Trauma/Edmonton/Psychology

Trauma

What is trauma? During moments when we are overwhelmed, our ability to integrate what is happening is diminished. Trauma is the result of stressors which threaten your sense of security, sense of self, and self-agency and the stress of which exceeds your ability to cope, make sense of, and move forward from that stressful experience. At the core of trauma are often feelings of helplessness, hopelessness, hyper-vigilance, and a sense of pervasive threat, risk, insecurity, or danger.

The essence of trauma is psychological injury – and presents as unhelpful emotional, perceptive, cognitive, behavioural, interpersonal, and physiological functioning which is persistent and causes distress in an individual’s life.

Traumatic experiences often involve a threat to life or safety, however, trauma may occur in situations in which there is not observable physical harm or a life-threatening event.

Although we often speak about events as ‘traumatizing’, trauma is not the event itself but the reaction to the event. The objective facts do not necessarily determine whether an event is traumatic, the subjective emotional experience of the event determines whether the event is considered traumatic.

A traumatic event, then, is a potentially traumatizing event. And, a traumatic reaction is one where the body’s primitive defence system becomes activated - stress hormones launch the body into fight, flight or freeze, and some of these defence systems become stuck, especially when we are unable to fully enact them or when enacting them does not produce a satisfactory result. And when there is limited or no opportunity for healthy processing, emotional repair, and recovery this may lead to a trauma disorder, of which Posttraumatic stress disorder is only one.

Who has trauma?

Not everyone who experiences a potentially traumatizing event will suffer the effects of trauma. And, for some, the effects of trauma are limited and/or resolve without intervention. However, many of us have encountered traumatic events, ranging in severity and effect, which require a trauma-informed lens of therapy.

Trauma may occur after a single event, through what we can one-trial learning, where the mind and body respond very quickly and, through trauma, develop maladaptive beliefs, perceptions, and behaviours, due to this event.

Trauma may occur as a response to ongoing stress or cumulative stress - multiple traumatic events or stressors, e.g. growing up in an abusive home, dealing with a life-threatening medical condition or illness, multiple losses.

Where do we find trauma?

Trauma is often associated with situations in which:

•The individual was unprepared for the event and/or the event was unexpected

•The person felt powerless to prevent the event and/or helpless to respond to it

•The event was repeated, e.g. bullying, abuse

•If the event involved humiliation, intense pain, and/or extreme cruelty

•If the event occurred during the infant, childhood, or adolescent years

Examples of potentially traumatizing events or events which may trigger previous trauma include:

Natural disasters such as floods, fires, earthquakes, landslides, avalanches, tornados, and hurricanes
Interpersonal violence such as mental and emotional abuse, systematic abuse, ritual abuse, sexual abuse and rape, or the suicide of a loved one or friend
Intimate partner violence, such as emotional, physical, sexual, financial abuse from a partner or spouse.
A threat or occurrence of grievous or serious bodily injury such as a motor vehicle or workplace accident.
Sudden, unexpected loss such as suicide, murder, or accidental death of someone close.
Sudden, unexpected loss such as child apprehension, spousal abandonment, job termination
Ongoing, severe stress, such as a hostile divorce and custody battle
Acts of violence such as a mugging, armed robbery, vandalism, bullying, race-motivated crimes, stalking, war, or terrorism
Surgery, medical distress, medical life-threat
Falls and sports-related injuries
Relationship break-up

Trauma signs and symptoms may include (these symptoms may overlap other disorders, as well):

Increased physiological arousal, symptoms of panic, difficulty falling asleep, trouble concentration, feeling disorientated, and/or feeling jumpy or easily startled
Feeling overwhelmed by stimuli, e.g. too much and many different types of noise, novel noise, increase in volume of noise; too many people or too much visual stimuli such as found at a mall or recreation or social event; various smells; and/or changes in light and other sensory disruption
Chronic muscle patterns and/or unexplained aches and pains
Intense and prolonged emotional and/or physiological distress after a trigger, reminder, or cue of the traumatic material
Feeling disconnected from one’s self or surroundings, feeling floating, foggy, far away, or in a fugue
Emotional numbing or numbness
High level of emotion and difficulty regulating this emotion
Feeling easily irritated, edgy, angered, or grouchy
Distressing, intrusive thoughts, images related to the trauma
Flashbacks, nightmares or night terrors, and/or a feeling of reliving the traumatic event
Avoidance of places, people, and activities that are in some way related to or reminders of the trauma
Behaviour, attitudinal, and habit changes which often present as disruptive to interpersonal relationships
Inability to remember important aspects of the traumatic event(s), situation, or time-period.
Ongoing inability to experience positive emotions
Hyper-vigilance – feeling as though one is always on guard

or having to watch and be alert to self and/or surroundings.

