The Trauma Pandemic
Lucy Schafer, University of Southern California
Untreated trauma following a shocking or traumatic incident (recurrent or not) can have a long term impact on our physical and mental health. The literature has shown time and time again that potentially traumatic events (PTE) happen all around us, everyday — from car crashes, to chronic illness diagnoses, to physical, emotional, or sexual abuse. What exactly are Potentially Traumatic Events? Well, PTEs refer to an individual experiencing or witnessing actual or threatened death and/or serious injury. They can occur on the large scale-level, at crowded events affecting a large number of people, such as mass shootings and natural disasters, or they can occur at the individual level, such as exposure to abuse, violence, injury, and/or illness. Because PTEs encompass a broad range of experiences, they reach and affect a large number of people. According to a 2016 study, about 60% of children have been exposed to a PTE in the last 12 months and about 66% of adults had been exposed to at least one PTE during childhood, if not many (Marsac, et al., 2016).
Well, trauma has consequences!
The psychological reaction to trauma is known as post-traumatic stress symptoms (PTSS). The negative effects range from intrusive flashbacks, thoughts or memory, cognitive impairments (i.e. memory), negative mood changes. Additionally, it impacts individuals in so many other ways inferred from the positive correlation of poor physical health outcomes into adulthood with childhood trauma (Marsac, et al., 2016). Significant negative experiences, such as a PTE, can inhibit the proper development of neural networks and functioning. The frequency and regularity with which traumatic events happen today explains the large population currently struggling to cope with trauma of all types. Trauma related mental health issues can no longer go unnoticed because of the grossly negative impacts that couple them.
So, what are we doing about it?
Because of the frequency of PTEs in everyday life, I argue that everyone you meet has likely been exposed to a PTE at some point in their life, whether as a witness or as the individual, themselves. Let’s say for argument’s sake that this is true. Knowing how widespread these events are and how adverse their impacts are, what can we do to relieve post-traumatic stress symptoms and what can we do to prevent them altogether?
Mindfulness-based therapies are one therapeutic practice that aims to alleviate symptoms of PTSD which PTSS predicts. You can read about PTSD, its negative symptomatology and how we can utilize mindfulness-based therapies to address the mental health issues that couple such disorders here in the comprehensive literature review conducted by SoundMind Solutions CRO, Sanyia Soni, and myself.
To reduce the frequency of intrusive thoughts and retraumatization after PTE, aside from mindfulness-based therapies (summarized in my last article (above)), how can we foster a system that is trained and well-versed in handling and understanding individuals’ needs post-trauma? That’s where trauma-informed care comes in.
The model of a trauma-informed approach has emerged as a result of increasing acknowledgement of the widespread impact of trauma. Mental health services are becoming less and less stigmatized as people begin to prioritize their mental wellbeing. So, trauma-informed care was introduced to provide services for struggling individuals; it focuses on understanding each individuals’ needs as a result of trauma (Muskett, 2013). The literature surrounding a trauma-informed approach shows that the model consistently focuses on four key aspects: I) understanding how widespread the impact of the trauma is; II) using knowledge of how the trauma has impacted the patient or individual’s psychopathology to provide informed care practices; III) preventing retraumatization by ensuring the patient or individual feels connected, and valued; IV) understand how the trauma’s impact reaches beyond the patient or individual but also the staff, family, etc (Muskett, 2013 and Marsac, et al., 2016).
Additionally, the incorporation of a trauma-informed approach is important especially within pediatric healthcare environments, because PTEs often result in a medical visit. This can often mean retraumatization, because of the hostile environment that hospitals can foster, especially for children. Medical procedures and routines can be very frightening and invasive for a child; therefore, we must ensure that we are incorporating trauma-informed care even on routine check-ups. This is a necessary measure to avoid both the retraumatization of a past PTE and to prevent a PTE from occurring during the hospital visits (Marsac, et al., 2016).
As aforementioned, trauma has undesirable impacts/consequences that can manifest in your physical health years after a traumatic event. For example, studies have found a positive correlation between childhood trauma and problems of physical health occurring later into adulthood, such as: heart disease, diabetes, unplanned pregnancies, etc (Muskett, 2013). The link between childhood trauma and negative health outcomes spanning long into adulthood is too great to be ignored. We must begin implementing trauma-informed care globally to achieve better health outcomes and to encourage a stronger awareness of the impact of traumatic experiences both within the walls of a hospital and outside.
