The Big Five Personality Traits: Exploring the Connection Between Personality & Mental Health

Origins: The Formation of the Big Five

Some people are more outgoing than others; some prefer to keep to themselves. Some people love to argue and others prefer to keep the peace. Some people are highly organized, making their beds every morning; others can hardly find a pair of socks under the mountain of a pile of clothes. In our own experience of life, we can probably think of a vast variety of individuals with their own personalities, each coping uniquely with the challenges life throws at them.

Personality psychologists have come up with a concept of ‘traits’ – the stable tendencies of individuals – to explain everyday behaviors like journaling, throwing socks on the floor, cleaning after themselves, etc. But how do we figure out which traits are the most important? Are there any traits that serve as the most common among every individual? Can we describe someone’s personality in just a few words? To answer these questions, personality psychologists have tried for more than a century to develop a comprehensive measure of personality traits, resulting in questionnaires such as the Minnesota Multiphasic Personality Inventory (MMPI).

The modern study of personality psychology is attributed to Francis Galton who developed the idea of the lexical approach.[1] This idea explains how language captures the traits most important to people in their everyday lives. It argues that if a trait is important, then it would be encoded in language with individual words such as “nervous” or “outgoing”. Following this reasoning, all of the adjectives in the English dictionary were recorded; screening out words that referred to momentary states (e.g., annoying), the remaining words alluded to psychological attributes (e.g., outgoing, nervous, and neat).[2]

After the researchers had people rate themselves on the recorded adjectives, they did a factor analysis [3,4] which formed groups of adjectives based on their correlation with each other. This resulted in five major factors that had the most adjectives, which we now know as the Big Five Personality Traits: Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness to Experience. 

Understanding the Big five Personality Traits

These five factors are best understood as a continuum of traits, each having its own sub-categories (i.e., facets).[5] The following facet examples helps explain the diversity of characteristics within each grouping:[6]

1. Extraversion: friendliness, gregariousness, assertiveness, activity level, excitement seeking, cheerfulness

2. Agreeableness: trust, morality, altruism, cooperation, modesty, sympathy

3. Conscientiousness: self-efficacy, orderliness, dutifulness, achievement-striving, self-discipline, cautiousness

4. Neuroticism: anxiety, anger, depression, self-consciousness, immoderation, vulnerability

5. Openness to Experience: imagination, artistic interests, emotionality, adventurousness, intellect, liberalism

Internalizing these facets also helps us avoid common misunderstandings about the traits. Apart from being a continuum, there is no “right” or “wrong” personality – each trait has its advantages and disadvantages. For example, the extrovert might delve too much into excitement-seeking which can turn out to be reckless at times. The neurotic person, on the other hand, might be anxious, but that will prevent them from reckless behavior.

The Five traits and Mental Health

1. Extraversion

Extraversion is the dimension that ranges from how outgoing and stimulant-seeking a person is to how much they conserve their energy and do not actively engage to earn social rewards. Extraversion includes preferring the company of others as opposed to being alone, aspiring for leadership roles, being physically active, and experiencing more happiness and joy. It captures the most positive emotions – joy, energy, happiness – out of all the traits because of which extraverts are more likely to experience positive moods.[7] Due to its link with positive emotions, individuals who score higher on extraversion tend to have better mental health; they are less likely to suffer from mood and anxiety disorders.[8] These benefits occur not from extraversion itself but because extroverts are often better at maintaining relationships, which are linked to physical and mental health.[9]

The opposite dimension of extraversion is introversion. Introverts are not hermits who isolate themselves; instead, they prefer the company of close friends and family as opposed to large gatherings. Hans Eysenck (1967) posited that introverts are sensitive to stimuli which causes them to prefer solitude.[10] On the other hand, extroverts seek stimulation and excitement which might be linked to higher levels of dopamine – the brain-chemical responsible for pleasure.[11]

2. Agreeableness

The dimension of agreeableness describes an individual’s tendency to put others’ needs ahead of their own, making those low in agreeableness more antagonistic. Agreeable individuals are sympathetic to the needs and feelings of others and trust them more. They prefer cooperation as opposed to competition and tend to be honest, humble, and compliant. In short, individuals high in agreeableness tend to hold other people’s needs above their own; they tend to gain pleasure from serving others and taking care of them.[12] While agreeableness is the least studied factor in the Big Five, most research on it is done by investigating both ends of its spectrum.[13] The opposite end of the agreeableness spectrum – antagonism – encompasses characteristics such as: angry, argumentative, hostile, egotistical, condescending and skeptical.[14]

Unfortunately, these characteristics result in a correlation with antisocial behavior. Research has found that disagreeable individuals are more likely to be involved in crime, aggressive behavior, drug abuse, and gambling.[15-18] Those high in agreeableness, however, show behavior that includes helpfulness, forgiveness, and acceptance.[19] As a result of prosocial behavior, agreeableness comes with many benefits which include, but are not limited to: positive emotions, decreased depression, healthy social connections and relationships as well as greater life satisfaction.[20]

3. Conscientiousness

This dimensional trait measures an individual’s self-discipline and control in order to achieve their goals, making those on the other end of the spectrum more impulsive. Conscientiousness involves willpower; individuals high in this trait can delay gratification, consider the consequences before acting, and work hard toward their goals. As a result, conscientious people are diligent and organized, achieving their goals despite boredom, frustration, or distractions. Similar to individuals low in agreeableness, research has found those low in conscientiousness are more likely to abuse drugs, involve themselves in criminal behavior, and gamble more often.[21]

Due to greater self-control, highly conscientious people tend to enjoy better mental and physical health, including living longer.[22,23] Willpower motivates this cohort to be more-likely to exercise, follow a well-balanced diet, avoid drug abuse, and achieve educational and career goals to try and avoid stressful financial problems. For example, they have been found more likely to eat salads and are less likely to be overweight.[24] They also benefit from better mental health by managing their negative emotions; as a result, perhaps, conscientious people are more likely to have stable marriages.[25]

4. Neuroticism

This spectrum describes how much someone experiences negative emotions as a reaction to a situation. Neuroticism is the tendency to experience negative emotions such as anger, depression, anxiety, shame, and self-consciousness. Highly neurotic individuals may experience negative emotions more frequently and intensely. As a result, they are more prone to mental health issues such as depression, generalized anxiety disorder, PTSD, OCD, substance abuse disorder, and eating disorders.[26-28]

An individual high in neuroticism is less likely to engage in processing their emotions than an individual who does not worry often. To aid a neurotic person in psychotherapy, it is beneficial to help them overcome their inclination to avoid emotions. This is better achieved by helping them realize their emotions as negative, instead of figuring out the origin of their emotions. It is this suppression that harms their mental health, so labeling their emotions as negative serves to alleviate the stress they experience.[29]

5. Openness to Experience

The openness dimension ranges from thinking in abstract, complex ways to thinking more traditionally. Openness is the least intuitive of the Big Five. It has been labeled differently – such as ‘intellect’, ‘culture’, and ‘imagination’ – in many personality questionnaires; McCrae (1996) defined it according to the lines of ‘vivid fantasy’, ‘intellectual curiosity’, ‘behavioral flexibility’, and ‘unconventional attitudes’.[30] Individuals high in openness to experience love to try new things, play with complex ideas, and consider alternative perspectives. Most importantly, they are more likely to name travel as an important personal goal.[31] For example, they are more likely to engage in meditation (associated with new experiences), go to art exhibits, or speak a foreign language.[32] In contrast, low-openness people value the status quo, favor traditional activities, and prefer routine.

Openness does not have many links with psychiatric disorders; however, researchers argue having too much vivid imagination overlaps with psychotic symptoms like hallucinations or unusual beliefs.[33] Overall, those high in openness are less likely to suffer from anxiety disorder or depression.[34] It is also the only factor linked with intelligence; although the correlation is small, those high in openness tend to score higher in IQ tests.[35] The facets of being highly open to experience allow an individual’s brain to retain its plasticity as they age, minimizing the decline in cognitive abilities.

Again, it is important to note how the five personality traits are a continuum more so than a concrete representation of who we are. Since life is not black and white but nuanced in essence, how we react to situations is equally gray and can differ from situation to situation. Just as our personality traits can determine how we react to circumstances; our circumstances can also impact our personality traits. Nevertheless, it is beneficial and empowering to know our personality features as it can equip us with a better understanding of ourselves and the people around us. It can help us cater to the specific characteristics of our friends and colleagues and at the same time allow us to make better choices considering our personalities.

Contributed by: Musa Zafar

Editor: Jennifer (Ghahari) Smith, Ph.D.

REFERENCES

1 De Vries, R. E., Tybur, J. M., Pollet, T. V., & Van Vugt, M. (2016). Evolution, situational affordances, and the HEXACO model of personality. Evolution and human behavior, 37(5), 407-421.

2 Cattell, R. B. (1943). The description of personality: Basic traits resolved into clusters. The journal of abnormal and social psychology, 38(4), 476.

3 Norman, W. T. (1963). Toward an adequate taxonomy of personality attributes: Replicated factor structure in peer nomination personality ratings. The journal of abnormal and social psychology, 66(6), 574.

4 Goldberg, L. R. (1993). The structure of phenotypic personality traits. American psychologist, 48(1), 26.

5 Bratko, D., & Marušić, I. (1997). Family study of the big five personality dimensions. Personality and Individual Differences, 23(3), 365-369.

6 Ibid.

7 Lucas, R. E., Le, K., & Dyrenforth, P. S. (2008). Explaining the extraversion/positive affect relation: Sociability cannot account for extraverts' greater happiness. Journal of personality, 76(3), 385-414.

8 Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010). Linking “big” personality traits to anxiety, depressive, and substance use disorders: a meta-analysis. Psychological bulletin, 136(5), 768.

9 Pollet, T. V., Roberts, S. G., & Dunbar, R. I. (2011). Extraverts have larger social network layers: But do not feel emotionally closer to individuals at any layer. Journal of Individual Differences, 32(3), 161.

10 Eysenck, S. B., & Eysenck, H. J. (1967). Salivary response to lemon juice as a measure of introversion. Perceptual and motor skills, 24(3_suppl), 1047-1053.

11 Wacker, J., Chavanon, M. L., & Stemmler, G. (2006). Investigating the dopaminergic basis of extraversion in humans: A multilevel approach. Journal of personality and social psychology, 91(1), 171.

12 Psychology Today. (n.d.). Agreeableness. Retrieved from https://www.psychologytoday.com/us/basics/agreeableness

13 Miller, J. W., & Lynam, D. (Eds.). (2019). The handbook of antagonism: Conceptualizations, assessment, consequences, and treatment of the low end of agreeableness. Academic Press.

14 Graziano, W. G., & Tobin, R. M. (2017). Agreeableness and the five factor model. The Oxford handbook of the five factor model, 1, 105-131.

15 Miller, J. D., & Lynam, D. (2001). Structural models of personality and their relation to antisocial behavior: A meta‐analytic review. Criminology, 39(4), 765-798.

16 Jones, S. E., Miller, J. D., & Lynam, D. R. (2011). Personality, antisocial behavior, and aggression: A meta-analytic review. Journal of Criminal Justice, 39(4), 329-337.

17 Lackner, N., Unterrainer, H. F., & Neubauer, A. C. (2013). Differences in Big Five personality traits between alcohol and polydrug abusers: Implications for treatment in the therapeutic community. International Journal of Mental Health and Addiction, 11(6), 682-692.

18 MacLaren, V. V., Fugelsang, J. A., Harrigan, K. A., & Dixon, M. J. (2011). The personality of pathological gamblers: A meta-analysis. Clinical psychology review, 31(6), 1057-1067.

19 Psychology Today

20 Aknin, L. B., & Whillans, A. V. (2021). Helping and happiness: A review and guide for public policy. Social Issues and Policy

21 Miller, J. D., & Lynam, D. (2001). Structural models of personality and their relation to antisocial behavior: A meta‐analytic review. Criminology, 39(4), 765-798.

