the brain and so our assumption had been we are nice and sweet to people he'll make him feel safe this is mistaken notion our patients who have been abused neglected do not necessarily see us as safe people and we may become so let me just finish with two things so how do you rheostat overcome trauma first of all we are social animals so stabbed you mean it's terribly important how do we establish community by moving together see get together drop me together making music together this is a brain scan of brain scans that my friend Yuriko photography and saint-petersburg justice off kids singing together I sing it together dramatically changes their brain second piece is talking you need to be able to tell the truth and they're perfect Games champion is John Bowlby whose favorite saying as far as I'm concerned was what cannot be communicated the mother cannot become it itself has to be able to say what happens it's critical if you cannot say it that goes into your body and it didn't happen so talking is important and how do you do it but in any way you can this happens to be a series of drawings I'm not going to explain because I want to show one more thing before we start and that is that oftentimes people come out to me and try to tell me about their own favorite treatment I get more advice for favorite tapers than all of you combined nobody feels good on this I adopted and that's sometimes pleasant and about 25 years 20 years ago people start telling me about a neuro feedback I say do you know about neurofeedback and I say no what is it he said well you could put electrodes on people's skulls you can harvest the brainwave below it you can project his brainwaves a little computer screen and you can create games that give feedback to the brain that rewards certain brain forms and don't support all of us and I think that's cool show me your research how are we saying show me your research there nothing appears in the mail and then the man I called my best friend Alexander McFarland does a very important study that is very relevant to all of us and it shows how normal people including kids who are traumatized versus kids were know traumatized process information and there's the response to an ordinary thing like this sound like hey you make me make a sound like that you collect I see so sick and tired of talking to us or has he lapsed into his native tongue where is he unwell you brain need to do something to figure out what I'm saying and what turns out that normal people if there are such people when they hear sound like this all different parts of the brain are working together to figure out other this when you're traumatized there is an internal desynchronization and all the part of the brain are not working together and specifically in a normal brain you generate a wave that filters out everything else and say don't pay attention to anything else until you figure out what n means traumatize people no filtering to pass next thing is a normal person creates a piece free hundred fish is a learning way for the brain to V take things in and learn stuff and we get traumatized you have a lousy piece three hundred it's very hard to learn things and you're traumatized because your brain is muddled up oh my god how are you ever going to address that and then and meets secret fish who teaches me about in neurofeedback way she says here I was treating this eight-year-old kid and that is his family drawing I say that's a pretty large family drawing and then she says I do 20 sessions and you were feedback and that's his family toy that's pretty good and you tell you more sessions and that's the story and if you already know treatments that can do that in three months you should definitely not learn your feedback but if you can I would like to hear about it because I never knew of anything I've can do that can change people's capacity to represent the reality in three months and that way let me show you not bad and so you learn about neurofeedback you learn about brainwaves artists or stuff and you get to work you do studies and so here's an example he'll see here's an Somali refugee boy who is completely out of control we do a quantitative EEG on him much easier to do Turner's brain scan that's a good resolution but cost about 350 euros to do it in your office I'd love to see is his frontal lobe is all in Delta means that his frontal lobe is asleep I have it very much like to encourage people did you pontedera VG's and may you seek one today VG's and you look almost on the Peconic oh my god I wondered how that this kid is actually able to do anything and you see how messed up his brains are it's astounding and then we train him for study sessions there's fall to log because normally no bridge there we do study on adults plus one very good results at PTSD but the interesting thing and it's both true for the adult study and the child study we have done yes we train the brain over here we train the brain in the primitive fear center of the brain and limbic system where basically sir trauma sits at all upset out of control part of the brain is not falta lovers back there and what do we see huge differences in effect violation susceptible to the difference interpersonal conflict basically by training down the theater from brain RTC as dramatic improvements in executive functioning and planning and decision-making error correction that mental flexibility dealing with danger stuff like that same with kids kids based before and after finished so basically does what we are into love and report by Freud oldest trauma sits in a nether survival part of your brain that keeps selling you're in danger will hate you you're a terrible person and basically