TRAUMA INFORMED THERAPIES
Physicians and Healthcare Providers
After becoming familiar with the effects of trauma on the brain, it will help to become familiar with the different treatment modalities for trauma and toxic stress. Some modalities are more useful for different ages and different types of trauma. It will save you time to become familiar with the referral sources are in your area. Do a quick search for your area on the below websites, and you should find therapists and licensed professional counselors as well as the nearest pediatric psychiatrists. If you are limited by location in nearby therapists, find out what treatment modalities your local therapists use. This will help you to know what your patients can expect, and if they may need to consider driving further to get the help they need. This information is here to streamline your efforts to get help to your patients. If we can intervene at an early age, rather than waiting for significant symptoms to show up, we can mitigate the effects of trauma on the next generation.
Patients, Parents, and Caregivers
This information is available to help you find out what different types of treatment are available for trauma, toxic stress, behavior issues and attachment. If you have not started treatment yet or have not been satisfied with the results of your current therapy, you may find another treatment that would be a better fit for you. You can also search what is available to you locally. Always be open and honest about what difficulties you are having with your primary care doctor and your therapist. They want the best outcome for you! There are things you can do at home to help build resilience in your children and to foster recovery from past trauma. But if you are having difficulties, it is always better to get professional help than to wait and see. It helps to get a different perspective and to get resources you may need in the future as well.
National Alliance on Mental Health, 6 weeks Basics Course for Parents/Caregivers - LINK
National Alliance on Mental Health, 6 weeks Basics Course for Parents/Caregivers - LINK
National Websites - find a mental health provider
SAMHSA - Behavioral Health Treatment Services Locator - LINK
TF-CBT, Trauma Focused Cognitive Behavioral Therapy search - LINK
CPP, Child Parent Psychotherapy - LINK
TBRI Practitioner List - find local therapists trained in TBRI - LINK
Theraplay Practitioner List - LINK
PCIT, Parent Child Interaction Therapy - LINK
ARC, Attachment, Regulation and Competency Framework, Practitioner List - LINK
APA, American Psychological Association, search for a psychologist by zip code - LINK
Psychology Today - search for mental health professionals by name, city or zip code - LINK
Dougy.org - Grief resources for families, including therapy finder - LINK
InclusiveTherapists.com - search for therapists - LINK
TF-CBT, Trauma Focused Cognitive Behavioral Therapy search - LINK
CPP, Child Parent Psychotherapy - LINK
TBRI Practitioner List - find local therapists trained in TBRI - LINK
Theraplay Practitioner List - LINK
PCIT, Parent Child Interaction Therapy - LINK
ARC, Attachment, Regulation and Competency Framework, Practitioner List - LINK
APA, American Psychological Association, search for a psychologist by zip code - LINK
Psychology Today - search for mental health professionals by name, city or zip code - LINK
- You may list your city and the modality you are looking for, such as PCIT, neurofeedback, or EMDR and you will see therapists who are advertising that they have been trained in these modalities. You may then want to research their certifications to verify training.
Dougy.org - Grief resources for families, including therapy finder - LINK
InclusiveTherapists.com - search for therapists - LINK
Oklahoma Websites - find a mental health provider
Child and Adolescent Psychiatrists - M.D. or D.O. - in Oklahoma - LINK
Oklahoma Systems of Care - Community Health Centers - search by county - LINK , to make a referral LINK
TF-CBT, Trauma Focused Cognitive Behavioral Therapy - search - LINK
TBRI Practitioner List - find local therapists trained in TBRI - LINK
PCIT, Parent Child Interaction Therapy, Provider List - LINK
CPP, Child Parent Psychotherapy - LINK
Theraplay Practitioner List - LINK
ARC, Attachment, Regulation and Competency Framework, Practitioner List - LINK
APA, American Psychological Association, search for a psychologist by zip code - LINK
Psychology Today - search for mental health professionals by name, city or zip code - LINK
Dougy.org - Grief resources for families, including therapy finder - LINK
InclusiveTherapists.com - search for therapists - LINK
Oklahoma Systems of Care - Community Health Centers - search by county - LINK , to make a referral LINK
TF-CBT, Trauma Focused Cognitive Behavioral Therapy - search - LINK
TBRI Practitioner List - find local therapists trained in TBRI - LINK
PCIT, Parent Child Interaction Therapy, Provider List - LINK
CPP, Child Parent Psychotherapy - LINK
Theraplay Practitioner List - LINK
ARC, Attachment, Regulation and Competency Framework, Practitioner List - LINK
APA, American Psychological Association, search for a psychologist by zip code - LINK
Psychology Today - search for mental health professionals by name, city or zip code - LINK
- You may list your city and the modality you are looking for, such as neurofeedback, DBT, or EMDR and you will see therapists who are advertising that they have been trained in these modalities. You may then want to research their certifications to verify training.
