TRAUMA
PHYCO-EDUCATION
DEFINING
TRAUMA
The sympathetic nervous system goes into full alert sending stress
hormones to the respiratory system, cardiovascular system, and muscles
preparing us to either fight or flee.
The neo-cortex (thinking part of the brain) shuts down, including Broca’s
area for speech. This is because instinct is faster than thought and in a
dangerous situation creating words and taking time to contemplate our
choices is a luxury we cannot afford! This is also why often when we feel
threatened it is hard to communicate both hearing information accurately
as well as finding the right words to use.
If we cannot fight or flee, all mammals, including humans prepare to die;
this is called the freeze response. Endorphins are released to manage
pain and the mind dissociates from the body and from the experience.
This means that the trauma has overwhelmed our resources to cope. The
trauma does not have to be from physical violence or natural disaster; it
can be anything that causes the mind/body/spirit to be overwhelmed
and shut down.
When this happens the traumatic experience is encoded in implicit
memory; this means that instead of in words and story the memory is laid
down in the brain in fragments-pieces of images, thoughts, sounds, smells,
physical sensations, and with highly charged emotions. When the threat
has ended all mammals, including humans, need to discharge the energy
physically by shaking, pacing, running, or crying. Humans have the added
task of moving the experience from implicit memory into explicit memory
by adding words and creating a meaningful narrative/story that
describes not only the experience but also how we see ourselves-what we
believe about life and ourselves after the event.
Implicit memory has no sense of time; this means that
every time something reminds us of a traumatic
incident it is not just remembered but is re-
experienced. Stress hormones are released again.
The sympathetic nervous system goes into “alarm
mode” causing the heart to race, muscles to tense,
and the neo-cortex to go “offline”. Instead of remembering the past, it
feels like it is happening in the present. This is what defines a traumatic
memory. Traumatic memory is the result of a traumatic experience being
blocked from moving out of implicit into explicit memory; this is especially
likely if the freeze response occurred. The mind continues to attempt to
heal by “knocking on the door” of the conscious verbal brain; however
when that part of the brain “looks out the window” it sees a bunch of
neural memory networks filled with upsetting information and so it
barricades the door and hides instead of inviting them in!
INTRUSION SYMPTOMS INCLUDE:
Trauma flashbacks
Uncomfortable feelings with no apparent source
Emotional over-reactions
Physical sensations that don’t make rational sense
Anxiety about performance when you know you are prepared
Negative self talk
Slips of speech
Self-sabotaging behaviors
These are often implicit memory “knocking”; avoidance symptoms like
dissociation, self-destructive behaviors, isolating, and denial are the neo
cortex trying to ignore the “unwelcome visitors”!
It takes an enormous amount of psychological and physical energy to
keep this door shut and guarded. EMDR works by helping implicit and
explicit memory talk to one another while keeping the body relaxed. The
traumatic incident(s) become narrative history instead of wordless terror
without end.
SYMPTOMS OF TRAUMA PHYSICAL COGNITIVE
Extreme alertness - easily Amnesia - memory lapses,
startled, hyper-vigilance, hyper- difficulty in recalling information
arousal, edginess, jumpiness, or past events
agitation, restlessness, feeling 'on (especially events leading up to,
guard' or on 'red alert'. Sleep during and after the traumatic
problems - sleep disturbances, event.)
nightmares and bad dreams, Disturbing, intrusive, repetitive
insomnia. Eating problems - and uncontrollable flashbacks,
eating more or less than normal, a thoughts,
loss of appetite, overeating, visions, sensations and emotions.
comfort eating. Loss of energy - Difficulty concentrating, feelings
fatigue, tiredness, exhaustion. of being distracted.
Physical sensations - aches and Difficulty in decision-making.
pains, unexplained pain Confusion and disorientation, an
(especially chest and stomach altered sense of time.
pain and headaches), chronic
pain, muscle tension, nausea,
sweating, racing heart, trembling,
dizziness. Sexual dysfunction - loss
of libido.
