By Charlton Jones, Treatment and Marketing Manager at Tranquility Clinic

“How long will I be away?” is one of the first questions we hear from people thinking about rehab, and from the families supporting them. It is a fair question. Work, children and finances all depend on the answer.

The honest answer is that it depends on the person. But there are clear patterns, and knowing them makes the decision much easier.

The short answer

Most inpatient rehab programmes run from 21 days to 3 months. Medical detox, which often happens at the start, usually takes a few days to about a week. At Tranquility Clinic, our inpatient programmes run for 21 days, 28 days or 5 weeks.

Most registered medical aids, including Discovery Health, Bonitas, Momentum, Fedhealth, GEMS and Profmed, cover 21 days of inpatient treatment per beneficiary per calendar year.

Detox: the first few days

Detox is the process of safely clearing alcohol or drugs from the body while withdrawal symptoms are managed. Depending on the substance and how long it has been used, this usually takes a few days to about a week.

Detox is an important first step, but it is not treatment on its own. It deals with the body. It does not deal with the thinking, habits and emotions that keep someone using. That is why detox is followed by a structured programme.

Withdrawal from some substances, especially alcohol and benzodiazepines, can be dangerous without medical support. At Tranquility, detox takes place in our on-site medical detox unit, with nurses on duty 24 hours a day.

Inpatient rehab: 21 days to 5 weeks

During inpatient treatment, you live at the clinic full time. That takes you away from the people, places and pressures linked to using, so you can focus fully on getting well. Each day combines one-on-one counselling, group therapy, step work, exercise, healthy meals and rest.

Here is how our programme lengths usually compare:

In general, people who stay in treatment longer give themselves a better chance of staying sober. But the right length is always a clinical decision, made with you and your family after a proper assessment. Our inpatient treatment page explains the programme in more detail.

What about 3 months, 6 months or longer?

You may see programmes advertised as 3 months, 6 months or even a year. These usually suit people with a severe or long-standing addiction, repeated relapse, or a mental health condition alongside the addiction. Longer programmes often combine a residential stay with a period of supported living afterwards, such as a step-down facility, halfway house or sober living home.

For some people, that extra structure makes a real difference. The key point is this: recovery does not end on the day you leave rehab. What matters is having a clear plan and the right support for the months that follow.

Outpatient treatment: 6 to 8 weeks

Outpatient treatment lets you attend therapy while living at home and keeping up with work or family responsibilities. It suits people with a stable, supportive home and a less severe addiction, and those stepping down after an inpatient stay. Keep in mind that most medical aids do not cover outpatient programmes.

Our outpatient programme runs for 6 to 8 weeks.

Aftercare: what keeps recovery going

The first months after treatment are when people are most at risk of relapse. That is why aftercare is not an optional extra.

Our aftercare programme continues for 8 weeks after inpatient treatment. It includes one-on-one and family counselling, group therapy, relapse prevention and reintegration workshops, and drug testing. Former patients are also welcome at our weekly onsite AA, NA and CA meetings, for as long as they need them.

What decides how long you need?

Treatment is never a fixed timeline. Our clinical team looks at four main things:

• How severe the addiction is. A long history of use, heavy use or more than one substance usually needs more time.
• Mental health. Depression, anxiety, trauma or bipolar disorder alongside addiction, known as a dual diagnosis, means treating both conditions together, which takes longer.
• Previous treatment and relapse. If a shorter programme did not hold, a longer stay often gives a better foundation.
• Progress during treatment. We review each patient’s progress regularly. The plan can be adjusted if more time is needed.

Does medical aid cover rehab?

In South Africa, treatment for alcohol and drug dependence falls under the Prescribed Minimum Benefits (PMBs). This means registered medical schemes must provide a level of cover, generally up to 21 days of inpatient rehabilitation and up to 3 days of detox a year at a registered facility. Pre-authorisation is usually required, and the exact cover differs from scheme to scheme.

This is one reason the 21-day programme is so common: it matches what most medical aids cover. Longer stays may need to be funded privately. Our team can help you check your benefits before admission. See our medical aid page for more.

Not sure which length is right?

You do not have to work this out alone. Every journey with us starts with a free, confidential assessment, where we look at your situation and recommend the programme that gives you the best chance of lasting recovery.

If you want to start with a few questions on your own, try our self-assessment. When you are ready, contact our admissions team. We are here to help you or your loved one take the first step.

