Understanding the Trauma Response

Dave Wyner, MA, LPC, NCC, CCTP, CGCS 720.551-8951 | [email protected] www.APathForwardCounseling.com About this booklet

Hello! My name is Dave Wyner and I’m a Licensed Professional Counselor in Louisville, Colorado (just outside of Denver). In my practice, called A Path Forward Counseling, I help people find a path from post-traumatic distress to post-traumatic success. That includes recent traumas, childhood and developmental traumas, big life transitions, and grief. I put together this booklet to provide a brief summary of the ways our bodies are designed to react to threats and the ways our bodies can get stuck in those reactions long after they’ve served their purpose.

This booklet is not intended to be a comprehensive explanation of trauma or post-traumatic stress disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. Many good books have been written on the subject (I highly recommend Bessel van der Kolk’s The Body Keeps the Score and Peter Levine’s Waking the Tiger), so what I’ve tried to do is distill a lot of very complex information into easily-digestible explanations. I’ll be the first to admit that many subjects are only briefly summarized and some not covered at all. I firmly believe that a personal, trusting relationship with a trauma-trained mental health professional is the best forum in which to explore and expand upon these topics.

This booklet is not intended to be a substitute for professional mental health support.

I welcome your feedback and questions about this information. Please don’t hesitate to contact me directly at 720-551-8951 or [email protected].

Here’s to your courage, resilience, and growth.

P.S. While I’ve primarily focused the following pages on researched-based, generally-accepted information, I have interspersed my own perspective on trauma and healing in a handful of places. If you’d like to read more about my perspective and thoughts, please check out my website, including my blog posts, at www.APathForwardCounseling.com.

A good place to start is to understand what constitutes a traumatic situation. I tend to cast a wide net when considering what qualifies as “trauma.” Here’s how I define it:

An experience or situation that a person subjectively perceives as a threat to his or her physical or emotional safety over which they feel they have no control and/or that overwhelms his or her resources to handle it.

There are three categories of trauma: “big T,” “little t,” and “H”.

Big T trauma Little t trauma A single, catastrophic event (i.e. an A persistent, pervasive situation or accident, natural disaster, military circumstance or an event that may combat, street violence, physical/ appear to outsiders as smaller or sexual assault or abuse, significant less catastrophic than a big T medical conditions or interventions, trauma (i.e. bullying, harassment, death of a loved one) emotional abuse/neglect/invalidation, relationship loss, pet loss, non-life threatening injury)

trauma Ultimately, the only definition that H matters is your own. What matters Hidden or historical traumas like isn’t what others think “should be” racism, poverty, and discrimination traumatic, only what YOU feel is traumatic for you.

The part of the nervous system responsible for responding to stressful and threatening situations is called the autonomic nervous system. This system is made up of two equal and opposite branches.

The sympathetic Sympathetic Parasympathetic nervous system (“Fight or flight”) (“Rest and digest”) This is the part of the system

that prepares your body to Dilates pupils Constricts pupils fight or flee from a threat. When one or more of your senses detect danger, this Reduces salivation Increases salivation system sets into motion several physical changes designed to help your body Increases heart rate Decreases heart rate protect itself. You can think of the sympathetic nervous system as your body’s Stretches/opens airways Relaxes/contricts airways gas pedal.

The parasympathetic Inhibits stomach activity Stimulates stomach activity nervous system This is the part of the system responsible for Inhibits intestinal activity Stimulates intestinal activity returning your body to a baseline state of arousal Increases release Reduces release once the danger or threat of glucose of glucose has passed. It’s also the part

of the nervous system that Increases release Decreases release shuts the body down when of epinephrine and of epinephrine and norepinephrine norepinephrine it’s not possible to fight or flee from danger (i.e. the freeze response). You can Relaxes bladder Contracts bladder think of it as your body’s brake pedal.

Fight Flight Freeze

The body mobilizes it’s energy The body mobilizes its energy The body begins to shut down and resources to actively and resources to flee from and the brain dissociates with protect itself by deterring or the threat. the body to blunt the pain eliminating the threat. caused by the threat. This is the “deer in the headlights” or “playing possum” response. Sometimes, “playing dead” can actually deter the assailant If the fight or flight is successful, the body’s physiological or predator. response is “completed” and the mobilized energy is released from the body.

