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When I was 18 years old, I was a passenger in an automobile that was involved in a fatal crash. It happened so quickly and as I was uninjured, I tried to assist those who had been hurt. At the time, I went into action not thinking or even seeing the full extent of what had happened. But about a week later, I started experiencing periods of time when brief scenes of the accident, like clips of a movie, would flash into my mind. I was jumpy, easily startled and had trouble sleeping. Even today, I become anxious if I’m riding in a car and the driver is following too closely or quickly applies the brakes. What I’m describing are symptoms that commonly occur when we are in what we believe to be a life-threatening situation. My reactions were normal and eventually resolved except for some anxiety or hypervigilance when riding in automobiles. We frequently hear the word trauma used in conversation. We may even use it ourselves but what is trauma? Is it common or uncommon? According to the National PTSD Center: “Going through trauma is not rare. About 6 of every 10 men (or 60%) and 5 of every 10 women (or 50%) experience at least one trauma in their lives. Women are more likely to experience sexual assault and child sexual abuse. Men are more likely to experience accidents, physical assault, combat, disaster, or to witness death or injury.” The National Institute of Mental Health (NIMH) describes trauma as a normal reaction to an extreme event. The Substance Abuse & Mental Health Service Administration (SAMHSA) proposed defining trauma as having 3 components: 1) Event 2) Experience and 3) Effect. The most severe types of trauma are known as complex or chronic trauma and can have lifelong devastating effects. We know that children as well as individuals with disabilities, particularly with limited language skills, subjected to trauma by trusted relatives and friends suffer severe and lasting damage. This article is a limited introduction to the subject and more general in nature. It is meant to provide basic information and, hopefully, guidance that might stimulate awareness in learning more as well as gaining an understanding of the extent and impact of trauma. Trauma occurs when an individual experiences a situation or event where they believe their life or physical welfare or someone close to them is in immediate danger. Reactions to trauma can include the normal flight, fight or freeze responses. These are automatic responses to extreme fear and have evolved to help us respond quickly. Our brains become overloaded and cannot process the information, particularly if it is horrifying and we are unable to manage or change the situation. We can’t protect ourselves or someone else from real or perceived danger. Here’s a quick true/false question. “Everyone experiences trauma in a crisis?” Do you believe this statement is true? False? Either or both is the correct answer. People respond differently depending on a number of factors, including, but not limited to, their temperament, history, medical or emotional situation. While most people might experience immediate stress as a normal response to a threatening event and return to normal, some go on to develop PTSD (post-traumatic stress disorder). Symptoms of PTSD are: 1) Intrusive memories (of the event); 2) Recurrent, distressing dreams related to the experience; 3) Flashbacks (feeling as if the event is happening again); 4) Exposure distress when around people, places or objects that remind you of the event; 5) Physiological reactions when around people, places or objects that remind you of the event. These are some of the symptoms people experience. People may have all, a few or one or two symptoms. This can occur within a short time after the event or even months or years later. Trauma Types Include: Acute trauma (Type I) results from exposure to a single overwhelming event. Examples: Rape, death of a loved one, natural disaster Characteristics: Detailed memories, omens, hyper-vigilance, exaggerated startle response, misperceptions or overreactions Complex trauma (Type II) results from extended exposure to traumatizing situations. Examples: Prolonged exposure to violence or bullying, profound neglect, series of home removals Characteristics: Denial and psychological numbing, dissociation, rage, social withdrawal, sense of foreshortened future Crossover trauma (Type III) results from a single traumatic event that is devastating enough to have long-lasting effects. Examples: Mass casualty school shooting, car accident with fatalities involved, refugee dislocation Characteristics: Perpetual mourning or depression, chronic pain, concentration problems, sleep disturbances, irritability People who work as first responders, doctors, nurses, counselors, and in some cases teachers or others can also be affected by traumatic events. Even though they are trained and prepared to respond, they can and often are impacted. Caregivers might not experience direct trauma but can be affected by secondary trauma. This can occur immediately upon hearing about the traumatic event from someone else or later. Processing and support along with adequate self-care can help. If not managed, caregivers might begin to develop compassion fatigue. This doesn’t happen immediately but occurs over time. Once recognized, it is critical to take time for self-care and to talk with someone to help process and build up personal wellness. If the signs and symptoms aren’t recognized or managed, burnout can result which may force the person to do their own personal work in order to recover. Unfortunately, often symptoms are ignored or recognized too late and the individual leaves their profession. Recognizing signs that you are growing fatigued and responding is important. We often push ourselves even though we encourage others to pay attention and practice self-care. If you notice the following, you might want to check with someone who cares about you and is willing to provide honest and helpful feedback:
Obviously recognizing and managing secondary trauma is much easier than compassion fatigue or burnout. In my last blog I provided some examples of ways to practice self-care. Regularly taking time for self-care can help reduce our vulnerability to traumatic events. As with most things, prevention is generally a better option than treatment. If we practice self-care preventively, even if we do experience secondary trauma, we are more likely to recognize it and take steps toward healing. If you are a caregiver (which really is most of us at some time in our lives!) and would like to further evaluate your potential for trauma, you might want to take the Professional Quality of Life Scale (ProQOL) by going to their website: http://proqol.org/. The test is free and can be copied as long as the author is credited and no changes are made. I’m also attaching a copy so if the link doesn’t work, you can download it. It has a self-scoring guide at the end. If you score as at risk and/or are experiencing any of the signs listed above, you might want to use some of the self-care techniques I listed in my previous blog or use the self-care meditation attached to the blog. I’m adding it here again as it is one I frequently use as a part of my own self-care practice. Talking to a friend, family member or spiritual advisor can be helpful. Often trauma does resolve over time - if we acknowledge it occurred and affected us. It is human nature to want to push it away or even try to pretend it didn’t happen or didn’t affect us. In the short-term, this might be an adaptive, helpful strategy to allow ourselves time to address our distress. However, if left unattended and unaddressed for too long, it will likely creep into our consciousness and cause problems in our lives, including with family, friends, school or work. If self-care doesn’t seem to resolve the symptoms or they get worse, consider finding a counselor or therapist to help you process and begin healing. You might consider asking about Prolonged Exposure Therapy, EMDR, or Cognitive Processing Therapy. You may have an EAP at work who can help with short-term supportive counseling. You can also call us here at Elephant Rock Counseling, as all our counselors have training that can help you work through trauma. San Mueller, M.Ed., LPC, DBT Elephant Rock Counseling Kirkwood, MO San is a Licensed Professional Counselor with Elephant Rock Counseling, LLC. San specializes in therapies that utilize mindfulness based principles such as Dialectical Behavior Therapy (DBT). She enjoys teaching yoga, spending time with her family, and working with her clients.
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AuthorsChad Randall, Steph Metter, and San Mueller are all licensed professional counselors who practice in Missouri. Archives
January 2021
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