Trauma is a general term applied to distressing experiences that are so overwhelming the brain and nervous system struggle to integrate the experience and function normally afterwards.
It is normal for a person to respond in shock after a frightening or assaulting or injurious experience or witnessing the same. The nervous system will tend to over-function for a time, or under-function. Thoughts may become distorted, over-imagining the likelihood of threat or harm in relatively neutral situations. Trauma related feelings may persist – fear, anger, loss or sometimes the opposite, a state of being numbed or zoned out.
As people we vary in the way we respond following a traumatic event or time in our lives. For some, your nervous system will recalibrate and return to normal fairly soon afterwards.
For others, the impact of the trauma will stay with you a very long time and effect the way you experience and interact with the world. You may find yoruself avoiding people, places, thoughts and memories related to the event and feeling either hyper-alert or not quite there. When this is the case, sometimes we develop coping mechanisms for dealing with the wound up nervous system, or the sense of isolation or the lack of basic trust in the world. The coping mechanisms (for example drinking, self-harming, withdrawing from the world, restricting food, being overly self-contained, protective or rigid in behaviour) serve a purpose and are usually adaptive for a period. However, there is a cost involved as well. There will come a time where the cost of the coping mechanism is at least as great as the impact of the initial trauma.
Therapy can help to:
- Understand why your body and mind are responding the way they do, including related physical health issues
- Put you in touch with personal and social resources to help navigate your healing process
- Learn new skills and ways to manage emotion and physiological arousal, so there is less need to rely on the negative coping behaviour
- Integrate the traumatic experience, tell your story, find your evolving place with it, allow it to be real and not cut off from you, so that all of you (not just part of you) can now be available for your life
- Reflect on how the experience has shaped you, who and how you want to be in life going forward, including any gifts of heightened wisdom, compassion or awareness or passion for a cause that you would now like to offer the world.
The field of psychology recognises the impact of trauma on the human experience through the following psychological response patterns:
Post Traumatic Stress Disorder (PTSD)
PTSD is perhaps the most commonly recognised constellation of symptoms that can result from exposure to trauma. This occurs when a person experiences or witnesses death, serious injury or sexual violence or the threat of any of these. Exposure may occur also through learning of this experience effecting someone close to you (must be violent or accidental death in this case) or repeated or extreme indirect exposure to this through a person’s work or through the electronic media.
You will experience one or more of the following – involuntary and intrusive memories related to the event, nightmares, flashbacks, intense or prolonged emotional or physiological distress on exposure to a reminder of the trauma.
You will tend to avoid thoughts or feelings or external people, places or situations that relate to or remind you of the trauma.
Your mood and thinking will be affected in at least two of the following ways – unable to recall some aspects of the distressing event, persistent negative beliefs about yourself and the world, a distorted sense of blame (either blaming yourself or another to an inappropriate degree), ongoing trauma-related negative emotions such as fear, horror, anger, guilt or shame, loss of interest in activities previously enjoyed, feeling alienated or isolated from others, flattened ability to experience positive emotion.
Your nervous system activation will be impacted in at least two of the following ways, after the traumatic experience – irritable or aggressive behaviour, self-destructive or reckless behaviour, hypervigilant, constant checking behaviour, exaggerated startle response, difficulty concentrating, problems with sleep.
For a diagnosis, these symptoms need to be present for a month or more, to impact your functioning in life – at work, study or socially – and not be a direct result of substance use, medication or another illness.
Acute Stress Disorder
In the first month following exposure to actual or threatened death, serious physical injury or sexual violence, either directly experienced, witnessed or experienced vicariously through the workplace, electronic media or learning or the experience of a close friend or relative, many people will develop a range of symptoms, stemming from impact on the nervous system of the traumatic event.
For some these symptoms disappear after the first three days and life returns to normal. For others, the symptoms continue for up to one month. A diagnosis of Acute Stress Disorder is appropriate if nine of the following 14 symptoms are present for more than three days and no more than one month (after that an assessment in relation to PTSD needs to be made).
