CJ 720 Trauma & Crisis Intervention Blog

Strategies for Self-Care

No matter the type of trauma people experience, its effects on the brain and body can profoundly impact their lives. Van der Kolk (2014) discovered that trauma is not only a past event, but "the imprint left by that experience on mind, brain, and body" which "has ongoing consequences for how the human organism manages to survive in the present." Trauma is complex and systemic, impacting personal lives, relationships, careers, and interactions with the world (Rousseau, 2024). It can alter life paths, impair personal abilities, and cause physical and neurological damage that may or may not be repairable, with effects extending to hospitals, courts, and the criminal justice system (Rousseau, 2024).

Practicing self-care becomes essential when navigating the aftermath of trauma. Regular engagement in self-care strategies can strengthen resilience through social support and promote posttraumatic growth. Rousseau (2024) notes that self-care can provide a sense of control, allow individuals to pursue meaningful goals, and encourage healthy lifestyle choices. When developing a self-care practice, it is important to "be present and to engage in activities that nourish your mind, body, and soul" (Rousseau, 2024).

Self-care activities can be personalized to fit individual preferences, needs, or lifestyles. Examples of ideas for self-care include:

• Develop mindfulness practices such as meditation
• Do yoga
• Exercise
• Take a few deep breaths
• Prepare a nice meal
• Spend time with a good friend
• Read a good book
• Spend quality time with your family
• Get outside and spend time in nature
• Go on a hike
• Go see the ocean
• Take a relaxing bath
• Take a walk
• Meditate
• Start a gratitude journal or list
• Get a massage
• Get outside and get some sun
• Spend time with a pet
• Journal (Rousseau, 2024)

Creating a playlist with your favorite songs can help create a calm space for relaxation. Watching comfort TV shows or movies can also help with self-care by giving your mind a break. Additionally, taking a break from social media and technology can reduce distractions, allow individuals to reconnect with themselves, and minimize constant exposure to negative content, news, comparisons, and bullying. Drawing, painting, sculpting, or other creative outlets can allow individuals to process and explore their emotions and thoughts and express their feelings that may be difficult to verbalize.

Another important aspect of self-care is separating work life from home life. This can be easier said than done, especially in jobs involving high stress and critical incident exposure, such as those in the criminal justice field. After finishing work, individuals can take 10 minutes to sit in their car, reflect on their day, and engage in deep breathing. This brief pause can create an opportunity to shift their mindset, prevent work-related issues and stress from coming home with them, and process the events of their day.

Barriers to self-care often derive from misconceptions and personal challenges related to implementing it. One common barrier is the stigma surrounding self-care, with many viewing it as selfish and lazy (Connected Health and Wellbeing, n.d.). Social media trends have also commercialized self-care, leading many to believe it is expensive.

Another barrier is a lack of knowledge or awareness about how to start a self-care routine or create an effective self-care plan. Time constraints can make it difficult for individuals to find time for themselves, especially when managing busy work schedules, family responsibilities, and numerous commitments (Connected Health and Wellbeing, n.d.). Additionally, guilt may prevent people from engaging in self-care, as they may feel guilty about prioritizing their well-being when others rely on them.

Despite barriers to self-care, it is essential to prioritize it by engaging in activities that address all areas of wellness such as emotional, financial, social, spiritual, occupational, physical, intellectual, and environmental (Rousseau, 2024). Integrating self-care activities into daily routines can empower individuals by building resilience, encouraging self-compassion, and creating a sense of control. Self-care does not have to be costly, as it often includes simple, accessible, and low-cost practices such as mindfulness, exercise, deep breathing, spending time in nature, connecting with family or friends, or journaling. By taking the time to engage in self-care, individuals can better care for themselves and show up more fully for others.

