Connection between trauma and brain
The 13th European Congress of Mental Health in Intellectual Disability (EAMHID) was held in Berlin, Germany, September 23- 25, 2021. The central theme was 'From Science to Practice'. To kick off sharing the knowledge we have interviewed some of the keynote speakers. This is an interview with Lien Claes, master and doctor in Special Needs Education, Ampel WINGG (CGG Prisma) & Ghent University.
Intellectual disabilities and mental health (or challenging behaviour). What comes to mind reading these key words?
A lot of research is readily available that has been conducted based on an individualistic, medical-psychiatric discourse, and therefore focused on individual problems and treatment models. But research on the mutual and dynamic relations between mental health issues and the contexts in which people live, learn, and work remains rather hard to find. The use of qualitative, narrative, and participatory research methodologies is also underrepresented. Finally, transferring and implementing scientific research findings into daily practice remains challenging. The practice-based evidence work of our team aims to fill this void.
What is the main research objective/theme/focus of the study you will be presenting? What are the main results from your study?
Research and literature on trauma in people with intellectual disabilities is limited. However, both theory and practice indicate that, due to various risk factors, people with intellectual disabilities and their families have an increased risk of suffering from trauma. Nevertheless, the diversity of complaints linked to complex trauma can lead to diagnostic confusion. Consequently, people with trauma may be diagnosed differently by different diagnosticians. Specific behaviours are rarely interpreted as being caused by a traumatic experience. We found that this kind of fragmentation subsequently results in ‘mis-tuned’ or ‘not-enough attuned’ care and support and maintains or even reinforces challenging behaviours and mental health issues. Trauma-informed or trauma-sensitive care is essential in both families and in professional care and support systems in the treatment and prevention of further trauma.
Historically, trauma had rather fatalistic connotations of hopelessness and lifelong injury. Indeed, complex trauma greatly impacts the architecture and chemical processes of the brain and the connected stress system. Many clients develop a permanent hypersensitivity of the stress system and a sustained vulnerability in terms of cognitive, emotional, and relational development. But gradually, concepts of stabilization, recovery and post-traumatic growth are gaining more ground: a healing development from wound to scar is possible. Stabilization practices targeting the body and the mind may provide a perspective for improvement.
How might outcomes of your (previous) studies affect daily practice in the support of persons with intellectual disabilities and mental health disorders and/or challenging behaviour? How can daily care providers improve their support based on your study/work?
The importance of a broad, not label-oriented but action-oriented and multidisciplinary diagnostic process cannot be overestimated. A careful reconstruction of someone’s life course and their life events is crucial throughout our diagnostic process: after all, mental health problems are rooted in a person’s historical and cultural context. In trauma-sensitive care contexts, the ‘trauma reflex’ enters all diagnostic work: not as an end point (diagnosis) but as a starting point in the fine-tuning and alignment of care and support.
In social and (mental) health care, trauma is associated with taboo and avoidance?. For instance, the idea that ‘only therapists are positioned to address trauma.’ However, trauma-informed care also takes place outside of the therapy room. It is our shared responsibility to teach families and professionals in schools, workplaces, and residential living units to be trauma-sensitive. On the one hand, this is made possible by sharing concrete, approachable tools that help to regulate and stabilize. On the other hand, this is only possible when environments in which reasoning is under pressure due to complex trauma are supported with shared and ongoing mentalization processes.
Can you suggest topics for future studies you will be working on? How can we better implement scientific findings in daily practices?
In our view, further research should be performed on the effectiveness of EMDR for people with intellectual disabilities. Also, an in-depth, qualitative study of the different factors that make a context ‘trauma sensitive’ would be appropriate. In this respect we would like to maintain and strengthen the connection with Ghent University in terms of research, case studies, and internships. A bridge like this between theory and practice is key to a better implementation of scientific findings in daily practices.