In the wild, if an animal tries unsuccessfully to fight or flee omfr a predator, it may, as a last resort, employ the freeze response. If playing dead successfully deters the predator, the animal that froze will then use ways of discharging the pent-up energy the body initially mobilized to fight or flee (i.e. whole-body shaking). Humans don’t typically employ effective discharging methods, which can lead to a thwarted or incomplete threat response that becomes “stuck” in the body. This stuckness can be felt as both physical and emotional symptoms.

! A very important point ! The fight/flight/freeze response to a threat is OUTSIDE our conscious control. It’s directed by a primitive survival center in the brain. And everyone’s brains are wired differently. One person’s brain may react by fighting, another by fleeing, and still another by shutting down or freezing. It’s not like, when faced with a threat, the cognitive part of your brain stops and thinks, “Hmmm. What are the pros and cons of fighting in this situation?” Far from it. Sometimes, even when the brain and body mobilize energy and begin to fight or flee, the danger persists and, in response to inevitable or imminent pain, the brain switches survival tactics and begins shutting the body down; freezing.

Why is this important? Because a lot of trauma survivors, especially those whose brains and bodies went into freeze mode, carry guilt, shame or hopelessness with them for the way they reacted in the moment of threat. “Why didn’t I fight? Why did I just shut down like that? I’m so weak. I’m such a coward.”

My message to survivors: No. You. Are. Not.

Again, the way the brain and body react in a moment of threat is NOT a conscious choice and it is NOT a statement of anybody’s character.

The threat-perception system The filtering system Tells us when danger requires a response Helps us figure out what’s important – This becomes dysregulated, making survivors – During a traumatic event, survival depends hyper-alert to threats and prompting them to see on being hyper-attuned to the threat. threats in places, situations, or behaviors others – After the event is over, this system can may find non-threatening. remain hyper-active. – The brain doesn’t distinguish between real and – Everything seems important and perceived threats; between ego threats and requires immediate attention. physical threats; between “being safe” and – This increases chronic stress load. “feeling safe.” – Or, it can become shutdown/disconnected. – When the survivor perceives a threat, – Nothing seems important. his or her body reacts as if the threat – This reduces motivation. were very real. – Either way, the survivor can find it hard – This interferes with the survivor’s ability to feel to focus on and attend to what’s actually fully alive and calm and to find pleasure in what going on around them in the moment. they used to.

The self-sensing system The executive system Helps us know what we feel and gives Helps us think and plan us a sense of our body in relation to – During a traumatic event, when the body’s our environment reactions are being directed by the more – During a traumatic experience it’s not safe primitive threat-response systems of the to feel. Emotions can be useless, or even brain, this cognitive system goes offline; dangerous, so this system is blunted. it stops communicating with other parts – After the experience, this system can of the brain. remain blunted as a defense mechanism – Later, if the survivor is triggered, this system to cope with uncomfortable feelings and again goes offline as other systems prepare physical memories in the body. the body to fight, flee, or freeze. – This doesn’t just dampen the – This makes it virtually impossible response to pain; it also dampens to use reason and logic to respond the response to pleasure. to the trigger. – This makes it difficult to connect with your body, your emotions, and with other people.

Trauma changes the body in many ways. One way to think of this is that the body stores the memory and energy of the trauma.

What does it mean that the body stores the trauma? If the body’s natural response to threat (the sympathetic nervous system’s preparation for fight or flight) is thwarted or if the remaining energy is not adequately released after the threat has passed, all that mobilized energy can become “stuck” in the body (the muscles, joint, and organs). It’s like flooring the gas pedal while the car is in neutral. This helps explain why survivors often experience very real, very troubling physical symptoms like headaches, stomach aches, neck pain, muscle soreness, and exhaustion.

The brain’s ability to make a coherent story out of the body’s sensory memories of the event (like the sound of breaking glass or the smell of burning rubber in the case of an auto accident) breaks down. That means the survivor has trouble processing all those sensory inputs into a story they can remember as something that happened in the past. Instead, in what’s known as a flashback, the survivor feels those same sensations as if they are happening here and now. The survivor doesn’t remember the event; they relive it.

You can think of it like this: at the time of a traumatic experience, the body’s sensations are stored into physical memory as chocolate chips; individual little sensory morsels. One goal of healing from a trauma is to melt those chocolate chips into chocolate syrup so you can use the rational, cognitive part of your brain to create a coherent narrative of the trauma and place it behind you in the context of your life.

