Blog #13 Trauma Part 1: The Wisdom of Trauma - Why Trauma Develops, and How to Rid of it.

Trigger Warning: This vignette contains descriptions of sexual trauma. Discretion is advised. Click HERE if you wish to skip to the rest of the content.

A Story of Bad Romance

A friend was telling me about his recent experience shopping at IKEA while we were sharing a meal at his place. The story he would tell me was full of tension and drama.

A year ago, he met a woman at an art night at a local brewery. He is an average-looking guy whose had some trouble with dating for years. At the event, he saw a woman so full of energy, it immediately caught his attention. At first, he did not find her to be his usual type, but after a drink or two, their small talk turned into a long conversation about childhood upbringing. Before leaving, the two decided to exchange phone numbers.

It turned out she lived six hours away, visiting for a personal trip. The two started spending time together on the last day of her time in town. The first few days after she went back home, the two found themselves spending hours on the phone, talking about anything and everything, from politics to spirituality. However, my friend would often find himself with the feeling of walking on eggshells in the conversation, especially when his views were misaligned with hers. After a few days, he grew uneasy with these long conversations. However, if he didn’t call, she would ring his phone multiple times consecutively. He felt a sense of anxiety anticipating her communications. 

Not even three weeks after they first met, she told him that she had already booked an Airbnb to come visit him. It was not an option for him to say no, as she was already heading to him. During the visit, he was pretty disinclined about engaging in sexual activity with her, as he thought it was “going too fast”, but under her aggressive persuasion, he reluctantly agreed. In the following month, he found himself on edge as she would call everyday and visit all the time. He would become startled when his phone would ring everyday, and he anticipated conversations with her inevitably turning into yelling and criticizing. He found himself frozen and becoming increasingly detached. After four months, they broke up.

After the split, he occasionally found himself laying in bed emotionally paralysed, replaying in fear and confusion about the times he felt forced into some of their intimate interactions. However, eventually he would experience fewer and fewer episodes. Although he had been feeling better, he never thought it would all come back on a mundane visit to IKEA.

It was eight months after they split. He decided to visit IKEA to get some picture frames for his apartment. He was mindlessly wandering through the unending maze of furniture, home decor, and gadgets, when at the edge of his periphery, he caught a silhouette of a person resembling his ex. Before he could even react, his heart rate instantly shot up, he felt a rush of adrenaline, and his mind went blank. He looked carefully and determined it was someone he didn’t know - it was not his ex. However, his stress remained high for the next 30 minutes. He no longer felt safe in the store, and so he hurriedly finished shopping and drove home. 

The next evening, he and I hung out. We shared a small dinner and a few drinks, where he spilled to me all the details of his relationship. He asked me about the topic of trauma - what it is, and why it exists. I explained to him that although trauma is sometimes seen as a pathology, it does have functions relating to survival and threat avoidance. 

Defining Trauma

The American Psychological Association defines psychological trauma as “Any disturbing experience that results in significant fear, helplessness, dissociation, confusion, or other disruptive feelings intense enough to have a long-lasting negative effect on a person’s attitude, behavior, and other aspects of functioning…(it) often challenges an individual’s view of the world as a just, safe, and predictable place.” (APA, 2018) In layman’s terms, it is said that trauma is when we experience something that continues to distress us and rock us to our very core. On top of the APA’s clinical description, I would like to emphasize it doesn’t always take overtly harmful or dangerous events to rock us to our core - neglectful parents, intense experiences that are confusing, or personal revelations about the world, such as revealing traumas in our ancestry, may create symptoms of trauma to various severity. 

Across disciplines, a newer wave of thinkers in the field propagate the idea of defining trauma by not what happened, but by what our brain finds difficult to process. What is uniquely intense for one person might be dismissed as insignificant by another. From stories from first responders, I was often told that the onset of terror doesn’t always come from the first couple of encounters with a gruesome scene. It can happen at a later time - maybe at the 10th, 15th, N'th encounter, when it should be familiar by then. Sometimes, they might be the only ones on the team experiencing the terror. The takeaway message is that traumatic experiences are incredibly personal. If someone is listening to you recount a traumatic experience and is baffled by your intense reaction to it, that doesn’t make your trauma invalid. However, it is precisely because trauma is such a personal experience, it is our responsibility to address our own trauma and find safety again. By doing so, we can rediscover wellness and become more available for a fulfilling personal and social life.

