Bay Area Study Finds Early Childhood Trauma Therapy Can Prevent Serious Disease

A form of psychotherapy to address early childhood trauma has the potential to prevent serious disease later in life by slowing down the rapid aging of the body’s cells, according to a study published Wednesday in the journal Psychological Science.

The study, which focuses on a group of Bay Area youngsters who received child-parent psychotherapy, shows that the treatment not only has psychological benefits but is making a difference on a biological level, according to a team of researchers at UCSF.

“We know that stress is associated with all sorts of health and disease outcomes later in life, and we’ve learned that stress gets under the skin to affect our physiology as early as early childhood,” said Nicki Bush, a psychiatry and pediatrics professor at UCSF.

The study’s findings are “just one more bit of strong evidence that shows intervening on trauma early in life can have a really positive impact on children and their families,” she said.

Child-parent psychotherapy, also known as CPP, helps young children overcome trauma related to abuse, violence or grief by helping parents respond to their children’s distress in appropriate ways. During sessions, therapists incorporate toys to help children process their traumatic experiences and help parents understand how their children’s behavior is linked to their own exposure to trauma.

The goal is to heal the relationship between adult and child and help prevent what psychiatrists call the intergenerational transmission of trauma during a sensitive period of the child’s development.

“The brain grows fastest in the first five years of life, and so it’s most malleable [then],” said Alicia Lieberman, who pioneered this form of therapy at UCSF three decades ago. “That’s why it’s so important to make sure that the neural connections that happen [during this time] are associated with protection, with safety, with trust, with growth, with pleasure, with exploration.”

Previous studies have shown that exposure to a greater number of adverse childhood experiences, including physical, emotional and sexual abuse, neglect and domestic violence, may accelerate aging in older adults and that exposure to violence speeds up children’s epigenetic clock.

The concept of an epigenetic clock was developed about a decade ago by Steve Horvath, a principal investigator at the Bay Area biotech company Altos Labs, to estimate a person’s biological age by looking at a chemical tag in their DNA called methyl groups.

Because child-parent psychotherapy has been shown to lower traumatic stress symptoms and behavior problems in children, researchers wanted to see whether the treatment has any effect on the rate at which their bodies are aging.

They swabbed the cheeks of a group of children between 2 and 6 years old who received up to 20 weekly child-parent psychotherapy sessions and compared the DNA samples from their saliva to those of another group of children who experienced trauma but didn’t receive the treatment. The study was conducted in San Francisco and Oakland between 2013 and 2015.

All the children had epigenetic clocks that ran on average at the same speed when the study began. But after two years, the kids who didn’t receive the therapy had a faster-ticking epigenetic clock than those who received therapy.

Researchers say the level of trauma was higher for the children who received the therapy than the kids in the comparison group, which makes the findings even more noteworthy. The majority of participants from both groups were mixed-race or Latin American and from low-income households.

“It makes sense that when children are exposed to stress [they’re] working really hard to cope with these environments, but that adaptation can come at a cost because their bodies are working harder,” said the study’s co-author, Allie Sullivan. “That’s when we can potentially see associations with future health problems like chronic disease.”

Bush said she hopes evidence that the therapy can slow cellular aging takes away the stigma oftentimes associated with seeking mental and behavioral health support.

The study is one of several underway that shows the impact of toxic stress or traumatic stress on the developing body and the impact of “really good interventions” that can reverse or slow down the biological toll of these kinds of stress, said Dr. Rahil Briggs, a child psychologist and national director of Healthy Steps, a program that provides early childhood development support to low-income families.

She cited a study that found babies whose mothers experienced psychological distress had lower electrical activity in the brain.

“We have long known that there’s no health without mental health,” Briggs, who was not involved in the UCSF research, said. “But now we see the link between stress and anxiety and something like severe maternal depression and the actual, physical well-being of the infant or toddler.”

She hopes the findings make a convincing case for funding dyadic care as part of a child’s pediatric checkups. Dyadic care is based on the idea that a parent’s or caregiver’s well-being is important for a child’s healthy development.

Last year, California began covering dyadic services for Medi-Cal patients. That means doctors can get reimbursed for screening the child and parent for mental and behavioral health problems and referring them to appropriate follow-up care. Children up to 20 years old and their parents qualify for the benefit.

Child-parent psychotherapy is also covered under the state’s $4.7 billion Children and Youth Behavioral Health Initiative. A diagnosis is required before treatment can begin.

“If you can show that trauma affects biology in a manner we can’t control consciously and that therapy can reverse that biological harm, it gets people to think, ‘Gosh, I may not be concerned about mental health, but I’m compelled to invest in and support policies that would pay for this type of intervention because it’s going to prevent asthma, it’s going to prevent obesity or heart disease down the line,’” Bush said.