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Trauma is an emotional and physiological response to a distressing event that overwhelms an individual's ability to cope. It often results from experiences involving a threat to life or safety, such as accidents, natural disasters, or interpersonal violence, but it can also stem from prolonged exposure to stressful environments. When trauma occurs, the brain’s "alarm system" (the amygdala) can become hyper-sensitive, keeping the body in a state of high alert long after the event has passed. This often manifests as:

• Intrusive thoughts: Flashbacks, nightmares, or sudden emotional triggers.

• Avoidance: Steering clear of people, places, or thoughts associated with the event.

• Hyperarousal: Chronic anxiety, irritability, or difficulty sleeping.

• Dissociation: Feeling numb or disconnected from one's body and surroundings.

Therapeutic Treatments for Trauma

Therapy aims to help the brain and body process the traumatic memory so it no longer feels like a current threat. Several evidence-based approaches are highly effective:

1. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): This approach helps individuals identify and challenge distorted thought patterns related to the trauma (such as self-blame) and gradually exposes them to triggers in a safe environment to reduce fear.

2. Eye Movement Desensitization and Reprocessing (EMDR): This involves focusing on a traumatic memory while experiencing bilateral stimulation (typically side-to-side eye movements). It helps the brain "reprocess" the memory into a less distressing form.

3. Somatic Experiencing (SE): Since trauma is often stored in the body as physical tension, SE focuses on releasing that pent-up energy by tracking physical sensations rather than just talking through the event.

4. Dialectical Behavior Therapy (DBT): Often used for complex trauma, DBT teaches skills in emotional regulation and mindfulness to help manage intense feelings and improve relationships.

Trauma

Post Traumatic Stress Disorder (PTSD)

It is necessary that to receive a PTSD diagnosis, the individual had to have experienced or been exposed to a traumatic event, exposure could be indirect so the individual could have heard about a death of a family member or friend and be impacted. PTSD can also develop by being exposed to the specifics of the trauma such as police officers being subjected to horrific events repeatedly.

Symptoms of PTSD Diagnosis

1.Intrusion: unwanted thoughts, images, impulses, or urges that can occur spontaneously or that can be cued by external/internal stimuli. Typically, these thoughts are distressing (hence “intrusive”) and tend to recur. Nightmares, experiencing flashbacks of the traumatic event. This can make people feel as though they are re-experiencing the trauma again and again.

2. Evasion: Evasion of things that trigger the traumatic experience such as, but not limited to situations, people, locations, activities, and certain items that played a role in the traumatic event. Individuals often try to forget or avoid remembering the events. They may internalize their emotions as a way to avoid their emotions and will not want to talk about what happened.

3. Modification in mood and cognition: many people cannot remember details of the traumatic event, some may have negative thoughts and emotions that lead to twisted thinking and distorted beliefs about self or others (“I am not likable,” “people are all bad”); distorted thought process about ramifications or cause of the traumatic event leading to inaccurately placing blame on others or self, some experience ongoing fear, anger, shame or guilt and do not enjoy activities they once liked, feeling disconnected or distant from others, or unable to feel happiness or experience positive feeling and/or emotions.

4. Adaptation in reactivity and arousal: this may cause symptoms of irritability, angry outbursts, negligence, or becoming self destructive, hypervigilance-being watchful over one's environment, feeling unsafe; heightened startle response, lack of concentration and problems falling or staying asleep.

For a person to be diagnosed with PTSD, the symptoms listed above must have lasted for longer than a month and must cause impairment in daily functioning. Multiple individuals notice symptoms within three months of the traumatic event, but symptoms may happen later on and will persist for months and/or even years later. PTSD can be linked to other mental health disorders such as depression, memory issues, substance use and other mental or physical health problems.

Related Conditions

Acute Stress Disorder

Acute stress disorder can arise as a response to a traumatic event, the symptoms can mirror PTSD. The symptoms from acute stress disorder can transpire between three days and 30 days after the traumatic incident takes place. Individuals experiencing acute stress disorder, can re-experience the traumatic event, have flashbacks and/or nightmares and may feel dissociated. These symptoms can cause impairment in functioning with daily life. Approximately 50% of the individuals that have acute stress disorder will go on to develop PTSD.

A 13% to 21% of trauma survivors regarding car accidents will develop acute stress disorder and between 20% and 50% of survivors of mass shootings, assault, and rape will develop this disorder.

Cognitive Behavioral Therapy, which is psychotherapy can help individuals struggling to control symptoms learn how to cope with them in a healthy manner which will prevent the symptoms from increasing and/or developing into PTSD. Medications, known as SSRI antidepressants can help to alleviate the symptoms.

Adjustment Disorder

Adjustment disorder can occur in response to a traumatic or stressful life event. The emotional or behavioral symptoms an individual may experience after responding to a stressor are more rigorous or more intensive than what may be expected.

Symptoms can include sadness, feelings of hopelessness, isolation, acting rebellious or impulsively, or developing physiological tremors, heart palpitations and headaches. Symptoms can include impairment in daily functioning such as school, social interaction and/or work. Adjustment disorder can start to appear within 90 days after the traumatic event occured and last no longer than six months after the stressor or implications have ended.

A stressor can be defined as a single event, such as a relationship break up, or there could be complex events with an accruable effect. The stressors may be continual or non stop. Stressors can have a negative impact on more than one person, an entire family and even a large group of people such as a community can be affected.

