Leyden transgenerational trauma 10-30-16 (2)

Healing Ourselves, Our Children and Our World
Transgenerational Trauma:
Background and Recommendations for Treatment and Prevention
Lori Leyden, PhD
Lori Chortkoff Hops, PhD, Jan Warner, LISW-S, ABD
Email: Lori@CreateGlobalHealing.org
Submitted October 2016 to:
International Conference on Healing and Social Cohesion: Understanding Reconciliation
Practices From Post-Genocide and Extreme Violence
TABLE OF CONTENTS Page
ABSTRACT 2
Introduction 3
Transgenerational Transmission Theories and Research 5
Understanding the Nature and Physiology of Trauma 8
Brain-Based Somatic Release Strategies for
Transgenerational Trauma Treatment and Prevention 10
Perspectives and Implications for
Prevention, Treatment and Peacebuilding 14
Conclusion 17
References 18

Lori Leyden, PhD pg 2 of 25

ABSTRACT
Transgenerational trauma refers to trauma occurring from the experience of extreme
violence – often war or genocide – that is transmitted from one generation to subsequent
generations. With over 52% of our world’s population under the age of 30 (3.7 billion), treating
transgenerational trauma effectively is an essential step toward cultivating a generation of young
people who will be able to lead us into a peaceful future.
This paper reviews international literature on transgenerational trauma, neurological and
physiological aspects of trauma and Post Traumatic Stress (PTS), as well as the treatment
efficacy of a subset of Brain Based Somatic release (BBSR) treatment methods called Acupoint
Mediated Neural Change (AMNC). These include Emotional Freedom Techniques (EFT) and
Thought Field Therapy (TFT).
Implications from this review suggest that 1) PTS may be transmitted biologically from
parents to children; 2) PTS is connected to brain-based dysfunctions; and, 3) PTS linked to
transgenerational trauma may be effectively treated with AMNC protocols and disseminated to
sizeable populations.
AMNC research, including Randomized Control Studies (RCTs), suggest these therapies
address biological correlates of trauma responses, often found in persons with transgenerational
trauma reactions. RCTs and other field studies tracking outcomes in over 24 post war/extreme
violence settings have shown AMNC protocols to be a highly promising intervention in treating
possible transgenerational PTS.
The challenges of treating large populations experiencing catastrophic trauma have not
been widely addressed in academic literature or clinical practice. Developing practical approaches
for confronting the emotional and neurological impact of trauma to attain long-term individual and
societal healing are a critical need. AMNC therapies may meet this need and are low risk, cost-
effective, easily taught in large groups and compatible with other treatment models.
Recommendations for more effective trauma-informed prevention, treatment, and
peacebuilding models for post-genocide and extreme violence environments are proposed.


Introduction
For so many of us who dedicate our lives to ending conflict and war in our countries so
that our children can experience a peaceful world, the possibilities can appear extremely bleak.
Wherever we look it may seem that our world is at war. Following on the heels of the 20th
century, referred to by some scholars as the century of genocide (Tottten, 2012), and only a few
years into the 21st
century, the Institute for Economics and Peace’s (IEP’s) latest study suggests
that only 11 of the 162 countries they review are not involved in some degree of conflict. Not
only are people currently suffering from the effects of conflict, but those effects also ripple into
our future. Research suggests that the effects of extreme violence and war can have negative
effects lasting over three to six generations (Dias and Kessler, 2013; Levine and Kline, 2007;
Atkinson et al., 2002). With over 52% of our world’s population under the age of 30 (3.7 billion)
it is imperative that we address the issue of preventing and treating transgenerational trauma in
order to stop the cycle of violence and nurture our next generation of young people to heal and
lead us into a peaceful future.
For the purposes of this paper, the term “transgenerational trauma” refers to trauma
occurring from the experience of war, genocide in particular, and extreme violence that is
transmitted from one generation to subsequent generations. Early research assumed that trauma
transmission was mainly caused by the parents’ child-rearing behavior, however, more current
research and theory center on four modes of possible transmission: 1) biological, 2)
psychological, 3) familial, and 4) social (Kellerman, 2013; Weingarten 2003).
The literature on transgenerational trauma and its transmission mechanisms is not
conclusive. However, the impact and significance for healing and social cohesion are becoming
well-recognized among scholars, researchers and practitioners across cultures and professional
disciplines in the fields of social justice, conflict transformation, health and human services, and
psycho-social healing.
In order to better understand transgenerational trauma several terms and theories are
now explored.
The word “trauma” is a Greek word for wound in the physical sense but we now use
the term for psychological trauma. People are susceptible to trauma when:
1. They are exposed to unexpected events such as violence, terrorist attacks, physical
and sexual abuse, car accidents, natural disasters, or serious illness.
2. Witness another person experiencing a traumatic event.
3. Learn that a traumatic event has occurred to a loved one.
4. Are repeatedly exposed to the details of a traumatic event.
Exposure to trauma can lead to a host of mental, emotional, physical and spiritual
symptoms that are often described as Post Traumatic Stress (PTS), Post Traumatic Stress
Disorder (PTSD) and Complex PTSD (U.S. Dept of Veterans Affairs, 2014; A.P.A., Diagnostic
and Statistical Manual V, 2013).
Largely underestimated and unrecognized until recently (Van der Kolk, 1996; Scaer,
2005; Levine, 1997) are the neurological and physiological impacts of trauma on the brain and
the body. Neurological and physiological impacts range from hyperarousal to hypoarousal of the
sympathetic nervous system (Ogden et al., 2006). Hyperarousal can result in irritable or
aggressive behavior, hypervigilance, self-destructive or reckless behavior, sleep disturbance,
exaggerated startle response, and concentration problems. Hypoarousal can be exhibited in
memory loss, attention deficits, motor reflex weakness, numbness, and paralysis.


