Trauma: What is it? How does it happen? How does it impact us? How can therapy help?

“We are a hopeful species. Working with trauma is as much about remembering how we survived as it is about what is broken.” (The Body Keeps the Score, p. 21)


For a long time, the word, “trauma” has been something that people didn’t talk about. Thankfully, today it has become increasingly part of our societal consciousness and conversation. Yet, even as we talk about trauma and its effect on us as humans, there is some confusion about what it really is and how it impacts a person. Some, like writer Abigail Shrier, still believe that trauma is a rare occurrence, and believe it is instead an excuse made by weak people to behave poorly. Others see it as a terminal diagnosis that can never be healed from, and therefore avoid it or become preoccupied by it. The therapists at our practice believe that trauma is real and sadly occurs at varying degrees more often than many realize, but also believe that experiencing trauma does not have to dictate a person’s life. We have seen firsthand how with support, kindness, and honest, deep internal work, a person can learn to use their trauma to continue to grow and flourish in their lives. This article is an attempt to better articulate what trauma is, understand how it works, and how therapy can help in the recovery from its impact on the human mind and body.


Trauma Defined
The word “trauma” is the Greek word for “wound”. Oxford Languages defines a wound as “an injury to living tissue caused by a cut, blow, or other impact, typically one in which the skin is cut or broken.” The Substance Abuse and Mental Health Services Administration (SAMHSA) states that “Trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional, or spiritual well-being.” This definition encapsulates the understanding that whether it is a single incident (such as an accident, assault, natural disaster, single act of violence, abuse, neglect, or oppression) or chronic exposure to these things, a person can be injured at a deep psychological, emotional, and bodily level that can negatively influence how they experience the rest of their life. In essence trauma is a wound to the body and soul of a person that can leave a lasting scar.



How the Brain and Body are involved in Trauma
At the very core of a human’s response to trauma is their brain’s assessment of threat and its activation of the nervous system, which has for many ages helped our species avoid danger and stay safe, subsequently allowing us to survive and flourish. The nervous system transmits signals between the brain and the rest of the body, thus controlling the ability to respond, breath, think, and more. When life is copacetic and things are going well, a person’s brain uses the parasympathetic nervous system to govern the automatic functions like heart rate, respiration, digestion, and sexual arousal. And so, in a state of peace, the body hums along at a normal, relaxed pace.

But, when there is danger or stress detected, the brain jump starts the sympathetic nervous system (also known as our fight-or-flight response) and the hypothalamic-pituitary-adrenal axis (HPA) into high gear, readying the body for action. Adrenaline releases into the blood stream, which causes the pupils to dilate in order to allow in more light and speeds up the heart rate. The faster beating heart pumps more oxygen to muscles and other vital organs. The lungs relax to improve oxygen delivery and the adrenaline helps dull the experience of pain. Cortisol is also released and helps the digestive track slow down and the energy stored in the liver is activated into an energy that can be used quickly. The brain and body is ready to respond and preserve the person through action.

When Trauma creates a Trauma Response
This physiological response is adaptive and necessary for survival in the short term to deal with the event/s to stay alive and safe. After the distressing danger is survived, the brain and body then returns to a place of equilibrium and the person moves forward with their day/week/month/life. They are able to metabolize the event and continue on. Their ability to digest what has happened to them in such a way that their human dignity, safety, and hope for the future is preserved, and so they can experience traumatic events and still live life afterwards. This process has been called, by some, metabolization.

Unfortunately, this ability to return to equilibrium can be short-circuited if the trauma is so extremely painful and disorienting that it cannot be metabolized. Artificial Intelligence (AI) was created based on the human brain’s ability to learn from many data sets and is pretty amazing at predicting the next word in a given sentence. The brain learns concepts from the regular experiences it experiences in an attempt to help conserve energy. For example, when you walk into your room your eyes are not taking in the field of sight for the first time. Instead, your brain anticipates what it has seen before and tells the eyes what it is seeing without your eyes doing a lot of work. The eyes are not really “online” unless there is something in the room that does not match what is “supposed” to be there. So, if there is a large pink elephant in the room, then the brain notes this and sends signals to the eyes to investigate. This is why you can walk into a room and not notice something out of place the first time. Unfortunately, for many who experience the harm of trauma, especially repeated or prolonged trauma, their brain/body understandably conceptualizes the world as an overall dangerous place and cannot turn off the expectation of something bad happening.

