Trauma Overview
Trauma is a word often used to describe anything really bad or scary that happens to someone that leaves lasting emotional wounds that are not easily shaken. Not every bad or scary experience is considered traumatic and sometimes what one person considers traumatic is not experienced or labeled as traumatic by someone else. There are many kinds of traumatic experiences such as from natural disasters, war zones, physical abuse, sexual abuse, neglect, emotional abuse, domestic violence, witnessing violence death or injury, or even medical traumas. Trauma happens to men and women, people of all ages, races, religions, nationalities, and social classes. Although trauma does not discriminate, individuals from less privileged backgrounds are more likely to be exposed to traumatic situations early on-in life due to systemic and generational influences.
Most people recover from trauma on their own over time, though some find it helpful to talk to someone along the way, while a smaller percentage of people will find that their symptoms have progressed to what therapists label Posttraumatic Stress Disorder (PTSD) https://www.ptsd.va.gov/understand/index.asp. This condition is marked by feelings of acute fear and anxiety, avoidance of things that remind someone of the trauma, and intrusive, unwanted, and often distressing thoughts about the trauma. PTSD is treatable for most people, even people who have struggled with it for years once they have had the appropriate treatment. There is hope. You are not alone.
This video resource from Scotland on the brain and trauma is helpful for understanding more about how people are impacted by a traumatic situation and why their responses afterward may seem so confusing to others.
Most people recover from trauma on their own over time, though some find it helpful to talk to someone along the way, while a smaller percentage of people will find that their symptoms have progressed to what therapists label Posttraumatic Stress Disorder (PTSD) https://www.ptsd.va.gov/understand/index.asp. This condition is marked by feelings of acute fear and anxiety, avoidance of things that remind someone of the trauma, and intrusive, unwanted, and often distressing thoughts about the trauma. PTSD is treatable for most people, even people who have struggled with it for years once they have had the appropriate treatment. There is hope. You are not alone.
This video resource from Scotland on the brain and trauma is helpful for understanding more about how people are impacted by a traumatic situation and why their responses afterward may seem so confusing to others.
From Visually.
Simple vs Complex Trauma
A common issue that is coming up lately is confusion from misinformation about complex PTSD. Let's talk for a moment about simple vs complex trauma. Simple trauma is usually associated with singular traumatic events, whereas complex trauma is associated with multiple, serial, or a combination of big T and little t traumas.
So now you may be asking, Megan, what is this big T and little t trauma thing? Big T traumas are the events most commonly associated with criterion A of the PTSD diagnosis in the DSM-5 (the diagnostic manual for mental health professionals), such as those events listed in the first paragraph. These events are the ones most commonly known to cause flashbacks, nightmares, avoidance, and hypervigilance. Little t traumas, by contrast may go under that radar a bit because of how common they are or how overlooked in society they are, but they may result in acute distress such as divorce, racism, homophobia/transphobia, microaggressions, having a family member who has mental illness, is imprisoned, or has a substance abuse problem. The cumulative impact of little t traumas over time can have a big overall impact on one's physical and mental wellbeing.
So here's where the confusion comes in, despite the fact that we have long known that complex trauma exists and our definition for PTSD in the DSM is too narrow, and despite efforts by many of our most prominent trauma specialists in the field like Bessel van der Kolk to get a new complex PTSD diagnosis into the DSM, one still does not exist. So recently we are seeing an influx of clients looking for CPTSD specialists, when technically, CPTSD does not exist in our diagnostic manual, which means it cannot be billed to/covered by insurance companies. The truth is, any therapist that specializes in PTSD likely specializes in CPTSD because most traumas are complex, they just may not advertise that because it is not formally recognized yet by the institutions that govern our practices. Read about Complex Trauma here https://www.isst-d.org/public-resources-home/fact-sheet-i-trauma-and-complex-trauma-an-overview/?www.isst-d.org/public-resources-home/fact-sheet-i-trauma-and-complex-trauma-an-overview/?
