Trauma

What is Trauma?

Psychological trauma is a broad umbrella term for the negative psychological impact that can result from experiencing situations that are too overwhelming to cope with. Trauma can come about as a result of one big incident such as being involved in an accident or a sexual assault, or many incidents experienced over time such as being bullied, neglected or abused. It can also come through witnessing harm to others. It usually involves a violation of our core need of safety, whether that is attachment-based or physical, and can lead to psychological disorders such as Post Traumatic Stress Disorder (PTSD) or Complex Post Traumatic Stress Disorder (CPTSD). PTSD can occur as a result of a single-event trauma, whereas CPTSD tends to follow more chronic violations of safety over time, such as abuse or neglect. 

Straight after experiencing or witnessing a traumatic event, we may notice symptoms such as shock, numbness, confusion or distress. These symptoms are normal reactions to abnormal events and can often resolve on their own, especially if there is an opportunity to share the experience and to be supported by friends and/or family after the event. However, if these symptoms do not resolve after a month or so, it may be that you need some help with processing the trauma.  

PTSD symptoms include 4 main clusters:

1. Re-experiencing: which can make you feel like you are reliving the traumatic experience(s) again in the present. These include visual or emotional flashbacks, nightmares, and intrusive memories.

2. Avoidance: Attempts at suppressing the memory of the event, avoiding thinking or talking about what happened, or reminders such as people or places associated with the event. 

3. Negative changes to the way you think and feel about yourself, others and/or the world, and emotions that are not resolving naturally – such as shame, guilt, anger, or fear. It may be difficult to remember the event properly. Mood can be low and you may feel detached from the people you are close to, or find yourself withdrawing from people and activities you value. Another symptom is feeling numb. You may be experiencing dissociation as a result of the trauma you have experienced, whereby you may feel removed from yourself and/or your surroundings. 

4. Being more emotionally or physically reactive. You may notice that you have more of a startle reflex, or that you are scanning for danger all the time. You may feel irritable, angry or aggressive or find it harder to concentrate or sleep. Some people notice that their hearts are beating more rapidly or that they are sweating a lot more than usual. 

You may notice that everyday features of life may trigger symptoms. For example, if you were involved in a road traffic accident, you may feel like you are reliving the emotional/physical experience of your accident when you hear the sound of screeching brakes. This can make people feel very out of control and like they are going crazy, however, it is just due to how the brain has stored away core features of the memory. Trauma-based memory tends to be more sensory in nature than normal memories, and so sensory reminders can bring back intense re-experiencing of the event.  PTSD can be treated successfully with psychology therapy.

Complex PTSD:

C-PTSD shares the same 4 core clusters of symptoms as above but also some other symptoms due to the recurrent nature of the trauma experienced, or the longer time span of the trauma. These extra symptoms are:

• Low self-worth: chronic trauma is often personalised, whereby the person affected may blame themselves, feel that the abuse/neglect means something about their worth as a person, and may feel intense shame or guilt as a result

• Relationships might feel difficult: it may feel difficult to trust people leading to avoidance of establishing relationships, or maybe it feels too difficult to establish a healthy relationship with boundaries, leading to connections that are too intense. 

• Emotion dysregulation: emotions may feel very out of control at points or feel like they escalate suddenly. This is sometimes accompanied by attempts to regulate or numb such as self-harm, substance misuse, or overeating, amongst others. Sometimes this can also lead to risky behaviours.

How are trauma, PTSD and CPTSD assessed?

Trauma is assessed via an initial consultation, through taking a life history and also speaking about recent events, current lifestyle, and the difficulties you are facing. This allows a shared understanding of the origins of the trauma as well as the natural coping mechanisms that may inadvertently be maintaining the disorder. PTSD and CPTSD are further assessed via measures such as the PCL-5 and the International Trauma Questionnaire. Measures such as these allow us to get a sense of the extent of the difficulties and help us track how well our treatments are working.

What therapies we use and why?

The National Institute for Health and Care Excellence (NICE) and the World Health Organisation (WHO) recommend two gold standard treatments for PTSD:

1. Trauma-Focused Cognitive Behaviour Therapy, also known as TF-CBT. All of the therapists here are trained to use this both with children/adolescents and adults.

2. Eye Movement Desensitization Reprocessing therapy (EMDR). Alison is fully trained in this approach, and Sara has undergone initial training and can also use this approach as part of her treatment, when appropriat

Some therapists here are also trained in Dialectical Behavioural Therapy for Complex Post Traumatic Stress Disorder (DBT-CPTSD), which is an evidence-based structured 45 session therapy for those who are experiencing distress as a result of chronic trauma. 

What does a typical course of treatment look like?

Typically for PTSD, it is recommended to begin with 8-12 sessions, unless more sessions are indicated because of things like having experienced multiple traumas, or having other mental health diagnoses. How treatment looks varies person to person, but TF-CBT tends to follow:

• An assessment session which involves a history taking and description of current difficulties, discussion and goals, expectations and fears

• Collaborative formulation of the difficulties – how they have arisen, how they are being maintained and a plan for how to recover

• Orientation to the model being used, including psychoeducation around trauma, PTSD/CPTSD 

• Gentle introduction to stabilisation and grounding to ensure that you feel equipped to cope with exposure to memories of the traumatic events to help start processing

• Work on the impact that the trauma may have had on your emotional and cognitive processing via engagement with core memories and updating based on what is known now. This also includes looking at things that may be maintaining inappropriate guilt or shame – such as hindsight bias or over-responsibility

• Sometimes people are encouraged to revisit the site of the trauma, if it would be helpful – this may be in person or online. 

• Future planning – reclaiming your sense of yourself and getting back on course with what you want for yourself now and in the future. 

However, treatment is very much adapted to suit the needs of the individual so may include other techniques as well. 

What results you might expect?

Treatment is of course structured around your aims, but typically we would expect to see a very noticeable decrease in symptoms – to the point of no longer meeting the diagnostic criteria for PTSD. People often describe feeling as though they are more able to be in the here and now, no longer experience nightmares, and that the memories no longer bring up intense, uncontrollable emotions. We would aim to help you feel less stuck in the past and to feel hopeful and able to take steps towards a future you value.

In some situations, we may need to incorporate other types of therapies, such as compassion-focused therapy – particularly if self-criticism is acting as a barrier. And in other situations, EMDR or DBT-PTSD may be more appropriate or beneficial. Sometimes a combination of approaches is indicated and that has been helpful for many clients.

For extra information on trauma please see the following blogs as well as the resources page on our website: 

PTSD and complex PTSD

Depersonalisation