Many people will experience a traumatic event in their lifetimes – something involving physical harm or the violation of their basic rights. Trauma can also come in the insidious and low-grade form of long-term emotional abuse. Of the millions of people who experience trauma, some will develop post-traumatic stress, a pattern of anxiety-like symptoms that can become severe enough to interfere with daily living, at which point it is called post-traumatic stress disorder.
Post-traumatic stress results from feelings of helplessness and terror when the brain’s normal response to intense stressors (the “fight or flight” response) is insufficient. As a result, the brain’s ability to process and store the memories of the traumatic event is compromised. Reminders of the traumatic event (“triggers”) prompt the same fearful, trapped, helpless response as the brain and body struggle and fail to move through the difficult memory. Triggers can be obvious – such as sexual activity in the case of rape survivors, driving in those who survived a car accident, or a partner’s anger in someone who has left an abusive relationship. But they can also be subtle and subconscious – a smell, a sound, the accelerated heart rate from exercise or “good” stress, or feeling vulnerable with a partner or friend. Many people with PTSD are not consciously aware of all their triggers and live in a state of frequent anxiety and high adrenaline or else numbness and shame, pushing others away and not knowing why.
Traumatic memories do not need the severity of PTSD in order to interfere with functioning. Many people have what trauma therapists sometimes call “small-t traumas.” These are difficult, stressful, and often shameful memories from the past that cause or worsen ongoing mental health issues, especially anxiety and depression.
Trauma treatment is a little different from other forms of therapy. If you want to address trauma in psychotherapy, your best option is to find a provider who is 1) trained in a method of treatment specifically for trauma, and 2) trained in more than one of these methods. Your ideal provider is someone who has a flexible and varied toolkit to address the different ways in which trauma manifests itself. Why is trauma therapy different from standard psychotherapy? In PTSD, the words of trauma researcher Bessel Van Der Kolk, “the body keeps the score.” Trauma involves the deeper, instinctive levels of the brain, the levels that involve our body sensations and tell us whether we are safe or in danger in any given moment. Regular talk therapy, while an important part of trauma work, misses a vital component if it does not include working directly with the body and the associated autonomic nervous system. Therapies that incorporate the body and its unconscious wisdom such as Babette Rothschild’s somatic trauma therapy, EMDR, and even DBT (in the form of self-regulation skills) speak directly to the activated threat center of the brain. Once we build a foundation of safety and self-regulation from the “bottom up” while working with the body and the autonomic nervous system, then we clear the way to address the trauma with talk therapy strategies.