Dynamic Psychotherapy

Dynamic Psychotherapy is a Melbourne Psychology Practice with an ISTDP focus

Trauma Therapy: Mapping the Cycle

To be human is to contend with inevitable experiences of adversity, in which we continue to demonstrate tremendous resilience to ensure our own survival. Regardless of the scale of these adversities, traumatic experiences leave traces across individual, interpersonal, societal, and historical levels. When an adversity becomes traumatic is when the integration of an emotionally distressing experience has exceeded our own capacity to cope; simply defined as intolerable and unbearable by trauma expert and author Bessel Van Der Kolk in his book The Body Keeps The Score (pg. 3, 2014). When an individual experiences severe emotional distress, the brain undergoes changes to adapt and protect itself. This often results in altered perceptions and responses to similar or related stimuli in the future, designed to increase sensitivity to threats as to avoid further risks to self.  

For example, imagine a person who has been in a serious car accident. The intense emotional distress of the event can lead the brain to change in an effort to protect the individual from future harm. One of these changes may include the development of a heightened sensitivity to driving or even being near cars. In the future, this person may experience increased heart rate, anxiety, or hypervigilance when hearing car engines or horns, or when they need to drive. These altered perceptions and responses are the brain’s way of saying, “Be careful, remember what happened last time!” This is an adaptive response intended to minimise the risk of experiencing such trauma again. It’s the brain’s effort to alert and protect the individual from similar threats. However, if these responses become too intense or pervasive, they can interfere with daily functioning and well-being, which is where therapeutic interventions can help in recalibrating these protective mechanisms.

In therapy, instead of just looking at the problems or symptoms a person has, we try to figure out what experiences caused them. This change—from asking “what’s wrong with you?” to “what happened to you?”—helps us see how trauma affects a person in many ways, not just one. We start to look at all the different areas of a person’s life that trauma might have touched. These include:

1. Neurobiological Changes: Traumatic stress can cause changes in brain structures and functions that are involved in mood regulation and fear responses. For example, trauma can lead to heightened activity in the amygdala (associated with fear responses) and reduced activity in the prefrontal cortex (involved in regulating those responses). It can also affect the hippocampus, which is involved in memory formation and stress regulation. These changes can contribute to the symptoms of anxiety and depression.

2. Hormonal and Chemical Imbalances: Trauma can disrupt the body’s natural balance of stress hormones, such as cortisol and adrenaline. This can result in a person being in a constant state of ‘fight, flight, or freeze’ or lead to adrenal fatigue, both of which can contribute to clinically distressing anxiety and depression.

3. Cognitive and Emotional Effects: Trauma can alter a person’s thoughts and beliefs, often leading to negative perceptions about oneself, others, and the world. These negative thought patterns can contribute to the development of depression. Trauma can also lead to emotional dysregulation, making it difficult for individuals to manage and express emotions effectively, which can manifest as anxiety.

4. Behavioural Changes: Trauma can lead to avoidance behaviours, withdrawal from social interactions, and a decrease in activities that used to bring joy, all of which are common in depression. Additionally, hypervigilance can lead to pathological anxiety as individuals become overly alert to potential threats.

5. Social and Relational Impact: Trauma can affect relationships and social support systems. Isolation and lack of support can contribute to depression, while strained relationships can increase stress and anxiety.

6. Sleep Disturbances: Trauma often disrupts sleep, and poor sleep can exacerbate or lead to mood disorders like depression and anxiety.

7. Substance Use: Individuals with trauma may turn to alcohol or drugs as a way to self-medicate, which can lead to substance use disorders as well as exacerbate or cause symptoms of depression and anxiety.

8. Existential Impact: Trauma can lead to a crisis of meaning or belief, shattering an individual’s sense of safety, predictability, and fairness in the world. This can lead to existential depression and anxiety.

9. Intergenerational Transmission: Traumatic experiences and the resulting coping mechanisms can be passed down within families. Children of traumatised parents may inherit maladaptive coping styles or heightened stress responses, even if they haven’t experienced the trauma directly. This cycle perpetuates the impact of trauma across generations.

10. Chronic Stress: The ongoing stress response from trauma can become chronic, contributing to a persistent state of anxiety. This chronic stress can also deplete the individual’s resources over time, contributing to the development of depression.

Mapping The Cycle of Trauma: Case Example

Let’s take the example of Maya, whose father, Alex, returned from military service with untreated PTSD. Alex’s trauma manifested in sudden outbursts of anger, emotional withdrawal, and hyper-vigilance. As a child, Maya learned to walk on eggshells, constantly alert to avoid triggering her father’s anger. She also learned that expressing emotions could lead to instability, so she suppressed her feelings, a coping mechanism she observed in her father.

Growing up in this tense environment, Maya developed an anxious attachment style, always striving to anticipate the needs of others to keep the peace. As an adult, Maya found herself in relationships where she replicated the dynamics of her childhood, exhibiting a heightened stress response and emotional suppression.

When Maya became a parent, she noticed her own short temper and difficulties with emotional connection, reminiscent of her father’s behaviour. Her son, feeling the effects of Maya’s unresolved trauma, began to show signs of anxiety and emotional withdrawal himself.

Left unaddressed, Maya risked repeating the pattern of her own early childhood experience which would have maintained the intergenerational transmission of the untreated trauma. However, in this example, Maya sought therapy. By doing this, she recognised the patterns inherited from her father. With guidance, she worked to understand her father’s trauma and its impact on her. She learned new ways to regulate her emotions and communicate effectively. This not only improved her own mental health but also changed how she interacted with her son, who, in turn, became more secure and expressive.

By addressing her trauma, Maya broke the cycle, ensuring that her son would not have to carry the same burdens into his future, illustrating the potential to halt intergenerational trauma through awareness and therapeutic intervention.

The Role of Trauma-Informed Psychotherapy

Trauma-informed therapy addresses the complex effects of trauma through a holistic approach that prioritizes safety, trust, and the processing of traumatic memories. Therapists help clients become aware of how trauma has influenced their lives and guide them in developing skills for emotional regulation and cognitive restructuring. By doing so, individuals learn to manage their responses to triggers and transform negative thought patterns that have stemmed from past trauma.

Central to this approach is the creation of a supportive environment where clients can explore their experiences without fear of judgment, as well as building trust in the therapists ability to hold and contain the exploration of their distress. At a neurobiological level, the stress-response system is worked with experientially which increases tolerance of emotional distress and reducing immediate symptoms that might be maintained by unconscious avoidance processes. This therapeutic approach not only aims to reduce immediate symptoms, but also to increase resilience, self-worth, and fulfilment. By fostering healthier coping mechanisms and interpersonal dynamics, the transmission of trauma across generations can be better mitigated.

Trauma Therapy: Mapping the Cycle

Jesse Muscatello

Jesse is a registered psychologist and a Clinical Psychology Registrar, experienced in both public and private mental health sectors, as well as in tertiary education. Specialising in a psychodynamic approach influenced by ISTDP, Jesse helps clients uncover and address unconscious patterns affecting their current behaviours and emotions. His empathetic, non-judgmental style fosters a strong therapeutic relationship, crucial for tackling various challenges such as depression, anxiety, trauma, relationship, and performance issues. Jesse's focus extends beyond symptom relief, aiming to assist clients in achieving a more meaningful and fulfilling life.

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