The GodShaped Brain How Changing Your View of God Transforms Your Life The Journal of the Watcher The Remedy New Testament Expanded Paraphrase The GodShaped Heart How Correctly Understanding Gods Love Transforms Us ID: 933330
Download Presentation The PPT/PDF document "AUTHOR: Could It Be This Simple? A Bibli..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
AUTHOR:Could It Be This Simple? A Biblical Model for Healing the Mind The God-Shaped Brain: How Changing Your View of God Transforms Your Life The Journal of the WatcherThe Remedy New Testament Expanded ParaphraseThe God-Shaped Heart: How Correctly Understanding God’s Love Transforms UsThe Aging Brain: Proven Steps to Prevent Dementia and Sharpen Your MindThe Remedy of the Lord in Song: The Psalms
Timothy R. Jennings, MD, DFAPAPast-President, TN Psychiatric AssociationPast-President, Southern Psychiatric Association
RECOVERING FROM SEXUAL ABUSE
Slide2OVERVIEWThe ProblemThe ConsequencesThe Treatment
Slide3THE PROBLEMIn Christian Homes?The rate of child physical and sexual abuse is no different in Christian homes than non-Christian homes
Slide4Slide5WHAT IS SEXUAL ABUSE?Not everything that is legally defined as sexual abuse is equally damaging FrotteurismVoyeurism
Slide6WHAT CAUSES THE PSYCHOLOGICAL DAMAGE FROM SEXUAL ABUSE?The meaning, the interpretation, the way the experience is internalized by the person – Person beaten with whipOne person may experience terrible psychological trauma another might experience arousal and pleasure This is true for any exploitation Your home, broke into & something is stolen you never found out or you find out?
Slide7WHY IS THIS IMPORTANT?What if you discover a person has been molested, exploited or abused?First assess that person’s knowledge, understanding and awarenessA child being bounced on a lap – The real damage might come from the psychological evaluation “therapy” and court testimony
Slide8But what about when the abuse is clear, known and experienced –A parent who beats their child or molests them?What happens, what’s the damage, what’s the problem?
Slide9BRAIN CIRCUITS
DLPFCAdministrator
Hippocampus
Fire Chief
Amygdala
Alarm
Hypothalmus
911 Operator
Pituitary
Adrenal Glands
Emergency responders
Illustration by: Simon Harrison
Slide10SALIENCE NETWORK
Temporal-parietal Junction
Thalamus
Amygdala
Nucleus
Accumbens
Illustration by: Simon Harrison
ACC
VMPFC
Orbital PFC
DLPFC
Slide11WHAT DISRUPTS SALIENCE NETWORK?Denial or believing liesUnresolved guiltGrudge holding and resentmentUnresolved trauma contributes to all of these
Slide12Imagine you believed any moment someone was going to walk in and either rape you or beat you severely and you had to take final exams with that threat hanging over your head – would your exam scores be affected?
Slide13WHAT IF AMYGDALA DOESN’T CALM?
Amygdala Increased
Illustration by: Simon Harrison
Slide14OVER ACTIVE AMYGDALAActivates sympathetic nervous systemWhich activates macrophages – Why?Which release cytokines – IL1, IL6, TNF Which damage:Insulin receptors, glucocorticoid receptors, interfere with NE, 5HT, DA signalingResulting in:Increased DM, obesity, high cholesterol, MI, Stroke, autoimmune problems and bone density loss
Slide15UNREGULATED AMYGDALA FIRINGUnremitting stress response cascade results in inflammatory factors affecting the bodyThe changes in the body then react back upon the brain causing brain changes Suppresses BDNF and damages glia, resulting in depression
Slide16THE TRIPARTITE SYNAPSE:THE ROLE OF ASTROGLIA IN SIGNALING
Halassa
MM, et al.
Trends
Mol
Med.
2007;13(2):54-63.
Slide17THE TRIPARTITE SYNAPSE:THE ROLE OF ASTROGLIA IN SIGNALING
5-HT=serotonin. BDNF=brain-derived neurotrophic factor. CNS=central nervous system. GLU=glutamate. IDO=indoleamine 2,3 dioxygenase. IFN=interferon. IL=interleukin. NMDA=N-methyl-D-aspartate. QUIN=quinolinic acid. RNS=reactive nitrogen species. ROS=reactive oxygen species. TNF=tumor necrosis factor. TRP=tryptophan. Miller AH, et al.