The post How Long Is Rehab? 21 Days to 5 Weeks Explained appeared first on Tranquility Clinic.

Teenagers change. Mood swings, new friends and a need for privacy are a normal part of growing up, which is exactly why substance use in teens is so easy to miss. If something about your child feels different and you cannot quite name it, trust that feeling enough to look a little closer.

Warning signs of substance abuse in teenagers

No single sign proves that a teenager is using drugs or alcohol. What matters is a pattern, or a sudden change. Watch for:

Physical signs

• Red or glassy eyes, or pupils that look unusually large or small
• Changes in sleep, such as sleeping all day or staying up all night
• Sudden weight loss or gain, or a big change in appetite
• Smells of alcohol, smoke or chemicals on breath, clothes or in their room
• Poor coordination, slurred speech or frequent nosebleeds

Behavioural signs

• Falling grades, skipping school or losing interest in sport and hobbies
• A new group of friends they do not want you to meet
• Secretive behaviour, locked doors and vague answers about where they have been
• Money or valuables going missing from the house
• Breaking curfew or rules they used to respect

Emotional signs

• Irritability, anger or aggression that is out of character
• Anxiety, low mood or withdrawing from the family
• Sudden mood swings, or seeming unusually energetic and then very flat

Some of these signs can also point to depression, anxiety or other struggles, which is one more reason to talk rather than assume. You can read more about specific substances on our signs of abuse page.

What to do if you suspect your teen is using

• Stay calm. Choose a quiet moment when neither of you is angry, rushed or under the influence.
• Talk about what you have noticed. Describe specific behaviour, not labels. “I have noticed you are missing school and money has gone missing” lands better than “Are you on drugs?”
• Listen more than you speak. Ask open questions and try to understand what is going on in their life.
• Set clear boundaries. Be consistent about rules and consequences, and agree on them with any other parent or caregiver.
• Do not try to handle it alone. A school counsellor, your GP or an addiction professional can help you work out the next step.

When to get professional help

Get help sooner rather than later if the substance use is regular, if it is affecting school, safety or relationships, or if your teen has tried to stop and cannot. Get emergency help immediately if they have taken an unknown substance, are very drowsy or confused, or talk about harming themselves.

The national 24-hour Substance Abuse Helpline is available on 0800 12 13 14 (or SMS 32312).

How Tranquility Clinic supports families

Addiction affects the whole family, not just the person using. At Tranquility Clinic in Midrand, family involvement is one of the four pillars of our treatment, and we run weekly onsite family support groups. If you are worried about your child, call our team 24/7 on 011 568 5197 for a confidential conversation about your options, or start with our free self-assessment.

The post Signs of Substance Abuse in Teenagers: What Parents Should Look For appeared first on Tranquility Clinic.

Rehab is expensive, and many families who need help do not have medical aid. The good news is that free and low-cost addiction treatment does exist in South Africa. The harder news is that it is limited, and getting a place usually takes time. This guide explains how state-funded rehab works, how to access it, and what your other options are.

Is there free rehab in South Africa?

Yes. Provincial Departments of Social Development run public treatment centres where treatment is free or heavily subsidised. In Gauteng, for example, the Dr Fabian and Florence Ribeiro Treatment Centre in Cullinan is run by the Gauteng Department of Social Development. Some non-profit organisations, such as SANCA, also offer community-based and outpatient services at reduced cost.

Public treatment in South Africa is governed by the Prevention of and Treatment for Substance Abuse Act 70 of 2008, which sets out the standards that both public and private treatment centres must meet.

How to get into a government rehab

Government treatment centres generally do not accept walk-ins. The usual route looks like this:

• See a social worker. Visit your nearest Department of Social Development office or a local clinic. A social worker will screen and assess the person.
• Get a referral. State centres typically need a referral from a social worker, psychologist or psychiatrist.
• Medical clearance. Many centres ask for a medical assessment first, especially where detox is needed.
• Waiting list. Once referred, the person is placed on a waiting list until a bed becomes available.

You can also call the national 24-hour Substance Abuse Helpline on 0800 12 13 14 (or SMS 32312) for guidance on services near you.

