Trauma impacts a person’s sense of self, how they relate to others, and how they see the world including their identity, self esteem, ability to trust, sense of intimacy, general beliefs, and their relationship to their emotions.

Identity

• Who am I now?

• Who was I before?

• How do I get back to the older version of me?

• Is who I believed I was before accurate?

• Who do I want to be in the future?

• Who am I really?

Self-Esteem

• The ability to see myself as good enough even when things fall apart, conflicts occur, disagreements occur, and I am unable to control experiences.

Trust

• Who can I trust?

• Can I even trust myself? What is trust?

• Is it a feeling? Or is it a thought?

• Who don’t I trust?

• How can I trust more?

Intimacy

• Do I need a lot of physical and emotional space in relationships?

• Do I need others to be around me close in proximity?

• How do I get my needs met? Do I ask? Do I assume? Do I avoid? Do I get overwhelmed?

Beliefs About The World

• Is the world a safe place generally?

• Is the world a dangerous place generally?

• Where would I never go to by myself?

• Are there certain people I wouldn’t trust at all?

• Are there other people I would be more apt to trust?

Emotions

• Is it easy for me to feel my emotions?

• Is it difficult for me to feel my emotions?

• Am I easily overwhelmed by emotions?

• What do I do when I’m overwhelmed?

• Do I have the appropriate skills to manage my emotions?

• Are emotions acceptable or unacceptable?

Common emotions after experiencing trauma include:

• Fear

• Terror

• Worry

• Nervous

• Edgy

• Sadness

• Grief

• Anger

• Frustration

• Irritability

• Confusion

• Guarded

• Tense

Examples can include:

• Fear of being attacked, hurt, put in a danger, and/or harmed again.

• Sadness over the pain, hurt, loneliness, vulnerability.

• Grief over what was lost including loss of safety, loss of time, loss of security, loss of love, loss of relationship, loss of money.

• Anger over what was not in your control, what was unfair, what should not have happened to you, what was scary.

• Tense because your body is signaling to you to be on edge in case of future danger, to protect you, and let you know something might happen in the future.

Formal Definitions of Hypervigilance

• A state of abnormally heightened alertness, particularly to threatening or potentially dangerous stimuli (APA, 2022).

• Hypervigilance is a state of being constantly on high alert or excessively watchful and wary, even in situations that are not particularly dangerous.

• It is a common symptom of anxiety and posttraumatic stress disorder (PTSD).

• People with hypervigilance often experience intense and persistent feelings of anxiety and a heightened sense of threat, which can interfere with their daily functioning (APA, 2013).

My Definition of Hypervigilance

• I think of hypervigilance as your body’s fire alarm going off. You are on high alert, feel unsafe, stressed, and very aware of your surrounding, searching for danger and threat.

• Your body is signaling danger in order to protect you.

• Your body is physically preparing for a fight, conflict, threat, or danger, but perhaps now after the trauma has occurred, there is no real physical danger.

• An example of hyperviglance is walking alone at night and feeling like someone is following you, so you constantly look behind you and over your shoulder.

Effects of Hypervigiliance

• The effects of hypervigilance include feeling constantly on edge, tired, exhausted, tense, jumpy, and easily startled.

• The goal is to move toward healthy vigilance and to differentiate between real danger in the moment versus the perception of danger as a result of triggers and the remnants of trauma.

• This is a very nuanced and complex practice that requires effort, time, and practice. However, this is very much possible.

Example of Hypervigiliance

• Living with the constant real danger and threat as a body/person of color in a racist society.

• How do we learn to differentiate between real vs. perceived danger?

Body/Muscle Armoring

• A somatic way of thinking about hypervigilance is the body’s unconscious response to trauma.

• The body begins to automatically tense and restrict. This often happens with the jaw, hands, arms, stomach, chest, shoulders, neck, and back.

• Some people begin to take shallow breaths or hold in their breaths without even noticing it.

What Can I Do?

• Draw your attention to the area of tension in or around your body. Notice the sensations around this area of your body. Allow your body to complete the action it wants to do.

• Example 1

  • If you are clenching your jaw, try to relax your jaw fully moving it around in a circle

• Example 2

  • If you are holding tension in your shoulders and they are raised, pause, slow down, notice these feelings, and allow your shoulder to relax and then rotate it, slowly drop your shoulders, and release these sensations.

• Make your body feel physically or emotionally safer. This can include: locking all the doors at home, using a weighted blanket, wearing comfortable clothing, etc.

• Other adjunctive methods such as acupuncture, massage therapy/body work, somatic therapy, and yoga. Find someone trauma-informed and understands the mind-body connection.

• Physical movement such as walking, stretching, dance, qigong, and tai chi. The goal is to do this mindfully and in the moment.

