In the following article, I will answer the question, “What is trauma?” Different people may have different trauma definitions or perceptions about the various categories of trauma, but I hope this article will bring some clarity.
What is Trauma?
Trauma is an event in your life that you have survived. The traumatic event could be anything from a car accident to a natural disaster that has occurred in your city and/or neighborhood.
In other words, you have experienced and/or have witnessed something terrible that has changed the way you look at your life because a traumatic event can affect your relationships, your thoughts, feelings, and behaviors. You feel like you are no longer safe and have no control over what may happen to you.
It is said that every individual in the family acts and experiences the symptoms of trauma differently because every member of the family has a different distress and resiliency level. It has also been said that if a child has one strong support person in their life they can survive.
According to the National Institute of Mental Health (NIMH), PTSD was first brought to public attention in relation to war veterans, but it can result from a variety of traumatic incidents, such as mugging, rape, torture, being kidnapped, or held captive, child abuse, car accidents, train wrecks, plane crashes, bombings, witnessing the death of a loved one, or natural disasters such as floods or earthquakes.
Soldiers that have come home after fighting for our country who have witnessed traumatic events may experience trauma related symptoms that require treatment and medications. Children that have been physically and/or emotionally abused and/or neglected show symptoms that need to be treated. Women who have been abused and/or raped show symptoms that require treatment and possible medication.
Symptoms of Trauma
NIMH also notes that people with PTSD may startle easily, become emotionally numb (especially in relation to people with whom they used to be close), lose interest in things they used to enjoy, have trouble feeling affectionate, become irritable, become aggressive, or even violent.
They avoid situations that remind them of the original incident, and anniversaries of the incident are often very difficult. PTSD symptoms seem to be worse if the event that triggered them was deliberately initiated by another person, such as in a mugging or a kidnapping.
According to the Washington State Department of Social and Health Services, Post Traumatic Stress Disorder symptoms include:
- Exposure to actual or threatened death, serious injury, or sexual violence. Example: A woman watches her husband die in his hospital bed and in the future is unable to enter a hospital due to the smells and sites and experiences symptoms of significant distress and feels like she is going to have a panic attack.
- Presence of intrusion symptoms associated with the traumatic event.
- Persistent avoidance of stimuli associated with the traumatic event(s).
- Negative changes in thoughts or moods associated with the traumatic event(s).
- Marked changes in arousal and reactivity associated with the traumatic events.
- Significant distress or impairment in social, occupational, or other important areas of functioning.
Judith Lewis Herman, in her book Trauma and Recovery: The Aftermath of Violence-from Domestic Abuse to Political Terror, wrote: “The responses to trauma are best understood as a spectrum of conditions rather than as a single disorder. They range from a brief stress reaction that gets better by itself and never qualifies for a diagnosis, to classic or simple post-traumatic stress disorder, to the complex syndrome of prolonged, repeated trauma.”
According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition, 2013), those who have been diagnosed with Post Traumatic Stress Disorder experience a number of the following symptoms:
- flashbacks, intrusive thoughts and memories
- avoidance of persons, places, things, and other triggers that cause distress, anxiousness, and jumpiness, (triggers are experienced through the five senses)
- recurrent distressing dreams in which the dreams are related to the event
- negative beliefs about self and others such as; “I am ruined,” “no one can be trusted,” “the world is dangerous,” “I am bad.” The person blames her or himself, or others.
- an inability to feel love or happiness
- feeling irritability, with angry outbursts
- self-destructive behaviors
- exaggerated startle response
- problems with concentration
- an inability to sleep, stay asleep, or experience restless sleep
- dissociation, which means: you may only remember and are only able to recall certain parts of the traumatic event
- physical and/or emotional numbness in difficult situations
It is important to note that not all who experience or witness a traumatic event will develop symptoms of PTSD. NIMH reports symptoms usually develop within three months of the event but may develop years after the event. The symptoms must last for more than a month to be diagnosed as PTSD.
Trauma Treatment and Care
There are several treatment modalities that can be used to treat trauma depending on client preference. The treatment therapies and techniques used are either evidenced-based or are based on promising emerging evidence.
Trauma Informed Therapy is applied by focusing attention on emotional, neurological, psychological, social, and biological effects of trauma and can promote healing of childhood trauma, complex PTSD, addictions, and eating disorders.
I would like to note that trauma patients appear to be more susceptible to chronic illnesses. Working as a team with medical professionals is also an essential part of treatment, using empowerment to offer many choices through education and information and allowing the client to have and make choices though a collaborative approach. This assists the client to identify strengths that have helped them survive and helps them learn how to regulate their emotions.
EMDR is explained by Mary Beth Williams, Ph.D., LCSW, CTS in the PTSD Workbook. Eye Movement Desensitization and Reprocessing is a technique developed through Shapiro in 1995. Shapiro observed that certain eye movements are able to reduce the intensity of disturbing thoughts that have not been released.
When information in the brain is associated with trauma or chronic pain and gets “frozen in time” along with its associated emotion and memories, EMDR seems to change the way information is processed. After EMDR, pain sensations, and the way a person experiences and perceives pain get changed.
