Sunday, April 20, 2008

Kevin Creeden at MASOC

As I mentioned, I presented at the Massachusetts Adolescent Sex Offender Coalition Tenth Annual Joint Conference on The Assessment, Treatment and Safe Management of Sexually Abusing Children, Adolescents, and Adults in Marlborough, MA. (

I was lucky enough to attend a workshop by Kevin Creeden, M.A., LMHC, LMFT- Director of Assessment and Research at Whitney Academyan East Freetown, MA, an excellent speaker who I have seen several times.

Here are some of the points that Kevin made:

Important facts about the brain:

Children with trauma histories have fewer connections between their limbic system and their pre frontal cortex
The cortex is created by caretaker doing cortex-functions (care taking, safety, meeting needs, figuring out problems)

With psychological arousal the baseline heart rate goes up
There is constant scanning for threat

Cerebellum is responsible for balance, rhythm

Give infant rhythmic activities- rocking, structured activities, schedule
Rocking is a human comfort response (person rocking in crisis)

Amygdala adds emotional valence to events
Screens for threats

Kindling effect- trauma survivor over-screens, over identifies threats
Interferes with reading social cues, distorts

Humans hard-wired to pay attention to sex and danger
Hence use in advertising

Hard to extinguish

Hiking example- you are on a hike in the woods and you see something dark and curvy, it moves- a snake! All danger systems are activated. As you walk on and it slithers away, you see something else dark and curvy- you are on alert again! This time it is only a stick- but for the rest of the hike you over react to every stick.

Movie example- You are alone at home and you put on "Psycho" which you have seen many times before. Still, when he walks towards that shower curtain your heart races. After the movie is over, you have to go down to the basement and get the laundry. Even through you KNOW this was a movie, you put it in yourself, and you have seen it before, you are scared and on alert, and you run back upstairs and close the door. All night you are jittery and over-react to noises- and this after only two hours of something you had total control over and that you knew was not real. (Understanding does not lower arousal!)

Humans programmed to identify danger: darkness, sudden loud noises, being alone
PTSD produces constant danger signals- person may become immune; no longer differentiate real danger, under react (the body that cried wolf)

Humans programmed that comfort and protection is found in: closeness, rocking, stroking
Note similarities to sex
Can’t distinguish nurturing touch from sexual touch

Humans programmed to learn more quickly and more deeply, remember better, those things with strong affect, especially danger- you can’t afford many repetitions to learn that a snake is dangerous

"Normal" people have arousal/relaxation cycles and know ways to calm down-
Trauma survivors start higher, have rapid spikes, and rely on the external environment to help them calm down
Must do something to draw in external control (i.e. cutting)

In normal human relationships, attachment is the road to sexuality- we play monopoly, then we gradually become friends
In trauma survivors, sexuality is a desperate method for attachment- I don’t know how to start, form or maintain relationships so maybe if I have oral sex with you, you will play monopoly with me.

Right hemisphere- gestalt, big picture
Initial impressions
Negative emotions, anger, anxiety
Left hemisphere- details, analysis
Positive emotions
Generally the left hemisphere is larger; in trauma kids the right is larger

Corpus collosum connects the two- smaller in trauma victims
Less integration

Less integration and generalization in learning- child works on methods for not fighting with his room mate, doesn’t think to use these methods to avoid fighting with another person

We must actively teach problem solving, considering alternatives and pros and cons

Amygdala involved with fear conditioning, aggressive behavior, triggers fighting
Gets bigger with increased use

Hippocampus involved with retrieval of verbal and emotional memory
Gets smaller as amygdala gets bigger

When dysregulated, children are helped by slow, rhythmic activities not high energy level activities- yoga, tai chi, brain gym, walking, swinging hands, crawling, rocking, exercise balls, metronomes

Trauma victims have 40% higher prevalence of learning disabilities especially language: auditory processing and expressive language. (Receptive/expressive language disorder)

Often crisis plans and relapse prevention plans are cognitive and language-based, and also are avoidance based- what I am trying NOT to do instead of what I am trying TO do.

Emotion is the central organizing mechanism of the brain

The pre-frontal cortex controls emotional behavior through cognition
If there are persistent stressors in the early years of life, neurons do not grow and connect in prefrontal cortex, less inhibition is available
Less developed pre-frontal cortex leads to:
Short attention span
Memory problems
Impulse control difficulty
Social and test anxiety
Poor judgment
Problems reading social cues
Poor organization and time management

The primary goal of attachment for humans is safety.
One method of engagement is aggression and provocation
(A new way of looking at that awareness we have that for these kids, negative attention is better than no attention)

Sexual offending behavior is about trying to get your needs met in a relationship- otherwise, why not sit home and look at pornography on the Internet?

Healing comes through persistent attention to the daily task of caring

Need whole brain learning, concrete examples, pay attention to generalizing
Understand cannot learn in emotional situations

Incorporate movement

Primary treatment goals:
Establish safety and predictability
Deconditioning and decreasing anxiety and arousal levels
Altering the way victims view themselves and the world
(Van der Kolk, 1996)

Attachment exercises: (do 5X a day, 3-5 minutes at a time)
Reading facial cues- use movies, sop, ask: what was he feeling now? What will he do next?
3 leg races
Jump rope
Reflective listening practice
Passing rhythms around
Taking own pulse, finger monitors
Boundaries- hula hoops

I would highly recommend Kevin Creeden as an excellent speaker and great thinker in our field.

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