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Trauma-focused therapy, trauma-informed care, or trauma therapy is a form of psychotherapy (talk therapy) designed to manage the impact of traumatic events on people’s lives. Trauma therapy helps people process traumatic events and the lasting experience of trauma that may follow those events.
A traumatic event is any event in a person’s life that they experience as life-threatening, abusive, frightening, or dangerous. A person can also be traumatized from witnessing traumatic events. These events may permanently impact a person’s psychological and emotional functioning.
This article discusses the types and benefits of trauma therapy.
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What Is Trauma Therapy?
Trauma therapy focuses on helping people with a past experience of trauma or a diagnosis of post-traumatic stress disorder (PTSD) manage their traumatic experiences.
Typically, a trauma therapist has additional training in trauma and will use skills and strategies that are designed to help people overcome the effects of traumatic events without re-traumatizing.
When Is It Time to See a Trauma Therapist?
When trauma disrupts your daily life and functioning, it may be time to seek the expertise of a trauma-informed therapist. A skilled trauma therapist may be beneficial if you are experiencing:
- Repeated flashbacks
- Insomnia or trouble sleeping
- Frequent nightmares
- Isolation or other symptoms that indicate trauma is impacting your daily life
What Trauma Therapy Can Help With
People seek trauma therapy for any number of different issues. Some of the reasons people might need trauma-informed therapy include:
When Trauma Becomes PTSD
It’s important to note that trauma does not always lead to a diagnosis of PTSD. When anyone experiences a traumatic event, this sets off emotional, physical, and brain-based responses. If this continues beyond a month timespan, and you experience flashbacks, nightmares, or any symptoms that are causing significant distress or dysfunction, see a healthcare provider about PTSD. A diagnosis of PTSD often occurs when people have experienced chronic trauma, such as first responders, or who have a past history of trauma.
Types of Trauma Therapy Treatments
There are many types of trauma therapy treatments. Evidence-based treatments have research evidence supporting their effectiveness. The following are a few of the main types of evidence-based treatments.
Prolonged Exposure (PE)
Prolonged exposure (PE) is a treatment in which a person is gradually exposed to their trauma-related memories, fears, emotions, and feelings about the event(s) to learn that these are no longer dangerous or need to be avoided. Patients typically meet with a therapist once a week for three to four months.
PE is strongly recommended by the American Psychological Association as a first-line intervention for PTSD. In one study, 71% of participants experienced a decrease in PTSD symptoms with PE treatment.
Cognitive Processing Therapy (CPT)
Cognitive processing therapy (CPT) is a trauma-focused therapy designed to treat PTSD. It helps patients challenge and modify unhelpful beliefs related to the trauma. Writing a detailed account of the traumatic event allows patients to re-conceptualize the event to reduce its impact on one’s current life.
Patients typically meet with a therapist for about 12 sessions. CPT is considered a first-line intervention for PTSD and is strongly recommended by the APA.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) focuses on thoughts, feelings, and behaviors, and the relationship between them. A trauma-focused therapist might help a client understand how they are thinking about their trauma and how to shift it into more helpful thinking.
CBT usually takes 12 to 16 sessions. This treatment is strongly recommended by the APA for the treatment of PTSD.
There is also trauma-focused cognitive behavioral therapy, or TF-CBT, which is also evidence-based. It’s designed for children and adolescents but includes their caregivers as part of the therapy.
Eye Movement Desensitization and Reprocessing
Eye movement desensitization and reprocessing (EMDR) was developed as a treatment for PTSD. It involves processing the memory and the way it is stored in the brain, which reduces problematic triggers and symptoms.
During this therapy, rhythmic eye movements are combined with focus on memories of the trauma. EMDR usually involves six to 12 weekly or twice-weekly sessions.
Narrative Exposure Therapy (NET)
Narrative exposure therapy (NET) focuses on the stories people tell themselves about their lives, which impacts their well-being and how they view themselves.
With the help of a therapist who is actively listening, offering connection and positive feedback, the patient creates a chronological narrative of their life, including both traumatic experiences and positive experiences. This helps reframe how they perceive their life and memories overall.
Treatments That May Also Help Trauma
There are some complementary and alternative treatments that may also be helpful for people with trauma:
- Somatic therapy: This is a body-centered therapy designed to heal trauma stored in the body and help with stress disorders.
