#complextrauma – Catherine's Field of Ideas

Trauma 101: The Basics No One Told You and You Didn’t Know to Ask

Fight, Flight, or Freeze (FFF) Responses

The brain is an interesting muscle. It can do so much and yet we don’t utilize more than ten percent of its capabilities. It is responsible for all the other muscles and functions in our body, and it is multitasking all the time (consciously and unconsciously). It has this neat thing called neuroplasticity, meaning despite any damage to some of its parts the muscle can be strengthened and experience some healing. In trauma this is evident in the fight or flight response, which has been expanded to include freeze and fawn. You can read more about these responses here, but it is important to understand the basic brain structures in this response system.

Back in the caveman days we needed to stay alive, so our bodies needed a way to keep us safe without overworking our muscles when it was not necessary. Imagine a sabretooth tiger slowly coming to the cave opening-it is crouched low to the ground, its head is lower, and ears are back, the mouth is open slightly reveling fangs and there is drool. Our amygdala senses there is a danger, checks with the hippocampus quickly (which remembers another time when it saw this scene and it was not safe), and quickly tells the hypothalamus to make the body run (flight), grab a weapon and defend itself (fight), or be really still (freeze). This all happens extremely fast, because if there was too much time to think our ancestors would have been eaten and we would not be here reading this. This is a survival response.

In order to do any of these effectively the body makes some major changes. Pupils dilate to see better, goosebumps appear on the skin as hair stands up to better sense the environment, breathing becomes quicker and shallower, and the heart rate increases-that way the muscles have more blood and oxygen to work better. Other tasks are less important and they stop, like digestion (butterflies in the stomach) and urination.

However, our body cannot remain in this heightened state for too long or it will become overworked, sometimes causing unhealthy physical effects. The prefrontal cortex is able to talk to the hippocampus and the amygdala to determine when the situation is once again safe and works to return the body to its usual functioning. In addition, if that “sabretooth tiger” was simply your neighbors’ cat walking by, the hippocampus will find it in its memory, share it with the cortex and the whole system is shut down almost immediately because there is no danger. This process is much slower than the FFF response. This all looks something like this:

How does trauma impact the FFF Response

For children who have experienced complex trauma, they never know when or where the abuse may come from. Therefore, they always operate on the FFF response to a stimulus. Unfortunately they have learned that they cannot predict who or what is safe so everything starts to become a threat; they do not have the luxury to check with their memory and determine if there is something different this time that may mean they are safe. Like any muscle that we work out all the time, the FFF response becomes very strong, and the more logical thinking parts of the brain begin to atrophy. Scientists have seen images of trauma victims’ brains that show the reasoning centers of their brains are much smaller than those without trauma. At the very core they are thinking differently. They must always be ready to keep themselves safe for their own survival.

Behaviors indicative of children with complex trauma

So now we know what is happening in the brain. Many of the kids we are educating or raising are now in safe environments that no longer require the FFF response to always be on. So how can you tell when the response system is activated, even when it does not need to be?

Trembling-increased hormones caused by the FFF response can cause muscles to shake as they are preparing for hard work
Hyperventilating-the shallower quicker breath meant to oxygenate the blood faster
Complaints of “chest pains” -increased heart rate pumping blood faster to the system
Sweating-perspiration increases to keep the body from overheating during the survival response
Hypervigilance-always scanning and watching for potential danger, always “in the ready”
Tunnel Vision-focus on one stimulus causing distress and unable to shift focus. This could be on an object, behavior, or topic of conversation.

Providing a supportive environment/Trauma Informed Care

There are many ways to be supportive to a child who needs to learn how to manage their survival response and become better at assessing the people and situations around them. They need tools that can help delay the automatic survival response long enough to let the thinking parts of the brain exercise and grow stronger, helping them make better decisions. The great thing is, the more they work out the brain, the stronger the atrophied parts can become, and they will heal. Sensory Modulation is a great tool that helps children learn ways to retrain their survival response.