References

Connected Health and Wellbeing. (n.d.). Understanding why we neglect self-care. https://www.connectedhealthandwellbeing.com/understanding-why-we-neglect-self-care/

Griner, T. (n.d.). Self-care and wellness: The important difference that may affect your mental health. https://anxietyandbehaviornj.com/self-care-and-wellness-the-important-difference-that-may-affect-your-mental-health/

Rousseau, D. (2024). Module 1: Introduction to trauma [Lecture Notes]. Blackboard. BU MET.

Rousseau, D. (2024, December 3). Vicarious trauma and self-care [Lecture recording]. Blackboard. BU MET.

Taking the High Road: The Mindful Approach to Traumatic Experiences

It is very difficult having to deal with the debilitating effects of trauma on a daily basis.  Imagine someone living their lives to the fullest and all of a sudden, something unexpectedly happens.  They could either witness or become a victim to a crime or an accident of any sort.  They may possibly find themselves stuck in a natural disaster.  They are in a state of shock and terror as the traumatic moment happens.  It gets to a point where the person becomes frozen in fear.  Then, having to relive the moment over and over for a very long time replaying the moments in their head.  Not only does it take a toll on a person’s mental, emotional and physical health, but it can lead to harming themselves as well as their loved ones and other people.

“Recovery from trauma is a long process and can often feel both daunting and overwhelming” (Rousseau, 2024).  However, not all hope is lost as we become more informed about the effects of it.  “Although no treatment has been shown to be effective for all people who are exposed to trauma, there are several that have evidence-based efficacy” (Rousseau, 2024).  We have discussed multiple approaches to addressing trauma this semester, stemming from medications to gender-responsive approaches.  There is one we have talked about in class that I would like to discuss in particular, mindfulness.

Mindfulness is defined as “the awareness that arises when paying attention to the present moment nonjudgmentally” (Kabat-Zinn & Hanh, 2009).  It enables the person to be more aware of thoughts that can lead to post-traumatic stress symptoms.  In addition, this technique shifts their focus into something more positive.  Practicing mindfulness on a continuous basis can help the individual concentrate more on physical feelings and regulating their emotions.  Not only does it bring awareness to thoughts occurring at the exact moment, but it lessens the severity of the negative impact that traumatic events have on the individual.

People have different ways of practicing this technique.  “Mindfulness puts us in touch with the transitory nature of our feelings and perceptions” (van der Kolk, 2014, p. 209).  It can start from practicing breathing techniques, where the individual shifts their attention to their breathing patterns.  Meditation is another technique that blends in well with mindfulness, as it helps the person clear their thoughts and deepen their connection with the body, mind and soul.  One other way of utilizing mindfulness in dealing with trauma is learning to accept the experience they endured.  Through acceptance, it encourages resilience in the individual and helps them to become stronger as they continue to live their lives.

From a personal experience, I have come to find that practicing mindfulness techniques has a wide range of benefits when it comes to mental health.  As someone who practices this technique on a regular basis, it alleviates stress and it does help to regularly control your emotions.  Practicing mindfulness helps with clearing your mind and you do tend to focus more on your breathing patterns.  Taking at least 5 - 10 minutes of your time to practice this skill makes a huge difference.

To conclude this post, traumatic events change a person’s life in many different ways.  It causes the individual to have a negative perspective because they will never be the same after experiencing such event.  When the individual opens up to engaging in mindful techniques, it encourages them to accept the things they cannot change in the past.  They learn to live with what occurred and become stronger in coping with the traumatic event.  “Mindfulness not only makes it possible to survey our internal landscape with compassion and curiosity, but can also actively steer us in the right direction for self-care” (van der Kolk, 2024, p. 284).  By forming that connection within, it helps the person with self-reflection and knowing that they are stronger and more resilient than they initially thought.  “It is important to remember that a first and crucial step to recovering from trauma is to reduce the symptoms that result, allowing for a deeper healing experience” (Rousseau, 2024).  Just remember that mindfulness may not fix the problem right away.  But with time, persistence and patience, it will pay off in the long run.

Rousseau, D. (2024). Module 4: Pathways to Recovery: Understanding Approaches to Trauma Treatment. Boston University MET CJ 720. Blackboard.