- Acupuncture: Part of traditional Chinese medicine, acupuncture with a trained practitioner is designed to restore balance within the body’s systems.
- Clinical hypnosis: Under the care of a clinically-trained provider, hypnotherapy allows trauma survivors to process trauma in a controlled way.
- Mindfulness-based cognitive therapy (MBCT): MBCT incorporates cognitive therapies with the concepts of mindfulness meditation.
Trauma and the Mind-Body Connection
Trauma is not just experienced emotionally but in the body as well. During a traumatic event, the mind and body become activated. For some people, after the threat has passed, the mind and body will return to normal. For others, hyperarousal and hyperreactivity remain and become chronic. The chronic stress response can dysregulate the stress system in the body, causing stress-related physical conditions to develop, such as chronic fatigue, fibromyalgia, and high blood pressure.
Benefits of Trauma Therapy
Traumatic experiences can impact a person’s life and relationships, as well as cause difficulties at work, school, and in social settings. Trauma therapy can improve quality of life.
Although it can be challenging to face those difficult events, with support and psychotherapy, symptoms can lessen over time.
Some other benefits of trauma therapy include:
- Learn coping skills to handle distorted or negative thoughts and feelings
- Reframe the traumatic experience and make some sense of it
- Improve close relationships and connections with people
- Reduce irritability, anger, frustration, and increase peace of mind
- Eliminate or reduce triggers and symptoms of PTSD
How Effective Is Trauma Therapy?
In a 2018 study, PE, CPT, and CBT were found to be highly effective.
The study found that 30% to 97% of PTSD patients treated with CPT no longer met the diagnostic criteria. For PE, rates of patients who no longer met the criteria ranged from 41% to 95%. For CBT, it was 61% to 82.4%.
Help Is Available
If you or a loved one is struggling with trauma, you can contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline online or call 1-800-662-4357 for more information on how to find support and treatment options specific to your geographic area.
Trauma-informed therapy helps people overcome the effects of traumatic events. It can be especially beneficial for people with post-traumatic stress disorder (PTSD). There are several types of evidence-based trauma therapies and treatments that can improve a person’s quality of life.
A Word From Verywell
Trauma is a significant health issue. It’s important to acknowledge your own traumatic experiences so you can get the help you need to process your trauma. You can start by finding a therapist who specializes in trauma that you feel comfortable connecting with.
Frequently Asked Questions
How does trauma affect the brain?
When a person experiences trauma, it triggers heightened activity in the part of the brain known as the amygdala. This is involved in the regulation of emotions and memory processing. One study indicated the amygdala may be slow to recover from high-intensity trauma, so people may have heightened reactions to everyday stimuli. The findings in the study suggest that there may be long-term effects in the brain from trauma exposure, even in people who seem to recover and don’t develop PTSD.
What’s the best way to process trauma?
There are effective ways to process trauma. Researchers and clinicians have found these suggestions can help:
- Seeking emotional support from family, friends, and mental health professionals
- Processing your feelings about traumatic events
- Prioritizing self-care and doing things you enjoy
- Being patient with yourself
Why is trauma therapy so difficult?
Trauma therapy can be challenging. However, living with unprocessed trauma can be very emotionally debilitating. At first, looking into past traumatic experiences can cause symptoms of trauma to surface. One study found that those who experienced an increase in symptoms experienced significant improvement by the end of treatment.
What other methods are there for overcoming trauma?
The treatment methods most highly recommended by professionals include trauma therapy and medication. Other methods of coping include engaging with art and music, relaxation, yoga, journaling, mindfulness meditation, and spending time in nature.
When you’ve experienced trauma, it can be excruciating. You may feel at a loss as to how to process what you’ve been through or how you can even start to heal. You just want to experience a sense of safety again. But the impact of trauma can cut deep, especially when it causes emotional or psychological harm. Even if you feel lost, there’s hope and a variety of trauma treatment programs and support groups available that can help you.
In this article, we will review the best trauma treatment programs available for you and how you can find a treatment center, online therapist to treat your trauma, or a trauma therapist near you. Therapy can help you overcome your trauma. Many people who experience repeated trauma develop PTSD, and PTSD counseling can help you overcome the condition.