Symptoms – involuntary and intrusive distressing memories, recurrent distressing dreams related to the event, flashbacks where it feels like the distressing event is recurring, intense or prolonged psychological or physiological distress on internal or external cues or reminders of the event, persistent difficulty feeling positive emotions, feeling zoned out or not quite with it, inability to remember an important aspect of the event, efforts to avoid reminders of the event, disturbed sleep, irritable or angry outbursts, hypervigilance or checking behaviour, problems with concentration and an exaggerated startle response.
Development of distressed emotional and behavioural symptoms in response to an identifiable life stressor (it does not need to be a life threatening stressor). The symptoms occur within three months of the onset of the stressor and last no more than six months. The distress will be out of proportion to the severity and intensity that might normally be expected and impact social and/or workplace functioning.
Life events that might result in Adjustment Disorder include loss of a job, end of a relationship or a serious illness or disability.
Complex Post Traumatic Stress Disorder (CPTSF)
Complex Post Traumatic Stress Disorder is currently viewed as a subset of PTSD. It can occur when the traumatic event is not a one-off incident, but a repeated exposure to an abusive, neglectful, harmful or high risk situation. Complex PTSD often has its roots in childhood abuse or domestic violence and commonly the perpetrator is known to the victim, as part of the family or general community. Complex PTSD can also result from adult experiences of ongoing abuse, neglect or threat, such as in a war torn environment, a domestic violence relationship or experiencing a chronic illness where a person’s reduced ability to care and provide for themselves puts them at risk or exposes them to abusive scenarios.
Given the recurring nature of the traumatic experience and that it often involves abuse or betrayal by friends, family or community, people and places who could normally be expected to be “safe”, the symptom profile for Complex PTSD has some unique characteristics.
Often the most obvious and impacting feature is difficulty with affect or emotion regulation, having extreme emotional responses to cues or reminders of the traumatic scenario. This may be combined with one of the following – difficulty managing anger, self-destructive behaviour, suicidal thoughts, difficulty managing sexual boundaries or excessive risk taking.
There will be alterations to attention or consciousness through amnesia or through becoming dissociated or zoned out.
Your sense of self will be impacted in at least two of the following ways – a sense of ineffectiveness or learned helplessness, poor sense of self or self-worth, overly guilty or responsible, inappropriate shame, feeling that others cannot understand or empathise or minimising your personal trauma.
In relation to other people, you may find it difficult to trust others, you may find yourself repeatedly in relationships or situations where you are victimised or you may find yourself victimising or putting others down.
There will be a physical correlate to your experience, with two or more of the following symptoms present – problems with your digestive system, chronic pain, cardiopulmonary symptoms (such as shortness of breath, dizziness, chest pain, high blood pressure), conversion symptoms (such as paralysis, deafness, blindness, balance problems, numbness, loss of speech, incontinence or urinary retention, gait problems, difficulty swallowing not medically explained) or sexual symptoms, such as an inability to experience orgasm or premature ejaculation.
Finally there will be alterations in youe systems of meaning, the way you make sense of the world and events, where there is a sense of despair and hopelessness or a loss of previously sustaining beliefs.
Understanding the nature of your trauma
It is often helpful to have a clear diagnosis about the way trauma has impacted your functioning. We do this through a combination of discussion in session about your symptoms and sometimes also through incorporating an assessment questionnaire. This can help you focus on exactly how you are being impacted and make sure I have a really clear picture of how things are for you. Having a diagnosis can help you understand your own experience and be kinder towards yourself when symptoms are triggered. It can also help family and friends understand why you respond the way you do sometimes.
Below are some general principles I work with in trauma therapy.
Note – every therapeutic relationship and interaction is unique. This will give you an idea of the kind of territory we may cover.
- We start slow and pace it your way. We start with today, how things are right here and right now. We look at where you are resourced and where you are feeling stretched, worried or overwhelmed.
- We do what we can to make sure you have safe places and people to return to when difficult feelings come up. We bring in soulful practices that help you feel connected in some way, even when others can’t provide the support you need – this might be time out in nature, listening to music, meditation or reading something inspiring.
