Psychological trauma is a type of damage to the psyche which occurs as a result of a sudden, quick traumatic event. When that trauma leads to post traumatic stress disorder, the damage may involve physical changes inside the brain and to brain chemistry, which changes the person’s response to future stress.
A traumatic event involves a single experience, or an enduring or repeating event or events, which completely overwhelms the individual’s ability to cope or integrate the ideas and emotions involved with that experience.
Psychological trauma may accompany physical trauma, or exist independently of it. Typical causes and dangers of psychological trauma are sexual abuse, bullying, domestic violence, indoctrination, being the victim of an alcoholic parent, the threat of either, or the witnessing of either, particularly in childhood. Catastrophic events such as earthquakes and volcanic eruptions, war or other mass violence can also cause psychological trauma. Long-term exposure to situations such as extreme poverty or milder forms of abuse, such as verbal abuse, can be traumatic (though verbal abuse can also potentially be traumatic as a single event).
Changes inside the brain:
Thanks to brain scan technology, scientists can observe the brain in action. These scans reveal that trauma actually changes the structure and function of the brain, at the point where the frontal cortex, the emotional brain (limbic system) and the survival brain converge (brain stem). A significant finding is that brain scans of people with relationship or developmental problems, learning problems and/or social problems related to emotional intelligence reveal similar structural and functional irregularities as is the case resulting from PTSD.
Symptoms of Psychological Trauma:
The emotional and psychological symptoms of psychological trauma are shock, denial, disbelief, anger, irritability, mood swings, guilt, shame, self-blame, feeling sad or hopeless, confusion, difficulty concentrating, anxiety, fear, withdrawing from others and/or feeling disconnected or numb.
The physical symptoms of trauma are insomnia or nightmares, being startled easily, racing heartbeat, aches and pains, fatigue, difficulty concentrating, edginess, agitation and muscle tension.
Re-experiencing the Trauma:
After a traumatic experience, a person may re-experience the trauma both mentally and physically, hence avoiding trauma reminders, also called triggers, as this can be uncomfortable and even painful. They may turn to psychoactive substances, including alcohol, to try to escape the feelings. Re-experiencing symptoms is a sign that the body and mind are actively struggling to cope with the traumatic experience.
Triggers and cues act as reminders of the trauma and can cause anxiety and other associated emotions. Often, the person can be completely unaware of what these triggers are. In many cases this may lead a person suffering from traumatic disorders to engage in disruptive or self-destructive coping mechanisms, often without being fully aware of the nature or causes of their own actions. Panic attacks are an example of a psychosomatic response to such emotional triggers.
Intense feelings of anger may surface frequently, sometimes in very inappropriate or unexpected situations, as danger may always seem to be present, as much as it is actually present and experienced from past events. Upsetting memories such as images, thoughts or flashbacks may haunt the person and nightmares may be frequent. Insomnia may occur, as lurking fears and insecurity keep the person vigilant and on the lookout for danger, both day and night.
The person may not remember what actually happened, whilst emotions experienced during the trauma may be re-experienced without the person understanding why. This can lead to the traumatic events being constantly re-experienced, as if they were happening in the present, thus preventing the subject from gaining perspective on the experience. This can produce a pattern of prolonged periods of acute arousal, punctuated by periods of physical and mental exhaustion.
Emotional exhaustion may lead to distraction and clear thinking may become difficult. Emotional detachment can occur, having dissociation from emotions, leading the person to appear distant or cold.
Responses to psychological trauma:
There are several behavioral responses common to stressors including the proactive, reactive, and passive responses. Proactive responses include attempts to address and correct a stressor before it has a noticeable effect on lifestyle. Reactive responses occur after the stress and possible trauma has occurred and is aimed more at correcting or minimizing the damage of a stressful event. A passive response is often characterized by an emotional numbness or ignorance of a stressor.
Those who are able to be proactive can often overcome stressors and are more likely to be able to cope well with unexpected situations. On the other hand, those who are more reactive will often experience more noticeable effects from an unexpected stressor. In the case of those who are passive, victims of a stressful event are more likely to suffer from long term traumatic effects and often enact no intentional coping actions. These observations may suggest that the level of trauma associated with a victim is related to such independent coping abilities.
The experience and outcomes of psychological trauma can be assessed during a clinical interview. The risk for imminent danger to the self or others is the initial focus of assessment. That is, it is necessary to assess the physical safety of both the individual and others by considering the individual’s physical and mental functioning as well as the immediate environment. In many cases, ensuring the individual’s safety may involve contacting emergency services (e.g. medical, psychiatric, law enforcement, etc.) as well as members of the individual’s social support network.