Sight-pictures of pets/family/friends they find pleasant and safe, Defocus books where they look for patterns, Seek and find books where they have to locate specific objects
Sound-music and sounds the child finds pleasant. This may take some adult supervision for appropriateness. Playing or resuming playing a musical instrument. A loved one’s voice pre-recorded.
Smell (*warning: smell is the fastest way to trigger a positive or negative reaction, smell works directly on the amygdala)-favorite perfume of a loved one, favorite food, favorite dessert
Taste-fireballs, favorite food/drink, salty things, sour things
Vestibular rocking, swinging
Tactile-manicures, head rubbing/scratching, soft or hard items, favorite blanket or material,

This is a basic outline and understanding of how trauma impacts the brain of a child and how we can support resiliency. It is important with any of these tools to offer choice whenever possible. This can be empowering to a child who has felt their life was completely beyond their control, including their safety. Just because you like something does not mean they have to like the same things. Help them identify what they find helpful. These can change from day to day. Once thy find these things take the time to show interest and learn about them. That way, when the brain is thinking in pure survival mode, the child can rely on you to provide those coping tools. And don’t forget the power of play. Play is where children work out their struggles and can find/practice good coping skills.

Remember, it’s not “What’s wrong with you?” but rather “What happened to you?“

Now, have a little fun and find these important words in the word search below:

Multi-Disciplinary Approach to Complex Trauma: Does it really take a village?

For a long time, the concept of “trauma” did not exist. What happened at home was to stay at home, and if bad things happened you were supposed to “get over it” and “move on”. It wasn’t until the 1970’s that the term “post-traumatic stress” became a common term-primarily related to symptoms experienced by returning Vietnam Veterans. It wasn’t until the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980 when trauma was officially recognized by the American Psychiatric Association as a diagnose (PTSD). Over the next forty years the PTSD diagnosis has undergone a variety of changes as a result of ongoing research and new technology. We are now more aware of the variety of traumatic experiences and the life-changing effects they have on individuals. More specifically, the concept of complex childhood trauma has been shown to impact someone from the DNA to their life-expectancy. Although the call to include complex trauma as a stand-alone diagnosis in the DSM-V (2013) was unsuccessful many of its features have now been incorporated into the current PTSD diagnosis. This better, more comprehensive understanding of trauma would not have been possible without the hard work of many disciplines who have studied trauma and the brain. In turn, it takes multiple disciplines to also successfully treat it.

Neuroscience/Biology

Using MRI in children experiencing complex trauma, as well as adult survivors of childhood abuse, it has become clear these experiences cause lifelong changes in several important brain structures. There are proven effects on working memory, white and grey matter of the prefrontal cortex, the corpus collosum, hippocampus, and brain volume (De Bellis & Zisk, 2014). These changes impact a person’s ability to organize their thinking, process information, and make decisions. And these changes are only the beginning. Changes are also occurring at the DNA and hormonal levels, exacerbating the biological effects and having significant impact on the overall health and wellness of trauma survivors. This information is crucial in understanding trauma as more than a memory or experience, but helped bring trauma into light as a whole health issue.

Here’s another way to look at it. A child is in a car accident and suffers an injury to the brain. After the accident the child has difficulty remembering things and struggles more at school. Aware of the injury and the change in the child’s abilities due to the known physical injury, teachers and parents may alter their expectations and provide supports. They may not expect that child to maintain high honor roll grades and may celebrate their success if they do. The same is true of the brain that it is affected by abuse. We need to understand it is an injury to the organic brain requiring appropriate expectations, support, and praise for success.

Education

With more information available about the impact of trauma on an individual, school systems are beginning to look at traditional structures and policies as they relate to trauma and student success. For some districts this is an active process with trauma-informed principles being instituted on every level. For other districts struggling with meeting basic educational needs of their students due to budget cuts and low attendance, to name a few, instilling trauma informed principles is more difficult to implement. With trauma comes anxiety, hypervigilance, behavioral problems, and inattention that are often are addressed through disciplinary measures and reflected in poor grades. For children who are already being victimized and have an enormous sense of self-shame these consequences push them away from, rather than foster, a potential resiliency component. Schools run the risk of increasing the Pipeline to Prison phenomenon of many schools.