- I come from a place of respect for you and your journey and how you have managed to get yourself to this point in life, despite the challenges you are facing.
- I will be noticing and helping you see also your unique strengths and beauty (I know that sometimes this is hard).
- Together, we will monitor and manage the “unhelpful” coping behaviours (they’re always helpful in some way, they just often come at a cost) with the aim in time to reduce your reliance on them.
- You will learn new skills and approaches for managing stress and emotion and promoting ease and relaxation.
- If appropriate, in consultation with your doctor, I can help you consider the pros and cons of medication and monitor its helpfulness in managing your symptoms.
- Not everyone, but for many people, experiencing the ongoing impact of trauma on a life can result in feelings of despair and hopelessness that can sometimes see a person having thoughts of suicide. In session we can talk openly about these thoughts and what they really mean for you, what it is that really needs to stop. We make sure you have a good plan in place to keep yourself safe, should they escalate. Beyond that, we are looking to uncover a new sense of meaning, purpose, hope and capability in your life, to work towards and to sustain you when things are difficult.
- In the case of CPTSD, I will provide information to help you understand the impact of early life social context, attachment, trauma or neglect on neurological development. We need our environment to appropriately respond to our inner experience, expression and needs. Where this doesn’t happen well enough, our brains can evolve with a predisposition to anxiety, emotional overwhelm and social withdrawal. It helps to understand. Then we do more of what helps your brain respond in more balanced, realistic and self-supporting ways.
- I talk with you about how traumatic experiences get laid down in the brain in non-linear ways, as feelings, images, flashes and fragments of sensory experience and we find safe ways, when you are ready, to notice and integrate these kinds of memories.
- We allow the body and its somatic responses, cues and memories to be a part of the process – for uncovering what needs attention and for creating new states of calm, ease and acceptance.
- I incorporate principles of neuroscience to help you understand the states of overwhelm or shut down you may often find yourself in. We use a whole person approach to help rewire and rebalance your brain, including exercise (as you are ready, in a way that feels good to you) and nutrition, rest, social life and fun stuff and having projects, goals and/or work that has meaning to you.
- We may use CBT (Cognitive Behavioural Therapy) to sift through thoughts and feelings and how they affect the actions you take. For example, you may have inaccurate thinking about your self-worth or how safe your world is or the likelihood of good things happening in the future. We will work through the layers of your daily thoughts and long term core beliefs and evolve them to what is really true and helpful right now.
- We will utilise principles and techniques from ACT/Mindfulness to bring a deep level of acceptance to how things are – not making wrong stuff right, but deeply and with self-compassion, accepting what has happened and how life is just now. This will often bring a new sense of freedom to move forward.
- We will draw on techniques from Positive Psychology to assist you to recognise, accept and operate from your strengths and to continue to build your capacity for working with “positive” emotions such as gratitude, acceptance, courage and hopefulness.
- Drawing on key concepts and techniques from DBT (Dialectical Behaviour Therapy) you will learn and practice mindfulness skills, distress tolerance skills (such as distraction, improving the moment and self-soothing), emotion regulation and interpersonal effectiveness.
- You will have a chance to be heard, simply, honestly and compassionately; to hear the truth of your own story, to tell it as many times as you want to until you feel at ease with it, in your power in it, wise inside of it. You may find that you tell it differently over time, as you evolve inside of it.
- Sometimes we may laugh, because that’s how life is and sometimes you have to!
- We will help you evolve a stronger sense of yourself, your purpose, your values in life, what matters to you and the strengths and skills you bring to the table to evolve your life in line with your values.
- I can play the role of coach as you step forward in life in new ways, celebrating your achievements with you and helping you develop new goals and plans and generally navigate the new stage of life you are creating for yourself.
Working with Complex Post Traumatic Stress Disorder (CPTSD):
For referring clinicians – with Complex Post Traumatic Stress Disorder (CPTSD) I work to the recommendations and guidelines outlined in this report: “Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery. © Adults Surviving Child Abuse 2012”. Authors: Dr Cathy Kezelman and Dr Pam Stavropoulos