Schools Aim to Tackle Trauma in Light of Pandemic’s Impact on Adolescents

What’s happening – More than ever, young people are feeling the impact of trauma in their personal lives and it is affecting them academically. The mental health blow to adolescents, largely stemming from the COVID pandemic, has prompted policymakers in Kentucky to develop a plan requiring the board of education in each of the state’s school districts to take a trauma-informed approach to teaching.

The policy, which goes into effect July 1, 2021, requires schools to create a trauma-informed team to identify students who are impacted by trauma in some way. The team must also develop effective services to support these vulnerable students and enrich their learning process. In addition, the schools are being tasked with finding new ways to create a positive and safe environment for every child and to ensure equity for all.

To date, Kentucky is establishing itself as a leader in mandating this approach, with schools in other states likely to follow the important trend.

Reports & Perspectives

  • At its May 2021 annual meeting, the AMA called for expanded access to psychiatric care for children and pointed to the American Academy of Pediatrics’ behavioral and mental health principles, which are endorsed by a number of organizations and which highlight the importance of early identification and intervention, and of school-based mental health.
  • Edutopia explores the role of trauma-informed education and provides a look at facts and misconceptions around this approach.
  • Understood.org takes a deep dive into the effects of trauma on learning and provides advice and resources to help educators be successful with children who have experienced some form of trauma.
  • Educational Leadership offers small changes that educators can make in the classroom that will provide important benefits for students who have experienced some form of trauma.
  • Harvard’s Trauma and Learning Policy Initiative, in collaboration with Massachusetts Advocates for Children, hosts an informative site for trauma-sensitive schools. 
  • The NEA also supports trauma-informed schools as does SAMHSA’s site for trauma-aware schools.
  • @NAESP (National Association of Elementary School Principals) tweets: “Setting Priorities in Trauma-Informed Education: In this excerpt from her new book, Alex Shevrin Venet explains how she makes decisions that support students who have experienced trauma.”
  • @nortonoeducation (publisher) shares: “As schools set out to become trauma-informed or implement social-emotional learning, some teachers may feel concerned that their role is becoming fuzzy” and tweets Venet’s book.
  • @care_informed (resource training) says: “Federal funding update: Make your ‘asks’ for trauma-informed education, childcare, support for workers, addressing pre-pandemic structural and racial inequities, more.”

In Practice

Delving into the Roots of Borderline Personality Disorder

What’s happening – Borderline personality disorder (BPD) – estimated to affect 20% of people who are hospitalized due to a psychiatric diagnosis – can impact a person’s ability to deal with rejection, interpersonal relationships, self-image, affect, and actions. Yet little research has been done to understand potential biological factors behind the disorder. Such insights may be helpful in identifying and treating BPD.

A recent study by Ruocco et al attempts to fill in the gaps by exploring neurocognitive and neural markers in young people and adults with BPD, as well as in their relatives, and to look for meaningful patterns. The researchers discovered a relationship between familial risk for BPD and activation of the prefrontal cortex (PFC) during response inhibition. It’s worth noting that relatives who had a permanent psychiatric diagnosis and who exhibited higher impulse traits had elevated PFC activity. Ruocco shared some of the research in a Brain and Behavior Research Foundation webinar.

Why it’s complicated – A related review in Cureus reveals that exposure to an adverse childhood experience (ACE), which triggers neuromorphological and epigenetic changes to occur, seems to be linked to the development of borderline personality disorder. While both genders are at risk of developing the disorder, females are more likely to seek help and therefore, more likely to be diagnosed. More on supporting patients with borderline personality disorder in our Psy-Q below.