what all of our job is to strengthen this self frontal lobes to avoid in the field of perception and larger this organization is getting a corporate first portion of its that stuff that sits out there where it was I shall come to be it's a work of culture not unlike the training of desire as a for advances in 1932 but it just started the trainers are those they took till about 1958 to joy to trainers are today so this is not a quick fix but if you keep doing it and try over at different methods sooner or later you will get there thank you very much [Applause] yeah yeah thank you so much if we have time at the end then we will have time for questions okay but right now we always invite in Israeli discussant to these public lectures to be able to respond from our countries so I would like to invite our very own booth potential PhD she's a professor of Social Work at the School of Social Work and Social Welfare here yet here University a clinical psychologist who received her PhD also from here and completed her postdoctoral training at the University of California in San Diego her current research topics focus on risk and protective factors for childhood pH PTSD relational trauma emotional regulation and post-traumatic growth and she co-edited the books treating traumatized children risk resilience and recovery and helping children cope with trauma individual family and community its perspectives and there you go thank you very much bein sink I thought how fortunate it is to speak after the doctor peasant Vandercook now I think how unfortunate it is to speak after bezel vanderkoff it is a great honor and a wonderful opportunity to be here today and I would like to thank the organizers of this fifth annual conference of the memory on the memory of Patricia Van Horne dr. Pollard Ovid professorship in area and her off center for their generous invitation and to thank dr. basil wonderful for a very inspiring lecture I think Patricia would have been very curious to hear about the latest development and insight on trauma and attachment disruptions know less about the new directions and innovative methods for recovery first I will highlight the major lesson that we learn from Patricia van Owen for militia Lieberman from desert vandal Cole and then I will describe how we applied this insight in our research on early childhood trauma and in the development of the new clinical interventions for young children and parents I remember how the Israel Center for the treatment of psycho trauma invited Elisha Lieberman Patricia Van Horne Chandra Ghosh ethan and other colleagues from the University of California San Francisco for a conference on treating traumatized children at the Hebrew University in spring 2009 this conference actually changed the trajectory of training of many Israeli professionals it definitely played a central role in putting the topic of early childhood trauma infant mental health in child parent psychotherapy at the center of our academic and clinical attention since then we have developed at the Hebrew University a special training in infant mental health and dr. Pollard of Eden HOF Center created a wonderful program of CPP child parent psychotherapy from the lecture given by Patricia Van Horn back then in 2009 I add it was entitled training to build capacity to provide services I remember the main message which was there are effective ways to treat childhood trauma and we need to provide services as soon as possible with the focus on the primary and most meaningful relationship the inspiring book of bezel van der Kolk on body the body keeps the score has been at the center of many professional meetings I know that here in Israel there are groups of therapies to meet regularly for systematic discussion of its various topics and implications we learn from to determine and from basil van der Kolk how important it is for trauma therapists to connect and to elaborate together on this complex and painful topics in a way these books this book brings us together and in a way I felt here that bezel was in synchrony with the audience and that felt so good in our body - I read the book in small bites pausing to think to reflect on my clinical experience and to integrate the new insights and revelations that often provided deeper perspective moreover I could share some of these revelations with my traumatized patients and they often felt understood the students here I'm sitting among the audience are familiar with both Patricia Van Horn Alicia Lieberman and bezel Vander Kolk writing they are including in the reading list film in my courses and Roman resilience in fact they have a lot in common in their deep understanding of the complex childhood trauma and in their keen enthusiasm for treatment and recovery and innovative ways of treatment and recovery the more they understand the pervasive damage of attachment disruption to the development the more they are committed to effective and relational treatment and they both reiterate the message safe connections are fundamental to recovery and that healing is about restoring the process of development of trust in a significant relationship I will just mention a few similar theoretical and clinical emphasis the first and the most important one is the focus on the primary and most meaningful relationship and the construct of synchronicity a term that both patrician basil used to describe the delicate yet so natural healthy way to create bi-directional communication and relationship according to Patricia van Horn when development takes place in optimal relational environment the resisting chronic interplay between mother and baby in which each matches the other affective patterns