Article: Effectiveness of “healing the child within” techniques for well-being, anxiety, and depression. Trivedi G. & R, et al. Is. 34

Effectiveness of “healing the child within” techniques for well-being, anxiety, and depression

Riri G Trivedi, Gunjan Y Trivedi, Neha Pandya, Hemalatha Ramani Society for Energy & Emotions, Wellness Space,
Ahmedabad, India.

Abstract— Adverse childhood experiences (ACE), based on data from more than 0.25 million subjects, were found to be linked to an increased risk for adult anxiety and depression, as well as mental health issues. ACEs were observed to leave a lasting imprint on the minds and bodies of individuals. The methodology known as Healing the Child Within, involving regression to specific ACE events to address the mind-body imprint, is explored. By addressing these imprints, the study aimed to reduce anxiety and depression and, thus, overall well-being.

Keywords: Healing the Child Within, Adverse Childhood Experiences, Post-Traumatic Stress Disorder, Inner Child Integration Therapy, Childhood Trauma.

Aim: The study’s objective was to evaluate the effectiveness of Healing the Child Within methods on the well-being of individuals. 56 subjects were recruited and assessed after four sessions (excluding initial consultation). Approximately 28 continued through 4 more sessions (i.e., 8). The hypothesis was that the “Healing the Child Within” intervention would result in increased well-being, decreased anxiety and depression, and improved sleep quality.

Methodology: The methodology involved assessments during the initial consultation to draw a (1) timeline based on the ACEs experienced (2) to capture mental health parameters (anxiety using GAD-7, depression using MDI, well-being using WHO-5 well-being index, and sleep quality using Insomnia Severity Index or ISI). These assessments were repeated after 4 and 8 sessions.

The intervention included (a) safe space anchoring, (b) emotional bridges to regress to specific events, (c) processing the events, and finally, (d) integration and future pacing. The results included before and after assessments and documentation of the implications for therapists.

Introduction

Mental health is a pressing challenge in India, with one out of seven individuals needing help and only 1% of India’s healthcare budget allocated to mental health (Trivedi et al., 2021). Unfortunately, India has the highest per capita suicide rate in Asia and the rest of the world (Trivedi et al., 2021). Also, mental health and substance abuse-related suicides globally contributed to about 62% of the DALY (Disability-Adjusted Life Years) (Ferrari et al., 2014). From 1990 to 2017, the contribution of mental disorders to the total disease burden in India has doubled, and the contribution of mental disorders in DALY has increased from 2.5 to 4.7%.

With a limited central budget allocation and a lack of research on mental health in India, it is a catastrophe waiting to happen. Public health strategies are required to identify, prevent, and diminish the causes of mental health disorders. Therapists suggest that many adult challenges involving trust, intimacy, co-dependency, and addictive and compulsive behaviours may be traced back to a wounded inner child. Therefore, delving into and examining the inner child concept becomes crucial.

What is an “Inner Child?”

The “inner child” is a term adopted from a concept introduced by Eric Berne, where the child’s ego state has been enriched to become the “Inner Child” (Berne, 1961; Sjöblom et al., 2016). Kohut described the inner child in connection with the pains and strains of not being acknowledged (Kohut, 2009).

In other words, the concept of the “inner child” phenomena (a psychosynthesis of all ages from childhood to old age) continues to impact human being’s overall expressions of themselves in the world (Sjöblom et al., 2016; Trivedi et al., 2021). Bradshaw described the metaphor of the inner child as “There’s a compassion that comes when you look at a child” (Bradshaw, 2005). The idea of my grown-up self, taking care of and nurturing the wounded little boy in me who didn’t have a father and went through a lot of pain and fear and emptiness and loneliness, has been enormously helpful. I think there is a child in all of us.

