Trauma

How your brain responds to extreme stress

When I first started in clinical practice, I was trying to decide what to specialize in. Then my specialty found me, trauma. It was disguised, though. I worked with clients who presented with depression, anxiety, hated their jobs, hated people, couldn’t set boundaries, thought they might have ADHD/ADD, avoided socializing, couldn’t maintain significant relationships, or had low self-esteem. When we drilled down deeper into the sources of their symptoms, it frequently led back to trauma.

 In some cases, it was what we refer to as big “T” trauma; a big event that most would consider traumatic, like a plane crash or mass shooting, something life threatening. There were also the ones we refer to as little “t” traumas; these are traumas on a more personal level such as emotional abuse, neglect, abandonment, or bullying, which aren’t life threatening but can cause emotional injury depending on how chronic the experiences are and the period of brain development the person is in at the time. Neither is more impactful than the other. They can both be the cause of trauma related symptoms.

HOW TRAUMA AFFECTS THE BRAIN

I Will Survive

 Everything about you is hardwired for survival. When confronted with a threatening situation, your body and brain adapt to the situation. Adaptations can include being on constant alert, shutting down, or mistrust. That’s right—the symptoms we use to identify trauma are the very adaptations that helped you survive it. But, if those adaptations helped you then, why do they keep showing up now, when you no longer need them; why do they keep you from having the life you want?

Cinnamon Buns and Hand Grenades

The answer involves a lot of scientific research about brain function and the nervous system. Bessell van der Kolk’s book The Body Keeps the Score does a fantastic job of explaining the research on how trauma affects the brain and the body (yes, your body stores trauma, too!). The simple answer is neurons that fire together wire together. When we experience an event, be it good or bad, our brains store the sensory information (smells, sounds, etc.,) along with the emotional reaction we have. For some of us, the smell of cinnamon buns reminds us of grandma’s house and invokes feelings of nurturing and well-being. That feeling and that smell are wired together. For others, loud sounds remind us of gunfire and grenades, and invokes deep feelings of fear and danger. The emotions attached to the memory can be so strong, it can feel as though it is happening now. What about intrusive thoughts? Why do I think about the event when I don’t want to, and why does it seem like it’s on a replay loop?    

Surviving and Thriving Aren’t The Same Thing

Our brains are very efficient when it comes to keeping us alive. When we are in survival mode, all our mental and physical resources are devoted to getting safe. That means certain processes pause, like digestion or cognitive processing. When the event has passed, those processes usually restart on their own. When the brain attempts to process the event (because it naturally moves toward self-healing), it can feel overwhelmed. The flood of somatic stimuli and emotions can cause the logical brain to go off-line leaving the survival brain in charge. When this happens, the brain can’t differentiate between past and present (a flashback). This re-triggers survival mode, causing cognitive processing to stop again. This start-stop processing loop, which involves flashbacks, nightmares, intrusive thoughts, panic attacks, dissociation, can go on for years. Essentially, the experience is stuck, unable to process. 

Getting Unstuck 

At this point, you have hopefully recognized that trauma responses have nothing to do with your fortitude, character, or strength. They are hard-wired physiological protective mechanism. That’s why so many people share some of the same adaptations to the same types if stressors. These shared reactions allow us to study and develop evidence-based treatments for trauma.   

Eye Movement Desensitization and Reprocessing (EMDR)

This treatment has been around since the late 1980s. Initially, people were skeptical, including me. It looked weird compared to the talk therapies of the day, and the results just seemed too good to be true. I waited and watched to see where it would go. When I saw the research, saw who was endorsing it as an evidence-based practice, and met people who had experienced it, I was finally in. I will go into more detail about how EMDR works in another post, but what is important is the results. Many people experience deep and rapid results. As a practitioner of EMDR, I never cease to be amazed when I see someone process something in a few sessions that used to take months for someone to process with talk therapy. You can learn more about EMDR from the EMDR International Association or from the Veteran’s Administration.

Trauma Focused Cognitive Behavioral Therapy (TF-CBT)

I’m not against talk therapy. It has an important role in treating trauma, and it goes well with EMDR. TF-CBT works to educate clients about their symptoms and how the triune brain works, and then build both cognitive (thinking) and behavioral strategies for managing symptoms. Talk therapy can also help challenge cognitive distortions, irrational and negative beliefs about ourselves that develop as a result of the trauma (read more about how shame and self-blame are adaptive responses to trauma here). I used TF-CBT for years to treat PTSD, and it was helpful. But I have found that EMDR provides much deeper healing and results come more quickly. You can learn more about TF-CBT here.  

Prolonged Exposure Therapy (PE)

This therapy is a form of Cognitive Behavioral Therapy that works to desensitize you to the trauma. It focuses on reducing avoidance of the memory, talking about it repeatedly, looking at the memory from different angles for perspectives that you hadn’t considered, and uses “in vivo exposer” (in vivo meaning real life), all in an effort to reduce your response to the memory and associated stimuli (triggers). Talking or writing about, or imagining the event repeatedly helps to desensitize and prepare you for real life exposure to elements of the experience. During all of this, you are taught calming and thinking techniques to keep your brain and nervous system on-line. This is a similar approach to how phobias are treated. While it is effective for some, others find it destabilizing, re-traumatizing, or too intense. While I have used desensitization strategies when treating phobias, this is a treatment I have preferred not to use for trauma due to the drawn-out intensity of the experience for clients. My opinion aside, PE is endorsed by the Veteran’s Administration and the American Psychological Association as an evidence-based treatment which you can read about here.

I’ve been licensed since 2000 and working with trauma during most of my career. I do not endorse EMDR simply because it is the treatment I provide. I specifically pursued education and training in EMDR because of the research I’ve read and results I’ve observed. There are several treatments for trauma that are evidence-based. I encourage those struggling with trauma to learn about what options are available to them. That might include basic web searches, reviewing research literature, talking to family or friends, or joining forums. Regardless of what approach you think is best or who is best to provide it, get the help you need. Get the help you deserve. You don’t have to carry it anymore. 

Sunny Street, M.Ed.

Licensed Clinical Mental Health Counselor, North Carolina

Licensed Professional Counselor, South Carolina

Licensed Mental Health Counselor, Florida