Supporting young people to reduce increased risk of trauma

This is in part due to the lack of preparation from services that would normally be there to help children face the challenges they are presented with, but also because this pandemic is not going to end soon or in a simple manner. Unfortunately, we are going to see significant increases in mood disorders and in trauma functioning amongst children and young people during and after this period.

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Currently the conditions exist for a very significant rise in post traumatic stress disorder (PTSD) in the population but especially in children and young people. We are all living with the sight of possible death of self or loved ones and being fed a daily diet of high numbers of people who have died. And although thankfully the numbers dying may be levelling and falling, we are still being told very clearly they could rise, and we must remain vigilant. This produces stress as does the conditions we are being asked to live in, social distancing, disconnection from our usual support systems, disruption of our normal and fears of economic collapse etc. These conditions of high stress and fear of death are the environmental stressors that can lead to PTSD.

For children and young people the usual systems that would help ameliorate this are no longer available in the form they were before: peer groups cannot meet, schools are closed, and services have been scrambling to adapt to social distancing. Although many providers have “gone online”, they have done this with little experience or understanding of how to make the online services effective relying on technology they do not understand. 

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Most childcare practitioners in the UK have not had extensive experience of the issues presented by online work as the “face-to-face” paradigm has dominated therapeutic work and in that paradigm online has been seen as second best or with suspicion by many. The usual systems are moving online in a hurry in response to the pandemic and trying their best to adapt to the current situation but without the experience or training to utilise online spaces fully.

Trauma can be ameliorated in a number of ways and can be explored with children and young people in services:

• Cognitive vaccination approaches – any type of cognitive activity that will block the symptoms for the patient can be very effective. Using games such as Tetris work well, they block the formation of traumatic memory and the development of the most well-known and ubiquitous trauma symptom, flashbacks and are simple to use.

• Distraction common techniques - distraction though activity to sources of pain (emotional or physical) can help as pain management and stress management are generally synonymous. This can be used to help young children and offset their attention to other things which will essentially stop them from focusing on the very thing that stresses them out. You cannot stop someone thinking, but you can help by replacing that thought with something else such as playing a game, observing nature etc. This is a standard psychological technique that stops people from ruminating.

• Stress management techniques, PTSD is the overwhelming of the ability of the parasympathetic nervous system to manage the sympathetic nervous system. Support the parasympathetic system with relaxation techniques and use one of the relaxation apps to help with this. Teach people how to physically relax their body and learn breathing techniques, creating a safe space and self-soothing will help enormously.

• Cognitive behavioural interventions utilising the four pillars of cognitive behavioural therapy (CBT); which are psycho-education on depression, anxiety and mind (teaching us how to understand and improve our conditions), cognitive restructuring techniques to allow the children and young people to challenge unhelpful thinking and reframe our thinking, exposure work to reduce avoidance mechanisms and face fears (avoidance increases stress levels) and behavioural activation techniques to encourage exercise to reduce stress hormone build up.

• Make existing services more helpful through simple restructuring of online delivery of support to increase engagement and improve outcome. This could work by having shorter online sessions more often, utilising a mixed economy approach using less frequent but regular real world contact (to facilitate social distancing), offering out of session and out of hours messenger services (WhatsApp etc) contact systems to respond to children and young people attempts at engagement, offer rewards for engagement, use modalities that rely more on outcomes and learning than relationship when doing online therapeutic sessions

Alongside this, other factors which will reduce the risk of PTSD are general healthy living guidelines and the implementation of these in children's services, therefore looking at back to basics issues for children and young people around self-care:

• Develop good sleep hygiene and encourage normal sleep patterns, challenge the move to a holiday sleep pattern or staying up late and getting up late.

• Regular exercise, go for walks, do home gym sessions, practice yoga, just keep active.

• Regular hydration – this allows us to think more clearly stopping the brain from having to struggle against the effects of dehydration.

• Regular mealtimes provide structure and a rhythm for the day.

• Meditation - meditate regularly and recommend mindfulness, there are a lot of apps available to learn.

All these practices will improve global functioning in children and young people and increase resilience in the face of traumatic experiences.

One of the key protective factors will be strong psychoeducation to children and young people on trauma, such as how to see the signs of it and how to get help. Help seeking behaviour remains the strongest protective factor of all in working with children and young people.

Noel McDermott is a psychotherapist with over 25 years’ experience in health, social care, and education.