Trauma Treatment

Trauma is defined as “a single event, multiple events, or a set of circumstances that is experienced by an individual as physically and emotionally harmful or threatening and that has lasting adverse effects on the individual’s physical, social, emotional, or spiritual well-being” (Center for Substance Abuse Treatment [CSAT], 2014, p. 7).

The United States Department of Veterans Affairs estimates that “seven or eight out of every 100 adults will have post-traumatic stress disorder (PTSD) at some point in their lives” (Veterans Affairs [VA], n.d, para, 4). These statistics point out that about eight million adults in the United States would meet the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) criteria for a clinical diagnosis of PTSD during a given year (Veterans Affairs, n.d). However, these statistics only consider a small portion of the population and negate those who do not formally qualify for a clinical diagnosis of PTSD. The DSM-5 provides a limited definition of trauma that requires “exposure to actual or threatened death, serious injury, or sexual violence” (APA, 2013, p. 271). However, there are events in one’s life that have the potential to cause trauma such as extreme emotional abuse, losses or separations, humiliation, coercion, and yet not violent sexual experiences. The DSM-5 definition of trauma undervalues the scope of actual trauma in American society.

The most common type of trauma I’ve seen as a clinician is interpersonal, which is defined as “emotional abuse, emotional neglect, physical abuse, physical neglect, and/or sexual abuse in childhood and/or adulthood” (Mauritz et al., 2013, p. 3; Andrews et al., 2000). Researchers have found that interpersonal trauma can cause severe mental illness, PTSD, Complex PTSD, and dissociative disorders (Mauritz et al., 2013). Trauma responses vary depending on the type of trauma and the frequency of its occurrence. However, some responses to trauma are major depressive disorder, anxiety, panic, dissociation, somatic symptoms disorders, substance use disorders, and personality disorders.

Research has shown that trauma impacts three primary dimensions of life: Attachment (relationships), emotional regulation, and self- perception (beliefs about oneself and beliefs about the world) (Friedrich, 1995). Dysfunctions in these dimensions of life will cause significant distress or impairment in social, occupational, or other important areas of functioning (APA, 2013).

Recommendation for Treatment

Trauma treatment is often divided into three interconnected phases: safety, remembrance and mourning, and reconnection (Herman, 1997). The first phase of treatment would help the client focus on creating safe relationships and emotional regulation by increasing her capacity for emotional awareness and emotional expression. Moreover, during this phase of treatment, the goals are to improve day-to-day function and help the client manage PTSD symptoms, thus decreasing suicidal ideation. Four primary therapeutic interventions would be necessary during this phase, including building a therapeutic alliance between client and therapist, psychopharmacology, psychoeducation, cognitive behavioral therapy (CBT), and mindfulness.

The second phase of treatment would consist of transforming, reconstructing and integrating life before the traumatic event with life after the traumatic event. During this phase of treatment, a recommended intervention would be eye movement desensitization and reprocessing(EMDR). Research has shown that “after EMDR people thought of the trauma as a coherent event in the past, instead of experiencing sensations and imagines divorced from any context” (Van Der Kolk, 2015, p. 257).

The third phase of treatment would be reconnection. The process of reconnecting is focused on helping individuals develop healthy relationships with themselves and others. To emphasize the importance of safe relationships, Dr. Bessel Van Der Kolk, M.D., writes, “being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives” (Van Der Kolk, 2015, p. 81). If the individual who has suffered trauma has supportive and caring relationships the prognosis would point towards healing and recovery.

In conclusion, trauma is a pervasive problem in American society. Depending on the severity of one’s experiences, trauma treatment may require continued attention from medical and mental health professionals. If you have experienced trauma, seek help. Find a therapist that you trust and be an active participant in your healing journey. Trauma treatment is designed to help individuals create safe relationships, promote self-regulation, and foster positive self-perception. Healing might take some time, but you are not alone in this journey.

References:

Andrews, B., Brewin, C. R., Rose, S., & Kirk, M. (2000). Predicting PTSD symptoms in victims of violent crime: the role of shame, anger, and childhood abuse. Journal of abnormal psychology, 109(1), 69.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5 th ed.). Arlington, VA.

Briere, J. N., & Scott, C. (2014). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment (DSM-5 update). Sage Publications.

Center for Substance Abuse Treatment. (2014). Trauma-informed care in behavioral health services.

Department of Veteran Affairs, (n.d). How common is PTSD in Adults?. Retrieved July 25, 2021, from https://www.ptsd.va.gov/understand/common/common_adults.asp

Herman, Judith. (1997). Trauma and Recovery. Basic Books.

Mauritz, M. W., Goossens, P. J., Draijer, N., & Van Achterberg, T. (2013). Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness. European journal of psychotraumatology, 4(1), 19985.

Van Der Kolk, B. A. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.