Greg Fritz, MD (Host 1): Hello, and welcome back to Mindcast: Healthy Mind, Healthy Child, a podcast from the children's mental health experts at Bradley Hospital. I'm your host, Greg Fritz, along with my colleague, Anne Walters. And we are thrilled to have you join us for another insightful episode. Today, we're diving into a topic that's incredibly important for all parents and caregivers and clinicians, childhood trauma and trauma-informed care.

Anne Walters, PhD (Host 2): Whether you're a parent, a healthcare professional, a teacher, or anyone providing support to others, you hold a unique and significant role in people's lives. Your care and compassion can have a profound impact, especially on those who may have experienced trauma.

Host 1: Imagine a child who has faced neglect, or a veteran dealing with the aftermath of combat. Their experiences may not always be visible, but they ripple through their lives, affecting their behaviors, thoughts, and emotions. As caregivers, it's our responsibility to create a safe and understanding environment, one that considers the weight of these experiences. And that's where trauma informed care comes in. It's not just a set of techniques or buzzwords. It's a philosophy, a mindset, that guides how we approach and interact with those in our care. And today, we are so happy to be joined by an expert in this area, Dr. Ryann Morrison. Welcome.

Ryann Morrison PhD: Thank you, guys, for having me. I am a psychologist at Bradley and I split my time between the Children's Partial Hospitalization Program and the Outpatient Program, working with kids ages six through 18.

Host 2: To start off, I think we can ask the question, what is trauma and what's considered traumatic?

Ryann Morrison PhD: So, I think a lot of people can have different definitions of what trauma means. And I think one of the important things to always consider is that trauma is the reaction more so than the actual experience. So, two people can go through the same thing and one person may feel trauma symptoms later on, while the other person may not. But when you think about childhood trauma, typically that would include things like physical and sexual abuse, emotional abuse, neglect. That could also be being in a natural disaster, a car crash, any type of those kinds of accidents. And again, it's really about how the person responds to that. It's pretty common after a scary situation for someone to have some symptoms. When we think about trauma, we really think about a month or longer after that experience has happened, is that person still experiencing those symptoms? So, that's a really important part to consider when we think about what we're considering to be traumatic.

Host 1: So, what are the common signs and symptoms that are associated with trauma? In other words, what does it look like a child who's reacting to a traumatic experience?

Ryann Morrison PhD: Yeah. So, trauma can look different in different people. Some common symptoms that we see are sometimes kind of disassociating, not being fully present in the present moment. It's also pretty common for there to be some sleep disturbances, so maybe having nightmares about the situation or the incident or trouble sleeping. Also sometimes during the day, having flashbacks to those traumatic situations, especially if something in the environment is triggering for that situation. So for example, if the traumatic incident happened and there was a lot of loud noises, sometimes loud noises in the future might trigger some of that trauma response for someone as well.

I think an important consideration when we think about childhood trauma, a lot of times, children will display their distress in more outward ways than maybe adults will. So, it might be increased irritability, disruption, defiance. So, a lot of behaviors that on the outside look like a very defiant kid might be a very traumatized kid. So, it's really important for us to really get to the bottom of where these behaviors are coming from, and If it's related to trauma, treating the trauma rather than just the behavior.

We also sometimes see, you know, avoidance of certain things that might remind the person of something traumatic. So, for example, if they were in a car accident, it may be avoiding getting in the car, avoiding any type of transportation that requires them to be driving. Or if they were abused by somebody, it might be avoiding people who remind them of that person, avoiding situations that remind them of that abusive situation, so a lot of avoidance behaviors. And again, with kids, it won't always look like a kid telling you that something is triggering them or reminding them of that. It might come out as yelling or screaming or disruption or being defiant or verbally aggressive when really it might be their way of communicating that they are scared to be in that certain situation.

Host 2: So, for those involved in a child's life, what are the things that you feel are important to consider after a child experiences this?

