T/W. Talk of trauma – please read with care.
A traumatic event is an emotional shock: we feel intensely afraid & unsafe. We don’t need to do battle in war to experience it. We know adverse childhood experiences (ACES) such as physical, sexual & emotional abuse, neglect, exposure to domestic violence, and social inequalities including poverty & feeling ‘othered’ (for eg in terms of race, gender or sexuality) can lead to developing trauma symptoms.
Trauma is a broad, rich topic – it can’t be summarised neatly here. In this post I’ll cover some basic points about what trauma is & the impact on our brains & bodies. Remember, most people experience trauma symptoms after a traumatic event. These typically resolve through helpful ways of coping, talking with others & creating some meaning around it.
But for some, symptoms of post-traumatic stress disorder (PTSD) persist, including:
· Re-experiencing of the trauma (eg flashbacks or nightmares)
· Avoidance of any traumatic reminders
· Hyperarousal (feeling constantly on alert, jumpy, easily startled). Certain triggers (a particular smell or tone of voice) may remind you of the trauma, provoking an automatic fear reaction, making you feel as if you’re reliving the event (even when you’re in relative safety)
· Impact on mood (eg feeling worthless, defeated or full of self-blame)
The question is not ‘What is wrong with you?’ but ‘What has happened to you?’
Research shows that the more ACES a person experiences, the more likely they are to experience trauma symptoms. It’s important to understand that different people respond differently to trauma - PTSD is just one diagnostic definition. We can think of many mental health difficulties such as anxiety, depression & psychosis as understandable responses to trauma.
Depending on the nature of the trauma (perhaps feeling total helplessness, skin/body penetration), a survivor’s response will be intense fear – ranging from sympathetic arousal (flight-flight) to parasympathetic arousal (“shut down” reactions eg feeling “frozen with fear”, disassociation).
Repeated trauma forms a fear network in our brain. Due to high activation in the amygdala (the fear centre), traumatic memories aren’t processed & integrated in the hippocampus as non-traumatic memories are. This means trauma memories aren’t date & time stamped – they lack a narrative, a coherent story. This is why after the event survivors become “stuck in the trauma” - experiencing ‘intrusions’ (‘hot’ spots of their trauma) as sensory & emotional fragments: vivid images, sounds, physical sensations.
I use the linen cupboard analogy to understand trauma memories. Imagine a linen cupboard, in which all the neatly folded sheets represent non-traumatic memories. You can pull them out when you want to, then ‘file’ them away in their proper place. The trauma memories are like a big fluffy duvet stored in the cupboard covered with thorns. This duvet keeps popping out when you don’t want it to, pricking you with its spiky thorns (like the highly emotional, sensory-based intrusions). Understandably, you want to stuff this duvet back in again as fast as possible (in the way we want to avoid those memories & reminders). So we can think of trauma-focused therapy as learning to pull out those thorns from the big duvet – it’s still there, we can’t get rid of it –yet we can become less scared when we remember those difficult memories. They become less ‘hot’.
Eye Movement Desensitisation & Reprocessing
The foundation of EMDR theory is that we all have the natural ability to heal, which is disrupted following trauma. It’s thought that in REM (rapid eye movement) sleep, our brain integrates emotionally powerful information from our experiences, which gives our memories a coherent story. EMDR simulates this natural healing process, using bi-lateral stimulation to process & integrate trauma memories. Focusing on those memories while making side-to-side eye movements or right-left hand taps allows for free associative processing. This helps to put the trauma memories in a larger context, creating new meaning around the event & a coherent ‘story’ - so it feels less overwhelming & upsetting. This moves the client from feeling defined by their trauma to a sense of ‘wholeness’.
Help-seeking info:
If difficult thoughts & feelings are getting in the way of enjoying everyday life, I recommend talking to a supportive loved one as a first step and a trusted health professional such as your GP.
For emergency support (for example, if you have an overwhelming sense of wanting to hurt yourself)
· Call 999 or visit your nearest hospital A&E department
· Contact your GP out of hours service
· Contact your local crisis team ; https://www.nhs.uk/service-search/mental-health/find-an-urgent-mental-health-helpline
Call the Samaritans 24/7 helpline on 116 123.
If you have the funds & want to access private therapy, you could start with the BACP, BPS or the UK Council for Psychotherapy. I would always recommend speaking with a therapist on the phone for a brief consultation to discuss your concerns and hopes for therapy. This will help to give you a sense of the therapist - if you think they’re someone you can build an empathic, trusting relationship with.
I offer 1:1 online therapy and run a 6-week maternal anger course for mothers via Zoom. If you’d like to receive dates of my next anger course, please sign up to my mail out (scroll to bottom of home page to register) or email me at drcarolineboyd@gmail.com
For exploring past traumatic experiences, it can be helpful to focus your search around therapists with experience in approaches such as Compassion Focused Therapy, Schema, Narrative Therapy & Psychodynamic therapy.
www.bacp.co.uk/search/Therapists
https://www.bps.org.uk/public/find-psychologist
https://www.psychotherapy.org.uk/find-a-therapist/?Distance=10
For an EMDR accredited therapist: https://emdrassociation.org.uk/find-a-therapist/
Trauma refs & resources
In my IG Live with Nicole @nicolesneuroscience, we discuss the basics of trauma (what trauma is, common reactions to traumatic events & where to start if you want to seek professional help).
Key refs:
Schauer & Elbert (2010). Disassociation for traumatic stress.
Van der Kolk – The Body Keeps the Score
Brewin (2001). A cognitive neuroscience account of posttraumatic stress disorder and its treatment
Attachment Focused EMDR – Laurel Parnell
UKPTS (UK Psychological Trauma Society) Guidelines on complex PTSD. This includes a lot about complex trauma & cites some of the theories I speak about in more detail:
https://ukpts.org/2020/02/14/cptsd-guideline/
This brilliant website offers lots of accessible info on trauma informed approaches to mental healthcare - including a super helpful Stabilisation Manual with tools on self-soothing & practising mindfulness and self-compassion. It is co-authored by my lovely friend, Dr Faye Nikopaschos, who works in a trauma-informed team in NW London:
https://www.cnwl.nhs.uk/services/mental-health-services/cnwl-trauma-informed-approaches-tia
NICE guidelines for PTSD:
https://www.nice.org.uk/guidance/ng116/chapter/recommendations
Book: The Compassionate Mind Guide to Recovering from Trauma & PTSD using Compassion Focused Therapy by Deborah Lee & Sophie James
The Body Remembers - Babette Rothschild
Reinventing Your Life - Jeffrey Young