What to expect from free rehab

Public centres do important work, but it helps to go in with realistic expectations:

• Waiting times can be long. Demand is high and beds are limited, so it can take weeks or longer to be admitted.
• Detox may not be on site. Some centres expect people to be medically detoxed before admission, which matters for alcohol, heroin and benzodiazepine dependence, where withdrawal can be dangerous.
• Programmes are standardised. Group-based programmes with fixed lengths are common, with less one-on-one therapy.
• Motivation matters. Most programmes are voluntary, so the person needs to be willing to go.

Using medical aid for rehab

If you or your family member has medical aid, even a basic hospital plan, treatment may be more accessible than you think. Substance use disorder is a Prescribed Minimum Benefit (PMB) condition, which means registered medical schemes must cover a portion of addiction treatment, subject to pre-authorisation. Read more on our medical aid and fees page.

When waiting is not safe

Sometimes waiting for a state bed is not an option. Get help urgently if someone:

• Has severe alcohol withdrawal symptoms such as shaking, confusion, hallucinations or seizures
• Has overdosed, or you are worried they might
• Talks about harming themselves or others
• Is using substances while pregnant

In an emergency, go to your nearest hospital emergency unit or call an ambulance.

How Tranquility Clinic can help

Tranquility Clinic is a private rehabilitation centre in Glenferness, Midrand, registered with the Department of Health, the Department of Social Development and the Board of Healthcare Funders. We have an on-site medical detox unit, a counsellor-to-patient ratio of 1:3 and programmes from 21 days to 3 months. Private treatment usually avoids long waiting lists, and our admissions team can help you check your medical aid benefits.

Even if private treatment is not right for your family, our team is happy to talk you through your options. Call us 24/7 on 011 568 5197, or take our free self-assessment.

Information in this article is general and may change. Please confirm details directly with the relevant service.

The post Free and Government Rehab in South Africa: How It Works appeared first on Tranquility Clinic.

The link between gambling addiction and substance abuse is one of the most destructive cycles in mental health and recovery, yet it is frequently overlooked.

When someone is trapped in a gambling loop, the intense stress, shame and financial pressure often trigger a search for immediate relief. That is where alcohol and drugs usually enter the picture.

How Gambling and Substance Abuse Feed Each Other

• Substance use as a coping mechanism: The overwhelming anxiety and depression caused by gambling losses lead many to use alcohol or drugs to numb the emotional pain and temporarily escape reality.
• Lowered inhibitions and escalated risk: Alcohol and drugs impair judgement and executive function. Under the influence, a person’s risk tolerance spikes, leading to impulse betting, chasing losses and deeper financial missteps they would not make while sober.
• The dual-addiction spiral: What starts as an escape from gambling stress quickly turns into a secondary dependency. The guilt and financial strain from substance use then drive the individual right back to gambling in hopes of a “quick fix”, locking the cycle in place.

Breaking the Cycle

Effective recovery requires addressing co-occurring disorders simultaneously. Treating gambling without addressing underlying substance use, or the other way around, leaves the door wide open for relapse. Breaking the cycle starts with recognising that these behaviours do not exist in isolation.

If you or a loved one is struggling with gambling, alcohol or drugs, contact Tranquility Clinic for a free and confidential assessment.

The post Gambling Addiction and Substance Abuse: Breaking the Cycle appeared first on Tranquility Clinic.

Instead, it suggests that there is something greater that connects all beings to each other and to the universe itself. It also proposes that there is ongoing existence after death and strives to answer questions about the meaning of life, how people are connected to each other, truths about the universe, and other mysteries of human existence.

Spirituality and religious activity have been a source of comfort and relief from stress for multitudes of people. While people use many different religions and paths to find God or to express their spirituality, ​research has shown that those who are more religious or spiritual and use their spirituality to cope with challenges in life experience many benefits to their health and well-being.

Signs of Spirituality 

Spirituality is not a single path or belief system. There are many ways to experience spirituality and the benefits of a spiritual experience. For some people, this might involve the belief in a higher power or a specific religious practice.

For others, it may involve experiencing a sense of connection to a higher state or a sense of inter-connectedness with the rest of humanity and nature. Some signs of spirituality can include:

• Asking deep questions about topics such as suffering and what happens after death
• Deepening connections with other people
• Experiencing compassion and empathy for others
• Experiencing feelings of interconnectedness
• Feelings of awe and wonder
• Seeking happiness beyond material possessions or other external rewards
• Seeking meaning and purpose
• Wanting to make the world a better place

Not everyone experiences or expresses spirituality in the same way. Some people may seek spiritual experiences in every aspect of their lives, while others may be more likely to have these feelings under specific conditions or in certain locations. For example, some people may be more likely to have spiritual experiences in churches or other religious temples, while some might have these feelings when they out enjoying nature.

