By
Venita Adams
Adverse childhood experiences (ACEs) are traumatic events that occur in a person’s life before the age of 18. These events can include physical, emotional, or sexual abuse, neglect, domestic violence, parental separation or divorce, substance abuse, mental illness, or incarceration of a family member. ACEs can have lasting and profound effects on a person’s physical, mental, and emotional well-being throughout their lifespan. In this blog post, we will explore the need for adverse childhood experiences therapy, the core principles and techniques of this specialized approach, the evidence-based approaches within it, the practical applications and outcomes, and the challenges and limitations in implementing it. We will also discuss the future potential for expanding access to this therapy for individuals who have experienced ACEs.
ACEs are defined as “potentially traumatic events that occur in childhood (0-17 years)” by the Centers for Disease Control and Prevention (CDC). These events can be categorized into three types: abuse, neglect, and household dysfunction. Abuse can be physical, emotional, or sexual; neglect can be physical or emotional; and household dysfunction can include exposure to domestic violence, substance abuse, mental illness, parental separation or divorce, or incarceration of a family member.
ACEs are measured by a 10-item questionnaire that asks about the frequency and severity of these events in a person’s childhood. The higher the number of ACEs, the higher the risk of developing negative health and social outcomes in adulthood.
ACEs are very common and widespread. According to a national survey conducted by the CDC, about 61% of adults in the United States reported having at least one ACE, and 16% reported having four or more ACEs. The prevalence of ACEs varies by demographic factors such as gender, race, ethnicity, education, income, and geographic region. However, ACEs can affect anyone, regardless of their background or circumstances.
ACEs can have detrimental and long-lasting effects on a person’s physical, mental, and emotional health. Research has shown that ACEs are associated with increased risk of chronic diseases, such as heart disease, cancer, diabetes, and respiratory diseases; mental health problems, such as depression, anxiety, post-traumatic stress disorder (PTSD), and substance use disorders; and behavioral and social issues, such as violence, criminality, unemployment, and low educational attainment.
ACEs can also affect a person’s brain development, especially during the critical periods of early childhood and adolescence. ACEs can disrupt the normal functioning of the stress response system, which regulates the levels of hormones and neurotransmitters that affect mood, cognition, memory, and learning. ACEs can also alter the structure and connectivity of the brain regions involved in emotion regulation, impulse control, executive functioning, and social skills. These changes can impair a person’s ability to cope with stress, form healthy relationships, and achieve their full potential.
One of the most common and serious consequences of ACEs is the development of mental health issues in adulthood. ACEs can increase the likelihood of experiencing psychological distress, such as sadness, anger, fear, guilt, shame, and loneliness. ACEs can also increase the vulnerability to developing mental disorders, such as depression, anxiety, PTSD, and substance use disorders.
There are several mechanisms that explain how ACEs can lead to mental health issues in adulthood. One of them is the concept of complex trauma, which refers to the cumulative and chronic exposure to multiple and/or interpersonal sources of trauma, often within the context of a caregiving relationship. Complex trauma can result in a range of psychological symptoms, such as difficulty trusting others, low self-esteem, poor emotion regulation, dissociation, and identity confusion.
Another mechanism is the concept of developmental trauma, which refers to the interference of trauma with the normal developmental processes of a child, such as attachment, exploration, and autonomy. Developmental trauma can result in a disruption of the sense of self, the sense of others, and the sense of the world, leading to difficulties in forming secure attachments, expressing emotions, and coping with challenges.
A third mechanism is the concept of intergenerational trauma, which refers to the transmission of trauma from one generation to another, through biological, psychological, and social pathways. Intergenerational trauma can result in a perpetuation of the cycle of violence, abuse, and neglect, as well as a loss of cultural identity, values, and traditions.
Given the complexity and severity of ACE-related trauma, it is evident that traditional therapy approaches may not be sufficient or appropriate to address the needs of individuals who have experienced ACEs. Traditional therapy approaches, such as cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), or psychodynamic therapy, are often focused on treating specific symptoms or disorders, rather than the underlying causes or the holistic aspects of trauma. Traditional therapy approaches may also lack the sensitivity, flexibility, and cultural competence to work with diverse populations who have experienced ACEs.
Some of the limitations and challenges of traditional therapy approaches in addressing ACE-related trauma are:
In contrast to traditional therapy approaches, adverse childhood experiences therapy is based on the principles and practices of trauma-informed care. Trauma-informed care is defined as “a strengths-based framework that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment” by the Substance Abuse and Mental Health Services Administration (SAMHSA).
Trauma-informed care is guided by six key principles:
Trauma-informed care provides a foundation for adverse childhood experiences therapy, as it aims to create a safe, respectful, and empowering environment for the client to heal from their trauma and to reclaim their well-being.
One of the most essential and effective components of adverse childhood experiences therapy is the establishment of a safe therapeutic relationship between the client and the therapist. A safe therapeutic relationship is characterized by empathy, trust, and respect, and it creates an environment conducive to emotional healing.
Empathy is the ability of the therapist to understand and share the feelings, thoughts, and experiences of the client, without judgment or criticism. Empathy helps the client feel seen, heard, and validated, and it fosters a sense of connection and rapport with the therapist.
