Bringing Trauma to Light

November 6, 2013

Emotional trauma has long been a part of the human experience, but it has only been in recent decades that we have begun to comprehend and study its effects.

“We owe much of our current understanding about the impact of trauma to the difficulties faced by soldiers returning from the Vietnam War,” said Milissa Kaufman, MD, PhD, medical director of the trauma-focused Hill Center for Women at McLean. “At around the same time, the women’s movement made us confront the traumatizing effects of rape, domestic violence, and childhood abuse.”

Today, McLean is a leader both in treating individuals whose emotional difficulties are linked to past traumatic events and in driving research to understand how trauma alters brain systems and increases the likelihood of developing a psychiatric illness.

Addressing a Common, But Under-Recognized Condition

McLean’s Dissociative Disorders and Trauma Program has become one of the preeminent treatment centers in the country for adults who suffer the lasting effects of trauma, often rooted in severe childhood abuse. Its patients often suffer from post-traumatic stress disorder (PTSD). Many also struggle with co-occurring conditions like depression, substance abuse, borderline personality disorder, and eating disorders.

Milissa Kaufman, MD, PhD; William D. S. Killgore, PhD; Isabelle Rosso, PhD; Sherry Winternitz, MD

Milissa Kaufman, MD, PhD; William D. S. Killgore, PhD; Isabelle Rosso, PhD; Sherry Winternitz, MD

“Despite how common trauma is, there aren’t many places that offer a dedicated inpatient unit to treat those with trauma-related issues as part of a whole continuum of care,” said Sherry Winternitz, MD, clinical director of the Dissociative Disorders and Trauma Program. “It can be so helpful for patients to be treated in an environment where there are others who struggle with similar symptoms, and where the staff understands trauma and the unique impact it may have on an individual’s life.”

The 20-year-old program includes the Proctor House inpatient unit and the Hill Center, which offers residential and partial hospital levels of care for women. Both Proctor House and the Hill Center have a singular focus: helping patients feel safe so healing can begin.

The programs’ treatment approach reflects a change in thinking about how to help trauma victims who are in crisis. “In the old days, it was common to have people rehash their trauma as a way to work through it,” said Kaufman. “But people can get very destabilized if first they are not provided with the tools they need to stabilize. Here, from day one, we get them back to functioning. That includes helping them feel safe, educating them about their symptoms, and giving them hands-on skills to move forward.”

A key component of that work involves creating a caring, home-like environment for residents. The Hill Center recently got a boost from donor Joan Collins, who funded new furnishings for the patient bedrooms. Through her gift, each bedroom received quality wood furniture including a bed, armoire, and night stand, as well as new lighting and artwork. “It was important to me that the women at Hill Center felt at home, and not as if they were in an institution,” said Collins. “Investing in furniture was one simple, but meaningful way to support their recovery.”

Essential to patients’ recovery is having clinicians skilled at detecting and treating trauma-related issues. Because trauma is commonly a contributing factor in mental illness, many clinical units at McLean routinely screen for trauma histories. Programs such as the Klarman Eating Disorders Center, for example, find a very high prevalence of trauma among their patients and therefore screen every patient upon admission. Likewise, in the adolescent residential treatment program clinicians are evolving a specialized “trauma track” to address the unique concerns of their young patients for whom trauma is a major factor. A generous gift from the Joseph Leroy and Ann C. Warner Fund has helped to support this effort.

Rounding Out the Picture Through Research

Just as McLean has become an important hub of clinical services for trauma survivors, it also is leading efforts to understand how traumatic experiences affect the brain and an individual’s mental health. A number of researchers are using high tech imaging tools to help them see what happens on a structural and chemical level in the brains of people with trauma histories.

The Dissociative Disorders and Trauma Program recently received an anonymous, private donation to support research for a study that is looking at how women who report histories of childhood abuse and neglect and show severe dissociative symptoms may have underlying structural differences in the areas of the brain that are involved in emotional regulation, attention and memory.

McLean researcher Isabelle Rosso, PhD, is taking a complementary approach by examining certain neurochemicals involved in PTSD. One of her studies uses brain imaging to assess levels of an inhibitory neurotransmitter called GABA that has a dampening effect on firing neurons. The study is measuring GABA levels in a few areas of the brain, including the insula, which mediates emotional states and physical feelings. The theory is that lower concentrations of GABA may be contributing to an overactive insula in PTSD, and may be relevant to emotional and physiological hyperarousal symptoms.

“We hope this work will lead to the identification of biomarkers of illness mechanisms in PTSD, and ultimately assist with monitoring and prediction of treatment effectiveness in individual patients—for example, gauging one medication’s effectiveness over another’s,” said Rosso. “Over the long term, we hope to better understand whether certain neurochemicals might serve as imaging markers of risk and resilience in PTSD, both before and after exposure to trauma.”

Rosso’s colleague William D.S. Killgore, PhD, also seeks to better understand PTSD through science. His recent study suggested that people who suffer from PTSD and other anxiety disorders have a hyper-responsive amygdala—the brain area that processes memory and emotions. Furthermore, the amygdala also was larger among those with PTSD relative to healthy control participants. “We found that individuals with PTSD showed increased amygdala volume and reduced volume in the medial prefrontal cortex, a problem that may predispose these individuals toward many of the symptoms common to PTSD,” said Killgore.

The exciting research occurring in McLean laboratories will have important implications for trauma patients, said Winternitz. “The more we learn about the differences in brain structure and chemistry, the better we’ll understand why some people get PTSD and others don’t,” she said. “And that will translate into ways of intervening earlier to prevent the difficult, long-term effects on mental health.”

Beyond McLean: Helping Those in Our Community Who are Affected by Trauma

McLean staff members are taking their expertise in trauma care well beyond the traditional hospital setting.

Take the example of John Rodolico, PhD, a clinical psychologist and director of adolescent addictions training at McLean who also is a Lieutenant Colonel in the Army Reserves. During Operation Iraqi Freedom, Dr. Rodolico directed a unit that provided mental health care to soldiers and marines in the dangerous Sunni Triangle of Iraq. He was awarded two Bronze Stars for his work there and today, he serves as director of military and veteran consultation for McLean. In that role he leads the hospital’s ongoing outreach to military personnel veterans and their families. Dr. Rodolico presently is the Chief of Behavioral Health for the Massachusetts National Guard.

“Post-traumatic stress is not new to war. It can be traced back to the Civil War where it was called ‘Soldier’s Heart,’” he said. “We’re working to create a more seamless continuum of care between the VA, military providers, and the private sector so we can help as many veterans and service members as possible.”

Another McLean staffer who shares her expertise in the community is Christine Tebaldi, RN/NP, McLean’s director of community hospital programs, who oversees psychiatric emergency and consultative services at McLean. Off-hours, she is the lead for the American Red Cross of Massachusetts’ disaster mental health team. In that role, she heads up preparedness and planning activities, which include managing relationships with partner agencies and training new volunteers.

When a disaster strikes—whether it is a house fire or the marathon bombing—Tebaldi and her team are available to provide emotional support at the scene, connect people with disaster-related resources and refer them to mental health services, if needed. “In times of disaster, we help people manage ‘normal’ reactions to abnormal events,” Tebaldi said. “There is a natural synergy between my role at McLean and my volunteer work,” she added. “The trauma response—whether it is happening in an emergency room or at a disaster scene—follows a similar model. Recognizing it, intervening early and referring people to mental health services, when needed, are the first steps toward helping them move through a traumatic experience without the long-term consequences that so often occur when trauma goes unrecognized.”

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