How Trauma Affects The Brain
There are many reasons that trauma hurts us and causes post-traumatic stress. One thing you may not know is that trauma physically changes our brains. According to trauma therapists, when you experience a traumatic event, your mind changes. Areas of trauma survivors’ brains that once worked in a particular way change based on hyperarousal due to trauma.
For example, the amygdala gets over-activated after a traumatic experience. When you hear the phrase “fight, flight or freeze” that’s when you have a physical and emotional response to a trigger. You remember your trauma, and your amygdala becomes overactive. You’re hypervigilant, and you’re on alert, making sure that you’re safe from danger. Your trauma is real, and your brain is telling you that you’re hurting and need help. Mental health disorders, personality changes, and other symptoms can develop as a result.
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Getting Help For Trauma: Trauma Therapy
It’s essential to find a trauma related treatment center that can help you after you’ve experienced at least one trauma. You need to talk about your pain and start to process what happened to you. This may sound scary, but think of it as an empowering statement. You truly have the ability to process past events, address memories, and live an empowering, fulfilled life. One of the best ways to do this processing is to find a therapist who is skilled at helping people who have been through trauma. There are many kinds of therapy, but trauma focused therapy is explicitly focused on helping people who have had unfortunate things happen to them. Remember you didn’t bring upon psychological harm, any mental health disorders, personality changes or anything else upon yourself. But you can take steps to heal from a traumatic experience with the support of a trauma therapist who can help you identify unhealthy behavior patterns. You can either find a treatment center and trauma therapist in your local area or seek the help of an online trauma therapist.
What Is Trauma Therapy?
It is important that you find a psychiatrist and trauma focused treatments that can address your needs and different conditions. Treating trauma and be difficult, especially when it impacts things such as mood, sleep, or pushes you towards substance abuse as a coping mechanism. One treatment of trauma includes trauma focused therapy. This is a type of mental health treatment adopted by a trauma-informed therapist to assist affected individuals to deal with their traumatic condition. What is a traumatic event? It basically refers to an event perceived by an individual as a threat to sanity, the integrity of the body, and life. Trauma and traumatic events are two different things. Learn more information about the difference between the two is incredibly important, and studies have been done to understand the risk associated with experiencing trauma in addition to the study of traumatic events.
It’s pertinent to know that trauma-focused therapy can’t be regarded as a specific treatment type– for example, each person experiences trauma related beliefs differently. There are different therapy types. Sometimes, a therapist may decide to use a type alone or combine different types purposely for effective treatment of psychological trauma. For example, if the therapist specializes in childhood trauma, they may preform a child trauma assessment to understand the best course of treatment. As a therapist, it’s always essential to know the best treatment therapy type that can potentially handle a patient’s traumatic condition.
What Are The Benefits And Goals Of Trauma Informed Therapy?
There is always a need to prepare your mind that trauma therapy is beneficial, even before you begin your therapy sessions. Learning more information about these services and what counseling entails before stepping into an office can help preserve relationships with trauma counselors. Social workers, psychologists, and psychiatrists can all help you with talking through intrusive thoughts, avoidance coping, or even group therapy for various medications or a specific disorder.
It is important to be aware of your trauma, what your triggers are, and in what way do your react. It is also important to know what your goal in therapy will be? Is it to tell your story? To create awareness? To be at peace? To confront your abuser, or some other reason not listed? Realizing these factors will help you realize what problem you want to address, and what might lack from your current treatment. Talk therapy and CBT can help you with a rang of fears, safety, shame, tips, and different environment and education factors at play.
The following are some of the basic goals of trauma therapy:
- To successfully handle the reality of the traumatic event that occurred in the past ( it prevents it from getting a hold on you).
- To eliminate or ameliorate the symptoms of trauma
- To change the focus of the past event to the present
- To boost day to day functioning
- Getting people to know about hereditary trauma
- Helping individuals regain their “personal power”
- Helping individuals getting over addictions caused by traumatic stress
- To equip individuals with skills to help prevent deterioration or relapse
There is nothing bad about developing feasible goals for yourself with respect to what you’ve experienced over time– whether working through flashbacks, post-traumatic stress disorder, guilt, difficult emotions, fear, or another trauma response, trauma therapy aims to use psychotherapy to effectively treat these responses and help make sense of the information given.