Research shows that 5% to 20% of people in mental health treatment receive a diagnosis of adjustment disorder. A study showed that more than 15% of adults with cancer had adjustment disorder. This mental health issue can be treated with psychotherapy.

Treatment

It is crucial to know that not every person that experiences a traumatic event in their life will develop PTSD, not every person is required to receive psychiatric treatment. Some people that experience PTSD symptoms will find that the symptoms may dissipate over time. Many will more than likely need the support of their families, friends, and any other person they look to for help. Many people that are diagnosed with PTSD will need therapy and treatment to recover from the psychological distress that can lead to impairment in functioning in everyday life. Just remember, that PTSD is very treatable. Please receive help as soon as possible, in order to heighten the recovery process.

Cognitive Behavioral Therapy-CBT

Cognitive behavioral therapy is used to focus on altering negative emotions that can be painful. It helps with changing the negative belief system people have after experiencing trauma (such as “everyone is bad”). The therapist will help the client to approach such disturbing emotions and memories.

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th Edition. Arlington, VA: American Psychiatric Association; 2013... here...

The Phases of EMDR

Eye-Movement-Desensitization-Reprocessing

Sometimes an experience is simply too large, painful, or shocking for a person to process by themselves. So, a therapist can help ‘reprocess’ this experience with EMDR therapy. Maybe the experience reminds a person of similar negative experiences that have occurred in the past. The experience is overwhelming or traumatic. This is when EMDR therapy can be used to jump-start our natural processing system. EMDR Therapy allows the overwhelming experiences to ‘reprocess’ until they no longer feel disturbing. The eight phases of EMDR therapy provide the map to guide treatment.

The Eight Phases

The eight phases are 1) history taking and treatment planning, 2) preparation, 3) assessment, 4) desensitization, 5) installation, 6) body scan, 7) closure and 8) reevaluation.

● Phase 1: The first phase begins with a discussion between the therapist and client regarding what brings the client into therapy and if EMDR therapy is a suitable treatment for the individual. The therapist and client develop a secure and therapeutic alliance. The client’s history is discussed and a treatment plan is developed with attention to the pacing of therapy and the of traumatic events that will be part of EMDR treatment. In addition, the client’s internal and external resources are assessed. The client and therapist will work on building a trauma timeline and the client finds a secure place that makes them feel comfortable and safe, which is used at the end of each EMDR session.

● Phase 2: In the preparation phase, the therapist goes over the EMDR therapy process, terms, and sets appropriate expectations. This is a good time for client concerns and questions to be addressed and a safe and therapeutic relationship is built between the therapist and client. The therapist and client collaborate to prepare and select specific coping techniques and then discuss any emotional disturbance that might come up. Clients may need more time in phases 1 and 2 in order to feel ready to move on to the following phases It is important for the counselor to meet the client where they are at and never rush the client into EMDR treatment before they are ready.

● Phase 3: In assessment, the event to reprocess (also known as the target event) is identified, along with images, beliefs, feelings, and sensations about the event. Initial baseline measures are set by using the Subjective Units of Disturbance (SUD) scale is 0-10. Zero is feeling no disturbance and 10 is the worst disturbance the client can imagine. and The Validity of Cognition (VOC) scale is 1-7. 1 is low and 7 is the highest.

The next three phases are known as the ‘reprocessing’ phases and all involve dual attention bilateral stimulation (BLS). Dual attention BLS activates the client’s information processing system while keeping the client anchored in the present moment. Dual attention BLS can be side to side eye movements, sounds, or taps.

● Phase 4: In the fourth phase, desensitization, the side to side eye movements, sounds, or taps begin while focusing on the chosen traumatic event, and continue until the client’s SUD reduces to zero (or 1 if appropriate). During this time, new thoughts, sensations, images, and feelings may emerge. Clients may communicate that they notice improvement.

● Phase 5: When desensitization is complete, installation begins. In this phase, the client associates and strengthens a positive belief with the target event until it feels completely true, which is usually at a "7" on the 1-7 scale.

● Phase 6: During the body scan, the client is asked to keep in mind the target event and the positive belief while psychologically scanning the body from head to toe. Any lingering disturbance from the body is reprocessed. The scale used for this phase is 0-10 and the goal is reaching "0" preferrably.

The last two phases ensure safety for the client both at the end of a current session and at the beginning of the next session.

● Phase 7: Every session of reprocessing ends with the seventh phase, closure, in which the client is assisted to return to a state of calm in the present moment whether the reprocessing is complete or not. Reprocessing of an event is complete when the client feels neutral about it (SUD=0), the positive belief feels completely true (VOC=7), and the body is completely clear of disturbance. The client either does breathing and/or their secure place to close for that session.

● Phase 8: Reevaluation, is how each new session begins after reprocessing. The client and therapist discuss recently processed memories to ensure that distress is still low and that the positive cognition is still strong. Future targets and directions for continued treatment are determined.

References:

Hase, M. (2021). The structure of EMDR therapy: A guide for the therapist. Frontiers in Psychology, 12, 660753. Open access: https://doi.org/10.3389/fpsyg.2021.660753

Hase, M., Balmaceda, U.M., Ostacoli, L., Libermann., P., & Hofmann, A. (2017). The AIP model of EMDR therapy and pathogenic memories. Frontiers in Psychology 8: 1578. Open access: https://doi.org/10.3389/fpsyg.2017.01578

Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing Therapy: Basic Principles, Protocols, and Procedures (3rd ed.). New York, NY: The Guilford Pressure

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