allowing recreation of their other in their own inner psycho biological States van der Gaal says being in sync with oneself and with others requires integration in the body based on the census vision hearing touch balance and if this doesn't happen in infancy there is an increased chance for later sensory integration problems later I will show a research that actually looked at it and documented it the construct of synchronicity described kind of an ordinary magic which is part of mother child early relationship Ruth Feldman used micro analysis to research these dyadic interactions that create the synchrony she argued that the synchrony is very specific to the parent baby interaction and the children and parents brains coordinate during those moments and how the parents mature brain extremely regulates the infant immature brain many other related concepts such as parental attunement parental sensitivity parental warmth reflective functioning mentalization save and return reciprocity mirroring they all describe the process of developing attachment which is a fun dimension from foundation of healthy development all of them try to capture the core aspect of this central developmental achievement which make makes all the difference for future life and the creation of future meaningful relationship and I quote here another beautiful sentence from the book early attachment patterns create the inner maps they chart our relationships throughout life not only in terms of what we expect from others but also in terms of how much comfort and pleasure we can experience in their presence second the needs to identify trauma in early childhood ELISA Lieberman Patricia Van Horne basil Vanderpool they all confronted us with a deeply rooted tendency to deny childhood trauma Patricia pointed out that we tend to idealize infancy as early childhood period of time and safe and carefree time of life and in fact there are there has been little research on the incidence of trauma among infant toddlers and preschoolers and basil is in his colleagues they put forward the DT D the developmental trauma disorder diagnosis and convinced us with the need to better capture the identity and the broad clinical phenomena of developmental trauma disorder which goes beyond PTSD and which emphasized the regulation problems we are now more aware of it and we are aware that many children who suffer from neglect and abuse may receive multiple diagnoses which may distract the clinicians from identifying the core developmental trauma and the complex PTSD that can be at the center of the distress and thus may lead to ineffective treatment failing to address the central developmental trauma we listen carefully to this call and actually started to do more research on early childhood trauma and the accumulating evidence is alarming both in terms of high incidence of traumatic stressors that affect young children below the age of five but also there is evidence that young children disproportionally are the direct victims of violence with children from birth to age of three having higher rate of morbidity and mortality due to physical abuse third the understanding of the trauma is stored in the body and there is bi-directional communication between body and mind Patricia wrote that the body responds to highly stressful stimuli with a dynamic process that involved multiple systems and vonda called phrase it in his book trauma reshapes both body and brain compromising sufferers capacities for pleasure engagement self-control and trust they also pointed out to the link between trauma and dysregulation into the growing understanding how trauma impairs regulation in all domain emotional physical cognitive and interpersonal enforce the promise of intervention Alecia Patricia Basel repeatedly described in depths the long-lasting and pervasive consequences of trauma abuse and neglect and at the same time the great belief in attachment based treatment for childhood trauma led them to write teach and train many clinicians in effective trauma treatment there are angels in the nursery and also in therapy rooms they belong to a growing group of optimistic proactive social activists group of trauma expert that believes that bonding and building relationship can heal but also we need to learn how to integrate body focus treatment into trauma recovery work including specific methods to rewire the brain it is not surprising that the lecture we just heard addressed innovative treatment modalities such as yoga role-playing dance meditation and as it's written in the book the approaches to healing damage attunement system need to include training in rhythmicity and risk reciprocity this insight are in the are in the basis of our latest intervention developed to enhance awareness of emotion and bodily sensation and to strengthen the capacity of emotion and physical regulation and now I will move to briefly describe our research in Israel on early childhood trauma and on relational emotion regulation and relational trauma and relational trauma was defined by syringa and zina as the co-occurrence of post-traumatic stress in Multan easily in parent and child and most likely the symptomatology of the parents accepted by the symptomatology of the child and it's also called regulation that influenced from both sides we search for mediating and moderating factors in relational PTSD now when I talk about my research item with the papers and we are we aware of the fact that parental post-traumatic distress and parental depression and PTSD influence child post-traumatic symptoms and distress but the more interesting questions are how does this happen what are the mechanism by which the influence of the parental