Trauma 101 – A no BS guide to everything trauma. #7 Trauma diagnosis, treatment and recovery

The term trauma is used to describe events which occur outside of an individuals normal everyday experience. Generally speaking, professionals describe traumatic experiences as an experience which seriously threatens life or causes (severe) injury however, in my own experience of trauma; this definition does not quite stand true. Many events considered traumatic (or abusive) do not involve a threat to life or injury – cases of emotional neglect, forms of bullying, financial abuse and many abuse tactics such as gaslighting and manipulation do not as a general trend incorporate physical injury or threat to one’s life.

Using such closed descriptors in which to educate/work off actually becomes counterproductive – as the very nature of trauma causes a survivor to experience feelings of poor self-worth and image; in many cases believing they are ‘just sensitive’ or ‘exaggerating’. Being given a descriptor which doesn’t fully fit only serves to further this inner belief.

– 1 in 5 children have experienced trauma before the age of 18 (King college London, 2019).

-common causes of trauma have been described as;

• Experience abuse, neglect, bullying
• Witness to traumatic events (car crash, robbery, terrorism)
• Life threatening event, serious injury (type 1 trauma is one event with clear beginning, middle and end (potentially causing PTSD), type 2 trauma involves no clear beginning, middle or end – over multiple events (potentially causing CPTSD).)
• Disability
• Bereavement

– Trauma can impact a survivors life in a multitude of devastating ways; causing issues within the self, within relationships and a survivors personal life.

Different people can experience different things as traumatic. What is traumatic to one person may not be for someone else and for this reason; No single trauma is ‘better’ or ‘worse’ than another. Traumatic events should not have a hierarchy and doing such diminishes the experiences of hundreds of thousands of survivors across the UK.

What happens during trauma?

When an individual experiences a traumatic event they may experience a type of overload within the brain in the sense that the brain switches to survival mode and begins taking in huge amounts of information during this time in order to best protect the individual. This overload is important as not only does it help the survivor at that moment, but it can also play a huge role in how a survivor experiences trauma related symptoms in the future and can be beneficial in understanding in terms of moving forward and recovering, For instance; some images which are stored in the form of visual memories may manifest to become flashbacks or intrusive memories, information stored in the sense of smells or sounds can transform in the future to be specific triggers if experienced again and so beginning to understand ones own personal trauma can really catalyse a survivors recovery journey in many ways.

After a traumatic event, a survivors mind will begin to try and deal with the revenants left behind in the form of processing the memory which has been stored and associated senses/experiences. How a survivor processes this trauma can greatly differ from blocking the memory out completely to repeating events constantly and everything in between. There is no one correct way, nor is there a better way than another. A survivor will naturally do the best they can with what they have at that time.

Types of trauma (cont.)

 

At present, the UK currently recognizes two main types of trauma related disorder.

PTSD (once called ‘shell shock’, ‘soldiers heart’, ‘da costa syndrome’, ‘effort syndrome’, ‘traumatic hysteria’, ‘hysteria’, ‘functional disorder’ and ‘gross stress reaction’) has been written about in early literature since the 14^th century. The term PTSD was given its own category of diagnosis in the DSM in 1980 which incorporated both military and civilian trauma.

CPTSD was officially recognized by the world health organisation and following countries and introduced in to the ICD-11 in 2020. CPTSD is a form of trauma disorder which occurs after a type-2 trauma; multiple traumatic events with no clear beginning, middle or end. Type-2 traumatic events include; child abuse/neglect, bullying, domestic violence, trafficking amongst others.

Recent research by trauma theorists have asked for the inclusion of the term ‘developmental trauma’ this is referring to a traumatic event(s) which occurred during the time of brain development in childhood. This new category would thus include all forms of childhood trauma and abuse and would be beneficial to incorporate in its own right due to the complications that childhood developmental trauma can cause in terms of recovery and attaining a sense of self. There is hope that in the future this will be included as its own trauma disorder which would change the face of diagnostic manuals at present.

Theorist Dr. Bessel Van Der Kolk has stated that the inclusion of the term developmental trauma has the potential to completely change the face of mental health as many co-occurring mental health issues which occur as a result of trauma (currently labelled as personality disorders etc) would become void.

Diagnosis

In the UK, the diagnosis of any trauma related disorder is more commonly completed through Psychotherapy and health care teams.

As every trauma differs; individual reaction and coping also differs. This is part of the beauty of being human. It is not uncommon for survivors of trauma to turn away from diagnosis as many survivors believe it gives them another label (or vulnerability) and argue that professionals should consider what in their life may have contributed to their difficulties, and help with these – instead of a focus on finding problems in them as an individual.

On the other hand, many survivors of trauma find that receiving a diagnosis as being beneficial to their own personal recovery due to associated feelings of validation and normality. Whichever route a survivor chooses to walk down; it is the decision of the individual survivor and not the opinion of others around them or within their lives. Making this decision either way is considered the very first step in recovery from trauma related issues.