The Education Law Center in Pennsylvania released a comprehensive article for educators explaining trauma as it impacts student learning and offering numerous recommendations and best-practices for supporting the academic success of trauma victims. These can be helpful for both educators and parents advocating for their children in academic settings. Here are just a few of their recommendations:

Recommendations for Classroom Learning

Specific strategies such as including discovering and building on the student’s individual interests and competencies; maintaining predictable routines and expectations; maintaining expectations for the student that are consistent with those of his/her peers; and providing positive behavioral supports.
Language-based teaching approaches can help students process information and alleviate their fears. Students who have experienced trauma often pay more attention to nonverbal cues than verbal communication, so using multiple forms of communicating can be helpful
School evaluations, including psychological, speech and language, functional behavioral, and occupational therapy evaluations, should assess the role of trauma and identify needed supports.

Recommendations at the Policy Level

School discipline policies are trauma-informed when they balance accountability with an understanding of traumatic behavior
Teach students the school and classroom rules while reinforcing that school is not a violent place and abusive discipline is not allowed at school
Minimize disruptions to education with an emphasis on positive behavioral supports and behavioral intervention plans; · Respect confidentiality while using open communication and relationship-building with families
Ensure ongoing monitoring of new policies, practices and training.

Occupational Therapy (OT)

The role of OT is to enhance the physical and mental health of individuals by focusing on education, play, social activities, and activities of daily living. They use discipline specific tools to identify and assess factors that may be impacting full participation in any of the above areas. When it comes to trauma, the American Occupational Therapy Association, Inc (AOTA) states “Occupational therapy practitioners can serve an important role in addressing trauma at the universal, targeted, or intensive levels of intervention. They are invaluable members of the mental health team because of their knowledge of the cognitive, social and emotional, and sensory components of activity and its impact on behavior (AOTA, 2015).” When it comes to working with children, occupational therapists with training in trauma and sensory-based interventions are qualified to provide sensorimotor arousal regulation, teach mindfulness strategies to reduce stress and increase coping skills, provide environments and opportunities intentionally designed to increase a sense of mastery, connection, and resiliency, and provide opportunities to facilitate the development of likes, interests, and motivators. OT’s will often provide services at home, school, hospital, and in the community as part of multidisciplinary teams because of their knowledge of the cognitive, social and emotional, and sensory components of behavior (AOTA, 2015).

For further information on the role of occupational therapists in helping children with complex trauma refer to the complete document published by the AOTA by clicking the image below.

So who else is in the village………

Many different disciplines are looking at the impact of trauma and trauma informed care. It is being implemented in many aspects of children’s daily life and will hopefully encourage better outcomes for adult survivors of childhood complex trauma. These are just a few of the disciplines asking the questions and making an impact, and certainly not a comprehensive list of people looking at trauma. What we do know is that all these professionals and viewpoints are necessary to develop the full picture of trauma and resiliency. It really does take a village to raise a child.

Caregiver Resources for Children with Trauma

There a lot of resources about trauma and complex trauma, including how it impacts children and how to treat it. For those charged with caring for and supporting youth who have been traumatized, these effects can create a myriad of questions and barriers. Parents and caregivers may find themselves asking things like “Why won’t he listen to me?”, “We’ve talked about this a thousand times, why hasn’t it changed?”, or “Why is she getting so upset over something so small?”. To answer these questions you must first understand hw trauma changed the basic wiring of a child. Here a few resources parents and educators may find helpful in beginning to learn about these very complex issues.

The NCTSN offers a wide variety of educational material around trauma and children. It includes a section specifically for parents and caregivers that gives helpful information regarding traumatic stress, age-related effects, and even helpful books and videos that can be shared with children.

