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Understanding and learning about trauma becomes a very important and necessary tool in our work with immigrant youngsters and their families, so that we can recognize its presence and evaluate the need for trauma informed treatment.  There is now robust research evidence demonstrating the dramatic effects of traumatic experience on human neurobiology. Even uterine exposure to maternal distress has been shown to increase the level of secretion of the stress hormone cortisol in the unborn child system. (Fisk, 2000) During infancy, elevated levels of cortisol have been correlated with attachment disorganization in infancy and cognitive and developmental deficiencies in toddlers. (Spangler & Grossman, 1999) (Glasser & Barbernie, 2001) Furthermore, current research about the brain in a child supports the ideas of the impact of childhood experiences in the developing brain. Poor, inconsistent or traumatic early attachment relationships have been shown to lead to the establishment of very different brain and nervous system structures (Mc Ewen, 2000)

Dr. Robert Scaer is a neurologist whose main expertise and interest is the study of traumatic stress and its role in mental illness and even chronic diseases.  He is the author of the books :  The Trauma Spectrum:  Hidden Wounds and Human Resiliency and also: The Body Bears the Burden: Trauma Dissociation and Disease In an interview with Dr. Ruth Buczinski, Ph.D., director of the National Institute for the Clinical Application of Behavioral Medicine, he defines trauma “as a life threat in a state of helplessness” and states that “our brain is strongly wired to protect us from life threats through a series of message systems in the limbic brain (mainly the amygdale, the fight or flight center) that allow us to assess danger and then institute a self- preservation response”. The problem, as he explains, is that sometimes it is impossible to escape the threat and then the brain reacts as it has been wired to respond through evolution with a freeze or immobility response. Through evolution this response has allowed escape at times, fooling the predator into thinking that the animal is dead and it also allows the animal not to feel the pain of injuries.  If normal recovery does not happen through a discharge of autonomic and body energy, then, a conditioned response occurs “whereby all the body memories and sensations of that experience are stored in the survival brain….if you freeze and don’t get rid of that energy, that will be stuck in your brain as a survival response, but a false response.   The storage of those false, procedural responses or procedural memories is the structure of trauma.”  This process then affects our future way of assessing danger, or our future way of assessing options, so even if the event is over, the part of the brain in charge of survival thinks it is still in front of us and this is what makes up the traumatic response a lasting one.Dr. Scaer refers to trauma as an imprisonment of the mind.  When he is asked to explain this he states that “Little cues will keep erupting, that replicate old subtle traumatic memory that hasn’t been resolved and you’re imprisoned by the past. This is especially true in cases of early childhood trauma because that sets the pattern.”

A well- known expert in the treatment of trauma, Dr. Peter A. Levine (2010) has put forth the idea that trauma is not a disease or disorder, as per the DSM Classification of Mental Disorders of the American Psychiatric Association, but it is an injury caused by fright, helplessness and loss.  Based on his theories and brain research, he proposes a treatment that uses instead of talk therapy, deemed by him as less than helpful in dealing with the natural protection of the brain to the experience of trauma, but using instead the wisdom of the body in restoring healthy responses. This wisdom is based on the evolution of the species and when carefully supported, it successfully manages to break through the state of frozen paralysis and helplessness that afflicts the trauma victim, releasing him or her from trauma. (Levine, 2010)

Temores

In the last 20 years there has been a tremendous amount of research and emergence of new treatments of trauma based on that research. Cognitive Behavioral Treatment approaches such as one of the primary ones being Prolonged Exposure Therapy, where the patient is asked to describe the traumatic event in great detail and repeatedly in order to prevent avoidance, which is seen as the main factor of maintenance of the disturbances. They have to repeat this procedure as if living the experience in the moment and audio tapes maybe made for the patient to listen at home, while also training the patient to face situations that remind them of the trauma in order to experience the possibility of doing this “without loosing their mind.”  These forms of treatment are seen by some authors as having an  increased risk of re-traumatizing the person and a higher risk of treatment desertion. Instead the movement has been towards treatments that integrate the body and mindfulness awareness, paying particular attention to creating a carefully monitored exposure to the more painful memories and specially creating a sense of safety through many self- soothing techniques. Based in the combination of western research of understanding the neurobiology of trauma and eastern forms of meditation, that apply those techniques borrowed from ancient practices to create mindfulness, new therapies have surface that  work on alleviating the painful emotions associated with trauma through meditation and thus facilitate a better integration of the experience in the brain through integration of the lower brain or subcortical brain and the cortex or higher brain. Very succinctly, mindfulness meditation cultivates a state of maintaining an awareness of our present experience together with an acceptance of that experience in a gentle compassionate, nonjudgmental presence. By allowing and carefully increasing, in order to avoid re-traumatizing the patient, the focusing of attention to the intensity of the feelings and painful past memories instead of avoiding them, they eventually subside in their intensity and grip. This is facilitated through exercises of focused attention to the person’s breathing and body sensations awareness among others. This is a very carefully orchestrated process that is done after there is great attention to developing, at the beginning stage, techniques that increase safety and stabilization in the patient, self-soothing and self-compassion. This psychotherapeutic technique has been increasingly widely accepted and researched for treatment at many psychological, as well as medical training centers such as the Harvard Medical School of Medicine ( Germer, C.; Siegel,R; Fulton, P; 2005). Prominently in this trend, in the UCLA School of Medicine, Dr. Daniel J. Siegel, MD, a Professor of Psychiatry and Executive Director of the Mindsight Institute, has conducted and published research on the brain for the past 25 years.  In his studies, he has integrated the advances of technology in the imaging of the brain with enormous advances in the study of the neurosciences studying the functioning of the brain, and particularly, the neuroplasticity (capacity to change itself) of the brain. His current research documenting structural changes in the brain has been instrumental in advancing his new therapeutic interventions, or validating already existing ones, that work in the treatment of trauma and other psychopathology producing new integrations of different areas of the brain and pathways of communication that create beneficial behavioral and emotional concomitants. (Siegel, 2010, Siegel, 2012).

Dr. Pat Ogden, Ph. D, director of the Somatic Psychotherapy Institute and creator of a form of treatment that integrates somatic and cognitive approaches in the treatment of trauma within the context of a deeply emotionally connected relationship is another example of treatments that integrates the body.  Brain, mind and body are all one system in her approach and the road to healing means integrating all through being aware of reactions inside our body and our emotions connected to them through interventions and guided mindfulness while the therapist is very present in the relationship, so that there is a relational repair as well. All of these new treatments developed at clinical centers throughout the country have training programs available for clinicians.

To be continued in the next post.

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