22 Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010)

23 Kern, M. L., & Friedman, H. S. (2008). Do conscientious individuals live longer? A quantitative review. Health psychology, 27(5), 505.

24 Keller, C., & Siegrist, M. (2015). Does personality influence eating styles and food choices? Direct and indirect effects. Appetite, 84, 128-138.

25 Claxton, A., O’Rourke, N., Smith, J. Z., & DeLongis, A. (2012). Personality traits and marital satisfaction within enduring relationships: An intra-couple discrepancy approach. Journal of Social and Personal Relationships, 29(3), 375-396.

26 Lahey, B. B. (2009). Public health significance of neuroticism. American Psychologist, 64(4), 241.

27 Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010) 

28 Samuel, D. B., & Widiger, T. A. (2008). A meta-analytic review of the relationships between the five-factor model and DSM-IV-TR personality disorders: A facet level analysis. Clinical psychology review, 28(8), 1326-1342.

29 Whitbourne, S. K. (2020, January 18). Neuroticism, emotions, and your health. Psychology Today. Retrieved December 6, 2022, from https://www.psychologytoday.com/us/blog/fulfillment-any-age/202001/neuroticism-emotions-and-your-health 

30 McCrae, R. R. (1996). Social consequences of experiential openness. Psychological bulletin, 120(3), 323.

31 Reisz, Z., Boudreaux, M. J., & Ozer, D. J. (2013). Personality traits and the prediction of personal goals. Personality and Individual Differences, 55(6), 699-704.

32 Chapman, B. P., & Goldberg, L. R. (2017). Act-frequency signatures of the Big Five. Personality and Individual Differences, 116, 201-205.

33 Widiger, T. A. (2011). The DSM-5 dimensional model of personality disorder: Rationale and empirical support. Journal of Personality Disorders, 25(2), 222.

34 Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010) 

35 DeYoung, C. G., Quilty, L. C., Peterson, J. B., & Gray, J. R. (2014). Openness to experience, intellect, and cognitive ability. Journal of personality assessment, 96(1), 46-52.

Imprisioned Youth: Mental Health Impacts of the Juvenile Justice System

The Goal & The Current Reality

Established in 1899, the U.S. Juvenile Justice System was created with the goal of deterring youth offenders from the damaging punishments of criminal courts while encouraging rehabilitation based on the individual juvenile’s needs.[1,2] Although the number of arrests of minors has been decreasing since 1997, nearly 60,000 minors are incarcerated daily in the United States. While roughly two-thirds of youth in juvenile facilities are 16 or older, more than 500 confined children are no more than 12 years old.[3-5] Youth who are incarcerated may be exposed to negative circumstances such as overcrowding, physical and sexual violence, risk of suicide and death.[6] 

Violence and abuse

Youth are exceptionally susceptible to many types of abuse during incarceration.[7] Many types of violence may occur in youth prisons, including:[8]

• physical violence amid detainees

• excessive violence committed by prison staff towards detainees amounting to torture or ill-treatment

• sexual assaults of inmates by other inmates or by prison staff

• psychological violence (e.g., verbal aggression, intimidation, etc.)

• suicides, attempts and other self-harm.

In “Victims Behind Bars: A Preliminary Study on Abuse During Juvenile Incarceration and Post-Release Social and Emotional Functioning,” researchers Dierkhising, Lane and Natsuaki (2014) examined the consequences of abuse while incarcerated. Of the youth surveyed, 96.8 percent had experienced at least one type of abuse during their incarceration (e.g., neglect or witnessing of abuse); 77.4 percent experienced a direct form of abuse, including physical injury.[9] The most common forms of direct abuse were the excessive use of solitary confinement, peer-to-peer physical assault between youth and psychological abuse of youth by staff.[10,11] Although violence is difficult to assess and address due to it being underreported, roughly approximately 25% of incarcerated youth are victimized by violence each year; 4-5% of whom experience sexual violence, with 1-2% subject to rape.[12] Psychological and physical effects of abuse may persist after the release of inmates.[13]

The abuse endured and exposure to violence in prisons and jails are associated with long term problems. These long term issues include post-traumatic stress symptoms, such as anxiety, depression, avoidance, hypersensitivity, hypervigilance, suicidality, flashbacks, difficulty with emotional regulation, and increased risk of criminal involvement.[14,15] Quandt & Jones (2021) note that the lasting effects of the trauma experienced while incarcerated can lead to Post-Incarceration Syndrome.[16] Similar to Post-Traumatic Stress Disorder (PTSD), Post-Incarceration Syndrome is a set of symptoms present in many currently incarcerated and recently released prisoners; it is caused by being subjected to prolonged incarceration in environments of punishment with few opportunities for education, job training, or rehabilitation.[17] In addition, a study conducted by Piper & Berle (2019) examined the relationship between trauma experienced during incarceration and PTSD outcomes. They found that incarcerated people experience high rates of potentially traumatic events, and that there was a relationship between experiencing these events behind bars and the rate of PTSD upon release.[18] The National Child Traumatic Stress Network (2007) found an average of 30% of previously incarcerated youth develop some form of PTSD.[19]

 

Mental Health in the Juvenile Justice System

The National Conference of State Legislatures found that the juvenile justice system is ill-equipped to handle minors with mental health needs.[20] Approximately 1-in-4 children and adolescents arrested each year suffer from a mental illness so severe it impairs his or her ability to function as a young person and grow into a responsible adult.[21] The lack of treating a minor’s mental illness can increase the chances of delinquency transforming into adult criminality.[22] It is estimated that 60 to 70 percent of the 2 million children and adolescents that enter the juvenile justice system have one or more diagnosable disabilities (e.g., learning disabilities, emotional and behavioral disorders and developmental disabilities).[23] The most common diagnoses found in incarcerated youth include: Attention-Deficit Hyperactivity Disorder (ADHD), learning disabilities (LD), depression, developmental disabilities (DD), conduct disorder, anxiety disorders, Post-Traumatic Stress Disorder (PTSD), and substance abuse.[24] 

Many youth experience conduct, mood, anxiety and substance disorders that frequently put them at risk for troublesome behavior and delinquent acts.[25] Symptoms of mental health disorders often start in childhood; behavior disorders such as ADHD impact about 9-10 percent of children in America and emotional disorders (e.g., depression) impact 1 in every 33 children.[26] Mental health disorders in youth can be difficult to treat; however, assessing and treating issues early can create positive outcomes.[27] 

Many youth with mental health disorders also engage in substance abuse and there is an overrepresentation of this co-occurrence within the juvenile justice system.[28] Two-thirds of juveniles within the system with a mental health diagnosis also had dual disorders; this most often involves substance abuse in addition to another diagnosis.[29] 

Methods of Reform

In order to reform the juvenile justice system, the subsystems within it need to be addressed. While reform is a long process that can take many years, Sander (2021) notes that many states have already made such reforms over the last 15 years to reduce youth incarceration.[30]

Eliminating violence and abuse while incarcerated poses a difficult task, however there are many policies currently in place that can accomplish this. Jocelyn Fontaine, Director of Criminal Justice Research at Arnold Ventures believes that, “The pathway to reform is in opening them, making the invisible more visible so by revealing what’s happening, then we hope that people would be motivated to change them.”[31] Fontaine considers transparency and accountability of  reform as shedding light on a situation due to the public and policymakers wanting to change it because they didn’t know about it before.[32] Other suggested reforms include increasing programs in order to keep juveniles focused to avoid violence. This notion, Social Bond Theory, was founded by Travis Hirschi and is based on the basic assumption that humans naturally tend towards delinquency.[33] Hirschi states that the stronger amount of social control and the denser the network of social bonds are, the more likely people are to behave in accordance with standards.[34]

The Healthy Returns Initiative is another way to combat the juvenile mental health crisis. This initiative was created to strengthen the capacity of county juvenile justice systems to improve health and mental health services, and ensure continuity of care as youth transition back to the community.[35] The Healthy Returns Initiative, created by The California Endowment, follows practices considered critical to any systems reform effort.[36,37] Life-changing reform practices have been implemented by the Initiative, such as: screening using validated mental health screening tools; connecting youth and families to benefits and resources (e.g., health care, housing assistance, and food stamps); collaboration and integration across services; and providing funding and resources to sustain multi-disciplinary, collaborative, holistic approaches.[38]

In addition to HRI, the Comprehensive Systems Change Initiative (CSCI) is a model that brings together juvenile justice and mental health systems to identify youth with mental health needs at their earliest point of contact with the juvenile justice system to develop an effective service delivery system to meet their needs.[39] This includes collaborating among all relevant youth-serving agencies and families, identifying youth with mental health needs through use of standardized screening and assessment tools, diverting youth from the justice system to community programs where possible and treating youth who remain in the system using a continuum of evidence-based mental health services.[40,41] 

By applying and executing reform in the juvenile justice system, society as a whole can better understand, assess and treat mental health disorders in children and adolescents. This implementation will allow youth in America to remain on-track to do better academically and subsequently have better odds at leading healthier and more fulfilling lives. 

Contributed by: Ariana McGeary

Editor: Jennifer (Ghahari) Smith, Ph.D.

REFERENCES

1 Juvenile Justice History. (n.d.). Retrieved from Center on Juvenile and Criminal Justice: http://www.cjcj.org/education1/juvenile-justice-history.html

2 McCord, Joan; Spatz Widom, Cathy; Crowell, Nancy A.; National Research Council. (2001). Juvenile Crime, Juvenile Justice. Washington: National Academy Press.

3 ACLU. (n.d.). America’s Addiction to Juvenile Incarceration: State by State. Retrieved from ACLU: https://www.aclu.org/issues/juvenile-justice/youth-incarceration/americas-addiction-juvenile-incarceration-state-state#:~:text=On%20any%20given%20day%2C%20nearly,prisons%20in%20the%20United%20States.

4 Youth Involved with the Juvenile Justice System. (n.d.). Retrieved from Youth.gov: https://youth.gov/youth-topics/juvenile-justice/youth-involved-juvenile-justice-system

5 Ibid.

6 Stephens, R. (2021, May 28). Trauma and Abuse of Incarcerated Juveniles in American Prisons. Retrieved from Interrogating Justice: https://interrogatingjustice.org/prisons/trauma-and-abuse-of-incarcerated-juveniles-in-american-prisons/

7 Modvig, J. (n.d.). 4. Violence, sexual abuse and torture in prisons - WHO/Europe. Retrieved from WHO/Europe: https://www.euro.who.int/__data/assets/pdf_file/0010/249193/Prisons-and-Health,-4-Violence,-sexual-abuse-and-torture-in-prisons.pdf

8 Dierkhising, C. B., Lane, A., & Natsuaki, M. N. (2014). Victims Behind Bars: A Preliminary Study on Abuse During Juvenile Incarceration and Post-Release Social and Emotional Functioning. Psychology, Public Policy, and Law, 20(2), 181-190.

9 Repka, M. (2014, March 26). Confronting an Unseen Problem: Abuse and Its Long-Term Effects on Incarcerated Juveniles . Retrieved from Chicago Policy Review: https://chicagopolicyreview.org/2014/03/26/confronting-an-unseen-problem-abuse-and-its-long-term-effects-on-incarcerated-juveniles/#:~:text=The%20most%20common%20forms%20of,staff%20was%20also%20widely%20reported.

10 Dierkhising, C. B., Lane, A., & Natsuaki, M. N. (2014)

11 Modvig, J. (n.d.). 

12 Dierkhising, C. B., Lane, A., & Natsuaki, M. N. (2014)

13 Repka, M. (2014)

14 Quandt, K. R., & Jones, A. (2021, May 13). Research Roundup: Incarceration can cause lasting damage to mental health . Retrieved from Prison Policy Initiative: https://www.prisonpolicy.org/blog/2021/05/13/mentalhealthimpacts/#:~:text=Exposure%20to%20violence%20in%20prisons,and%20difficulty%20with%20emotional%20regulation.

