How childhood trauma affects health across a lifetime？
Vincent Felitti, a US doctor, and his team conducted a research on adverse childhood experience (ACE) in 1995. They conducted research on more than 17,000 targets and discovered a strong relationship between ACE and the health of their adulthood. In their research on ACE, negative childhood experiences included:
Physical abuse
Sexual abuse
Emotional abuse
Physical negligence
Emotional negligence
Violence between parents
Parents with mental illnesses
Parents with drug addiction or imprisonment
Parents being separated or divorced
Among the research targets in 1995 (the majority being middle class white-collar workers with college degrees), almost 2/3 of them have had one or more ACEs, with 1/8 of them having an ACE score of greater than four. In this research, the greater the ACE score, the more likely it is to develop physical and mental illnesses during adulthood. ACE is closely related to a variety of physical and mental problems in adulthood, such as alcoholism, obesity, insomnia, depression, suicidal tendency, sexually transmitted diseases, heart diseases etc.
Prologue
When I first joined the trauma team at the hospital and began doing psychiatric counseling, I knew I was going to work with young patients with a variety of childhood traumas. So I was prepared to put in a lot of time and patience in the trauma therapy process. However, I was still shocked by the many different kinds of cases that I encountered.
This has made me realize the uniqueness of trauma therapy for minors. Since minors aren’t independent enough, there tends to be uncontrollable factors that may come up during the counseling process. So it is necessary to take their surrounding environment into consideration. Some of the traumas that these children have experienced include poverty (yes, the most recent research report has proven that growing up in extreme poverty is a kind of chronic trauma); either parent or both parents with drug addiction, serious mental illnesses, are imprisoned for crime or have passed away so there’s nobody to look after the child; the child having experienced physical or sexual abuse etc.
The majority of these families required financial assistance from the government. Some of the children were still living with their immediate families, but some of them were temporarily allocated to foster families by the US Child Protective Services because their parents have temporarily lost their right of custody. Statistics have shown that more than 600,000 children were placed into temporary foster families in 2016. This figure usually remains at more than 500,000 every year.
In conclusion, children with ACEs will often continue to live in an unstable or traumatic environment.
Therefore, a lot of unexpected situations came up during my counseling sessions with children and their families. For example, parents would suddenly cancel our appointment because they had to work to earn a living; there might be more than one child in a foster family so the foster parents didn’t have an available time or place to meet with me because they already had too many appointments; the parents or relatives might still be involved in a custody lawsuit so we couldn’t progress with the therapy until the child’s placement was certain; sometimes I’d have no choice but to reduce the number of my visits due to the child’s area being quite an unsafe neighborhood etc.
Trauma Systems Therapy involves a number of effective components from Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) such as offering psychological education to the child and his family, stress relief and relaxation exercises, emotional management, self-recognition exercises etc. It also takes the minor’s surrounding environment into consideration. This includes helping the minor change his living environment, establishing family bonding, establishing a safe environment, communicating and working with the minor’s social-ecological model (school, doctors, child protective services, courts etc.), promoting the minor’s rights, assisting with mental illness medication etc.
In China, a lot of children are experiencing living, medical and schooling difficulty due to poverty. There are children with physical disabilities which have led to recovery, care, nursing and social difficulty. There are also children whose safety is being threatened or violated due to a lack of or inappropriate custody whereby they are being abused, abandoned, hurt in accidents, illegally treated etc. Although a lot of children can still survive amidst such adverse environments, many reports have shown that such adverse environments will cause lifelong damage to their physical and mental health in their adulthood. Trauma Systems Therapy (TST) may suggest new concepts for social workers and psychiatrists and help them assist and support these children with problems.
Dawning Public Lecture
29thSession
The Application of Trauma Systems Therapy
in Helping Children with Problems
Beijing Time: Saturday 11 August
21:00 – 22:30
Speaker: Yumin Tan
Main Contents:
Trauma Systems Therapy
Definition of trauma systems therapy
Definition, contents and application of social-ecological model in trauma therapy
Procedures of Trauma Systems Therapy
Preliminary assessment
Treatment plan of trauma systems therapy
Preliminary preparation
Introduction of different phases and components
Introduction of treatment methods
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Step 3: Access to the open lecture will be announced in the WeChat group three days prior to the date of the lecture.
Bessel van der Kolk, a US psychiatrist, defines trauma as an experience or disaster that leaves people in a state of helplessness and terror, thereby losing the ability to deal with the problems, threats and disasters in everyday life. Traumatic incidents can cause profound and lasting changes in our physiology, emotions, cognition and memory, as well as cutting off the connections between these four components.
Trauma can be classified as one-off trauma or continuous and repetitive trauma. One-off traumas include serious accidents (car accidents, robbery etc.), natural or man-made disasters (earthquakes, tsunamis etc.), terrorist attacks etc. Continuous and repetitive traumas include long-term sexual abuse, physical abuse (physical violence), emotional abuse (verbal abuse and control), serious illnesses, wars etc. Both one-off traumas as well as continuous and repetitive traumas can cause serious psychological and physical harm for the survivors and witnesses of traumatic incidents.
What Is Post-Traumatic Stress Disorder (PTSD)?
