Tag Archives: Treatment For Childhood Trauma

Recovery: How the Brain can ‘Rewire’ Itself (Neuroplasticity).

childhood_trauma_effects

Childhood Trauma And The Brain :

Severe childhood trauma can adversely affect the way in which the brain develops, leading to, for example, extremes in anxiety or great difficulty in controlling emotions. However, there has been exciting research conducted showing that the brain is able, under certain conditions, to ‘rewire’ itself, correcting its own faulty circuitry, and, thus, alleviating the behavioral and emotional problems caused by the original damage.

The adult brain is much more changeable and modifiable than had previously been believed. There is now a large amount of evidence to show that damaged neural (brain) circuitry resulting from severe childhood trauma can be corrected, reshaping our brain anatomy and consequent behavior, with the right kind of therapeutic interventions. In other words, it is now clear that brain architecture continues to change throughout adulthood and this can be manipulated in highly beneficial directions.

Many people who suffer extreme childhood trauma go on to develop personality disorders as adults; one hallmark of these disorders is rigid, destructive behavioural patterns. Research is now showing, however, that certain therapeutic interventions, due to neuroplasticity (the brain’s ability to change itself), can change those behaviours to become more flexible and adaptive (helpful in creating a more successful life).

Another problem those who have suffered extreme childhood trauma  develop later on is extreme and obsessive worry which can be so severe it is pathologically categorized as obsessive-compulsive disorder (OCD). For the purposes of explaining how neuroplasticity works, let’s take that (ie OCD) as our example of a problem which needs to be alleviated.

With OCD, obsessive worries can become so extreme that the person experiencing them becomes actively suicidal. Such a tortured state of mind can persist for months or even (as in my own case) years. Indeed, one suicide attempt nearly killed me and I even underwent electroconvulsive therapy (ECT) — to no avail, most regretably (see the ‘My Story’ category if you want to read a bit more about this profoundly distressing period of my life). When anxiety is this pathological, medications may dampen the symptoms somewhat, but, this, of course, fails to address the root psychological cause of the problem.

With this kind of anxiety, terrible and terrifying events are unremittingly anticipated – whether these are largely imagined or not is not the point : the problem is that the threats FEEL real. When something truly appalling is even remotely possible, in the mind of the individual experiencing obsessional anxiety, it FEELS INEVITABLE.

Neuroplasticity-Based Treatment :

In order to address such life-threatening (due to risk of suicide) conditions, the psychologist Jeffrey Schwartz has developed a NEUROPLASTICITY-BASED TREATMENT; it has already yielded excitingly successful results.

To understand his form of treatment, let’s first examine the theory of why those suffering from OCD become mentally fixated on their intense anxieties.

Schwartz, first of all, compared the brains of those who suffered from OCD with the brains of those who did not (by taking scans). After he delivered his form of psychotherapy, he took the scans again which revealed the brains of the patients had normalized.

In ‘normal’ people, when something goes wrong, there is a period of anxiety which gradually wears off. However, with OCD sufferers, the period of anxiety is not only much more intense but also maintains an iron mental grip on the sufferer – the individual becomes ‘stuck’ in this intense anxiety phase. So what is going on in neurological terms?

Schwartz generously enlightened us in the following manner :

1) When something anxiety inducing occurs, a region of the brain, known as the ORBITAL FRONTAL CORTEX, is alerted. Activity in this region of the brain is far greater in those who suffer OCD – it becomes HYPERACTIVE.

2) A chemical message is then sent from that brain region to another brain region – the CINGULATE GYRUS, triggering the anxiety response. IN PEOPLE WITH OCD, the activity here is, again, far more than normally intense. Crucially, too, in people with OCD, the intense activity in this brain region STAYS ‘LOCKED ON’ (as if the ‘ON SWITCH’ which has activated it CANNOT BE ‘SWITCHED OFF’). Indeed, Schwartz referred to this phenomenon as ‘BRAIN LOCK’. (In ‘normal’ individuals the activity in the stimulated brain regions gently fades away, as the brain designed it to do).

The treatment Schwartz developed is designed to ‘UNLOCK’, and normalize, the manner in which the brain’s circuitry works.

THE FIRST STEP in the therapy is for the OCD sufferer to RELABEL what s/he is experiencing AS A SYMPTOM OF HIS/HER OCD. S/he should remind him/herself that it is ‘just’ the neurological malfunctioning (the ‘brainlock’) which is the true cause of his/her discomfort, NOT the content of the anxiety itself. This relabeling provides some mental distance from the content of the obsessive concern. The more the person can concentrate on the physiological reasons for the feeling of distress, and the more s/he can distance her/himself from its actual content, the more effective the therapy tends to be.

Once this has been acknowledged, THE SECOND STEP is to REFOCUS THE ATTENTION ON SOMETHING POSITIVE and, ideally, pleasure-inducing.

