Holistic Approach to Child Sexual Abuse

 Holistic Approach to

Child Sexual Abuse

Research paper written by Danielle Daniel February 2018 Child sexual abuse is a growing problem worldwide. It is defined from an article in the Asian Journal of Psychiatry as “the involvement of a child in a sexual activity that he or she does not fully comprehend and is unable to provide informed consent, or for which the child is not developmentally prepared or that violates the laws or social taboos of society” (Sowmya et al., 2016. Pg. 44).  Because non-reported accounts are hard to estimate, it is thought that approximately every one in ten children have been subject to some form of sexual abuse before the age of eight years old. This number could be higher with factoring in that many cases go unreported. There are several risk factors that develop as the result from child sexual abuse, however the severity and quantity of risk factors depends upon the severity and duration of the abuse usually and innate individual resilience of the child. Generally, psychological risk factors are more severe when the child has had longer or repeated offenses, more severe sexual victimization and/or the perpetrator was a trusted adult in their life (Güven et al., 2018).  The Psychoneuroimmunology and the Effects from Child Sexual Abuse To examine the psychological risk factors, I have broken them down into three categories; clinical diagnosis, inter-personality traits, and emotional belief identity. Clinical diagnosis is the risk factor commonly seen and diagnosed from a mental health provider. Inter-personality traits are the common personality traits developed in children who have been sexually abused and the category of emotional belief identity are the common emotions children who have been sexual abused carry with them through adulthood.   However, overall the experience of sexual abuse produces stress on the psyche as well as the body.  Clinical psychological risk factors from sexual abuse include most commonly depression, anxiety, and post traumatic stress disorder. Inter-personality traits developed from child sexual abuse are more commonly seen as having an  introverted personality, a low level of control in their environment, distrust of others, a low self-esteem, and a low self-concept. The most common emotional beliefs that children who have been sexually abused carry with them throughout their life are feelings of shame, anger, sorrow, and mistrust (Güven et al.,2018).With the myriad of emotions and psychological stress child sexual abuse produces, these symptoms and diagnoses can lead to physical health and overall developmental issues.  Children who have been sexually abused have been found to be sick more often, have surgery more often, and increased risk for chronic pain. Cancer, fibromyalgia, chronic lung disease, and irritable bowel syndrome are also associated with child sexual abuse. However child sexual abuse is most strongly correlated with heart disease, osteoarthritis, chronic spinal (back or neck) pain, and frequent or severe headaches. Female victims are also at a higher risk for female related health issues (Cashmore & Shackel 2013).  To look at the Psychoneuroimmunology effects of the risk factors from child sexual abuse in more detail, I will take the most prevalent risk factors studied and discuss the findings. Anxiousness is an emotion and Anxiety is the diagnosis and it is the most common risk factor developed from not only child sexual abuse but overall in general in mental health. Anxiety is a result of feelings from fear, worry, stress and mistrust, emotions that are all identified with sexual abuse victims.  Because anxiety triggers a strong stress response in the body, there are various health issues related to it. First let’s look at the stress response generated in anxiety which in turn lead to health risk factors.  When we experience feelings of stress, the body responds by releasing catecholamines from the adrenal glands such as epinephrine, norepinephrine and cortisol. These chemicals stimulate the body to respond to this “stressor” whatever it may be, to go in a fight or flight mode by increasing one’s heart rate, oxygen distribution to the brain, dilating blood vessels in the muscles and increasing blood glucose levels. In case of having to fight for our lives or flee, this added boost of energy to the body and brain allow us the strength to do so, however at a compromising cost to other systems in the body. A number of neurotransmitters, neuropeptides and hormones also fire resulting in psychosomatic symptoms from anxiety.  