What forms an Inner Child? (Adverse Childhood Experiences):

Catastrophic Inner Child events, termed as Adverse Childhood Experiences, are traumatic events that occur during childhood (Ages 3 to 18) and include abuse, neglect and household categories (Felitti et al., 1998). ACE is associated with obesity, diabetes, inflammatory bowel disease (e.g., ulcerative colitis, Crohn disease), and abnormal pain perception with or without the related body pathology (Herzog & Schmahl, 2018). Traumatic events within a child’s immediate environment impact the child’s development. Recent studies on ACEs have shown increased health and disability diagnoses associated with higher ACE scores (Hughes et al., 2022; Oh et al., 2018). Data from over 0.25 million individuals across developed and developing countries indicate that Adverse Childhood Experiences (ACE) such as neglect, abuse, household challenges, peer isolation/victimization, and community or household violence have long-term implications on mental health and physical health.  Increased ACE exposure has a dose-response influence on adults’ (1) mental health issues such as depression & anxiety, PTSD, borderline personality disorder and substance dependence, and (2) physical health issues such as obesity, diabetes, inflammatory bowel disease (e.g. ulcerative colitis, Crohn’s disease), and abnormal pain perception with or without related body pathology (G. Y. Trivedi et al., 2021).

Impact of ACE on Mental Health Parameters

Adverse childhood experiences (ACEs) are known to be closely related to depression, anxiety, and sleep problems (Park et al., 2021). Results of a systematic review showed that exposure to ACEs, including household dysfunction, was associated with a higher risk of depression (ORs ranged from 1.34 to 3.17). The number of ACEs was a nonlinear predictor of depression (Tan & Mao, 2023). ACEs are negatively associated with general and overarching health concepts, such as quality of life (QoL) and well-being (Vederhus et al., 2021).

Given the impact of ACE on mental health, it becomes important to work on those negative experiences to improve the results of psychotherapy. Various therapeutic interventions can be used to work on those experiences, inner child healing, the child within being one of them.

What is Healing the Child Within (Inner Child)?

Several experts have provided perspectives on the “Inner child” and highlighted the importance of “Healing the child within” using inner-child integration therapy. According to Assagioli, the inner child is a psychosynthesis of all ages, transitioning from childhood to old age. Each developmental age is not left behind but forms one small part of our lives. In addition, Assagioli holds that the psychosynthesis of the ages can be achieved by keeping the best aspect of each age alive (Assagioli, 1973). According to inner child therapists, individuals have an internal, emotional child-like state, or states, that harbours any unprocessed pain, neglect, or other harm related to trauma or dysfunction from their childhood (Smith, 2017).

While there is existing literature on the impact of childhood trauma on mental health and well-being, there is limited research on how to address the impact of childhood trauma on the adults. The current study aims to address this gap identified in the literature review. Specifically, the proposed research addresses the gaps in mental health care in India by investigating the effectiveness of “Healing the Child Within” techniques (also known as inner child integration techniques or inner child integration therapy). The study is based on acknowledging the widespread occurrence of mental health challenges, the influence of Adverse Childhood Experiences (ACEs), and the therapeutic possibilities associated with addressing the inner child. By assessing the impact on well-being, anxiety, and depression, the research seeks to contribute valuable knowledge to the field of mental health interventions, potentially offering new avenues for improving mental health outcomes in India.

Aim & Hypotheses.

The study’s objective was to evaluate the effectiveness of 4 and 8 sessions’ (post-initial consulting) of Healing the Child Within methods on the well-being of the individuals. 56 subjects were recruited and assessed after four sessions (excluding initial consultation). About 28 continued through 4 more sessions (i.e., 8).

The hypotheses are to Evaluate the effectiveness of Healing the Child Within intervention’s impact on well-being, anxiety, depression and sleep quality.

 

Methodology:

The methodology is shown in Figure 1 and described in further detail below:

 

 

Figure 1 Methodology & measurements

 

Study design and participants:

Participants were recruited through social media and word-of-mouth, adhering to the standard payment procedure for consultations followed by therapeutic interventions. The consultation served as the foundation for establishing selection criteria. Every participant signed an informed consent, and the data collection procedures were outlined in the Institutional Ethics Committee (IEC Ref No ECR/274/Inst/GJ/2013/RR-19, dated 27/10/2020) for approval.

