"Fear not, for I am with you; be not dismayed, for I am your God; I will strengthen you, I will help you, I will uphold you with my righteous right hand." Isaiah 41:10
We have received a number of questions related to the topic of trauma and have decided to put together some FAQs to address the commonly asked questions.
What actually constitutes ‘trauma’ over ‘adverse experiences’?
One of the simplest definitions of trauma is an experience that is “anything other than the nurturing”.
Trauma can thus be thought of as any experience that overwhelms your thoughts, emotions, or body. This is admittedly a very broad definition and trauma is not a specific condition or diagnosis in its own right, but in clinical practice what matters most is not how severe the traumatic event(s) was, but the extent to which it has affected the victim of the trauma.
Adverse childhood experiences (ACEs) have been demonstrated in psychiatric research to increase the risk that someone will develop a range of mental health (and physical health) difficulties later in their life. These include, but are not limited to: bereavement; any form of abuse of neglect; parental separation; and previous mental illness. Significant adverse experiences can also occur in adult life.
What therapies actually work for trauma?
It should be emphasised that post-traumatic stress disorder (PTSD) is just one of the conditions that may result from a traumatic experience; others include depression, other anxiety disorders (such as panic disorder) and in some cases psychotic disorders. Trauma does not necessarily result in PTSD, as the response to trauma vary from person to person, and the absence of a PTSD diagnosis does not indicate the absence of trauma.
There are a number of evidence-based therapies for the range of trauma-related conditions, including PTSD, other anxiety disorders and depression. Trauma-informed therapy usually occurs in several phases. Initially it aims to provide the affected person with a sense of safety and stabilisation. This is followed by the delivery of interventions that help them to process the trauma without it activating the mind and body in a distressing manner, one of the hallmarks of significant trauma. Lastly, the therapy should enable them to re-integrate into society, as significant trauma often results in social withdrawal and avoidance of day-to-day activities.
The National Institute for Health & Care Excellence (NICE) recommends the use of psychological interventions as first-line treatment for people with PTSD symptoms and medication as second-line treatment.
Common psychological therapy modalities that have an evidence base for treatment of PTSD include eye movement desensitisation and reprocessing (EMDR) and trauma-focused cognitive behavioural therapy (TFCBT). The former is useful when the patient is reluctant to talk about the trauma, whilst the latter is generally indicated only where there have been two or less traumatic incidents. An initial brief course of TFCBT may consist of 8-12 one-to-one sessions with a trained therapist.
Narrative exposure therapy (NET) is an evidence-based time-limited therapy which exposes trauma victims (in a therapeutically safe environment) to the memories of traumatic events and aims to reorganise these memories into a coherent chronological narrative, thus reducing the fear of the trauma and reducing the PTSD symptoms. A typical course lasts for approximately six months of weekly individual sessions.
EMDR can be particularly helpful for people who have difficulty talking about their traumatic experiences. However, a number of therapy approaches are often adopted during a course of trauma therapy.
These therapies are delivered by therapists trained in their use.
Does all trauma have to be addressed to be healed?
Trauma responses may vary from person to person – they are not predictable – and there is thus no one size fits all approach to tackling trauma. In some cases, trauma or related symptoms will resolve spontaneously, without professional support. Other people may benefit from support by family members, friends or others, e.g. their church community.
However, for some people trauma-related symptoms may persist for a significant period of time without professional support. Adverse trauma responses are often a way of protecting ourselves from further danger, which may be seen as useful at first. However, as time passes and one would expect that the apparent danger has in fact past, there is an exaggerated response to perceived ‘threats’ and this prevents people from feeling safe or conducting their lives as they normally would.
What are the dangers in accelerating trauma recovery?
There is little evidence to support initiating trauma therapy soon after the traumatic incident. The trauma symptoms may naturally resolve without any formal intervention and techniques such a ‘debriefing’ after an event have not been shown to promote recovery.
What can go wrong when people meddle with trauma who are not qualified?
Trauma-informed therapy should be conducted by a suitably qualified professional. This would typically be a Psychologist, Psychotherapist, Counsellor or Psychiatrist. You should never feel hesitant in asking the clinician about their level of training in trauma-based therapies and about their approach to tackling trauma related issues.
An experienced clinician will provide a clear framework for how the trauma will be addressed and should also recognise when to slow things down e.g. if working through the trauma is proving to be too challenging or there are other factors that may make the therapy less effective than it should be, it may be necessary to pause therapy for a period of time.
Without this level of expertise, there is a danger that the process of trauma therapy may be destabilising i.e. the trauma symptoms may actually be worsened and recovery impaired.
We hope that this information provides useful information about how trauma affects people and some of the support available for people affected by past traumatic experiences. We recommend that anyone significantly affected by trauma-related symptoms seeks help from a healthcare professional to discuss the treatment options available.
Further information on trauma:
Dr Chi-Chi Obuaya is a Consultant Psychiatrist working in the NHS and in independent practice, as well as a Mind & Soul Foundation Director