Theories of Crisis and Trauma
Crises and trauma can impact children in multiple ways, including behavioral changes, emotional distress, and difficulties with attention and academics (National Child Traumatic Stress Network [NCTSN], 2011). School psychologists, with their unique knowledge of education and psychology, can take leadership roles in school-wide implementation of a trauma-informed approach by empowering administrators to develop strategic trauma-informed policies, conducting staff training, and providing direct intervention (NCTSN, 2017). In this chapter, we address both crisis and trauma by presenting major theories related to these constructs and reviewing empirical evidence supporting the theories. We apply these theories and associated research to school psychologists’ roles of assessment, intervention, and research. The chapter concludes with a case study.
Major Theories of Crisis and Trauma
Most theories of trauma and crisis have been derived from work with adults. There are psychodynamic, learning, cognitive, biological, and interpersonal/resource theories related to trauma. Also relevant are theories related to diathesis-stress, coping, and intergenerational trauma. However, the majority of empirical studies on child trauma are disconnected from theory (Alisic, Jongmans, van Wesel, & Kebler, 2011). After providing a brief historical context of trauma and crisis theory, we focus more specifically on the most relevant and frequently referenced theories for children: the developmental psychopathology model (e.g., general risk factors model), biological theory, and cognitive theory (Alisic et al., 2011).
Theories of trauma first emerged over 150 years ago as a biomedical approach to treating physiological manifestations of trauma in soldiers and railway workers (Crocq & Crocq, 2000). Eric Lindemann (1944) studied the grief processes resulting from a fire in a Boston nightclub in the 1940s, finding that individuals needed to transition to nonnative grief processes (e.g., somatic complaints, guilt, preoccupation with the crisis) in order to resolve the crisis. Alongside Lindemann, Gerald Caplan (1964) conceptualized the crisis state, which posited that a crisis disrupts one’s homeostasis (i.e., equilibrium), leading to stress and discomfort that cannot be addressed easily using customary problem-solving strategies, which can lead to feelings of inadequacy and increased stress. The crisis state lasts approximately four to six weeks, when homeostasis is reestablished; if this steady state is not reestablished, extreme disorganization or psychiatric problems may arise. Slaikeu (1990) further noted that as individuals try to cope and reestablish homeostasis, outcomes can range from very positive to very negative. Currently, three major theories about trauma are most prominent: the developmental psychopathology model of childhood traumatic stress, biological, and cognitive theories.
Developmental Psychopathology Model of Childhood Traumatic Stress
The most integrated model used to guide many longitudinal studies regarding the development of posttraumatic stress disorder (PTSD) after a crisis or traumatic event is the developmental psychopathology model, also referred to as the general risk factors model (Alisic et al., 2011). This model posits that a child’s reaction to a traumatic event and development of PTSD are compounded by multiple and complex factors, including the event and exposure to it, pre-existing child characteristics and coping (discussed in greater depth in the Research/Empirical Evidence section below), and the ecology/post-crisis environment, including social support and major life events (La Greca, Silverman, Vemberg, & Prinstein, 1996; Pynoos, Steinberg, & Piacentini, 1999). Appraisal of the event, distress experienced as part of the event, reminders about the event, other adversities and trauma, and exposure to repeated or chronic traumatic experiences also impact the development of PTSD (Pynoos et al., 1999).
Biological theories address how trauma impacts the brain, which also relates to fear conditioning models that associate stimuli with a traumatic stressor (Alisic et al., 2011). The biological framework focuses on how the brain processes, stores, perceives, and acts on internal and external information and adapts in response to external cues (Perry, Pollard, Blaicley, Baker, & Vigilante, 1995). Because children’s brains are more malleable to the external environment, experiencing a traumatic event can disrupt neurochemical signals (Pern- et al., 1995). The brain acts as a mediator to all emotional, social, cognitive, and behavioral functioning, and neuropsychiatric disorders such as PTSD involve damaged or altered functioning of the systems in the brain. Essentially, trauma can alter the mediation of the stress response by directly affecting brain systems that are essential in that mediation (Perry, 2008). Childhood trauma, adversity, or toxic stress can result in a re-regulation of the fight or flight response due to hyperarousal from increased stress hormones. A deregulation of systems involved in fight or flight (e.g., sympathetic nervous system, amygdala) result from a continuous supply of cortisol that is experienced by a child who experiences chronic stress (Harris, 2018). Children may also develop dissociative symptoms in an attempt to adjust if they are exposed to re-occurring trauma and are unequipped to engage the fight or flight response or be reassured or comforted (Perry, 2001). Also related is avoidance of neutral stimuli that are associated with the traumatic event.
To illustrate, consider the case of Suki, who witnessed a drive-by shooting when walking to school. Suki saw that the gunshots were fired from a red corvette. Months later, Suki is visiting her aunt in another city when she sees a similar red car. Although she is miles away from where the shooting occurred, Suki becomes very anxious and runs away from the red car. Suki’s amygdala has connected her previous traumatic event with the red car (neutral stimulus), which has triggered this stress response.
According to cognitive theory, the meaning an individual prescribes to the event plays a significant role in the development and expression of PTSD symptoms. Highlighted by Ehlers and Steil (1995), some important cognitive mechanisms following a traumatic event include unpredictability and uncontrollability, perceived threat versus actual danger, causal attributions, and the effects of trauma on beliefs. For children who experience a trauma, a daily routine that once felt safe may now feel unpredictable and uncontrollable. It is important to note that cognitive theory focuses on the perceived feeling of being out of control.