Types of Spirituality 

There are many different types of spirituality, ranging from religious traditions to more secular approaches. Some of the major forms of spirituality include:

• Buddhism
• Christianity
• Hinduism
• Humanism
• Islam
• Judaism
• New age spirituality
• Sikhism

It is important to remember that there are many other spiritual traditions that exist throughout the world, including traditional African and Indigenous spiritual practices. Such spiritual practices can be particularly important to groups of people who have been subjected to the effects of colonialism.

Uses 

There are a number of different reasons why people may turn to spirituality, including but not limited to:

• To find purpose and meaning: Exploring spirituality can help people find answers to questions they have about philosophical questions such as “what is the meaning of life?” and “what purpose does my life serve?”
• To cope with feelings of stress, depression, and anxiety: Spiritual experiences can be helpful when coping with the stresses of life. 
• To restore hope and optimism: Spirituality can help people develop a more hopeful outlook on life.
• To find a sense of community and support: Because spiritual traditions often involve organized religions or groups, becoming a part of such a group can serve as an important source of social support.

Impact of Spirituality 

While specific spiritual views are a matter of faith, research has demonstrated some of the benefits of spirituality and spiritual activity. The results may surprise no one who has found comfort in their religious or spiritual views, but they are definitely noteworthy in that they demonstrate in a scientific way that these activities do have benefits for many people.

The following are a few more of the many positive findings related to spirituality and its influence on physical and mental health:

• Research has shown that religion and spirituality can help people cope with the effects of everyday stress. One study found that everyday spiritual experiences helped older adults better cope with negative feelings and enhanced positive feelings.
• Research shows that older women are more grateful to God than older men, and they receive greater ​stress-buffering health effects due to this gratitude.
• According to research, those with an intrinsic religious orientation, regardless of gender, exhibited less physiological reactivity toward stress than those with an extrinsic religious orientation. Those who were intrinsically oriented dedicated their lives to God or a “higher power,” while the extrinsically oriented ones used religion for external ends like making friends or increasing community social standing.

This, along with other research, demonstrates that there may be tangible and lasting benefits to maintaining involvement with a spiritual community. This involvement, along with the gratitude that can accompany spirituality, can be a buffer against stress and is linked to greater levels of physical health.

People who feel comfortable and comforted using spirituality as a coping mechanism for stress can rest assured that there’s even more evidence that this is a good idea for them. Prayer works for young and old alike. Prayer and spirituality have been linked to:

• Better health
• Greater psychological well-being
• Less depression
• Less hypertension
• Less stress, even during difficult times
• More positive feelings
• Superior ability to handle stress

Tips 

Whether you are rediscovering a forgotten spiritual path, reinforcing your commitment to an already well-established one, or seeking a new source of spiritual fulfillment, exploring your spiritual side may help improve your well-being.

Spirituality is a very personal experience, and everyone’s spiritual path may be unique. Research shows, however, that some spiritual stress relief strategies have been helpful to many, regardless of faith.

 Some things you can do to start exploring spirituality include:

• Pay attention to how you are feeling: Part of embracing spirituality means also embracing what it means to be human, both the good and the bad. 
• Focus on others: Opening your heart, feeling empathy, and helping others are important aspects of spirituality.
• Meditate: Try spending 10 to 15 minutes each morning engaged in some form of meditation.
• Practice gratitude: Start a gratitude journal and record what you are grateful for each day. This can be a great reminder of what is most important to you and what brings you the greatest happiness.
• Try mindfulness: By becoming more mindful, you can become more aware and appreciative of the present. Mindfulness encourages you to be less judgmental (both of yourself and others) and focus more on the present moment rather than dwelling on the past or future.

Need support? Recovery is about more than stopping substance use. Learn about our aftercare programme and other treatment options, or take our free, confidential self-assessment.

The post What Is Spirituality? appeared first on Tranquility Clinic.