As the person gets better at implementing these steps, new brain circuits start to develop : the obsessive circuits begin to be bypassed. Of course, changes do not materialize instantaneously – the brain takes time to ‘rewire’ itself.

If the person finds implementing the above two steps difficult to do, s/he should remind him/herself that even distancing him/herself from the content of the anxiety and doing something pleasurable instead for just one minute will help develop the beneficial new brain circuitry.

Two rather pithy sayings, often quoted by psychologists, help us to remember the theory behind the therapy :

– ‘neurons that fire together, wire together’

– ‘neurons that fire apart, wire apart’

To end this post with an encouraging statistic, it is worth recording that 80% of Schwartz’s patients got better when this therapy was combined with medication.

RESOURCES:

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David Hosier BSc Hons; MSc; PGDE(FAHE).

Borderline Personality Disorder (BPD) : Further Treatment Options.

childhood-trauma-fact-sheet

Individuals suffering from psychiatric conditions such as borderline personality disorder (BPD) find there are a vast array of therapies on offer purporting to be able to effectively treat them. The choice can seem overwhelming and confusing.

In the case of BPD, however, although many different therapists may claim that the particular therapy that they offer is beneficial, research shows that there are only a few which result in significant improvement.

Cognitive Behavioural Therapy (CBT) is one example of an effective treatment, but, as I have dealt with that in several of my other posts (just enter ‘CBT’ into this site’s search facility if you are interested in reading any of them) so will not discuss it further here. Instead, in this post I will look at the following 4 evidence-based therapies for individuals suffering from the condition of BPD. These are:

1) DIALECTICAL BEHAVIOUR THERAPY (DBT)

2) MENTALIZATION BASED THERAPY (MBT)

3) TRANSFERENCE-FOCUSED PSYCHOTHERAPY (TFP)

4) SCHEMA THERAPY

Let’s look at each of these in turn:

DIALECTICAL BEHAVIOUR THERAPY –

this was the first therapy specifically designed to treat BPD. Research into its effectiveness have yielded encouraging result : it reduces the risk of the individual who undergoes it from attempting or commiting suicide, and, further, after a year of being treated with DBT many show a significant improvement in their condition (although, despite this improvement, they may still feel substantial emotional distress; due to this fact, it is clear treatment programs lasting significantly longer than a year need to be implemented and assessed).

What does DBT involve? The therapy uses a combination of psychotherapy and group therapy. The group therapy helps the individual recognise that his/her intense emotions often get out of control, in a destructive way, and teaches techniques related to how these emotions may be regulated (controlled) by the individual who suffers them.

DBT is strongly influenced by Buddhist philosophy, and, drawing from it, encourages the individual to accept his/her distress (see my post entitled ‘Why Fighting Anxiety can Make It Worse’ for more on why such an approach is effective); it also encourages the individual being treated to meditate to calm down the inner emotional storms that may often rage within them.

In conclusion, it is worth saying that although much research suggests that DBT is very effective for treating BPD, because it is complex, and uses techniques from several other therapies, it is difficult for researchers to know exactly which elements of the therapy are the effective ones. More research is necessary to answer that question.

MENTALIZATION BASED THERAPY –

MBT, like DBT, was designed specifically to treat borderline personality disorder. MBT is largely based upon the idea that the core reason why individuals develop BPD is that they EXPERIENCE PROBLEMS EARLY IN LIFE IN CONNECTION WITH HOW THEY BONDED, AND RELATED TO, THEIR PRIMARY CAREGIVERS, which, in turn, leads to them experiencing further DIFFICULTIES WITH FORMING AND MAINTAINING RELATIONSHIPS IN LATER LIFE. MBT seeks to help the individual suffering from BPD empathize with others, ‘put themselves in their shoes’, and develop awareness and understanding in relation to how their volatile emotional outbursts affect others (people with BPD tend to have an impaired ability to do this if they do not seek out trewatment).

So far research into the effectiveness of MBT has been encouraging. It has been found to:

– reduce hospitalizations

– reduce suicidal behaviours

– improve day-to-day functioning

TRANSFERENCE-FOCUSED PSYCHOTHERAPY (TFP) –

this type of therapy is based upon the theory that individuals who suffer from BPD often have severe difficulties with their perception of interactions with others. Following on from this observation, the theory also assumes that the BPD sufferer will tend, too, to misinterpret his/her relationship with the therapist. In order to try to correct these chronic misperceptions and misinterpretations relating to the individual’s personal interactions, the therapist helps the individual gain awareness of what is going wrong with his/her interpersonal interactions and teach him/her strategies and techniques which help to correct the problem. Research into the effectiveness of TFP continues.

SCHEMA THERAPY –

SCHEMAS are deeply embedded CORE BELIEFS ABOUT ONESELF, OTHERS and THE WORLD IN GENERAL; these deeply held beliefs are LAID DOWN IN CHILDHOOD. The therapy aims to change the BPD sufferer’s NEGATIVE, MALADAPTIVE and UNHELPFUL SCHEMAS into more POSITIVE, ADAPTIVE and HELPFUL ONES.

