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