“Trauma is what happens inside of you, as a result of what happened to you” – Gabor Maté.
About Trauma
Trauma comes from the Greek word for ‘wound’. It is important to distinguish between the traumatic event and the body’s response or wound. While what happened cannot be changed, the impact of the event on our minds; that is, the wound, can be healed.
While most people recover well from a traumatic event, including with good self-care and social support, for some the psychological impact can result in severe distress, and be emotionally, a life-altering experience. Or some people successfully deal with the first few events but then due to repeated exposure, for example in the case of war trauma and emergency service personnel, eventually the emotions triggered become overwhelming.
The reaction of an individual to shocking and sudden events is deeply personal and can be a life-altering experience, manifesting in both physical and psychological symptoms. Five to ten per cent of Australians are expected to meet the diagnosis for Post-Traumatic Stress Disorder (PTSD) at some stage during their lifetime with approximately one to three per cent of the population experiencing PTSD at any point in time. This incidence rises following a major event, for example, rising to 4.4 per cent following recent widespread bushfires. The incidence for individuals who are frequently exposed to traumatic events, such as police in Australia, is higher and thought to be at 16 to 20 per cent at any given point in time.
Trauma counselling involves a specialised approach, distinct from general therapy, to address the unique impact of traumatic experiences.
It is normal to experience heightened arousal, alertness, and hypervigilance in the days and weeks after exposure to a traumatic event. It is common to experience anger, grief, guilt and sadness. Generally these symptoms will resolve over the coming weeks including that a strong mitigating factor is social support: How is there to care for and support the person following the event and how able is the individual to accept care and support from others. With good self-care and support, many people find that their symptoms quickly significantly reduce. However, for those who experience ongoing distress, they may need trauma counselling to heal.
What is PTSD?
Post-Traumatic Stress Disorder (PTSD) is specific diagnostic category for a trauma-related condition that can develop after someone has had direct experience of a traumatic event involving actual or threatened death or serious injury or sexual violence, either directly or witnessing it in others, or learning of it in close family members and friends, or repeated exposure to hearing accounts of traumatic events
Not all trauma meets the diagnosis for PTSD but regardless, may still be deeply distressing. All diagnoses of PTSD involve a deeply distressing and often sudden and unexpected event.
If an individual experiences symptoms immediately a traumatic event, they may be diagnosed with Acute Stress Disorder. If these symptoms persist after one month, a diagnosis of PTSD is given.
People who experience PTSD are at a higher risk of also suffering other psychological conditions such as depression, anxiety including panic attacks, and substance abuse. When all current problems are taken into account in assessment and therapy, treatment for PTSD is more likely to be successful.
Symptoms of PTSD
It is common to re-experience aspects of the trauma, particularly when an event or interpersonal interaction in the current, activates memories of the traumatic event. This involuntary reliving of events can be through distressing memories and nightmares, or via flashbacks that have the person experiencing themselves as back in the midst of the traumatic event. At an extreme level, dissociation, where the person loses awareness of their present time and surroundings, can result from very high levels of emotional activation and anxiety.
Avoidance of potential triggers for memories and feelings is common among those experiencing PTSD. Sometimes what starts as avoidance of specific people and situations generalises to the avoidance of most people and places outside of a very confined comfort zone. This in itself can exacerbate mental health issues and put strain on close relationships. Sometimes people suffering PTSD seem to just ‘disappear’ from their social network and over time, it can be easy to lose touch with friends and hard to re-engage in former relationships.
Alcohol and other substances can be used in an attempt to avoid the memories, and/or the emotions and triggers, associated with the distressing event. Although alcohol and drug use may help to reduce anxiety and blunt the emotional distress that is experienced, it tends to impede successful recovery and bring other serious problems.
Changes in cognitions and mood can be indications of PTSD, including negative thoughts, anger, including explosive outburst of anger, irritability, guilt, and shame. Sometimes an individual seems to lose capacity for joy, happiness, love and other positive emotions. Numbness and a lack of awareness of any feelings is a common feature of PTSD.
Hypervigilance is a common feature of PTSD. The person is constantly vigilant and watchful for signs of threats. It is difficult to relax. They can startle easily. Sleep disturbances such as insomnia or restless sleep may result including the experience of never being able to full relax and ‘let go’.
Heightened physiological symptoms of anxiety such as increased heart rate, breathing difficulties, sweating, and agitation are common. A sense of losing control or impeding catastrophe is often a feature of this rise in anxiety. High anxiety can also result in impaired memory, concentration and attention.
Some people engage in reckless behaviours as if they have no regard for their well-being or that of others.
For a diagnosis of PTSD, the symptoms need to be severe enough to negatively impact with capacity to function in the home, socially, or at work.
For a complete symptom check list, visit Beyond Blue.
Chronic, untreated, PTSD leads to additional mental health issues in up to 80 per cent of people; generally depression, anxiety including panic attacks, and substance abuse.
Causes of PTSD
PTSD involves a prolonged and heightened physiological threat response in the body.
There is a relationship between severity of the threat and the likelihood of developing PTSD but there are also other risk factors such as a lack of good coping mechanisms, inadequate social support, relationship stressors and other life stressors. Childhood trauma, a family history of psychological conditions such as depression and anxiety, and a previous episode of unresolved trauma can also contribute to a greater vulnerability for PTSD following a traumatic event.