In order to receive diagnosis, an individual should present to their local G.P or healthcare team in order to explain their personal struggles. A referral is then made to psychological services and depending on location and supply; the individual may be placed on a waiting list in order to receive assessment and treatment if applicable.

• Assessing individuals for trauma related disorders usually involves multiple screening methods which are further analysed by a psychiatrist.  In primary care (G.P), the Trauma Screening-Questionnaire (TSQ) may be helpful to identify people with (Complex and) post-traumatic stress disorder. The TSQ consists of 10 questions which measure re-experiencing and arousal symptoms. If the individual has six or more positive responses, they are at risk of having (Complex) post-traumatic stress disorder and should be referred for further assessment which is usually carried out by lead psychiatrists.

• The G.P may (also) choose to screen the individual using the ACE questionnaire. The adverse childhood experience questionnaire was created in 1995 by the Centers for Disease Control and Prevention and Kaiser Permante in California. The ACE study itself found a correlation between childhood stressors and poor adult health outcomes; further showing that individuals with 4 or more ACE’s were at higher risk of chronic ill health than those with 0-3 ACE’s. The ACE study itself has come under some criticism and it has been suggested that further research is required in order to provide a comprehensive questionnaire free from confirmation bias.

• When referred to psychological services, individuals will be re-assessed using various methods. This is usually completed by the acting psychiatrist and involves one or more of the following;
• Impact of Events Scale-Revised
  • A 22-item self-report measure that assesses subjective distress caused by traumatic events.
• Davidson Trauma Scale
  • A 17-item self-report measure that assesses the 17 DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) symptoms of post-traumatic stress disorder.
• Post-Traumatic Stress Disorder Checklist for DSM-V
  • A 17-item self-report measure of the 17 DSM-IV symptoms of post-traumatic stress disorder.

Once assessed and diagnosed survivors are offered treatment in the form of psychotherapy.

Treatment currently offered by the NHS includes CBT (cognitive behavioural therapy), EMDR (Eye Movement Desensitisation and Processing), medication and in some areas community support and mental health teams.

Severe or persistent (C)PTSD is commonly treated with a combination of medication and talking therapies. Currently the NHS has a waiting time of 18 months (March 2021) of which differs by location and need. Primary treatment consists of cognitive behavioural therapy

Therapy options – The details

As we are aware, the NHS uses cognitive behavioural therapy in their blanket approach to treating mental illness.

However in recent years, trauma specialist have contested that the use of this therapy alone is ineffective in treating trauma and a multi-level approach is needed. Trauma informed therapy is gaining in recognition as trauma researchers begin to examine the best approach for therapy.

Cognitive Behavioural Therapy (CBT)

Cognitive Behavioural therapy (CBT) has an exceptionally high Dropout rate and from those who complete this therapy; we see 30% feeling benefit.

CBT is described as therapy which evaluates an individual’s faulty cognition through evaluation of an individual’s thoughts and feelings about their trauma and lives. I don’t believe that in the case of trauma; survivors have faulty thoughts, what we think and feel is completely natural: what happened to us is the only faulty thing. It is our abusers who are faulty not us. We do not need to change how we think and act about a situation that was clearly horrific for us and so we see the rate of revictimization in this type of therapy as being high. CBT is more effective for treating PTSD, not complex or developmental trauma, however alongside other therapy methods it can be effective. CBT attempts to restructure an individual’s thought patterns through reflection and self-analysis over a short time frame (6 to 10 weeks).

Many theories have debated that this is too simplistic in treating trauma and especially complex and developmental trauma’s. Those are issues that won’t be solved in two months of therapy. Bearing in mind that CBT therapy Sessions are short, lasting around 45 minutes to 1-hour. That equates to roughly 6 to 10 hours of “cognitive reprogramming” of which to heal what could be a lifetime of trauma. 

Of course, there are positives to using CBT therapy in treating our trauma symptoms however, I do believe that it has to be used in a trauma informed way and through a multi-levelled approach. Some of the benefits of CBT can be found in Unit 10 in the group as they are relatively easy to find. There is limited research in the negatives of CBT, I am unsure if this is because the NHS use this in the UK as their main method of treatment. From what I have researched, top trauma specialists such as professor Van der Kolk, Walker, Herman and Schwartz all agree that in treating complex trauma more than one approach is necessary.

 EMDR (Eye movement desensitisation and reprocessing)

EMDR is also commonly used within the NHS. EMDR is often now included along with CBT and involves a therapist sitting close to you whilst passing their hand back and forth across your field of view. This type of therapy also has mixed reviews and although it can be very valuable in treating trauma, Schwartz, 2017; states this therapy requires careful modification for survivors to work on any dissociative symptoms or complex trauma events involved.

EMDR involves and 8 phase treatment model which is constructed to allow individual to resolve and process traumatic experiences by processing their emotional, somatic and mental distress. EMDR must be paced appropriately and tailored to suit an individual – this therefore leaves responsibility with the individual therapist; which can lead to either success or failure in terms of therapeutic intervention.