Kabat-Zinn, J., & Hanh, T. N. (2009). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Delta.

van der Kolk, B. A (2014). The body keeps the score: brain, mind, and body in the healing of trauma. https://ci.nii.ac.jp/ncid/BB19708339

The Use of EMDR in Patients With PTSD

 According to the lecture, EMDR refers to a psychotherapy approach that is used on patients who have experienced some sort of trauma. EMDR uses a series of bilateral stimulation, such as eye movement, desensitization, and reprocessing (Rousseau, 2024). EMDR is commonly used among those who have Post-Traumatic Stress disorder, in order to help cope with the traumatic memories one has. There are many ways in which PTSD can be treated, however the best way to treat it may be EMDR, that is because it allows patients with PTSD to process the traumatic memories that constantly haunt them (U.S. Department of Veteran Affairs, 2023). Moving forward, the psychotherapy approach may be most commonly used by veterans who experienced a traumatic event, such as a way. It is used to help reprocess the memory that brings them anxiety and fear, to a way that I would not cost them to fear the experience. 

However, the use of EMDR is not only used on patients who are veterans, but also victims of sexual abuse or physical abuse, such as children, or adults who suffered abuse as a child, but did not have the resources to seek for help. The majority of the time, these children will process these memories, in an unhealthy way that will allow them to shut off the part of them that will help process and heal from the event. In chapter 15 of “The Body Keeps the Score” , we are introduced to a patient named Maggy, in which she was sexually molested by her father at a young age. In order to cope with the trauma, her brain chose to forget the memory, which allowed her to not feel the pain of having to carry that trauma with her. (Van Der Kolk, 2015) Once Maggy began going to therapy, she confessed that her father had sexually molested her as a child, Maggy believed this was her fault. After a few sessions, she was introduced to EMDR, which allowed her to be able to reprocess the memory her brain chose to shut out, and accept that her father molesting her, was not her fault (Van Der Kolk, 2015).

There have been many studies that showed success rates the relief of PTSD symptoms. One success story would be Maggy’s story which showed a 100% success rate. However, there have been another thirty studies that have been conducted, which show positive incomes when it comes to the relief of PTSD symptoms among trauma victims (The Trauma Practice, 2024). There have been studies that showed approximately 80 to 90 percent of success rate among single event trauma victims (The Trauma Practice, 2024). Another example of case study is from the book “The Body Keeps the Score” by Bessel van der Kolk, the results showed that 60 percent of those who have received the EMDR approach to overcome their trauma have reported being wholly healed after their treatment. However, those who did not receive the treatment note that they relapsed after the case study concluded (Van Der Kolk, 2015). 

Reference: 

National Center for PTSD.(2023). Eye Movement Desensitization and Reprocessing (EMDR) for PTSD. U.S. Department of Veteran Affairs.   https://www.ptsd.va.gov/understand_tx/emdr.asp

 Rousseau (2024).Module 4: Neurobiology of Trauma Pathways to Recovery: Understanding Approaches to Trauma Treatment. MET CJ720: Trauma and Crisis Intervention. Boston University. 

The Trauma Practice. (2024, december 8). Does EMDR Work?. https://traumapractice.co.uk/does-emdr-work/

Van Der Kolk, B. A. (2015). The body keeps the score: Brain, Mind, and Body in the Healing of Trauma. Penguin Books.

Beyond “What Happened”: Trauma Counseling and the Importance of Pre-Treatment Work

Trauma counseling often begins with a simple yet profound question: “What happened?” However, as I’ve learned through Dr. Janina Fisher’s course, effective trauma treatment requires going far beyond recounting events. Understanding the neurobiological underpinnings of trauma is a critical first step in helping clients navigate the complexities of their symptoms, not just their memories.

This insight fills a significant gap I encountered during my earlier EMDR training. While my instructor emphasized the need for clients to achieve relative stability before initiating eye movement desensitization, I often felt unclear about how best to support clients in reaching that stage. Dr. Fisher’s structured approach to pre-treatment work—grounded in neuroscience and somatic awareness—offers a practical roadmap for clinicians like myself.