Persistent and exaggerated negative or maladaptive belief

about oneself, other individuals, or the world around them

Reckless or self-destructive behavior
Obsessive and compulsive behaviours
Mood swings
Fatigue and exhaustion
Sexual dysfunction
Panic attacks
Anxiety
Depression
Changes in eating patterns
Social isolation and withdrawal
Feeling detached or estrangement from others
Often or persistent feelings of

fear, horror, anger, guilt, or shame

Feelings of not knowing who oneself is

or a fractured, skewed, or disturbed sense of self

Overwhelming and/or incongruent, and difficult to manage

feelings of shame, guilt, and/or disbelief

Difficulty functioning and performing tasks

at home, work, or in other activities

Significantly diminished interest or participation

in activities one had an interest in before the traumatic event(s), situation, or time-period

Using alcohol or drugs (illicit or prescription) to regulate emotions and body sensations
Impending sense of doom, and/or concern about or feeling that one will die early

There are various terms which refer to types of trauma, provided in the context of psychology. These are often read or heard about in literature, pop-psychology, social media, and physician or psychologist’s offices. Although listed separately, here, these terms and definitions are overlapping.

All Trauma at it's core is an outcome of an overwhelmed nervous system and feeling helpless and/or hopeless. There are forms of trauma that are linked to life-threat and others linked to development in childhood, primary caregivers, and relationships. The following terms are interchangeable but are explained separately as trauma in the literature and clients referring to their experience or previous assessments often refer to trauma in these ways.

Psychological Trauma, as an outcome of Life-threat and/or grievous bodily injury.

When an event overwhelms the capability of the body and mind to cope with pain or threat to life, the body and mind respond by moving into protection by stimulating the fight, flight, or freeze response (sympathetic nervous system). In order for this response to work quickly and automatically and in order for the body to reserve energy for what may be needed in order to fight or flee, the most recently developed part of the brain, the neocortex, which engages in integration of events, information, and meaning, stops working as it has been. Without appropriate processing and integration following a traumatic event, the effects of the trauma stay with the body and in present time as iterations of the past experience which continues to try to protect.

“Trauma treatment is about coming to life in the present…” - Dr. Bessel van der Kolk.

“These initially adaptive responses to immediate danger turn into inflexible and pervasive procedural tendencies when trauma is unresolved. Once these actions have been procedurally encoded, individuals are left with regulatory deficits and “suffer both from generalized hyperarousal [and hypoarousal] and from physiological emergency reactions to specific reminders” (van der Kolk, 1994, p. 254). Traumatized clients often experience rapid, dramatic, exhausting, and confusing shifts of intense emotional states, from dysregulated fear, anger, or even elation, to despair, helplessness, shame, or flat affect. They may continue to feel frozen, numb, tense, or constantly ready to fight or flee. They may be hyperalert, overly sensitive to sounds or movements and easily startled by unfamiliar stimuli. Or they may underreact to stimuli, feel distant from their experience and their bodies, or even feel dead inside.”

― Pat Ogden, Sensorimotor Psychotherapy: Interventions for Trauma and Attachment

“Traumatized people chronically feel unsafe inside their bodies: The past is alive in the form of gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside. They learn to hide from their selves.” (p.97)” ― Bessel A. van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

Attachment/Developmental Trauma:

When an event, series of events, or environment interferes in our ability to develop healthy attachment with a primary caregiver so as to feel safe and secure as new or young humans.

We grow up seeking answers to the questions, Is it Okay to be me, Is it Okay to be here, and Is the World around me Safe. Sometimes, our early and late childhood experiences provide answers contrary to what we need to feel accepted, comforted, loved, and secure enough to explore our inner and external world. Sometimes, these experiences are so overwhelming we are left feeling unsafe, stuck, and emotionally and physiologically overwhelmed and focused in our behaviour with creating safety or seeking or avoiding connection with others.

Poor attachment or maladaptive attachment styles present in people who have suffered attachment trauma and this shows up in relationships with parents, spouses, friends, and others.

“A securely attached child will store an internal working model of a responsive, loving, reliable care-giver, and of a self that is worthy of love and attention and will bring these assumptions to bear on all other relationships. Conversely, an insecurely attached child may view the world as a dangerous place in which other people are to be treated with great caution, and see himself as ineffective and unworthy of love. These assumptions are relatively stable and enduring: those built up in the early years of life are particularly persistent…” - Jeremy Holmes, John Bowlby and Attachment Theory

Multiple or chronic exposure to trauma including physical, sexual, emotional/mental during the developmental phases of a growing person when that individual is attempting to organize self and safety may fracture the sense of identity and hinder healthy growth and interpersonal relating.

Early Childhood Trauma:

Infants and young children are either not able or not as well able to express and verbalize what may be happening for them in terms of their thoughts, emotions, and body reactions in response to dangerous, painful, threatening, or overwhelming situations, which may include physical, emotional, sexual abuse, neglect, exposure to violence or war, and medical procedures.