Biol
Psychiatry. 2009;65(9):732-741. Reprinted with permission from Elsevier Limited.
Slide18PET SCAN
Slide19BRAIN CHANGES DURING DEPRESSIONInflammatory factors damage gliaGlia stop providing support and instead release oxidative factorsImpaired neurogenesisAltered DNA expressionLoss of neurotrophic factorsImpaired PFC functionThinning of PFC and hippocampal regions
Slide20CHILDHOOD ADVERSITY REPRESENTS A RISK FOR DEPRESSION
Major depression (panel 1): z=4.94, P<.001. High-sensitivity C-reactive protein (hsCRP) level 3 mg/L (panel 2): z=3.24, P=.001. Clustering of metabolic risk markers (panel 3): z=4.58, P<.001.
1
age-related disease risks (panel 4): z=5.66, P<.001. Adapted from
Danese
A, et al. Arch
Pediatr
Adolesc
Med. 2009;163(12):1135-1143.
32-year prospective study.
% of Study Members With the Condition
Major Depression
hsCRP
>3 mg/L
Clustering of Metabolic Risk Markers
Number of Adverse
Childhood Experiences
≥2 (n=98)
70
60
50
40
30
20
10
0
0 (n=502)
1 (n=253)
Slide21WHY DO SOME GET PTSD AND OTHERS DON’T?
Slide22Panels A and B. In individuals who experienced high levels of early life stress, the rare allele of 2 SNPs had a protective effect on the severity of adult depressive symptoms
Panel C. Similar interactive gene dosage patterns were seen across the other SNPs that were significant prior to correction
Bradley et al. Arch Gen Psychiatry 2008;65:190-200.
EFFECTS OF GENOTYPES AND CHILDHOOD ABUSE ON ADULT DEPRESSION
Slide23SEROTONIN S/S OR L/LGENETIC POLYMORPHISM ACCOUNTS FOR 30% VARIANCE IN PTSD AMONGST POST ABUSE VICTIMSIllustration by: Simon Harrison
Slide24Slide25Main effect of childhood trauma score (including physical, sexual, and emotional abuse) on cortical thickness in 54 adult women(Heim et al, in preparation)
Somatosensory homunculus and fMRI studies showing somatosensory representation of the human genital area (circles and rectangles)
(
Michels
et al, 2010; Kell et al, 2005)
CHILDHOOD TRAUMA ASSOCIATED WITH DECREASED THICKNESS OF SOMATOSENSORY CORTEX GENITAL FIELD
Slide26GENE EXPRESSION CHANGEMcGill University study 24 suicides, 12 with history of abuse, 12 withoutNR3C1 Gene expression in the brain is suppressed in children who are abusedNR3C1 is critical in stress management, and this alteration may permanently alter the ability to cope with stress
http://
psychcentral.com
/news/2009/02/23/child-abuse-alters-brain-gene/4283.html
Slide27CHILD ABUSE AND GENE EXPRESSIONIN BRAIN TISSUE41 Canadian men (25 severe abuse, 16 controls)DNA examined from hippocampal neurons362 different epigenetic changes248 hypermethylated114 hypomethylatedThose most significantly affected where genes which regulated neuronal plasticity
Arch Gen Psych, 2012; 69(7):722-731
Slide28ADULTS WHOWERE ABUSED AS CHILDRENHave higher rates of medical illnessesHave higher rates of mental illnessesHave higher suicide ratesHave higher alcohol/drug problems
Slide29Video Courtesy of NEINeuroscience Education Institute
Slide30Videowww.comeandreason.com
Slide31FIGHT, FLIGHT, FREEZE
Slide32ALTERED RELATIONSHIPSThey have distortions in male/female relationships and family dynamicsIf the abuser was a parent or priest or teacher they have distorted images of God, as parents are the template which our initial God constructs are built
Slide33WHAT IS WORSE THANRAPE OR MOLESTATION?Betrayal – when it is done by a parent, or when a parent colludes, or fails to stop itThe more serious damage from sexual abuse is typically not done to the body, but to the mind
Slide34WE HAVE POWER OVER WHAT WE BELIEVE BUT WHAT WE BELIEVE HAS POWER OVER US – WHAT DO VICTIMS OF ABUSE BELIEVE?I’m worthless, ugly, dirty, nasty, Its my faultLife isn’t fair People can’t be trusted They have self doubt Increased fear, increased firing of amygdala and more damage to brain and body
Slide35THE TREATMENTBio-psycho-social-spiritual interventionsBiological – physical exam, exercise, diet, avoid substances of abuse, psychotropics, sleep Psychological – Psychotherapy
Slide36COGNITIVE THERAPY
Improved DLPFC
Calmed Amygdala
Slide37Adapted from
DeRubeis RJ, et al. Nat Rev Neurosci. 2008;9(10):788-796.
