NEWS

Wyoming Behavioral Institute (WBI) began the process of fully implementing trauma informed care in 2005, completing the transition in 2007. The resulting statistics were dramatic, as seclusion and restraint used diminished to minimal levels and staff injury rates fell at an equally rapid rate.

What is trauma?

The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV) defines a “traumatic event” as one in which a person experiences, witnesses, or is confronted with actual or threatened death or serious injury, or threat to the physical integrity of oneself or others. A person’s response to trauma often includes intense fear, helplessness, or horror. Trauma can result from experiences that are “private” (e.g. sexual assault, domestic violence, child abuse/neglect, witnessing interpersonal violence) or more “public” (e.g. war, terrorism, natural disasters).

Trauma is a central mental health concern and the one “common denominator” of all violence and disaster victims. Different individuals react to trauma in their own ways, depending on the nature of, and circumstances surrounding, their traumatic experiences. For example, trauma associated with repeated childhood physical or sexual abuse can become a central defining characteristic to a survivor’s identity, impacting nearly every aspect of his or her life. However, whether the cause of the trauma is a hurricane, loss of a loved one, sexual assault, child abuse, or domestic violence, or other incidents, the trauma experience is one thing that all victims share.

How does trauma-informed care differ from traditional mental health care?

Trauma-informed programs and services represent the “new generation” of transformed mental health and allied human services organizations and programs serving people with histories of violence and trauma. When a mental health care provider takes the step to become trauma-informed, every part of its organization, management, and service delivery system is assessed and potentially modified to include a basic understanding of how trauma impacts the life of an individual seeking services.

Trauma-informed programs and services are based on an understanding of the vulnerabilities or triggers of trauma survivors that traditional service delivery approaches may exacerbate, so that these services and programs can be more supportive and avoid re-traumatization. The use of coercive interventions such as seclusion and restraint, forced involuntary medication practices, and philosophies of care based on control and containment vs. empowerment and choice often cause unintentional re-traumatization in already vulnerable populations.

Trauma-informed services acknowledge lived experiences as the bedrock for therapeutic decision-making and promote consumer choice and empowerment, as necessary, for successful treatment. A trauma-informed approach is based on the recognition that many behaviors and responses (often seen as symptoms) are directly related to traumatic experiences that often cause mental health, substance abuse, and physical health concerns. Systems of care perpetuate traumatic experiences through invasive, coercive, or forced treatment that causes or exacerbates feelings of threat, a lack of safety, violation, shame, and powerlessness.

Trauma-informed care recognizes trauma as a central issue. Incorporating trauma-informed values and services is key to improving program efficacy and supporting the healing process. With a better collective understanding of trauma, more survivors will find their path to wellness and recovery.

How often is trauma a root cause of a mental health patient’s condition?

Study findings indicate that adults in psychiatric hospitals have experienced high rates of physical and/or sexual abuse, ranging from 43% to 81%. Studies have shown that up to 2/3 of men and women in substance abuse treatment suffer from posttraumatic stress disorder, acute stress disorder or symptoms. Teenagers with alcohol and drug problems are 6 to 12 times more likely to have a history of being physically abused and 18 to 21 times more likely to have been sexually abused than those without alcohol and drug problems.

Children are particularly at risk – more than 3.9 million adolescents have been victim of serious physical violence and almost 9 million have witnessed an act of serious violence. Especially significant for behavioral health care service systems are findings by the National Child Traumatic Stress Network and others linking serious behavioral problems to the biological, neurological and psychological effects of violence and trauma in childhood. Early abuse is now believed to create a particular vulnerability to hyper-arousal, explosiveness and/or de-personalization that results in ineffective coping strategies and difficult social relationships. In children, trauma may be incorrectly diagnosed as depression, attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, generalized anxiety disorder, separation anxiety disorder, and reactive attachment disorder.

The science of trauma

Especially when experienced in childhood, trauma produces neurobiological impacts on the brain, causing dysfunction in the hippocampus, amygdala, medial prefrontal cortex, and other limbic structures. When confronted with danger, the brain moves from a normal “information-processing” state to a survival-oriented, reactive “alarm state.” Trauma causes the body’s nervous system to experience: an extreme adrenaline rush; intense fear; information processing problems; and a severe reduction or shutdown of cognitive capacities, leading to confusion and a sense of defeat.

If there are insufficient biological or social resources to assist in coping, the “alarm state” may persist even when the immediate danger has passed, and this can lead to PTSD. Excessive and repeated stress causes the release of chemicals that disrupt brain architecture by impairing cell growth and interfering with the formation of healthy neural circuits. When trauma occurs repeatedly, permanent changes in the brain can occur, compromising core mental, emotional, and social functioning – and resulting in a brain that is focused on surviving trauma.

Developments in neuroscience show a multi-directional interconnection between the body, brain, and mind. Post-traumatic stress is not a permanent neuropsychological condition, but a functional and largely reversible distortion in the multi-dimensional somatic and autonomic pathways that meld the mind and body. These discoveries, together with a range of new therapy approaches, are opening new perspectives on healing, and new treatments are being explored within this context. For example, cognitive behavioral therapy is thought to bolster cortical function, especially that of the prefrontal cortex. The healing journey is now seen to include biological as well as psychological transformation.

Footnotes: Information provided by the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration National Mental Health Information Center and the Center for Mental Health Services National Center for Trauma-Informed Care, found on the Internet at http://mentalhealth.samhsa.gov/nctic/.