Trauma

Trauma can occur when an individual lives through, or hears about, a traumatic event. A trauma event is an event, or series of events, that causes moderate to severe stress reactions, characterized by a sense of horror, helplessness, serious injury, or the threat of serious injury or death. Trauma is subjective. If you've been impacted by trauma, regardless of if you think others may view it as big or small, reach out for help now.

Symptoms of trauma

Below are some of the symptoms associated with trauma (APA. 2013a):

1.     Recurrent, involuntary, distressing, or intrusive thoughts related to the traumatic event

2.     Difficulty sleeping or recurrent dreams about the stressful experience

3.     Flashbacks, or moments where you feel you are reliving the experience

4.     Avoidance of people, places, or things associated with the stressful experience

5.     Increased symptoms of anxiety and/or depression

6.     Social isolation, including withdrawing from friends, family, or others

7.     Loss of sleep and/or appetite

8.     Poor concentration in areas that were not a problem previously

9.     Becoming easily startled or hyperalert

Causes

Trauma is unique to everyone and can be any event that leads a strong or overwhelming emotional response which impairs one’s ability to emotionally cope. Trauma can even occur when an individual hears about an event without experiencing the actual event themself.

 Below are some events that can commonly lead to trauma:

1.     Psychological abuse

2.     Physical abuse

3.     Sexual abuse or assault

4.     Serious accident, for example: a car crash, plane crash, or serious injury

5.     Life threatening illness, for example: cancer or severe COVID-19

6.     Being present at, or learning of, a community or social event, including a school shooting, riot, or other violent event

7.     Childhood emotional or physical neglect

8.     Physical assault or robbery

9.     Hearing about someone else’s traumatic event

Types

 There are multiple types of traumas, including those that occur during a single event, ongoing or repeated events, and repeated exposure to various events.

            Acute

            An acute trauma is a single event, which may or may not have occurred recently. Examples include a single physical or sexual assault, car accident, other act of violence, or sudden loss of a close family member or friend.

            Chronic

             A chronic trauma is one that has occurred repeatedly or entails long exposure to a highly stressful situation. This may include ongoing abuse of a physical, emotional, or sexual nature, bullying or continued harassment.

            Complex

            Complex trauma occurs when an individual has been exposed to repeated or multiple traumatic events. These events may have happened close together or even years apart. When an individual is exposed to multiple traumas, they may feel an increased sense of hopelessness and helplessness, leading to their past traumas impacting various aspects of their life.

Effects

Research has shown that traumatic events can impact not only how an individual views the world and appraises situations, but also how their body processes information. Trauma can impact how someone responds in a stressful situation by activating either the sympathetic or parasympathetic nervous system. The sympathetic nervous system activates the fight or flight response while the parasympathetic nervous system activates the freeze response. All of these can be helpful systems to have activated depending on the situation, however trauma can lead these systems to be activated when they are not needed.

Treatments

 There are many different treatments for trauma. You and your therapist will discuss your specific needs and decide from any of the following.

Eye Movement Desensitization and Reprocessing (EMDR)

Eye movement desensitization and reprocessing (EMDR) is a form of therapy that has been shown to be highly effective in the treatment of all forms of trauma. This form of therapy involves engaging in what is called bi-lateral stimulation (e.g., eye movements, hearing bells in opposite ears, or opposite side of body tapping) while focusing on a traumatic experience. Throughout the process of EMDR the client becomes desensitized to the traumatic memory and can change the automatic thoughts associated with that memory. For example, at the beginning of treatment an individual who has been through a physical assault may think about the traumatic event and experience high anxiety or fear, avoid thinking about the event, and having negative thoughts about themself (e.g., I am not safe, I am always vulnerable, people will hurt me). At the end of treatment, the individual should be able to think about the event while maintaining a sense of calm and have more adaptive thoughts about themselves (e.g., I am safe now, I can protect myself now, I am valuable). One of the cool things about EMDR is that you can choose exactly how much about the event, or events, you want to share with your therapist. You do not have to go into any details you don’t want to. Read more about EMDR or visit the official EMDRIA website.

Prolonged Exposure (PE)

Prolonged exposure (PE) is a form of trauma treatment that encourages the client to discuss and share about their trauma in detail while reprocessing the event. The therapist guides the client through the retelling of their trauma narrative, allowing the client to view the trauma as having a specific beginning, middle, and end. The client also engages in various exercises outside of treatment to help them re-engage in the activities they have been avoiding. PE can be conducted with a single or repeated traumatic event.

Cognitive Processing Therapy (CPT)

Cognitive Processing Therapy (CPT) is a form of trauma treatment that utilizes many similar components found in cognitive behavioral therapy (CBT), however the course of treatment is focused on a specific event. The client writes a trauma narrative, learns how to identify, and challenge, cognitive distortions, and begins to integrate a new way of processing information by practicing coping mechanism between sessions. Although CPT focuses on a singular event, the same process can be applied multiple times and heal past traumas that are not the focus of the initial work.

Written Exposure Therapy (WET)

Written Exposure Therapy (WET) is a 5-session intervention that targets a singular traumatic experience. WET helps the client to view their traumatic event as an event that has come to an end, one that does not have to define them, and one that they are able to move past. Like the other forms of therapy, WET helps a client to see the event as one that had a beginning, middle, and end, while also helping the client to make conscious decisions about how they will move on from the traumatic event.

Citations

American Psychiatric Association.  Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.