15 Ibid.

16 Post Incarceration Syndrome (PICS). (2021, October 16). Retrieved from BarNone, Inc.: https://barnoneidaho.org/resources/post-incarceration-syndrome/#:~:text=Post%20Incarceration%20Syndrome%20(PICS)%20is,%2C%20job%20training%2C%20or%20rehabilitation.

17 Piper, A., & Berle, D. (2019). The association between trauma experienced during incarceration and PTSD outcomes: a systematic review and meta-analysis. The Journal of Forensic Psychiatry & Psychology, 30(5), 854-875.

18 Bierkhising, C. B., Ko, S. J., Woods-Jaeger, B., Briggs, E. C., Lee, R., & Pynoos, R. S. (2013). Trauma histories among justice-involved youth: findings from the National Child Traumatic Stress Network. European Journal of Psychotraumatology, 4.

19 National Conference of State Legislatures. (2012, May 25). Mental Health Needs of Juvenile Offenders. Retrieved from NCSL: https://www.ncsl.org/documents/cj/jjguidebook-mental.pdf

20 Ibid.

21 Sawyer, W. (2019, December 19). Youth Confinement: The Whole Pie 2019. Retrieved from Prison Policy Initiative: https://www.prisonpolicy.org/reports/youth2019.html

22 Juvenile Justice Issues. (n.d.). Retrieved from Pacer Center: https://www.pacer.org/jj/issues/

23 Ibid.

24 National Conference of State Legislatures. (2012)

25 Ibid.

26 Ibid.

27 Substance Abuse and Mental Health Services Administration. (2022, March 22). Criminal and Juvenile Justice . Retrieved from SAMHSA: https://www.samhsa.gov/criminal-juvenile-justice

28 National Conference of State Legislatures. (2012)

29 Sanders, C. (2021, July 27). State Juvenile Justice Reforms Can Boost Opportunity, Particularly for Communities of Color. Retrieved from Center on Budget and Policy Priorities: https://www.cbpp.org/research/state-budget-and-tax/state-juvenile-justice-reforms-can-boost-opportunity-particularly-for#:~:text=Though%20much%20work%20remains%2C%20several,shifting%20to%20community%2Dbased%20approaches.

30 D'Abruzzo, D. (2020, August 24). How Can Prisons Eliminate Violence? One Researcher Is Determined to Find Out. Retrieved from Arnold Ventures: https://www.arnoldventures.org/stories/how-can-prisons-eliminate-violence-one-researcher-is-determined-to-find-out

31 Ibid.

32 Wickert, C. (2022, April 18). Social bonds theory (Hirschi). Retrieved from SozTheo: https://soztheo.de/theories-of-crime/control/social-bonds-theory-hirschi/?lang=en

33 Ibid.

34 Healthy Returns Initiative. (n.d.). Retrieved from i.e. communications, llc: https://www.iecomm.org/healthy-returns-initiative/

35 Reform Trends: Mental Health & Substance Use. (2022)

36 Healthy Returns Initiative.

37 Reform Trends: Mental Health & Substance Use. (2022)

38 Ibid.

39 Chayt, B. (2012, December). Juvenile Justice and Mental Health: A Collaborative Approach. Retrieved from ModelsforChange: https://www.modelsforchange.net/publications/350/Innovation_Brief_Juvenile_Justice_and_Mental_Health_A_Collaborative_Approach.pdf

40 Reform Trends: Mental Health & Substance Use. (2022)

Mindfulness: Armor Against Anxiety

Anxiety Snapshot

Approximately 25% of adults in the United States will experience an anxiety disorder in their lifetime.[1] Feelings of anxiety and worry can stem from regular daily events such as taking an important exam, giving a speech, or going on a first date. Normal occurrences as such will not always point to the presence of an anxiety disorder. However, when feelings of worry and negative thought patterns are chronic and uncontrollable, they can indicate that an anxiety disorder is present.[2] Experiences of anxiety can vary from person to person, and different types of anxiety disorders can provoke various uncomfortable feelings or thought patterns. BetterHelp (2022) lists the ten most common “hallmarks” of an anxiety disorder whether it be generalized anxiety disorder (GAD), panic disorder or social anxiety disorder (i.e., social phobia):[3]

1. Excessive Worry - Experiencing a sense of dread that lasts six months or longer about regular topics such as school, work, social life, relationships, heath, and finances.

2. Difficulty Sleeping - Lying awake at night and not being able to fall asleep due to anxious or fearful thoughts about a possible upcoming event.

3. Fatigue - Feeling exhaustion throughout the day or becoming easily tired even if one gets an adequate amount of sleep.

4. Trouble Concentrating - Procrastinating either knowingly or unknowingly and struggling to complete daily tasks at school or work due to blanking out.

5. Irritability and Tension - Feeling on edge regularly or becoming easily angered when stressed out. Tension can also present itself physically in tense muscles or aches and pains.

6. Increased Heart Rate - Experiencing rapid heart rate or irregular palpitations can occur during panic attacks and episodes of social anxiety. 

7. Sweating and Hot Flashes - Feeling one’s body temperature rise can stem from increased heart rate and higher blood pressure.

8. Trembling and Shaking - Feelings of fear and anxiety can induce limb shaking, especially in the hands. A state of heightened adrenaline and a fight-or-flight response can cause shaking as well.

9. Chest Pains and Shortness of Breath - Limiting the amount of oxygen in the lungs can cause chest pains, particularly during panic attacks. One may feel a sensation of tightness in the chest.

10. Feelings of Terror or Impending Doom - Feeling like something negative is going to occur can happen suddenly and come from an unknown source. Such feelings are likely to be disproportional to the actual events causing anxiety and panic.

Mindfulness Meditation as a Modern Practice

The field of positive psychological research has a common goal of focusing on what can go right in life, also known as positive affect. Positive affect can include enjoyment, personal connection, and states of pleasant feelings.[4] Deliberate trainings of positive emotions are referred to as Positive Psychology Interventions (PPIs); mindfulness meditation (MM) is one of the most effective known PPIs (Morgan, 2021). MM recently made its way into Western culture during the last century and can be defined as, “The awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment”.[5] As a result of practicing MM, emotions can be regulated, and physiological and mental changes can occur, enhancing one’s reality.[6] 

Mindfulness meditation manifests in two forms: state mindfulness and trait mindfulness. State mindfulness is the feeling of being present in the moment after practicing MM, whereas trait mindfulness is a practice one carries throughout their life, regardless of knowing about mindfulness or not.[7] There are five approaches one can take when practicing MM:[8]

• Body Scan: Focusing on one’s bodily sensations; typically starting at the top of the head down to the toes.

• Focused Attention: Holding concentration on one object or a specific feeling.

• Open Monitoring: Allowing your mind to wander and focusing on the sensations it naturally is pulled towards while remaining present.

• Mindful Movement: Utilizing practices such as yoga and tai chi to focus on one’s bodily sensations.

• Loving Kindness: Visualizing oneself and others while cultivating feelings of gratitude, forgiveness, and love. First turning inward to oneself and progressing outward toward a cherished friend, a neutral person, a difficult person, and eventually everyone elsewhere.

Loving-Kindness Meditation and Loving-Kindness Coloring

A study conducted in the United Kingdom by Mantzios et al. (2022) found that loving-kindness meditation (LKM) and loving-kindness coloring (LKC) were both successful in decreasing feelings of anxiety.[9] Previously mentioned in the last section, LKM is one of the primary and effective practices that show up in mindfulness meditation. LKC is an alternative practice where one redirects attention to a colorful design such as a mandala and actively observes one’s thought patterns to understand which thoughts are provoking certain feelings.[10] Ultimately, both LKM and LKC showed to partially increase state mindfulness, self-compassion, and decrease anxiety.[11] Having the choice between different meditation practices allows individuals to find what works best for them. Some limitations to the study include: the results were only minimally statistically significant and only included under-graduate students as participants. In the case of such limitations, future research should replicate the same study with more of a general population to improve the external validity of the information.[12]

Coping with Anxious Thought Patterns

Additional mindfulness approaches for coping with anxious and fearful thoughts include: thinking realistically, facing one’s fears, and getting regular exercise.[13]

Think Realistically

A real-life example of coping with anxiety using realistic thinking is when one is experiencing health anxiety. For instance, if an individual feels tired most of the time and wonders, “What if I have cancer and don’t know it?” Catastrophic patterns of thought can cause one to go down roads of fearful thinking that are counterproductive to becoming healthier. 

First, one must identify the distorted thoughts that may be occurring on a regular basis. One way to identify a distorted thought is to change a “what-if?” question to an affirmative statement. For example, change “What if my low energy and fatigue are signs of cancer?” to “Because I have low energy and fatigue, I have cancer.” Then, question the validity of the affirmative statement. For instance, what are the actual odds that low energy and fatigue could be indicative of cancer and not something more simple and likely such as a lack of sleep, being overworked, overstressed or possibly dehydrated? Additionally, considering the results of an unrealistic outcome can bring about feelings of peace: “If the worst did happen, is it really true that I’d not find any way to cope?” Once you have assessed the validity of the statements, replace them with more realistic ones. Since there are several possible explanations for fatigue, the “worst-case” odds of having cancer in this scenario are very low.[14]

Face Your Fears

One of the most effective approaches to overcoming one’s fears is to face them head-on.[15] For individuals that experience phobia-related anxiety, facing fears can seem extremely off-putting. However, exposure should be a gradual, step-by-step process instead of immediate and sudden immersion into a fearful situation. This process, known as exposure therapy, usually involves a comprehensive plan to face one’s phobias when feasible.[16] Phobias are likely to induce avoidance behaviors, which can interfere with normal routines such as work or relationships and cause significant distress. Common phobias include: public speaking, riding in elevators, fear of flying, and fear of heights.[17] Sensitization (i.e., the process in which one becomes overly sensitive to particular stimulus) is a prime factor in the development of phobias. For example, a phobia of giving speeches in public can stem from past negative experiences with public speaking. These prior negative experiences are likely to lead to feelings of physical anxiety (e.g., sweating and shaking) as well as psychological symptoms (e.g., worry and low self-esteem). Real-life exposure allows one to unlearn the connection formed between a situation and an anxious response by re-associating feelings of calmness and confidence with that certain situation.[18] A licensed mental health professional can help direct one how to safely be exposed to stimuli they are afraid of. 

Exercise Your Fears Away 

Bourne and Garano (2016) note that getting regular exercise is one of the most powerful and effective methods to combat feelings of anxiety. The body’s natural fight-or-flight response is activated when faced with a perceived threat bringing along an influx of adrenaline. Exercise acts as a natural outlet for an overwhelming amount of adrenaline, diminishing the tendency to react with an anxious response to one’s fears.[19] Regular exercise has a direct effect on the following various physiological factors associated with anxiety:[20]

• Reduction of Muscle Tension

• Rapid Metabolism

• Discharge of Frustration

• Enhanced Oxygen of the Blood and Brain

• Increased Levels of Serotonin

In addition to physiological factors, there are also several psychological benefits that accompany increased amounts of regular exercise:[21]

• Increased Self-Esteem

• Reduced Insomnia

• Reduced Dependence on Alcohol and Drugs

• Improved Concentration and Memory

• Greater Sense of Control Over Anxiety

If feelings of anxiety are chronic and impact one’s everyday life, steps should be taken to reduce such negative experiences by contacting a licensed mental health professional for further guidance.[22]

Contributed by: Tori Steffen

Editor: Jennifer (Ghahari) Smith, Ph.D.

