Dr. Daniel Knoepflmacher (Host): Hello, and welcome to On the Mind, the official podcast of the Weill Cornell Medicine Department of Psychiatry. I'm your host, Dr. Daniel Knoepflmacher. In each episode, I speak with experts in various aspects of psychiatry, psychotherapy, neuroscientific research, and other important topics on the mind.

Our focus today is on trauma. The news in our world has been rife with crisis. Millions of people in the US and around the world are directly impacted by violence, upheaval and catastrophic tragedies. Debilitating psychological effects persist long after an initial traumatic experience has passed. Among children who endure trauma, many problems can emerge, including symptoms of depression, anxiety, emotional dysregulation, relationship difficulties, struggle with school, troubles with eating and sleeping, and the emergence of physical aches and pains.

Adults face their own stress reactions to trauma, and are even more susceptible if they've experienced prior trauma earlier in life. Some exhibit a constellation of long-term symptoms that meet the criteria for a diagnosis of posttraumatic stress disorder or PTSD. However, the majority of people exposed to trauma don't develop PTSD, but still face ongoing psychological distress that manifests in different ways.

The effects of trauma can also be intergenerational, with research pointing to neurodevelopmental, genetic, and social factors leading to impacts on the children and grandchildren of trauma survivors. And with era-defining crises, like the COVID-19 pandemic, studies of collective trauma reveal widespread and persistent psychological stress across the population, with associated increases in physical and mental illness. Government and healthcare organizations across the country are focused on addressing this problem by promoting trauma-informed care as a central part of health service delivery. Fortunately, with appropriate support and the right interventions, people recover from the effects of traumatic experiences.

In this episode of the podcast, we will explore what trauma is, how it impacts human psychology, and how we can help people recover after traumatic life events to build resilience in the face of adversity.

To help us do all of this today, we're joined by Dr. Jessica Hartman, who is an Assistant Professor of Clinical Psychology and Psychiatry here at Weill Cornell Medicine. She currently splits her time between our Adolescent Inpatient Unit and Child and Adolescent Outpatient Department. In both settings, she serves as a clinical supervisor for psychology and psychiatry trainees. She has extensive experience working with children, adolescents and families affected by social, emotional and behavioral difficulties, including trauma. Dr. Hartman has been trained in a variety of trauma-focused interventions and has been involved in creating and implementing system wide trauma-informed care environments.

Jess, thank you so much for joining us on the podcast today. I'm really eager to talk to you. This is a big, important topic and I'm hoping you can really help us understand it.

Dr. Jessica Hartman: Thank you so much for having me. I'm really excited to be here.

Host: Well, I want to begin by asking you, what led you to specialize in this area? Were there specific reasons why you gravitated towards this kind of work, helping children who've been impacted by early traumatic experiences?

Dr. Jessica Hartman: So, I'll start by saying I'm not used to talking about myself, so thank you for that question. It's a nice introduction. Like many who have been on this podcast, I knew for a long time and from a young age what I wanted to do. to do with my life. And I really sort of, as I got to high school, I planned my activities in accordance with that, and my college majors, which were psychology and philosophy, were sort of in service of this plan. And really, I spent the better part of a decade working towards these goals.

Unlike many of the people who've come before me on this podcast, my plan was not to go into a human services field. My plan was actually to become a lawyer. And my intention with a psychology major was really to be able to better understand people, thinking I would need that in practicing law, and I had never really considered it a career path.

And it just so happened, I found a summer job that I ended up coming back to in college. It was designed specifically for college students, working at a certain behavioral health center located in White Plains that was specifically, you know, for college students to get some experience in the field working on the inpatient units, and that was really my initial exposure to the field.

And the experience was an extremely challenging and humbling one, and also a very rewarding one, because I had the opportunity to really work for the first time along a multidisciplinary team who are really phenomenal that included doctors and nurses and psychosocial rehab, mental health workers, and really just so many others. And from that experience after doing it for a couple of years, I turned around, I think probably much to the surprise of my parents one day and threw my whole plan out the window and said, "I think I'm going to go to grad school for Psychology."

