Archive for Sunday, November 21, 2004

Therapy helps counter trauma

November 21, 2004


Some kids are more easily traumatized by shocking events than others. This raises two questions.

Can you predict which ones will be more traumatized after personal abuse, community violence or a natural disaster? And can you lessen the trauma by working with those kids either before the event or right after?

Wendy Silverman, a professor of psychology at Florida International University, answered "yes" to both questions at a recent conference sponsored by the Kansas University Clinical Child Psychology Program.

Kids who live through trauma may suffer an array of problems, she said, from post-traumatic stress disorder to anxiety, phobias and depression. Or they may just act up.

The key word is "may." It's hard to know who will and who won't.

So Silverman looked at 12 large studies focused on persistent reactions to trauma. She came away thinking that four factors are more important than others in predicting whose trauma will last.

The factor of greatest importance is the threat posed by the trauma. Trauma lasts longer when a child perceives his or her life to be at stake or in danger of tremendous loss or disruption.

The second factor is how much support a child has from family and friends. The more the better, Silverman said.

The third factor is how the child behaves in the wake of the trauma. A child who does something constructive is better off than one who just gets angry or withdraws.

Fourth is how stable the child was before the trauma. An anxious kid who's traumatized is worse off than a contented one.

Silverman is working on a research-based questionnaire that can identify vulnerable kids before trauma occurs, or right after, so they can be treated quickly.

Today, it's typical to have a counselor come to a school to talk with kids after a shooting or natural disaster occurs.

The approach may be well-intentioned, but it's not wise, Silverman said. Research shows that the effect of such debriefing is neutral or negative, not positive.

Silverman endorsed the use of cognitive-behavioral therapy for traumatized children.

Here, a child is opened gradually to a traumatic memory and learns new ways to think about the event rather than stay on the same treadmill of thoughts. This lowers the feeling surges that traumatic memories bring, Silverman said.

The approach is called cognitive-behavioral therapy because besides thinking, the child does something related to the trauma.

A kid in New York might visit the site where the World Trade Center stood, for example, or a Kansas youngster might draw a picture of her house after a tornado.

Of course some traumas don't allow much doing. In those cases, the only refuge may be the mind.

Victor Frankl, a psychotherapist who survived a Nazi concentration camp, wrote of himself and his fellow inmates, "We needed to stop asking ourselves about the meaning of life, and instead to think of ourselves as those who were being questioned by life -- daily and hourly."

In other words, Frankl stopped regarding himself as a victim and became a student of the experience. Later, he imagined being released from the camp and then lecturing to students about the experience.

Most of us aren't Frankl. We need some coaching in how to use our minds to get through hard spots. Research like Silverman's ensures that the coaching is not just well-intentioned but wise.

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