Understanding Trauma
From the mental illness to an adaptive response
Trauma has been seen for a long time as a brain disorder, an incurable psychiatric illness resulting of a particular event.
This notion as evolved over the last century, specially the last 50 years, thanks to scientists, doctors and therapists that have been dedicating theirs studies to the comprehension of how our biology reacts to threat and how that adaptive response impacts our lives.
Currently, most of trauma-related symptoms are seen as part of the human survival instinct, becoming pathological only if they are inhibited (Turnbull, 1998), or not recognized (Scott, 1990).
The traumatic stress response is now seen as a universal adaptive response following exposure to a overwhelming event, whose complexity and intensity depends on individual characteristics and context (internal and external) in which the event occurs. Each person has different coping mechanisms and react to stressful events depending on numerous factors.
What is trauma?
“Trauma is a highly activated incomplete biological response to threat that stays frozen in time.”
When we think about trauma, we often link it to a specific event, like an accident, extreme physical violence or abuse, some unexpected situation that left an injury, or a catastrophe.
TRAUMA is not what happens to a person, but what happens inside them, in that person's physiology. It’s about how the body responds to a real or perceived threat*, not necessarily about the event itself, and is directly related to the person’s ability to restore a sense of safety after whatever happened.
*A perceived threat is anything considered to be dangerous by our internal alarm system in the brain (the amygdala) and it may be different for each person in different moments of their lives.
“In response to threat and injury, animals, including humans, execute biologically based, non-conscious action patterns that prepare them to meet the threat by defending themselves” (Payne, Levine, Crane-Godreau, 2015).
When threatened or injured, all animals draw from a range of possible responses. We orient, dodge, duck, stiffen, brace, retract, fight, flee, freeze, collapse, etc. All of these coordinated responses are somatically based – they are things that the body does to protect and defend itself.
In humans, these defensive responses work fundamentally the same way, with the autonomic nervous system being responsible for our abilities to fight, flight or freeze when facing a threatening situation and asking for help is not enough (this would be our primal response).
Like in childhood, when the developmental capacity to protect ourselves is markedly limited (meaning that anything can be potentially threatening), a mere look of disapproval or scorn in the eyes of a parent, can make a child feel uncared for, unloved, or abandoned, activating the freezing defensive mechanism and compelling the feeling of numbing out.
As our ancestors, the primates, whenever we feel threatened, we turn ourselves to the first level of defense that is “asking for help”, calling someone or alert the crowd that there is some eminent danger. But if no-one is around, or cannot hear our voice, our organisms resorts to the more primitive survival responses. These mechanisms play an essential role in our development and in everyday life. They keep us out of harm and we couldn’t survive without them.
Activation (fight or flight), freezing, dissociation, and collapse are all reactions that are based on the evolution of survival behaviors and all of them require the reunion and organization of huge amounts of energy inside the body.
Animals in the wild recover spontaneously from the activation state – involuntary movements, changes in breathing patterns, yawning, shaking or trembling, release or discharge the intense biological arousal.” After the release they are able to return to a relaxed, curious, socially engaged and exploratory state.
Contrary to what happens in wild animals, there is a variety of factors that prevent the “resetting” of the nervous system in humans (and also some domesticated animals):
Fear of the discharge process itself (discomfort with body sensations);
Extension of the traumatic situation in time;
Complex cognitive and psycho-social considerations (emocional inhibition, lack of space, time, social environment, etc.);
Cortical interference (rationalization and conditioning).
Trauma happens when the circumstances (internal and external) in which the event occurs, as well as the characteristics of the event itself, make it so overwhelming to the point of overcoming the individual's capacity to support/manage the situation – to complete the defensive response and following discharge.
PTS vs Trauma
Someone experiencing a post traumatic stress (PTS) reaction presents symptoms that tend to decrease over time. Allowing the experience and manifestation of physical sensations and emotional responses is essential in the process of signification, integration, and overcoming an event.
It’s considered that a person develops TRAUMA (such as PTSD) when these symptoms persist over time. When the incomplete response pattern keeps repeating over and over again, having a prolonged negative effect and functional impairment that disturbs fundamental aspects of life like relationships and emotional balance.
How unhealed trauma affects our lives
When the natural adaptive process is inhibited, interrupted, or blocked for some reason, there is a high probability of developing a traumatic response.
After having gathered a great amount of energy for defensive purposes, the nervous system is not allowed to complete its physiological process and release, leaving this energy stuck in the system, fueling ineffective responses that persist over time.
Each one of these incomplete responses (flight, fight, freeze and also fawn) can be translated in every day reactions, conditioning our core beliefs and have an impact on our emotional balance, behavioral changes, cognition, and physical symptoms. A few examples:
Emotional symptoms: sadness, numbness, fault, shame, rage, irritability, fear, disbelief, panic, confusion, shock, anxiety, low self-esteem, difficulty with intimacy and deep love, struggle demonstrating and/or feeling empathy, no desire to connect and/or bond with others, never being good enough, fear of failure and fear of success.
Physical symptoms: chronic pain, fibromyalgia, Irritable Bowel Syndrome (IBS), muscle tension, tachycardia, tiredness, hyper-vigilance, chills, tremor, insomnia, immune and endocrine issues, gastrointestinal problems, sexual dysfunction, anorexia or bulimia.
Behavioral symptoms: mood fluctuations, loss of interest in previously pleasurable activities, social isolation, avoidance, defensive attitude, addiction feeling startle, body-image issues, inability to set clear boundaries, perfectionism, playing small, experiencing resistance and lack of drive.