Ryann Morrison PhD: Yeah. I think it can be so hard for the people in the child's life, because when your kid experiences something traumatic, that's also very distressing for the parent, typically. I think one thing that is really important is, as much as possible, to try to be calm in your communication with your kid. I think back to the example of a car accident. That is something that it's not realistic that that kid will never get in the car again. And so if the parent is reacting in a very distressed way and really overwhelmed, the kid may interpret that as more reason to be afraid of that thing and then, therefore, less likely to keep going from there. Obviously, that's easier said than done. When you see your kid going through something tough, it's going to be hard to be calm. But as much as possible, trying not to put more meaning on the incident than the kid is putting on it themselves. With that as well, we still want the kid to know that we're taking it seriously, so being calm while still being very clear about the nature of the situation.

So, when we think about abuse, being calm doesn't mean we're ignoring what happened. We're still letting the kid know that what happened was not okay and that there's something that needs to be addressed, but not approaching it in a panicked way that's going to increase that situation for the kid.

And then again, other things to look out for, any changes in behavior that you've noticed from before the incident, especially if it's happening more than a few weeks after the incident. So again, if it's been a couple of months and you notice your kid is still avoiding certain situations or decreased appetite or eating more, sleeping less, having nightmares, different behavioral issues at school, increased anxiety, increased depression, those are changes that we would want to make note of if it's happening a few months later after the incident and getting your kid into treatment if possible.

Host 1: Let's talk for a minute about treatment. What treatments are available and the treatment approaches?

Ryann Morrison PhD: It's a very good question. So, one of the typical treatments for trauma is trauma-focused cognitive behavioral therapy. And that is a type of treatment that begins with learning more so of those skills to help when kids are feeling distressed, how to manage those symptoms when they come up, because the next section would be getting more into actually talking about the trauma. And so before we go into the trauma, we want to make sure that the kid has skills and resources of how to manage that distress when it does come up.

Another important component of TFCBT is the parent component. So, a lot of parent training, a lot of parent education, because we know that a biggest resource for kids are their parents and their parents are one of the biggest change agents for the kid. So, we want to make sure the parent also has that information and the skills to help support their child.

The part of the TFCBT that really delves into trauma is the trauma narrative. And that would be after several sessions, after the kid has already built a therapeutic relationship with their provider, is ready to start talking about the trauma. That would be a way for the kid to kind of take some control over their story and they can either write it out, sometimes kids will write it out like a poem or a song, whatever feels best for them, and really starting by going through their trauma with their trained professional.

And then from there, going through it in more detail under the therapist's guide, and really starting to, again, kind of take power back over that story. A lot of times when we experience something traumatic, our instinct is to try to ignore it and forget about it, which is very protective in the beginning, but doesn't actually help us move through that traumatic situation. And so, the narrative is a really great way for kids to be able to face a traumatic incident and be able to move forward rather than avoiding it as long as they possibly can.

We would want to make sure that this is only happening when the kid is ready. I think that's one of the most important things to consider when doing trauma treatment, is that just because the kid has something traumatic happen doesn't mean that they are ready to do trauma treatment. Sometimes that could be a few months after the incident. It could also be a few years after the incident. So, it's really important to be consulting with their therapist before jumping into any treatment or assuming that that treatment is necessary because we don't ever want to retraumatize the child or talk about something before they are ready to fully talk about it.

 Another very important consideration in trauma treatment is making sure that the kid is in a safe situation. So, if we are working on trauma, but they are still in that traumatic situation, it's not going to be very effective. So, if they were abused by a caregiver, and they're still living with that caregiver, TFCBT is most likely not going to be effective because that kid is still in danger. And a lot of trauma symptoms that we see, so, more so like hypervigilance, really looking around you, you know, being very aware of your surroundings, that is something that's very protective and adaptive if you are in a dangerous situation. If a child is still in that dangerous situation, we don't really want to reduce some of those trauma symptoms because in some ways they're protective. So before we really work on healing, kid has to be safe first. So, that's the first thing to always make sure that they are safe from whatever that traumatic situation was as much as you can possibly manage that.