 

Table 1 – The quantitative assessments for ACE and mental health

Measurement area Type of measure Examples (ease of use) Outcome, benefits
ACE16 Binary form

 

Covers adverse childhood experiences from age 3 to 18 Core categories of Abuse, Neglect, Household experiences, and others (such as peer violence/bullying) See the clickable link above. (Felitti et al., 1998; Trivedi et al., 2021, 2023)
Overall Well-being Well-being measurement WHO-5 Well-being Index Applicable to everyone, easy to compare before/after and across subjects and groups (demographics). It takes only a few minutes to administer and demonstrate use across medical problems, emotional problems, psychiatric issues, pain, etc. Evidence confirms it can screen for depression (Trivedi, 2019).
Depression Major Depression Inventory MDI for depression

 

The MDI is a conservative instrument for diagnosing ICD-10 depression in a clinical setting compared to the M-CIDI interview (Konstantinidis et al., 2011; Nielsen et al., 2017)
Generalized Anxiety Disorder GAD-7 A well-documented and simple instrument used across several mental health areas The GAD scale effectively evidence clinically significant anxiety symptoms and can help differentiate between mild and moderate anxiety in adolescents as per the evidence (Mossman et al., 2017)
Sleep Quality Insomnia Severity Index

(ISI)

The Insomnia Severity Index is a very simple and useful tool ISI has been used across several studies and provides valuable idea about sleep quality (or challenges) sleep (Trivedi et al., n.d.)

 

Assessment of Adverse Childhood Experiences:

Before the consultation, each subject received a self-assessment ACE form filled out online. During the consultation, a detailed timeline was made covering each ACE score, and as needed, based on client confirmation, the relevant ACE score was revised. The detailed ACE binary questionnaire included sixteen questions; the first ten questions were from the original ACE (Felitti et al., 1998), and an additional five questions were based on insights from subsequent research (Trivedi et al., 2021, 2023). The final question was added based on our practical experience in India, where parental separation is less prevalent. Typically, parents stay together, continuing the physical and verbal violence in the family environment where the child is growing up.

To ensure the quality of the data, the individual first completed the online ACE self-assessment, which was then validated and revised (as needed) after the consultation with two experienced therapists (including a psychologist). The consultation also gathered qualitative information such as events connected with each ACE element on the timeline, the individual’s emotions based on their interpretation of what happened because of the event, and their internalization. The observations also noted the interconnectedness of several events leading to trauma and their intertwined impact on several ACE elements.

The intervention and measurements:

Measurements were done based on Figure 1. The focus was on current life events as highlighted, mainly (but not limited to) the ACE form filled out by the client and revised based on the initial consultation. Detailed notes included a review of each ACE exposure and the entire timeline, specifically focusing on events between ages 3 and 18. Several details of the assessment are highlighted below.

  1. Fifty-six individuals were enrolled in the study.
  2. Inclusion criteria: Healthy individuals with or without psychiatric medications between ages 18 and 60. Individuals with chronic diseases were also included.
  3. Exclusion criteria: Individuals with chronic disease complications (recent myocardial infarction or hospitalization within the past one month). Individuals with complex PTSD.
  4. All 56 individuals underwent at least 4 sessions of the therapeutic intervention highlighted earlier. Out of these, 28 individuals continued through 4 more sessions.
  5. The sessions were conducted both online and offline. The scores were collected using (mostly) online assessment, utilizing the existing Google Form-based technology platform at the Society for Energy & Emotions.
  6. To minimize the impact of the therapist, at least three different therapists worked on the 56 subjects.

The intervention method (Inner Child integration or Healing the Child Within methodology) steps are highlighted below:

  1. Client interview and problem identification (includes preparation of the timeline and identification of all the ACE events on the timeline)
  2. Anchoring safe space with positive emotion
  3. Regression and processing
  4. Transformation (release from the body, reframe in mind, based on the Release Reframe Methodology developed by the Society for Energy & Emotions, Wellness Space)
  5. Integration and closure
  6. Measurability and follow-up.

