What is trauma?

Trauma is a psychological and emotional response to an event or experience that is deeply distressing or disturbing. These events can be single incidents, like a car accident or a natural disaster, or they can be ongoing, such as abuse or neglect. Trauma overwhelms a person’s ability to cope, leaving them feeling helpless, vulnerable, and often experiencing intense fear, horror, or helplessness.

It’s essential to recognize that people respond to trauma differently, and what may be traumatic for one person may not be for another. Additionally, trauma can be complex, involving multiple incidents or experiences over time, and it can also be intergenerational, passed down through generations. Trauma treatment often involves therapy, support groups, and sometimes medication to help manage symptoms and promote healing (Herman, 2022).

What kind of experiences can be traumatic?

Traumatic events can vary widely and can be classified into different categories, including:

  • Natural Disasters: These include earthquakes, hurricanes, floods, wildfires, and tsunamis. These events can cause widespread destruction and loss of life, leading to trauma for those directly affected as well as for witnesses or individuals indirectly impacted.
  • Accidents: Including car accidents, plane crashes, industrial accidents, and other incidents resulting in physical injury or loss of life. Survivors of accidents may experience trauma due to the sudden and unexpected nature of the event and its consequences.
  • Violence and Assault: This encompasses various forms, such as physical assault, sexual assault, domestic violence, and terrorist attacks. These events can profoundly impact survivors, causing feelings of fear, powerlessness, and betrayal.
  • War and Combat: Exposure to war zones, combat situations, and acts of terrorism can lead to trauma for soldiers, civilians, and refugees. Witnessing or experiencing violence and the loss of comrades can have long-lasting effects on mental health.
  • Childhood Trauma: Abuse (physical, emotional, or sexual), neglect, and other adverse childhood experiences (ACEs) can have profound and enduring effects on a person’s development and well-being. Childhood trauma can influence mental health, relationships, and behaviour throughout life.
  • Medical Trauma: Serious illness, medical procedures, surgery, or experiences in healthcare settings can be traumatic, especially if they involve pain, loss of control, or life-threatening situations.
  • Loss and Grief: The death of a loved one, whether sudden or anticipated, can be deeply traumatic. Grief reactions vary widely, and some individuals may experience symptoms of trauma as they navigate the grieving process.
  • Community Trauma: Events that affect entire communities, such as mass shootings, terrorist attacks, or large-scale accidents, can lead to widespread trauma and collective grief. These events can shatter a community’s sense of safety and cohesion.
  • Systemic Trauma: Oppression, discrimination, systemic racism, and other forms of social injustice can contribute to ongoing trauma for individuals and communities. Historical trauma, resulting from the collective trauma experienced by a group across generations, is also a significant factor in many communities.

These are just a few examples, and it’s important to recognize that trauma is subjective and can result from a wide range of experiences. What may be traumatic for one person may not be traumatic for another, and individual responses to trauma can vary based on factors such as past experiences, resilience, and available support systems (Briere & Scott, 2015; Herman, 2022).

What is PTSD? What is Acute Stress Disorder?

PTSD stands for Post-Traumatic Stress Disorder, while ASD stands for Acute Stress Disorder. Both are psychological conditions that can develop in response to experiencing or witnessing a traumatic event.

Post-Traumatic Stress Disorder (PTSD):

PTSD is a mental health condition that can develop after experiencing or witnessing a traumatic event. The symptoms of PTSD can be severe and persistent, significantly impacting daily functioning and quality of life.

Symptoms of PTSD may include intrusive thoughts or memories of the traumatic event, flashbacks, nightmares, avoidance of reminders of the event, adverse changes in mood and cognition, hyperarousal (such as being easily startled or feeling on edge), and alterations in arousal and reactivity.

PTSD can occur in anyone who has experienced trauma, including survivors of accidents, violence, natural disasters, and military combat. It can develop shortly after the traumatic event or months to years later.

Acute Stress Disorder (ASD):

ASD is a psychological condition similar to PTSD but occurs within the first month following exposure to a traumatic event. It is considered an immediate response to trauma.

Symptoms of ASD may include intrusive memories, dissociative experiences (feeling detached from oneself or surroundings), avoidance of reminders of the event, negative mood, heightened arousal, and anxiety.

