Introduction to the NMT, Bruce D. Perry

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The ChildTrauma Academy
Introduction to the NMT
Integrang Principles of 
Neurodevelopment into Clinical 
Pracce 
Introducon to the Neurosequenal Model of 
Therapeucs (NMT  
 
 
Theory of Change 
Why do you do the things you do? 
How do you think they will cause 
change for the client – for your child? 
 
2011 
All rights reserved © 2010 Bruce D. Perry
 
All rights reserved © 2010 Bruce D. Perry
 
The Brain Maers
 
• 
The human brain is the organ responsible for 
everything we do.  It allows us to love, laugh, walk, 
talk, create or hate. 
• 
The brain ‐ one hundred billion nerve cells in a 
complex net of connuous acvity ‐ 
allows us our
 
humanity

• 
For each of us, our brain’s funconing is a reflecon 
of our experiences. 
NMT Core Principles 
A.  Brain Organizaon and Funcon 
 
All rights reserved © 2010 Bruce D. Perry
 
All rights reserved © 2010 Bruce D. Perry
 
Abstract thought
Concrete Thought
Affiliation/reward
"Attachment"
Sexual Behavior
Emotional Reactivity
Cortex
Neocortex
Limbic
Limbic
Plasticity
Complexity
Motor Regulation
Diencephalon
Cerebellum
"Arousal"
Appetite/Satiety
Diencephalon
DA 
Sleep
NE 
SER 
Blood Pressure
Heart Rate
Body Temperature
Brainstem
Brainstem
ANS - body
All rights reserved © 2010 Bruce D. Perry
 
All rights reserved © 2010 Bruce D. Perry
 
Materials may not be replicated, repurposed or
modified without permission
Bruce D Perry, MD, PhD © 2010
 
The ChildTrauma Academy
Introduction to the NMT
C
ORTICAL 
M
ODULATION 
“Out”
“In”
Mature
 
Developing/neglect
 
Cortex 
Cortical
Cortex 
Limbic 
Limbic
Limbic 
Multi-level
Processing
DE 
DE 
BS 
BS 
All rights reserved © 2010 Bruce D. Perry
 
All rights reserved © 2010 Bruce D. Perry
 
The Neuron
Synapses
Dendrites
NMT Core Principles 
Axon
B.  Neurodevelopment and Memory 
 
Cell
Body
Myelin
Sheath
All rights reserved © 2010 Bruce D. Perry
 
All rights reserved © 2010 Bruce D. Perry
 
The Brain Develops 
USE-DEPENDENT DEVELOPMENT
The human brain, with all of its complex 
structure and funcon, does not just 
“pop” into existence. 
 
In the 9 months following concepon, 100 
billion neurons and 10 trillion glial cells are 
born. These cells organize, move, connect and 
specialize to create the amazing and 
funconing brain of the newborn.   
The more a neural system is 
“acvated,” the more that system 
changes to 
reflect
 that paern of 
acvaon
  
 
This is the basis for development,
 
memory and learning 
All rights reserved © 2010 Bruce D. Perry
 
All rights reserved © 2010 Bruce D. Perry
 
Materials may not be replicated, repurposed or
modified without permission
Bruce D Perry, MD, PhD © 2010
 
The ChildTrauma Academy
Introduction to the NMT
Brain Growth vs. Body Growth 
Sequenal Neurodevelopmen
 
• 
The brain is undeveloped at birth 
 
• 
The brain organizes from the “boom” up ‐ 
brainstem to cortex and from the inside out 
20 
l
 
15 
Body
 
 
• 
Organizaon and funconal capacity of 
neural systems is sequenal  
10 
 
• 
Experiences do not have equal “valence” 
throughout development 
Brain
 

 


15 
10 
20 
Age in Years
 
www.ChildTraumaAcademy.org 
All rights reserved © 2010 Bruce D. Perry
 
All rights reserved © 2010 Bruce D. Perry
 
Associaon 
What is Memory ? 
• 
The capacity to bring 
elements
 of an experience 
from one moment in me to another. 
• 
The brain makes associaons between sensory 
signals co‐occurring in any given moment in 
me 
 
• 
This is the unique property of life forms. 
 
• 
There are many ways that life forms do this ‐ 
genes, immune system, nervous system 
 
• 
This capacity allows humans to learn, create 
images of the future and survive. 
 
• 
Nervous ssue is 
designed
 to store  
elements of experience.
 
 
• 
This capacity can also make humans vulnerable 
to false associaons ‐ creang fears of non‐
threatening objects.
 
www.ChildTraumaAcademy.org 
All rights reserved © 2010 Bruce D. Perry
 
All rights reserved © 2010 Bruce D. Perry
 
Neuroarcheaology 
• 
The age at which an adverse event takes place 
will influence the neurodevelopmental impact 
and the resulng funconal consequences 
• 
Therefore, developmental history of adverse 
experiences is crucial to understanding 
current funconing 
• 
NMT includes a developmental review of 
adverse experiences AND the buffering effects 
of relaonal health 
Creang First Memories 
The first set of unique sensory smuli 
shape neural “networks” which will 
“encode” and store – in neurons – the 
template for future sensory smuli 
similar to this original sensory 
experience 
All rights reserved © 2010 Bruce D. Perry
 
All rights reserved © 2010 Bruce D. Perry
 
Materials may not be replicated, repurposed or
modified without permission
Bruce D Perry, MD, PhD © 2010
 
The ChildTrauma Academy
Introduction to the NMT
“Out”
“In”
New
experience
is “filtered”
through
past
experience
NMT Core Principles 
C.  Relaonal Neurobiology and Aachment 
 
www.ChildTrauma.org 
All rights reserved © 2010 Bruce D. Perry
 
All rights reserved © 2010 Bruce D. Perry
 
Relaonal Neurobiology 
Foundaonal Neural Systems  
 
The neural systems mediang the stress‐
response, reward, procreaon, reproducon, 
social‐affiliaon and communicaon are all 
are inter‐related  ‐ indeed, they oen share 
the very same fundamental neurotransmier 
networks and brain regions 
Human beings are social 
creatures. 
The neural systems which mediate social 
interacon, communicaon, empathy and the 
capacity to bond with others are all shaped by the 
nature, quanty and ming of early life 
relaonships. 
www.ChildTrauma.org 
All rights reserved © 2010 Bruce D. Perry
 
All rights reserved © 2010 Bruce D. Perry
 
VTA
DA
Sensation of
pleasure and
safety
Release of
hormones
and “calmer”
regulation of
key stress
related
neural
systems
Somatosensory
cues
Primary
caregiver
Decrease
physiological
distress
All rights reserved © 2010 Bruce D. Perry
 
All rights reserved © 2010 Bruce D. Perry
 
Materials may not be replicated, repurposed or
modified without permission
Bruce D Perry, MD, PhD © 2010
 
The ChildTrauma Academy
Introduction to the NMT
All rights reserved © 2010 Bruce D. Perry
 
All rights reserved © 2010 Bruce D. Perry
 
LC
NE
Fear and
confusion
Activation of
key stress
related
neural
systems
Somatosensory
cues
Primary
caregiver
Increase
physiological
distress
All rights reserved © 2010 Bruce D. Perry
 
All rights reserved © 2010 Bruce D. Perry
 
All rights reserved © 2010 Bruce D. Perry
 
All rights reserved © 2010 Bruce D. Perry
 
Materials may not be replicated, repurposed or
modified without permission
Bruce D Perry, MD, PhD © 2010
 
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