Before assessing an individual’s psychological symptoms, it is necessary to determine whether or not the individual has returned to a state of psychological stability. If an individual remains in a state of crisis (i.e. overwhelmed with emotion, experiencing cognitive disorganization, etc.), it may not be appropriate or possible to conduct a psychological assessment until intervention has been provided. If deemed appropriate, the assessing clinician may proceed by inquiring about both the traumatic event and the outcomes experienced (e.g. post traumatic symptoms, dissociation, substance abuse, somatic symptoms, psychotic reactions, etc.). Such inquiry occurs within the context of established rapport and is completed in an empathic, sensitive and supportive manner. The clinician may also inquire about possible relational disturbance, such as alertness to interpersonal danger, abandonment issues and the need for self-protection via interpersonal control. Through discussion of interpersonal relationships, the clinician is better able to assess the individual’s ability to enter and sustain a clinical relationship.
Traditional approaches to treating emotional trauma include talk therapies, Cognitive-Behavioral Therapy (CBT) (intentionally changing one’s thoughts and actions) and systematic desensitization to reduce reactivity to a traumatic stressor. These approaches to healing trauma were developed without brain science information and therefore have varying degrees of success. Recent developments in the treatment of emotional trauma include new, effective forms of psychotherapy and somatic (body) therapies which were developed with new brain science information in mind. Although often intensely interpersonal, these therapies are also psychological and neurological in their focus and application. This group of therapies relies on innate instinctual resources, rather than medications, to bring about healing. Although they differ in some ways, the one thing they have in common is combining talk therapy with a focus on the body. As with any therapy, but especially due to the intensity of the emotions involved, it is important to find a therapist with whom one feels trust and a strong bond. Therapies include:
Eye Movement Desensitization/Reprocessing (EMDR):
This was developed by psychologist, Francine Shapiro, after she noticed her own stress reactions diminishing when her eyes swept back and forth as she walked through a park. It is conducted by licensed mental health professionals who have taken specific training in this complex approach. It combines elements of a range of therapeutic approaches with eye movements or other forms of rhythmical stimulation, such as hand taps or sounds. Theories as to why EMDR is effective are still evolving. Some speculate that the rapid unique therapeutic element of EMDR – the eye movements or other rhythmical stimulation – might help the brain access and process traumatic material.
EMDR has been most effective with single-incident trauma, but its uses continue to evolve in addressing longer histories of emotional or physical trauma and in balancing other aspects of a person’s life.
Somatic Psychotherapies: The term somatic, coined by Tomas Hanna, means mind/body or more precisely brain/body. The idea is that to change the body, we have to engage the brain and change the brain – not only how we think and feel, but also the neurological connections themselves. The body, its sensations and direct sensory experience are referenced throughout the therapeutic process. Somatic therapies include:
- Somatic Experiencing: eveloped by Peter Levine, this approach evolved in part from observations of how animals literally ‘shake off’ traumatic experiences, allowing the body to process stress chemicals completely until they return to normal levels. The SE therapist may be a licensed professional or unlicensed but with some mental health training. All SE therapists complete an extensive training program, in which they learn to observe the body, facial expressions and gestures carefully and to help the person ‘thaw’ a response that was ‘frozen’ in a traumatic situation (illustration: the person might be observed to make short gestures, which almost appear to be a ‘pushing’ motion, but that stop abruptly – the therapist might have the person complete the gesture in full and notice how the body’s tension level changes).
- Hakomi Method: originated by Ron Kurtz, this system is based on five therapeutic principles – Mindfulness, Organicity, Non-Violence, the Mind-Body Connection and Unity. It is a body-centered approach for which, in part, the therapist helps the client experiment with small changes in gesture or other movements, to see what differences occur in the processing of emotionally charged content (illustration: the person might be observed to always make a certain gesture or have a certain posture when talking about the attacker – the therapist might suggest the gesture or posture be changed to a different one as an experiment and then to notice the changes in feelings or thoughts).
- Somatic Psychology: Developed by Pat Ogden, this treatment merges somatic therapies, neuroscience, attachment theory and cognitive approaches, as well the Hakomi Method. The approach often uses physical expression to process the energy stored in the body following a trauma, to reset the neurological system into better balance (illustration: the person might be asked to push the attacker away by forcefully pushing against a wall, or against a pillow held by the therapist, to allow the body’s neurological and musculature systems to reset themselves to a more normal level).
- AEDP (Accelerated Experiential Dynamic Psychotherapy): Developed by Diana Fosha, a New York based psychoanalyst, her approach brings the elements of secure attachment into her work with adults. The talk therapy she practices focuses on the mutual exchange of all deeply-seated emotions, bodily awareness and joyous playful exchange.