Thursday, April 20, 2006

Biological Changes from Trauma

One challenge in trauma informed treatment is the recognition of the biological changes that accompany trauma. Children who have experienced early, repeated and multiple abuse are left with disturbed biological regulation systems. Their abilities to relax, calm down, sooth themselves, and rest are all compromised. At times these changes are superimposed on biological systems already impacted by maternal drug use in utero, and by family pre-disposition to mental health disorders.

What does this mean to us day to day?

When LaShanna’s mother doesn’t come for a visit- or when LaShanna even thinks about that happening- she becomes agitated. She experiences an intolerable emotional state. She feels a painful pressure. It is not that she is thinking through her situation and considering her options. In fact, she cannot think at all. She is feeling jagged, irritable, disconnected. So far, what she knows to do to relieve that feeling is break windows and destroy furniture. It helps. It provides a release.

We must try to remember times when we have felt this way, even to a mild degree- when we have felt so agitated by something that we could not sit, could not relax, and could not concentrate. Then multiply that feeling, and take away any coping skills and supports we may have. Have those been the moments when we wanted to talk about our issues and engage in problem solving?

It doesn’t help LaShanna if we respond to her furniture-breaking by confining her to her room. In fact, it is unbearable for her, and she does something else to escape the prison of her room, and of her mind.

But what can we do? We have to provide her with methods to change the intensity of her pain and hyper-arousal without hurting herself or others (or even the furniture). These would be things like going for a walk, moving around, accomplishing something active but not very difficult, engaging in an activity that provided a distraction (such as cooking). We have to take her by the hand and do these things with her. We have to be active to engage her and almost drag her into another space. Hopefully, we get better at noticing the early signs of her distress and intervening then. Eventually, we hope that LaShanna will notice her own signs of distress and use her own interventions. But we are a long way from that place.

None of this is about punishment and reward. That will not help. It is about recognizing biological distress and teaching by example how to moderate it.

LaShanna will feel understood and safe. The compassion of the people around her will strengthen their relationships. Her motivation to change, to learn to master her own body, will grow when she thinks that is possible to do so, and when she feels that people she cares about want her to have a better life.

1 comment:

Dr. Deborah Serani said...

Realizing that trauma incorporates aspects of the body and the psyche are so important. This is a really great post. I will link my blog to yours.