The word trauma gets tossed around a lot in contemporary informal speech.
When something bad happens to us, we say things like:
“That was traumatic.”
“I was totally traumatized.”
And quite often, we mean it. We have a bad experience and it has a negative emotional impact on us. Maybe we had a near-miss driving a car, as in we came close to having an accident, felt a rush of stress hormones, and felt jittery and awful for a few minutes – or maybe a few hours – afterward. Then we calmed down and felt okay.
Sometimes, though, we use the word in a tongue-in-cheek, joking way. As in, something not very bad happens to us or someone else, and we say things to each other like this:
“Aww, did that traumatize you?”
“I got mad at my kid and probably traumatized them for life.”
“Omg, I saw a spider in the shower and I swear I’m traumatized.”
“That circus clown legitimately traumatized me.”
We want to take this moment to encourage you not to trivialize the word trauma and to be mindful if you want to use it sarcastically or as a backhanded insult/put-down/jibe that implies the person you’re talking to is weak or incapable of handling stress or difficulty.
Even if you’re totally, one hundred percent just joking.
Because trauma is real, and millions of people in the U.S. suffer the effects of many different types of trauma every day. They don’t think trauma is funny at all. And every time we, as a collective, use the word as a joke, we play a part in undermining or delegitimizing the real pain and anguish victims of trauma experience. For some people, the trauma they experience early in life has a negative effect on their entire lives.
That’s no joke.
What is Trauma?
Let’s back up a second.
We’re not here to be the thought police or to tell you what kind of jokes you can or cannot make.
But please do take a moment and think about that feeling you get after a near-miss in the car. Or that rush of adrenaline you get when someone jumps out from behind a door and scares the stuffing out of you. Or even when you trip, almost fall, and realize you could have seriously injured yourself – that rush of ohmigod that hits you. It’s not pleasant.
Multiply that unpleasant by a thousand. Then Imagine living with that feeling almost all day, almost every single day of your life.
That’s a good approximation of what the survivors of trauma feel like – almost all day almost every day of their lives.
Now do you see why we encourage you to be mindful of how you use that word?
What we just offered was an example of how trauma feels that we hope you can relate to. Now we’ll offer a more official definition of trauma. Here’s how the helpful website Trauma-Informed Care: Implementation Resource Center defines trauma:
“Trauma results from exposure to an incident or series of events that are emotionally disturbing or life-threatening with lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, and/or spiritual well-being.”
The Consequences of Trauma
Our current understanding of trauma and its long-term negative effects owes everything to a study conducted in 1998 by the Centers for Disease Control (CDC) and Kaiser Permanente Health Systems. This groundbreaking project, called the ACE Study, is widely recognized as the origin of an approach to healthcare – both mental and physical – now known as trauma-informed care.
The ACE Study identified the following adverse childhood experiences:
- Physical, emotional or sexual abuse
- Physical or emotional neglect
- Domestic violence
- Living with an individual struggling with substance abuse, an individual diagnosed as mentally ill or an individual who was incarcerated or sentenced to be incarcerated
- Experiencing racism and/or bullying
- Living in foster homes
- Living in an unsafe neighborhood
- Witnessing violence
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), individuals who experience ACEs are at increased risk of the following:
- Early alcohol use
- Illicit drug use
- Prescription drug misuse
- Alcohol use disorders
- Substance use disorders
- Suicide attempts
- Risky sexual behavior
- Adolescent pregnancy
- Lowered IQ
- Impaired cognitive function
- Heart Attack
Adverse childhood experiences are things that happen early in life – the items on the first bulleted list – that correlate with negative physical and mental health consequences later in life – the conditions on the second bulleted list. This is proven and accepted science: no one in the scientific, medical, or mental health community doubts early trauma leads to later complications. The more ACEs a person has in the past – an ACE score – the higher their chances of developing one or more of the ACE-associated consequences.
Now we’ll move on.
ACEs: Facts and Figures for Adults, Children, and Adolescents
Let’s take a look at the prevalence of ACEs in the adult U.S. population:
- 62% of adults in the U.S. report at least one ACE.
- 25% of adults in the U.S. report three or more ACEs.
With an adult population of over two hundred million people, that means around 50 million adults in the U.S. have an increased risk of developing a mental health or physical disorder as a result of ACEs.
Now let’s take a look at the prevalence of ACEs among children and adolescents in the U.S.:
- 46% of children and adolescents age 0-17 have at least one ACE
- 35% of kids 0-5
- 47% of kids 6-11
- 56% of adolescents 12-17
- 28% of children and adolescents ag 0-17 have two or more ACEs
- 112.% of kids 0-5
- 22.6% of kids 6-11
- 29.9% of adolescents 12-17
It’s also important to note here that ACEs are significantly more common among African-American kids and adolescents. ACEs also have a disproportionate impact on people with incomes more than 200 percent below the federal poverty level. For detailed tables and statistics, please click here and here.
At this point, we’ve established that ACEs correlate with problems later in life, and that an alarming percentage of kids, adolescents, and adults in the U.S. have a history of ACEs. That means we have one more thing to talk about before we address how behavioral health treatment centers help teens with a history of trauma.
An Adverse Childhood Experience is Traumatic
Trauma is synonymous with extreme stress. An extremely stressful life event – an ACE – is characterized as traumatic, and almost any traumatic event you can name is defined by the level of stress it causes. That leads us to this question: how does stress cause harm?
Let’s start by defining stress. The American Psychological Association (APA) Dictionary of Psychology offers this definition:
“…the physiological response to internal or external stressors. Stress involves changes affecting nearly every system of the body, influencing how people feel and behave. By causing these mind–body changes, stress contributes directly to psychological and physiological disorder and disease and affects mental and physical health, reducing quality of life. See also chronic stress.”