So now you may be asking, Megan, what is this big T and little t trauma thing? Big T traumas are the events most commonly associated with criterion A of the PTSD diagnosis in the DSM-5 (the diagnostic manual for mental health professionals), such as those events listed in the first paragraph. These events are the ones most commonly known to cause flashbacks, nightmares, avoidance, and hypervigilance. Little t traumas, by contrast may go under that radar a bit because of how common they are or how overlooked in society they are, but they may result in acute distress such as divorce, racism, homophobia/transphobia, microaggressions, having a family member who has mental illness, is imprisoned, or has a substance abuse problem. The cumulative impact of little t traumas over time can have a big overall impact on one's physical and mental wellbeing.
So here's where the confusion comes in, despite the fact that we have long known that complex trauma exists and our definition for PTSD in the DSM is too narrow, and despite efforts by many of our most prominent trauma specialists in the field like Bessel van der Kolk to get a new complex PTSD diagnosis into the DSM, one still does not exist. So recently we are seeing an influx of clients looking for CPTSD specialists, when technically, CPTSD does not exist in our diagnostic manual, which means it cannot be billed to/covered by insurance companies. The truth is, any therapist that specializes in PTSD likely specializes in CPTSD because most traumas are complex, they just may not advertise that because it is not formally recognized yet by the institutions that govern our practices. Read about Complex Trauma here https://www.isst-d.org/public-resources-home/fact-sheet-i-trauma-and-complex-trauma-an-overview/?www.isst-d.org/public-resources-home/fact-sheet-i-trauma-and-complex-trauma-an-overview/?
Why does trauma matter and why we shouldn't just try to ignore it or "get over it"
One of the most frustrating things survivors often tell me they experience is being told they should "just get over" what happened. That they need to "put it behind them." That they need to leave the events in the past and "forgive and forget." Although this colloquial advice is well-meaning, it is ill-informed and not all backed up by current research and tends to hurt survivors far more than it helps.
A game-changer came as a result of the ACE (Adverse Childhood Experiences) Study (Felitti et al, 1998) which showed us that there was a direct cause and effect link between adverse childhood experiences and negative health outcomes later in life. The findings were so robust that it indicated a dose-response relationship, meaning that the more traumas someone experiences early in life, based on a 10 question assessment of trauma, the more likely they were to have to have worsening health problems to such an extent that individuals who had an ACE score of 6 or more on average lived 20 years shorter lifespans. Watch this video from Paper Tigers to understand more about ACES.
Despite the fact that people like to dismiss trauma as being in the past, we now know that the past is still present and trauma is often carried in the body and passed on from one generation to the next. Unless we are proactive, a person is more likely to suffer emotional and physical health impairments that could have been prevented. Your trauma matters. What happened matters. Talking about it and getting help matters.
A game-changer came as a result of the ACE (Adverse Childhood Experiences) Study (Felitti et al, 1998) which showed us that there was a direct cause and effect link between adverse childhood experiences and negative health outcomes later in life. The findings were so robust that it indicated a dose-response relationship, meaning that the more traumas someone experiences early in life, based on a 10 question assessment of trauma, the more likely they were to have to have worsening health problems to such an extent that individuals who had an ACE score of 6 or more on average lived 20 years shorter lifespans. Watch this video from Paper Tigers to understand more about ACES.
Despite the fact that people like to dismiss trauma as being in the past, we now know that the past is still present and trauma is often carried in the body and passed on from one generation to the next. Unless we are proactive, a person is more likely to suffer emotional and physical health impairments that could have been prevented. Your trauma matters. What happened matters. Talking about it and getting help matters.
The Healing Process
Healing often takes time, but the time it takes is different for everyone. The healing process can be like a roller coaster, fast and furious at times, slow and frustrating at other times. Be patient with yourself. It is not unusual for people to come in years or even decades after their initial trauma, suddenly realizing the pain they had swept under the rug for so long. Sometimes earlier memories get triggered by re-victimization or another abuse incident, reaching a new developmental milestone, or having children reach the age you were when you were abused.
