Psychiatric Nurse Practitioners’ Strategies for Providing Trauma-Informed Psychiatric Care

Trauma is a pervasive experience with profound impacts on mental health, often influencing how individuals interact with the world and seek care[1]. Psychiatric Nurse Practitioners (PNPs) are uniquely positioned to deliver trauma-informed care (TIC), a framework that emphasizes understanding, recognizing, and responding to the effects of trauma while fostering a sense of safety, trust, and empowerment.[2] This article explores core strategies for providing TIC, using case studies to illustrate practical applications in various clinical scenarios.

Understanding Trauma-Informed Care
Trauma-informed care requires clinicians to adopt a lens that views patients’ behaviors and symptoms as potential adaptations to past trauma.[3] It involves:

• Recognizing the prevalence of trauma.

• Understanding its widespread impacts on mental and physical health.

• Resisting re-traumatization through safe, compassionate, and collaborative care.

For PNPs, applying TIC involves tailoring psychiatric interventions to acknowledge and address the unique needs of trauma survivors, ensuring care is not only effective but also healing.

Case Study 1: Establishing Safety and Trust
Patient Profile:
Emily, a 29-year-old woman, seeks psychiatric care for generalized anxiety disorder (GAD) and panic attacks. During her intake, she hesitates to discuss her history but mentions experiencing “a lot of stress growing up.”

Challenges:
Emily appears guarded and avoids direct eye contact during the session. Her heightened sensitivity to certain questions suggests a potential trauma history, though she is not ready to disclose details.

TIC Strategy:
The PNP focuses on building a foundation of trust by creating a safe and welcoming environment. Using open-ended questions[4] and validating Emily’s feelings without pressing for details, the PNP reassures her that she is in control of what she chooses to share. During the session, the PNP introduces grounding techniques to help Emily manage anxiety.

Outcome:
Over several sessions, Emily begins to share her experiences of childhood emotional abuse. Feeling safe and understood, she becomes more engaged in therapy and explores coping strategies for her anxiety.

Takeaway:
For trauma survivors, establishing safety and trust is paramount. PNPs can foster this through active listening, nonjudgmental validation, and patient-led disclosure.

Case Study 2: Addressing Trauma in Co-Occurring Disorders
Patient Profile:
Marcus, a 45-year-old man, presents with symptoms of post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD).[5] He describes frequent nightmares related to a traumatic car accident and admits to using alcohol to “drown out the memories.” 

Challenges:
Marcus exhibits hypervigilance and struggles to regulate emotions, creating barriers to engagement in care. His reliance on alcohol complicates treatment for PTSD, as substance use can both mask and exacerbate trauma symptoms.

TIC Strategy:
The PNP adopts an integrated treatment approach, addressing both PTSD and AUD simultaneously. Trauma-focused cognitive-behavioral therapy (CBT)[6] is introduced alongside motivational interviewing (MI) to explore Marcus’s ambivalence about reducing alcohol use. Additionally, the PNP prescribes prazosin to help reduce his trauma-related nightmares.

Outcome:
Over time, Marcus reduces his alcohol consumption and engages more actively in therapy. By learning alternative coping mechanisms, such as mindfulness and deep-breathing exercises, he begins to process his trauma without relying on alcohol.

Takeaway:
PNPs can provide effective trauma-informed care for co-occurring disorders by integrating evidence-based treatments, addressing both trauma and substance use with compassion and collaboration.

Case Study 3: Empowering Resilience in Youth
Patient Profile:
Sophia, a 16-year-old girl, is referred for treatment of depression and self-harming behaviors. She has a history of foster care placement following neglect and physical abuse by her biological parents.

Challenges:
Sophia’s mistrust of authority figures makes engagement difficult. She frequently downplays her emotional pain and avoids discussing her past, instead focusing on her academic struggles.

TIC Strategy:
The PNP uses a strengths-based approach[7], focusing on Sophia’s resilience and ability to excel despite adversity. During sessions, the PNP emphasizes her achievements and fosters a sense of agency by involving her in treatment planning. Trauma-focused therapy is introduced gradually, ensuring that Sophia feels empowered to set the pace for discussions about her past.