EMDR’s main goal is to allow a trauma survivor to process and control their emotions and feelings of vulnerability. This places a responsibility on individual therapists to understand how developmental trauma can affect individuals. With regards to PTSD, this type of therapy has a high success rate. However; that trend tends to dip as more trauma is added.

EMDR has been criticised due to its need to modify its 8-phase model to individual needs. Many professionals are not fully aware of how adverse childhood experiences affect individuals or how complex trauma at different developmental stages can manifest into Adulthood. Therefore, its success rate dips due to misinformed care. In order for therapy to be successful in treating trauma; there must be a multimodal trauma informed approach in order to obtain benefit.

EMDR on its own works well in treating depression, anxiety, panic attacks, eating disorders and addiction and so can help alleviate many maladaptive coping mechanisms used by an individual with multiple traumas. Using EMDR alongside different therapies can provide a higher success rate in terms of relief from symptoms. Studies on EMDR each have very small sample sizes and limited follow-up information.

Trauma has never been a quick fix and the lack of awareness regarding trauma in the UK can result in longer term treatment being required. Single incident trauma benefits greatly from EMDR’s 8 phase model in a straightforward manner, but for survivors of complex interpersonal trauma and childhood trauma it relies heavily on the therapists awareness to modify accordingly.

Trauma Informed practice and communities.

Matthew and Skuse (2014) built the trauma recovery model (see ‘guides’ in our group) on the notion that recovering from trauma is multilevel. It follows from Maslow’s Hierarchy of Needs (1943) which shows basic safety and physiological needs are required to be met before healthy psychological growth. Therefore, if you are not meeting these basic needs; adequate sleep, food, hygiene and education etc progression on to the next level of Recovery will not be fully possible. The first level described by Matthew and Skuse are all attained by achieving enough respect for your body and mind that you have a healthy level of self-care. Realising when you’re mind needs rest and recovery but also when your body does too.

As we develop along the path we begin to trust people and form relationships. Challenges of boundaries and openness can be explored with adequate support, as can adding safer coping mechanisms to our toolbox.

Matthew and Skuse state that is this trust in addition to meeting one’s own basic needs; that it becomes possible to really look at our personal trauma in more detail. This allows for more personal issues to arise that are unique to the individual and trauma. I believe, as adults we can have an understanding of our own trauma, even if we haven’t an adequate level of self-care or met all of our basic needs. We only need to look at eating disorders to argue that.

With trauma, the main goal is to attain some level of control and stability within our minds and release pent-up tension held within our bodies.

Revisiting memories in the form of EMDR has been debated. Do we really need to experience every trauma event all over again to feel safe, or can we attain that control and safety through other means? Imagine how freeing it would be, if we could enter treatment in the safety that it is trauma informed, that we don’t have to go back there instead focus on here and gain strength through self-reflection and coping (Herman, 1992).

The notion of trauma informed practice is ground-breaking in terms of recovery and treatment options, but it does not stop within healthcare. Ultimately a trauma informed approach in communities, frontline workers, business and education would transform the notion of trauma (and its recovery chances) in the UK.

Supporting a survivor of trauma – requires self support too.

Recently, I have compiled a set of blog posts which directly cover ways in which to support a survivor of trauma whilst they recover. I have looked in depth at why support is important (HERE), Responding VS Reacting (HERE), tips to support (HERE), how to support during a flashback (HERE) and anger (HERE). Moving forward in this series of posts; I thought that I would cover self support.

Supporting a survivor of trauma is no easy task at times, it is vital that you have your own support network and utilise it – you can’t support anyone if you are wilting yourself.

Self care is NOT selfish

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When supporting a survivor of trauma through recovery, tendency is to suggest treatment for the survivor and encourage attendance. However, it can also be equally as important to seek such treatment for yourself. In accessing treatment; you are able to access a wealth of information with regards to how to appropriately support your partner and yourself through recovery efforts. Seeking treatment or therapy is not weak, quite the contrary – in asking for help you are revealing a vulnerability that only the strong can fare.

Treatment allows a survivor to focus on specific problems and teaches self care and patience – partners of survivors are also entitled to such support; vicarious trauma is real and research shows that those who are in a meaningful relationship with a survivor of trauma can also experience secondary trauma symptoms as a result.

Vicarious Trauma

A vicarious trauma is described as indirect exposure to trauma through first hand narritive of the event. That being said; vicarious trauma can be experienced by any individual who is involved with hearing first hand accounts (and reactions) of traumatic events; Doctors, Nurses, Psychiatrists and yes; partners, friends and family too.

Vicarious trauma occurs following the disclosure of abuse/traumatic event(s) and can cause the sufferer to experience similar (yet lesser) symptoms to survivors who have had first hand experience(s) of said trauma.

Vicarious trauma typically involves a shift in the world view of the helper. The helper’s beliefs about the world may be altered and/or damaged by repeated exposure to traumatic material.