Popular therapies for trauma may only deal with symptoms rather than the cause. For
example, Cognitive Behavior Therapy (CBT) is a common type of talk therapy used in PTSD
usually taking place over five to 10 months and focused on changing a person’s attitude,
emotions and behaviors related to the problems they are experiencing (U.S. Dept of Veterans
Affairs, 2014; National Center for PTSD, 2016). The Institute for the Society of
Transgenerational Trauma Studies (ISTTS) identifies related first-line interventions as narration
of trauma memory, emotional regulation strategies, cognitive restructuring, and education. If
neurological and physiological effects are found alongside PTSD diagnoses, then treatment
strategies that can re-regulate the brain after trauma (Church and Feinstein, 2013) provide
promising opportunities for healing and prevention in subsequent generations.
According to the Common Bond Institute (CBI), “Transgenerational trauma is an
underlying and complex global syndrome that divides, polarizes, and perpetuates enemy images,
has been a central basis for past conflict and wars, and is a potent fuel for the eruption of
violence in the present and future.” CBI concludes that, “Understanding its dynamics and
implications, and developing ways to effectively prevent and treat it, are essential to healing and
reconciliation within and between communities, establishing compassionate local and global
relations, and achieving sustainable peace (www.cbiworld.org).”
Scholars and researchers at the ISTTS strongly emphasize that: “Profound
psychological and emotional injuries may be the most enduring effects of war and violence, yet
historically, they are the least addressed in rebuilding a community or society and preventing
future violence within and between communities. This invariably leads to transgenerational
trauma becoming embedded as part of the psyche of a society, extending wounds into future
generations where they too often play out in dysfunctional behavior, further violence, and the
creation of new victims. In this way the cycle of violence and the cycle of trauma directly
contribute to each other (www.istss.org).”
A review of the literature suggests the impact of trauma may influence up to six
generations (Muid, 2006), Atkinson et al., 2002, Dias and Kessler, 2013) and that there are four
possible modes of transmission: 1) biological; 2) psychological; 3) familial; and, 4) social
(Weingarten, 2003). The possibility of biological modes of transmission is of particular interest
given the Brain-Based Somatic Release (BBSR) treatment strategies assessed later in this paper.
However, research and theory regarding transgenerational trauma is limited and
inconclusive. Symptoms among adults and children vary as well as possible variations in social,
environmental and biological conditions requiring further study. There is a specific need for
controlled longitudinal studies in order to verify the multi-generational impact of trauma and
trauma interventions. The result has been a lack of practical, implementable, methodologies to
attain long-term individual and societal healing.
Research and theory are just beginning on transgenerational trauma with little available
data regarding procedures to aid in its prevention and treatment, especially in areas with
widespread trauma such as developing countries where even the most basic needs go unmet due
to economic hardships.
Further exacerbating the problem is that PTS has long been considered a difficult, if
not intractable emotional and psychological disorder (U.S. Dept. of Veterans Affairs, 2014).
However, a growing body of research indicates the powerful relationship between trauma and
neurological and physiological impairment (Van der Kolk, 1996; Levine, 1997; Scaer, 2005).
Given the possible neurological and physiological underpinnings of trauma, popular treatment
approaches have centered on cognitive and psychopharmacological strategies that may treat the


symptoms but not the cause.
In order to prevent trauma transmission to future generations, what is needed are
trauma-informed methods and models that not only treat the neurological and physiological
dysfunctions of trauma but are effective, scalable, culturally appropriate, and cut across all
aspects of society affecting the individual and the society or population as a whole. These range
from meeting basic needs like food, water, electricity and shelter, to education, mental and
physical healthcare; to institutions providing safety, social justice and national security.
A subset of Brain-Based Somatic Release (BBSR) methods have proven successful,
efficient and scalable in treating simple and complex trauma in post violence, low resourced
environments (Connolly et al, 2013; Connolly and Sakai, 2011; Robson, 2016; Feinstein, 2008).
A literature review for two of those methods referred to as Acupoint Mediated Neural Change
(AMNC) protocols, Emotional Freedom Techniques (EFT) and Thought Field Therapy (TFT) is
provided here. The results of these studies show promising results for large-scale
transgenerational treatment and prevention models and strategies.
Transgenerational Transmission Theories and Research
Research and theory regarding transgenerational trauma is limited and inconclusive,
however several insights can be drawn from a review of the literature. The first body of research
centered on Holocaust survivors and their affected families (Kellerman, 2000). Subsequent
research examined transgenerational trauma transmission in societies and individuals
experiencing genocide and extreme violence in Eastern Europe, Cambodia, Rwanda, Australian
Aborigines, and others (Nolte, 2016; Meskova and Kupsane, 2015; Ekiti et al, 2015; Atkinson,
2002; Hinton et al., 2010; Sack, 1995).
According to Priebe et al. (2010) millions of people have been exposed to war in the
20th and the beginning of the 21st century. In the case of the Rwandan massacre, researchers
discovered that the resultant mental health symptoms exhibited by people who experienced terror
first-hand could also be found in people who knew of the trauma or knew some of the victims
but who did not personally experience the massacre (Rieder and Elbert, 2013). According to
Danieli, (1998) more civilians than soldiers appear to suffer from the aftereffects of such
violence. However, very few studies have been conducted on the long-term mental health of
bystanders, civilians and transmission of trauma to off-spring in war-affected countries.
Weingarten (2003) posited four possible mechanisms for how post traumatic stress
may be transmitted intergenerationally: 1) biological; 2) psychological; 3) familial; and, 4)
social). Following is a review of the literature related to these four categories.
Biological Transmission of Trauma
The first mode is biological. For our purposes, we will briefly explain that biological
transmission can be looked at in two ways. The first is genetics, referring to the genes that one
inherits from one’s biological parents. For example, changes in the stress hormone cortisol found
in survivors of the Holocaust can be found in their offspring, starting in infancy through
adulthood. (Yehuda et al., 2001). Johnsson (2014) found a correlation between parents with post
traumatic stress and elevated mental health problems in their offspring and postulated that the
explanation for this was genetic or epigenetic in nature. Likewise, Van der Kolk (1996, 2015),
who originated the phrase “the body keeps score,” also suspected that elevated cortisol levels are
a way in which symptoms are transmitted across generations. Bowers & Yehuda (2015) reported
genetic associations between parental stress and elevated cortisol levels in their offspring. The