Trust is the belief of the client that the therapist is reliable, honest, and competent, and that they have the client’s best interest at heart. Trust helps the client feel secure, confident, and comfortable in sharing their trauma story and their emotions with the therapist.
Respect is the recognition of the client’s dignity, worth, and uniqueness, and the acceptance of their differences, preferences, and goals. Respect helps the client feel valued, appreciated, and supported by the therapist.
Creating an environment conducive to emotional healing involves ensuring the physical and emotional safety of the client and the therapist, providing clear and consistent information and expectations about the therapy process, facilitating the connection and collaboration of the client with other individuals who have lived experience of trauma and recovery, recognizing and honoring the equal power and expertise of the client and the therapist, acknowledging and enhancing the client’s strengths, skills, and abilities, and respecting and addressing the client’s cultural, historical, and gender identity, values, and beliefs.
There are different types of therapies that can help individuals cope with the impact of ACEs. Two of the most common and effective ones are trauma-focused cognitive behavioral therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR).
TF-CBT is a short-term, structured therapy that helps children and their caregivers overcome the negative effects of trauma, such as post-traumatic stress disorder (PTSD), depression, anxiety, and behavioral problems12. TF-CBT helps children and caregivers learn how to identify and cope with trauma triggers, express and regulate emotions, develop positive coping skills, and enhance safety and trust12. TF-CBT also helps children and caregivers correct distorted beliefs related to self-worth and safety, such as blaming themselves for the trauma or feeling helpless to prevent future harm12.
EMDR is a psychotherapy that uses eye movements or other forms of bilateral stimulation (such as tapping or sounds) to help clients process traumatic memories and reduce their emotional distress34. EMDR consists of eight phases: history taking, preparation, assessment, desensitization, installation, body scan, closure, and reevaluation34. During desensitization, the client focuses on a traumatic memory while following the therapist’s bilateral stimulation. This helps the client access and reprocess the memory in a less distressing way. During installation, the client replaces the negative belief associated with the memory with a positive one. The body scan helps the client identify and resolve any physical sensations related to the memory. Closure and reevaluation ensure the client’s well-being and progress34.
ACE therapy can help clients heal from their trauma and improve their quality of life. Here are some examples of real-life cases where ACE therapy was successful.
This case study shows how TF-CBT helped a 10-year-old girl who experienced sexual abuse by her stepfather and witnessed domestic violence between her parents. She had symptoms of PTSD, depression, anxiety, low self-esteem, and suicidal ideation. After 12 sessions of TF-CBT, she reported significant reductions in her symptoms, improved self-esteem, and increased trust in her mother. She also learned how to cope with trauma reminders, express her feelings, and assert her boundaries5.
This case study shows how EMDR helped a 35-year-old woman who suffered from complex PTSD due to multiple ACEs, including physical and emotional abuse, neglect, and parental substance abuse. She had difficulties in interpersonal relationships, self-regulation, and identity formation. After 18 sessions of EMDR, she reported decreased emotional reactivity, increased self-compassion, and enhanced sense of self. She also developed more positive and stable relationships with her partner and children.
Some of the positive changes observed in clients’ lives post-therapy include:
ACE therapy is not widely available or accessible to all who need it, and there are many challenges and limitations that may hinder its implementation. Some of the factors that may affect the delivery and outcome of ACE therapy are:
Therapists may face difficulties in engaging and retaining clients who have experienced ACEs, as they may have low motivation, high resistance, poor attachment, or distrust of professionals. Therapists may also experience vicarious trauma, burnout, or compassion fatigue when working with clients who have experienced ACEs, as they may be exposed to secondary stress, emotional distress, or ethical dilemmas. Therapists may need specialized training, supervision, and support to deliver ACE therapy effectively and competently, as they may encounter complex and challenging cases that require advanced skills and knowledge.
Clients who have experienced ACEs may face barriers to accessing or affording ACE therapy, such as lack of awareness, stigma, availability, transportation, or insurance coverage. Clients who have experienced ACEs may also encounter societal factors that limit their recovery or well-being, such as poverty, discrimination, violence, or lack of resources.
ACE therapy is a specialized approach that recognizes the impact of trauma on child development and adult health, and provides evidence-based interventions to help clients heal and thrive. However, there is a need for more research, advocacy, and collaboration to expand the access to ACE therapy services. Some of the potential strategies to achieve this goal are:
Here are some frequently asked questions about ACE therapy and their answers.
In this post, we have explored the concept of adverse childhood experiences (ACEs) and how they can affect physical and mental health, as well as social and economic outcomes. We have also discussed two evidence-based approaches to ACE therapy: trauma-focused cognitive behavioral therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR). We have seen how these therapies can help clients heal from their trauma and improve their quality of life, through some real-life case studies. Finally, we have acknowledged some of the challenges and limitations in implementing ACE therapy, and suggested some potential strategies to expand its access and availability.
ACE therapy is a specialized approach that recognizes the impact of trauma on child development and adult health, and provides effective interventions to help clients cope and thrive. If you or someone you know has experienced ACEs, we encourage you to seek professional help and explore the benefits of ACE therapy. You are not alone, and you deserve to heal.
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