Adult Trauma Therapy for Complex Childhood Trauma

This is the second segment of a two part article on childhood trauma and adult health consequences, and on therapy as an adult to address complex childhood trauma.

In the first article in this series, we looked at how childhood traumas lead to a wide range of adult mental, emotional and physical health diseases and ultimately to early death.

So if you’ve got a trauma history, things can seem pretty bleak – but remember, statistics just represent an ‘average’ experience – you do not have to live this negative trajectory. By addressing your past, learning to cope with symptoms and ultimately reprocessing your memories so they no longer hold such power over you, you can earn a great health and quality of life increase.

Read on to learn how to get started. By the end of this article, you’ll know

• If your current symptoms likely originate from childhood experiences
• Why you should consider treatment
• About trauma specific treatment and about how and where to find this specialized care.
• About the 3 phases of trauma therapy and about how long you can expect the process to take.
• About learning to cope with symptoms and manage your emotions without getting overwhelmed.

Is Childhood Trauma Affecting You as an Adult?

Though exposure to adverse experiences in childhood increases the risks for many diseases and conditions, many people with terrible childhood abuse histories grow into healthy and well adjusted adults.

So, if you experienced adverse events as a child, are they affecting you today, as an adult?

To help with finding an answer to this question, it's a good idea to learn a little about how childhood trauma usually manifests in adulthood.

Childhood trauma can lead to a wide range of cognitive and emotional symptoms across the lifespan, but in general, childhood traumas tend to cause adulthood symptoms that fall into 2 primary categories:

1. Avoidance symptoms, such as disassociation or escape through substance use
2. Re-experience symptoms, such as intrusive thoughts or flashbacks

As an illustration, consider how avoidance and re-experience symptoms manifest across a range of domains:¹

• Cognitive – Avoidance symptoms such as dissociation (daydreaming or spacing out during difficult moments) or amnesia of past events. Re-experience symptoms such as flashbacks or intrusive thoughts or recurring nightmares.
• Emotional – Avoidance symptoms such as feeling numb much of time or re-experience symptoms such as anger, hopelessness, shame, loneliness, depression and anxiety.
• Behavioral – Avoidance symptoms such as excessive sleep, substance use and abuse, avoiding people, places and things that remind of past traumas. Re-experience symptoms such as aggression or a high tolerance for inappropriate behaviors.

Considering Treatment

Overcoming ambivalence about treatment.

For adult survivors dealing with a legacy of childhood trauma, the idea of revisiting the past through treatment may provoke anxiety and uncertainty. So, should you get treatment now, so long after the fact?

There are no easy answers and no single right answer for every person, but in making a decision, consider the following four truths:²

1. Childhood trauma can have lasting impacts. Many people subjected to childhood abuse or neglect develop maladaptive thinking strategies that lead to poor decision-making and snowballing life-consequences.
2. Many people exposed to childhood traumas use drugs or alcohol as a way to self-medicate and to avoid dealing with difficult feelings.
3. Though you may feel imprisoned by your habits, thinking patterns and choices, there are people and programs to turn to for help.
4. People that seek professional assistance can learn effective coping skills and this can translate into a happier life, free from the depression, anxiety or intrusive thoughts and memories that characterize unresolved trauma. 

Seeking Trauma Specific Treatment

If you suffer with substance abuse, depression, anxiety, depersonalization, unhappiness or other complaints that you believe are at least partially caused by traumatic childhood experiences, you should consider seeking out treatment that is trauma informed or trauma specific.

Trauma specific services are set-up to address past traumas and the symptoms and syndromes that can occur after trauma exposure. Key interventions typically include:

• Learning grounding techniques to manage disassociation symptoms.
• Working through desensitization therapies to reduce the power of negative memories or images.
• Learning behavioral therapies that help you temper and manage powerful emotions in effective and healthy ways.

Trauma specific programs also:

• Acknowledge that your symptoms are actually adaptive responses to impossible situations in childhood.
• Acknowledge that childhood traumas, such as abuse and neglect, can lead to lasting interpersonal difficulties based on excessive fear and mistrust.
• Make emotional and physical safety a high priority.
• Avoid certain types of interventions that may actually re-traumatize by reproducing emotional situations that are similar to the original traumatizing experience.

