Treating Trauma: Body, Brain and Behavior
Joey is a quiet and shy child. The 5-year-old is prone to daydreaming and seems content to play alone. He rarely gets into trouble, unlike his 11-year-old brother Jonathan who is easily agitated and always seems to be angry. The brothers were removed from their biological parents two years ago and placed into foster care. They are now with loving foster parents who want to adopt them but are concerned about Jonathan’s aggressive and destructive behaviors. The boys’ social worker has referred Jonathan to a therapist but not Joey. He seems to be adjusting well, quietly settling into his adoptive family.
The American Academy of Pediatrics reports that virtually all children who have been adopted and/or have been in foster care have experienced trauma. They all have experienced some form of maltreatment, neglect or abuse. At least one fourth of these youth will eventually be diagnosed with Posttraumatic Stress Disorder. But for some youths, symptoms of trauma-related disorders may be missed. They will go undiagnosed, or even misdiagnosed. When trauma goes unrecognized and untreated, “the lifetime consequences of early trauma are often severe,” the American Academy of Pediatrics notes.
According to the National Child Traumatic Stress Network, traumatic stress occurs in youth when they are exposed to traumatic events or situations which overwhelm their ability to cope. Abuse, neglect, removal from biological parents, multiple foster home placements and even transitioning into adoption can be very traumatizing to children. Depending on the youth’s age, and the type and severity of trauma experienced, they may respond in different ways. As noted by the Network, youth may show signs of “intense distress—disturbed sleep, difficulty paying attention and concentrating, anger and irritability, repeated and intrusive thoughts, withdrawal and extreme distress.” They can become stuck in fight or flight, like Jonathan, or shut down and frozen in fear, like Joey.
Fight, flight and freeze responses are activated when we feel threatened or in danger. These primitive responses were helpful to our ancient ancestors during their encounters with hungry predators. Fight or flight activates intense, automatic responses in the brain and body. The rational, reflective, and verbal part of brain, known as the prefrontal cortex, shuts down while the reactive, emotional limbic area of the brain becomes highly activated in preparation to fight or flee a predator. The body prepares itself by releasing adrenaline and cortisol, tensing muscles in the arms, legs and torso, elevating heart rate and respiration, and shutting down parts of the body not essential for flight or flight, like digestion.
Fight or flight served our ancestors well while they were trying to avoid being eaten by predators like saber tooth tigers. But when they were cornered or captured, with no real hope for survival, our ancestors’ only option was the freeze response. During the freeze response, an individual can become paralyzed, like to a deer in headlights, unable to move or respond. Freezing helped our ancestors avoid detection by predators. But when under direct attack with no hope for survival, they collapsed into a “profoundly altered state of numbing,” according to Peter Levine, renowned trauma expert and co-author of “Trauma Proofing your Kids”. In this state, our ancestors were not fully conscious and were numb to pain. Children who have experienced chronic trauma can also collapse, becoming “lost in a kind of anxious fog,” Levine notes. “Being scared stiff or frozen in fear, collapsing and going numb, describe the physical, visceral, bodily experience of intense fear and trauma.”
Young children and females are most likely to go into a freeze response when under stress or triggered by reminders of past trauma, according to the American Academy of Pediatrics. Like Joey, these children can appear quiet, passive and spacey. They can also be misdiagnosed as having an attention deficit disorder. Older children and males are more likely to respond via fight or flight. Like Jonathan, they can become highly reactive, destructive and aggressive, and may attempt to flee challenging situations. These individuals are often misdiagnosed as having disruptive, impulse-control or oppositional defiant disorders.
The temporary states of fight, flight or freeze/collapse can become “long-term traits” of traumatized youth, according to Levine. These youth can become “stuck in in habitually ineffective and often compulsive patterns of behavior.” The chronic activation of the freeze/collapse response “gives rise to the core emotional symptoms of trauma; numbness, shutdown, entrapment, helplessness, depression, fear, terror; rage and hopelessness.” Chronic activation of the fight or flight response becomes a “vicious cycle of intense sensation, rage, and fear.”
The American Academy of Pediatrics notes that “traumatized children do not have the skills for self-regulation or for calming down once upset” and “don’t always know how to say what they are feeling.” Given these unique needs and challenges, youth who have experienced trauma may not always respond well to traditional talk or cognitive therapies because they may not have the ability to process their trauma verbally.
Traumatic memories are not stored in areas of the brain associated with language and verbal expression. They are stored in more primitive, reactive and emotional areas of the brain, and in the body itself. “For this reason, behavior and memories cannot be changed by simply changing one’s thoughts,” according to Levine. He notes that most traditional trauma therapies also involve the individual’s reliving of his or her traumatic experiences through various forms of exposure. “Just exposing a client to his or her traumatic memories and having the person relive them …. is at best unnecessary (reducing feelings of mastery and goodness) and at worst re-traumatizing. If trauma is to be transformed, we must first learn not to confront it directly. Therapeutic approaches that neglect the body, focusing mainly on thoughts, will consequently be limited. One must also work with sensations and feelings … the totality of experience.”
Levine has found that psychotherapeutic treatment of traumatized youth is most effective when it helps to “cultivate and regulate the capacity for tolerating extreme sensations through reflective self-awareness, while supporting self-acceptance.” Therapies which integrate experiential, such mindfulness and movement based approaches, along with expressive art approaches have been proven effective in this regard. The use of mindfulness, movement and expressive arts in therapy enhances the individual’s ability to identify, express and release traumatic stress. Neuroscience research also shows that mindfulness and expressive therapies are effective in activating and strengthening areas of the brain responsible for reflection, self-awareness, self-regulation and positive emotions. Levine’s treatment approach, Somatic Experiencing (SE), was specifically developed to do this. This novel form of therapy helps youth gradually develop capacity for self-regulation so that they can manage uncomfortable sensations and feelings without becoming overwhelmed or re-traumatized. Though SE’s gradual, balanced approach, youth can develop an awareness and mastery of their own emotions, physical sensations and behaviors.
Parents can also use the SE approach to help train their children to rebound from stressful and traumatic events, and help prevent them for developing a trauma-related disorder. In the book “Trauma proofing your Kids,” he and his co-author Maggie Kline offer a simple-to-use, step-by-step guide on “stress busting, boundary setting and sensory/motor activities” which counteract trauma’s effects on youth.
(Orginally published in Adoption Today, June 2016)
Helping Foster and Adoptive Families Cope with Trauma. American Academy of Pediatrics, 2013
The National Child Traumatic Stress Network: http://nctsnet.org/
Somatic experiencing: using interoception and proprioception as core elements of trauma therapy. Peter Payne, Peter Levine, and Mardi A. Crane-Godreau. Frontiers in Psychology, Feb. 4, 2015
Trauma-Proofing your Kids: a Parent’s Guide for Instilling Confidence, Joy and Resilience. Peter A. Levine and Maggie Kline. Random House, Inc. 2008.