Individuals who are exposed to isolated traumatic events, such as crime, car accidents, serious injuries, or medical procedures, may have a similar reaction to mine, but more intense. These individuals experienced a biological reaction—stress, pain, fear—and the body replays these reactions whenever something reminds them of the stressful event. They may find themselves avoiding situations that remind them of their scary experience. They might sense a physiological stress reaction to cues that have become associated with their painful memories.
Therapeutic interventions for people exposed to single traumatic events are designed to expose them to the cues associated with their painful memories of the event, but in a predictable, moderate manner. This allows them to master the situation and integrate it into narrative story that can be used to build resilience for the future. Cognitive focused treatments, EMDR (eye movement desensitization and reprocessing) and other trauma-sensitive treatments are very effective in helping these clients recover from their exposure to an overwhelming event.
Sadly, the children referred for treatment at the Denver Children’s Advocacy Center (DCAC) are rarely the victims of a single crime. While parents live in fear of “stranger danger,” the little girl from a happy home who experiences one vicious sexual assault on her way home from school is actually much more likely to heal from the trauma than is a child who has been repeatedly abused from infancy.
The majority of children in treatment at DCAC have a chronic history of maltreatment that has affected their development and disrupted the functioning of their regulatory systems. Current stressful events are interpreted through a lens filtered with past traumatic experiences. Their brains lose the capacity to use internal sensations and feelings as a guide to interpret current events. Everything is associated with threats from the past and perceived as dangerous. They are in a state of perpetual stress.
Fight or flight works well in the jungle, or in response to a single isolated emergency—the need to run for a plane, for example. The children we see are in a state of constant high alert, with elevated heart rates and no ability to rationally evaluate threats. If your abuser could strike at any moment, and your home—which should be a place of safety—was instead a scary place where danger lurked around every corner, you would be hypersensitive too.
Staying hyper alert and constantly scanning the environment for possible threats takes up a great deal of these children’s energy, and interferes with their healthy development. Many of them have learning problems, sleep problems, relationship problems, mood regulation problems and behavioral control problems. All of these problems are symptoms of a poorly organized, poorly functioning regulation system. All of these symptoms are the result of unremitting trauma over a long period of time. The body never has the opportunity to self-regulate. For these individuals an event similar to my airport experience could have been devastating.
Even when the children know that their abuser can no longer harm them, it can take many months (sometimes years) to “de-program” the accumulation of years of adverse experiences. In the assessment and treatment program at DCAC, our therapists use trauma-informed assessments and provide developmentally sensitive interventions. Many of the initial therapeutic interventions are patterned repetitive regulatory sensory stimulation within a relationally safe environment. Teaching children and adolescents how to tolerate, identify, express and integrate emotional experiences into an adaptive behavior response becomes an important treatment goal. As the children and adolescents experience a sense of safety both in their bodies and within the therapeutic relationship, work on traumatic memories becomes possible. The therapists stay attuned to their clients’ verbal and nonverbal communication, shifting back and forth between focusing on traumatic memories and regulatory exercises. This dosing of the trauma work allows the client to re-experience past painful memories in a more predictable, safe, moderate manner.
When we are scared we move into a protective stance and survival becomes the primary objective. Our thinking becomes more concrete, our focus is on the immediate situation and our actions are impulsive. As a species, when we feel safe and secure, we become motivated to take risks and to explore both our internal and external environments. We become open to growth, capable of abstract thinking and effective problem solving. We develop innovative, alternative solutions and respond in a flexible adaptive manner. It is under these conditions that healing becomes a reality.
Dr. Jerry Yager
For more on our work at DCAC, including upcoming training opportunities, please visit us on the web at www.DenverCAC.org.