Outcome:
Sophia begins to develop healthier coping strategies and builds confidence in her ability to navigate challenges. Her depressive symptoms decrease as she feels more supported and understood.

Takeaway:
For adolescent trauma survivors, emphasizing strengths and providing patient-driven care are key components of TIC.

Case Study 4: Addressing Systemic Trauma in Marginalized Populations
Patient Profile:
Jamal, a 52-year-old African American man, seeks care for severe depression and chronic pain. He expresses frustration with previous providers who he felt dismissed his concerns, citing experiences of racial bias in healthcare.

Challenges:
Jamal’s experiences of systemic trauma contribute to feelings of mistrust and hopelessness, complicating the therapeutic relationship. He is reluctant to engage, fearing further invalidation.

TIC Strategy:
The PNP acknowledges and validates Jamal’s experiences, expressing empathy for the challenges he has faced. Recognizing the impact of systemic trauma, the PNP adopts a culturally responsive approach, incorporating Jamal’s preferences into the treatment plan. Collaboration with a multidisciplinary team ensures his physical and mental health needs are addressed holistically.

Outcome:
Jamal begins to rebuild trust in healthcare providers and actively participates in his care. His symptoms improve as he feels heard and supported.

Takeaway:
TIC must consider the broader context of systemic trauma, particularly for marginalized populations. PNPs can help mitigate these impacts by fostering cultural humility and advocating for equitable care.

Core Principles of Trauma-Informed Care
Across these case studies, several core principles[8] emerge as essential to trauma-informed care:

1.    Safety: Creating a secure environment where patients feel physically and emotionally safe.

2.    Trustworthiness and Transparency: Building trust through consistent, honest communication.[9]

3.    Collaboration: Empowering patients by involving them in treatment decisions.[10]

4.    Empowerment: Focusing on strengths and resilience to promote healing.

5.    Cultural Competence: Recognizing and respecting cultural, social, and systemic influences on trauma.

Conclusion
Trauma-informed psychiatric care is an essential framework for PNPs, allowing for a holistic, compassionate approach that meets the unique needs of trauma survivors. By integrating safety, trust, collaboration, and empowerment into every interaction, PNPs can help patients not only manage their symptoms but also rebuild their lives. Through real-world applications like those highlighted in the case studies, PNPs can create a healing environment that fosters resilience and recovery for individuals impacted by trauma.

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References

[1] Center for Substance Abuse Treatment. "Understanding the impact of trauma." Trauma-informed care in behavioral health services. Substance Abuse and Mental Health Services Administration (US), 2014.

[2] Lewis, Rosel Forwang. An Action Research Project that Explores the Impact of Educating Nurses and Nurse Practitioners on Trauma and Trauma Informed Care. Diss. Regis College, 2023.

[3] Roberts, Susan Jo, Genevieve E. Chandler, and Karen Kalmakis. "A model for trauma-informed primary care." Journal of the American Association of Nurse Practitioners 31.2 (2019): 139-144.

[4] Cannon, Lindsay M., et al. "Trauma-informed education: Creating and pilot testing a nursing curriculum on trauma-informed care." Nurse education today 85 (2020): 104256.

[5] Back, Sudie E., and Jennifer L. Jones. "Alcohol use disorder and PTSD: An introduction." Alcoholism, clinical and experimental research 42.5 (2018): 836.

[6] Mannarino, Anthony P., Judith A. Cohen, and Esther Deblinger. "Trauma-focused cognitive-behavioral therapy." Evidence-based approaches for the treatment of maltreated children: Considering core components and treatment effectiveness (2014): 165-185.

[7] Brissett, Daniela I., Shelby H. Davies, and Lydia Sit. "Reimagining No-Shows as a Symptom and Not a Diagnosis: A Strength-Based, Trauma-Sensitive Approach." Pediatrics 151.6 (2023).

[8] Frydman, Ruth. "6 key principles of a trauma-informed approach." Cent Integr Heal Solut Trauma (2020).

[9] Lanphier, Elizabeth. "Trust, transparency, and trauma informed care." The American Journal of Bioethics 21.5 (2021): 38-40.

[10] Wright, Kirsten, and Nicola Laurent. "Safety, collaboration, and empowerment: trauma-informed archival practice." Archivaria 91 (2021): 38-73.