Trauma is the emotional and psychological reaction to a negative event. According to Peter Levine, the founder of Somatic Experiencing, trauma is experiencing fear in the face of helplessness. Fear plus helplessness equals trauma.
While many experiences might trigger trauma, individual responses vary dramatically and cause a range of personal suffering. Different financial means, medical conditions, living situations, family landscapes, and relationship health can all affect trauma responses. The CDC-ACE score (Adverse Childhood Experiences) is one tool to indicate the level of dysfunction and abuse, and the impact on adult health – both mental and physical. Persons with higher ACE scores may be more prone to disease and even early death.
As therapists, recognizing the wide-range of possible responses helps guide treatment strategies. Clients may not fully understand the impact of their own traumatic experiences, and yet they have symptoms of trauma.
As therapists, identifying these trauma indicators in session can be invaluable.
Common Types of Trauma
Developmental trauma – Developmental trauma occurs in the first three years of life. It is a reaction to an environment of neglect or abuse that disrupts the cognitive, neurological, and psychological development of the child with repercussions that can impact adult relationships and mental health.
Complex trauma – Complex trauma is an experience or collection of experiences sustained by an individual that causes harm. Complex traumatic experiences have a cumulative effect. Complex trauma often happens during a certain period or within a specific relationship or series of relationships.
PTSD/PTS – Post-traumatic stress disorder, more recently called the less stigmatizing post-traumatic stress, is a response to a traumatic event or series of events that cause the individual to relive or replay the event in a terrifying and horrific cycle that causes additional suffering. PTS may cause nightmares, terror, withdrawal, insomnia, substance abuse, depression, and fear.
Post-traumatic stress is a natural response to abuse, combat, and disasters. It results in a more sensitive brain, primed to react to threat – both perceived and actual. The amygdala is the brain’s natural security system. It is instinctive, animalistic and primitive, designed specifically for survival.
The prefrontal cortex is our emotional response to threat. It evaluates and determines an appropriate response. It is our threat decision-maker. It decides if the threat is real and what to do in order to survive. An overactive amygdala and an underactive prefrontal cortex can result in engaging the threat-response, even when it’s not necessary.
The hippocampus works to remember the traumatic event to improve survival for future threats and plays into the recall of traumatic events.
Examples of Traumatic Experiences
Trauma-causing experiences include emotional, physical, and sexual abuse, or witnessing abuse or violence. Others include war, mass tragedy, school or community violence, natural disasters, and pandemics. Even sickness, accidents, surgery, grief, or illness can cause trauma or PTS. Finally, neglect and systemic abuse via home or foster care, or even being evicted from the home can all lead to trauma.
Identifying the Signs of Trauma
Indicators of trauma include nervous system dysregulation. Trauma resides in the nervous system, not in the event itself.
Reactions to trauma are wide-ranging. As therapists, in session, the in session, you may observe the traumas to be reasonably clear sometimes, while other times, while other times, you may feel like you are acting like a detective to help uncover the cause of your client’s distress.
Common Signs of Trauma
- Changes in mood or disposition, including anger, outbursts, sadness, despair, and hopelessness
- Substance abuse or addiction to porn, gambling, sex, or reckless behaviors
- Somatic symptoms such as body aches, nausea, numbness, dizziness, blurred vision, digestive issues
- Isolation and hopelessness
- Shame or guilt
- Difficulty stabilizing emotions, erratic changes in behavior or mood
- Nightmares and sleeplessness or chronic insomnia
- Feeling startled by fast movements or loud sounds
- Nervous system dysregulation
- Dissociation
- Fragmentation
- Acting out re-enactments
- Anniversary trauma
- Intergenerational and collective trauma
Experts on Trauma and Resilience and the Body
According to Peter Levine, “Trauma plays out in the theatre of the body.” Somatic Experiencing highlights that the mind, or memory, may not have an explicit memory, but am implicit (emotional) memory stored within the body. It is indeed essential to work through the body to release the trauma. Until the body changes, the trauma can linger, since our reaction to trauma with the flight-fight-freeze response is biologically necessary for our survival.
How we manage trauma often depends on the resources available. Developing resilience is far more effective when working from secure attachment and having a solid foundation of resources to pull from. Rick Hanson, PhD states that having a resilient brain depends on three factors: the challenges that wear upon a person, the vulnerabilities the challenges penetrate through, and the resources that we draw on to deal with these.
