What is trauma?

According to Merriam-Webster the definition of trauma is “a) an injury (such as a wound) to living tissue caused by an extrinsic agent. b) a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury and c) an emotional upset.” (Merriam-Webster, 2020). While that might suffice for some therapists, it is important to understand the true definition of trauma. Trauma is what happens to the body neurobiologically when it has experienced a moment of being completely vulnerable and unable to control whatever incident is happening (Halter, 2013). It is important to know that trauma compounds itself within the body; that means that the first time one experiences vulnerability and lack of control, the brain becomes rewired to identify any similar set of emotional feelings as being a threat to existence. Therefore, moving forward, the more times one experiences vulnerability and lack of control, the deeper ingrained the threats become until it is impacting every-day existence (Halter, 2013).

In order to understand how to treat trauma in clients of any age, one must understand how the body works from a sensory processing perspective. This means we must come to grips with the fact that we are biological beings with built in warning systems and the ability to become either predator or prey (i.e. fight or flight). The body will always choose to survive when given the opportunity. How it does this (either as fight or flight) depends on the individual and how he or she was nurtured growing up.

Identifying ourselves as animals is difficult for some of us to comprehend because we consider ourselves socialized and civilized, but perhaps this might help move things along. We, just like all other species, spend every waking moment identifying items and situations through our senses. In other words, we see it, hear it, taste it, touch it, and smell it. Each time we enter a situation no matter how big or small, our brain starts calculating all of the sights, sounds, smells, temperature, and even how the air tastes (it is extremely subtle, but it does taste like something) (Halter, 2013). It then gathers all of the data (within the blink of an eye) and depending on whether the situation was safe or unsafe (in our estimation) will depend on how it files it away for future use to either do it again or identify it as a significant “hell no.”

The autonomic nervous system consists of two parts; the parasympathetic nervous system or where we spend most of our time in a relaxed body and the sympathetic nervous system which is what creates our desire to either run for our lives or fight to survive (Halter, 2013). When we are in sympathetic mode, the drive mechanisms within our brains shift and our need to eat, drink, sleep, poop, or pee is quite diminished, our heart beats faster to ensure more than adequate blood flow to vital organs and limbs; this also triggers our breathing to become rapid and shallow so that our intake of oxygen is acceptable. All of these biological responses happen so that we are able to go long periods in hiding or in battle without the need to sustain ourselves. In addition, the executive processing center located in the frontal lobe of our brain does not process anything but survival, giving us tunnel vision as our eyes are scanning either for a way out or a weapon to use to protect ourselves (Halter, 2013). This is why individuals with significant impairing trauma in their history are often mistaken for being ADD or ADHD. The smallest item can overwhelm and create a scenario that looks like the inability to focus. If we assist our clients in moving back into a relaxed body (parasympathetic) they are suddenly able to focus again. This is also the reason why when our clients are working in their “passion” they are able to do so for long periods of time, as they are in a relaxed body. Once the body returns to parasympathetic mode, all drive mechanisms return to the status quo and we are able to do all the things we are driven to do to assure homeostasis has been obtained (Halter, 2013).

One of the challenges individuals with impairing trauma face is something called General Adaptation Syndrome (GAS) (Halter, 2013). GAS posits that we live our lives in a state of alarm; that means our reflexes are working, thus allowing us to slam on the brakes if a ball rolls in front of our car, catch something before it falls, etc.… If the body goes into crisis it can only stay in crisis for just so long before it either exhausts or dies. For busy people this means we get the flu, severe cold, or bronchitis which forces us to stop and rest until the body returns to normal. Using GAS theory as a backdrop it becomes even more imperative that we assist our clients to return to a relaxed body as soon as possible.

In order to have a better understanding, let’s look at this example, keeping in mind that each sense is creating a potential emotional trigger: Imagine you are walking down the street with your best friend. The air is warm, the sky clear, the sun is shining brightly, there are the sounds of cars and trucks in the background; a slight warm breeze is gently blowing at perfect intervals and your friend just reminded you of something that makes you both laugh. Let’s imagine it is the beginning of summer and during this walk you smell oranges in the air from a man making fresh squeezed orange juice at his cart about ½ a block away. You and your friend stop to get a hot dog from a vendor, making your day pretty close to perfect. If that was the end of the story it would be labeled safe and filed away for future notice with a “safe, free to do again” sticker. However, on this particular day, let’s imagine you get mugged and someone steals your purse or wallet. In the moment of the mugging you are at your most vulnerable while experiencing a total lack of control, and as a result your “fight or flight” response comes into play and the event is now labeled “unsafe, do not repeat.”

Now, let’s imagine it is a year later; you believe you have put the incident behind you to the best of your ability and are going about your morning rituals. It just so happens the window is open and the sounds of cars and trucks are in the background, the sun is shining and you open the refrigerator and robotically take out the container of orange juice. You grab a glass and open the juice and immediately smell the delicious scent of oranges. Normally, this is a fairly neutral situation, however; instead, you suddenly become extremely anxious, your heart starts to pound, and your hands become ice cold. While you may not consciously realize what is happening your subconscious and your muscle memory are both vividly remembering the incident from the year before through the magic of sensory processing. Had the event been marked as “safe, free to do again” and the mugging had not happened, the same sensory information would have created a warm, fuzzy feeling and you might have even smiled at the thought of that day with your friend.

