Term Paper “psychological intervention for Trauma Effected Children”

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Abstract

In general, trauma can be defined as a psychological, emotional response to an event or an experience that is deeply distressing or disturbing. When loosely applied, this trauma definition can refer to something upsetting, such as being involved in an accident, having an illness or injury, losing a loved one, or going through a divorce. However, it can also encompass the far extreme and include experiences that are severely damaging, such as rape or torture.

Because events are viewed subjectively, this broad trauma definition is more of a guideline. Everyone processes a traumatic event differently because we all face them through the lens of prior experiences in our lives. For example: one person might be upset and fearful after going through a flooding, landslide and earthquake but someone else might have lost family and barely escaped from a flooded also destroyed home during Gorkha Earthquake 2072.

In Nepal, psychological counseling is only now beginning to be used to help children address and recover from trauma and the stresses of life. In this case, a minor Category One earthquake may bring up traumatic flashbacks of their terrifying experience, because trauma reactions fall across a wide spectrum, psychologists have developed categories as a way to differentiate between types of trauma. Among them are complex trauma, post-traumatic stress disorder (PTSD), and developmental trauma disorder and counsellor are trying their best in the field support.

To treat mental disorders psychological interventions can be coupled with psychoactive medication.  Psychiatrists commonly prescribe drugs to manage symptoms of mental disorders. Psychosocial interventions have a greater or more direct focus on a person’s social environment in interaction with their psychological functioning.

Psychological interventions can also be used to promote good mental health in order to prevent mental disorders. These interventions are not tailored towards treating a condition but are designed to foster healthy emotions, attitudes and habits. Such interventions can improve quality of life even when mental illness is not present.[ Feldman, D. B. & Dreher, D. E. (2012]

Interventions can be diverse and can be tailored specifically to the individual or group receiving treatment depending on their needs. This versatility adds to their effectiveness in addressing all kinds of situations.  [Mauri, L. & Barrantes-Vidal, N. (2011]

 

 

Table of Contents

Chapter I

Introduction

Definition

Types

Causes

Symptoms of trauma

Reasons for increasing trauma

Child and Teen Problems Resulting from Trauma

Impacts of trauma in children

Specific Objectives

Methodology

Chapter II

Literature Review

Chapter III

Factors that moderate trauma

Chapter IV

Trauma Counseling with the help of therapy

Chapter V

Discussion and Conclusion

References

 

Chapter I

Introduction

  • Definition

Childhood itself is quite an anxious process. Kids are tasked with learning new skills, meeting new challenges, overcoming fears, and navigating a world that doesn’t always make sense. But sometimes these fears or stressors prove too much to handle, and the normal comforts that adults can provide don’t quite seem to be enough. In these cases, a child may have a diagnosable traumatic disorder.

Childhood trauma has profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being. Referred to in academic literature as adverse childhood experiences (ACEs), childhood trauma ranges from sexual abuse to neglect to living in a household where a parent or sibling is treated violently or there is a parent with a mental illness. Kaiser Permanente and the Centers for Disease Control and Prevention’s 1998 study on adverse childhood experiences determined that traumatic experiences during childhood are a root cause of many social, emotional, and cognitive impairments that lead to increased risk of unhealthy behaviors, risk of violence or re-victimization, chronic health conditions, low life potential and premature mortality. As the number of adverse experiences increases, the risk of problems from childhood through adulthood also rises. Nearly 30 years of study following the initial study has confirmed this. Many states, health providers, and other groups now routinely screen parents and children for ACEs.

Types

There are many types of trauma, but here is the most common Trauma type experienced by the children.

Acute trauma: Results from exposure to a single overwhelming event/experiences (car accident, natural disaster, single event of abuse or assault, sudden loss or witnessing violence).

Repetitive trauma: Results from exposure to multiple, chronic and/or prolonged overwhelming traumatic events (i.e., receiving regular treatment for an illness).

Complex trauma: Results from multiple, chronic and prolonged overwhelming traumatic events/experiences which are compromising and most often within the context of an interpersonal relationship (i.e., family violence).

Developmental trauma: Results from early onset exposure to ongoing or repetitive trauma (as infant, children or youth) includes neglect, abandonment, physical abuse or assault, sexual abuse or assault, emotional abuse witnessing violence or death, and/or coercion or betrayal. This often occurs within the child’s care giving system and interferes with healthy attachment and development.

