Trauma, Treatment and Adjunctive Therapies (Episode 1)

“Trauma” is a word used to describe experiences that are so stressful that they are overwhelming. We also use “trauma” to talk about the impacts of events and experiences. In recent times, impacts of Covid, significant natural disasters etc “Trauma” is a word we commonly hear. Perhaps you have been personally affected by trauma in your life.

Sometimes the impacts of a traumatic event or experience occur immediately after it, and resolve over time, but sometimes they can be ongoing and affect us much later in our life, with significant and debilitating effects. This is why professional support can be essential.

Resource: Facebook Page: FearLess PTSD- Australia New Zealand 2022

Post-traumatic stress symptoms and impacts of trauma can affect anyone, emotionally, psychologically, and physically. Trauma can disrupt areas of the brain that help regulate emotion, and assess our environment for threat. Specifically, is thought to disrupt the circuitry between the amygdala/limbic system (responsible for our fight/flight/freeze or survival response) and the prefrontal cortex/executive functioning centre (which helps with memory, rationalising, decision-making, emotional regulation, and impulse control). It can affect how we integrate and experience thoughts, feelings, physical sensations and sensory information in any current moment.

For example, after experiencing trauma, reminders may trigger strong physical reactions, you may feel emotionally disconnected from friends/family, have lost a sense of your body, continue to feel unsafe, feel highly anxious, have to push difficult thoughts and feelings out of your mind as they are too overwhelming. You may believe you are to blame, the world isn’t safe, or you can’t trust others.

Post Traumatic Stress Disorder (PTSD) – is a set of clinically significant symptoms that result after experiencing or witnessing a single incident trauma or specific event. Once upon a time, PTSD was viewed as relating only to life threatening events. Now we know PTSD can involve exposure to actual or threatened death, serious injury, or trauma such as sexual violence, through directly experiencing it, or even witnessing it happening to others.

It may develop from learning about the violent or accidental death of a friend or family member, through repeated exposure to traumatic events as a front-line responder, or whilst working with people affected by trauma, called Vicarious traumatisation.

PTSD effects 1-2% of Australians each year, while 12% experience it in their lifetime. With Covid and bushfires and other natural disasters in the past two years, it is predicted prevalence rates will increase.

Complex PTSD (C-PTSD) – is a recently recognised type of trauma condition, and results from repeated, ongoing, and often extreme interpersonal trauma (between people). It may involve abuse, violence, neglect or exploitation over a period of time, as a child, young person or adult. It often involves a situation a person could not escape from. According to the Blue Knot Foundation, complex trauma from childhood events affects 1 in 4 Australians.

Some examples include domestic and family violence, developmental or childhood trauma e.g. abuse, neglect, violence, poor attachment, or loss of a caregiver. Complex trauma occurs in refugee populations from the impacts of war and relocation. Intergenerational trauma can also occur, as experienced by our First Nations people. Some groups are more at risk of trauma e.g. people who identify as LGBTQIA+ and people with a disability.

Trauma can cause more ongoing serious mental health issues if it happened repeatedly or is not treated. The good news it is possible to recover from single incident trauma and complex trauma. Sometimes people even experience “post-traumatic growth” where they find some positive outcome occurs due to their experience, through approaching life differently, developing some meaningful role, or leading some community initiative.

As a therapist, I find many people who come for treatment have experienced multiple traumas- this might include developmental or complex trauma earlier in life, and then further trauma as adults. Their reason for coming to therapy may relate to some other issue but we identify trauma has played a part. All of Nurturing Minds practitioners operate from a trauma informed approach, and ensuring a safe and supportive environment is paramount.

How is PTSD and C-PTSD experienced?