Dougy.org - Grief resources for families, including therapy finder - LINK
InclusiveTherapists.com - search for therapists - LINK
“adverse childhood experiences are the single greatest unaddressed public health threat facing our nation today.”
-Robert Block, MD former President of the AAP
-Robert Block, MD former President of the AAP
Treatment Modalities
Scientific Rating Level is from the California Evidence Based Clearinghouse for Child Welfare
Level 1 - Well Supported by Research Evidence
Level 2 - Supported by Research Evidence
Level 3 - Promising Research Evidence
Level 4 - Evidence Fails to Demonstrate Effect
Level 5 - Concerning Practice
TF-CBT - Trauma Focused Cognitive Behavioral Therapy - LINK
Level 1 - Well Supported by Research Evidence
Level 2 - Supported by Research Evidence
Level 3 - Promising Research Evidence
Level 4 - Evidence Fails to Demonstrate Effect
Level 5 - Concerning Practice
TF-CBT - Trauma Focused Cognitive Behavioral Therapy - LINK
- Scientific Rating Level 1
- (ages 3 to 18) A structured, short-term treatment model that has shown improvements in symptomatic outcomes after 8-25 sessions in children with a history of trauma or PTSD and their caregivers. It also improves anxiety, depression, cognitive and behavioral disorders related to trauma and is effective for diverse, multiple and complex trauma experiences at different ages and across cultures.
- Scientific Rating Level 1
- (ages 2 to 7) PCIT is a dyadic behavioral intervention for children and their parents or caregivers that focuses on decreasing externalizing child behavior problems (e.g., defiance, aggression), increasing child social skills and cooperation, and improving the parent-child attachment relationship. It teaches parents traditional play-therapy skills to use as social reinforcers of positive child behavior and traditional behavior management skills to decrease negative child behavior. Parents are taught and practice these skills with their child in a playroom while coached by a therapist. The coaching provides parents with immediate feedback on their use of the new parenting skills, which enables them to apply the skills correctly and master them rapidly. Sessions usually last an hour weekly and last an average of 14 weeks but as long as needed.
- Scientific Rating Level 2
- (age 0 to 5) Typically, the child is seen with his or her primary caregiver, and the dyad is the unit of treatment. CPP examines how the trauma and the caregivers’ relational history affect the caregiver-child relationship and the child’s developmental trajectory. A central goal is to support and strengthen the caregiver-child relationship as a vehicle for restoring and protecting the child’s mental health. Treatment also focuses on contextual factors that may affect the caregiver-child relationship (e.g., culture and socioeconomic and immigration related stressors). Targets of the intervention include caregivers’ and children’s maladaptive representations of themselves and each other and interactions and behaviors that interfere with the child’s mental health. Over the course of treatment, caregiver and child are guided to create a joint narrative of the psychological traumatic event and identify and address traumatic triggers that generate dysregulated behaviors and affect.
- Scientific Rating Level 1
- (age 6 months to 2 years) ABC targets several key issues that have been identified as problematic among children who have experienced early maltreatment and/or disruptions in care. These young children often behave in ways that push caregivers away. The first intervention component helps caregivers to re-interpret children's behavioral signals so that they provide nurturance even when it is not elicited. Nurturance does not come naturally to many caregivers, but children who have experienced early adversity especially need nurturing care. Thus, the intervention helps caregivers provide nurturing care even if it does not come naturally. Second, many children who have experienced early adversity are dysregulated behaviorally and biologically. The second intervention component helps caregivers provide a responsive, predictable, warm environment that enhances young children's behavioral and regulatory capabilities. The intervention helps caregivers follow their children's lead with delight. The third intervention component helps caregivers decrease behaviors that could be overwhelming or frightening to a young child.