offspring who were studied at ages 14 months to 60 years of age, had been exposed to parental
trauma during pre-conception through 32 weeks in utero.
The second area of biological research on transgenerational trauma is epigenetics, a
growing field showing that our genetic codes can be influenced, mitigated or changed based on a
variety of circumstances in the environment. Bowers and Yehuda (2015) compiled a table of
epigenetic associations between stress ratings of parents exposed to trauma and their children,
finding positive correlates of parental stress in offspring aged newborn to 60 years old exposed
to parental stress in the periods preconception and in utero. Even more significant, offspring of
parents with PTSD were three times as likely to suffer from PTSD themselves.
In one study on mice Dias and Kessler (2013) found evidence of transgenerational
transmission of trauma suggesting that the experiences of a parent, before even conceiving
offspring, markedly influence both structure and function in the nervous system of up to three
subsequent generations. Dias indicated that “such phenomenon may contribute to the etiology
and potential intergenerational transmission of risk for neuropsychiatric disorders such as
phobias, anxiety and post-traumatic stress disorder.”
In support of Dias and Kessler (2013), Professor Wolf Reik, head of epigenetics at the
Babraham Institute in Cambridge suggests that, “These types of results are encouraging as they
suggest that transgenerational inheritance exists and is mediated by epigenetics, but more careful
mechanistic study of animal models is needed before extrapolating such findings to humans.”
Psychological Transmission of Transgenerational Trauma
The second posited mode of transmission is psychological and this concept connects
trauma with attachment theory. Silove and Franzcp (1999) researched the after events of mass
human rights violations and the effects of torture on civilians and refugee. They concluded that
an individual’s personal adaptation system becomes overwhelmed and that five core adaptive
systems become disrupted for an unknown time period after the injustice. The five domains
noted were: safety, attachment, justice, identity-role and existential meaning. While the Silove
and Franzcp (1999) study does not specifically address transgenerational trauma it does suggest
long term reactions and disruptions that theoretically can lead to disruptions in the following
generations. The implications here indicate the consideration of treatment strategies addressing
these specific psychological issues and lend significance to a holistic, whole person approach to
transgenerational trauma healing. The studies cited in the sections on Biological, Familial and
Social Transmission provide further justification of the linkage between parent and child
psychological symptoms including aggressive behavior, depression, anxiety and PTSD.
Familial Transmission of Transgenerational Trauma
The third transmission mode that Weingarten described was familial mechanisms of
transmission. First, silence can act as a mode of communicating stress or pain. For example,
children in families in which speechlessness dominates and few facts have been disclosed may
fantasize details to imagine the parental trauma” (Weingarten 2003). Second, in some
circumstances, the cycle of violence usually associated with domestic violence may actually
have its roots in traumatic experiences of war. For example, Catani (2010) indicates that war
veterans are more aggressive toward their intimate partners. Recently, Rieder and Elbert (2013)
concluded that “exposure to organized violence and family violence in Rwandan descendants
poses a risk factor for the development of depressive and anxious symptoms. In addition, they
added that “stressors such as poverty and parental psychopathology additionally may affect the


family system” and they may pose “a risk factor for the future development of descendants who
may be more likely to develop depressive and anxious symptoms.”
In a study of 125 Rwandan mothers who experienced PTSD as a result of the genocide
and their 12-year old children, Roth et al., (2014) findings suggest that there was no
transgenerational correlation between the mother’s current PTSD from exposure to genocide and
a child’s mental health. Instead, they found an association between children’s psychopathology -
anxiety, depression, aggressive behavior and antisocial behaviors as determined by survey data -
and maternal violence at home based on the mothers’ own experiences of family violence during
childhood. Although there was no data provided about the fathers and their potential impact on
the children’s psychopathology, the implications of this study add the additional tendencies of
maternal violence to the risk factors indicated in Catani (2010) regarding war veterans as well as
Reider and Elbert (2013) regarding Rwandan intergenerational depression and anxiety.
Hadi, Llabre, and Spitzer (2006) wrote about Kuwaiti Gulf War-related trauma and the
severe psychological distress of Kuwaiti children and their mothers. Kuwaiti children of fathers
who served in the first Gulf war show elevated scores of anxiety and depression (Al-Turkait &
Ohaeri, 2008). Children of veterans with war-related PTSD often showed significantly more
developmental, behavioral, and emotional problems than veterans without PTSD (Klarić et al.
2008). Schick et al, 2013 studied transgenerational trauma symptoms in Kosovo. Eleven years
after the Kosovo war, the prevalence of mental health symptoms in the children and civilian
adults was found to be significant listing posttraumatic stress, anxiety, and depressive symptoms.
Social Transmission of Transgenerational Trauma
Lastly, generational transmission is posited to be accomplished via a societal or
community mechanism. Muid (2006) offers a noteworthy definition of historical or
intergenerational trauma as “the subjective experiencing and remembering of events in the mind
of an individual or a community, passed from adults to children in cyclic processes as collective
emotional and psychological injury … over the life span and across generations.
Milroy (2005) detailed the transgenerational trauma impact on future generations this
way: “Even where children are protected from the traumatic stories of their ancestors, the effects
of past traumas still impact on children in the form of ill health, family dysfunction, community
violence, psychological morbidity and early mortality.”
Blanco’s work, described in Levine and Kline (2007) outlines a five-generation model of
transgenerational trauma occurring from violence in South America. This work has strong
similarities with Atkinson et al.’s (2002) six-generation “traumagram” linking violence
perpetrated against Aborigine Indigenous people of Australia. Both depict the breakdown of
functional society in a “violence begets violence” pattern in subsequent generations when trauma
continues and remains unacknowledged and/or unresolved. Well-controlled, large sample
longitudinal studies with multivariate analyses would greatly enhance our understanding of these
theories.
In Rwanda, memories about the genocide occur in a background of societal post-war
social and economic tensions. At times, in order to get along with one another, Rwandans
appear to deliberately forget the genocide in everyday company. Buckley-Zistel, (2006) termed
this strategy for neighborhood tolerance as a “chosen amnesia” about the genocide events. This
collective, lingering, traumatic pain along with unnatural silence can create familial
environmental and emotional impact on children. From a developmental psychology perspective