While ASD and PTSD share many symptoms, ASD is distinguished by its timing; if symptoms persist beyond one month, a diagnosis of PTSD may be considered.

How can trauma affect people?

Trauma can affect people in a variety of ways, impacting their mental, emotional, physical, and social well-being. Trauma can have lasting effects on a person’s cognitive, emotional, and physical well-being. It can disrupt one’s sense of safety and security, leading to symptoms such as flashbacks, nightmares, intrusive thoughts, anxiety, depression, mood swings, difficulty concentrating, and changes in behaviour.

Here are some common ways trauma can affect individuals:

Emotional Impact:

  • Intense emotions: Trauma can lead to overwhelming emotions such as fear, sadness, anger, shame, guilt, or helplessness.
  • Emotional numbing: Some individuals may experience a numbing of emotions as a coping mechanism to protect themselves from the intensity of their feelings.
  • Mood swings: Trauma survivors may experience frequent mood swings, alternating between periods of intense distress and emotional numbness.

Mental Impact:

  • Intrusive thoughts: Trauma survivors often experience intrusive thoughts or memories of the traumatic event, which can be distressing and difficult to control.
  • Flashbacks: Flashbacks involve re-experiencing aspects of the trauma as if it were happening again in the present moment. Reminders of the traumatic event can trigger them.
  • Cognitive difficulties: Trauma can impair cognitive functions such as concentration, memory, and decision-making, making it challenging to focus or complete tasks.

Physical Impact:

  • Physical symptoms: Trauma can manifest in physical symptoms such as headaches, stomachaches, muscle tension, fatigue, and insomnia.
  • Health problems: Prolonged exposure to trauma and stress can increase the risk of developing physical health problems, including cardiovascular issues, gastrointestinal disorders, and autoimmune conditions.
  • Changes in appetite and weight: Trauma can affect appetite regulation, leading to changes in eating habits and fluctuations in weight.

Behavioural Impact:

  • Avoidance behaviours: Trauma survivors may avoid situations, people, or places that remind them of the traumatic event as a way to cope with distressing emotions and memories.
  • Substance abuse: Some individuals may turn to alcohol, drugs, or other substances as a way to self-medicate and numb their emotional pain.
  • Risky behaviours: Trauma can lead to engaging in risky behaviours such as self-harm, impulsivity, or reckless driving as a way to cope with overwhelming emotions or seek relief.

Social Impact:

  • Relationship difficulties: Trauma can strain relationships with family, friends, and romantic partners due to changes in behaviour, communication difficulties, and emotional distance.
  • Social withdrawal: Trauma survivors may withdraw from social activities and isolate themselves from others as a way to avoid triggers and cope with distress.
  • Trust issues: Trauma can erode trust in others, leading to difficulties forming new relationships or trusting others with personal information or emotions.

These effects of trauma can vary widely from person to person. They may depend on factors such as the nature of the trauma, individual resilience, available support systems, and access to resources for coping and recovery. Seeking support from mental health professionals and building a solid support network can be essential for healing from trauma and minimizing its long-term impact (Razvi, 2013; Herman, 2022; Briere & Scott, 2015).

Why can’t I remember my trauma?

The inability to remember traumatic events is a common phenomenon known as dissociative amnesia. There are several reasons why people may have difficulty recalling traumatic experiences:

  • Protective Mechanism: Memory loss can serve as a protective mechanism to shield the individual from the overwhelming emotions and distress associated with the trauma. The brain may block access to memories of the traumatic event as a way to preserve psychological well-being.
  • Dissociation: Dissociation is a coping mechanism in which individuals mentally detach from their surroundings or experiences as a way to cope with trauma. During a traumatic event, dissociation can lead to altered consciousness or detachment, impairing memory formation and encoding.
  • Fragmented Memories: Traumatic memories may be fragmented or incomplete, making them difficult to recall in a coherent narrative. Instead of a linear sequence of events, traumatic memories may be disjointed or stored as sensory fragments, such as images, sounds, or emotions.
  • Memory Distortion: Trauma can distort memory formation and encoding, leading to inaccuracies or gaps in recollection. Stress hormones released during a traumatic event can impact the functioning of the hippocampus, a brain region involved in memory processing, and interfere with the consolidation of memories.
  • Repression: In some cases, individuals may actively repress memories of trauma, pushing them out of conscious awareness as a way to avoid confronting painful or distressing experiences. Repressed memories may resurface later, often triggered by reminders or cues associated with the trauma.
  • Age and Developmental Factors: Age and developmental factors can influence memory formation and retrieval processes. Children, in particular, may have difficulty recalling traumatic events due to their still-developing cognitive abilities and language skills.
  • Interference and Blocking: Memories of traumatic events may be obscured or blocked by other competing memories, making it challenging to access specific details or recall the event accurately.

