Like the brain impacts of substance use disorders (aka substance abuse or addiction), most people do not understand the brain impacts of trauma.
Trauma takes many forms: neglect, sexual assault, physical abuse, emotional abuse, parental divorce, and growing up with a parent who has an untreated substance use disorder or mental illness, to name a few. Thanks to the CDC-Kaiser ACE Study, there is now solid research to help us understand the brain impacts of trauma (aka adverse childhood experiences), which in turn helps us better understand the physical impacts of trauma, as well. These brain impacts are related to toxic stress and how toxic stress changes how the brain works, wires, and maps. The physical and emotional ailments and quality of life outcomes of toxic stress include: anxiety, depression, stomach ailments, skin disorders, sleep problems, neck/back/shoulder pain, and inflammatory diseases, to name a few. Check out the American Academy of Pediatrics’ article,“Adverse Childhood Experiences and the Lifelong Consequences of Trauma.”
Healing Trauma Takes Time
Thus understanding the impacts of trauma and what it takes to heal those impacts is critical, which is what prompted me to share and comment on Jonathan Shedler, Ph.D.’s article, “Selling Bad Therapy to Trauma Victims.” Dr. Shedler, Clinical Associate Professor at the University of Colorado School of Medicine, opened his article with, “The American Psychological Association (APA) just issued guidelines for treating trauma. Patients and therapists would be wise to ignore them.” He goes on to write,
“Psychotherapy takes time. Psychotherapy follows a ‘dose-response’ curve. It takes more than 20 sessions, or about six months of weekly therapy, before 50 percent of patients show clinically meaningful improvement. It takes more than 40 sessions before 75 percent of patients show meaningful improvement.1 These findings, based on the scientific study of more than 10,000 therapy cases, dovetail with what therapists report about successful treatments2 and what patients report about their own therapy experiences.3,4The RCTs [randomized controlled trials] behind the [APA’s] trauma treatment guidelines studied only therapies of 16 sessions or less. Many were eight sessions or less. In other words, the guidelines considered only therapies that are inadequate. Read his article here.
As someone who spent three years in cognitive behavioral therapy to overcome a number of traumatic events (read my story, here) and as someone who has spent a great deal of time studying current brain research, I cannot help but agree that trauma cannot be healed in 16 sessions or less. Why? Because of the complexity of the human brain — complexity influenced by all the factors that contribute to how an individual’s brain wires, develops and maps from birth and across a lifetime.
As importantly, the impacts of trauma left untreated (whether it occurred before the age of 18, which is the basis of trauma measured in the ACE Study, or later in life, perhaps the death of a loved one, PTSD, living with someone who has a severe substance use disorder) do not go away until the trauma is treated. And until it’s treated, a person will continue to experience the toxic stress-related physical and mental health issues caused by the untreated trauma. For more on this concept, please check out two of my articles chronicling my experiences, “When Recovering From ACEs is Recovering from Secondhand Drinking and Visa Versa” and “The Legacy of Untreated ACEs.”