Written by Dr Abrar Hussain, a Consultant who specialises in General Psychiatry and Liaison Psychiatry, which is the interface between psychological and physical health. His areas of expertise include depression, anxiety, traumatic stress, personality disorders and psychosomatic disorders.
What is psychological trauma?
Experiencing a distressing event that threatens our sense of safety can evoke an emotional response in us. This is especially true when the experience is overwhelming for us or when our coping mechanisms are not sufficient to deal with it. Trauma is a subjective experience and what is traumatic for one person may not be traumatic for another. Sometimes, the trauma is in the form of a single event (car accident) and this can be relatively easier to deal with when compared to multiple, prolonged and severe traumatic episodes (childhood abuse). In some instances, trauma can bring to surface previous traumatic experiences that were all along buried and hidden from our conscious awareness.
How does our brain process trauma?
Our brain is making sense of the world all the time, it is generally very good at processing our experiences and this helps us build our map of the world. The brain has a natural ability to process traumatic experiences. There are neural networks (connections of neurons) that help in processing trauma. However, if the trauma is too big, the brain struggles to process it. Trauma can, therefore, disrupt the normal information processing system. A part of the brain called the Hippocampus that usually processed and encodes experience struggles to do its job. As a result, another part of the brain called the Amygdala (referred to as the Watchtower) gets activated and starts scanning for more threat. A hyperactive Amygdala makes it difficult for us to rest as relax as we are constantly on the lookout. It can be quite exhausting.
What is the impact of traumatic stress?
Traumatic experiences that remain unprocessed continue to cause us distress. They might give rise to nightmares and flashbacks. They might make us feel sad, angry and impulsive. We can become ‘hypervigilant’ which means we are always looking out for danger. Events that remind us of the traumatic event can end up causing a lot of distress and because of this, we can start avoiding certain situations, places and even people! Traumatic stress can also manifest in the form of physical symptoms including pain symptoms. These physical symptoms can be distressing and investigations done by doctors to identify the cause of the symptoms can often draw a blank.
What is dissociation?
Dissociation is a defence mechanism that we can involuntarily adopt to deal with big trauma. It means that we “zone out” and “switch off” and this keeps us psychologically safe as we are cut off from the trauma. Although it is an excellent mechanism to preserve our sense of integrity in the short term, it is not so helpful in the long term. It prevents us from getting in touch with our distressing memories and therefore the trauma remains unprocessed. Dissociation can sometimes give us a false sense of safety and it can also be hard to identify. Depending on the severity of the trauma, the extent of dissociation can vary. In it’s more severe form, dissociation can split off parts of ourselves and we may not even be aware that these parts exist. Each part may have its own way of dealing with things and may behave differently.
How can we deal with psychological trauma?
The first step is to recognise that we have encountered a traumatic experience. This can take time to identify especially if we have learnt to cope by dissociating. Having flashbacks and nightmares of a particular event is generally a good indicator of trauma. Trauma can sometimes leave us feeling responsible and guilty and these can become barriers to seeking help.
In order to free ourselves from the impact of traumatic stress, we must first try and get out of the environment in which the trauma is happening (if it is still continuing). Finding psychological safety is very important and we must start to learn to feel safe again. This can be difficult as we may have learnt that the world is an unsafe place and people cannot be trusted. Reaching out and finding people you can start to trust is important. These may be family and friends or a trained and experienced professional.
Dissociation can be usually managed by learning ‘grounding techniques’ such as tapping on ourselves (butterfly hug) or using a pleasant smell. A trained clinician can help you learn these techniques and put them to practice. The more you practice the easier it gets.
Clinical treatment of trauma involves in the first instance establishing psychological safety, preparation and stabilisation work. Once this is done, processing the traumatic memories can start using established evidence-based therapies such as EMDR (Eye Movement Desensitisation and Reprocessing). EMDR helps to convert distressing charged traumatic memories into normal neutral memories so that the experience can be recalled without distress.
There is also a role for the use of medication for traumatic stress and to treat any co-existing depression or anxiety. The medication usually used are anti-depressants. A combination of the right medication and the right therapy approach can pave the way for us to heal and recover.