Often, victims do not tell others about their victimization and most do not go to the hospital or police without some urging or encouragement from their support system or unless they have been seriously physically injured. Again, contrary to what gets shown on CSI: SVU, there is no "typical" way a victim acts. Some people are sad, some angry, some are in shock, many will smile, laugh, and talk to you just like normal, but that does not mean they are not suffering or that it didn't really happen. Many people get very good at covering up their emotions around others as a way to conceal their vulnerability. In cases of drug-facilitated sexual-assault, the survivor may be very confused because she/he may not have clear memories of what happened, but the events leading up to it and afterward all suggest that something bad happened to her or him.
Some people may not fully feel the effects of the abuse for weeks or months down the road. It is not unusual to see survivors initially upset in the 1st few months after the trauma and they may want to talk about it or seek help. This however, may be followed by a period of just wanting to forget about it or deny that it ever happened. This phase can last for a long time until they are ready and in a safe enough place in their life to come to terms with the traumatic experience. Once a person recognizes their victimization and its impact, they may feel like they are in a state of crisis and wish to come into therapy, as they may be having difficulty managing aspects of their life that they previously were able to do. Once a person makes the brave commitment to seek trauma therapy, the hard work begins. With trauma work, people often feel worse before they feel better. Much like a sliver that needs to be removed from your fingertip, the removal process will be unpleasant, but letting the wound fester will be be sure to make things feel worse over time. For those that commit themselves to sticking with treatment, they often will find themselves moving from victim, to Survivor, to THRIVER.
Often, victims do not tell others about their victimization and most do not go to the hospital or police without some urging or encouragement from their support system or unless they have been seriously physically injured. Again, contrary to what gets shown on CSI: SVU, there is no "typical" way a victim acts. Some people are sad, some angry, some are in shock, many will smile, laugh, and talk to you just like normal, but that does not mean they are not suffering or that it didn't really happen. Many people get very good at covering up their emotions around others as a way to conceal their vulnerability. In cases of drug-facilitated sexual-assault, the survivor may be very confused because she/he may not have clear memories of what happened, but the events leading up to it and afterward all suggest that something bad happened to her or him.
Some people may not fully feel the effects of the abuse for weeks or months down the road. It is not unusual to see survivors initially upset in the 1st few months after the trauma and they may want to talk about it or seek help. This however, may be followed by a period of just wanting to forget about it or deny that it ever happened. This phase can last for a long time until they are ready and in a safe enough place in their life to come to terms with the traumatic experience. Once a person recognizes their victimization and its impact, they may feel like they are in a state of crisis and wish to come into therapy, as they may be having difficulty managing aspects of their life that they previously were able to do. Once a person makes the brave commitment to seek trauma therapy, the hard work begins. With trauma work, people often feel worse before they feel better. Much like a sliver that needs to be removed from your fingertip, the removal process will be unpleasant, but letting the wound fester will be be sure to make things feel worse over time. For those that commit themselves to sticking with treatment, they often will find themselves moving from victim, to Survivor, to THRIVER.
What Kinds of Trauma Treatments are There?
There are many types of trauma treatments available, but there are a few that are more widely recognized and endorsed for their ability to treat trauma. The decision on whether to seek out talk therapy, psychopharmacology, or crisis related interventions may depend on your level of need and personal preference. Here are a few of them:
Cognitive Processing Therapy (CPT)
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Prolonged Exposure (PE)
Eye Movement Desensitization and Reprocessing (EMDR)
Dialectical Behavioral Therapy (DBT)
Integrative Treatment for Complex Trauma (ITCT)
Internal Family Systems (IFS)
Parent-Child Interaction Therapy (PCIT)
Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS)
For a full detailed list of therapies with adolescents and children go to: http://www.nctsn.org/resources/topics/treatments-that-work/promising-practices