distress affect the child and the many theoretical explanation through attachment reflective functioning parental attunement parental competence but we chose to focus on parental emotion regulation and the reason we chose parental emotion regulation is because we believe parental emotion regulation can be taught can be practiced can be improved or promoted and we want to develop services and treatment to improve them so the the idea the rationale for our our study was to look at the construct of emotional regulation and to see how it can be helpful for understanding the intergenerational transmission of trauma and how we can contribute to promoting better abilities of emotional regulations so we can mitigate the distress transmitted from the mother to child and how we can translate they do clinical interventions so this is my favorite star a slide showing how the mother regulate herself and that helps her to Co regulate the child and then the child learned to regulate himself or herself but when the trauma strikes it makes this task of self-regulation much more complicated and if the mother suffer from post-traumatic symptoms it's much harder for her to regulate herself and then more complicated to provide this sensitivity attunement reflective functioning etc good modeling and coagulate her child under stress that both of them are experiencing and then the child may have a problem to learn to self-regulate himself and can develop all kind of behavior problem problems emotional problem etc and that makes the life of the mother and the task of power regulation even more complicated so I'll briefly describe two studies that we did one based on a large representative study sample of Israeli society of young children and mother and the other based on a smaller sample of children who grow grew in the Roth area and were exposed to multiple and continual traumatic stress before we explained the results or show the result I just want to show you how how we assess maternal emotional regulation how we operationalize that and how we assess it using this questionnaire that has the following sub skills the ability of the mother to accept her emotional responses or these difficulties of the mother to engage in goal directed behavior because of her emotion problems in impulse control problems in in ability to be aware of the emotions or limit access to emotion regulation strategies or no no emotional clarity or little emotional clarity all these aspects assess problems in emotion regulation of the mother and just a quick slide to show that maternal emotional regulation is not synonymous of maternal post-traumatic distress because we may argue that we just invented a new term for an old phenomena and that maternal emotion regulation and maternal PTSD are actually describing the same thing and this correlation show that this is not the case the correlation is around 0.43 which is moderate high so what we found we did kind of mediation analysis and the mediate the meaning of this mediation analysis is that the difficulties of the mothers in regulating her own emotions mediate between maternal post-traumatic distress and the child problems and we found it in internalizing problems in externalizing problems in regulation problems and in PTSD symptoms and we published quite a lot of studies about this we also did some longitudinal studies to follow the children that grew up under continuous traumatic stress we actually assessed them when they were between the ages of two to four living in the road near Gaza Strip and then we reassess them after seven years to see how they were doing seven years later at the age of ten eleven so we did it in 2005 seven and then again 2012 and 13 just before the break of the one of the war and we found four longitudinal courses this is just to illustrate the interesting thing that the resilient longitudinal course which is defined that these children were not suffering for significant symptoms at the age of three and when they were reassessed still they didn't have significant symptoms they were resistant at the age of three they were resistant at the ages eleven and we called it resilient trajectory was the most common trajectory more than half of the children were fine then and find seven years later then we had another longitudinal course of recovered those who had symptoms when they were younger but when we reassessed them didn't suffer from significant distress and they had they were 18 percent of the sample those who developed symptoms didn't have symptoms at young age but developed them later and we don't know exactly as a result of what percent and the chronic distress was found in 11% more result of this study showed that there was more stability than change over that over time those who were distressed most likely remain distress 70 percent of them remained in distress those who were resilient most likely remained resilient and as I said resilient was the most common longitudinal course which shows that resilience is common rather than uncommon we also found that maternal post-traumatic symptoms predicted the chronic distress of the children I didn't bring here the the results because we don't have the time I just the summary of the results but not surprisingly what could what predict the distress of the chronic distress of the children was much their mother's chronic distress recently together with Aviva dr. Aviva yeoman who sits here and I'm sure you were very pleased with the sensory integration problem that dr. vandal called described because the occupational therapists are experts in sensory modulation problems and actually it was a diva who together we collaborated and looked at the result how