Understanding Trauma

Mar 7

Written By ACNAtoo

As an abuse advocacy organization, ACNAtoo sees the impacts of trauma in all aspects of our work. We also know that it is very common for people to have an incomplete understanding of trauma and trauma-informed care, so we asked an expert for some help.

Dr. Karisa Smith is a Licensed Clinical Psychologist specializing in Complex Trauma, Child Welfare and Trauma-Informed Care, and she was kind enough to respond to our questions:

Can you help us understand what trauma is?

Trauma occurs when an individual experiences an event (or series of events) as physically or emotionally dangerous and subsequently experiences lasting negative responses which disrupt their physical, relational, spiritual, and/or emotional functioning. Trauma is both an experience and the effect of the experience.

While there are categories of experiences that are somewhat universally accepted as potentially traumatic (e.g. medical trauma, severe physical assaults, war, torture, etc), it is important to note that the definition of trauma hinges on a person’s perception of the experience they were in. Spectators, experts, best friends, and family members do not determine whether the event an individual experienced was threatening to their safety and personal integrity. If the individual perceives their life, safety, or sense of self were harmed or at risk of harm, the event would be considered traumatic.

We also know that exposure to adverse childhood events that disrupt a child’s sense of safety and restrict their access to developmental needs are a form of trauma. This can occur when a child witnesses domestic violence, is repeatedly told they are worthless, loses a caregiver to incarceration or death, is physically or sexually abused, has a caregiver who abuses substances or is unstable due to untreated severe mental illness, and other developmentally adverse situations.

Trauma hinges so significantly on our individual perception of the events and our developmental stages at the time of the events due to the neurological and biological sequences that are initiated when we experience stress and perceive a threat.

Think of our cognitive processing under typical situations like a scenic country road. In normal day to day life, information is processed through our brains as we first observe a novel situation, input the stimuli through our senses, interpret the sensed stimuli, process the information, evaluate options to respond to the situation, develop plans, and ultimately act on the information. Within seconds, this information will have activated multiple areas of the brain, including the cortex, to make sense of the information and develop a response.

When we perceive threats, however, an entirely different process occurs. Incoming information no longer takes the scenic road to be processed through the brain. Instead, our brain takes the most direct route. We will still observe the novel situation, intake the stimuli through our senses, and make an interpretation of that stimuli. However, as soon as we interpret the stimuli as a threat, our brain will make a short cut straight to reaction by activating our fight, flight, freeze or fold responses. The higher parts of the brain do not get a chance to process the data, evaluate options, and develop plans. Instead, the autonomic fight/flight/freeze/fold responses facilitate rapid processing of information and mobilize the body to respond to the threat by either up-regulating (fight or flight) or down-regulating (freeze or fold). These autonomic processes alter our blood pressure, heart rate, digestion, hormones, and many more parts of our bodies.

An easy way to think of what this might feel like is to think of what happened the last time you thought you were almost in an auto accident. Most of the time, our brains and bodies can return to normal processing and regulation after the threat is gone, allowing the regular cortical processing to make sense of the events and reactions that we had during the threat exposure. Traumatic events, however, can overwhelm our ability to return to normal processing and regulation. In these instances, the fight/flight/freeze/fold response stops being used for emergencies and becomes a primary path through which the world is experienced. This leads to traumatized individuals experiencing profound dysregulation of their bodies and minds, often switching rapidly between states of hyperarousal and hypoarousal.

It is important to note that trauma begins as an adaptive response to a threatening situation. The response becomes maladaptive if it continues after the threat is gone. The very processes that helped you survive become the symptoms that can cause you immense distress. For example, constantly scanning your environment for warning signs (hypervigilance) is essential for survival when you are with a volatile partner or caregiver. Maintaining that hypervigilance at school and work, however, prevents you from focusing on the tasks in front of you, making the hypervigilance maladaptive. Understanding trauma, therefore, begins with understanding what happened to a person and how they survived.

How does trauma impact us?

Though the impact of trauma looks different for each person and situation, there are two issues that are typically at the core: a disrupted sense of safety and difficulty regulating your body and mind to engage effectively with the world around you. Bessel van der Kolk states this well: “Traumatized people chronically feel unsafe inside their bodies: The past is alive in the form of gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside. They learn to hide from their selves.” This typically impacts a person’s physical health, how they perceive the world, how they think, how they feel about themselves, and how they relate to others.

The most common symptoms associated with trauma and PTSD (Post-Traumatic Stress Disorder) are re-experiencing (flashbacks, nightmares, intrusive thoughts), avoidance (attempts to avoid reminders, numbing), distortions (perceiving the world as entirely dangerous, feeling that they are worthless, self-blame, dissociation), and alterations in their body’s regulation (hypervigilance, startle reflex, sleep disturbances). It’s important to note here that when the developing brains of babies, children, and teens are exposed to chronic stressors and traumatic events, trauma’s scope of damage widens due to the impact it has on the developing brain and developing self. Individuals who experienced developmental trauma are more likely to experience difficulties with attentional and behavioral dysregulation (harmful self-soothing, self-injurious behaviors, impaired abilities to initiate towards goals), emotional and body-based regulation impairment (difficulty identifying and discussing emotions, dysregulated body systems, difficulty monitoring body sensations, mood lability), and distress in relationships (difficulty with empathy, disrupted spirituality, impaired boundaries, betrayal-based interpretation of events, and self-loathing).

