Motivation and emotion/Book/2020/Transgenerational trauma

Overview
Trauma was at first thought of as a "single-episode, present-life" occurrence, something that could be processed through one life time (DeAngelis, 2019, p. 36). The emergence of transgenerational trauma has proven that the affects of trauma do not die with that individual - it extends to children, future generations and communities. In this article, trauma and the transgenerational nature of trauma will be defined. The transmission of trauma will then be explored, the complexity of which broken down into both nature and nurture standpoints. It is essential to first understand transgenerational trauma and its transmission in order to then explore tactics for how it can be dealt with.

Focus questions:
 * What is transgenerational trauma?
 * How is it transferred?
 * How can it be dealt with?

Definition
It is essential to first begin with the general definition of trauma, with more complex definitions added. This contributes to the broader context of transgenerational trauma. The causes of transgenerational trauma and the resulted negative affects are then explored.

Trauma
Before exploring the complex topic of transgenerational trauma, it would be useful to first define trauma. According to the DSM-V, trauma is the main diagnostic criteria for post-traumatic stress disorder. The DSM-V describes trauma as "actual or threatened death, serious injury, or sexual violence" (as cited in Pai et al. 2017, p. 271).

Building upon this basic definition of trauma, several other layers of trauma can be added:


 * Historical trauma details the complex and collective trauma experienced over time and across generations by a group of people who share similar identities or circumstance (Mohatt et. al, 2014; Atkinson, 2002, p. 82).
 * Communal trauma refers to the joint experience of those who first came into contact with trauma, including diseases and massacres (Atkinson, 2002, p. 82)
 * Extended-family trauma details the effects of trauma through familial domestic violence, child abuse and neglect and other negative connotations of unhealed traumatic experiences within families (Atkinson, 2002, p. 82).
 * Individual trauma includes suicide and suicide attempts, and mental illness (Atkinson, 2002, p. 82).

Transgenerational trauma
Transgenerational trauma can be defined, in its simplest terms, as the transmission of trauma from one generation to the next. However, it needs to be highlighted that there is a difference between transgenerational and intergenerational trauma, such that:


 * Intergenerational describes the transmission of trauma from one generation to the next (Yehuda et al., 2016).
 * Transgenerational details the transmission over multiple generations (Atkinson 2002).
 * Academic papers have explored intergenerational trauma more than transgenerational, as more time needs to pass in order to fully comprehend the affects trauma has over multiple generations (Bremness, 2014; Yehuda et al., 2016).

According to Tamara Hill, a licensed therapist who is a certified professional in trauma, transgenerational trauma can be caused by:


 * 1) Unresolved emotions and thoughts about a traumatic event
 * 2) Negative repeated patterns of parenting
 * 3) Untreated substance abuse
 * 4) Poor attachment styles
 * 5) Personality disorders

The offspring of those who have experienced trauma first hand can experience a "distrust of the world, impaired parental function, chronic sorrow, inability to communicate feelings, an ever-present fear of danger, pressure for educational achievement, separation anxiety, lack of entitlement, unclear boundaries, and overprotectiveness" (Braga et. al, 2017, p. 2). As a result of this, the future generations are more likely to experience symptoms of anxiety, depression and post-traumatic stress disorder (PTSD).

Transmission
In the transmission of transgenerational trauma, literature highlights both a nature and nurture viewpoint. Through exploring both epigenetics and attachment styles, the joint combination of nature and nurture are, more often than not, at play in transgenerational trauma.

Nature
A biological standpoint of transgenerational trauma leads us to epigenetics. Epigenetics will be explained and defined, then clinical evidence of epigenetic influence being a direct carrier of transgenerational trauma will be examined.

