2017 neurobiology of trauma and Sexual Assault

Module 4
The Neurobiology of
Trauma and
Sexual Assault

Learning Objectives
 Describe the basic components of the brain
related to trauma.
 Explain common ways the brain is affected during
and after sexual assault.
 Recognize common ways a traumatic experience
may affect a victim’s behavior.
 Assist victims in understanding the neurobiology
of trauma, when appropriate.
4-2

Please note that some mental health
professionals, agencies, or entities may or may
not agree with models of the neurobiology of
trauma as scientific knowledge, models, and
theories are rarely unanimously accepted.
Disclaimer
4-4

Module Overview
 The prefrontal cortex of the brain.
 Key circuitries in the brain affected by trauma.
 Emotional and brain responses when
confronted with a traumatic situation.
 Traumatic events and memory.
 How knowledge of neurobiology can assist
crime victims.
4-5

The Prefrontal Cortex
4-6

 Holds thoughts and
memories in mind.
 Helps us manage emotions
and reflect on behavior.
 Helps manage other brain
regions.
 Allows us to focus our attention where we choose,
and do what we choose, consistent with our goals
and values.
 Becomes impaired in traumatic situations.
4-7

Fear Circuitry
 Plays a huge role
in trauma and
PTSD.
 Located in multiple
brain areas.
 Operates
automatically and
mostly outside
awareness.
Amygdala
4-8

Seeking Circuitry
 Seeks escape from
fear, anxiety, sadness,
and any unwanted
experiences.
 May be “quick fixes”
that don’t solve the
problem and may
lead to addiction.
 Also enables victims to seek
to uphold their values.
4-9

Satisfaction Circuitry
 Produces feeling of
satisfaction when we
get what we seek.
 Central to feeling
safe, soothed, and
connected to others.
 Produces opioids
involved in feelings
of satisfaction,
connection, etc.
4-10

Embodiment Circuitry
 Includes the insular
cortex (insula).
 Receives sensory
data from all body
systems.
 Key to healing from
trauma.
 Allows us to know
what it feels like to
be in our body. 4-11

Source of
diagram:
Arnsten 2009,
Nature
Reviews
Neuroscience,
410
Traumatic Situations: Amygdala Control
4-12

In Traumatic (and High-Stress) Situations…
 Loss of prefrontal regulation: Chemicals from the
brain stem impair (and may shut down) the
prefrontal cortex.
 Bottom-up attention: Attention is automatically
captured by anything perceived as dangerous or
threatening, or as necessary for survival.
 Emotional reflexes: Reflexes are automatic and
include freeze, flight, or fight responses, as well as
bodily responses like your heart pounding quickly.
4-13

The Amygdala and Attention
4-14

Survival Reflexes in the Body
Pupils dilate Heart beats faster Blood pressure
increases
Breathing rate
increases
Blood flow to
muscles increases 4-15

 Our brains are not wired this way.
 We evolved to freeze first, then flee.
 And fighting is only in the service of fleeing,
unless there is no other option.
 It’s important that assault victims understand
this because many will be ashamed they did
not fight back.
“Fight or Flight” is Misleading
4-16

Freeze, Flight or Fight – Primary Purpose
Freeze:
 Brief response, when
danger is perceived.
 Highly alert.
 Not moving.
 Ready to suddenly
burst into action.
4-17

Drastic Survival Reflexes
 Occur when escape is – or appears –
impossible.
 Attempting to escape and survive when there is
no (physical) escape.
 Automatic survival reflexes.
4-18

“It was silence, looking at her
through a glass wall,
so it couldn’t affect me, couldn’t touch me.”
Dissociation – Drastic Survival Reflex
4-19

 Victim feels:
 “Spaced out.”
 Disconnected.
 “On autopilot.”
 These are common responses to sexual
abuse in children, although it can happen to
anyone.
4-20

4-21
Explain to victims that
these are brain-based,
automatic survival reflexes.

Tonic Immobility – Drastic Survival Reflex
4-22
 Freezing = Alert and immobile, but able to move.
 Tonic immobility = Paralysis, can’t move or
speak.
 Caused by extreme fear, physical contact with
perpetrator, restraint, perception of inescapability.
 An estimated 10-50
percent of victims
experience tonic
immobility.

 Sudden onset and termination.
 Lasts from seconds to hours.
 Does not impair alertness or memory.
4-23

Can overlap with dissociation and may include:
 Trembling or shaking.
 Rigid muscles.
 Feeling of cold.
 Numbness to pain
 Unfocused staring or
intermittent eye closure.
4-24

Heart gets massive parasympathetic input,
resulting in…
 Extreme decreases in heart rate and blood
pressure.
 Faintness, “sleepiness”
or loss of consciousness.
 Loss of muscle tone.
Kozlowski et al. in press 2015; Baldwin 2013
Collapsed Immobility –
Drastic Survival Reflex
4-25

 Often accompanies mental
defeat.
 Can be triggered by seeing
blood, a skin puncture, a knife.
 More likely in women.
 Can be a source of shame in victims.
 These are normal, brain-based responses.
Collapsed Immobility –
Drastic Survival Reflex
4-26
Kozlowski et al. in press 2015; Baldwin 2013

Brain-Based “Counter-Intuitive Behaviors”
4-27
 Did not resist.
 No attempt to escape.
 Did not scream.
 “Active participant."