Cognitive changes: emotional flashbacks (intrusive emotional experiences), nightmares, inability to concentrate, lack of focus, memory loss, current disorientation, dissociation (living out of the body or the present moment), trouble communicating and expressing oneself, ruminant thoughts, feelings of living 'on the edge'.
Have you ever found yourself over reacting (or not reacting at all) to a situation without comprehending why? This is often due to the unresolved trauma. Energy from the past that is locked in your nervous system.
Recent research in the fields of neuroscience, psychopathology and neurobiology have shown that trauma causes real physiological changes in the brain such as:
Re-calibration of the "brain alarm system";
Increased secretion of stress hormones;
Change in the system that filters information (from what is relevant of the rest);
Compromise of the feeling of "being alive";
Causes permanent states of hyper-vigilance and difficulty in fully and spontaneously engaging in everyday tasks;
Difficulties in learning from experience, leading to the repetition of old patterns.
Trauma conditions our everyday life, especially because we live in a world where we let ourselves experience constant stress. Our bodies feel like they're constantly under threat.
Have you ever noticed yourself:
Any of the examples above might suggest that your organism is stuck in survival mode, and its energies are focused on defending yourself from invisible enemies, which leaves no room to care and love, beginning for yourself.
“While the spirit defends itself from these attacks, our closest ties are threatened, as is our ability to imagine, plan, learn, and pay attention to the needs of others.” Dr. Bessel van der KolkTrauma is a consequence of being alive but it’s not a life sentence!
Trauma impacts our life in many different ways. Chronic stress response and unexplained symptoms are rooted in a dysfunctional physiology where our developmental coping mechanisms are stuck in survival mode.
The physiology of trauma may seem complex and hard to understand because society and many clinicians still approach mind and body as they're two separate parts. Cartesian dualism is still so present that we have medical specializations to treat the mind and others for all the different parts of the body. This approach is useful at some measure, but it bypasses the complex web of connection and regulation between our body and our mind. We are one - mind and body working together, trying to dance fluidly throughout our lives.
When we feel scared, we sweat, our muscles contract and our mouth gets dry.
When we think about dinner, our salivary glands start producing more saliva.
When we perceive danger, our pupils dilate and our heart goes faster.
When we live our lives feeling constantly under threat (even unconsciously), repeating emotional and physiological stress responses over and over again, our body’s normal functions become chronically affected.
Trauma impacts much more than just our prefrontal cortex or our behavioral activation system. It impacts our whole being and must be treated from a holistic perspective.
Rest is not enough. Chronic thought patterns do not come from conscious thinking. They come from subconscious roots. They come from the past (trauma).
There are several approaches that can be helpful in overcoming the effects of trauma but research has shown that somatic modalities, in alternative to, or combined with talk/cognitive therapy may offer a more successful answer to long-term treatment for trauma. When affect can be processed through the body first, and then through a cognitive process, efficacy seems to increase.
Some somatic modalities:
Somatic Experiencing (Peter A. Levine)
Feldenkrais Method (Israeli Moshé Feldenkrais)
EMDR (Francine Shapiro, Margot Silk Forrest)
Sensorimotor Psychotherapy (Pat Ogden)
The Safe And Sound Protocol (Stephen Porges)
Biodynamic Psychology and Psychotherapy (Gerda Boyesen)
Trauma has cure. When the body recovers the capacity to self-regulate, it restores its balance, gaining a new experience of being alive, and a renewed sense of safety. The person restores the ability to experience a joyful and connected life filled with deep, meaningful relationships.
Healing from trauma means:
Stress hormones lower and the body can produce more “feel good” hormones such as serotonin and oxytocin;
Improve or recover the ability to focus and concentrate;
Learn to remain calm in the face of situations, thoughts, sounds, or physical sensations that normally activate responses learned in the past survival 'mode';
Recover the feeling of being completely alive in the present and connected with others;
Integrate the security of living authentically, without the need to keep secrets about oneself, including the adaptive ways used in the past - live more authentically;
Feel free to know and feel your truth without being overwhelmed, nervous, embarrassed, or blocked;
Recovery of the functional ability to perform tasks (productivity) with purpose;
Confidence to play and express creativity.
By combining the wisdom of the body and the awareness of the mind, we can built the safety to respond to our unmet needs, release the energy trapped in our defensive system and allow the re-signification of our life experience. Breaking patterns, creating new neural pathways, and changing the narrative of our lives.
“I came to the conclusion that human beings are born with an innate ability to triumph over trauma. I believe not only that trauma is curable, but that the healing process can be a catalyst for a profound awakening—an opening to genuine spiritual and emotional transformation.I have no doubt that, as individuals, families, communities, and even nations, we have the ability to learn how to heal and prevent much of the harm caused by trauma.In doing so, we significantly increase our ability to fulfill individual and collective dreams. ”Peter A. Levine
Payne P., Levine Peter A., Crane-Godreau Mardi A. (2015) Somatic experiencing: using interoception and proprioception as core elements of trauma - Frontiers in Psychology, vol. 6, pag. 93.
Hays, Johanna T. (2014) Healing trauma in the psyche-soma: Somatic experiencing® in psychodynamic psychotherapy - Pacifica Graduate Institute. ProQuest Dissertations Publishing, 3611759.
Levine, P. (2010). In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. Berkeley, CA: North Atlantic Books.
Van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind and Body in the Healing for Trauma. New York, NY: Penguin Press.