When chronic stress is experienced, meaning a persistence of stress and anxiety is developed as a way of functioning, these health responses can turn into severe physical conditions. Even further, with traumatic stress, like that which some sexually abused victims experience, it can induce more life-threatening physical responses. Some of the physical health issues developed from this type of stress from anxiety are hypertension, respiratory failure, gastrointestinal disturbances, migraines and headaches, fibromyalgia and ulcers. Cortisol is also released and creates a state of heightened arousal in the fight or flight defense and it causes behavioral effects from the stimulation of the hippocampus, amygdala, and the prefrontal cortex.  The increased amygdala activity encodes emotional memory and can have an effect on traumatic memory (Satsangi & Brugnoli, 2018).  Anxiety and stress therefore are obvious mental emotions that do not just affect the mind, but have a surging effect on the entire body and can act as a gateway to physical health problems in the future if intervention is not done early enough to reverse these effects from the body’s response.  Stress has also been linked to suppression of the immune system (Kennedy 2016) which lowers the defenses of the individual to fight off bacterias and viruses, thus causing them to get sick more often which was a common risk factor developed in those of childhood sexual abuse.  At birth the immune system is not fully developed but continues to develop throughout childhood, therefore the environmental situation can have a big influence on the development of the immune system if a child is exposed to high levels of stress provoking anxiety at early ages.Another common symptom from child sexual abuse is that of depression. Physically depression has been associated with increased inflammatory response in the body. Over 20 years of studies has shown a correlation with major depression and increased inflammation and hyperactivity of the hypothalamic-pituitary-Adrenal (HPA) axis.  This research study found that not all those diagnosed with depression are inflamed, but rather a distinct group who were exposed to trauma during their childhood, especially that of childhood maltreatment associated with high blood pressure. This inflammation seemed to act as a sort of ‘biological scar’ to the early exposure of high levels of stress causing a result both mentally and physically (Pariante 2017).  The common factors were childhood stress from maltreatment, high blood pressure and inflammation and depression. Inflammation acts as a cushion to a wounded area, like a protectant and when it continues chronically in the body it has been deemed in medicine the core cause of every disease. I find it interesting that the initial response of inflammation is to act as a protectant because when you think of childhood maltreatment, that is exactly what they are needing and their body is wanting to do, is to protect themselves. It is not surprising that inflammation therefore is associated with childhood trauma from maltreatment.  We have thus far reviewed the most common risk factors those that have been sexually abused as a child face such as chronic stress, anxiety, and depression and how those psychological risk factors manifest in the body. Because there is commonly co-existing psychological and physiological symptoms clients deal with from childhood sexual abuse, it is important to approach treatment from a holistic perspective, meaning looking at the “whole” situation. Just addressing the symptoms of the mind will not cure the physical and vice versa.  A multidisciplinary treatment team would be ideal for holistic care.  There are various approaches I would take with my clients to offer a holistic treatment. Treatment would need to be focused on improving daily functioning as a start, not just the presenting symptoms.  Helping the client gain a sense of control and manageability to their own life so they can restore their locus of control and develop the confidence they need to heal.  Research on anxiety suggests that biofeedback can help the client relax as it reduces stress, muscular tension anxiety. Hypnosis is also suggested as an enhanced way to obtain biofeedback. Acupuncture can also be a valuable therapy treatment with over 4,000 years of empirical evidence resulting in reducing pain and anxiety (Satsangi & Brugnoli 2018).  Communication and interviewing techniques in therapy can be effective when doing talk-therapy with those who have had childhood sexual abuse. This entails asking open-ended questions, allowing your client to think and respond in a narrative fashion and listening to the client.  This type of talk therapy allows your client to do most of the talking and discovering of identifying their emotions, thoughts, and feelings. Cognitive-behavioral therapy is also an effective treatment for depression and is based upon helping the person recognize false beliefs and change them by resolving the faulty thinking.  