Goodtherapy.org

In such cases of supporting a trauma survivor through their recovery, it can be thus extremely beneficial to seek personal support to reduce the risk of experiencing vicarious trauma (more info on this HERE).

Get support for you

In practicing self care, the risk of experiencing vicarious trauma and further mental health issues diminish and decrease. Though self care is not always practiced in current sociocultural climates. At the moment, we have the looming dread of the COVID-19 pandemic which is changing the way we live and interact on a daily basis. The pandemic is also causing a reduction of self care as individuals began to get caught up with related issues (losing employment/income, following guidelines, childcare issues, ill health, reduction in GP appointments and services etc). When the cultural climate begins to change, it can be hard to keep up with self care; however – this is the most important time to establish a good strong routine and balance.

Self care is the act of taking time out for yourself in whatever capacity that may be – that is time out away from normal conditions and expectations; where you can be you and find balance within your personal life. When supporting a survivor of trauma through recovery; personal self care becomes fundamental.

Taking care of ones physical needs and emotional needs; frees up a vast amount of space in which to be able to tackle other issues within your life. Achieving a balance between adequate sleep, hygiene, nutrition, relaxation and mastery (that is to describe activities such as painting, drawing, crafting, exercise, music etc) can really balance other areas within the self that may not be as easily navigated. For instance, using journaling, music or art to navigate difficult feelings can help the brain to slow down and process emotions in a safer way – this then stops the build up of emotions which comes to eventually spill over if not addressed.

Feeling full up?

Do you ever find yourself feeling ‘full up’?. In this instance, I am not referring to hunger; being ‘full up’ means that you are at your emotional tipping point and about to spill over.

If you imagine a glass of water. Above the glass; is a tap – slowly dripping water in to the glass. The water is used to describe our emotions and stressors that happen to us regularly throughout the day. That could be; running late for work or school, missing a deadline, having an exam or test or emotions such as anger, fear or sadness.

As the water drips throughout the day; the glass fills. The water keeps dripping and eventually becomes full up. The next stage; the water becomes too much for the glass and begins to spill over – this spilling over refers to us having an emotional response (getting agitated, angry or crying).

There is a way to stop the glass from flowing over – and that comes with self care, safe coping and balance.

On one day, the glass may fill quicker than other days. The key however is to notice those days that seem to fill quickly and employ self care and rest in order to reduce the chances of the water spilling over.

If we imagine the same glass; for a trauma survivor the water may come in the form of memories, triggers, smells, sounds, tone, body language, perception, blocking behaviours, unsafe coping, dissociative states as well as a plethora of other aspects. I write this for a reason, a trauma survivor is already way ahead of anyone else in terms of how full their glass is and in that sense it only seems fair to realise that fact and hold it within your considerations and responses.

What does self care look like?

It can be hard to imagine positive self care or put it in to practice; I have began to compile a list of ideas for partners to try – these may also work for survivors of trauma however; for the purpose of this blog my focus is on partners of survivors.

• Stretch for 10 minutes
• Call a friend
• Join a new group
• Watch a new TV show
• Listen to the radio/music
• Learn a song (to sing or play)
• Focus on your breathing
• Draw a cartoon
• Paint a picture
• Create a scrapbook
• Journal
• Look up ideas for a project to try
• Take a nap
• Get some food
• Go for a bath or shower
• Brush your hair
• Change your clothes
• Go a walk
• Visit a park
• learn a new dance
• Paint a room in your house or plan decorating
• Try your hand at gardening
• Go out specifically for a treat for yourself. Sit and enjoy it.
• Play Xbox/PS or PC
• Look for helpful apps for your phone
• Spend time in nature and solitude to clear your mind and recharge.
• End your day by reflecting on the things you did or enjoyed today, even if they seem small
• Have something to look forward to.
• Occasionally try new things to expand your comfort zone.
• Learn to say ‘No’ and set healthy boundaries

As we continue to grow, TRUK will aim to make some helpful self-care infographics which can be saved and refered to when needed. Further information can be found on our Facebook group; TRUK.

Helping a survivor of trauma through a flashback

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Our recent posts have focused on partners and friends of survivors in the sense of how to support a survivor through their trauma illness. A wealth of information can also be found on our Facebook group; TRUK. Having already covered an overview of trauma and the types of disorder it can cause, the importance of support (found here) and helpful advice in supporting survivors (found here); I felt it was also important to look more specifically at how to support during a flashback episode.

Understanding what a flashback is and what it causes can be extremely helpful with regards to being able to provide appropriate support. On gaining an understanding of triggers and flashbacks you will have a general view of how these MAY impact your friend or loved one however it is important to note that every reaction, interpretation and perception will differ and this information will only provide you with a first step. The next steps are completely reliant on you personally having a good level of awareness of the personal triggers and issues that may cause an acute onset of trauma symptoms. Anticipating these triggers is the best way to support a survivor of trauma; having that awareness not only makes the survivor feel heard but provides a sense of safety.

