Those subjected to traumatization as children are, tragically, more likely to be re-traumatized as adults (Cloitre et al, 2009 -- [LINK]). When a traumatic experience occurs, a person's or community's sense of safety and well-being can be so damaged that normal ways of coping with things cannot be maintained, or don't seem to work. After a traumatic experience, victims may have problems that they did not have before the trauma. It is important to remember that unresolved trauma can live on to negatively affect the mental, physical, emotional, financial and spiritual health of individuals and their loved ones — even for years to come. Subsequent re-traumatization after childhood trauma is likely to lead on to more severe, and more complex trauma reactions. Those traumatized as children are both more likely to avoid social connection (Dorahy, 2010) and more likely to avoid close relationships with treatment providers (Fuertes et al, 2009; van der Kolk, 2005). In such circumstances it is natural to try to avoid experiencing the negative emotions that are a result of the trauma -- it is natural, but it is NOT helpful. Recent research has shown that "experiential avoidance" -- [LINK], active efforts to avoid exxperiencing negative emotions, likely contributes to both the severity, and the duration, of the effects of the trauma (Cameron, Palm, & Follette, 2010 -- [LINK]; Dulin & Passmore, 2010; Tull et al, 2011 -- [LINK], [LINK]). Thus, it is highly important that dysfunctional forms of emotional avoidance be avoided (dysfunctional forms result in more valued goals not being achieved).
- Symptoms of Trauma for Adults-- [LINK]
- Coping with Trauma -- General Tips -- [LINK]
- Positive Coping Actions -- [LINK]
- Lifestyle Changes to Consider -- [LINK]
- Peer Support Groups -- [LINK]
- Coping with Specific Symptoms -- [LINK]
Someone experiencing trauma may:
- not be familiar with how trauma can affect their life, and have trouble understanding what is happening to them
- feel like they are "going crazy"
- have upsetting memories such as images or thoughts about the event
- feel as if the trauma is happening again (flashbacks)
- have bad dreams and nightmares
- have a strong emotional reaction to something they see, hear, feel, smell, or taste that reminds them of the trauma
- have anxiety, fear or feeling like they are in danger again
- have angry or aggressive feelings, and feeling the need to defend oneself
- have trouble controlling emotions
- experience difficulty with concentration and memory
People can have physical reactions to a traumatic event such as:
- difficulty breathing, chest pains, or blood pressure problems (immediately consult a physician if you experience these symptoms)
- trouble falling or staying asleep
- feeling nervous and constantly looking out for danger
- being easily startled by loud noises
- discomfort with people coming up behind them
- feeling shaky and sweaty
- a pounding heart
A traumatic experience is upsetting and can cause uncomfortable thoughts, feelings and sensations. People often cope with these feelings by:
- avoiding people, places, and activities that remind them of the trauma (isolation)
- having trouble remembering parts of what happened
- shutting down emotionally or feeling numb
- feeling disconnected from the world as they knew it
- not feeling pain or other sensations
- losing interest in the things they used to enjoy
- staying really busy
It is not uncommon for a person who has been traumatized to experience any, or all of the mentioned behaviors. Because these behaviors only offer temporary relief, the person who has experienced a trauma may develop secondary symptoms such as:
- depression due to losses connected with the trauma
- despair and hopelessness out of fear that life will never be good again
- disruption of belief systems including spiritual beliefs and the idea that the world is good and safe
- difficulty trusting others
- aggressive behavior towards self or others
- self-blame, guilt and shame
- loss of relationships, because others do not understand what they are going through
Currently, "first line" clinical treatments -- [LINK] for posttraumatic stress disorder (as recommended by the US Government's National Centre for PTSD; and the Substance Abuse and Mental Health Services Administration SAMHSA, following the results of extensive multi-site randomized clinical trials) include: Prolonged Exposure, Cognitive Behavioral Therapy, and EMDR. However, large scale trials of Acceptance and Commitment Therapy are underway (Lang et al, 2012-- [LINK]. A number of these therapies now also have apps for mobile devices to assist in "in vivo" (real world) treatment -- important in ensuring the effects of therapist-assisted gains are achieved in people's everyday lives [LINK].
