Dr. Angela Hanford
We are inundated with images of war, terrorism, murder, and rape and we see the impact that it has on individuals, families, and society. As you probably already realize, trauma is fairly common. In fact, in a survey conducted by the World Health Organization (WHO), 70.4% of those who responded to the survey reported trauma at some point in their lifetime (Kesseler, et al., 2017).With the trauma that is so evident throughout the world, the term Post Traumatic Stress Disorder (PTSD) is most likely familiar. However, not everyone who experiences trauma develops PTSD.
It has been estimated that 3.5% of adults in the United States are diagnosed with PTSD in a given year, with higher rates occurring in professions that have a higher risk of exposure to trauma (e.g., military or police officer) (APA, 2013).
What is Post Traumatic Stress Disorder?
Post Traumatic Stress Disorder, or PTSD, is defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (American Psychiatric Association, 2013). PTSD may develop after someone has either experienced or was threatened with an injury that is serious (including death) or sexual trauma.
These events can be either: experienced, witnessed, learning of someone who is close to you experiencing trauma (e.g., family member), or having repeated exposure to details of traumatic events (e.g., first responders). For PTSD to be diagnosed when the trauma is experienced through repeated exposure to the event, this must not simply be through television or other forms of media unless it is in the function of your job.
Symptoms vary from person to person, but can include (APA, 2013):
- Experiencing intrusive and troubling memories or dreams of the trauma that cause significant distress. For children six years and younger, the DSM 5 authors specify that, rather than talking about memories specifically, themes of trauma may be present in play. Furthermore, this age-group might have terrifying dreams that may not seem directly related to the trauma.
- Flashbacks or other experiences that the trauma is occurring again. This trauma reenactment may be present in the play of children.
- Emotions or physical reactions may be triggered by an internal feeling or external trigger.
- There will be some type of avoidance of trauma associations. For example, there may be an attempt to avoid reminders of the trauma, which could be external (e.g., people or situations), memories, or other associations to the trauma (e.g., feelings).
- Difficulty remembering what happened (this is not induced by physical injury or substance).
- Extreme and negative beliefs may develop about people, including oneself, and the world, such as the never being safe again or being “bad”.
- Developing incorrect and troubling beliefs about what caused the trauma to occur, such as blaming oneself.
- Constantly feeling strong negative emotions, such as intense fear, shame. or anger. The individual may also have difficulty experiencing positive feelings. Intense mood swings, reactivity, or even aggression can occur.
- Loss of interest in activities
- Feeling detached or like the world or oneself is not real
- Engaging in reckless behavior or self-destructive behavior, such as excessive substance use or injuring oneself. Suicidal thinking may also be present.
- Becoming hyper-alert for danger and/or easily startled
- Problems with sleep, which can also be related to nightmares or not feeing safe.
- Concentration difficulties
Symptoms of PTSD may begin suddenly or take months or years to develop, but typically being within three months of the traumatic event (APA, 2013).
Other Diagnoses and Reactions Besides PTSD
As previously mentioned, not all people who experience trauma are diagnosed with PTSD or even develop significant distress. Some people may develop acute stress disorder, which has similar symptoms as PTSD but remits within a month (APA, 2013).
Other diagnoses are also possible after trauma. For example, one set of researchers found that the survivors of childhood abuse in their sample were most commonly diagnosed with separation anxiety disorder, oppositional defiant disorder, phobic disorders, PTSD, and attention-deficit/hyperactivity disorder (Ackerman, Newton, McPherson, Jones, & Dykman, 1998).
Bessel Van der kolk (2005) indicated that early childhood trauma may result in problems with regulating emotions and disruptions in the attachment system. As you can see, the potential diagnoses or emotional consequences of trauma can be diverse.
Coping with Trauma
The first thing to remember is that you need to give yourself time and space to heal. There are strategies that you can use to help in the healing process. One such strategy is to examine the “three pillars” that need attention in individuals who have experienced trauma (Bath, 2008). These pillars include:
- Safety: It is important to develop a safe place for someone who has experienced trauma. This could include physical safety, along with a safe environment where the individual can express his or her emotions and process the trauma. Examples of safety for a child who has been traumatized is to ensure that there is consistency in his or her life (Bath, 2008).
- Connections: Having safe and close relationships with people is important to help promote healing. Conversely, isolation can lead to loneliness and depression. Furthermore, part of healing involves talking about what happened, including the thoughts and feelings associated with the event/(s). It should be noted that talking about a trauma needs to be done at the individual’s own pace and without coercion.
- Managing Emotion: It is helpful to learn tools to manage emotional reactions that can result from trauma. Examples of tools for coping with emotions include:
- Relaxation Exercises: Being in a state of constant alertness or emotional arousal can result in prolonged exposure to high cortisol levels. Chronically elevated cortisol has been shown to have a negative impact on the body. Examples of relaxation exercises include some stretching with paced breathing, progressive muscle relaxation, and yoga.
- Breathing Techniques: There are various types of breathing exercises and a variety of apps that will take you through breathing exercises. Find something that works for you.