maternal post-traumatic symptoms actually was associated with executive functioning of the child with sensory processing problem of the child and behaved that show it in different ways emotional a sensory and behavioral in a very recent paper that is still under review Aviva showed that those children who suffer from PTSD those are in the right histogram have higher rate of sensory modulation problem it's like 31 percent of them suffer from definite sensory modulation problem and another 31 percent suffer from probable if I understand it right Aviva and you can see the huge difference between those children who suffer from PTSD as compared to children who do not suffer from PTSD and that's really open our eyes to look at the broad picture that being exposed to continuous traumatic stress is beyond PTSD symptoms it's spread to regulation problem that includes beyond the emotion regulation also sensory regulation problems and executive functioning problems and that means what what it means to suffer from PTSD distress of a post-traumatic distress in every in life why you sit in class and you cannot concentrate while you are so he / sensitive that any touch can distract your attention so that's that's the meaning of the toll that these children pay for being exposed to chronic or to continuous traumatic stress so the clinical implication are that there is a need to enhance parental emotion regulation no doubt and there are effective intervention for increasing emotion regulation capacity for both parents and children and as we learn from Tremblay why not start early we should start as soon as possible we should started early childhood and interventions in with preschoolers and school-aged children appear to foster gains in emotion identification and emotion regulation and I remember what dr. Valle del Cauca said that $1 for $7 the best prevention is early and in early childhood so I just want to mention two intervention that were developed at the Israel Center for the treatment of psycho trauma the first is called enamel make room for play this is a dyadic group program for mother and young children that are practicing together core regulation in group and everything is done in a playful and fun manner and this program was developed by Professor Estelle Coyne and together with the team art for this row center and we implemented it in many groups since the roadways the result it's published so those who are interested can read the paper the second program that I'd like just to mention is the panda bear this is a program for building emotion and effect regulation for school-aged children and let me just show you a few photos of the group activity it address regulation in several domain physical regulation emotion regulation cognitive regulation behavior regulation and social regulation that is when can I ask help for other from other and when I can provide help to other and everything is done in in a fun and playful manner so just an example from practicing mindfulness in the group it's based on three stages of slow down your body in your thoughts orient and focus on yourself and the environment and skin and rate yourself and then they are doing self-monitoring activity they rate their relaxation or anger or any other emotion that they are working on on what we call me meter they just rate how how much do they feel it now and they rate it again after the activity is over and they just can notice the difference or the stability or just be aware of it they also draw safe place as a physical regulation and practicing physical regulation and all the resources that they accumulate in the group activities are stored in what we call eye box these are actually treasure chests it's not shoe box and they just accumulate it and some of the children are using it for when they are in distress in other under other circumstances such as if they are hospitalized they take the treasure chest with the resources to calm themselves down just one example from the evaluation would do we do mixed method we do quantitative and qualitative analysis of the effectiveness of the group I just brought you an example of behavior change that we give them vignette he pathetically vignette and they answer to how would they respond to hypothetical vignette for example if someone would provoke them so at first before the group a boy said I would throw a chair in table at and after the group he did say I would go out and try to calm myself down so that's the purpose and and the satisfaction from the program just to conclude safe connection are fundamental to meaningful and satisfying life also another beautiful quote there's a Vander Kolk book I would like to summarize that they are a lot to do in order to strengthen parents to provide better protection of their children or to coach parents in connection and atonement we need to further explore and evaluate innovative treatment including biofeedback and mindfulness and meditation and all kinds of sports in addition to relational psychotherapy in order to open new paths for recovery and to activate the brain natural neuroplasticity and in regulation capacities I will conclude with the center that was written about the book the book exposes the tremendous power of our relationship both to hurt and to heal and offers new hope for reclaiming lives [Applause] questions before Misha or the college tuitions - a lot a few questions if anybody wants do I even have a microphone to pass around when I see a two year old and a mother often instead of the interactions that you saw in your videos the nice ones I think of both of them having a smartphone or a tablet good I'm wondering if that concerns you well it's certainly sherry