A Review of Equine Facilitated Change in Complex Trauma

Transcription

1 1 Laurie A. Benton, Psy.D. The Forensic Psychology Department at The Chicago School Elizabeth Freund, Healing Tales School of Equine Facilitated Learning 2 Facilitate collaborative exchange between equine facilitated and trauma professionals Offer a theoretical foundation and conceptual framework on which to begin a peer-reviewed discussion of equine facilitated change in complex trauma

2 3 Overview of complex trauma Overview of therapeutic approaches to trauma Discuss benefits Offer a theoretical foundation and conceptual framework of equine facilitated change in complex trauma Provide a brief review of research approach 4 Children s experiences of multiple traumatic events that occur within the caregiving system (Cook, et al., 2003, p.5). Complex trauma has had several labels over time: Disorders of Extreme Distress, Not Otherwise Specified Complex PTSD Developmental Trauma Disorder Cumulative Impact of Multiple Adverse Childhood Experiences Emotional, Physical & Sexual Abuse Neglect Exposure to Violence Witness to Domestic Violence Incarceration of Parent Parental Substance Abuse/Mental Illness These experiences are chronic and begin in early childhood

3 5 Current System Frequent misdiagnosis Unnecessary multiple diagnoses Never diagnosed Focusing on the behavior rather than the underlying problems that are causing the behavior Complex Trauma Enhanced description of clinical presentation Assists clinicians with effective interventions Impairments of complex trauma go beyond DSM-IV PTSD diagnostic criterion Includes disruption in capacity for selfregulation and secure attachment Includes potential impact on individual s ability to self-regulate, self-organize, or draw upon relationships to regain selfintegrity Focuses on new research & importance of neurobiological differences of complex trauma 6 1.Visual 2.Association/ST Memory/Equilibrium/Emotion 3. Motor Function 4. Muscles/speech 5. Auditory 6. Emotion/pain/hunger/fight & flight 7. Sensory Association 8. Olfafactory 9. Sensory/skin 10.Somatosensory 11. Language Comp 12.Motor Function/orientation 13.Higher Mental Function 14.Motor Function The brain is organized in a hierarchical fashion: All information first enters the lower brain The survivor brain Lower brain in charge of regulatory functions Upper brain more complex thinking, planning Upper and lower need to communicate Clinical Implication: A young child growing up in a home and community with pervasive threat may create a set of associations, quite outside of awareness, for threat. Thus, many cues will trigger the fight or flight response and alter behavior, emotions, and physiology.

4 7 1.Visual 2.Association/ST Memory/Equilibrium/Emotion 3. Motor Function 4. Muscles/speech 5. Auditory 6. Emotion/pain/hunger/fight & flight 7. Sensory Association 8. Olfafactory 9. Sensory/skin 10.Somatosensory 11. Language Comp 12.Motor Function/orientation 13.Higher Mental Function 14.Motor Function The brain develops from the bottom up and inside out The brain grows during development and becomes more organized The stress response system originates in the lower parts of the brain to help regulate and organize higher parts of the brain Clinical Implication: If the lower part of the brain is poorly organized and regulated, upper parts of the brain will be dysregulated. Traumatic stress will result in patterned, repetitive stress response that will negatively impact thinking and emotions 8 The brain develops in a sequential fashion Success of one phase depends on success of the previous phase 1.Visual 2.Association/ST Memory/Equilibrium/Emotion 3. Motor Function 4. Muscles/speech 5. Auditory 6. Emotion/pain/hunger/fight & flight 7. Sensory Association 8. Olfafactory 9. Sensory/skin 10.Somatosensory 11. Language Comp 12.Motor Function/orientation 13.Higher Mental Function 14.Motor Function Clinical Implication: If the lower part of the brain is poorly organized and regulated, upper parts of the brain will be dysregulated. Traumatic stress will result in patterned, repetitive stress response that will negatively impact thinking and emotions

5 9 1.Visual 2.Association/ST Memory/Equilibrium/Emotion 3. Motor Function 4. Muscles/speech 5. Auditory 6. Emotion/pain/hunger/fight & flight 7. Sensory Association 8. Olfafactory 9. Sensory/skin 10.Somatosensory 11. Language Comp 12.Motor Function/orientation 13.Higher Mental Function 14.Motor Function Neurons change in a use dependent fashion Typical development requires attentive, attuned, caregiving and rich array of relational opportunities Clinical Implication: A child exposed to neglect, chaos, and constant fear will have an increased risk for significant problems in all domains of development 10 1.Visual 2.Association/ST Memory/Equilibrium/Emotion 3. Motor Function 4. Muscles/speech 5. Auditory 6. Emotion/pain/hunger/fight & flight 7. Sensory Association 8. Olfafactory 9. Sensory/skin 10.Somatosensory 11. Language Comp 12.Motor Function/orientation 13.Higher Mental Function 14.Motor Function The brain develops most rapidly in early life Clinical Implication: Early childhood trauma or maltreatment has a disproportionate capacity to cause significant dysfunction

