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Trauma-Informed Care and Mental Health
Abstract
To be trauma-informed is to understand the involvement and impact of violence and victimization in the lives of most consumers of mental health, substance abuse, and other services. It is also to apply that
understanding in providing services and designing service systems to accommodate the requirements and vulnerabilities of trauma survivors and to facilitate their participation in treatment. This lesson will explain the difference between trauma-informed care and trauma-specific interventions, briefly review trauma history prevalences among consumers of mental health services, describe the development of a trauma-informed perspective in mental health, and discuss how standard clinical practices may inadvertently retraumatize those with trauma histories. This lesson will also outline the central features of a trauma-informed organization/department and the 5 principles of trauma-informed practice. Given the prevalence of traumatic experiences, especially those during development, and their long-standing effects on patients’ lives, the trauma-informed perspective offers a compelling and humane organizing principle for conceptualizing and addressing many of the problems and challenges facing those seeking mental health and other services.
... The consistent associations between early trauma and adult intimate relationships highlight a need to identify mediating pathways to identify points of interventions. Moreover, in clinical settings not considering how childhood maltreatment influence adult intimate relationships precludes a complete picture of the presenting problem which may lead to ineffective or retraumatizing interventions (Butler et al., 2011). Ineffective or retraumatizing interventions may result in client dropout from therapy, increased absenteeism from sessions, or a slowing of therapeutic progress (Butler et al., 2011). ...
... Moreover, in clinical settings not considering how childhood maltreatment influence adult intimate relationships precludes a complete picture of the presenting problem which may lead to ineffective or retraumatizing interventions (Butler et al., 2011). Ineffective or retraumatizing interventions may result in client dropout from therapy, increased absenteeism from sessions, or a slowing of therapeutic progress (Butler et al., 2011). ...
... Thus, clinicians should be aware of and integrate historical experiences of trauma when encouraging couples to cope together to resolve experienced stressors rather than simply advocating for coping together. Simply advocating for dyadic coping is a misattuned and likely ineffective modality due to ignoring historical experience of interpersonal betrayal that may be unresolved (Butler et al., 2011). Clinically, couple therapists may need to help the couples navigate historical trauma (e.g., recognizing the impact of past historical trauma on current relationship) before encouraging and helping couples cope together. ...
Childhood maltreatment is associated with poorer quality relationships and attachment theory has proffered an influential framework. The role of dyadic coping remains unclear and may play an integral role linking attachment insecurity and relationship quality among adults who experienced maltreatment. Using a sample of 177 adults (56.6% racial minority) were recruited from a southern university a serial mediational model was examined using structural equation modeling. Childhood maltreatment was linked with relationship quality through greater attachment avoidance and lower levels dyadic coping. Focusing on dyadic coping among avoidantly attached individuals from a trauma-informed perspective may be a point of clinical intervention.
... They describe actively seeking or using drugs to numb their emotions or memories that might be painful or difficult to tolerate. Trauma informed care approaches emphasize that maintaining trust throughout treatment and resisting retraumatization are especially paramount for these individuals (Butler et al., 2011). Mindfulness based relapse prevention techniques (Bowen et al., 2011), or a non-exposure-based psychotherapy (Flanagan et al., 2016) may be most useful as the trauma is heavily interfering in the day-to-day experiences of these individuals, while modalities such as "Seeking Safety", a "present-focused" model of psychotherapy, might be beneficial, with its focus upon coping skills and psychoeducation without delving into the trauma narrative (Najavits, 2002). ...