Turkle who is the person at my - vice versa his freaked out buyers and I'm actually of course gravely concerned about kids being raised by i-pass but I'm also really amazed by is that the children who I have in my environments both all the all the parents where I know three generations down they all don't do if smartphones they're all doing the iPad pass we I live in a very conscious community I'm astounded by that actually so that's sort of my people who I my framework for the future you look puzzled like that may not be generally true but actually I'm astounded how young people I know are very cautious but these are off course educated people people who see parents of course in general being raised by see the brain is made to interact and for you to have an action on somebody else and others have an action are you I research is out yet but having a law stimulation when you're not part of the stimulating and defeating back is unnatural for of course value worrisome but I'm also impressed with how many young people I know are aware you're still waiting for the research to I in our research EMDR people with chronic his childhood trauma as a group did not get better and some of they've got worse on the MDR that doesn't mean that the MDR cannot be a helpful tool and I certainly use EMDR as one of the many tools for developmental trauma but develop out the charm is about attachments as part feeling safe with people I don't think EMDR has a lot to offer in terms of the attachment system it's great for helping you to neutralize traumatic memories our latest research a reaction to what happens in the brain when you do a sure death again but attachment issues do not resolve get resolved by that stuff I know people who disagree with that but they haven't done the research to prove this their religious opinions are correct research is important of an aviso shows it didn't work for now I chose that it didn't burn but but but we do know is that every therapist should know multiple techniques if you work with develop will determine you need to become very good for many different things and if you only adore one thing maybe should charge or game the third off your did you ask maybe it's for a whole other lecture but team if you can say in a few words the impact of the yoga and martial arts on the grain what happens there that is what working about the movements that makes the difference well but but our neural imaging part of the yoga shot has you activated medial prefrontal cortex and the medial prefrontal cortex is that one part of your conscious brain and actually have a direct connection with your limbic system so this is sort of the part where your consciousness is able to say I'm upset right now but remember I'm safe so that what the Hindus called the third eye happens to be the seat of consciousness and that's the one place where you can actually consciously calm yourself down and yoga meditation sweetly activates that that part very very powerfully but there's also intriguing is that yoga activated the insula and that kitchen is a whole body thing because the insula always shows up in all the neuroimaging studies of trauma particularly developing to trauma namely if your if your body is filled with heart-wrenching and gut-wrenching heartbreaking sensations you try to push that down right so you get a deactivation of the insula it means that you feel less in your body that means you don't get so upset by your heart breaking you got venge but your source of pleasure excitement and motivation is also comes from bodily impulses if this feels good I'm going to more of them so if you shut down or kill that part of your brain you lose your instinct of purpose which is very poor in PTSD so as long as as long as you're out of touch with your body you really are a heart of touch with life various Hebrew thing to say look I because I say it's very important thing that I talked about yesterday findability is that there's this misconception that romic is about an event that's happened in the past and the sooner we get away from there the better it is that the event is over just like you're no longer in high school you no longer in the military you're here right now but so trauma is to degree to which that particular event has less left an imprint on your current sense of a world and so to my mind all good trauma therapy is done right now because it's alive right now here and you work with the present state of the body and the mind so this notion you should blast people with the memory of the trauma so don't get upset anymore is to my ready sleep misunderstanding barbar traumas I see Beth Donna no to keep keep nollie passive in I see the drastic change between angry outbursts and there doesn't seem to be any mention that was addressed it seemed that the neurofeedback was the single treatment what about the developmental trauma they got him here and is there also a piece that addresses that well maybe he didn't have developed on to trauma I'm actually quite friendly with the guy in Melbourne Marshall Perot who staked it is and he said I mean II don't know what's happened to the kid it was not a very normal family but maybe other people in this room have also experienced that just because you are a social parent your kids don't necessarily develop perfectly normally most of my friends have and myself have kids who are some funny features not because we beat them up because and so not everything in life is caused by trauma so I don't know is that kids us affected by trauma it's just something I don't care as it is a newer feedback person I want you know why should see this brain scans and how messed up the earth I want to get that brain to get