The Neurobiology of Trauma

Trauma changes the way our brain functions, locking us into survival mode. Understanding the roles of key brain structures—the amygdala, hippocampus, and prefrontal cortex—illuminates why trauma manifests as symptoms rather than discrete memories.

• Amygdala: This is the brain's alarm system, responsible for processing emotional reactions like fear and anxiety. Trauma can leave the amygdala overactivated, constantly signaling danger even in safe situations.
• Hippocampus: Responsible for forming and retrieving memories, the hippocampus often struggles under trauma. This results in fragmented or intrusive memories that are difficult to process.
• Prefrontal Cortex: This part of the brain governs decision-making and self-regulation. Trauma disrupts its ability to operate effectively, leaving clients reactive and overwhelmed.

For example, consider a scenario where someone doesn’t receive a text reply. For a trauma survivor, this minor incident might trigger unresolved feelings of abandonment from past relationships or childhood experiences. Their amygdala flares up, signaling danger, and they spiral into fear, sadness, and compulsive behaviors like repeatedly checking their phone. Despite rationally knowing the situation isn’t dire, their brain remains stuck in a reactive loop(Fisher, 2021).

The Body Remembers

Trauma isn’t just stored in the brain—it resides in the body. The phrase “the body keeps the score” rings especially true for trauma survivors, whose physical responses often include chronic muscle tension, altered breathing patterns, and unexplained pain. These somatic symptoms reflect the body’s ongoing attempts to process unresolved trauma van der Kolk, B. A. (2014).

Dr. Fisher’s Approach: Building Safety and Awareness

Dr. Fisher advocates for a foundational approach to trauma treatment that focuses on creating safety and integrating mind and body. Her methods address the “survival brain” by calming the amygdala and fostering a sense of security (Fisher, 2021).

Key Elements of the Approach:

1. Recognizing Triggers: Helping clients identify and understand their triggers is a crucial first step. This shifts their focus from reactive behavior to self-awareness.
2. Mindfulness Practices: Introducing mindfulness allows clients to observe their thoughts and bodily sensations without judgment. This opens the door for memories stored in the amygdala and hippocampus to flow naturally, reducing their intensity.
3. Somatic Awareness: Trauma-informed yoga, breathing exercises, and grounding techniques can release tension stored in the body and re-establish a connection to the present moment.
4. Prefrontal Cortex Activation: As clients develop emotional regulation skills and somatic safety, the prefrontal cortex regains functionality, enabling them to process trauma more effectively.

Application in Practice

For clinicians, this approach offers a pathway to help clients move out of the hypervigilant state often caused by trauma. By working with both the mind and body, we can help them lay the groundwork for deeper therapeutic work, such as EMDR or cognitive processing therapy.

A Call for Cultural Competency

Cultural considerations are essential in this work. Trauma manifests differently across communities, and factors like systemic oppression, family dynamics, and cultural stigmas around mental health shape clients’ experiences. Tailoring trauma treatment to account for these nuances is vital for fostering trust and efficacy.

Conclusion

Understanding the neurobiology of trauma transforms how we approach therapy. Rather than focusing solely on the question “What happened?” we can help clients address the lingering effects of trauma stored in their bodies and minds. By creating safety, integrating mindfulness, and fostering awareness of the brain’s survival mechanisms, we empower clients to move toward healing—one step at a time.

Dr. Fisher’s course has given me a renewed perspective on trauma treatment and the tools to approach this critical pre-treatment phase with greater confidence and compassion.

