The Profound Effect of Childhood Trauma; A Gentle Revolution of Trauma Informed Care

“We are all impacted by trauma.  We are all paying the cost whether personal or societal. We help people heal when we promote connections to one another.” ~ Dr. Vicky Kelly

Nowadays we are witnesses of significant trauma and the consequences of trauma every time we connect with social or commercial media.  We are drawn into graphic displays of individual and community experiences which include violence, abuse, bullying, natural disasters, death, war, terrorism and the effects of an opioid epidemic.  And so, trauma has moved to the forefront of national consciousness.It is important to note that every one of us has experienced some kind of trauma in our own lives as well. Trauma seems to be everywhere.  Of course, it is.  And it always has been.  But with our increased awareness of the pervasiveness of trauma and our collective brokenness, a gentle revolution has evolved.  We have created and are developing behavioral, medical and mental health services that are effectively healing childhood and adult trauma.  This new approach to what the CDC is calling perhaps the single biggest healthcare problem facing our nation today is called Trauma-Informed Care (TIC).Just what is Trauma-Informed Care?Trauma-Informed Care (TIC) is one of the most exciting things to happen in the way we provide psychosocial treatment (behavioral health) services for children and adults. We are shifting our perspective and treatment model from one which asks “What is the matter with you?” to “What happened to you…and how does that impact your life and functioning today?”  This basic modification in approach is offering a dramatic new strategy which is helping people cope and heal.  We are now equipped with new, extensive research and information about trauma, development, and the brain.We begin to be trauma-informed when we understand what trauma is;“Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.” ~ Substance Abuse and Mental Health Services Administration (SAMHSA)There you have it.  SAMSHA gives us a good definition of trauma.  With that understanding, you have just become more trauma-informed.  And I believe that being trauma-informed is a way we can shape the future.Where Did the TIC Model Come From?The stage was set for Trauma-Informed Care by two major research studies.

1. Adverse Childhood Experiences (ACEs) Study (Kaiser Permanente from 1995 to 1997 and Centers for Disease Control and Prevention, 2013) was a large epidemiological study involving more than 17,000 individuals from the United States; it analyzed the long-term effects of childhood and adolescent traumatic experiences on adult health risks, mental health, healthcare costs, and life expectancy.
2. The Women, Co-Occurring Disorders and Violence Study (Multiple studies from 1998 to SAMHSA, 2007) was a large multisite study focused on the role of interpersonal and other traumatic stressors among women; the interrelatedness of trauma, violence, and co-occurring substance use and mental disorders; and the incorporation of trauma-informed and trauma-specific principles, models, and services.

These two studies generated action within the behavioral health systems creating a basic adjustment from short term biomedical/pharmaceutical and behavior modification in nature (diagnosis and symptom treatment) to a longer-term, holistic model of neurological healing which treats the set of circumstances that have created the trauma/stress.  We have not abandoned the other treatments altogether of course. There is still a place for medications and traditional methodology.  We have just found a new and more effective approach.Trauma-Informed Care Comes From a Brain ThingWe can now help brains heal and rewire with Trauma-Informed Care. As a result, there is new hope for victims of adult PTSD and Developmental Trauma Disorder (Childhood PTSD). Studies show that a healthy well-regulated brain where the thinking brain and survival brain work well in tandem can be facilitated with TIC.It helps to understand that we have two brains and a mediator.  The thinking brain is the Cortex.  It is where our personality lives, where we make good decisions, and where our memories are stored. This is where we receive information, process it and take action based on that information.  The other brain is the midbrain and brainstem also known as the survival brain.  It is out autopilot. and runs our bodies so that we don’t have to think about those functions  It is where we are told to breathe, where our heart is told to beat, and where we are informed about how to digest food.  It is also where fight, flight and freeze responses reside. Trauma and stress have particular influence on the survival brain. The important mediator in the brain called the Thalamus which receives sensory information (sight, sound, touch, taste) and acts as a relay station that sends a signal to both brains. The survival brain is wired faster than thinking brain (because the faster you react the more likely you are to survive).Here is why this is so vital to trauma-informed care.  The brains of adults who suffer from PTSD and children with Developmental Trauma Disorder have been hyper-activated or hyper-aroused.  A soldier who is constantly facing an enemy who wants to kill him or a child who is being sexually, physically or emotionally abused is in a survival brain mode of operation of fight, flight or freeze twenty-four hours a day.  When that soldier returns home from war, or when the abused child is placed in another home the brain is still programmed to expect trauma or abuse. The thinking brain has been informed of the change but the survival brain is still hyper-activated. They cannot think their way out of new stressful situations but react with programmed survival brain responses.Traumatized brain impacts:

1. Fear and lack of safety in the adult or child’s environment cause automatic conditioned behavioral responses of fight, flight and freeze (along with more complicated survival responses such as hiding, withdrawing, pretending, and so on). Brain studies show that the survival brain literally hijacks (turns off) the thinking brain. In other words, the traumatized brain cannot effectively discern good decisions from bad decisions because it cannot always access the thinking brain.
2. The brain’s alarm system for danger becomes distorted. The traumatized brain perceives the presence of danger almost everywhere.  Impedes the ability to find help and establish relationships.
3. An inability to appraise the present and to learn from experience. The traumatized brain becomes Velcro for bad and Teflon for good. Such that good experiences in later life cannot balance the negative trauma experiences of the past (childhood).

