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Trauma

Trauma2017-06-08T21:22:13+00:00

What is Trauma?

The word trauma comes from the Greek word for “wound”. In the world of psychology, trauma refers to an emotional injury or wound. It’s helpful to think about physical wounds when trying to understand emotional traumas. Wounds come in different shapes and sizes. They affect each individual in different ways. And, failure to receive the proper treatment after a wound can complicate the healing process. The same is true for emotional traumas as physical wounds.

Individuals respond to trauma in complex ways but it usually involves reactions that are physiological, emotional, and psychological. It involves a bodily reaction in what is termed a ‘stress response’ wherein the brain triggers a biological response to a distressing event. Subsequently, if the traumatic experience is not processed or overwhelms the individual, there are usually psychological sequelae and behaviors that ensue which often manifest as symptoms.

Types of Trauma

Trauma can be a single event or a series of events in which the trauma is prolonged and repeated.
Some examples of traumatic events that are likely to overwhelm one’s ordinary experience include the following:

  • Serious illness, injury, accident, or disability
  • Divorce or loss of a significant relationship
  • Loss of a child
  • Partner violence/abuse
  • Witnessing horrific events
  • Military combat
  • Natural disasters

Developmental trauma refers to experiences in childhood that significantly impact a child’s development and functioning. Children are rendered ‘captive’ by their condition of dependency and thus abuse and neglect is often repeated and prolonged which affects the child’s developmental trajectory. Some types of developmental trauma include the following:

  • Physical abuse
  • Sexual abuse
  • Emotional (mental) abuse
  • Physical or emotional neglect
  • Witness to domestic violence
  • A parent who is an alcoholic
  • Abandonment or loss of a parent

When there has been developmental trauma that is unresolved, further losses in adulthood may be experienced as traumatic and intensify the reaction to that specific event. This can further complicate the healing process. Some trauma-related symptoms may seem to fade but then can be revived, even years after the event, by reminders of the original trauma.

What is PTSD (Post-Traumatic Stress Disorder)?

One of the common clinical diagnosis associated with trauma is called Post-Traumatic Stress Disorder (PTSD). The key symptoms of PTSD are hypervigilience (hyperarousal), numbing or emotional constriction (avoidance), and intrusive memories (re-experiencing). There is a biphasic response to trauma which manifests as an oscillation between hyperarousal and hypoarousal states. Hyperarousal includes emotional overwhelm, panic, impulsivity, hypervigilience, feeling unsafe, reactivity, anger/rage, and racing thoughts. Hypoarousal, in contrast, includes feeling numb, ‘dead’, lack of energy, disconnection, shut down, dissociation, and ‘not there’. PTSD is also often accompanied by depression, substance abuse, or other anxiety disorders.

As written by Judith Herman, MD, in her book, Trauma & Recovery, “This dialect of opposing psychological states is perhaps the most characteristic feature of post-traumatic syndromes. Since neither the intrusive nor the numbing symptoms allow for integration of the traumatic event, the alternation between the two extreme states might be understood as an attempt to find satisfactory balance between the two. But balance is precisely what the traumatized person lacks.” Part of the recovery and healing work involves integration and balance. It also involves regulating a dysregulated nervous system and expanding what is termed a ‘window of tolerance’ (optimal level of arousal).

Identification and coping with triggers is also a part of the therapeutic work. Trauma triggers (there are also addiction triggers) are usually cued by something internal (anything that happens within your body, such as thoughts or feelings) or external (anything that happens outside your body, such as a stressful situation). The trauma trigger brings about emotional distress, bodily changes, and symptom reactions. Even though it may seem that trauma reactions come ‘out of the blue’ they rarely spontaneously occur. It comes about in reaction to internal or external triggers. Examples of internal triggers include feeling anger, vulnerable, or abandoned. Examples of external triggers include an argument with a loved one, a specific place, or watching a movie that evokes one’s traumatic experience. Identifying one’s triggers and then learning to find healthy coping strategies to deal with them is an important aspect of the therapy work.