ALSO SEE -- New Haven Competency Conference -- Consensus Statement:
Cook, J. M., & Newman, E. (2014). A consensus statement on trauma mental health: The New Haven Competency Conference process and major findings. Psychological Trauma: Theory, Research, Practice, and Policy, 6(4), 300–307. doi:10.1037/a0036747 [LINK]
Another promising treatment, perhaps with special relevance to the treatment of Complex Trauma is Cognitive Processing Therapy (CPT):
- discussion of background -- [link]
- training guide for therapists -- [link]
although research using CPT has not been conducted specifically with patients with Complex Trauma, professional communications (with Jay Spence, June 6th, 2012) I have had with those conducting CPT treatment with patients suffering Posttraumatic Stress Disorderr (PTSD) have indicated that up to 50% of patients in their treatment groups have histories consistent with suffering Complex Trauma -- one program in particular with such experience is that offered by the This Way Up Clinic at the School of Psychiatry, University of New South Wales, Australia -- [link] -- email -- [LINK] -- especially promising is that this therapy program is available online, and shows signs of being "well-received" by clients (as research is showingn of a number of programs) as well as achieving some excellent clinical outcomes -- [LINK]. See also Stige (2011) for a discussion of a "stabilization group" for patients suffering trauma due to a variety of causes -- [link].
Such treatments primarily directly target acquired reactions to stimuli associaed with the initial trauma, and the way in which the cause of the trauma and their reactions to it are "interpreted". Successful coping is perceived as Active Coping -- approach to previously feared situations, and successful performance in desired and previously enjoyed activities, and non-engagement in Negative Coping -- dysfunctional forms of avoidance behaviour. Active Coping is different from the sort of avoidant coping referred to at the start of this article. But in order for active coping to be effective one must have an accurate gauge on one's reactions and of the stimuli that elicited them. An important element in Acting Coping is to ensure one has a range of coping strategies available, and to be able to choose flexibly between them depending on the circumstances and the values one places on alternative outcomes. As asked on the page on >Acceptance and Commitment Therapy -- [LINK]: "Given the distinction between you and the stuff you're struggling with and trying to change, are you willing to have that stuff, fully and without defence, as it is and not as it says it is, AND do what takes you in the direction of your chosen values, at this time and in this situation? Behavioral techniques of desensitisation and exposure can be incorporated with other ACT techniques to facilitate the "and do what takes you in the direction of your chosen values" -- the difference being ACT does not assume it is necessary to bring about changes in internal reactions, but action in the context of still experiencing those reactions, though change in those reactions may still occur. Thus, with ACT too, Active Coping occurs:
- When trauma survivors take direct action to cope with their stress reactions, they put themselves in a position of power. Active coping with the trauma makes you begin to feel less helpless.
- Active coping means accepting the impact of trauma on your life and taking direct action to improve things.
- Active coping occurs even when there is no crisis. Active coping is a way of responding to everyday life. It is a habit that must be made stronger.
Know that recovery is a process
Following exposure to a trauma most people experience stress reactions. Understand that recovering from the trauma is a process and takes time. Knowing this will help you feel more in control.
- Having an ongoing response to the trauma is normal.
- Recovery is an ongoing, daily process. It happens little by little. It is not a matter of being cured all of a sudden.
- Healing doesn't mean forgetting traumatic events. It doesn't mean you will have no pain or bad feelings when thinking about them.
- Healing may mean fewer symptoms and symptoms that bother you less.
- Healing means more confidence that you will be able to cope with your memories and symptoms. You will be better able to manage your feelings.
Certain actions can help to reduce your distressing symptoms and make things better. Plus, these actions can result in changes that last into the future. Here are some positive coping methods:
Learn about trauma and PTSD
It is useful for trauma survivors to learn more about common reactions to trauma and about PTSD. Find out what is normal. Find out what the signs are that you may need assistance from others. When you learn that the symptoms of PTSD are common, you realize that you are not alone, weak, or crazy. It helps to know your problems are shared by hundreds of thousands of others. When you seek treatment and begin to understand your response to trauma, you will be better able to cope with the symptoms of PTSD.
Talk to others for support
When survivors talk about their problems with others, something helpful often results. It is important not to isolate yourself. Instead make efforts to be with others. Of course, you must choose your support people with care. You must also ask them clearly for what you need. With support from others, you may feel less alone and more understood. You may also get concrete help with a problem you have.
Practice relaxation methods
Try some different ways to relax, including:
- Muscle relaxation exercises
- Breathing exercises
- Swimming, stretching, yoga
- Listening to quiet music
- Spending time in nature
While relaxation techniques can be helpful, in a few people they can sometimes increase distress at first. This can happen when you focus attention on disturbing physical sensations and you reduce contact with the outside world. Most often, continuing with relaxation in small amounts that you can handle will help reduce negative reactions. You may want to try mixing relaxation in with music, walking, or other activities.Distract yourself with positive activities
Pleasant recreational or work activities help distract a person from his or her memories and reactions. For example, art has been a way for many trauma survivors to express their feelings in a positive, creative way. Pleasant activities can improve your mood, limit the harm caused by PTSD, and help you rebuild your life.
Talking to your doctor or a counselor about trauma and PTSD
Part of taking care of yourself means using the helping resources around you. If efforts at coping don't seem to work, you may become fearful or depressed. If your PTSD symptoms don't begin to go away or get worse over time, it is important to reach out and call a counselor who can help turn things around. Your family doctor can also refer you to a specialist who can treat PTSD. Talk to your doctor about your trauma and your PTSD symptoms. That way, he or she can take care of your health better.