Now that we know all of these things about the brain and can actually see how it works in brain imaging and brain scans we are tasked with doing things to reduce the stress from trauma.The hurt happens in powerful childhood relationships and it takes new relationships to promote the healing.  We have found that Trauma-Informed Care actually causes the brain to reprogram.TIC; A ‘Best Practice’ for Kids and AdultsDuring my 48 years as a provider of behavioral services for children and adolescents, I have seen the worst kinds of things that can happen to my clients. They have suffered multiple stressors that most people could never imagine.  And the effects are cumulative. These are kids who have been physically and sexually abused.  They have experienced their mothers enduring domestic violence and other disturbing chaos at home.  Many witness chronic substance abuse and the effects of mental illness every day along with frequent incarceration of family members. They are dependent and neglected.Trauma-Informed care has allowed me to see my clients through a new pair of glasses.  I believe that this exciting treatment model is the emerging framework for human service delivery. Until recently, the toxic stress and trauma these kids faced went largely untreated or undertreated.  Trauma-Informed Care is now effectively healing the effects of the traumatic events which result in adverse physical, social, emotional, or spiritual consequences. One example of a TIC program in action can be found at St. Aemilian-Lakeside in Milwaukee, Wisconsin. SaintA is in the forefront of trauma-informed care therapeutic practices.  They teach that there are seven essential ingredients in understanding what trauma-informed care is and how to implement it. These elements are;

1. Prevalence — Exposure to and difficulty adjusting to adverse experiences is significantly more common than we previously had known. A keen appreciation for the scope of adverse events, especially on children, is a key element to understanding the needs of people who have been exposed to events such as domestic violence and substance abuse, separation/divorce, mental illness, physical and sexual abuse, emotional and physical neglect, and acts of violence.
2. Impact — Trauma occurs when a person’s ability to cope with an adverse event is overwhelmed and contributes to difficulties in functioning. The impact of this process is profound, especially when the adverse event occurs during key developmental timeframes. The seminal ACE (adverse childhood experiences) study shows how early trauma also can have a serious effect on a person’s physical health in later life and ultimately impact life expectancy.
3. Perspective Shift — A shift in perspective can bring a new reality. Helping those charged with caring for people struggling with trauma by simply changing the question from “What is wrong with you?” to “What has happened to you and how can I support you?” can bring enormous understanding.
4. Regulation — Knowledge of the basic architecture of the brain provides both an understanding of the impact of trauma and a key toward effective treatment. Many of the interventions that have been offered to people struggling with trauma have focused on the cognitive or “thinking” parts of the brain. Trauma-informed interventions often prioritize enhancing emotional and behavioral regulation. This could include the use of sensory and regulating strategies such as drumming, singing, dancing, yoga, etc., which have been shown to be effective in addressing the impact of trauma.
5. Relationship — Relationships are key to reaching a traumatized child and to mitigating trauma. Strong relationships help create resilience and shield a child from the effects of trauma.
6. Reason to Be — Reason to be creates a sense of purpose or direction for individuals by ensuring they’re connected to family, community, and culture. It is bolstered by resiliency – a combination of the individual’s internal attributes and the external resources that support them.
7. Caregiver Capacity — To effectively work with traumatized individuals, caregivers must take care of themselves and find a work/life balance. Critical is identifying our limits, knowing sometimes we will be pushed beyond them, and what we will do to find balance.