What are the effects of emotional trauma?

There are complex biopsychosocial-spiritual effects of trauma. Often the pain that is suppressed in childhood re-emerges and is experienced, re-created, and lived out in adult functioning.
Symptoms are the ‘living legacy’ of trauma. The symptoms are the symbols of the trauma rather than memories recorded as narrative. In fact, traumatic memories tend to be encoded as bodily and emotional states rather than narrative.

As stated by the National Traumatic Stress Network (NTSN), “Complex trauma (or developmental trauma) can have devastating effects on a child’s physiology, emotions, ability to think, learn, and concentrate, impulse control, self-image, and relationships with others. Across the life span, complex trauma is linked to a wide range of problems, including addiction, chronic physical conditions, depression and anxiety, self-harming behaviors, and other psychiatric disorders.”
Some of the symptoms of trauma survivors include the following:

  • Depression
  • Irritability
  • Anger
  • Shame & worthlessness
  • Self-loathing
  • Emotional overwhelm
  • Numbing
  • Anxiety or Panic attacks
  • Chronic pain
  • Self-destructive behaviors
  • Substance abuse
  • Eating disorders
  • Nightmares or flashbacks

Additional sequelae of emotional trauma

Some additional common sequelae of emotional trauma involve the following:
(1). Development of survival skills (to include addiction) (2). Chronic mood dysregulation (3). Post-traumatic cognitions/thoughts (4). Development of a ‘false self’ (5). Repetition Compulsion (to include relationship problems).

Survival Skills: Children who grew up in families where there was not a consistent sense of physical and emotional safety, nurturing, and protection often develop coping skills to survive and function day to day. These survival skills or learned adaptations enable the child to survive in that environment, however, when carried into adulthood these ways of being and relating often become problematic. For example, a child may learn to shut off all emotions in order to cope (hypoarousal) or may be overly-attuned to the moods and emotions of others (hyperarousal). This was what was required then but as an adult it may prevent healthy relationships and carry with it depression, anxiety, or anger & resentment. Adult Children of Alcoholics/Dysfunctional Families (ACOA) lists types of survival skills in the ‘Laundry List’ of 14 traits of an Adult Child.

Addiction is another survival strategy that often begins as a way to medicate the pain and help with regulating one’s moods but as more is needed to obtain the same effect, a dependence emerges. The addiction arises as a way to function and to feel safer in the world.

Chronic mood dysregulation: Another significant impact of emotional trauma, particularly developmental trauma, is the loss of the ability to self-regulate. As with PTSD an individual is often reacting to internal or external triggers in a way that leads to oscillating between highs and lows or hyperarousal and hypoarousal states.

As noted by Tian Dayton, PhD in her book The ACOA Trauma Syndrome, “We all have an emotional set point,” a default setting that represents our personal “norm”. It’s a set point that we can continually return to as our set point of emotional balance and equilibrium out of which our thinking, feeling, and behavior grows. Trauma disturbs that delicate balance. It upsets the equilibrium and can cause us to lose our ability to return easily to our emotional set point because it has been disrupted too deeply and too often”.

Post-Traumatic Thoughts: Trauma impacts one’s thinking in terms of ‘automatic thoughts’ (or self-talk) and core beliefs about oneself, others, and the world. Some of the problematic trauma-related beliefs revolve around four areas: responsibility, safety, choice, and value.

Responsibility: I am to blame; I should have done something; I should have known better
Safety: I cannot trust anyone; I am not safe; I cannot show my emotions
Choice: I have no options; I have to be perfect/please everyone; I am trapped
Value: I’m not good enough; I am damaged; I am worthless/inadequate

Part of the work in therapy is aimed at changing these types of trauma-related beliefs as if affects how one feels about oneself, level of distress, and functioning in the world.