PSYCHOLOGICAL/ BEHAVIORS
EMOTIONAL
Anger, hostility, irritability, Obsessive and compulsive
resentment, mood swings, behavior patterns, including an
emotional reactivity, frequent obsession with death Impulsive
arguing with loved ones, behaviors Symptoms of ADHD
unprovoked aggression. Anxiety (hyperactivity, inattention, and
and fear - general and chronic impulsiveness). Addictions -
anxiety, worry, panic attacks, Substance abuse, alcoholism,
difficulty relaxing. Depression, gambling, sex, food, exercise, etc.
despair, sadness, loss of hope, Self-harm. Inability to develop
feeling permanently damaged or and maintain healthy
defective, feeling ineffective, relationships. Making self
spontaneous crying. Grief destructive lifestyle choices.
Guilt, including survivor's guilt, Avoidance of people, places and
shame, self-blame. Emotional activities that are both related
numbness, shock, disbelief, denial, and unrelated to a traumatic
dissociation, detachment. event Detachment from other
Sexual problems. Feeling out of people and emotions, social
control. withdrawal and isolation.
RESPONSES TO TRAUMA
After a trauma, people may go though a wide
range of normal responses. Such reactions may
be experienced not only by people who
experienced the trauma first-hand, but by those
who have witnessed or heard about the trauma,
or been involved with those immediately
affected. Persons, places, or things associated
with the trauma can trigger reactions. Some
reactions may appear totally unrelated.
PHYSICAL REACTIONS EMOTIONAL REACTIONS
Aches and pains like headaches, Shock and disbelief
backaches, stomach aches Fear and/or anxiety, expectation
Sudden sweating and/or heart of doom and fear of the future
palpitations (fluttering) Grief, disorientation, denial
Changes in sleep patterns, Hyper-alertness or hyper
appetite, and interest in sex vigilance
Easily startled by noises or Emotional swings -crying then
unexpected touch laughing, irritability, restlessness,
More susceptible to colds and and outbursts of anger or rage.
illnesses Nightmares
UNHELPFUL
HELPFUL COPING STRATEGIES
COPING STRATEGIES
Reach out and connect with Avoidance through alcohol,
others, especially those with substance abuse or social
whom you may share the stressful withdrawal
event Aggressive attitudes or acts
Cry Acting out though promiscuity,
Hard exercise like jogging, spending or gambling
aerobics, bicycling, walking Self-harm
Relaxation exercise like Depressive symptoms
stretching, massage, swimming Excessive worrying
Humour Displacement of anger
THE IMPACTS OF
TRAUMA (ADULTS)
The word trauma is derived from a Greek Word meaning ‘wound’. Its
pure definition is an event that threatens ones life. The broader
definition refers to any physical, sexual, emotional or spiritual wound
that involves threat to ones life or sense of self.
Traumatic events often shatter our assumptions about the world and
ourselves. The following table adapted from Hicks (1993: p.17) outlines
the common assumptions that are commonly shattered as a result of a
traumatic experience.
Traumatic
events that wound and
scare a person challenge
the assumption of
Invulnerability
Traumatic
events that don’t make “It can’t happen to me” Traumatic events
sense challenge the that change your image
assumption of of yourself challenge the
assumption of
Rationality
Traumatic Identity
“The world makes sense”
events that seem “I know who I am”
unfair challenge the
assumption of
Morality
“The universe is just”
Trauma always leaves people changed, either
positively or negatively. If the normal trauma response
can be modulated effectively then evidence suggests
that change following trauma can have positive
aspects. For example Michael Christopher (2004: 83)
outlines the following positive changes that can occur
following a trauma:
“The first type of change entails a more integrated sense of self,
to be more specific, a greater competence and resilience when
dealing with life’s challenges.
The second type of change entails relationships with others, more
specifically, closer relationships with family and significant others,
reconciliation of estranged relationships, an increased ability to
protect oneself and prevent abusive relationships, greater
altruism, increased willingness to help, increased sensitivity to
others and increased openness to new behaviours.
The third type of change involves a more integrated philosophy of
life. That is, the third type of positive change following trauma
includes an increased appreciation of ones existence, changed
priorities, stronger beliefs, a greater sense of meaning, and a
whole new comprehensive perception of reality”
Trauma can be survived and most people will eventually come
through a trauma back to full functioning. The human spirit is resilient.
Ernest Hemingway states, “The world breaks everyone, then some
become strong at the breaks”. However, if pain is buried or a person
fails to process their grief adequately then healing is blocked and
the pain remains. The ongoing pain, (either buried or overtly
expressed through emotions such as anger, resentment, and
helplessness) will then negatively impact the person and often their
family and friends.