children are unable to process such trauma that can lead to significant undermining of their sense
of internal and external safety.
Larger scale, longitudinal research is needed to explore the impact of transgenerational
transmission of PTSD from parents to their children. The current review suggests that the role of
all four possible modes of posited transgenerational transmission of trauma need to be further
explored.
Understanding the Nature and Physiology of Trauma
Emerging research shows that trauma causes brain-based dysfunction. In this section we
define terms for trauma, Post Traumatic Stress Disorder (PTSD) and Complex PTSD.
Additionally, we review the physiology of trauma.
Trauma, PTSD, Complex PTSD Definitions
According to the U.S. Department of Veterans Affairs (2014), conditions for trauma to
occur are characterized by an individual and/or community experiencing:
1. An event that is shocking or unexpected
2. A real or perceived sense of imminent death
3. As sense of isolation or being totally alone
4. A sense of powerlessness or being trapped with no solution
These conditions can occur when an individual:
• Directly experiences the traumatic event;
• Witnesses the traumatic event in person;
• Learns that the traumatic event occurred to a close family member or close friend
(with the actual or threatened death being either violent or accidental); or
• Experiences first-hand repeated or extreme exposure to aversive details of the
traumatic event.”
Post Traumatic Stress Disorder (PTSD): The trigger for Post Traumatic Stress Disorder
(PTSD) as defined in the Diagnostic Statistics Manual V (American Psychiatric Association,
2013) occurs when the trauma causes clinically significant distress or impairment in the
individual’s social interactions, capacity to work and/or other important areas of functioning.
Behavioral symptoms that accompany PTSD include four distinct diagnostic clusters. They are
described as:
1. Re-experiencing.
2. Avoidance.
3. Negative cognitions and mood.
4. Arousal.
Re-experiencing covers spontaneous memories of the traumatic event, recurrent dreams
related to it, flashbacks or other intense or prolonged psychological distress.
Avoidance refers to distressing memories, thoughts, feelings or external reminders of the
event.
Negative cognitions and mood represents myriad feelings, from a persistent and distorted
sense of blame of self or others, to estrangement from others or markedly diminished interest in
activities, to an inability to remember key aspects of the event.


Finally, arousal is marked by aggressive, reckless or self-destructive behavior, sleep
disturbances, hyper-vigilance or related problems.
Complex PTSD occurs over time as original traumas are compounded by chronic or long-
term exposure to emotional, physical, societal and economic trauma. The individual can feel they
have little or no control over these circumstances and feel there is little or no hope of escape,
such as in cases of ongoing threat of violence, poverty, illness, recurring emotional, physical
and/or sexual abuse.
Understanding How Trauma Affects the Brain
According to medical biophysicist, Peter Levine in his groundbreaking book, Waking the
Tiger, trauma is perhaps the most avoided, ignored, denied, misunderstood, and untreated cause
of human suffering. Unless the trauma is released from the brain it will continue to be self-
perpetuating (Levine, 1997).
Most professionals and lay people still think of trauma as an “emotional” event. They do
not realize that trauma is a physiological process, a biochemical freeze response created in the
brain and central nervous system when one is confronted with overwhelming fear. Because it is
wired into the reptilian brain that runs our bodily functions, it cannot be treated with
psychosocial therapies alone (Scaer, 2005). PTSD left untreated can cause cognitive, emotional
and physical symptoms that occur for years after a traumatic event, and/or triggered years later,
often returning in waves at unpredictable times. (U.S. Deptartment of Veterans Affairs, 2014;
Van Der Kolk, 2015)
Exciting new brain science research over the past decade offers a more thorough
understanding of what happens physiologically when trauma occurs. But because this
information is leading edge, there is often a lack of comprehensive trauma awareness among
professionals who treat trauma survivors.
The clinical syndrome of Post Traumatic Stress Disorder (PTSD) constitutes a psychiatric
syndrome described in the American Psychiatric Association’s, DSM-IV (2013). However, the
underlying cause of this syndrome is not explained. While there are many theories about the
causes of PTSD, for the purpose of this paper, one opinion will be offered. According to
neurologist, Dr.Robert Scaer: “The entire constellation of symptoms attributable to this
syndrome, however, I believe is explainable by both the sustained arousal and over-reactivity of
the autonomic nervous system and by the procedural memory mechanisms activated in the
traumatic experience. Stimulus hypersensitivity and symptoms of anxiety and panic are directly
due to the over-responsiveness of the sympathetic nervous system to even minor stressful stimuli
(2001).”
Professional literature often refers to the fight-flight response—a person’s reaction to a
stimulus perceived as an imminent threat to their survival (Seltzer, 2015). However, less well-
known is the fight-flight-freeze response, which adds a crucial dimension to how a person is
likely to react when the situation confronting an individual overwhelms their coping capacities
and leaves them paralyzed in fear.
We now know that trauma is related to a biochemical freeze response created in the brain
and central nervous system when one is confronted with a fear that overwhelms them. All
mammals are capable of suffering from trauma. When someone witnesses an event that frightens
them and feels overwhelming, the “flight/fight/freeze” mechanism automatically takes over in
the brain, triggered by the amygdala in the mid-brain (Van der Kolk, 2015).


