An Excerpt from a

Transcript

Below you will find an excerpt of the transcript (including a full table of contents) from the course with Bessel van der Kolk, MD. Transcripts are a great way to review, take notes, and make the ideas from Bessel’s teaching your own. Here’s the sample:

How to Target Treatment to Help Patients Reclaim Their Lives After Trauma

with Bessel van der Kolk, MD
and Ruth Buczynski, PhD

Contents

Developmental Trauma Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	3
Childhood Trauma: Attention, Affect Regulation, and Relationships . . . . . . . . . . . . .	4
Fertile Environments for Developmental Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	7
Questions and Treatments to Uncover Developmental Trauma . . . . . . . . . . . . . . . . .	7
Regulating Heart Rate Variability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	9
How Cumulative Trauma Affects Adult Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . .	12
Treatments for Neglect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	14
The Integration of Yoga and Meditation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	15
Future Issues Related to Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	18
About the Speakers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	20

Childhood Trauma: Attention, Affect Regulation, and Relationships

Dr. van der Kolk: We collect all kinds of different ways of treating patients to see what happens with those kids, and we’re really beginning to develop a discipline of childhood trauma.

This is what we see when we look at these kids and as they grow older: their problems are very different from PTSD. Their problems primarily have to do with attention – being able to focus in and to engage in a very steady, consistent way.

“This is what we see when we look at kids and as they grow older: their problems are very different from PTSD.”

Kids (with trauma) get thrown off – they have a hard time really focusing – sticking to and concentrating and filtering irrelevant information out.

They get hijacked, and that’s one very big issue, which deserves its own special series of treatments.

Secondly, the core issue is affect regulation. We have our emotions in order to tell us what to do and where to go – to orient our bodies and our minds to the reality around us.

“…the core issue is affect regulation.”

Traumatized people’s emotions become too large, too extreme or they become too quiet and once they get activated, unlike people who are doing pretty well, they get upset and ten minutes later they’re fine again – they go back to work.

Chronically, traumatized people keep getting stuck on something that happened yesterday, and today, they’re still out of sorts about it, and tomorrow they’ll still be out of sorts about it – their whole weekend is hijacked by something that’s happened.

“Traumatized people’s emotions become too extreme or they become too quiet.”

They deal with this hijacking by trying to calm themselves down in any way they can – that’s where the whole issue of drugs and alcohol, self-mutilation, and eating disorders comes in.

These all seem to be chronic adaptations to this affect dysregulation problem that you see in this population.

“…drugs and alcohol, self-mutilation, and eating disorders all seem to be chronic adaptations to this affect dysregulation problem ”

The third area is one of relationships. If someone has messed with you, you will have a basic perception of the world that people will hurt you and make you not feel safe – that you’re helpless…

So, you position yourself in the world as somebody who should always protect yourself, or as somebody who should be aggressive or arrogant or distant, or as someone who is dependent, compliant, and there to please everybody. If you stand up for yourself, terrible things will happen to you.

Those are the three different areas of (childhood trauma). It’s not about memory, but it’s the formation of the self, the brain, the mind and body.

Dr. Buczynski: Let’s just review the three different areas…

Dr. van der Kolk: The first is attention. Attention has to do with focusing – paying attention.

Almost all the kids we treat – and we treat a large number of kids in our clinic – meet the diagnosis criteria for attention deficit disorder.

“Almost all the kids we treat – and we treat a large number of kids in our clinic – meet the diagnosis criteria for attention deficit disorder.”

They almost always come with a diagnosis of attention deficit disorder, which isn’t so bad.

I’m not really convinced that giving medications for attention deficit disorder is dramatically bad for traumatized kids, but we don’t know that for sure. So that’s one area – and that, of course, persists into adulthood.

Then, second area is affect dysregulation that makes people too angry, too intense, too upset, and too reactive.

Now, almost every kid who comes to our clinic gets misdiagnosed as having bipolar disorder, and thereby hangs a very important tale.

Because people don’t see the trauma issue, these kids get treated for their affective arousal, which usually means that they get antipsychotic medications – they get medications that block the dopamine system.

“Because people don’t see the trauma issue kids get antipsychotic medications.”

The dopamine system, indeed, makes people aroused, but it also makes people motivated, and it makes people have an interest in things – to be passionate.

If you block kids’ dopamine system, you knock out their capacity to become engaged and motivated.

“If you block kids’ dopamine system, you knock out their capacity to become engaged and motivated. ”

If people are going to keep kids on antipsychotics for any length of time, the likelihood that these kids will grow up to become well-functioning, engaged, passionate, committed adults is very slim.

I see that as a very large, gigantic public health issue. Last year the US spent 16.1 billion dollars on antipsychotic-like drugs for kids.

“Last year the US spent 16.1 billion dollars on antipsychotic-like drugs for kids. ”

This is a national disaster that these kids get misdiagnosed. Unless you help these kids to deal with the trauma, you’re just stirring this all up.

Unless we have self-regulatory methods that do not involve drugs, but help them to regulate themselves, they’re going to be very disabled adults.

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