Equine-Facilitated Psychotherapy for Trauma

Developing safe relationships is crucial for the treatment of trauma-related disorders. In The Body Keeps the Score, van der Kolk asserts that “traumatized human beings recover in the context of relationships” (van der Kolk, 2014, p. 212). He further states that relationships provide “physical and emotional safety” (van der Kolk, 2014, p. 212). Individuals whose traumatic experiences occurred in the context of a relationship find it more difficult to develop safe and healthy relationships with other people. For these individuals, animal-assisted therapy provides an opportunity to build trusting relationships with animals. Equine-facilitated psychotherapy is a form of animal-assisted therapy that utilizes horses to help individuals recover from symptoms of traumatic stress. In The Body Keeps the Score, van der Kolk shares the case of fifteen-year-old Maria, who has an extensive history of childhood abuse and behavioral problems (van der Kolk, 2014). When traditional treatment approaches didn’t work for Maria, the residential treatment center she was staying at tried equine therapy. Maria credits this unique therapeutic approach for marking the turning point in her recovery. The safety and “visceral connection” Maria felt with her horse helped her open up to her counselor (van der Kolk, 2014, p. 153).

Equine-facilitated psychotherapy (EFP) is a novel approach for the treatment of trauma-related disorders. In EFP, an individual is paired with a horse and learns how to interact with and care for the horse over several weeks. Participants stay with the same horse for the duration of the treatment, if possible. A mental health professional leads group sessions where an individual learns skills ranging from “basic caretaking tasks, such as grooming and feeding…to horse handling skills, such as leading a horse around the arena” (Equine-Facilitated Psychotherapy: Facing Trauma With a Horse by Their Side, 2020). In order to accomplish these caretaking tasks, participants need to develop trust and safety with the horse. Horses are particularly suited for addressing traumatic stress in humans because of their predictable and responsive nature. According to Dr. Neria, Director of Trauma and PTSD at the New York State Psychiatric Institute, horses are “naturally hypervigilant and sensitive to verbal and nonverbal cues” (Fisher, 2021). When humans engage with horses, horses give them immediate feedback. This helps participants adjust their behavior in response to the horse’s feedback. Horses are also “patient and nonjudgemental,” which gives participants space to learn caretaking tasks and communication patterns without fear of retribution (Equine Therapy Helps to Heal PTSD, n.d).

Although there is no standard protocol for equine-facilitated psychotherapy, sessions generally last three months. There are three objectives of EFP: “1. safety 2. attachment 3. regulation” (Naste, 2017). Participants learn how to “recognize and respect boundaries” with the horse, as well as how to set their own boundaries and engage in safe physical contact with the horse (Naste, 2017). Participants also learn how to attune to the horse’s “non-verbal cues” and respond appropriately (Naste, 2017). This strengthens the attachment bond between the participant and the horse. Participants are able to apply the skills they’ve developed in EFP towards building safe relationships with other people. Equine-facilitated psychotherapy is a bottom-up regulation strategy. Similar to techniques such as meditation and yoga, EFP can decrease the activity of the sympathetic nervous system. Participants with trauma-related disorders are in a state of hyperarousal due to an overactive fight/flight system (van der Kolk, 2014). EFP can help these individuals regain the ability to feel safe in their bodies. Since EFP is a bottom-up regulation strategy, it doesn’t involve talking about traumatic experiences directly (Equine-Facilitated Psychotherapy: Facing Trauma With a Horse by Their Side, 2020). However, EFP can help individuals regulate their nervous system so that top-down approaches, if used later, are more effective.

Initial research shows that EFP can decrease symptoms of traumatic stress, including hypervigilance and dissociation. In a study of 63 veterans with PTSD, equine-assisted therapy was shown to decrease PTSD symptoms; these results were maintained three months post-treatment (Fisher, 2021). Case studies of children and adolescents with complex PTSD who underwent equine-facilitated therapy also show reduction of trauma-related symptoms and “behavioral dysregulation,” as well as improvements in “interpersonal skills, communication strategies, and overall social functioning” (Naste, 2017). There are several limitations to equine-facilitated psychotherapy. First, there is no standardized approach for conducting this therapy. More research is needed to develop EFP into an evidence-based treatment for trauma-related disorders (Equine-Facilitated Psychotherapy: Facing Trauma With a Horse by Their Side, 2020). Second, the high cost of horse maintenance and lack of insurance coverage for EFP decreases the accessibility of this treatment for the general population (Naste, 2017). Despite these limitations, equine facilitated therapy has the potential to help individuals learn to develop safe and healthy relationships. Establishing safe relationships is a pivotal step in an individual’s recovery from trauma-related disorders.

