Therapies for Adolescent PTSD and Early Trauma
We recently published an article here called “Behavioral Health Treatment Centers Help Teens Overcome Trauma.” That article offered an overview of what trauma is and how trauma can lead to long-term, adverse physical, psychological, social, and emotional consequences. We then presented the fundamentals of a framework for processing, healing, and moving beyond trauma that’s called trauma-informed care.
This article will focus on one evidence-based approach – within the broader context of trauma-informed care – to treating teens with a history of trauma that has helped people recover from trauma for close to three decades: Seeking Safety.
In fact, we’ve already published a short article on this approach: What is Seeking Safety?
You can read that article for a quick primer on Seeking Safety, then continue reading this article to learn more about Seeking Safety and why mental health professionals consider it one of the most effective ways to help adolescents process past trauma and start the road to recovery.
Seeking Safety Helps Treat Trauma and Co-Occurring Disorders in Adolescents
Let’s focus by refreshing our definitions, starting with trauma and co-occurring disorders. The website Trauma-Informed Care: Implementation Resource Center defines trauma this way:
“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.”
When specific types of trauma happen early in life, they’re called adverse childhood experiences (ACEs). The Centers for Disease Control (CDC) indicates that ACEs correlate with a host of physical, emotional, and psychological complications during adolescence and later in life. Long-term psychological, emotional, and behavioral consequences of ACEs include alcohol/substance use disorders (AUD/SUD), behavioral and emotional disorders, including post-traumatic stress disorder (PTSD), depression, and anxiety. Long-term physical consequences of ACEs include diabetes, hypertension, cardiovascular disease, cancer, and asthma, among others.
That’s it for our definition of trauma, for now – with that necessary diversion to explain ACEs. To learn more about ACEs and trauma-informed care, please read this article here.
Now, here’s a definition of co-occurring disorders:
“When a person – child, adolescent, or adult – is diagnosed with a mental health disorder and an alcohol/substance use disorder (AUD/SUD) at the same time, they receive a dual diagnosis, and have what clinicians call co-occurring disorders.”
The reason we give you both those definitions is because Seeking Safety (SS) was initially created to help treat people with co-occurring trauma and alcohol or substance use disorder. However, since its creation in 1992 by Harvard graduate student Lisa M. Najavits – who now has a Ph.D. and decades of clinical experience – mental health professionals discovered that SS is an effective treatment for both trauma and AUD/SUD separately, as well as when they co-occur.
We’ll focus on how Seeking Safety helps teens with post-traumatic stress disorder (PTSD), ACEs, or a history of trauma.
How Seeking Safety Helps Teens with Trauma/PTSD
The prime distinguishing characteristic of Seeking Safety for the treatment of adolescent trauma, in comparison to other approaches to treatment, is something most people don’t expect, but – especially people with a history of trauma – are almost always interested to hear more about.
Here’s what we mean:
Treatment with Seeking Safety does not require individuals to dive deep into their trauma narrative or spend time recounting details of their traumatic experiences.
Many people avoid treatment for past trauma for that very reason: they don’t want to spend time going over and over memories of the past experiences that cause them the most pain. It makes sense, and anyone with even a hint of trauma in their past can relate.
That’s the first way that Seeking Safety helps adolescents with a history of trauma: by not asking them to recount the traumatic events of their past in detail as the main focus of their treatment. The seeking safety approach avoids re-traumatization. In order to accomplish that important goal, clinicians using SS follow five core principles.
Seeking Safety: Five Core Principles
- This may be redundant, but it’s crucial. People with PTSD need to feel safe during treatment. When they don’t feel safe, the chances of successful treatment decrease.
- Integrated Treatment. The SS model prioritizes the simultaneous treatment of trauma and any additional mental or behavioral disorder, such as depression, anxiety, or AUD/SUD.
- The founders and creators of SS realized that one thing trauma survivors and people with AUD/SUD have in common is a loss of ideals. Seeking Safety helps people rediscover their ideals and implement them in their day-to-day lives.
- Content Areas. Seeking Safety always includes work on four areas of an individual’s life: cognitive (thinking), behavioral (doing), interpersonal (relationships), case management (treatment progress).
- The Role of the Clinician. Mental health professionals who treat teens pay close attention to and monitor their emotional responses, practice responsible self-care, and self-regulate to ensure their role as clinician is as objective as possible, and their clients feel safe, seen, and understood.
Those five core principles allow the Seeking Safety model to work for a wide range of people with a broad scope of traumatic experiences as well as a variety of emotional or behavioral disorders.
Seeking Safety: Skills That Make a Difference for Teens with Trauma/PTSD
Before we discuss the skills that Seeking Safety (SS) teaches, it’s worth taking a moment to discuss one aspect of SS: the adaptability. Among treatments for PTSD and AUD/SUD, this approach is probably the most flexible ever devised. If you read our articles, you know we neither use hyperbole nor exaggerate any claims, especially where adolescent mental health is concerned.
