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Dr. Bessel Verdercock, a researcher and professor of psychiatry at Boston University Medical School is an expert in Developmental Trauma Disorder.  In his webinar for the National Institute for the Clinical Application of Behavioral Medicine, in April 2013, he makes a clear distinction between acute trauma, as it happens to an adult like a war veteran or a sex assault victim, where the person is able to make the connection between his experience and the start of his troubling symptoms, and developmental trauma, where the experience happened in childhood and kept recurring in a chronic way. The brain and mind of the child are shaped by that trauma of neglect or abuse with long term consequences. The children symptoms as he describes them are clustered in 3 areas:

Attention:  inability to focus, inability to filter stimulus and difficulties with sticking with tasks, mimicking and often diagnosed as ADD.

Affect Regulation:  affect is too intense, too reactive, often misdiagnosed as bipolar disorder, or too quiet.

Problems in the area of relationships: perceiving people as dangerous and reacting with excessive aggressiveness, excessive compliance or distance.

Dr. Verdercock feels it is then very important to investigate the possibility of trauma in the lives of these children to give the appropriate treatment. Sometimes, the presence of PTSD in the parents, who then cannot function as normally parents do, teaching affect regulation to their children, because they have problems with affect regulation themselves and this creates an increased risk for abuse and/or neglect. Trauma, as Dr. Verdercock puts it affects an organism, so it affects every system in that organism.  It affects your mind and brain and it affects your body. One of the consequences of this is its heart rate variability, which is a very good measure of your being deregulated from stress. This measures the degree in which your heart rate corresponds to your breathing and it can be used to measure overreaction or under reaction to stress and it can even be used in helping the individual learn to manage stress by learning to change the breathing.  Yoga is an activity proven to regulate these systems and so he uses yoga as one of the many activities in which the children under his care participate, as well as sensory integration exercises and even theater to help children learning to regulate themselves.

In adults, some authors call developmental trauma, Complex Trauma. For an excellent description of complex trauma and its treatment approaches you can visit:

www.giftfromwhithin.org/html/cptsd-understanding-treatment.html

Here you can read the article written by Dr. Christine A. Courtois, PhD, a therapist specializing in the treatment of complex trauma who practices in Washington, DC.

Dr. Ruth Lanius, MD, PhD is the director of the Posttraumatic Research Unit at the University of Western Ontario, a research center studying the effects of mother-infant interaction and its effects on trauma and mental health. She has discovered an important effect in adult severely traumatized individuals, when studying their brain scans.  The areas of the brain which are related to social cognition appear much less active than non-traumatized individuals in MRI brain scans, as measured in experimental conditions.  Social cognition is fundamental for the ability to develop relationships with others and is based on the ability of the person to be aware of their own feelings and then through that process, being able to be attuned to the other person’s feelings and finally, being able to hold this awareness of the other person’s mind in your own mind, which is called mentalizing. So, for mothers of infants who have experienced chronic and repeated trauma, they observed that they lack the ability to read the cues that signal the emotional state of the infant and are unable to respond in ways that calm the baby in distress and are even unable to make the baby smile, though they feel very guilty and distressed about it.  She hopes that by training these mothers through gradually increasing mindfulness awareness of their own emotions may be the key in them learning to increase their social cognition and stimulating growth of neuronal connections in the corresponding areas of the brain, so they can be mothers that support a secure attachment.  The benefits are also that these children will eventually develop increasing self- awareness, which in turn is also associated with better self- regulation of emotions as studied by Dr.Peter Fonagy at the University College London in Great Britain.  An important fact to note as helpers, as Dr. Lanius mentions is that for people who have suffered severe trauma it is very difficult to make eye contact as this makes them feel that their shame is evident to the other person. This is an important sign to notice and respect by allowing the person to avert their eyes.

So, empirical research of mother infant interactions supports that consistent, healthy attachment experiences with a caretaker lead to well organized well regulated baby brains. Poor, inconsistent, or traumatic early attachment relationships lead to the establishment of a very different brain and nervous system structure, associated with poor capacity for self-regulation and concomitant emotional and behavioral difficulties. (Siegel, 2003) Siegel(2012).  Numerous of the reunited family youngsters have been separated from their mothers at infancy, or early childhood.  Not all of these experiences are experienced as traumatic by the child, however, depending on many other factors surrounding the experience i.e., whether the main caretaker never was the mother, but the grandmother, with whom the child ended up staying when the mother left the child behind and of course the quality of the care the infant receives from the substitute caretaker.  However, when the experience results in trauma for the young child, it is necessary to keep this important information at the center of our work in planning interventions, both educationally and psycho-therapeutically. When the trauma happens before language is fully developed, the experience is essentially non-verbal and at a somatic-sensory level. Thus, cognitive and social learning interventions are not likely to succeed. Therefore, the attachment theory therapists stress that the repair must occur at the level of the original damage, so they work recapitulating the primary attachment relationship.  Nurturing, playfulness, security and containment not experienced in childhood need then to be provided to the child by the present caretaker.