PTSD and C-PTSD include a range of symptoms related to Hyperarousal, Re-experiencing, Changes to Cognition/Mood, and Numbing/Avoidance. (DSMIV)

Hyper-Arousal:

Being hyper-alert

the brain scanning for possible threat

high startle reflex

flight/flight/freeze system easily activated

Hypersensitive to sensory material in environment e.g. sounds, smells, visual cues

Difficulty thinking straight- racing thoughts, fear-based thoughts, risk assessing, ruminations

Heart racing, breathing more rapidly or over breathing

Sweating, nausea and other somatic symptoms including gut disturbance

Sleep disruption e.g., initial or middle insomnia

Irritability or anger outbursts or acting aggressively

Re-experiencing:

Recurrent involuntary and distressing memories of the event

Recurrent distressing nightmares or disturbing dreams related to the event

Sudden unwanted thoughts, feelings from the past, which can cause a person to feel as if the trauma is happening in the present.

Suddenly acting as if the stressful experience is actually happening again- Flashbacks can be so vivid a person believes they are there again

Feeling upset when reminded of the event

Strong physical reactions to something that reminds you of the event

Changes in thoughts and mood:

Strong negative beliefs about yourself, other people or the world

Difficult thoughts such as “I am bad’ “There is something wrong with me” “No one can be trusted” “The world is completely dangerous”

Blaming self or others

Having strong negative feelings such as fear, guilt, anger, shame.

Trouble remembering important aspects of the experience

Taking too many risks or doing things that cause you harm

Numbing/Avoidance

Feeling numb

Loss of interest in activities you used to enjoy

Feeling distant or cut off from people

Trouble experiencing positive feelings

Avoiding memories, thoughts feelings of the stressful experience

Avoiding external reminders of the event or specific triggers of trauma related emotions (people, places, conversations, activities, objects, or situations)

Dissociative reactions- spacing out, feeling detached or separate from reality. This is a human defence mechanism to manage/cope with overwhelming feelings.

People can have a range of these symptoms, but not necessarily fill all the criteria for a PTSD or C-PTSD diagnosis. This does not mean that trauma has not had impacts. Some never develop PTSD but have other mental health issues, that greatly affect their lives like:

Depression or anger issues, anxiety problems and/or panic

Attempts to regulate or numb difficult thoughts and feelings through substance use, self-harming, disordered eating, gambling and other addictions.

Overusing activities that give relief or distraction (e.g., work, exercise) causing other problems

Physical issues such as chronic gut disturbance (GIT disorders), chronic pain, sleep issues

Difficulty managing relationships and trusting others, finding it hard to keep close relationships

Recovery and what can help?

One way of viewing trauma recovery, is to accept all of us are vulnerable to develop trauma symptoms, but the level of impact can be different, and the time taken to recover differs from person to person.

After a single incident trauma, for example, a car accident during a severe weather event, a person may experience heightened anxiety, distressing memories and thoughts about it, trouble sleeping, nightmares, hypervigilance, fear about being in a car, being triggered during wet weather etc. This occurs for several weeks or a few months following the event. Generally, this allows time to process what happened, talk about it to supports, and hopefully be able return to the same activities again. When a person’s symptoms become ongoing and more severe, and they attempt to avoid them, PTSD can develop. People who have Complex PTSD may have had trauma symptoms for many years, and have learnt to manage them the best they can. Sometimes current stressors, can lower our coping resources, and see an increase in symptoms that once had seemed well managed.

What increases risk of developing trauma related disorders: previous trauma or mental health conditions, genetics, support systems or coping resources at the time, whether we had choice or ability to get ourselves safe, how intense, shocking or impactful the experience was, and how the event was dealt with or treated by others.

In a future blog, I will talk more about approaches to treat trauma related problems, and what other adjunctive approaches may help. Everyone is different, and finding the right fit for you, can take some time. There are some helpful Apps and Online PTSD programs (see below), and all of Nurturing Minds Psychologists offer a variety of evidence-based approaches to treat trauma. In the future Nurturing Minds plans to trial other adjunctive treatments including Mindfulness Groups and Trauma Sensitive Yoga, watch this space!

To be continued…

APPS:

PTSD Coach Australia (suitable for serving and ex-serving ADF personnel and their families)

High Res App (Open Arms)

Mindfulness Apps:

Headspace

Smiling Minds

Insight Timer

Calm

Resources and Supports:

Blue Knot Helpline 1300 657 380 https://blueknot.org.au/resources/

MindSpot PTSD Online Course https://www.mindspot.org.au/course/ptsd/