REFERENCES

1 Bourne, E. J, & Garano, L. (2016). Coping with Anxiety: Ten Simple Ways to Relieve Anxiety, Fear, and Worry. New Harbinger Publications. https://ezproxy.snhu.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=1197205&site=eds-live&scope=site

2 BetterHelp. (n.d.) How to tell if you have anxiety: 10 signs and symptoms. (accessed 10-20-2022) https://www.betterhelp.com/advice/anxiety/how-to-tell-if-you-have-anxiety-10-signs-and-symptoms/

3 BetterHelp

4 Morgan, W. J., & Katz, J. (2021). Mindfulness meditation and foreign language classroom anxiety: Findings from a randomized control trial. Foreign Language Annals, 54(2), 389–409. https://doi-org.ezproxy.snhu.edu/10.1111/flan.12525

5 Kabat‐Zinn, J. (2003). Mindfulness‐based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156. 

https://ezproxy.snhu.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edswah&AN=000182986300002&site=eds-live&scope=site

6 Morgan (2021)

7 Ibid.

8 Roeser, R. W. (2016). Mindfulness in students' motivation and learning in school. In K. Wentzel & D. Miele (Eds.), Handbook of motivation in school (pp. 385–487). Taylor and Francis. https://www.researchgate.net/publication/301813078_Mindfulness_in_students'_motivation_and_learning_in_school

9 Mantzios, M., Tariq, A., Altaf, M., & Giannou, K. (2022). Loving-kindness colouring and loving-kindness meditation: Exploring the effectiveness of non-meditative and meditative practices on state mindfulness and anxiety. Journal of Creativity in Mental Health, 17(3), 305–312. https://doi-org.ezproxy.snhu.edu/10.1080/15401383.2021.1884159

10 Mantzios et al. (2022)

11 Ibid.

12 Ibid.

13 Bourne & Garano (2016)

14 Ibid.

15 Ibid.

16 Ibid.

17 Ibid.

18 Ibid.

19 Ibid.

20 Ibid.

21 Ibid.

22 Mantzios et al. (2022)

The Cost of Caring: Compassion Fatigue and How To Overcome It

The Dark Side of Caring for Others

Compassion is one of the foundational elements of a thriving community.[1] Helping others has numerous benefits for the self— from improvements in emotional and social wellbeing to reductions in stress, anxiety, and depression.[2,3] But is there such a thing as too much compassion?

Compassion fatigue is a specific kind of burnout that occurs after prolonged exposure to others’ trauma. It manifests as a combination of secondary traumatic stress (STS) and general burnout.[4] STS involves vicariously experiencing the emotions of others’ trauma while burnout results in feelings of exhaustion and helplessness.[5] This results in a hindered capability to be empathetic towards others’ suffering, as well as many adverse physical and emotional symptoms.[6,7] 

Mechanisms of Compassion Fatigue

There are various potential psychological mechanisms by which exposure to others’ trauma can result in the onset of compassion fatigue:[8]

1. Countertransference: Countertransference is a concept rooted in psychodynamic therapy. In psychotherapy, it refers to the therapist’s emotional reaction to the client and their experiences. This is essentially the reverse of transference, which refers to the client's emotional reaction to the therapist. Countertransference involves deep identification with the client and the fulfillment of needs through them on the part of the therapist. It is mediated by various sources, such as the therapist’s past experiences, their view of the client, and the specificities of the vicarious trauma brought on by the client’s experiences. Countertransference is seen as an issue in therapy as it can lead to biases in the way therapists provide care. [9]

2. Burnout: Burnout is a state of physical and emotional exhaustion due to prolonged exposure to situations demanding intense emotional involvement.[10] Rather than a static condition, burnout is a progression that gradually increases and worsens over time if not dealt with. It involves job stress, loss of idealism, and a feeling of helplessness and non-achievement. The main manifestation of burnout is feeling helpless in dealing with the other person’s situation. It can also lead to feelings of dehumanization.[11]

3. Emotional Contagion: Emotional contagion is an affective process that involves feeling similar emotions upon observing someone’s experiences— the specific emotional response that results may be based on the actual or expected emotions of the other person.[12] Those who view themselves as a hero or savior to others are the most likely to experience this.[13]

Presently, each of these mechanisms is studied in specific contexts. As compared to countertransference and burnout, emotional contagion is relatively infrequently cited as a mechanism of compassion fatigue. Additionally, countertransference is currently thought to be specific to the setting of therapy while the literature on burnout focuses primarily on professional settings. Emotional contagion, on the other hand, has been documented as a widespread phenomenon that can occur in almost any context involving interactions between people, from interpersonal relationships to therapy. Therefore, as noted by Figley (1995), as these mechanisms are often studied individually by different researchers, it is fairly unclear as of now how these interact to produce compassion fatigue. [14]

Who Is Affected By Compassion Fatigue?

Compassion fatigue was originally defined by Figley (1995) as “the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced or suffered by a person.”[15] Therefore, it follows that people in professions that involve routinely helping others through traumatic experiences are the most susceptible to developing compassion fatigue— healthcare practitioners, social and emergency workers, and those in similar career fields.[16] In fact, the concept of compassion fatigue was originally developed to describe the feelings of people within these professions.[17]

However, even though it is far less researched in other populations, compassion fatigue can be experienced by anyone. A plethora of universal contexts exist that involve supporting others through traumatic experiences— such as leadership, relationships, parenting, etc. — and any of these can potentially bring about an episode of compassion fatigue.[18-20] 

Risk Factors for Developing Compassion Fatigue

Possessing certain qualities can put people at a higher risk of developing compassion fatigue. These include:

1. Empathy: It is well-known that trauma can occur directly through the experience of disturbing events. However, trauma can also occur indirectly, from learning about a traumatic event that happened to a close acquaintance.[21] Empathy propagates this vicarious trauma, as it involves experiencing what the other person is feeling.[22,23] Empathy therefore acts as one of the primary mechanisms of compassion fatigue as it increases the likelihood of becoming traumatized and subsequently burnt out by others’ experiences. In fact, those therapists that are most impacted by compassion fatigue are the ones who are the most effective at empathizing with and mirroring their clients’ feelings.[24]

2. Prior Traumatic Experience: Past, unresolved trauma can make one more susceptible to developing secondary trauma from listening to others’ traumatic experiences. This is particularly likely when there are similarities between the traumatic experience of both people.[25]

3. Exposure to Children’s Trauma: Suffering in children is particularly evocative of secondary trauma due to its emotional salience. Emergency workers report that they feel most susceptible to developing compassion fatigue upon witnessing children facing traumatic events.[26]

Signs & Symptoms of Compassion Fatigue

Since compassion fatigue involves both burnout and secondary traumatic stress, its symptoms can be organized based on which of these are their root cause.[27]

The symptoms caused by burnout are:[28]

• Feeling unable to help the other person

• Overwhelmed and exhausted

• Feelings of failure

• Perceived inability to do one’s job well

• Frustration

• Skepticism and loss of idealism

• Apathy and withdrawal from others

• Depression

• Substance use

The symptoms caused by secondary traumatic stress are:[29]

• Fear in situations that don’t necessarily warrant it

• Paranoia about something bad happening to the self or loved ones

• Constantly feeling on edge

• Physiological symptoms of anxiety such as high heart rate, breathlessness, and tension headaches

• Persistent, uncontrollable thoughts about others’ traumatic experiences

• Experiencing others’ trauma as if having gone through it

Compassion fatigue can also result in physiological and behavioral changes such as:[30]

• Lack of concentration

• Sleep disturbance

• Appetite changes

Compassion fatigue is sometimes difficult to distinguish from burnout since it involves the same symptoms in addition to those related to secondary traumatic stress. However, besides the fact that compassion fatigue involves additional symptoms, burnout is also distinct in that it gradually advances whereas secondary traumatic stress has a more sudden onset. Moreover, secondary traumatic stress has a faster recovery rate than burnout. Figley (1995) designed the Compassion Fatigue Self-Test for Psychotherapists to help people differentiate whether they are going through only burnout or also the additional component of secondary traumatic stress that characterizes compassion fatigue.[31,32] 

How to Overcome Compassion Fatigue

There are many strategies that individuals can adopt in order to reduce their risk of developing compassion fatigue. These include:[33]

• Keeping a healthy work-life balance

• Taking the time to practice relaxation techniques, such as meditation

• Engagement in creative activities to help with emotional expression

• Learning how and when to set boundaries

• Cognitive restructuring through routinely running through situations with a problem-solving lens

• Development of a plan for when compassion fatigue emerges

Additionally, there are myriad ways for individuals to alleviate symptoms if they are suffering from compassion fatigue. These are:[34]

• Prioritizing self-care and a healthy lifestyle that involves the right amount of exercise, diet, and sleep

• Journaling about feelings and takeaways related to caregiving

• Using stress management techniques can help ameliorate physical symptoms 

• Delegating tasks to co-workers during the recovery process

• Reflecting on successes and other positives related to providing care to others 

• Joining a support group of others going through compassion fatigue

All of these strategies essentially involve prioritizing self-care and drawing boundaries when necessary. In addition to these, seeking out professional help through counselors with specializations in trauma and its processing is also another way to alleviate compassion fatigue.[35]

The Costs of Caring Affect All of Us

Although the actual symptoms of compassion fatigue only impact the caregivers who are afflicted by it, its impacts are far more widespread than expected. Particularly within the healthcare industry, compassion fatigue has far-reaching consequences that impact not only the caregiver, but also co-workers, managers, patients, and even the healthcare system as a whole.[36,37] The performance of professionals can be severely hampered by poor judgment, frequent errors, and disconnected interactions during an episode of compassion fatigue. This leads to lower quality and less impactful care for clients. Additionally, compassion fatigue can lead to healthcare practitioners quitting their jobs. This is especially harmful to the current healthcare system, wherein there is already a lack of manpower.[38] 

As compassion fatigue can be costly to patients, professionals, and even institutions, its treatment and alleviation are key to facilitating an abundance of improvements. In order to promote well-being for all, it is important for both individuals and organizations to take the time to understand and treat compassion fatigue.[39]

Contributed by: Sanjana Bakre

Editor: Jennifer (Ghahari) Smith, Ph.D.

REFERENCES

1 Lonczak, H. S. (2022, August 6). 20 reasons why compassion is so important in psychology. PositivePsychology.com. Retrieved September 12, 2022, from https://positivepsychology.com/why-is-compassion-important/#:~:text=There%20are%20numerous%20proven%20benefits,psychopathology%2C%20and%20increased%20social%20connectedness

2 Ibid.

3 Pogosyan, M. (2018, May 30). In helping others, you help yourself. Psychology Today. Retrieved September 15, 2022, from https://www.psychologytoday.com/us/blog/between-cultures/201805/in-helping-others-you-help-yourself 

4 Cocker F, Joss N (2016). Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review. Int J Environ Res Public Health. 2016 Jun 22;13(6):618. doi: 10.3390/ijerph13060618. PMID: 27338436; PMCID: PMC4924075.

5 Substance Abuse and Mental Health Administration. (2014). Tips for Disaster Responders: Understanding Compassion Fatigue. Understanding Compassion Fatigue | SAMHSA Publications and Digital Products. Retrieved September 28, 2022, from https://store.samhsa.gov/product/Understanding-Compassion-Fatigue/sma14-4869 

6 Adams RE, Boscarino JA, Figley CR (2006). Compassion fatigue and psychological distress among social workers: a validation study. Am J Orthopsychiatry. 2006 Jan;76(1):103-8. doi: 10.1037/0002-9432.76.1.103. PMID: 16569133; PMCID: PMC2699394.

7 Cleveland Clinic (2021, August 29). Empathy fatigue: How it takes a toll on you. Cleveland Clinic. Retrieved September 16, 2022, from https://health.clevelandclinic.org/empathy-fatigue-how-stress-and-trauma-can-take-a-toll-on-you/ 

8 Adams et al. (2006)

9 Figley, C. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. New York, NY: Brunner-Routledge. 

10 Pines, A., & Aronson, E. (1988). Career burnout: Causes and cures. Free Press.

11 Figley (1995)

12 Miller, K. I. , Stiff, J. B. , & Ellis, B. H. (1988). Communication and empathy as precursors to burnout among human service workers. Communication Monographs , 55 (9), 336–341.