Early research into the effectiveness of this type of therapy suggests that it can significantly improve quality of life and reduce BPD symptoms. Whilst these findings are encouraging, it is necessary to carry out further research into the therapy’s effectiveness.

David Hosier BSc Hons; MSc; PGDE(FAHE).

Psychotherapeutic Interventions That Research Suggests Are Helpful For Individuals Suffering with Borderline Personality Disorder (BPD).

childhood-trauma-fact-sheet

A quick search of the internet reveals a very large range of therapies on offer which purport to treat BPD effectively. Indeed, the sheer range of putative treatments can seem confusing and overwhelming.

It is for this reason that I concentrate on just six treatments which research suggests are the most beneficial.

Let’s look at each of these in turn:

1) MENTALIZATION-BASED THERAPY (MBT).

My previous post on BPD referred to how people suffering from it have difficulties with how they are attached to (ie how they relate to) PRIMARY CARE GIVERS (eg parents). This can manifest itself in ATTACHMENT DISORDERS (which I also looked at in my last post) making other relationships they develop in adult life very difficult, volatile, complex, painful and distressing.

MBT seeks to help the person understand the roots of these difficulties and how their feelings and behaviours may be impacting on their relationships which in turn makes these relationships problematic.

Research shows that outcomes of MBT treatment have so far been very encouraging.

As well as reducing relationship problems, the therapy has also been found to lessen the likelihood of suicidal ideation ( thoughts and plans about suicide) and hospitalizations. Also, it has been shown to improve day-to-day functioning.

2) SCHEMA THERAPY.

Schemas are deeply entrenched beliefs relating to both oneself and the world in general. In people with BPD, these schema can be extremely negative (inaccurately so) and very unhelpful (or, to use a more technical term, MALADAPTIVE) to the individual who holds them.

Very often, they stem from a negative mindset which developed during the individual’s early life, due to, in no small part, childhood trauma. It is worth repeating that these negative schema can be very deeply ingrained and colour the individual’s entire outlook on life.

Schema therapy seeks to change these maladaptive schema into more adaptive (helpful) ones.

Treatment can be very lengthy, but there is strong evidence that it can significantly reduce symptoms of BPD.

Research into this type of treatment remains ongoing and I will report on any significant developments.

3) TRANSFERENCE-FOCUSED PSYCHOTHERAPY (TFP).

It is certainly worth first defining the psychotherapeutic idea of TRANSFERENCE:

it may be defined as: THE INAPPROPRIATE REPETITION IN THE PRESENT OF A RELATIONSHIP THAT WAS IMPORTANT TO THE PERSON’S CHILDHOOD.

For example, if our parents hurt, exploited or rejected us as children, in adult life we might feel that everyone we get to know will do the same, but without evidence that this will be the case (we are basing our view on a past relationship which is now not relevant).

The treatment aims to help individuals stop viewing present relationships in a rigid way determined by their painful past and show them that they could be misperceiving their present interactions with others ( including the therapist, as often individuals transfer the feelings they had for their parents as children -eg resentment- onto the therapist in the present).
Research, so far, has shown positive results and remains ongoing.

4) COGNITIVE THERAPY.

Cognitive therapy has long been known to be a very effective treatment for conditions such as anxiety and depression, and it is now being increasingly used to treat BPD. Studies of its effectiveness in relation to this have, so far, been encouraging.

One advantage of cognitive therapy is that it often leads to very significant improvements over quite short treatment periods. I myself underwent cognitive therapy and found it very beneficial.

Cognitive therapy focuses on correcting faulty, distorted, negative thinking styles relating to how we view ourselves, the world and the future. I write in more detail about cognitive therapy in the EFFECTS OF CHILDHOOD TRAUMA category of my blog.

5) DIALECTIC BEHAVIOUR THERAPY (DBT).

The studies on this therapy have , so far, given mixed results. It has been shown, though, in several pieces of research, to reduce the likelihood of suicide attempts in the individual undergoing treatment (the risk of suicide in people suffering from BPD without treatment is high).

Also, after a year of treatment, individuals report a more general improvement in their condition, but, unfortunately, often are still left with significant levels of distress. More studies are required, and, indeed, are being conducted to see if longer treatment periods yield better outcomes. I will report on any significant developments in this area.

DBT draws on psychotherapy, group therapy, meditation, elements of Buddhism and cognitive-behaviour therapy. More research needs to be conducted on the therapy to discover which of its varied components are the most effective in treating BPD. Again, I will report on significant developments.

6) MEDICATION.

Whilst there is, at the moment, no obvious, single medication to treat the whole range of BPD symptoms equally effectively, there are, nevertheless, established medications which can help with some of the symptoms the BPD sufferer might experience, such as anxiety and depression. This is, though, of course, the province of GPs and psychiatrists.

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Best wishes, David Hosier BSc Hons; MSc; PGDE(FAHE).

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