• Activity

  • Draw an outline of a human body. Using colored pens/pencils or markers, draw tension around areas of your body using different colors to represent different sensations. You could use blue or grey for heaviness and feelings of burden or yellow and purple for lightness and calm. You can also write words along areas of your body corresponding to the tension. Throughout the rest of your day, notice how these sensations shift, change, or stay the same. Be curious about what these areas might need to feel calmer, at ease, more peaceful, and more free. Engage in 1-2 relaxation behaviors. Notice how you feel now after taking good care of your body.

References

• APA Dictionary of Psychology. (2022). Hypervigilance. Retrieves from https://dictionary.apa.org/hypervigilance

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596

Definition of Dissociation

• A defense mechanism in which conflicting impulses are kept apart or threatening ideas and feelings are separated from the rest of the psyche. Detachment or feeling as if one is outside one’s body, and loss of memory or amnesia. Dissociative disorders are frequently associated with previous experience of trauma. (APA, 2022).

Common Statements of Dissociation

• Feeling like I’m floating above my body

• It’s like I’m watching a movie of my life

• My eyes begin to wander and I lose focus

Examples of Dissociation

• Going for a drive and not remembering how you arrived at a destination

• Daydreaming for hours

• Checking out

• Putting on a mask/facade

• Talking about painful experiences while laughing

• Revenge fantasies

• Going blank

• Losing connection to who you are

Depersonalization & Derealization

• Depersonalization/derealization disorder is characterized by persistent feelings of detachment from one’s body or experiences (e.g.: feeling as though things are unreal or a dream).

• Dissociative identity disorder (DID), the most severe dissociative disorder, includes both persistent depersonalization/derealization and dissociative amnesia as well as the presence of distinct self-states with unique attributes or experiences.

Amnesia

• Dissociative amnesia is characterized by gaps in autobiographical memory beyond normal forgetting, that may range from one experience to several years.

What Can I Do?

• Checking back into your body

• Pushing both feet on the ground

• 54321

  • dentifying 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, and 1 thing you can taste.

References

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9162402/

Definition of Emotional Dsyregulation

• Emotion regulation is the ability to control and modulate your emotions and feelings. Your feelings and emotions are appropriate for the given experience at hand.

• Emotion dysregulation is the opposite. It is the inability to control your emotions and feelings and reacting to experiences in an extreme manner or a manner which is not appropriate to the given situation.

• This can include temper outbursts, self-harm, acting out, blaming, yelling, screaming, etc.

• Emotions are very intense, difficult, cause distress, and overwhelming for those with emotional dysregulation.

• Emotions largely motivate and drive your behavior.

Examples of Emotional Dsyregulation

• Self-harm

• Perfectionism

• Depression

• Anxiety

• Shame

• Anger

• Irritability

• Substance use

• Difficulty and conflict in relationships

What Can I Do?

• Look into Dialectical Behavior Therapy (DBT). DBT The Emotional Regulation module.

  • Some DBT skills for emotion regulation include: Check The Facts, Problem Solving, Opposite Action, and more.

• Learn the basics of emotions.

  • Recognize the role of emotions, learn the myths of emotions, validate your emotions, and accept them.

• Expand your emotional vocabulary.

References

• Emotion Dysregulation and Posttraumatic Stress Disorder: A Test of the Incremental Role of Difficulties Regulating Positive Emotions: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6552656

• https://dictionary.apa.org/dysregulation

• DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan.

Survivors of trauma experience extraordinary or adverse experiences that should not occur.

These experiences are violent, abusive, neglectful, and/or oppressive leaving survivors feeling terror, panic, shame, guilt, angry, grief, and sad.

In turn, unhelpful beliefs about the world can begin forming as a way to make sense of what occurred and to prevent such experiences from occurring again (defense/protective skill) as a form of control.

However, these thoughts keep survivors “stuck” in a loop of avoidance, fear, worry, anxiety, and hypervigilance.

Negative Core Beliefs

• Core beliefs are beliefs a person has about themselves, others, and the world. Core beliefs help us to make sense of our world by organizing experiences into familiar patterns.

• Core beliefs can be negative or positive, but with trauma, they are usually negative and related to the traumatic events.

• A negative core belief is a broad, negative, and generalized judgement you have made about yourself, based on some previous negative experiences (childhood, past relationship, past work experience, life experiences)

• Core beliefs can shift gradually with practice and effort, but become more stable and stronger over time if left unchecked.

