Trauma results from extraordinarily stressful events that overwhelm a person’s ability to cope. It is not necessarily the event itself that defines trauma, but rather the individual’s subjective experience of it. The more overwhelming the feelings of endangerment, threat to personal integrity, and helplessness that one experiences, the more likely it is that a traumatic reaction may occur.  Furthermore, physical injury does not need to take place.  In fact, any event that leaves someone feeling alone and helpless, such as witnessing another person’s trauma, can be traumatizing.

Estimates are that between 55% and 70% of people will experience at least one traumatic event in their lifetime. These can be one-time incidents, such as car accidents, fires, natural disasters, crimes, the break-up of a significant relationship, accidental losses of loved-ones, or they can be prolonged, repeated experiences, such as child abuse, neglect, or battering relationships.

Initial reactions to trauma may include some or all of the following:

• denial or disbelief
• mood swings or irritability
• self-blame or guilt
• sadness or hopelessness
• confusion, difficulty concentrating,
• withdrawal from people and normal activities
• nightmares or recurrent images
• tension, irritability,
• being easily startled

These are normal reactions to abnormal events, but can seem confusing and upsetting. Taking care of yourself during this time can be helpful.

• don’t isolate; participate in social activities
• ask for help when you need it
• avoid using alcohol and drugs. These may worsen feelings of anxiety and depression, and may further isolate you
• get plenty of sleep
• eat well – small, well-balanced meals frequently throughout the day
• exercise regularly, and try to maintain daily routines

People heal at their own pace. For some, symptoms may improve in a few weeks. If, however after several months, symptoms persist without improvement, and interfere with normal functioning at home or at work, you may be experiencing Post Traumatic Stress Disorder (PTSD). This is often the case with prolonged traumas, such as those deliberately perpetrated by others. Interpersonal traumas generally create more injury than one-time incidents, particularly where the victim has been dependent on the perpetrator, and has therefore, been helpless (e.g.  parent-child relationships).

Survivors of such trauma often struggle with some or all of the following:

Re-experiencing symptoms –

• recurrent nightmares or distressing dreams of the trauma
• recurrent, unwanted, intrusive memories of the trauma
• flashbacks (a sense of re-living the trauma)
• intense emotional distress when reminded of the trauma (e.g. extreme anxiety)
• intense bodily reactions  (e.g. sweating, heart racing or pounding).

Avoidance or numbing symptoms –

• avoidance of people, places, or things that are reminders of the trauma
• avoidance of thinking or talking about the trauma
• inability to recall important aspects of the trauma
• diminished interest in previously enjoyed activities
• emotional detachment from others
• difficulty establishing trusting relationships with others
• restricted range of feelings (e.g. love, joy)
• sense of foreshortened life

Hyper-arousal symptoms –

• sleep disturbances  – difficulty falling or staying asleep
• impaired concentration
• irritability or intense anger
• pervasive sense of danger – always on guard
• exaggerated startle response  – easily startled, jumpy

Alcohol or drugs may be used as an escape from the pain, confusion, and isolation that may ensue from trauma, but may ultimately exacerbate the situation. Thoughts of suicide are not uncommon, when life feels hopeless. If you believe that you or someone you care about may be struggling with suicidal thoughts, it is extremely important to consult with your physician, or a qualified mental health professional.

Help is available for trauma survivors. In fact, a number of therapies have been proven helpful.

Cognitive Behavioural Therapy (CBT) has different elements that can be effective.

• Exposure therapy involves exposure to the thoughts, feelings and reminders of the trauma, to enable trauma survivors to face their fear, and gain mastery over it. Exposure is done in a gradual and safe way, and may involve mental imagery, writing, or visits to the site of the traumatic incident.
• Cognitive restructuring. People often remember things in ways that may not accurately reflect what happened. As a result, they may experience painful feelings of guilt or shame over a situation that was really not their fault. Cognitive restructuring helps clients to re-evaluate these thoughts and feelings, and to develop a more realistic understanding of what actually took place.
• Stress inoculation training involves reducing PTSD symptoms through anxiety reduction strategies, such as breathing or relaxation training.

Dialectical Behaviour Therapy (DBT) was developed by Dr. Marsha Linehan. It is based on the concepts of acceptance and change, and on the Buddhist philosophy of mindfulness, which allows one to accept and tolerate powerful emotions. It is a skills-based approach which teaches clients distress tolerance, emotional regulation, interpersonal, and core mindfulness skills.

Eye Movement Desensitization and Reprocessing (EMDR) therapy (EMDR) was developed by Dr. Francine Shapiro. It employs eye movements or rhythmic left-right stimulation, in order to free up unprocessed traumatic memories, and allow for their resolution.  Please visit the EMDR International Association:  www.emdria.org for further information.

Medication can often be a helpful adjunct to therapy, targeting symptoms of anxiety and depression. Decisions regarding appropriateness of, and monitoring of medications must be done in consultation with a Psychiatrist, or Family Physician.

Healing from trauma is an emotionally difficult process, but within time, and with the assistance of a skilled therapist, it is possible to heal from the pain, and feel safe again.