‘False Self’: Regarding the ‘false self’, when we learn as children that who we are does not get us what we need, we learn to adapt to survive. This may begin a pattern of hiding one’s authentic self in favor of developing a self that is acceptable to the family. The ‘false self’ is primarily constructed to meet the needs of the family and make the system work. The ‘false self’ is meant to absorb the pain that the child finds too overwhelming. It seeks out outward affection, recognition, or praise but secretly one believes he or she doesn’t deserve it. Sometimes it manifests as dysfunctional roles in a family such as the role of the family hero, scapegoat, lost child, or mascot. The more one spends time functioning through a ‘false self’ however, the more unexplored the authentic self becomes. Even though the ‘false self’ is meant to protect the more vulnerable parts of oneself, it actually has the effect of weakening it like a muscle that atrophies without use.

As written in Drama of a Gifted Child by Alice Miller, “Accommodation to the parental need often (but not always) lead to the “as-if personality” (Winnicott has described it as the “false self’). This person develops in such a way that he reveals only what is expected of him, and fuses so completely with what he reveals that – until he comes to analysis – one could scarcely have guessed how much more there is to him, behind this “masked view of himself.” Another aspect of the therapeutic work is to establish new emotional habits and allow the more authentic parts of oneself to be brought forth.

Repetition Compulsion: Moreover, when there has been childhood trauma and emotional wounds what tends to happen is repetition compulsion or cycles of reenactment. As written in The ACOA Trauma Syndrome by Tian Dayton, PhD, “Repetition compulsion is a psychological phenomenon in which we repeat the emotional, psychological, and behavioral aspects of a traumatic event over and over again without awareness, recreating the pain from yesterday in relationships and circumstances of today.”

Partnering and parenting are particularly common ways of passing on this type of pain. For example, an individual who grew up with an alcoholic father may get into a relationship and marry an alcoholic. Even if this person divorces, the next relationship is often also with an alcoholic. There is an attempt to repair the original wounding through these adult relationships; to have a different outcome than that of one’s childhood. Additionally, there is modeling that happens in families and internalization of parental behaviors that contribute to this repetition compulsion. Thus, there is a strong tendency to recreate familiar family dynamics. Only through recovery work and becoming more conscious of these patterns can there begin to be a change. Given the significant impact of one’s legacy of childhood trauma it often becomes increasingly burdensome leading an individual to seek help.

What psychotherapeutic modalities are used to treat trauma?

Treatment Modality: As trauma affects the whole person in terms of the nervous system (physiology), emotions, cognitions/thoughts, and relationships I utilize a blend of various psychotherapeutic techniques to address these areas. Three central therapeutic modalities that I draw upon include Sensorimotor Psychotherapy, Trauma-Informed CBT (Cognitive Behavioral Therapy), and Expressive Arts Therapy. I also will work with an individual going through the ACOA 12 Steps (Adult Children of Alcoholics & Dysfunctional Families) as I believe in the power of 12 Step Recovery.

Sensorimotor Psychotherapy: This is a body oriented talking therapy and the interventions are directly aimed at addressing the somatic legacy of trauma. There is attention to how the body has “remembered” the trauma with a focus on providing the somatic experiences needed for resolution. It is based on the premise that traumatic memories are encoded primarily as bodily & emotional states rather than narrative (memory). Therefore, trauma can’t be fully healed until the essential role played by the body is addressed. The body reacts profoundly in trauma and is viewed as a source of information and a target for intervention in this treatment modality.

As there is a biphasic response to trauma in which the nervous system often gets chronically stuck on high (hyperaoursal state) or low (hypoarousal state), it is imperative to help stabilize the nervous system. With this modality the treatment of the trauma attends to regulating autonomic arousal. The “window of tolerance” refers to an optimal level of arousal where an individual can integrate thinking and feeling in dealing with stress. Part of the work in healing the trauma is identifying sensations of dysregulation versus balance and trying to expand one’s “window of tolerance”.