Many with PTSD have found treatment with medicines to be helpful for some symptoms. By taking medicines, some survivors of trauma are able to improve their sleep, anxiety, irritability, and anger. It can also reduce urges to drink or use drugs.LIFESTYLE CHANGES TO CONSIDER IF SUFFERING CONTINUES
People with PTSD need to take active steps to deal with their PTSD symptoms. Often these steps involve making thoughtful changes in your lifestyle. By making these changes, you can reduce your symptoms and improve your quality of life. Here are some positive changes you could make:
Have more contact with other trauma survivors
Other trauma survivors are a good source of understanding and support. This is often lacking in the health system -- I have often been treated more compassionately within the physical health care system, when people have known about my troublesome family background, than I have within the Psychiatric System. There are clear exceptions, if those psychiatrists have a "natural" interest in the implications of childhood abuse for adults -- by all means ask them this but if they don't respond positively, best ignore them unless you have a critical need -- this is especially the case if you''ve worked in the Health Care system like I have -- doctors themselves realise this and will tend to avoid their colleagues, or simply deny it, if they have mental health problems (Adams et al 2010 -- [LINK]). You could join a survivors' organization. By having contact with others who have had similar experiences, you will no longer be isolated, no longer as stigmatised, though even here, more education may be needed -- mental illness is more stigmatised in oursociety than criminal offending, something also very misunderstood. You will also begin to break down any distrust of others -- that takes time and positive experiences, but for people who are naturally inclined to being "disconnected" from society in general, and often even from "close others", extemely important.
It may be hard to take the first step and join a counselling group or other peer support group. You may have said to yourself, "What will happen there? Nobody can help me anyway." Many people with histories of trauma find it hard to meet new people. They have trouble trusting enough to open up to someone new. Yet it can also be a great relief to feel that you have taken positive action. You will learn that you are not the only one dealing with the types of feelings you have. In time you may also end up being friends with another survivor. Being part of a peer support group can also help with benefitting from other types of therapy -- [LINK].
Walking, jogging, swimming, weight lifting, and other forms of exercise often reduce physical tension. It is important to see a doctor before starting to exercise. If your doctor gives the OK, exercise in moderation can help those suffering emotional distress. Exercise may give you a break from difficult feelings. It may distract you from painful memories or worries. Perhaps most important, exercise can improve self-esteem. It may create feelings of personal control.
Survivors of trauma often think that the world is a very dangerous place. You may think it is likely that you will be harmed again. If you have been traumatised, living in a high-crime area may confirm these beliefs and make you more fearful. If it is possible, move to a safer area. It may then be easier for you to rethink your beliefs about danger. You may be better able to trust that you will be safe.
Volunteer in the community
Most people need to feel as though they can contribute to their community. You may not feel you have anything to offer others, especially if you are not working. One way survivors can reconnect with their communities is to volunteer. You can help with youth programs, health services, reading programs, sports activities, building housing, and in many other ways.
Stay away from drinking and drugs
Sometimes trauma survivors turn to alcohol and drugs to help them cope with distress and ill feelings. While these substances may distract you from your painful feelings for a short time, relying on alcohol and drugs always makes things worse in the end. These substances get in the way of treatment and recovery. Rather than trying to beat substance abuse or dependency (psychological or physical) by yourself, you may want to join a treatment program. It is often easier to deal with substance use if you can be around others who are working on the same kinds of issues.
Invest more in personal relationships
Most trauma survivors have a son or daughter, a wife or partner, or an old friend or work buddy. Make an effort to renew or increase contact with that person. This can help you reconnect with others, which in turn helps you cope with the ongoing effects of being traumatised. It will increase the chances you have to feel good and have fun. Others can offer you emotional support as you change your habits and behaviors.
PEER SUPPORT GROUPS
Peer support groups are a place where you can discuss day-to-day problems with other people who have been through trauma. Support groups have not been shown to reduce PTSD symptoms, but they can help you feel better in other ways. Because they can give you a sense of connection to other people, a peer support group could be a great addition to your treatment, or something you do after you finish an evidence-based treatment (PDF) for PTSD. Support groups can also help family members or friends who are caring for someone with PTSD.
Remember, if you are suffering from PTSD, is it important that you get treatment for PTSD as well. An evidence-based treatment provides the best chance of recovery from PTSD.
What are peer support groups like?
Peer support groups are led by someone like you who has been through a trauma. Groups often meet in person, but many groups also provide online (internet) support.
Sharing your story with others may help you feel more comfortable talking about your trauma. Or it may help to listen to other people talk about their experiences with a similar trauma. Peer support groups can help you cope with memories of the trauma or other parts of your life that you are having trouble dealing with as a result of the event. You may learn to deal with emotions such as anger, shame, guilt, and fear if you open up to others who understand.