So, if seeking help for adult difficulties with childhood trauma origins, it makes sense to seek out a trauma informed or trauma specific provider or program. By doing so, you avoid making your problem worse through re-traumatization, your mistrust or worries about betrayal won’t seem abnormal and most importantly, you’ll learn specific skills that can really help you get to the root of your problems.

How to Find Trauma-Informed Treatment

To find trauma informed care you can:

Call up local programs or counselors and ask each specifically about their trauma informed or trauma-specific practices – and if a provider claims trauma-sensitive capabilities, ask again for specifics on how these practices differ from standard care.

Use the Substance Abuse and Mental Health Services Administration’s (SAMHSA) treatment locator tool, which lets you search by zip code for mental health or addiction treatment providers in your area. To use the locator:

1. Search by zip code to find a list of behavioral health treatment providers within a radius around your home.
2. Click on the change service selections button at the top of the list to get to an advanced selection menu.
3. On this menu, click on the 'individuals with post traumatic stress disorder' button (people with childhood trauma may not have PTSD, but this selection is the most likely to get you to trauma-informed providers able to help you with early life trauma, abuse or neglect).
4. If you also need addiction treatment, also click on the button for ‘individuals with co-occurring mental and substance abuse disorders’.

The Importance of Phased Treatment

You can’t run before you learn to walk…

Experts agree that for complex trauma, such as for adult survivors of child abuse or neglect, therapy works best when it is delivered in phases and when people learn coping skills first before delving into memories of traumatic events.

Treatment usually occurs in three phases:

Phase 1, Stabilization and Safety

In phase 1 you first address your physical and emotional safety. This may mean addressing dangerous behaviors, such as substance abuse or self harm and also learning grounding techniques to manage your emotional responses and to develop safety and other coping skills (see below for ‘staying in the window of tolerance’). This first stage can take a while, but you can’t make meaningful progress in stage 2 until you’re capable of managing your reactions to difficult emotions and stressors.³

Phase 2, Working through Traumatic Memories

The second phase focuses on the processing and resolution of traumatic memories. By exploring traumatic memories you can shape them into something that makes sense to you and become desensitized from the intense emotional reactions they can provoke. Therapeutic techniques you might use during this second phase include eye movement desensitization response therapy (EMDR), exposure therapies and cognitive processing therapies.

Phase 3, Reintegration

In the last phase, you turn away from the past and look at the present and future. You start addressing how the avoidance of trauma reminders may have limited your choices and look toward broadening your range of everyday experiences. You address, work, relationship, spiritual and recreational aspects of life as you strive to build a satisfying existence for yourself.⁴

Note – There is wide expert consensus on the importance of phased treatment for complex trauma. Some of the organizations recommending a phased approach include: the Australian Center for Posttraumatic Mental Health, the International Society for the Study of Trauma and Dissociation, the National Institute for Clinical Excellence, the Canadian Centre for Addiction and Mental Health, the American Psychological Association Division 56 (Trauma Psychology) and the International Society for the Study of Trauma and Dissociation.⁵

How Long Does Phased Treatment Take?

There are no definitive length of treatment guidelines for adults dealing with complex trauma histories, however, according to an expert consensus panel from the International Society for Traumatic Stress Studies, reasonable time-frame expectations for the 3 phases of treatment are:

• Phase 1 – 6 months
• Phase 2 – 3 to 6 months
• Phase 3 – 6 to 12 months 

Staying in the ‘Window of Tolerance’

One of the skills you'll learn in trauma therapy is expanding your 'window of tolerance' so negative emotions and environmental stressors don’t overwhelm and so you can start to address your past in ways that free you from its legacy.

One model used to explain how complex childhood traumas lead to lasting emotional and behavioral problems is called the ‘window of tolerance model’. In this model, overwhelming and inescapable occurrences in childhood cause extremely high arousal states that effectively dysregulate (break or alter) your arousal regulation systems for life.