One-to-one sessions helps the client gain and exercise trust which also mends their false emotional beliefs were identified common in those who have been sexually abused. CBT, or cognitive behavioral therapy, is a problem-focused and action oriented talk therapy treatment that addresses thoughts, beliefs, and attitudes, which can therefore lead to improving behaviors and emotional regulation.  With all the suggestions on talk therapy models, empathy during these session is at the core. Therapy must be a safe zone and leading with the emotion of empathy is crucial in the healing process (Satsangi & Brugnoli 2018).  Meditation has also been shown to relieve mental and physical symptoms. Meditation has effects on the reduction of stress in the body therefore reversing the heightened response of neurochemicals surging with anxiety and stress.  Meditation also increases awareness and acceptance, taking blame away from another therefore gaining back the lack of control they may feel from their abuse. Meditation can also help the client discover meaning and purpose in their life, including resolution for the things that happened to them (Satsangi & Brugnoli 2018). Meditations main goal is to “reassemble the divided part of the human being” (Satsangi & Brugnoli 2018).Yoga is another effective alternative method for reducing stress and anxiety for those who have suffered childhood abuse. Because yoga is considered a sort of meditative practice, it can help restore balance to the bodies firing stress chemicals. Because yoga is a comprehensive physical, mental, and meditative practice, it can be very useful for the multidisciplinary treatment approach in addressing the risk factors in childhood abuse.  The word “yoga” actually means union or yoke, the uniting and bringing together. So yoga can help bring harmony to the mind, integration, and equilibrium within the body through accessing all stages of our inner consciousness. One yoga practice in particular is recommended to benefit those healing from trauma, and that is yoga Nidra. This practice is also called yoga sleep and practices through a relaxed state of consciousness very similar to hypnosis. With yoga Nidra, the body and mind are completely relaxed and the client is brought through different levels of awareness around the body following the verbal directives. The practice helps the person stay in a single state of focus, heightening their five senses to individual areas throughout the body and mind. Yoga Nidra represents one of the deepest states of mind all the while preserving full awareness and total relaxation (Satsangi & Brugnoli 2018).  So far we have identified a multi-disciplinary approach to treating the mind and body from the effects of child sexual abuse through talk therapy, meditation, acupuncture,  biofeedback through hypnosis, and yoga Nidra. Lastly I want to add in a powerful form of alternative therapy that also helps to stimulate a state of relaxation to bring homeostasis to body and mind, through the application of Aromatherapy.  One can receive various neurochemical as well as physical reduction to stress, anxiety, depression and other emotional responses in the body and mind just from the use of essential oils.Psychoaromacology is a term I coined to define the study of the effects aromatic compounds have on the brain. This is a powerful and simple solution one can implement in therapy as well as the client can implement at home or even in the car as needed to restore themselves to a state of relaxation. Essential oils have been used for thousands of years in the medical practices among different cultures. There are thousands of research articles detailing the scientific effects the natural chemical compounds from the aromatic molecules in plants have on body and brain. This is also an area I have much practice in and have witnessed profound results with clients in times of heightened anxiety and tension.   In addressing the stages of stress from child sexual abuse, it is a key factor to address as it is the gateway to onsetting anxiety and depression.  This one research study is worth mentioning because they took and examined slices of brain tissue on the rodents after administering the aromatic compound s-limonene, and were able to record amazing neurotransmitter and brain activity results.  Limonene is a natural occuring chemical compound found high in citrus essential oils such as lemon, orange, grapefruit, lime, tangerine etc. In this study limonene was found to attenuate the effects of stress in the brain and body. This study took the test subjects and compared them to the controls with exposing them to stress which released corticosteroids in the brain. These corticosteroids caused an imbalance in the gamma-aminobutyric acid (GABA) and glutamic acid (GLu) which are key neurotransmitters involved with anxiety.  