Vicarious trauma: Creates a change in the service provider resulting from empathetic engagement with a client’s/patient’s traumatic background. It occurs when an individual who was not an immediate witness to the trauma absorbs and integrates disturbing aspects of the traumatic experience into his or her own functioning.

Historical and/or Intergenerational trauma: Emotional and psychological trauma that can affect cultural groups, communities and/or generations. Examples of this type of trauma include racism, colonization, loss of culture, forcible removal from family/community, slavery, genocide and war. Coping and adaptation patterns developed in response to trauma can be passed through generations.

Complex Trauma: Complex trauma happens repetitively. It often results in direct harm to the individual. The effects of complex trauma are cumulative. The traumatic experience frequently transpires within a particular time frame or within a specific relationship, and often in a specific setting.

 

Post-Traumatic Stress Disorder (PTSD): Post-Traumatic Stress Disorder (PTSD) can develop after a person has been exposed to a terrifying event or has been through an ordeal in which intense physical harm occurred or was threatened. Sufferers of this PTSD have persistent and frightening thoughts and memories of their ordeal.

  • Causes
  • Combination of genetic and environmental,
  • psychological and developmental factors,
  • over scheduled children and poor sleep.
  • Brain regions associated with trauma: Thalamus, Hypothalamus, Hippocampus, Amygdala, Basal Ganglia, Prefrontal Cortex, Orbitofrontal Cortex, and Anterior Cingulate Gyrus
    • Symptoms of trauma:

Often, shock and denial are typical reactions to a traumatic event. Over time, these emotional responses may fade, but a survivor may also experience reactions long-term. These can include:

  • Anger
  • Persistent feelings of sadness and despair
  • Flashbacks
  • Unpredictable emotions
  • Physical symptoms, such as nausea and headaches
  • Intense feelings of guilt, as if they are somehow responsible for the event
  • An altered sense of shame
  • Feelings of isolation and hopelessness
    • Reasons for increased trauma:
    • parental pressures.
    • Natural Disaster, earthquake, flood etc.
    • Fears social media pressures
    • Perceived threats.
    • Child and Teen Problems Resulting from Trauma:
  • Poor school performance
  • problems with peers
  • substance use
  • psychosomatic illnesses
  • low self-esteem
  • psychopathology in adulthood.
  • Impact of trauma in children

Trauma can impact individuals in many ways, including socially, psychologically, academically, neuro physiologically, and socioeconomically, and can impair physical health as well.

Traumatized individuals, particularly those who are traumatized in childhood are at increased risk for: Social and behavioral problems, including, but not limited to: relationship difficulties, risky sexual behavior, aggression and criminal behaviors. Impaired psychological health throughout the lifespan, including, but not limited to: PTSD, depression, substance use/abuse, and suicide attempts. Adverse childhood experiences are related to the onset of a range psychological disorders as well. Additionally, adults who had four or more adverse childhood experiences were 7.3 times more likely to have at least one diagnosis from each of the following four types of disorders: mood, anxiety, impulse control, and substance abuse disorders. Cognitive and academic problems, including, but not limited to: low IQ and reading scores, delayed language and cognitive development, and poor academic performance. Neuropsychological alterations involving areas of the brain that regulate emotion, control of emotions, judgment, and problem solving, in addition to the stress response system.

Impaired physical health that can endure for decades, such as increased risk of cancer, heart disease, liver disease, pulmonary disease, auto-immune disease, and obesity.

  • Specific objectives
  • To identify the childhood Trauma and its need.
  • To identify types of childhood Trauma.
  • Ways to help in Childhood Trauma with the help of counseling.
  • Methodology

For this term paper, secondary data will be utilized. Various journal, book and research articles will be reviewed to explore the counseling for traumatic children.

Chapter II

Literature Review

Trauma-informed care (TIC) is increasingly recognized as an approach to improving consumers’ experience of, and outcomes from, mental health services. Deriving consensus on the definition, successful approaches, and consumer experiences of TIC is yet to be attained. In the present study, we sought to clarify the challenges experienced by mental health nurses in embedding TIC into acute inpatient settings within Australia. A systematic search of electronic databases was undertaken to identify primary research conducted on the topic of TIC. A narrative review and synthesis of the 11 manuscripts retained from the search was performed. The main findings from the review indicate that there are very few studies focusing on TIC in the Australian context of acute mental health care. The review demonstrates that TIC can support a positive organizational culture and improve consumer experiences of care. The present review highlights that there is an urgency for mental health nurses to identify their role in delivering and evaluating TIC, inclusive of undertaking training and clinical supervision, and to engage in systemic efforts to change service cultures.