13 Figley (1995)

14 Ibid.

15 Ibid.

16 Adams et al. (2006)

17 Figley (1995)

18 Smith, D. (2022, March 30). Compassion Fatigue is real and it may be weighing you down. Harvard Business Review. Retrieved September 20, 2022, from https://hbr.org/2022/03/compassion-fatigue-is-real-and-it-may-be-weighing-you-down 

19 Koza, J. (2019, August 21). 5 signs you're experiencing compassion fatigue. One Love Foundation. Retrieved September 21, 2022, from https://www.joinonelove.org/learn/5-signs-youre-experiencing-compassion-fatigue/ 

20 Robertson, B. (2021, February 26). Preventing compassion fatigue in Foster and adoptive parents through therapeutic support and self-care. enCircle. Retrieved September 21, 2022, from https://encircleall.org/blog-2/preventing-compassion-fatigue-in-foster-and-adoptive-parents-through-therapeutic-support-and-self-care#:~:text=Compassion%20fatigue%20is%20a%20combination,apathy%2C%20exhaustion%20and%20ultimately%20burnout

21 Figley (1995)

22 Ibid.

23 American Psychological Association. (n.d.) Empathy. American Psychological Association. Retrieved September 13, 2022, from https://dictionary.apa.org/empathy

24 Figley (1995)

25 Ibid.

26 Ibid.

27 Substance Abuse and Mental Health Administration (2014)

28 Ibid.

29 Ibid.

30 Administration for Children & Families. (n.d.). Secondary Traumatic Stress. Administration for Children & Families. Retrieved September 21, 2022, from https://www.acf.hhs.gov/trauma-toolkit/secondary-traumatic-stress

31 Figley (1995)

32 Stamm, H.B. (1998). Compassion Satisfaction/Fatigue Self-Test for Helpers National Child Welfare Workforce Institute. Retrieved September 30, 2022, from https://ncwwi.org/files/Incentives__Work_Conditions/Compassion-Satisfaction-Fatigue-Self-Test.pdf

33 Administration for Children & Families (n.d.).

34 Ibid.

35 Ibid.

36 Chaudoin, K. (2020, July 27). Pandemic leads to compassion fatigue, burnout for health care workers. Lipscomb University. Retrieved September 30, 2022, from https://www.lipscomb.edu/news/pandemic-leads-compassion-fatigue-burnout-health-care-workers

37 Lombardo, B., Eyre, C., (Jan 31, 2011) "Compassion Fatigue: A Nurse’s Primer" OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 1, Manuscript 3. https://doi.org/10.3912/OJIN.Vol16No01Man03 

38 Chaudoin, K (2020)

39 Ibid.

Back to School: How Students and Parents Can Cope with Anxiety in the Wake of the Uvalde Tragedy

In the Wake of Uvalde

The nation was shaken following the traumatic Uvalde school shootings on May 29, 2022, resulting in the fatality of 19 students and 2 adults.[1] Parents, students, and teachers listened in shock to the reports of a joyous day of honor roll celebrations ending in such startling tragedy.[2] Annual preparations for a relaxing summer slowed to a halt as the country took time to mourn.

In the days that followed, parents across the nation chose not to send their children to school.[3-5] This abrupt transition to summer now leaves some parents wondering how to reconcile these events and approach the coming school year. Even though most students and parents were not in physical proximity to this crisis, evidence shows that repeated exposure to school shootings on the news is having an impact on mental health.

It's important to recognize that these events are not occurring in isolation but are instead following a series of national struggles including the COVID-19 pandemic, devastating wildfires, destructive hurricanes, economic uncertainty, and equal rights protests.[6] Roxane Cohen Silver, PhD describes these experiences as “a cascade of collective trauma,” in which, “our reserves are depleted as a nation, and our young people are suffering.”[7]

In an interview with US News, the director of the Child and Adolescent Mood Disorders Program at UCLA’s Semel Institute explained that the increase in violence at schools is impacting all children, saying, “You don’t have to be where the acute distress occurred to get acute stress reactions or PTSD… Nationally, kids are asking more and more if it’s safe to go to school.”[8] Repeated exposure to these events on the news has been increasing in recent years. Education Week’s most recent report states that as of July, there have already been 27 school shootings resulting in 83 people either killed or injured in 2022.[9] Additionally, over 900 school shootings have taken place since the tragedy at Sandy Hook Elementary almost ten years ago.[10]

As these events become more common, they can chip away at the sense of safety and security that would normally be expected in a school environment. Even those who are indirectly exposed to a traumatic event, through hours of media exposure, can contribute to the development of PTSD-like symptoms.[11] In a 2018 survey conducted on “Generation Z,” (the generation born between 1997-2012 that is most directly impacted by the rise in these events) 72% of students surveyed stated that they considered school shootings to be a significant source of stress.[12] Adding to the devastation is the sense of loss and confusion at the end of an event. Since these shootings often result in the suicide of the shooter, the public is left without answers as to the motivation of the violence or what could have been done to prevent it, which can have long-term psychological impact even to those who do not directly experience it.[13] The persistent exposure to these topics in the media can lead to a cycle called, “perseverative cognition,” in which exposure to violence in the media causes distress, leading an individual to worry about future violence, which causes the individual to consume more media.[14]

The impact school shootings have on children throughout the nation can be found dating as far back as the Columbine tragedy in 1999; when a sample of high school students who were not directly involved with the event indicated a 30% increase that they “did not feel safe returning to school” and absences of students due to safety concerns were 2.6 times higher in the days that followed the tragedy.[15] This statistic is backed by a 2014 analysis of Twitter accounts following the 2012 Sandy Hook Elementary tragedy in Newton, Connecticut, which showed that while distance and time from the physical event may have decreased the use of words related to sadness, the use of words related to anxiety actually increased.[16] This increase in anxiety may be due to a phenomenon called, “psychological proximity,” which can cause people to become more severely impacted by an event if they are able to identify with the victims.[17]

Increased access to instant news and updates through social media is broadening the impact these events have on a national level.  In the week following the Sandy Hook Elementary shooting in 2012, three million tweets circled the globe with some providing instant access to graphic images of the scene.[18] Recent decades have drastically changed our access to information, with the emergence of devices that allow people to simultaneously receive and stream information about tragic events twenty-four hours per day.[19] This was illustrated when teenagers caught  in the middle of the Stoneman Douglas High School shooting used their personal smartphones to live stream and tweet their own experiences.[20] These events illustrate how the public is increasingly gaining access to details in near real time, which can simulate personally experiencing the tragedy.  

All of this raises the question of how to move forward. In the wake of yet another school tragedy, how can students and parents address the fear that arises from beginning another school year?

Preparing Students to Return

While the initial instinct may be to shelter children from school tragedies, current evidence indicates that children are able to better process the news when it comes from parents than when they learn about it through peers or social media.[21] Parents need to approach the topic of returning to school differently with children depending on their age. Kary Kunzelman, who supervises a mental health outpatient program in Butler County, Ohio, called Community First Solutions, warns that parents should monitor how they are reacting to the news of events because even if parents believe they are shielding children by not discussing the news, children can often tell that something is wrong and that their parents are behaving differently.[22] 

For younger children, parents can start the discussion by asking them how they feel about returning to school and helping them find words that describe their feelings such as sad, angry, or frightened.[23] Experts recommend discussing these topics, in a simple factual manner, because it is important for them to see that there is language that can be used to describe these feelings.[24]

Children should be reassured that adults in their lives have plans in place to keep them safe.[25] They will trust adults more if they provide truthful answers, so it’s important to state that even though schools are generally safe places, there are still risks.[26] Parents can review with their children the plans that are in place at school if a dangerous situation develops and allow children to explain what they would do.[27] This is not only an opportunity to review safety procedures but can also empower students by helping them understand that they have some control in the situation.

With younger children, it’s also important to limit exposure to the news when new events occur since they may lack the skills to process events in the way they were intended to be perceived. For example, in the days following September 11, 2001, children watching the events unfold on television interpreted the replayed footage to mean that hundreds of planes were repeatedly flying into buildings.[28] If elementary school children want to see images of an event to know and understand what is going on, parents can choose photos that focus on positive contributions, such as showing relief efforts aimed at helping the families.[29] This will provide reassurance that there are people helping in bad situations and that things can be done to make a situation better.

Tweens and young teens are likely already familiar with recent tragic events and have heard various versions from friends and social media. Start by checking in with them about their feelings towards returning to school. It’s best to hear what they have to say and discuss any concerns they have while being careful not to interrupt and respectfully correcting misunderstandings.[30] At this age, if students are concerned, they can look for ways to get involved that would be age appropriate.[31] Based on their interests, they can volunteer in the community or work with school clubs to find solutions for concerns they have about the school environment.

With teenagers who are aware of these events and are learning about them on social media, it is alright for caregivers to share feelings about the situation, while also modeling positive ways to cope with these feelings.[32] Natalie Lareos, a teenager in South Los Angeles told the press that whenever she enters the classroom, or any public place, she now looks for a place to hide.[33] Teens are reaching the age where they are trying to solve their own problems, and adults in their lives can help them find proactive ways for them to advocate for solutions. Parents can speak with teenagers about what solutions they think would help to solve the problem and search together to find organizations that are advocating for that approach.[34] By volunteering, donating, and learning about solutions, teens focus their energy on advocacy - which is a mature coping mechanism to help address their concerns.[35]

Another common reaction for children of all ages is having no reaction. While some children may want to discuss these events, others may take a while to process their thoughts and will not exhibit reactions until much later.[36] Children who were not initially affected by this tragedy may now express new concern about returning to the school building in the fall. In this case, make sure they know a parent or guardian is available to talk or answer questions if they want to discuss it later.[37] A 2020-2021 analysis (utilizing survey data from 2015 and 2016) of 2,263 teenagers showed that concern about school shootings was correlated with “heightened odds of meeting borderline/clinical criteria for generalized anxiety disorder and panic disorder six months later,”[38] illustrating how the impact may be extended over longer periods of time.

If a child has a history of anxiety or trauma, parents should monitor the child for signs of difficulty coping such as physical complaints, changes in behavior, or difficulty sleeping, to see if professional services may be needed.[39] Even if a child does not have a history of trauma or anxiety, exposure to a singular traumatic event can have lasting consequences. Professionals trained to work with youth can use specialized techniques, like play therapy, which can help children who may not be able to form words to explain what they are feeling.[40] If parents or guardians believe their children are struggling to process their feelings, it is best to seek out professional assistance to determine if counseling or other services may be needed.

There is no easy solution to the issue of gun violence in schools. While parents debate their comfort levels of sending their children back into a school environment, it is worth remembering the need to provide consistency. Unpredictable situations can cause fear for children, so it is important for parents to try to keep their routines as normal as possible, whether in a home or school environment, so that they can experience the comfort of normalcy that can be found through consistency.[41]

Helping Parents Cope with Fear

Prior to Uvalde, in 2018, reports already showed that parental concern over school shootings had reached a two-decade high. In the same year, 54% of parents surveyed reported that additional funding to increase school safety was a top priority, and 44% reported they were “very worried” about an active shooter.[42] With the recent events at the end of the last school year, these fears have only increased. The morning after the Uvalde tragedy, parents throughout the country grappled with the decision of whether to send their children to school. Stories filled the media from places like Encino, where the mother of two elementary school boys chose to keep them home that day, while another mother in Long Beach dropped off her first grader at school and then went to her car and cried.[43] Now, as a new school year approaches, parents find themselves struggling with the decision to either send their children back to the school environment, or return to the homeschool option that many families grew accustomed to during the pandemic.[44] Interest in homeschooling has grown so much this summer that the Deputy Director of the Texas Homeschool Coalition, Jeremy Newman, told NBC News that a June convention showcasing their program was “packed to the brim this year,” and explained that school shootings have historically led to a rise in inquiries.[45]

Yet parents may find themselves questioning this instinctive desire to switch back to a home environment when they hear multiple reports from experts warning of the damaging mental health impacts that missing in-person education has had on youth. On December 7, 2021, the US Surgeon General issued an advisory warning that the youth’s mental health crisis is growing due to the COVID-19 pandemic.[46] This statement is supported by a global study of 80,000 children which found that symptoms of depression and anxiety doubled during the pandemic, and attributes part of these impacts to the months of missed in-person education, as well as missing significant events such as first days of school or graduation ceremonies.[47] Similarly, a recent CDC survey found that high school students who reported having a close relationship with someone at school during the pandemic had “significantly lower prevalence of poor mental health,” (28.4% versus 45.2%)[48] Trying to resolve this simultaneous and seemingly contradictory information on both the dangers and benefits of in-person education can leave parents feeling confused as they struggle to determine how to protect both the physical and mental health of their children.

