- Cynthia Yoo
Trauma - Definition, Causes, Symptoms, and Treatment
Trauma refers to an injury or a wound. When you experience a physical trauma, your body will do its best to heal the wound - and it is capable. Even significant injuries like broken bones can mend without medical treatment - but other parts of your body will be compromised in an attempt to adapt to and compensate for the untreated part. The more significant the untreated physical injury, the more your optimal functioning and development will be impaired. The same is true for psychological trauma. Most of us can bounce back from challenging circumstances, but if we choose not to treat unresolved effects of psychological wounding - there will be lasting consequences to the detriment of our overall health and wellbeing.
What is trauma?
It is not uncommon for a group of people to experience an adverse event and for only some people to experience trauma as a result of it. This is because trauma is not an event. Trauma is what happens inside of us when we encounter an extremely distressing situation that we cannot control or escape. Feelings of fear, terror, doom, hopelessness, and helplessness are all experiences used to describe trauma. Trauma can result from a single event (e.g., serious illness or injury, witnessing violence, natural disaster, sudden death of a loved one), multiple events, or long-term exposure to adverse circumstances (e.g., childhood abuse, neglect, abandonment).
What happens to us during a traumatic event?
In the event of trauma, our brain and body (also called our "nervous system") quickly adapt to keep us safe and ensure our survival. Depending on the severity of trauma, the following may occur:
our brain and body registers that we are in danger;
our sympathetic nervous system becomes activated and releases a surge of biochemicals that mobilize our primitive survival response (fight-flight response);
our heart rate increases, our breathing rate escalates, our blood gets redirected to our large muscle groups, our vision becomes narrowed, and our non-essential bodily functions shut down (e.g., thinking, digestion, immunity, reproduction);
our right, emotional, nonverbal brain becomes highly activated;
our left, logical, verbal brain shuts down;
we cannot process what is happening in a functional and adaptive way;
incoming sensory information gets stored in our nervous system as free-floating sensations, images, urges, thoughts, and feelings (not situated in time, space, or context);
if our attempt to fight back or flee the situation are not successful in helping us achieve safety, our parasympathetic nervous system becomes activated and releases biochemicals that immobilize us into a state of collapse (freeze-collapse response);
we experience an 'out of body' experience and lose connection with ourselves and the present moment (i.e., dissociate);
we experience a state of shock, disbelief, or denial;
we experience a fragmented or fractured sense of self and reality.
What happens to us after we experience trauma?
We all have the capacity for adaptive information processing - that is, to take in new stimuli/ information, process and make sense of it, integrate what is meaningful with what we already know, and let go of what is irrelevant. However, during a traumatic experience, our thinking and language brain shuts down and we rely on our subconscious survival instincts. The benefit is that we can quickly avert danger, acting with more agility, speed, and strength than we typically have access to. The drawback is that the flood of incoming stimuli/ information cannot get adaptively processed in a coherent manner. It is what happens after we experience trauma that determines our outcomes - for better or worse.
Not all people who experience trauma suffer from long-term impairment. In fact, many people experience "post-traumatic growth” - that is, positive transformative change. This includes an awareness of new possibilities, a greater appreciation for life, a recognition of personal strength and resilience, a spiritual awakening, and stronger interpersonal relationships. Some common factors among people who experience positive outcomes (also called "protective factors") include being able to act quickly and effectively when feeling threatened, accepting the way we reacted, being able to make sense of what happened in a reasonable and meaningful way, having social support, having an outgoing disposition, and being open to new experiences. As we know, not everyone experiences post-traumatic growth.
When trauma remains unprocessed, free-floating memories from the time of trauma (e.g., thoughts, sensations, feelings, images, urges) remain stored in our nervous system without context. Our brain and body does not realize that the threatening event has passed - rather, the past seeps into the present and we lose touch with reality. Whether we misinterpret neutral stimuli as dangerous, or are easily triggered by our traumatic memories, we become trapped in our brain and body's response to trauma (i.e., fight, flight, freeze, collapse). Many people who struggle with trauma report feeling out of control and disconnected with themselves, others, and the world around them long after they are out of harm's way.