Epigenetics
Epigenetics is the environmental influence on genes, resulting in specific genes being expressed or not (Lacal & Ventura, 2018). Environmental stimulus can directly affect our genotype (genes), eventually manifesting itself into our phenotypes (physical attributes). There are two notable types of epigenetic inheritance that can be applied to transgenerational trauma - intergenerational and transgenerational:




 * 1) Intergenerational inheritance involves an environmental stimulus leading to an epigenetic alteration in the parent and, most likely, the offspring of that parent (see Figure 1) (Tuscher & Day, 2019)
 * 2) Transgenerational inheritance differs in that an environmental stimulus does not have to be present, instead relying heavily on the genetic transference throughout generations (Tuscher & Day, 2019, p 3). An inherited epigenetic mark and corresponding trait would have to be present in generations beyond the initial environmental stimulus transforming parent genes (see Figure 2) (Tuscher & Day, 2019).



If the effects of trauma are imprinted onto one's genes, the argument for trauma lasting through multiple generations becomes clear.

Clinical evidence
In the real-life examples of the transmission of trauma through epigenetics, we can look to the offspring of Holocaust survivors. In 2014, Rachel Yehuda and colleagues identified paternal PTSD as a risk factor for PTSD developing in the adult offspring of Holocaust survivors (Yehuda et. al., 2014, p 872). Through gathering participants with at least one Holocaust survivor parent, and utilising clinical interviews, self-report and blood tests, the researchers found chemicals in the body that positively correlated with a higher chance of developing PTSD.

Yehuda, being the leading researcher in the field of epigenetics and Holocaust survivors, found a methylation change (repressing gene transcription) on the same site as the specific gene FKBP5 that is associated with PTSD and depressive disorders. Yehuda et al., (2016, p. 379) states that the data collected “support an intergenerational epigenetic priming of the physiological response to stress in offspring of highly traumatised individuals”.

Through these examples we can see the nature side of transgenerational trauma, and together with nurture, a clear idea of the transmission of trauma will come to light.

Nurture
Within the nurture explanation of transgenerational trauma, there are many routes to assess, one of them being attachment styles promoted by parenting (see Figure 3). Attachment styles are outlined, then practical clinical evidence is brought forward. This evidence link the negative affects of trauma to damaging attachment styles.



Attachment styles
Before applying attachment theory to transgenerational trauma, it is important to understand what it is. Developed by both John Bowlby and Mary Ainsworth, attachment details a lasting connection between human beings. Attachment styles in infants are directly influenced by their caregivers. Attitudes and behaviours that caregivers give to infants have a lasting effect that continues through life. There are four types of attachment that infants display (see Table 1).

Table 1

Attachment styles and their definitions. Ambivalent and avoidant attachment styles predict more symptoms of PTSD compared to the other attachment styles (Ogle et. al., 2015). In combining both the parent’s lived experience of trauma with infant attachment that are more susceptible to PTSD, it shows the very real potential of transmission of trauma over generations (Ogle et. al., 2015).

Clinical evidence
In a study of women with psychiatric disorders and their children, it was determined that mothers and children with insecure attachment styles were more likely to have been abused (Ozcan et. al., 2016). Another study conducted in 2017 found that avoidance tendencies of those offspring of trauma exposed participants contribute to heightened PTSD vulnerability (Wittekind et. al., 2017).

It’s important to note that most studies conducted in relation to generational trauma are about intergenerational trauma – intergenerational inheritance only refers to the transmission of trauma of the parent and the offspring of that parent, not future generations. More studies need to be conducted as both technology advances and new generations become effected by past trauma, in order to fully comprehend the effect trauma has on everything in its path. In doing this, especially with the use of examining genes, there is a large possibility of seeing the effects of trauma in whole cultures.

How can it be dealt with?
To assist with the understanding of how to deal with transgenerational trauma, a case study will be introduced. Sam is an Indigenous Australian, his grandmother being a part of the Stolen Generation. First, theory will be introduced to help explain why it is difficult to seek help when trauma is transgenerational, and the affects of the Stolen Generation will be explored. Then, healing methods with reference to Indigenous Australians will be highlighted. Case Study:

Sam has been raised by his single mother who has an unhealthy coping mechanism in alcohol, developed when she was a teenager. Sam's mother was insecurely attached to her mother growing up, and her father physically abused her. Sam's grandmother was part of the Stolen Generation, separated from her primary caregiver and receiving a series of physical, institutional, and sexual abuses. As a result, Sam's grandmother lost her cultural identity and sense of connection with the Indigenous Australian community. Sam's grandmother has not found her biological family. Sam's mother grew up in poverty and still struggles to make ends meet with Sam. All his life, Sam has felt like he doesn't belong to either White or Black Australia. Sam has always felt like an outsider, and has started developing symptoms of anxiety and depression. He has started skipping school, and has thought about ending his life.