- Scientific Rating Level 3
- ( ages 0 to 17) TBRI® is an attachment-based, trauma-informed intervention that is designed to meet the complex needs of vulnerable children. TBRI® uses Empowering Principles to address physical needs, Connecting Principles for attachment needs, and Correcting Principles to disarm fear-based behaviors. While the intervention is based on years of attachment, sensory processing, and neuroscience research, the heartbeat of TBRI® is connection. It is a caregiver-based intervention that is designed for children who have experienced relationship-based traumas such as institutionalization, multiple foster placements, maltreatment, and/or neglect. (Although not as extensively researched, it has been widely used by adoptive and foster parents for some time with good results. Principles have also be applied to schools, juvenile justice centers, and camps.)
- Scientific Rating Level 3
- (ages 0 to 18) Theraplay is a child and family therapy for building and enhancing attachment, self-esteem, trust in others, and joyful engagement. In treatment, the Theraplay Practitioner guides the parent and child through playful, fun games, developmentally challenging activities, and tender, nurturing activities. The very act of engaging each other in this way helps the parent regulate the child’s behavior and communicate love, joy, and safety to the child. It helps the child feel secure, cared for, connected and worthy. We call this “building relationships from the inside out.” (Although not as extensively researched, it has been successfully used by many foster and adoptive families.)
- Scientific Rating Level 1
- (age 2 to adults) Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy treatment that was originally designed to alleviate the distress associated with traumatic memories (Shapiro, 1989a, 1989b). Shapiro’s (2001) Adaptive Information Processing model posits that EMDR therapy facilitates the accessing and processing of traumatic memories and other adverse life experiences to bring these to an adaptive resolution. After successful treatment with EMDR therapy, affective or mood distress is relieved, negative beliefs are reformulated, and physiological arousal is reduced. During EMDR therapy the client listens to or remembers emotionally disturbing material in brief sequential doses while at the same time focusing on an external stimulus. Therapist directed lateral eye movements are the most commonly used external stimulus but a variety of other stimuli including hand-tapping and noises are often used (Shapiro, 1991). EMDR therapy uses a three pronged protocol: (1) the past events that have laid the groundwork for dysfunction are processed, forging new associative links with adaptive information; (2) the current circumstances that elicit distress are targeted, and internal and external triggers are desensitized; (3) possibilities of future events are incorporated, to assist the client in acquiring the skills needed for adaptive functioning. EMDR is similar to TF-CBT but it does not include the caregiver, so it is not attachment based. Therefore, it may be more useful for processing specific traumatic events, but less so for more ongoing dysregulation or attachment issues.
- Scientific Rating Level 3
- (age 0 to 17) The Attachment, Regulation and Competency (ARC) Framework is a flexible, components-based intervention developed for children and adolescents who have experienced complex trauma, along with their caregiving systems. ARC’s foundation is built upon four key areas of study: normative childhood development, traumatic stress, attachment, and risk and resilience. Drawing from these areas, ARC identifies important childhood skills and competencies which are routinely shown to be negatively affected by traumatic stress and by attachment disruptions, and which – when addressed – predict resilient outcome. Has been used across many institutional levels - schools, juvenile justice centers, head start, inpatient, outpatient.
- Scientific Rating Level 3
- (age 8 to adults) Dialectical behavior therapy (DBT) provides clients with new skills to manage painful emotions and decrease conflict in relationships. DBT specifically focuses on providing therapeutic skills in four key areas. First, mindfulness focuses on improving an individual's ability to accept and be present in the current moment. Second, distress tolerance is geared toward increasing a person’s tolerance of negative emotion, rather than trying to escape from it. Third, emotion regulation covers strategies to manage and change intense emotions that are causing problems in a person’s life. Fourth, interpersonal effectiveness consists of techniques that allow a person to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships. DBT was originally developed for use with patients with Borderline Personality Disorder and is well researched in that area. It has recently been found to be helpful for use in patients with PTSD as some of the goals of treatment are the same. Research in this area is in early stages and it is minimally researched in children and adolescents. May be helpful for teens with self-harming behaviors.
- Not ranked on the CEBC
- (age 5 to adult) Neurofeedback can be thought of as a specialized kind of operant conditioning in which pre-selected EEG frequencies are provided to the trainee in the form of a computer game that employs visual, auditory, and tactile feedback. The individual is ‘rewarded’ by progressing in the game only when specific EEG frequencies corresponding to a calmer or more regulated mental or emotional state exceed threshold. Repetitive ‘training’ in select frequencies reinforces the individual’s ability to achieve a target state of baseline EEG activity corresponding to enhanced cognitive functioning or improved emotional self-regulation. The technique is currently widely used to treat ADHD and a range of anxiety. disorders in both children and adults. Since some children manifest hyper-arousal from traumatic experiences as behavior similar to ADHD, it would be beneficial to have more research into this treatment for ADHD symptoms with history of trauma or high ACEs.
