Wednesday, July 24, 2013

What PTSD and toddlerhood have in common

So I'm still in the early stages of The Whole Brain Child (related: Preventing and responding to tantrums) and I like it. It is just taking me a long time because life. But I like it. I think if you are really into neuroscience, the over simplification of the brain might annoy you. But because I took neuro pass/fail, I don't really count as an expert so I'm like, uh, whatever, good enough.

The thing that struck me in the first chapters is how some of the strategies they offer to help kids deal with the emotional difficulties of toddlerhood mirrored some of the strategies that psychologists and psychiatrists use to help trauma survivors cope with PTSD. It is simultaneously clever and sort of scary. Not that it necessarily means toddlerhood is traumatic. But, still. I mean, maybe a little? Yikes.

The Whole Brain Child talks about the importance of helping your child process stressful events by giving them the words (You're sad/angry/scared?) and describing the situation (you got an owie, and then the doctor fixed it). Young kids can lack the language skills to do this, and stress also tends to "hijack" the parts of the brain that are needed to process events linguistically (which is really important for preventing and treating PTSD symptoms like flashbacks and problems concentrating).

Post Traumatic Stress Disorder (PTSD) occurs in some (not all) people who endure a trauma (something where your life feels like it is actually in jeopardy, common in veterans and accident and violence survivors); during the trauma, the limbic system tends to take over. This system is associated with emotions, memories, learning and attention. Language, not so much. So what happens is you have very strong, emotional memories that cause you to learn to associate certain things with the trauma (triggers), and have difficulty concentrating, etc.  That is why PTSD victims have flashbacks and tend to re-experience the trauma. (PSA, people on the internet, you seem to have a lot of psychological issues. GET HELP!! Most of them are solvable. If you are having traumatic flashbacks or panic attacks, please, please get help!!)

One of the most effective treatments is called Prolonged Exposure, and it is based on Emotional Processing Theory. It involves four components (many of which are captured in The Whole Brain Child):
  • education: explaining how the limbic system and prefrontal cortex impact learning, memories, etc. and how they impact PTSD and recovery. The Whole Brain Child even offers some cute ways to explain this using your hands to represent the brain (think: here is the church, here is the steeple, open the door...except for the brain and with less rhyming).
  • breathing: for relaxation (honestly, I don't know yet if the book gets into this because, yeah. I'm not done. But Dr. Wendy Swanson has an AMAZING video on teaching kids to "blow colors." Watch it!)
  • real world practice: by strategically not avoiding the triggers, patients learn that the triggers don't cause the trauma (just the memories of it) and eventually the triggers become less, well, triggering. So when your kid flips out at bath time, letting them not bathe reinforces the fear. Conversely, gradually, incrementally, and safely exposing them to the tub teaches them they won't go down the drain. Or whatever. I'm not in my toddlers' heads (thank god, it seems kinda scary).
  • imaginal exposure/talking through it: this is where The Whole Brain Child is great. It gives some good examples of this. When you help kids talk through upsetting stuff (give them words, prompts (and then?) to come up with their own words, etc) it helps them "get over it" more completely and effectively. This descriptive language helps move the memory from the limbic brain to the prefrontal brain. When this happens (for toddlers or PTSD patients in talk therapy), the memory becomes less emotional, and more rational (think, you store it alphabetically instead of pictorially; so you only "retrieve" the memory when you want to instead of when you randomly see/hear/smell/whatever something that reminds you of the event. And when you do "retrieve" the memory, it is a narrative and not a visceral experience of terror.). Therefore, the memory is less likely to overwhelm you in the form of flashbacks, and you become less distractable and anxious.
Anyway, I find this incredibly fascinating and (despite my inability to devote much time to reading) am actually really excited to finish this book. Because, science. And stuff.


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