It’s important to note that memory is complex and influenced by various factors, including individual differences, the nature of the trauma, and the surrounding context. While some individuals may have difficulty remembering traumatic experiences, others may have vivid and intrusive memories that are difficult to forget. Seeking support from mental health professionals can help individuals navigate the complexities of trauma and memory processing, facilitating healing and recovery (Shahri, 2019; Razvi, 2013).

What happens during the therapeutic process?

Trauma therapy is a specialized form of therapy aimed at helping individuals process and heal from traumatic experiences. The process of trauma therapy can vary depending on the therapeutic approach and the specific needs of the individual, but it typically involves several key components:

  • Building Trust and Safety: Establishing a safe and trusting therapeutic relationship is essential in trauma therapy. The therapist creates a supportive and nonjudgmental environment where individuals feel comfortable sharing their experiences and emotions.
  • Psychoeducation: The therapist provides education about trauma and its effects on the brain, body, and emotions. Understanding the physiological and psychological responses to trauma can help individuals make sense of their experiences and reduce feelings of shame or self-blame.
  • Stabilization: Before delving into the trauma memories, the therapist helps the individual develop coping skills and strategies to manage distress and regulate emotions. This may involve relaxation techniques, mindfulness practices, grounding exercises, and emotion regulation skills.
  • Trauma Processing: Trauma processing techniques aim to help individuals safely revisit and process traumatic memories, thoughts, and emotions.
  • Integration and Meaning-Making: As trauma processing progresses, the therapist helps the individual make sense of their experiences, identify personal strengths and resilience, and integrate the healing insights into their sense of self and worldview.
  • Relapse Prevention and Continued Support: Trauma therapy may also include strategies for relapse prevention and ongoing support to help individuals maintain progress and cope with future stressors or triggers. (Grabbe & Miller-Karas, 2018; Briere & Scott, 2015; Herman, 2022).

What types of therapies are suitable for trauma?

Several types of therapies have been found to be effective in treating trauma-related symptoms and promoting healing. Here are some of the most commonly used treatments for trauma:

Cognitive-Behavioural Therapy (CBT):

CBT is a structured, goal-oriented therapy that focuses on identifying and changing negative thought patterns and behaviours associated with trauma.

In trauma-focused CBT, the therapist helps individuals challenge and reframe maladaptive beliefs about the self, others, and the world. It often involves exposure techniques to confront and process trauma-related memories and triggers gradually.

Eye Movement Desensitization and Reprocessing (EMDR):

EMDR is a specialized therapy approach that involves bilateral stimulation (such as eye movements, tapping, or auditory tones) while processing traumatic memories.

This therapy aims to facilitate the reprocessing of distressing memories, allowing individuals to integrate them into their autobiographical memory network and reduce associated emotional distress.

Narrative Therapy:

Narrative therapy focuses on helping individuals construct and make sense of their personal narratives, including their experiences of trauma.

Through storytelling and guided reflection, individuals are encouraged to explore their trauma narratives, identify strengths and resources, and rewrite empowering narratives of resilience and recovery.

Trauma-Focused Cognitive Processing Therapy (TF-CBT):

TF-CBT is a specific form of CBT designed to address the unique needs of trauma survivors, particularly children and adolescents. It integrates cognitive-behavioural techniques with trauma-specific interventions to help individuals process traumatic memories, manage distressing emotions, and develop coping skills.

Dialectical Behavior Therapy (DBT):

DBT is an evidence-based therapy initially developed for individuals with borderline personality disorder but has been adapted for treating trauma-related symptoms.

DBT emphasizes skills training in mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. It provides practical tools for managing intense emotions and reducing self-destructive behaviours.

Somatic Experiencing (SE):

SE is a body-oriented therapy that focuses on releasing physical tension and trauma-related energy stored in the body.