 * Why did Sam's family not seek out help earlier?
 * What is the root of Sam's trauma?
 * How can Sam deal with his trauma now?

Development of transgenerational trauma
Before exploring how transgenerational trauma can be dealt with, it is essential to first understand why Sam's family has not sought out help earlier, and what the root of the trauma is. In doing this, it sheds a light on what trained professionals will need to understand in order to help Sam and his family heal from years of trauma.

Learned helplessness
In understanding the case study above and how to assist Sam in healing from his transgenerational trauma, it is important to note a relevant psychological theory.

Learned helplessness can be defined by behaviour exhibited by a person after enduring a repeated traumatic stimuli that are beyond their control. Further, the theory of learned helplessness takes the stance that clinical depression and other mental health issues may arise from the absence of control over situations. In understanding this theory, it helps to explain why it is an extremely difficult thing for Sam's family to seek help. Since there is an already existing learned comfort with this trauma, plus genetic and environmental transmission methods, trauma itself becomes attached to identity.

Sam’s grandmother control stripped from her from a young age, resulting in a learned helplessness that has spread across generations – shown in Sam’s mother’s unhealthy coping mechanisms. Sam’s family highlights a comfort with trauma – learning to be okay with the lack of control as a result of unresolved trauma.

The Stolen Generation
Sam's grandmother was a part of the Stolen Generation, an initiative that continued between 1910-1970 in Australia. The policy removed Aboriginal children from their caretakers and guardians, over the misguided intention for assimilation into white society. In this assimilation, the stolen children were manipulated into rejecting their culture, forced to accept the dominant coloniser's way of life. Many of these children were told that their parents did not want them anymore, or were too young to remember who their biological parents where. Colonisers intended these children to become labourers or servants, leading to a low standard of education and ongoing economic struggles amongst the survivors.

As a result, the Stolen Generation where unable to pass Indigenous culture on to future generations, and ultimately, whole languages and sacred traditions were lost.

A longitudinal study conducted by Wilson and Dodson (1997) over three years found that survivors of the Stolen Generation were:


 * Geographically mobile, less likely to have a stable living condition
 * Less likely to complete a secondary education
 * Three times more likely to have no support system
 * Less likely to have a supportive relationship with a partner
 * Twice as likely to have been arrested or commit an offence
 * Three times as likely to have gone to jail
 * Less likely to have a strong sense of their Aboriginal cultural identity
 * Twice as likely to use illicit substances

As seen in Sam's story, the affects of his grandmother's lived trauma has been passed through multiple generations. His mother relying heavily on alcohol and Sam starting to skip school is evidence of this. Further, Sam's lack of cultural identity and sense of belonging has led to worsening mental health problems.

A combination of learned helplessness and lived traumatic experience makes transgenerational trauma an inevitability.

Road to healing
In the road to healing for transgenerational trauma, an individual approach or a population approach can be taken. As seen from the case study, the Stolen Generation included a whole community of people, and Sam is just one individual who has been affected by this.

Trauma-focused cognitive therapy
Trauma-focused cognitive therapy (TF-CBT) is one method that can be used to deal with trauma. The main components include psychoeducation, parent-child sessions and parenting skills, relaxation, and trauma narrative (Phipps & Thorne, 2019).

Psychoeducation phase
The psychoeducation phase would educate Sam about the Stolen Generation, the root of his trauma and feelings. In psychoeducation, the forgotten traditions and language can never be replaced, but the process of being reconnected to a forgotten culture in his family can begin. This phase can also include education about institutionalised racism, and about the genetic transmission of trauma through epigenetics. Sam can also begin to understand learned helplessness, possibly taking away any anger aimed at his family members. It is essential in this first stage to take away any self-blame, and provide Sam options for where he can belong including Aboriginal communities (Phipps & Thorne, 2019).

