Trauma exposure is widespread, affecting 70 percent of Americans, but getting help is not easy. Eighty percent of consumers consider mental health care too costly and less than half of those who do seek help for trauma get well.
The annual cost of Post-traumatic stress disorder (PTSD) in the U.S. stands at a staggering $232.2 billion. Traumatic experiences are associated with chronic mental and physical health conditions across the lifespan. Those living with PTSD are 15 times more likely to attempt suicide, four times more likely to develop a substance use disorder, and three to five times more likely to experience depression.
Humans have a tremendous capacity for resilience. We have the ability to access a psychological immune system that can help transform our wounds into opportunities for growth and disrupt intergenerational transmission of trauma.
But, humans don't live in a bubble and we need each other to heal. Systems of care must change at scale to support an individual's ability to bounce back from adversity and trauma.
Here are five things we can do better:
Stop Pathologizing Reactions to Traumatic Events
The medical field now recognizes that reactions to traumatic experiences exist on a spectrum and that people can be affected differently by the same experience.
PTSD is a dramatically heterogeneous condition, and there are over 636,120 different ways to meet the most current criteria for it. Some people will need specialized services for PTSD, but the majority will not. Imagine if we could help prevent the development of PTSD by societally acknowledging and validating suffering and normalizing that reaching out for support is an act of courage, not weakness.
The impact of trauma, for most people, can be framed as a human response to a terrible situation. Oprah Winfrey and Dr. Bruce Perry have challenged the public to shift from focusing on "What's wrong with you?" to "What happened to you?" Traumatic experiences do not have to define us. It is possible to reclaim our identity and personal narrative by adapting new, more helpful beliefs and coping tools for managing life's storms. Services that normalize reactions, support personal agency, and promote social connection move away from a disease model and empower individuals for self-healing.
Decolonize Trauma Care
The needs, preferences, cultural values, and lived experiences of marginalized populations are typically not honored in institutionalized systems of care. It is critical to acknowledge the inherent biases and inequities within traditional trauma treatment paradigms which have been primarily studied in Western, Educated, Industrial, Rich, Democracies (WEIRD) populations.
Decolonizing therapy involves dismantling hierarchical power dynamics within therapeutic relationships and systems. Liberation psychology is the freeing of minds from the psychological bondage of oppression that prevents one from claiming agency over their healing journey. By employing culturally-affirming methods and fostering collaboration, mutual respect, and cultural curiosity we can create inclusive spaces and systems where all voices are heard and valued.
Break Down Barriers to Accessing Care
As of 2023, our workforce of mental health providers only have capacity to serve 7 percent of the population with weekly sessions. Even among available providers, not nearly enough are trained in evidence-based treatments for PTSD to meet the demand. To improve access to trauma care, we need to lower costs, increase convenience, train a larger workforce of providers, and provide extra support to marginalized communities.
In order to provide survivors with the support they need and deserve, we must prioritize solutions that meet people where they are. Asynchronous telehealth and text-based interventions allow communication with therapists on one's own schedule, lowering costs. Peer-support groups can connect struggling individuals with others who understand their experience firsthand, providing invaluable new frames of reference, social connectedness, and accountability.
Increase Options for Healing Across the Continuum of Care
Only half of those with severe PTSD report receiving any treatment. Of those who do begin treatment for PTSD, a large portion drop out, with attrition ranging from 24-39 percent. Qualitative studies suggest patients want treatments that are adaptable to their needs and circumstances. The loss of control inherent in exposure therapy methods can become a barrier to seeking help, and especially for already marginalized groups.
We need to offer more choices beyond traditional therapy, such as digital tools for self-management, somatic approaches, Indigenous healing practices, and coping skills coaching with paraprofessionals to build psychological resilience. Patient-centered decision making empowers individuals to prioritize their mental health, not because it's the right thing to do, but because they intrinsically want to.
Use Technology To Supplement (Not Replace) Care
While traditional in-person therapy has been the primary modality for delivering trauma treatment, tech-enabled telehealth platforms can improve accessibility and efficiency at scale. Digital health technologies have the capacity to increase human connection and engagement in care, and facilitate accelerated and sustained self-healing. Large language models (LLMs) like OpenAI's GPT-3/4, have the potential to support, augment, or even automate administrative aspects of care, freeing up time for patient interaction and rate limiting factors for training. AI powered tools can also help therapists with training and supervision. However, ethical, safe, and responsible uses, cultural and racial bias and responsiveness, and user privacy are paramount to consider.
The Call to Action
It's time to reimagine how we care for individuals and communities with trauma. As we collectively strive to break the cycles of trauma, let us advocate for approaches that prioritize inclusivity, affordability, and the fundamental right of every individual to heal and thrive.
Adrienne Heinz, Ph.D., is a clinical research psychologist at the VA National Center for PTSD Public Digital Health Innovation Program and Stanford University School of Medicine.
Karolina Komarnicka is CEO of Space of mind.
The views expressed in this article are the writers' own.
Uncommon Knowledge
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