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People respond to negative events in different ways. Trauma is the emotional response when a negative event is overwhelming. When thoughts and memories of the traumatic event don’t go away or they get worse, they may lead to posttraumatic stress disorder (PTSD), which can seriously disrupt a person’s life.
Trauma can affect how a person feels. He or she may experience:
Trauma can affect a person’s ability to have satisfying relationships with others. This may include:
not knowing how to trust
having difficulty being close to people
having problems in sexual relationships
being afraid of others
being isolated and withdrawn
not recognizing when he or she is in a dangerous situation
not knowing how to give and take in relationships
repeatedly searching for someone to rescue him or her.
Trauma can affect the body. The person may experience:
body memories and flashbacks (a feeling of reliving the traumatic experience, e.g., seeing images, hearing voices or sounds, smelling odours, experiencing unexplained tastes and physical sensations)
sleep problems, including nightmares
physical complaints (e.g., headaches, nausea, stomach aches, pelvic pain, stomach/digestive problems) for which no medical cause can be identified
Trauma can affect how a person thinks. This may include:
Trauma can affect how a person behaves. He or she may:
inflict self-injury (e.g., cutting, burning)
engage in addictive behaviours (e.g., self-starvation, binge-eating, drug/alcohol misuse)
constantly look for sexual relationships, or avoid them
be abusive toward others.
People who experience repeated trauma tend to have more severe symptoms. Also, the earlier the trauma, the more severe the symptoms are likely to be.
Trauma is caused by negative events that produce distress. These events can be physical, sexual or emotional in nature. Some of the most common traumatic events include:
physical, sexual and verbal assault, including childhood abuse
being threatened with physical or sexual assault
witnessing violence against others
long-term neglect in childhood
accidents and natural disasters
war or political violence.
Most skilled therapists are trained in several types of treatment, which they may use in combination or alone. All treatment approaches should follow the stages of the trauma therapy model. Effective therapists adapt the different treatment approaches to best suit the client.
Here is a brief description of the main therapeutic approaches:
Psychoeducation teaches trauma survivors about different psychological processes and their effects. The therapist may explain that what the person is feeling and doing is typical of reactions that other survivors also describe. Understanding that these reactions are normal may help the person feel less isolated or “crazy.”
The therapist may explain the short-term and long-term effects of trauma and how trauma can affect the body, emotions and development. The therapist may also give the client information about abuse and neglect.
The therapist provides information throughout therapy, depending on what the client and therapist are discussing and dealing with at the time.
Cognitive-behavioural therapy (CBT) focuses on helping the client become aware of how thoughts, attitudes, expectations and beliefs can contribute to feelings of unhappiness. The client learns how certain beliefs, which he or she may have developed in the past to deal with difficult experiences, are no longer helpful or true in the current situation. For example, the therapist may help a client who was physically abused as a child to explore and question the mistaken belief that he or she is responsible for the abuse.
CBT can also involve exposure techniques. These strategies are particularly helpful for people with simple posttraumatic stress; that is, those who have been traumatized by a single event. Exposure therapy involves gradually exposing the person to the feared situation.
CBT can also help the client to develop coping strategies to reduce anxiety. Strategies may include breathing retraining and relaxation and visualization exercises.
Eye movement desensitization reprocessing
Eye movement desensitization reprocessing (EMDR) is a psychotherapy technique used to treat trauma responses, such as anxiety, depression, panic, sleep disturbance and flashbacks. EMDR is not a complete therapy system; it is a technique that can be used within a broader therapeutic approach to treat trauma.
The idea behind EMDR is that people who have experienced trauma have stored memories of the trauma without adequately processing them. EMDR stimulates the brain’s natural information processing mechanisms, allowing the “frozen” traumatic memories to become integrated.
EMDR can only be done by a properly trained clinician.
Many people with posttraumatic stress find that medication gives them relief from sleeplessness, depression, panic attacks and other trauma reactions. Only medical doctors, including psychiatrists, can prescribe medication. The doctor should be trained in understanding trauma as well as in prescribing psychotropic drugs (medications used to treat mental health issues). Medication can help to manage some of the effects of trauma, but it is not a complete solution, and is best used along with psychotherapy.
Trauma affects the body and the mind, so therapy should address both. Body psychotherapy targets the physiological reactions to trauma. Sensorimotor psychotherapy is a type of body psychotherapy that helps trauma survivors deal with disturbing bodily reactions. It can help them manage and disconnect physical feelings from trauma-based emotions. Therapists who practise sensorimotor psychotherapy will sometimes touch clients, but only when clients give consent.