Emotional Trauma:

Emotional trauma, also known as psychological trauma, is psychological damage or injury experienced during an extremely distressing event or situation which results in disrupted emotional responding, coping, and behavioural functioning after the event or situation. Emotional trauma is a term used in tandem with emotional abuse or to describe the experience of someone experiencing psychological trauma. Emotional trauma refers to the emotional upset which persists long after the traumatic event has occurred.

Relational Trauma:

Relational trauma may occur in the context of any relationship, including a child-parent, sibling, spousal, caregiving, etc., Relational trauma may occur in the developmental stages of a human being or during adulthood. Relational trauma is a violation or repeated violations of an individual’s boundaries and harm to that individual’s dignity and self-worth which results in symptoms of traumatic stress. Relational trauma is an outcome to intimate partner violence (physical/emotional/sexual), infidelity, or neglectful or abusive childhood experiences.

Dr. Judith Herman calls relational trauma; “trauma inflicted on one person by another …characterized by a violation of human connection.”

Dr. Barbara Steffens is a leading partner-trauma specialist and describes relational trauma as “attachment injuries, (which) occurs when one person betrays, abandons, or refuses to provide support for another person with whom he or she has developed an attachment bond.”

Single Incident Trauma:

Single incident trauma refers to one overwhelming incident which had the potential to traumatize or which did elicit symptoms of traumatic stress in an individual. One trial learning is a phrase that describes a change in behaviour and responding that occurs with exposure to one powerful experience. This does not mean that for those who have suffered one exposure to traumatic material that they suffer less or more.

Sexual Trauma:

Sexual trauma refers to one or multiple sexual violations. Some individuals who have endured sexually traumatic event(s), do not refer to their experience as rape, assault, or trauma, due to the complex perceptions and emotions involved such as the perception of presence or absence of overt violence and/or the level of familiarity of perpetrators. However, sexual boundary violation may result in trauma and short and long-term psychological consequences. Survivors are at an increased risk of developing mental health issues.

Complex Trauma:

Dr. Bessel Van Der Kolk describes complex trauma as “the experience of multiple and/or chronic and prolonged, developmentally adverse traumatic events, most often of an interpersonal nature (e.g., sexual or physical abuse, war, community violence) and early-life onset. These exposures often occur within a child’s caregiving system and include physical, emotional, and educational neglect and child maltreatment beginning in early childhood.”

Trauma Therapy - Sensorimotor Psychotherapy

What is Sensorimotor Psychotherapy? This is a therapy which connects traditional psychotherapy with somatic-oriented therapies to investigate the ways in which sensory communication from our body about our environment informs and impacts our functioning. This therapy focuses on mind-body-spirit holism.

Our every moment, our past moments, and our predictions about future moments are wonderfully organized by our nervous system. Cognition (thoughts and thinking styles), Affect... (emotions/feelings), Behaviour (conscious and non-conscious), and the Body (sensations and impulses) culminate and reciprocate as four core organizers of our moment to moment lived experience.

Traumatic events, early poor attachment to primary caregivers, and our life experiences leave impressions within our bodies which inform the way we carry ourselves; the way we move into relationship with others; and, the manner in which our nervous system ‘lights up’ to inform of us of (real or perceived) threat, our core-beliefs about ourselves, the world around us, and our place in it. Engaging the body and utilizing the body’s intelligence is critical in reshaping our behaviour, thoughts, and emotions.

SP is primarily a therapy for trauma, but a client does not have to have a trauma to benefit from engaging the body and the body’s intelligence in treatment.

From the get-go of life, our nervous system organizes through environmental and sensory stimuli to create messages of safety, security, and approach or avoidance responding. As we grow, hopefully, we became better able to integrate these messages and regulate our responding appropriately through positive attachment and improving development of the brain.

During moments when we are overwhelmed, or as a consequence of maladaptive attachment, our ability to integrate what is happening is diminished affecting our ability to sense an event as being over or in the past, affecting intra- and interpersonal relating, and organizing our response to stressors and triggers in unhelpful ways.

SP therapy integrates the role of the whole self so that physiological, behavioural, and mental functioning improves and returns to adaptive states. SP therapy does this in a safe environment and attuned relationship between therapist and client.

Some signs and symptoms overlap other mental health concerns and for an individual to be appropriately diagnosed with a disorder, they need be examined through a mental health assessment; this may be completed by a physician, registered psychologist, clinical social-worker, or a psychiatrist. There are pros/cons, helpful bits and unhelpful pieces, cautions and considerations when seeking a diagnosis that are important to discuss with your mental health professional, e.g. the risks of pathologizing and labeling and the benefits of diagnosis.