Developmental Impact of Complex Trauma

Developmental Impact of Complex Trauma

When Dr. Bessel van der Kolk, an expert in the field of traumatic stress and founder of the Trauma Center in Boston, gave the keynote speech during the “Treating Complex Trauma within Systems of Care” conference at Mercy Home for Boys & Girls, he outlined a series of perspectives and initiatives that illustrate why his organization is at the forefront of treating complex trauma among adolescents.

His work integrates developmental, biological, interpersonal, psychodynamic, and neurological aspects of the impact of complex trauma and its treatment. He’s also pioneered the use of a number of innovative treatment methods, including neurofeedback, theater, and yoga, just to name a few.

Mercy Home home’s partnership with Trauma Center has allowed us to refine our model of care.

“Dr. van der Kolk’s research and practice experience has informed our thinking about how trauma impacts the body, and how trauma can be healed through non-verbal pathways,” said Emily Neal, Mercy Home’s Clinical Director. “The partnership has brought us into a larger community of trauma-informed providers with whom we can share ideas and get consultation when we hit bumps in the road with the implementation of our model.”

Fractured Relationships as Trauma Catalyst

In his speech, Dr. van der Kolk laid the foundation for therapeutic healing by pinpointing the catalyst of trauma: fractured relationships.

“With kids, the issue is not so much about traumatic events, but it’s about relationships,” he said. “What we oftentimes lose track of is how our whole mind and brain is built to have relationships, and that when you get traumatized your relationships get impaired.”Relationships.

When dysfunctional relationships begin to fracture early in a child’s life, when the brain is very impressionable and still developing, can be most damaging. When infants become upset in a distressful situation, typically, a nurturing adult swoops in to alleviate the baby’s anxiety. Dr. van der Kolk says this teaches the baby, ‘if I get upset, sooner or later it will be over.’

“When you have this experience all the time and it doesn’t come to an end, that timekeeper of your brain malfunctions, and when you’re distressed you feel like it’s catastrophic, because it will never come to an end,” he said. “So these early experiences of abandonment and reunion, frustration and connection are the way that your brain gets organized to deal with frustration, distress, and with what to expect in the future.”

Creating Bonds to Repair Relationships

Because humans are deeply imitative beings and engineered to ‘become like other people,’ Dr. van der Kolk encourages people, particularly in treatment settings, to do a lot of moving, interacting, and vocalizing with each other. Doing so creates the ultimate bond of being in sync.

“Sharing rhythm and sympathy is the foundation of mental health or therapy or church movement, etc. And that builds our brain,” he said. “And so that’s how we know ourselves. That’s how we are able to communicate. We receive communications, have feelings for others, know how other people feel, and that gets hardwired in our brain.”

An activity as simple as tossing a beach ball back and forth can quickly re-establish synchronicity between people. Once this baseline is achieved, and everyone is on the same frequency, the healing process can move forward.

Dr. van der Kolk also stresses the importance of therapy that uses sensory integration, where kids might learn to walk on a balance beam, sit on swings, or sit on heavy blankets. Doing so activates the vestibular-cerebellar system, the part of the brain that assembles the most elementary sensations so people can engage with their environment.

Bar.“The basic rhythm-movement-integration part of the brain [of traumatized kids] is quite damaged,” he said. “Many traumatized kids develop, for example, very severe learning disabilities. We are so preoccupied with controlling their behavior that we really oftentimes miss that, underneath it all, they have major problems with movement integration, coordination, and hand-eye coordination.”

Another sensory integration technique, integral to the Trauma Center, is jumping on a trampoline.

“When kids jump rhythmically up and down on a trampoline, something changes in the way they talk,” Dr. van der Kolk said. “What you see oftentimes is when kids start jumping up and down, they start talking about yesterday and tomorrow. And the capacity to think about yourself over time is a critical capacity to get a life for yourself.

“So what we see when kids start jumping up and down, their time sense starts coming online. And so we love to have kids jump on trampolines because something happens in their ability to look at themselves and organize themselves.”

Jumping on the trampoline also helps kids lock in and really live in the moment.

“The illness of being a traumatized person is you cannot be fully alive in the present,” Dr. van der Kolk said. “The biggest issue in complex trauma treatment is that event that’s happened [in the past] has left traces in your self-experience, has traces in your sensory system, and has left changes in the way that you deal with other people.”

Beyond getting people in sync, this playful interaction awakens an elemental sensation – one that is often absent, Dr. van der Kolk notes, from psychiatric textbooks: pleasure.

“Pleasure is what life is all about at the end. And pleasure is so dramatically lacking when you’re traumatized,” he said. “When you’re in sync with people, if you sing in a choir together, if you play music with people, if you play volleyball, if you do anything that requires you to adjust your rhythmicity to other people, the feeling of joy is inevitable […] so this should be an essential part of all of our therapy interventions with traumatized individuals, particularly kids.”

Physical Effects of Trauma

But the consequences of trauma aren’t merely limited to psychological damage – they can also inhibit physical, regulatory functions within the body.

“When you get traumatized you get abnormal breathing patterns, you get abnormal sleep-dream patterns, you get abnormal eating patterns, and so that’s where a lot of trauma plays itself out,” Dr. van der Kolk said.

Yoga, he says, is one of the best ways to combat these abnormalities.

“We found that yoga is more useful for chronic PTSD than any medication that anybody has ever studied,” he said. “We found it was much more effective because you can learn to breathe yourself and move yourself into calming down part of your brain.”

When more acute measures of treatment are needed, Dr. van der Kolk endorses innovative, neurofeedback systems in the form of interactive computer games. For example, electrodes placed on a traumatized patient’s head can measure brain waves that correspond to their ability to regulate anxiety.

In one computerized model, brainwaves were represented as different colored spaceships. The electrodes on the patient’s head sensed when he was relaxed and focused. Therefore, on screen, the patient saw a green spaceship speed up, overtaking other spaceships that showed if he was tired or tense. Though he’s trying to get the rockets to go faster, in effect, he’s really teaching himself to slow down.

Fascinated by these results, Dr. van der Kolk thinks neurofeedback represents a new, therapeutic frontier for victims of trauma.

“The first few studies really show very dramatic effects in trauma symptoms – most of all, executive functioning: being able to focus, paying attention, and filtering relevant from irrelevant information,” he said. “So we can probably rewire those brains. To my mind, this is the future of biological psychiatry.”

Dr. van der Kolk disagrees with the common perception that the brains and minds of traumatized kids are only capable of producing outcomes of murder and mayhem. Herein, he says, lies the great challenge of treating victims of traumatic stress.

“How do we change their map of the world that lives inside of them?” he asked. “To my mind, it’s only by having them actively involved in experiences that directly contradict the horror and helplessness that they grew up with.”

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