In the drug rehabilitation context, patients often present with a particular substance use disorder and a comorbid mental disorder. Some of the comorbidities include mood disorders such as bipolar, major depressive disorder, anxiety disorders, personality disorders such as borderline personality disorder, antisocial personality disorder and trauma-related disorders such as PTSD. However, perhaps the most common comorbid mental disorder that is seen at drug rehabilitation centres is substance induced psychosis which may be generally characterised by a loss of touch or sense of reality. Some of the drugs or psychoactive substances that may trigger a psychotic episode include alcohol, cannabis, crystal meth (methamphetamine) and cocaine. This article will provide information on substance induced psychosis as it presents in the drug rehabilitation setting. 

Definition and Symptoms of Psychosis

As mentioned in the introduction, psychosis may be generally defined as a loss of touch or sense of reality, therefore, substance induced psychosis is a loss of touch from reality triggered or induced by the use of a psychoactive substances. The majority of people only begin to recognise a psychotic episode when a person presents with the hallmark or telltale symptoms of the disorder which are delusions and hallucinations. Delusions are fixed ideas that persist despite evidence proving this idea to be false, the most common types of delusions that occurs in the drug rehabilitation setting include persecutory delusions where a person believes that someone or something is after them. Also, referential delusions, colloquially referred to as paranoia, consists of the belief that certain gestures, environmental cues, and comments are directed to oneself, this mainly occurs as a result of amphetamine-type use disorders.  Hallucinations are perceptions that occur without any external stimulus, these can include hearing voices this is referred to as auditory hallucinations or seeing things that others do not which is referred to as visual hallucinations, lastly, tactile hallucinations involve feelings such as insects crawling in or underneath the skin. These hallmark or recognisable symptoms are also accompanied by other less noticeable symptoms namely disorganised thinking and abnormal motor behaviour. These accompanying symptoms may be observed and identified during a clinical interview conducted by a healthcare professional such as medical practitioners, psychiatrists, or clinical psychologists. 

Disorganised thinking can be observed through the manner by which a patient is speaking, it consists of answering questions in a vague or irrelevant way (tangentiality) and switching from one topic to another unrelated topic (flight of ideas and loosening of associations). In addition, abnormal motor behaviour may be noted when a patient struggles to engage in goal-directed behaviour with the result that it adversely impacts their daily functioning. 

In the Diagnostic and Statistical Manual, fifth edition, text-revision (DSM-5-TR), for a patient to be diagnosed with substance induced psychosis they must meet the follow criteria; “there must be a presence of hallucinations or delusions or both, there must be history from a physical examination or laboratory findings that the hallmark symptoms occurred during or soon after the ingestion, withdrawal, or exposure to a psychoactive substance, the psychoactive substance that is ingested must be capable of producing these symptoms, the disturbance  is not better explained by another psychotic disorder, the disturbance must not occur exclusively during the course of a delirium, and the psychotic episode must cause clinically significant distress in social, occupational, educational, and other important areas of functioning.”

It must also be mentioned that prior to the occurrence of hallucinations, delusions, disorganised thinking, and abnormal behaviour, psychosis also has a prodromal phase or a stage where the early signs or symptoms of psychosis are present. This phase usually occurs before admission to a mental healthcare facility, or a drug rehabilitation centre, thus it is perhaps important to educate the general public on these symptoms to enable them to be able to identify an individual who might require psychiatric assistance. The prodromal phase of psychosis may last a few weeks to several years and it is characterised by signs or symptoms such as isolation or withdrawal from friends and family, a decline in self-care or hygiene, trouble concentrating or thinking clearly, a sudden decline in job or school performance, and decreased or intense emotions. Because these signs occur before the hallmark symptoms, it is during this period that early interventions may prevent the psychotic episode from persisting.  

Treatment and Management 

Broadly, treatment interventions for substance induced psychosis consists of psychotherapy, psychopharmacology, and social support. Psychotherapeutic interventions involve psychoeducation to improve adherence to medication and to increase the patient’s insight, family therapy to bolster and improve social support, and modality-specific treatment goals that are mainly aimed at resolving any accompanying issues or problems that might either precipitate or perpetuate the psychotic episode. While psychopharmacological treatments may not always be necessary, sometimes it may be prudent to manage the aggressive and disruptive behaviour with the relevant antipsychotic medication. Importantly, the combination of psychotherapy and psychopharmacology is more likely to improve the effectiveness of treatment outcomes. Furthermore, social workers are also important for the monitoring of patients subsequent to their discharge, this is essential to ensure that the patient does not relapse which might result in the reoccurrence of substance induced psychosis. This is also the reason that aftercare programs and support groups such as Alcoholics Anonymous, Narcotics Anonymous and Cocaine Anonymous are important in the ongoing maintenance process.   

