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 Were You Traumatized?
by Kathleen Howe
When something serious happens
in our home, most of the time I'll ask if the victim of the situation was traumatized
from it. I ask that before I know if they were physically injured. In a concerted effort to raise my family's awareness about the importance of recognizing trauma as well as the feeling of being traumatized - I ask the question often and it seems funny sometimes because I
have a teenage drama queen amongst us.
My own personal growth recovery journey has been the talk of the family because I have difficulty keeping everything I learn to myself. I am in the arena as the mother
of this family and I want to do all the things I need to do for a healthy family. I've been learning so much about it all and I just feel that it's important for everyone in the family to understand not only what can hurt them in the future, but what I experienced in my ignorance.
When you've seen the light of what "normal" actually is - it's something
that you want to share with those you love. Those who have been addicted to something, let's say alcohol, want to get everyone they know sober when they've been to rehab and seen the light of their
addiction. If it's spending too much money, eating or whatever the addiction might be, once you've had the good fortune to free yourself from it - it's like being release from jail! It's a celebration
of a huge accomplishment. You're empowered!
Those who are addicted to something get traumatized. Addiction's consequences leap so far off the scale of what is considered normal behavior that traumatizing
incidents are dealt with more times than not. The traumatizing behaviors don't just affect
the addicted; like a contagious plague - addiction's powerful traumas are experienced by the entire family of those who are addicted. It can financially, emotionally and physically devastate an entire family in a very short time.
When you're experiencing a lifestyle
that is full of trauma, crises, problems and dysfunctional relationships the chances of you being traumatized
is very high. Risk factors enter into the equation for multiple traumas when you're in this position and if you are unaware - it will pass you by and you'll find yourself in a stupor of sorts,
wondering what the license plate number was of the truck that just hit you.
Unfortunately, traumas happen and sometimes we're too young to realize what's going on. We are traumatized and
the emotional wound stays with us, just like a physical wound does. A physical wound heals and scars over just as an emotional wound does. When we are traumatized we become emotionally wounded and it leaves us scarred for life.
It is with a serious tone that I speak to my teenagers and tell them,
should you drink and drive you may live through it physically but you will be traumatized
emotionally forever should you injure someone or heaven forbid kill someone in your stupidity. You need to know better. The
same goes for doing drugs. I speak to them about how their brains could be injured and they would be traumatizing
the entire family should we all have to watch our loved one hooked up to a breathing machine or totally mentally disabled.
It is with the same seriousness I am asking you to read the articles on
this page and examine your lifestyle, your relationships, but mostly your own self. We are a strange world of people that
always seem to look at the world and it's problems and it's dangers, blaming everyone and everything else for who we are.
We claim to be shaped, formed and then we plead our independence. Which is it? I'm wondering if you are brave enough to take
my challenge and face your own self in honesty.
It is only then that you can prepare yourself to be ready and aware of
what is happening in your world all around you that you are able to stay as safe as possible. There is always the obvious
"accident" that we can't keep ourselves from experiencing; but you would be surprised how much it will help you to know who
you are and what you will expect of yourself should you experience a traumatizing situation.
Part of this personal examination must take place in your past. You must
research your own history and your family's history to find out what has been already engraved into your psyche. I am including
enough information within the network that you will be able to accomplish this task easily and should you have any questions, please feel free to email me anytime.
Trauma
in Adolescent Populations
By Debbie Dodge, PhD, LPC, CHLC
Introduction
This paper will describe
the many different modalities for treating trauma in an adolescent population. Therapeutic
treatment is designed to encompass the whole person in a holistically healing manner. It takes into consideration the body,
soul and spirit in the trauma experience.
All trauma
affects the whole person: spirit, body and soul. Therefore, we cannot have complete healing from any trauma
until we deal with how we have been affected emotionally and spiritually by the trauma.
Trauma Defined
Trauma has been defined by Levine and Kline (2007, p. 4) as “…any experience that stuns us like a bolt out of the blue; it overwhelms
us, leaving us altered and disconnected from our bodies.”
They go on to say that “While
the magnitude of the stressor is clearly an important factor, it does not define trauma.