 

Analysis:

The data was analysed and presented based on the before-after Student’s t-test assessment along with descriptive statistics. The outcome included a case summary of 5 cases with individual quantitative data and qualitative details – including a high-level summary by session. This provided a framework for budding therapists and could help in reapplication.

 

Results

The demographics of the participants are highlighted in the table below. Their ACE score is also indicated in the table highlighting the average number of childhood adversities experiences (out of 16 binary outcomes).

Table 2– Demographics

Male Female Total
Count 07 49 56
% 12.50% 87.50% 100.00%
Average ACE score 6.14 6.76

 

The outcomes of the intervention are shown in Table 3. It indicates average scores of several measures before and after the intervention (after 4 and after 8 sessions). The statistical significance (p<.05) is also highlighted.

Table 3 – Changes in well-being, anxiety & depression,
and insomnia severity scores

Measure Scores Before (N=56) Scores After 4 sessions (N=56)* Scores After 8 sessions (N=28)**
Well-being (>52 is good) 35.1 48.6 56.6
Anxiety (<=9 is desired) 12.3 8.1 6.3
Depression (<=19 is acceptable) 28.4 19.3 13.4
Insomnia severity (<=9 is desired) 11.0 8.8 6.7

*p<.05 based on paired samples t-test (Before vs After 4 scores)
** p<.05 based on paired samples t-test (After 4 vs After 8 scores)

 

The findings highlight a statistically significant improvement across all parameters (p<.05). The improvement in well-being is noteworthy, evidenced by an increase in average from 35.1 to 56.6 after 8 sessions. The data is statistically significant and establishes the scores beyond the threshold of good well-being (52). Anxiety scores decreased from 12.3 to 6.3 after 8 sessions, falling within the desired range. Depression scores decreased from 28.4 to 13.4 after 8 sessions. Finally, insomnia severity scores decreased from 11.0 to 6.7 after 8 sessions, reflecting improved sleep quality. All the changes in all parameters, when compared after (4 and 8 sessions) with the scores at the beginning, show statistically significant improvement.

 

Discussion and limitations

Our study investigated the impact of “Healing the Child within” (or inner child integration) intervention on participants’ well-being, anxiety, depression, and insomnia severity scores. The results (Table 2) confirm the effectiveness of the Healing the Child Within technique for individuals who were assessed for the presence of childhood trauma based on ACE assessment. These findings suggest that the intervention effectively improves the participants’ mental health based on a comprehensive evaluation of several parameters. Moreover, the data show that the positive effects tend to be more pronounced with a longer duration of the intervention, as seen in the comparison of parameters after four and eight sessions.

Healing the Child within methodology identified the key childhood trauma events (i.e. the inner child components). It focused on the events with the most significant emotional pain first. The approach is similar to identifying the index trauma (Priebe et al., 2018). The evidence indicates that severity scores for trauma assessments are significantly higher when the index trauma process identifies several distinct traumatic events compared to defining index trauma as single worst incident (Trivedi et al., 2023). Identifying ACE events and highlighting few key events clusters may have contributed to more effective outcomes in the study.

Overall, these results support the effectiveness of the “Healing the Child Within” intervention in improving well-being and reducing symptoms of anxiety, depression, and insomnia. Future research could delve into specific reasons behind this improvement and assess the sustainability of these interventions.

There are several limitations of the study. Specifically, having a control group that did not go through any intervention could help enhance the credibility of the findings. While this was not explicitly part of the study, data confirms that the impact of ACEs on the individual does not reduce with time (Chapman et al., 2004; Dube et al., 2001). Moreover, the study is applicable in an urban Indian, English-speaking population. Hence, its interpretation should be limited to a similar setup, i.e., psychologists, psychotherapists, or psychiatrists in urban Indian settings. The research assessed childhood trauma exposure (ACE scores). However, it would be worth exploring if there is a difference in the outcomes for individuals exposed to high vs medium vs low trauma components.