12 Weeks of Cognitive Therapy
0.15
0.10
0.05
0.00
-0.05
2
4
6
8
10
12
Time (Seconds)
BOLD Signal (% Change)
Time (Seconds)
BOLD Signal (% Change)
0.30
0.15
0.10
0.05
2
4
6
8
10
12
14
16
18
0.00
0.20
0.25
Pre
Post
Control
a. Emotional
b. Cognitive
Is it you?
UGLY
Put the digits
in numerical order
7 4 3 1 5
Patients with depression (n=9)
Controls (n=24)
IMPACT OF COGNITIVE THERAPY ON AMYGDALA AND PREFRONTAL (DORSOLATERAL PFC) ACTIVITY IN MDD
Slide38COGNITIVE THERAPY AND GENE EXPRESSIONPTSD pts lower: FKBP5 gene expression and smaller hippocampal and medial orbitofrontal cortex, but not amygdalaAfter CBT: PTSD patients did not differ from controls in:FKBP5 gene expression or hippocampal volumeThinking new thoughts alter gene expression and brain structure
Biological Psych, Vol 74,(1) Dec 2013 p. 793-800
Slide39Effective TherapiesProlonged Exposure (PE)Involves working with a trained provider to face the feelings or activities that you have been avoiding in order to work through the intense emotions, resolve the trauma memories, and stop the automatic responses.Cognitive Processing Therapy (CPT)Focuses on working with your provider to reprocess and reframe the trauma. This involves writing assignments, learning to identify how the trauma has been labeled in your thinking, and moving away from exaggerated and inflammatory labels to fact-based ways of remembering.Eye Movement Desensitization and Reprocessing (EMDR)Helps you reprocess and resolve the trauma by talking through the memories with a provider while paying attention to a back-and-forth movement or sound (like a finger waving side to side, a light, or a tone).
Slide40TRUTHTo remove distortions and stop negative cascadeInability forgive What truth is needed?The truth about what sin does to the sinnerDistorted self image Mirror analogyInappropriate filing/meaning of eventsChild in parking lot, pastureGodWhy did God let this happen?
Slide41THE TREATMENTBio-psycho-social-spiritual interventionsBiological – physical exam, exercise, diet, avoid substances of abuse, psychotropics, sleep Psychological – PsychotherapySocial - Healthy friends, group therapies, family therapies Spiritual - Healthy spirituality and worship, Bible study, reframe to larger view, truth about themselves, their abusers and their situation, learning how to reason and think and tolerate powerful feelings, the nature and character of sin – forgiveness issues
Slide42GOD AND BRAIN CIRCUITS
ACC
Amygdala
Newberg, A. How God Changes Our Brain. Ballantine Books, New York. 2009: p.49.
Slide43WHAT DISRUPTS SALIENCE NETWORK?Denial or believing liesUnresolved guiltGrudge holding and resentmentUnresolved trauma contributes to all of these
Slide44WHAT CONNECTS SALIENCE NETWORK?TruthRepentance ForgivenessResolved trauma applies all of these
Slide45SUMMARYSexual abuse damages brain, body, mindBut the damage can be healed, particularly the damage to the mindWhen the mind heals the brain and body also heal