Trauma. We all know the word; it’s been the hot topic since Bessel van Der Kolk released The Body Keeps the Score. We see posts on Instagram and Tik Tok, explaining concepts like “trauma responses” and “triggers”, but I worry that the word is getting watered down and overused without a real understanding of what trauma actually is. I also anticipate that with the overturning of Roe v. Wade, many individuals will be feeling an uptick in symptoms. I’d like to provide you with some information that might be useful to you. Welcome to Trauma 102.
In Trauma 101, I covered what psychological trauma is, but let’s have a little refresher. Psychological trauma is an extremely stressful event(s) that overwhelms an individual’s existing coping mechanisms. 70% of adults have experienced a trauma at one point in their lives; 3.5% of the U.S. population (or 7.7 million Americans) meet the criteria for Post-Traumatic Stress Disorder, or PTSD. Of those cases, 37% of those are categorized as severe. Women are twice as more likely to develop PTSD, experience a long duration of symptoms, and display more sensitivity to stimuli. However, these results may be skewed by under-reporting of men. There is a lack of information on the rates of PTSD in non-binary and trans people.
To meet the criteria for PTSD, according to the DSM-5, see below.
Criterion A (one required): The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):
Witnessing the trauma
Learning that a relative or close friend was exposed to a trauma
Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)
Criterion B (one required): The traumatic event is persistently re-experienced, in the following way(s):
Emotional distress after exposure to traumatic reminders
Physical reactivity after exposure to traumatic reminders
Criterion C (one required): Avoidance of trauma-related stimuli after the trauma, in the following way(s):
Trauma-related thoughts or feelings
Criterion D (two required): Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):
Inability to recall key features of the trauma
Overly negative thoughts and assumptions about oneself or the world
Exaggerated blame of self or others for causing the trauma
Decreased interest in activities
Difficulty experiencing positive affect
Criterion E (two required): Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):
Irritability or aggression
Risky or destructive behavior
Heightened startle reaction
What I tell clients is that even if you don’t meet the precise criteria for PTSD, as the diagnoses of the DSM-5 are rigid and made by old white men, it does not mean you have not experienced trauma and are not struggling with PTSD. In my opinion, all diagnoses are on a scale. It is where on that scale you lie that is crucial to understand.
Other symptoms not listed in the DSM-5 criteria include numbing, dissociation, hyperarousal, limited range in mobility, headaches, digestive concerns, chronic illness, unspecified pain, changes in sexual interest, difficulty trusting self, difficulty trusting others, appetite disturbances. This is not an exhaustive list.
So what happens during a trauma?
When we experience a trauma, the amygdala, a structure in the brain responsible for detecting threats is activated. It responds by sending out an alarm to multiple body systems to prepare for defense. The sympathetic nervous system jumps is activated and releases adrenaline and noradrenaline that prepare the body for a fight-flight-freeze-fawn response. Essentially, the higher developed "smart mind" shuts off, and the limbic system, or "lizard brain" is in control and is solely responsible for keeping us alive. With higher functioning down, memories cannot be processed properly. This is why traumatic memories are often fragmented and sensory instead of narrative. When the threat proves to be too much to handle, the nervous system may become overwhelmed and malfunction. Parasympathetic nervous system malfunctions, leaving the sympathetic nervous system aroused. If the nervous system does not calm down, it can lead to manifestations of depression, anxiety, and physiological complaints. If the response is thwarted and the response is not completed, the energy gets stored in the body as trauma. Dr. Peter Levine argues that traumatic symptoms are not caused by the event itself, but by the frozen energy residue that did not get to be discharged. Like popular trauma expert Bessel van der Kolk states "the body keeps the score."
Unfortunately, those who suffer from trauma are likely to be disconnected from their bodies. While their body may be keeping the score, they don’t feel safe enough to address it. Similarly, they may not feel safe enough to talk about it. My favorite quote on trauma exemplifies this. “The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma”-Judith Herman, Trauma and Recovery. What happens for trauma survivors is a constant push-pull dynamic of “this never happened” and “please let me tell you.” The body essentially does the same thing. It numbs, it dissociates, it avoids, all while being in pain and dysfunction, desperate to get your attention.
There are currently many avenues to treat trauma. There is traditional talk therapy, Prolonged Exposure Therapy, Somatic Experiencing, Sensorimotor Processing, EMDR, and medicine-assisted therapies like Ketamine Assisted Therapy and other psychedelic assisted therapies. While this pains me to say as a psychodynamic (talk) therapist, insight-oriented therapies are not the most beneficial in healing trauma. Insight-oriented therapy will help trauma survivors learn to understand their reactions, and can learn to make behavioral changes based on the understanding, but to truly heal active trauma symptoms, you need to get into the body. More on that in one second. I will say, that I find relational psychotherapy to be profoundly helpful in learning how to be in relationship with others and with self after a relational (with another person) trauma. If the trauma was in the context of a relationship, we need to heal within the context of a relationship. But back to the body. If you are experiencing active trauma symptoms like the ones listed above, it is imperative that you work with a practitioner who can help you heal the nervous system. Bessel van Der Kolk in The Body Keeps the Score suggests using the body to express the sensations associated with the memories of the event will help people overcome their traumas. Peter Levine, the creator of Somatic Experiencing, believes that the trauma is not caused by the event itself, but by the frozen residue of energy not expressed during the trauma. Think of animals in the wild. After a trauma, they shake. It expels the residue, and then they can proceed forward. Humans don’t do that. We think we should be above that. But we are not. In order to heal, the body needs to expel this residual energy and learn that the danger has passed. This restorative reaction appears to be a prerequisite for processing traumatic stimuli with hopes of reestablishing stabilization. The body has a language of its own: visceral sensation, rhythm, movement, gesture, arousal states, facial expression, tension, breath, physical symptoms. It speaks what the mind cannot. We have to work with the body’s language in addition to the mind to fully heal. Bruce Perry, another leading trauma expert, believes that patterned, repetitive, rhythmic somatosensory activity is the key to healing trauma. He argues the body needs to be regulated through rhythm before cognitive or emotional effects can be addressed. Activities like dancing, drumming, singing, yoga, etc are ways to get regulated through rhythm. In a study by the National Institute of Health and the Trauma Center at JRI, results showed that ten weeks of yoga practice markedly reduced the PTSD symptoms of patients who had failed to respond to any medication or to any other treatment. The proof is in the pudding…or the yoga.
There are many ways to help regulate your nervous system outside of the therapy room. My favorite, and most simple, is breathing. There are many ways to breathe, and many of us don’t breathe well, but my favorite is focusing on making your exhale longer than your inhale. That’s it. This simple trick is proven to shift your nervous system back to a more regulated state. As you become more comfortable with the breathing technique, focus on pushing breathe out with a little force. There’s also a self-regulation hug. Put your right hand under your left armpit and cross your left arm over it to your right side, mimicking a hug. This will mimic the coregulation that happens in a hug. Another one includes crossing your hands over your chest, so one hand is on the opposite breast bone, and tapping back and forth in a rhythmic fashion. This bilateral rhythmic tapping is also shown to help regulate the nervous system.
To conclude: my suggestion is, if you are in an active trauma state, work with someone who is trained in modalities specifically for trauma-EMDR, Sensorimotor Processing, Somatic Experiencing, or psychedelic-assisted therapy, which will help to regulate your nervous system. Then, when the symptoms are settled, move into a more insight-oriented therapy to help you understand and make behavioral changes to help stay out of a trauma state. Be wary of any quick fixes. As Robert Frost stated “the best way out is through.”
Please get in contact with me if you have any questions or are interested in working together.