The scope of trauma’s impact can feel overwhelming when you first start to understand it. Those familiar with trauma, either personally or professionally, know that feeling well. So how do we heal trauma when its impact can be so far-reaching? Relationships and regulation. As Dr. Richard Butman, a psychologist and former Wheaton College professor, would often say: “It takes people to make people sick and people to make people better.” While trauma disconnects us from our bodies and our community, trauma recovery re-connects us to our bodies and our relationships. The relational work begins with establishing safety, ensuring the traumatized individual is heard, and earning trust. We find ways to regulate the body through rituals, routines, and sensory processing.

What is trauma-informed care?

A church or organization adopting a trauma-informed care approach understands that the majority of individuals who come through its doors have experienced trauma. As such, it can recognize and respond to signs and symptoms of trauma in order to reduce the effects of trauma and avoid retraumatizing people. It is committed to removing barriers to access of care or services by establishing safety, demonstrating trustworthiness, empowering others, and collaboration.

Safety: The physical space and interactions with leaders and parishioners create physical and emotional safety. All church leaders are trained in safety systems and committed to ongoing assessment of safety within the church or organization.

Trustworthiness: A trauma-informed approach understands that trustworthiness is demonstrated, not assumed. Churches and organizations demonstrate trustworthiness through consistency in follow through, clarity of roles and processes, clear communication, and respecting boundaries.

Collaboration and Voice: Understanding that traumatized individuals have often experienced abusive power and/or felt out of control and unable to protect themselves, trauma-informed care ensures that systems are in place for voices and concerns to be heard and addressed. Parishioners are involved in decision making when appropriate and have significant roles in planning and evaluating programs and procedures.

Empowerment: A trauma-informed approach resists the pull to "rescue" victims and focuses instead on increasing parishioners' understanding of their strengths and promoting skills to continue healing and discipleship.

A trauma-informed response is also committed to resisting retraumatizing individuals through dehumanizing and disempowering processes. This includes ensuring that people feel seen and heard, are not treated like a number, are given choice in how they interact with a church, and are offered a genuine opportunity to provide feedback on their experience with church leaders and parishioners. For example, if entering a church building causes extreme distress for individuals, church leaders might find a neutral place to meet with them.

What is not trauma-informed care?

As trauma-informed care has become more widely known and practiced, there are increasing misconceptions of what a trauma-informed response means. Generally, these are split into two camps: Trauma is Everything and Trauma is Nothing.

In the Everything camp, trauma-informed care is seen as the magic cure-all for all that ails this world. It is characterized by the misperception that understanding trauma is sufficient to heal trauma. Programs stuck in this tend to treat trauma like an excuse for unhealthy behaviors and have low expectations for traumatized individuals to grow. Often, the core components of empowerment and collaboration are lost as the organization focuses on “rescuing victims” instead of empowering them. This approach equates safety with lack of conflict and is quick to shut out people who question how to implement trauma-informed responses on a practical level. The danger of this approach is that trauma impacts the way we experience the world, and an important part of healing trauma is reconnecting your mind and body to the world around you. When an environment instead re-orients reality to align with your trauma, the trauma continues.

The Trauma is Nothing camp tends to see trauma-informed responses as pandering to popularity and/or attempts to circumvent authority structures. They say if an individual doesn’t feel safe or is re-traumatized, it is the responsibility of the individual, not the organization, to help themself. They don’t believe trauma has an impact on people and tend to see talking about trauma as harmful instead of helpful. This response sees trauma-informed care as a threat to power structures, with the misconception that trauma-informed care means those responsible in leadership must always defer to what traumatized individuals want.

How does a trauma-informed approach impact investigations of abuse?

In short: by never using the words “just trust the process.”

A trauma-informed approach to investigation ensures that the people conducting the investigation are trauma-informed and the process of the investigation resists (re)traumatizing individuals. This begins with the training and preparation of the investigative team. Teams should ensure that each person involved in the investigation has a moderate level of understanding of trauma and abuse dynamics. Additionally, they will either have a trauma expert on their team or the ability to consult with one.

Once the team is adequately trained and assembled, it is ready to begin planning and collaboration. During this time, the team should define the purpose of the investigation and establish the parameters of the investigation. Together, the team should review the available information and plan out the steps of the investigation. This planning time should review what is already known, what needs to be known, who is already involved, who may not be involved yet and should be, and the specific roles each person will play. This is a time to consider what trauma reactions they are already noticing and how they might be prepared to respond to those. Before plans are finalized, someone who has been a victim (and is not connected to this investigation) should review the procedures to provide feedback.

The investigation itself will begin by ensuring that safety is established for the victims and any other potential victims. If individuals are not already connected to appropriate services to support their processing and recovery, the team helps connect them. The investigative team errs on the side of over-communicating the purpose of the investigation, the process of the investigation, roles, and limits of confidentiality (i.e. who will know the reporting victims’ information and stories). When victims express concerns, they receive a response that communicates they were heard and what will be done with the information received. Regular updates on the process are provided. When the investigation is concluded, the investigation provides a debrief to victims of what the findings were and what the next steps will be. Avenues for follow-up and to express concerns are provided.

Due to the ways in which trauma dysregulates and disconnects, any team interacting closely with trauma victims should consider regulation routines before and after interviews and/or meetings in order to engage cortical (and non-reactive) thinking, connect and repair. This both helps prevent secondary traumatic stress among team members and reduce retraumatization of victims. For some teams, this includes brief huddles before and after an interview in which the investigative team discusses what they are bringing into the interview (e.g. feelings of frustration, tiredness, curiosity about certain aspects of the story) and what they took out of the interview (e.g. feelings of anger, uncertainty, clarity, narrative summary, etc). Some teams open team meetings with a routine such as each member sharing a variation of the Rose/Thorn/Bud exercise (Rose=something that is working well, Thorn=something that isn’t working or is unclear, Bud=something you are looking forward to learning more about). Consistent practices such as these increase regulation, promote collaboration, and increase safety.