Episode 1: The Roots of Chronic Posttraumatic Stress Disorder
Listen in to hear Melissa, Bridger and Caleb discuss and articulate some of the concepts found in the article “The roots of chronic post traumatic stress disorder, childhood trauma, information processing and self protective strategies” written by Patricia McKinsey Crittenden and Mary Brownescombe Heller.
“The Roots of Chronic Post Traumatic Stress Disorder” by Patricia McKinsey Crittenden and Mary Brownescombe Heller
Looking at European attachment styles, not just security and insecurity, but strategy for seeking safety.
Quote from Abstract- “We propose a developmental process in which unprotected and uncomforted danger in childhood would be associated with “shortcuts” in information processing that in adulthood, could result in PSTD, if the adult experienced additional exposure to danger” (Crittenden & Brownescombe, 2017).
- 66 participants split into 3 groups
- 22 individuals with chronic PTSD and 22 with other psychiatric diagnosis
- 22 normative adults without any diagnosis
- Compared each population across the Dynamic Maturation Model and traditional attachment inventory.
At Beyond Healing Center, we conceptualize that every diagnosis has its roots in trauma but not everyone who experiences trauma goes on to experience PTSD symptoms.
- We believe that every psychiatric diagnosis in the DSM is a direct result of an adaptive survival strategy of the human nervous systems to overwhelming situations in our environment.
- DSM was not intended to be used for insurance classification. It gives approximations of symptom presentations.
- “Up until now, the roots of post traumatic stress disorder have not been well understood. We wonder if that was partly attributable to considering it a disorder rather than an adaptive process gone awry” (Crittenden & Brownescombe, 2017).
Their definition of information processing- “basic associative and dissociative and integrative processing used by all humans”(Crittenden & Brownescombe, 2017).
- When information comes into our system, we decided to “associate” it or “dissociate” it.
- “Protective and comforting behaviors of caregivers becomes an immediate factor in developing PTSD” (Crittenden & Brownescombe, 2017).
- Don’t just look at if the need was met, but also how the need was met and under what condition.
- Acceptance and attunement made contingent.
- What did the client have to do as a child to get their needs met?
The difference between American attachment theory and European attachment theory:
- European attachment theory doesn’t use categories as much as assessing on a spectrum.
- American attachment theory is rigid and over-simplified.
- “Although the brain has evolved to give preferential attention to signs of danger, the long period of childhood is needed for children to learn to recognize the signs of danger and to organize self-protective strategies. This developmental process shapes how the brain organizes and functions in the future”(Crittenden & Brownescombe, 2017).
- “Short cuts” are adaptations in response to danger.
The adult experience of what is dangerous is very different to what a child experiences.
- Childhood is a prolonged nervous system programming as a survival strategy.
- As therapists, our job should be to help our child/client to effectively navigate how to accurately and calmly perceive and respond to danger and to trust that comfort is available. And if it’s not, we must help them make sense of that experience.
- Example- child alone attacked by a man in a red jacket.
- First, type A strategy- omitted negative affect and distorted cognition- totally dismiss the whole event. “I was attacked” I’m not going to prioritize any of the information. They depersonalize the whole experience
- Type C strategy- omitted cognition and distorted affect- would focus on a particular stimuli or sensation of the event, such as the color of the jacket. “I can feel safe around women, just not men.”
- Type B secure strategy- there is a grounded integration through the way they perceive information. “I was unaware of my surroundings.”
- Lastly, A/C combination- Integrated Transformed Delusional Affect and Delusional Cognition- you are telling yourself delusional stories about the event and brining affect that is incongruent with the experience.
“PTSD treatment facilitated by the provision of a protective and supportive therapist who is focused on the correction of information processing errors and use of more adaptive strategies is our goal” (Crittenden & Brownescombe, 2017).
- The strategies that we develop in response to trauma leave us unprepared for when our strategies fail.
- This is where our dysfunction/ “illnesses” get entrenched because we double down on our commitment to our strategies.
- When a strategy fails, it continues to change and develop.
- We are unprepared when a strategy fails. We also do not spontaneously move to a more adaptive strategy. We tend to double down in our strategy that we are used to.
- “If my strategy fails, I’ll have nothing.”
- Attachment is not about love, it’s about pure safety and survival.
Attention and Reflection
- The genesis of these strategies; the misapplication of attention and lack of reflection being part of how these strategies develop.
- As a therapist, understanding the role of how we help the client focus on certain aspects of their experience and be the “attention director.”
- “Focusing” by Eugene Grendlin
First and second hypothesis- The article was looking at whether the group with chronic PTSD differed from the adults with other psychiatric diagnosis and protective strategies, psychological trauma and depression, and had a signature pattern and were different in ways that might affect vulnerability to treatment of PTSD.
- Adults with PTSD and other psychiatric disorders were similar in using unbalanced strategies and higher rates of depression.
- The PTSD and psychiatric group differed in psychological trauma. In the PTSD group, there was more ongoing trauma from childhood, complex traumas and dismissive preoccupied traumas.
- It’s not about “was this strategy a result of trauma?” The answer is yes, if adaptive strategies were there then that means that the trauma was present.
- PTSD represents a threshold in which once we surpass it, we have a recognizable commitment to a clinical degree.
Third hypothesis: Does this information have implications for how therapists should be treating PTSD?
- Yes, because those strategies/shortcuts are reflective of the information processes style and system that is in place.
- Strategies that collude can often worsen symptoms.
- Type C strategies may be more likely to seek treatment than type A. Dismissive strategy can often be augmenting.
Conclusion: We are not just talking about random areas of illness but a strategy that went awry.