Common Negative Core Beliefs

• I’m all alone

• It’s not safe to feelI’m unimportant

• I’m powerless at work/in my relationships

• ’m trapped

• I have to be in control

• I’m responsible

• I should have done something to prevent (insert situation)

• I’m unlovable

• I’m undeserving of love and support

• I’m worthlessI'm

• not good enough

• I’m a bad person

• I’m a failure

• I'm incompetent

• I’m flawed

• I should have done something different

• I’m vulnerable and helpless

• I can’t trust my judgment and myself

• I’m in danger

—

PATTERNS OF PROBLEMATIC BELIEFS

Jumping to conclusions, fortune telling, predicting the future, catastrophizing

Exaggerating or minimizing a situation (blowing things way out of proportion or shrinking their importance inappropriately)

Ignoring important parts of a situation

Oversimplifying things as good/bad or right/wrong

Over-generalizing from a single incident (a negative event is seen as a never-ending pattern)

Mind reading (you assume people are thinking negatively of you when there is no definite evidence for this

Emotional reasoning (using your emotions as proof, e.g., "I feel fear so I must be in danger")

Should, must, never, have to, always statements

Labeling

A trigger is a stimulus that sets off a memory of a trauma or a specific portion of a traumatic experience.

Imagine you were trapped briefly in a car after an accident. Then, several years later, you were unable to unlatch a lock after using a restroom stall; you might have begun to feel a surge of panic reminiscent of the accident, even though there were other avenues of escape from the stall.

Some triggers can be identified and anticipated easily, but many are subtle and inconspicuous, often surprising the individual or catching him or her off guard.

In treatment, it is important to help clients identify potential triggers, draw a connection between strong emotional reactions and triggers, and develop coping strategies to manage those moments when a trigger occurs.

A trigger is any sensory reminder of the traumatic event: a noise, smell, temperature, other physical sensation, or visual scene.

Triggers can generalize to any characteristic, no matter how remote, that resembles or represents a previous trauma, such as revisiting the location where the trauma occurred, being alone, having your children reach the same age that you were when you experienced the trauma, seeing the same breed of dog that bit you, or hearing loud voices.

Triggers are often associated with the time of day, season, holiday, or anniversary of the event.

Behavioral Reactions

Traumatic stress reactions vary widely; often, people engage in behaviors to manage the aftereffects, the intensity of emotions, or the distressing aspects of the traumatic experience.

Some people reduce tension or stress through avoidant, self-medicating (e.g., alcohol abuse), compulsive (e.g., overeating), impulsive (e.g., high-risk behaviors), and/or self-injurious behaviors.

Others may try to gain control over their experiences by being aggressive or subconsciously reenacting aspects of the trauma.

Behavioral reactions are also the consequences of, or learned from, traumatic experiences.

For example, some people act like they can’t control their current environment, thus failing to take action or make decisions long after the trauma (learned helplessness).

For others, because they can’t control their current environment, they may seek structure, rigidity, and external control long after the trauma. This can include: overworking, exercising excessively, over eating, under eating, addiction, etc.

Other associate elements of the trauma with current activities, such as by reacting to an intimate moment in a significant relationship as dangerous or unsafe years after a date rape. The following sections discuss behavioral consequences of trauma and traumatic stress reactions.

Self Harm & Destructive Behaviors

• Self-harm is any type of intentionally self-inflicted harm, regardless of the severity of injury or whether suicide is intended.

• Often, self-harm is an attempt to cope with emotional or physical distress that seems overwhelming or to cope with a profound sense of dissociation or being trapped, helpless, and “damaged” (Herman, 1997; Santa Mina & Gallop, 1998).

• Self-harm is associated with past childhood sexual abuse and other forms of trauma as well as substance abuse.

• Thus, addressing self-harm requires attention to the client’s reasons for self-harm.

A hallmark symptom of trauma is reexperiencing the trauma in various ways.

Reexperiencing can occur through reenactments (literally, to “redo”), by which trauma survivors repetitively relive and recreate a past trauma in their present lives.

This is apparent in children, who play by mimicking what occurred during the trauma, such as by pretending to crash a toy airplane into a toy building after seeing televised images of the terrorist attacks on the World Trade Center on September 11, 2001.

Attempts to understand reenactments are very complicated, as reenactments occur for a variety of reasons. Sometimes, individuals reenact past traumas to master them.

Examples of reenactments include a variety of behaviors

• Self-injurious behaviors, hypersexuality

• Walking alone in unsafe areas or other high-risk behaviors

• Driving recklessly, or involvement in repetitive destructive relationships (e.g., repeatedly getting into romantic relationships with people who are abusive or violent), to name a few.

A flashback is reexperiencing a previous traumatic experience as if it were actually happening in that moment. It includes reactions that often resemble the client’s reactions during the trauma.

Flashback experiences are very brief and typically last only a few seconds, but the emotional aftereffects linger for hours or longer.

Flashbacks are commonly initiated by a trigger, but not necessarily. Sometimes, they occur out of the blue. Other times, specific physical states increase a person’s vulnerability to reexperiencing a trauma, (e.g., fatigue, high stress levels).

Flashbacks can feel like a brief movie scene that intrudes on the client. For example, hearing a car backfire on a hot, sunny day may be enough to cause a veteran to respond as if he or she were back on military patrol.

Other ways people reexperience trauma, besides flashbacks, are via nightmares and intrusive thoughts of the trauma.