Future work should add a control group, identify exposure to different categories (at least low vs high) of childhood trauma and understand the changes or variations in the results of such groups.

Finally, the work should expand beyond India’s urban settings to get a more integrated understanding of the intervention.

 

Conclusion

The study on the effectiveness of “Healing the Child Within” techniques for well-being, anxiety, and depression holds promise in addressing the long-term impact of Adverse Childhood Experiences (ACEs) on individuals. By utilizing regression (release reframe methodology) to identify and address the impact of specific ACE events, this research demonstrates a potential avenue for reducing anxiety and depression while enhancing overall well-being. Moving forward, continued research in this field may shed more light on the efficacy of inner child healing techniques and their applicability in addressing not only anxiety and depression but also complex issues such as Post-Traumatic Stress Disorder (PTSD).

 

Disclosure:

This work was partly funded by the Earth Association of Regression Therapists (EARTh) in year 2022.

 

References:

Assagioli, R. (1973). The conflict between the generations and the psychosynthesis of the human ages (Vol. 31). Psychosynthesis          Research Foundation New York.   http://www.synthesiscenter.org/PDF/0131.pdf

Berne, E. (1961). Transactional analysis in psychotherapy grove press. New York.

Bradshaw, J. (2005). Healing the shame that binds you: Recovery classics edition. Health Communications, Inc.               https://books.google.com/books?hl=en&lr=&id=eWijAgAAQBAJ&oi=fnd&pg=PR1&dq=+Bradshaw+J:+Healing+the+Shame+That+Bind      s+You.+Deerfield+Beach,+FL,+Health+Communications,+2005&ots=DYESMA7slV&sig=f7DSB-sDYod-KnMVOPHxMtShmGw

Chapman, D. P., Whitfield, C. L., Felitti, V. J., Dube, S. R., Edwards, V. J., & Anda, R. F. (2004). Adverse childhood experiences and the risk of               depressive disorders in adulthood. Journal of Affective Disorders, 82(2), 217–225.

Dube, S. R., Anda, R. F., Felitti, V. J., Chapman, D. P., Williamson, D. F., & Giles, W. H. (2001). Childhood abuse, household dysfunction, and the          risk of attempted suicide throughout the life span: Findings from the     Adverse Childhood Experiences Study. JAMA, 286(24), 3089–       3096.

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of           childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258.  https://doi.org/10.1016/s0749-3797(98)00017-8

Ferrari, A. J., Norman, R. E., Freedman, G., Baxter, A. J., Pirkis, J. E., Harris, M. G., Page, A., Carnahan, E., Degenhardt, L., Vos, T., & Whiteford, H.   A. (2014). The burden attributable to mental and substance use disorders as risk factors for suicide: Findings from the Global Burden        of Disease Study 2010. PloS One, 9(4), e91936. https://doi.org/10.1371/journal.pone.0091936

Herzog, J. I., & Schmahl, C. (2018). Adverse Childhood Experiences and the Consequences on Neurobiological, Psychosocial, and Somatic Conditions Across the Lifespan. Frontiers in Psychiatry, 9, 420. https://doi.org/10.3389/fpsyt.2018.00420

Hughes, P. M., Ostrout, T. L., Pèrez Jolles, M., & Thomas, K. C. (2022). Adverse Childhood Experiences Across Birth Generation and    LGBTQ+ Identity, Behavioral Risk Factor Surveillance System, 2019.  American Journal of Public Health, 112(4), 662–670.             https://doi.org/10.2105/AJPH.2021.306642

Kneisl, C. R. (1991). Healing the wounded, neglected inner child of the past. The Nursing Clinics of North America, 26(3), 745–755.

