Transcript 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
• 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
Horror, Threat, Danger
Event
Arousal
Sensitivity
to danger
Sensomotor memory,
Psychological
No episodic memory
mechanisms
Expressed
symptoms
•Nightmares
•Excessive fears
•Withdrawal & numbing
•Concentration problems
Biased
perceptions &
interpretations
No
integration between
feeling & knowing
© Raija-Leena Punamäki 2007
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
© Raija-Leena Punamäki 2007
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
© Raija-Leena Punamäki 2007
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
Social relations
• Interactions: scapecoting, rigid & reversedroles
• Family secrets: everybody protects each other
• Communication fragmented: ”knowing-notknowing”
Mental Health & Psychopathology
•
•
•
•
Posttraumatic stress disorder (PTSD)
Depression and PTSD comorbidity
Somatic symtoms, difficulty to name pain
Dissosiative disorders
© Raija-Leena Punamäki 2007
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”
© Raija-Leena Punamäki 2007
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
© Raija-Leena Punamäki 2007
Traumatic events and symptoms
Horror, Threat, Danger
Event
Arousal
Sensitivity
to danger
Psychological
mechanisms
Expressed
symptoms
Sensomotor
memory,
No episodic
memory
•Nightmares
•Excessive fears
•Withdrawal & numbing
•Concentration problems
Biased
perceptions &
interpretations
No
integration between
feeling & knowing
© Raija-Leena Punamäki 2007
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
© Raija-Leena Punamäki 2007
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
© Raija-Leena Punamäki 2007
Scoring the dreams
• Structure of dreams:
• Content of dreams:
Fantasy - Documentary
Bizarre - Mundane
Narrative - Broken story
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
© Raija-Leena Punamäki 2007
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
© Raija-Leena Punamäki 2007
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
© Raija-Leena Punamäki 2007
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
© Raija-Leena Punamäki 2007
Protective dream
content
Vulnerable dream
content
• Parental shield
• No protective shield
I dreamt that the soldiers
I dreamt that I was collecting
intruded our neighbours.
shells on the beach.
They broke the door and
Suddenly the soldiers
took their son. I put lights
appeared and they started
on, and soldiers came to my
to follow me. Other
room and asked why I had
children were running
put the light on. I was
away, but I can not run. My
afraid and shiwering all
feet were clued to the
over my body. They hit me
ground. I shouted for help,
on my face. I called for my
but nobody heard me. The
mother. She came and took
waves of the see started to
me away from the soldiers,
rise, and were very high,
and said to them: ”But he
the waves approached me,
the waves covered me.
is only a little boy".
(Boy of 12, Gaza)
(Boy
of 11,Punamäki
Gaza) 2007
© Raija-Leena
Protective dream
structure
Vulnerable dream
structure
• Symbolic, emotional &
• Repeats reality &
unemotional
fantasy
Last night I dreamt that water
I dreamt that soldiers followed
had dried from the see. I was
me in the streets of the camp.
walking in the middle of the
I run as much as I could.
dried see. Suddenly I saw a
huge fish in front of me, and I
They follow and run more
got frightened.... He said: I
until they caught me. They
talk to you, because I want to
tied my hands and took me
protect you from the anger of
the prison. They said me that
other fish and from the rageful
I had thrown stones. I said
see. I said to him... The fish
that I had not thrown.. They
asked me to hurry up, because
asked ....
the see was just sleeping, and
(Boy 13, Gaza)
when it wakes up it will get
back its real nature.(Girl 13, Gaza)
© Raija-Leena Punamäki 2007
Interventios: What can be changed?
How? When? By whom?
Neurofysiology
•stress
regulation
•brain
specification
Experiences
Sensomotor
•coordination*
Cognitive
complexity
•language
Emotional
•attention
Maturation
•memory
•emotion
recognition
Social
•problem
• emotional
•empathy
solving
expression
•friendship
© Raija-Leena Punamäki 2007