Repeated exposure to trauma, such as living in a war zone or working in a frontline role in a police organisation, leads to a greater risk of PTSD.
Innate or learned resilience and good coping skills lower the risk of developing PTSD, however, not everyone has had the opportunity to build these capacities. Some individuals may not have overly suffered from the lack of specific coping skills and capacity, until faced with a severe traumatic event.
Special Groups:
- Police
- Other Emergency Services Personnel
- Defence Force Personnel
- SES and Other First Responders
- Victims of Crime
- Witnesses to Intensely Distressing Event
- Historical, Recent and Current Abuse
- Aboriginal and Torres Strait Islander Peoples
- Non-English Speakers
- Partners and Family Members
When to Seek Help
If you are experiencing extreme levels of anxiety, or other distress, in the aftermath of a traumatic event, it is recommended that you seek help from your GP or a psychologist.
It is expected that two weeks after the traumatic event that, although it is common to have some symptoms, you should be noticing marked improvement. If two weeks after the trauma you are not experiencing natural recovery and continue to significantly emotionally suffer, it is recommended that you seek professional help. If you are experiencing symptoms of PTSD for longer than one month after a traumatic event, obtaining professional help is indicated.
If you are having thoughts of self-harm or harming someone else, at any stage, seek immediate help.
Some people do not regard themselves as meeting the criteria for PTSD but notice being constantly irritable or having difficulties with tasks that previously did not pose a problem, such as tasks around the home or at work. They notice being withdrawn, uncommunicative, and emotionally numb. Even if the specific criteria for PTSD is not met, it is suggested you seek help if you are experiencing negative changes that show no signs of improvement as you approach the one-month mark.
Avoidance behaviours can make it more difficult to seek help for PTSD. There is often a desire to avoid talking about or thinking about the traumatic event. Normalising the wish to avoid discuss the incidence or getting help, can be useful in then overcoming to desire to avoid.
If you have chronic long-term PTSD, it is not too late to seek help. PTSD can be successfully treated at any time following the initial event or events.
The first step in seeking help is usually to make an appointment with your GP to get a referral to a psychologist experienced in treating PTSD.
Treatment for PTSD
The first stage of treatment is finding a psychologist or other mental health professional with whom the individual experiences at least some level of trust and hopefulness with. For some people it can take a few appointments before a strong sense of trust and hope develop. Sometimes it takes trying two or three different therapists before finding the one that seems right.
A detailed assessment will be undertaken. This will include the specific help that the individual is seeking with established therapeutic goals and the plan to achieve these goals.
Psychoeducation, including understanding commonality in experiences associated with PTSD is important so that the person can understand that there is a reason why they are suffering as they are suffering. It can be helpful to realise that while their experiences may seem different to others in their immediate interpersonal circle, their experiences are common among others who have PTSD.
There are various psychotherapeutic approaches to treating PTSD:
Prolonged Exposure (PE) is a well established treatment that exposures the individual to the traumatic event via imagery, aiming to keep anxiety regulated during the process. The aim is to build the individual’s capacity to face memories of the traumatic event without emotional distress. A specific schedule and plan is devised to build capacity to undertake tasks currently avoided. Breathing retraining is used in Prolonged Exposure to help the individual stay regulated.
Intensive Short Term Dynamic Psychotherapy (ISTDP) can draw on elements of PE while focusing also on the current suffering that is attributable to the traumatic event. Capacity is built to face emotions, to stay more emotionally regulated, and to understand the deeper meaning of the impact of the trauma including why it is so difficult to leave what happened in the past, in the past.
Eye movement desensitisation and reprocessing (EMDR) aims to help the individual access and process traumatic memories. It is believed that if the patient moves their eyes back and forth across their field of vision by tracking the therapist’s finger, the brain is activated in a way that enables the trauma to be accessed, processed and integrated.
Cognitive Restructuring can help people who suffer PTSD to better reality test and rationalise their experience in the current relative to their traumatic experience, and to change unhelpful beliefs that impact on mood.
Cognitive Processing Therapy uses elements of cognitive therapy combined with a small exposure component that often includes writing about the traumatic event.
Stress Inoculation Training can build capacity to lower anxiety when in emotionally activating situations.
Relaxation Training can be a useful adjunct to other therapeutic approaches including recognising physiological signs of rises of anxiety in the body, and using specific learned skills to lower anxiety before it reaches distressing levels.
Group Therapy can be helpful for PTSD, particularly in the context of others who have experienced similar traumatic events. Shared experienced can help the individual to not feel so alone or ‘abnormal’
Psychotherapy combined with better habits relating to diet, sleep, exercise and general self-care can result in the total resolution of PTSD.
Additional Resources
Lifeline 13 11 14
Grief line 1300 845 745
Beyond Blue 1300 224 636
Phoenix Australia Centre for Post-Traumatic Mental Health (03) 9035 5599
Some of our Trauma Therapists
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Jesse M
Psychologist
Claudio Donisi
Senior Psychologist
David Temme
Psychologist
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Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so we may fear less.
-Marie Curie