A year has passed since life as we knew it seemingly vanished overnight. As we move forward, we must acknowledge the collective trauma we have experienced.
Let’s start by naming the fears and challenges created by COVD-19 and other experiences – such as the illumination and exposure of racial injustice – that compounded the grief and loss of the pandemic. Saying the truth out loud can be freeing: Isolation, uncertainty, chaos, stress, helplessness, anger, and frustration to name a few. For me, I miss sending my kids and my husband into the world without excessive fear, eating lunch with my colleagues and visiting our family in Florida.
The next step is taking a hard look at how those feelings affect the way we live our lives every day, and whether we need more support.
Everything is not okay. But self-awareness motivates us to get help. People can successfully recover from trauma, and I want to continue my discussion from a previous post by exploring the different trauma therapies and the importance of ongoing support.
Why people can’t “snap out of it”
I want to make this clear: Trauma is a normal response to an abnormal event. Even so, people may still feel like something is off and they can’t quite put their finger on it.
People beat themselves up because they can’t seem to “get over” their traumatic experiences. But the reality is that trauma changes the way the brain works. It’s not about willing oneself to “get over it”.
When you are threatened, a part of brain called the amygdala signals the brainstem, which throws out neurotransmitters that depress the prefrontal cortex, the part of the brain that makes rational decisions. In fight, flight or freeze mode, that thinking and planning part of the brain is completely bypassed.
For some people, an experience can seem so threatening and stressful that the amygdala becomes hyper sensitized to future situations. The pandemic seems to have evoked that response for many people. The circumstances may not be remotely threatening, but somehow the amygdala responds as if they are, flooding the brain with neurotransmitters that depress the person’s ability to think clearly. The brain is also no longer able to tell the difference between then and now.
One of the hallmarks of trauma is intrusive thoughts and feelings. People can suddenly dissociate, where it seems like they’re not in the here and now. And they’re not. The timekeeper (the dorso lateral prefrontal cortex) is not able to say, ‘then is then, and not now’. Instead, it is saying ‘then is now and I don’t know when it is going to end.’ To these individuals, their flashbacks represent a “now” they are experiencing all over again.
Trauma touches on our basic instinct for survival, and in addition to trauma being understood as getting stored in the body, we also develop cognitive schemas which are a frameworks or themes that we use to understand things and make sense of our world. If a person’s schema is around mistrust, then holding people at a distance, physically and emotionally, serves a purpose in keeping them from getting hurt in a relationship. When we work with people, we help them understand that, yes this may have once served them, yet the costs may be outweighing the benefits in their lives right now.
Why avoiding trauma treatment is bad for you
Avoidance is commonplace in people who have experienced trauma, and it can be adaptive if we think of it as a survival mechanism. Yet avoidance is also a behavioral pattern that can reinforce the very mistaken beliefs, distortions and misinterpretations that so badly twist the emotional and cognitive experiences of those suffering trauma.
In fact, a recent study revealed that people who experience post-traumatic stress disorder (PTSD) may be twice as likely to suffer dementia later in life. On top of the other health impacts of unresolved trauma – a higher risk of high blood pressure, cardiovascular risk, and substance use disorder among others – it is imperative that people seek professional treatment for their trauma.
Trying hard to resist thinking about the trauma or the emotional pain, avoiding certain places or reminders, can contrarily result in prolonged suffering. All that worry tricks the brain into thinking there really is a threat, so it holds on to the pain as a reminder.
People especially try to avoid unpleasant emotions, something that often leads people to substance use to numb themselves. Many are afraid of what will happen if they allow themselves to feel these emotions. We help people understand emotions serve a purpose, that they are messengers of information that guide our decisions and actions to help keep us safe. When we avoid emotions, we often find they hang around as if waiting to finally be heard.
Different approaches to treating trauma
For those who experienced trauma during the pandemic or who had prior trauma resurface due to the extenuating circumstances this year, it’s essential to “retrain their brains” and pay attention to their bodies and resolve any deep-seated and maladaptive response. Addressing it now is critical, so that in 10 years you are not operating from a place of fear. There are several different tangible ways that we treat trauma, and all have shown tremendous success. Highlights include:
Cognitive Processing Therapy. CPT helps patients learn how to challenge and modify unhelpful beliefs related to the trauma. In so doing, the patient creates a new understanding and conceptualization of the traumatic event so that it reduces its ongoing negative effects on current life. This is generally the recommended treatment for PTSD, and it is one of the approaches we use at Caron.
Internal Family Systems. IFS identifies the multiple subpersonalities at work within a person’s mental system and helps the patient understand how these subpersonalities are often in conflict with one another. I personally find Internal Family Systems useful in my own work with patients.
EMDR. EMDR stands for Eye Movement Desensitization and Reprocessing and addresses the physiological storage of memory and how it informs experience. The idea is to target memories that are inadequately processed and maladaptively stored. It is an evidenced based treatment that has been shown to provide relief from PTSD symptoms. This is also one approach we use at Caron.
Prolonged Exposure. Avoiding thinking or feeling about traumatic experiences only gives them greater power over our thoughts and emotions. Prolonged Exposure challenges people to gradually approach the memories, feelings and situations related to their trauma, helping them to relearn how to respond.
Trauma-focused CBT. Cognitive Behavioral Therapy (CBT) encourages patients to re-evaluate their thinking patterns and assumptions to identify unhelpful patterns – overgeneralizing bad outcomes, thinking negatively and “catastrophizing” – and move to more balanced and effective thinking patterns.
Research shows that all these approaches produce similar results. It comes down to the needs of the individual patient: Similarly, to substance use disorder treatment, there is no one size fits all in treating trauma.
Recovery from trauma is possible
People can recover from trauma – even with the year we have just had. As I mentioned earlier, we have been through a collective trauma this year. It has also been a period of incredible strength, and resilience. I think there is a misconception that once you have trauma, the suffering never goes away. That is not true. We have a lot of research showing that trauma can be resolved – often completely – using all the interventions I outlined above.
At a foundational level, we can help people develop a sense of safety. By exploring what we call their “window of tolerance,” we can help them put words to their thoughts and feelings. Their brain finally begins to understand that the amygdale does not need to continue being activated. The threat is over, and their prefrontal cortex can be trained to get back to functioning normally.
There is one activity I use in one of our psychoeducational trauma groups to help them understand that change is possible. We start with a blank sheet of paper, and I asked them to fold it in half again and again until it is just a small rectangle of paper and they can’t possibly fold it anymore. Then I ask them to unfold it and then fold again along the creases they made the first time. Then we unfold and fold it again. Each time they fold along the creases, it becomes faster and easier to fold. It is as if the paper remembers the shape. Those creases, I tell the group, are like our habitual response to remembered trauma. Each fold is your behavior response to the original trauma, and it gets easier to respond that way as you do it over and over and over. And 20 years after your trauma, you are still responding this way.
Then I have them fold the paper a different way, avoiding the creases. It is hard and it is messy, but just as it is possible to make a new fold in that piece of paper, it is possible to establish new ways of thinking and responding.