~~~Trauma
What is Trauma?
- “Traumatization occurs when both internal and external resources are inadequate to cope with external threat.” (Van der Kolk, 1989)
- Internal resources – resiliency, coping skills, etc.
- External resources – support system, access to healthcare, therapy, etc.
- External threat – domestic violence, sexual assault, other crime, car accident, natural disaster, etc.
- Private experiences v. widespread or public experience
- Key to definition = there are many different things that can cause trauma which ARE NOT the same for everybody
- A traumatic event is one in which a person experiences (witnesses or is confronted with):
- Actual or threatened death
- Serious injury or the threat of injury
- Threat to the physical or emotional/mental integrity of self or another
- Responses to a traumatic event may include:
- Intense fear
- Helplessness
- Horror
Prevalence
- The Relationship of Adverse Childhood Experiences to Adult Health Status (ACE) study
- Conducted by Drs. Felitti and Anda as a collaboration between Kaiser Permanente and the Centers for Disease Control
- Examined relationship between adverse childhood experiences and later health outcomes in adults
- 18,000 adults in San Francisco area
- Examine two categories of adversity: abuse and household dysfunction
- 2/3 of participants reported exposure to some level of adversity in childhood
- OUTCOME = trauma is a universal experience
- Other statistics
- More than 1 in 3 women (35.6%) and more than 1 in 4 men (28.5%) in the United States have experienced rape, physical violence, and/or stalking by an intimate partner. (CDC,2013)
- Nearly 80% of female offenders with a mental illness report having been physically and/or sexually abused. (Marcenich, 2009)
- The majority of clients served by public mental health and substance abuse service systems are survivors of trauma. (Mueser et al, 1998)
- Seventy-five percent (75%) of women and men in treatment for substance abuse report trauma histories. (SAMSHA/CSAT, 2000)
Impact of Trauma
- Trauma alters the functioning of the brain
- Using a simplistic definition – trauma forces the brain into “survival mode”
- After the trauma is over the brain returns to normal, but can be easily re-triggered into “survival mode”
- When in “survival mode” complex thinking abilities are overshadowed by a person’s instinct to self-preserve
- Chronic trauma can have a lasting effect on how the brain functions
- When trauma is extreme or prolonged the brain can get “stuck” in “survival mode”
- A constant state of “survival mode” or hyperarousal can appear like dysfunctional behavior:
- Hypersensitivity to minor threats (reactions seem extreme or out of context)
- Extremist thinking (which can also lead to out of context reactions)
- Hyperarousal = brain is constantly looking for danger
- Exposure to chronic stress means exposure to extreme emotional reactions – often too intense for the brain to handle
- Numbing (or disassociation)
- Acting out
- Exposure to chronic stress also creates a sense of helplessness
- Can’t seem to escape the trauma – stuck in “victim” role
- Exposure to chronic stress and changes in the brain often lead to other symptoms:
- Substance abuse
- Self-harm
- Aggressive or violence behavior
- Risk taking behaviors
- Emotional dysregulation
- Remember – a person’s response to trauma is a NORMAL reaction to a very ABNORMAL circumstance
What Does This Mean?
- Help individuals who experience trauma understand that it’s not “what’s wrong with them,” but rather they are impacted by “what’s happened to them.”
- Acknowledge their experience and normalize the emotions and cognitions associated with the trauma
- Attention to basic needs – people need to feel SAFE
- Connection to resources
- Safety plans
- Self-care
- Identification of a support system
- Take care of YOU!
- Inactions with those who are affected by trauma can cause secondary trauma
- Identify resources and support and engage in self-care