Trees through a glass ball showing how PTSD and Trauma can affect perception

We were recently interviewed for an article about trauma in a Brazilian magazine. The questions and answers which came up should prove to be useful information for anybody looking to find out more about PTSD and Trauma recovery.

What is the difference between a ‘normal’ trauma and a big trauma, such as surviving a school shooting? Are the symptoms different? Does one ‘matter’ more than the other?

There isn’t really a ‘normal’ trauma, as trauma by its very nature is always overwhelming, disturbing and disruptive and whatever its origin can have a significantly adverse impact on a person’s physical and psychological well-being. Thus every trauma matters. However, certain types of trauma, especially when they involve intended harm, violence, cruelty, killings and injuries inflicted on humans by other humans, involving the loss of children or closed loved ones are usually much harder to come to terms with. Further the effect of some of these ‘larger scale’ traumas does not only severely impact those directly affected but its shock also ripples into and affects whole communities and larger social networks. The initial symptoms for those affected would be those of an Adjustment Disorder to stressful life events and may include secondary symptoms of traumatic grief, depression, anxiety and a number of dissociative symptoms. After a month’s time these may develop into Post Traumatic Stress Disorder (PTSD). Trauma affects each person differently depending on a variety of underlying factors, including their developmental age, the internal and external resources available to them, their life circumstances, including their past life history, emotional maturity and resilience, their family and support network, their health, the help and support provided during and immediately following the trauma and others. Thus it is very difficult to make predictions as to the effect on each individual, however, the psychological consequences of such events can be enormous on a person’s life.

What effect does time have on PTSD and trauma? Does time make it easier to live with it? Why?

Time itself does not usually help people to recover if a trauma has been totally overwhelming and the person has been affected by PTSD, as this would have led to neurophysiological changes in the body, which do not get healed by time alone. On the surface it may seem that those affected by PTSD have come to terms with the impact of their trauma, because it is difficult for outsiders to glean the actual internal psychological wounds people may be carrying. People may have learnt to adjust through processes of dissociation from the traumatic experiences and by avoiding reminders of the events that happened. This can lead to a heavily restricted quality of life and those affected by PTSD often can’t share with others how they are truly feeling inside. The PTSD may affect their ability to maintain close relationships with others, they may alternate between feelings of numbness and shut-down and feelings of hyperarousal, flashbacks and irritability. They may be on constant alert to potential triggers in their environment. Their sleep might be very disrupted and they may be plagued by nightmares and bad dreams. They may also suffer from concentration problems and their day-to-day memory may be affected. Many sufferers of these symptoms adapt by splitting into a so-called “Apparently normal functioning” Personality (ANP) part that is oriented towards helping them get on with life as best as possible, while attempting to keep away or dissociate from the emotional, traumatised parts of self (EPs). These EPs stay stored away in subconscious or unconscious memory systems often in the form of body memory, from which they interfere at unbidden times with a person’s ability to functioning.

Do you have any data that proves the efficiency of therapy or medicine in helping trauma survivors?

Organisations such as NICE (National Institute for Health and Care Excellence) and WHO (The World Health Organisation) collate and systematically review research studies to arrive at their national and international guidelines. Research findings suggest that currently the most effective forms of psychological therapy for trauma are Trauma-focussed Cognitive Behavioural Therapy (TF-CBT) and Eye Movement Desensitization and Reprogramming (EMDR). The NICE guidelines recommend that medication should not be used as a first line of treatment for trauma, further underlining the credentials of TF-CBT and EMDR in trauma treatment. For more complex and multiple traumas there is a growing body of anecdotal evidence from practitioners in the field that Comprehensive Research Model (CRM) and body-sensitive trauma therapies such as Sensorimotor Psychotherapy or Calatonia may also be integrated into the therapeutic process with positive results. The aim of any type of trauma therapy should be to enable a client to re-visit their traumatic experiences under specific conditions of safety created in the here-and-now of the therapy. This allows the full emotional and sensory content of their experiences and its impact on their life to be remembered and integrated in a way that creates new understanding, meaning and eventual relief from the disturbing effects of the trauma.

How can trauma evolve into PTSD? How common is it?

Most people can be expected to have some negative reaction in response to severe adverse traumatic events of a horrific nature. For many people these symptoms ease after a while. However, if these symptoms do not ease or they increase and get more severe and last beyond a four week period, people may go on to develop PTSD. This would need to be assessed by a properly qualified trauma specialist as assessment needs to take place under safe conditions and it is not easy to achieve for those not trained in this. Current estimates indicate that 1 in 5 people who experience a traumatic event go on to develop symptoms of PTSD.

What is the most important thing that can be done to help someone who recently had a traumatic experience?

The most important first step is to create conditions of external safety for a person who has recently had a traumatic experience. Additionally, they need to be gently supported ideally by people who are knowledgeable about the potential effects of trauma. They need to be provided with an environment where they are given the opportunity to talk about anything they are able to share without being pushed into disclosing anything they are not ready to touch on. If they experience emotional release this can be helpful as long as they are supported in an appropriate way. It may also be helpful to inform them about potential symptoms in response to trauma in a way that doesn’t overwhelm them. It would help if they could be monitored very gently (watchful waiting) to assess how they respond in the longer term and if their initial reactions are easing or increasing. If there is any concern that they may be developing PTSD or other trauma-related complications it would be helpful to offer them an assessment with a specialist trauma professional with a view to finding out what therapeutic approach might be most helpful for them. The person supporting them or they themselves may also find my book: ‘Overcoming traumatic Stress: A Self Help Guide Using Cognitive Behavioural Techniques (2nd Edition, 2017)’ helpful.

Why does trauma ‘stick’ to the traumatised person? Why does it not go away easily?

Overwhelming traumatic events activate our inherent emergency survival responses which are controlled by our autonomic nervous system. Under normal conditions once the danger is over the system should slowly reset and go back to a baseline of ‘safe and normal’ so that a person can regain their sense of equilibrium and calm. However, when trauma has been extremely severe, horrific, ongoing and life changing, the initially adaptive emergency response may fail to shut off and the body may continue to get flooded by high levels of stress hormones. This will maintain the sense of danger and prevent the autonomic nervous system from re-setting to normal functioning. A person’s system remains on ‘red alert’ leading to uncomfortable symptoms that are associated with PTSD, such as memory flashbacks, nightmares, disturbing emotions and body sensations and many others. This can lead to a ‘vicious cycle’ of trauma where a person alternates between autonomic shut-down and high-arousal states, which maintain the sense of danger and keep up this cycle. Once the responses to trauma get ‘stuck’ in such a way a person needs professional support from a trained trauma therapist who knows how to help with recovering from this. Depending on the severity of the trauma and the longevity of the PTSD specialist trauma treatment may take some time, but in most instances people can recover.