Trauma is a complex phenomenon involving many perspectives. From a personal point of view, it might be something that terrifies us that we just want to get away from. From a practical point of view, clinicians have tried categorizing our suffering as definable by a cluster of measurable symptoms (DSM 5-TR, 2022). From an interpersonal point of view, it is something that can ruin relationships. From a scientific point of view, it is a set of physiological mechanisms that are linked to the brain and nervous system. As convoluted as this may all sound, here is my ultimate message for you - it is unimportant to get bogged down by the many different perspectives of trauma; the important thing is that if you are suffering because you are challenged by events in the past and present, we deserve a way to address suffering through trauma resolution.

In the context of this blog series, I am going to define trauma as such - Trauma is the phenomenon in which emotionally intense, hard to understand, or confusing events that are sometimes dangerous result in emotional distress that repeats until we find ways to understand and mentally resolve what happened. 

The Formation of Trauma

If trauma—a psychological process so incredibly powerful that it changes people’s personality, behaviors, and thoughts—can pass down through hundreds, if not thousands, of generations, it probably serves a function. From an evolutionary point of view, there is scholarly speculation that postulates trauma as an adaptive response, meaning that it enhances survival (Christopher, 2004). The uncomfortable truth is that survival does not always equal wellness. If we think about many of our discomforts, they give us vital information on how we should behave in order to preserve our bodies. For example, hunger motivates us to eat, exhaustion or pain for rest, etc. In the case of psychological trauma, it is expected that we react when triggered. Sometimes, we want to fight. Other times, we freeze. Or like my friend in this blog’s featured story, he reacted by fleeing. Through these reactions, we may be able to secure safety. However, unlike a non-trauma fight, flight, or freeze response, our body learns to anticipate potential threat,s drawing from previous experiences.

In order to understand how trauma develops, we can use another story to demonstrate: 

Sue is 14 years old and reported a fear of going outside for walks. A few months ago, she was bitten by an uncollared dog when she was out jogging in the neighborhood park right outside her house. The incident required medical attention and left some scars on her left calf. She described the experience as “scary” and “a blur”. At first, she would be startled when she heard any kind of barking, but it was generally tolerable for her to walk to the bus station when commuting to school. As time passed, she became more hyper-fixated on looking out for dogs, even at a distance. Since then, she developed depression, and other than going to school, she preferred to stay at home. 

Before Sue was bitten, she never felt unsafe at the park. In fact, the park filled her with childhood memories for as long as she could remember. However, the dog incident created a new set of memories and body reactions, redefining her perception. We can think about her memory system as like an archive, filled with shelves after shelves of files, each one documenting experiences and its resulting reaction. Before the incident, memories relating to the park were mostly a collection of sensory experiences connected to non-stressful emotional responses. When the incident happened, imagine little archive gnomes going to their desks writing new files, connecting the sensory inputs—the barking, the scenery, the imagery of the dog, the pain with her extreme stress response— to confusion, freezing, fear, and panic. Although the new files do not erase the previous ones, it is now the newest addition to the archive. So, whenever Sue experiences any sensory inputs that match the ones on file, for instance, the same kind of barking she heard right before she was bitten, those gnomes look up the “appropriate” response to the sensory input, in this case, fight/flight, freeze, and even panic. This is how trauma operates—It develops when we learn from experience of emergencies, and when our body believes we are facing the same threat, we will respond in the swiftest way possible.

Eventually, through EMDR (Eye Movement Desensitization and Reprocessing) and systematic desensitization therapy, Sue recovered. Her recovery was the result of working with her emotional reactions and skillful efforts to re-expose herself to her triggers in a safe environment. However, if she had not engaged in creating safe memories that overwrite the trauma reaction, she might have gone down a very different path.

