Because of this article's topic I am first and foremost including the following resources for readers who need immediate support or know someone in need.
National Domestic Violence Hotline
The National Sexual Assault Hotline and Online Hotline
Disaster Distress helpline for those experiencing emotional distress due to human made or natural disasters
"TalkWithUs" to 66746
National Suicide Prevention Lifeline
Para español llama 1-888-628-9454
Deaf or hearing impaired 1-800-799-4889
Crisis Text Line
Text MHFA to 741741 for free 24/7 crisis counseling and referrals
Veterans Crisis Lifeline
1-800-273-8255 select #1
Deaf or hearing impaired 1-800-799-4889
Let’s talk about trauma and post traumatic stress disorder. In this article you will learn what trauma is, ways people might respond during a traumatic event, how people might process their trauma, how trauma effects the brain, and how experiencing a trauma may or may not lead to Post Traumatic Stress Disorder (PTSD). You will also learn about PTSD symptoms as well as personal grounding techniques and possible treatment options you can explore.
This article is researched based and all sources are cited at the end of this article. Resource links are included too. If any symptoms I discuss resonate with you, it is important to avoid self-diagnosing. Instead, I encourage you to seek guidance from a professional who is clinically licensed and has undergone the appropriate training.
What is Trauma?
If you or someone you know has experienced or witnessed an extremely distressing and/or life-threatening event that caused physical or psychological harm, then that is considered a trauma. Some examples of this including physical violence, sexual violence, natural disaster, war in combat, kidnapping, gun violence, extreme bullying, death of a loved one, being diagnosed with a terminal illness, and being in a car crash. It is possible to experience trauma as a huge event or little overwhelming events that build up over time. As you can see trauma comes in many varieties and unfortunately the occurrence of trauma is common.
A striking 70% of U.S. adults have experienced at least one type of trauma in their life (How to manage trauma - National Council for Mental Wellbeing). The good news is a good portion of people who experience trauma do have the resilience, resources, and support to work through the trauma in a healthy way and ultimately recover. In these cases, the person does not go on to develop PTSD. However, there are about 6 percent of the U.S. population that do develop PTSD after a trauma (Va.gov: Veterans Affairs 2018).
What Happens During a Traumatic Event?
In the depths of a distressing and life-threatening event the fight, flight, freeze, or fawn response is initiated. Depending on the situation and what the person’s brain concludes is the best course of action for survival, a person might fight back, run away, do nothing, or try to appease the person or persons who abused them. When a person fights back, they are trying to save themselves from harm and regain control of the situation. If a person believes they can escape the attacker or dangerous situation, such as a house fire, they will run away.
Fighting and fleeing are easier for many people to understand than the reason a person might freeze or fawn during a dangerous and abusive situation. You might be wondering how it logically makes sense to freeze when you are at risk of harm. This is something I initially had trouble fully comprehending. I could understand how a person could be frozen with fear. But I wanted to know the exact mechanisms in the brain and body that caused this response to occur.
In a video about why most sexual assault survivors freeze in the moment, (McAdams, 2019) explains tonic immobility as the brain turning off your muscles ability to move and fight back. She continues by providing the example that rape and sexual assault has been used as a method of power and control during times of war,. When invaders would attack the villagers of the town a person who fought back would most likely be killed. Submitting to the assault was how the victims survived. We have carried this survival technique forward with us into modern day even in moments where a different reaction might have been the better option.
The last response to trauma is to fawn. This response is more common when there is ongoing abuse or dysfunction in a family. You may see this response in children who are being abused or a spouse who is experiencing domestic violence. Fawning shows up as people pleasing behaviors to keep the peace and stay safe. For instance, a child may desperately try to keep a caretaker calm to avoid a violent outburst. Another example is the spouse who stays with the abuser and tells herself “As long as I obey and don’t take up space, I will be safe”. This fawn response is carried over into other aspects of people’s lives and can become ingrained in their personalities.