Consequently, they predict that they are often in danger. Their brain is highly aware of unsafe environments and unsafe people, and they can often sense the sinister subtext of a seemingly innocuous social situation. They listen and interpret the world around them in order to stay safe. But, oftentimes their brain, while highly attuned to danger that is present in life, struggles to see the beauty, joy and goodness around them as well. They struggle to accept that there are safe people in their life or relax to enjoy intimate relationships. Consequently, they struggle to move past the event and accept they have survived and instead experience being in a constant level of threat, which begins to affect their quality of life and quality of their relationships.

Because their brain anticipates a constant, high level of threat, their nervous system remains stuck in a state of hyper arousal and/or hypo arousal. Hyper arousal (being stuck in the fight or flight state) leads to the chronic activation of the stress response, which can have negative effects on our physical health over time. It is like keeping your car revved at 5000 rpms continuously or trying to run at a dead sprint without ever stopping – at some point the car or you will experience a breakdown or complete failure. Consequently, those whose nervous system gets stuck in the hyper arousal state have an increased physical risk of cardiovascular disease, impaired immune system, digestive problems, chronic pain, sleep disturbances, headaches, fatigue, and sexual dysfunction to name a few. Emotionally, they often struggle with, mood swings, anger outbursts, anxiety, fear, flashbacks, nightmares, avoidance, and hypervigilance.

Hypo arousal (being stuck in the freeze state) leads to a suppression of the stress response and can lead to depression, loneliness, numbness, detachment, distrust, and low self-esteem. Instead of being stuck in a state of readiness, the brain/body attempts to dull itself to avoid the painful experiences of the threatening world, and consequently minimizes awareness of all threats whether they be legitimate or illegitimate. Both states indicate that after this traumatic event the persons’s body/brain is unable to return to a state of safety and activation of the parasympathetic nervous system, which allows the individual to engage with the world around them and live curiously and vibrantly with a sense of hope.


The person with unresolved trauma may fear being fully engaged with the painful and the enjoyable parts of life because doing so makes them feel vulnerable to being harmed again. Consequently, they can struggle with being highly emotionally reactive, emotionally compulsive, and/or emotionally restrictive as they unconsciously attempt to protect themselves from more harm. Relationally, others can experience them as “prickly” or emotionally distant. Internally, they long for intimacy, but find it difficult to enter into relationships with others because they mistake normal relational difficulties to be terribly dangerous and their emotional and bodily reactions are misaligned with the actual threat. They may use substances such a as smoking, alcohol, drugs, eating disorders, or reckless behavior like dangerous sexual encounters or self-harm as way to numb their pain, which only exacerbates their experience and prediction of a dangerous, painful world. Painfully, they hang in the ambivalence of longing for closeness with others and a desire for distance and safety.

PTSD
Bessel VanderKulk states in his book The Body Keeps the Score, “Trauma affects the entire human organism—body, mind, and brain. In PTSD the body continues to defend against a threat that belongs to the past.” Here, he names that this protective strategy can become all encompassing for an individual, and when it does, it can turn into Post Traumatic Stress Disorder (PTSD), which is another way of saying that danger becomes the primary lense that someone sees all of life with. And so, they cannot find a sense of safety with themselves, others, and the world around them in their present and future because they believe that the past is the only truth and reality. Their body and brain are stuck in a hypervigalent state and significantly interferes with almost all aspects of their lives. We see this with a number of vets who come back from battle and struggle with reintegrating into civilian life.


Intergenerational and Generational Trauma
Evolutionary adaption through gene transfer has led to humans with a brain/body that responds to stimuli from the outside world, allowing them to survive and sustain relationships. It is possible that the chronic activation of the stress response may also be passed down generationally. Research shows that trauma can have profound and lasting effects on the body, brain, and emotions of those who experience it. Epigenetic research suggests that the changes can happen at a cellular level and can possibly be transmitted across generations. In broad strokes, this area of exploration asserts that when a trauma victim deals with trauma it can change the way that their cells respond and express themselves, and that their children and grandchildren will inherit these changed cellular expressions, thus transferring the biological and psychological makeup of their ancestors’ suffering to them.