Parent-child sessions and parenting skills
Through joint sessions with both Sam and his mother, parenting skills can be addressed and explored. It is here that attachment styles can be addressed. Skills and strategies can be provided to Sam's mother during this, and avenues for her own healing can be opened (Phipps & Thorne, 2019).

Relaxation
Relaxation techniques involve breathing exercises and basic mindfulness, as the exposure part of the therapy during trauma narrative can be distressing; Sam could benefit from this technique (Phipps & Thorne, 2019).

Trauma narrative
Trauma narrative is the most essential part of this process. It involves gradual exposure processes, eventually resulting in a written, verbal or artistic interpretation of the trauma experienced. In this, psychologists can examine what cognitive distortions still exist in the client’s mind, such as self-blaming thought processes, and can start to work on restructuring them into realistic and empowering ways of thinking. Eventually, therapists can assist clients to know what strategies to use when reminders of this trauma appear in everyday life, reminding them of the relaxation techniques that can be used (Cohen et al. 2006).

Trauma-focused cognitive therapy can be effective towards individual trauma experiences, however, mainstream cognitive behaviour therapy would need to be adapted for minority groups. For Indigenous Australians, research has highlighted the importance of incorporating spirituality, utilising culturally relevant language and metaphors, and incorporating a range of mediums to highlight therapy goals (Bennett & Babbage, 2014).

ADAPT model
The Adaptation After Persecution and Trauma (ADAPT) model aims to link psychosocial factors to mental health outcomes of relevance in populations who have undergone extreme trauma (Atkinson et. al, 2014). They do this through the five pillars that are expressed through society and the individual, where trauma can underlie:


 * Safety and felt security
 * Attachment and bonds
 * Justice
 * Identity and roles
 * Meaning and coherence

(Atkinson et. al, 2014).

The ADAPT model outlines the impacts that are both normal and negative adaptive outcomes if there is a threat is each of the five pillars, refer to Table 2.

Table 2

Impacts of threat and the ADAPT model Adapted from (Atkinson et al., 2014, p. 297).

Through simultaneously combining the pillars and applying it to large communities, healthcare can become targeted towards what is needed most. In Sam's example; attachment, roles and identity and meaning and coherence are all threatened, resulting in negative adaptive outcomes. Further, by placing the roots of this framework in the hands of the community who have also lived through this trauma, the Indigenous Australian community, it can result in not only the adaptation of it, but can help with the healing process.

We Al-li
By putting methods of trauma healing in the hands of the community, We Al-li is one of the results. Coming from the Woppaburra language, 'We' translates to fire, and 'Al-li' translates to water. Fire being the symbol of healing, re-creation and regeneration, and water being the source of all life. We-Ali provide three main processes to minimise trauma:


 * 1) Healing people: Trauma informed and specific education, providing sustainable pathways of positive change for individuals, families and communities.
 * 2) Sharing culture: Promoting Indigenous cultural traditions and ways of sharing, caring and renewal
 * 3) Regenerating spirit: Nurturing a life long process of seeking and sustaining wholeness.

Through these processes, elements of both TF-CBT and the ADAPT model can be seen. We Al-li can assist Sam with his transgenerational trauma, as he is able to begin the healing process with those who understand him, those he belongs with and those who will help him rediscover a lost culture.

Conclusion
Transgenerational can be defined by the transmission of trauma passed through multiple generations, and is imparted through both nature and nurture methods. In dealing with transgenerational trauma, there are traditional psychological methods including TF-CBT, and the ADAPT model, that can be used. When these methods are combined by those who have healed through the same trauma, and working for the same community, the best possible outcomes can be seen.

An essential step in the healing from trauma is the education. If Sam had not of been educated about his family's history, it would be hard for him to remove any self-blame, guilt or negative feelings from his everyday life. When transgenerational trauma and the causes of it are more widely broadcast, it may help others in recognising their ingrained trauma, and start the healing journey.