The Brain's Response After Experiencing Trauma
Earlier I mentioned that after a trauma there are people who can return to healthy functioning without much trouble and there are those who develop PTSD. In short it seems that having adaptive coping skills, a strong foundation of support, believing in one’s self-worth despite the trauma, and feeling safe after the trauma has passed serve as protective factors against the development of PTSD (McAdams, 2019). Sadly, some people who experience trauma do not have the knowledge or resources to cope, often live in unstable and abusive environments, continue to feel threatened, and have much shame and guilt that prevents them from seeking help.
Symptoms of PTSD include hyper-vigilance, frequent crying, irritability, anger, nightmares and other sleep disturbances, flashbacks, dissociation, avoidance of trauma reminders, self-isolation, and strained relationships. They may go on to develop other mental health disorders as result of their trauma including, depression, anxiety, borderline personality disorder, dissociative identity disorder, substance abuse, alcoholism, and eating disorders. Some survivors may not completely remember the trauma because their brain deemed it too much for them to handle. This can lead to frustration and fear of not being believed when there are gaps in trauma memories.
Another way people may react to trauma is by repeatedly putting themselves in similar situations. Take the example of the person who has been in multiple abusive relationships. Outside observers may wonder how it is possible for this person to keep finding themselves in this scenario. The survivor probably does not consciously know why they are reacting this way. It is thought that people who repeatedly find themselves in similar traumatic situations are trying to fix or undo the original trauma.
How to Improve PTSD Symptoms and Recover from Trauma
First, I want to say I am not formally trained in trauma, PTSD, or it’s treatment. I do believe I can offer insight and resources that will encourage people to explore the topic more in depth. Snipes (2022) provides insight on a few things people can do after they have experienced trauma. After a trauma the first and most important step is to create safety. Once safety has been established you can acknowledge the trauma in a supportive environment. Become aware of its impact on you, accept your response for what it is, and acknowledge your symptoms. Accept where you are and how you feel instead of berating yourself by telling yourself you should feel different.
Next, experiment with ways to address your symptoms to see what could help you live a more fulfilling life. Ask yourself how managing your symptoms would improve your physical, psychological, emotional, and cognitive functioning. How would you react to different environments if your symptoms were under control and how can you feel safe in certain environments? Are there trauma triggers you can remove? Are there things you can add to your environment to remind yourself you are safe? How might your relationships improve if you start feeling joy? Set small and measurable goals and keep a journal to review your progress.
There are a few therapeutic treatment options that have been known to help people during PTSD recovery. As stated on the APA.org website an article explaining PTSD treatments states that Prolonged Exposure (PE) is one evidence-based treatment for PTSD which includes psychoeducation about PTSD and trauma. The client is given distress tolerance tools to deal with emotions that arise during treatment. There is repeated telling of traumatic experience in a safe setting with a trained therapist. It is recorded and client listens to it until it becomes bearable. Trauma memory becomes narrative memory. Treatment is usually 8 to 15 weeks. This is a common method to treat Veteran's with PTSD.
There is evidence that Trauma-Focused Cognitive Behavioral Therapy is useful in children and adolescents. Parents or caregivers may be involved in the therapeutic process if deemed clinically appropriate. According to (Trauma-focused cognitive behavioral therapy (TF-CBT, 2018; Idaho Youth Ranch: Trauma-focused cognitive behavioral therapy (TF-CBT)), the goal is to help children and parents process emotions and thoughts related to the trauma in a healthy way. They will learn positive coping skills, how to reframe faulty perceptions, relaxation techniques, and parenting skills to help their traumatized child. Gradual exposure is another factor of treatment where the child will slowly discuss the traumatic event in a safe and supportive environment. In vivo exposure is when the child is exposed either in real life or through imagination to unpleasant stimuli or perceived threats with the goal of desensitizing them and teaching them how to tolerate the situations. Trauma-Focused CBT is considered short-term treatment with a maximum of 16 sessions.
