Psychological Trauma: What is it, and What to Expect in Treatment

Sometimes, something really bad happens to us – so bad that it alters you in a very fundamental way. Such experiences are often referred to as traumatic events. In Canada, it is estimated that 9.2% of the population will have suffered some form of post-traumatic stress disorder (PTSD) at some point in their lives. In this article, we will briefly explore what psychological trauma is – and what treatment might look like if you are seeking individual therapy!

What is Psychological Trauma?

 Loosely speaking, psychological trauma occurs when something overwhelmingly upsetting happens to someone – and it’s so upsetting that the brain processes it in a way that produces lasting psychological symptoms. It is important to note that sometimes psychological trauma can be incurred even if the bad thing didn’t happen directly to you. Many people experience trauma simply by witnessing something that is overwhelmingly upsetting (ie. such as a loved one getting hurt, or learning about the death of someone close to you).

You may have noticed the word overwhelming being used a lot. This is because psychological trauma, by definition, is an experience that the mind considers intolerable. This is a key difference between a really bad experience and a traumatic experience. Bad experiences are hard to bear – but traumatic experiences are, in your mind’s eye, actually unbearable. As such, your brain processes them differently, and will go to great lengths to protect you from having to experience them again. 

Symptoms of Post-Traumatic Stress

People who are suffering from post-traumatic stress typically present several clusters of symptoms that are highly disruptive. In no particular order, these may include: 

Repeated experiences of unpleasant mental intrusions, such as flashbacks or recurring nightmares. When you experience these flashbacks, it might feel like the actual trauma is happening all over again.

Persistent avoidance of the traumatic experience. Remember that your mind has deemed the traumatic experience to be unbearably upsetting, so naturally it’s going to put some defences in place to prevent you from experiencing it again!

 Negative changes in the person’s mood and thought patterns. It is common for people to develop exaggerated, negative beliefs as a result of the trauma. These beliefs might take the form of statements to the effect of: “I’m a bad person.”, or “People can’t be trusted”, or “I’ll never be the same again.”

Increased reactivity and arousal. The nervous systems of people who are struggling with trauma often become really sensitive to things that can be perceived as threats (even if they are actually harmless). As such, a traumatised person might be more irritable or easily startled than usual.

As you read this, you may be wondering whether you or someone you care about are or is suffering from psychological trauma. I should note that the best way to find out is to consult a family doctor, a psychologist, or a psychiatrist. In Ontario, these professionals are qualified to examine your symptoms, offer a suitable diagnosis, and provide a treatment plan. Self-diagnosis is never recommended and can potentially lead to harm!

Psychotherapy for Trauma: What to Expect

So what should you expect out of treatment? With post-traumatic symptoms, psychotherapy is considered the most effective first line of treatment. In some cases, medication can be helpful in addition to therapy – but that’s a conversation best had with a doctor or a psychiatrist. There are several types of trauma therapy that have been shown by research to be highly effective at managing, reducing, or even eliminating post-traumatic symptoms. Each type of therapy has slight variations in terms of approach and emphasis, but virtually all types of evidence-based approaches will include the following elements:

Stabilization: As the name implies, this stage of trauma therapy is focused on helping you foster a sense of emotional and psychological stability. During this phase, you and your therapist will generally focus on a couple of things:

Your therapist is going to focus on building a really safe and trusting relationship with you. This is of utmost importance, so don’t downplay it if something feels off! If you’re feeling unsafe or uncomfortable, or you feel like your therapist just isn’t getting it, it’s very important to bring that up. In general, for therapy to work, your relationship with your therapist has to be built on a real sense of trust and safety.

Your therapist might drop some nuggets on trauma and how it works. In therapy terms, we call this psychoeducation. The idea is, if you know a little bit more about how trauma works, you’ll have some context for what you’re going through. Since a lot of traumatised people feel guilty about their trauma responses, knowing why these responses keep happening can be really validating and freeing.

Your therapist might help you develop a range of coping skills. These might include grounding skills, which means keeping your mind and attention focused on the here and now (this is really helpful when you find yourself being pulled into a flashback or a trigger). A lot of therapists will help you work on deep breathing, and moving your body in ways that can help calm you down when the triggers come. Some of the skills they give you might seem overly simplistic, hokey, or even suspect at times – but try your best to keep an open mind!

Reprocessing the Trauma: This is the phase of therapy where you will be asked to revisit or talk about your traumatic experience in some way. In all likelihood, this will be distressing and uncomfortable, but your therapist should guide you through the process so that it is never unbearably so. There are many reasons as to why revisiting the trauma is necessary, but most schools of thought will agree on the following principles (or variations of them):

Revisiting the memory helps your brain to learn that the traumatic experience is no longer as scary as it once was. Remember, when the trauma happened, it was unbearably upsetting. Now, as you revisit the memory with all your new coping skills and with the support of a warm and trusted therapist, you’ll have a chance to teach your brain that while the memory is uncomfortable, it is no longer unbearable. Essentially, you’re teaching your brain that it’s OK – you don’t have to avoid the trauma anymore. You’re strong enough to face it!

Talking about the traumatic experience helps you activate the parts of the brain that got shut down when the trauma happened. One particularly important part is the dorsolateral prefrontal cortex (DLPFC). This part of the brain helps you put your experiences in context (ie. time and place) – and unfortunately it has a tendency to duck out when your trauma gets triggered. That’s why sometimes, when the trauma gets triggered, it feels like it’s happening all over again, right here, and right now. When you talk about your trauma, you are revisiting the memory while actively engaging the DLPFC. As such, you’re teaching your brain to put the traumatic experience into the context of space and time. So by talking about the trauma, you’re teaching your brain that it’s OK – the trauma happened in the past, and we’re in the present now!

Consolidation and Integration: In this phase, you and your therapist will work on developing the skills and resources you need to move forward with your life. This might include helping you to confront once debilitating triggers (ie. perhaps you were in a car accident and your goal was to get behind the wheel again – this is the phase during which we would start exploring that), or strengthening your coping skills. In this phase, you might also be encouraged to tell your narrative of trauma to loved ones. Recovery is a team effort, and it’s important for you and your support system to be on the same page about what happened to you.

Trauma can wreak absolute havoc on our lives and sometimes it may feel like we’ll never be able to recover the person that we once were. I would like to leave you  by offering a dollop of hope. The research tells us that, with a little guidance and a dash of courage, recovery is absolutely within reach. If you think that you may be suffering from post-traumatic symptoms, may you find the courage to seek a qualified professional and begin your journey of healing!

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