The Child Mind Institute offers a variety of easy access to tools for families as well as educators, and provides several trauma response guides in nine languages outside of English including, but not limited to, Spanish, French, Arabic, and Chinese.

The National Childhood Stress Trauma Initiative was created between SAMSHA and NCTSN to raise awareness about the impact of trauma on children including related behavioral health concerns. This site offers several infographics that explain trauma and its effects in a quick and easy manner to understand and digest.

So how does one go about creating a list such as this? It is important to remember that the web has grown exponentially since its birth. And why was it born? To allow people to actively engage with and participate in the sharing of information and knowledge in way that books and magazines do not allow. The internet was started for, and continues to be, a way for people to collaborate across distances in order to work together for some purpose.

With all these people being able to add to, subtract from, and actively manipulate this system of information sharing it is no surprise that not all information is useful or accurate. When looking at resources you find on the internet it is important to not just accept anything as fact just because it was published on the internet. The truth is anyone can post anything, unlike books and journals that are scrutinized by editors and peers, so not all information is good information. Georgetown University Library provides a condensed and quick list of questions you can use when evaluating a resource. The general themes are summed up here.

Author

First and foremost, if you cannot identify an author or creator for an article or webpage you should proceed with extreme caution. If the author is identified, is there a link to a homepage or “About Me” section? What type of information is on that page about the author(s) credentials, experience, or connections to reputable organizations?

Purpose

Sometimes articles that look informational and/or scholarly turn out to be an attempt to sell a product or persuade the reader to a particular viewpoint. When reading the material try and determine who the author’s intended audience is-for example are they focusing on experts and researchers or providing important information to the general public?

Objectivity

While examining the intended audience of an article or webpage the reader should begin to form some assumptions on how objective the author is in presenting the material. If the author, in their personal information, is affiliated with an organization is there a sense of bias in their presentation? Sometimes biases and opinions can be stated to sound like facts, so it is important to always read with a questioning attitude. Often if something sounds too good to be true, it probably is!

Accuracy & Credibility

One way to check for objectivity is to check the stated facts. Can similar information be found elsewhere on other sites and by other authors? Even if it is presented slightly differently, the core information should be the same. Does the author use quotations and does the author cite where they found the information? This could be done by either including the name and author of the work they are quoting or providing a link directly to the resource. Clicking on these links can be important to verify it is a legitimate resource and if those links still exist, and therefore if the page is regularly maintained.

Timeliness

When looking at a webpage it would be helpful to start by checking when it was created and when was the last time it was updated. New research is always being completed and information is always being added, so it is important to try and stick with the latest information. It can be confusing and difficult to keep track of a there can be conflicting information, For example, how many time eggs have gone from being good and then bad and then good again?

In using all of these tools together you can begin to make a general assumption about what is safe and accurate.

Good luck and happy web reading!

5 Myths about Trauma You Always Wondered About………………

Most people have experienced a situation that feels out of their control. They see the car coming but there is nothing they can do to get out of the way. The company is going out of business and there is little work in their field. A loved one gets diagnosed with a potentially life-threatening illness. As humans we often feel helpless when the circumstances outweigh our resources. The good news is most people manage to cope with the situation and can move on with their lives with minimal impact. As adults we have hopefully learned some skills and developed some networks that protect us from the long-term effects of trauma.

What happens when the person experiencing the trauma is five years old? What if the situation that is beyond their control is being physically abused several times a week? What if the perpetrator is one of those people who should be protecting them, like a parent? No one would expect a child to have the resources or ability to manage a situation like this, and there is where complex trauma is born.

NAMI (National Alliance of Mental Illness) reported 50% of youth between 6-17 years of age received mental health treatment in 2018. Further, nearly 9 million adults were diagnosed with Post Traumatic Stress Disorder in 2016. Add on the fact that suicide is the second leading cause of death for people ages 10-34 you begin to realize the problem of trauma is larger than you may have believed. And yet, the world is still wrought with inaccurate beliefs about adolescents with mental illness and PTSD.