So, that was my entree into the field. And when I started grad school, I had this plan that I wanted to work with adults doing primarily DBT. And of course, it should come as no surprise that that plan didn't really go according to plan either. And instead what happened when I ended up starting my clinical experiences, I worked in a hospital that catered to teenagers and there were exceptionally high levels of trauma in that population.

It's usually pretty rare to secure a hospital-based experience so early on in your training. But because I had spent several summers already working in a hospital and was still doing it on an ongoing basis during grad school, I was selected despite the fact that I was a young trainee. And I think when you see so early on in your training just how pervasive trauma is, you realize It's something you really can't ignore. And I was very fortunate along the way to have some really amazing supervisors who encouraged me not to shy away from this work, even though it can be so challenging. I think that was really, in many ways, a key element to my success and, hopefully, why I try and pay it forward now in my role as a supervisor.

And for me, I think the beauty in being part of trauma work, even though in a perfect world maybe it wouldn't need to happen, is that at its core, trauma-focused work is about connection. And yes, you teach skills and you're trying to reduce symptoms. It's also very much about the ability for two people to connect in a moment that's very vulnerable. And if you're lucky, you get to be part of somebody's journey towards building resilience. And especially for adolescents who have their whole lives ahead of them, it makes it all the more rewarding.

 If you'll indulge me, I'd like to share some words from a former patient who I think really captures the value of doing trauma-focused work and why it can be so meaningful. And what she wrote was, "You helped me realize that there are actually people out there that care about me, even though that's hard to believe. So, thank you. Thank you for giving me hope." And that, I think, is really what keeps me doing trauma-focused work. It is about hope.

Host: Really meaningful, and must have meant a lot to you hearing that from your patient. Just so our listeners know that that hospital in White Plains is the Westchester Behavioral Health Center where Jessica Hartman now works as a psychologist. So, it's kind of a full circle experience. I want to ask you a definition question. So, I've used the word trauma several times in the introduction to this, and I think it'd be helpful to clarify exactly what we mean by this term, especially as it pertains to mental health. So, can you give us a definition of trauma?

Dr. Jessica Hartman: Absolutely. I'm going to start by saying there's no sort of single universally agreed upon definition, but we do sort of know broadly what constitutes a traumatic experience. And APA has a nice definition, and what they say is trauma is any disturbing experience that results in significant fear, helplessness, dissociation, confusion or other disruptive feelings intense enough to have long-lasting negative effects on a person's attitudes, behavior, and other aspects of functioning. Traumatic events include those caused by human behavior, such as rape, war, industrial accidents, as well as by nature, for example, an earthquake, and often challenge an individual's view of the world as just, safe and a predictable place.

With that said, I'd like to also share a definition from Bessel van der Kolk who's really one of the preeminent researchers in this field, in this area. And I like to sort of share his definition. I think the other one is very sort of formal, and I think his words really speak to what it means to live through a traumatic experience. And what he says is trauma is specifically an event that overwhelms the central nervous system, altering the way we process and recall memories. Trauma is not the story of something that happened back then. It's the current imprint of that pain, horror and fear living inside of people.

Host: That's really helpful. I mean, both of those definitions focusing on the long-term effects, not just the event itself. I'm curious what you think about the preponderance of the use of the word trauma in our popular culture. I think on social media with celebrities talking about events, some of which may fit that definition, some of which maybe are short of that definition. Do you think that that is maybe not a good trend, that there's over identification with trauma sometimes?

Dr. Jessica Hartman: That is a good and very loaded question. And I think it's a challenging question, and here's why. When we think about trauma, and when I think about trauma, and something that will hopefully be helpful to others when they think about trauma, is we want to think about the three E's. That's something we talk a lot about in this field. And those three E's are the event, the experience and the effects of the event.

