Tag: sexual abuse

Trauma Treatment: Understanding the Complexity of Trauma

The complexity of trauma is explained both scientifically and by case histories by Bessel Van Der Kolk in his book, The Body Keeps the Score: Mind, brain and body in the transformation of trauma.  As I mentioned in an earlier post, psychologists agree that trauma is not the “life-threatening”, precipitating event but the ongoing impact on a person’s mind, brain and body.  In his book, Bessel discusses the evolution of trauma treatment methodologies (and his roles in this evolution), the complex impact of trauma on individuals, the differential behavioural responses to trauma by individuals and the common responses that lead to addiction.

Evolution of trauma treatments

Bessel explains that in his early training and working days, he experienced different treatment modes for trauma such as “talk therapy” and the pharmacological approach.  He explained that talk therapy involved having an individual recount the trauma event in detail so that they had to confront the reality of the event.  Unfortunately, this often lead to the person experiencing a traumatic episode as a result of the stimulus of recall.  In the pharmacological approach, reliance was placed on drugs to treat the trauma patient.  Unfortunately, these were often administered in isolation without the support of therapy and contributed to ongoing psychological problems such as prescription drug addiction and depression.

The most heartless approach that Bessel describes is electrical shock treatment designed to desensitise individuals to precipitating stimuli.  Sometimes the treatment itself created a trauma response because of the effect of the stimulus (e.g. touch) and the inhuman nature of the treatment, e.g. for someone who had been sexually abused.  Bessel highlighted the lack of understanding of trauma and the absence of an adequate framework for treatment modalities illustrated in these early methodologies. The pursuit of a more holistic and scientific approach to trauma treatment underpinned his life’s work in helping trauma sufferers, especially those suffering from P.T.S.D. (post-traumatic stress disorder).

Result of visceral overload of precipitating event

Bessel was at pains to explain the complexity of trauma and its impact on individuals.  In his book, he explains the different regions of the brain, how they interact normally and the dysfunctionality caused by trauma.  He stated, for example, that a traumatic event can leave a “visceral imprint” on the lower region of the brain, the amygdala (the source of our fight/flight/freeze response). Thus a particular sensation (a smell, sound, sight, touch or taste) can create a “flashback” and trigger a trauma response in an individual.  This traumatic experience of discrete sensations illustrates the ever-present challenge for a traumatised person of “misreading signals” and seeing danger where it does not exist.  This inability to control the stress response is in part due to what Bessel describes as the ”visceral overload” at the time of the trauma-precipitating event.  He also makes the point that therapists are often misguided by their own belief systems, including the belief that the interaction of the mind and body is top-down only.  However, his own experience of trauma patients and recent neuroscience research shows clearly that the body/brain influence is bidirectional.

Same event – different behavioural responses

Different people respond differently to the sensory overload precipitated by a traumatic event.  Bessel tells the story of Stan and Ute who were involved in a major pile-up on a Canadian motorway in 1999 involving 87 cars.  They were travelling in the same car and met a wall of fog and were part of the continuous crashing of cars and trucks.  They feared for their lives and witnessed people being killed by the intensity of the crash and associated fires.  Stan’s reaction to subsequent stimuli was one of aggression and anger (fight response) whereas Ute was numb, a condition involving “massive dissociation” (the freeze response).  Bessel suggested that Ute’s freeze response was a learned behaviour precipitated by her upbringing by a mother who continuously “yelled” at her.  Through Bessel’s caring therapy, they were able to progressively restore their lives, regaining emotional control.  Ute benefited from the bottom-up approach of the Trauma Center where the focus was on physiological monitoring to enable the patient on change their “relationship to bodily sensations”.  Bessel subsequently established the Trauma Research Foundation after he had been unfairly dismissed from the Center, experiencing trauma in his own professional life.

Common responses to trauma

Trauma and its incessant re-activation through discrete sensory stimulation along with flashbacks and nightmares, create a life situation of continuous pain.  Many people attempt to numb the pain by resorting to drugs or excessive alcohol to block out the painful memories. This can eventually lead to addiction, associated mental illnesses and censorious misunderstanding by family and friends.

Reflection

Trauma is a very complex phenomenon precipitated by a great variety of events, experienced in differential ways by individuals and leading to individualised responses.  Added to these diverse events, impacts and responses are the variety of initiating stimuli that can trigger a seemingly unrelated trauma response in everyday life.

Bessel argues that one of the problems for traumatised individuals is that they spend so much time and energy in the past.  They become unaware of, and insensitive to, the present.  He maintains that mindfulness practices can help to restore top-down, emotional regulation and that bottom-up approaches such as “breath, movement, touch” can help to restore physical equilibrium and calmness.  The widespread use of somatic meditation for trauma management  is consistent with his view.

As we grow in mindfulness, we gain increased insight into our “inner landscape”, our behavioural responses and the options we have to behave differently.  We come to understand better the impact of past events on our present-day triggers and responses.  This can help us to achieve clarity, calmness and compassion towards others experiencing their own physical and emotional challenges.

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Image by Gerd Altmann from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group, and the resources to support the blog.

Disconnection from Childhood Trauma: A Potential Determinant of Depression and Ill-Health

Johann Hari, in his book Lost Connections: Uncovering the Real Causes of Depression, identified seven social causes of depression including the loss of connection to other people.  One of the surprising findings in his discussions with researchers and his colleagues, was the link between obesity, childhood trauma and depression.  In the final analysis, collectively they established that in many instances unresolved childhood trauma was a determinant of obesity and depression. 

