We understand through medical studies that certain health conditions, exposures, and lifestyle factors make us more susceptible to diseases and conditions such as heart disease, cancer and diabetes. But what makes us more susceptible to shock trauma, an impaired connection in relationships or having less resiliency as adults?
While trauma therapy is a growing field with varied treatment modalities, our need to address trauma therapy with a body-based approach is supported in evidence-based science through studies such as the ACE-CDC Kaiser Permanente Study.
Somatic Experiencing® takes a body-first approach to trauma resolution, relieving the most severe symptoms with a bottom-up philosophy of first addressing somatic symptoms to then present trauma as more manageable neurologically even with little or no information about the actual trauma event or experience.
ACE-CDC Kaiser Permanente Study Origins
The ACE (Adverse Childhood Experiences) Study began when Dr. Vincent Felitti discovered his obesity clinic clients did not put on excess weight gradually over the years, as expected, but instead gained weight all at once over a relatively short period of months or years.
When reviewing records, he noticed nearly all of the clients were born at an average weight and despite their success in the program, he had a high dropout rate. Dr. Felitti followed up with clients in an exit interview to determine why they left the clinic. Upon further inspection of their backgrounds, he uncovered a common link – sexual abuse.
Kaiser Permanente in San Diego obtained over 17,000 participants to fill out a questionnaire regarding adverse childhood experiences and began compiling the data. The questionnaire initially covered three types of abuse – verbal, sexual and physical and ten childhood experiences, including living with a parent with mental illness, addiction, incarceration, a victim of domestic violence, loss of a parent through divorce or abandonment and emotional or physical neglect.
What the research uncovered was an undeniable link between adverse childhood experiences, abuse and childhood dysfunction with increased risk factors in several leading causes of death in adults, including diabetes, heart disease and COPD, as well as an increased risk for substance abuse and addiction.
The CDC-Kaiser ACE Study and Trauma Therapy
In many cases, trauma can be misdiagnosed as a behavioral or medical issue, masking the underlying cause for specific actions and habits in both children and adults. While the ACE Study does not predict that everyone with traumatic childhoods will have issues into adulthood, it is a tool to add to the therapists’ toolkit when working with difficult cases. Trauma often shrouds itself in anger, aggression, depression, anxiety and myriad somatic ailments. It also frequently appears as difficult or unfulfilling relationships, some of which travel through families generationally.
Using the ACE Study, or a more conversational variation thereof, can inform your approach with a client, keeping in mind that their predisposition to particular medical and psychological vulnerabilities can mean that they pose additional challenges in sessions.
How Trauma Changes the Brain and Emotional Regulation
Because developmental trauma impacts the brain by causing constant states of hypervigilance and stress, the overactive amygdala is constantly triggering aggression, fear or stress. Dr. Peter Levine’s “Bottom-Up” approach to treating somatic symptoms first with exercises like gentle movements or vibrational sounds calms the body to calm the mind.
Practices like meditation, yoga and mindfulness exercises promote the reconnection of the brain’s emotional regulator, the ventromedial prefrontal cortex, with the emotional center, the limbic system, in a meaningful way to begin making lasting repairs to the connections within the brain. The ventral prefrontal cortex is the emotional regulator and allows you to see your emotions clearly.
The dorsolateral cortex reveals oneself and your emotions over time. When reliving trauma that often is coded in implicit memory. It can feel as if the emotional pain will last forever. Diane Poole Heller often says, “trauma stops time.” It locks you into the worst moment because of our brain’s natural negativity bias. We also back up a moment to “unhappen the trauma” and often dissociate the moment before the worst to protect ourselves. The problem is the worst moment then lives within you, as the next thing in front of you. This keeps you on guard and excessively hyper-vigilant until you can move gradually through time and integrate enough of what happened so that the threat response is extinguished and you regain the physiological capacity to relax again. You may have dozens of positive, happy moments since the traumatic event, but the brain focuses on the negative (perceived threat) because of our biological survival system.
A therapeutic awareness of both developmental trauma and PTSD can inform the clinical approach to healing. Trauma healing can enhance life’s pleasure, enjoyment, and vitality and positively impact our clients’ longevity and health. Once these overwhelming experiences are resolved, our clients reconnect to a sense of an optimistic future again as well as their curiosity to explore and engage in life and their relationships.
Developmental Trauma and ACE Study Results
Alongside the ACE Study, a parallel program that studied the impact of toxic stress on the developing brain found that when exposed to constant cycles of fight-flight-freeze responses at home, children cannot learn properly in school. The constant toxic stress cycles damage the normal progression of a child’s healthy brain development and cause them to engage in riskier behaviors than their typically developing peers as a way to cope or soothe stress, anxiety or depression.
Some of the risky behaviors include substance abuse, overeating, promiscuity and aggressive sports. The high exposure to stress and the release of stress hormones can cause the turning on and turning off of specific gene expressions, which can then result in intergenerational or inherited trauma. This connection could be a contributing factor as to why particular traumas and habitual behaviors run through families.
Developmental Trauma and Attachment Theory
The breakdown in normal development in children often results in broken attachment bonds between parents and children. Rather than feeling safe to be themselves and feeling protected (secure attachment), children adapt their behaviors and expectations based on the deficiencies of their caregivers and their unsafe growing-up environment, leading to attachment adaptations, such as avoidant, anxious/ambivalent and disorganized attachment that carry through to their adult relationships.
Adults with attachment injury may not have the resources or ability to establish secure attachment with their children, perpetuating the cycle of trauma. They can learn secure attachment as adults with the proper support.
Developmental Trauma and Its Relationship to Shock Trauma and PTSD
Bessel van der Kolk, MD, author of The Body Keeps the Score, and his colleagues conducted a study published in the European Journal of Psychotraumatology in 2019 linking the comorbidity of developmental trauma and PTSD. The context of not feeling safe, suffering abuse, or having unmet needs as children can mean those early developmental experiences give us a predisposition to be more susceptible to shock trauma in addition to the relational and mental fallout of attachment injury and social dysfunction.
Developmental trauma may make individuals less resilient since they lacked the foundational safety, regulation and having needs met as children. The attachment system is the primary system that influences how safe, connected and calm individuals feel in the context of relationships with others, with themselves, and in life.
According to Dr. van der Kolk, one of the best ways to treat both developmental and shock trauma is by developing a loving and compassionate relationship with the body. Finding a way to increase awareness of the body’s sensations, its needs, and its connection with the brain will repair some of the brain’s traumatic programming. As we find our bodies, we can access an inherent resiliency and our capacity to heal.
When combined with communication, developing a positive relationship with one’s body can elevate the life experience and overall aliveness by destigmatizing the traumatic experience and embracing the authentic self.