Theoretical Basis

Excerpted from Ford (2004) "Exposure to Early Life Traumatic Stress and Psychobiological Self-Regulation:" Exposure to traumatic stress in early life is associated with enduring problems with biopsychosocial self-regulation that have been described as complex posttraumatic stress disorder (PTSD) or Disorders of Extreme Stress Not Otherwise Specified (DESNOS). Results of human and animal studies on brain development, the ontogeny of self-regulation, and adverse effects of exposure to traumatic stressors in early life involve three domains of self-regulation: somatic self-regulation (i.e., attachment: affiliation, dyadic synchrony, separation adaptation, reunion acceptance, self-other "working models"), affect regulation (i.e., somatic monitoring, threat detection, reward pursuit, effortful integration and utilization of affect), and information processing (i.e., selective attention and cognitive control, memory acquisition, consolidation, extinction, and reconsolidation, and working and autobiographical memory).

When early childhood exposure to traumatic stressors has occurred, the development of central nervous system pathways that promote survival but are fundamentally incompatible with knowing when and how to feel and be genuinely secure, safe, or hopeful, may cause PTSD to be exacerbated by fundamental alterations in attachment, affect regulation, and information processing. Other people may be experienced as potential rescuers or perpetrators who have special powers to either fix or horribly compound terrible damage to the individual's sense of self-worth and purpose in life. Bodily and emotion feelings may seem completely absent, alien, or overwhelmingly dangerous, painful, and hopeless, leading to self-harm or dissociation as means of avoiding intolerable internal body states. Mental concentration, memory, and behavioral self-control may be impaired by impulsivity, indiscriminant risk taking, and indifference to the safety or best interests of self or others. Therefore, interventions for PTSD should systematically focus on enhancing basic self-regulatory capacities (Ford et al., in press). PTSD treatment can assist patients in identifying and modulating not only fear and anxiety but a range of discrete emotions (e.g., anger, grief, shame). In teaching skills for anxiety management and cognitive restructuring, patients may benefit from learning ways to recognize, verbally label and cognitively re-construct emotions, contexts (e.g., rewarding as well as aversive features of settings and events) and salient stimulus complexes (e.g., facial expressions). For example, verbal labeling of emotions has been shown to be associated with activation of neural pathways within and between the ventral striatum, hippocampus, insula, ACC, and Or/DLPFC which counterbalance or inhibit more primitive threat-related activation in the HPA axis, brainstem, and amygdala. Although the extent to which focused psychotherapy and educational interventions actually can influence brain functioning and restore somatic, affective, and cognitive self-regulation is not yet scientifically established, interventions designed with these psychobiological and psychosocial systems as the focus represent an important next step in the development of effective approaches to trauma recovery.

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