Creative therapies are very well suited to working with children or adolescents who have experienced trauma. Throughout this text, note that “trauma” refers to both Type 1 and Type II trauma, i.e., Single shock or developmental.
Trauma affects many areas of the body and brain. For example, the brainstem, provides for life supporting autonomic functions, including defence mechanisms. These defence mechanisms can reflect early patterns of trauma, giving the therapist clues as to how best attend to the child.
Pathogenesis of Trauma
What is traumatic to one, may not be traumatic to another, to some degree it is the ability of the child or adolescent to integrate the traumatic experience(s) which will trigger sustained traumatic responses. One could simplify the categorisation of childhood trauma into
two criteria:
- the experience which includes the nature of and duration (or repetition) of the trauma;
- how the child reacts to the trauma exposure; to what extent the experience overwhelms a child’s inability to cope and integrate the experience leading to extreme fear or helplessness.
Often, when we think of trauma, we think of terrible events, but trauma can be experienced without such dramatic causes. Consistent fissures or breaks of attachment can be considered potentially traumatic.
Neuroscience
The focus of trauma treatment is shifting from a cognitive perspective to the emotional development of the brain (Shore, 2012) and we now understand that trauma can become the organising principle of the brain (Perry, 2009). The brain develops from the bottom up and trauma affects neurological developmental pathways; trauma treatment requires that clinicians understand the critical milestones of the nature of brain development in order to provide effective therapeutic interventions. Understanding the impact is more helpful than knowing the details of the actual trauma(s) (De Bellis, 2001).
Recent developments in neuroscience have challenged and elucidated our understanding of childhood trauma. Trauma during childhood impacts psychobiology and certain areas of the brain such as the prefrontal cortex and frontal lobes, these are the areas of the brain that determine executive functioning (EF). If EF is impacted, it may result in problems with “planning ahead, self-reflection, working memory, concentration and behavioural inhibition” (Music, 2014). Other important areas of the brain that are affected due to trauma include the limbic system, cerebellum and the corpus callosum. Trauma has been shown to inhibit regulatory processes of the autonomous nervous system, particularly the vagus (vagal tone) and elevated parasympathetic arousal (Porges, 2017). In short, disruptions cause a non-integration of experience meaning a bias on the child’s cerebral operations from the more primitive lower brain regions and “contributes to severe emotional states and may be related to emotional states of ‘immobilisation’ such as extreme terror (Porges, 1997, p. 75).
Developmental Trauma
At present, there is no official definition of complex or developmental trauma in either DSM V or ICD-10, presently children may receive a diagnosis of Post-traumatic stress disorder, van der Kolk (2017) and others have argued that a diagnosis of PTSD misses the specificity of childhood trauma and have proposed a new categorisation; Developmental Trauma Disorder. Terr (1991) defines childhood trauma as
the mental result of one sudden, external blow, or a series of blows, rendering the young person temporarily helpless and breaking past ordinary coping and defensive operations” (Terr, 1991).
References
Bowlby, J. (1999). Attachment and loss: Vol. I:attachment. New York: Basic Books.
Bronfenbrenner, U. (1994). Ecological models of human development. In International Encyclopedia of Education, Vol. 3, 2nd. Ed. Oxford: Elsevier. Reprinted in: Guavain, M. & Cole, M. *eds.) Readings on the development of children, 2nd Ed. (1993, pp. 37-43)
Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., & van der Kolk, B. (2005). Complex trauma. Psychiatric Annals, 35(5), 390–398.
De Bellis, M.D. (2001). Developmental traumatology: The psychobiological development of maltreated children and its implications for research, treatment, and policy. Development and Psychopathology, 13(3), 539–564.
Goldberg A.D., Allis C.D., Bernstein E. Epigenetics: A landscape takes shape. Cell. 2007;128:635–638. doi: 10.1016/j.cell.2007.02.006.
Hart, H., & Rubia, K. (2012). Neuroimaging of child abuse: A critical review. Frontiers in Human Neuroscience, 6(52), 1–24.
Landreth, G. L. (2012). Play therapy: The art of the relationship. New York: Routledge.
