Positioning Psychiatry as a Leader in Trauma-Informed Care (TIC): the Need for Psychiatry Resident Education

Abstract

Trauma is highly prevalent in patient populations, particularly those encountered by psychiatrists and psychiatry residents. Exposure to traumatic events increases an individual's toxic stress burden and increases the risk of mental health problems and chronic physical disease [1]. Adverse childhood experiences (ACEs), including abuse and neglect, have been linked to an array of medical sequelae, including heart, lung, and liver diseases, obesity, diabetes, depression, substance use, and sexually transmitted infections [1-3]. Adverse experiences also lead to epigenetic cellular and molecular mechanisms that produce changes in gene expression, producing lasting effects in the body as well as alterations in neuronal structure and function [4]. The impact of adverse experiences across the lifespan impact interpersonal dynamics as well as individual health, and there is an emerging appreciation of the convergence of discussions about the impact of trauma on workplace morale and safety, with related concerns about resilience and burnout [5]. Trauma is ubiquitous worldwide, whether from adverse childhood experiences (ACEs), abuse, life events, or disasters. The scope of potentially traumatic events has, moreover, expanded in recent years to include experiences of social determinants of health, from food security to race, gender, and religious bias. Trauma-informed care (TIC) provides a framework for considering trauma at all levels, including patients, providers, and the overall organizational culture. Psychiatry as a field is uniquely positioned to advance trauma-informed care (TIC) and its implications for patient and clinician engagement. The field combines an understanding of neurobiological underpinnings of the effect of trauma, its consequences, and its sequela, with the psychodynamic and psychotherapeutic engagement with patients in their trauma narrative. Psychiatry resident education in TIC is essential to train the next generation of psychiatrists who are already interacting with patients and who will continue to shape this role in the future.

Trauma-Informed Care Curricula for the Health Professions: A Scoping Review of Best Practices for Design, Implementation, and Evaluation

“…43 Despite this broad need, a significant gap exists between the recognized importance of TIC training and the implementation of structured TIC curricula across multiple disciplines, including medicine, nursing, psychology, and social work. [44][45][46][47] Best practices for these educational interventions remain unclear; evidence-based practices for TIC instruction within medical education are largely unexplored in the literature. Addressing this gap should be of critical interest to medical educators as they develop curricula and prepare learners to provide patient-centered care.…”

Teaching Trauma Content in Higher Education: A Systematic Literature Review

“…More than half of the articles were conceptual or position pieces ( n = 14) and did not collect data (Black, 2006; Carello & Butler, 2014, 2015; Cless & Nelson Goff, 2017; Cunningham, 2004; Dane, 2002; Fox et al, 2018; Kosman & Levy-Carrick, 2019; McKenzie-Mohr, 2004; Miller, 2001; M. S. O’Halloran & T. O’Halloran, 2001; Sanders, 2019; Sommer, 2008; Zurbriggen, 2011).…”

“…Five articles used theories, including radical trauma theory (McKenzie-Mohr, 2004), self-constructivist or constructivist theory (Agllias, 2012; Dane, 2002; Zurbriggen, 2011), attachment theory (Fox et al, 2018), or contemporary interdisciplinary theory (Breckenridge & James, 2010). Four articles used the trauma-informed care model (Carello & Butler, 2014, 2015; Kosman & Levy-Carrick, 2019; Sanders, 2019), and one article used a trauma-informed classroom care model (Cless & Nelson Goff, 2017). Furthermore, five articles used Herman’s (1997) triphasic model (Bussey, 2008; Cless & Nelson Goff, 2017; Miller, 2001; M.…”

Essay topic - What is the role of psychiatry in recovery from severe trauma?

“…1 Trauma's effect on the human body can be profound, with molecular and epigenetic responses to trauma resulting in structural and functional alterations to both brain and body. 5 Trauma may also surface as harmful somatic manifestations including physical self-harm, sleep and appetite disturbances, pain, and functional disabilities. 3,6 Over a lifespan, trauma exposure can engender a myriad of medical sequelae including metabolic, heart, lung, and liver diseases.…”

“…3,6 Over a lifespan, trauma exposure can engender a myriad of medical sequelae including metabolic, heart, lung, and liver diseases. 5 These secondary complications can cyclically worsen sufferer's mental wellbeing and lead to dramatically reduced life expectancy. 7 It is therefore imperative that psychiatrists recognising the extensive health implications of trauma and provide care focusing on prevention, early detection and intervention of trauma-related illness.…”