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Understanding and Implementing Trauma-Informed Care for Clients in Pain: Summary 41
Parasympathetic: The parasympathetic branch is associated with the “freeze” response. When fighting or fleeing proves unsuccessful, a “freeze” response is a last-ditch effort in order to survive. We also enter a parasympathetic state when we are sleeping, digesting, resting, and even connecting with others. The parasympathetic branch represents immobilization. A freeze is a person’s inability to think clearly. It can lead to fuzzy thinking and hypoarousal expression: | CLINICAL CONSIDERATION When responding to a client in the parasympathetic state: encourage their own regulation and avoid further hypoarousal. Give them time to respond and simplify your session or communication to avoid further overwhelm.. Dissociation Dissociation is the disruption of one or all four main areas of functioning, including our consciousness, our identity, our memory, and our awareness of ourselves and our surroundings. When this occurs, we may feel detached or as if the world is unreal. Under extreme and inescapable stress, the ANS may have concurrent or alternating activation of the sympathetic and parasympathetic branches. This may manifest as depressive shutdown followed by extreme anxiety or rage. Nervous System Regulation Regulation is the ability to respond appropriately to the inputs and stressors of life. A state of regulation is not necessarily being in a state of calm or being happy. The window of tolerance is the range in which we can toggle from states of activation or arousal (toward sympathetic) or states of deactivation and immobilization (toward parasympathetic) without becoming dysregulated. The window of tolerance is also referred to as our capacity. Everyone has different degrees of capacity depending on their unique history, the stimulus, accumulated stressors, or the degree in which their basic biological needs have been met. It is best not to assume our client has adequate capacity or resources. If we move out of our window of tolerance and become dysregulated, our ability to come back to regulation is an example of our resilience. • Neocortex : The neocortex helps regulate lower regions of the brain. When we collapse into a survival response, less blood flow reaches this region. As the phrase goes, “when emotions are high, intelligence is low.” Place your hands on the front of your head. This is your neocortex. We create stories and narratives here; we analyze, calculate, and learn • Limbic system : The limbic system is responsible for our emotions, memory (including unconscious memory), and sexual arousal, and it creates an
EVIDENCE-BASED PRACTICE: MINDFULNESS Research has demonstrated that meditation-based tools such as meditation using focused attention, mindfulness-based stress reduction, and mindfulness- based cognitive therapy have been shown to lower anxiety, minimize symptoms of PTSD, and reduce depression, blood pressure, cortisol levels, and stress markers. Exercise: Grounding Meditation • Bringing awareness and attunement to your body • Find an area and position where you feel relaxed Core Response Network This is defined as a functional dysregulation of the subcortical autonomic, limbic, motor, and arousal systems, referred to as the core response network (CRN). The CRN is comprised of the autonomic nervous system, the emotional motor system, the reticular arousal systems, and the limbic system. The CRN leads to neuroendocrine, neurochemical, and neuroanatomic changes. • Hypothalamic–pituitary–adrenal axis and hypothalamic–pituitary–thyroid axis dysregulation: ○ Upregulated response to stress ○ Abnormal fear processing Trauma impacts the hippocampus, amygdala, and cortical regions such as the anterior cingulate, insula, and orbitofrontal region, which mediates our response to stress and fear. Hippocampal deficits may lead to an activation of and failure to terminate stress responses, and an ability to discriminate between what is safe and unsafe. Autonomic Nerve System Your autonomic nervous system has two main divisions: the sympathetic and parasympathetic branches: Sympathetic The sympathetic branch is associated with the “fight or flight” response. Our heart rate increases, eyes may dilate, or we may become flushed. Our thoughts quicken and focus narrows to evaluate routes of escape or strategies of attack. Sympathetic activation gives us the ability and motivation to mobilize. It is the “mobilization” branch: | CLINICAL CONSIDERATION When responding to a client in the sympathetic state: stay calm, create distance as needed, and observe for new signs of safety and down-regulation. ○ Hippocampal atrophy ○ Abnormal T3:T4 ratio ○ Increased subjective anxiety
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