Through gentle somatic interventions and awareness of bodily sensations, SE helps individuals regulate the autonomic nervous system and complete interrupted fight, flight or freeze responses.

Mindfulness-Based Therapies:

Mindfulness-based approaches, such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), can complement trauma therapy by promoting present-moment awareness, acceptance, and self-compassion.

Group Therapy and Support Groups:

Group therapy and support groups provide a supportive environment for trauma survivors to connect with others who have had similar experiences, share their stories, and receive validation and support.

It’s important to note that the effectiveness of therapy depends on individual factors such as the nature and severity of the trauma, personal preferences, and the quality of the therapeutic relationship. A qualified mental health professional can help determine the most appropriate therapy approach based on the individual’s needs and circumstances (Herman, 2022; Briere & Scott, 2015; SAMHSA, n.d.; Bilal et al., 2015; Cloitre, 2013; Mott et al., 2015; Chesin, 2018).

What mental health professionals can I see for trauma therapy?

In Ontario, Canada, there are several options for accessing trauma therapy. Here are some potential resources and professionals you can consider:

Registered Psychotherapists (RP):

Registered Psychotherapists are regulated mental health professionals trained to provide psychotherapy services. They may have specialized training or experience in trauma therapy.

You can search for Registered Psychotherapists in Ontario through the College of Registered Psychotherapists of Ontario (CRPO) website.

Registered Social Workers (RSW):

Registered Social Workers are trained to provide counselling and psychotherapy services, and many have experience working with trauma survivors.

Registered Social Workers in Ontario can be found through the Ontario College of Social Workers and Social Service Workers (OCSWSSW) website.

Registered Clinical Psychologists (C.PSYCH):

Clinical Psychologists are licensed professionals who specialize in the assessment, diagnosis, and treatment of mental health issues, including trauma-related conditions.

You can search for registered clinical psychologists in Ontario through the College of Psychologists of Ontario (CPO) website.

Psychiatrists (MD):

Psychiatrists are medical doctors who specialize in the diagnosis, treatment, and prevention of mental, emotional, and behavioural disorders. They are trained in both the medical and psychological aspects of mental health and are uniquely qualified to assess and manage a wide range of psychiatric conditions. You can search for psychiatrists in Ontario through the College of Physicians and Surgeons of Ontario.

Community Mental Health Centres:

Many mental health centres in Ontario offer trauma therapy services by trained therapists and counsellors.

You can contact local mental health organizations or use online directories to find community mental health centres.

Trauma Treatment Centres:

Some specialized treatment centres in Ontario focus on trauma therapy and may offer various trauma-informed services and programs.

You can search for trauma treatment centres online or ask local mental health organizations for recommendations.

Referral from a Physician:

Your family doctor or primary care physician can provide a referral to a mental health professional or specialized trauma therapy program in Ontario.

They may also be able to recommend specific therapists or treatment centres based on your needs.

Teletherapy Options:

With the increasing availability of teletherapy (therapy conducted remotely via videoconferencing or phone), you may have access to trauma therapy services from providers outside your immediate area.

Many therapists in Ontario offer teletherapy services, allowing you to access trauma therapy from the comfort of your own home.

When seeking trauma therapy in Ontario, it’s essential to consider factors such as the therapist’s training and experience, the therapy approach used, location and accessibility, and cost and insurance coverage. Before deciding, you may want to schedule initial consultations with potential therapists to discuss your needs and preferences. Additionally, inquire about fees, payment options, and whether the therapist accepts insurance or offers sliding scale fees based on income.

What does trauma-informed mean?

“Trauma-informed” refers to an approach that acknowledges the widespread impact of trauma and emphasizes creating environments and interactions that promote safety, trust, and empowerment for trauma survivors. A trauma-informed approach recognizes that trauma is prevalent in society and can affect individuals across their lifespans, influencing their thoughts, behaviours, and relationships.

