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Trauma-informed care
Trauma and mental health
Trauma may occur as acute stress from a perceive life-threat (e.g. war, rape) or as the end product of cumulative stress (e.g. ongoing childhood abuse). Both can seriously impair a person’s ability to function with resilience and ease. Numerous studies show that trauma is significantly associated with mental health diagnoses.
The greater and more frequent the trauma, the greater the risk. Consider the evidence:
Bipolar also has a tie to trauma. One study did a statistical analysis of 19 studies covering 34 years of patient records. They found that people diagnosed with bipolar were 2.6 times more likely to have experienced traumatic events in childhood than people without the diagnosis. [1]
Psychiatric drugs may relieve some of the symptoms, but they don’t consider and therefore cannot resolve challenges borne from our traumatic human experiences.
Two paths to processing trauma
Our minds and bodies are deeply entwined. They influence each other in ways we don't fully understand.
Not surprisingly, there are two broad approaches to process and resolve trauma: one emphasizes the mind, the other the body. It seems that the most effective results occur when using techniques that consider both.
Mind-based approaches use forms of “talk therapy” that work directly with thoughts and emotions. Somatic (body) oriented approaches use techniques grounded in our body, nervous system, and our fight, flight, or freeze response.
Gaining support from a trusted therapist may be very important to help identify past adversity, recommend treatment, and aid recovery. Often, the quality of the relationship with the therapist is more important than the specific therapy used.
Psychological Interventions
Exposure therapies, are one form of psychological intervention. They gradually re-expose the individual to circumstances that rekindle the trauma. It is done slowly and in smaller doses to allow the individual to experience a form of the trauma but be able to respond without being overwhelmed, more directly controlling thoughts and emotions. Over time these approaches are designed to instill a resilience to the original trauma.
Cognitive Behavioral Therapy focuses on how our thoughts influence our emotions which in turn influence our actions. It helps us more ably control our thoughts related to traumatic events.
Somatic Interventions.
Somatic disciplines include mind-body disciplines (like yoga), biofeedback, Emotional Freedom Technique (EFT, also called "tapping") and Eye-Movement Desensitization and Reprocessing (EMDR). All involve some form of physical movement or focused physical awareness to process trauma. EFT and EMDR are both considered front-line treatments for trauma.
Somatic Experiencing (SE) is based on the idea that when a traumatic experience occurs, the body holds on to the trauma unless it’s given the opportunity to resolve it. SE uses bodily grounding, awareness, movement, and other techniques. Like exposure therapies, SE introduced small amounts of distress at a time with a goal to discharge the full. tension.
For a review of trauma-targeted therapies, presented in the context of the larger set of non-drug approaches, see the book, Choices in Recovery.
References for childhood adversity infographic:
[1] Read J et al, Child Maltreatment and Psychosis: A Return to a Genuinely Integrated Bio-Psycho-Social Model. Clinical, 2008, Clinical Schizophrenia, https://goo.gl/nMLrx4.
[2] Shevlin et al, Cumulative Traumas and Psychosis: an Analysis of the National Comorbidity Survey and the British Psychiatric Morbidity Survey, Schizophr Bull. 2008, PMCID: PMC2632373
[3] Read J, 2013, Childhood Adversity and Psychosis: From Heresy to Certainty, https://goo.gl/5LYCQA.
[4] Read J, Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications, Acta Psychiatr Scand. 2005, PMID: 16223421.
References for psychosocial therapy infographic:
[1] Canadian Psychological Assoc, The Efficacy and Effectiveness of Psychological Treatments, 2013, http://goo.gl/ysJzMf.
[2] Farah WH et al, Non-pharmacological treatment of depression: a systematic review and evidence map, Evid Based Med. 2016, PMID: 27836921; Vaswani A, Non-Pharmacological Treatments (NPTs) for Depression Are Effective, Mad in America, https://goo.gl/Zrlvjh.
[3] Zayfert C, Exposure utilization and completion of cognitive behavioral therapy for PTSD in a real world clinical practice, J Trauma Stress. 2005, PMID: 16382429.
References for body of the page.
[1] Palmier-Claus et al, Relationship between childhood adversity and bipolar affective disorder: systematic review and meta-analysis. British Journal of Psychiatry, 2016. PMID: 27758835.