It can be helpful to ask your loved one (friend, colleague etc) if they are personally aware of their own triggers and if so; what they are. You don’t need to push to understand why or hear the details – of course if your partner looks to divulge this, then by all means provide a listening ear – this will give you a bigger understanding of individual triggers and issues in order to help you support.

If there is no awareness of many (or any) triggers, it can be important to begin to identify these. We have a lot of files on our group which help identify emotions, triggers and flashbacks. You cannot force your partner to work on identifying triggers, no one wants to be triggered in to such panic – survivors of trauma WILL get there when they CAN.

A flashback is a vivid and sometimes intense experience where an individual may relive some aspects of a traumatic event or feel as if it’s happening right now. Flashbacks don’t always involve a dissociative type state such as feeling as if you are watching videos of your trauma, flashbacks don’t always involve reliving your trauma beginning to end and can actually come in the form of feeling physiological sensations such as: pain or pressure, noticing sounds or smells associated to your trauma or experiencing the emotions that you felt during the trauma.

Flashbacks range from one-off smaller experiences that may go unnoticed to repeated places and situations triggering an emotional response. Some flashbacks can be worked through with a combination of therapy, analysis and safe coping mechanisms however, for some flashbacks you need to learn to ride the wave. When emotions come and go, it’s best not to fight them off; rather than to ride with them.

CPTSD triggers often go unrecognised, not like single type 1 traumas with a beginning middle and end that can be identified easily. With CPTSD, due to the nature of traumatic events – multiple traumatic events result in small social environmental cues that can be easily missed. With complex trauma; the effects of trauma are not clear-cut and neither are the flashbacks associated with it. Every person is different and will experience different types of flashbacks and every person may also respond differently to treatment methods – more info on emotional flashbacks can be found here.

The important thing is that flashbacks can be managed through reflecting on personal triggers and working on perception, grounding, removing unnecessary stress and appropriate support. They can appear out of control and frightening however, the only individual experiencing debilitating fear is the survivor of trauma.

During a flashback or trigger response, it can be helpful to vocalise this and give it meaning. Identify to your partner that what they are experiencing is a flashback (or they have been triggered by x, y or z) and that you are there for support.

Many survivors have never experienced the beauty of strong authentic support and this can catch them off guard. This may take practice to really overcome. The finer points of course being patience and non judgement, survivors usually belittle themselves for experiencing flashbacks so strongly and it’s important to normalise this. Let your partner know how they respond is normal.

It can also be helpful to remind your partner of their surroundings, this works as a sort of grounding at times bringing them back quicker than would normally. We have a great deal of grounding exercises over at TRUK. These can help in assistance and during progression however just putting a voice out there can be extremely therapeutic.

Encourage your partner to breathe slowly and deeply. Usually shallow breathing comes along side panic, fear and triggers/flashbacks. Regulation of breathing resores oxygen back to where its needed and allows the frontal lobe to return.

It is important to avoid sudden movement. Even if you think you have given your partner enough space, slowing down that movement will really help in Calming the emotional storm and survival activation. Our graphic should be helpful in reminding you of these subtle tips.

Remember it’s so important to always ask before you touch. Some survivors can handle unexpected touch and that’s fantastic, however many survivors can not. It is physically painful to be touched unexpectedly especially during a flashback or trigger. Giving your partner that sense of control can do wonders for recovery in general and not just in times of deep emotional distress.

Once again we have a huge resource available on TRUK covering the smaller points of support. This however will give a good solid starting point in which to open up communication lines and make your own plan.

Support is available to any one who needs it, please Contact us!

Helpful ways to support a partner of trauma

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There is very limited help available for partners of trauma survivors nor is it easy to locate. It is my intention to compile a set of articles which covers information of which I believe would be helpful with regards to being in a relationship with a survivor of abuse/trauma. My last post gave an overview of the types of trauma, disorders and common reactions experienced following traumatic events as I feel this understanding is paramount in supporting a partner with a trauma related disorder. You can find this post HERE. Within this particular post, I aim to focus more on specific ways to support survivors of trauma and responding as opposed to reacting.

A survivor of trauma is the only expert in their own trauma. As TRUK Diamond theory shows; Just as every diamond is completely unique; as is every experience and reaction to trauma. Diamonds form under pressure, their core uniquely shaping its edges and appearance; A survivor’s trauma is held within the core and it is that trauma which has the ability to shape every interaction and value which a survivor holds. We are not victims, many of us are experts in abuse and trauma and so hearing what we have to say is paramount in understanding difficulties which are faced on a daily basis. As a survivor of trauma myself, I have my own set of difficulties in which to process however, I know from experience – having my voice heard served to be one of the most beneficial aspects in my own recovery. In being heard, I was believed and it is that validation that forms trust in others and catalyses recovery efforts.

