Treatment for Trauma
Trauma: What's in a name?
The topic of trauma has become a hot menu item in public discourse in recent years. Almost every talking head in public media seems to use this term in one capacity or another, without truly defining it. The common usage of the word ranges from “I was traumatized when she rejected me” to “I was raped and it was traumatic.” While language use is inherently individualistic and dependent on the speaker’s lived experiences, psychologists use the term in very specific ways.
The American Psychiatric Association’s (APA) Diagnostic and Statistical Manual (DSM-5), which houses all the known psychiatric disorders and its commonly occurring symptoms, requires exposure to an “actual or threatened death, serious injury, or sexual violence” in order to use the term ‘trauma’ (p. 271). Trauma is further limited to use in instances where there is direct personal exposure, witnessing of trauma to others, and indirect exposure through trauma experience of a family member or other close associate. First-response professionals such as firefighters, emergency workers, and investigators of child abuse, or those whose job requires direct, repeated exposure to grotesque details of a life-threatening nature may be included in the definition.
In other words, unless someone has experienced an actual or potential death or near death experience, or has continuous exposure to disturbing details of an event or situation in one’s work, the word trauma does not usually apply. This means that having watched something horrific on television or the Internet is not usually considered trauma in psychology.
Now that we have defined trauma, what does this mean for the person subjected to the trauma?
Impact of Trauma
Traumatic experiences can have immense emotional, cognitive, and social consequences for the youth involved in general. Recent neurobiological, epigenetics, and psychological studies have shown that school-aged children have a higher likelihood of reduced concentration, memory, organizational and language abilities. These cognitive difficulties then prevent the child from developing a strong sense of self, limiting their emotional regulation skills and interrupting their ability for developing helpful relationships with peers and caregivers.
Once it has been determined that a person has actually been exposed to one or more life-threatening events, a psychologist can assess the person for up to 20 individual symptoms that are broken down into five symptom categories. The categories include intrusion, avoidance, negative changes in cognition and mood, and changes in arousal and reactivity.
Due to the nature of traumatic events, some children begin to see places where they once felt safe to be dangerous. In fact, depending on the developmental age of the youth, these are ways youth may express trauma symptoms:
Fear being separated from their parent/caregiver
Cry or scream a lot
Eat poorly or lose weight
Become anxious or fearful
Feel guilt or shame
Have a hard time concentrating
Have difficulties sleeping
Feel depressed or alone
Develop eating disorders or self-harming behaviors
Begin abusing alcohol or drugs
Become involved in risky sexual behavior
What usually happens is that the trauma may result in a person feeling so overwhelmed that they are left unable to cope using skills that would work in ordinary circumstances. If you have experienced a traumatic event or set of events, and are experiencing changes in the way you feel, think, and act continuously for up to 3 months, it is highly advised that you seek further evaluation by a mental health professional.
Additionally, while it sounds like an oxymoron, the idea that individuals may grow from surviving trauma has been researched since the mid-90s. Psychologists Richard Tedeschi, PhD and Lawrence Calhoun, PhD have found that people who have endured extraordinary trauma may experience post-traumatic growth (PTG). PTG theory suggests that people develop positive responses in the following areas: appreciation for life, relationships with others, new possibilities in life, personal strength, and spiritual change. What this means is that the survivor is not only able to integrate the experience of trauma into their sense of self, they are able to transcend towards a more positive view of their life despite the negative experiences and reactions.
What is also helpful to note is that PTG is different from resiliency. Resiliency is thought to be a trait that someone already has that may protect the individual from experiencing negative post-traumatic stress reactions in the first place. PTG is believed to be acquired by the survivor following the trauma.
What next? Treatment and Resources
If you are a family member or friend of a trauma survivor, here are some ways you can personally help survivors increase their chances for gaining PTG.
First and foremost, believe and acknowledge the horrific experiences that the survivor shares with you.
Genuinely listen to them and avoid questioning the legitimacy of their realities. Ask open- ended questions, as opposed to leading ones. Provide support and follow through over time.
If you are unable to provide ongoing support, be honest about this, state why, and propose what you are able to offer by way of support, and follow through.
Whatever you do, do not invalidate the survivor’s feelings by suggesting that they should get over it, or move on.
Often times, what a survivor is experiencing is a great deal of grief and a sense of literal or figurative loss following a traumatic event. If you are concerned if you are behaving appropriately, a good guideline is behave the way you would like to be treated if you experienced an actual loss of a loved one in your life.
If you are the survivor of trauma, here are some helpful guidelines.
Be easy on yourself. You would not scold a child after they have fallen, so why would you do this to yourself?
What you are experiencing may feel confusing right now, but it will become clearer over time.
Ask for a listening ear from loved ones and let them know what it is that you need from them. If you do not speak up, they are not going to know how best to support you.
Seek professional support, even if your loved ones are helpful, as they are not trained to be the sort of support that a professional could provide. If the cost of seeing an individual psychotherapist is prohibitive, there are lower or free of cost options available. Churches and other religious organizations provide counseling. Also, there are therapy groups in hospitals or community health centers, and even schools can be a good source of support.