Trauma is typically defined as life-threatening experiences or a significant threat to one’s (or someone close) physical and psychological wellbeing. And, unfortunately, trauma is omnipresent – for instance, the loss of a loved one is inevitable, and sometimes it happens in the least expected way and time. In addition, we may face our own or a family member’s life-threatening illness. Despite these possibilities, not everyone develops Post-traumatic Stress Disorder (PTSD) or other psychopathology after traumatic events.
The severity and chronicity (or the number of trauma exposures), as well as the nature of trauma, are used as predictors of individual differences in post-traumatic reactions. Indeed, trauma is sometimes seen as on a dimensional scale from less complex to complex, and the dichotomy of childhood vs. adulthood. Of these, childhood complex trauma is known to be closely related to psychopathology. Childhood complex trauma is often characterised as its long-term chronicity (repeated exposure to trauma), severity (threatening to life and/or physical/psychological wellbeing as opposed to non-life threatening), and nature (e.g., interpersonal as opposed to natural disaster). It is believed that childhood complex trauma affects multiple domains of the individual’s life, including the following:
- intra-personal e.g., emotion regulation, self-concept;
- interpersonal e.g., attachment;
In severe cases, traumatic experiences may affect an individual’s memory and identity at a significant level (e.g., Dissociative Identity Disorder).
Symptoms of Post-traumatic Stress
Even if there is no history of childhood complex trauma, you can experience posttraumatic stress symptoms. It is important to seek professional assistance if you are not coping with your physical, cognitive, behavioural and/or emotional symptoms of psychological trauma. For instance, are you experiencing the following symptoms?
- Intrusion symptoms: intrusive thoughts, visual images/flashbacks, nightmares, feeling very upset with strong physical reactions when something reminded you of the event
- Avoidant symptoms: avoiding memories, thoughts, feelings associated with the event, people, places, and situations that remind them of the event
- Cognition and mood change: trouble remembering important parts of the event, having strong negative beliefs about yourself/others, the world, fear/anxiety, depression, anger, numbness, and/or excessive guilt and shame
- Arousal and reactivity: excessive alertness, easily startled, feeling jumpy, difficulty concentrating, trouble falling or staying asleep
These symptoms represent four clusters of Posttraumatic Stress Disorder (PTSD). However, other psychopathology may also be experienced, such as depression and social anxiety, etc.
One of the unhelpful coping styles commonly used among traumatised individuals is ‘avoidance’ of any reminders (cognitive, physical, situational, emotional reminders) and such individuals may use suppression, social isolation, drug/alcohol, and/or other impulsive and unhelpful behaviour (e.g., gambling, impulsive shopping, impulsive sex with multiple partners, workaholia). All of these are aimed at avoiding/numbing the emotional pain. However, avoidance is one of the major maintaining factors in psychopathology, and it is only helpful over a short-term.
There are many different approaches when treating posttraumatic symptoms, depending on trauma history, symptoms, the individual’s preference, and the therapist’s expertise. The following evidence-based methods are found to be useful to different degrees and for different presentations:
- Prolonged Exposure Therapy / Cognitive Behavioural Therapy (CBT);
- Eye Movement Desensitisation and Reprocessing (EMDR);
- Dialectical Behavioural Therapy (DBT);
- Schema Therapy;
- Cognitive Processing Therapy.
My approach is eclectic, combining ingredients from different therapeutic approaches, especially when the trauma experienced is complex. There is useful information for individuals with a history of trauma and their families at the Australian Centre for Posttraumatic Mental Health (www.acpmh.unimelb.edu.au) and The National Child Traumatic Stress Network (http://nctsn.org/trauma-types/complex-trauma) websites.
From a different, positive psychology perspective, more and more researchers and clinicians are interested in posttraumatic growth. Although this is not a new concept, this approach focuses on the resilience of the human being and the process of transformation to a positive, meaningful life after traumatic events. And this is what I am passionate about when it comes to treating individuals with a history of trauma.