Scholarly Saturday- PTSD and Neuroscience
Two recent articles that I have read about neuroscience have made me think carefully about its clinical implications. http://www.theguardian.com/education/2014/apr/26/misused-neuroscience-defining-child-protection-policy?CMP=twt_gu. It basically questions the notion of what neglect does to the brain and how to treat it. And a rebuttal to that article: http://www.parentingposttrauma.co.uk/1/post/2014/04/why-i-love-using-neuroscience-in-early-years-and-parenting-work.html
This got my wheels spinning in a case that I am “stuck on.” It is young man who is really struggling with PTSD. I have to give credit to the rebuttal article and it’s author Jane Evans (https://twitter.com/janeparenting). She pointed me to the work of Perry (2009) that provides framework of integrating neuroscience with clinical intervention, especially with trauma. He provides a framework called The Neurosequential Model of Therapeutics (NMT). When treating trauma, no matter what intervention you choose, it should be informed by the area of the brain most effected by the trauma and not the behaviors. This includes doing a good developmental assessment to determine what areas of the brain are effected. In terms if interventions, Perry (2009) argues that we should look beyond 1 hour of therapy ..
“This may involve initially focusing on a poorly organized brainstem/diencephalon and the related self-regulation, attention, arousal, and impulsivity by using any variety of patterned, repetitive somatosensory activities (which provide these brain areas with the patterned neural activation necessary for reorganization) such as music, movement, yoga (breathing), and drumming or therapeuticmassage. Once there is improvement in self-regulation, the therapeutic work can move to more relational-related problems (limbic) using more traditional play or arts therapies; ultimately, once fundamental dyadic relational skills have improved, the therapeutic techniques can be more verbal and insightoriented (cortical) using any variety of cognitive-behavioral or psychodynamic approach.”
This made me think about what we could be doing differently for this young man that I am working with now. This reframe has been helpful as he engages in a lot of risky behaviors. We often treat the risky behaviors but we need to treat the area of the brain that may activate these risky behaviors. This provides validation to the feeling the therapist and I had that we are “missing something” with this young man. I hope that this may help you with PTSD through a different “lens.”
Examining Child Maltreatment Through a Neurodevelopmental Lens: Clinical Applications of the Neurosequential Model of Therapeutics. Journal of Loss and Trauma Vol 14 page 240-255
For more info go to childtrauma.org