Trauma Informed Expressive Therapies
Trauma occurs when an individual witnesses or experiences emotional, psychological or physical injury and the result of the experience, or series of experiences, is one of extreme stress leaving the individual feeling helpless, alone and vulnerable. Traumatic experiences have been demonstrated to cause significant changes to the brain, specifically to an individual’s memory and ability to manage or process stress.
Traumatic events are multi-sensory experiences. Traumatic memories are often nonverbal and contain elements of sights, sounds, smells and physical sensation, which are difficult to access through verbal processing.
Trauma informed expressive therapies integrate knowledge of the impact of trauma on neurological development with the multi sensory expressive experiences of visual art, music, movement and drama in order to:
• Create a safe space to explore and process the impact of the traumatic event(s) and express related thoughts and feelings through direct and indirect creative experience.
• Regulate emotional responses to everyday interactions and experiences following a traumatic event by providing structured sensory stimulus and providing support and guidance in recognizing and processing triggers.
• Re-establish bonds and attachment to significant others or primary care givers through empathic metaphoric play and structured family or couples therapy.
• Enhancing brain functioning by using expressive experiences to process the memories of the traumatic event(s) and provide the memories with historical context enabling the individual to reconnect the sensory and declarative memories of the experience.
Definitions of Trauma and Related Disorders:
From the DSM-5:
Trauma- and stressor-related disorders include disorders in which exposure to a traumatic or stressful event is listed explicitly as a diagnostic criterion. These include reactive attachment disorder, disinhibited social engagement disorder, posttraumatic stress disorder (PTSD), acute stress disorder, and adjustment disorders. Placement of this chapter reflects the close relationship between these diagnoses and disorders in the surrounding chapters on anxiety disorders, obsessive-compulsive and related disorders, and dissociative disorders.
From American Psychological Association Glossary of Psychological Terms:
Posttraumatic stress disorder (PTSD) An anxiety disorder characterized by the persistent reexperience of traumatic events through distressing recollections, dreams, hallucinations, or dissociative flashbacks; develops in response to rapes, life-threatening events, severe injuries, and natural disasters.
From National Institute of Mental Health:
PTSD is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.
Types of Trauma-Related Disorders:
From the DSM-5:
Reactive Attachment Disorder: ‘Reactive attachment disorder of infancy or early childhood is characterized by a pattern of markedly disturbed and developmentally inappropriate attachment behaviors, in which a child rarely or minimally turns preferentially to an attachment figure for comfort, support, protection, and nurturance. The essential feature is absent or grossly underdeveloped attachment between the child and putative caregiving adults. Children with reactive attachment disorder are believed to have the capacity to form selective attachments. However, because of limited opportunities during early development, they fail to show the behavioral manifestations of selective attachments. That is, when distressed, they show no consistent effort to obtain comfort, support, nurturance, or protection from caregivers. Furthermore, when distressed, children with this disorder do not respond more than minimally to comforting efforts of caregivers. Thus, the disorder is associated with the absence of expected comfort seeking and response to comforting behaviors. As such, children with reactive attachment disorder show diminished or absent expression of possible emotions during routine interactions with caregivers. In addition, their emotion regulation capacity is compromised, and they display episodes of negative emotions of fear, sadness, or irritability that are not readily explained. A diagnosis of reactive attachment disorder should not be made in children who are developmentally unable to form selective attachments. For this reason, the child must have a developmental age of at least 9 months.’
Disinhibited Social Engagement Disorder: ‘The essential feature of disinhibited social engagement disorder is a pattern of behavior that involves culturally inappropriate, overly familiar behavior with relative strangers. This overly familiar behavior violates the social boundaries of the culture. A diagnosis of disinhibited social engagement disorder should not be made before children who are developmentally able to form selective attachments. For this reason, the child must have a developmental age of at least 9 months.’
Posttraumatic Stress Disorder (PTSD): ‘The essential feature of posttraumatic stress disorder (PTSD) is the development of characteristic symptoms following exposure to one or more traumatic events. Emotional reactions to the traumatic event (e.g. fear, helplessness, horror) are no longer a part of Criterion A. The clinical presentation of PTSD varies. In some individuals, fear-based re-experiencing, emotional, and behavioral symptoms may predominate. In others, anhedonic or dysphoric mood states and negative cognitions may be most distressing. In some other individuals, arousal and reactive-externalizing symptoms are prominent, while in others, dissociative symptoms predominate. Finally, some individuals exhibit combinations of these symptom patterns.’
Acute Stress Disorder: ‘The essential feature of acute stress disorder is the development of characteristic symptoms lasting from 3 days to 1 month following exposure to one or more traumatic events. Traumatic events that are experienced directly include, but are not limited to, exposure to war as a combatant or civilian, threatened or actual violent personal assault (e.g., sexual violence, physical attack, active combat, mugging, childhood physical and/or sexual violence, being kidnapped, being taken hostage, terrorist attack, torture), natural or human-made disasters (e.g., earthquake, hurricane, airplane crash), and severe accident (e.g., severe motor vehicle, industrial accident). For children, sexually traumatic events may include inappropriate sexual experiences without violence or injury. A life-threatening illness of debilitating medical condition is not necessarily considered a traumatic event. Medical incidents that qualify as traumatic events involve sudden, catastrophic events (e.g., waking during surgery, anaphylactic shock). Stressful events that do not possess the severe and traumatic components of events encompassed by Criterion A may lead to an adjustment disorder but not to acute stress disorder.’
Adjustment Disorders: ‘The presence of emotional or behavioral symptoms in response to an identifiable stressor is the essential feature of adjustment disorders (Criterion A). The stressor may be a single event (e.g., a termination of a romantic relationship), or there may be multiple stressors (e.g., marked business difficulties and martial problems). Stressors may be recurrent (e.g., associated with seasonal business crises, unfulfilling sexual relationships) or continuous (e.g., a persistent painful illness with increasing disability, living in a crime-ridden neighborhood). Stressors may affect a single individual, an entire family, or a larger group or community (e.g., a natural disaster). Some stressors may accompany specific developmental events (e.g., going to school, leaving a parental home, reentering a parental home, getting married, becoming a parent, failing to attain occupational goals, retirement).’
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Trauma- and Stressor-Related Disorders (265-290). Arlington, VA, American Psychiatric Association, 2013.
Gerrig, R. J., & Zimbardo, P. G. (2002). In Glossary of Psychological Terms. Retrieved from http://www.apa.org/research/action/glossary.aspx?tab=16
Post-Traumatic Stress Disorder (2016, February). In National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
Disclaimer: Due to the nature of this post, this information is meant to be informative and not serve as a diagnosis for trauma- and stressor-related disorders. If you believe you or someone you know needs help with trauma- and stressor-related disorders, please seek out a doctor or professional for a proper diagnosis.