MYTH 1: They are only acting that way to get attention

There is a common misconception that when children act out, they are seeking attention. However, what we know is all behavior serves a purpose. Sometimes what looks like inappropriate behavior is actually a survival tool that helped someone manage a difficult situation. Now that they are out of the situation that behavior is no longer needed, yet they engaged in it for so long to get their needs met that it has become as natural as blinking their eyes. Aggression, for example, may be a child’s learned behavior to keep people away from them as people are not safe in their eyes.

MYTH 2: It happened so long ago they should be able to forget about it.

Unfortunately, as more research is done in the area of childhood complex trauma, we are learning that trauma is more than a memory. It is not simply events that happened in someone’s life that they may or may not remember. Early complex trauma affects individuals biologically, most obviously in the structure and size of their brains. Childhood victims become adult survivors with smaller brain structures, such as the hippocampus and frontal lobe, as well as super powered structures including the amygdala-the driving force of the fight, flight, or freeze response. In addition, their brains have been found to be physically smaller. Newer research is showing trauma even has the power to cause genetic mutations that can transmit a parent’s trauma to their child through DNA.

Image result for brain scans of complex trauma

MYTH 3: Trauma and PTSD are only mental health disorders

Thanks to Dr. Felleti and the ACE’s study we have learned that trauma has a major impact on the overall health and life span of a person. Adults and children with a history of complex trauma are often treated for chronic, potentially life-threatening diseases that are preventable and a direct result of trying to cope with their overwhelming experiences. Not only do adults with trauma histories die approximately 20 years earlier from preventable disease, this also impacts the health care system as whole including the cost of services, health insurance, and life insurance premiums. Below is a video of Nadine Burke Harris, MD, giving a TedTalk on her experience with trauma from the medical perspective.

MYTH 4: PTSD is a life-long struggle and cannot be effectively treated

There are several options for treating PTSD from traditional psychotherapies to medications. One of the most well-known treatments is Trauma Focused Cognitive Behavioral Therapy (TF-CBT) where clients receive psychoeducation about trauma, develop coping skills, and use these to process their “trauma narrative”. Other evidence-based practices include EMDR (Francine Shapiro, PhD), Progressive Counting (Ricky Greenwald, PhD), and Trauma Based Yoga (Bessel van der Kolk, MD). Newer research is finding exposure therapy, including the use of Virtual Reality as part of treatment, is also helpful. There are also some medications that help manage symptoms of PTSD such as Prazosin, Zoloft, and Paxil-all of which are approved for the treatment of PTSD. Treatment, however, does not erase the trauma but rather allows the person to live the best life they can with their trauma.

MYTH 5: Everyone reacts to trauma the same way

One of the side effects of the DSM V (Diagnostic and Statistical Manual Version 5) is the belief diagnoses are simply check off lists of symptoms, and that the symptoms listed in the manual are the only way in which the disorder manifests. That could not be further from the truth. There are people diagnosed with depression who do not sleep all day in a dark room, refusing to get up or shower-they go to work and do what they must at great personal strain, or in children who look irritable or angry. The same holds true for trauma. No two people experience trauma the same way so no two people will experience traumatic grief in the same way either. If one looks at the criteria for a diagnosis of PTSD they will find there are multiple criterion with multiple symptoms in each, making PTSD a personal experience.

What is quite clear is complex trauma has detrimental effects on all aspects of a person’s life and death and is simply not something that can be ignored. Trauma, and trauma related disorders, are treatable and people can live meaningful healthy lives. It is up to the lucky ones, those who have not endured the terrible experiences of ongoing physical, sexual, and emotional abuse and neglect to reach out and support our children and young adults. They are the next generation and they deserve as much happiness as anyone.

Don’t believe me, watch this video of teens and young adults speak of their personal experiences: