Did you know that just learning to relax is key to trauma-informed intervention, resiliency and recovery from a variety of disorders? Dr. Roger Klein, expert on the impact of relaxation training with children and adolescents, presented a workshop “Helping Children and Teens Self-Regulate Using Imagery and Relaxation” at a recent trauma conference. In this presentation, Klein underscores that that there are many ways children and teens can learn to regulate their responses to stress and traumatic events. Additionally, using imagination along with relaxation activities and resilience-focused thinking, young people can learn to minimize their responses to every day stress and traumatic experiences.
Relaxation is a state of being in which there is an absence of tension and hyperarousal, two common reactions to stress or traumatic events. Roger Klein and other experts on trauma propose that practicing relaxation skills over time is a highly effective way to mediate and reduce the effects of stress on the body and mind. Without the ability to relax, we may stay locked in a “fight or flight” response; the latter leads to chronic feelings of anger, depression, panic, and burnout and even stress-related medical conditions. In other words, there are many benefits to practicing relaxation including reduced susceptibility to disease, improved concentration and most of all, increased happiness and life satisfaction.
Meditation is one form of relaxation and is often defined as a form of mindfulness, the bringing of one’s complete attention to the present experience on a moment-to-moment basis. Mindfulness meditation has been studied for several decades and has proven to be effective in the treatment of pain, anxiety, stress and even addictions. Many trauma specialists now regularly apply some form of mindfulness practice in work with clients of all ages, including children, because of the outstanding evidence indicating that meditation actually “changes” our brains in positive ways. Mindfulness expert Jon Kabat-Zinn developed a now widely used protocol called Mindfulness-Based Stress Reduction (MBSR) to treat chronic stress and the illnesses that repeated exposure to psychological trauma causes, including high blood pressure, heart disease and weakened immune system functioning.
Just recently researchers at University of California at Los Angeles (UCLA) found that certain areas in the brains of individuals who meditated for many years were larger than those individuals who did not engage in regular meditation. They also found that those people who meditate have more gray matter and show less age-related brain atrophy (weakening), suggesting that meditation may be good for everyone because our brains naturally shrink in size over our lifespan. In follow-up studies, these researchers found that the benefits of meditation are not isolated to one part of the brain, but involve many parts including the cortex, limbic system and brain stem.
When it comes to children, some readers may ask, “Well, how do we successfully adapt what is known about meditation, mindfulness and relaxation to young people?” One popular technique I have used with children for many years is called “Lion’s Breath” and uses an imaginative metaphor (the lion’s roar) to help young people learn the same relaxation skills that teens and adults may learn through traditional methods and yoga breathing:
“I am going to teach you about a way to let go of worries or thoughts that might be bothering you. It’s called the Lion’s Breath and I want you to imagine you are a lion. Remember, a lion has a really, really big roar—can you roar? Now I want you to sit up with your legs crossed; if you feel more comfortable sitting up against a wall with your legs crossed, go ahead and do that (some children feel safer with their backs against a wall). Now, get ready to make your roar! Let’s try one all together as a group (we all roar in unison).
Before we roar again, let’s all think of a worry that we would like to let go off. For a minute I want you to watch me and see how I roar. First, I am going to take in a really, really deep breath through my nose and then let my roar out through my mouth, sticking my tongue out at the same time and stretching out my arms out as far as I can in front of me. Let’s all try it together, okay?” (Leader and children perform the breathing and roaring together, sticking out their tongues and stretching out arms) (Malchiodi, 2000, p. 14).
Repeat this activity several times; inevitably the deep breathing, roaring and stretching lead to a child-friendly (and fun) form of relaxation. For more information on relaxation with children and teens, visit Roger Klein’s website.
Be well,
Cathy Malchiodi, PhD, LPAT, LPCC
References
Malchiodi, C. (2000). Creative activities manual for children from violent homes. Salt Lake City, UT: WIJ Publications.
The details about the shooting rampage that left six people dead, a Congresswoman in critical condition, and another dozen injured are still unfolding. While the focus is on the condition of survivors and sympathy for the victims, the “whys” of this event also are emerging. Although the suspected shooter’s intentions and motives remain unknown, there is speculation that the inflammatory language and violent images permeating the media played some role in the incident. Clarence W. Dupnik, Pima County sheriff, captured the essence of the incident at a news conference saying it was time for all of us to “do a little soul-searching” about the caustic political climate in the US. He observed that talk radio and other media “invite the kind of toxic rhetoric that can lead unstable people to believe this is an acceptable response.”
Having worked in the field of interpersonal violence, particularly domestic violence, discussion of how language and images influence behavior is not a new issue for me. Whether or not violence language played a role in the shooter’s motives is not yet known. But if you work in settings that address interpersonal violence, you are probably very familiar that domestic violence shelters often provide education to both clients and staff about how words communicate violence in our culture (for one example, visit Mid-Valley Women’s Crisis Center or Google and search “violent language, domestic violence” for more information). This education not only teaches to how violent language, actions, and image impact families and children, it is also reminds all helping professionals about the importance of empathy in our work, communities, and culture.
InDeep Brain Learning: Pathways to Potential with Challenging Youth, Brendtro, Mitchell, and McCall summarize empathy as follows:
“Empathy is the foundation of moral development and pro-social behavior. The original word began in the German language as Einfuhlung which is literally translated as feeling into. Empathy taps the ability of mirror neurons to display in our own brain the emotions, thoughts, and motives of another. Empathy allows us to share anothers joy and pain and motivates care and concern” (p. 91).
Linguist Noam Chomsky notes that children not only have the ability to learn language, but also that they have the capacity for learning what is called moral grammar. Chomsky’s research underscores that the human brain uses social interaction to develop both language and moral grammar; more importantly, he notes that the quality of an individual’s language and moral values are dependent on verbal and cultural environments. In other words, the same “mirror neurons” in the brain respond to violent verbal and cultural environments as to empathetic words and ecologies. In fact, it was recently noted that empathy and violent tendencies actually overlap within the brain.
As the details of the shooting in Tucson unfold, more questions than answers will likely emerge, just as they have after violent episodes like the Oklahoma City bombing and shootings at Columbine and Virginia Tech. Undoubtedly, mental illness played a role in these and many similar scenarios; it’s also impossible to say that some of these incidents could have been easily prevented for that reason. But what is possible, as Dupnik noted, is to accept that our words and actions do have profound and far-reaching consequences within our families, communities and cultures; what we say and do can make a difference in the lives of those we encounter. Children can only flourish and become positive, productive adults in environments where empathy is the core value and violence, in all its forms, is unacceptable.
Be well,
Cathy Malchiodi, PhD, LPAT, LPCC
References
Brendtro, L., Mitchell, M., & McCall, H. (2009). Deep brain learning: Pathways to potential with challenging youth. Albion, MI: Starr Commonwealth.
Hauser, M. (2006). Moral minds: How nature designed our universal sense of right and wrong. New York: Harper Collins.
Chomsky, N. (2008). The essential Chomsky. New York: New Press.
In a recent summary published in Cerebrum from the Dana Foundation, Regina Sullivan offers intriguing research data on how early negative experiences cause developmental changes in the brain, biochemistry, and psychosocial responses. Like many researchers in the area of child abuse and early intervention, she notes that there is wide agreement that providing nurturance, positive interactions, and experiences of safety have a long-lasting impact on children’s brain development.
When abuse goes undetected or is allowed to continue to impact children’s development, Sullivan cites that approximately 80 percent of abused individuals are diagnosed with a major psychiatric disorder by adolescence. Additionally, brain scans brains of individuals who have experienced abuse during childhood show abnormalities in areas of cognition and emotion. But something even more intriguing is also detectable in the brain function of children who are abused and maltreated. Changes in neurodevelopmental areas go even deeper than just brain function; abuse literally can change one’s genes.
Simply put, the influence by environmental and social factors on our genes is a field of study known as epigenetics. In brief, when an epigenetic change occurs, the biochemistry of how the gene is expressed is altered. In the case of child abuse, how gene expression is changed by abuse may tell us why many of the effects of child abuse do not appear until adolescence and why many maltreated individuals eventually become abusers themselves. Sullivan cites an intriguing study of the brains of individuals who committed suicide to underscore the profound influence of abuse and just how it may alter genetic expression. Of the individuals who committed suicide and who were the subjects of this particular study, some had been abused early in life and others had not. The brains of those who were abused showed significant genetic changes in the hippocampus function that could predispose them to life-long stress responses; those who were not abused, but had died from suicide, did not show similar changes. Individuals who died of natural causes also did not show changes to the hippocampus.
This finding may imply that abuse causes severe alterations in the hippocampus in those who have experienced abuse in childhood; these alteration are not found in others, even those individuals who may have conditions such as depression or anxiety that predispose them to suicide. And while these changes occur early in life, their presence may not be observed behaviorally until later in life, making early detection and intervention for abuse all that much more critical. Because of the nature of epigenetic changes, Sullivan speculates that these alterations may be present for at least two generations, a possible partial explanation for the intergenerational cycle of abuse that trauma specialists see in their work with abuse and domestic violence.
Despite the profound impact of child abuse, we know that we can counter the effects through early intervention and identification of maltreatment and provision of caregiving and conditions that provide positive social interaction and stimulation. As trauma specialists, it is undeniable that we face difficult challenges in our work with abused children and the impact of maltreatment over the lifespan. Fortunately, emerging research is continues to inform us on how to better meet these challenges on behalf of children and how to improve our efforts as trauma informed practitioners.
P. O. McGowan, A. Sasaki, A. C. D’Alessio, S. Dymov, B. Labonté, M. Szyf, G. Turecki, and M. J. Meaney, “Epigenetic Regulation of the Glucocorticoid Receptor in Human Brain Associates with Childhood Abuse. Nature Neuroscience 12, no. 3 (2009): 342–348.
I have been working with Mark, an Army officer who has been diagnosed with posttraumatic stress disorder [PTSD], for almost six months now. In addition to medical intervention including medications for anxiety, Mark has been making good progress through a combination of somatic therapy, art therapy, mindfulness approaches, and stress reduction. However, Mark continued to have problems with language and cognition; in contrast, his ability to recognize the onset of stress reactions and reduce hyperarousal steadily improved. My concern led Mark and I to sit down with his doctor at our local clinic and revisit his symptoms and injuries sustained from his tour of duty in Iraq. After a number of tests, his doctor concluded that Mark had an undiagnosed mild traumatic brain injury [TBI], possibly due from a jolt to his head as a result of a bomb blast a week before his return to the US. In fact, Mark did not recall an injury since he had no visible head injury and only recently remembered that there he had been a block away from the bomb blast that likely caused some post-traumatic amnesia and a mild TBI.
We are now adjusting Mark’s psychosocial program to address TBI, in addition to PTSD and anxiety. For Mark, just having been identified has relieved the stress of his symptoms and his treatment can be redirected to focus on returning his cognitive functions to normalcy through rehabilitative efforts, including art therapy, occupational therapy, and other methods. Fortunately, much of the sensory intervention involved in treating his PTSD and anxiety issues were helpful in addressing TBI. Mark is lucky in that he is already in recovery from his TBI and is expected to have no long-term affects from his head injury;
As trauma specialists and mental health professionals, we generally focus on psychological symptoms our clients present and particularly stress reactions and posttraumatic stress in particular. However, when working with survivors of traumatic events who may have been exposed to head injuries, I learned from Mark that I have to take a broader perspective on what may be causing distressful reactions and lack of progress. We now know that returning military are not only susceptible to PTSD, but also TBI, a condition that often goes undiagnosed for days, weeks, or months.
A TBI is most often defined as a blow or shock to the head or a penetratinghead injury that disrupts the function of the brain. TBI has been named one of war’s “signature wounds;” it can be caused by shock waves from bombs, a hit to the head, or a jolt that affects the brain. There may be no visible scars, but lasting cognitive and physical harm may be extensive. In contrast to a missing limb or spinal injury, TBIs are not visible, but still of great concern in the overall treatment of trauma to mind and body. Here are some facts about TBI:
Not all blows to the head result in a TBI;
Concussions are a type of TBI and are also known as closed head injuries.
TBIs can be mild, moderate, or severe, depending on the impact on consciousness and duration of amnesia or other symptoms, post-trauma;
TBI symptoms may occur immediately after an event or may appear days or weeks after an injury;
TBIs may affect thinking, sensing, motor skills, and emotions; their psychosocial impact can appear similar to emotional disorders such as PTSD;
In military, blast injuries are a significant cause of TBIs.
Hundreds of thousands of service members are believed to have suffered TBIs during their service in Afghanistan and Iraq, and many go undiagnosed, suffering the “invisible wounds” of war without explanation. The military is currently addressing TBI and the Pentagon recently opened a new 72,000 square foot facility for TBI research. The intent is to keep a comprehensive database that will follow US troops from the war zone through post-deployment, recording all personnel who are exposed to bomb blasts or similar trauma. Ideally, these individuals will be continuously monitored for developing symptoms weeks and months after exposure to injury.
As with PTSD, returning military with TBIs may have personality changes that impact family members, including their children. Imagine the stress a spouse and children experience when a husband, wife, “daddy” or “mommy” comes home with invisible scars that have altered behavior and interpersonal actions. According to my client Mark, his family might have been able adapt to broken leg or back injury more easily than to his personality changes. He feels fortunate that he and his family are getting the help they need in terms of his TBI and posttraumatic stress; he believes that his children are doing better than others under similar circumstances because they are receiving support and counseling at their schools and that he has benefited from medical and psychosocial care.
Finally, while the focus of this article is on TBI in returning military, let’s not forget that we may see undiagnosed brain injury in anyone, including children. Child and adolescent athletes often sustain a blow to the head, but may not be evaluated for TBI; meanwhile, these youngsters may show signs of cognitive and emotional problems for days and weeks after an incident. Their symptoms, too, may be identified as psychological when, in fact, an undiagnosed head injury is the main cause of behavioral changes and cognitive challenges.
There are a large number of great websites on the topic of TBI and the military; here is a short list of resources to get you started:
Traumatic Brain Injury in Theater: When Blasts Damage the Brain. This website provides a visual overview of various head injuries sustained in battle.
Making Art After Trauma. Listen to a short podcast, see a slide shows, and read about art and art therapy in the recovery process of Bret Hart, with commentary from Dr. Kathleen Bell.
And remember on July 13th, 2010, National Institute for Trauma and Loss in Children will welcome military personnel and their families to the Annual TLC Practitioners’ Assembly at Macomb ISD Education Center, Clinton Township, Michigan. For more information, click here. We hope to see you there!
Think that computer games are merely a mindless distraction that has no real benefits other than as a leisure activity? What if something as simple and ubiquitous as the popular computer game Tetris could actually reduce symptoms of posttraumatic stress? While it sounds counterintuitive, researchers have discovered that games like Tetris have applications well beyond just recreation.
Over the past couple of years, investigators at Oxford University have come up with some interesting findings about computer games in the treatment of posttraumatic stress disorder (PTSD). In brief, if individuals exposed to a stressful event play computer games immediately after the event, painful memories of trauma may be removed. In other words, playing Tetris could reduce PTSD according to preliminary research. An investigation of computer games as trauma intervention was inspired by previous studies that demonstrated that video games increase brain activity and actually create observable structural changes in the brain. These games are easily accessible and often free to anyone with Internet access, an added reason for their use.
In the Oxford study, participants were shown a movie with scenes of stressful images of car accidents, injury, and death. Because it takes approximately six hours for memories to become stored in the brain, researchers intended to disrupt the cycle and prevent memory storage. Indeed, playing video games did interrupt storage of painful memories, while leaving the trauma narrative intact. However, in order to prevent memory storage, the video game playing had to be conducted immediately after a stressful event to put a halt to flashbacks to traumatic memories.
So just how does this work? Apparently the effect of computer game involves a combination of increased brain activity at a critical juncture and activation of the motor area of the brain. Games that involve rearranging mental shape and strong graphic images are the most helpful in increasing brain activity and subsequently cortical thickness of the brain with regular play. The Oxford research team also surmised that moving the colored blocks around in Tetris after witnessing traumatic events competes with the actual visions of the trauma maintained by sensory parts of the brain. According to investigator Catharine Deeprose, there is a window of approximately six hours during which it is possible to influence memories recently encoded in our minds.
While providing computer games immediately after exposure to a traumatic event may be difficult to arrange in many cases, this research underscores the value in disrupting memory storage at the earliest stages. If the brain can be convinced to refocus on something other than traumatic experiences in the earliest moments post-trauma, it may be possible reduce or even eliminate the uncomfortable re-experiencing of distressful aspects of an event over the long term. Games like Tetris may not be the only way; any activity that competes for the brain’s focus on sensory experiences theoretically could achieve similar results. In the interim, these current studies indicate that computer gaming is apparently not just play. Under the right conditions, it has the potential to literally restructure the brain while reducing stress in those at risk for trauma symptoms down the road.
Be well,
Cathy Malchiodi, PhD, LPCC, LPAT
References
Holmes EA, James EL, Coode-Bate T, Deeprose C, 2009. Can Playing the Computer Game “Tetris” Reduce the Build-Up of Flashbacks for Trauma? A Proposal from Cognitive Science. PLoS ONE 4(1): e4153. doi:10.1371/journal.pone.0004153.
What do Sesame Street’s Elmo and friends have to do with military children and their families? It all about learning how to “talk, listen, and connect” with family members when dad or mom return home from deployment.
Sesame Street’s “Talk, Listen, Connect: Deployments, Homecomings, Changes” is a DVD series that was launched in 2008 by the Sesame Street Workshop and was designed for military families with young children. It came about in response to the challenges of multiple deployments, homecomings, and changes to family relationships as a result of injuries post-tour of duty. It is also in recognition of the selfless service of the US Armed Forces—Army, Navy, Marines, Air Force, Coast Guard, National Guard, and Reserves. “Talk, Listen, Connect” has helped countless military families to learn how to communicate more effectively with each other with greater understanding, sensitivity, and clarity, strengthening parent-child bonds and attachment.
In true Sesame Street style, these DVDs introduce children and families to the important challenges of reintegration and multiple deployments through the characters familiar to everyone. In one segment, Elmo’s dad has just returned home and Dad, Mom, and Elmo have to readjust to family life after their reunion; as a family, they have to reconfigure their roles as parents and child now that dad is back. In another segment, the viewer also meets Rosita whose father has been injured in the war and now is in a wheelchair. Rosita is understandably anxious, afraid, and confused by the changes in her father and the family’s life and does not want to talk to her mom and dad initially because, like many children, she thinks she might upset her parents. However she eventually learns that there are new ways to be with her father and that she can even play ball and dance with her dad despite his injuries. Overall, the DVDs also instill a sense of pride, honor, and resilience, underscoring both challenges and triumphs. To learn a little more about this program, please take a couple of minutes to watch this short film:
For those readers not yet familiar with the consequences of the current conflicts, over 12,000 children of military have lost a parent since the start of the Iraq and Afghanistan wars over eight years ago. In response, the Department of Defense has again partnered with Sesame Street to produce another military-themed episode called “When Families Grieve.” This particular installment addresses death and loss and how children experience grief when a parent in the military does not return home again. Sesame Street intends to make available approximately 800,000 new resource kits to military families to provide hope and reassurance that they need during the difficult experience of a death of a father or mother. You can find out more information about this latest project at the Sesame Street Workshop website.
And have you made plans to attend the National Institute for Trauma and Loss in Children 2010 Summer Practitioner Assembly? The first day of the conference [July 13th] is dedicated to how practitioners can help military children via a renowned panel of experts on families, US armed services, and reintegration, homecomings, and multiple deployments. The panel includes Retired Brigadier General Don Scott and Betty Scott, Retired Major Margaret Dellio Storey, and other notable experts on military issues and children and families. The remainder of the conference features special sessions focusing on children of the military as well as workshops and courses on intervention with children who have experienced violent trauma, disaster, domestic violence, abuse, deaths, or loss. You will also receive a free copy of Sesame Street’s “Talk, Listen, Connect: Deployments, Homecomings, Changes.” And military personnel and families are invited to attend the July 13th presentation free of charge.
So consider taking advantage of this unique opportunity! If you are in the military, you and your family can connect with other families and share your expertise and wisdom with practitioners in attendance. If you are a practitioner, you’ll be enhancing your trauma intervention skills via the National Institute for Trauma and Loss Certification courses; you can attend Level 1 and Level 2 courses in addition to other workshops on non-military trauma and loss subjects during the four-day conference. We look forward to seeing you there!
A 5th revised edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) will be published in 2013. If you are a mental health professional who has used the current DSM-IV in your work, you may remember that the previous document was introduced in 1994, approximately 16 years ago. Since that time we have witnessed tremendous changes in how emotional disorders are viewed and evaluated. Everything from brain imaging technology, advancements in the understanding of genetic and environmental influences, and how data are collected and analyzed have increased our knowledge of psychiatric conditions, including those disorders resulting from traumatic events during the lifespan.
While there are many ongoing discussions about proposed revisions, there are two discussions in particular that are relevant to our work with traumatized children. The first is the proposed section involving posttraumatic stress disorder (PTSD) in preschool age children; the second is the debate about the proposed section on developmental trauma disorder (DTD).
Posttraumatic Stress Disorder in Preschool Children
Research tells us that the younger a child is at the time of the trauma, the more likely he or she is to develop PTSD. According to the latest information, 39% of preschoolers develop PTSD in response to trauma, while 33% of middle school children and 27% of teens do. Young children (ages 1 to 6 years) react with helplessness and passivity; generalized fear; heightened arousal; cognitive confusion; nightmares and sleep disturbances; anxieties about death; somatic symptoms; freeze responses; and “fussiness,” crying, or neediness. Understandably, these youngsters often have little comprehension of traumatic events because of age and other influences.
With regard to this proposed revision to the DSM, the intention is to create guidelines for identification of PTSD in young children inclusive of developmentally appropriate factors. While the criteria will be familiar to most helping professionals, there is still some disagreement about several items. Two symptoms still under discussion include: 1) negative alterations in cognitions and mood as evidenced by increased negative emotional states in young children exposed to trauma; and 2) reckless or self-destructive behavior. Those of you who work with young children may see these reactions manifest through children’s sensory responses such as play activities in contrast to older children who may express these reactions in other ways. In addition, there is some debate about whether or not children who are exposed to traumatic events that have occurred to close relative or close friend should be included in this category.
Recommendations for severity criteria for this disorder are forthcoming; you can check the APA website for updates here.
Developmental Trauma Disorder
Well-known trauma expert Bessel van der Kolk and colleagues propose Developmental Trauma Disorder (DTD) as a new DSM category intended to identify children who have a history of complex trauma. In brief, this category addresses the differences in the expression of PTSD in children, particularly those who have experienced a series of traumatic events throughout their lifespan. Like many trauma specialists who work with children with complex trauma histories including abuse and neglect, I was particularly excited about the possible inclusion of this category to help identify and address the unique constellation of symptoms in chronically traumatized young people.
As it turns out, this category has been controversial and is not currently included in the final revisions. A recent article by Mary Sikes Wylie called “The Long Shadow of Trauma” by Mary Sikes Wylie (March/April 2010 Psychotherapy Networker), provides some insight as to why this category ended up on the “cutting room floor.” While DTD broadened the symptom range of children with PTSD-like reactions, epidemiologists and researchers generally revise the DSM, not clinicians who actually encounter clients face-to-face. Thus, revisions are based on data gathered through rating instruments, population studies, and other quantitative measures and less on clinical reports or qualitative studies. Others argue, including van der Kolk, that a category such as DTD challenges the structure of traditional research, funding initiatives, and accepted rating scales. In essence, DTD demands that we look at the children we see in treatment as individuals with needs best addressed by a combination of approaches not currently promoted by the status quo in the trauma field. These approaches include mind-body, somatic, sensorimotor, art therapy and other expressive arts therapies, play therapy, and neurofeedback, among others—approaches that promote the integration of mind and body. Bessel van der Kolk’s Trauma Center utilizes a number of these methods, implementing a blend of psychology, integrative approaches, and neuroscience as well as accepted evidence on how the body responds to repeated chronic trauma.
If you would like to read more about the DSM-V and send comments about these two categories and other proposed revisions, you can access the DSM-V website at: http://ow.ly/1oqfI.
Anyone who has experienced a traumatic event knows that it is only one part of life and that the sum of one’s life is much more than the event itself. Fortunately, in the first weeks and months after a trauma or loss most children and adolescents gradually recover and the event becomes less emotionally disruptive over time. But for others, painful memories of the traumatic event become a habitual way of reacting to life and tenacious feelings of anxiety, sadness, or even terror and posttraumatic stress disorder may take hold. On a daily basis these youngsters revisit worries and hurts, appear withdrawn, and are unable to enjoy normal activities with friends and family.
Currently, many helping professionals use verbal cognitive-behavioral techniques (CBT) to address trauma reactions. However, just talking to traumatized children and adolescents to change the way they think about themselves and their lives post-trauma will often be heard by them from a negative perspective, even though what is said is factual. TLC founder, Dr. William Steele, says, “Imagine saying to a traumatized adolescent, ‘Joey, what happened to you is horrendous. I can’t imagine what it’s all been like for you. What you need to tell yourself is that trauma is only one part of your life, there are many parts who make you who you are and trauma is just one part of your life.’
Listening to these words, traumatized Joey will hear, ‘Don’t be so upset, just move on.’ He is likely to be experiencing you as someone who is minimizing his experience, even frustrated by his being ‘stuck’ in it. However, if you present Joey with a sensory activity that engages the right brain and parts of the brain that tap the senses, he can begin to implicitly change his experience. By doing so, Joey sees himself differently than he would through cognitive attempts to help him reframe that experience.”
What Bill Steele is saying sounds simple, but it is a concept that many helping professionals miss when trying to address the needs of a traumatized child or adolescent. How we successfully recover from trauma is not by insight, but through our sensory experience of it because the body remembers it as a physical reaction, not just a narrative account. By using the senses to help young people reframe their experiences, there is a greater likelihood that they will be able to communicate the hurts, worries, and terrors. They also will start to view themselves as resilient and empowered individuals and survivors, not as victims.
Bill offers the following activity taught in TLC workshops to demonstrate how to facilitate cognitive understanding by including sensory experiences. This activity is adaptable to a variety of ages ranging from school age children to adolescents.
Many Parts Make Me Who I Am
Materials: 8” x 11” plain paper, pencil
1) Draw a line from the middle top of the page to middle bottom. Draw another line from upper left hand corner to lower right hand corner, then another line from upper right corner to lower left corner, and finally one more line from the middle of the left hand side of the paper to the middle right edge of the paper. The paper now has eight sections.
2) Now briefly recall a trauma in your life and choose a word or phrase that reflects that trauma. For example, for a car fatality you could use the word “car,” or death of a father, the word “dad.”
3) Write that word or phrase in one of the eight sections, any section.
4) Using the same process. think about the neat things that have happened in your life and write the word or phrase that reflects that neat thing in another section and do this until the remaining seven sections contain “neat” memories.
5) Now simply look quietly at what you just created. What thoughts now emerge about you and the trauma?
The two most common responses are, “There are more neat things than bad things,” and “trauma is only one part of my life.” These responses may seem obvious, yet the power of this simple activity is that you, the helping professional, have created a sensory “prop” that gives the child a visual (iconic) view of himself and his life. Now the youngster, with your help, can more easily cognitively reframe the belief that, “Trauma is only one part of life. “ Through sensory activities, children and teens can experience that there are many parts of life that make them who they are; with the help of the therapist or counselor, they can also begin to integrate the experience of trauma into other parts of life.
Sensory interventions can change the way we think about and perceive traumatic events; they can also eventually moderate how our bodies react to traumatic memories, reminders of loss, and other negative experiences. When those sensory activities are designed to address and alter major trauma reactions, “victim thinking” can be replaced by “survivor thinking,” followed by more resilient behavior.
All TLC intervention programs capitalize on sensory-based experiences and have undergone evidence-based research and evaluation documenting their value as a structured approach to reducing counterproductive trauma reactions and other mental health symptoms. The activity described in this post –and additional activities– can be found in Trauma Informed Practice and At Risk Adjudicated Adolescent Program at the TLC Online Bookstore or seminars. For training and/or additional information, be sure to visit www.starrtraining.org/tlc.
There are many ways to effectively help children express traumatic experiences. Play, drawing, movement, and of course, talk therapies are all good approaches. But what happens when an activity, intervention, or counseling session calls forth a powerful sensory memory, causing the child to become overtly anxious, tearful, hyperaroused, frightened, or speechless? We know now that these are important signs of autonomic over-activation — that stress hormones are pouring into the body and the sympathetic nervous system is in high gear. For helping professionals, these reactions may be as frightening to them as they are to the children who experience them.
On February 27th, 2010, National Institute for Trauma and Loss in Children will welcome international expert Babette Rothschild, founder of Somatic Trauma Therapy, to its four-day seminar in San Antonio, TX. This is an exciting opportunity for trauma specialists to learn exactly what to do when confronted with the more difficult symptoms of acute and chronic trauma including hyperarousal and reexperiencing. A practitioner since 1976, Rothschild proposes that when stress hormones are pouring into the body that it is time to simply calm the client down. It is at this juncture that we need to not only know when to “apply the brakes,” but also to know what techniques to use.
Babette Rothschild describes applying the brakes as follows: “My logic stems from the observation that both driving and trauma therapy involve controlling something that can easily go out of control. It is not a good idea to proceed with directly addressing a traumatic incident — accelerating trauma processes in the mind and body — unless both therapist and client know how to find and apply the brakes: stop the process if it becomes too uncomfortable or destabilizing….the body is often missed in trauma treatment. On the other hand, some body-approaches neglect the importance of psychological integration. Neither aspect can be neglected. Trauma treatment must regard the whole person and integrate trauma’s impact on both body and mind” (2009).
This wisdom is based on what we now know about how the brain responds to traumatic events. In brief, one key component in the brain’s reaction to trauma is the hippocampus. This region is extremely susceptible to stress hormones that are released when the body feels threatened and a cascade of stress hormones can be stimulated by an actual event or recall of an upsetting memory at any time. If stress hormones reach a high level, they diminish the activity of the hippocampus, causing it to become non-functional. The hippocampal region is key in resolving and integrating incidents and memories; when it is compromised, the hippocampus ceases to provide important information to the cortex [the thinking part of the brain], making rational thought difficult. Suddenly, the cortex may not recognize that a traumatic event is over or no longer present, causing the individual to feel overwhelmed, confused, anxious, or fearful.
According to Rothschild, keeping the hippocampus functioning is important to successful therapy. But how is this accomplished? In sum, by keeping stress hormone levels low so that the nervous system does not go into over drive. And that is why it is critical that every trauma specialist understand how to help children “apply the brakes” during intervention. Applying the appropriate techniques not only stabilizes emotional responses, it is actually helping the hippocampus to return to its proper function as soon as possible when over-activation occurs.
Want to learn more? The National Institute for Trauma and Loss is offering its three core certification courses at this San Antonio training as well as a special presentation by Babette Rothschild on how the “body remembers trauma” and what you can do to help traumatized individuals. You do not have to register for all four courses, but if you attend all four you can obtain your Level-1 Trauma and Loss Specialist Certification by simply completing one TLC online 6-hour course and the Level-1 online exam.
There are currently 1.8 million children who have at least one parent in the military and currently over 230,000 children who have at least one parent who is deployed. Unlike previous wars, US military have faced multiple deployments, leading to stresses that are different than those found in past conflicts. While many military personnel deal well with these challenges, others have catastrophic problems that impact their lives as a result. Approximately 20 percent of military sent to Iraq and Afghanistan come home with posttraumatic stress disorder [PTSD], traumatic brain injury, or depression; others find it impossible to adjust to life away from the war front, finding that relationships, mood, and cognition are impaired or disrupted. When a parent with one or more problems returns to a family on the home front, there is a ripple effect on the partner, extended family, and children. For some, the first deployment is the most stressful; for others the cumulative affect of returning to battle and then to home increases the chance of trauma reactions, marital problems, and even family violence and child abuse at home.
As trauma specialists, we really haven’t had to deal with anything like this before and many of us are finding ourselves in new territory when we attempt to intervene with children and families of today’s military. Multiple homecomings, re-integrations, and deployments are difficult for children to understand and may cause changes in behavior, social interactions, and even cognitive functioning. For example, children and teens who have endured multiple deployments of a parent may have problems with sleep, attention deficits in the classroom, and even higher blood pressure and increased heart rates. School-age children may have behavioral problems in school and lose interest in their favorite activities; adolescent development is disrupted by the deployment of a parent. Young children [up to 5 years old] may regress to earlier behaviors or cling to parents, displaying otherwise unexpressed fear and worry. Do these reactions sound familiar? Of course they do; they are similar to the responses we see in children who have experienced extended or chronic trauma.
Presently there are some programs such as Zero to Three, the Military Child Education Coalition, and the Boys and Girls Clubs of America that address the stress of multiple deployments on children. However, we really know relatively very little about how the unique aspects of the recent wars have impacted military families, particularly children. In order to address the lack of research on intervention for children of military families, the National Institute for Trauma and Loss in Children is currently working on developing programs to address the needs of children adjusting to parents with multiple deployments, including those children who are attending schools not associated with a military base.
TLC would like to know if you are working with children of military or if have you worked with military families. If so, TLC would like your contact and employer information so that you can be involved in this initiative as the project develops. Please send an email to bsteele@tlcinst.org or phone the TLC office at 877-306-5256. It is important that TLC hear from you as soon as possible so that we will have a comprehensive list of those trauma specialists encountering children of military in their work.
Look for more information on the TLC website, the official TLC Fan Page on Facebook, and TLC’s Twitter very soon. It’s exciting to envision how we all can more effectively provide intervention to children and military families to help these children cope, thrive, and become more resilient– and we look forward to hearing your experiences on how we can all make this happen.
Be well,
Cathy Malchiodi, PhD, LPAT, LPCC
Resource
Sesame Street provides free DVDs to help younger children cope with the cycle of deployment, homecoming, and reintegration. Visit “Talk Listen Connect” at http://www.sesameworkshop.org/initiatives/emotion/tlc to find out more and to obtain these materials.
Did you know that just learning to relax is key to trauma-informed intervention, resiliency and recovery from a variety of disorders? Dr. Roger Klein, expert on the impact of relaxation training with children and adolescents, presented a workshop “Helping Children and Teens Self-Regulate Using Imagery and Relaxation” at a recent trauma conference. In this presentation, Klein underscores that that there are many ways children and teens can learn to regulate their responses to stress and traumatic events. Additionally, using imagination along with relaxation activities and resilience-focused thinking, young people can learn to minimize their responses to every day stress and traumatic experiences.
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