Once considered a focused style of treatment for a small subset of patients, trauma-informed care (TIC) is now a critical component of mental healthcare for a wide range of conditions. Due to the high rates of trauma exposure within the general US population, this approach is becoming widespread within both inpatient and outpatient settings, for clients of all ages.
As an essential ingredient of evidence-based treatment, TIC is central to Newport Healthcare’s programming for teens and young adults, and informs everything we do, from the clinical and experiential modalities we utilize to our choices of furniture and colors in our treatment environments. Our clinical model of care views mental health disorders and co-occurring substance use as manifestations of trauma and attachment wounds. Hence, clinicians and support staff are trained in trauma-informed modalities, and understand the universality of trauma and its impact on our patients.
Moreover, the collective trauma catalyzed by the pandemic is exponentially expanding the number of individuals who need the support of trauma-informed care—and the majority of those are adolescents and emerging adults. While collective trauma has different effects than childhood trauma, it nevertheless carries a high risk of related mental health issues, including an increased likelihood of suicide.
Is There a Difference Between Big T and Little t Trauma?
In the mental health field, traumatic experiences are sometimes categorized as big T vs. little t trauma. The idea is that some traumatic events are more intense and severe than others. Big T Trauma is generally related to a life-threatening event or situation. This could be a natural disaster, a violent crime, a school shooting, or a serious car accident. In addition, acute psychological traumas, such as the death of a parent, are part of the big T trauma definition. Chronic (ongoing) trauma, such as repeated abuse, can also qualify as big T trauma.
Little t trauma refers to events that typically don’t involve violence or disaster, but do create significant distress. For young adults, examples of small trauma might be a breakup, the death of a pet, losing a job, getting bullied, or being rejected by a friend group. While these incidents don’t threaten a young adult’s physical safety, they can produce the same trauma responses in adults and children as big T trauma does. In fact, there is now evidence that repeated exposure to little t trauma can cause more emotional harm than exposure to one big T traumatic event.
Newport Healthcare’s model of care doesn’t distinguish between big T and little t trauma. What matters is the impact the traumatic experience had on the individual and how it continues to affect their life. “It’s not what happened on the outside, it’s what happened on the inside,” says Barbara Nosal, PhD, LMFT, LADC, Newport’s Chief Clinical Officer.
Ultimately, any event or ongoing situation that causes distress, fear, and a sense of helplessness qualifies as trauma, and can have negative effects on young adults. Traumatic stress can catalyze PTSD, depression, anxiety, substance abuse, physical problems, and other mental health and co-occurring disorders. Childhood trauma is a significant factor in both depression and anxiety. There is also a strong association between traumatic childhood experiences and substance abuse, as well as evidence of a link between trauma and eating disorders. Traumatic stress is associated with a higher risk of suicide.
An Underlying Factor in Mental Health and Co-Occurring Disorders
The first step in understanding why trauma-informed treatment services are so important is to grasp just how common trauma is, and how it impacts emotional, mental, relational, and physical development. Trauma can take many forms and can impact children, adolescents, and adults. Its effects can stem from an acute incident, or derive from ongoing patterns of chronic negative experiences. The unfortunate prevalence of trauma underscores the critical role that a trauma-informed perspective plays in evidence-based mental healthcare.
According to the US Centers for Disease Control (CDC), trauma due to violence and abuse occurs at incredibly high rates, affecting vast segments of the population from an early age. The CDC’s statistics on trauma show that one in four children experience some form of maltreatment (physical, sexual, emotional abuse). The ACE questionnaire was developed to determine the level of trauma an individual experiences in childhood, in an effort to determine the possible extent of the impact.
Know the Facts
90% of people who seek treatment for personality disorders, substance abuse, and other mental health disorders, including anxiety and depression, were exposed to significant trauma in childhood.
The Impact of Trauma on the Brain
Neuroscientists have identified numerous ways in which the structure and development of the brain is impacted by traumatic experiences. This is especially true during infancy and childhood, when the brain is forging important connections between the neuropathways that govern thoughts, feelings, and behaviors. But this development can be derailed when a child is exposed to trauma, leading to
- Impairment in mood regulation
- Difficulty regulating behavior
- Problems with executive functioning
- Trouble forming healthy interpersonal relationships
- Increased risk for physical health concerns like cardiovascular disease, diabetes, obesity, and more.
Shifting Mindsets, Shifting Treatment Environments
Given the widespread nature of trauma, the majority of teenagers and young adults who seek treatment have some level of trauma history. However, many traditional models of care and treatment environments do not take this consideration into account. Furthermore, individuals who have suffered from trauma may be less likely to seek care, since the idea of facing one’s past and submitting to physical exams and in-depth assessments may be triggering.
Fortunately, the standard of care is constantly evolving, and if an individual is in need of TIC for themselves or a loved one, there are many options available. But like other terms associated with mental healthcare, “trauma-informed” isn’t a regulated phrase, so it can be difficult to vet a program or provider. Thus, understanding the three pillars of TIC can be helpful in selecting an appropriate and high-quality treatment program.
The 3 Hallmarks of Trauma-Informed Care
A Safe Environment
On the most basic level, a TIC environment is a safe space in which to access compassionate and caring treatment. First and foremost, the physical space should be intentionally designed as a home-like environment, rather than an institutional setting. This promotes a feeling of physical safety and comfort, so that providers and patients can work together to foster emotional safety. Furthermore, clinicians should provide consistency, reliability, honesty, and transparency. And they should include patients in decision-making whenever possible, giving them control and power over their treatment experience.
A Focus on Emotional Regulation and Impulse Control
One of the most common symptoms of trauma is a constant state of hypervigilance— remaining fearful of impending threats even when none exist. Survivors may experience startling, involuntary triggers that remind them of the trauma or cause them to emotionally relive the event. This ongoing nervous system arousal damages their ability to control their impulses and emotions in the present, because they are living in a constant state of reactivity.
But neuroplasticity—the scientific understanding of how individuals’ brains can change and heal, even into adulthood—offers hope for shifting this state. TIC supports this healing of brain function and patterns with interventions focused on:
- Impulse control
- Labeling and expressing feelings
- Self-awareness and self-soothing tools
- Active listening techniques
Often, trauma damages patients’ ability to form positive connections with others due to past experiences. This can cause them to be wary of vulnerability within any relationship, even the therapeutic one. From a neurological perspective, the task for TIC providers is to create a corrective emotional experience so that patients can derive positive emotional responses from connecting with others. In terms of reversing the negative impact of trauma, research shows that the quality of the relationship between the patient and provider is equally or more important to outcomes than the therapeutic technique itself.
In short, individuals who have suffered trauma benefit most from treatment when they feel connected, valued, and informed. Hence, TIC providers use specialized therapeutic techniques to address co-occurring disorders that arise from trauma, while equipping patients with the skills and understanding that ensure sustainable healing.