That is because (p. 4) “trauma is not in the event itself; rather, trauma resides
in the nervous system.” Lee, Taylor, and Drummond (2006, p. 105) state, “…that PTSD occurs when an event
is sufficiently arousing to prevent its transfer from encoding as an episodic memory to a semantic memory.
The core of PTSD is
extreme stress that causes hyperarousal in the body’s nervous system and makes it possible to fight, freeze, or flee
as a result of threat or danger. This is a normal response under most circumstances. However, if the bodily symptoms of this
heightened state of arousal do not subside after hours, days, or weeks PTSD can develop (Rothschild, 2003). In an article
by Clinton (2006, p. 98) trauma is defined as,
“…any
occurrence which, when we think of it or it is triggered by some present event, evokes difficult emotions and/or physical
symptoms, gives rise to negative beliefs, desires, fantasies, compulsions, obsessions, addictions, and/or dissociation, prevents
or hinders the growth of positive qualities and spiritual connections and development, and fractures human wholeness.”
The Brain and Trauma
We have many communication
systems within our body and brain that help the different parts to work properly. In the 1980’s, medical science
became aware of a communication system in our body called the ligand-receptor system that involves communication between the
neuronal, hormonal, gastrointestinal, and immune system, that is passed on to the rest of our body via peptides and messenger
specific peptide receptors (Smith, 2002).
It was also found that the
white blood cells manufacture all of the peptides that the other parts of the system make (serotonin, dopamine, norepinephrine, endorphins, etc.) and that a person’s thoughts can directly influence the functioning of the ligand-receptor system (Smith, 2002).
Negative thoughts can increase the level of cortisol (stress hormone) and decrease the production of immune cells, while positive thoughts can increase production of immune cells, endorphins,
dopamine, sex hormones, and others in the blood stream (Smith, 2002). Smith (p.
5) writes,
“It is becoming increasingly clear that
our control center is not only a place, but a process involving the interrelationship between the brain, our hormones, our
biochemistry, and the environment.”
It is the intense, unpredictable and ongoing stress that creates a chaotic biochemical environment that keeps the brain from full maturation and information from traveling
from one brain center to another ( Stein & Kendall, 2004).
When this information is constantly short-circuited, brain systems (right to left hemisphere, cognitive to emotional) fail to mature adequately. When you take
these trauma related malfunctioning brain processes and add them to the adolescent brain,
as described below, there needs to be careful consideration as to what therapeutic modality one should use to treat the traumatized youth.
The Body and Trauma
Acute threat or danger cause the neurotransmitters that are released from the brain’s limbic system to signal an alarm to the
body’s autonomic nervous system (ANS), which, in turn, cause the sympathetic nervous system (SNS) to activate in preparation
for fight, flight, or flee.
Blood flows from the skin and organs into the muscles to activate this response. However,
when fight or flight is not an option, the limbic system may signal the ANS to activate the peripheral nervous system (PNS).
In this situation, the SNS continues its high state of arousal while the PNS freezes
the action of the body (Rothschild, 2003).
When a person freezes, it appears to cause more psychological damage than the fight
or flight response and is a major predictor to who will develop PTSD as somatic symptoms caused by the (Rothschild, p. 7) …”hyperarousal in both SNS and PNS persist chronically or are easily set in motion
by internal or environmental triggers”.
Body memory, as spoken of in many theories of psychology, is an intercommunication
between the brain and the body’s nervous systems. The hippocampus and the amygdala are the two parts of the brain that
are involved in the memory of traumatic events. The amygdala is responsible for registering
highly charged emotions and the body sensations that identify them (Rothschild).
These memories are not stored in the amygdala, they need to be processed through the
amygdala in order to be recorded as implicit memories in the neocortex. The hippocampus is necessary to store information
so that we can make cognitive sense of our memories in time and space.
Memory is not stored here either, but needs to be processed through this
brain system to be recorded as explicit memory in the cortex (Rothschild). Stress hormones
can suppress the activity of the hippocampus, keeping context from attaching to a memory, and preventing that past experience
to be (p. 11) “…anchored in time. They seem to float freely, often invading
the present”. Rothschild writes (p. 11),
“In the absence of hippocampal activity, memories of unresolved traumatic incidents may remain in the implicit memory system alone. There images, sensations, and
emotions can all be provoked, but without engagement of the explicit memory system, they cannot be narrated (cohesively recounted) or understood. It is this mechanism that is behind the PTSD symptom of
flashback – episodes of reliving the trauma as if it is happening now.”
