#trauma – Catherine's Field of Ideas

How Trauma can Lead to Positive Outcomes, Post Traumatic Growth

We have all heard of Post-Traumatic Stress Disorder (PTSD) and how challenging it can be in a person’s life. As a society, we have become more concerned with the types of abuse faced by children and how it can potentially negatively impact the rest of their life. We talk about PTSD in relation to abuse, natural disasters, war, and any number of other events that overwhelm a person’s ability to cope. However, PTSD just came into formal diagnosis in 1980, with the DSM-3, but its existence is much older than that. Professionals first began to examine post-traumatic stress when they noticed a set of similar symptoms that interfered in the daily lives of young men returning from the Vietnam War, but its existence is still older than that. Traumatic experiences have been part of the human experience as long as there have been humans on the planet, and from those experiences, our world has grown into what it is today. In other words, those events that we think of as life-ruining may be better described as life-altering as the experiences may negatively and positively change a person.

Post-traumatic growth can be seen as a positive change in a person as a result of trauma that supports the return to an improved level of functioning.

For parents, foster parents, educators, and caregivers dealing with the challenging after-effects of trauma on a child it may difficult to imagine there may be something good that can come out of all these struggles. Psychologists refer to this positive outcome as post-traumatic growth (PTG) and it has been growing as an area of research in the past 10 years. Post-traumatic growth is defined as positive psychological change experienced as a result of adversity and other challenges in order to rise to a higher level of functioning. It occurs when an event challenges a person’s core beliefs and causes significant struggles that ultimately lead the person to gain a deeper understanding and ultimately grow from their experiences. This does not deter from the experience of trauma but offers a person a different perspective to work through it. For more in-depth information you can read here.

There are 5 areas by which PTG are defined:

Appreciation of life
Relationship with others
New possibilities in life
Personal strength
Spiritual change

Examples of PTG

One of the most notable recent examples of post-traumatic growth came in the aftermath of the Parkland school shootings. These can easily be seen as an even that rocked core beliefs (school is a safe place), caused psychological distress (grief, confusion), and ultimately lead to growth and advocacy (March for Our Lives). ABC News did a story on how some victims demonstrated the above areas of growth, which was again emphasized in a post from Shrink Tank.

There are other notable examples of trauma turned advocacy and growth. When a mother gets the call that her 13-year-old child has died because a drunk driver with a long history of DWI hit her, she begins a campaign to prevent other parents from experiencing her pain. When the core belief that the legal system keeps us safe is shattered and causes extreme emotional distress of anger, grief, and confusion the result is the creation of Mothers Against Drunk Driving (MADD).

Another example is when a 6-year-old child shopping with his mother, ends up missing from the Atari section and later his decapitated head is found but not the rest of his body with no killer ever convicted a father work to improve how the cases of missing children are managed from the micro to the macro level. When the core belief that the world is a safe place results in pain, grief, and frustration the result is the Center for Missing and Exploited Children.

PTG as Resiliency and Hope

It is important to note that no one, not even a trauma-based therapist, can force post-traumatic growth in a child. What they, and caregivers, can do is foster areas that contribute to PTG and support a child’s efforts to grow. As a caregiver or important person in a child’s life, there are several things you can do to encourage post-traumatic growth.

Be consistent and involved enhances an appreciation for life and relationships with others.
- This does not just mean attending scout meetings or going to parent-teacher conferences. It means putting down your phone and being attentive to whatever nonsensical story it is really important they tell you right now. Not just listen but sit down, look them in the eye, and really hear they have to say. Ask questions, keep the conversation going, remember what they say for later. Validate their feelings even when it doesn’t make sense to you. It doesn’t have to, it’s not your feelings.
- It also means taking an interest in their interests, even if it doesn’t interest you. Take time to ask about it. Pursue information about it on your time and surprise them with what you know. How better to show someone you care than taking the time to find out about what they like. And don’t just learn about it, try it. It’s okay to let that teenage boy humiliate you in a game of Rocket League if you took the time to learn some of the terms and spent the time playing with them.

Introducing new things and give to the community can build on new life-possibilities and strength
- One of the biggest things I see working with young children in an inpatient setting is their wonderment at new things. Doing things like going to the zoo, visiting a park or walking in the woods, playing board games together, or riding bikes have been brand new experiences to more than half of them. Group activities like sports and clubs are also new experiences, and when they discover something they love and are good at, a whole new world of possibilities opens up for them. They may need some gentle support to get out there, but getting out there can be a good place to be.
- Another activity that can be helpful is the act giving back. It is inherent in human nature to want to contribute in some way, and children are no different. From collecting pet items and delivering them to the SPCA to becoming peer advocates youth find a way to take their negative experiences and help others. They don’t need to start a foundation or solve world hunger, but they know what it feels like to have a need that’s not meeting met. Sometimes the best way to heal that need for yourself is to do it for others.

Post-traumatic stress is a newer concept in mental health and even newer in relating it to children. What studies thus far have shown is not everyone experiences PTG, but there are ways to support a traumatized child that may foster it. And we have seen real examples. What’s amazing is once the growth begins there is no way to know just how far it will go.

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:

Will technology enhance or destroy the therapeutic process as we know it?

Trauma and its affect on individuals, families, and communities has become a focus of many studies including the development of treatments to improve outcomes for victims. Yet so many people continue to struggle with symptoms related to their trauma experience and suicide rates remain high among children and adolescents. What is going on? How is it with all this knowledge our children and young adults continue to suffer? What if we held the answers in our hand? Literally.

According to an article by Ruzek & Yeager (2017) roughly 40% of the world population currently as access to the internet while mobile contracts and smartphone use is rapidly increasing. As technology continues to grow and more people have access to texting and mobile apps there just may be a vast field of possibilities to reach more survivors and enhance ongoing treatments. For a brief review of current technologies you can read the Ruzek & Yeager article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5719483/

There are countless numbers of apps geared towards teenagers, however there are very few that focus specifically on trauma. PTSD Coach is the most commonly used app and was designed initially by the Veterans’ Association for soldiers with trauma-based symptoms. This app provides a variety of interventions from assessment, to psychoeducation, as well as coping strategies, guidance for seeking therapy, and crisis response options.

PTSD Coach is a great start in technology-based outreach and intervention. However, it should not be used in place of support of mental health professionals when symptoms are interfering with activities of daily living. In addition, it may be more involved and require a greater digital literacy that may leave some users frustrated. On the flip side, PTSD Coach and its partner app, PTSD Family Coach, offer a starting place for the use of technology in treating trauma and supporting survivors.

Unfortunately, although there are a few apps like PTSD Coach that can aide in diagnosis and treatment of post-traumatic stress there appears to be a lack of focus on integrating technology into clinical treatment as well as testing the validity of these applications. One area of technology that is beginning to be explored is the use of virtual reality in trauma treatment. VR has been examined with pain management, Autism Spectrum Disorder, anxiety, Parkinson’s Disease, and variety of other health concerns. Now those lessons are being translated into trauma related symptomology, as seen in this news segment:

This is just the beginning. Much of this work has focused primarily on veterans, although has shown success in people with single episode traumatic events such as car accidents. Can this technology also help victims of chronic complex trauma in childhood? Can VR enhance already well-established evidence-based practices? Will the marriage of technology and traditional EBP create more effective treatment in less time optimizing heath care costs? Only the future will tell, and social workers hold a key in the ethical and valid development of these tools.

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