Trauma and the Brain
A Q&A with Diane Bigler on How They Work Together
"Not all fifty minutes of a session needs to be intense, deep trauma work... We give the nervous system a break, and then we go back into the work."
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On August 5th, Diane Bigler (LCSW, LSCSW), showed attendees how trauma physically reshapes the brain and what that means for recognizing, and responding to, the clients who carry it.
Below is a breakdown of what was covered in the event, "Trauma and the Brain: How They Work Together", as well as a Q&A from Diane on the topic's most pressing questions.
Meet the Triune Brain
Diane presented to the audience a simplified model of the brain itself: the Triune Brain. This concept breaks the brain into three interconnected parts.
- The neocortex is the "thinking brain," responsible for logic, reasoning, and abstract thought.
- The limbic system is the "feeling brain," the seat of emotion, empathy, and connection.
- And the "reptilian brain", centered in the brainstem, is the survival brain and the part responsible for fight, flight, freeze, or shutdown.
Trauma, Bigler explains, can disrupt any one of these three systems, and she walks the room through how clinicians across disciplines (mental health, nursing, occupational therapy, even dietetics) each have a role to play in supporting a client whose brain is struggling in a particular area, whether that shows up as difficulty with executive functioning, emotional dysregulation, or a nervous system stuck in survival mode.
A Voice on Trauma: Dr. Bruce Perry
The above framework sets up one of the day's central figures: Dr. Bruce Perry, a physician and psychologist and one of the top experts in the country on childhood trauma.
His research on the limits of individual therapy alone, as Perry puts it, is that doing great clinical work with someone who returns each week to a family, community, or neighborhood in crisis is "like treading water."
As a renowned individual in the psychology space, Dr. Bruce Perry went on to collaborate with Oprah Winfrey, herself a survivor of childhood trauma, which produced the book What Happened to You?, a book built around a simple but significant reframe that highlights a fresh way of thinking: instead of asking someone "what's wrong with you," trauma-informed clinicians learn to ask "what happened to you." It's a shift from judgment to curiosity, and it carries through the rest of the training.
From ACEs to Adverse Community Environments
That same shift (from individual pathology to context) is important to note as we learn about Adverse Childhood Experiences, or ACEs.
In Dr. Bigler's August 5th presentation, she traces the original ACEs framework back to a survey developed by Kaiser Permanente in the 1990s, identifying ten categories of childhood adversity linked to long-term physical and mental health outcomes.
From these outcomes, the thinking around ACEs were upgraded to what researchers now call ACEs 2.0 -- adverse community environments, such as discrimination, community violence, or lack of access to opportunity, that shape a person's experience of trauma just as powerfully as what happens inside their own household. Past that, ACEs 2.0 also include experienced events like climate disasters, learning differences, bullying, domestic violence.
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Why This Framework Matters
Together, these frameworks discussed in Bigler's August 5th presentation support the case they are building toward: that trauma-informed care has to look beyond a single diagnosis or symptom.
Understanding which part of the brain a client's trauma response is coming from, and understanding that the trauma itself may be rooted in community, not just family, changes how a clinician shows up in the room. With that foundation in place, below is a Q&A, featuring Diane Bigler, on what practitioners wanted to know Trauma, the Brain, and how they work together.
TRAUMA AND THE BRAIN
Q&A: Diane Bigler on Recognizing and Responding to Trauma
How do we ask "What's Wrong with You," or "What Happened to You"?
DIANE BIGLER: "We approach people with the curious question of 'what happened to you,' because that is more of an affirming way, rather than being judgmental — why are you acting this way, why do you feel this way, why can't you control yourself. We want to understand what happened to them and what their lived experience is."
Can a person have both Hyperarousal and Hypoarousal?
"Yes, a person can have both hyperarousal and hypoarousal.
Sometimes it's a matter of moments where they're vacillating between one or the other — sometimes in a period of a day or a couple of hours. They may wake up in hypoarousal, not motivated to get out of bed, feeling very low energy. When they do start moving around, their nervous system starts to become overactivated, so they go back to bed as a means of trying to bring down that anxiety."
Should periods of processing trauma be shorter?
"Not all fifty minutes of a session needs to be intense, deep trauma work.
In fact, it's recommended that you lean into titration and pendulation, so that your clients have the tolerance to do little bits of work at a time, rather than forty-five minutes of straight trauma work. We do a little bit of the work — one swing of the pendulum — and when we see the client's distress increasing, we take a break and talk about gardening, their dog, a movie they saw. We give the nervous system a break, and then we go back into the work."
When should we be watching for a client moving out of their window of tolerance?
"You have things that cause people to go out of their window of tolerance — those are things we're often aware of in psychotherapy, that trigger people, activate people's nervous system.
That moves them into either being hyperaroused or hypoaroused. And then you have things that are recommended to help people go back into, or stay within, their window of tolerance."
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Is it possible that self-harm is a way of exercising control?
"Yes, absolutely. We find that that can be one of the main motivations for self-injury — this is what I have control over.
This is a way for me to either be in control of my pain, experience numbness, feel more alive. We really need to explore with a client who is self-injuring and get into the root of what the reason is. That's why I like to do a DBT chain analysis — it's going to go back in time, the minutes, the hours, the days before the self-injury, and look at those links in the chain."
Is trauma work only about addressing problems — or is there room for growth?
"We don't just want to look at the deficits or problems that trauma creates in the body and the brain, but also look at resiliency, strengths, and resources.
I introduce this to my clients early in treatment — we talk about the endpoint, the reality, and I give anecdotal examples of other clients who have been able to develop and demonstrate post-traumatic growth. That can be very inspiring and create a sense of hope for a client who isn't sure they'll ever feel different." ◼
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