Trauma Sensitive Behavior Support Strategies

Trauma often is about an individual’s reaction to and difficulty recovering from an upsetting event(s) rather than the occurrence itself. (For example, the COVID-19 pandemic was a major stressor for most Americans, but was not necessarily a trauma for all of them.) Potential traumatic events for youth range from abuse or neglect and housing insecurity to social isolation and violence at home or in the community. Teens can be deeply affected by trauma that involves their friends or local, national and international tragedies. Common signs of post-traumatic stress disorder include constantly being alert to danger, a preoccupation with thinking about the incident, and a lack of feeling or persistent extreme emotions that linger long after the event. Children also can struggle with chronic fatigue, forming relationships, negative thinking and staying organized.

Through Trauma-Focused Cognitive Behavior Therapy (TF-CBT), individuals gain a better understanding of how their thinking affects both the way they feel and their actions and learn how to challenge unhelpful thoughts, along with relaxation skills that allow them to better control physical symptoms, Patients also often create a “trauma narrative” (typically a cartoon/drawing, PowerPoint presentation or written story) that helps them to discuss what happened in a calm, safe manner and makes their memories less frightening. Prolonged exposure therapy involves a client retelling the traumatic experience and then creating a list of the things he/she has been avoiding that are associated with it, which are ranked in order of how distressing he/she finds them. Over time, this can separate memory from the fear response.

Avoiding thinking about a traumatic event can mean that a person is not processing the experience and that it likely will continue to cause him/her distress. Youth can experience confusion over how they feel about what happened and/or choose to distract themselves rather than contemplate the trauma. A delayed onset of trauma symptoms often is common in adolescents, who initially can use strong defense mechanisms like denial or disassociation until periods of stress or transition trigger associations with the earlier event. An openness by parents and other loved ones is crucial for helping children confront traumatic memories and realize that it is safe to discuss them. Adults can validate young people’s emotions simply by listening and replying, “Thank you so much for sharing.”, and can help them identify (and then reflect) their feelings by saying something like, “I can see this was frustrating/overwhelming for you.”

Survivors of trauma often feel shame and blame themselves. In fact, not being believed by others can be as traumatizing for a victim as the actual event itself. If someone is reliving a traumatic experience, listen to hear rather than to reply and do not ask for details. Unlike normal memories, traumatic ones cause the release of adrenaline, placing the individual’s body in fight or flight mode. Allow the person to express whatever emotions arise, even if they make you uncomfortable; and never compare his/her trauma to another’s. Let the individual know that you hear him/her; ask what you can do to help; provide him/her space if requested; and do not give advice unless you are asked to do so. Examine your own stress level; use a calm, respectful tone in order to avoid escalating the situation; and offer concrete choices, like a quiet place for him/her to calm down. Avoid arguments by having any discussions after the other person has regained his/her composure.

It is impossible for anyone to think his/her way out of trauma. Survivors need to be kind to themselves and let others help. (Often, the trauma occurred to those surrounding the individual as well and being part of his/her recovery can benefit everyone’s healing.) Organization and structure are important, and group activities and helping others often can play a role in restoring predictability. In addition to TF-CBT, Dialectical Behavior Therapy and Eye Movement Desensitization and Reprocessing have been shown to be effective treatments, helping patients address maladaptive thought processes, develop coping skills and process traumatic memories. Remind those affected by them that trauma responses are normal reactions to abnormal situations and that they can in fact heal with proper support.