As parents search for the balance between these two choices, more products are emerging on the market to address these fears, such as the production of bulletproof backpacks, which adds more options, and perhaps more confusion, to this already difficult decision. The day after the Uvalde shooting the company Bulletproof Zone reached their highest sales record to date.[49] This purchase trend continued over the summer with Steve Naramore, owner of TuffyPacks, a company which produces bulletproof backpacks and inserts, stating his company has seen an increase in sales of 300 to 500 percent.[50] These products add more options for parents to consider while navigating the complex choices of the coming school year as they are often still working through processing their own fears.

While navigating this complex barrage of decisions, parents should be careful to monitor their own levels of anxiety and mental health.[51] If someone finds themselves obsessively thinking about potential school threats, and it is beginning to manifest in ways that are unhealthy, the first step is to limit any exposure to news or social media sources that may be drawing their attention back to the topic and repeatedly reminding them of their fears.[52] It’s important for parents to question sources of information and try to evaluate whether this information is helping them move forward and make important decisions or holding them back and reminding them of why they are afraid.

Parents need to make time to process their own feelings and fears that arise from these situations. Monitoring thoughts and listening to their bodies can help to become aware of how they are personally responding.[53] Mental health counselor Stephanie Moir recommends experiencing these emotions, but warns about the dangers of getting stuck, advising that listening to music, writing about thoughts, or drawing a picture may help to pull a person out of the overthinking phase.[54] Talking to friends and making plans together to work through what is happening in the world is also a productive approach.[55] If a parent is having difficulty and experiencing problematic anxiety and/or depressive symptoms, contacting a mental health professional, such as a psychotherapist, psychologist, or psychiatrist, would also provide additional support.  

School psychologist Kay Streeter advises caregivers to deal with these events using the Five Ks:[56]

1. Keep Talking (Talk as a release and to process your own feelings)

2. Keep Thanking (Appreciate that you are here and there are things in life that are good)

3. Keep Planning (Engaging in planning provides a sense of control and hope)

4. Keep Forgiving (Forgiving allows you to let go of anger and move forward)

5. Keep Breathing (Deep intentional breaths can reduce stress and anxiety)

Parents should take time to process their feelings by using their network of support and avoid making any major life-altering decisions in the immediate days that follow an event.[57] With time, as parents work through their thoughts and talk through situations with their support systems, they will be able to sort through the pros and cons of the coming school year and create a plan that meets the needs of their children and themselves.

Working towards a Solution

One of the debilitating effects of experiencing a traumatic event is the feeling of helplessness and despair that can follow.[58] Strickland (2022) states, “Anxiety is meant to prepare us for action, so channel the worries you are feeling into something proactive you can do.”[59] While the specific solution to school shootings in America is hotly debated, there does not seem to be a disagreement that something needs to change. Parents and older teenagers can use the energy generated from anxiety to work towards solving this problem; getting involved with an organization working to mitigate school shootings in a way that makes sense to them, can be a productive approach. 

Advocating for a solution can help to regain a sense of empowerment and remember that it is possible for things to improve. There are multiple organizations working to address this issue at both the local and national level. Finding a group of others who are like-minded to collaborate with and work towards solutions can provide a sense of empowerment. People often make progress towards recovering from trauma when they feel that they have some ability to fight back and take control.[60]

Contributed by: Theresa Nair

Editor: Jennifer (Ghahari) Smith, Ph.D.

* If you or someone you know is experiencing signs of PTSD, click here to access our PTSD Self-Care Tips inforgraphic.

References

1 Strickland M. Idaho capital sun - states newsroom: Parents must be prepared to talk to their kids about school shootings. here are tips on how. Idaho Capital Sun. 2022.

2 Anderson N, Lang MJ, Elwood K, et al. What we know about the victims of the school shooting in Texas. The Washington Post. 2022.

3 Gomez M, Hailey Branson-Potts, Shalby C, Watanabe T. Touched by a tragedy; texas school shooting stirs anxiety, fear in L.A.-area parents. The Los Angeles times. 2022.

4 Chuck E. Bulletproof backpacks, homeschool: With no new gun laws, parents make changes of their own. NBC News. June 12, 2022. Available from: https://www.nbcnews.com/news/us-news/uvalde-shooting-parents-feel-no-safe-place-children-rcna32534. Accessed Jul 15, 2022.

5 Weekman K. Parents are facing the "nightmare" choice to send their kids to school after another mass shooting. BuzzFeed News Web site. https://www.buzzfeednews.com/article/kelseyweekman/uvalde-texas-shooting-parent-reactions-social-media. Updated 2022. Accessed Jul 15, 2022.

6 Silver RC, Holman EA, Garfin DR. Coping with cascading collective traumas in the United States. Nature human behaviour. 2021;5(1):4-6. doi:10.1038/s41562-020-00981-x

7 Abrams Z. Stress of mass shootings causing cascade of collective traumas. https://www.apa.org. 2022. https://www.apa.org/monitor/2022/09/news-mass-shootings-collective-traumas. Accessed Jul 15, 2022.

8 School shootings and their effect on student mental health. Curriculum Review. 2018;58(4):8

9 School shootings this year: How many and where. Education Week. -01-05T18:16:47.67 2022. Available from: https://www.edweek.org/leadership/school-shootings-this-year-how-many-and-where/2022/01. Accessed Jul 11, 2022.

10 Li, Jones & Livingston, Kelly. Teachers face mental health challenges dealing with school shootings. ABC News Web site. https://abcnews.go.com/Politics/teachers-face-mental-health-challenges-school-shootings/story?id=85069493. Updated 2022. Accessed Jul 11, 2022.

11 Silver et al., 2021

12 Ibid.

13 Cimolai, Schmitz, J., & Sood, A. B. (2021). Effects of Mass Shootings on the Mental Health of Children and Adolescents. Current Psychiatry Reports, 23(3), 12–12. https://doi.org/10.1007/s11920-021-01222-2

14 Abrams Z., 2022

15 Cimolai et al., 2021

16 Doré B, Ort L, Braverman O, Ochsner KN. Sadness shifts to anxiety over time and distance from the national tragedy in newtown, connecticut. Psychol Sci. 2015;26(4):363-373. doi: 10.1177/0956797614562218.

17 Abrams Z., 2022

18 Cimolai et al., 2021

19 Silver et al., 2021

20 Cimolai et al., 2021

21 Abrams Z., 2022

22 Denise GC. In wake of mass shootings, health experts warn of mental toll. Knight-Ridder/Tribune Business News. 2022.

23 Pearson C. A guide to talking to your children about mass shootings: National desk. The New York times. 2022.

24 Denise GC., 2022

25 Ibid.

26 Strickland M., 2022

27 Ibid.

28 Ibid.

29 Stout C. Chalkbeat: Gun violence: Resources for students, parents, and teachers. Chalkbeat. 2022.

30 Pearson C., 2022

31 Stout C., 2022

32 Pearson C., 2022

33 Gomez et al., 2022

34 Pearson C., 2022

35 Ibid.

36 Stout C., 2022

37 Pearson C., 2022

38 Riehm KE, Mojtabai R, Adams LB, et al. Adolescents’ concerns about school violence or shootings and association with depressive, anxiety, and panic symptoms. JAMA network open. 2021;4(11):e2132131-e2132131. doi:10.1001/jamanetworkopen.2021.32131

39 Strickland M., 2022

40 Hateli B. The effect of non-directive play therapy on reduction of anxiety disorders in young children. Counselling and Psychotherapy Research. 2021;22(1):140-146. https://onlinelibrary.wiley.com/doi/abs/10.1002/capr.12420. Accessed Jul 19, 2022. doi: 10.1002/capr.12420.

41 Strickland M., 2022

42 Sign of the times: Parents so concerned about school safety they are willing to pay for it themselves: New survey shows kids and parents agree: Anxiety runs high over school shootings with the start of new school year; experts cite need for more safe-school solutions. NASDAQ OMX's News Release Distribution Channel. 2018.

43 Gomez et al., 2022

44 Chuck E., 2022

45 Ibid.

46 U.S. surgeon general issues advisory on youth mental health crisis further exposed by COVID-19 pandemic. HHS.gov Web site. https://www.hhs.gov/about/news/2021/12/07/us-surgeon-general-issues-advisory-on-youth-mental-health-crisis-further-exposed-by-covid-19-pandemic.html. Updated 2021. Accessed July 17, 2022.

47 Protecting Youth Mental Health : the U.S. Surgeon General’s Advisory. [U.S. Department of Health and Human Services]; 2021.

48 Jones SE, Ethier KA, Hertz M, et al. Mental Health, Suicidality, and Connectedness Among High School Students During the COVID-19 Pandemic - Adolescent Behaviors and Experiences Survey, United States, January-June 2021. Morbidity and mortality weekly report Supplement. 2022;71(3):16-21. doi:10.15585/mmwr.su7103a3

49 Picket K. Bulletproof backpack companies see record sales hours after texas school shooting. The Washington Times Web site. https://www.washingtontimes.com/news/2022/may/31/bulletproof-backpack-companies-see-record-sales-ho/. Updated 2022. Accessed Jul 18, 2022.

50 Chuck E., 2022

51 DOnofrio M. Axios: Coping tips for parents and teachers after the uvalde school shooting. Axios. 2022.

52 Strickland M., 2022

53 DOnofrio M., 2022

54 Vazquez L. Managing your mental health through crises. WFTS Web site. https://www.abcactionnews.com/news/region-hillsborough/cascading-tragedies-reinforce-need-to-take-care-of-mental-health. Updated 2022. Accessed Jul 18, 2022 

55 DOnofrio M., 2022

56 Stout C., 2022

57 Ibid.

58 Strickland M., 2022

59 Ibid.

60 Curriculum Review.

PTSD Self-Care Tips

A Path to Healing

Post-traumatic stress disorder (PTSD) is a mental health condition triggered by experiencing or witnessing a terrifying event. Currently experienced by approximately 3.5% of the U.S. adult population; it is estimated that 1-in-11 people will be diagnosed with PTSD in their lifetime.[1]

The most common types of events leading to the development of PTSD include:[2]

• Combat exposure

• Childhood physical abuse

• Sexual violence

• Physical assault

• Being threatened with a weapon

• A serious accident (e.g., vehicle crash)

Many other traumatic events also can lead to PTSD; these include: the sudden, unexpected loss of a loved one,[3] life-threatening medical diagnosis, natural disaster, fire, mugging, robbery, plane crash, torture, kidnapping, terrorist attack, mass shooting and other extreme or life-threatening events.[4] 

Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.[5] Most people who go through traumatic events may have temporary difficulty adjusting and coping, but with time and proper self-care, recovery can occur. If symptoms worsen, last for months or years, and interfere with your day-to-day functioning, you may have PTSD.

While trauma-focused psychotherapies are the most highly-recommended type of treatment for PTSD and provide the greatest evidence for recovery, you may wish to include some supportive self-care strategies. These include:

1. Journaling

   Writing (including expressive, transactional, poetic, affirmative, legacy, and mindful writing) can increase resilience, and decrease depressive symptoms, perceived stress, and rumination.[6] Specifically, when people write and translate their emotional experiences into words, they may be changing the way their experiences are organized in the brain, resulting in more positive outcomes.[7] Guided, detailed writing can help people process what they’ve been through and help envision a path forward. Additionally, it can lower blood pressure, strengthen immune systems, and increase one’s general well-being. Resulting in a reduction in stress, anxiety, and depression, expressive writing can additionally improve the quality of sleep, leading to better focus, clarity and performance.[8]

   Research has found that the most healing of writing must contain concrete, authentic, explicit detail. Linking feelings to events, such writing allows a person to tell a complete, complex, coherent story, with a beginning, middle, and end. In this retelling, the writer is transformed from a victim into something more powerful: a narrator with the power to observe. In the written expression of what occurred, people can reclaim some measure of agency and control over what happened.[9]

   The following tips may help getting started with journaling:[10]

   • Make it a habit – try to stick to a routine.