When you connect with other people it can help you feel better. You can work together with others to get better at talking about your PTSD or learning how to ask for help when you need it. You might even share some of the materials from this web site to help others.
What are the benefits of joining a peer support group?
Joining a peer support group can help you to feel better in any number of ways, such as:
- Knowing that others are going through something similar
- Learning tips on how to handle day-to-day challenges
- Meeting new friends or connecting to others who understand you
- Learning how to talk about things that bother you or how to ask for help
- Learning to trust other people
- Hearing about helpful new perspectives from others
Peer support groups can be an important part of dealing with trauma, but they are not a substitute for effective treatment. If you have ongoing difficulties, or feel ar risk, you should consult a treatment professional.
COPING STRATEGIES FOR SPECIFIC SYMPTOMS OF TRAUMA
Unwanted distressing memories, images, or thoughts -- if you experience these as intrusive, remember part of the ACT question: "Are you willing to have that stuff, fully and without defence, as it is and not as it says it is?"
- Remind yourself that they are just that, memories
- Remind yourself that it's natural to have some memories of the trauma(s)
- Talk about them to someone you trust
- Remember that, although reminders of trauma can feel overwhelming, they often lessen with time
Sudden feelings of anxiety or panic
Traumatic stress reactions often include feeling your heart pounding and feeling lightheaded or spacey. This is usually caused by rapid breathing. If this happens, remember that:
- These reactions are not dangerous. If you had them while exercising, they most likely would not worry you .
- These feelings often come with scary thoughts that are not true. For example, you may think, "I'm going to die," "I'm having a heart attack," or "I will lose control." It is the scary thoughts that make these reactions so upsetting
- Slowing down your breathing may help
- The sensations will pass soon and then you can go on with what you were doing
Each time you respond in these positive ways to your anxiety or panic, you will be working toward making it happen less often. Practice will make it easier to cope.
Feeling like the trauma is happening again (flashbacks) -- "contact the present moment, remind yourself your thoughts come from a different "place" or context, by:
- Keep your eyes open. Look around you and notice where you are
- Talk to yourself. Remind yourself where you are, what year you're in, and that you are safe. The trauma happened in the past, and you are in the present
- Get up and move around. Have a drink of water and wash your hands
- Call someone you trust and tell them what is happening
- Remind yourself that this is a common response after trauma
- Tell your counselor or doctor about the flashback(s)
Dreams and nightmares related to the trauma
- If you wake up from a nightmare in a panic, remind yourself that you are reacting to a dream. Having the dream is why you are in a panic, not because there is real danger now
- You may want to get up out of bed, regroup, and orient yourself to the here and now
- Engage in a pleasant, calming activity. For example, listen to some soothing music
- Talk to someone if possible
- Talk to your doctor about your nightmares. Certain medicines can be helpful
Difficulty falling or staying asleep
- Keep to a regular bedtime schedule
- Avoid heavy exercise for the few hours just before going to bed
- Avoid using your sleeping area for anything other than sleeping or sex
- Avoid alcohol, tobacco, and caffeine. These harm your ability to sleep
- Do not lie in bed thinking or worrying. Get up and enjoy something soothing or pleasant. Read a calming book, drink a glass of warm milk or herbal tea, or do a quiet hobby
Irritability, anger, and rage
- Take a time out to cool off or think things over. Walk away from the situation
- Get in the habit of exercise daily. Exercise reduces body tension and relieves stress
- Remember that staying angry doesn't work. It actually increases your stress and can cause health problems
- Talk to your counselor or doctor about your anger. Take classes in how to manage anger If you blow up at family members or friends, find time as soon as you can to talk to them about it. Let them know how you feel and what you are doing to cope with your reactions
Difficulty concentrating or staying focused
- Slow down. Give yourself time to focus on what it is you need to learn or do.
- Write things down. Making "to do" lists may be helpful
- Break tasks down into small do-able chunks
- Plan a realistic number of events or tasks for each day
- You may be depressed. Many people who are depressed have trouble concentrating. Again, this is something you can discuss with your counselor, doctor, or someone close to you
Trouble feeling or expressing positive emotions
Remember that this is a common reaction to trauma. You are not doing this on purpose. You should not feel guilty for something you do not want to happen and cannot control.
Make sure to keep taking part in activities that you enjoy or used to enjoy. Even if you don't think you will enjoy something, once you get into it, you may well start having feelings of pleasure.
Take steps to let your loved ones know that you care. You can express your caring in little ways: write a card, leave a small gift, or phone someone and say hello.
A FINAL WORD
Try using all these ways of coping to find which ones are helpful to you. Then practice them. Like other skills, they work better with practice.