The 2015 earthquake in Nepal affected the country in terms of economy, and by causing damage and stress reactions. This study aimed to estimate the prevalence and determine individual child- and family-level predictors of post-traumatic stress disorder (PTSD) symptoms especially based in children.         Among the children, 51% had moderate-to-severe PTSD symptoms. Children of school age (adjusted odds ratio=2.83 [1.45-5.49]), those attending lower-secondary school (2.26 [1.21-4.21]), those having a higher exposure to the severity of the earthquake, and those with low psychosocial acuity were more likely to have more severe PTSD symptoms compared with those who were adolescents and in higher-secondary school, whereas children from a family living in an urban  setting and following Hindu religion were less likely to have PTSD symptoms compared with children from suburban areas and those following Buddhist religion.

Trauma’s Impact on attachment

According to attachment theory created by John Bowlby, attachment patterns are “formed in the context of early experiences with caregivers and maintained by later interpersonal relationships in adulthood.” Over time, attachment patterns become internalized and shape how individuals see the self and others in close relationships, which in turn influence how individuals perceive and cope with stress through the lifespan. A researcher named Mary Ainsworth identified three categories of infant attachment styles: secure, insecure avoidant, and insecure ambivalent/resistant.

Securely attached babies and children “feel confident that the attachment figure will be available to meet their needs. They use the attachment figure as a safe base to explore the environment and seek the attachment figure in times of distress”.

Insecure avoidant children “do not seek contact with the attachment figure when distressed. Such children are likely to have a caregiver who is insensitive and rejecting of their needs. The attachment figure may withdraw from helping during difficult tasks and is often unavailable during times of emotional distress”.

Insecure ambivalent/resistant children fail to “develop any feelings of security from the attachment figure. When distressed they are difficult to soothe and are not comforted by interaction with the attachment figure. This behavior results from an inconsistent level of response to their needs from the primary caregiver”.

Research has also shown that trauma involving caregivers may significantly disrupt caregiver-child attachment, leading to insecure or disorganized attachment.

 

 

Chapter III

 

Factors that Moderate Trauma

Risk Factors

A risk factor is a variable that is associated with a negative outcome such as higher risk for disorders.

Overall, the earlier age of child abuse and the longer the child is maltreated, the worse the outcome. Chronic child maltreatment is a serious risk factor for a wide range of social, psychological, and medical problems across the lifespan, as demonstrated in a controlled, prospective study that followed children for 15 years and controlled for potentially confounding variables such as economic status and parental mental health problems.

Additionally, women are more likely to develop PTSD than men, and they are more likely to have chronic PTSD than men (22% of women versus 6% of men).

Protective Factors

Some variables have been identified as protective factors that are associated with relative resiliency to childhood maltreatment.  Resiliency is more common among maltreated children who have a supportive caregiver.  Adults who were maltreated in childhood have been found to be more resilient when they have a supportive partner and/or a stable living situation. Family and community factors play a larger role in predicting resiliency than do factors related to maltreated children.

 

 

Chapter IV

 

Trauma Counseling:

Trauma counseling is not one-size-fits-all. It must be adapted to address different symptoms. Mental health professionals who are specially trained in treating trauma can assess the survivor’s unique needs and plan treatment specifically for them.

Currently, there are several trauma therapy modalities in place:

Cognitive Behavioral Therapy (CBT) teaches the person become more aware of their thoughts and beliefs about their trauma and gives them skills to help them react to emotional triggers in a healthier way.

Exposure therapy (also called In Vivo Exposure Therapy) is a form of cognitive behavior therapy that is used to reduce the fear associated with the emotional triggers caused by the trauma.

Talk therapy (psychodynamic psychotherapy) is a method of verbal communication that is used to help a person find relief from emotional pain and strengthen the adaptive ways of problem management that the individual already possesses.

These modalities treat the memory portion (the unconscious) of the trauma, however we now know that a survivor’s conscious brain must be treated, as well. Recent studies have found that body-oriented approaches such as mindfulness, yoga, and EMDR are powerful tools for helping the mind and body reconnect.

Additionally, neurofeedback (a type of biofeedback that focuses on brain waves) shows promise in helping patients with trauma symptoms learn to change their brain wave activity to help them become calmer and better able to engage with others.