When Kindlings Ignite The Entire Forest

Let’s explore the hypothetical scenario if Sue continued to self isolate without any kind of intervention.

Instead of going to therapy, Sue continued to stay home. As time went on, she started to experience increased intensity of her anxiety and depression symptoms. She was no longer only hyper-vigillant walking to the bus station, but she also only found herself challenged by everything outside, and even parts of her home that were not her bedroom. Furthermore, she was startled not only by dogs barking, but by all manner of loud noises. Sue’s trauma symptoms worsened, putting her in a difficult place. 

So what happened to hypothetical Sue? When the archive gnomes wrote the files, it was only for specific triggering sensory inputs, such as certain kinds of dog barks, the specific kind of smell in the air, and certain objects she saw. However, one of the effects of trauma is that one can feel a level of fight/flight and freeze without the presence of triggers, resulting in chronic stress (Van Der Kolk, 2015). Under this constant strain, Sue started to include new sensory inputs into her trauma without knowing it. As a result, she started to be triggered more often, with sensory inputs that were not originally triggering. In psychological terms, we call it “generalization”, or “overgeneralization”—the phenomenon in which we transfer our fear to something not related to the events we try to avert (Lis et al., 2020). In plain language—when we “overgeneralize”, we start to feel the scary trauma emotions with places, events, people, and senses that originally didn’t trigger us. 

One of my mentors called this “kindling”. All it takes is an ember to start a forest fire. It always starts small, and if it is left burning it will start to ignite the materials next to it. Given time, it will spread across miles and miles of forest. Like a forest fire, our trauma triggers can spread to more and more aspects of our daily life. This is truly a terrifying prospect. It is important to clarify that just because we may have unresolved trauma, that doesn’t mean it will continue to affect us our entire lives. However, there are factors that can contribute to whether our symptoms may improve or worsen. Below is a brief list: 

	Protective Factors	Risk Factors
Resiliency	Able to find meaning and value in changing circumstances	Difficulty adapting to new reality
Interpersonal relationship style	Able to feel emotionally safe with others	Insecure attachment - Feeling unsafe with others.
Shame	Tend to have a positive self-regard.	Tend to self-blame
Social Support	Consistent nonjudgmental social support	Lack of meaningful relationships
Culture	Socialized to be “inclusive to all emotions”	Socialized to “push away bad feelings”
Retraumatization	One-time event	Repeated traumatic experience
Mental Health	Free of existing mental health challenges	Trauma symptoms co-exist with other mental health challenges.

Table: Factors influencing trauma recovery.

It is highly recommended that you review the contents of the table and contemplate which protective factors apply to you. If we look at each of the factors, we might notice a clear trend—whether a factor is protective or risky depends on the ability to orient to safety. For example, in resiliency, being able to find meaning and value in changing circumstances gives us a sense of ground and certainty, even if the world is constantly shifting. In this case, feeling certainty creates a sense of safety. Similarly, having a positive self-regard feels safe, whereas self-blame often leads to feelings of not being safe.

Safety is the Cure, and the Cure is Safety

“Safety is the cure” is a phrase I often heard from one of my supervisors. If we can find a way to return to safety, we can undo our suffering. In Sue’s case, she put in the effort by recounting her traumatic emotions in the presence of support, by accessing psychological safety* and social engagement**. The two kinds of therapies she received were 1. EMDR or Eye Movement Desensitization and Reprocessing (which we will cover in a later post), and 2. Systemic Desensitization, which involves listing out triggers of varying intensity and allowing some exposure of triggers starting with the mildest, then increasing only if one no longer feels triggered by the lesser ones. The important point about trauma recovery is that it has to consider how much we can tolerate in any one moment.

*Psychological safety refers to recognizing one is safe and feeling a general sense of being away from danger.

** Social engagement refers to the de-escalating mind state when we engage in social activities, according to the polyvagal theory.

Window of Tolerance (or can it be… Window of Presence?)