Kohut, H. (2009). How does analysis cure? University of Chicago Press. https://books.google.com/books?hl=en&lr=&id=h5UkCgAAQBAJ&      oi=fnd&pg=PR7&dq=How+does+analysis+cure%3F+&ots=fjBpDCTmuP&sig=edh2gjCg2pMKoHaXE3TIagSJO0A

Konstantinidis, A., Martiny, K., Bech, P., & Kasper, S. (2011). A comparison of the Major Depression Inventory (MDI) and the Beck       Depression Inventory (BDI) in severely depressed patients. International Journal of Psychiatry in Clinical Practice, 15(1), 56–61.       https://doi.org/10.3109/13651501.2010.507870

Mossman, S. A., Luft, M. J., Schroeder, H. K., Varney, S. T., Fleck, D. E., Barzman, D. H., Gilman, R., DelBello, M. P., & Strawn, J. R. (2017). The   Generalized Anxiety Disorder 7-item scale in adolescents with generalized anxiety disorder: Signal detection and validation. Annals of Clinical Psychiatry: Official Journal of the American Academy of Clinical Psychiatrists, 29(4), 227-234A.

Nielsen, M. G., Ørnbøl, E., Bech, P., Vestergaard, M., & Christensen, K. S. (2017). The criterion validity of the web-based Major Depression Inventory when used on clinical suspicion of depression in primary care. Clinical Epidemiology, 9, 355–365.       https://doi.org/10.2147/CLEP.S132913

Oh, D. L., Jerman, P., Boparai, S. K. P., Koita, K., Briner, S., Bucci, M., &  Harris, N. B. (2018). Review of tools for measuring exposure to       adversity in children and adolescents. Journal of Pediatric Health Care, 32(6), 564–583.

Park, E.-J., Kim, S.-Y., Kim, Y., Sung, D., Kim, B., Hyun, Y., Jung, K.-I., Lee,   S.-Y., Kim, H., & Park, S. (2021). The relationship between adverse       childhood experiences and sleep problems among adolescent students: Mediation by depression or anxiety. International Journal        of Environmental Research and Public Health, 18(1), 236.

Priebe, K., Kleindienst, N., Schmahl, C., & Bohus, M. (2018). Defining the index trauma in post-traumatic stress disorder patients with              multiple trauma exposure.

Sjöblom, M., Öhrling, K., Prellwitz, M., & Kostenius, C. (2016). Health throughout the lifespan: The phenomenon of the inner child reflected in events during childhood experienced by older persons.  International Journal of Qualitative Studies on Health and Well-Being, 11(1), 31486. https://doi.org/10.3402/qhw.v11.31486

Smith, J. (2017). Working with the Inner Child. In J. Smith, Psychotherapy (pp. 141–151). Springer International Publishing.          https://doi.org/10.1007/978-3-319-49460-9_12

Tan, M., & Mao, P. (2023). Type and dose-response effect of adverse  childhood experiences in predicting depression: A systematic review       and meta-analysis. Child Abuse & Neglect, 139, 106091.

Trivedi, G. Y. (2019). Importance of Screening for Wellbeing in Diabetes Management. System, 15, 17.

Trivedi, G. Y., Pillai, N., & Trivedi, R. G. (2021). Adverse Childhood Experiences & mental health – the urgent need for public health         intervention in India. Journal of Preventive Medicine and Hygiene,  62(3), E728–E728. https://doi.org/10.15167/2421-  4248/jpmh2021.62.3.1785

Trivedi, G. Y., Ramani, H., Trivedi, R. G., Kumar, A., & Kathirvel, S. (2023). A pilot study to understand the presence of ACE in adults with post-   traumatic stress disorders at a well-being centre in India.  European Journal of Trauma & Dissociation, 7(4), 100355.  https://doi.org/10.1016/j.ejtd.2023.100355

Trivedi, G. Y., Saboo, B., & Hasnani, D. (n.d.). Clinical Importance of Screening for Sleep Disorders for Chronic Disease.

Vederhus, J.-K., Timko, C., & Haugland, S. H. (2021). Adverse childhood experiences and impact on quality of life in adulthood: Development    and validation of a short difficult childhood questionnaire in a large population-based health survey. Quality of Life Research, 30, 1769– 1778.

Useful information for this article