Trauma experienced during childhood can have profound and enduring effects on a child’s development and well-being. Trauma can influence how we think, feel, and behave, long after the traumatic event has passed. Post-Traumatic Stress Disorder (PTSD) occurs in roughly 15% of young people that have experienced a traumatic event or events, and is characteristed by instrusions (for example, flashbacks, nightmares), avoidance of reminders (of memories, thoughts or people or place) and hyper-vigilance to threat. Other symptoms include negative emotions and beliefs about themselves, the world and others and/or a feeling of detachment.
In this post we will describe one of the most effective therapies for PTSD, which is Cognitive Behavioural Therapy (CBT). CBT is a well-established psychological treatment, recommended in the National Institute for Health and Clinical Excellence guidelines for treating PTSD in children and adolescents.
The Linen Cupboard Metaphor:
The linen cupboard metaphor is a way of demonstrating how trauma responses can be stored and triggered within the brain. Neuroscience has taught us that trauma memories are stored and activated differently to other types of memories. Imagine a linen cupboard where you neatly store various items like bedsheets, blankets, and towels. Memories in PTSD are a bit like items stuffed in a messy linen cupboard. Whenever you brush pass the cupboard the door flies open and towels, clothing or blankets fall out. Each item represents a trauma memory or response. Whenever you come across a reminder of the trauma (which can be internal thoughts or external stimuli), you have flashbacks or intrusive memories, and feel intense fear. A typical response is to try to stuff things back in the cupboard, and to close the door as quickly as possible. This may help you to manage in the short term, but over time, this just keeps the problem going: memories are jammed in the cupboard, and the door will still swing open at the lightest touch.
Trauma-focused therapy involves taking each item out of the cupboard, slowly and carefully examining them, before nearly folding them up and putting them back in their right place.
How CBT Helps with PTSD
Cognitive Behavioural Therapy is a structured, time-limited therapy that focuses on identifying and changing negative thought patterns and behaviours. Here's how CBT can be particularly effective for those dealing with trauma:
Identifying Negative Thoughts: Trauma can lead to distorted thinking patterns, such as believing that the world is entirely dangerous or that one is to blame for the trauma. CBT helps individuals identify these negative thoughts.
Challenging and Reframing Thoughts: Once identified, these thoughts are critically examined and challenged. For example, a therapist might help a young person see that the event was not their fault and that it doesn't mean they are powerless or worthless.
Exposure Therapy: A component of CBT, exposure therapy gradually and safely exposes individuals to trauma-related memories and situations. This helps reduce the power these memories hold and diminishes avoidance behaviours. Within a safe and containing therapeutic relationship, a young person will re-tell their story. In this way, they are taking each item of clothing out of that messy cupboard, folding it up, and placing it back in its right place.
Building Coping Strategies: CBT equips individuals with practical tools and strategies to manage stress and anxiety, such as relaxation techniques, mindfulness, and problem-solving skills.
Improving Emotional Regulation: CBT helps individuals understand and manage their emotions, reducing the intensity and frequency of traumatic stress reactions.
What does Trauma Focused-CBT look like?
Assessment: The therapist conducts a comprehensive assessment to understand the nature and extent of the trauma and its impact on the individual's life.
Goal Setting: Together, the therapist and young person set specific, achievable goals for therapy, such as reducing flashbacks or improving sleep.
Skill Building: The therapist introduces various coping strategies and techniques that the young person can use to manage symptoms and stress.
Exposure and Processing: The therapist guides the client through the process of confronting and processing traumatic memories in a safe and controlled manner.
Review and Maintenance: Therapy concludes with a review of progress and the development of a plan to maintain and continue the progress made.
The Benefits of CBT for PTSD
Trauma can leave a lasting imprint, but it doesn't have to define one's life. Cognitive Behavioural Therapy offers a path to understanding and managing the complex responses to trauma. By reframing negative thoughts, confronting traumatic memories, and building robust coping strategies, individuals can reclaim their lives and move towards healing and recovery. CBT has been shown to be highly effective in reducing symptoms of Post-Traumatic Stress Disorder (PTSD) and other trauma-related issues for children and young people. There are other trauma-focused psychological therapies that we offer at The Lotus Psychology Practice, which you can read about here.
If you are worried about your child following a traumatic experience, seeking professional help is an important first step. You can contact your local GP or us at The Lotus Psychology Practice.