While numerous studies have established relationships between Adverse Childhood Experiences (ACEs) and adult substance use, few qualitative studies have explored the differing ways in which experiences of childhood adversity are emplotted into narratives of drug use and recovery. This paper analyzes qualitative data collected as part of a mixed-methods longitudinal study of people with opioid use disorder. Narratives of adverse childhood experiences emerged unprompted. After coding qualitative data for mention of ACEs, we thematically analyzed coded data using a framework of critical phenomenology and constructed a four-part typology to differentiate the ways that ACEs were emplotted into narratives. Our four sub-types—which we call ‘casual mentioners’, ‘seeking redemption’, ‘haunted by trauma’, and ‘reckoning with inevitability’—did not necessarily cleave along types or number of ACEs, but rather by the manners in which these experiences were conditioned by subsequent life trajectories, and the social, structural, and interpersonal factors that contextualized them. While participants often linked experiences of childhood adversity to adult opioid use, we argue that the differing ways in which individuals understand and process these linkages has implications for both clinical and therapeutic practice. For frameworks like trauma-informed care to be meaningful, we must pay closer attention to these meaningful differences.
Increased attention to the prevalence and impact of traumatic experiences have been highlighted within the mental health field since Felitti et al.'s study of adverse childhood experiences. Black communities experience traumatic events at a higher rate than other racial groups. The phenomena of historical trauma, race‐based trauma, and intergenerational trauma have been speculated to be reasons for this discrepancy. In this article, the authors explore factors that compound the traumatic experiences of Black communities, review socioculturally attuned family therapy and trauma‐informed care, and propose an approach to addressing intergenerational trauma in Black families that integrates socioculturally attuned family therapy and trauma‐informed care.
Chronic pain and posttraumatic stress symptoms frequently co‐occur. Both may be associated with how individuals perceive stimuli; yet, to our knowledge, studies have not considered their joint effects on the perception of stimuli. In the present study, we examined main and interactive effects of chronic pain phenotype (no chronic pain; <4 regions of chronic pain; ≥4 regions of chronic pain) and high posttraumatic stress symptoms (>3 symptoms) on sensory sensitivity (i.e., external sensory sensitivity and somatic awareness) and sensitivity to social stimuli (i.e., hostility, perceived rejection, and rejection sensitivity). Adult patients with a self‐reported history of trauma or abuse (n = 305) completed across‐sectional, online survey. A chronic pain phenotype indicating ≥4 regions of chronic pain exhibited significant main effects on somatic awareness and hostility. High posttraumatic stress symptoms exhibited significant main effects on all sensory and social variables. An interaction between chronic pain phenotype and high posttraumatic stress symptoms was also found for perceived rejection, such that the association between high posttraumatic stress symptoms and higher perceived rejection was buffered for individuals with <4 regions of chronic pain. The findings suggest that both chronic pain phenotype, particularly ≥4 regions of chronic pain, and high posttraumatic stress symptoms are related to the perception of sensory and social stimuli. These findings may be important for understanding the impact of each condition on functioning and well‐being, as well as how to appropriately treat and manage symptoms.
The research published in the clinical psychology forum evaluated a 6 week emotion regulation group in an outpatient group who present with varying diagnosis (incl autism, ADHD bipolar affective disorder). The results showed statistically significant improvements in emotional regulation and alexithymia and increased wellbeing overall. The research promotes the use of emotion regulation as a trans diagnostic intervention and has implications for those who experience alexithymia.
Social work practice with refugees and immigrants requires specialized knowledge of these populations and specialized adaptations and applications of mainstream services and interventions. Because they are often confronted with cultural, linguistic, political, and socioeconomic barriers, these groups are especially vulnerable to psychological problems such as anxiety, depression, alienation, grief, and post-traumatic stress disorder, as well as concerns arising from inadequate health care. Institutionalized discrimination and anti-immigrant policies and attitudes only exacerbate these challenges.
The second edition of Best Practices for Social Work with Refugees and Immigrants offers an update to this comprehensive guide to social work with foreign-born clients and an evaluation of various helping strategies and their methodological strengths and weaknesses. Part 1 sets forth the context for evidence-based service approaches for such clients by describing the nature of these populations, relevant policies designed to assist them, service-delivery systems, and culturally competent practice. Part 2 addresses specific problem areas common to refugees and immigrants and evaluates a variety of assessment and intervention techniques in each area. Using a rigorous evidence-based and pancultural approach, Miriam Potocky and Mitra Naseh identify best practices at the macro, meso, and micro levels to meet the pressing needs of uprooted peoples. The new edition incorporates the latest research on contemporary social work practice with refugees and immigrants to provide a practical, up-to-date resource for the multitude of issues and interventions for these populations.