After 1 week of administration of limonene, it was found that it had a positive effect by protecting neurotransmitter activity from being disrupted by the onset of stress and cortisol being released from the body. The subjects who received limonene showed a decrease in cortisol, even though they were exposed to the same amount of stress, and they showed higher modulation between GABA and GLu which are crucial in regulating anxious emotions. The study concluded that this limonene compound may act as an anti-stress solution through the GABA receptor and could inhibit hypothalamic-pituitary-adrenal (HPA) activity when under physical stress (Zhou et. al. 2009).   This is a simple way to help the brain attenuate the effects of stress before getting to the anxious level. You can put a citrus essential oil like orange in a diffuser, or add lemon essential oil into your water or in a capsule to get these benefits.  One student of mine who dealt with stress on a regular basis, was an 8-year-old female with low coping skills and with starting a new school her stress was through the roof. I did several sessions without bringing in aromatics, but her symptoms in school and at home were not improving. One session I brought in my diffuser and put a citrus blend in it and diffused citrus essential oils into the air. The little girl loved the smell so much that she kept her nose over the diffuser the entire session. She literally moved her chair next to the diffuser and kept her nose over the mist the entire 40 minutes. To my amazement, the next week when she came back, she had made improvements with coping with her stress and anxiety, she was more positive and reported feeling hopeful throughout the week. We did another session with the citrus blend that week again and each week she continued to improve. It was like it gave her the extra battery juice she needed to apply the coping techniques we talked about into her life.  The mother purchased the citrus blend for her daughter and she used it frequently throughout the week as needed and after a month of this therapy, she reported feeling so much better so they terminated services. It is amazing what one little shift in brain chemistry from a plant compound can do for our mentality, outlook, and coping skills.  The next major symptom to address that is common with children who have been sexually abused is that of anxious emotions. There is really one main essential oil that has over thousands of studies most of which confirm the calming properties of the scent and that is of lavender.  There are two main chemical compounds in the essential oil of lavender that play a major role in calming the central nervous system, they are linalool and linalyl acetate. However the plant as a whole has other small fragment of natural aromatic compound that all interact together to cause a calming effect in the body and brain. One study showed that just from the inhalation of lavender alone, it caused a significant effect on decreasing blood pressure, heart rate and on improving mood. Lavender oil was also shown to increase the power of theta and alpha brain activities, which are common during a calming or resting state (Sayorwan et. al 2012).  Lavender is no doubt a healthy solution to managing anxious emotions and can easily be applied on the neck, heart, or inhaled to get a quick result in the brain. I personally experienced a panic attack a couple of times in my life and before I used the lavender oil, my heart raced for at least 30 minutes. It felt like I was having a heart attack. Once I started using essential oils, when a panic attack happened again, I put a drop of lavender over my heart and then just breathed in the scent, my heart was able to regulate itself within three minutes rather than 30 minutes! Plus after using the oils I now have not had one panic attack since. It has been a very useful and helpful treatment for me to manage anxious emotions from my own living room.  Lastly I will address the other common risk factor through psycho-aromatic-therapy from child sexual abuse and that is of mood.  Throughout my years of studying aromatics and using them in my practice, citrus oils have been very effective in uplifting mood. However today I want to highlight some new findings on the hot topic of cannabinoid receptors.  There are two cannabinoid receptors in the brain, CB1 and CB2. CB1 receptors in the brain are psychoactive and produce the high or hallucination that people often experience when smoking marijuana. CB2 receptors interact with the cells at the nervous system level and are responsible for pain management and even mood.  