regulated once the brain is regulated that person is able to have some language for the internal experience and they made them be able to say oh you know the reason my of's got triggered and try to hit that door down is because way back I saw something that my dad did to me but as long as your fault the logo is just offline and you're just one terrified person I wouldn't share appear doesn't work your therapy only works once you have a capacity to reflect upon yourself but as long as you live in the middle of danger you cannot reflect it for yourself so the first order of business is actually get the brain and the forebrain and Yoga is quite nice you can hang it for breath as are any number of other things we happen to study yoga smoking many other ways of doing it dating to the children who don't respond to kindness that you spoke about at the beginning and we meet these children do we know of any way to change to make it change to be able to make them fun well I'd like to say that if I ever had become head of the National Institute of Mental Health I would have made the issue of overcoming deficits that were developed because you miss a certain critical periods of functioning my first but in our neurofeedback with very severely abused kids we do see them calm down and we see them become more relational absolutely as us be seeing kids who actually can tolerate do karate and martial arts and sports they do make them more relational so there is just things you can do but you know when you hang out with primatologists so I'm quite friendly with the successors of heart Perry Harlow I mean these brains get damaged and if you do not get social in put in the quillion critical periods of your brain development it's going to be really hard to meet other people's emotions and all your emotions these are very hard things and you and even things as a simple doesn't nobody as we like to talk about neuroplasticity but I like to always say have you ever been married and try to change your spouse it's not so easy to change people yeah I was wondering how much of a disturbed child who does it take to result how much of disturbance in someone's childhood does it take to result in see it again showed how much of a disturbed childhood you know hates post-traumatic build a disturbed Cal troop doesn't necessarily lead to post by stressors are red who leads to externalizing internal behaviors the things that in the DSM said they brilliantly call oppositional defiant disorder meaning discusses penteado conduct disorder meaning I can't stand this gift so you get behavioral abnormalities but I mentioned yesterday is that when we created a diagnosis of PTSD it was very clear from the very beginning that early childhood trauma sets you up to be more vulnerable to develop PTSD in response a later life events and so it turns out very very substantial literature on it now is that the early childhood trauma makes you vulnerable to any number of DSM diagnosis that survived trying to get away from the 10th year because it's such a lousy scientific instrument and so you get to get pervasive you get set up to pervasively be vulnerable to just things like depression like sofia mood dysregulation like some salt disorder probably sensory integration but there's probably Brenda genetics come in and certain people are more likely to take that path or is that path so it's not like okay you can beaten up and good by parents who don't like you you develop exactly that's and these are not linear things to have the mind and the brain are very complex systems so it's not that one see these two but for example Frank Putnam study show very clearly passed in Marty Tigers here's the D studies come out all the time as if they're new every study that ties a cohort off time test kids comes up with these kids developing multiple different somatic and psychological problems that are not easily captured in a very narrow but PTSD is one and then once you have this PTSD attitude you've got to blow to the PTSD world but but our PTSD world is but what events happened to you more than about how how is this person organizing their mind and brain about reality and how I can how can I help this person to be to have a mind that's VD here and oriented to the present rather than continuing to react as if they're danger mr. Nelsen to you question I see low of questions of your I still know what and background of trauma in the home but I think that's researches is very interesting that regard and they very intrigued how you actually a diagnosis bears really we never do that but I think it says it's very clear that and the very hardest work or shows that yeah yeah yes I was like Lord though it's a but but eventually who does work shows for example is that if your mother but not your father is a Holocaust survivor you are at very fatalistic develop PTSD and I should look further into that and none of the long lines of what you find is that it's not better you a Holocaust survivor but but if your mom was a Holocaust survivor with PTSD you are more likely but an estimate emotion regulation and so choose your mom carefully again last minute there's a nice mellow mom say so but if funk tippling example probably very familiar to many of you this room if you're a kid and your mom is so reactive that you start crying and your mom gets more upset than you are a few people to zoom has an experience going up beside for me that means that that your mom is there as a source of comfort but you need to somehow regulate yourself and you start feeling very guilty about feeling anything so you start inhibiting yourself last year mom freaks out in response to it does but you're got it all spell out for us I hope