This small organ, known as the ‘smoke detector’ of the body, triggers the cascade of a
neurochemical sequences that create the fight/flight/freeze behaviors we have all experienced at
some time in our lives. Once these biochemicals begin to flow, they are very hard to stop until
the cycle is complete. The brain stores the event; if the original event was frightening or
threatening enough, anything thereafter that ‘reminds’ it of the original trauma will set off the
fight/flight-or freeze response again and again, long after the event has passed. Even unconscious
anticipation of that original event, now long gone, can trigger the repetitive traumatic cycle of
PTSD (Van der Kolk, 2015).
If the hippocampus and amygdala (organs in the brain that regulate the fight/flight/freeze
response) “think” the trigger is real, even if the initial event has long passed, the body will react
as if it is in mortal danger. This is why sudden loud noises can trigger a traumatic episode in
someone who had previously experienced the sound of gunfire in wartime, why driving over a
bump in the road can trigger a traumatic episode for someone who had been in an earthquake, or
why an anniversary of a traumatic event can bring on another wave of trauma.
Unless the freeze response is released from the amygdala, the devastating physical and
emotional effects of trauma will be self-perpetuating. To heal trauma we must extinguish post-
traumatic procedural memory cues, and you can't do that with words alone (Scaer 2001).
Stress brought on by repetitive trauma response affects every cell in the body, and over
time begins to take its toll on the body’s overall health through the generation of high levels of
cortisol, commonly known as “the stress hormone.” The long-term effects of chronic high
cortisol production are well studied and understood to create most of the diseases of our modern
age, including heart disease, stroke, depression, auto-immune disorders, digestive disorders,
diabetes and cancer (Leyden, 1998; Leyden, 2013).
While we cannot prevent the many different events that can cause trauma, it is vitally
important that the effects of trauma be treated as quickly and effectively as possible to allow the
body to return to balance and health.
Long-term effects of wide-spread trauma within a community can be devastating and can
include: increased illness, decreased productivity, increased demand for medical services on
already strained medical systems, not to mention the myriad of emotional and mental symptoms
that can seriously affect quality of life, productivity and recovery for the entire community
(Leyden, 2013).
Until the brain-based trauma relief component is addressed, any community will be
handicapped in benefiting quickly and effectively from peace-building strategies.
Brain-Based Somatic Release Strategies for
Transgenerational Trauma Treatment and Prevention
In this section we review the relevant literature on 1) the affects and use of a subset of
Brain Based Somatic Release (BBSR) therapies referred to as Acupoint Mediated Neural Change
(AMNC) protocols for the treatment of PTSD including studies that indicated AMNC methods
provide epigenetic mediation of PTSD; and, 2) we offer evidence and implications for using
AMNC protocols for large-scale treatment and prevention of transgenerational trauma.
A Review of Acupoint Mediated Neural Change (AMNC) Literature
Research at Harvard Medical School has documented that the most effective treatment
for trauma seem to be found in Brain Based Somatic Release (BBSR) therapies, including
AMNC protocols such as EFT and TFT. The stimulation of certain acupressure points on the


body have been shown, through fMRI and PET Scans, to calm the amygdala and stop the
fight/flight/freeze process. Moreover, research has also shown that the hippocampus and other
fear sensors in the body are similarly and often very quickly affected and discharged. (Hui et al.,
2000).
The result is that memories are retained, but they no longer carry an emotional intensity
or “charge” to trigger the trauma response in the body, thus allowing a full healing of the original
trauma.
According to Varvogli and Darviri, (2011) gently tapping or holding acupressure points
triggers the body to do three things:
1. Generate opiods, like endorphins which reduce pain and slow the heart rate;
2. Generate neurotransmitters like serotonin (a feel-good neurotransmitter) and
GABA, which reduce anxiety;
3. Reduce cortisol by up to 50% ending the fight/flight/freeze response.
Additionally, these biochemical changes create a rapid desensitization to traumatic
stimuli because they:
1. Terminate or disconnect the body's fight/flight/freeze response in the Sympathetic
Nervous System; and,
2. Replace it with the Relaxation Response of the Parasympathetic Nervous System.
For the same reasons, AMNC protocols discharge the emotional pain and physiological
triggers of PTSD, bringing the body back into balance and resourcefulness, resulting in
resilience. Memories can be present or recalled without triggering the fight/flight/freeze response
(Lane 2009).
The need for effective, evidence based treatment strategies to address acute and
posttraumatic stress disorders is manifest in our world. It is estimated that AMNC protocols have
been delivered to well over 10 million people in over 24 countries including Rwanda, Uganda,
Congo, Nigeria, Israel, Indonesia, Haiti, Japan, Kosovo, South Africa, Israel, New Zealand,
Ecuador, Kenya, Guatemala, Kuwait, Mexico, Moldavia, Tanzania, Thailand, South Sudan,
Burundi, Brazil and the US as a treatment for PTS resulting from genocide, extreme violence and
natural disasters (Robson, 2016; Connolly, 2013; Feinstein, 2008; www.tftfoundation.org).
The past decade has been remarkable for concerted efforts being made to scientifically
validate the undeniable therapeutic value of AMNC therapies. These efforts have yielded a
number of well-designed studies involving Randomized Controlled Trials (RCT’s), which
demonstrate the efficacy of AMNC in the treatment of Post-Traumatic Stress Disorder (PTSD).
AMNC treatment protocols combine psychological exposure, in which the client verbally
or non-verbally visualizes traumatic events in the service of desensitization, while engaging in
motor or verbal behaviors that are understood to facilitate neural integration.
AMNC protocols have proven successful with different populations, produce rapid
remediation of symptoms, and simultaneously treat anxiety and depression. Their long-lasting
results all make AMNC protocols an effective evidence-based treatment modality for PTSD.
Church et al. (2013) investigated the effect of 6 one-hour EFT sessions on military
veterans diagnosed with PTSD. Symptoms of PTSD, as measured by scores on the PTSD Check
List (PCL-M), were assessed pre and post treatment. These scores were compared to those of the
control group that received only standard care. The results indicated that 90% of the subjects in
the EFT group no longer met criteria for a diagnosis of PTSD. This was in stark contrast to the
Control Group in which only 4% of the participants showed similarly significant improvement.


