Working through Trauma

Working through trauma

What is trauma?

Trauma is the mind’s response to a situation which has been experienced as overwhelmingly threatening. The emotional reaction to the situation has been sufficiently strong to result in formation of a poorly processed memory which may be fragmented, with the sensory details accentuated, scrambled, experienced from an alternate viewpoint or it might be repressed and unremembered.

Normal autobiographical memories of life experiences have been processed by the hippocampus (which is a key part of the brain’s memory ‘filing’ system) and can be put into long term memory storage in a format which allows retrieval as a coherent narrative.

Trauma memories are stored in the quickly-accessible amygdala (which is a part of the emotional processing system), so that any situation which matches similar sensory elements of the traumatic incident can automatically activate the fight, flight or immobilise response. The trauma response is a mechanism which has evolved to help people avoid threatening events.

The threshold to overwhelm the nervous system is both individual and situational:

Four people witness a car crash with a motorbike and the biker lies on the ground, unconscious and bleeding.

Matt is sensitive and empathetic by nature, he takes in all the detailed information in the scene and identifies with the biker. The incident results in nightmares and flashbacks for a period and ongoing anxiety when driving.

Kai was on his phone at the time and is a calm person who is not particularly sensitive to what is happening around him. Two days later, he describes the incident to a colleague with sympathy for the biker, but little distress.

Gemma and Oscar are a couple who are horrified by what they witness, but they hold each other instinctively and talk about how awful it was immediately. They suffer distress, but not trauma.

Two friends meet for a coffee to discuss that they have both just broken up with their partners. Josie is not sleeping, experiencing panic attacks and the final conversation with her ex plays on a vivid loop in her mind. Her parents had a bad break up when she was four. She can’t remember it, but break ups always feel hard to survive. Lily is crying all the time and has had to move back in with her parents, but in her better moments, she can see that she will get past this.

What causes trauma?

Trauma can be caused by anything which is experienced as overwhelmingly threatening by the nervous system. This could be a battlefield scenario, a violent fight, a sexual assault, road traffic incident, flood, fire or a death. But equally, it could be triggered by a medical emergency or a difficult childbirth, a pandemic, a shocking revelation, a relationship break up, losing a job, being bullied physically or emotionally, being shamed or put down, having a panic attack in public, a serious financial loss, being shouted at or physically threatened or a non-consensual sexual incident. Seeing someone else go through a frightening experience also may invoke (vicarious) trauma, such as the situation of a small child who witnesses explosive arguments between parents.

External factors which may affect the likelihood of a trauma response are how sudden and unexpected the incident was (especially when the mind did not have the opportunity to prepare for a disaster), the perceived severity of the threat, the mind’s interpretation of the situation and the imagined outcome of the incident. The presence or absence of another trusted person as support can mitigate or accentuate the severity of the trauma.

Internal factors which affect the response are the sensitivity of the nervous system of the individual (more sensitive people take in and attempt to process more information, which can lead to overwhelm), the person’s state of mind at the time of the incident and previous trauma experienced.

The younger the person is and the degree of maturity of the nervous system, the greater impact a given situation will have.

The severity of the trauma also relates to the degree of control the person experienced themselves as having over the unfolding events, ‘I felt so completely helpless when it happened!’

Trauma tends to be cumulative and, whatever the initial cause of the trauma, it will compound as further trauma is experienced.

What does a trauma response look like?

At the time of the trauma, the person may become angry, frightened and back off or shut off emotions and take practical steps. After the incident, they may recall the situation in great detail or be unable to remember it at all. If they have dissociated (gone into a shut down state of partial immobilisation of the nervous system) at the time, they may have been unable to act promptly or at all and later blame themselves, ‘Why didn’t I do or say anything?’

Memories may return as flashbacks, which interrupt normal thought processes with visual ‘clips’ of the incident, auditory experiences of what was said or other sensory details, e.g. the smell of burning or the sound of a front door being slammed. Any future sensory experiences which are similar to those experienced in the original incident may fire off a ‘fight or flight’ response in which the person startles, withdraws, starts to breathe faster, trembles, becomes aggressive or tearful or freezes. Sleep may be troubled by disturbing dreams and restlessness. The capacity for concentration, memory recall and control of emotional states may all fluctuate.

The amygdala, which has stored the conditions of the threatening situation on loop, is ready to fire if it recognises that pattern of conditions again. The amygdala is the mind’s ‘fire alarm’ and when it believes that smoke is present, it triggers the reaction to act, outside of conscious thoughts and control. Survival of a potential threat overrides reasoning every time.

The overt signs of Post Traumatic Stress Disorder may include flashbacks, nightmares, panic attacks, dissociative states, withdrawal from others and social isolation, disrupted sleep, irritability and poor concentration. However more subtle signs may be lethargy and demotivation, a feeling of being stuck and unable to move forward in life, hypervigilence, persistent exhaustion, poor emotional regulation, substance misuse, mood swings, a loss of interest in life and avoidance of specific trigger situations.

When is trauma problematic?

As trauma does not go away without being resolved due to the way it is stored in the mind, the trauma memories remain outside the ordinary autobiographical narrative of the person’s life. Because of the way the memory has been retained, without full processing, the mind sees the incident as still current, as if it is still happening in the present, rather than an episode from the past. However, trauma memories may remain dormant and not interfere with everyday life.

