This weeks podcast was requested by Ed because he was feeling disturbed by an event that he had witnessed on his way to work that resulted in a man’s death. He was left with some feelings of trauma, some flashbacks and problems with concentration. His question was what is trauma and what is it that we can do about it?
Trauma is a Greek word meaning “wound”. Originally this was related physical injury. With the development of psychology a wound can now be considered to be physical, mental, emotional, financial and so on. The concept of trauma comes from the idea that the wound, or event that is being experienced, is greater than our resources to deal with it. In that sense we have been overwhelmed. However there is a difference between experiencing trauma and being traumatised.
Traumatised, or traumatisation is when the overwhelming experience/trauma creates an amount of stress that is so great that it exceeds our ability to deal with the emotions aroused. This is clearly an emotional issue. Trauma or traumatic disorders are always emotional even if they come from physical damage.
Post trauma is the emotional fall out that stays with us after the experience has ended. It is our time to process the emotions and this may take hours, days or weeks. In most cases the emotional effects of a trauma will be normalised within four weeks and sometimes extends to eight or ten weeks. The important thing is that it does subside as the emotional arousal is desensitised.
Repressed trauma can happen when an event is too difficult for us to deal with in the present and we hide it in the recesses of the mind. When this happens we may have no direct memory of the event that caused the trauma though it may still effect who we are, how we experience the world and, our behaviour. It is assumed that repression developed to protect us from that which was too difficult to contemplate. In repression the victim will often sleep after the incident. In the post incident sleeping process the R.E.M. (rapid eye movement) part of the sleep cycle, similar to dreaming, allows the memory to be hidden or repressed.
Recovered memory may be delayed by weeks, years, or even decades. Though when it does emerge the original repressed emotions are released as though they have just happened. Therapeutically this release of emotion and memory is termed an abreaction and involves the re-experiencing of the trauma physically, emotionally and mentally. This may occur many years after the original incident.
Emotional responses Although in repression the memory is lost to the conscious mind it has a constant effect on everyday life and experience and may appear as irrational fears, anxiety, depression, phobia etc. This is described and ‘something within us but outside of our control’.
Post Traumatic Stress Disorder (PTSD) is when the emotional responses are not repressed but are also not processed. When the effects of the incident remain active after six weeks it is given the PTSD diagnosis. As acknowledged above trauma may take eight to ten weeks to process. This means that definitions and diagnosis of PTSD can be difficult in the first instance. When we are looking at symptoms continuing after months or years we are definitely talking about PTSD.
PTSD Symptoms will vary but will include finding it difficult to forget the incident or event that happened. There may be flashbacks, daymares or nightmares about the incident. Unstable and irrational emotional responses such as anger, tears, anxiety, depression, phobias, disturbed sleep/eating patterns, and so on.
Rumination is the symptom builder. We know that, what we think about we bring about and that thoughts become things. When we continually go over the traumatic incident we are unable to let them go. The more we ruminate on them the more they become intensely embedded in our unconscious and conscious mind because we keep thinking about, and reinforcing them in our mind/brain.
The MindBrain This is where the software of the psychological mind and the hardware of the brain interface. The main aspect of the brain that effects our emotional self is the limbic system in the centre of the brain. Within the limbic system is a little organ called the amygdala. In this organ are templates of cells that relate to our emotional responses.
Lets say that when I am young I watch my mother reacting phobic-ally to spiders, I then build a template of cells in my amygdala so that when I see a spider the template cells release chemistry and so I also react to the spiders as a phobia. Over time my spider template will become hotter and more embedded the more I visit it.
All emotional responses are like this, even the positive ones. So, that if I see the object of my love the love template of cells become hot and releases the chemistry that make me feel loving.
It normally takes about five repetitions of emotional experience to set up a template in the amygdala unless it is punched traumatically and then it is created immediately. Once a traumatic template has been established it will remain hot and active and become more embedded over time unless, or until, it is treated.
Treatment for trauma is a variable feast and will depend on where you live and the therapy that is fashionable at the time. Cognitive therapies such as CBT (cognitive behavioural therapy) are not that good at dealing with trauma in the long term. They do have a short term effectiveness by putting in place cognitive tools that often repress the emotion that creates a feeling of relief and the expectation of cure. However, when this happens the emotions are not processed but held in check leaving them to reappear at a later date.
EMDR or Eye movement desensitisation and reprocessing is a therapy that mimics the rapid eye movements that happen during the dream cycle in the sleep pattern. As the emotional trauma is encoded into the MindBrain using the same part of the system EMDR is surprisingly effective in the majority of cases.
Rewinding is by far my best option. This technique uses the very same process to desensitise a template in the amygdala, that was used to put it there in the first place. When we revisit a trauma it is through the senses of sight, smell, tastes and touch, none of which are cognitive. During rewind therapy the emotional memories are address directly and desensitised.
Mindful meditation is becoming main stream psychology. Mindfulness is the best prevention for all forms of stress and provides the resources needed at the point of trauma. The process of mindfulness is awareness, contemplation, concentration and meditation a process that is in itself therapeutic. Consistent meditators become their own therapists and counsellors and are able to overcome many things that overwhelm others.
Medication has to be the last on my list. I am not against medication on this basis, if I have a headache I will do all that I can to get rid of it, and as a last resort I will take an aspirin. There are medications that can help with anxiety, depression, panic, high blood pressure and so on. There are also natural alternatives that may be gentler on the system both psychologically and physiologically. If you do suffer trauma never suffer alone psychotherapy is a good and powerful thing.
Take care and be happy