Obesity and depression

Johann drew on the ground-breaking research of Dr. Vincent Felitti, Founding Chairman of the Department of Preventative Medicine of Kaiser Permanente – a fully integrated medical provider offering not only health care plans but also services such as specialist medical practitioners, a dynamic medical school, mental health services and education and an affordable housing initiative.  Kaiser Permanente views a healthy life for all as a cause to pursue, and is a pioneer in offering seamless health services along with leading edge research into preventative methods and treatment approaches.

Kaiser Permanente commissioned Vincent to undertake research into obesity because it was becoming the major factor in the growth of its operational costs.  Vincent started out by using a specialised diet plan supported by vitamin supplements that was designed to help obese people lose weight.  This approach appeared highly successful on early indications, but Vincent noticed that the people most successful at losing weight were dropping out of the program and returning to their eating habits and becoming overweight again.  Additionally, they often experienced depression, suicidal thoughts, rage or panic. 

Research by way of interview of 286 participants dropping out of the obesity program established that most had been sexually abused or experienced some other form of childhood trauma.   Obesity was their way to deal with the aftereffects of childhood trauma, including fear of sexual assault and the desire to hide their shame.

Childhood trauma and depression

Vincent was surprised by the findings of the initial study and realised that research of childhood history as a determinant of adult ill health had been avoided previously because of shame, secrecy and the taboo nature of the topic.  Yet his early findings established that childhood trauma played out powerfully decades later in terms of emotional state, biomedical disease and life expectancy.  He found, for example, that 55% of participants in the obesity study had suffered childhood sexual abuse.

The link between obesity, depression and childhood trauma was not well received by the established medical profession.  The video, A Tribute to Dr. Vincent Felitti, highlights the scorn he experienced when first announcing his findings at a medical conference and demonstrates the resilience of a man who had the courage to back his research and the bravery to pursue his creativity.

Vincent was convinced that he had to undertake research with a larger and broader sample of people to establish the credibility of his findings.  Through Kaiser Permanente’s processes of capturing the medical history of patients he was able, in collaboration with Dr. Robert Anda of the Center for Disease Control (CDC), to add additional questions relating to life history.  The questions picked up on the 10 types of childhood trauma identified by participants in the earlier study. The 17,500 participants involved in the second study were representative of the broader population of California where the study was done.  They were middle class with an average age of 57 and were employed.

The research titled the Adverse Childhood Experience Study (ACE) highlighted even more surprising results.  Two thirds of the participants in the research program had experienced one or more traumatic events.  One in nine had experienced 5 or more adverse childhood events.  They also established that the higher the number of different adverse childhood events experienced by an individual (their ACE Score), the greater the likelihood of that person committing suicide.

Typical strategies adopted by individuals to cope with the impacts of childhood trauma only exacerbate the problem of ill health, e.g. smoking or over-eating.  Vincent maintained that the experience of chronic, unrelieved stress affects the nervous system and the brain and can produce “the release of pro-inflammatory chemicals in a person’s body”, leading to suppression of the immune system.

What can be done about childhood trauma?

I have previously discussed principles and guidelines for trauma-informed mindfulness practice.  Johann Hari, in the section of his book on reconnection strategies offered several strategies that could have a positive effect on the negative impacts of childhood trauma, such as obesity and depression.  His recommended reconnection strategies include social prescribing and reconnection with nature, meaningful work and meaningful values.

Vincent Felitti, too, was concerned that people who had experienced childhood trauma need some form of hope about their ability to redress its negative effects.  He decided to do further research involving medical practitioners who were treating patients through Kaiser Permanente.  He provided them with a few simple questions to ask patients that related to life history and covered childhood experiences, and asked them to express genuine empathy and respect for the patient. 

Vincent found that the participants showed “a significant reduction in illness” once a patient shared their story of childhood trauma with a doctor.  He thought that the explanation for this was twofold – (1) the person was sharing their story with another person for the first time and (2) the recipient of the disclosure was a trusted authority figure who treated them with kindness and respect.  He postulated that the intermediate effects related to the fact that the experience removed the shame and self-loathing associated with the adverse childhood event.  The association of the childhood trauma with the experience of humiliation was broken. Vincent acknowledged that this was an area for further research.

Vincent argued that the ultimate solution to childhood trauma lay in “primary prevention” and advocated for the integration of their research findings into primary care medical practice.  He also supported the development of a life experience questionnaire reporting on childhood trauma as a part of a patient’s medical record that could subsequently be viewed by the treating doctor.  A healing conversation could take place if the patient was willing and able to share their story.

David Treleaven warns, however, that when dealing with someone suffering from post-traumatic stress disorder (PTSD), it is imperative not to tackle the trauma experience head-on.  He advocates a trauma-sensitive mindfulness approach.  Sam Himelstein also cautions against the use of direct questioning and talking where a person is outside their window of tolerance. 

Reflection

As we grow in mindfulness through research, meditation and reflection, we can begin to recognise the impact of our own experience of childhood trauma and address the negative impacts it has on our own life and relationships. We can also become sensitised to the experience of others who have experienced adverse childhood events and take this into account when dealing with individuals and groups who are seeking to use a mindfulness approach to improve their quality of life.

Johann provides a further resource to explore the whole question of depression in his later book, Lost Connections: Why You’re Depressed and How to Find Hope.

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Image by Pete Linforth from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.