Need support? Learn about our medically supervised inpatient treatment with 24/7 care, explore our treatment options, or contact our team for a confidential conversation.

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Exposure to trauma in childhood is a risk factor for many forms of psychopathology, including post-traumatic stress disorder (PTSD), anxiety, depression, disruptive behaviors, and substance abuse [1–4]. Risk for psychopathology following trauma is most pronounced in children exposed to interpersonal violence [1,3,4]. Identifying mechanisms that underlie the strong link between child trauma and psychopathology as well as factors that buffer this risk is critical in order to develop targets for preventive interventions. In this paper, we review mechanisms that underlie vulnerability to psychopathology following child trauma and protective factors that mitigate risk pathways (see Figure 1). Specifically, we highlight the role of disruptions in threat processing as a central mechanism linking child trauma to multiple forms of psychopathology and identify protective factors spanning social, emotional, and neurobiological levels that may buffer children from the negative mental health consequences of trauma exposure. We specifically focus on innovative recent discoveries and factors that could be directly targeted with psychosocial interventions.

Figure 1

A biopsychosocial model of risk and resilience to psychopathology following child trauma.

This figure depicts a biopsychosocial model of mechanisms linking child trauma with psychopathology and protective factors that mitigate risk pathways. Solid lines reflect direct associations between child trauma and threat processing and between threat processing and psychopathology. Enhanced threat processing is a transdiagnostic factor associated with multiple forms of child psychopathology. Each domain of threat processing is associated with internalizing and externalizing psychopathology, as well as post-traumatic stress disorder (PTSD); although greater research is needed to clarify whether the specific disruptions in emotional learning associated with child trauma are associated with mental health problems other than externalizing psychopathology. PTSD is depicted separately from internalizing and externalizing problems given its current classification as a trauma and stressor-related disorder in DSM-5. Dashed lines represent the buffering effect of each of the protective factors on specific risk pathways.

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Trauma Exposure and Threat Processing

Traumatic events involve harm or threat of harm [5]. This is particularly true for traumatic events involving exposure to interpersonal violence, including physical abuse, sexual abuse, witnessing domestic violence, and exposure to other forms of violence in the home or community. Approximately one in five children in the U.S. will experience a traumatic event involving interpersonal violence by the time they reach adulthood [4]. Exposure to these types of traumatic events in childhood alters affective and neurobiological development to enhance the identification of potential threats in the environmental and magnify emotional responses to those threats. Although these adaptations may promote safety in dangerous environments, they are a central mechanism linking child trauma to the onset of both internalizing and externalizing psychopathology. We review evidence for heightened threat processing at multiple levels—including social information processing biases, altered emotional learning, elevated emotional reactivity, and emotion regulation difficulties—as a developmental mechanism linking child trauma with psychopathology. Given that disruptions in threat processing and risk for psychopathology are particularly pronounced in children who have experienced interpersonal violence, we focus primarily on this form of child trauma exposure. We constrain our review to domains of threat processing that present plausible targets for psychosocial interventions, although additional mechanisms clearly play a role in the pathways linking child trauma to psychopathology, including changes in stress hormones and epigenetic factors [6].

Social Information Processing Biases

Trauma-exposed children exhibit information processing biases that facilitate rapid identification of environmental threats. One such bias involves heightened perceptual sensitivity to anger. Children with trauma histories identify anger with less perceptual information and classify a wider range of emotions as anger than children who have never experienced trauma [7–9]. Trauma-exposed children also exhibit attention biases to threatening social information [10], including faster attentional engagement and delayed attentional disengagement from anger [11,12]. In social situations, extensive evidence documents that children exposed to trauma are more likely to attend to threatening cues, ignore non-threatening cues, and generate hostile attributions than children without trauma histories [13].