So, I just sort of want to clarify, because I think also a lot of times colloquially people use the term PTSD. They have a bad experience and then they say they have PTSD. And they just sort of want to differentiate, right? Because you can experience a negative event, whatever it might be. And there are a lot of individual and environmental factors that will impact how you experience the event, so your age, your sexual identity, your biological factors, your attachment style, if you have a history of prior traumas. There are environmental factors like the nature of the event, your proximity to the event, was it something that happened directly to you or perhaps to a close friend or family member, how your culture or your ethnic group sort of deals with trauma and what's acceptable to talk about, your level of social support, the health of your broader community. These are all sort of things that can impact how you experience an event.

And I'm not sure that there's a single agreed upon threshold for what qualifies as trauma. What I can say is if somebody's experienced a difficult event, it can be really invalidating if you then come in, whether you're a professional, or a friend, or a family member, and you say, "Mm. No, that's not really a trauma," right? And I don't know that that needs to be our role. I think really what's important to think about is if somebody is telling you that they've experienced a trauma, they're communicating that there's a level of distress that they're experiencing. And perhaps on the medical side of things, I know you work with our residents, right? We teach this to trainees in the ER when people walk in and they're asked to rate their pain and someone says, "I'm at a 10." And they're sitting up, and they're talking, and they're texting on their cell phones, they're probably not at a 10 sort of in an objective way. Where when we think of a 10, that's someone who can't even answer a question. But what they're communicating when they say, "I'm at a 10," is, "Hey, I'm in a lot of pain, and I want you to take this seriously." And I think that's the important thing to take away from this. When somebody's saying something's been traumatic, what they're saying is, "I lived through something, and it's been difficult. And there might be some kind of support that I need."

Host: Such a great answer to that loaded question. And I think what it really gets to the heart of is the idea of connection that you emphasized in the beginning, because you have to listen thoughtfully and connect with the experience that person's expressing to you. I want to ask you about complex trauma, which is something that we encounter as a result of a traumatic experience. Can you help differentiate that and explain what complex trauma is?

Dr. Jessica Hartman: Sure. So actually, I'm going to back up a little bit more and just clarify a little bit. There's a few different types of traumas that can occur. There is a single event or acute trauma. So, that would be something that maybe happens one time. So for example, if you get into a car accident or you're assaulted, that's a one-time acute event.

There's also another kind of trauma called chronic trauma, and this is something that happens on an ongoing basis. So for example, if you are bullied in school, or if you live in a home where there's domestic violence, whether you're the victim or you're witnessing it, that's something that's likely happening over a period of time.

Complex trauma is a little bit different, and what that refers to specifically is a child's exposure to multiple traumatic events that tends to occur within the context of a caregiving relationship. So, an example of this might be physical, sexual or emotional abuse. It could be neglect. And because these events occur in childhood, we tend to see a greater impact on the child's overall development and sense of self. And so, that's a little bit of what differentiates, I think, complex trauma. It's happening within that caregiver relationship where we would oftentimes think that's the person or the people you're going to go to for comfort or support. And therein lies the challenge, is that sometimes you're dealing with someone who is both a source of comfort and support and can also evoke a lot of feelings of fear or a lack of safety.

Host: At a very vulnerable time in someone's development, and you could understand why that would have such long-lasting impact and affect their identity and sense of self. I want to ask about, along these lines, the neurobiological and psychological effects of trauma. You gave one example. But in general, what is the neurobiology and then, of course, the psychology that emerges?

Dr. Jessica Hartman: Sure. So, the impacts of trauma, particularly for children and adolescents, and this is also true of adults. It can be wide ranging and really impact every facet of development, starting with when you're an infant, attachment, and even as you get older, your biology, your affect or emotional regulation, your behavioral control, your cognition, your self concept. And in the brain, we know that trauma or a stress response can impact brain development, and specifically the amygdala, which is really sort of the fire alarm in our brain.