Not all traumatic experiences will lead to trauma response or trauma-related illness or diagnoses.
After a trauma, people will become nervous, anxious and will even have nightmares. These are all normal reactions to traumatic incidents. Once they spend some time recovering and adjusting with the help from family and friends, the majority of people will be able to get on with their lives again. However, a small portion of people will develop psychological illnesses relating to the trauma and the most commonly seen illness is called post-traumatic stress disorder (PTSD).
The US Diagnostic and Statistical Manual of Mental Disorder (DSM-5) noted that the symptoms of PTSD include: (1) nightmares and intrusive memories where sufferers will experience flashbacks of the traumatic incident again (2) avoiding people, incidents, objects, places and scenes that are related to the traumatic incident (3) pessimistic thoughts and feelings eg. not trusting people around them, not showing interest in things that happen around them, blaming themselves etc. (4) excessive arousal and reactivity eg. being impatient, aggressive, impulsive, overly alert, finding it difficult to focus etc. Sufferers can only be diagnosed as having PTSD if such symptoms persist for at least one month.
How Trauma Can Cause A “Short Circuit” In Our Brain
According to Joseph LeDoux, a neurologist who conducted research on how our brain processes emotions, our brain has two systems which process our emotions, namely high road and low road. These emotion-processing systems are especially important to our ability to survive.
As an external danger signal enters our brain, it will enter the low road first. The low road has a tissue called amygdala which will cause our body to become more tense and alert so that we are ready to make an emergency response. This is the renowned fight or flight response mechanism. It is an unconscious channel and doesn’t contain any contextual messages. It is very quick but lacks details.
Then the danger signal will enter the high road – cortex (sensory cortex, frontal lobe and temporal lobe storage system). The main function of the cortex is to assess and analyze danger signals, and then send this signal to the amygdala to confirm whether or not this danger signal will be a threat to us. If it won’t pose as a threat, the amygdala will send a signal to relax our body.
For example, when you are walking in a zoo one day, you suddenly notice a tiger walking towards you. Your body will instinctively enter into a very tense condition, you will start to sweat and your heart will begin to race (danger signal has reached the amygdala). As you are about to flee the scene, you suddenly realize that the tiger is locked up inside a cage (danger signal has reached the cortex). Once you realize there is nothing to be scared of, you let out a breath of relief, your body will relax and you will decide to keep walking around the zoo.
The difference between normal people and sufferers of PTSD is that when normal people receive a danger signal, after the signal enters the low road, it will be able to enter the high road so that an assessment can be made as to whether or not it is dangerous, then our body can respond accordingly. But as for sufferers of PTSD, the danger signal will get stuck in the low road and won’t be able to enter the high road where it will be assessed. So their body will always remain in an emergency response condition eg. increasing heart rate, breathing difficulty, anxiety, paralyses etc.
In our previous example, if you have been chased by a tiger before and almost lost your life (traumatic incident) and you haven’t recovered from that incident, when you see a tiger at the zoo again, it is very likely that you will immediately become paralyzed. Your mind will become a total blank (the cortex is unable to rationally analyze the danger signal), so you won’t be able to calm yourself down. The false threat will become a real threat to you.
For sufferers of PTSD, survival is their core aim. Everything in life can trigger memories of their trauma eg. hearing the song that was being played when the car accident happened, a similar smell as that of the clothes of your perpetrator, having a nightmare that is related to your trauma etc. This can cause the victims to lose control and feel that they have gone back to the scene of their trauma because their danger signal is stuck in the low road again.
Trauma will also seriously affect the internal order of the brainstem. Brainstem, also known as the survival brain, is responsible for controlling our breathing, heartbeat, blood pressure etc. It plays a vital role in keeping us alive. Brainstem also controls our body’s instinctive automatic survival function. In order to effectively perform high-level functions such as languages, social and emotional interactions, create inventions and innovations etc., the functional network which supports our basic needs must remain in good condition. However, trauma can disrupt the internal order of our brainstem, thereby making people feel anxious, impulsive and disoriented. It will then be very difficult for people to develop social skills, improve self-esteem, participate in creative and innovative training programs and thereby benefit from such activities.
References:
American Psychiatric Association (2010).DSM-5Brendtro, L. K. (2015). Our resilient brain: Nature’s most complex creation. Reclaiming Children & Youth, 24(2), 41-49.MacKinnon, L.(2012). The neurosequential model of therapeutics: an interview with Bruce Perry. Australian & NewZealand Journal Of Family Therapy, 33(3), 210-218.Perry, B. D. (2009). Examining child maltreatment through a neurodevelopmental lens: Clinical applications of the neurosequential model of therapeutics. Journal Of Loss & Trauma, 14(4), 240-255. Dealing with the Effects of Trauma-A Self-Help Guide SAMHSA http://www.samhsa.govSaxe, G. N., Ellis, B. H., & Kaplow, J. B. (2007). Collaborative treatment of traumatized children and teens [electronic resource] : the trauma systems therapy approach /Glenn N. Saxe, B. Heidi Ellis, Julie B. Kaplow. New York : Guilford Press, [2007].Van der Kolk, B. A. (2014). The body keeps the score : brain, mind, and body in the healing of trauma. New York : Viking, [2014].
