Mental health experts from afar have volunteered to join the social workers, psychologists and psychiatrists in and near Newtown because of the importance of treating the emotional trauma inflicted on parents, teachers, first responders and others on Dec. 14.
Time is of the essence, because after the first few weeks, the vivid memories of the event may become more generalized in the minds of those who witnessed it, making it more difficult to treat the psychological wounds.
“What we know is in the immediate aftermath” of a traumatic event, there is what mental health experts call a peri-traumatic period, which can last from a few days to several weeks, said Steven Marans, director of the National Center for Children Exposed to Violence. After that, the patient is more in danger of developing post-traumatic stress disorder, though not all do. The center is based at the Yale Child Study Center in New Haven, Conn.
Esther Howe, interim associate dean at Southern Connecticut State University’s School of Health and Human Services, described it this way: “People often freeze at the beginning. It’s just like you compartmentalize it. … But then we sort of relax into it and our defenses go down and then our troubles begin.”
Marans said trauma “refers specifically to the subjective experience of individuals when they are confronted with unanticipated, overwhelming danger that leaves them hopeless and out of control and terrified, and we know that in these circumstances there is an immobilization of normal patterns of fight or flight.”
There is a “disregulation” that disrupts “the normal abilities, capacities of the brain to integrate feelings, thought and action.” It’s like being confronted with “our worst nightmare,” such as our own death, the death of a loved one or severe injury. In addition to physical symptoms of terror, we are hit with “jumbled thoughts, feelings and not being able to think clearly,” Marans said.
Our ability to live our daily lives becomes disrupted, as well, he said, which helps determine “what’s needed to move in the direction of recovery.”
Barbara Greten of Meriden, a certified trauma therapist and a lecturer in neurobiology at the University of Connecticut School of Social Work, agreed that treatment needs to begin early, and that whether someone will develop PTSD is not predetermined.
“Two people who are having the same exact experience — one may get PTSD and the other will not,” she said. But early treatment will lessen the chances.
She said there are numerous ways to treat trauma in children, and ways everyone can help, simply by being supportive.
“Every time we offer something positive, like a hug or some kind of soothing gesture, our brains actually process that and it helps to process” the trauma, Greten said.
“Treat them with behaviors that are very emotionally soothing, because PTSD is an anxiety disorder,” Greten said. “It has to do with our ability to regulate our affect.”
Children may revert to behaviors like thumb-sucking, which is OK. “The holding and soothing, it’s just very, very important. Sing to them, whatever, help them to soothe and help them to regulate their emotions,” she said.
Howe, a former school social worker at the Academy of Mount St. Ursula in South Bronx, N.Y., an all-girl school, said a long-term move would be to have psychologically savvy people in the classroom to watch for children who need intervention, those who may be suffering trauma such as parental abuse.
“What you want is sort of a sympathetic observer who would notice if this person starts manifesting” evidence of trauma, such as not displaying feelings or describing nightmares, she said. “But you don’t want to impose on them.”
One of the most successful short-term therapies was developed by Marans and other mental health experts working with the New Haven Police Department and other agencies that helped identify children in need. Called Child and Family Traumatic Stress Intervention, it brings together the youth who underwent the trauma, such as watching a relative slain on the street, the family or other caregiver and the therapist.
After an initial screening, four to eight sessions are held, involving the youth and the caregiver alone and together with the therapist. By having the parties describe their experiences, the “symptoms that are most troubling and disruptive” are identified. The family members are helped “to put into words” the most important areas to focus on, Marans said.
“The best parents in the world don’t always know that their kids are having symptoms,” and the sessions bring the individuals together “to literally compare notes,” he said.
Once the caregivers are taught supportive techniques to help what the child identifies as the most troublesome symptoms, a second screening is done and further steps are determined.
The important thing is “recognizing that if we’re not addressing what the ongoing, concrete needs are and issues are, then we’re not doing a complete job,” said Marans. The goal is to bring back “a position of strength” and “a feeling of safety.”
With the shootings in Sandy Hook in mind, Marans said, “We’ve learned an enormous amount about how to help children and families and adults recover” from trauma, through work with those who have been in combat or undergone rape.
“If we want to honor the dead in this tragedy, one of the ways would be to make a commitment to applying what we know,” he said.