What is Trauma?

The Diagnostic and Statistical Manual for Mental Disorders (DSM-V) describes a traumatic experience as exposure to an event that involves death, serious injury (actual or threatened), or sexual violence (actual or threatened). It usually creates intense feelings of helplessness, horror, or fear in the individual. It is direct exposure to an event that causes trauma but can also be caused by witnessing an incident that happened to someone else. Other forms of trauma include indirect exposure by hearing about a close friend or family member undergoing trauma, or through extreme or repeated exposure to aversive details of an event, typically through professional duties, such as first responders to a fatal crash site, or repeated exposure to information of child abuse.

Trauma can create long-standing changes in the brain. For example, imaging studies have shown heightened brain-stem activity, which controls the fight-or-flight (or freeze) system. It is the brain’s inbuilt survival mechanism. Imaging studies also show increased amygdala activation, which floods the body with feelings of fear. These changes can be pretty effective in keeping people safe in times of imminent danger. They allow individuals to scan the environment and react quickly to anything perceived as dangerous.

The problem is that once these areas of the brain become overreactive, they will respond to anything that is potentially similar to a traumatic experience from the past without first trying to assess the actual level of threat accurately. As a result, it makes it more difficult to respond calmly and rationally in an individual’s everyday life.

The hippocampus, an area of the brain responsible for memory, can also be severely affected by traumatic events. The more extreme, unexpected, and inconsistent an event is with previously held beliefs about themselves, the world or other people, the harder it is for the brain to fully process and integrate this experience. As a result, some of it remains unprocessed or “stuck”, which reduces the capacity to move on from the traumatic event and process and integrate following information taken in by the senses.

Re-experiencing symptoms, such as flashbacks and nightmares, are thought to be the brain’s attempt to process and integrate the traumatic experience. As scary as this can be, it generally does help in healing and resolving trauma symptoms over time. Unfortunately, with Post-traumatic stress disorder (PTSD), the brain continues to be unable to process and integrate what has taken place. As a result, it can lead to devastating consequences and severe functional impairment for the individual suffering from the condition, especially if they don’t understand the symptoms or what to do with them when they occur.

How to Best Respond to Each Cluster of Trauma Symptoms:

Four clusters of symptoms indicate that a person suffers from an acute stress reaction or post-traumatic stress disorder after exposure to a traumatic event. Even if you do not have all of these symptoms, it can still be helpful to know what is occurring when you experience these symptoms after trauma and what you can do about it.

A: Intrusion symptoms — This includes intrusive memories, traumatic nightmares, dissociative reactions, such as flashbacks, and marked physiological reactivity and intense or prolonged distress after exposure to trauma-related stimuli or reminders.

When these intrusive symptoms occur, our brain rushes back to the past and starts to think and feel the same way it did when the traumatic event occurred. The mind feels in imminent danger, and the initial feelings of intense helplessness, horror or fear come rushing back in.

I have found a grounding process to be most effective when this occurs, as it helps me reconnect with my senses at the moment and brings my brain back from the past to the present.

Next time an intrusive symptom occurs, ask yourself the following:

1. What are five things that I can see right now?
2. What are four things that I can touch/feel right now?
3. What are three things that I can hear right now?
4. What are two things that I can smell right now?
5. What is one thing that I can taste right now?

Once you are present, ask yourself, “Am I safe right now?” If you are in danger, remove yourself from the situation. If not, you are not at risk of harm and instead need to focus on reducing your distress and physiologic reactivity through self-soothing activities.

The more that these activities can engage you and your senses at the moment, the better, as it will help you to continue to feel present and safe. Grounding must occur first, though, or the brain will want to stay in a hypervigilant state to protect you from the perceived threat, even if the danger is only a memory in your head.

B: Avoidance — Persistent avoidance of distressing external (people, places, conversations, activities, objects or situations) or internal (thoughts or feelings) reminders of the trauma

Avoiding any reminders of the trauma in the first month after the incident is a good thing, as it can lower your arousal levels and reactivity, assisting your recovery.

Ongoing avoidance of these reminders, particularly after a month, is not recommended, however, and may prevent a full recovery. Chronic avoidance prevents processing and integration of the traumatic event. Moreover, it sometimes means that people begin to avoid more and more things that may seem dangerous when they are logically relatively safe.