   • Keep it simple – journal only for a few minutes; consider setting a timer. ‌

   • Do what feels right – find what’s best for you and go with it.

   • Write about anything, with any type of pen/pencil, in any type of book – there are no rules, this journal is yours.

   • Get creative – write lists, make poetry, draft a letter to someone, doodle or draw art.

   • Aim small, win big – keep in mind that journaling isn’t a “magic fix”, but it will help and provide benefit, and will give back the effort you put in.

2. Grounding and 4-7-8 Breathing Techniques

   Grounding strategies can help a person who is dissociating or overwhelmed by memories or strong emotions and help them become aware of the “here and now”. Examples of grounding techniques include:[11]

   • Stating what you observe around you (e.g., what time is it, what pictures are on the wall, how many books are on the table, etc.)

   • Decreasing the intensity of affect - clenching fists can move the energy of an emotion into fists, which can then be released; visualize a safe place; remember how you survived and what strengths you possess that helped you to survive the trauma.

   • Distract from unbearable emotional states - focus on the external environment (e.g., name red objects in the room or count objects nearby). Somatosensory techniques (e.g., toe-wiggling, touching a chair) can remind people of their current reality.

   4-7-8 breathing techniques - controlled breathing is one way to move our systems out of a state of panic. Inhaling activates the sympathetic nervous system (fight-or-flight), while exhaling activates the parasympathetic nervous system (rest and digest).[12] To employ the 4-7-8 breathing relaxing technique:

   • breathe in for 4 counts

   • hold the breath for 7 counts

   • exhale for 8 counts

   Note that any variation on these numbers should still elicit a calming response as long as the exhale is noticeably longer than the inhale.

3. Peer Support Groups

   Within a peer support group, a person can discuss day-to-day problems with other people who have also been through trauma. While support groups have not been shown to directly reduce PTSD symptoms, they can help you feel better by giving a sense of connection to other people with similar, shared experiences. Further, peer support groups can help people cope with memories of a trauma or other parts of their life they are having difficulty dealing with as a result of the event. Dealing with and processing emotions such as anger, shame, guilt, and fear becomes easier when talking with others who understand.[13]

   Similarly, group therapy may be another outlet one can employ to receive support as they recover from trauma.

4. Meditation & Mindfulness

   Meditation practices can combat symptoms of PTSD as they have elements of exposure, cognitive change, attentional control, self-management, relaxation, and acceptance.[14] Specifically, mindful meditation orients one’s attention to the present with curiosity, openness, and acceptance. Experiencing the present moment non-judgmentally and openly may lead to the approach of (and not avoidance of) distressing thoughts and feelings, thus potentially leading to the reduction of one’s cognitive distortions.[15]

5. Healthy Diet & Exercise

   A healthy neuro-nutritional diet is beneficial for both your mind and body. Good neuro-nutrition, based on a holistic and healthy diet of fresh fruits and vegetables, lean proteins, whole grains, nuts and seeds and spices and herbs, can improve moods and cognitive function, help reduce the risks of cognitive decline due to ageing as well as provide healthy nutrients to the rest of your body. Further, healthy neuro-nutrition can help improve the brain’s neuroplasticity (i.e., its ability to change) as well as neurogenesis (i.e., its ability to create new neurons.) Additionally, healthy neuro-nutrition helps to mitigate inflammation, which has been linked to a myriad of health deficits. Animal meats, hydrogenated oils, and many of the chemical and preservatives in processed foods have inflammatory qualities.[16] A healthy diet can also help address physical health conditions associated with PTSD, including diabetes, hypertension, and metabolic syndrome.[17]

   Glucose is a critical nutrient to fuel a healthy mind and brain, with the healthiest sources of glucose found in unprocessed plant-based complex carbohydrates. By incorporating a steady, balanced supply of these vegetables, fruit, beans, nuts, seeds and whole-grain products, one can additionally achieve better mood regulation. The PTSD Association of Canada notes: blood sugar is balanced by having meals spaced fairly evenly, and eating every three to four hours. Choosing unrefined carbs and balancing those meals with protein and fat help delay the absorption of the glucose into the bloodstream. This can help keep your blood sugar level even, for both mood stability and appetite control.[18]

   Exercise and other physical activity has been found to lessen the symptoms associated with PTSD. A 2022 meta-analysis by McKeon et. al., found that physical activity and structured exercise are inversely associated with PTSD and its symptoms. Moreover, exercise interventions may lead to a reduction in symptoms among individuals with, or at risk of PTSD.[19] Additionally, a 2021 meta-analysis by McGranahan and O'Connor notes that exercise training has promise for improving overall sleep quality, anxiety, and depression symptoms among those with PTSD.[20] The duration of exercise does not need to be significant in order to be effective. In fact, Pontifex et al., (2021) report that just twenty minutes of moderate intensity aerobic exercise has been shown to improve inhibitory control, attention and action monitoring.[21] To get the most out of one’s exercise, physical activity enjoyed outdoors has been shown to boost these beneficial effects.

It is important to keep in mind that the benefits of the afore-mentioned self-care tips will likely develop over time, following a consistent approach. Try not to get discouraged in the process and remember that some self-care tips will be more effective than others. Everyone’s path to recovery and healing will be different.

To learn more about PTSD, click here to access our interviews with experts on the subject; click here to access a multitude of articles including additional ways to recovery.

Contributed by: Jennifer (Ghahari) Smith, Ph.D.

Editor: Jennifer (Ghahari) Smith, Ph.D.

REFERENCES

1 “What is Post-traumatic Stress Disorder (PTSD)?” American Psychiatric Association (accessed 7-5-22) psychiatry.org/patients-families/ptsd/what-is-ptsd

2 Ibid.

3  “Post-traumatic Stress Disorder,” National Institute of Mental Health (accessed 6-22-20) www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

4 “Post-traumatic Stress Disorder (PTSD),” Mayo Clinic (accessed 6-22-20) www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967

5 Ibid.

6 Glass, O., Dreusicke, M., Evans, J., Bechard, E., & Wolever, R. Q. (2019). Expressive writing to improve resilience to trauma: A clinical feasibility trial. Complementary therapies in clinical practice, 34, 240–246. https://doi.org/10.1016/j.ctcp.2018.12.005

7 “Writing Can Help Us Heal from Trauma,” Harvard Business Review (accessed 7-6-22) hbr.org/2021/07/writing-can-help-us-heal-from-trauma

8 Ibid.

9 Ibid.

10 “The Benefits of Journaling for Mental Health,” Diversified Rehabilitation Group (accessed 7-6-22) ptsdrecovery.ca/the-benefits-of-journaling-for-mental-health/

11 Melnick SM, Bassuk EL. Identifying and responding to violence among poor and homeless women. Nashville, TN: National Healthcare for the Homeless Council; 2000.

12 “Proper Breathing Brings Better Health,” Scientific American (accessed 2-16-22) www.scientificamerican.com/article/proper-breathing-brings-better-health/

13 “PTSD: Peer Support Groups,” U.S. Department of Veterans Affairs (accessed 7-6-22) www.ptsd.va.gov/gethelp/peer_support.asp

14 Baer RA. Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice. 2003;10:125–143. doi: 10.1093/clipsy.bpg015.

15 Gallegos AM, Cross W, Pigeon WR. Mindfulness-based stress reduction for veterans exposed to military sexual trauma: Rationale and implementation considerations. Military Medicine. 2015;180:684–689.

16 “Neuro-Nutrition for a Healthier Brain,” PTSD Association of Canada (accessed 7-6-22) www.ptsdassociation.com/nutritional

17 McKeon, Grace; Steel, Zachary; Wells, Ruth; Fitzpatrick, Alice; Vancampfort, Davy; Rosenbaum, Simon. Exercise and PTSD Symptoms in Emergency Service and Frontline Medical Workers: A Systematic Review, Translational Journal of the ACSM: Winter 2022 - Volume 7 - Issue 1 - e000189 doi: 10.1249/TJX.0000000000000189

18 PTSD Association of Canada

19 McKeon, et. al.

20 McGranahan, M. J., & O’Connor, P. J. (2021). Exercise training effects on sleep quality and symptoms of anxiety and depression in post-traumatic stress disorder: A systematic review and meta-analysis of randomized control trials. Mental Health and Physical Activity, 20, 100385. doi:10.1016/j.mhpa.2021.100385

21 Pontifex, M. B., Parks, A. C., Delli Paoli, A. G., Schroder, H. S., & Moser, J. S. (2021). The effect of acute exercise for reducing cognitive alterations associated with individuals high in anxiety. International journal of psychophysiology : official journal of the International Organization of Psychophysiology, 167, 47–56. https://doi.org/10.1016/j.ijpsycho.2021.06.008

Manifestations of Childhood Trauma in Adults

Understanding Trauma

More than 70% of adults have experienced a traumatic event at some point in their lives.[1] Trauma exposure is classified as any event that threatens or causes death, injury, or personal integrity.[2] Such experiences can include: emotional, psychological, physical and/or sexual abuse, natural disasters, war, injuries, or neglect. Further, traumatic events can occur as repeated, long-term experiences or as one single incident.[3]

As discussed by Majer et al., (2010), children are particularly receptive to traumatic experiences due to the heightened plasticity of a developing brain,[4] as well as their reliance on the environment for emotional and cognitive development. A child’s environment directly influences gene expression and brain growth; the stress that one’s environment imposes can help or hinder development.[5] While a normal amount of stress is crucial for the strengthening of important neural connections involved in emotional regulation and response to stress,[6] extreme, frequent, or long-lasting stress, will cause the body to adapt by sending a myriad of chemical and hormonal stress signals throughout the brain, altering its functional components.[7,8] Specifically, the overabundance of the stress hormone cortisol, will weaken bodily functions, including immune function, memory, learning, and emotional regulation.[9] Therefore, if childhood trauma occurs and is not properly addressed, it can lead to cognitive impairment and psychological disorders in adulthood.[10] 

When a child's environment feels unsafe or threatened, there are various ways they will adaptively react in order to maintain a feeling of safety and protection. Such reactions include the development of extreme reactivity to stimulation, heightened sense of vulnerability, and the addition of attachment & neediness behaviors.[11] Additionally, research done by The National Scientific Council on the Developing Child (2005/2014) found that the adjustment of the stress-response system, through the strengthening of neural connections involved in fear and anxiety, causes the child to become stressed at a lower threshold.[12] Further, if a child doesn’t receive the proper emotional support and comfort following a traumatic experience, it can disrupt normal brain development and cause issues with emotional regulation and response to stress in adulthood.[13]

Symptoms of childhood trauma in adults

The intensity and type of traumatic exposure in childhood affects how it will appear in adulthood.[14] Traumatic experiences involving one’s caretaker pose the greatest risk to harming the child’s psychological state and development.[15] Additionally, traumatic experiences that are repetitive are more detrimental than a single episode;[16] as the rate of negative childhood experiences increases, so does the likelihood that the adult will experience symptoms.[17]

As it can be difficult for an adult to disclose childhood trauma,[18] the best indication of its existence is through the expression of conscious and unconscious symptoms. While the effects of childhood trauma manifest differently in everyone, common symptoms include: difficulty controlling emotions, impulsiveness, an increased response to stress, relationship instability, development of mental illnesses, dissociation, avoidance, and heightened anger.[19,20]

