Trauma: Responses, symptoms, and therapeutic interventions

Trauma is a complex psychological condition that results from experiencing deeply distressing events that overwhelm an individual’s ability to cope. These events can range from personal assaults and natural disasters to accidents, war, and prolonged abuse. The impact of trauma can be debilitating, affecting emotional, physical, and mental well-being.

How the body responds to trauma

When encountering trauma, the body activates protective mechanisms involving the autonomic nervous system, triggering fight, flight, freeze, or fawn responses to safeguard against immediate harm. According to van der Kolk (2014), traumatic experiences can disrupt this system, leaving the body in a state of hyperarousal or, conversely, in a shutdown mode known as dissociation.

Peter Levine, in his book Waking the Tiger (1997), posits that trauma can become trapped in the body, suggesting that the ‘frozen’ energy from traumatic events can result in symptoms like chronic pain, anxiety, and fatigue until it is released. Levine advocates for somatic experiencing, a process that helps individuals re-engage with this trapped energy, promoting both physical and psychological healing.

The psychological and social impact of trauma

The effects of trauma extend beyond immediate physical responses, having long-lasting psychological consequences. Common psychological impacts include Post-Traumatic Stress Disorder, characterised by intrusive thoughts, flashbacks, and severe anxiety, along with depression and other anxiety disorders. Trauma can also severely impair social functioning, leading to trust issues, feelings of isolation, and withdrawal from social interactions.

Judith Herman, in her book Trauma and Recovery (1992), discusses complex PTSD, which can result from prolonged exposure to traumatic situations. Individuals with complex PTSD may experience profound changes in their sense of self and struggle with emotional regulation.

Symptoms and identification of trauma

Trauma manifests in various ways, generally categorised into physical, emotional, psychological, and behavioural symptoms.

Physical symptoms

Physical expressions of trauma often include unexplained aches and pains not attributable to any medical condition. This might involve chronic headaches, muscular tension, and gastrointestinal issues. Individuals may have an increased startle reflex, easily startled by loud sounds or movements. Sleep disturbances are also common, with many experiencing insomnia, nightmares, or restless sleep patterns leading to fatigue and poor rest.

Emotional symptoms

Emotionally, trauma can cause persistent feelings of sadness and hopelessness. Affected individuals may detach from their emotions and be unable to experience joy or happiness. Irritability and anger are also common, with these emotions often being intense and long-lasting, interfering with daily life and relationships. Feelings of guilt or shame stemming from the traumatic event further complicate emotional well-being.

Psychological symptoms

Psychological symptoms include flashbacks and severe anxiety, which can be debilitating. Flashbacks involve vividly re-experiencing the traumatic event, complete with the sensory information of the original occurrence. Intrusive thoughts about the trauma can dominate the mind, preventing focus on other matters. This can result in disorientation and difficulty processing the impact of the traumatic experience.

Behavioural symptoms

Behavioural changes in traumatised individuals often include avoidance behaviours, where they go to great lengths to avoid reminders of the trauma, such as specific places, people, or activities. Social withdrawal is common, with individuals isolating themselves from friends, family, and social activities. There may also be a noticeable loss of interest in previously enjoyed activities.

Therapeutic interventions for trauma

Recovering from trauma often necessitates tailored therapeutic interventions. Effective approaches include:

• Trauma-focused cognitive behavioural therapy (TF-CBT): Trauma-focused cognitive behavioural therapy is a structured, evidence-based treatment model that helps individuals deal with the harmful effects of traumatic experiences. TF-CBT blends cognitive behavioural therapy (CBT) techniques with trauma-sensitive approaches to meet the specific needs of trauma survivors.
• Eye movement desensitization and reprocessing (EMDR): EMDR helps process traumatic memories by mimicking the psychological state of REM sleep, aiding individuals in integrating and understanding these memories.
• Somatic experiencing: Developed by Levine, this therapy focuses on bodily sensations rather than the traumatic event’s thoughts and memories.
• The rewind technique: A therapeutic method used to help individuals with PTSD by reducing the emotional impact of traumatic memories.

References

Herman, J. L. (1992). Trauma and Recovery: The Aftermath of Violence--From Domestic Abuse to Political Terror. New York, NY: Basic Books.

Levine, P. A. (1997). Waking the Tiger: Healing Trauma. Berkeley, CA: North Atlantic Books.

Rothschild, B. (2000). The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment. New York, NY: W. W. Norton & Company.

Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing (EMDR) Therapy, Third Edition: Basic Principles, Protocols, and Procedures. New York: Guilford Press.

van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, NY: Penguin Books.