Lockwood L.E., Su S., Youssef N.A. The role of epigenetics in depression and suicide: A platform for gene-environment interactions. Psychiatry Res. 2015;228:235–242. doi: 10.1016/j.psychres.2015.05.071.
Music, G. (January 01, 2014). Top down and bottom up: trauma, executive functioning, emotional regulation, the brain and child psychotherapy. Journal of Child Psychotherapy, 40, 1, 3-19.
Panksepp, J., & Oxford University Press. (2014). Affective neuroscience: The foundations of human and animal emotions. Oxford: Oxford University Press.
Pechtel, P., & Pizzagalli, D.A. (2011). Effects of early life stress on cognitive and affective function: An integrated review of human literature. Psychopharmacology, 214(1), 55–70.
Perry, B. D., Pollard, R.A., Blakely, T.L., Baker, W.L., & Vigilante, D. (January 01, 1995). Childhood trauma, the neurobiology of adaptation, and “use-dependent” development of the brain: how “states” become “traits”. Infant Mental Health Journal, 16, 4, 271-291.
Perry, B.D. (2009). Examining child maltreatment through a neurodevelopmental lens: Clinical applications of the neurosequential model of therapeutics. Journal of Loss and Trauma, 14(4), 240–255.
Piaget, J. (1936). Origins of intelligence in the child. London: Routledge & Kegan Paul.
Porges, S. W. (2017). The pocket guide to polyvagal theory: The transformative power of feeling safe. New York: WW Norton & Co.
Porges, S. W. (January 01, 1997). Emotion: an evolutionary by-product of the neural regulation of the autonomic nervous system. Annals of the New York Academy of Sciences, 807, 62-77.
Prendiville, E., Howard, J. (2017). Creative psychotherapy: Applying the principles of neurobiology to play and expressive arts-based practice. London ; New York : Routledge.
Pynoos, R. S., & Eth, S. (January 01, 1986). Witness to violence: The child interview. Journal of the American Academy of Child Psychiatry, 25, 3, 306-319.
Ramo-Fernández L., Schneider A., Wilker S., Kolassa I.T. Epigenetic Alterations Associated with War Trauma and Childhood Maltreatment. Behav. Sci. Law. 2015;33:701–721. doi: 10.1002/bsl.2200.
Salmon, K., & Bryant, R. A. (January 01, 2002). Posttraumatic stress disorder in children: The influence of developmental factors. Clinical Psychology Review, 22, 2, 163-188.
Schore, A. N. (2012). The science of the art of psychotherapy. New York: W.W. Norton.
Schore, A. N. (January 01, 2001). Effects of a secure attachment relationship on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal, 22, 7-66.
Schore, A.N. (2015). Plenary Address, Australian Childhood Foundation Conference Childhood Trauma: Understanding the basis of change and recovery early right brain regulation and the relational origins of emotional wellbeing. Children Australia, 40(2), 104–113.
Schore, A.N., (1997). Early organisation of the nonlinear right brain and development of a predisposition to psychiatric disorders. Development and Psychopathology, 9, 595- 631.
Solomon, M. F., & Siegel, D. J. (2003). Healing trauma: Attachment, mind, body, and brain (p. 15). New York: W.W. Norton.
Stein, N. L., Trabasso, T., & Albro, E. R. (January 01, 2001). Understanding and Organizing Emotional Experience: Autobiographical Accounts of Traumatic Events. Empirical Studies of the Arts, 19, 1, 111-130.
Terr, L. C. (January 01, 1991). Childhood traumas: An outline and overview. The American Journal of Psychiatry : Official Journal of the American Psychiatric Association, 148, 1, 10-20.
van der Kolk, B. (2015). The body keeps the score: Mind, brain and body in the transformation of trauma. London: Penguin Books.
van der Kolk, B. A. (2017). Developmental Trauma Disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric annals, 35(5), 401-408.
Vinkers C.H., Kalafateli A.L., Rutten B.P., Kas M.J., Kaminsky Z., Turner J.D., Boks M.P. Traumatic stress and human DNA methylation: A critical review. Epigenomics. 2015;7:593–608. doi: 10.2217/epi.15.11