Geronilla et al. (2014) replicated the earlier study by Church et al. (2013) and obtained
similar results. After 6 sessions of EFT, significant reductions in scores on the PTSD Check List
(PCL-M) were determined to be indicating a very large treatment effect (Cohen’s d=3.44).
Therapeutic gains were maintained 3 and 6 months post treatment. At 6 months, 95% of the
experimental sample no longer met clinical criteria for PTSD based on PCL-M score >50.
Various studies compared the efficacy of EFT to other treatment modalities. Karatzias et
al. (2011) compared the effectiveness of EFT to Eye Movement Desensitization and
Reprocessing (EMDR) in the inpatient treatment of patients in the United Kingdom. Both
treatment modalities were demonstrated to successfully resolve symptoms of PTSD as measured
by the Clinician Administered PTSD Scale (CAPS) (d=1.0), and the PTSD Check List (PCL)
(d=1.1)
Nemiro, et al. (2015) examined the effectiveness of EFT and CBT in treating women who
had been victims of sexual violence in the Congo. Participants received two 2-1/2 hour treatment
sessions per week for 4 consecutive weeks (eight sessions total). Assessments occurred before
and after treatment, and 6 months later. Participants demonstrated significant posttest
improvement in both groups on both measures. Follow-up assessments showed that participants
maintained their gains over time whether treated with EFT or CBT. The results indicated that
both EFT and CBT are effective when delivered in a group format and in the setting of a
developing nation.
Church, Sparks, and Clond (2016) examined the therapeutic response to EFT of veterans
who scored below the clinical cutoff on the PTSD Check List (PCL-M), but were still considered
to be at risk for delayed onset PTSD. The reduction in scores was significant and consistent with
those typically displayed by veterans who score above the clinical cutoff. The Church, Sparks,
and Clond (2016) treatment protocol comprised two 90-minute treatment sessions per week, for
4 consecutive weeks. After treatment, participants demonstrated a significant pre posttest
reduction in symptoms as measured by The Harvard Trauma Questionnaire (HTQ) and the
Hopkins Symptom Checklist-25 (HSCL). Significant improvement was obtained in both
treatment modalities.
Sakai et al. (2010) used TFT in the treatment of 50 orphaned Rwandan adolescents
presenting with PTSD. After a single treatment session lasting 20 to 60 minutes followed by
relaxation training, only 6% of the adolescents still scored within the PTSD range. Staff reports
were consistent in describing a dramatic decrease in the severity of observed PTSD symptoms
following treatment.
Additionally, Connolly and Sakai (2011) examined the efficacy of TFT in reducing
PTSD symptoms in adult survivors of the 1994 genocide in Rwanda using an RCT study design.
Participants included 145 randomly selected adult genocide survivors. Reduced trauma
symptoms for the group receiving TFT were found for all scales. Reductions in trauma
symptoms were sustained at a 2-year follow-up assessment.
Connolly et al. (2013), in a randomized control study, found that that a one-time,
community leader facilitated trauma-focused TFT intervention delivered to 164 Rwandan
genocide survivors showed a significant difference in reduction of trauma symptoms and PTSD
symptom severity and frequency between the treatment group and the waitlisted control group.
These positive outcomes suggest that a one-time, community leader facilitated trauma-focused
TFT intervention may be beneficial with protracted PTSD in genocide survivors.
A similar RCT study teaching TFT to 36 community workers who treated 256 Ugandans
suffering from post violence conflict PTSD resulted in significant improvements with some


evidence persisting benefits 19 months later (Robson, 2016). This and the previous studies
support the value of using TFT and EFT in resource poor environments as a rapid, efficient and
effective therapy, empowering traumatized communities to treat themselves.
Two of the most exciting recent AMNC pilot studies indicated that EFT may have a
significant impact on mediating the epigenetic effects of PTSD. In the first study, Maharaj,
(2016) used a salivary messenger RNA protocol for measuring gene expression in an EFT
treatment group versus a control group. Saliva test validation before and after treatment showed
significant differences in gene expression in the EFT group linked to overall health and increased
neuronal processes in the brain. In the second study conducted by Church et al. (2016), 16 war
veterans with clinical levels of PTSD were divided into EFT and control groups. Messenger
RNA testing on PTSD related genes before and after a 10 session EFT protocol indicated a
significant decrease in PTSD symptoms, a decrease of 53% that were maintained after follow-up
at three and six months.
Why Use AMNC Protocols for Treatment and Prevention of Transgenerational Trauma.
A review of the literature indicates that AMNC protocols are easily integrated with
traditional psychosocial therapies for quicker, more effective results and have been shown to be
extremely effective and successful as community trauma intervention tools around the world,
including Rwanda, Uganda, Congo, Nigeria, Israel, Indonesia, Haiti, Japan, Kosovo, South
Africa, Israel, New Zealand, Ecuador, Kenya, Guatemala, Kuwait, Mexico, Moldavia, Tanzania,
Thailand, South Sudan, Burundi and Brazil and the US (Robson, 2016; Connolly, 2013;
Feinstein, 2008; www.tftfoundation.org).
AMNC protocols are quick, easy to learn, do no harm, are non-pharmacological and have
minimal costs to learn (Church and Feinstein, 2013). In addition they can be administered by
paraprofessionals to groups or individuals and can be used by the individuals themselves for self-
care (Robson 2016; Connolly et al., 2013; Connolly and Sakai, 2010).
These attributes make AMNC protocols very practical for scaling and replicating
treatment to large groups of people.
The specific advantages of AMNC protocols are:
1. No dropout rates due to single session administration;
2. Utilize a train the trainer public health model endorsed by the World Health
Organization;
3. Easy for trainers to learn in a few days, and easy for the clients learn how to apply
the technique very quickly;
4. Evidence-based;
5. Appropriate to be delivered in groups. Research has shown that for acute or
chronic psychological trauma, a group treatment modality is especially
recommended.
6. Easily delivered by paraprofessionals in a Train the Trainer model;
7. Easily adapted for self-administration.
Church and Feinstein’s (2013) summary some of the most important advantages to using
AMNC protocols with clients who exhibit symptoms of PTSD also support AMNC use for:
1. Limited number of treatment sessions usually required to remediate PTSD
2. Depth, breadth, and longevity of treatment effects