Unique Aspects of Adolescent Development
Dr. Jay Giedd, chief of brain imaging at NIMH, studied the brains
of 1,800 teens and found that the point of brain maturation is somewhere near 25 years of age and that impulsive behavior
during adolescence is due to raging hormones and late development of the decision-making part of the brain (Howard, 2006).
At the age of puberty and then around the age of 25 are the ages a person has the highest
amount of brain density (grey matter)
and it is also when pruning takes place, making one lose capacity and gain efficiency (Howard,
2006). Due to this pruning, we gain speed of transmission but we lose the capacity to recover from trauma (p. 95).
Howard (2006)
writes that the adolescent processes emotions and instructions differently than adults, with more activity in the amygdala
(emotion center), as opposed to adults, who normally process their emotions
in the frontal lobe (rational center). Teens also find it more difficult
to explain these emotions to other people.
During the adolescent years there are elevated levels of dopamine that increase
the desire to engage in risk-taking behaviors. It is the combination of
“…excess brain capacity, maturity of the sensory cortex, flooding of sex
hormones, elevation of dopamine, and late development of the maturity module…”
that can lead to problematic behaviors (Howard, p. 94). Stein and Kendall (2004, p.137) stress the importance of helping children process trauma through as many modalities as possible
(e.g., images, thoughts, emotions, sensations, and movement) and to help
children to gain access to both hemispheres through various activities to assist in trauma
integration.
Another major problem
that an adolescent, as well as people of all ages, can encounter is recurrent nightmares. A meta analysis (Levin & Nielsen, 2007) of nightmare processes have revealed some startling facts about the differences in
dream states and the after effects of nightmares, including specifics in the adolescent population. Levin and Nielsen (p. 489) write,
“Both clinical and research studies
call attention to the importance of assessing nightmare distress as integral to defining pathology and of distinguishing the
number and severity of traumatic precursors. Research studies further emphasize the importance
of distinguishing nightmares, which awaken the sleeper, from bad dreams, which do not.”
This
is important when it comes to the adolescent population. The age groups of youth through adolescence has 3 to 4 times
more frequent nightmares than older age groups and these nightmares can be reenactments of the actual trauma and all of its physiological and emotional distress (Levin & Nielsen).
The actual waking is similar
to the freeze state, avoiding the processing of traumatic material. Another finding from
dream research is that these traumatic nightmares can have long-lasting effect, heightening
negative arousal and distress in the hours and days following (Levin & Nielsen).
Nightmares appear to be more frequent and are found more often in psychiatric populations
and there is a link between frequent nightmares and psychosis and can immediately precede psychotic episodes (Levin & Nielsen).
The frequency of nightmares can be up to six times a week and, if treatment is not
sought, can last up to 40-50 years after the trauma. Nightmares can set off certain neurotransmitters,
stress hormones, and alter numerous bodily systems. The startle reflex is higher after a nightmare and can remain elevated
for days.
Levin and Nielsen state that these hyperarousal reactions may involve more defensive
reactivity and reduced visual perception. Levin and Nielsen (p. 502) go on to say,
“…PTSD patients may expend so much more cognitive, behavioral, and emotional effort managing hyperarousal and reactivity that they
exhaust or deplete their emotional and neurochemical resources, such as catecholamines.”
Therapists, teachers, and parents should take these factors into consideration
when working with youth and adolescence. The developmental level functioning in clients with complex PTSD, stemming from early childhood abuse and neglect, in most cases, show that almost every developmental line has been disrupted
( Segall, 2005, p. 148) writes,
“… there are disturbances in the
biological regulation of affective arousal, the hypothalamic-pituitary-adrenal axis, and the autoimmune system; in the stability
and continuity of memory, attentional processes, and consciousness; in the regulation of sleep, appetite, and libido; in self-soothing,
identity formation, and the regulation of self-esteem; in the planning, self-regulation, and performance of health-maintenance,
house-keeping, budgeting, academic and vocational activities; in the self-regulation of intimacy and control, and the maintenance
of boundaries and stable affectional bonds in interpersonal relations.”