But SS is unique and flexible. It works in and for all the following scenarios and populations:
- Group or individual therapy
- Females, males, and across gender identities
- Adolescents or adults
- Any level of care and any length of treatment:
- All types of trauma
- All types of AUD/SUD
In addition, evidence shows Seeking Safety (SS) works across treatment contexts and helps people with trauma that’s severe and not severe. Clinicians successfully apply SS principles in homeless populations, criminal justice scenarios, for people with severe mental health issues, and military combat veterans.
The 25 skills of Seeking Safety all address one or a combination of the three domain areas – cognitive, behavioral, interpersonal – and are taught in the context of treatment topics. Here are 10 of the most common and effective treatment topics found in SS, with the domain or they address and a brief description of the skills they teach.
1. Safety (Combination of Domains)
Teen and therapist discuss what safety means to them and brainstorm strategies for staying and feeling safe.
2. Taking Good Care of Yourself (Behavioral)
Teen and therapist discuss how well they take care of themselves, and devise at least one practical, immediately applicable self-care technique each session.
3. Honesty (Interpersonal)
Teen and therapist discuss the importance of honesty in recovery by addressing questions such as When is it safe to be honest? and What are the consequences of dishonesty?
4. Asking for Help (Interpersonal)
Teen and therapist address reasons why people may not ask for help and create strategies and tactics for asking for help when necessary.
5. Recovery Thinking (Cognitive)
Teen and therapist discuss how mental patterns or patterns of thought influence the present experience of past trauma, and work on replacing old, maladaptive patterns of thought with new, productive patterns of thought through think aloud and rethinking
6. Setting Boundaries in Relationships (Interpersonal)
People with a history of trauma often have problems with boundaries: they either say yes too much or no too much. Teen and therapist discuss the benefits of yes and no in relationships, and together identify productive ways to say yes and no in their lives, which helps them set firm and healthy relationship boundaries.
7. Healthy Relationships (Interpersonal)
Teen and therapist discuss the impact of relationships on trauma. Therapists help teens identify the difference between life-affirming relationships and life-interrupting/attenuating relationships. Teen and therapist then identify the presence or absence of relationships in the teen’s life, and help the teen learn techniques for cultivating positive, life-affirming relationships.
8. Red and Green Flags (Behavioral)
Red means danger and green means safety. Teen and therapist work together to identify red flag and green flag situations – and more importantly, how to cultivate and move toward green flag situations, and minimize or avoid red flag
9. Coping with Triggers (Behavioral)
Triggers are people, places, or things that elicit a behavioral or emotional response that can lead to a relapse, in the case of AUD/SUD, or re-traumatization, in the case of PTSD. In SS therapy, therapists simplify trigger management to a simple three-step process: (1) change who you’re with, (2) change what you’re doing, and (3) change where you are.
10. Life Choices (Combination)
This typically takes place toward the end of a course of treatment as a way to review what a teen has or hasn’t learned. The therapist takes a slip of paper from a hat (figuratively speaking) that has a challenging situation written on it. The teen then decides how they’ll react, what SS skill to use, and discuss how and why they think that particular skill fits that particular scenario. This process helps reaffirm what a teen learned during treatment, and identify the progress they still need to make.
Two things unite all 20 examples above: (1) they’re not traumatic, and (2) they apply to anyone, anywhere, anytime, with either a history of trauma or a current AUD/SUD. In addition, Seeking Safety treatment therapy focuses on the present, and does not require teens to talk about their trauma or their addiction in detail. Instead, Seeking Safety clinicians and teens focus on how to create a more fulfilling life today, now, in the present moment.
Evidence Shows Seeking Safety Works for Teens
When you read about something that seems too good to be true, it’s almost always too good to be true. When you dig into it, you find out the initial claims about [insert thing that’s too good to be true] are not really what you thought.
That’s not the case with treatment for trauma using the seeking safety model.
The claims we make above are all true about Seeking Safety:
- It works for all types of trauma: early, recent, simple, or complex
- It works for all types of addiction: alcohol and all types of drugs
- SS works for all age groups, from adolescents to adults
The last thing we want you to know about Seeking Safety – especially if you’re the parent of a teenager with co-occurring disorders – is that it helps teens overcome both their trauma and their second mental health, behavioral, or addiction disorder at the same time.
In that way, the Seeking Safety model helps teens and families heal and grow on all levels. Because the SS model focuses on the present moment, teens, parents, and families can experience the benefits of treatment almost as soon as treatment begins – and that statement is evidence-based: no exaggeration or hyperbole here, at all.