Enhanced threat processing may occur at the expense of processing non-emotional aspects of the environment. Specifically, trauma-exposed children have poor memory for contextual information that occurs in the background of threatening cues as well as reduced activation of the hippocampus and atypical hippocampal-prefrontal cortex functional connectivity when contextual encoding occurs in the presence of threat [14]. Heightened attention to threat following child trauma may interfere with processing contextual information that could help children discriminate between safe and dangerous environments. This pattern might ultimately contribute to psychopathology by making it difficult for children to contextualize cues that have previously been associated with threat, leading to persistent fear even in safe environments.

These disruptions in social information processing are developmental mechanisms that underlie the association of child trauma with anxiety [12], PTSD [15], aggression and conduct problems [10,13].

Altered Emotional Learning

Disruptions in learning processes involved in the acquisition and extinction of conditioned fear are considered a central mechanism in the etiology of trauma-related psychopathology [16], but have rarely been studied in children. A recent study shows that whereas children without trauma exposure exhibit robust discrimination in skin conductance responses (SCR) during fear conditioning between cues that predict threat (CS+) and safety (CS−), trauma-exposed children fail to discriminate between threat and safety cues, exhibiting SCR of similar magnitude to both types of cues [17]. This pattern could reflect either generalization of fear, whereby children exposed to trauma interpret a wider range of cues as potential threats, or difficulty learning safety signals. Poor threat-safety discrimination mediates the association of child trauma with externalizing problems [17], indicating that perturbed fear learning is a potential mechanism linking child trauma to psychopathology.

Heightened Emotional Reactivity

Children exposed to trauma exhibit exaggerated emotional responses to negative stimuli that could signal the presence of threat, which serves as an additional mechanism linking child trauma with psychopathology. Heightened emotional reactivity following child trauma has been observed at both state and trait levels [18,19], and in magnified negative emotional reactions to daily stressors in adulthood [20]. Elevated amygdala response to numerous types of negative stimuli has been observed among trauma-exposed children [21–23], suggesting that negative emotional cues are particularly salient following child trauma. Atypical physiological responses to stress have been consistently observed in trauma-exposed children. Here we focus on recent work examining physiological patterns based on a well-validated model of threat responding, where threat appraisals produce a pattern of autonomic nervous system (ANS) response characterized by increased sympathetic nervous system activation but constricted cardiac output (i.e., blood flow from the heart) due to peripheral vasoconstriction [24]. Two studies have documented this threat pattern of ANS reactivity to stress among adolescents with trauma histories [25,26].

Magnified emotional reactivity to negative stimuli is associated with concurrent psychopathology [25,26] and mediates the association of child trauma with both internalizing and externalizing problems [18,27,28]. Heightened amygdala response to negative stimuli assessed prior to trauma exposure predicts the onset of PTSD symptoms following a traumatic stressor [29] and increases in internalizing symptoms following stressful life events [30].

Emotion Regulation Difficulties

Trauma-exposed children also experience disruptions in emotion regulation that make it difficult to disengage from negative emotional content. For example, frequent engagement in rumination—a strategy characterized by repetitive thought about the causes and consequences of distress—is common among trauma-exposed children [18]. Effortful emotion regulation strategies that modulate responses to negative stimuli, such as cognitive reappraisal, require greater cognitive resources or effort for children who have experienced trauma; when engaging in cognitive reappraisal, children exposed to trauma recruit prefrontal cortex regions involved in cognitive control to a great degree than children without trauma exposure [23]. Several recent studies have documented poor adaptation to emotional conflict, a form of implicit emotion regulation, among trauma-exposed children [31,32]. These trauma-related behavioral differences are mediated by reduced functional coupling of amygdala and medial prefrontal cortex (mPFC) [32]. The mPFC inhibits the amygdala in numerous forms of implicit emotion regulation. Reduced resting-state mPFC-amygdala functional connectivity has been observed in multiple studies of trauma-exposed adolescents [33,34], highlighting a potential neural substrate of implicit emotion regulation difficulties.

Patterns of emotion regulation observed in trauma-exposed children have been associated consistently with youth internalizing and externalizing psychopathology [35,36], and, when measured prior to trauma exposure, predict the subsequent onset of PTSD symptoms following a traumatic event [37]. Longitudinal studies confirm that emotion regulation difficulties are a mechanism linking child trauma to the onset of internalizing and externalizing symptoms [18,38].

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Protective Factors

Protective factors spanning social, emotional, and neurobiological domains may buffer children either from enhanced threat processing or from experiencing psychopathology following exposure to trauma.