I continue to think of revenge. But this thought of revenge, it doesn't know how to stop. And we should not have this thought or the matter will grow and keep going on and on for a long time. We should be a person who thinks and acts in accordance with dhamma. [A person who seeks revenge] only creates misery for our society. It is a germ in society. But I continue to think of revenge … The people who killed my brother, who put down his name to get into the truck, are all alive, living in my village. To this day, I still really want revenge. I keep observing them. But, I don't know what to do…. The government forbids it. - Chlat, whose brother's family was executed by Khmer Rouge There were many ways to die during Democratic Kampuchea (DK), the genocidal period of Khmer Rouge rule in Cambodia (1975-1979). Some starved to death. Others died from malnutrition and illness. Many more were executed, often en masse, in a genocide that took the lives of more than 1.7 of Cambodia's 8 million inhabitants (Kiernan, 1996) - almost a quarter of the population. Such numbers are almost incomprehensible, yet they fail to take account of the toll such death and destruction took on the survivors, who suffered the loss of friends and loved ones; struggled on in a world of privation and relentless work; tried to survive for another day in a time in which fear, terror, and trauma were omnipresent; and, after DK, attempted to piece together their fractured lives in a society that had been turned upside down.
This document outlines the fundamentals of the Creating Cultures of Trauma-Informed Care approach to organizational change. Buyilidng on core vales of safety, trustworthiness, choice, collaboration, and empowerment, this framework includes equal attention to the experiences of those receiving and those providing services. Though built on a foundation of behavioral health (mental health and substance abuse) agencies, this approach has been adapted to schools, to general medical settings, and to a variety of correctional settings, including juvenile justice.
The common stressful and traumatic exposures affecting the (neuro)development of our children are referred to as adverse childhood experiences, or ACEs. ACEs represent a constellation of experiences including: abuse (emotional, physical, sexual), neglect (emotional, physical), witnessing domestic violence, growing up with substance abuse (alcohol or other drug abuse) or mental illness in the household, parental discord, or crime in the home. The information presented here is in the public domain (see reference list) and does not necessarily reflect the viewpoints of any organization(s) with which Dr. Anda may currently be, or has previously been, affiliated. Editors' Note: At the 2007 Guest House Institute Summer Leadership Conference in Minneapolis, MN Dr. Robert Anda, co-Principal Investigator for the Adverse Childhood Experiences studies of the Centers for Disease Control and Prevention (CDC), presented the following material. His presentation and handouts have been revised and edited to present a coherent and unified presentation. Dr. Anda has reviewed and approved this presentation. This data is state-of-the-art. These reflections are reprinted here to provide a unique perspective on trauma & addiction that raises critical questions and provides caution about how we proceed within and outside the Church.
The author uses personal narrative to vividly describe his entry into the mental health system with a diagnosis of schizophrenia. Based on his experience, he describes and criticizes a mental health system that forces people to endure oppressive treatments in the name of help. Interweaving first-hand experience as a patient with his later training as a psychologist, he challenges the biomedical brain disease model and advocates for self-help, empowerment, and peer-run alternatives. The history of the almost 30-year-old movement of activist consumers/survivors/ex-patients is described and introduced as offering promising possibilities for creating innovative options for services. Questions are raised as to why mental health professionals have absented themselves from speaking out against the obvious abuses, rights violations, discrimination, and social injustices faced by people who are diagnosed and treated for madness. An invitation is extended for professionals to modify and reconsider the usefulness of the expert role and instead to form new partnerships of collaboration and advocacy.