And what happens when we experience trauma, we're not focusing on any of our higher order thinking or reasoning skills, we're really only focused on survival. And so just like when a fire alarm goes off in your home, when that fire alarm goes off in your brain, you're only focusing on safety and getting to safety. The problem with trauma, though, is that you essentially have a fire alarm that goes off in situations where there isn't actually a fire. And you may or may not, in that moment, know that it's a drill.

Relatedly, there are other sort of structural changes that we see in the brain. So, the hippocampus, which is involved in memory formation. There's smaller gray matter volume, and we know this trauma is largely related to how we recall and remember and process events. And there are also some implications in the prefrontal cortex, which is really what controls our judgment and thinking and higher order reasoning. And those areas of the brain are often less developed, and that is what aids us with things like regulating our attention and awareness, making decisions about the best response to a situation, our ability to initiate conscious and voluntary behavior, determining the meaning and emotional significance of events and our emotion regulation. So, the impacts of trauma can be really sort of far-ranging and they really sort of fundamentally shape who we are in our brains and our bodies.

Host: Well, both spoke about PTSD a little bit as a specific psychiatric syndrome related to trauma. But as we've both said, many people endure trauma, have long-term psychological distress, but don't meet the specific criteria for a PTSD diagnosis. Can you help us understand the full range of psychological impacts that a traumatic experience can have on an individual?

Dr. Jessica Hartman: Sure. So, I think the main sort of differentiating factor is trauma, or a traumatic event, is a lived experience. Posttraumatic stress disorder, by contrast, is a mental health condition that is triggered by one of these events, so either experiencing it or witnessing it or hearing about it. And there are sort of a certain constellation of symptoms that get grouped into different types that we think of when we talk about PTSD. And this can include things like intrusive memories, such as flashbacks or having nightmares, avoidance of triggers that remind us of that trauma or traumatic event, negative changes in thinking or mood, so that sense that the world is no longer a safe place. You can become depressed or anxious. And then, there are changes in terms of physical and emotional reactions. You often see hyperarousal or a lot of kind of anxiety and jumpiness.

And I just want to sort of step back from all this to also make note of the fact that many people who experience a traumatic event have temporary difficulty coping or adjusting, and that's completely normal and appropriate oftentimes. And I think the difference is, if you're struggling with these things for sort of weeks or months, or in some cases, even years after an event occurs, and it's interfering with your functioning, at that point, you might be thinking about a diagnosis of PTSD.

Even if you aren't meeting the criteria for PTSD, though, it doesn't mean that that lived experience isn't impacting you. So, you could have some symptoms of PTSD that might not meet criteria for the full diagnosis, and it doesn't mean you should have any less support to help you in working through that.

The other thing I just sort of want to mention and say, because I think it can't be said enough, that is helpful for people to remember, trauma is a normal response to abnormal experiences. And I think that's really important, because those traumatic reactions that people have, that's sort of what's normal and expected. It's the event that they've gone through that's what's really sort of out of the norm in many ways.

Host: Thank you. It is a normal response to abnormal situations. And as you alluded to earlier, these awful abnormal experiences can happen in childhood, which is an incredibly vulnerable time. Can you explain why it's really important for us to understand the impact of trauma in youth, and that's why there's so many efforts by government and healthcare organizations to address this in medical care?

Dr. Jessica Hartman: Sure. So, it's such an important question. And what we know about the experience and exposure of children to traumatic events, because this is such a critical developmental period for them, is that when children are exposed to events like this, there can be increased odds of negative outcomes, not only in their adolescence, and even into adulthood.

And I want to sort of start by talking a little bit about the ACES study, which is a reference to adverse childhood experiences, is what that stands for. And that was a study that was done in the mid to late '90s by the CDC and Kaiser Permanente. And it was a study that was done entirely with adults. However, they were asking them about different adverse experiences that they may have had at or before the age of 18, so really about these experiences in their childhood, and then asked a series of questions about their current health status and outcomes. And there were only 10 ACEs that they identified and included, and this was sort of based on a survey from a subset of the Kaiser Permanente population.