Eye Movement Desensitization and Reprocessing Therapy (EMDR) is another evidence-based treatment for PTSD. According to an article on APA.org titled Eye movement desensitization and reprocessing (EMDR) therapy, treatment focuses on the memory itself rather than the thoughts associated with it. It combines revisiting the traumatic memory while simultaneously engaging in bilateral stimulation. This combination is supposed to reduce vividness of trauma memories and decrease the emotional response associated with the memories. Treatment last 6-12 sessions and includes 8 phases: History taking, client preparation, assessment, desensitization, installation, body scan, closure, and reevaluation of treatment effect. Please see article linked further below for an explanation of these phases and how EMDR works.
Being able to talk to a therapist who is specifically trained in the treatment of trauma and who specializes in one of these therapies can make a difference. Of course, therapy is not always accessible, can be costly, and the person may not be interested in talking to someone about their trauma. There are plenty of professionals who create free videos on this topic. There are numerous articles and books written about trauma.
There are also grounding techniques like deep breathing and meditation. For example, you can allow yourself to feel your bodily sensations and slowly relax any muscle tension. You can distract yourself with music, movement, and activities. You can address basic needs like drinking plenty of water, eating well-balanced meals, going outside, and taking a shower or bath. With all that said, I also recognize how incredibly difficult it might be to engage in these self-care behaviors especially if you do not feel worthy. Also, some self-care behaviors I listed might be triggering depending on the person's trauma, which complicates matters. Therefore, having a support system in place is vital. When shame is heavy it can feel impossible to give yourself permission to take care of your needs, advocate for yourself, and love who you are. What is important is taking small steps toward being able to live a healthy and fulfilling life. I hope this article provided you with insight, knowledge, and empowerment toward your healing journey.
With much compassion,
Jacqueline Ulissey, LMSW
Please click on links for further learning.
American Psychological Association. (n.d.). Eye movement desensitization and reprocessing (EMDR) therapy. American Psychological Association. Retrieved February 16, 2023, from https://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing
American Psychological Association. (n.d.). Prolonged exposure (PE). American Psychological Association. Retrieved February 16, 2023, from
GoodTherapy. (2018, August 3). Trauma-focused cognitive behavioral therapy (TF-CBT). Trauma–Focused Cognitive Behavioral Therapy for Children and Adults. Retrieved February 16, 2023, from https://www.goodtherapy.org/learn-about-therapy/types/trauma-focused-cognitive-behavioral-therapy
How to manage trauma - National Council for Mental Wellbeing. (n.d.). Retrieved February 16, 2023, from https://www.thenationalcouncil.org/wp-content/uploads/2022/02/Trauma-infographic.pdf
Idaho Youth Ranch: Trauma-focused cognitive behavioral therapy (TF-CBT). Idaho Youth Ranch | Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). (n.d.). Retrieved February 16, 2023, from https://www.youthranch.org/tf-cbt
McAdams, E. (2019, January 1). The freeze response and sexual assault: PTSD and Trauma Recovery #2. YouTube. Retrieved February 16, 2023, from https://www.youtube.com/watch?v=pes7H4ECTdw
McAdams, E. (2019, January 23). Trauma resilience: 6 things I learned from Elizabeth Smart about trauma resilience: PTSD recovery #4. YouTube. Retrieved February 16, 2023, from https://www.youtube.com/watch?v=qRiwDx4qb51
Snipes, D. (2022, July 19). Post traumatic growth thriving recovering from traumatic injury. YouTube. Retrieved February 17, 2023, from https://www.youtube.com/watch?v=wnmbF-mzhKI
Trauma-informed care. ACEs Aware. (2021, November 19). Retrieved February 16, 2023, from https://www.acesaware.org/ace-fundamentals/principles-of-trauma-informed-care/
Va.gov: Veterans Affairs. How Common is PTSD in Adults? (2018, September 13). Retrieved February 16, 2023, from https://www.ptsd.va.gov/understand/common/common_adults.asp