Symptoms of trauma
Here is a list of some common symptoms that result from unresolved trauma:
including headaches, digestive problems, body pain, muscle tension, dizziness, trouble breathing, racing heart, panic attacks, and nausea
feeling over stimulated (hyper vigilant, on edge, easily startled, panicked, reactive, impulsive)
feeling under stimulated (frozen, shut down, inability to feel, numbing out, tuning out, withdrawal)
chronic feelings of fear, anxiety, panic, depression, irritability, agitation, anger, confusion, guilt, or shame
frequent and intense mood swings
difficulty identifying and expressing feelings and needs
feeling disconnected, detached, dissociated, or "unreal"
intrusive and unwelcome thoughts and/or memories
misinterpreting neutral stimuli as threatening
sudden vivid flashbacks (e.g., feel as if the traumatic event is happening all over again)
vivid and distressing nightmares
difficulty with memory, attention, problem-solving, task-completion, or learning (i.e., "brain fog")
low self-worth, negative self-talk, or self-blame
loss of pleasure in life
feeling powerless, helpless, or hopeless
reacting or shutting down when triggered by (conscious or subconscious) reminders of the event (e.g., sounds, smells, tastes, touch, images)
avoiding reminders of the traumatic event (e.g., places, people, things)
difficulty sleeping and/or fatigue and exhaustion
changes in appetite
feeling unmotivated, disinterested, or withdrawn from life
seeking strategies to self-soothe (e.g., drugs or alcohol to help calm the mind)
engaging in risky behavior (e.g., fearless and reckless)
feeling exhausted, alone, confused, or disconnected from self and/or others
difficulty relating to or trusting others
challenges with communication, trust, or intimacy
withdrawal or isolation
When left untreated, trauma increases our risk for developing a host of challenges including:
attentional disorders (e.g., memory and focus);
behavioral disorders (e.g., addictions);
emotional disorders (e.g., anxiety and depression);
sensory processing challenges;
eating and sleeping difficulties;
chronic medical conditions (e.g., digestive issues, inflammation, and pain).
Without proper treatment and support, unresolved effects of trauma are persistent and will interfere with your best efforts to live a meaningful, satisfying, and fulfilling life. The more significant the trauma, the more it will diminish your sense of trust, safety, control, agency, and connection.
How counselling can help
The goal of counselling is to help reorganize the nervous system so that the brain and body can process what happened, resolve the disconnect, and become integrated to function as a unified whole. A therapist can help create new restorative experiences that directly contradict your brain and body's response to trauma (e.g., fear, hyper vigilance, reactivity, dissociation, shut down). Because trauma impacts the brain and body at a subconscious level, trauma treatment requires more than traditional talk therapy. Trauma work involves emotional, relational, brain-body, and experiential approaches that help repattern and regulate the nervous system. In doing so, your sense of safety, connection, security, choice, and autonomy can become restored. Here are some considerations when it comes to trauma counselling.
It is important that you find a therapist you feel comfortable with because trust and safety are critical to the work that lies ahead. Trauma hinders our natural capacity for regulation, presence, and connection. When you feel emotionally connected with your therapist, your social engagement system will become activated and play a key role in reintegrating your nervous system. Your therapist's capacity to regulate, be present, connect with themselves, and connect with you will all have an impact on your capacity to do the same.
It is important to find a therapist trained in trauma work. Your therapist will not only attentively listen to you, but will track how trauma is currently impacting your nervous system by paying attention to your body and other nonverbal cues (e.g., your posture, breath pattern, movement, tone of voice, facial expressions, etc). Your therapist does not need to know the details of your trauma history. What they will focus on is how you are being impacted today as a result of experiencing trauma in the past.
Talking about trauma can be healing and meaningful for you - particularly in cases where the trauma experience remains a secret. While disclosing details of your trauma experience may not be necessary for counselling to be effective, giving voice to your experience in the presence of safety, validation, compassion, and care can be comforting and empowering.
Some modalities that are commonly used in the area of trauma work include: EMDR (Eye Movement Desensitization and Reprocessing), IFS (Internal Family Systems), Sensorimotor Psychotherapy, Narrative Exposure Therapy, Accelerated Emotional Dynamic Psychotherapy, and Cognitive Processing Therapy - among others. Many therapists integrate complimentary approaches and that can work great too.
There is an element of psychoeducation that is often empowering in trauma work. When you learn accurate information about what trauma is and how our brain and body adapt to keep us alive and safe, you can begin to feel normalized and validated in your personal experience. It may help you take on a new perspective and/or make sense of your experiences in a new way that once felt incomprehensible.
A therapist can support you to develop mindfulness skills. Trauma work involves learning how to tune into your body and tolerate what is happening in-the-moment without triggering a trauma response of overwhelm, reactivity, and/or shut down. Your therapist can guide you through breath work, somatic awareness, attuned touch, and/or mindful movement to explore and attend to your moment-by-moment sensations, thoughts, images, feelings, and urges as they arise. With support and practice, you can learn to connect with your body, feel safe in your body again, and manage stress effectively.