This brings me to my first helpful tip in supporting a survivor of trauma, Validating your partners experiences will solidify a deep bond that can grow to become unshakable. In cases of survivors who have experienced trauma which occurred in childhood, validation serves to disprove deeply enmeshed beliefs which may have been built and reinforced over many years (and decades). Survivors of adult interpersonal relationship trauma may require just as much validation; as their new set of beliefs around the self shape interaction in similar ways to childhood survivors.

A survivor doesn’t necessarily need to fully divulge what abuse they experienced in order to be heard. Nor do they need to relive painful memories for their partner to hear them. Simply put, outright asking a partner to explain what they went through can be counter productive; it can cause retraumatization as well as an acute onset of (C)PTSD related symptoms and should only be approached on the survivors request. Not every survivor will want to relive or share their abuse; it is therefore important to take your partners lead in any conversation surrounding their past. In such cases where a partner may not be willing to share their experience, it is also important to let them understand that choice is perfectly normal. In allowing your partner to have control in these situations, it gives a sense of safety and empowerment which could ultimately be the one thing they need in order to accept and share their trauma(s). The act of accepting either outcome during conversations surrounding uncomfortable topics gives a survivor of trauma their own control back – this is where the sense of safety comes from because many survivors have been conditioned against speaking up or taking control, giving them that back not only deepens the bond in the relationship; but allows them to hear their voice for what could be the first time.

I do feel it is important to state that some survivors will never share what they experienced. That is a choice that should not be met with negative attitude, hostility, blame or conflict. A conversation about how one person feels should never end in conflict; for it to do so can be so counterproductive to not only a survivors recovery but the relationship itself.

Resist the urge to fix.

Whether a survivor divulges their experience or not, refrain from attempting to fix your partner. To put it clearly; what a survivor has endured has caused a reaction which is completely normal. A reaction of which hundreds of thousands of other survivors share a similarity with. This reaction is not abnormal; the abusive event(s) carried out by the perpetrator was the abnormal factor in this. It is therefore the perpetrator of abuse who is abnormal and shame should rightfully be taken away from the survivor and their reaction. In this case, it is not appropriate to try and place your core values on to your partner. Attempting to fix of course comes from the best of hearts, but in cases of trauma experiences – it is not the survivor who needs fixing. To fix; assigns blame in some form – blame that the survivor did not react at the time; (in your opinion) appropriately. However, that fact is not for you to state. You were not there, you haven’t felt it and even if you are reading this now; a survivor of your own trauma – every reaction, interpretation and perception can be and is hugely different. Unsolicited advice is not recommended in any interaction never mind one with a survivor of trauma, survivors do not need to hear what they should do – instead try re-framing to a more positive light and simply be there for your partner; accepting them in entity.

Fixing behaviour can come from inner insecurities. Personally; you may feel the need to fix others as a way to feed your ego and alleviate your own anxiety. Individuals do not require to be ‘fixed’ – it can be important in such cases; to work on your own insecurities and build interpersonal relationship skills in the process. This will benefit the relationship with a survivor of trauma in a plethora of ways; allowing a survivor to witness healthy interaction consistently will aid in increasing personal recovery.

Refrain from stopping your loved one from talking or expressing fears; as difficult as this can be. It is naturally difficult to hear someone we love fear issues that may not seem fearful. Trauma causes deep rooted fear in many ways and this can naturally come out in behaviours and reactions. If your partner trusts you enough to relay these fears – no matter how ‘trivial’ they may seem; it is important to give them the space and safety to do so without fear of retribution or criticism. In that same respect it is also important to not give ‘easy’ answers. ‘Easy answers’ are responses such as; “everything is going to be OK”, “you will be fine”, “I wont let anything happen to you”. Such responses wont serve to rebuild trust and a sense of safety for a survivor of trauma for many reasons – some which may be personal to the survivor. Saying that everything will be fine only causes a survivor intent on self preservation to question; “but what if it isn’t”, increasing anxiety and reluctance – similarly, telling a survivor they will be fine only strengthens the fact that they do not feel ‘fine’ at that particular moment (if ever). Finally, becoming the protector does to serve to benefit a survivors recovery. It is the survivor of trauma who has to be their own protector, not only that but a survivor will also fear for their partners safety and so stating you will protect them leads them to question; “but what if something happens to you?” – No easy answer will ever give any positive effect with regards to fears or phobias held by a survivor. Trust me, the survivor will already have answers to every one of your attempts to calm them using easy answers -validating their fears and hearing them provides much more benefit. It allows a survivor to take a risk and benefit from a positive outcome and just as traumatic events shaped inner beliefs; positive experiences can dissolve this allowing for repeated (more successful) attempts and increased recovery.

Usually, by the time a survivor actually voices any inner fear; they have analyzed it numerous times within before airing it to anyone else. Not only that, but a survivors fears are as valid and rational as any phobia around. For a survivor to vent these fears not only shows how trusted you are, but that your opinion to them matters, that you are a safe person with good intent. To dismiss or give easy answers can be devastating to the individual relationship and only serves to harm recovery. No progression can be made in cases where a survivors fears are lessened because of the nature of trauma. The most horrific of acts occur in real time and for no reason – any fear after that is absolutely valid; real or not. It is important to once again – validate these fears; allow your partner to understand that you can empathize and help them cope. As this blog progresses, I look to cover specific ways in which you can cope with flashbacks, triggers, fears and conflict.

