“Neuroscience research shows that the only way we can change the way we feel is by becoming aware of our inner experience and learning to befriend what is going inside ourselves.” – The Body Keeps the Score.
What comes to your mind when you hear the word trauma? Probably you are thinking about an accident or an injury or even a natural calamity. However, if you are a mental health professional, you might be thinking of Post-Traumatic Stress Disorder or even post-traumatic growth. The terms trauma and trauma-informed care are all the rage lately. Why is it so? Is it just a fad or is it of some significance?
Trauma-informed care acknowledges that experiences of trauma can be more common than once thought. It also acknowledges the deep and long-lasting impact it can have on an individual’s life. Mental health professionals define trauma as an emotional and psychological response to an event or series of events leaving lasting effects on people’s emotional, mental as well and physical well-being. Trauma involves life-threatening events like war and natural catastrophes but also non-life-threatening events and continued exposure to intense stressors with serious impacts. For example, the experience of a child who has witnessed their parents split, been continuously abused or someone who has faced domestic violence is also considered as trauma. Trauma also takes the form of psychological catastrophes like absent parenting or the experience of gaslighting in intimate relationships. Thus, trauma can be of different types like the ones resulting from a single incident (acute trauma), continuous, ongoing interpersonal stressors like domestic violence are called complex trauma and of course developmental trauma in the growing up years of children which may lead to faulty attachment patterns, like anxious or avoidant styles in future relationships.
People often confuse trauma-informed care and trauma-focused care. While the latter is an immediate, crisis-oriented approach that deals with immediate symptoms of trauma, the former is an outlook, a lens per se from which many therapists operate. It is based on the understanding that experiences of trauma are common leading to them following a more mindful approach in dealing with their clients. Trauma-informed care is a point-of-view that applies across settings like healthcare, education as well as social work. The crux of it is being able to identify all kinds of trauma. The goal is to create a supportive and empowering space for the clients that in no way is triggering or re-traumatising. Whereas trauma-focused care is a set of targeted procedures and techniques that are especially used by trained
professionals with the goal of recovery. Eye-movement Desensitization and Reprocessing and Systematic Desensitization are kinds of Trauma-Focused therapies.
Trauma is often not just about the event but also how subjectively an individual perceives it. For example among the two children brought up in the same household, for one child their parents’ split might be deeply scarring while the other child is able to grow above it. So how do experiences of trauma impact an individual in the long run? Let’s take the example of a rape survivor, the nature of trauma is such that their entire sense of identity, self-worth and self-efficacy gets shattered. Since their self-worth falls very low, their way of looking at their future relations drastically changes. Even a little validation from others, in any form, makes them feel worthy once again and subsequently, they might end up in manipulative relationships. Symptoms like intrusive thoughts, flashbacks, emotional numbness and physical symptoms like insomnia are common post experiences of trauma.
‘Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma’ by Besser van der Kolk is an interesting book that talks about how trauma is stored in the body and its somatic manifestations. Trauma can affect the body’s stress regulation system, leading to hyperarousal or hypo-arousal on facing elements that are associated with the trauma for the individual. In daily conversations, we often use phrases like “heart-breaking” and “gut-wrenching”, these usages stem from the fact that these are the places in the body where the symptoms of autoimmune diseases, for example, are seen. Healing the mind can cure the body and vice versa is true as well, treating the body affects one’s thoughts as well. The most relatable of examples in the scenario would be how grounding techniques like mindful deep breathing can cause the shiver of the body to slow down and declutter one’s thoughts so that one can collect oneself and talk.
Quoting one of the most insightful lines from the book: “Long after a traumatic experience is over, it may be reactivated at the slightest hint of danger and mobilize disturbed brain circuits…” Mental Health professionals often talk about the “trauma window” also known as the “window of tolerance”. It refers to the optimal zone where the person can cope with the stress and function optimally. Within the window of tolerance, an individual can continue to be calm, and in control and respond to stress in a balanced way, their nervous system is regulated. Going above this window causes hypervigilance, anxiety and panic (hyperarousal) and going below this window can cause emotional numbness, disassociation, disconnectedness from self and depression. (hypoarousal). Experiences of trauma can significantly narrow this window and can cause rapid shifts between hyper and hypo arousal. The goal of psychotherapy is to widen this window so that the individual can manage a wide range of emotions and physiological
experiences without getting dysregulated. A trauma-informed therapist understands this idea and thus custom-makes interventions that aid regulation, resilience and recovery.
While trauma and its impact can be profound and long-lasting, trauma-informed care aids recovery and maintenance of a balanced state with appropriate support and interventions. Somatic work and trauma-informed approach are intertwined, in the sense the former taps into the trauma stored in the body. While an objective understanding of trauma is crucial, it is to be followed by an understanding of the subjective perception of trauma by the individual to tailor-make the interventions. In conclusion, the recent realisation and widespread acceptance of trauma-informed care signify a pivotal shift in how we understand and address trauma. Far from being a fleeting trend, trauma-informed care acknowledges the profound and pervasive impact of trauma on individuals’ lives. By integrating principles that prioritize safety, trust, empowerment, and cultural competence, we are better equipped to foster healing and resilience. Recognising the nature of trauma and its far-reaching effects is not just a compassionate approach but a necessary evolution in the fields of mental health, healthcare, education, social services, and beyond. It is high time we embrace this framework, ensuring that our systems and practices are genuinely supportive and effective for all those affected by trauma.