Your therapist will work with you to determine the method that works best for you – your therapist will never do anything that you’re uncomfortable with. When it comes to online therapy, both research and personal stories show us that online therapy can play a powerful role in helping people heal from trauma. Psychotherapy interventions are an opportunity to get on the same page, receive feedback, and talk to clinicians about medications and their effectiveness and purposes. For trauma survivors, any difficulties with neglect or mental health issues can be worked through with a practitioner.
BetterHelp Wants You To Process Your Trauma And Heal
The online counselors at BetterHelp care about what you’ve been through in your life. They want to help you process your trauma and begin to heal. There is no timeline on mental health. Your online counselor will be patient with your healing process. They want to support you as you talk through your trauma, learn about yourself, accept what happened to you, and begin to move forward with their help. Read below for some reviews of BetterHelp counselors.
“Natalie has efficiently and effectively helped me through some pretty tough times. She is very patient, sweet, understanding, and knowledgeable and I would definitely recommend her to anyone on BetterHelp. I also really liked that her appointment schedule was very flexible for those of us who work long days.”
How To Get Started
If you or a loved one is dealing with trauma and PTSD, it’s crucial to find a therapist and start a trauma treatment process as soon as possible. Because the symptoms of traumatic stress can lead to secondary problems, the sooner you find a psychiatrist who has experience working with trauma and PTSD, the fewer challenges you’ll have to overcome. Make a commitment to finding a trauma therapist you can work with and stick with your trauma focused therapy as long as it’s needed. You can get through this, and you don’t have to do it alone.
Frequently Asked Questions (FAQs)
What is the best therapy for trauma?
Many different kinds of therapy treat trauma. One common modality is EMDR, which stands for Eye Movement Desensitization and Reprocessing. This form of treatment is when a trauma therapist helps a client think of a painful memory and work through it using eye movements. There’s also trauma-focused therapy where a therapist is a specialist in trauma and can help a client heal because of their expertise in trauma. Out of the many kinds of therapy that help people with trauma, EMDR is one of the most effective. It helps people process trauma by desensitizing them to their painful memories. If you experience real trauma and want to work on new coping strategies, you may want to find a therapist find a support group find someone who is experienced to work with trauma issues and offers focused treatments like EDMR. There are also other types of therapy that you may be able to benefit from, which could help you change your thoughts and behaviors.
What is trauma therapy?
There are different types of trauma therapy, and what works for each person will differ depending on who they are and the professional medical advice they’re given. Some kinds of therapy are more frequently used for children, and there are some forms of therapy that focus on adults. Children exposed to trauma should see a trauma therapist as soon as possible. You can find a therapist by searching online or asking your doctor for advice. It is imperative that anyone get benefits of trauma focused therapy whenever they need it.
Trauma therapy that is specifically for adults would be something like EMDR, where a person works with a specialized therapist and talks about the trauma they’ve experienced so that they can heal from it, and eliminate their stress symptoms. The techniques used in trauma therapy for adults are different than those that would be used on children. Very young kids might go to play therapy, which provides focused treatments, whereas adults and teens might find more success in cognitive processing therapy, exposure therapy or prolonged exposure therapy, or cognitive-behavioral therapy (CBT). These types of therapy are empirically supported, which means evidence has shown that they work for some. When it comes to therapy, CBT is the gold standard for concerns such as depression, anxiety management, and other mental health disorders, since it is designed to help you with your thoughts feelings and more. But it can be used for trauma and other issues as well, namely on those that are combat veterans, have an eating disorder, or others who need help treating trauma. In contrast, couples therapy can be helpful if you’re a person that wants to understand your partner’s trauma. It all depends on the individuals that the trauma effects, what their goals are in therapy, and what they find most helpful as a unique person. Keep in mind that you can also seek out a support group find individuals that are going through the same thing as you, in regards to life experiences and trauma experience, or look at evidence based research, so you’ll have a better chance at lessening trauma symptoms.
What trauma does to the brain?
Trauma literally changes the brain and the way that the neural pathways are. In people with posttraumatic stress disorder, you’ll see that on brain scans, their brains are lit up at times because they’re hypervigilant, overly aware, and are possibly in a fight, flight, or freeze mode because they believe there’s a threat. Fundamentally, trauma changes the brain to think that there’s a constant threat. These intrusive symptoms are caused by real trauma that a person has faced. If you have suffered from real trauma in your life, you should think about finding a therapist that has the training and experience to offer you the trauma focused therapy you might need. For instance, a trauma therapist has specialized training, which allows for them to provide treatment post trauma.