Does that mean you can ever forget the trauma or that the memories never trouble you again. No way. What it means is that you can learn to remember the trauma instead of reliving it. And THAT frees up precious physical and emotional energy to begin moving forward.

© 2020 A Path Forward Counseling. All rights reserved. www.APathForwardCounseling.com 7 Distressing behaviors after a traumatic experience The four categories medical and mental health professionals consider when diagnosing post-traumatic stress disorder

Re-experiencing Changes in mood and thoughts

Nightmares Flashbacks Aggressive behavior Feelings of Negative mood guilt or shame

Avoidance

Negative thinking Difficulty Loss of interest concentrating

Avoiding thinking Avoiding talking about the experience about the experience Changes in arousal and reactivity

Avoiding places that remind Avoiding activities that remind you of the experience you of the experience Easily frightened Difficulty sleeping Always on guard

Factors that increase the Factors that decrease the risk of developing PTSD risk of developing PTSD – How an individual’s brain controls hormones – Seeking out support from other people, such and chemicals in stressful situations as friends, family, and support groups – Inherited risks of depression or anxiety – Learning to feel good about one’s own – The temperament or personality of an individual actions in the face of danger – The level of severe trauma experienced during – Having a positive coping strategy, or a way and since early childhood of getting through the bad event and learning from it – Family instability, lack of a social support system, or poverty – Being able to act and respond effectively despite feeling fear – Women are twice as likely as men to develop PTSD Source: https://www.nimh.nih.gov/health/topics/post- traumatic-stress-disorder-ptsd/index.shtml – Having a pre-existing emotional or mental health disorder, eating disorder, or drug/alcohol abuse – Sleep disorders such as insomnia or sleep apnea Source: http://www.ptsdalliance.org/who-is-at-risk/

Healing after a traumatic experience can feel like a daunting journey. Trauma wounds us and changes how our brains, nervous systems, and bodies work. So, healing involves recovering from those emotional, cognitive, and neurological changes caused by the trauma. You could think of it as rewiring how different parts of your brain communicate with each other and with your body. A lot of that rewiring involves re-learning how to feel safe, and feeling safe can be divided into four steps. Feeling safe:

in the present in your body with your emotions with other people moment (both positive and negative)

What could help look like? Several types of therapy have been shown to be effective or are currently being researched and show great promise in reducing and/or managing the troubling symptoms, feelings, thoughts, and behaviors that can linger after a traumatic experience. Some of those styles or techniques include:

– Trauma-informed cognitive behavioral therapy – Eye movement desensitization and reprocessing (EMDR) – Neurofeedback – Hypnotherapy – Somatic Experiencing Therapy – Equine-assisted psychotherapy – Peer support groups

In addition to, and arguably more important than, the specific technique or style of therapy a professional may offer is the relationship you can form with that professional. Do you feel safe sharing with him or her? Do you feel validated, supported, and respected? Can that person create a space where you can slowly and over time allow yourself to feel vulnerable?

4 RECLAIM Relcaim your sense of personal power and purpose by creating meaning from your experience and You can begin to minimize placing it in the full context of your life story. the anxiety, hyper-vigiliance,

nightmares, flashbacks, and dissociation that sometimes occur after traumatic RETELL (WITHOUT RELIVING) events even before you 3 Gain control over traumatic memories by keeping reach these last two steps. your body relaxed while you tell the story of your experiences to a person you trust in a place where you feel safe.

2 REGULATE Learn self-soothing skills to remain relaxed and return your body to calm when you feel triggered.

1 REFRAME Gain confidence that you’re not “broken” or “going crazy” by learning about your body’s natural response to trauma, how it kept you alive during the event, and how your body may remain stuck in that response mode long after the trauma has passed.

If you have asthma or have ever known somebody who does, you may be familiar with the idea of a daily maintenance medication to minimize the potential for an asthma attack and a rescue inhaler to counteract an attack if one does happen. That same approach helps when you’re healing from a traumatic experience.

The idea is to engage in daily habits and practices (maintenance) that help your nervous system remain at a comfortable and appropriate level of activation to enjoy life and accomplish your daily tasks. Still, even the best maintenance routine can’t prevent all potentially triggering events, places, memories, or thoughts from initiating the fight-flight-or-freeze response. That’s why it’s helpful to have a toolbox of techniques you can use to counteract that response (rescue) and return your body to a state of calm when you do feel triggered (assuming you’re not actually in immediate danger).