From a sensorimotor psychotherapy perspective, symptoms are viewed as a valuable piece of information about how the individual survived the trauma; the adaptive and protective aspect of the symptoms. Some of the work involves understanding the relationship between the trauma-triggering and the perpetuation of one’s symptoms. While a narrative (or one’s story) is being told, the therapist brings the person’s attention to what is felt or experienced in one’s body with the goal of remaining in the “window of tolerance” while addressing the traumatic material. Mindfulness and psychoeducation are core elements of this type of work. In addition, there are somatic techniques that can be learned to maintain bodily and emotional regulation.

Expressive Arts Therapy: Trauma-informed expressive arts therapy, as stated by it’s founder, Cathy Malchiodi, is “based on the idea that art expression is helpful in reconnecting implicit (sensory) and explicit (declarative) memories of trauma in the treatment of PTSD”. It is an approach that assists an individual’s capacity to self-regulate affect and modulate the body’s reactions to traumatic experiences through the modality of the expressive arts. The sensory qualities of art making often provide a way to tap into emotions more easily than words alone.

Art therapy helps those who have been impacted by trauma to reconnect with the image-based part of the brain, a process which calms the parts of the brain that have been overworked by trauma. Because trauma memories are sensory memories, the sensory-based qualities of art make it a unique fit for processing traumatic material and coming to a healing resolution. Thus, an impressive quality of art making is its ability to help restore an individual to psychological equilibrium. It can also help deepen one’s understanding of the trauma which is a starting point for integration. Another aspect to expressive arts therapy that makes it particularly conducive to working through trauma is that it is a way to tap into unconscious thoughts and memories to bring them to the surface in order to reconcile and heal them. Art therapy has been proven by a number of studies to be effective in dealing with the aftereffects of trauma. For a full description of Expressive Arts Therapy see the page designated to that topic.

Trauma Informed Cognitive-Behavioral Therapy (CBT): As trauma not only impacts one psychobiologically and affectively, it also alters one’s cognitions (thoughts) about oneself, others, and the world. Given this is the case, I also draw upon CBT strategies for dealing with trauma-based cognitions. Following a traumatic event (or developmental trauma), children will often search for an explanation of why something bad happened. Children are prone to develop irrational beliefs about causation in order to gain some sense of control or predictability over the situation.

The most common irrational belief involves blaming oneself or coming to believe that he/she is bad, shameful, or in some way lacking that “justifies” bad things happening to him/her. These type of cognitions about oneself negatively impact one’s self-esteem, contribute to the maintenance of PTSD symptoms, and often lead to behavioral choices that become “self-fulfilling prophesies.” Common problematic trauma-related cognitions often revolve around responsibility (“I should have done something”), safety (“I can not trust anyone”), choice (“I am trapped”), value (“I am not important” or “I am defective”), and power (“I am helpless”). These cognitions are part of the legacy of trauma. An aspect of the therapeutic works involves addressing and changing these type of cognitions to something more rational and positive.

Trauma & Emotional Wounds Resources

Trauma & Recovery by Judith Herman, PhD
Healing the Scars of Emotional Abuse by Gregory Jantz, PhD with Ann McMurray
The Drama of the Gifted Child by Alice Miller
The Truth will Set you Free: Overcoming Emotional Blindness & Finding your True Adult Self by Alice Miller
The Emotionally Abused Woman: Overcoming Destructive Patterns and Reclaiming Yourself by Beverly Engel, MFCC
Adult Children of Abusive Parents: A Healing Program for those who have been Physically, Sexually, or Emotionally Abused by Steven Farmer, MA, MFCC
Toxic Parents: Overcoming their Hurtful Legacy and Reclaiming Your Life by Dr. Susan Forward with Craig Buck
The Emotional Freedom Workbook by Stephen Arterburn & Connie Neal

www.ptsd.va.gov – National Center for PTSD
www.istss.org – International Society for Traumatic Stress Studies
www.traumacenter.org – Dr. Bessel van der Kolk’s Trauma Center
www.cathymalchiodi.com – Trauma & Expressive Arts Therapy with Cathy Malchiodi, PhD
http://traumaresourceinstitute.com – Trauma Resource Institute (Trauma Resiliency Model TRM)
iChill – App which teaches skills to help those suffering from the effect of trauma

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