According to John M. Grohol, Psy.D, DBT is a type of Cognitive Behavioral Therapy that is used to also treat depression and emphasizes the psychosocial aspects of treatment “that helps identify thoughts, feelings, and assumptions that make life harder.”
Weekly psychotherapeutic sessions that emphasize problem solving, self-injurious and suicidal behaviors, quality life issues, and working on improving life in general. Helping to enhance the client’s self-respect and self-image. Emphasis is also placed on teaching clients how to manage emotional trauma.
Sheela Raja, Ph.D., notes in her workbook Overcoming Trauma and PTSD, that DBT provides mindfulness skills to “develop awareness of what is happening around you, learning how to form better relationships with people, and improving your ability to manage difficult emotions.”
John M. Grohol, Psy.D notes that DBT provides skills for interpersonal effectiveness – how you interact with the people around you. It teaches the client effective strategies to be able to ask for what they need, how to assertively say “no,” and to learn how to cope with inevitable interpersonal conflict. Distress tolerance skills are taught as well.
Sheela Raja, Ph.D. describes Cognitive Behavioral Therapy as being used for PTSD for over 30 years and is used to change the way we think and the way we behave and can help us function better and deal with difficulties. “Thus, CBT tends to focus on your current functioning.”
In using CBT skills, we take a look at our thoughts and behaviors, dispute negative thoughts and change negative behaviors. Exposure Therapy which is a form of Cognitive Behavioral Therapy is used to expose our us to our trauma memory’s in little bits and pieces and at the same time provide you with the guidance of your therapist remain in control of the process.
Those who have been diagnosed with PTSD try to avoid memories, feelings, and traumatic events and Sheela Raja, Ph.D. notes; this really has an impact on the quality of people’s lives. Learning to manage the emotions brought on by traumatic memories can help people get back into enjoying activities they enjoy participating in.
ACT (Acceptance and Commitment Therapy) is according to Sheela Raja, Ph.D., another form of Cognitive Behavioral Therapy that is a newer treatment used to treat anxiety and PTSD which focuses on “accepting your thoughts and emotions rather than trying to change them. ACT can help you accept the thoughts you can’t change. ACT can also help you to identify values and make a commitment to work toward achieving your values.”
Healing and Developing Resilience of Further Traumatization
Suggestions from SAMSA to help you manage retraumatization are:
- Appreciate the impact of the original trauma. Do not underestimate what you have been through, but also recognize that you are strong and able to recover.
- Understand how and why the event happened.
- Connect with people who understand and will help you through triggering events.
- Ensure that you have a support system in place that is easily accessible that consists of people who know, accept and care about you.
- Re-apply effective coping skills to include: stress management, self-care, and peer support.
- Practice your chosen spiritual beliefs and reach out to spiritual leader for support.
- Seek out care for a trauma informed provider who can recognize and treat your symptoms with evidence-based treatment and guidance.
Treatment and care should begin with gaining an understanding that what happened was not your fault. SAMHSA DHHS Publication SMA17-5047 Printed 200-17 notes: Do not underestimate what you have been through, and also recognize that you are strong, you survived, and are able to recover.
Lauren Dockett, in an article entitled “The Inheritance Within,” caught my attention when he wrote: “Every clinical approach has its stories of sudden, life-changing breakthroughs and revelations. Those are the moments every therapist hopes for: when clients caught in a maze of self-defeating patterns and despair, make a sudden leap that frees them from the prison of their past.”
Throughout therapy, the healing process may feel frightening at times, stressful, and be long and difficult. However, healing can and does happen. You can have a life you never imagined.
Lauren Docket. The Inheritance Within. Psychotherapy Networker. May/June 2019
Diagnostic and Statistical Manual of Mental Disorders (DSM-5) 5thed. (Washington, DC London England: American Psychiatric Publishing, APA, 2013), page 271-274
John M. Grothel, Psy.D 2018.
Judith Lewis Herman. Trauma and Recovery: The Aftermath of Violence-from domestic Abuse to Political Terror. Published in 1992.
NIMH PTSD. Printed 12/24/2014. http://www.nimh.nih.gov/health/publications/anxiety-disorders/index.shtml
Sheela Raja, Ph.D.: Overcoming Trauma and PTSD. Published in 2012
Mary Beth Williams, Ph.D., CTS: The PTSD Workbook. Copyright 2002.
Washington State Department of Health Services. Post Traumatic Stress Disorder Symptoms
Kessler, R.C., Sonnega, A., Bromet, E., Hughes, M., Nelson, C.B., & Breslau, N. (1999). Yehuda (Ed.) Risk factors for PTSD. (pp. 23-59). Wahington, DC; American Psychiatric Press. firstname.lastname@example.org DHHS Publication SMA17-5047 Printed 2017
“On the Beach”, Courtesy of Steve Halama, Unsplash.com, CC0 License; “Recovery”, Courtesy of Sharon McCutcheon, Unsplash.com, CC0 License; “Soldiers”, Courtesy of Toa Heftiba, Unsplash.com, CC0 License; “Girl in the Green Skirt”, Courtesy of Joshua Rawson-Harris, Unsplash.com, CC0 License