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PTSD Episode 2. A Brain Under Threat · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:00
  SPEAKER_00: Welcome back to the series on children and young people and PTSD.
• 0:07
  SPEAKER_00: What I'm uh wanting to try and work on today is the question of the way in which the neurological features come together under significant trauma, and it's called the brain under threat.
• 0:22
  SPEAKER_00: Now, trauma isn't simply what happened to a child, it's what the mind was forced to carry afterwards.
• 0:30
  SPEAKER_00: Now, in the previous episode, we explored how trauma can become a wound within the mind, but also to understand trauma fully, we have to look at something else.
• 0:43
  SPEAKER_00: Because trauma doesn't only affect the mind psychologically, it actually affects the developing brain.
• 0:50
  SPEAKER_00: And when a child's brain becomes organized around danger rather than safety, the world itself can begin to feel unpredictable and threatening.
• 1:00
  SPEAKER_00: Now the brain's first task at its most basic level is very simple, and it's not happiness or understanding.
• 1:08
  SPEAKER_00: Its first task is survival.
• 1:11
  SPEAKER_00: And deep within the brain lies a structure known as the amygdala.
• 1:16
  SPEAKER_00: So you can think of it really as the brain's alarm system, and it constantly scans the environment for signs of danger.
• 1:25
  SPEAKER_00: But it also scans internally.
• 1:28
  SPEAKER_00: If there are changes within the body's system, the amygdala will detect this and alert us to that change.
• 1:37
  SPEAKER_00: But whether the threat is internal or external, the amygdala is activated and in turn the body's survival responses emerge.
• 1:47
  SPEAKER_00: Things like the heart beating faster, breathing changes, blood sugar levels, muscles tighten, and essentially the body is preparing for fight, flight, or freeze.
• 2:00
  SPEAKER_00: Now these responses occur automatically.
• 2:04
  SPEAKER_00: It's not something we have a choice over.
• 2:06
  SPEAKER_00: And long before cautious thought has time to intervene, these systems are activated.
• 2:15
  SPEAKER_00: A child once told me that whenever something loud happened, her body jumped even before she could think about it.
• 2:24
  SPEAKER_00: This is a very typical, fairly simple example.
• 2:30
  SPEAKER_00: But the child's brain, if it has an overactive or oversensitive amygdala because it's been constantly exposed to what it experiences is danger, it doesn't take a lot for a reaction to occur.
• 2:47
  SPEAKER_00: Now, under normal circumstances or ordinary circumstances, the emotional brain, which we call the limbic system, and the thinking brain or the neofrontal cortex work together.
• 3:03
  SPEAKER_00: The emotional brain responds to those things that it detects as danger, and then the thinking brain evaluates whether or not the threat is real.
• 3:14
  SPEAKER_00: But during traumatic experiences, something different happens.
• 3:19
  SPEAKER_00: The emotional brain becomes highly activated and the thinking brain temporarily steps aside because it's overwhelmed.
• 3:28
  SPEAKER_00: Now the brain prioritizes survival over reflection.
• 3:34
  SPEAKER_00: This response is extremely useful when someone is facing danger, but trauma occurs when the nervous system becomes stuck in this state of alarm.
• 3:47
  SPEAKER_00: I use an example of a TV remote control, and we all know that if you if you turn a TV off, if it's still plugged in, you'll probably see a little red light.
• 4:02
  SPEAKER_00: And when you press a button, the TV comes on.
• 4:07
  SPEAKER_00: Well, the red light is a sort of state of readiness.
• 4:11
  SPEAKER_00: Trauma operates in the same way.
• 4:14
  SPEAKER_00: The light never really goes off, it's never unplugged.
• 4:18
  SPEAKER_00: And so consequently, the child is in a state of readiness, even though they're not consciously aware of that.
• 4:26
  SPEAKER_00: Now, what research has taught us is that over the past several decades, understanding of trauma has really developed, and a very famous psychiatrist, Bessel Vanderkock, demonstrated how the traumatic experiences can remain embedded within the body and nervous system.
• 4:48
  SPEAKER_00: Bruce Perry, a child psychiatrist, showed how very early trauma can shape the development of the stress systems within the brain.
• 4:57
  SPEAKER_00: And the famous neuroscientist Stephen Borges, through his theory of about the polyvagal system, explained how the nervous system is constantly evaluating whether the environment feels safe or threatening.
• 5:14
  SPEAKER_00: Interestingly, Daniel Siegel talked a lot about how relationships help to regulate the emotional brain.