in the future very good question okay first of all thank you very very much for coming it's been really really interesting I back a couple of years ago before you did the neurofeedback research you gave a lecture online with a big plea and call to action on the part of the larger mental health community regarding neurofeedback at that time I started doing my own research in terms of what was available here in Israel just to see what what we could get for some of my clients who really needed it there was one place at the time I don't know if that's changed in Tel Aviv that was doing sort of the standard neurofeedback kind of like that's like the see burn for sure was doing and and then I discovered there's this other thing called interrupt all based on some sort of quantum physics a totally different thing it was much easier to find that available and so I sent my clients for that with totally only anecdotal evidence with some really nice success and I wondered if you had experience with neurons yeah and what you think of it yeah yeah I heard about no optimal I heard people who loved is that my wife and I had lunch miss the people invented this I've blown away by how smart they were as name is brown I listen Victoria British Columbia and then afterwards we had their own or their optimal sessions and we both went crazy doing her optimal so the end of to sure didn't work for us and they said fundamentally you know his thievius grades very smart guy study with all the right people but it is one size fits all how you have a formula that you make our experience is that it's a little bit site like psychotherapy it's like you may come into my office and I think I bet EMDR s go to work for this person and in about a third of the cases it doesn't work and we find very much that our neurofeedback protocols need to be highly individualized and that even our quantitative EEG is not always a good predictor of about the best placement is I sometimes tell superficial who top in your feedback I curse the day I met you she's a very good friend and lover because it's you know it is so hard and there is so little known it's very hard to get money to do it there are a lot of very irresponsible neurofeedback practitioners and yet I think that if we learn how to do it right it can make a gigantic difference in the world but boy is it the birkin progress no but well if you don't do it we had to tear off their electrodes both of us individually we were separate rooms and I find myself getting more and more agitated I rip the thing off and time is late my wife comes out of her seat said oh my god I've never felt so bad in my life and I'm not a fan of protocol I stuff of anything because you always need to see is this working for you right now and observe the way I was trained to do neurofeedback and that's how we do it is we didn't feedback it every few minutes we say how are you doing and we get a self-report are you feeling sharper are you clearing are you are you sleeping and to continuously adjust our settings according to people's subjective response I think that interaction is quite quite important just like your psychotherapy in psychotherapy I'd like to ask people how are we doing was this helpful to you sort of a good thing by psychoanalyst never asked me most is helpful to you it's just - are you too screwed up your legs that's never like how can I help you I think it's very important for us to say how can I help ya yeah I thank you for coming it was very interesting and I'm following all of your work and my studies certify tre provider so we are working with your book and it's amazing my question is that if we speak about children and froma and the correlation between children and their mothers if we shouldn't first address working with their moms instead of with the children great question great observation so we do this nerdist kids study off like this unspeakably out of control kids with very dedicated parents and much too much and these kids can tolerate 3 minutes of neurofeedback that it turns off and it's very tough study and they don't expect very much but beer we do a double-blind study and after we open the blinds it turns out that kids who did get neurofeedback need added to Menace improvement I didn't expect that and then we had the parents debriefing evening and the opening line of the Paris was can we get neurofeedback too and I said I know what you're talking about insanity is hereditary you get it from your kids and if you're living with a completely disorganized kid who does don't responds to your affection or to your limits and nothing you will go crazy and you'll probably be artless to become fairly abusive because these is will do very bad things to your capacity to control yourself so I don't quite know their next study will look like an adult quite now how much money we have but one of my hopes is actually trained the parents and the children had to have a group of parents and children who gets alone and to compare how another group tickets sham cooks all and to see how this freak match but just like what you say but the control of the pair's has a major effect on the kids I think that's very relevant data and they think we should keep that in mind yeah we have to I'm very sorry it's already late Ruthie thank you so much for coming discussing that so thank you so much for being heard is that it's a pleasure the decorum sabatham [Applause]

Channel: מכון חרוב Haruv Institute

Views: 205,831

Keywords: Childhood trauma, Van der kolk, Ruth Pat-Horenczyk, Trauma, emotion regulation, early childhood, posttraumatic stress, Bessel A. Van der kolk

Id: r6p93kV054Q

Length: 143min 46sec (8626 seconds)

Published: Wed Apr 17 2019