They have a YouTube video which is terrific at telling the story of Trauma Informed Care.  I suggest that you connect with it at the following web address: https://www.youtube.com/watch?v=p_dZAqP_tfYSAMHSA offers some sobering statistics in their recent Treatment Improvement Protocol (TIP 57) that have compelled service providers of all stripes from educators to chaplains to behavior and mental health professionals to juvenile justice institutions and police officers to embrace trauma-specific interventions in their work.  How can we not when we learn that;

• 71 percent of all children are exposed to violence every year
• 3 million children are maltreated or neglected each year
• 5-10 million kids witness violence against their mother each year
• 1 in 4 girls and 1 in 6 boys are sexually abused before adulthood
• 94 percent of children in juvenile justice settings have experienced extreme trauma

Finally, Trauma-Informed Care is about healing through building safe relationships and developing trust. When mentors extend a helping hand to kids and adults who have suffered so much they begin to develop a reason for being.  Peer support and mutual self-help are also key vehicles for establishing safety and hope, building trust, enhancing collaboration, serving as models of recovery, healing, and maximizing a sense of empowerment.We can make this happen by encouraging politicians to sponsor ACEs and TIC legislation.  We can make this happen by making noise in the public square at PTA meetings, Service Clubs, Town Hall gatherings and the like.  We can make this happen by offering ourselves as available mentors. There is a groundswell of hope.  38 states and the District of Columbia are gearing up.  It’s time to join the movement.Robert Kenneth Jones is an innovator in the treatment of addiction and childhood abuse.In a career spanning over four decades, his work helping people recover from childhood abuse and addiction has earned him the respect of his peers.His blog, An Elephant for Breakfast, testifies to the power of the human spirit to overcome the worst of life’s difficulties. We encourage you to visit and share this rich source of healing, inspiration and meditation.Contact Bob Jones on LinkedinBob Jones’ blog An Elephant for Breakfast

Survivor Guilt: What Happens When We Are Left Behind

When tragedy strikes and we are untouched by its’ full force, the pangs of Survivor Guilt can plague us.  We are grateful on one hand, but filled with thoughts of “Why not me?” We ask ourselves what we might have done to prevent this from happening.  How could we have not seen this coming? There is a sense that we are responsible for remaining intact and living on. The self-condemnation can be crippling.

“The problem with surviving was that you ended up with the ghosts of everyone you’d ever left behind riding on your shoulders.” ~ Paolo Bacigalupi

How Can We Begin to Understand and Cope With Survivor Guilt?The awful weight of self-indictment is the main characteristic of Survivor Guilt.  People experience a seemingly endless loop of the gut-wrenching belief that they did something wrong or failed to do what they could have done.  It happens to war veterans, accident survivors, those who live through natural disasters, cancer survivors, police officers, and Holocaust survivors. It is also common among friends and family members who have suffered the loss of a loved one to suicide.I am no stranger to Survivor Guilt.  My sister died of neuroblastoma when she was four years and nine months old.  Mother was grief-stricken as one might imagine.  Her beautiful little child had been taken and she was left to cope with the terrible loss feared by almost every parent.  We should not have to survive our children.She slipped deeper and deeper into dark sadness and depression. Her continual demand was to know why God would take Mary Kathryn instead of her. She had begged to be the one to die in my sisters’ stead only to be forsaken. There was no comforting her.  Despite opening her own business and trying to carry on with family and friends, she could not.  Our family doctor told Dad that the only thing that might help would be for Mom to get pregnant again.She did, and I was the replacement kid. Sixteen months after my sisters’ death, I was born into a house replete with Survivor Guilt. I have learned that many kids who survive the death of their siblings also experience this phenomenon.  I will never forget an occasion while playing on the living room floor with my Aunt Lucille. She was a registered nurse and had spent many hours with my sister.  At one point she mistakenly called me Mary Kay.  I could hear my mother break down into sobs in the kitchen.  I wondered why I was alive when my sister was not.  A wave of shame swept over me. I wished we could trade places. I was only three years old.Symptoms, Indicators and Healing ToolsSurvivor Guilt has been linked with PTSD in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which recognizes the role of negative emotions such as guilt and shame.  The following are symptoms associated with those negative emotions;

• Avoidance
• Feeling on edge
• Hypervigilance
• Detachment
• Easily startled

Other associated indicators not included in DSM are;

• Feeling disoriented, confused and unworthy
• Obsessing over the tragedy
• Being ambivalent about living
• Overwhelmed by the sense that you’re never really safe

Measuring Survivor Guilt

A good instrument for measuring Survivor Guilt and PTSD is the Trauma and Loss Spectrum Self-Report instrument (TALS-SR).It explores the lifetime experience of a range of loss and traumatic events and lifetime symptoms, behaviors and personal characteristics that might represent manifestations or risk factors for the development of a stress response syndrome.This tool is of great value to those like Police Chaplains, who deal with survivors.  Police Week reported in www.officer.com that one of the most important things an LEO who is experiencing Survivor Guilt can do is to “share your story with someone you trust and who will actually hear you rather than judge you.” The Chaplain fulfills such a role for many officers. First responders witness some of the most unimaginable sights in unfiltered, graphic situations. Police officers, firefighters, and paramedics also need to be given action-oriented methods of healing to cope with all they experience.