- Not ranked on the CEBC
- (age 5 to adult) Forms of biofeedback, especially Heart Rate Variability have been shown to be helpful in training patients to calm themselves and decrease physiological hyper-arousal. It has been successfully used as an adjunctive therapy during other forms of trauma or PTSD treatments. Alone it would not be curative of trauma related symptoms as it would not deal with the source memories and current patterns of thought.
OKLAHOMA MENTAL HEALTH PROVIDERS
Due to lack of access in the state leading to a need for families to access whatever care becomes available near them, TraumaInformedMD.com cannot endorse all of the following service providers, but desires to include all available.
Outpatient Services
OK Dept of Mental Health and Substance Abuse Services
NorthCare - LINK
CREOKS Health Services - LINK
The Halo Project - LINK
Southwestern Medical Center - Lawton - LINK
- Youth Counseling - LINK
- Behavioral Health Agencies/Integrated Care - LINK
- Use this website to search more rural parts of the state
NorthCare - LINK
CREOKS Health Services - LINK
The Halo Project - LINK
- 10 week outpatient intensive training program for parents of adopted or foster kids to work on attachment and behavior issues. 4 locations near Oklahoma City. It is free to the families and supported by donations. It uses the TBRI principles of the Karyn Purvis Institute at TCU. This is excellent for referring caregivers who are having a difficult time. They now have services for biological families and adults as well. Now with programs for parents with a personal history of intimate partner violence or child abuse.
- Parent and child support for grief from loss of a loved one and divorce. Resource page is great.
- Infant/Early Childhood Mental Health services and consultations, counseling, home-based services, school-based services at OKC public schools.
- Nonprofit organization providing infant mental health, baby pantry, parenting skills and support, counseling services including TBRI, Theraplay and TFCBT, divorce support services
- Youth shelter, counseling, juvenile intervention services, divorce support
- Outpatient - 6yrs and up, Inpatient - 13yrs and up
- Outpatient - all ages, Inpatient - 18yrs and up
- Outpatient - all ages, Inpatient - all ages - 7 day crisis stay
- Residential, Partial Hospitalization, Intensive Outpatient, and Outpatient treatment programs
Southwestern Medical Center - Lawton - LINK
- Pediatric inpatient unit with outpatient follow up
- Adult inpatient, outpatient, and substance abuse care
Inpatient Services
Child/Adolescent Acute Inpatient Hospitals - LINK
- SSM midtown campus - LINK
- OU Children's Hospital, disordered eating program, emergency room/ inpatient care not designated for psychiatry but used when no other services available in the state or pediatric informed care is needed - LINK
- Southwestern Medical Center - Lawton - LINK
Crisis Services
Call 2-1-1 in Oklahoma to get help with a variety of crisis services
Youth Mobile Crisis Line 1-833-885-CARE (2273)
Youth Mobile Crisis Line 1-833-885-CARE (2273)
promote healing from trauma and toxic stress
- Activities that require increased body awareness - Yoga, trauma sensitive or trauma informed yoga, tae kwon do, other martial arts, ballet, dance, gymnastics, tai chi, and therapeutic massage.
- Activities that require listening to others and blending in with a group - Band, choir, music groups, theater, and music and movement classes.
- Creative Arts - Creative writing, journaling, coloring, drawing, visual arts, music, drama, etc.
- Mindfulness and Meditation - There are guided meditation apps (Calm, Headspace, Abide) and YouTube videos that a parent and child could do together or separately at a regular time to reduce stress, become more self-aware, and learn to focus thoughts.
- Sleep Hygiene – Talk to your primary care physician about any ongoing sleep issues. Seek professional help when needed for frequent waking, delayed sleep onset or early awakening.
- Nutrition – Boost immune system and even out blood sugar, increase water intake.
- Moderate Exercise – Reduce inflammatory cytokines and boost immune system, release serotonin and endorphins that reduce feelings of stress and pain.
- Occupational Therapy – OT can help with sensory issues created by a
that may occur when trauma happens to children.
- Sources: The Body Keeps the Score by Bessel van der Kolk MD, The Boy Who
- Was Raised as a Dog by Bruce D. Perry, MD, and Maia Szalavitz, and The Connected Child
- by Karyn B Purvis, David R. Cross and Wendy Lyons Sunshine
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