Child-parent therapy has biological benefits for traumatized children

A new study from UC San Francisco finds that psychotherapy sessions with caregivers may help prevent serious illness later in life in young children who have experienced severe trauma.

Previous research has shown that young children benefit psychologically from dyadic parent-child treatment for trauma for up to nine years. However, this is the first time that a biological benefit of this treatment has been found.

UCSF researchers looked at the effects of dyadic therapy on a biomarker they called “age acceleration,” which indicates how quickly or slowly a person’s body is aging relative to their chronological age. This “epigenetic clock” runs faster for people who experience trauma in early childhood, which in turn puts them at greater risk for heart disease, cancer, obesity and asthma.

The study compared two groups of Bay Area children between the ages of 2 and 6 who had experienced traumatic events. Before treatment, both groups had similar rates of biological age acceleration.

One group received up to 20 weekly sessions of Child-Parent Psychotherapy (CPP), a program designed by Alicia Lieberman, Ph.D., director of UCSF’s Child Trauma Research Program and a co-author of the study. The other group did not receive CPP.

The 45 children who participated in the therapy had less acceleration of age than the 110 who did not. While the difference was not large, it could still be significant, since even small biological changes early on can lead to large differences in health outcomes over the lifespan, noted senior author Nicole Bush, Ph.D., a psychologist and chair of UCSF’s Division of Developmental Medicine.

“These findings underscore the need to ensure that families dealing with trauma and stress have access to child-parent therapies to improve their mental and physical health,” said Bush, the Lisa and John Pritzker Professor of Developmental and Behavioral Health.

The study will be released on August 14th in Psychological science.

Relationships are important for health

More than 80 percent of the children in the treatment group and two-thirds of the comparison group were Hispanic. This is important because families of color and low-income families are more likely to be exposed to trauma than higher-income white families. Yet these families are typically not included in medical research.

The participants’ levels of trauma were higher than what is typically studied in children, making the findings even more remarkable, said Lieberman, who holds the Irving B. Harris Endowed Chair in Infant Mental Health.

“We’re talking about very acute trauma in young children, things like the loss of a parent, abuse and community violence,” Lieberman said. “The children in the intervention had an average of five traumatic events under the age of six, whereas the literature shows that if you have four or more by age 18, you’re more likely to develop one of the 10 leading causes of death as an adult.”

Their parents had an average of 13 traumatic experiences, which puts them at greater risk for problems regulating their own emotions and actions in response to their children’s challenging behavior, according to Lieberman.

In child-parent psychotherapy, therapists use toys to help children process emotions and thoughts related to their traumatic experiences, and to help parents understand how their children’s behavior is related to their experiences. They also facilitate the parent-child bond by guiding the pair through positive social interactions.

“When both parent and child have experienced trauma, it compounds the effects of the trauma,” Lieberman said. “Our approach is to heal the relationship and the trauma of both child and adult in sessions together. Relationships are the key to health, starting in early childhood.”

“Parents can sometimes feel powerless over their children’s exposure to trauma,” added psychologist Allie Sullivan, Ph.D., co-first author of the study and a postdoctoral researcher in the Department of Psychiatry and Behavioral Sciences at UCSF. “We hope these results will reassure parents that they have the capacity and power to protect their children from adversity.”

A critical time for development

Interventions before age five, when a child’s brain is undergoing its most dramatic development, have the greatest impact on a child’s mental and physical health later in life.

In recent years, California’s Department of Health Care Services has created benefits to support family therapy and dyadic care for pediatric Medi-Cal patients, starting at birth. Zuckerberg San Francisco General Hospital provides this care and offers technical assistance to medical practices throughout California on how to provide it and be reimbursed.

The researchers hope their work will demonstrate the social, ethical and economic value of therapy-based alternatives to medication when it comes to treating family trauma.

“Something as fundamental as bringing families together and naming the trauma, and creating an environment of emotional safety and healing, can lead to biological repair that can benefit mental and physical health throughout life,” Bush said. “We hope that policymakers and professionals will pay attention to this.”