Treating Trauma 1 of 5. The Effects and Treatment of Trauma in Adolescent Females By Brad Rentfro, LPC. Part 1

Transcription

1 Treating Trauma 1 of 5 The Effects and Treatment of Trauma in Adolescent Females By Brad Rentfro, LPC Part 1 This first part of this article will address new information in the field of neuroscience regarding the impact of traumatic experience on an individual as a whole. In part two, principles derived from what we now know about the development of the brain will be applied to the treatment of the effects of trauma. It is important first of all to understand the stage of adolescence as a whole. It is helpful to know a little about what is going on in the brain development of the adolescent. During our lifetime there are 2 major growth spurts in the brain. During these growth spurts the brain is taking in information at an incredible rate. With each new experience or thought, neurons reach out and form synapses with other neurons to connect so those thoughts or experiences become easier to perform. This is why we get better at doing things we repeatedly do. The first growth spurt occurs during the third trimester of pregnancy and continues through birth to the age of 2-3 years. The brain is specifically gathering information during this stage about how to form attachments to others, how to interpret language, muscle control, the basics of identity and how they fit in the world. During the first year of life the brain expands by 2 and a half times, from 400 to 1000 grams (Schore, 1994). This growth spurt is rivaled only by that of the adolescent stage (Thompson et al., 2000). Beginning at puberty, the same hormones that begin making changes in our body s outward appearance are also making changes to the brain. The 2 main areas that come under construction at this time are the limbic system and the neocortex. The limbic system is sometimes referred to as our emotional brain because it is the source of our urges, needs, and emotions. It also plays the primary role in the functions necessary for self-preservation, such as the fight or flight response. The limbic system takes in information through the senses and evaluates our experiences for emotional significance and codes it for storage in memory (Stien & Kendall, 2004). As these emotional centers of the brain expand, we begin to feel emotions at intensity levels we haven t felt before. This is why it can feel like something trivial to an adult, like a zit, can seem like the end of the world to a teen. This is also why someone who has been sexually abused as a young child can seem to be coping very well until they reach adolescence, at which time they begin acting out as a means to cope with overwhelming emotion. If we understand what is going on in the teenage brain as it attains new milestones in development, it can help us be more understanding and compassionate toward them. We can also be more helpful in giving them experiences that will aid their development in positive ways. The neocortex is sometimes referred to as the thinking brain and is where conscious thinking, perception, planning and communication take place (Stien & Kendall, 2004). This part of the brain is also responsible for determining the meaning of our experiences,

2 Treating Trauma 2 of 5 including what it means about who we are and how we fit in the world. Adolescents begin to be able to think abstractly and understand concepts not directly linked together in concrete ways. This explains why teenagers begin to challenge why parents believe the way they do or have the rules they have. They have just acquired the ability to think in new terms and are trying to make sense of things for themselves. It is not always due to defiance. Traumatic experiences are stored in the limbic system of the brain and encoded with emotion in the hippocampus and the amygdala. Meaning is given to the experience in the frontal cortex. The more traumatic the experience the more it seems to be filed in the right hemisphere of the brain which is not connected to language but very connected to emotional states, smells, sights, hearing and touch. The brain assumes that if an experience is associated with vehement emotions it is very important, and a survival threat, so it is encoded in these deeper areas. This allows them to be hypervigilant to anything that could be connected to the experience, thereby increasing their chances of survival. Defense mechanisms are enlisted to protect them from suffering another such experience. If the overwhelming emotions produced by traumatic experiences are not dealt with and resolved adequately people eventually find other ways to decrease the stress they feel. If the brain senses heightened levels of stress hormones over a long period of time it interprets it as a survival threat. When something is found that reduces the level of stress hormones the brain tags that thing as the answer to the survival threat. This answer can be good or bad, healthy or unhealthy, productive or destructive. The next time there is stress or some perceived danger, the brain will reach for what it perceives as the answer. Some common unhealthy or destructive things that get tagged as the answer are: alcohol, drugs, sex, self-harm, eating disorders, anger, defiance, thrill seeking, depression (suicidal ideation), social withdrawal, partying and music that normalizes their experiences. These things lead to even more stress in the long run and a deepening sense of hopelessness that things can ever be different. When someone feels the same thing over a long period of time it becomes their normal state of being. The neocortex part of the brain is always trying to find the meaning of our experiences and eventually interprets this state of being as meaning something about who they are. This becomes their identity. This core belief about who they are and how they fit in the world becomes the driving force behind their perceptions, emotions, thoughts, attitudes and actions. After a long period of time people come to believe that this can t be changed, because to change their lives would require changing who they are. This core belief is what must be addressed and changed in order for lasting change to occur. The Effects and Treatment of Trauma in Adolescent Females Part 2 Since traumatic experience is primarily encoded in the limbic system, which is the emotional center, and in the right hemisphere of the brain where the five senses are also located we must access these parts of the brain to change how it is encoded. It is

