“One does not have to be a combat soldier, or visit a refugee camp in Syria or the Congo to encounter trauma. Trauma happens to us, our friends, our families, and our neighbors.”
-Bessel van der Kolk
What is Trauma?
Trauma can be a difficult thing to define. Like all things psychological, it is inherently subjective, and different things can be traumatic for different people. In this sense, it may be easier to define trauma by how an individual reacts to the event or series of events, rather than the event itself. In other words, the important factor when discussing trauma is the experience of the individual after the event. This is important because an event that may elicit what we in the mental health profession call a trauma response in one individual may not have the same effect on another.
It can be helpful to break trauma down into distinct categories. Specifically, there are three main types of trauma; acute, chronic, and complex. Each type often results from different circumstances and events. Equally important, each type often responds differently to different types and techniques of treatment.
Acute trauma typically results from single traumatic events, such as a car accident, assault, rape, or natural disaster. Whatever it was, the event was intense enough to make the individual feel threatened either psychologically, physically, or both. Those who experience acute trauma can experience intense anxiety, panic attacks, dissociation, uncontrollable anger and aggression, sleep disruptions, and lack of self-care or hygiene, among other symptoms.
Chronic trauma can occur when an individual is exposed to distressing traumatic events or environments for an extended period of time. Domestic violence, serious medical illnesses, ongoing sexual abuse, and extremely high-stress environments such as war are some of the things that can result in chronic trauma responses. Those who experience these may find themselves with similar symptoms to acute trauma, with the added likelihood of experiencing difficulty in their relationships, an inability to trust anyone, and rapid, unpredictable mood swings. Importantly, those who experience chronic trauma may not experience symptoms until long after the traumatic event itself, sometimes even years after.
Complex trauma is very similar to chronic trauma in that it happens over an extended period of time and is often interpersonal (between people) in nature. Complex trauma, however, is distinct in that it often occurs early in life or when an individual finds themselves in vulnerable situations such as dependency or disempowerment. Symptoms of complex trauma include difficulty regulating emotions, self-destructive and self-sabotaging behavior, dissociative episodes, a chronic sense of guilt or responsibility, difficulty trusting people or feeling intimate, and hopelessness or despair. Like chronic trauma, symptoms may not reveal themselves for an extended period of time after the events.
While it can be helpful to make distinctions between acute, chronic, and complex trauma, the most important thing to remember is that each individual reacts differently and no two circumstances, events, or set of symptoms are identical. If you or a loved one are experiencing symptoms such as those described above, trauma could be a possible explanation. Seeking help from a trained mental health professional can provide some clarity and be an invaluable step to healing and growth.
Symptoms as Trauma Responses
Symptoms, in the context of trauma, can be thought of as the individual’s responses to that trauma. Responses, both conscious and automatic, are designed to protect that individual, in one way or another. Specifically, symptoms are, more often than not, ways your body, brain, and mind are trying to protect you from whatever specific trauma was experienced. A combat veteran, for example, may be suffering from hypervigilance and restless sleep. In the combat zone, the individual’s hypervigilance likely helped keep them safe. Once that veteran returns to civilian life, however, they will more than likely experience difficulties in their relationships, at work, etc. if they continue to be hypervigilant. It is important to note, however, that the way these responses “protect” the individual is not always easily evident or, for that matter, logical. While physical protection is one way our bodies, brains, and minds react to trauma, they are just as concerned with meeting our emotional needs as they are with physical needs.
The Role of the Body
Trauma forces us to see an individual holistically. Separating the mind, brain, and body is useful and helpful in many situations, but when it comes to treating trauma, the systematic nature of the symptoms cannot be ignored. During trauma responses, the body takes control, in a sense.
In the most basic explanation, traumatic events and environments cause our bodies to go into fight, flight, or freeze response, where our body prepares to defend itself from whatever is threatening us at the moment. During these responses, many physiological responses occur, from a change in heart rate and decrease in pain perception to dilated pupils and an increase in hearing ability. Sometimes, these responses can be helpful, such as slamming on the brakes to avoid a car accident or jumping out of the way of an oncoming vehicle. Sometimes, however, these responses become our body’s default response to non-threatening situations. There is no hard and fast rule for predicting what types of events cause individuals to get “stuck” in these types of responses. However, single events of great intensity and environments that chronically expose individuals to traumatic events and stress, can often result in the body continuously being in a fight, flight, or freeze mode.
So what does this mean for the role of the body in trauma responses and treatment? These responses are often thought of as outside of our control. That is, we can’t consciously tell our body to secrete fewer stress hormones or to stop causing us to have nightmares every night. This, in turn, can cause those living with the imprints of a traumatic past to feel as if they have lost control of themselves. As if they no longer are in charge of their bodies, emotions, and behaviors. They often feel as if their brain is broken or their body has hijacked their life.
The key challenge and goal for treatment, then, is first and foremost helping individuals reestablish a sense of ownership of their mind, body, and brain.
What Does Treatment Look Like?
Treatment for trauma is far from a one-size-fits-all approach. A varied approach to treatment is often the most effective. At the core of treatment for trauma, however, lies the therapeutic relationship. The therapeutic relationship is simply the relationship between you and your therapist. So what makes this so critical for treatment? In a sense, the therapeutic relationship creates the space, support, and environment in which the client can begin to piece together the parts of themselves that have been torn apart by trauma.
Once the therapeutic relationship is established, you and your therapist will work out a plan to address each aspect of your trauma responses. Sometimes, this can mean focusing on specific symptom reduction, such as using CBT (cognitive behavioral therapy) techniques to reduce the power of negative or intrusive thoughts. Other times, treatment may focus on finding ways to continue to live a full and meaningful life despite the pain and discomfort you are experiencing. What’s more, trauma therapy may include complementary methods to incorporate outside of the therapy room, such as drama therapy, trauma-informed yoga, and neurofeedback. EMDR is another popular and evidence-based treatment for healing the effects of trauma.
As with any treatment plan for mental health, treatment for trauma is not a one-size-fits-all and will ultimately be up to you and your therapist. Together, you will take into account your symptoms, resources, strengths, and goals in order to tailor your treatment specifically towards your needs.
There is Hope
“Working with trauma is as much about remembering how we survived as it is about what is broken.”
-Bessel van der Kolk
Trauma can leave us feeling hopeless as if there is no escaping the past. It can feel like we are stripped of our ability to love, grow, make our own decisions, and be our own person. It can even make us forget that we are resilient. It can make us forget that we are still here. That there is hope. Trauma can reveal the darkest parts of humanity. But, when viewed from the right perspective, it illuminates the vast amounts of strength and resiliency human beings are capable of. That resilience is just as much the focus of therapy as any other aspect of trauma. Finding and tapping into your own resiliency and, just as importantly, the resiliency of those there to support you is key to healing, growth, and living a full, rich life.