Treatment of Trauma
When children are exposed to traumatic events, such as a motor vehicle accident, sexual or physical abuse, loss and divorce, medical illness, neglect, natural or human made disaster, it can be devastating to them and their families. After making certain the child is safe and no longer in harm’s way, it is important to obtain support to manage the difficult emotions that often follow. Although not everyone who is exposed to trauma develops Post Traumatic Stress Disorder, when untreated, the effects of trauma can be long lasting. Children exposed to trauma are at risk for anxiety, depression and PTSD; they also are found to have higher rates of health problems, substance dependence, learning problems, and criminal acts. As in most psychological disorders, early intervention and treatment is key. At The Midtown Practice, after a thorough history and evaluation of your child and the crisis that occurred, your clinician will develop a treatment plan individualized to your child’s psychiatric symptoms, temperament, and developmental stage. Collaboration with parents, family members, teachers, and other professionals is also a valuable part of the healing process.
Crisis Intervention and Psychological Debriefing
Crisis intervention and debriefing consists of several visits immediately after a trauma exposure. The impact of the trauma is assessed and any immediate issues surrounding safety are identified. The child is then encouraged to talk about the critical event in a safe and nurturing environment in order to process their fears and emotions. The clinician will also make your teen or child aware of any possible emotional or physical reactions that may surface over time and review resources for them in case these impair their life. Some studies indicate that children who receive this intervention immediately following a tragedy have a lower rate of psychological sequelae, but it is important to continue communication in case symptoms progress to Post Traumatic Stress Disorder.
Psychotherapy, or talk therapy, is a general term for treating emotional struggles by talking to an experienced clinician, such as a Therapist, Psychiatrist, or Psychiatric Nurse Practitioner (PMHNP). At The Midtown Practice, our skillful clinicians will tailor an evidence-based treatment to the symptoms your teen or child is experiencing and the type of trauma that has occurred. There are many types of psychotherapy, each with their own philosophy and approach. Our clinicians are trained in various specialties such as Dialectical Behavioral Therapy, Cognitive Behavioral Therapy, Psychodynamic Therapy, Supportive Therapy, Acceptance and Commitment Therapy, and Cognitive Processing Therapy.
Cognitive Processing Therapy is a specific form of therapy designed to address trauma and has been shown to reduce symptoms of PTSD. The treatment begins with psychoeducation around PTSD and learning tools to identify and process the unhelpful thoughts, emotions and behaviors that are causing prolonged distress and complicating recovery. Your child or teen will then learn adaptive strategies that they can use outside of treatment to improve functioning and quality of life and regain a sense of overall safety and control.
At The Midtown Practice, our general philosophy is that less medication is better, especially in the pediatric setting. However, there are instances when medication can be a safe and effective treatment for those suffering after a trauma. Rarely do we recommend medication as a first line course, but rather use it in combination with psychotherapy. The decision to prescribe medication depends on the severity of your child’s condition, the extent it interferes with their school work, social life, and everyday functioning, or if your child is experiencing thoughts of harming themselves. At times, medication is recommended when psychotherapy or another treatment alone is ineffective. Medication can sometimes be prescribed similarly to how training wheels can be used when learning to ride a bicycle. In these instances, the medication can be used to temporarily relieve symptoms, while a child learns to manage their emotions within the context of therapy, and then is tapered once a child achieves adequate progress in our care.
There are several types of medication that can help with PTSD and other psychological conditions following a trauma. Although they often have confusing names, they generally fall into discrete categories. These include antidepressants such as Selective Serotonin Reuptake Inhibitors (such as Zoloft, Prozac, and Celexa), Antidepressants called Selective Serotonin and Norepinephrine Reuptake Inhibitors (such as Effexor XR or Cymbalta), Anti Anxiety medications called benzodiazepines (such as Ativan or Klonopin), Atypical Antipsychotics (such as Abilify or Latuda), or Antihistamines and Atypical Anti Anxiety (such as Vistaril and Buspar). After thoroughly discussing and weighing the risks and benefits with you, your clinician at The Midtown Practice will make a recommendation best suited for your child and family, constantly reevaluating to make sure progress is being made.
Behavioral and Lifestyle Modifications
Through self monitoring of daily lives and reactions, your child can learn to identify specific triggers, physical sensations, and thoughts that interfere with the recovery following exposure to a traumatic event. Perhaps your child can benefit from greater structure, more exercise, or social re-engagement. Your clinician might also teach relaxation and mindfulness techniques, such as diaphragmatic breathing or progressive muscle relaxation. Multiple studies have shown that these methods ease the nervous system, and effectively manage subjective and objective symptoms of distress.
Diaphragmatic breathing involves breathing slowly and deeply from the diaphragm to facilitate a relaxation response. Sometimes we combine this type of breathing with mindfulness exercises, such as counting your breaths, intentionally making your exhalation longer than your inhalation. Progressive muscle relaxation involves tensing and relaxing muscles throughout the body, beginning with the lower extremities and moving upward the length of the body. Other mindfulness exercises, such as focusing on the senses, mindful walking or paying attention to how your body moves when you walk slowly, or taking a 3 breath hug with your child can also help them regulate their emotions. Our skillful clinicians know how to adapt these techniques to your child’s age, symptoms, and temperament in order to achieve the highest level of success.
At The Midtown Practice, we know how important it is to include you and your child in all treatment decisions, and spend whatever time is necessary to ensure success. We are dedicated to helping young people early and comprehensively, so that they can mature into healthy, well adjusted adults living full and meaningful lives of their own making.