3 Treating Trauma 3 of 5 important to note that during the experiencing or even reexperiencing of a traumatic experience, Broca s area the part of the left hemisphere responsible for connecting our experiences to language - turns off (Van der Kolk et al., 1996). This is why people who experience something traumatic struggle to explain what happened or even how they re feeling about what happened. This inability to put words to their experience, coupled with feelings of shame or guilt derived from their struggle to assign some kind of meaning to their experience creates the first obstacle that must be overcome in treating victims of trauma. The client has to feel safe and confident in the therapist in order to allow themselves to feel the painful emotions associated with their experiences. Research shows that the most important factor in determining successful outcomes in therapy is the relationship between the therapist and the client as perceived by the client (Hubble et al. 1999). The thing that makes a trauma memory different from regular memory is that it is not encoded like other memories. That is, it is not connected to language and instead is encoded in the limbic system and connected to the senses. This connection to the senses is the reason flashbacks can be triggered by hearing, smelling, or touching something that is reminiscent of the original experience. Flashbacks and nightmares are frequently a product of traumatic experiences and can sometimes be seen by the client as evidence that there is something wrong with them. The truth is that this is the brain s way of trying to work through what has happened and resolve the situation on its own. It is trying to get everything out on the table so it can be worked through and brought to a peaceful conclusion. The key to treating trauma is to change the memory from a trauma memory to a regular memory in the way it is encoded in the brain and then to change the ways the event was interpreted and evolved into a belief about their identity. There are many different approaches that utilize a variety of techniques in treating trauma so rather than try to explain all of them, I ve chose here to describe one philosophy that incorporates many common factors into one strategy. This philosophy is best encapsulated by the self-trauma model explained in John Briere s book entitled, Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment (2006). I ll briefly explain what this approach consists of during each of its five key components. The first component of trauma processing is called exposure. Exposure refers to anything that provokes client memories of traumatic events. Generally speaking, this is done by having the client recall and discuss traumatic events with the therapist. This is important because, as was noted before, trauma memories are often not encoded with any words to describe the experience itself or the feelings that were felt while it was happening. This changes it in a very fundamental way from being a fragmented trauma memory into a memory that is more integrated and understandable as more areas of the brain are recruited to help make sense of it. Assignments can also be given to write a couple pages about what happened in detail, including their feelings and the circumstances surrounding the event(s). This can then be read to herself and then to the therapist.