Most psychological responses that are unhealthy are due to a
breakdown in the modulation of the normal stress response and the
specific dynamics of the response will be an interaction between the
individual’s socio-cultural environment and psychological makeup
(Christopher, 2004).
ACUTE STRESS
DISORDER
For a diagnosis of Acute Stress Disorder, symptoms must persist for a
minimum of two days to up to 4 weeks within a month of the trauma. If
symptoms persist after a month, the diagnosis becomes Post
Traumatic Stress Disorder
SYMPTOMS INCLUDE:
Lack of emotional responsiveness, a sense of
numbing or detachment
A reduced sense of surroundings
A sense of not being real
Depersonalisation or a sense of being
dissociated from self
An inability to remember parts of the trauma,
"dissociative amnesia"
Trouble experiencing pleasure
POST-TRAUMATIC STRESS
DISORDER (PTSD)
PTSD is identified as a serious emotional disorder. It can very seriously
damage a person’s normal functioning. When diagnosing PTSD,
psychologists are guided by textbooks, which require certain
symptoms to be present. The following criteria have to be met for a
person to have a formal diagnosis of PTSD. However, it is very
important for us to be aware that a person may not meet all the
criteria for PTSD, but still have their life severely affected by trauma.
They will show some of the symptoms.
CRITERIA FOR PTSD
1. TRAUMA
The person must have been involved in one or more traumatic
experiences, or witnessed them, where either life was in danger
or, at least, there was the danger of terrible injury to someone.
The person’s response must also have involved intense fear,
helplessness or horror.
2. RE-EXPERIENCING SYMPTOMS
The traumatic event is persistently re-experienced in one or more of
the following ways.
The person keeps remembering what happened and can’t get it
out of their mind. Even if they try not to think about it they
remember bits of the trauma – either as images, thoughts or
perceptions.
They keep having distressing dreams about what happened.
They have experiences when they feel as if the event is actually
happening again and they are “in it”. These are called
“flashbacks”.
The person reacts with intense psychological distress if they are
exposed to “triggers’, (external or internal) that remind them of
the trauma. e.g’s 1. People in Sri Lanka feeling strong fear when
they hear water, even though the tsunami has been over for many
months. 2. People feeling intense fear if they just think about some
part of the trauma.
The person has physiological reactions when they are exposed to
these kinds of external or internal “triggers”. e.g. 1. Their heart
starts to beat fast. 2. They start to sweat and breathe quickly.
3. AVOIDANCE SYMPTOMS
People do their best to avoid anything associated with the traumatic
experience. This includes a numbing of their general responsiveness
(not present before the trauma), as indicated by three or more of the
following:
Efforts to avoid thoughts, feelings or conversations associated
with the trauma. e.g. As much as possible they avoid talking about
it.
Efforts to avoid activities, places or people that remind them of
the trauma. e.g. As much as possible they keep away from possible
“triggers”.
Inability to recall an important aspect of the trauma. (It seems like
an inbuilt mechanism sometimes “blocks” from conscious memory
some especially horrible parts of what happened.)
Markedly diminished interest or participation in significant
activities. e.g. They no longer feel like meeting people, or going
out of the house much.
Even when they are with other people, they feel disconnected or
detached from them.
They have a restricted range of emotions (e.g. Usually able to feel
anger and fear but not able to have loving feelings).
4. PHYSICAL HYPER-AROUSAL SYMPTOMS
It seems like the “Volume Knob” on people’s bodily reactions is
turned up higher than normal and they tend to have physical over-
reactions. They need to have two or more of the following:
1. Difficulties falling or staying asleep.
2. Irritability or outbursts of anger.
3. Difficulties concentrating.
4. Hypervigilance i.e. constantly looking around them for any signs
of danger.
5. Exaggerated startle response.
The duration of the symptoms above must be more than one
month for a diagnosis of full PTSD to be made.
ADDITIONAL NOTES
1. The majority of people who experience a trauma do not suffer
from full-blown PTSD.
2. Most people’s trauma symptoms gradually settle down, so that
they are not excessively troubled by them six months after the
event.
3. About 20% of people experiencing a severe trauma continue to
have distressing symptoms longer than six months, and these may
continue for many years.
4. Symptoms of PTSD can appear soon after the event, but may not
appear for years afterward. Usually they appear within 3 months.
5. If a person has PTSD it does not mean that they are weak.
If PTSD is severe it is a family condition, for all members of the family
are affected.