Major constructs
Eye Movement Desensitization
and Reprocessing (EMDR) incorporates elements of other psychotherapies such as:
- psychodynamic
- cognitive-behavioral
- person-centered, body-based, and interactional therapies
into a treatment approach that guides the client through different
elements of trauma while at the same time moving their eyes back and forth (Shapiro & Maxfield, 2002).
EMDR is composed of an eight-phase
treatment that works a client through body sensations, emotions, and cognitions associated with the trauma,
in such a way as to slow down the cognitions enough to process the somatic and emotional sensations at the same time and create
an explicit memory. This primarily nonverbal method stimulates interhemispheric activity and makes it possible to recall the
body and cognitive memories into an integrated whole (Maxwell, 2003).
Intervention strategies
The intervention strategies
involved in EMDR include an eight-phase treatment approach.
- The 1st phase focuses on gathering a client history & treatment
planning
- The 2nd phase involves the explanation of EMDR treatment protocol
& theory
- The 3rd phase is an assessment of baseline levels of emotional trauma
- 4th is desensitization of emotional & physical responses
- 5th is the installation of reprocessed material
- 6th, residual body tension & emotion is resolved
- 7th is closing & debriefing
- 8 is evaluation
A big advantage to using EMDR
treatment is that a therapist does not have to work only with an actual trauma, but can
treat nightmares as well. This protocol works for the reprocessing of traumatic material,
regardless of the form, and also for the installation of positive material such as a ‘safe place’ image, complete with color, sight, sound, smell and temperature.
The process of change
In research conducted by Lee,
Taylor, and Drummond (2006), it appears as if the process of change in EMDR involves dual
focus of attention in the desensitization phase and distancing. Pairing eye movements with memory helped clients reduce the
vividness of images and the negativity of emotions and the eye movement may produce a relaxation response (Lee, et al.).
Foa, Keane, and Friedman (2000) reviewed seven published, randomized, controlled efficacy studies on EMDR and found it to
be more efficacious for PTSD than wait-list, routine-care, and active treatment controls.
Transpersonal Theory
Major constructs
Transpersonal theory differs in many ways from other psychological theories
because it holds a very different philosophical worldview (Capuzzi & Gross, 2007). This
theory does not exclude other therapeutic modalities; rather they include all therapeutic interventions (behaviorism, psychoanalysis, humanism, Jungian analysis, and Eastern philosophy) as needed
in the course of therapy (Capuzzi & Gross, 2007).
Even though this theory is inclusive of other theories, it maintains that
other theories are limited in their view of human experience and potential. Higher states of being are strived to be reached
in the course of the therapeutic intervention and transpersonal theory (p. 394)
“…primarily encompasses the dualistic and monistic approaches
in an effort to reconcile the divine and human qualities of humankind (dualistic)
as well as to uncover one’s true source of being and the underlying unity of all existence (monistic).”
Intervention strategies
The intervention strategies from this theory that are advantageous
for dealing with adolescent trauma include meditation, mindfulness, intuition, yoga, biofeedback,
breath training, contemplation, inward focusing, visualization, dream work, guided imagery, and altered states of consciousness
(Capuzzi & Gross).
Mindfulness is being in a state of pure attention to the process of experiencing and improves trauma conditions due to a person’s
increased ability to become aware of body processes, emotions, sensations, thoughts, and affective cues (Segall, 2005).
This expansion in the state of consciousness has helped individuals
find a new sense of aliveness and can eventually discontinue using numbing, dissociative and avoidance behaviors to cope with
their trauma. Since mindfulness and meditation practices help a person to monitor their
thought processes, somatic and affective experiencing can be an additional focus of these practices.
In the adolescent population,
“The regulation of social behavior requires awareness of internal
affective states such as attraction, anxiety, shame, or anger, and awareness of external cues such as facial expressions, body language, and vocal inflection (Segall,
p. 149).”
The process of change
The process of change with transpersonal theory focuses on overcoming
one’s life problems so that the primary work of spiritual integration and/or self-actualization can begin, leading the
client toward higher qualities of creativity, compassion, selflessness, and wisdom ( Capuzzi & Gross).
In order to reach these levels of personal transformation, however, one
will first need to be able to have a complete sense of self. Mindfulness is one of the most helpful ways to get to this point
because it allows a person to proceed at his or her own pace as his or her own tolerance allows (Segall, 2005).