For a list of therapeutic interventions recommended for use with adults by the National Center for PTSD visit https://www.ptsd.va.gov/understand_tx/tx_basics.asp and https://www.ptsd.va.gov/understand_tx/talk_therapy.asp
Cognitive Processing Therapy (CPT)
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Prolonged Exposure (PE)
Eye Movement Desensitization and Reprocessing (EMDR)
Dialectical Behavioral Therapy (DBT)
Integrative Treatment for Complex Trauma (ITCT)
Internal Family Systems (IFS)
Parent-Child Interaction Therapy (PCIT)
Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS)
For a full detailed list of therapies with adolescents and children go to: http://www.nctsn.org/resources/topics/treatments-that-work/promising-practices
For a list of therapeutic interventions recommended for use with adults by the National Center for PTSD visit https://www.ptsd.va.gov/understand_tx/tx_basics.asp and https://www.ptsd.va.gov/understand_tx/talk_therapy.asp
Media Resources
Videos
Affects of Trauma http://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime
Adverse Childhood experiences and health https://vimeo.com/139998006
Trauma and the brain www.youtube.com/watch?v=4-tcKYx24aA
Books on Trauma and Recovery
Unkind Gifts, Ellen Ranney
Thriver Zone, Susan Omilian; www.thriverzone.com (Writing activities/Fillable)
The Courage to Heal Workbook, Laura Davis (Writing Activities Fillable)
The Gift of Fear, Gavin De Becker
I Hate You Don't Leave Me, Jerold Kreisman & Hal Straus
Blaming the Victim, William Ryan
Boundaries: Where you end and I begin, Anne Katherine
From Diapers to Dating, Debra Haffner
Brave Bart, Caroline Sheppard (for kids)
My Story, Elizabeth Smart (memoir)
I know Why the caged bird sings, Maya Angelou (Memoir)
Trauma and Recovery, Judith Herman
Coersive Control: How Men Entrap Women in Personal Life, Evan Stark
The Body Betrayed, Babette Rothschild
Why Does He DO That? Inside the Minds of Angry and Controlling Men, Lundy Bancroft
The Joyous Recovery: A New Approach to Emotional Healing and Wellness, Lundy Bancroft
When Dad Hurts Mom: Helping Your Children Heal the Wounds of Witnessing Abuse, Lundy Bancroft
Should I stay or Should I go, Lundy Bancroft
Trauma and Health: Physical Health Consequences of Exposure to Extreme Stress, Paula Schnurr & Bonnie Green
The Body Keeps the Score, Bessel van der Kolk
Apps and online support
My Plan -Relationship health/abuse warning signs
Eve.-women’s health tracker and connect to online group therapy resources
I feel like shit - Depression, self-care help
Mindfulness Daily - Self-care help
Woebot-Self-care help
Headspace- Self-Care help
Calm guided meditation app
Facebook sexual abuse support groups: Talking Trees
RestfulRambles ASMR Videos on Youtube/TikTok
Common Questions
Q: How is Trauma Therapy different from regular therapy?
A: Trauma treatment usually involves an "exposure" component, in which the client is asked to talk, play, write, or draw about their traumatic experience. Usually, the more details they are able to give about the events they least want to discuss, the better the outcome of therapy.
Q: Why do people decide to come in for rape or trauma counseling?
A: People seek therapy for a variety of their own reasons, but usually what drives them to finally walk through the door is their level of distress, finding it difficult to manage on their own or becoming tired of dealing with their painful symptoms for so long. Events that send people into a state of crisis or a peak level of distress frequently include: being re-traumatized or re-victimized, no longer being numb through use of alcohol, drugs, or avoidance and feeling their feelings that they have not allowed themselves to have, or reaching a new developmental stage like puberty and getting into a new relationship, having a new sexual experience, getting married, having children, or their children reaching the age they were when they were abused triggering fears and flashbacks.
A: Trauma treatment usually involves an "exposure" component, in which the client is asked to talk, play, write, or draw about their traumatic experience. Usually, the more details they are able to give about the events they least want to discuss, the better the outcome of therapy.
Q: Why do people decide to come in for rape or trauma counseling?
A: People seek therapy for a variety of their own reasons, but usually what drives them to finally walk through the door is their level of distress, finding it difficult to manage on their own or becoming tired of dealing with their painful symptoms for so long. Events that send people into a state of crisis or a peak level of distress frequently include: being re-traumatized or re-victimized, no longer being numb through use of alcohol, drugs, or avoidance and feeling their feelings that they have not allowed themselves to have, or reaching a new developmental stage like puberty and getting into a new relationship, having a new sexual experience, getting married, having children, or their children reaching the age they were when they were abused triggering fears and flashbacks.