3. Low risk of adverse events
4. Limited commitment to training required for basic application of the method
5. Efficacy when delivered in group format
6. Simultaneous effect on a wide range of psychological and physiological
symptoms
Perspectives and Implications for
Prevention, Treatment and Peacebuilding
The authors would like to offer some perspectives and implications on how
transgenerational trauma impacts the overall intention of this conference on healing and social
cohesion, in other words, peacebuilding.
The Alliance for Peacebuilding (2013) defines peacebuilding as a process that facilitates
the establishment of durable peace and tries to prevent the recurrence of violence by addressing
root causes and effects of conflict through reconciliation, institution building, and political as
well as economic transformation.
While the need for more research in this area is clear, we cannot wait for studies to
confirm what we as peacebuilders know to be true. Healing for every generation is necessary for
peace in our communities, our countries and in our world.
We would like to offer the following five considerations:
1) Healing transgenerational trauma in the context of peacebuilding is not simple and
requires full and long-term commitment by individuals, communities and governments.
We found references in the literature to only two large scale community-based,
transgenerational trauma treatment models relating to the affects of extreme violence. Both the
Family Well-Being Program (Tsey et al, 2009) and the We-Al-Li Train-The-Trainer Workshops
(Atkinson et. al. 2010) address transgenerational trauma in Indigenous Australian communities.
These programs indicate a strong level of commitment and holistic approach to healing
and community change by “equipping a core group of community members with the skills
necessary to direct vulnerable individuals away from antisocial and unlawful behavior, substance
and alcohol misuse and family violence and neglect, these programs are contributing to the
development of safe, structured and stable Indigenous communities (Atkinson et al., 2010).”
Skill sets include: environmental wellbeing, spirituality, relationship wellbeing, physical
wellbeing, emotional wellbeing, stress regulation, sexuality and life purpose.
Tsey et al., (2009) offer a key suggestion for next steps in creating effective
transgenerational trauma healing and prevention: “A key limitation or challenge in the use of
psychosocial empowerment programmes relates to the time and resources required to achieve
change at population level. A long-term partnership approach to empowerment research that
creatively integrates micro community empowerment initiatives with macro policies and
programmes is vital if (community) health gains are to be maximised.”
An indication of the strong level of commitment needed for peacebuilding is Never
Again Rwanda’s (NAR) four-year pilot program, Societal Healing and Participatory
Governance for Peace in Rwanda. This represents a significant, large scale initiative in healing
wounds and creating a peaceful, inclusive Rwandan society. The program is based on NAR’s
Societal Healing in Rwanda Mapping Report (2015) that identifies the importance of offering
holistic, whole-person approaches for peacebuilding addressing psychological, social, economic,
spiritual and legal needs.


On a smaller but very dynamic level, is the exemplary work of Community Based
Organization for Peace (CBOPE-Ihumure) in Rubavu, Rwanda, led by Quaker Pastor and peace
artisan, Augustin Habimana. CBOPE’s mission is to promote community healing and prevention
of transgenerational trauma through their train-the-trainer programs in Trauma Healing, Conflict
Transformation, Trauma-Informed Mediation, Women and Children’s Rights, and Income
Generating Community Projects. They inclusively serve all members of their community, both
survivors and perpetrators
Such models must be culturally appropriate and include every level of society from the
top down and bottom up – from community leaders to the most under-resourced individuals,
from youth to elders, and from victims to perpetrators. Special emphasis should be considered
for empowering healthy parent-child relationships.
2) There is a great need for large-scale brain-based, trauma-informed PTSD treatments in
post violence environments using Train-The-Trainer models.
The World Health Organization (WHO) recognizes PTSD as a health problem of growing
concern, not only for those in resource poor environments where natural disasters and war occur
but for those humanitarian aid workers who serve them (WHO, 2014). In addition, WHO
recommends training paraprofessionals to treat most trauma survivors in such settings and only
then, referring those who cannot be helped to professionals.
3) AMNC therapies have proven efficient and easily implemented in post violence
communities and show great promise for large-scale replication.
AMNC research and implications have been reviewed in the section above entitled: Why
Use Brain-Based Somatic Release/Acupoint Mediated Neural Change. The following anecdotal
information provided by the lead author and her colleagues is further descriptive of the success
of including AMNC treatment in peacebuilding initiatives.
TFT in post-conflict Kosovo: The use of AMNC strategies in post war and natural
disaster environments began as early as 2002 when Dr. Carl Johnson used TFT in his trauma
relief work in Kosovo (www.TFTFoundation.org). Similar TFT trauma relief work with
genocide survivors began in Rwanda in 2006. Published studies are cited above.
Project LIGHT: Rwanda. The lead author of this paper, Dr. Leyden began her AMNC
trauma healing work in Rwanda in 2007 using EFT with hundreds of widows and orphan
genocide survivors. After returning each year to conduct train-the-trainer trauma healing
workshops with students at the Remera Mbogo residential High School and Orphan Heads of
Household beneficiaries of local NGOs, she was inspired to develop a new form of a
peacebuilding humanitarian aid program called Project LIGHT: Rwanda.
Her goal was to test the hypothesis that “love and the right resources” can heal anyone
from anything.
In 2011, Dr. Leyden implemented the Project LIGHT pilot program with 12 orphaned
high school graduates of the Remera Mbogo High School. The program used EFT in each of its
five peacebuilding pillars: 1) trauma healing, 2) heart-centered leadership, 3) conflict
transformation, 4) economic sustainability opportunities, and 5) community-building. Eleven of
the 12 Project LIGHT: Rwanda “Ambassadors” achieved significant trauma healing outcomes,
continue to show no signs of PTSD, have become official and unofficial leaders and counselors
in their communities and been sponsored for small businesses and/or enroll in Bachelor and
Master Degree programs.