Alternatively, it can be that flashbacks and nightmares persist, as the mind is still trying to process something which it finds difficult to make sense of and threatening. Anxiety and panic attacks may arise seemingly out of the blue or the person may live in a state of perpetual anxiety. They may find that every time something minor goes wrong, they are pitched into catastrophising, imagining the worst case scenario. Obsessive and compulsive behaviours may have the person checking and rechecking their actions, obsessively overthinking every response or over-analysing the behaviour of others. The person may respond unreasonably strongly to everyday situations, e.g. shouting at a child who drops food on the floor, bursting into tears in a work meeting or needing to switch off a film in which a couple are arguing. In some cases, avoidance of potentially threatening situations and procrastination inhibit carrying out everyday tasks, engaging in an intimate relationship or taking on more challenging responsibilities. The person might fall into apathy and depression, avoiding risks through withdrawal from life. Alternatively, the person may actively seek risks, e.g. through dangerous sports or travel, taking financial risks, self-harming, taking substances, excessive consumption of alcohol, provoking arguments and fights with others or engaging in sexual acts with unknown others, in unsafe surroundings.

Trauma tends to isolate the person from others, as they are preoccupied and withdrawn into their inner world and their behaviour may impact negatively on those around them.

Trauma from abusive relationships

Trauma can arise from one incident or from a long term situation. This may take the form of interpersonal interactions between individuals, in which one or more people are behaving in ways which are aggressive, manipulative, controlling, critical, demeaning or devaluing towards the person who has less power in the situation. The person subject to the abuse may be sexually or physically violated at times. However, being shamed by another person who is critical and demeaning is sufficient to result in deep rooted trauma wounds which undermine the sense of self as being ‘good enough’ and secure. This can lead to generalised anxiety or anxiety in specific situations where the shame could potentially be repeated. Abuse may undermine the sense of self, leaving low self-esteem and depression.

The scars from this form of trauma can result in avoidance of intimacy in later relationships or repeatedly seeking similarly non-reciprocal relationships. The person may either avoid challenge, leaving their potential unfulfilled, or drive themselves ever harder to achieve an unattainable standard.

How can trauma be resolved?

Trauma tends to ‘sit’ under anxiety and/or depression unnoticed, as the link to specific incidents or situations is often unnoticed by either the individual or the clinician assessing the person. It can also be masked by other conditions, such as ADHD (Attention-deficit hyperactivity disorder), which presents with struggles to concentrate, hyperactivity, difficulties in completing everyday activities and sensitivity to shame and rejection.

Talking therapy can be helpful in uncovering and exploring trauma and in preparing the person for resolving it. However, talking about the traumatic incidents and situations does not resolve the trauma and the automatic reactions which accompany it. The ‘thinking mind’ understands how being shouted at by that scary teacher has led to a fear of making a presentation at work, but the ‘survival mind’ will still shut everything down in the boardroom meeting.

As the trauma memory has not been processed by the mind in the normal way and cannot be recalled in the usual way, processing fragments of trauma memories and the associated strong emotional reaction is addressed through specific techniques. However, there needs to be a readiness to face the memories. Signs that a person is not ready for addressing the trauma could be repression of the memories, e.g. ‘I don’t remember anything before the age of 11,’ or dissociation of the associated emotion to protect the mind from further overwhelm, e.g. ‘I can remember him threatening me, but it’s as if it happened to someone else, it doesn’t bother me at all’ or avoidance, e.g. ‘I don’t like to think about it, if anything reminds me of that, my mind just moves on to something else’ or a suppression of the memory with the use of alcohol or cannabis.

Processing can be carried out on partial, inaccurate or scrambled fragments which are causing distress. If the trauma relates to an ongoing situation which was traumatising, it may be sufficient to remember three stand out incidents from several years of trauma.

It is important that the person undergoing the therapy has a good rapport with the therapist, feels ready to face the experience and let it go and feels safe while they go through the process. After a period of preparing for the processing, it may take one or more sessions to work through each memory and release the associated emotion.

Processing techniques include EMDR (Eye Movement Desensitization and Reprocessing), EFT (Emotional Freedom Technique) or the rewind technique. The techniques start by guiding the person who is processing the trauma into a relaxed state, e.g. through calming breathing techniques, muscle relaxation and visualisation of a safe place or moment. The therapist leads and supports the person through stages in which they step back through the trauma, while maintaining the sense of being in a safe state. The procedures involve controlled visualisation of the memory and may be accompanied by relaxed breathing, tapping on points of the upper body or knees, directed eye movements, a focus on the sensory aspects of the memories, a focus on the bodily reactions to trauma, the speeding up or reversing of the direction of the memory and statements of intent regarding the outcome of the processing. Processed memories are laid down in the long term memory as part of that person’s life narrative, decoupled from the trauma response. 

Is trauma processing successful?

Limitations on trauma processing are encountered when a person is unwilling or unable to remember the trauma and the associated emotions or when benefits linked to remaining stuck (e.g. being dependent on substances, financial benefits or the gain of emotional support) outweigh the desire to resolve the issues. Additionally, being unable to visualise scenes can hamper the processing.

Occasionally, the rapport with the therapist does not build due to a lack of trust and the experience of being guided through a procedure by another person is in itself triggering. This situation relates to individuals who have had little or no good childhood experiences of relationships with trusted others and the procedure of trauma processing feels akin to ‘mind control’, which is the nature of the original trauma. In this case, several years of therapy may be required to reach a state where the trauma can be safely addressed.

When successful, the memory can be recalled appropriately, without the overwhelming and triggering emotion, which leads to an automatic defensive response, or the blank denial of the impact of the situation. The memory has been decoupled from the trauma response through the stimulation of the mind during specific techniques.