Maintain healthy communication

In supporting a survivor of trauma it is imperative to maintain and nourish healthy communication. Communicating with your partner in an open, balanced and consistent way helps to build trust in the relationship and allows a survivor of trauma to begin to emulate the same communication style. In early recovery (and there is no time line to this – an individual could be within early recovery decades after the event(s) or immediately; the spectrum is huge) it is important to build a sense of resilience in that you refrain from taking things personally. At times a survivor of trauma may have experienced multiple toxic relationships – from parents, caregivers, services or within romantic relationships or friendships which causes a build up of traumatic experience, memory and reactive behaviour. It can be extremely difficult for a trauma survivor who has been used to the constant roller coaster of emotions experienced in chronic abuse; to settle in a healthy relationship. Many survivors feel themselves becoming more anxious and combative in an attempt to pull conflict out and self sabotage, other survivors will test boundaries to make sure they are safe – or as a reaction to triggers, flashbacks and fear. It is important to gain an awareness of the subtle intricacies that comes along with trauma experiences – a wealth of information can be found on our Facebook group which is ordered by topic and organized in to relevant units.

Healthy communication builds a huge sense of trust within the relationship and opens lines of communication in cases where the survivor may need support. Remember, support is the number one factor in helping a survivor of trauma begin or continue recovering. Having healthy communication is the pre-requisite to trust and this is especially true for a survivor who has had to endure abuse. Survivors benefit from clear and transparent interaction, a survivor has built their defenses so high that they can at times; sense and feel your own mood or motive. Survivors are experts in reading situations because they had to build this defense, do not go in to any interaction with ulterior motive (even the best intended ones!), bad feeling or in judgment. Personally, I can tell by the slight change in footsteps – it sends me in to defense mode as I scramble to self protect and preserve. It leads me to close off and retract, from experience; I know I am not the only survivor who feels this. It is relatively common for survivors to be empaths; feeling tone and emotion at times before others even realize within themselves. This can prove problematic with passive aggressive behaviour; this type of reaction really causes a reaction within a survivor of trauma because individual actions do not match words. It causes uncertainty and can trigger to past memories or trauma.

Refrain from overly focusing

It can be relatively easy in a relationship to overly focus on the reactions and issues or difficulties faced by a survivor of trauma – especially when things feel too intense or confusing. Focusing on issues as they arise is beneficial, however it is important to reflect on an issue and give it a natural conclusion. This conclusion is what has been skewed in terms of abusive event(s) experienced. Having a relationship which is high in healthy, open communication and validation will bring these conclusions naturally to any interaction. Once the conclusion has been made and voiced; the importance then lies within moving on and resuming normal life.

Overly focusing on your partners trauma and the reactions it may cause only merges their (C)PTSD symptoms with their own identity. This acts as a barrier in recovery and within the relationship as any further interaction turns self critical and guilt inducing.

It can be a natural reaction, that if you focus on this issue now – you can solve it and move on. Recovery is a life long process, in many cases; survivors of trauma never reach a state of being fully recovered because that is the nature of trauma. Nothing in any hospital or pharmacy will ever be able to take the event(s) from memory or stored within the body (because even survivors who do not recall the trauma(s) can still repress the emotion within) and thus total recovery is rarely reached. A survivor can learn how to live with their trauma(s) and that is theirs to live with – focusing on that will not take it away unfortunately – no matter how much you wish it would.

Anticipate and help manage triggers.

As survivors learn to live with their symptoms; they begin to form coping mechanisms and rely on ways which have been helpful in the past (side note; some of these can actually be counter productive and this is important to identify). Survivors become experts in their own trauma as part of recovery involves identifying and managing triggers and reactions, in order to support a partner who has experienced trauma; it can be helpful to help understand and manage their triggers (and associated responses). Firstly, you could find out what things have helped in the past when dealing with symptoms, flashbacks and triggers and encourage this – even take part; pain shared is pain halved after all.

It can be helpful to understand what a trigger is and what it can cause both mentally and physically. In times where your partner is unable to identify they have been triggered; you can rely on your own awareness and knowledge ultimately supporting them through something they otherwise would have been crippled by.

Within the brain it is the amygdala that triggers this natural response. Those with trauma tend to have an overactive continual response.
When their amygdala is wired it makes the pre frontal cortex under active. In a natural response, the amygdala sends signals to produce noradrenaline, however for people with trauma disorders this doesn’t follow the natural peak and depth found in patients who haven’t experienced a traumatic event. Instead, adrenaline peaks and can stay in a hyper vigilant state for considerably longer – not necessarily returning to average levels either. If you experience hypervigilance, your emotional tolerance will decrease as there is a constant supply of adrenaline flowing to your brain when it is not needed.