A very interesting development is the discovery that Attachment Disorders are emerging as the core basis of vulnerability to trauma as well as, at the basis of many adult mental and physical problems and diseases. As Dr. Scaer puts it: …We are beginning to see recognition that the subtle nuances of the relationship of the mother and the infant change the brain in a way that either fosters resiliency, or prevents it throughout the life span……”This early period of time is absolutely critical for the development of the regulated brain”, meaning the ability of the brain to control negative emotion.

Additionally, another worthy of note method created by western psychology exploring and researching the application of eastern forms of medicine and healing practices is E.F.T: Emotional Freedom Techniques, a part of energy psychology practices.  This method utilizes the idea of energy meridians in the body, through which energy travels, and points in the body, identified by Chinese acupuncture, that could be used to alleviate the intensity of negative feelings through tapping lightly with the patient’s own fingers and thus allowing the energy to flow uninterrupted once more, while simultaneously bringing into consciousness the experience of those feelings and negative memories. (Craig, G.; 1999; Carrington, P.; 2000, Ortner, N. 2013) By tapping on specific points certain areas of the lower brain (the amygdala) where the negative emotions and memories “reside” are helped to calm down and the neurological activity in these parts of the brain subsides while the patient verbally describes the painful feelings and statements about the experience.

Dr. Francine Shapiro, PhD, recipient, among other awards, of the “Award for Outstanding Contributions to Practice in Trauma Psychology, given by the American Psychological Association, is the founder of the Eye Movement Desensitization Reprocessing, or EMDR, another method that has been around for the last 20 years for the treatment of trauma and its effectiveness has been proven through randomized control trials. The path for treatment is based on the understanding that the symptomatology is maintained because unprocessed memories of the traumatic experience are held in the brain together with the emotions, the physical sensations and the beliefs. By first identifying these memories and symptoms and then applying different techniques, one of which is the bilateral rapid eye movement, as the patient is holding the memory in their mind, this allows the information processing of the experience by the brain and this in turn produces changes in the emotions, images, physical sensations and beliefs connected to it, much more rapidly than other forms of treatment, without the patient having to talk about it in detail, nor do homework by themselves. She is the executive director of the EMDR Institute in Watsonville, California and President Emeritus of the EMDR Humanitarian Assistance Programs, a non- profit organization that coordinates disaster response and low fee trainings worldwide.

In the hands of trained clinicians, one method that was successfully used by mental health professionals in Chile when working with the survivors of torture and their loved ones during the times of the Pinochet dictatorship was the testimonio or testimony. This involves a first person oral or written account recorded by the therapist who helps to be a witness to the experiences of abuse and loss and then this story is disseminated as appropriately and the victim is able to start recovery from the symptoms of PTSD, regaining his/her dignity and self-respect. (Lira et al. 1989) This method has also been used successfully in other victims of political persecutions from other countries in Central and South America. (Aaron, 1992; Comas-Diaz, 2007) In Chile, as well, trained Psychology college students have volunteered in times of need to go to the sites affected by earthquakes and tsunamis, to help the survivors and victims suffering from PTSD, by utilizing EFT techniques as described earlier and thus providing alleviation of symptoms to adults and children. They were also able to avoid secondary trauma by practicing these techniques on themselves, after listening to especially disturbing stories.

In conclusion, trauma, as described in the life experiences of the immigrant families seems to be no stranger to them, not only as a possible risk of the separation of the infant from the mother, but in the possible experience of growing up with abusive caretakers, or in violent prone environments such as those described earlier, as also, through the crossing of the border in very dangerous circumstances, or arriving into situations that become abusive or traumatic to the young immigrant.  Many of these same descriptions apply as well for the parents of the immigrant youngsters, especially for those that grew up in the context of civil war and political persecution. This is not to say that trauma lives in the lives of all immigrants because, of course, many of them have not experienced it at all. But as helpers we have the obligation to keep a sensitive and informed attitude towards this important aspect of the assessment and treatment of our patients.

 

 

 

 

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