Understanding trauma

Since qualifying as a clinical psychologist, I have developed a specialist interest in working with people who have experienced traumatic events. What always strikes me when working with trauma is how much we still struggle to talk about it as a society. In spite of new campaigns to make workplaces, schools and society in general, more "trauma-informed", the difficult aspect of having been through a traumatic experience is that these experiences often leave people feeling ashamed and can thus push us into silence.

I wanted to write an article to cover some of the basics when it comes to trauma. If you or someone you love has been through a traumatic event, I hope that this article may enable you to understand a little more about trauma and its impact.

What is trauma?

Many of us have heard the word "trauma", but what do we actually mean by it?

In psychology, trauma is often defined as an emotional response to a distressing event. Distressing events can include, but are not limited to, accidents, physical, emotional, sexual abuse, natural disasters, war, torture, bullying. According to the DSM-5 a traumatic event is classed as so if there was "actual or threatened death, serious injury or sexual violence".

It is helpful to remember that what makes an event distressing or traumatic for a person can vary. Therefore, what I may find distressing can be very different to what one of my friends may find distressing. I want to emphasise this point because sometimes we can run the risk of minimising our experiences and the impact of these on our mental health, because we may feel as though "others have it worse" when in reality the impact of an event on our mental health is not always proportionate to the severity of the event.

Trauma can happen to all of us. The latest figures show that approximately 50-70% people will experience at least one traumatic event in their lives (PTSD UK).

The impact of trauma

We often associate trauma with Post-Traumatic Stress Disorder (PTSD). Whilst it is true that PTSD can be a response to a traumatic event, humans are actually a very resilient species.

It is common for people to experience an intense emotional response, shock, denial, difficulty sleeping, immediately after a traumatic event. However, most people recover naturally from a traumatic event and notice that, whilst the memory of the event will always remain distressing, they can move on with their lives without being significantly impacted by what happened. However, some people may have difficulty moving on with their lives and may still be impacted by the traumatic event months or even years after. 20% of people who experience a traumatic event may develop PTSD (PTSD UK) Cumulative trauma (experiencing more than a traumatic event) significantly increases the risk of PTSD.

Trauma and the brain

One of the reasons why trauma can have such a long lasting psychological effect is related to the impact of trauma on our brains. During a traumatic event our brain is very much operating in "survival mode". This means that certain areas of the brain dedicated to keeping us safe from harm will become more active and trigger the fight, flight or freeze response (if you are interested in knowing more, click here).

Whilst this is a very effective mechanism during a traumatic event, it has some consequences on the way our brain processes the traumatic memory. Our brains only have a limited capacity for processing information at any one time. Therefore, when the fight, flight or freeze response is activated and we are dealing with danger, to do this effectively the brain has to shut off other areas that are usually dedicated to thinking and processing events. This causes the traumatic memory to be stored in the brain in a different way to an everyday memory. The main difference is that the traumatic memory does not have a "time stamp", so even months and years after the event our brain is not able to recognise that the memory has happened on a particular date and time in the past. When we are reminded of the event, the brain feels as though the event is happening again in the present and this is why people often describe feeling as if they are "back there" (in the trauma).

Post-traumatic stress disorder (PTSD)

PTSD is a psychological reaction to a traumatic event that can last months or years after the traumatic event has taken place. Researchers are still not clear why some people develop PTSD and other don't but what we know is that the risk of developing PTSD is often influenced by:

• Our experiences prior to the traumatic event

• Our experience of the actual event (how long it lasted for, whether we feared death, whether there was any physical injury...)

• Our experience after the event (how we made sense of what happened, people's responses to the event, the actual consequences of the event on our lives)

PTSD is characterised by the following symptoms (Taylor, 2017):

Re-experencing

• Recurrent, Intrusive Recollections - finding it difficult to stop thinking about what happened or seeing images of what happened every time you close your eyes. Some people also have an experience of re-experiencing smells, tastes, sounds as well as emotions that they experienced at the time of the trauma.

• Nightmares - particularly recurring distressing dreams directly related to what happened or threat-related dreams on a particular theme.

• Flashbacks - people sometimes think of flashbacks as intrusive images of the traumatic experience. However, flashbacks are dissociative episodes where the person is re-experiencing the event "as if it was happening again" and therefore feeling as though they are "back there". It is common during a flashback to lose touch with reality. People experiencing a flashback might not be able to respond to you for example if you were to ask a question.

Avoidance

• Because the event experience is so distressing, it is common for trauma survivors to avoid any reminder of the trauma or situations that they might find particularly threatening because of what happened. For example people may avoid watching particular TV programmes or avoiding crowds or noisy environments.

Emotional numbing

• People experiencing emotional numbing may find that they may struggle to experience love and affection towards important people in their lives. Or they may no longer feel pleasure from activities that they used to enjoy prior to the traumatic event.

• People also describe sometimes finding it difficult to connect to others because they worry other people will not be able to understand or relate to what they have been through, thus experiencing a feeling of alienation from the world.

Hyperarousal

• It is common for people who have experienced traumatic events to present as very "hypervigilant", always on alert / on edge, scanning for danger due to a fear that they or their loved ones may suffer further harm.

• People may find that they struggle to sleep or concentrate due to being constantly "on alert" / "ready to go" as if their "fight or flight" response is always active. This is understandable as if we fear further harm, we want to be ready to fight or run away to protect ourselves and our loved ones from further danger. However, this symptom can limit our lives as it can cause us to avoid certain situations due to a perceived sense of threat.

• People sometimes notice that after a traumatic event they experience more irritability and feelings of anger.

Trauma related guilt and shame

• Guilt is an emotion related to a belief that we have done something wrong and that this is our fault. People who have experienced traumatic events may experience guilt about the things they did or didn't do during the traumatic experience.

• Shame is an emotion that sometimes is confused with guilt. However, the main difference is that whilst guilt is directly related to one's actions being perceived as "bad or wrong", shame involves a global belief that one is a bad person. People having experienced traumatic events can sometimes hold strong beliefs such as "I am bad", "I am dirty", "I am disgusting".

Healing from trauma

The important message here is that whilst traumatic experiences can have devastating consequences on a person's life, it is possible to heal from trauma and PTSD. There are several trauma therapies available that can help you process what happened and learn to feel safe again, so that you can live a fulfilling life.

Post-traumatic growth and transformation after trauma

Not only it is possible to recover from traumatic experiences but many people report experiencing positive transformation after recovering from trauma. This is known as post-traumatic growth. People describe sometimes having a new appreciation for life, new coping mechanism, increased resilience to distress.

Of course, no one wants to invite traumatic events into their lives and usually, especially at the beginning, the impact of a traumatic event is pretty devastating. However, down the road some people notice that there might be something of value in the experiences they have been through. This doesn't mean that all the hurt related to the traumatic experience has been wiped out and it is important to first and foremost acknowledge that it is understandable to feel angry that something so awful has happened in our lives. (Read more on post-traumatic growth here).

I hope this article was informative. This is one of a longer series of articles that I am hoping to write.

If you have been impacted by past traumatic experiences, please remember that you are not alone and help is out there. Reaching out can feel scary, but sometimes reaching out to a professional can be an important first step for your recovery journey. Your GP can be a helpful point of contact if you are thinking to access support through the NHS. There is also more information about trauma therapy on my website in the trauma therapy section.

#trauma #traumatherapy #EMDR #CBT #PTSD #posttraumaticstress #mentalhealth