Does emotional trauma change the brain?
Emotional trauma changes your brain. It’s unfortunate because people who have a traumatic history often struggle with the fact that their mind doesn’t function as it did before the trauma. It can be upsetting for people that have these concerns. Trauma disrupts lives and changes the way that people think and operate in the world. Trauma may cause negative thoughts, or even lead to mental illness if left unaddressed. But that doesn’t mean the person is permanently damaged. With the right therapy, and possibly medication, people who live through trauma can heal and get back to the activities they love to do in life. Do something for yourself, and find a trauma therapist that will be able to provide trauma specific treatment for you, if you feel that you would be able to benefit from good therapy that is trauma focused. There are many benefits of trauma therapy, so think about that when you are trying to find a treatment center find a support group or find a therapist.
What are the symptoms of trauma?
The symptoms of trauma vary from person to person. Often, people with trauma or PTSD symptoms will experience panic attacks, nightmares, insomnia, depression, and fits of anger or rage. These symptoms can be disruptive and potentially impact a person’s quality of life. If that’s the case, it’s crucial to reach out to mental health professionals for help. There are also different types of trauma when it comes to trauma psychology, such as dissociation trauma, where you do your best to ignore the trauma. Whichever type of real trauma you are experiencing, there is help out there for you. You can contact a center find a trauma therapist, and perhaps start getting the trauma focused specific interventions that are needed in your life.
What are the three types of trauma?
The three types of trauma are acute, chronic, and complex. Acute stress disorder is a type of trauma that occurs from one single incident. Chronic trauma is from long term, repeated abuse or domestic violence. It is something that occurs over a long period of time. Lastly, complex trauma occurs when a person is exposed to many different traumatic events, which are typically very intense and of an interpersonal nature. Each of these types is real trauma, so none of them should be downplayed. If you have experienced any type of trauma, you should seek treatment options from a your healthcare provider. They can help you work on your thoughts, feelings, or actions through trauma processing, or another empirically supported method.
What does a trauma therapist do and what are they called?
It is important to find a therapist who has experience in helping people with severe traumatic histories work through their painful memories and helps them heal from those traumatic incidents. Trauma therapists and trauma counselors are compassionate, empathetic, and understand that real trauma takes time to heal from. They’re patient with their clients and help them as much as they can. For treatment of PTSD, therapy can be life-changing, and results in good therapy through the use of various trauma treatments. Having experience working with trauma therapists will teach you coping skills and provide other tools to help you cope with how you are feeling related to the trauma.
What classifies as a trauma?
Real trauma can vary in nature from surviving a natural disaster to dealing with a history of physical abuse to witnessing mass violence to experiencing a sexual assault. It depends on what you classify as trauma for yourself. If you were in an abusive relationship, it might have been a very traumatic experience for you. The experience of trauma varies from person to person, and traumatic events can affect different people in a variety of ways. Some people are incredibly resilient and bounce back from trauma, while others take more time to heal. Every person responds to trauma differently, but it’s imperative to seek mental health treatment after experiencing a traumatic experience. That way, you can get the support you need. Trauma treatments are often personalized to your trauma experience, so each person will be able to get the trauma focused therapy or a trauma therapist that can help them. Let your therapist find a treatment for your trauma symptoms and all the other side effects you are experiencing.
What does trauma do to a person?
Real trauma can completely change a person. They may have never experienced abuse or a traumatic incident before, and as a result, they experience symptoms and sensations that they’ve never dealt with previously. They may begin to suffer from panic, depression, an eating disorder, self harm, have difficulty trusting or forming bonds with others, and so on. Working with trauma can be extremely dangerous, and it can change you entirely as an individual, but forms of treatment such as EMDR, exposure therapy, prolonged exposure therapy, or trauma-informed therapy can help. These methods have been tested, and in some cases researched by a specific department of psychiatry, and other professional sources who work with trauma and study it as well. A medical entity sometimes tests therapy techniques, to determine if they are effective.