Reports & Perspectives

  • Current Opinion in Psychology published a literature review that explores the course of BPD over the lifespan, from adolescence to old age, and looks at potential areas for future research.
  • Although controversy exists around diagnosing BPD, the condition is very treatable, making it important for clinicians to try to make a proper diagnosis, according to an article in the International Journal of Mental Health Nursing.
  • A study appearing in Psychological Medicine reveals that identifying and addressing individual features of BPD can help reduce the stress-related burden of the disorder.
  • Neuropsychopharmacolica Hungaria includes a comprehensive review looking at the impact of environmental and genetic factors of BPD and explores how a deeper understanding of these and other factors can guide the development of more effective BPD interventions.
  • @FrontPsychiatry tweeted a cross-diagnostic review: “New Research: Clinical Features, Neuropsychology and Neuroimaging in Bipolar and Borderline Personality Disorder: A Systematic Review of Cross-Diagnostic Studies: Background: Bipolar Disorder (BD) and Borderline Personality Disorder (BPD)…”
  • @NSFTresearch (mental health research group) shared its: “research recap for the BEST (Brief Education Supported Treatment) study which explored a new approach to supporting young people who had early symptoms of borderline personality disorder (BPD)…”

In Practice

A transdiagnostic model for BPD might improve accuracy in identifying this condition among people who identify as lesbian, gay, or bisexual.

Social Anxiety Disorder: Why Poor Sleep Impacts Exposure Therapy

What’s happening – People with social anxiety disorder (SAD) often experience poor sleep quality, which can compromise the effectiveness of common treatment approaches, including exposure therapy. This is because getting adequate sleep is essential for a number of brain functions, including learning and memory, that are necessary to help condition people to situations that cause fear and replace negative reactions with more positive responses.

Dutcher et al recently explored the impact of poor sleep in subjects with SAD who were undergoing exposure therapy. The findings, published in Depression and Anxiety, demonstrate that poor sleep leads to slower improvement of the disorder as well as more extreme symptoms – even after exposure therapy concluded. Getting better rest the night before treatment was also associated with milder SAD symptoms.

In addition, the research team looked at the effectiveness of adding an antibiotic called D-cycloserine (DCS) that is believed to enhance the effectiveness of exposure therapy. They found that DCS did not seem to overcome the negative impact of poor sleep. Their takeaway is that clinicians should assess a patient’s sleep habits and address any sleep quality issues proactively to get the best results from exposure therapy when treating SAD.

Why it’s complicated – The negative impact of poor sleep on psychiatric disorders can be significant. In fact, the Sleep Foundation reports that people with poor sleep habits are more likely to experience a variety of mental health problems, including depression, anxiety, and bipolar disorder. At the same time, these diagnoses can also be linked to sleep problems. It’s important to recognize this bidirectional relationship to intervene effectively – not only in treating social anxiety but also in helping to prevent it as well.

Reports & Perspectives

  •  The Sleep Foundation also provides a basic overview of the connection between sleep disorders and anxiety, including SAD, that offers patient-directed suggestions for breaking the cycle.
  • Research published in Nature explores whether treating insomnia at an early stage can head off related psychiatric diagnoses. While the findings look promising, more research is needed in this area to fully understand the potential.
  • A paper in Anxiety, Stress and Coping explores the relationship between sleep quality and treatment for SAD and concludes that engaging in mindfulness-based stress reduction improved sleep quality among study participants with SAD.
  • @APAPsychiatric (American Psychiatric Association) tweeted Dutcher’s paper: “For patients with social anxiety disorder who received exposure therapy, poor sleep quality was associated with slower symptom improvement over time, according to a study published in Depression & Anxiety.”
  • @NAMIMinnesota (state NAMI) pointed to Dutcher’s study as well, noting: “Patients With Social Anxiety Disorder Treated for Sleep Problems May Have Better Outcomes.”
  • @rTMSCentre (mental health center in London) tweets: “Sleep and mental health are closely connected. Disturbed sleep patterns or deprivation can lead to psychological problems. Also, people with mental health illnesses such as depression, anxiety, OCD, etc are more likely to suffer from insomnia.”

In Practice

Last Updated: Aug 26, 2021