Child therapy (also called child counseling) is much the same as therapy and counseling for adults: it offers them a safe space and an empathetic ear while providing tools to bring about change in thoughts, feelings, and behaviors. Just like adult clients, child clients receive emotional and goal support in their sessions. They may focus on resolving conflict, understanding their own thoughts and feelings, or on coming up with new solutions to problems.

The only big difference between adult therapy and child therapy is the emphasis on breaking down mental illness, trauma, or any other difficult issue the child is dealing with, to ensure children understand what is happening and can make sense of what they are experiencing. Child therapy can be practiced with one child, a child, and a parent or parents, or even with more than one family. It is often administered by a counselor or therapist who specializes in working with children, and who can offer the parents and/or guardians’ insights that may not be immediately apparent.

Consider outside help: Find a class where your child can learn yoga, meditation or deep breathing. Mental health experts who specialize in treating children with learning and attention issues can also help with stress management skills.

  • Pay attention to your child’s feelings.
  • Stay calm when your child becomes anxious about a situation or event.
  • Recognize and praise small accomplishments.
  • Don’t punish mistakes or lack of progress.
  • Be flexible, but try to maintain a normal routine.
  • Modify expectations during stressful periods.
  • Plan for transitions (For example, allow extra time in the morning if getting to school is difficult).

Keep in mind that your child’s traumatic disorder diagnosis is not a sign of poor parenting. It may add stress to family life, however. It is helpful to build a support network of relatives and friends. It’s important that you have the same expectations of your anxious child that you would of another child, according to psychologist.

Chapter V

 Discussion and Conclusion

A number of studies have found an association between trauma exposure and psychopathology. Individuals may experience a range of psychological disorders, including, but not limited to, posttraumatic stress disorder, developmental trauma disorder, severe dissociative disorders, depression, bipolar disorder, ADD/ADHD, obsessive compulsive disorder, substance use disorders, personality disorders, and disorders of adjustment.

Because of the severity of trauma, these dissociated self-states are kept separate and dissociated “in order to preserve both the self and the attachment to the “good” aspects of the caregivers while allowing the child to survive by maintaining functioning relationships with the “bad” aspects of the caregivers”.

Furthermore, parental loss or other severe life events within the first 2 years of a child’s life are also risk factors for the development of traumatic disorders. They need special care and counseling together.

Severe life events may affect the parental relationship in the crucial period when attachment develops, and contribute to disorganized attachment, which may increase the likelihood of dissociation in later life. In this situation we may attempt to the guardians and parents for counseling.

In particular, a parent’s unresolved loss of attachment figures seems to have the potential to influence their infant’s attachment style.

PTSD symptoms were prevalent among children of Nepal more than a year following the earthquake. Family-level indicators cannot be excluded when studying children’s trauma reactions.

References

  1. Kalra, Michelle (1996). Juvenile delinquency and adult aggression against women (M.A. thesis). Wilfrid Laurier University.
  2. Mulvey, MW Arthur, ND Reppucci, “The prevention and treatment of juvenile delinquency: A review of the research”, Clinical Psychology Review, 1993.
  3. Edward P. Mulvey, Michael W. Arthur, & N. Dickon Reppucci, “Prevention of Juvenile Delinquency: A Review of the Research”, The Prevention Researcher, Volume 4, Number 2, 1997, Pages 1-4.
  4. Regoli, Robert M. and Hewitt, John D. Delinquency in Society, 6th ed., 2006.
  5. Siegel, J Larry. Juvenile Delinquency with Infotrac: theory, practices and law, 2002.
  6. United Nations, Research Report on Juvenile Delinquency (pdf).
  7. Ainsworth, M. D. S., & Bell, S. M. (1970). Attachment, exploration, and separation: Illustrated by the behavior of one-year-olds in a strange situation. Child Development, 41, 49-67.
  8. McLeod, S. A. (2014). Mary Ainsworth. Retrieved from www.simplypsychology.org/mary-ainsworth.html
  9. https://www.ncbi.nlm.nih.gov/pubmed/28480568
  10. http://children .org/article /behavoural treatment

https://www.jaacap.org/article/S0890-8567(09)64316-1/abstract

Lok Raj Pathak
Lok Raj Pathak Administrator

Lok Raj Pathak is a Professional Computer Engineer and Technology enthusiast. He has completed Master in Science in Information Technology (M. Sc. IT) and Master in technology in Computer Science and Engineering (M. Tech. Eng). He usually writes in science and technology, life style and religion.

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