A therapist can support you to reprocess and integrate traumatic memory in an adaptive way. When you are able to stay in the moment, reflect on the past, and describe what you are noticing in your body as you are doing so (e.g., your emotions, sensations, images, urges) - you can reprocess subconscious dynamics that are playing out and reestablish a connection between your emotional brain, rational brain, and body. When your trauma experience becomes stored as a coherent, sequential, and meaningful memory of what happened in the past, your nervous system can return to an integrated state of balance (i.e., homeostasis) and any residual effects of trauma will subside.
A therapist can support you to develop emotion management and regulation skills. Our nervous system response to trauma interferes with our natural capacity to be calm and present, be focused and organized, engage in what is happening, filter out irrelevant stimuli, accurately interpret incoming stimuli, integrate meaningful information, learn, effectively problem-solve, rest, and relax. Your therapist can guide you to observe, monitor, and adapt yourself to remain in an optimal state of calm alertness. When you learn the skills to regulate and manage yourself (e.g., attention, thoughts, feelings, behavior), you will become empowered with your natural capacity for awareness, choice, and agency.
A therapist can support you to connect with different parts of yourself through genuine curiosity, openness, and self-compassion. At the time of trauma, we quickly adapt the way we think, feel, and act in an attempt to survive and protect ourselves from harm. These protective mechanisms often operate beyond our conscious awareness, long after they have served their purpose, and can contribute to a sense of feeling disconnected with ourselves. When we acknowledge, validate, and show compassion for these protective parts of ourselves, we can begin to integrate who we are into a coherent sense of self. When you restore trust, safety, and connection within yourself, you will experience an expansive sense of self characterized by presence, compassion, courage, perspective, clarity, creativity, and confidence.
A therapist can help you release any blocked energy through body work (e.g., relaxation, movement, vocalization). The nervous system response to trauma (e.g., tension, fear, anxiety, stress) shows up in our body and nonverbal communication (e.g., posture, breath pattern, tone of voice, facial expressions, and movement). Your therapist can support you to explore your body and experiment with mindful relaxation and/or re-enactment techniques (in reality or in your imagination) that contradict what your body has learned in response to trauma. For example, experimenting with vocal and physical movements (e.g., yielding, pushing, reaching, grasping, pulling, kicking) can help discharge blocked emotional energy and reprocess the brain and body's rigid, restricted, or paralyzed trauma response.
A therapist can support you to draw from your imagination to open up the realm of possibilities in your life. For example, imagining the repair of a ruptured relationship, alternative outcomes to a past event, or a preferred future can greatly impact your nervous system in ways that promote growth and healing.
A therapist can help you identify, challenge, and reframe unreasonable and/or unhelpful beliefs and thinking styles that you learned as a result of trauma (e.g., "men are unsafe, the world is dangerous, I am bad"). This exploration of thoughts typically happens while simultaneously observing your emotions and sensations. A therapist can help you construct positive beliefs and new meaning from your past experiences, then help you integrate these in an experiential way to promote the integrated functioning of your nervous system.
Your therapist can help you explore your inner strengths and resources. Many of us who are struggling are very aware of our challenges and limitations, but this would not be an accurate representation of who you are and what you are capable of. Recognizing and owning your resilience can give you a more balanced and optimistic perception of yourself.
Your therapist can guide you to gain clarity around your sense of self (e.g., values, principles, goals, and inner wisdom). As you start connecting with your intuition, making intentional choices, and taking purposeful action toward a 'life worth living', your sense of agency and confidence will naturally grow.
Counselling is about empowering you with choice, control, and agency. You get to decide who to work with, what to ask, what to disclose, what to explore, whether to accept or decline your therapist's recommendations, and whether you return for your next session. You get to decide what your next steps are and in what direction you want to move toward. It is important that you give your therapist continuous feedback to ensure that the work you are doing in counselling is meaningful and relevant to you.
If you are struggling with symptoms of trauma, you can share your struggles with someone in the context of a supportive, safe, and accepting relationship. Counselling is an option and there is support available to you. A qualified therapist can help you reprocess your trauma in an adaptive way that restores balance in your nervous system, integrates your mind-body connection, and a promotes a coherent sense of self. You are capable of transformative healing and growth. The first step is to book initial consultations with a few therapists to find a good fit - someone you feel comfortable with and someone trained in supporting people with trauma. You are not alone.
- Written by Cynthia Yoo, Registered Psychologist -
Waking the Tiger: Healing Trauma - by Peter Levine
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma - by Bessel van der Kolk
No Bad Parts: Healing Trauma and Restoring Wholeness with the Internal Family Systems Model - by Richard Schwartz
The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture - by Gabor Mate