• 5:25
  SPEAKER_00: And these discoveries together reveal something very important: that trauma isn't just psychological, it's also neurological.
• 5:35
  SPEAKER_00: Now, to give an example, a 10-year-old boy who was referred to me following a serious car accident was really struggling some eight, nine months later.
• 5:49
  SPEAKER_00: Although physically he had recovered, something else remained because whenever he travelled in a car, he became extremely alert.
• 5:58
  SPEAKER_00: He watched every passing vehicle, and if another car seemed to approach quickly, he shouted warnings to the driver.
• 6:07
  SPEAKER_00: And at night he experienced recurring nightmares.
• 6:11
  SPEAKER_00: And his parents initially just believed that he was simply anxious.
• 6:16
  SPEAKER_00: But in fact, what was happening was far deeper.
• 6:20
  SPEAKER_00: His brain had learned something during the accident.
• 6:24
  SPEAKER_00: He'd learned that the world could suddenly become dangerous, and it had not yet unlearned that lesson.
• 6:33
  SPEAKER_00: So here was a boy whose nervous system had not switched off.
• 6:39
  SPEAKER_00: It remained on standby.
• 6:42
  SPEAKER_00: And a car turned it on.
• 6:45
  SPEAKER_00: And this is a really good idea, a really good example of the post-traumatic stress reaction.
• 6:53
  SPEAKER_00: Traumatized children often develop one of two nervous system responses.
• 6:59
  SPEAKER_00: Some become hyper-vigilant, like the child I've just been speaking about, and they appear constantly alert, scanning their surroundings.
• 7:07
  SPEAKER_00: But sometimes others will move towards the opposite state, and they we we call that hypo vigilance rather than hyper.
• 7:17
  SPEAKER_00: So hyper is the heightened, hyper, hypo is the lowered.
• 7:21
  SPEAKER_00: And so with those children, we might see emotional shutdown, emotional numbing, they may appear distant, detached.
• 7:30
  SPEAKER_00: And these are these are not signs of weakness.
• 7:34
  SPEAKER_00: They're the nervous systems attempt to protect the child from further harm.
• 7:42
  SPEAKER_00: Now, under normal circumstances, the brain is capable of processing emotional experiences gradually.
• 7:50
  SPEAKER_00: That's the spontaneous recovery thinking.
• 7:55
  SPEAKER_00: Over time, memories settle into the story of our lives.
• 7:59
  SPEAKER_00: And and that that then becomes a sort of manageable thing.
• 8:02
  SPEAKER_00: It's something we can we can look back on and make some sense of without being overwhelmed.
• 8:09
  SPEAKER_00: But but trauma can interrupt this natural processing.
• 8:13
  SPEAKER_00: The experience becomes neurologically stuck, and the memory remains emotionally active.
• 8:21
  SPEAKER_00: And so the nervous system continues responding as though the threat might still return.
• 8:27
  SPEAKER_00: Now there's a particular model of therapy that was developed by somebody called Francine Shapiro, and it's called EMDR, and that stands for eye movement desensitization and reprocessing.
• 8:42
  SPEAKER_00: And during EMDR therapy, the child recalls aspects of the traumatic experience engaging in what's called bilateral stimulation.
• 8:55
  SPEAKER_00: Now that that's a that's a very curious scientific term, but it has to do with moving the eyes.
• 9:02
  SPEAKER_00: And if you want more detail, you have to do your own research.
• 9:06
  SPEAKER_00: But gradually the brain begins to reorganize the memory and the emotional intensity softens.
• 9:12
  SPEAKER_00: It's fascinating, but essentially what's happening is that through these structured eye movement exercises, something is changing in the neural and brain activity.
• 9:27
  SPEAKER_00: And then what happens is that the experience becomes something that happened in the past rather than something that feels as though it might happen again, or indeed is happening again.
• 9:51
  SPEAKER_00: But not all, because the we're still we still come back to the relational component.
• 9:59
  SPEAKER_00: Trauma processing doesn't occur in isolation.
• 10:03
  SPEAKER_00: Children must feel emotionally safe before they can even approach difficult memories.
• 10:08
  SPEAKER_00: And sometimes what I find is that I might do the initial work with the child, and if I feel that my approach isn't making the kind of progress that I would hope to see, I might then introduce the family to an EMDR therapist.
• 10:27
  SPEAKER_00: So but relational psychotherapy, regardless of the model, is essential.
