EMDR and big and little T

Surely all trauma, is trauma, right? Yes, it is, and if we use a trauma-informed lens we meet each person in our lives recognising trauma as having a widespread impact on individuals and communities.

Trauma is defined by the UK government as “Trauma results from an event, series of events, or set of circumstances that is experienced by an individual as harmful or life-threatening. While unique to the individual, generally the experience of trauma can cause lasting adverse effects, limiting the ability to function and achieve mental, physical, social, emotional or spiritual well-being” (Office of Health and Disparities November 2022). Symptoms range from insomnia, nightmares, anxiety, depression, flashbacks, dissociation, fogginess, feeling unsafe, struggling to function, panic attacks and more. Dread is a common theme and often the fear or threat is huge and cannot be named. So, what is the differentiation and why is it useful to consider this?

Big T trauma is usually an event or experience of catastrophe, so an accident, natural disaster, attack, or similar with all the horror, images, sensations, emotions and urges seared into our body and mind. Trauma predominates in three important parts of your brain: the amygdala, which is your emotional and instinctual centre; the hippocampus, which controls memory; and the prefrontal cortex, which is responsible for regulating your emotions and impulses. These three parts of the brain usually work to manage stressors.

When you’re reminded of a traumatic experience, your amygdala (like a smoke alarm) goes into overdrive, acting just as it would, if you were experiencing that first trauma. This means you are not choosing a response, the smoke alarm takes precedence and is urging you to act, while your thinking, planning brain (prefrontal cortex) is effectively, offline. The hippocampus, one of whose functions is to differentiate between past and present, cannot effectively discriminate. In other words, your brain can’t tell the difference between the actual traumatic event and the memory of it. It perceives things that trigger memories of traumatic events, as threats themselves. Trauma can cause your brain to remain in a state of hypervigilance, suppressing your memory and impulse control and trapping you in a constant state of strong emotional reactivity.

Not everyone who experiences Big T trauma gets post-traumatic stress (PTS). Advice following a traumatic event is to talk about what happened to you with people you trust. You should try to follow your routine, and take time to acknowledge and process your feelings. It can be helpful to talk to others who have experienced the same type of thing and to know you are having similar feelings or experiences. Spending time with others, asking for support or seeking help from your GP can all help support you. Being patient with yourself and not pressuring yourself to get better or back to normal will help you take the time you need. A big event takes time to digest emotionally and physically and like an injury needs nurture, care and gentle healing. This can help you come through a terrible experience.

Some people develop PTSD from a Big T trauma which can occur immediately or following the event. Sometimes this is because the event was so impactful and for others, their history may include previous trauma or adverse childhood events (ACEs). Stressors in a person’s current life, coping strategies and having a support system can also affect this outcome.

Little T trauma refers to events which are highly distressing and sometimes repeated having the same impact upon a person as a Big T trauma. For example, emotional abuse, neglect, bullying, harassment, loss of significant relationships, ACEs, life changes, isolation or being treated differently from others in your childhood home, workplace or school can all create a complex web of trauma. Some people who have experienced many ACEs may be diagnosed with complex trauma and others may struggle with esteem, depression, anxiety and relationships.

Attachment theory is used by most trauma therapists to make sense of the way a person’s day-to-day struggles impact them. The relationships experienced in the first seven years of life create a template for future interpersonal dynamics. EMDR therapy is a NICE-recommended therapy which is very effective in addressing trauma both Big and Little T’s. Using psychological resources to build a person’s connection to positive and calm feelings, to begin to feel safe in their body and to learn regulation for strong emotions, we begin to lay the foundations for a new way of relating to self and others. Discovering what you missed out on in early life helps us to work on creating experiences which build new neural pathways.

Using bilateral stimulation (eye movements, tapping, buzzers, sounds) we then reprocess the traumatic events, addressing beliefs, thoughts, sensations, emotions, images and urges. The magic of EMDR lies in tapping into the adaptive part of you, which offers new perspectives on the event, your part in it and how you feel about it now. The reprocessing may happen more quickly with a single incident trauma but with complex trauma or Little T’s, we can cluster events or reprocess representative incidents which are stored together in your memory network.

Once we have reprocessed, we check your beliefs, the original incident/s and your body for any residual trauma. We then look at the future and how you will manage, review things and either conclude or focus on the next target of therapy.