4 Treating Trauma 4 of 5 Activation refers to the emotions and thought patterns that are triggered by the traumatic memory are brought into conscious awareness. It is critical that these emotions become activated since this is where trauma derives its power to drive our thoughts, feelings and actions. Studies have shown that interventions that consist solely of the narration of trauma related memories without emotional activation will not necessarily produce symptom relief (Foa & Kozak, 1986; Samoilov & Goldfried, 2000). It is important to be careful to maintain a level of emotional activation that is manageable for the client so the client does not become overwhelmed by the emotions. Make sure the client knows beforehand that it s ok to stop talking and do some prearranged form of stress reduction exercise if they feel themselves beginning to become overwhelmed. This will help keep the amount of emotion within a therapeutic window where healing can be accomplished most efficiently. Disparity occurs when there is lack of agreement between the triggered emotions and your current situation with the therapist. It is crucial that the therapist provide a therapeutic environment of safety, unconditional love and support. As memories are brought forward and associated emotions are felt, the brain is simultaneously rerecording the event into memory. During this process, the new experience of safety, love and support is recorded with it. This provides a new sense of mastery over the past, overwhelming experience and knocking it down a notch toward being just another story, albeit a terrible story, among many other stories in their life. Counter conditioning happens when an expected result is not reinforced. It is known that non-reinforced responses get distinguished over time. For example, if you call a friend several times and get no reply, you will eventually stop calling that friend. It is the same with our traumatic responses. If we expect to be overwhelmed by remembering something but not only are we not overwhelmed, but we are met with positive emotions of safety, love and support, our fears will slowly diminish until it no longer has power over us. Extinction / resolution refers to the idea mentioned above where the traumatic memory no longer produces the same level of negative emotion and therefore becomes a normal memory something that can be learned from rather than run from. As was mentioned in part 1 of this article, the client s sense of self or identity usually becomes distorted as they feel shame or guilt over a long period of time and must therefore be addressed. Even after the traumatic memory has lost its power to drive their behaviors, there remains a belief about who they are and how they fit in the world that must be challenged for accuracy. There is usually a faulty belief that they are bad in some way for people to have treated them so badly or for them to do some of the things they did along the way. This belief stems from their interpretations about what their experiences mean about them. In order to help them figure out who they really are I will usually start by having them challenge their interpretations about what it means that bad things have happened to them or that they ve done bad things. I will ask them as they recount their stories, why they

5 Treating Trauma 5 of 5 think those things happened. They come up with as many possibilities as they can and then whittle it down to the one that makes the most sense. This helps them to see the truth about each situation and the misinterpretations they have believed over the years. The truth about identity is that we are not what we do, think, feel, look like, or how we ve been treated. Who we are is a much bigger concept that very few people take the time and energy to contemplate and discover. It involves seeking answers for ourselves regarding some of the most important questions posed by the world s greatest philosophers. Questions such as: What is the meaning of life? Why am I here? What happens after I die? Did I exist before I was born? Is there a higher power and if so what is it like? As part of this process I will have them go on a solo experience where they can be alone for 3-4 days while they think about these questions and read books like Viktor Frankl s book entitled Man s Search for Meaning, Max Lucado s book entitled You are Special, and Shel Silverstein s book The Missing Piece Meets the Big O. I also have a list of questions to ponder and lots of journaling about their thoughts and feelings throughout the solo experience. This has been a very enlightening time for many of the students who do it because they are able to be alone with themselves without any distractions. They can feel their deeper emotions and sit with them until they learn the real lessons their emotions and past experiences have been trying to teach them. I m obviously oversimplifying this process of trauma treatment and the search for identity due to length constraints. In a very small nutshell, successfully treating trauma includes the diminished ability of the traumatic memory to run the person s life and a new sense of identity that is well rounded and brings positive meaning to their life. References Van der Kolk, Bessel A., McFarlane, Alexander C., Weisaeth, Lars (1996) Traumatic Stress: The effects of overwhelming experience on mind, body and society. New York: The Guilford Press. Hubble, Mark A., Duncan, Barry L., Miller, Scott D. (1999) The heart and soul of change: What works in therapy. Washington, D.C.: American Psychological Association. Briere, John, & Scott, Catherine (2006) Principles of trauma therapy: A guide to symptoms, evaluation, and treatment. Thousand Oaks, California: Sage Publications. Foa, E. B., & Kozak, M. J. (1986) Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, Samoilov, A., & Goldfried, M. R. (2000) Role of emotion in cognitive-behavior therapy. Clinical Psychology: Science and Practice, 7, Dispenza, Joe., Evolve your Brain, Health Communications, Inc. Deerfield Beach, FL, (2007)