Thinking about treatment, TFCBT is It's really helpful when discussing singular traumatic events. It does get a little bit trickier when we're thinking about recurring trauma. So when it wasn't one really scary incident, but kind of maybe a year-long abuse or something that, you know, I think about kids who are refugees who maybe lived in a situation where every day was traumatic and it wasn't just one scary situation. That's where it gets a little bit tougher because there's not one narrative to go through. It's a much, much bigger experience. So, part of that too would be up to the professional to know when is TFCBT appropriate versus another approach.

One option is to go through TFCBT more than once. So, if a kid has a few traumatic situations, they can definitely do a narrative on more than one traumatic situation. But then, there's also going to be times where it is much more chronic than just a couple of situations. So with that again, most importantly is making sure that kid is currently in a safe situation. So again, if a kid was a refugee and they're living in a really dangerous area still, the trauma work isn't going to be effective because they are still fighting for survival on a daily basis. If they are in a safe situation, treatments should really focus on helping that kid feel safe. Because when you've lived in an unsafe situation for so long, your body will still feel unsafe even if you are physically safe. Our bodies have a way of reacting to trauma even when we are not intentionally doing it. Even if we logically know that we are safe, our bodies still have a way of reacting to that trauma. So with that, that can also include a lot of strategies to help calm the body as well. So when that anxiety is really increasing or that hypervigilance is really increasing, that can be helpful to use grounding strategies, so strategies that kind of take you out of some of those flashbacks or sometimes the zoning out or disassociation and getting back to your present moment.

One thing that I see a lot with kids who've experienced neglect is even if they're in a safe and comfortable home, still feeling like at any moment they may not have access to food or may not have access to what they need. And even if they logically know that there's that availability, that part of their brain, that part of their body is still reacting as if it's an insecure situation. So with that, typically, what we would do is a lot of parent work on helping the parents learn how to help the child in those situations. So, it could be something of having an area in the house where there's a basket of food and the kid knows at any time they can access that food. Even if they know that they have food, it makes it very clear that no matter what, it is right here. With that, we will also see sometimes kids overeating or hoarding food when they've had food insecurity or neglect, so that could also be something around still setting some limits around that,, of you will never have to ask for food, you will always have food available, and trying to encourage those behaviors of going to the appropriate places for that.

I think as caregivers, one of the most important things is being patient, because trauma, a lot of times, does not come out in very cute ways, I guess I'll say. It can be very, very challenging for parents, and very frustrating for parents, especially when they know that they're providing a safe environment for their child, and recognizing that trauma lives a lot longer than the traumatic incidents are. And just because the experience is over, doesn't mean that it's over for that child.

Host 1: It sounds like you're saying that when a child actually subjectively feels safe is a different time frame than when their objective situation is when they're safe. And in a way, that's a marker of the effectiveness of therapy, I would assume.

Ryann Morrison PhD: Absolutely. And we know that trauma changes the way that our brain reacts to situations. And so if a kid is used to, you know, this means something scary when that thing happens again, even if it's just a door closing loudly, even though they may logically know it's just a door, that part in their brain is still going back to when that traumatic thing happened, and this is a scary thing that I need to resolve.

Host 1: Well, we could continue for another hour and a half, I think.

Host 2: I was going to say, this is a very brief, very brief introduction.

Host 1: Yes, we're just touching the surface, but it's been fascinating. We'd like to thank you for tuning in to MindCast today, and thank you, Dr. Morrison, for offering a glimpse into your therapeutic world and your expertise in this area. In my mind, the biggest takeaway from today's conversation is that trauma-informed care isn't just a concept, it's a transformative approach in therapy.

Host 2: As caregivers, educators, healthcare professionals, parents and friends, you now have a greater awareness of the importance of patience, active listening and empathy in your interactions. Every small gesture, every compassionate act can make a significant difference in someone's journey towards healing.

Please share what you've learned today with your colleagues, friends and loved ones. Share Mindcast with them. Thanks for tuning in today. We appreciate all of our listeners. Until next time, this is Mindcast: Healthy Mind, Healthy Child.