Many adults who experienced childhood trauma also suffer from memory and learning deficits.[21] Additionally, some adults are found to have high blood pressure and increased inflammation.[22] Childhood trauma can also lead to interpersonal relationship problems including the creation of a “disorder of hope”, in which new relationships are either idealized or hated.[23] Moreover, Su & Stone (2020) note that if traumatic experiences involve a toxic relationship with a caregiver or trusted adult, those dynamics can also be reenacted in the adult’s life, such as involvement with an abusive partner or becoming abusive themselves.[24]          

Link between childhood trauma and mental health

Traumatic experiences that occur during childhood can cause disruptions in adult psychological function and lead to depression, anxiety, post-traumatic stress disorder (PTSD), and dissociation.[25]

Adverse experiences in early childhood can cause changes to the structural and functional components of the body, including increased sensitivity to stress, increased cortisol, glucocorticoid resistance, and decreased hippocampal volume. All of these changes closely parallel the features present in depression, suggesting traumatic experiences increase the risk of developing depression in adulthood.[26] Consequently, there is a high prevalence of childhood trauma in people with depression. It is also common for anxiety symptoms to develop following a traumatic experience, due to the heightened sensitivity to stress and production of cortisol.[27] Further Berber Çelik Ç, Odacı H (2020), found that childhood trauma can lower self-esteem, indirectly leading to the development of depression and anxiety.[28]

In some cases, typically those involving interpersonal violence or assault, traumatic experiences can lead to post-traumatic stress disorder.[29] PTSD refers to the development of symptoms following a traumatic exposure;[30] these symptoms include the re-experiencing of the traumatic event through nightmares, recollections, intrusive images, or reactions to reminders of the event. It also includes avoiding stimuli related to the traumatic event, increased arousal, and mood and thinking disruptions. To qualify as a diagnosis of PTSD, the duration of these symptoms must transpire for more than one month.[31]      

Dissociation also can occur as a result of a childhood trauma, especially if the experience is life-threatening or imposed by a caretaker. Dissociation is a feeling of disconnect towards psychological constructs, including the body, environment, behavior, and memory.[32] Dependent on where the disconnection is occurring, an absence of emotions, disorientation with surroundings, feelings of separation from the body, problems with self-recognition, or disruptions in hearing can transpire.

Treatment

It is never too late to seek help for trauma that occurred during one’s childhood. Although every treatment will not be effective for everyone, options exist.[33] Exposure therapies such as exposure and response prevention (ERP) and prolonged exposure (PE) are some of the modalities used to treat trauma. Individuals are “exposed” to reminders of the traumatic event, but in a safe and comfortable setting. It is common to develop avoidance and fear for stimuli related to one’s traumatic experience, and exposure therapy gradually decreases those negative reactions.[34] Another treatment for trauma is cognitive-processing therapy (CPT). This type of treatment involves recognizing detrimental thought patterns and behaviors related to the trauma, and implementing healthier beliefs about the self, others, and the world. This process can be done through the use of writing assignments and Socratic questioning.[35] Other possible treatments include eye movement desensitization and reprocessing (EMDR), psychoeducation, and support therapy. 

Image Sources [36,37]

Q&A

SAS’ Psychotherapist, Dr. Brittany Canfield, discusses childhood trauma

1. In your experience, how does childhood trauma typically present itself in adults?

“Based on the literature, there are many physical and psychological manifestations of childhood trauma in adults. What we often see in clinical settings is individuals coming in to treat unmanageable anxiety symptoms, depression, mood dysregulation, attentional issues, and challenges maintaining daily functioning. For many, the catalyst for treatment is suffering from personal relationships or difficulty managing their workload. Childhood trauma also hides within the confines of addiction, both in substance and behavioral as well as within personality disorders. Common symptoms reported when seeking treatment include the following:

• Difficulty falling asleep, staying asleep, or sleep disturbances (i.e. sleepwalking, sleep talking, nightmares, and night terrors).

• Anxiety, panic attacks, social anxiety, and obsessive-compulsive symptoms.

• Depression, suicidal ideation, history of suicidal ideation, plans, and/or attempts, self-harm, and/or mood dysregulation, often including anger.

• Attentional issues such as difficulty focusing, retaining information and/or other issues with recall, increased distractibility, decreased memory, losing time, and/or other symptoms commonly associated with ADHD.

• Physical or somatic symptoms called somatization, include but are not limited to frequent headaches, body aches, gastrointestinal issues, chronic fatigue, decreased immune function, and effects related to chronic stress.

• Other symptoms may include diminished self-esteem and self-worth, poor outlook, compassion fatigue or burnout, codependence, poor boundaries, disturbances in interpersonal relationships, and the need to stay busy.”

2. Are there any ways to prevent childhood trauma from affecting adulthood? If so, what are the most effective ones?

“While there is no single preventive tool, one of the biggest factors mitigating the impact of childhood trauma is resilience. The research highlights the protective qualities that resilience has on childhood trauma, especially when that includes a stable and safe connection with just one adult during childhood. Support has also been shown to mitigate the impact of trauma in the way the individual is able to process the experience and progress toward posttraumatic growth.”

3. What types of treatments are most effective in helping adults who are suffering from childhood trauma?

“Given the differences in how children and adults process trauma, further explained below, bottom-up therapies accessing the part of the brain that was impacted during the trauma have been shown to be the most successful. These therapies include somatic-based or somatic experiencing therapies, EMDR, sensorimotor therapy, and expressive arts. Individuals may also benefit from more traditional talk therapies such as cognitive-behavioral therapy (CBT), mindfulness-based CBT, and dialectical behavior therapy (DBT), the latter focusing on resource-building. Additionally, therapy will focus on building skills that can assist the individual in regulating their nervous system and learning to utilize other mind-body activities such as yoga, meditation, and polyvagal techniques, all of which have been shown in the research to mitigate the effects of trauma.”

4. Are there any differences in how children process traumatic experiences compared to adults?

“This is an excellent question and a very important aspect of the impact of trauma on the brain in human development. In childhood, the prefrontal cortex is still developing and will continue to do so well into the mid-20s. With that being said, we process trauma from the bottom-up, that is, from the base or "bottom" of our brain. Bottom-up processing includes our sensory system, meaning that we experience and store the trauma from our senses, thus somatically. Other parts of our brain impacted by trauma include our limbic system and peripheral nervous system. When we experience trauma as an adult and often when childhood trauma is not a precipitating factor, we do so from our prefrontal cortex, which allows us to process the trauma using higher cortical thinking including cognitive processes such as reasoning, language, and awareness. You may wonder why this is so important? People who experience childhood trauma often do not have the words to describe or process what they experienced, because the part of the brain that is engaged in those processes was not the primary part of the brain in use when the trauma occurred. This makes it difficult for childhood trauma survivors to even acknowledge that the trauma happened let alone impacted them.”

5. Do you have any advice or anything you want to share with someone who may be suffering from childhood trauma?

“There is often fear and shame associated with childhood trauma, which can prevent individuals from seeking help. We often internalize social stigma (self-stigma) of seeking help out of fear of being invalidated, shamed, pathologized, or perceived as "crazy." You do not have to go at this alone, feel ashamed for what you have gone through, or carry the burden of your childhood trauma well into adulthood. If you have a childhood trauma history, it is recommended that you seek the help of a professional, join a support group, educate yourself on childhood trauma and often complex PTSD, and engage in activities that regulate the nervous system.”

If you have experienced childhood trauma and would like to explore possible treatment options, please reach out to a licensed mental healthcare provider who specializes in trauma recovery.

For more information, click here to access an interview with Psychologist Michele Bedard-Gilligan on trauma & recovery.

Additionally, you may click here to access an interview with Psychologist Bethany Brand on trauma & dissociation.

To access our PTSD Self-Care Tips, click here.

Contributed by: Amelia Worley

Editor: Jennifer (Ghahari) Smith, Ph.D.

References

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2 Bedard-Gilligan, M., & Worley, A. (2022, May 13). Psychologist Michele Bedard-Gilligan on Trauma & Recovery - Psychology and Psychiatry Interview Series. Seattle Anxiety Specialists, PLLC: Psychiatry & Psychology. Retrieved May 17, 2022, from https://seattleanxiety.com/psychology-psychiatry-interview-series/2022/5/5/q6oxgila8beysefwg0qvb7gve9pb46

3 Harms, L. (2015). Understanding trauma and resilience. Macmillan Education. 

4 Majer, M., Nater, U.M., Lin, JM.S. et al. Association of childhood trauma with cognitive function in healthy adults: a pilot study. BMC Neurol 10, 61 (2010). https://doi.org/10.1186/1471-2377-10-61 

5 Stien, P., & Kendall, J.C. (2004). Psychological Trauma and the Developing Brain: Neurologically Based Interventions for Troubled Children (1st ed.). Routledge. https://doi.org/10.4324/9781315808888 

6 Ibid.

7 National Scientific Council on the Developing Child. (2005/2014). Excessive Stress Disrupts the Architecture of the Developing Brain: Working Paper 3. Updated Edition. http://www.developingchild.harvard.edu

8 Stien, P., & Kendall, J.C. (2004)

9 Excessive Stress Disrupts the Architecture of the Developing Brain. (2005/2014)

10 Majer, M., Nater, U.M., Lin, JM.S. et al. Association of childhood trauma with cognitive function in healthy adults: a pilot study. BMC Neurol 10, 61 (2010). https://doi.org/10.1186/1471-2377-10-61 

11 Van der Kolk, B. (2003). Psychological Trauma. American Psychiatric Pub. 

12 Excessive Stress Disrupts the Architecture of the Developing Brain. (2005/2014)

13 Stien, P., & Kendall, J.C. (2004)

14 Van der Kolk, B. (2003).

15 Everett, B., & Gallop, R. (2001). The link between childhood trauma and mental illness effective interventions for mental health professionals. SAGE. 

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17 Ibid.

18 Ibid.

19 Ibid.

20 Thatcher, T. (2018, November 20). Healing childhood trauma in adults. Highland Springs Clinic. Retrieved May 8, 2022, from https://highlandspringsclinic.org/blog/healing-childhood-trauma-adults/  

21 Stress disrupts the architecture of the developing brain. (2005)

22 Ibid.

23 Van der Kolk, B. (2003).

24 Su, W.-M., & Stone , L. (2020, July). 

25 Van der Kolk, B. (2003).

26 Christine Heim, D. Jeffrey Newport, Tanja Mletzko, Andrew H. Miller, Charles B. Nemeroff, The link between childhood trauma and depression: Insights from HPA axis studies in humans, Psychoneuroendocrinology, Volume 33, Issue 6, (2008), Pages 693-710, ISSN 0306-4530, https://doi.org/10.1016/j.psyneuen.2008.03.008.

27 Robert S Pynoos, Alan M Steinberg, John C Piacentini, A developmental psychopathology model of childhood traumatic stress and intersection with anxiety disorders, (1999), Pages 1542-1554, ISSN 0006-3223, https://doi.org/10.1016/S0006-3223(99)00262-0.

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29 Bedard-Gilligan, M., & Worley, A. (2022, May 13)

30 Ibid.

31 Wilson, J. P., & Keane, T. M. (2006). Assessing psychological trauma and Ptsd. The Guilford Press. 

32 Brand, B., & Worley, A. (2022, May 9). Psychologist Bethany Brand on Trauma & Dissociation- Psychology and Psychiatry Interview Series. Seattle Anxiety Specialists, PLLC: Psychiatry & Psychology.

33 Bedard-Gilligan, M., & Worley, A. (2022, May 13)

34 American Psychological Association. (2017, July). What is exposure therapy? American Psychological Association. Retrieved May 10, 2022, from https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy  

35 American Psychological Association. (2017, July). Cognitive processing therapy (CPT). American Psychological Association. Retrieved May 9, 2022, from https://www.apa.org/ptsd-guideline/treatments/cognitive-processing-therapy

36 Bowman, J. (2017, February 9). Socratic questions revisited [infographic] · James Bowman. James Bowman. Retrieved May 17, 2022, from http://www.jamesbowman.me/post/socratic-questions-revisited/  

37 R. W. Paul, L. Elder: The Thinkers Guide to The Art of Socratic Questioning, 2007