- Mindfulness: This practice can help you to develop that ability to be in control of your thoughts and to be present in the moment. There are many websites and apps that can provide mindfulness exercises.
- Engage in a healthy lifestyle:
- Adequate sleep
- Healthy eating
- Avoid coping through the use of alcohol or other substances. These substances can lead to negative moods (e.g., depression) and interfere with processing the trauma in a healthy manner.
- Physical activity (with your doctor’s consent), such as running, walking, or a dance class. The physical activity should be something that you enjoy.
- Journaling: This practice can help you to have a safe place to process the trauma and to express your emotions. It can also be a way to help track your mood and notice patters and triggers for emotions and behaviors.
- Art: Art can be a powerful way to express emotions.
- Managing everyday stress: Ask for help, take time off from work if you need the space, schedule activities, set attainable goals.
- Grounding: If you feel panicked or feel out of touch with your surroundings or yourself, there are ways to promote feeling present and grounded. For example, feel the sensation of your feet on the ground, look around and name objects, count the number of pictures in the room, say your name and location. You can also do math problems as a way to try to refocus on the present.
- Learn your emotional triggers and prepare yourself for when you encounter the triggering scenario.
Ultimately, it is important to remember that the journey of healing is just that – a journey. There are ups and downs. There will be times where it seems like you are going backwards. This is normal. Each “setback” is actually an opportunity for growth and is not, in fact, a setback but a new layer of healing.
Treatment for PTSD
Not everyone who experiences trauma needs professional help. However, if you feel overwhelmed, that your trauma symptoms are interfering with life, or if suicidal and/or homicidal feelings are present it is important to seek professional help.
A mental health professional will work with you to determine a diagnosis and the appropriate treatment approach. Treatment may include individual, group, family, and/or couples psychotherapy. You may also be referred to a medical doctor of a medical evaluation.
There are effective treatments for PTSD and other trauma reactions. Two such therapeutic approaches are Eye Movement Desensitization and Reprocessing and trauma-focused cognitive behavioral therapy.
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR has been empirically validated as a treatment for PTSD. The theory behind EMDR is that memories are not always processed adaptively and are then stored in an unprocessed, non-adaptive, state (Francine Shapiro, 2012). This lack of adaptive processing could be due to the stress surrounding the trauma, being young and not having the resources to process the traumatic event or other situation that prevents processing.These memories are then stored in an unprocessed state with all of the associated thoughts, feelings, images, and body sensations. Research (see the EMDR Research Foundation) has shown that bilateral stimulation (e.g., left to right eye movements or alternating taps), along with the standard EMDR protocol, allows the memories to become “unstuck” and effectively processed into an adaptive memory.
There are also recent events protocols for EMDR. These protocols are used when the trauma is recent (e.g., a day or a few months). Research is showing that these protocols can actually help prevent the onset of PTSD symptoms (see EMDR Research Foundation).
Trauma-Focused Cognitive-Behavior Therapy (TF-CBT)
TF-CBT aims at helping an individual who has been traumatized to process the thoughts and feelings associated with the trauma. Some of the components of TF-CBT include emotion regulation tools, relaxation training, processing the thoughts associated with the trauma, and developing a narrative of the traumatic event.
The bottom line is that PTSD is treatable. We are here to help you move through the consequences of trauma into healing and growth.
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (2014) – Bessel van der Kolk
Mindfulness (mindful.org) – https://www.mindful.org/what-is-mindfulness/
National Institute of Mental Health (NIMH), PTSD – https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
Crisis Clinic of King County: 1-866-427-4747 or 206-461-3222) – 24 hour, confidential, free
National Suicide Prevention Lifeline – 1-800-273-8255 – 24 hour, confidential, free
Ackerman, P. T., Newton, J. E. O., McPherson, W. B., Jones, J. G., & Dykman, R. A. (1998). Prevalence of post traumatic stress disorder and other psychiatric diagnoses in three groups of abused children (sexual, physical, and both). Child Abuse & Neglect, 22(8), 759-774.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Bath, H. (2008). The three pillars of trauma-informed care. Reclaiming Children nd Youth, 17(3), 17-21.
Kessler, R.C., Aguliar-Gaxiola, S., Aloso, J., Benjet, C., Bromet, E.J., & Cardoso, G., et al. On behalf of the WHO World Mental Health Survey Collaborators, K.C. (2017). Trauma and PTSD in the WHO world health surveys. European Journal of Psychotraumatology. 8(sup5), 1353383.
Shapiro, F. (2012). Getting past your past: Take control of your life with self-help techniques from EMDR therapy. New York: Rodale Books.
van der Kolk, B. (2005). Developmental Trauma Disorder: Towards a rational diagnosis fro children with complex trauma histories. Psychiatric Annals, 33 (5)! 401-408.
“Tears”, Courtesy of Luis Galvez, Unsplash.com, CC0 License; “Crocus”, Courtesy of Aaron Burden, Unsplash.com, CC0 License; “Sunset”, Courtesy of Artem Sapegin, Unsplash.com, CC0 License; “Journaling”, Courtesy of Hannah Olinger, Unsplash.com, CC0 License