• 10:33
  SPEAKER_00: Within the therapeutic relationship, the child encounters an adult who remains calm and emotionally present, even when frightening and difficult things emerge.
• 10:45
  SPEAKER_00: And over time, this relationship teaches the nervous system there's something new.
• 10:51
  SPEAKER_00: The world can contain safely again.
• 10:55
  SPEAKER_00: So when I'm doing what is called debriefing with a child, which is taking them gently to, if you like, the edges of the experience that they've that they've had, it's incredibly important that they experience me as someone who can do that gently and and manage whatever they are experiencing as as they're doing it.
• 11:23
  SPEAKER_00: I've I've worked with a lot of people who've had traumatic experiences, and some of them really are very, very shocking, and they're incredibly painful.
• 11:33
  SPEAKER_00: And as patients describe these things bit by bit, you can probably imagine that the release of emotion can be very powerful, and that emotion can be fear, it can be panic, it can be physical.
• 11:53
  SPEAKER_00: Patients report wanting to be sick.
• 11:57
  SPEAKER_00: I've had a patient who was sick, and the reliving, even part of the experience, is incredibly powerful.
• 12:08
  SPEAKER_00: But imagine being in a room with someone whose entire behavior and presence says it's okay.
• 12:18
  SPEAKER_00: It's okay.
• 12:19
  SPEAKER_00: I know, but it's okay.
• 12:22
  SPEAKER_00: That someone can bear the pain and do that on a repeated basis becomes internalized by the child.
• 12:31
  SPEAKER_00: Because, in a sense, the child is stuck in a neurological state where he says, Well, actually, no, things aren't okay, and they might be really not okay in a bad way, just like it was before, because the central nervous system is activated, you know, they're on standby, and so therefore, the power of the emotional safety as the foundation for the psychotherapeutic work is paramount.
• 13:03
  SPEAKER_00: When we see children who appear anxious, withdrawn, or volatile, it can be tempting to focus on the behavior itself.
• 13:13
  SPEAKER_00: But understanding things from a traumatic perspective invites us to ask a different question, not what's wrong with this child, but what has this child experienced?
• 13:26
  SPEAKER_00: And when we begin to ask that question, understanding becomes possible, and with that the process of healing can begin.
• 13:35
  SPEAKER_00: It was really interesting.
• 13:36
  SPEAKER_00: I read something on a Facebook page where a couple were having what seemed like an absolutely terrible time with a child, a young child who was behaving in clearly very, very disturbing ways, and they posted essentially a help, we don't know what to do message.
• 13:58
  SPEAKER_00: What was really interesting was to read the responses, they and they ranged from sympathy for the parents and other family members, which of course is reasonable.
• 14:09
  SPEAKER_00: There were lots of references to the child being sectioned under the Mental Health Act, which I thought was possibly a little creative.
• 14:18
  SPEAKER_00: One person said something along the lines of let me have him for a week, which I thought, well, not sure about that.
• 14:26
  SPEAKER_00: Only one person said, What on earth has happened to this child for him to behave in this way?
• 14:36
  SPEAKER_00: And I thought, well, you know, as a quick straw poll, what does that say?
• 14:40
  SPEAKER_00: How many people I mean, yes, of course, concern about the behaviour, but do people are people able to ask the question why, what's happened?
• 14:54
  SPEAKER_00: If you take a rescue dog and you don't know what's happened, and it growls at you, and whenever you put your hand near it, it cowers.
• 15:05
  SPEAKER_00: It can't tell you what's wrong, but it's showing you.
• 15:09
  SPEAKER_00: And most often, humans will will say that dog's experienced something bad.
• 15:16
  SPEAKER_00: That's why it's behaving the way it is.
• 15:18
  SPEAKER_00: We have to treat it carefully and teach it it's safe.
• 15:22
  SPEAKER_00: Well, here's the thing: the same happens with children.
• 15:27
  SPEAKER_00: Just because they can speak doesn't mean they have the words to describe what they've experienced.
• 15:34
  SPEAKER_00: In the next episode, we'll look some more and we'll explore one of the things that I think people find most disturbing about trauma, and that's the fact that the memories just refuse to stay in the past, and they manifest through flashbacks, nightmares, and the strange ways that uh the mind sometimes relives the experiences that logically are over.
• 16:00
  SPEAKER_00: Every wound tells a story, and every story uh deserves to be heard so that there is a chance for it to heal.
• 16:11
  SPEAKER_00: Thank you for listening.