The APA defines chronic stress as:
“The physiological or psychological response to a prolonged internal or external event. The stressor need not remain physically present to have its effects. Recollections of it can substitute for its presence an sustain chronic stress.”
When we talk about trauma and the long-term effect of ACEs, a big part of what we refer to this effect of long-term exposure to the stress hormone cortisol on our mind and body. Within this definition of chronic stress, you can also see a defining element of post-traumatic stress disorder (PTSD). Someone with PTSD relives the original trauma or stress over and over – sometimes for years – and memory is all that’s needed to trigger the phenomenon of re-experiencing or reliving the initial trauma. People with PTSD and multiple ACEs experience long-term, overexposure to cortisol.
To read our quick primer on cortisol, click here.
Now that we’ve defined trauma, explained the connection to childhood experiences, connected childhood trauma to stress, and explained the negative impact of long-term exposure to stress hormones on the body, we’re ready to talk about how behavioral health treatment centers for teens can help adolescents with a history of ACEs – meaning a history of trauma and chronic stress – process their trauma and move forward with their lives.
Treatment centers for teens do this with a therapeutic approach called trauma-informed care.
What is Trauma-Informed Care?
The best behavioral health treatment programs for teens with a history of ACEs or trauma embrace a set of best practices established by the Substance Abuse and Mental Health Services Administration (SAMHSA) in their publication SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach.
In this guidance publication, SAMHSA advises clinicians and treatment staff to:
- Realize the prevalence of trauma and understand the various, evidence-based paths for processing trauma.
- Recognize trauma in its many forms, including the common signs and symptoms.
- Seek to avoid re-traumatizing trauma victims.
Those three items are the big-picture, entry-level requirements that any clinician or treatment center must internalize in order to help trauma victims heal and process their past experiences. In addition to these general recommendations, SAMHSA identifies six core principles that lead to the most effective care for trauma survivors, including adolescents.
The Six Principles of Trauma-Informed Care
Adolescents with a history of trauma need to feel safe in order to heal. Care must be taken to avoid re-traumatization, which can result in unwanted, painful memories, and the detrimental rush of cortisol that causes both physical and emotional problems.
2. Trustworthiness and Transparency
In a treatment center for adolescents with a history or trauma, all staff – including clinicians, administration, and admissions staff – must conduct themselves in an open and honest manner. A young client is unlikely to open up and share difficult experiences if they get the sense they can’t trust the people who are supposed to help them.
3. Peer Support
Talking through the challenges of living with past trauma with other trauma survivors helps adolescents understand they’re not alone, and that their past trauma is not a life sentence, but rather something they can learn to move through and past. Peers help them develop the skills and techniques necessary to process trauma in healthy and productive ways.
4. Collaboration and Mutuality
SAMHSA advises treatment providers to recognize and implement this concept across all levels of treatment. The core is open, honest, and trusting relationships. This includes the relationships between treatment center staff and the public, therapists and patients, patients with each other, and therapists with other staff members. Reinforcing positive, honest relationships is essential in trauma recovery.
5. Empowerment, Voice, and Choice
To process trauma productively, trauma survivors benefit from having a voice in their treatment and a choice about how to manage their recovery. Treatment center staff should honor the ability of trauma survivors to heal by recognizing their inherent resiliency and strength. Clinicians should follow the lead of the survivor, and understand their role as facilitators rather than directors of the recovery journey.
6. Cultural, Historic, and Gender Issues
To best support trauma survivors, treatment center staff and clinicians must let go of a host of stereotypes, including those based on gender, ethnicity, race, sexual orientation, age, religion, or geography. Treatment centers must recognize the reality of institutional, systemic, and historical trauma, and recognize the value of both traditional and non-traditional cultural concepts of trauma, growth, and healing.
When the entire staff at a behavioral health treatment center for teens understands trauma and the role they play in helping survivors heal, they can work together to create a safe and supportive environment that promotes long-term recovery. This means creating a physical and emotional environment where survivors feel seen, heard, and understood. When someone with past trauma feels those three things – seen, heard, and understood – they’re more likely to open up, share, and allow themselves to be vulnerable without fear.
Treatment for Teen Trauma Survivors
The most effective treatment for teens with a history of trauma follows the integrated treatment model. This comprehensive, holistic approach – endorsed by SAMHSA and implemented in treatment centers worldwide – includes a combination of individual therapy, group therapy, family therapy, medication (as needed), lifestyle modifications, and complementary supports such as mindfulness, expressive therapies, experiential activities, and community support.
Individual therapy typically includes:
Family therapy typically includes:
- Multi-family groups
- Parenting groups
Mindfulness-based stress reduction typically includes:
- Mindful walking
Experiential therapies often include:
- General exercise
- Equine therapy (horses)
Expressive therapies typically include:
- Art therapy
- Creative writing
Community support typically includes:
- Group meetings for trauma survivors
- Group meetings for family members or trauma survivors.
- Find resources group support meetings on this resource page provided by the Trauma Survivors Network.
The exact combination of therapeutic approaches listed above depends on the specific needs of the teenager in treatment. After a full evaluation at a behavioral health center for teens, clinicians will create a treatment team and devise a treatment plan in collaboration with the teen survivor and their family. Each plan looks different because each individual is different.
One thing is common to all of them, however. They follow the protocols established by SAMHSA for creating a safe, supportive, and caring atmosphere where teenagers with past trauma can learn to process that trauma and live a life of their choosing. Treatment works – and the sooner a teen with a history of trauma or ACEs get treatment, the better their chance of sustained, lifelong recovery.