Many children are exposed to traumatic experiences. These experiences—physical or sexual abuse, living with domestic or community violence, surviving a serious car accident—all have an impact on the child’s development. Depending on the severity, frequency, nature, and pattern of traumatic events, at least half of all children exposed may be expected to develop a range of PTSD symptoms in adolescence and adulthood.
Trauma is an experience. How can this experience transform a child’s life into a terror-filled world that so dramatically alters the child’s trajectory into and throughout adult life? Ultimately, it is the brain that processes and internalizes traumatic and therapeutic experiences. Understanding the organization, function and development of the human brain, and brain-mediated responses to threat are the keys to understanding the traumatized individual and provide the necessary help.
All experience is filtered by our senses. Sound, sight, taste, touch, in turn, initiate a cascade of processes that alter brain structure and function. Traumatized children develop response patterns (e.g., hyperarousal or dissociation) that interfere with healthy development; these responses can results in more permanent traits.
The Child’s Responses to Trauma
The body and mind have sets of primitive physical and mental responses to threat. The most familiar set of responses to threat has been labeled the “fight or flight” reaction. There are also other responses to threat. At different stages of development, and in the face of different stressors, response patterns will vary, however, two major response patterns are hyperarousal and dissociation.
1. Hyperarousal: Defensive and “Fight or Flight” Responses
In the initial stages of threat, an alarm reaction is set off. This is characterized by a large increase in activity of the sympathetic nervous system, resulting in increased heart rate, blood pressure, shallow breathing, a sense of hypervigilance, and tuning out of non-essential information. All of these actions prepare the body for defense—to fight with or run away from the perceived threat. If the threat materializes, a full fight or flight response gets activated.
The brain regions involved in the threat hyperarousal response play a central role in regulating arousal, vigilance, emotions, irritability, the response to stress, sleep, and the startle response. Initially following the fear response, these systems in the brain will be reactivated when the child is exposed to a specific reminder of the traumatic event (e.g., the presence of a past perpetrator). Furthermore, these parts of the brain may be reactivated when the child simply thinks about or dreams about the event. Over time, these specific reminders may generalize (e.g., a specific perpetrator to any strange male). In other words, despite being distanced from threat and the original trauma, the stress-response system of the child’s brain is activated again and again.
A traumatized child may, over time, show hyperactivity, anxiety, impulsivity, sleep problems, hypertension, etc.
This also means that components of the fear response, themselves, become sensitized. Everyday stressors, which previously may not have produced any response now bring forth an exaggerated reactivity—these children are hyper-reactive and overly sensitive. This is due to the fact that the child is in a persisting state of fear.
Furthermore, the child will very easily be moved from being slightly anxious to feeling threatened to being terrorized. In the long run, what is observed in these children is a set of maladaptive emotional, behavioral and cognitive problems which are rooted in the original adaptive response to a traumatic event.
2. Dissociation: The Freeze or Surrender Responses
Children are not particularly well equipped to fight or flee. In the initial stages of distress, a young child will call, i.e., crying, to let a caretaker know that they are under threat. In reality, for many of the maltreated children crying for “help” from a potential trauma is doomed to fail as often the parent causes the trauma. In the absence of an appropriate caretaker response to their initial alarm outcry, the child, eventually after many painful disappointments, will abandon this behavior (a defeat or surrender response). In the face of persisting threat and, depending upon the age of the child and the nature of the threat, the child will respond with hyperarousal or dissociation.
A first reaction in the face of continuing threat may be to freeze. Freezing allows better sound localization, sharper visual observation and environmental scan for potential threat. In addition, lack of movement is a form of camouflage, reducing the chance of attracting a predator. In the face of escalating threat, increasing anxiety and decreasing cognitive processing, the freeze response can provide an adaptive advantage by allowing one to figure out how to respond.
Children who have been traumatized will often use this freezing mechanism when they feel anxious. At this point, they tend to feel somewhat out of control and will cognitively (and often, physically) freeze. When adults ask them to do something, they may act as if they haven’t heard or they refuse. This forces the adult to ask the child to comply often involving more threats. This situation will make the child feel more anxious, threatened and out of control. The more anxious the child feels, the quicker the child will move from anxious to threatened, and to terrorized. If sufficiently terrorized, the freezing may escalate into complete dissociation that is simply disengaging from the external world and attending to an internal world.
Traumatized children use a variety of dissociative techniques. Children report going to a “different place”, assuming persona of heroes or animals, a sense of “watching a movie that I was in” or “just floating” responses. Observers will report these children as numb, robotic, non-reactive, day dreaming, acting like he was not there, staring off into space with a glazed look. If immobilization or pain is involved in traumatic situations, the dissociative responses will become more predominant.
Because the brain changes during development in response to experience, the specific pattern of neuronal activation associated with responses to trauma are likely to be internalized. The specific symptoms that develop following trauma are related to the individual’s pattern of response present in the severe situation. If, in the midst of a traumatic experience, the child dissociates, and stays in a dissociative state for a long period of time, the child will internalize a sensitized neurobiology related to dissociation, predisposing to the development of dissociative disorders. On the other hand, if a child utilizes mainly a hyperarousal response which persists, the child may develop persisting hyperarousal symptoms.
Working with adults who experienced childhood trauma
Studies have shown that adults who experienced childhood trauma tend to be highly reactive to perceived threats. Their behaviors often correspond to the post-traumatic responses and may include withdrawn behavior, reenactment of the traumatic event, or avoidance of circumstances that remind one of the event, physiological hyper-reactivity, anxiety and stress. Because these adults may be dealing with preverbal and often unconscious memories they tend to internalize response patterns which can turn into traits. So how do we work with this type of memory and is encoded by the brain in the body?
1. Normalizing the Symptoms and Concerns
It is important to help clients understand their experiences, educate them about common PTSD symptoms. Education about loss and trauma, processing emotions, utilization of existing strengths and resources and exploration of existential and spiritual concerns are some areas included in this process. Initially amplifying positive moments where clients can access internal and external resources may increase their sense of connection and later assist the trauma processing.
2. Working through Hyperaroused States and Dissociative States
By becoming aware of levels of hyperaroused states and dissociative states clients learn to pay attention to the moment-to-moment reactions and eventually shift these states instead of focusing on the traumatic details of their traumatic storyline.
Gently brining attention to the body where the trauma memory is encoded, using images, gestures, and tracking sensations clients begin to learn how their body and mind reacts to emotional triggers and how to bring their experience back into a window of tolerance zone where emotions are slightly uncomfortable but not overwhelming.
3. Cultivating Therapeutic Presence
Presence entails cultivating a safe and supportive relationship with clients, one characterized by deep emphatic listening, attunement and compassion. It also includes consistency and clearing up misunderstandings, gentle eye gaze, a soothing voice, and ability to contain various emotional states that arise in the clients’ process while showing a responsive face and social engagement skills.
Maria Stella is a Registered Clinical Counsellor who specializes in trauma, grief and loss.