In popular culture there is a lot of talk about trauma. The word trauma is sometimes used too loosely, in efforts to refer to something that was especially challenging. But what is clinically significant trauma, and why should it be treated? People may be diagnosed with PTSD, or other trauma-related and stress disorders when they are exposed to any of the following: natural disasters (not interpersonal in nature), physical abuse, sexual abuse, loss that is particularly devastating or violent in nature, or illnesses and medical treatments that are frightening and invasive. Other types of trauma include repeated exposure to trauma, community violence, and complex trauma. Repeated trauma is commonly experienced in those in combat, police officers, firefighters, and other first responders. The term complex trauma describes both children’s exposure to multiple traumatic events, and the long-lasting negative effects of the trauma. Since these traumatic events often occur in the context of the child’s relationship with a caregiver (physical or sexual abuse), it interferes with the child’s ability to form a secure attachment bond and healthy physical and mental development.
Research has shown that our brain is much more malleable than we once thought it was, and many can heal from devastating events without therapeutic intervention. On the other hand, many trauma survivors suffer from serious side effects, and need professional help to get better. So how is it possible that a similarly traumatic event can cause one person to experience long lasting side effects, and another person can heal without intervention? There is a great deal of research around what causes PTSD, but from the stand point of cognitive-behavioral therapy, trauma disorders are born from the way in which a traumatic memory is stored in the brain.
In order to explain how trauma works, I often use the analogy of a fire alarm. If there is an actual fire and the fire alarm has gone off, the alarm has done its job and saved us from danger. But, if the fire alarm is going off because of burnt popcorn and not an actual fire, it’s a false alarm. People with PTSD are constantly experiencing false alarms, but their brain doesn’t know the difference. Because their brain interprets a false alarm as a real danger, their body goes into flight or flight mode. Fight or flight mode is necessary to our survival as human beings but when that switch is stuck on, trouble arises. Because the body is stuck in “go mode” there is often a depletion of two important hormones, cortisol and adrenaline, which can cause both hyperactive behavior, and under responsive behavior. In children, for example, hyperactivity as a trauma response may look like ADHD, making it easy to misdiagnose. This is why it is important for those in the community who work with children to be trauma-informed. Under responsive behavior can cause a child to act shy, hide, or show little positive or negative emotion.
Some common symptoms of trauma, for both adults and children, are: irritability, night terrors, flashbacks, avoidance of places or situations that trigger memories of the event, intense fear, sleep problems, worry, sadness, and emotional numbing. Let’s face it, traumatic events are tough to talk about both for the person who experienced them as well as for those around them.. This may be one of the reasons why people use avoidance as a tactic to feel better. However, avoidance is anxiety’s best friend, and by avoiding triggers (things that remind them of the trauma) the brain receives a strong message that there is actually something to afraid of. Another problem with avoidance is that one can never identify all of their possible triggers, making it impossible to avoid them. So while avoidance often feels like a safe choice, it doesn’t lead trauma survivors to a path of healing... but instead to a place of isolation.
So what is helpful? When it comes to trauma, cognitive-behavioral therapy can help people with trauma or stress-related disorders to organize and restore the memory in a way that allows their brain to interpret it in a way that is more accurate and helpful. By doing so, we can readjust our “fight or flight” switch, so that is only turned on when real danger exists. The overarching goal for treating clients who are suffering from a traumatic event/events is to help them get to a healthier level of functioning. The hope for treatment is that trauma wounds turn into scars. Unlike open wounds, scars don't usually hurt. With treatment, the once open wound becomes a scar, and while it may serve as a reminder of a painful time it becomes just another part of the person, not the whole.
Written by: Kaitlin Soule, LMFT
Www.nctsn.org (National Child Traumatic Stress Network)
Www.TFCBT.org (Trauma-Focused Cognitive Behavioral Therapy)
Www.ptsd.va.gov (National Center for PTSD)