Trauma related mental health is no longer something that we can ignore. It is a pandemic that reaches far and wide, and we must address it.
I might start to sound like a broken record, but I truly believe that trauma has consequences deeper than we understand. Trauma-informed care has strong potential to help decrease PTSS and PTE occurrences within a hospital. However, the future must focus on preventative measures for trauma, not solely how to mindful one’s medical practice post-trauma. According to the American Psychiatric Association, post-traumatic stress disorder (PTSD) is one of the only psychiatric, psychological disorders that has one obvious, clear onset event — the traumatic event itself (American Psychiatric Association, 2013). Therefore, we can incorporate preventative measures to counteract the possibility of PTSS by interfering after a clear onset traumatic event.
Intrusive memories of a traumatic experience are often the most distressing symptom of PTSD and predict other symptoms. These intrusive memories can arise within the first few days post-trauma. Because of this, we have the opportunity to act early in the memory consolidation process after any individual has suffered a trauma. Most preventative methods for intrusive memories post-trauma have focused on the synaptic process of memory consolidation, because it is during this period that one has a higher likelihood of altering memories or interfering in the consolidation process (Iyadurai et al., 2019).
There is a gap in the literature regarding the fundamental activity that occurs on the molecular level during the consolidation process. Although, one study investigated the role of N-Methyl D-Aspartate (NMDA) in synaptic consolidation. Nitrous oxide has been found to block NMDA receptors. The researchers had the experimental group breathe in nitrous oxide for 30 minutes post-viewing a traumatic film, based on this finding in hopes of inhibiting consolidation. They found that when compared to the control group, the experimental group experienced less intrusive memories during a 7-day window of observation (Das et al., 2016).
Although limited, the existing literature shows that there is potential in creating early, post-trauma, prevention-based treatments such as nitrous oxide inhalation as a means of reducing intrusive memories both short-term and long-term. This is significant for reducing post-traumatic stress disorder (PTSD) and acute stress disorder (ASD) symptoms for any given individual, because intrusive memories can be one of the earliest signs of PTSD and ASD, sitting at the core of their symptomatologies, among other psychological and neurological disorders. Therefore, taking steps to reduce intrusive memory occurrence post-trauma has a promising potential to prevent stress disorders such as PTSD and ASD (Iyadurai et al., 2019).
I have shared the frightening statistics that demonstrate the frequency of traumatic events and the large-scale impact that it has on us. With this knowledge, we must begin to prioritize not only preventing retraumatization and treating PTSS, but we must prioritize our future by seeking change. In the same way that we attempt to not avoid falling off our bikes altogether, rather than having a box of bandaids handy. We must also create a system that aims to prevent post-traumatic stress symptoms from occurring, immediately post-trauma.
About me:
My name is Lucy. I am beginning a research-based mental health blog! I am a member of the research team at SoundMind Solutions — a mental health startup dedicated to providing accessible, individualized, virtual mental health care. As I continue to work with SoundMind Solutions, I will also be pursuing a personal goal to further my knowledge in mental health research.
I will be publishing articles after reviewing and drawing from different literature sources to provide my readers with informed assessments and critiques. I believe that research should be open-access, accessible to anyone and everyone who needs, especially research investigating mental health. Although it is only a small step, I believe that creating and contributing towards a mental health research library is one thing I can do to tackle the task of achieving a comprehensive trauma and mental health-informed system that benefits all.
References:
Das, R. K., Tamman, A., Nikolova, V., Freeman, T. P., Bisby, J. A., Lazzarino, A. I., & Kamboj, S. K. (2016). Nitrous oxide speeds the reduction of distressing intrusive memories in an experimental model of psychological trauma. Psychological medicine, 46(8), 1749–1759.
Iyadurai, L., Visser, R. M., Lau-Zhu, A., Porcheret, K., Horsch, A., Holmes, E. A., & James, E. L. (2019). Intrusive memories of trauma: A target for research bridging cognitive science and its clinical application. Clinical psychology review, 69, 67–82
Muskett, Coral. (2013). Trauma-Informed Care in inpatient mental health settings: A review of the literature.International Journal of Mental Health Nursing, 23(1), 51–59.
Marsac, M. L., Kassam-Adams, N., Hildenbrand, A. K., Nicholls, E., Winston, F. K., Leff, S. S., & Fein, J. (2016). Implementing a trauma-informed approach in pediatric health care networks. JAMA pediatrics, 170(1), 70–77.