Newtown Trauma Relief and Resiliency Project. As a result of her work in Rwanda,
Dr. Leyden established the first United States, community-based trauma healing initiative based
on EFT to serve those affected by the Sandy Hook Elementary School shootings. The tragedy
claimed the lives of 28 people including 20 six-year old children in 2012. The entire community
of 29,000 people was affected. The Newtown Trauma Relief and Resiliency Program, sponsored
by The Tapping Solution Foundation successfully served hundreds of parents and families who
lost loved ones, child survivors and their parents, educators, mental health and health care
professionals, first responders and others suffering from PTS symptoms.
Dr. Leyden’s Newtown Trauma Relief and Resiliency Project Brief (NTR&RP, 2013)
was distributed by community leaders to local and state agencies as a model strategy for
community trauma recovery.
TFT Train-The Trainer Initiatives in Rwanda, Uganda, Burundi, Democratic
Republic of Congo, and South Sudan. The work of our TFT colleagues in replicating and
scaling train-the-trainer models with paraprofessionals has been outstanding. Studies of their
success have been outlined in the AMNC literature review. Reverend Celestin Mitabu assists the
Red Cross during commemoration genocide memorials and has trained as many as 10,000
paraprofessionals throughout Rwanda, Democratic Republic of the Congo, Uganda, Burundi, and
South Sudan and has treated and trained over 10,000 persons. As leader of the Rwandan Orphan
Project dedicated to rescuing street children, Reverend Mitabu has been using TFT and training
others to use the technique to treat orphan trauma since 2009.
Father Augustin Nzabonimana, also a trainer and Red Cross assistant has instituted
similar initiatives in the Catholic Diocese of Byumba serving as many as 20,000 trauma
survivors offering a variety of counseling services to disabled children, widows, schools and
more recently, prisoners. They have also worked with other NGO’s like USAID and Catholic
Relief Services to provide trauma relief training for community leaders working with vulnerable
populations, including ministers, police, doctors, nurses, red cross workers, mayors, priests,
nuns, community organizers, teachers, social workers, psychologists, people who head refugee
programs and people who run orphanages.
The TFT Foundation (www.tftfoundation.org) estimates that 40,000 East Africans have
been served by the work of Reverend Mitabu and Father Nzabonimana.
4) Those engaged in peacebuilding initiatives need to heal their own wounds first.
Dr. Leyden and her colleagues strongly agree with WHO recommendations for assuring
the wellbeing of those who serve survivors of natural disaster and extreme violence. In many
case,s those who serve have either been directly affected by PTSD or secondarily traumatized as
caretakers and service providers.
As a mentor for hundreds of mental health care professionals and paraprofessionals, Dr.
Leyden requires her mentees to “put the oxygen mask on themselves first” by healing their own
trauma wounds before and during their service to others. This was Dr. Leyden’s personal focus
in preparing for her work in Rwanda. Subsequently, it became a critical focus for the Project
LIGHT: Rwanda Ambassadors who were eager to serve their loved ones and their communities
but quickly realized the importance of healing their own PTSD first.
Accelerating Healing and Resiliency in Peace-Builders/Healers. Dr. Leyden began
developing her Train-The-Trainer peacebuilder/healer mentoring program in Newtown,
Connecticut, as leader of the Newtown Trauma Relief and Resiliency Project described above.
Over a three-year period she mentored 24 volunteer professionals and paraprofessionals in EFT,


self-care and healing their own deepest traumas so that they could be fully present, resourceful
and effective in implementing EFT protocols in working with those they served.
EFT Train-The-Trainer Mentoring with Rwandan NGOs. Realizing the importance
of replicating and scaling her AMNC based Project LIGHT train-the-trainer model, Dr. Leyden
began mentoring work in January, 2015 with the Rwandan NGO mentioned earlier, CBOPE –
Ihumure. CBOPE’s work is based on the same five pillars as Project LIGHT. After three
mentoring trainings in AMNC protocols, the Ihumure trainers have achieved great competencies
in using these strategies for self-care as well as in accelerating their success in working with
individuals and groups in the Rubavu area.
At the time of this writing, Dr. Leyden has conducted an initial training with NAR staff.
The outcome of the training was successful enough for NAR and Dr. Leyden to begin
discussions on developing a customized trauma healing training and mentoring program for
NAR staff.
The need for AMNC treatment protocols for self-care, PTSD and field implementation is
ever more important in environments like Rwanda where the traumas arise from the worst of
human tragedies. After training with Dr. Leyden, the Newtown volunteers, CBOPE-Ihumure and
NAR staff recognized the importance of healing their own PTSD and being well equipped with
personal and professional skills to enhance their trauma-informed peacebuilding work.
5) Brain-based trauma-informed peacebuilding models should consider including strategies
that can be implemented through existing and new institutions including education, health
and mental health, social justice and other community support systems focusing on
empowering healthy parent-child relationships.
The examples offered above indicate that AMNC Train-The-Trainer models for
professionals and paraprofessionals have been successfully implemented to serve traumatized
individuals via community leaders involved in mental health and health care, social justice,
education, religious organizations and peacebuilding settings.
Of particular promise for transgenerational trauma healing is the AMNC work being
implemented in schools, both in the classroom and with school counselors. AMNC protocols for
a variety of issues including trauma relief, stress management, self-esteem building, test anxiety,
and bullying. In Rwanda this includes the Remera Mbogo High School in the Rulindo District
and schools in the Byumba District. A number of teachers and school counselors in the US have
received training in EFT and successfully implemented these protocols with students. Our
colleague Professor Peta Stapleton of Bond University in Australia is currently leading a major
effort to train teachers to implement EFT in the classroom as well as research the results. Most
amazingly, the Slovenian Ministry of Education is officially offer funding EFT training for all
teachers and educational workers in secondary and primary schools and kindergarten
(www.AAMET.org).
While admittedly unresearched, our observations and results in Newtown working with
parent groups and individual parent-child sessions were particularly promising as a strategy for
healing transgenerational trauma. We observed the relationship between PTS symptoms in
parents and children directly and implemented highly successful PTSD trauma healing protocols
in clinical sessions as well as parent-child self care protocols for the home environment. In a
majority of cases this strategy provided a new way for parents and children to bond more
effectively and improved parent-child relationships overall.


Conclusion
Much more research is needed but there are strong indications that transgenerational
trauma inheritance exists, requires large-scale treatment and prevention strategies and can be
mediated for individuals and communities by integrating AMNC protocols into existing and new
peacebuilding models.


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