Dr. Hanson goes on to explain that the tougher a person’s life, the more they are being mistreated, the less the outer world is helping them, the more important it is to develop internal resources, to develop strengths from the inside out for their own wellbeing, as well as to cope with the challenges that they have.
What are those inner resources? They may include generosity, mindfulness, love, compassion, interpersonal skills, toughness, determination, grit, etc. Developing inner resources when external resources are limited or unavailable will support resilience when overcoming trauma or managing stress.
Our experiences continuously weave the tapestry of our brains, and because our brains are plastic, we can change those connections to reweave this tapestry throughout our lives. Learning to be in our experiences with curiosity and acceptance, and eventually starting the releasing process with mindfulness, breath or other practices all support healing trauma, and eventually make way for new, positive experiences and our ability to receive positive feelings.
Our Bodies Are Designed for Survival
As humans, we need safety – and our bodies are designed to protect us. Dr. Stephen Porges’ polyvagal theory describes the body-brain connection during stress and trauma through his research involving the vagus nerve – the ventral vagal nerve responds to safety and prepares us for social engagement, the dorsal vagal nerve is the calming part of our nervous system (shut-down, freeze or dissociation), and the contrasting sympathetic nervous system (fight-flight) that acts as our body’s surveillance or scanning system looking for threats and responds.
Ventral vagal, the social engagement system, requires a sense of safety. Since we can move more fluidly from flight-fight and freeze or shutdown to the social engagement system, helping our clients access feelings of safety and the social engagement system improves their resilience and gives them access to the full spectrum of responses rather than living life in constant anxiety or complete shutdown.
Safety in the Client-Therapist Relationship
Deb Dana shares that the relationship between the client and therapist, too, needs a sense of safety. Both the client and therapist need to be aware of their autonomic states. The client will constantly scan for cues from the therapist in their voice, facial expression, and micro-responses throughout the session. By helping clients map their own ANS and recognize their responses (as well as being aware of your own), it can inform and complement virtually any modality with a deeper understanding of the nervous system.
Safety within intimate relationships is essential. Stan Tatkin, founder of the PACT Institute, states that our absolute devotion to our safety and security within relationships is essential. Humans are naturally self-centered creatures living in our own brains and minds. We can be opportunistic and negative, often focusing on what’s missing and what we don’t have. Love is not enough to sustain a long-term intimate relationship because love is fleeting and fickle due to the natural ebb and flow of feelings that change on a dime.
Secure functioning relationships work because they have two members with a shared vision that puts the relationship first. Naturally, there will be some missteps and corrections along the way, but making the relationship the central focus and striving to repair threats to the relationship right away is important. The longer it takes to repair injuries, the more threat there is to the relationship.
When it comes to trauma in an intimate relationship, you are your partner’s burden and they are yours. In therapy, that means that you are there to work on the relationship, not on each other. As the therapist, caring about the justness and politics of the relationship is the focus. We see the partners as in each others’ care, as each others’ handlers.
By forcing interactive regulation, where couples are close, facing each other, you are teaching them to do something that is probably fairly rare. When you create the expectation early on that the relationship’s success is the central goal, therapy is more successful because everyone has a map and understands the vision.
Survivors of trauma believe nothing and no one is safe, and intimacy is dangerous. They may also feel that they are deeply flawed and unlovable, which is a threat to intimacy and the success of the relationship. In a relationship, trauma becomes a two-person problem instead of one. Teaching skills, like Stan Tatkin’s “couple bubble,” can help restore the sense of safety, both for the traumatized partner and for the other individual in the relationship, by creating a safe haven where both partners are secure. The couple bubble reinforces that ‘you are always safe with me, both in public and in private, and we are always looking out for one another’s well-being.’
Trauma Treatment and Helping with Hope
We know that the brain’s neuroscience is altered due to trauma, but also that neuroplasticity exists and that the brain can develop new neural pathways throughout life. With treatment from a trauma therapist who understands how to work with trauma while avoiding re-triggering the client, healing is possible, and plenty of people who have experienced even the most extreme cases of trauma can go on to lead fulfilling and connected lives.
