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Cheryl Sharp

Exclusive Consultant for Trauma Informed Care Initiatives, National Council for Behavioral Health

Stumped on Trauma Treatment? Start with the Brain, Says Bruce Perry

September 9, 2013 | Mental Health Treatment | Comments
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When I travel the country providing trainings and consultation to behavioral health providers on building trauma-informed systems of care, I see that providers struggle with trauma treatment.

Trauma is multi-dimensional and affects many areas of a person’s life — education, health, mental health, substance use, and social connections. Each area involves a different perspective and requires a different approach. This can lead to mixed messaging and confusion among those who provide treatment and services to individuals coping with trauma. Dr. Bruce Perry, renowned child trauma expert and senior fellow at the Child Trauma Academy, was with us at Conference 2013 (slides at and also did a National Council webinar on September 5th (recording at He explained how we can better address trauma when we evaluate it at the neurobiological level.

The brain controls functions that we — as providers — aim to treat. So, if we are to change the brain, we must first understand how it works. We must understand the core elements of developmental, educational, and therapeutic experiences — relation, repetition, reward, rhythm, and respect. These experiences help individuals develop and change their behavior to better adapt to everyday stress.

The human brain has complex stress response networks that incorporate cognitive and physiological features. The chemicals in the brainstem help the brain process information and physiological processes (e.g., breathing, heartbeat). When a brain develops “normally,” cognitive processes and body regulation are seamless. However, these systems can become deregulated dysregulated because of what Dr. Perry calls “developmental insults,” like traumatic stressors. These insults can interrupt neural systems and cause an array of emotional and physical problems.

Fortunately, the human brain is capable of change, but how do we promote change when trauma occurs? Dr. Perry explains that the brain reaches a point of equilibrium and will naturally resist change. This is why an infant who is in a rapid stage of development can more easily learn and adjust than a 15-year-old who has reached equilibrium. To change the brain, we need to follow rules to rebuild these systems. These rules fall in four different dimensions:

  • Development (time)
  • Anatomy
  • Specificity
  • Pattern

Breaking down each of these dimensions helps us understand how we effectively change brain behavior. We know it is easier to treat when the brain is in early development. But, we must also understand anatomy — specifically that our cognitive, high-functioning level is in our cortex (top of the brain), while our physiological, life-sustaining level is in our brainstem (bottom of the brain). The cortex has lots of complex moving parts that allow for more malleability whereas the brainstem has fewer moving parts and will not change as easily.

This relates to trauma treatment because dysregulation occurs in the lower brainstem from trauma, and treatment will not be effective if it isn’t focused there.  We need to administer pattern-repetitive stimulation to the areas of the brain impacted by trauma. We can then begin to treat trauma, and can change the brain.

Analyzing the brain and neurobiological processes might be the best way to address the impact of trauma. While the task is daunting, Dr. Perry gives us a way to look at children and adults affected by trauma and provide care that is specific to the individual. We need to work with individuals — not look to treat conditions.

To learn more about trauma, its causes, its treatments, and building and sustaining trauma-informed services in your center or community, please feel free to get in touch with the National Council. Email for more information.