Working with trauma therapists can help people who have survived trauma live better and develop healthier lives. Real trauma and PTSD are hard to live with, but breaking free is possible. Trauma therapists are trained to listen in a non-judgmental way and give you a safe place to work through things. You can find a therapist find a treatment center find the treatment that works well for you.
What are some healthy coping skills for dealing with being exposed to trauma?
One highly effective coping skill regarding trauma psychology is deep breathing as a form of self care. This simple and easy skill can be done anywhere. For this exercise, you can inhale for four seconds, hold for two more seconds, and finally exhale in six to eight counts. This exercise activates the part of the nervous system that helps calm your body during stressful situations. Using a weighted blanket and even laughing can help. But in order to help solve the deeper effects of your trauma, you should find a therapist and even find a support group as you work through real trauma.
What is the best therapy for trauma?
When it comes to treating trauma, you need to find a trauma informed therapist who is equipped and educated to help you start the healing process and give you a medical advice diagnosis. Be diligent and fact check from only high quality sources and board certified physicians before committing to a therapist or a treatment center, or find other resources related to therapy trauma.
Common trauma informed therapies used to help treat PTSD and trauma include pharmacotherapy, cognitive behavioral therapy, bilateral stimulation, and hypnotherapy. Make sure you find a therapist that can help you determine which treatment is best for you. Some people also try to find a support group to supplement their treatment. When you work with a trauma therapist, it may be best to let the therapist find a treatment that can help improve your life.
Medical reviewers confirm through the latest evidence based research, like these peer reviewed studies from the National Center For Biotechnology Information, that trauma therapy is the most effective form of treatment for PTSD.
How can therapy take on a trauma informed approach?
Treating real trauma requires therapists to recognize and understand how trauma can affect a person, especially in terms of mental illness. In order to successfully use a trauma informed approach to treat patients, healthcare professionals must be able to identify different paths of recovery for patients, learn how to recognize the mental health symptoms of trauma, and actively resist re-traumatization. It helps if they are trauma informed, have trauma experience, or work with trauma affected persons regularly.
What is trauma focused therapy for adults?
Trauma therapy for adults involves any treatment plans designed to help adults cope with the negative effects of going through a traumatic event or their trauma memory. Trauma-focused cognitive behavior therapy, in particular, is a common treatment used for patients who are struggling to reframe their negative thought patterns.
How do you fight trauma related issues?
First, you need to give yourself time to heal from real trauma. It can often take weeks and even months to accept what has happened to you, whether it is a sudden illness or an accident. During this time, you should avoid bottling up your feelings. Doing this can end up making you feel worse and prevent you from coming to terms with the trauma. You should also avoid attempting to self-medicate yourself with alcohol and drugs. Instead, starting a routine and accepting the support of your loved ones will help you fight through these issues. You can also find a trauma center that can help you with mental health resources and a strategy that works to improve your well being. These things can be done under the supervision of a doctor.
How do you deal with trauma without therapy?
Dealing with real trauma without a trauma specialist can be difficult. Working with a therapist for therapy trauma allows you to learn and practice different coping skills while decreasing negative stress symptoms. If you aren’t able to work with a therapist at the moment, it is important that you have a solid network of friends and family who can help support you through this hard time.
What are the benefits of trauma focused therapy?
Therapy can help by providing you with a number of benefits. For instance, it can help you learn more about trauma and its effect on the body and behavior patterns, identify triggers, and practice healthy coping skills for feelings related behaviors. That’s why you should find a therapist who is experienced in treating patients with trauma. When you find a therapist find a treatment center find a support system, and do your best to get all of the help and support that you need to rebuild your self esteem.
Can people develop eating disorders from child trauma?
Depression, eating disorders, bipolar disorder, and other issues can develop as a result of experiencing child trauma. Adolescents are also susceptible to a combination of thought patterns based on the places they have been, an account they have been given of what their childhood was like, what they read in an article, and a combination of other things that lead to a reduction in their wellness.
How do you treat child trauma and its results like depression, eating disorders, and bipolar disorder?
In order to treat child trauma, it is critical that you seek professional treatment for help. They will help you cope with these issues and learn effective techniques for dealing with them. Acknowledging these issues can be difficult, but it is important that you find help for them to treat them and prevent them from growing worse. Research evidence shows that childhood trauma, if left untreated, can cause a multitude of mental health conditions throughout early and mid-adulthood.