
What happened to you is not your fault.
I hear you. I'm here for you.
I believe you.
These are the key messages I strive to get across when working with trauma survivors. Messages that are often the exact opposite to the messages people will have been told when living through trauma. Messages that show their experiences happened, that their feelings matter, and that they matter.
What is trauma?
Trauma is a psychological response to events that are highly distressing, and outside of a person's control. There is a fear that serious harm or death will occur.
Trauma can occur as the result of a single event, such as a car accident, an assault, a natural disaster or a medical emergency. It can also be the result of ongoing or repeated traumatic experiences, such as child abuse and neglect, bullying, domestic violence, war, sex trafficking, or slavery. Experiences that are prolonged are often referred to as complex trauma.
PTSD - Symptoms and diagnosis
The ICD-11, which is the diagnostic manual used in the UK, states that Post Traumatic Stress Disorder (PTSD) may occur following exposure to a highly threatening or horrific event, witnessing threats, or actual injury or death, of others, and learning about the sudden, unexpected or violent death of a loved one. For a diagnosis of PTSD to be made an individual must have symptoms which include re-experiencing (such as flashbacks and intrusive memories, or nightmares), avoidance and hypervigilance to threat. These symptoms contribute to difficulties in every day activities, such as maintaining relationships, employment or education.
CPTSD - Symptoms and diagnosis
The ICD-11 states that Complex Post Traumatic Stress Disorder (CPTSD) may occur following prolonged or repetitive exposure to threatening events which are difficult or impossible to escape from. For a diagnosis of CPTSD to be made, the individual must meet the diagnostic criteria for PTSD, and must also have symptoms which include severe and pervasive difficulties with emotion regulation (such as emotional outbursts, emotional numbing, dissociation), persistent negative beliefs about the self (that they are worthless, helpless, or feel guilt and shame for how they did or did not behave during the trauma events), and persistent difficulties in relationships. All of these symptoms will have a significant impact on a person's functioning and their quality of life.
Surviving trauma
I frequently work with people with PTSD and CPTSD diagnoses or symptoms. One of the most common beliefs that I work to challenge is the "I should have done something" statement. To begin to challenge this, I often have to teach people how their brain works, and why it is so difficult to ignore this innate response.
During times of stress and trauma, our threat system kicks in. An alarm system goes off in our brain that tells us we are in danger (whether this is a real or imagined danger) and our brain responds. This is an automatic response - our brain is designed to respond as quickly as possible in order to keep us safe. We do not get to stop and choose how we respond - from an evolutionary perspective, stopping and thinking would have increased the likelihood of harm coming to us. An automatic call to action (or to freeze) ensured the greatest chance of us staying alive - and our brain still responds in this way.
Five survival responses are commonly discussed in relation to trauma:
Fight - taking action by moving towards the threat, by challenging and fighting back or disarming the threat;
Flight - taking action by getting out of the situation as quickly as possible, such as running away;
Freeze - "playing dead". Our brain recognises that fighting or running are not safe options for us, so it immobilises us in the hope that the threat will lose interest and go away;
Submit/Appease/Fawn - we may agree to, or go along with, things that we do not want, or do not like, in order to stay safe. For example, agreeing to engage with an abuser may be safer than saying "no";
Dissociate/Flop - if we have no choice but to be present for the situation, our brain may cut off from the experience. This can help to ensure psychological and physical survival (we feel numb, disconnected, like it isn't happening to us, and our pain tolerance is higher).
Again, we do not get to choose how our brain responds to stressful or traumatic events, but we can choose how we respond once the threat has passed.
Trauma recovery
Recovery from trauma is possible. Our brains are natural healers, and some people can have traumatic experiences and go on to recover without any professional interventions. Others may find that they need to develop an understanding of what happened to them, and skills for managing trauma symptoms.
When working with trauma, we use a three-phased approach. Phase 1 includes psychoeducation and trauma stabilisation (increasing your understanding of trauma, and improving your sense of safety). Phase 2 includes reprocessing (not everyone needs to reprocess to heal from trauma). Phase 3 includes reintegrating back into life and the community, to build a life worth living.
In my work with trauma survivors, I focus primarily on Phases 1 and 2, though Phase 3 is integrated throughout and is an important part of the recovery process. After stabilisation, we may discuss reprocessing. This usually takes the form of Eye Movement Desensitisation and Reprocessing (EMDR) or Trauma-Focused CBT (TF-CBT).
Recovery from trauma is possible. It is challenging, and can be destabilising, but it is possible. Please get in touch if you would like to know more about how I can support you to recover from your trauma experiences.
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