People with normally functioning arousal regulation abilities are able to self soothe and draw support from others as a way to stay within the window of tolerance, except in extreme situations. People with dysregulated arousal regulation systems, such as those affected by complex childhood traumas, have a diminished ability to self sooth or control arousal, and so moderate environmental stressors or difficult emotions or memories can easily lead to hyper or hypoarousal, and all the negative reactions and behaviors that accompany these states.⁶

According to the autonomic arousal model, we have three basic states of consciousness:

1. Hyerparousal – Sympathetic nervous system-based fight or flight type states - when we’re overstimulated and overwhelmed
2. The window of tolerance – normal functioning and thinking – feeling OK,  emotions are tolerable
3. Hypoarousal – parasympathetic nervous system-based states of understimulation - we shut down and go numb

Hyperarousal – emotional reactivity, emotional meltdowns, fight-or-flight mode, panic, racing thoughts, hypervigilance,

___________

Window of tolerance – Stay in the present and successfully process and integrate life events. In the window of tolerance our feelings are tolerable and we retain the ability to think and feel at the same time and so our responses to external stimuli are appropriate to the situation.

____________

Hypoarousal – slow thinking, disassociation, low motivation and energy, feeling numb, can’t defend yourself.⁷

Therapy to Widen the Window of Tolerance

Every person has a window of tolerance – an optimal level or brain arousal. When we’re inside our window of tolerance, we function well, feel OK and think clearly.

People who experienced childhood trauma often have an arousal dysregulation problem. They have a relatively narrow window of tolerance and they are easily knocked into hyperarousal or hypoarsoual by stressful or difficult life events or emotional states. They may also cycle quickly between states and have trouble drawing calm and strength from emotional attachment relationships with others.

Fortunately, with mindful awareness of bodily states you can retake control of your dysregulated arousal systems.

Mindfulness

To remedy this situation, in the first phase of therapy, a person can learn to feel and listen to the body and to develop an awareness of how different emotional states feel in the body. Once you gain an understanding of how your body  feels in your window of tolerance and how you feel as slip up or down out of it, you can learn to focus on the  body for calm and use mindfulness of bodily states as an anchor that keeps you tethered to your window of tolerance state.

Grounding Therapies

Complex trauma causes flashback/re-experience symptoms and disassociation symptoms – all phenomena that remove a person from staying focused on the present moment.

Because emotional stress prompts trauma symptoms, to benefit from reprocessing therapies, it’s important to learn self-soothing techniques that help you control your emotional/cognitive arousal and grounding techniques which keep your attention rooted in the here and now.

During the first phase of trauma therapy, you’ll likely learn one or more of the following self-soothing or grounding techniques:

• Progressive muscle relaxation or relaxation breathing exercises. By consciously controlling your physiological response to stress you can calm your emotional and mental response as well.⁸
• Looking around your environment and describing it to yourself in great detail.⁹
• Asking yourself a set series of questions (what time is it, where am I, how old am I, what is happening around me right now…?
• Stepping outside and noticing the current weather and then describing it yourself in detail.
• Calling up a friend or family member to talk about something recent.
• Washing your hands or spritzing water on your face. Feel the water on your skin. Rub your hands together and feel the sensation – clap your hands and listen to the sound.
• Carry something meaningful around with you in your pocket that keeps you focused on the present. When feeling overwhelmed, rub it like a talisman and remind yourself that you are an adult and you are safe.
• Stretch and take some time to feel the muscles in your body. Walk slowly around the room and focus completely on the feeling of your feet on the floor.¹⁰

The Importance of Early Intervention

Since trauma leads to social, emotional and cognitive impairments and these impairments cause all sorts of developmental problems and increase the likelihood of high risk behaviors, the earlier a person gets treatment to address a trauma legacy, the more avoidable damage can be averted.

Take-Home Ideas

If someone you love, especially a young person, struggles with the legacy of childhood trauma, the sooner they get trauma-specific therapy to resolve issues from childhood, the sooner they can start experiencing a full range of activities and environments and the better their long-term quality of life prognosis.

If childhood traumas keep you from living to your full potential, know that trauma-sensitive therapy can help open you up to a fuller and more satisfying range of experiences. Although the idea of re-approaching the past can be upsetting, since trauma therapy occurs in phases, you won’t have to relive anything until you’ve learned to control your emotions and manage your symptoms. You take things one step at a time, and step-by-step, get too the other side.