And what they found was that at least two-thirds of the population reported at least one adverse childhood experience, including those who were employed, those who were white, those who were middle class, those who had a college education. And hopefully, that isn't something that necessarily sounds shocking to us today and yet, at the time that that study was released, I think that was really sort of an eye-opening finding for a lot of people.

They also found that about one out of every five individuals was reporting three or more ACEs. And what they also found was in this study was that there was a direct link to chronic health problems, mental health issues, incarceration, and substance use in adolescence and adulthood. There were also negative impacts on education and job opportunities and earning potential well into adulthood.

And so, the other thing that I think is important to point out is that the ACEs study didn't account for certain things that we now know are really considered adverse experiences like systemic racism that individuals face, having interactions with child welfare services or juvenile justice system, facing bullying in school, and this was really sort of a critical study in this field because the direct nature of these links were really quite dramatic. It was often by multiples that individuals were more likely to be using substances, having issues related to their mental health, to their physical health, dying earlier and younger than individuals who did not have ACEs.

And I recognize there's an element of saying this that sounds very doom and gloom. And so, I also want to say ACEs and their impacts, there is a hope that it might be preventable. That's going to take some sort of larger scale system interventions. And yet, there's also this sense that the Impacts of ACEs can be mitigated to reduce the harm that they might cause.

So when you create and sustain safe and stable and nurturing relationships and environments for children and families, you may or may not be able to fully prevent the adverse experience. However, the idea is that even if they experience it, you might be able to mitigate the impacts of it such that the child still reaches their full health and life potential without sort of everything that we know can potentially follow.

And the CDC actually has a number of strategies that they've identified. Some are very large scale and probably require policy change and governmental intervention, so things like strengthening economic supports for families, which can include things like family-friendly workplace policies or increasing household financial security, ensuring everyone has access to high-quality child care and enriching sort of early preschool and school environments, promoting social norms against violence and adversity like public education campaigns, reducing use of corporal punishment, and yet there are also a number of strategies that can happen on a much smaller scale, such as connecting youth to caring adults or activities, so having mentorship programs and after school programs and helping teach skills to children about social-emotional learning and how to regulate their emotions. These are all things that can be done sort of on an individual level and can be really impactful for children in terms of reducing the likelihood that they will experience negative health outcomes.

Host: Given the widespread nature of this, how common is trauma in the general population?

Dr. Jessica Hartman: So, the estimates vary a little bit. I'm actually choosing to pull from, SAMHSA because they have some ongoing research in this area. SAMHSA is the Substance Abuse and Mental Health Services Administration. They're a federally-funded agency. And SAMHSA suggests that there are worldwide estimates that over 70& of people experience at least one traumatic event in their lifetime, with over 30% being exposed to four or more such events. In the United States, 90% of adults report exposure to at least one traumatic event.

Host: Wow. I didn't realize that was the commonness of this, 90%. I'm still processing that. So specifically though, you alluded to some of the experiences of structural racism, structural issues in general in our society. And I want to hear about the prevalence of trauma among marginalized groups. I mean, I imagine it's also not just the presence of trauma, but the amount of trauma, as you said, that someone could have one experience versus four experiences.

Dr. Jessica Hartman: That's a really great question and I think such an important one because we really can't ignore the intersection of all of the societal factors that are coming together that are resulting in, unfortunately, the experience of marginalized groups often being exposed to trauma at higher levels.

And what we know is that minority youth, in particular, are more likely to be exposed to trauma on the level of sort of historical trauma, in addition to other kinds of trauma, such as discrimination, violence, less access to medical or mental healthcare. In particular, black and Latino young men disproportionately experience violence, poverty, incarceration, a lack of access to healthcare, marginalization and low social status, because of the environments that they live in.

I also think we should note there are sort of historical and intergenerational traumas. For example, in American Indians or Alaskan Natives, that put them also in a group that is at higher risk to potentially re-experience trauma or experience a different kind of trauma. Individuals who identify as LGBTQI are another group that are up to four times more likely to experience violent assault compared to their cisgender and heterosexual counterparts.