Consciousness is similar to mindfulness and is a kind of energy in itself,
related to the cellular expression of the physical body, participating in the continuous creation of either health or illness
(Gerber, 2001).
Major constructs
Somatic (body-centered) and expressive art approaches to counseling focus on reuniting the body and
mind by using a variety of modalities such as meditation, massage, art, dance, drama, writing, sound, taste, sight, touch,
and voice (Capuzzi & Gross, 2007). Pointon (2004, p. 10),
from an interview with Bessel Van der Kolk, writes:
“The imprint of trauma
is the imprint on people’s senses, on people’s systems…that becomes particularly important because these
sensations stay in people’s memory banks and stay unprocessed.
If you do effective trauma processing, the individual smells, sounds, images and physical impressions of the trauma slowly disappear over time and that is something that doesn’t happen with talking.
It happens by working with people’s bodily states.”
The constructs of this theory
focus on the integration of experience involved in the trauma.
Intervention strategies
There are two types of interventions
primarily used in this approach and they include focusing the mind in order to listen and feel the body and moving the body
to physically discharge traumatic material.
Focusing the body and mind
is achieved by modalities such as meditation, yoga, T’ai chi, and visualization. Moving the body is accomplished through
dance, drama, reenactment, etc. Pointon (p. 12) writes,
“With children and young people, this work
may take the form of dance, movement or martial arts training – all aimed at empowering, and helping them to remain
grounded and embodied.”
Another modality is narrative story telling and/or writing. In this strategy the
person attempts to make sense of what has happened to him or her through story writing or story telling. The process of change
Peter Levine ( Pointon) talks about the process of
change involves being able to discharge the trauma energy from the areas of the body that have
‘locked’ it in and can be accomplished by accessing this energy somatically and discharging it through many different
types of somatic and expressive interventions.
With children, the use of the self-expression of drawing, the prefrontal cortex is
active and provides another way to symbolically represent the trauma and may help restore
the lost capacity for imagination (Pointon). Wieland (1998)
suggests somatic therapy as a way for children to reconnect to normal developmental processes that have been disrupted.
Diet & Exercise
Due to the stress involved in traumatic experiences,
the body’s hormones and neurotransmitters are altered by stress hormones, disruptions in sleep patterns, and somatic
sensations among other things such as medications and psychiatric instability.
Stress can deplete the body of vitamins and minerals and weaken its defense systems substantially. It is important to eat a balanced
diet and supplement vitamin and mineral intake with natural supplements. The stronger one’s body is, the more easily
it can deal with stress and the emotional distress that accompanies most trauma.
Along with diet, herbal supplements can help relax and restore the nervous system.
Mabey (1988) writes about two main classes of herbs that help the nervous system; relaxants
and restorative, with stimulants having a more limited use.
Herbal relaxants include passion flower, valerian, crampbark, hops, and chamomile.
Herbal restoratives include vervain, skullcap, wild oat, and ginseng. Restoratives help restore your nervous system when it
is run down and debilitated, such as often happens after trauma. It is always important
to talk to your doctor before starting any new diet, exercise program and/or herbal supplement.
Exercise is another important aspect of a healthy lifestyle and helps strengthen the body and brain centers. Exercise elevates serotonin
and other neurotransmitter levels in the brain and gives one an overall sense of well-being. Most health experts recommend
exercising at least 30 minutes a day at least 4 days per week.
Case Study
This case study focuses
on an 11-year-old male (Steven) that, at first meeting, resided in a group
home for psychiatrically unstable children. Steven had been adopted at age 7 by a single male who lived alone in a one-family
home. Prior to being referred to a psychiatric residential facility, Steven had been in and out of therapy, in and out of
crisis centers, and hospitalized several times for emotional breakdowns.
Steven held a diagnosis
of Bipolar disorder, ADHD, Conduct Disorder, and PTSD. Steven was on several antipsychotic medications and ADHD medications.
In Steven’s early years he was subjected to physical and sexual abuse by adult males, physical and emotional neglect
by his mother, domestic violence, drugs, and transient living conditions.
