Understanding Trauma

Terms such as “trauma” and “PTSD” have become more widely used and discussed outside of clinical settings. However, there are still misconceptions about its definition. For example, some associate trauma solely to those who served in the military or had exposure to significant violence. The reality is, a traumatic experience can entail direct exposure to the event, witnessing the event in person as it happened to others, learning that the traumatic event occurred to a close family member/close friend or experiencing repeated or extreme exposure to aversive details of the traumatic event. 

Over the last several years, there have certainly been significant stressors that have impacted us all. This blog article will provide a brief overview of trauma and stressor related symptoms and common treatment options.

Intrusion Symptoms

One category of symptoms is intrusion symptoms. This includes distressing and unwanted memories of the event, or dreams or nightmares, where content resembles the event. Additionally, flashbacks are a dissociative response when an individual feels as if they are reliving part of the trauma in the present day. This can feel particularly upsetting for the individual, as they may sometimes experience a sense of feeling disconnected from reality. Flashbacks can be uncued, or sometimes triggered by a reminder of the event. A common example can be fireworks during a holiday celebration, triggering a reaction in a veteran who is reminded of gunfire. Another example could be someone yelling or arguing, triggering a reminder of a domestic violence situation in which the individual felt unsafe due to loud verbal conflict.

Avoidance

Avoidance is the second category of symptoms. It is common for individuals to avoid talking about the event or things associated with the event. Additionally, someone may avoid seeing people, particular places or activities that remind them of the event. Avoidance is a behavior that temporarily provides relief to the individual, in that they do not experience distressing thoughts/feelings related to the trauma. However, long term avoidance can become a barrier to recovery. Avoidance can even present itself in therapy. While an individual desires to process the trauma and heal, they may feel the inclination to avoid sessions or refrain from disclosing too much information during the session, due to its painful nature.

Changes in mood

This category involves notable changes in mood following the event. Common symptoms include difficulty remembering traumatic event, feelings of detachment and difficulty experiencing positive emotions (such as love and happiness). Additionally, it is common to experience a negative emotional state (such as fear, guilt or shame). Traumatic events can also lead to negative beliefs about the world or themself. Common ones include that “the world is a dangerous place”, “people will hurt you” etc… These beliefs can then shape the way we perceive things and navigate our world. 

Changes in reactivity

This category involves changes in arousal level due to the traumatic event. Common symptoms include irritability or anger outbursts, self-destructive behavior or recklessness, and changes in sleep. Also central to this category is hypervigilance and an increased startle response. Hypervigilance is fixation on potential threats in the environment. Along with this is an increased startle response, which is a more intense response to a stimulus that is more pronounced. For example, someone brushing by an individual may seem harmless, but to someone who has experienced physical or sexual trauma, they may feel intense distress and anxiety related to the unexpected physical contact. 

Types of traumatic events

As referenced prior, an individual can still have symptoms of trauma even if they did not directly experience the event themselves. However, The LEC-5, known as the Life Events Checklist is a tool used to identify whether an individual has had exposure to common events known to potentially result in PTSD or distress. These are as follows: natural disaster, fire or explosion, transportation accident, serious accident, exposure to toxic substances, physical assault, assault with a weapon, sexual assault, unwanted sexual experience, combat or exposure to a war-zone, captivity, life-threatening illness or injury, severe human suffering, sudden violent death, and sudden accidental death.

Types of Treatment:

It is a brave decision to pursue therapy to process trauma-related issues. It is important that the individual feels comfortable and safe with their clinician to explore this.  Additionally, seeking out a clinician who has specific training in trauma work is key. There are several evidence-based treatment options that are effective in reducing symptom severity and intensity. Some of these are outlined below.

Cognitive Processing Therapy

CPT is delivered over a series of sessions to assist clients in challenging and modifying unhelpful beliefs related to the trauma. Through this process, the client is able to form a more balanced  understanding of the event and subsequently reduce ongoing symptoms and impact on functioning. A component of this treatment is writing an impact statement. This is from the client’s perspective of why they believe the traumatic event occurred and the impact it has had on beliefs about themself, others, and the world. There is specific focus on themes of safety, trust, power, control, esteem and intimacy, common areas that are impacted by trauma. 

Eye movement desensitization and reprocessing

EMDR therapy focuses directly on the memory, as opposed to other therapies which focus on thoughts/feelings. The goal is to change how the memory is stored, thereby reducing symptoms. During EMDR therapy, the clinician incorporates the use of eye movements and other forms of bilateral stimulation, such as tapping. While clients briefly focus on the trauma memory and simultaneously experience bilateral stimulation (BLS), the vividness and emotion of the memory are reduced.

Prolonged Exposure

Prolonged exposure is a modality within cognitive behavioral therapy that encourages the client to gradually approach trauma-related memories, feelings and situations. This involves two types of exposure, imaginal and in vivo. In imaginal exposure, the client and clinician explore the event in detail in the present. The client’s narration of the event is recorded, so that client can listen in between sessions and practice soothing/coping techniques. In in vivo exposure, the therapist and client identify situations/people/places connected to the traumatic fear to gradually expose oneself too. 

Pharmacological Treatment

It is also possible that your practitioner recommends medication in conjunction with therapy. Some medications may help to address associated symptoms such as sleep difficulties, depression, anxiety etc… In fact, research highlights the comorbidity of trauma with other mental health diagnoses. According to the US Department of Veteran Affairs, Most people with PTSD—about 80%—have one or more additional mental health diagnoses (predominantly sleep disorders, substance abuse and mood disorders). There is no single way to treat trauma, and it is important to discuss with your provider/treatment team the options available that best fit your needs.