Perpetrator Victim
 Not stressed
 Prefrontal cortex in control
 Thinking and behavior:
 Planned
 Practiced
 Habitual
 Terrified, overwhelmed
 Fear circuitry in control
 Attention and thoughts driven
by perpetrator actions
 Behavior controlled by
emotional reflexes and habits
from childhood (including
abuse)
Brains During Most Sexual Assaults
4-28

Activity
Response Scenarios Case Studies
Worksheet 4.1
 Work in groups.
 Review the case studies and answer the
questions.
 Report out to the large group.
4-29

 Brain releases high stress chemicals.
 High amygdala activity.
 Strong encoding of emotional and sensory
memories.
 Prefrontal cortex is impaired, including
language production area.
Joels et al. 2012
The Brain During Trauma
4-30

Hippocampus functioning altered:
 Elements and context poorly woven into whole.
 Sequence of events poorly encoded.
 Well-encoded emotional memories, especially
for experiences surrounding fear/terror onset.
Joels et al. 2012
The Brain During Trauma
4-31

 Mostly bottom-up attention.
 Fear circuitry focused on what seems most
important to survival and coping.
 Central details are encoded.
 Stimulus information is encoded much more
than contextual information.
Joels et al. 2012
Attention, Trauma, and Memory
4-32

 Fragments of experience “burned in.”
 “Islands of memory.”
 Few peripheral details.
 Little or no time-sequence
information.
 Little or no words or narrative.
What Gets Encoded Into Memory
4-33

Schwabe et al. 2012; Joels et al. 2012.
Fear Circuitry
in Control
Impaired
Prefrontal
Cortex
Increased
Stress
Hormones
4-34

Fear Circuitry
in Control
Bottom-Up
Attention
Impaired
Prefrontal
Cortex
Increased
Stress
Hormones
Altered
Hippocampus
Functioning
4-35

Some Aspects CAN Be Recalled Accurately:
Fear Onset, Central Details, Survival
Reflexes and Other “Islands of Memory”
Fear Circuitry
in Control
Bottom-Up
Attention
Retrieved Memories
Can Be Unpredictable,
Incomplete,
Disorganized
Impaired
Prefrontal
Cortex
Increased
Stress
Hormones
Altered
Hippocampus
Functioning
Fragmentary
Memories
4-36

 Micro-islands – Fragmentary sensations
 Larger islands – Key periods within assault
 When fear kicked in, right before and after
 Survival reflexes – Indicators of non-consent:
 Freezing
 Dissociation
 Tonic immobility
 Collapsed immobility
“Islands of Memory”
4-37

 Low to moderate dose/intoxication:
 Impairs context encoding (hippocampus).
 Does not impair encoding of sensations.
 Resembles effect of fear/trauma.
 High dose/intoxication:
 Impairs hippocampus-mediated encoding and
consolidation of both context and sensations.
 In a severe “black out,” nothing gets encoded.
LeDoux 1996, Bisby et al. 2009, Bisby et al. 2010, 280
Alcohol, Drugs, and Memory
4-38

 State of the brain when trying to remember
affects what can be retrieved and put into words.
 If victims feel unsafe when questioned, they may
not be able to use their prefrontal cortex to
understand the questions and retrieve certain
memories.
 If victims feel traumatized by questioning, this
may trigger the bottom-up retrieval of
fragmentary sensations and emotions that are
nearly as intense as the assault itself.
Remembering the Experience
4-39

 Remember: The survivor may
have been dissociated at the
time of the assault, and when
they remember it later.
 Or the survivor can alternate
between dissociated and emotionally upset
remembrances, for example, from one meeting
or investigative interview to the next.
Remembering the Experience
4-40

Assault Memory
Life as a Minefield of
Potential Trauma Triggers
4-41

“I’m going to help this victim feel safe,
in control, competent and cared for.”
Empathy for victim,
empowerment of victim.
Victim feels safer,
is more cooperative,
more able to remember,
more willing to report.
Victim advocate more
easily determines victims’
physical and
psychological needs.
Victim advocate provides better
support for victim in court and during
meetings with prosecutors.
4-42
A Better Understanding

Activity
How Would You Respond?
Worksheet 4.2
 Work in groups.
 Review the worksheet and answer the
questions.
 Report out to the large group.
4-43

Review of Learning Objectives
 Describe the basic components of the brain
related to trauma.
 Explain common ways the brain is affected
during and after sexual assault.
 Recognize common ways a traumatic
experience may affect a victim’s behavior.
 Assist victims in understanding the
neurobiology of trauma, when appropriate.
4-44

End of Module 4
Questions? Comments?
4-45

2017 neurobiology of trauma and Sexual Assault

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2017 neurobiology of trauma and Sexual Assault