The therapist in charge of Steven’s case quickly suspected that most, if
not all, of Steven’s behavioral and emotional problems were a result of severe childhood
trauma. The therapist had several individual sessions with Steven and several family sessions with Steven and his adoptive
father and it was decided to try EMDR with Steven. Steven reacted well to this intervention as well as many other modalities
of play therapy.
The therapist worked with the psychiatrist and slowly eliminated all of the psychotropic
medications that Steven was taking. Steven reacted well to taking no medication and psychiatric diagnoses were changed to only PTSD.
Steven was discharged
to home after 6 months of treatment and the therapist continued on with this case as an in-home therapist. Steven’s
adoptive father was very supportive and dedicated to try every therapeutic technique the therapist suggested. However, the school was not as patient with Steven
and his PTSD was triggered often in the classroom atmosphere.
Among the triggers that
set Steven off into an uncontrollable tantrum were:
(1) being yelled at by an adult male
(2) being teased by other children
(3) having to read or give answers out loud in class
(4) angry facial expressions
Steven was suspended
from school on several occasions for disruptive behaviors.
The therapist worked with
Steven on these triggers by using guided imagery, meditation, hypnotic audio tapes geared to raise self-esteem, and hours
of learning to express emotions and where these emotions were held inside of his body. Steven responded well and the problems
at school decreased a little at a time.
Unfortunately, after about a year and a half of treatment, puberty hit rapidly.
Steven grew taller and taller and started asking a lot of questions about sex and how babies are born. Steven’s father
asked the therapist to talk to him about sexual issues due to the fact that Steven had been sexually abused multiple times
as a small child.
The therapist talked with Steven and dad about puberty, how babies are born, and sexual relationships. Steven responded with a normal
degree of embarrassment, but continued to ask questions. The therapist explained the difference between good touch and bad
touch and this led into a conversation about sexual abuse.
Steven talked about some very abusive things that had happened to him and the therapist
helped him understand that this was not his fault and that some people do very bad things to children. The therapist used visualization to help
Steven find a happier and safer place before finishing the session.
That night Steven had a nightmare that was very powerful and his father helped
him to calm and feel safe again. However, in school the next day, Steven had several melt downs and had to go home early. The therapist came back to
help Steven through this experience and brought him a sound machine to help him sleep better at night and used visualization
to help Steven visually create a container with a padlock on it in his bedroom so that he could put all of his scary thoughts
in it before going to sleep at night. He also started taking his calming CDs to school for when he felt stress or upset.
The next several sessions focused on body awareness and sensory triggers. Steven did
much better in school and very rarely had problems. If problems arose, he was able to calm much quicker.
Steven is now a year older and continues to function well without medication, showing
no signs of ADHD or conduct disorder. He has joined several sports teams to help with body work and awareness and does well.
His father, a school teacher, tutors him every night and Steven has caught up academically
with his grade level. His father has followed the advice of the therapist and has taught Steven to eat healthy, exercise,
and use natural herbal products to help Steven maintain an even hormonal balance in his teen years.
Recently the therapist
had a session with Steven and Steven discussed a bad dream that he had had the night before. He told the therapist that his
(imaginary) padlocked box in his bedroom was full and he didn’t have
any room to put in his bad dream last night. The therapist asked him to go get the box and she would take it home with her
and put it somewhere safe. She then had Steven visualize another bigger box with a padlock to put in its place.
Steven has come a long way
in his recovery from complex PTSD and is now able to lead a normal life as a normal teenager. However, he has not worked through
all of his trauma, due to his age and comfort level, so will need to do so as he feels he
is able.
Fortunately, he has the
psychological tools and the support of a loving father to help him through whatever lies ahead.
Not very many children make it through the degree of abuse that Steven has made it through. He has a strong spiritual base
that his adoptive father has shared with him and a support system that understands the importance of a body / soul / spirit connection.
Conclusion
Regardless of the modality
of change that one utilizes, it is important to realize the place that defense mechanisms, such as numbing, dissociating, etc. have
served in the client’s life up to this point and to be gentle and go slowly in substituting new, healthier practices
into their life (Etherington, 2005).
“Rapidly
operating emotional reflexes are unconscious and do not have a feeling tone, except perhaps during the
period of arousal after the reflexive response has diminished (Panksepp, 2002, p. 226).”
Due to this factor, an individual,
especially an adolescent, may not
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