References: 

Equine Therapy Helps to Heal PTSD. (n.d.). NewYork-Presbyterian. Retrieved December 9, 2024, from https://www.nyp.org/newsletters/prof-adv/psych/equine-therapy-helps-ptsd

Equine-Facilitated Psychotherapy: Facing Trauma With a Horse by Their Side. (2020, January 22). McLean Hospital. Retrieved December 9, 2024, from https://www.mcleanhospital.org/news/equine-facilitated-psychotherapy-facing-trauma-horse-their-side

Fisher, P. W., Lazarov, A., Lowell, A., Arnon, S., Turner, J. B., Bergman, M., Ryba, M., Such, S., Marohasy, C., Zhu, X., Suarez-Jimenez, B., Markowitz, J. C., & Neria, Y. (2021). Equine-Assisted Therapy for Posttraumatic Stress Disorder Among Military Veterans. The Journal of Clinical Psychiatry, 82(5). https://doi.org/10.4088/jcp.21m14005

Naste, T. M., Price, M., Karol, J., Martin, L., Murphy, K., Miguel, J., & Spinazzola, J. (2017). Equine Facilitated Therapy for Complex Trauma (EFT-CT). Journal of Child & Adolescent Trauma, 11(3), 289–303. https://doi.org/10.1007/s40653-017-0187-3

Van Der Kolk, B. (2014). The body keeps the score: brain, mind, and body in the healing of trauma. Penguin Books.

Understanding the Relationship between Childhood Trauma and Codependency 

As humans, our early experiences have a huge impact on who we become, especially if they include traumas like abuse, neglect, or unreliable caregiving. These types of childhood trauma can cause emotional damage that persists throughout an individual's life, many of which affect how we handle relationships as adults. Codependency, a tendency where people put others' needs above their own, is a common symptom of trauma. In his book The Body Keeps the Score, trauma specialist Dr. Bessel van der Kolk analyzes the ways that trauma impacts the body and brain. His research provides an understanding of why codependency in relationships is a common problem for those who have unresolved childhood trauma (van der Kolk, 2014).

Codependency is defined as an unhealthy reliance on relationships to satisfy emotional needs (van der Kolk, 2014). Codependent people often repress their own needs, go above and beyond for others, and feel that their value is based on their capacity to "fix" or care for others. Even though this behavior may appear empathetic, it frequently compromises the codependent individual's well-being. According to van der Kolk's explanation, trauma limits self-awareness and emotional control, making it challenging for survivors to establish a positive sense of self. Codependent tendencies may develop as a result of these traumatic disturbances. Common signs of codependency include the inability to establish and enforce boundaries, low self-esteem, dependency, and close monitoring of the wants of others, as well as a fear of abandonment (van der Kolk, 2014).

Our early relationships can be significantly impacted by childhood trauma, which often results in codependency. Trauma physically changes the brain, especially the prefrontal cortex, which aids in self-control and decision-making, and the amygdala, which regulates our fear reactions (van der Kolk, 2014). People who experience these changes are often constantly on edge, anticipating danger, and often develop an excessive need to control other people's emotions to prevent rejection or conflict. Additionally, trauma interferes with children's ability to form stable relationships. Children who experience inconsistent care or neglect may grow up to question their own value and learn to put the needs of others before their own. As a result of the fear of being abandoned, this can cause them to depend on toxic, or even dangerous relationships as adults, often refusing or feeling incapable of leaving (Bowlby, 1988). Another common reaction to trauma is people-pleasing, or "fawning." This behavior can develop as a way of avoiding potential dangers, frequently crossing the individuals personal boundaries, in order to keep relationships free of conflict (van der Kolk, 2014).