                                                                           Treating Trauma

We are taught in graduate school that trauma survivors are nothing to be messed with and that we should refrain from treating them until we fully grasp how not to “re-traumatize” our clients. It is very difficult to avoid treating trauma as every individual has experienced trauma at the very least through birth. Think about birth, as an unborn child we are in a warm safe place just hanging out floating in a perfect climate in the peace and quiet. This works for about 9 lunar months or 40 weeks, then perhaps we get bored or perhaps we hear something that intrigues us, and we decide it is time to see what else is out there and we push our way into the world. 

Once we are outside it is cold, there are sights, sounds, smells and things touching our skin thus overloading all of our senses, we are at our most vulnerable and out of control, therefore; we go into sensory overload and try to process everything at once. What we do not realize is that our “fight or flight” response has been activated and our natural instinct to survive is taking over. All of that is if the birth is straightforward, imagine the sensory overload if a child has complications. While it is true that we have no vivid recollection of events until the age of two, we somehow forget that the reason behind that is so we actually move forward in life. Moving forward does not necessarily mean forgetting, all sensory input is processed and stored in our brains for future reference.

Over time we add to our initial trauma to varying degrees. These incidents compound either as a bunch of little “T” traumas or big “T” traumas. Little “t’s” are minor things such as falling off a bike, getting a papercut, burning your hand, etc… Big “T’s” are things like sexual assault, getting robbed, losing your home to fire, losing a loved one tragically, being abused.

Most of the population has been at their most vulnerable and at a complete lack of control thus triggering the sympathetic response at least once in their lives. The most important thing to remember about treating clients with trauma is that the details are NOT important. Never ask the client what happened, no matter how much you think it is important. When the client is ready to talk, they absolutely will; in the meantime; refrain from forcing the issue by asking questions that you have no need to ask except for your own morbid curiosity. The concept of understanding what is happening to them from a visceral (body) perspective is the most vital piece of the puzzle. 

The interventions we teach our clients through the magic of psychoeducation are with regard to being grounded to the Earth. Grounding can be accomplished in several different fashions with each one adding intensity to the last so it is important to teach your clients about each one so they have a readily available tool box when they suddenly become triggered by a sensory memory: 

1. Walking Barefoot- Take off both shoes and socks and just stand in the grass with your eyes closed, do this along with your client to ensure you are in a grounded state as well.

2. Room Scan- If it is not possible to get to the grass (such as in winter, or there is no grass in your location) then have your client place both feet on the ground in your office, then have them look around the room and without using the word “could” ask them if there is anything in the room that can harm them. Once they determine there is nothing unsafe about the space have them tell themselves, “I am safe.” This mantra will help “re-wire” the brain to remember not everything is going to eat, harm, or maim them.

3. Sensory Focus- If the client is having difficulty with the first attempt at grounding have them place both feet on the ground and utilize one of the senses to focus on such as looking at a poster or flower or listening to a sound. It is important to understand that this is a mindfulness exercise and that all aspects of the item must be experienced and focused on in order to reclaim a relaxed body.

4. Body Awareness- Assist and guide the client to become aware of their own body (the physical body, not emotional body) and identify what he or she is feeling in the moment. Are their hands cold? Is their heart pounding? Once they have identified what their body is doing ask them to focus on the muscles in their buttocks. If the muscles are contracted, ask them to focus on releasing the muscles to a relaxed state. Ask them to focus on how that feels and to make a mental note of the feeling for the future. Relaxing the buttocks allows for the pelvic floor to relax thus instantly creating a parasympathetic space. Another way to relax the pelvic floor is to ask your client to “Kegel” this means to contract the muscles of the perineum and then release them. This can be accomplished by clenching the buttocks and then releasing.

5. Visual Acuity- When the body is in sympathetic mode, as we discussed before, it has tunnel vision. In order to get the body to become parasympathetic once again we need peripheral vision. Ask your client to hold his or her arms out to their sides until they can see their hands in their periphery.

6. Using the Weighted Blanket- Have your client sit in a comfortable position and place the weighted blanket, shawl or lap pad. Be careful to utilize the appropriate amount of weight for the client too much as this can have the opposite effect and trigger a lack of control. This provides a dulling effect to the amped up nervous system and reduces their anxiety.

7. Guided Imagery- Have your client lie down on the sofa and cover them with the weighted blanket, shawl, or lap pad. The weight from the blanket allows the client to feel safe and reduces the anxious affects the body is feeling. Ask your client to take 3 deep breaths in through their nose and out through their mouth. Count the breaths. Take your client on a peaceful journey utilizing the different senses to create a scene they can relate to as their “safe space.”

8. EMDR- Eye Movement Desensitization Reprocessing is a psychotherapy treatment designed to alleviate the distress associated with traumatic memories.

Understanding the neurobiological aspects of trauma provides you with a multitude of tools to assist your client with a variety of dysfunctional trauma related situations such as the “traumatic bond.” This happens when the individual being abused forms an emotional attachment to the individual who is abusing him or her (Halter, 2013). Cluster B personality disorders such as Narcisisstic, Histrionic, Borderline and Antisocial personality disorders are most often affected by traumatic bonding either as the abuser or abusee.

References

Halter, M.,(2013). Varcolis foundations of psychiatric mental health nursing (7th Ed).

St. Louis, Missouri: Elsevier Saunders.

Merriam-Webster. (n.d.). Trauma. In Merriam-Webster.com dictionary. Retrieved July 11, 2020,

from https://www.merriam-webster.com/dictionary/trauma