And I think the crux of what's at this question is why is this happening? And I think the answer to that really is that trauma is a social justice issue. And what we know is that minority and underresourced communities disproportionately experience trauma, in part because there's trauma caused by systemic issues such as racism, genderism, homophobia, transphobia, poverty, sexism, ableism. And we know that these can have severe and long-lasting impacts. We also know that these impacts aren't just on the individuals who can experience it, it's the communities at large, and it can also impact these individuals' children and grandchildren. And I think that's why it's so important to really view this through the lens of a social justice issue.

Host: And as it relates, from what you're saying to collective trauma, intergenerational trauma, which you mentioned in the Native American community, that's part of this as well.

Dr. Jessica Hartman: Absolutely. Collective traumas are sort of psychological reactions to a traumatic event that affects the society at large. And it's different sort of from an individual trauma in that it's the recollected memory of a group. And so, there's this ongoing reconstruction and reproduction of the memory to make sense of it.

Some examples of collective traumas that we as a society have sort of experienced recently would be something like the shooting in Sandy Hook, which of course happened unfortunately fairly locally to us; the Boston Marathon bombing that took place, right? There were sort of these profound and reverberating impacts both within the smaller communities and even within sort of the larger communities at large.

I also want to talk for a minute about historical trauma, and this is a specific form of collective trauma. And that's a trauma experience to a specific racial or ethnic group, and it really happens on a multi-generational level. And so, there are a lot of examples, and so what we talked about before with Native and Alaska Natives being impacted, that happened in Canada too with the native population in that region.

And there are other examples, I think, that we can pretty easily, unfortunately, call to mind, like the Holocaust and slavery, forced migration, things like that. And so, what we see in historical trauma, there's a specific targeted community that is targeted for systematic oppression. And it results in suffering within the community, and it's often done purposefully and with malicious intent from outsiders. And what we see is the descendants who live through these events often experience signs and symptoms of trauma as though they experienced the trauma themselves. And that's a process that happens both through nature and nurture, right? So, we might expect someone who's lived through trauma to parent differently. And also, there's been studies confirming that there are epigenetic changes that can occur and certain genes get turned on or off based on the experience of trauma, and this can get passed on to future generations. So, it's really not an overstatement to say just how profound an experience of trauma can be for a group.

Groups can also help build resilience against trauma, right? You go through something together and it can be something that sort of uniquely bonds a group together. It doesn't lessen necessarily the impact of the trauma, and yet it can be a source of support and comfort to have a group who's had a similar experience.

Host: Speaking of support and comfort, we want to talk about how we can help people who have endured trauma. And in our field, we often hear about trauma-informed care. What is this exactly? And how is this distinct from trauma-focused treatments, which you've alluded to?

Dr. Jessica Hartman: Yeah. So, to me, trauma-informed care really is the answer to how we can impact people in our healthcare system and mitigate the impacts of trauma. And really, what it is, is it's a philosophy for human service fields, including healthcare systems, that recognizes and responds to the impact of trauma and traumatic stress to optimize the effects of healthcare practices and healing, so focusing on the creation and maintenance of safe environments for staff and patients in an effort to minimize practices that could potentially re-traumatize individuals. So, we want to have a culture of both physical and psychological safety at baseline.

And there's sort of the four R's that we talk about that guide the approach. It's a realization of the widespread impact of trauma and pathways for recovery. It's recognition of possible signs of trauma. It's responding to trauma at a system's level through trauma-informed practices and policy and resisting re-traumatization.

And I think the best way we can really think about trauma-informed care is it's a shift in culture from asking, "What's wrong with you" to asking the question, "What happened to you?" And encouraging people to tell their stories. And the CDC and SAMHSA collaborated on sort of these guidelines of what trauma-informed care should look like and the sort of guiding principles. And hopefully, they sound like common sense, and yet they're not always employed in a way that's meaningful. It's safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment, voice and choice, and cultural, historical and gender issues. And if we can incorporate these things into our framework, the idea is we don't want a client to have to disclose a trauma history to earn trauma-informed care. It should be the standard, not a specialty.