Trauma affects not only the brain, but stores itself in the body and nervous system, often leading to negative physical impacts (van der Kolk, 2014). In order to treat these symptoms, research suggests that mindfulness techniques such as yoga, meditation, and somatic therapies (including neurofeedback and EMDR), can help process these emotions in a safe space while restoring the connection between the mind and body (van der Kolk, 2014). Learning to set boundaries, particularly how to say "no" without feeling guilty, is another important part of recovery and is important for overcoming codependency. In order to respect one's own needs and create healthy relationships, therapy can be a very useful tool (Whitfield, 1987). Lastly, reestablishing a sense of self is important because trauma can cause people to feel isolated or worthless. Journaling, painting, or dancing are examples of creative practices that can help people rediscover who they are and regain their sense of autonomy (van der Kolk, 2014).

Without treatment, trauma can build up, and become evident by unregulated emotions, intrusive thoughts, and intense relationships. According to Dr. Bessel van der Kolk, trauma can alter our brains' physical structure and impact emotional stability, which makes it more difficult to build healthy, satisfying relationships. However, it is important to note that recovery is possible! Survivors can overcome codependent tendencies and establish relationships based on respect and independence by addressing the underlying causes of trauma and learning how to better care for themselves. 

References 

Bowlby, J. (1988). A Secure Base: Parent-Child Attachment and Healthy Human Development. Basic Books.

Van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.

Whitfield, C. L. (1987). Healing the Child Within: Discovery and Recovery for Adult Children of Dysfunctional Families. Health Communications.

Trauma-Informed Medical Care

My blog post focuses on trauma-informed care, its benefits, and ways trauma-informed practices can be implemented in other areas and fields that often interact with justice-involved people. Here, I focus on trauma-informed medical care. It is important to note that trauma-informed practices can help both offenders and victims of crimes in countless ways.  

Trauma-Informed Medical Care:  In a small study of sexual assault survivors, all participants report avoiding routine medical care after their sexual assaults. The details of each person's experiences differ significantly. However, none of the participants experienced sexual assault in a medical setting- an important distinction as we discuss why this population avoids care. Medical care often consists of exams with varying degrees of invasiveness, and there is usually a perceived power imbalance between provider and patient. Mary Farley (2022) writes about survivors avoiding medical care, "Avoiding these appointments, screenings, and tests comprise long-term care. For SA assault survivors, annual gynecological physicals have similarities to the details of their assault." (Farley, 2022, p.4). Farley (2022) suggests that trauma-informed care in primary care settings might have a significant impact on survivors and their willingness to consent to routine medical procedures and screenings.  Farley (2022) notes one key barrier to more providers embracing a trauma-informed approach: time.  Providers often try to see as many patients as possible daily, making visits rushed and usually impersonal. In this course, we discuss trauma-informed yoga or trauma-sensitive yoga. Dr. Rousseau (2024) includes in her week six lecture, the 'Yoga Service Council's Best Practices for Yoga with Veterans,' a critical point that applies to all trauma survivors is maximizing safety, control, and predictability. Whether in the medical setting or in a yoga class, survivors of any form of trauma will feel safer the more in control they feel.

Control and predictability are critical. Applying these principles to medical care, survivors must know what to expect, and they also must know their provider respects the word "no," something that was likely not respected during their assault.  

Farley, M. (2022). Access Barriers to Long-term Healthcare for Female Sexual Assault Survivors. University of Central Florida STARS.

Rousseau , D. (2024, August). Trauma and Crisis Intervention . Module 6. Boston, MA.

