Trauma Therapy

“While we all want to move beyond trauma, the part of our brain that is devoted to ensuring our survival (deep below our rational brain) is not very good at denial. Long after a traumatic experience is over, it may be reactivated at the slightest hint of danger and mobilize disturbed brain circuits and secrete massive amounts of stress hormones. This precipitates unpleasant emotions intense physical sensations, and impulsive and aggressive actions. These posttraumatic reactions feel incomprehensible and overwhelming. Feeling out of control, survivors of trauma often begin to fear that they are damaged to the core and beyond redemption.” Excerpt From: Bessel van der Kolk MD. “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.”

Understanding Trauma

Trauma is a Greek word that originated in the 1690s and literally means "wound".  Just as a physical injury can wound our bodies, emotional injuries can wound our psyche.  Physical wounds are usually obvious and therefore the need for treatment is evident and usually given.  Emotional wounds, however, are usually not as obvious and therefore often go untreated.  As a result, an emotionally traumatic event or experience can have a long lasting psychological impact.  Symptoms often seen in those who have experienced trauma include:

1. Anxiety
   Traumatic experiences can change our sense of feeling safe in the world.   Memories of the traumatic experience may be triggered  by environmental cues such as noises, smells, situations, or visual elements that remind us of what happened and bring on anxiety.  Sometimes we may be unaware of these triggers and anxiety can seem to come from nowhere.
2. Grief and Depression
   A traumatic experience can change our perception of the world and ourselves, leading to sadness and grief over what has been lost.  It may seem that returning to how we once viewed the world and ourselves before the traumatic experience is hopeless.   This is particularly true for those who have become stuck in a post-traumatic world where healing has not taken place.
3. Hypervigilance
   Someone who has been through a traumatic experience often anticipates another and may seem on constant alert, unable to relax.  This is a normal fight, flight or freeze response and is intended to protect us from danger.  However, being in a constant state of stress due to anticipated danger when we are in a safe environment is unhealthy and can lead to irritability, sleep difficulties, and other health issues.
4. Avoidance
   After a traumatic experience, a natural response can be to avoid anything that reminds us of the trauma.  Any environmental element present at the time of the traumatic experience can become something that is avoided.  For example, if the traumatic experience occurred on a train, trains may subsequently be intentionally avoided.  In addition to avoiding tangible reminders of trauma, thoughts and feelings about a traumatic experience may also be avoided, leading to a false sense that this is an effective way of coping.  It is important to realize, however, that these thoughts and feelings may still be there, and may be influencing many aspects of our lives that we are not aware of.
5. Nightmares
   During the day, we can sometimes effectively block memories of a traumatic experience.  At night, however, when our mental defenses are relaxed, memories of traumatic experiences can surface.  Then, we may try to make sense of what happened by replaying the memory over and over again.
6. Unhealthy coping
   Without treatment that allows effective healing, many trying to cope with the lingering emotional pain left by trauma turn to unhealthy ways.  In an attempt to block out painful memories, thoughts, or feelings related to the trauma some often try alcohol, drugs, unhealthy relationships, etc.  While these attempts to cope with emotional pain may seem to help in the short term, chronic use of alcohol or drugs will slow down recovery and ultimately make things much worse.

Types of Trauma

Psychological trauma is often thought of as something that comes from a single traumatic event such as a major fire, flood, sexual or physical assault in adulthood, or from fighting in a war, but there are other types of trauma that can result in lingering emotional pain.  Complex trauma most often occurs in childhood as the result of repeated physical, emotional, or sexual abuse, neglect or abandonment but can also occur in adults who experience ongoing domestic violence or abuse, or have repeatedly witnessed violence or abuse.

Trauma Therapy

Effective trauma therapy occurs in three phases.  These are not necessarily linear phases, but are typically dynamic meaning that as you move from one phase to the next, you may need to return to a former phase before proceeding.   A metaphor that is often used is of a house that has been damaged, say by a tornado.  Before moving in to clear remaining rubble left by the tornado, you would first need to make sure the area is safe and secure so that additional damage won't result by attempting work prematurely.  Once there is confidence that the area is safe to work in, gradual clearing away of the damaged structure begins.  As you work slowly, you may find areas of damage that weren't evident before work began and need to be attended to before moving forward.  Gradually, the damaged structure is cleared away leaving a stable foundation for rebuilding.  Some areas may need to be completely rebuilt.  Others may only need repair to be made sound.  Gradually, the new structure begins to take shape and is soon ready to provide a safe and secure place to live again.  In Phase 1 of trauma therapy the main goals are to help an individual develop a sense of personal safety by learning to rely on internal strengths to regulate emotions and behaviors.  In Phase 2, work begins to process traumatic memories and the emotions attached to them.  In the metaphor mentioned previously, this is when damage is removed to prepare the foundation for repair and rebuilding.  In Phase 3, personal insights, emotional regulation, and the sense of safety established in the first two phases are used to establish a new sense of self that is set free from the restrictions created by the traumatic experience so that life no longer has to be defined by the pain of the past.

EMDR

While working through these phases can be accomplished with traditional psychotherapy, Eye Movement Desensitization and Reprocessing  (EMDR) can potentially be more effective and efficient.  More information on EMDR is available by clicking the link above.