20th Annual International Trauma Conference

20th Annual International Trauma Conference

June 4-6, 2009

Boston, Mass

I have just returned from the 20th Annual International Trauma Conference in Boston, Mass. This conference is put on by Bessel van der Kolk and the Trauma Center at Justice Resource Institute (http://www.traumacenter.org/). It is such an exciting and inspiring conference, because it blends science and clinical expertise is a way that is unique in my experience, as well as containing an advocacy, social and moral component.

I attended a day long pre-conference work shop entitled: Reorganizing the Disorganized Brain, with Ruth Lanius, MD, PhD, Eric Vermetten, MD, PhD., John Gruzelier, MD. , Rachel Yehuda, PhD., James Hopper, PhD., Laurence M. Hirshberg, PhD., Alexander McFarlane, MB BS, (Hons), MD, and Bessel A. van der Kolk, MD. This workshop examined how trauma affects brain regions that support intense emotions while decreasing (a) activation in the CNS regions involved in the integration of sensory input with motor output, (b) the inhibition of emotional expression, (c) the organization of self-experience, and (d) the translation of experience into communicable language.

The first speaker was Ruth Lanius. She uses fMRI to study the brains of trauma victims and discover the effects on various parts of the brain. In this presentation Dr. Lanius was focusing on the default state of the brain, which is how the brain looks when we are not doing anything in particular. She has discovered that the parts of the brain that are related to self reflection, creating a self narrative, and self awareness are almost non-functional in the default states of trauma survivors, while being very active in those of the control groups. Therefore, biologically trauma survivors are less able to be self aware and notice and name their emotions. They develop a post traumatic alexithymia. Alexithymia is a psychological construct that refers to difficulties identifying and labeling emotional states. Alexithymic individuals with PTSD may experience intense emotional-physiological states (e.g., fear, anger, and dysphoria) that are poorly integrated with, and modulated by, higher-order verbal cognitive processing. Therefore these individuals may report that they either do not know what they feel, or cannot feel anything at all.

This ability to self reflect, this part of the brain, is developed through attuned relationships with loving care givers. What cannot be communicated to another cannot be communicated to the self. In order to develop self reflection and self awareness, some one must reflect on the child and be aware of them- tell them their story. This is what our children either have not had or have had in fragments.

Eric Vermetten, MD, PhD is a military doctor from the Netherlands. He works primarily with veterans who return from deployments in Iraq and Afghanistan. He reported on the good results his team is finding from neurofeedback.

James Hopper, PhD is a delightful presenter. He spoke of the Buddhist concept of the mind, and how that integrates with what modern biological science is discovering. He described how trauma gets in the way of being able to experience (and enjoy) the present moment. This of course interferes with the experience of pleasure and the richness of life, but also with the development of a narrative and self awareness.

The rest of the day was given to explaining what neurofeedback is, and the amazing results that are happening in 20-30 half hour sessions. I would love to add neurofeedback to our treatment- is any one doing it? I know that Kevin Creeden does it at his place.

The actual conference began on Friday. The first speaker was Rachel Yehuda, PhD who spoke on Mothers, DNA and the Transmission of Trauma. She is my new heroine. She is a bio chemist, very smart and rigorous in her work. And she is funny, irreverent, caring and always questioning. She started by saying she has more questions than answers- but a later speaker said she was lying. Her specialty is the blood chemistry and genetics, and the effects of trauma.

Rachel taught us a lot about the complexity of blood chemistry. One point she made is that cortisol is the substance in the blood which is responsible for stopping the human danger response. People who suffer from trauma have low cortisol, so PTSD can be thought of as a failure to effectively end the danger response.

But the main point Dr. Yehunda was communicating was that the chemicals that are in our bodies can actually interact with our genes and change them, through a mechanism she explained. So in this way trauma can be transmitted through the generations.

The next speaker was Alexander McFarlane, MB, BS (Hons) MD, who spoke on Integrating Past and Present: PTSD as an Information Processing Disorder. Dr. McFarlane, who is from Australia, discussed the fact that although we often realize the presence of flashbacks and dissociation in traumatized individuals, in fact the damage to thought processing is much more profound. Through careful fMRI studies Dr.McFarlane showed a large difference in the amount of processing going on in the brains of trauma survivors. In short, it’s not just that these kids are having flashbacks and dissociating, even doing their math is much harder for them.

Harry Spence, JD was the Commissioner of the Child Welfare agency in Massachusetts, and is no longer. He said he could speak more eloquently about the system now that he was not in charge of it. One important point he made was that the system was strongly influenced by the high profile case- the child death that makes headlines in the paper. In such situations there is tremendous pressure to scapegoat a social worker. At times this has been done, and the social workers are very aware of this possibility. So, Dr. Spence made the comparison between the experience of the workers and the families they serve- both are demoralized, under-resourced, distrust authority, and are overwhelmed. Another excellent point was that trauma work demands work in teams- and child welfare workers do not have any access to a team. Furthermore, the system almost prohibits workers from examining their own reactions to the work- silence is demanded from the workers. There is no culture of self examination. Young people are making life altering decisions about children and families with little team support, little self awareness, and emotional distress.

Dr. Spence spoke of the moral endeavors that all our organizations are engaged in. He said that workers join organizations- child welfare, the military, education- with the goal of doing good. All too often, however, they feel betrayed by their leaders. The compromises that are made erode the purity of purpose. When the workers are blamed or treated badly they become less connected to their moral purpose. Their moral universe shrinks- not it is just their unit, or their best friend and themselves that are doing good. They adopt a "who cares, it’s not my job" attitude towards the larger organization.

Dr. Spence called on all leaders and administrators of organizations to keep and enhance the moral commitment of their workers, by highlighting the moral victories of the organization, the ways in which the organization does good and changes the world.

In the afternoon I attended a workshop by Jane Koomar, PhD, OTR/L, FAOTA; Elizabeth Warner, PsyD; and Anne Westcott, LICSW. They were describing a program in which they integrated sensory intervention techniques into the therapy room. They used large balls, weighted blankets, rhythmic activities, and other sensory techniques to help the child regulate their body. Both in individual and family therapy this resulted in the child being much more open and available for both connection and discussion. Their video tapes were moving. This is something we could all do in our treatment centers without too much difficulty.

I will write about the second day next time, plus Steve Brown has written up the workshop he went to on Dissociation, which I will also post here.

As usual, all comments welcome. Did any one else attend the conference? Add your impressions by clicking on the word "comment" below.