Addressing Childhood Trauma

Childhood trauma can forever shape how we see ourselves, our relationships, and the world around us. Children undergo constant brain development, it is particularly occurring during the first three decades of life. For this reason, childhood trauma can be very complex.  Children who don't feel safe in infancy have trouble regulating their moods and emotional responses as they grow older (Van der Kolk, 2014). To understand childhood trauma, it is important to understand the neurobiology of trauma. The neurobiology of trauma is essential to understand when discussing childhood trauma because it is important to understand what is physically occurring within the human body when undergoing trauma. There is growing evidence that exposure to even a single event can alter the way one's brain functions (Rousseau, 2024). The human brain consists of the following:

Brain Stem: Responsible for our most primitive functions and found in all mammals. The most important functions of the brain stem include unconscious processes such as breathing, heart rate, respiration, and blood pressure.

Cerebellum: Responsible for the coordination of more complex processes, such as posture and blinking.

The Four Brain Lobes: Parietal Lobe, Temporal Lobe, Occipital Lobe, and the Frontal Lobe.

Frontal Lobe: The frontal lobe generates behaviors, forms personality, and maintains verbal fluency; it is the most advanced lobe.

(Rousseau, 2024)

The frontal lobe plays a crucial role in emotional regulation. Childhood trauma can affect the development of the prefrontal lobe in a child. Someone who has experienced severe trauma may have a smaller volume of or developmental issues with the prefrontal cortex. This can lead to hypersensitivity to stressful environments, an inability to self-regulate emotions, and increased levels of fear and anxiety (Rousseau, 2024).Due to this, the childhood mind is very fragile. This could lead to better understanding when working with justice-impacted youth as it could possibly help understand certain behaviors. What children are exposed to or experience at a young age can be detrimental. Childhood trauma can present itself in different ways, such as bullying, medical trauma, sexual abuse, traumatic grief, and early childhood trauma (The National Child Traumatic Stress Network). For this reason, it is crucial for a child to have a supportive and safe relationship with someone in their life where they feel comfortable speaking openly about anything.

The largest study on childhood trauma, the Adverse Childhood Experiences (ACE) study, revealed much information on the topic. It was a collaboration between the CDC and Kaiser Permanente, with Robert Anda, MD, and Vincent Felitti as co-principal investigators. The study generally revealed that traumatic life experiences during childhood and adolescence were far more common than expected (Van der Kolk, 2014). As the ACE score rises, chronic depression in adulthood also rises dramatically (Van der Kolk, 2014). The study found that as the number of ACE categories increased, so did the number of related conditions, such as:

Alcoholism and alcohol abuse

Chronic obstructive pulmonary disease

Depression

Drug use

Heart disease

Liver disease

Risk of partner violence

Smoking

Suicide

Overall decline in quality of life

(Rousseau, 2024)

Childhood trauma can have many negative long-term effects. Therefore, it is important to understand how children can be helped to heal from these effects. Some practices that can aid in healing include yoga, sanctuary mode, sand tray therapy, and trauma-informed behavioral therapy (Rousseau, 2024). TF-CBT (Trauma-Focused Cognitive Behavioral Therapy) is a structured, short-term treatment model that effectively improves a range of trauma-related outcomes in 8-25 sessions with the child/adolescent and caregiver. It addresses many other trauma impacts, including depression or anxiety, cognitive and behavioral problems, improving the participating parent’s or caregiver’s personal distress about the child’s traumatic experience, effective parenting skills, and supportive interactions with the child (About Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) - TF-CBT Certification Program, 2023). Healing childhood trauma is important for enhancing quality of life. It helps individuals move on from experiences where they may have felt helpless, giving them the chance to regain their power and improve their lives. Understanding the foundations of childhood trauma is important within the criminal justice field. We have a responsibility to care and provide rehabilitation and support. Especially to our justice-impacted youth.

References:

Van, K. B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma.

Rousseau, D. Module 2, (2024) BU Learn. Retrieved from https://learn.bu.edu/bbcswebdav/pid-13973861-dt-content-rid-107726427_1/courses/24sum2metcj720so2/course/module2/allpages.htm

Rousseau, D. Module 3, (2024) BU Learn. Retrieved from https://learn.bu.edu/bbcswebdav/pid-13973862-dt-content-rid-107725988_1/courses/24sum2metcj720so2/course/module3/allpages.htm

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