Trauma-Informed Care: Recognizing & Treating Toxic Stress: Part 1

Self Development, Trauma By Robyn E. Brickel, M.A., LMFT

What is trauma, and why do we need trauma-informed care?

When a person feels overwhelmed, threatened and endangered, the mind and body react for survival. If the person can’t find ways to feel safe again, the threat-response system tends to stay active, even though it’s not obvious. That person is likely to experience traumatic stress.

The journey toward mental wellness and self-care can be especially challenging for people with traumatic stress — trauma survivors.

A person struggling with trauma is “left with a host of intense responses and symptoms that ‘tell the story’ without words and without the knowledge that we are remembering events and feelings from long ago,” says Janina Fisher, PhD, therapist, author and educator.

Unhealed trauma impacts physical, emotional and psychological health. “The survival response system may become chronically activated, resulting in long-term feelings of alarm and danger, tendencies to flee or fight under stress, debilitating feelings of vulnerability and exhaustion, or an inability to assert and protect ourselves,” explains Fisher.

What does that mean for trauma-informed therapy?

Common Trauma Symptoms

Trauma-informed therapists know that trauma shows up in everyday life in countless ways. Some common symptoms include:

Trouble sleeping
Trouble managing intense emotions
Self-harming behavior
Substance abuse
Relationship difficulties
Recurring fights with loved ones
High blood pressure
Depression
Anxiety

Yet people with these symptoms may believe the symptoms are the problem. We need to advocate for healing trauma and for trauma survivors, even if they don’t recognize trauma’s role.

What makes a person a trauma survivor?

“Trauma literally means ‘wound, injury, or shock,’” says the International Society for the Study of Trauma and Dissociation (ISSTD).
“It refers to extreme stress that overwhelms a person’s ability to cope,” writes Esther Giller of the Sidran Institute.

Far More People Experience Trauma Than Even Experts Imagined

A well-known study in the 1990’s shocked the medical world by shedding light on trauma’s tremendous reach.

Researchers used the phrase Adverse Childhood Experiences — or ACEs — to represent 10 different types of traumatic experiences. They took a survey of 17,500 adults enrolled in a healthcare system to learn how common these events were. They asked these adults 10 questions about childhood experiences such as domestic violence, verbal abuse, sexual abuse, or feeling understood at home.

The study found that far more people grew up with trauma than anyone ever expected:

“What they found was striking. Two things: Number one, ACEs are incredibly common. Sixty-seven percent of the population had at least one ACE, and 12.6 percent, one in eight, had four or more ACEs. The second thing that they found was that there was a dose-response relationship between ACEs and health outcomes: the higher your ACE score, the worse your health outcomes.”

The study found that people with more ACEs also had “dramatically increased the risk for seven out of 10 of the leading causes of death in the United States,” says Dr. Nadine Burke Harris. Dr. Harris, a pediatrician, became a TED speaker and founder of the Center for Youth Wellness.

A Wide Range of Adverse Events Can Cause Trauma

Some causes of trauma are easy to recognize. We easily link trauma with:

Combat or war experience
Witnessing someone being hurt or killed
Sexual abuse of any kind
Physical abuse of any kind
Domestic violence for the person experiencing it
Domestic violence for anyone seeing or hearing it
Rape

However, people can experience trauma in ways that are subtle and hidden as well. A trauma-informed therapist knows that even hard-to-see conditions can cause trauma, especially in childhood.

Many People Don’t Recognize Adverse Events That Cause Trauma

An experience does not have to be abusive or violent to inflict trauma. Trauma can occur from:

Neglect of a child’s emotional experience
Emotionally unresponsive parenting (even when physical and financial needs are met)
Bullying
Shaming
A caregiver’s substance abuse
A parent’s angry outbursts
Inadequate protection from danger
Any experience that leaves a child feeling abandoned, threatened or helpless

The survivor — not witnesses or doctors — defines when trauma occurs. The experience of getting lost in the mall as a child may not seem traumatic to adults. But it is the impact on the child that defines the occurrence of trauma.

Exposure to Tragedies and Images of Violence Can Trigger Trauma

Watching devastating events on the news can be traumatizing for people at any age.

For some, repeatedly viewing broadcasts showing terrorist attacks and shootings can trigger overwhelming stress and a sense of despair.

Trauma-informed therapists are aware of these sensitivities, and can help clients take better care of themselves by developing ways to recognize traumatic stress and manage it.

How Does a Trauma-Informed Therapist Work Differently?

A trauma-informed therapist is aware that many people are not able to see how their present difficulties relate to past experiences.

Many people never think of their life experience as trauma.

But, moving too fast to review overwhelming emotions can be traumatic itself. So trauma-informed therapists move skillfully and slowly. They do so even when that person does not believe anything especially “bad” or hurtful happened to them.

A trauma-informed therapist creates a safe space to look at thoughts and feelings under the symptoms of traumatic stress.

The first priority is the foundation of safety. “If people don’t feel safe here, nothing else is going to happen.” notes Pamela Woll, MA, CADP, in her presentation, A Strength-based Approach Toward Trauma-informed Treatment and Recovery Support for Women.”

Therapy starts slowly. The therapist does not start by asking about the details of the trauma. Asking for details without tools to manage the emotions can be re-traumatizing.

A trauma-informed approach is about building a relationship of safety and trust first. Next, the therapist and client work together to build more resources to explore what happened, and manage the tremendous challenges of traumatic stress.

See Trauma-Informed Care: Recognizing & Treating Toxic Stress Part 2

About the Author

Robyn E. Brickel, M.A., LMFT Robyn E. Brickel, MA, LMFT is the director and lead therapist at Brickel and Associates, LLC in Old Town Alexandria, Virginia, which she founded in 1999. She specializes in the therapeutic treatment of individuals (adolescents and adults), couples, families and groups. Robyn E. Brickel offers treatment and psychoeducational services for many life issues and transitions, such as: A history of trauma and/or abuse, including Dissociation; Addictions, as well as Adult Children of Alcoholics (ACOA) issues; Body Image issues and Eating Disorders; Self-Harming behaviors, including Emotional intensity and instability; Anxiety, depression, and other mood disorders; Challenged family systems; Chronic illness; Co-dependency; Dysfunctional relationships; Life transitions; Loss and bereavement; Relationship distress; Self esteem; GLBTQ and sexual identity issues/struggles; Stress reduction. She is an LMFT, as well as a trained trauma & addictions therapist who has helped countless clients make and maintain positive changes in their lives. To learn more about Robyn E. Brickel, visit her website.