And there's actually some ongoing research. It's amazing how many governmental agencies are involved in this to really sort of look at and evaluate best practices about children and youth and how to incorporate families as well who've experienced or are at risk of experiencing trauma, and how federal agencies can coordinate a response. And I'm not even going to go through the whole list because it's rather long, but it includes the Department of Health and Human Services, the Centers for Medicare and Medicaid, SAMHSA, the CDC, the National Institute of Health, the FDA, the Department of Defense, the Office for Civil Rights, the Department of Justice is involved, the US department of Education is involved, the Department of Interior, Veterans Affairs, Housing and Urban Development. It's literally that widespread, because they think there's starting to be a recognition of how important it is to be able to respond to trauma in individuals lives.

Host: So, this is on the macro level. It's actually quite hopeful hearing about all of the effort being put into this. I'm curious though, on the individual level, when it comes to treatments that help people develop resilience and thrive, can you describe the range of available interventions that we have?

Dr. Jessica Hartman: Absolutely. So, we're very fortunate there are a number of strong evidence-based interventions that can address trauma. And in starting to answer this question, I realize that I didn't speak to your question before about the difference between trauma-informed care and trauma-focused work. And so, I just want to sort of briefly start there.

And what we're going to talk about here are specific trauma-focused treatments. This is one part of the larger kind of system of trauma-informed care. But trauma-informed care is something that happens on a macro systems level in how we interact with and treat individuals, any individual who sort of walks in the door and interfaces with us in any capacity. So, that's really the distinction.

Now if we happen to be working with an individual who has lived through a traumatic event and is maybe struggling or experiencing some of the sort of symptoms that can interfere with functioning, we really want to think about broadly the goals for treatment, which are to reduce those symptoms and to increase resilience. And particularly with kids and adolescents, we want to really build those critical relationships and that sense of connectedness.

There are many interventions that we know can be incredibly helpful, including individual therapy interventions, group therapy interventions, and even some medication or pharmacologically-based interventions. So, some examples of the kind of individual therapy that you might be offered would include things like trauma-focused cognitive behavioral therapy, or as it's often called TF-CBT. Cognitive processing therapy, or CPT, is another intervention that can be very useful. That one is specifically designed for adolescents and adults, less so for younger children. For individuals who are already in DBT and are stable, there is something called DBT prolonged exposure, which incorporates principles of both DBT as well as trauma-informed work. There's also eye movement desensitization and reprocessing or EMDR.

There are also a number of adaptations of the trauma-focused interventions that I just listed above that might be designed for a specific population or subgroup. So, for example, there is an intervention that's called Real Life Heroes that is an adaptation of trauma-focused therapy that's meant specifically for latency-aged children, which is a population that often gets missed. So, it's really important to have resources like that.

There are also a number of group-based interventions, so that cognitive processing therapy I mentioned before, that can also be done in a group-based setting. There's research coming out of the VAs in a new intervention known as STAIR or Skills, Training, and Affective and Interpersonal Regulation. Now, we're in process of seeing the adaptations follow for teenage populations.

And there are also sometimes medications that can help target some of the symptoms. So, for example, if you're struggling with depression or anxiety, you might be able to take some medications that will help alleviate some of those symptoms. There's another medication called prazosin that, for example, is sometimes used with individuals who have nightmares as a result of PTSD. And I also, without getting too controversial, just want to briefly touch, there is emerging research in areas like the use of MDMA for treating PTSD or microdosing with psilocybin for traumatic memories.

Host: And that was the end of our first episode on trauma. I'm grateful to Dr. Jess Hartman for speaking to us about trauma today. Tune into the next episode and we'll hear more about the treatments for trauma. Thank you to all who listened to this episode of On the Mind, the official podcast of the Weill Cornell Medicine Department of Psychiatry.

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