Below are suggestions for both “maintenance” and “rescue” tools. Some may work for you, some may not. Some may seem obvious, some may need further explanation. I encourage you to speak with a medical or mental health professional about your specific situation and needs.

Maintenance Rescue Tools to create a calm baseline Tools to return to calm after being triggered

– Healthy sleep habits – Breathing exercises – Healthy diet • Belly • Square • 5-finger • 4-7-8 – Meditation/mindfulness practices – Body scan – Yoga/Qigong – Progressive muscle relaxation – Exercise – Core muscle relaxation – Massage – Peripheral vision exercise – Affirmations/mantras – 5-4-3-2-1 sensory grounding – Art/music/writing – Yawning – Journaling – Humming – Gratitude journal – Mammalian diving reflex* – Looking for beauty – Hand warming (literal or with guided imagery) – Using social supports – Valsalva maneuver* – Connecting with other trauma survivors – Safe place imagery (with or without – “3 Questions” (an end-of-day practice) a transitional object) • Who helped you today? * If you have a heart condition or eating disorder • Who did you help today? talk with your doctor before using this technique. • What did you learn today?

It’s important to remember that “healing” from a traumatic experience doesn’t necessarily mean returning to exactly who you were before the trauma. That may not be a realistic goal, and focusing on that may set you up for disappointment. ! Trauma changes you. It affects your thought process, your likes and dislikes, and how you interact with people, to name just a few.

So here’s my outlook on healing from trauma (keep in mind, please, that this is my OPINION and is not a statement of medical or psychological FACT). I believe “healing” involves learning to live in – and accept – the new reality created by the trauma you survived, learning to carry your hurt with grace, and learning to find meaning after your experience.

Is what happened to you fair? Absolutely not! I wish that only good things happened to good people. If I ever find a genie in a bottle, that’ll be my first wish. In the meantime, the best I think we can do is heed the wisdom of Viktor Frankl, psychiatrist, Holocaust survivor, and one of my personal heroes: “When we are no longer able to change a situation, we are challenged to change ourselves.”

Experiencing something traumatic can dramatically affect how you view yourself. You could think about this post-traumatic self image as being on a continuum from victim to survivor to victor as shown below.

It’s important to know that it’s completely natural to feel like a victim after such an experience. Feelings of shame and anger (sometimes directed at yourself) are also very common. While some people may identify more quickly or more easily with the survivor or victor self image, others may spend a great deal of time (maybe even their entire life) imaging themselves as a victim. That doesn’t mean those people are weak or self-pitying. It means they have a unique set of experiences, beliefs, memories, and biology that affects their post-traumatic self image.

It’s also important to know that with support, hard work, and self-compassion, it is possible to find new strengths, new gifts, and new growth after a traumatic experience. What that growth looks like, how far it goes, and how long it takes will look different for each person.

Something really painful happened and...

... it’s too much of a burden to carry. ... it’s made me who I am, and it’s ... I have the power to choose how not all that I am. I respond. ... it defines me completely. ... I may never be the same, and ... I’ve discovered a new strength, ... it’s left me broken. that doesn’t mean I’m broken. purpose, or meaning. ... my world is over. ... it’s taught me a lot about the ... I can help the world with my ... I’ll never be whole again. world and about myself. experience and my message. ... I’m powerless to change my path. ... I’ll always carry it with me. ... I know I can make it through the next time something hard happens. ... I’m still here and I still have a self. ... I don’t have to control everything in ... I can control my life. my life becuse I know I can handle whatever happens. VICTIM SURVIVOR VICTOR

Comfort and wisdom can be found from many sources. I’m sure you have your favorite sources of inspiration. Here are a few of mine. (Feel free to email me some of yours. You can never have too much inspiration.)

“Fall down seven times. Get up eight.” – Japanese proverb

“I am not what has happened to me. I am what I chose to become.” – Carl Jung

“When we self-regulate well, we are better able to control the trajectory of our emotional lives and resulting actions based on our values and sense of purpose.” – Amy Leigh Mercree

“When we are no longer able to change a situation, we are challenged to change ourselves.” – Viktor Frankl

“Everything can be taken from a man but one thing: the last of the human freedoms — to choose one’s attitude in any given set of circumstances, to choose one’s own way.” – Viktor Frankl