What is Trauma?
Trauma, in the medical field, refers to any injury to any part of the body. In the field of psychology, trauma can similarly be understood as any injury to the emotional well-being of an individual. Using this broad definition, we must remember that there are varying degrees of trauma, both physical and psychological.
A cut on the finger or a bruise on the knee is, technically speaking, a trauma to that body part, but it probably doesn’t require extensive emergency care. Consistent with that example, a person may experience a disappointment, have a frightening experience, or feel worried about something without needing extensive intervention to restore them to emotional balance. However, since physical traumas are visible, they tend to receive more care and attention than psychological traumas, which are intangible, invisible, and poorly understood.
In psychological trauma, there are two main classifications of trauma. The first is classic trauma, meaning that it fits the diagnostic criteria for a traumatic incident as defined in the DSM-IV (Diagnostic and Statistical Manual). Specifically, it states that a traumatic incident results from
…exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate.
So, in other words, classic trauma is where you or someone else suffers a serious physical injury, or almost does. This seems like a fairly narrow definition when it comes to the many forms of psychological trauma. In recognition of this limitation, scientists have been studying trauma in great depth and have formulated a theory explaining the second type of trauma: complex trauma
Complex trauma is when many smaller traumatic incidents occur over a period of time, creating a pattern of seeing the world through a filter of stress and fear. For example, verbal abuse or bullying may not result in an actual physical injury and a single incident may not have lasting effects (although it is possible) but a repeated pattern of abuse can dramatically alter an individual’s sense of safety in the world.
On another level, interpersonal trauma does in fact lead to physical changes within the victim, though these are often not visible to the naked eye. Each experience we have modifies the structure and function of the brain. So, if there is a repeated pattern of verbal or emotional abuse, the brain would adapt to that experience to be able to cope with it (though not necessarily in a healthy way). This adaptation is often a short-term solution that leads to long-term damage. In other words, the complex trauma has caused a maladaptive physical change within the victim of the trauma.
What is Trauma Therapy?
How do I know if I need trauma therapy?
Simply put, if you are wondering if you need trauma therapy, would probably benefit from trauma therapy. If you are troubled by fears that you feel are irrational, have a difficult time controlling your emotions and managing your relationships with other people, if there are big blank spots in your memory, if you are troubled by nightmares and phobias, or if you are a fan of Lady Gaga, you probably need trauma therapy.
How does trauma therapy work?
This is the fun part, understanding the biology of trauma therapy. Basically, when we have an experience, our brain splits the experience into its various elements and distributes those elements throughout the brain. In a very small nutshell, the story of the experience, the sensory information and narrative of what happened, is processed and stored in the left hemisphere of the brain. The emotional and affective (physical) information and perception of the experience is stored in the right hemisphere of the brain.
The left side of the brain also contains our verbal centre, the home of producing and understanding language. In order for us to be conscious of something, it needs to travel to the left hemisphere and connect with the verbal centre. In traumatic experiences, the brain seeks to protect us against feeling the negative emotional impact of those experiences and so it sets up a biochemical wall between the hemispheres of the brain. This prevents the emotional information from entering our consciousness and causing us to re-experience the traumatic event.
On the surface, this seems like a wonderful adaptation by the brain but the long-term consequence is costly. While the brain is able to screen out the emotional pain in some circumstances, it allows leakage from the right hemisphere to the left either when it is caught off guard or when it is tired, or when it is triggered by environmental elements that resemble the initial event.
The effect is that we experience panic, anxiety, fear, and behavior that seems beyond our control and we don’t seem to be able to explain it. This leads to the cycle of worrying about worrying, or being afraid of being afraid. This is where trauma therapy is useful.
The purpose of trauma therapy, no matter what modality is used (as discussed below), is to reconnect the narrative with the emotion. With Post-Traumatic Stress Disorder (PTSD), one of the common symptoms is the presence of what are often referred to as flashbacks. Flashbacks are often dramatically portrayed in the popular media as visual hallucinations of the initial event. While this is certainly possible, it is not the most common form of flashback. Typically, we experience what I refer to as emotional hallucinations. In other words, elements of our current experience trigger emotional memories from our painful past. These painful emotions surface and we then attach them to our current experience instead of the past experience to which they actually belong.
For example, if you were constantly verbally abused by parents and school teachers for your inability to sit still, listen, concentrate, be organized, follow instructions etc., there would be a lot of painful emotion associated with the experience of being criticism. Fast forward 20 years and you have submitted a proposal at work which is reviewed by your boss. Just presenting the proposal may be enough to trigger fears of rejection and failure but when the boss begins to point out errors or inadequacies in the proposal, the brain reacts by triggering the fight or flight response, which shows up as extreme shame, embarrassment, despair, or aggressive defensiveness. What is actually happening is that the brain is not simply reminded of the past painful experiences, it is reliving them.
Trauma therapy seeks to attach those painful emotions to the experiences to which they actually belong. By doing this, we free ourselves to experience the present as a moment in and of itself, not a replay of the past.
What are My Options for Trauma Therapy?
Trauma therapy can range from basic talk therapy, discussing what has happened and what impact it has had on your life, to much more dramatic and invasive techniques. In keeping with the analogy of physical trauma, we may opt for a light massage or we may see that surgery is required.
Cognitive Behavioral Therapy has a well-established track record of treating many conditions, though the traditional approach falls short in my opinion. This involves examining the events, discussing the feelings and thoughts that have arisen as a result of those events, and then coming up with alternative ideas and beliefs.
Strictly behavioral approaches include exposure therapy, systematic desentization, flooding, prolonged exposure therapy, and other methods designed to extinguish the conditioned fear response.
Eye movement Desensitization and Retraining (EMDR) is a controversial method designed to encourage communication between the hemispheres on a sensory level and then using this improved connection to access memories and emotions that have been locked away.
Hypnosis is also a controversial approach as there is some question as to the accuracy of “memories” that may be uncovered through this process. Lots of research has been conducted in this area and many legal cases have arisen due to allegations stemming from such approaches.
A more subtle approach is relational therapy, which seeks to build the client’s ability to navigate personal relationships and find safety with other people by developing a trusting and safe relationship with the therapist. The therapist then assists the client in seeking safety with others outside the therapeutic relationship.
This approach may not require dramatic unveilings of memories or the vivid reliving of painful events but seeks to build the clients emotional resources, allowing the proper development of emotional regulation within the client’s brain. Louis Cozolino’s amazing book, “The Neuroscience of Psychotherapy”, although quite technical, is a great explanation of how this process works.