There are three main types of cannabinoids, which is a chemical compound that affects one or both cannabinoid receptors in the body. CBD which stands for Cannabidiol is a naturally occurring component of the cannabis and hemp plant and interacts indirectly with the CB2 receptors. THC, which stands for Tetrahydrocannabinol, is a chemical compound in cannabis that produces the “high” and affects primarily the CB1 Receptors and lastly is BCP, or Beta Caryophyllene, which only interacts with the CB2 receptors and affects the nervous system directly causing a myriad of benefits in the body such as mood and pain management.    Recent evidence is seeing that the cannabinoid receptor CB2 is involved in anxiousness and dmood.  BCP or B-caryophyllene was tested for anxiousness on mice in the elevated plus maze (EPM) test, the open field (OF) test, and the marble burying test (MBT).  It was also tested for mood on mice with the novelty-suppressed feeding (NSF) test, the tail suspension test (TST), and the forced swim tests (FST).  The study found that the mice who were administered BCP which interacts with the cannabinoid receptor 2 (CB2), showed an improvement over the control group in every single test.  One effect observed suggested it helps with a anti-compulsive-like behavior. Overall this study was able to determine that BCP by interacting with CB2 receptor site directly, produced not only a calming like effect, but also an uplifting like effect. The results suggests that by using BCP, it could be an alternative treatment of anxious emotions and mood (Bahi et. Al 2014).   Beta Caryophyllene, or BCP, is found high in the essential oil Copaiba. Copaiba is an oil that comes from the forests in South America. It interacts safely and directly with CB2 than does hemp, marijuana and CBD oil.  There are so many promising therapies to help with the effects of child sexual abuse which address the emotional and physical risk factors that could present.  From different talk therapy modalities to yoga, meditation and essential oils, this multi-disciplinary approach can directly interact with the chemistry activity in the person resulting in a healthier body and a healthier mind. References Bahi A., Mansouri S., Al Memari E., Al Ameri M., Nurulain S.M., Ojha S., (2014). β-Caryophyllene, a CB2 receptor agonist produces multiple behavioral changes relevant to anxiety and depression in mice. Journal of Physiology and Behavior. Vol. 135, Aug, pgs 119-124. Cashmore, J., Shackel, R., (2013) The Long-Term Effects of Child Sexual Abuse. Child Family Community Australia Paper No. 11 Retrieved from: Danese A., Lewis, S. J. (2017). Psychoneuroimmunology of Early-Life Stress; The Hidden Wounds of Childhood Trauma? Journal of Neuropsychopharmacology Vol 42(1) Fibler M., Quante A., (2014). A Case Series on the Use of Lavendula Oil Capsules in Patients Suffering From Major Depressive Disorder and Symptoms of Psychomotor Agitation, Insomnia, and Anxiety. Journal of Complementary Therapies in Medicine. Feb;22(1):63-9 Güven, Ş. T., Dalgiç, A. İ., & Erkol, Z. (2018). Emotional and psychosocial problems encountered by children who have been sexually abused. Journal of Psychosocial Nursing & Mental Health Services, 56(2), 37-43. Retrieved from Kennedy, S. (2016). Psychosocial Stress, Health, and the Hippocampus. Journal of undergraduate Neuroscience Education Fall 2016, 15 (1); R12-13Pariante, C.M. (2017). Why Are Depressed Patients Inflamed? A Reflection on 20 years of Research on Depression, Glucocorticoid Resistance and Inflammation. Journal of European Neuropsychopharmacology Vol 27, Issue 6, pgs. 554-559 Satsangi, A. K., Brugnoli, M. P., (2018). Anxiety and Psychosomatic Symptoms in Pallative Care: From Neuro-Psychobiological Response to Stress, to Symptoms’ management with Clinical Hypnosis and Meditative States. Journal of Annals of Pallative Medicine Vol 7, No. 1 January 2018.  Sayorwan W., Siripornpanich V., Piriyapunyaporn T., Hongratanaworakit T., Kotchabhakdi N., Ruangrungsi N. (2012). The Effects of Lavender Oil Inhalation on Emotional States, Autonomic Nervous System, and Brain Electrical Activity. Journal of the Medical Association of Thailand. Apr;95(4):598-606 Sowmya B.T., Seshadri S. P., Srinath S., Girimaji S., Sagar J.V. (2016). Clinical Characteristics of Children Presenting with History of Sexual Abuse to a Tertiary Care Centre in India. Journal of Asian Psychiatry, Volume 19, 44-49.  Zhou W., Yoshioka M., Yokogoshi H., (2009). Sub-Chronic Effects of s-Limonene on Brain Neurotransmitter Levels and Behavior of Rats. Journal of Nutritional Science and Vitaminology Vol. 55(4):367-73.

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