Survivors Continue to Suffer

The Associated Press reported that Survivor Guilt and symptoms of PTSD continues to plague those New Yorkers who lived through the attack on The World Trade Center on September 11, 2001. Dr. Nomi Levy-Carrick, mental health director of World Trade Center Environmental Health Center program reported that; "There was tremendous Survivor Guilt, so people who survived didn't feel worthy of wanting to seek care.The fact that they had survived, they felt, should have been enough." She said people who tried moving on despite the lingering psychological effects of 9/11 realized they weren't getting better. 9/11 is perhaps the national tragedy that most of us remember in vivid detail.  We were devastated on a personal and community level beyond anything since the bombing of Pearl Harbor.Think what it must be like for those who continue to suffer as if it happened yesterday. It never seems to leave. In a real sense, this is the essence of understanding Survivor Guilt PTSD.  When it brings the darkness once again, unannounced, that unspeakable yesterday suddenly becomes today…here and now.

Not Limited to Tragedies Surrounding Death.

We have learned that Survivor Guilt is not limited to tragedies surrounding death.  I have provided counseling services for both adult men and adolescent boys who were victims of sexual abuse. The effects of the abuse are lasting. They have complicated feelings and vivid memories that haunt them relentlessly.  One of the most heartbreaking revelations is that so many feel that they were somehow responsible for what happened.“I was cute and kind of a sexy kid,” said Shane “He (the abuser) probably couldn’t help it.  I could have stopped it.  If I would have, other boys wouldn’t have been hurt.  It’s all my fault.”  He begins to sob uncontrollably. Shane is reduced to the little boy in a dark bedroom under the blanket of violence in the monstrous act at the hand of a trusted adult. My response is to try and carry light into their darknesses.I have found that the most valuable thing we can bring to those who experience Survivor Guilt PTSD is the listening ear and open heart of one willing to accompany them without judgment and with unconditional acceptance and love.  When the victim is no longer alone in the memory healing can begin.

Our Veterans and the Burden of their Experiences

Veterans of war carry the burden of their experiences in silence like so many victims of sexual abuse.  Their service is often marred by the loss of comrades and buddies in bloody scenes that none of us can imagine.  They come home to families who have longed for their return only to feel estranged.  A different person seems to be living in the body of their loved one.  Repeated inquiries about what happened ‘over there’ are met with silence and denial.  I remember men, including my Dad, who were soldiers and sailors in WWII.[embed]https://youtu.be/0HUf68gFGEE?t=2m24s[/embed]They rarely, if ever, talked about their combat experiences.  There was a wall of unknowing behind which nobody could come.  One of my friends fought in Vietnam and was known to have witnessed something horrific over there.  It was not until thirty years later when we read his suicide note that we found he had held the body of his wounded best friend for hours.  Merciful death or help from medics was not coming so Billy did what he had to do and ended the suffering with his service revolver.The note said he could no longer bear the decades of pain.  Billy was alone for all of those years. I was never able to bring him a torch for the darkness.Some Truths and Some Hope for Survivor Guilt PTSDWe know of so many things can cause Survivor Guilt and how to cope or heal.  The one who lives on after a loved one takes their own life, the one who survives after a sibling dies and the one who stays alive in an otherwise fatal auto accident are among the many who might shoulder the weight of Survivors Guilt.  There are two facts which are universal when it comes to this;

• It always comes when something happens which brings an extreme state of feeling previously unexperienced
• It must be dealt with or will persist for a lifetime

Here is some good news that comes to us from the most unlikely of situations. A most remarkable thing is happening for survivors of the Marjorie Stoneman Douglas High School mass shooting. Social media, protest marches and the honoring of fallen friends seem to have empowered the young people who survived, helping them in ways that were not available to earlier such tragedies.  They tweet to huge audiences of thousands about their pain and about actions they are taking to prevent further violence.Their #NEVERAGAIN page on FaceBook has more than 165,000 followers. These kids bravely stand up to criticism by adults and persist in their efforts day after day. They are courageous. Though probably unaware, they are doing almost all of the things that are offered by experts on Survivor Guilt PTSD to heal from their tragic losses.We can learn a lot from these young people. They seem to be carrying light to each other (and to us) in the darkness.  Not in the form of a torch but in hundreds of thousands of little beams coming from their cell phone flashlights.Robert Kenneth Jones is an innovator in the treatment of addiction and childhood abuse.In a career spanning over four decades, his work helping people recover from childhood abuse and addiction has earned him the respect of his peers.His blog, An Elephant for Breakfast, testifies to the power of the human spirit to overcome the worst of life’s difficulties. We encourage you to visit and share this rich source of healing, inspiration, and meditation.Contact Bob Jones on LinkedinBob Jones’ blog An Elephant for Breakfast