Related links:

http://www.info-trauma.org/flash/media-e/victim_guide.pdf

American Professional Society on the Abuse of Children: www.apsac.org

American Psychiatric Association: www.psych.org

American Psychological Association:  www.apa.org

American Psychological Association – Division of Trauma Psychology : www.apatraumadivision.org

Anxiety B.C.: www.anxietybc.com

Anxiety Disorders Association of America: www.adaa.org

Anxiety Disorders Association of Canada: www.anxietycanada.ca

Association of Traumatic Stress Specialists:  www.atss.info

Australian Society for Traumatic Stress Studies: www.astss.org.au

Canadian Mental Health Association: www.cmha

Canadian Network for Mood and Anxiety Disorders: www.canmat.org

Canadian Psychiatric Association:  www.cpa-apc.org

Centre for Addiction and Mental Health: www.camh.net

David Baldwin’s Trauma Information Pages: www.trauma-pages.com

EMDR International Association:  www.emdria.org

European Society for Traumatic Stress Studies: www.estss.org

Gift From Within:  www.giftfromwithin.org

Info Trauma: www.info-trauma.org

International Society for the Study Of Dissociation:  www.isst-d.org

International Society for Traumatic Stress Studies:  www.istss.org

MedLine Plus: www.nlm.nih.gov/medlineplus

National Center for PTSD:  www.ptsd.va.gov

National Child Traumatic Stress Network: www.nctsnet.org

National Institute of Mental Health (NIMH): www.nimh.nih.gov

Psych Central: www.PsychCentral.com

PTSD Gateway: www.ptsdinfo.org

Sidran Foundation: www.sidran.org

Van der Kolk’s Trauma Center: www.traumacenter.org

www.bullyonline.org/stress/ptsd.htm

Suggested Readings:

Coping with Trauma:  A Guide to Self Understanding.  (1995). By  J.G. Allen.  American Psychiatric Press.

The Courage to Heal:  A Guide for Women Survivors of Child Sexual Abuse.  By  E. Bass and L. Davis.  New York, NY: HarperCollins.

Mind-Body Workbook for PTSD. A 10-week Program for Healing Trauma.  (2010).  By S.H. Block and C.B. Block.  Oakland, CA: New Harbinger Publications, Inc.

The Scared Child: Helping Kids Overcome Traumatic Events.  (1996).  By B. Brooks and P.M. Siegel.  John Wiley.

What About Me?  A guide for Men Helping Female Partners Deal with Childhood Sexual Abuse. (1994).  By G. Cameron.  Carp, ON: Creative Bound.

Unspeakable Truths and Happy Endings: Human Cruelty and the New Trauma Therapy.  (1998).  By R. Coffey.  Sidran Press.

Healing the Trauma of Abuse.  A women’s Workbook. (2000).  By M.E. Copeland and M Harris. Oakland, CA: New Harbinger Publications, Inc.

Posttraumatic Stress Disorder:  DSM-IV and Beyond.  (1993).  By. J.R.T. Davidson and E.B. Foa.  American Psychiatric Press.

Allies in Healing. When the Person you Love was Sexually Abused as a Child.  (1991).  By L. Davis.  New York, NY: HarperCollins.

The Right to Innocence. Healing the Trauma of Childhood Sexual Abuse.  (1982).  By B. Engel. Los Angeles, CA: Jeremy P. Tarcher.

Clear Your Past: Change Your Future.  (1997).  By L.D.  Finney.  Oakland, CA:  New Harbinger Publications, Inc.

Treating the Trauma of Rape: Cognitive-Behavioral Therapy for PTSD.  (1998).  By  E.B. Foa and B.O. Rothbaum.   New York, NY: The Guilford Press.

Trauma and Recovery.  (1997).  By I.L. Herman.  Basic Books.

Waking the Tiger. Healing Trauma. (1997).  By P.A. Levine.  Berkley, CA: North Atlantic Books.

Victims No Longer. The Classic Guide for Men Recovering from Sexual Child Abuse.  (2004).  By M. Lew.  New York, NY: HarperCollins.

Trust after Trauma:  A Guide to Relationships for Survivors and Those Who Love Them.  (1998).  By A. Matsakis.   Oakland, CA:  New Harbinger Publications, Inc.

The Dialectical Behavior Therapy Skills Workbook. Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance.  (2007). By M. McKay, J.C. Wood, and J Brantley.  Oakland, CA: New Harbinger Publications, Inc.

Reclaiming Your Life after Rape.  (1999).  By B.O. Rothbaum and E.B. Foa.   Psychological Corporation.

Reclaiming Your Life from a Traumatic Experience (workbook).  (2007)  By B.O. Rothbaum,  E.B. Foa, and E.A. Hembree.

The Body Remembers. The Psychophysiology of Trauma and Trauma Therapy.  (2000).  By B. Rothschild.  New York, NY: W.W. Norton & Co.

Don’t Let Your Emotions Run Your Life. How Dialectical Behavior Therapy Can Put You in Control.  (2003).  By S.E. Spradlin.  Oakland, CA: New Harbinger Publications, Inc.

PTSD Workbook. Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms. (2002).  By M.B. Williams and S. Poijula.  Oakland, CA: New Harbinger Publications, Inc.

When Someone You Love Suffers from Posttraumatic Stress: What To Expect and What You Can Do.  (2011).  By C. Zayfert and J.  DeViva.  New York, NY: The Guilford Press.