Trauma and Neglect from an NMT perspective
How does the Neurosequential Model of Therapeutics (NMT) make sense of developmental trauma and neglect and their impacts on the nervous system?
Bruce Perry teaches in his model that stress can create resilience or vulnerability based on the following patterns:
Predictability: If stress is predictable, it promotes resilience, while unpredictability fosters vulnerability
Control: If I can control when I stop the stress, then it makes me much more resilient than when I when I cannot control it and when it is prolonged
Intensity: moderate stress promotes resiliency, while overwhelming stress will create vulnerability
Here is a picture of what Bruce Perry shares (from one of his videos at about 11 minutes)
Neglect and the Brain
Neglect (also called acts of omission) is an integral part of developmental trauma and describes things that should have happened but didn’t such as being protected, reassured, soothed, played with, held, seen, heard, by caring adults.
While it may seem like it would not have an impact as big as stress, it has a very profound and visible effect when it is extreme.
The image on the left is a 3-year old brain without experiences of neglect. The one on the right has experienced extreme neglect. You can notice that not only it is overall smaller, but the ventricles (dark wholes in the middle) are enlarged, and the grooves all around seem deeper and wider, called cortical atrophy. (Image from Bruce Perry’s paper).
What this means is that brains that have suffered neglect may have less developed neural connections and networks, creating underdeveloped systems. These could be sensory, emotional regulation, relational, impulse control, and mentalization systems.
Stress can lead to sensitization of the nervous system or tolerance, depending on the specific stress patterns.
Sensitization of the Nervous System
Because developmental trauma involves unpredictable, extreme, prolonged (and repeated) stress (these are also called acts of commission in the trauma literature), these patterns create a sensitization of the nervous system.
I like to think of when you burn your skin and then your skin is very sensitive for a while. This is similar in a way as the nervous system becomes extremely sensitive to stress.
This means that what an outsider would consider minor stress will become a major stress for a sensitized nervous system.
This means that the nervous system will go from 0 - calm state- to 100 - fight or complete shut down very quickly.
Bruce Perry makes it very clear that any change is stressful. He uses the example of standing up, which creates a physiological stress in the body and to adjust, the heart has to beat faster and stronger.
This makes sense and really helps us think about how transitions, small changes, unpredictability, and uncertainty will make it very challenging for sensitized nervous systems.
What does this mean in Practice?
In practice, this means that sensitized nervous systems will respond extremely strongly to what others may perceive as little stress. Additionally, this will also mean that the time it will take for the nervous system to calm down will be much longer than non-sensitized nervous systems. It also means that small changes in daily life will create an intense response. It could be a change in routine, a teacher’s assistant not being there, or a transition from one activity to the next.
In my experience, this is very much how families describe their experiences to me.
On the other hand, what neglect means in practice, is that some of the skills non-neglected individuals will have developed may be underdeveloped. Usually these skills are more salient when looking at socio-emotional skills.
