The Treatment of Trauma: Talk About It

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Below is a good outline of trauma and how to manage this medical condition, of the brain and body.

“Children and adolescents become traumatized when they are repeatedly exposed to negative experiences that are intense enough to trigger an alarm response or another strong reaction of the defense cascade. The consequences are particularly devastating for mental health if the pain and fear are caused by the attachment figure, because caregivers are meant to provide the opposite of this: safety, reassurance, and calm.”

“Children who experience one type of adversity also frequently experience other forms of stress, which may include emotional neglect, social rejection, and physical or sexual abuse, either within the family or externally. Multiple experiences of severe stress form building blocks for trauma-related suffering that leave their survivors vulnerable into adulthood. Consequently, new traumatic experiences are most devastating when they affect those who have had to endure childhood adversities that have led to permanent changes in implicit memory.

Narrations from child survivors who have experienced severe and often ongoing stress describe immense pain and sadness. These children desperately seek emotional closeness and meaning-making. For survivors of multiple and complex traumatization, stabilization therapies that involve active detachment from the memory of the trauma, or therapies which only attend to the trauma incidentally, or select an isolated traumatic event as the target of therapy, have not proven to reduce the resulting suffering in its entirety in these children. Such therapies are insufficient to modulate maladaptive changes in neural and epigenetic organization and will not redirect development toward functionality. Humans with broken lifelines need a comprehensive approach of narrative restructuring and in sensu exposure not only of their trauma memories but also of their entire biography. Children and adolescents need support to be able to reflect on their life stories and process the traumata as well as their empowering life experiences. Narrative exposure therapy (NET} focuses on the elaboration of the autobiography, including integration of both the traumatic experiences and other highly arousing events.

In traumatized individuals:
– memory functions have lost their orchestration. – Their own biographies seem fragmented, without coherence
– Therefore a core component of NET is to assign each traumatic event a corresponding spatial and temporal context (where and when did things happen?).
– This autobiographical information is referred to as “cold memory”. It is verbally accessible and hence supports communication and reappraisal. This allows an adjustment in the meaning of events to occur. Cold memory contains records of conscious experiences that assign context to hot memories, which are the sensory, cognitive, and emotional traces of arousing experiences.

In trauma-related disorders, the key problem is the failure of proper connections to the associative hot memories including when and where the experience happened, resulting in feelings of impending threat and helplessness. This leads to lasting posttraumatic stress, anxiety, and depression. As a consequence, the attachment-seeking system in children is overly activated. Their ability to adequately regulate emotions and their motivation to explore and learn are jeopardized because of their decontextualized “hot memories.”

Emotionally arousing events result in detailed sensory and perceptual images tied together in associative networks. Arousing memories…may be activated by sensory cues such as the scent of a given perfume or invoke physiological responses such as heart pounding in pleasant anticipation.

In addition to sensations and emotions, hot memories also include a cognitive component…. For traumatic experiences, hot memories may involve features of the past scene:
– the sound of bullets,
– the smell of fire (sensory elements),
– fear and panic (emotions),
– thoughts of helplessness (cognition),
– sweating, and heart palpitation (physiological memories).

In traumatized survivors, these memories can only be accessed involuntarily, forming the basis for flashbacks and nightmares related to the traumatic moments themselves. With an increasing number of experiences, more and more sensory elements become associated to this memory (this phenomenon is called a “fear network”) and thus act as cues that increase the likelihood that the core feelings of trauma (fear, helplessness, arousal) will become activated. This hot memory network is the result of experiences that were made at different times, in different places, and thus do not share a common cold memory. Consequently, with increasing exposure to stressors, the fear network becomes larger while these hot traumatic memories lose their connections to spatial and temporal information. When cues trigger these hot memories, there is no connection to a single episode, and the experience is erroneously located in the here and now.”

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One thought on “The Treatment of Trauma: Talk About It

  1. Pingback: The Treatment of Trauma: Talk About It | Growth

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