Dr. Daniel J. Siegel (2020), a high profile figure in the field of interpersonal neurobiology, coined the concept, the “window of tolerance”. It is the idea that we have an optimal “window” in terms of how we feel, in order to maximize our ability to learn effectively. In the context of trauma recovery, we can only effectively relearn how to feel safe again if we are neither too activated (i.e., too anxious, panicked), nor under-stimulated (i.e., too exhausted, too bored).

It may seem like a straightforward concept to understand. However, being aware of our own window of tolerance might be somewhat challenging. In a therapy session, I was having a discussion on cultural upbringing with a man in his 50s. The conversation started out with family holiday rituals and favorite dishes. Soon, it turned into disclosing a traumatic experience. I paused him for a moment in order to explain to him about the window of tolerance, requesting him to continue with his story, but also to take notice if he felt too much. He continued to disclose his experience, but a few minutes later something felt off. I tried to check-in with him and it seemed like his attention was no longer in the room; he was reliving parts of his trauma in his own mind. I caught his attention, and administered some guided exercises to pull him out of that mind state, but it is apparent that he had exited his window of tolerance when he was retelling the story. When I asked him, “What happened?” He simply answered, “I don’t know, I just kinda got carried away.”

Our mind can jump into alternative unsafe states, sometimes without realizing it. The issue with the window of tolerance is that without intensive explanations, knowing what IS within the window of tolerance can be very abstract. However, there is another way to look at it. One of my supervisors told me about a simplistic way to discern our experiences—by framing our window of tolerance as really the “window of presence”. “Presence” in this case stands for the idea of being “able to be here”, to engage the environment of the present moment. For example, say I am feeling sad, mourning, and I am in emotional pain about a recent loss. As long as I can hold an engaged back-and-forth conversation with you, while noticing the room and setting around me, I am in the window of presence. The moment my mind becomes so occupied with our own thoughts, distracted from the conversation, we can slip outside of our window of presence. It is important to be curious about how long we can stay within our window of presence at one time.

Exercise: Finding Safety

Safety is a psychological experience we can all achieve. It does not have to correlate with the circumstances we are in. Being able to find some glimpse of safety, even if we know we are not in a safe circumstance, can help us make better decisions in stressful situations. Furthermore, our ability to orient ourselves to psychological safety is a protective factor for trauma recovery.

Here is a simple exercise to explore the emotion of safety:

1. Find a time and place free of obligations.

2. Take a few deep breaths, and with each breath, envision putting away worries, stories, and thoughts. If you have trouble doing this, try to engage in this exercise with some neutral and relaxing lofi music without lyrics.

3. Look around you and focus on the smaller details. Can you notice different shades of colors? What about textures on an object? Can you hear all the different sounds around you?

4. Out of all the sensory inputs (sights, sounds, textures), what puts you at the most ease?

5. Focus on the things that put you at ease, and notice the peaceful feelings they bring.

6. Stay connected to those feelings. 

7. Repeat this exercise as many times as you would like. Don’t be discouraged if you can’t find peace instantaneously; it may take time.

If you or someone you know is looking for therapy in the state of Colorado, you can reach me by visiting my PsychologyToday profile: HERE, or send an email to info@intorelationshipco.com

Sources:

American Psychological Association. (2018, April 19). trauma. APA Dictionary of Psychology. https://dictionary.apa.org/trauma

American Psychological Association. (2022). Posttraumatic Stress Disorder. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Christopher, M. (2004). A broader view of trauma: A biopsychosocial‑evolutionary view of the role of the traumatic stress response in the emergence of pathology and/or growth. Clinical Psychology Review, 24(1), 75–98. https://doi.org/10.1016/j.cpr.2003.12.003

Lis, S., Thome, J., Kleindienst, N., Mueller-Engelmann, M., Steil, R., Priebe, K., Schmahl, C., Hermans, D., & Bohus, M. (2020). Generalization of fear in post-traumatic stress disorder. Psychophysiology, 57(1), e13422. https://doi.org/10.1111/psyp.13422

Siegel, Daniel J. (2012). Self Regulation, in The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are (2nd ed.). The Guilford Press.

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