6 11 Intrapersonal and Interpersonal Domains of Impairment Biology Sensorimotor Analgesia Coordination Balance Somatization Medical Issues Affect Regulation Emotional Regulation Label & Express Feelings Label & Describe Internal States Communicate Wishes & Needs Anger turns into Aggression Sadness turns into Suicidality or Self Injury Dissociation Amnesia Depersonalization De-Realization Attention Regulation 2 or more States of Consciousness Impaired Memory of Events Cognition Executive Functions Sustained Curiosity Planning Understanding Responsibility Task Focus & Completion Language Learning Time & Space Orientation Self Concept Body Image Guilt Shame Self Esteem Self-Efficacy Unstable of Self Behavior Control Impulse Control Self-Destructive Behavior Aggression Understanding & Complying with Rules Excessive Compliance or Defiance Sleep Patterns Re-enactment of Trauma Behaviors (Sexual Abuse) Attachment & Relationships Boundaries Trust Suspiciousness Relationships not used for Self-Soothing Social Isolation Interpersonal Style Relationships not used for Self-Regulation Emotional Regulation Perspective Taking 12 The brain can change, but some systems are easier than others The upper brain is quite open to change The lower brain is not as easy to change Trauma related symptoms are related to lower brain function. These areas less open to change Traditional therapy does not target them directly

7 13 Experiential Novel Sensory Emotional Social/Relational Cognitive Variable Contexts Variable Applications 14 Explains how & why change occurs Predicts what change will occur Offers common ground for discussion Offers the rhyme and reason for innovative, goal-directed, evidence based practice. Contributes to the development of standards for application, evaluation, research and innovation.

8 15 Social animals Prey animals Primal Symbiotic Potential Safety Influence Attunement Trust Relationship Experience Sequence Pattern Repetition Intrapersonal skills Interpersonal skills 16 Primal symbiotic potential of horses & complex trauma survivors

9 17 Horse-Survivor Relationship 18 Social Learning

10 19 Theory of Equine Facilitated Change in Complex Trauma Social animals Prey animals Primal Symbiotic Potential Safety Influence Attunement Trust Relationship Experience Sequence Pattern Repetition Intrapersonal skills Interpersonal skills Shared instincts of social prey animals disrupt automated defense behaviors of complex trauma survivors and offer powerful motivation for learning. The survivor-horse relationship provides a developmental context for social learning experiences that lead to changes in intrapersonal and interpersonal skills. 20 How can you use this theory? Use it to improve your practice or use your practical experience to improve this theory Use it to set goals, design new activities and develop new programs Use it to measure the outcomes of your students/clients, monitor progress, refine programming & build evidence of success Use it to begin participation in a peer reviewed discussion and contribute to the knowledge base

11 In Conclusion 21 Complex trauma alters neurobiology Altered neurobiology poses therapeutic obstacles As a therapy or adjunct, the horse-survivor relationship can overcome therapeutic obstacles and enhance traditional trauma therapy A published theoretical foundation and conceptual framework fosters collaboration, enhances application, evaluation and research. Discussion contributes to the knowledge base and supports information exchange between disciplines The most useful theories are continually refined by those who use them Use it and help us refine it 22 Questions or Comments? References Ainsworth, M.D.S. (1989). Attachments beyond infancy. American Psychologist, 44(4), Bretherton, I. (1992). The origins of Attachment. Developmental Psychology, 28, Cook, A., Blaustein, M., Spinazzola, J., & van der Kolk, B. (Eds.). (2003). Complex Trauma in Children and Adolescents. Found at Courtois, C. A. (2008). Complex Trauma, Complex Reactions: Assessment and Treatment. Psychological Trauma: Theory, Research, Practice, and Policy, S(1), Craighead, W. E., Miklowitz, D. J., & Craighead, L. W. (2008). Psychopathology; History, diagnosis and empirical foundations. Hoboken, New Jersey: John Wiley & Sons, Inc. Dalenberg, C., & Carlson, E. B. (2012). Dissociation in PTSD Part II: How Theoretical Models Fit With Empirical Evidence and Recommendations for Modifying the Diagnostic Criterial for PTSD. Psychological Trauma: Theory, Research, Practice and Policy, Advanced Online Publication. Darwin, C. (1898). The expression of the Emotions in man and animals. New York: D. Appleton & Co. Retrieved March 24, 2013, from University of Virginia: =public&part=5&division=div1 DeBellis, M. (2005). Maltreatment may lead to adverse brain development. Child Maltreatment 10(2), Downes, S. M. (2010). Evolutionary Psychology. In E. N. Zalta (Ed.), The Stanford Encyclopedia of Philosophy. Elbert, T., Schauer, M., Ruf, M., Weierstall, R., Neuner, F., Rockstroh, B., & Junghofer, M. (2011). The Tortured Brain: Imaging NeuralRepresentations of Traumatic Stress Experiences with Affective Pictorial Stimuli. Journal of Psychology, 219(3), Flinn, M. V. (2006). Evolution and Ontogeny of Stress Response to Social Challenges in the Human Child. Developmental Review, 26, Ford, J. & Courtois, C. (2009). Defining and understanding complex trauma and complex trauma stress disorders. In C. A. Courtois & J. D. Ford (Eds.), Treating complex traumatic stress disorders: An evidenced based guide (13-53). New York, New York: The Guilford Press.

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