Caregiver Support

Relationships with caregivers play a key role in protecting children from the onset of trauma-related psychopathology. Meta-analytic evidence indicates that children who have supportive caregivers are less likely to develop psychopathology following trauma exposure [39]. Recent work highlights a potential mechanism for this protective effect: maternal buffering of threat processing. Cues that signal maternal presence are associated with dampened amygdala reactivity and greater mPFC-amygdala functional connectivity in children, particularly those who have a supportive relationship with their mother [40]. Similarly, maternal presence enhances threat-safety discrimination during fear conditioning in children [41]. Critically, amygdala reactivity to threatening cues following trauma exposure is weaker in children with high maternal support [42]. Together, these findings suggest that one pathway through which social support might confer protection from trauma-related psychopathology is by dampening threat processing after a traumatic event.

Sensitivity to Reward

Sensitivity to positive and rewarding stimuli at both neural and behavioral levels is associated with reduced risk for psychopathology following child trauma exposure. Child trauma is associated with anhedonia less strongly in young adults with high ventral striatum reactivity to reward [43]. Lower levels of anhedonia, in turn, are associated with reduced depression symptoms and problematic drinking following child trauma [43]. Similarly, child trauma is not associated with depression, either concurrently or prospectively, among adolescents who exhibit high behavioral sensitivity to reward during a reward-processing task or who exhibit high reactivity to positive social stimuli in the pallidum and putamen—basal ganglia regions implicated in reward processing [44]. These findings are consistent with evidence that the association of stressful life events with depression is weaker among individuals with high ventral striatum reactivity to reward [45]. Accumulating evidence suggests that sensitivity to rewarding and positive cues may protect against the development of trauma-related psychopathology. Identifying the mechanism of this protective effect is an important direction for future research.

Mature Prefrontal-Amygdala Circuitry

As reviewed above, child trauma influences numerous forms of emotion regulation and the neural circuitry that supports effective regulation. However, some aspects of emotion regulation ability appear to interact with childhood adversity, serving as a protective factor against the development of internalizing psychopathology. Two recent studies suggest that greater mPFC-amygdala functional coupling—a marker of mature emotion regulation neural circuitry [46]—is a protective factor that buffers children from the onset of psychopathology following environmental adversity. In both studies, greater mPFC-amygdala functional connectivity during a threat-processing task predicts lower levels of internalizing psychopathology among children who experienced early adversity—including institutional rearing and diverse family-related stressors [47,48]. Greater research is needed to clarify the direct links between trauma and mPFC-amygdala circuitry and the circumstances in which this circuitry protects against trauma-related psychopathology.

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Intervention Implications

Numerous evidence-based interventions exist for treating trauma-related psychopathology in youth [49]. Cognitive behavioral therapy (CBT) is currently the most well-established treatment for child trauma-related psychopathology [49] and targets many of the threat processing mechanisms reviewed here. CBT for child trauma targets social information processing biases with cognitive coping techniques, emotional learning with imaginal and in vivo exposure, emotional reactivity with relaxation training, and emotion regulation with affective modulation skills. CBT also incorporates parents into the treatment with techniques aimed at improving parenting skills and bolstering the parent-child relationship. These components may further improve caregiver support, a key protective factor that buffers children from trauma-related psychopathology. A critical future direction for the field is to determine whether these intervention techniques targeting threat processing and caregiver support can prevent the onset of psychopathology in children exposed to trauma. One study shows promising results of a skill-based intervention delivered to both parents and children in preventing child PTSD and anxiety 3-months following trauma exposure [50]. It is currently unknown whether interventions targeting reward processing (e.g., behavioral activation) can prevent trauma-related psychopathology, as these approaches have yet to be examined empirically in children with trauma exposure. Greater research on preventive interventions following child trauma is clearly needed.

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Conclusion

Disruptions in threat processing are a key neurodevelopmental mechanism underlying the associations between child trauma and the onset of psychopathology. Enhanced threat processing occurs at multiple levels, including information processing biases, altered emotional learning, enhanced emotional reactivity, and poor emotion regulation. Supportive relationships with caregivers, heightened sensitivity to rewarding and positive stimuli, and mature prefrontal-amygdala circuitry each serve as potential buffers of these risk pathways, highlighting novel directions for interventions aimed at preventing the onset of psychopathology following child trauma.

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