Mental Health and Foster Care Series: Cutting Edge Treatments in TRAUMA THERAPY

DISPLACEMENT TRAUMA caused by the frequent disruption of placements from biological home, foster home to foster home and finally aging out of the foster care system or becoming “unadopted” has deep and incisive effects into the human psyche’.  Thanks to recent advances in treatments we now have significant ways to or handling trauma in Foster children and children: left no longer in the foster/adoptive Care System.

Traditionally, Foster children are to engage in years and years of talk therapy treatments based on individual therapy that involve talking to the child and being familiar with the child’s life in a particular foster home.  Also in Foster children are so scared to speed up for fear of retribution.  So despite the use of counseling these children grow up angry, hurt, sad, and prone to drugs, alcohol and illicit activities.  Not feeling whole and feeling outcast in society lends itself to vulnerability in relationships, victimization, subjugation, and in some, an overwhelming desire to break out of the cycle of negativity and misery through positive and creative pursuits.

In more recent years, research on brain based treatment modalities has grown due to the realization that despite our best efforts, talk therapy in essence does not work.  Rather, children enjoy the social connectedness with a therapist they have learned to lean on (if fortunate to have that relationship), but do not learn the problem solving skills, relationship skills, or capacity to handle disappointment or lack of success.  As a result, the cycle of neglect and abuse continues into the next generation, in what we call “intergenerational transmission of trauma.” There are four major brain based treatments of complex trauma.  

These are:
1. Trauma-focused Cognitive Behavior Therapy (TF-CBT)
2. Eye Movement Desensitization Reprocessing (EMDR)
3. Neuro/biofeedback Training
4. ATTACh and other attachment based techniques

Q.  What is Trauma-Focused CBT?
A. Cognitive behavior therapy or CBT as it is commonly called is a form of therapy in which problem solving skills, social skills, coping skills are taught to children and adults so that they retrain their brains to act in different ways to obtain different consequences. So, for example, if you want to overcome your fear of flying, your therapist will first develop a scale with a series of thoughts and feelings that cause increase in anxiety to the point of the terrible fear of flying.  Gradually, you work through each of these steps from the least fearful to the most and finally, overcome the fear of flying.   Similarly, a combination of thoughts, belief systems and what are known as “automatic thoughts” are addressed and the individual is allowed to explore their automatic or false thoughts and beliefs and develop more realistic, positive and healthy coping styles for living day to day.  Take the additional component of trauma, and the focus becomes the actual events that were traumatic that are written in a narrative story telling style, and the complex trauma is explored via the narrative, and components of the trauma are processed using thoughts, emotions, behaviors while working on a workbook.   It is very successful with traumatized children and adults and can be done within 12-20 sessions depending on the extent and complexity of the trauma.  

Q.  What is EMDR?
A.  EMDR is also a brain based technique that focuses on restoring the calmness to the terrified brain by assisting and guiding the brain to resolve the trauma.  Studies have shown that when EMDR is done within 24 hours of a traumatic event, e.g., rape, death of loved one; no trauma related symptoms developed, in other words PTSD would not develop and was successfully averted.  In EMDR which I often do with my traumatized patients, the child may look at a pendulum that goes from one extreme corner of her eye to another, hold electrodes with mild stimulation in her hands while the therapist manipulates the frequencies, or follow the finger movements from side to side of the therapist.  Whichever way is chosen, the fundamental concept is to create rapid eye movement to jog the brain into information processing of the trauma centers of the brain.  As the brain processes the traumatic memories from the past, the therapist allows the patient’s brain to heal itself with initial guided communication; then brings the traumatized individual back to the present after a lengthy time of processing so that a “body scan” is done to reduce the physical symptoms attached to the traumatic memories.  With each session, traumatic memories are resolved and the individual moves to the next traumatic memory.  Eight stages are involved in EMDR and the results are widely published and accepted as very effective trauma treatment.  For more information, the reader is referred to their website: http://www.emdr.com/general-information/what-is-emdr.html

Q.  What is Neuro/biofeedback?
A. Neurofeedback training and biofeedback training were developed in Stanford University and in UCLA to address anxiety, depression and impulse control disorders.  It is currently being used to treat  posttraumatic stress disorder, addictions, anxiety, depression, ADHD, and RAD.  Neurofeedback training involves identifying areas of the brain and frequency levels that the patient can tolerate in  order to change the way the brain reacts to stress.  It is very effective in training the brain to regulate itself with regard to behaviors and emotions, so that the outbursts we see in foster children with regard to explosive behaviors, anger, aggression, bedwetting, impulsive behaviors and addictions are all treated.  It has become the alternative to medications and traditional forms of therapy.  For a  pictorial video of neurofeedback, please see the attached link: http://www.centerforbrain.com/what-is-neurofeedback-video/

Q. What is ATTACh?
A. ATTAChment Therapy is a “two week intensive’ treatment specifically for attachment related disorders such as Reactive Attachment Disorder. Here, the child and parents attend three hour therapy sessions for two weeks, five days a week during which anger management, problem solving, social reciprocity, family issues are all addressed and the child and family stay as a unit in nearby lodgings. It is perhaps the most intensive treatment of all of the above and the child’s early disrupted attachment bonds are healed through development of basic trust, respect, affection and nurturing. For more information the reader is referred to their website http://www.attachmentexperts.com/corrective.html