'Trauma-informed practice' is a phrase we hear more and more in our work, but what really is trauma, and how can we learn to recognise it? This simple guide illustrates how trauma can affect the body, and how to support distressed individuals.
This is a basic guidance note to support understanding and highlight some potential physiological effects of trauma. This is not an exhaustive note and is not specific to any individual.
What is Trauma?
Trauma is the result of singular or repetitive exposure to a deeply distressing or disturbing experience or event. Typical memories are reconstructions of past events and so they change and fade as time passes but traumatic memories do not follow this same pattern. Traumatic memories remain as horrible and vivid as when they were formed. Trauma leaves an imprint on the body and so it is not simply experienced as a memory but as disruptive physical reactions caused by the emotions and physical sensations imprinted by the initial trauma. Traumatised individuals regularly report the sense of reliving these past experiences.
What Effects Can Trauma Have?
A traumatised individual is changed by their experiences, and their baseline state might be to interpret the world around them as unsafe. The resulting constant vigilance and assessment of threat is mentally and physically exhausting and means that relaxation does not come easily. Individuals with trauma can be hyper-vigilant which makes them more sensitive to environmental stimuli, increases their anxiety levels, and can be exhausting.
Sensory sensitivity may increase, resulting in extreme reactions such as fear at loud and unexpected noises. Individuals can be stuck in ‘fight or flight mode’ or they may appear to chronically ‘shut down’. In either of these states the body’s main purpose is survival and defence which does not leave room for the ability to learn, play, imagine, plan, and pay attention to the needs of others, which can have a negative effect on relationships. Everyday pleasures of life can be hard to enjoy or even recognise for an individual who spends each day in a hyper-vigilant state.
Similarly, other traumatised individuals can be too numb to absorb new experiences. Traumatised people can struggle to accurately detect when they genuinely are in danger because their alarm system is essentially in a dysregulated and malfunctioning state. This can leave them more vulnerable in unsafe situations. Just as it can be difficult detecting what is truly dangerous, it can equally be difficult to detect what is genuinely safe and nurturing.
Trauma can present in very physical ways. The emotional brain manifests in physical reactions such as a pounding heart, fast and shallow breathing, sensations such as heartbreak or a gut-wrenching feeling, speaking differently or being unable to express yourself, and body language that communicates rage, defensiveness, collapse, or rigidity. Somatic symptoms for which no clear physical basis can be found are a pervasive factor reported in traumatised adults and children. These symptoms can include and are not limited to; chronic back and neck pain, fibromyalgia, migraines, digestive problems, spastic colon/ irritable bowel syndrome, chronic fatigue, and some forms of asthma.
Studies have shown that calm and mindful people have high Heart Rate Variability (HRV) while traumatised people have very low HRV. A low HRV indicates that the body is under stress which can be caused by internal or external stimuli such as physical exercise, psychological events, and environmental stressors.
Traumatised individuals also might regularly experience disconnection with their body, muffled senses, and not have a fully integrated understanding of how they physically feel. In an attempt to shut down the terrifying physical sensations brought on by undergoing trauma, their capacity to fully feel and experience can be dulled. In the struggle to cope with intense emotional responses a person might feel numb or turn to strategies such as self-harm, alcohol, drugs, and binge eating. Sleep may be chronically disturbed and food can lose its sensory appeal. An impaired sense of self and reduced sense of personal purpose and direction is also commonly reported. This can result in difficulty around decision making, even when faced with seemingly small choices. Alexithymia is regularly present in traumatised individuals, meaning that they struggle to identify or express how they feel emotionally. These feelings can be expressed physically though remain beyond the individual’s comprehension.
Social engagement can also be severely affected by trauma. An encounter which would usually activate a social engagement response in a non-traumatised brain can send a traumatised brain into survival mode. Many traumatised people experience feeling very disconnected and out of sync with the people around them. It is natural to seek comfort and safety from the people around us, but many traumatised people are unable to do this, meaning that they lack a key coping mechanism many of people rely on.
What Can Be Helpful in Supporting Individuals with Trauma?
When supporting traumatised individuals, it is important to remember the stress and difficulties they constantly endure and take this into account when reflecting on their emotional and behavioural reactions. The way we interact with a person with trauma can have a significant impact.
Our inherent social reciprocity means that being spoken to in playful tones results in relaxation and comfort in opening up. Regardless of what is being said, vocal tones indicate a sense of safety or danger. Shouting or speaking loudly to someone who is out of control will only result in further dysregulation. Reliable and predictably positive, engaging, and empathic interaction will help create a sense of safety.
Furthermore, knowing when to speak is important, and, when dealing with trauma, the need for talking is greatly reduced. Trauma impacts the area of the brain related to expressive language and articulation. This means that when an individual is caught up in a negative emotional response, their capacity for language is greatly impaired. Language becomes ineffective when an individual is in this state and so it is important to think about how to bypass this and to address the trauma on a physiological level. This means that when an individual is having an emotional reaction, it is not the best time to ask them to sit and explain what they are thinking and feeling. Appropriate distraction and redirection can be useful. Practitioners should be mindful that an individual cannot learn or effectively process information when in a state of high arousal and dysregulation.
Trauma removes the feeling of being in charge of yourself, and so regaining a sense of ownership over mind and body is important in the recovery process. Physical activities can be used to reconnect individuals to their body and improve mindfulness. Activities such as yoga have been identified as particularly effective in this but any form of regular, sustained, and engaging physical exercise will help with this.
Physical exercise is a well-established method of stress management and reduction. Due to the high level of baseline stress as a result of trauma, cardiovascular exercise in an important part of regulation and well-being for traumatised individuals. Stress hormones typically provide energy to help us deal with extreme situations that generally require action. Traumatised individuals are regularly and unnecessarily producing these hormones and physical movement is the only way to effectively dispel and benefit from this. Emotional regulation is helped by the relief of physical tension and active social engagement that tends to occur naturally with most physical activities. Cardiovascular exercise also aids in increasing Heart Rate Variability. It should be noted that the benefits discussed will not occur over night and so regularity and persistence is key. You can work with the traumatised individual to identify activities, sports, and games that they can enjoy and enthusiastically engage with.
When supporting traumatised individuals it is also important to consider the opportunity for relaxation. As discussed, trauma can result in a high level of baseline stress, hypervigilance, increased anxiety, and sensory sensitivity which does not foster relaxation. When building a routine for a traumatised individual, downtime should be scheduled in. It is useful to think about when specifically encouraging relaxation may be helpful, such as before going to bed or around an activity usually found to be stressful. The use of positive sensory experiences can also greatly benefit stress reduction and sense of well-being. Identifying smells, tastes, sounds, touch, and visuals that are soothing and calming for an individual can help in accommodating relaxation. Identifying any negative sensory triggers can also be of use but the focus should be on utilising sensory strengths. Examples of relaxing sensory experiences can include taking a hot bath, drinking a cup of hot chocolate, having your hair brushed. This will be very individual and time should be taken to help in identifying relaxation aids and ensuring that they are employed appropriately. With time, empathy and compassion, traumatised individuals can be supported to lead happy and fulfilling lives.
If you are supporting someone who has experienced trauma and would like to speak to a member of our clinical team, please contact us at firstname.lastname@example.org or 01225 334 111.
Written by Aylish McFarlane, Studio 3 Assistant Psychologist, and illustrated by Terry Culkin.