Gradual exposure to the things you fear (as long as they are relatively safe) is essential in treating an anxiety disorder, including PTSD. I have gone through the steps of doing this in my first article titled “Feel the Fear and Do It Anyway”. I followed these steps to challenge myself to get outside at night and stop hiding when cars came past. It did get more comfortable with each time as I realised that my fear of being attacked was much higher than the actual probability of it occurring (it’s never happened again).

Also, remember that we cannot entirely run away from our thoughts and feelings. Acceptance and Commitment Therapy teaches Defusion and Expansion skills to help us better manage our thoughts and emotions. Research shows that these are more effective long-term strategies than continually avoiding internal reminders of trauma through drugs and alcohol, emotional eating, meaningless distractions, or keeping busy all the time.

C: Negative alterations in cognitions and mood — including the inability to recall critical components of the trauma, persistent and distorted negative beliefs and expectations about oneself, others or the world, or blame of self or others for causing the traumatic event or its consequences, persistent negative emotions, including anger, fear, horror, impending doom, guilt and shame, diminished ability to experience positive emotions, as well as loss of interest and engagement in previously important activities, and feeling isolated, alienated, detached or estranged from others.

Exposure-based treatments, particularly cognitive processing therapy, are essential for addressing the extreme shifts in cognition and beliefs that can occur after trauma, particularly if they prevent you from doing the things you used to enjoy.

If you are feeling detached or physically or emotionally numb, movement can help a lot. It doesn’t matter what type of movement, but there’s a bonus if you enjoy it. So the next time you feel this way, go for a walk or run, stretch or try yoga, play a sport or even twist and dance. They all may help bring you back into your body more and feel a bit less distant and more connected.

Writing about how your beliefs and feelings have changed or explaining these changes to a friend that you can trust can help you feel more connected and better in time, but it should be done in collaboration with a therapist if you are concerned about how you may react.

If I ever felt disconnected, which happened occasionally, I found any movement to be the best strategy to reconnect. It could be playing a sport, doing yoga or Pilates, weight lifting, walking or running outside, or even dancing. Anything that helps you get out of your head and into your body or the world around you.

D: Alterations in arousal and reactivity — trouble falling asleep or staying asleep, difficulty concentrating, feeling jumpy or easily startled, and being super alert or watchful.

Learning emotional regulation and distress tolerance skills are critical to managing arousal levels, which diminishes reactivity.

Emotional regulation skills include adequate rest, recovery, leisure and socialising, or ensuring that things are in the right balance. For example, too much work and stress without sufficient breaks will slowly increase our arousal levels over time. Ensuring that we minimise caffeine and alcohol intake, eat a healthy, well-balanced diet and get a consistent 7 hours of sleep each night also help us to lower our arousal levels and better regulate our emotions.

Distress tolerance skills include relaxation and mindfulness skills, as well as a distraction at times. Practising these regularly when you feel calmer makes them easier to implement when you are most distressed so that things do not become too overwhelming for too long and you can calm yourself down.

Diagnosis of PTSD and Recommended Treatments

All four symptom clusters must be present to a significant degree and cause significant distress or functional impairment to warrant a diagnosis of PTSD.

If you are concerned that you may have PTSD from a trauma that you experienced more than a month ago, please complete the Post-traumatic Checklist for the DSM-V (PCL-5) questionnaire, which you can access for free online. If you score above 38 on this checklist, I encourage you to visit your GP or primary care physician to discuss the matter further and collaboratively decide on which treatment path you would like to go down.

Sometimes a referral to a Psychologist or Psychiatrist will be essential to give you the best chance of making a full recovery.

It is vital to realise that the most effective psychological therapies for trauma all include exposure (imaginal or in vivo) to parts of the traumatic experience or the impact it has had on you. For example, it could be trauma-focused cognitive behavioural therapy (CBT), Cognitive Processing Therapy (CPT), or Eye Movement Desensitisation and Reprocessing (EMDR) Therapy. All are considered first-line approaches for treating PTSD in Australia (NHMRC, 2007) and should be recommended before pharmacological interventions or alongside antidepressants (SSRIs) if sufficient benefits have not occurred through psychotherapy alone.

Even 8–12 sessions of 60–90 minutes of therapy are usually sufficient in treating PTSD. You can then address any co-morbid issues in further treatment once the PTSD symptoms have subsided.

Traumatic events can change the brain and the way that we respond to situations afterwards. Often the brain can heal itself over time, especially if we are engaging in the right strategies. However, if it doesn’t, practical psychological help is available, and it can make a big difference in helping you heal and grow.

You can also check out my new podcast ‘Deliberately Better’, which discusses PTSD and how to manage it.