Development in LIfe endanger

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Published on October 19, 2008

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Development in life-endanger: Emotional, cognitive & symbolic domains : Development in life-endanger: Emotional, cognitive & symbolic domains Raija-Leena Punamäki Chronic exposure to catastrophic war experiences & Political violence Jerusalem 15.-18.2004 © Raija-Leena Punamäki 2007 Developmental approach : Developmental approach Genetics & Experience, Nature & Nurturance (temperament & emotional regulation) Environmental & subjective security vs. stress Continuation:1) Linear, stages & qualitative spurts   2) Impact of first-year, adolescence Developmental domains neurophysiological & hormonal sensomotor & cognitive emotional social © Raija-Leena Punamäki 2007 Traumatic events and symptoms : Traumatic events and symptoms Event Psychological mechanisms Expressed symptoms Nightmares Excessive fears Withdrawal & numbing Concentration problems No integration between feeling & knowing © Raija-Leena Punamäki 2007 Attachment theory (J. Bowlby, M. Ainsworth, M. Main,) : Attachment theory (J. Bowlby, M. Ainsworth, M. Main,) To understand meaning of early human relationship in shaping response to threat & danger Inner working modesl (representations) of worth of oneself, whether to trust others, and safety of environment Cumulative developemnt: Attachment style organizes behavior, emotions, cognitions, and relationships Impact of Traumatic Experience I : Impact of Traumatic Experience I Emotional processing Fragmented & intrusive Lack of synchrony between levels (psychological/physiological) Fear dominates Biased either numbing or escalating of feelings Cognitive activity Memory changes Attention and interpretation distorted Lack of synchrony & framing Impact of Traumatic Experience II : Impact of Traumatic Experience II Psychophysiological Hippocampus volume decrease & Amygdala activity intensifies > Integration of new experiences as a part of old memory >> > fragmented and intrusive experience & difficult to reframe HPA-hypothalamic-pituitary-adrenal axis >>> Regulation of stress hormone Loss of stimulus discrimination a) acoustic startle response, b) low threshold to sound intensifies >>> uncontrollable fear © Raija-Leena Punamäki 2007 Impact of Traumatic Experience III : Impact of Traumatic Experience III Social relations Interactions: scapecoting, rigid & reversedroles Family secrets: everybody protects each other Communication fragmented: ”knowing-not-knowing” Mental Health & Psychopathology Posttraumatic stress disorder (PTSD) Depression and PTSD comorbidity Somatic symtoms, difficulty to name pain Dissosiative disorders Memory types (Tulving) : Memory types (Tulving) Sensory memory: eg. visual (icon), auditory (echo), smell, taste Semantic memory: ”Jerusalem is in the ME”, ”People are basicly good” Episodic & narrative memory: events, stories, jokes Prosedural memory: kinesthetic, emotional states, ”body remembers” Traumatisation and memory : Traumatisation and memory Traumatic Sensory & emotional Visual, auditory, kinesthetic, smell, taste Memories unchanged Sensory memory easily recalled : flashbacks Inner states & unclear cues evoke memories Intrusive & uncontrollable Neutral The meaning is constructed Can be verbalized and presented in symbols Memories fade & disappear with time Both inner states and environmental cues evoke memories Voluntary control Traumatic events and symptoms : Traumatic events and symptoms Event Psychological mechanisms Expressed symptoms Nightmares Excessive fears Withdrawal & numbing Concentration problems No integration between feeling & knowing Main results of dreams among Palestinian children : Main results of dreams among Palestinian children Exposure to trauma increases recall of dreams in the morning > Human mind works actively during the night Dreaming shows a compensatory function: Children with active and heroic coping during the day, reported helpless and fearfull dreams Symbolic, narrative, and emotional dreams protect the child mental health Dreams that ’break’ like nightmares harmful Dreams as material : Aims: Fragmented & broken dreams to complete narrative Exploring and expressing emotions, especially the absent or numbed feelings Facing the horror & monsters in safe place Change the end of the dream story Change the position of the dreamer (victim – hero, active-passive, helped-helped) Form a friendship with your dreams Dreams as material Scoring the dreams : Scoring the dreams Structure of dreams: Fantasy - Documentary Bizarre - Mundane Narrative - Broken story Content of dreams: Anxiety & threat Covert & overt aggression Persecution dreams Saviour dreams Develop. problem solving Behaviour of the dreamer: Passive - active Fearful - heroic Relying on others - alone Emotional repertoire & intensity Repetition of theme, characters, scenes, ending Trauma affects dreams I : Trauma affects dreams I Dream content: Persecution dreams, sense of falling, physical vulnerability Kurdish children dream about death; Orphans about their parents Dream structure: Concrete & content-less dreams (”I dreamt about a dog”, ”Somebody was chasing me”) Lack of narratives & happy endings Trauma affects dreams II : Trauma affects dreams II Many somatic feelings & action dreams (”I was running to escape, but my feet were glued to the ground”) Lack of emotional expression (both negative & positive: ”I fall down because of a killed body, and run away”) Exposure to trauma increases recall of dreams in the morning -> Human mind works actively during the night Trauma & dreaming III : Trauma & dreaming III Exposure to trauma increases recall of dreams in the morning > Human mind works actively during the night Dreaming shows a compensatory function: Children with active and heroic coping during the day, reported helpless and fearfull dreams Symbolic, narrative, and emotional dreams protect the child mental health Dreams that ’break’ like nightmares harmful Slide 17: Protective dream content Parental shield I dreamt that the soldiers intruded our neighbours. They broke the door and took their son. I put lights on, and soldiers came to my room and asked why I had put the light on. I was afraid and shiwering all over my body. They hit me on my face. I called for my mother. She came and took me away from the soldiers, and said to them: ”But he is only a little boy". (Boy of 12, Gaza) Vulnerable dream content No protective shield I dreamt that I was collecting shells on the beach. Suddenly the soldiers appeared and they started to follow me. Other children were running away, but I can not run. My feet were clued to the ground. I shouted for help, but nobody heard me. The waves of the see started to rise, and were very high, the waves approached me, the waves covered me. (Boy of 11, Gaza) Slide 18: Protective dream structure Symbolic, emotional & fantasy Last night I dreamt that water had dried from the see. I was walking in the middle of the dried see. Suddenly I saw a huge fish in front of me, and I got frightened.... He said: I talk to you, because I want to protect you from the anger of other fish and from the rageful see. I said to him... The fish asked me to hurry up, because the see was just sleeping, and when it wakes up it will get back its real nature.(Girl 13, Gaza) Vulnerable dream structure Repeats reality & unemotional I dreamt that soldiers followed me in the streets of the camp. I run as much as I could. They follow and run more until they caught me. They tied my hands and took me the prison. They said me that I had thrown stones. I said that I had not thrown.. They asked .... (Boy 13, Gaza) Interventios: What can be changed? How? When? By whom? : Interventios: What can be changed? How? When? By whom?

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