This research is somewhat controversial at this point, but even if trauma is not transferred on a cellular level, the impact of trauma can be intimately felt by the generations that follow the event(s). The parent with unresolved trauma does model and teach emotional, cognitive, and relational views about how life works to their children, thus teaching them a lense of how to see and experience the world through. Often those who have experienced abuse cannot see past their need for safety, even with their own children. Consequently, they may rage and become violent or go to the other extreme of being overprotective with their children to keep their fragile internal world safe by extension. Others struggle with inconsistent reactions and responses to their kids as they wrestle with their own confusion about whether the world is good/safe or bad/dangerous. Some become neglectful out of an unconscious sense of hopelessness. In the end they often leave their children with deep scars, fears, and confusion about their identity as individuals and how to relate to themselves, others, and the outside world.

The impact of trauma is not isolated to individuals and families. Throughout history there have been people groups who have undergone horrific oppression and abuse that has shaped their identity as a group and as individuals. These stories not only mold and shape their internal views of themselves but impacts their culture, thus creating shared beliefs, values, norms, and practices of a community. For example, the trauma of slavery in the United States has had a long-lasting impact on the Black Americans of this country. By misunderstanding that slavery was a group of events in the distant past, many fail to see that there is a long-lasting, generational trauma for a whole people group who is still trying to recover from being harmed because of the color of their skin. And, this resistance to acknowledge the harm incurred by the black community leads to more harm because as Resmaa Menakem states in his book, My Grandmother’s Hands, “Generational trauma tends to repeat itself until it is acknowledged and transformed.” Without acknowledging the pain and harm, there is not a path to moving forward.


How Therapy Can Help
This brings us to the question, “How can therapy help?” In short, therapy can help trauma survivors heal from the effects of trauma and find safety and connection with themselves, others, and the rest of life. By acknowledging the impact of the trauma, seeing how it impacts daily life, finding a new internal compass, and practicing new skills, the client learns how to do life differently and more effectively. The therapy process between the client and the therapist creates growth from the trauma, which leads to a stronger more resilient self and therefore a more full and enjoyable experience of life.

Understandably, it takes a lot of courage to face difficult experiences with a therapist. It can be scary to talk about something that feels so looming or feel weak to think that an event or group of events can paralyze you or hamper your experience of life. Hopefully, this article takes away some of the mystery and shame. Trauma impacts us all because we are human, and our body and brain are reacting in completely understandable ways to stay safe. These strategies have worked but at a cost, and talking with a professional can be a helpful path to finding a new perspective and way to live.

The person who goes to therapy to explore their trauma can experience a number of benefits. Probably the most impactful benefit of therapy is that the client does not have to hold the story of trauma alone any longer. Often trauma happens in secret and even if it happens in public the internal shame is held in the internal recesses of the clients mind and body, which can be a crushingly lonely experience. Having a nonjudgmental person who understands how the brain and body reacts to trauma can be such a breath of fresh air. Lori Gottleib writes, “For many people going into the depths of their thoughts and feelings is like going into a dark alley – they don’t want to go there alone.” By creating a safe, empathic, and authentic relationship with the therapist the client can find an ally in life.

Secondly, a person can use therapeutic approaches such as Narrative therapy, EMDR, Somatic Experiencing therapy, Relational Psychodynamic therapy, and others to become aware of and process the memories, emotions, and bodily responses that they had during the trauma and the ways that it is interfering with their normal day to day life. It is difficult to see how we are experiencing and are experienced in the world without having someone mirror to us how we present ourselves, and a therapist can act as a kind ally who reflects back to a client how they might be coming across and ways that they may be hiding from themselves.

Lastly, therapy can be an avenue to develop and grow coping skills, resilience, and self-compassion. Learning mindfulness, breathing exercises, movement, safe boundaries, or participating in bodywork can teach the client how to relate to their body effectively and find ways to regulate their nervous system so that they can respond in ways that are not so reactive and protective in situations where they experience danger, but are actually safe.

While therapy can be a challenging journey, it holds the promise of leading survivors to a place of strength, self-compassion, and renewed hope. Trauma does not have to be a lifelong sentence. It can instead be the path to growth and resilience.


Caleb Mitchell, LPC

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