Fundamental principles of trauma-informed care include:

  • Safety: Prioritizing physical, emotional, and psychological safety for individuals who have experienced trauma. This includes creating environments that are predictable, non-threatening, and conducive to healing.
  • Trustworthiness and Transparency: Building trust with trauma survivors through honest, open communication and transparent decision-making processes. This involves providing clear information about services, expectations, and boundaries.
  • Empowerment and Choice: Empowering individuals to make informed choices and participate in decisions about their care. Respecting autonomy and promoting self-efficacy can help restore a sense of control and agency for trauma survivors.
  • Collaboration and Mutual Respect: Collaborating with trauma survivors respectfully and nonjudgmentally, honouring their expertise and lived experiences. Recognizing the individual’s strengths and resilience fosters a sense of dignity and worth.
  • Cultural Humility and Sensitivity: Acknowledging and respecting the cultural, ethnic, and diversity of trauma survivors. Cultural humility involves self-reflection, awareness of biases, and a commitment to providing culturally responsive and inclusive care.
  • Trauma Awareness and Understanding: Educating staff and service providers about the prevalence and impact of trauma, as well as trauma-sensitive approaches to care. This includes recognizing trauma symptoms, understanding trauma triggers, and avoiding re-traumatization.
  • Resilience and Recovery-Oriented: Fostering a strengths-based approach that recognizes the inherent resilience and capacity for healing in trauma survivors. It supports individuals in their recovery journey and promotes a sense of hope and possibility.

A trauma-informed approach can be applied across various settings and sectors, including healthcare, mental health, education, social services, criminal justice, and community organizations. It involves a shift in organizational culture, policies, and practices to create environments that are supportive and responsive to the needs of trauma survivors. By implementing trauma-informed principles, organizations can better meet the needs of individuals affected by trauma and promote healing, recovery, and resilience (Powers et al., 2023; Ames et al., 2023).

References:

Ames, R. L., & Loebach, J. E. (2023). Applying trauma-informed design principles to therapeutic residential care facilities to reduce re-traumatization and promote resiliency among youth in care. Journal of Child & Adolescent Trauma, 16(4), 805–817. https://doi.org/10.1007/s40653-023-00528-y

Bilal, M. S., Rana, M. H., Khan, C. S. U., & Qayyum, R. (2015). Efficacy of eye movement desensitization and reprocessing beyond complex Post Traumatic Stress Disorder: A case study of EMDR in Pakistan. Professional Medical Journal, 22(4), 514-521. http://search.ebscohost.com/login.aspx?direct=true&AuthType=url,cookie,ip,uid&db=a9h&AN=102908891

Briere, J. N., & Scott, C. (2015). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment (2nd ed.). Sage.

Chesin, M. S., Brodsky, B. S., Beeler, B., Benjamin-Phillips, C. A., Taghavi, I., & Stanley, B. (2018). Perceptions of adjunctive mindfulness-based cognitive therapy to prevent suicidal behaviour among high suicide-risk outpatient participants. Crisis, 39(6), 451–460. https://doi.org/10.1027/0227-5910/a000519

Cloitre, M. (2013). The case: Treating Jared through STAIR narrative therapy. Journal of Clinical Psychology, 69(5), 482-484. http://search.ebscohost.com/login.aspx?direct=true&AuthType=url,cookie,ip,uid&db=pbh&AN=86980703

Grabbe, L., & Miller-Karas, E. (2018). The trauma resiliency model: A “Bottom-Up” intervention for trauma psychotherapy. Journal of the American Psychiatric Nurses Association, 24(1), 76–84. https://doi.org/10.1177/1078390317745133

Herman, J. L. (2022). Trauma and recovery. BasicBooks

Mott, J., Galovski. T. E., Walsh, R. M., & Elmwood L. S. (2015). Change in trauma narratives and perceived recall ability over a course of cognitive processing therapy for PTSD. Traumatology, 21(1), 47-54. http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,sso&db=pdh&AN=2014-55208-001&site=eds-live&custid=s7439054

Powers, A., Langhinrichsen-Rohling, R. A., Sonu, S. C., Haynes, T., & Lathan, E. C. (2023). Brief trauma-informed care training to enhance health care providers’ knowledge, comfort, and implementation of trauma-informed care in primary care clinics: A pilot effectiveness study. Psychological Services. https://doi.org/10.1037/ser0000823

Razvi, S. (2013, January 22). Stress, trauma, and the body [Video]. YouTube. https://www.youtube.com/watch?v=q6M1FumqeyM

SAMHSA. (n.d.). Trauma-informed approach and trauma-specific interventions. http://www.samhsa.gov/nctic/trauma-interventions

Shahri, H. (2019). Integration of traumatic memories. International Body Psychotherapy Journal, 18(2), 106.