Trauma survivors find unwanted and intense feelings tend to pop out of nowhere however, there could potentially be a Trigger Point causing a subconscious emotion and response. This makes identifying causes of emotion or triggers itself extremely difficult.
In addition to this, childhood trauma survivors may have been conditioned to ignore their own emotions and feelings. Focusing more on the emotions of others, people pleasing and splitting their personality to appease any authoritative figure in their lives.

The act of being triggered causes a biological reaction within a survivors body. The amygdala becomes activated and this sends cortisol and adrenaline throughout the body, the mouth may become dry as the salivary glands retract, blood flow reduces from less vital organs and flows to the muscles and other organs as a protective measure. The body may shake and tremble due to the increase of adrenaline, the hands may become cold and sweaty and pupils dilate causing headaches and migraines. As the amygdala is switched on, the front of the brain reduces in activity. This part of the brain is where rational thought is stored and makes it difficult to concentrate, identify emotions and regulate reactions. A survivor may rely on 4f responses (fight, flight, freeze or fawn – found HERE) which will shape their interaction and behaviour.

It can be easy to understand exactly why a survivor may have no realization of becoming triggered as their use of 4f responses seem perfectly appropriate in their given state. Perception can be the most important aspect in this case, as the survivor recovers their sense of perception of danger; their triggers decrease and with added coping skills; become more manageable.

The building of trust and a sense of safety.

As I have already covered; building trust and safety is key in supporting a partner who has survived trauma(s); Responding and not reacting can be helpful way to do this.

There are subtle differences in responding vs reacting to a partner who has survived trauma(s), reacting involves an emotional impulse whereas responding denotes a more balanced and thoughtful approach. When you constantly react to events that you cannot control, you waste energy and resources which could be more appropriately used.
Reacting emotionally removes the ability for core values to guide your interactions; survivors of trauma commonly react rather than respond because that is what they have been taught to do. In order to recover from those reactions; a survivor needs to witness healthy response over reaction. For you to support your partner you may benefit from teaching a survivor how to be a part of a healthy relationship by taking the time to carefully respond to any conflict or issue that may naturally arise.

A survivor who has experienced traumatic event(s) may be expecting reactionary behaviour to come with any conflict, this fear may cause the survivor themselves to react instead of respond. Not only that, conflict is extremely triggering as is the possibility of criticism or judgment. This trigger – as explained above; causes a whole plethora of effects which can cause the survivor to automatically rely on trigger responses. In order to successfully build trust, adopting a balanced and consistent response can aid in building a strong foundation moving forward.

Trust and safety can also be built by incorporating routine and minimizing home stress. That is not to say that your needs should come second or last, you have every right in a relationship to feel and desire what you do. This is as natural and acceptable as your partners needs; with or without trauma. The key is in the balance between understanding the intricacies of trauma and why certain aspects of what your partner needs may be uncompromisable. Adopting or maintaining a positive attitude will naturally bring positive rewards – understanding that ‘little things’ may be in fact big things to your partner as it may be clouded in experience and triggers. Healthy and open communication can bring these issues to light and resolution, however there are some things that just don’t need to be argued over. It can be common in relationships to enter conflict due to our own personal circumstances and emotions at the time, having an understanding and empathy of what your partner may struggle with on a daily basis can really put this in to perspective. Most cases of trauma survivors show that symptoms are a daily struggle, survivors can expend vast amounts of energy through symptoms related to their trauma(s). Many survivors struggle to feel good enough, with people pleasing or perfectionism and so some disagreements are more counterproductive than helpful.

Patience is key in supporting a partner who has experienced trauma(s), practiced consistently; patience allows a survivor to risk self expression and gives a sense of empowerment. Through emphasizing strengths and positive traits instead of focusing on negatives – you can really build a survivors confidence and feeling of belonging. It is important to be authentic and this is especially true when in a relationship with a survivor – authenticity brings acceptance and open communication aiding in interaction and relationship bonds. This authenticity is especially true in times of making promises, do not make a promise you don’t intend to or cannot keep. A survivor needs to know that when you promise or say you will do something that this will be followed through.

In terms of survivors, it is important for a survivor to see these efforts sometimes before they commit to attempting these too. Relationships can be a real fear of survivors and so many commonly become introverted and seem closed off. It is not until you dig through the protective shell however that you truly find the real person within. As you demonstrate patience, authenticity and consistency; trust becomes stronger and the relationship as a whole benefits from this.

Speaking of and building future plans can also help cement trust within a relationship. Survivors are more often than not driven by past events and so speaking of positive future plans can help to bring some balance to their lives. It also reminds survivors that there is more still to be experienced and can slowly make them more hopeful and positive of the future themselves. It is truly a sight to see when a victim forms in to a survivor and through the right support; a survivor manifesting to a warrior; ready to challenge life once more.

Encourage rest and self care.

Partners of survivors themselves should not only balance support with their own rest and self care – but remind and prompt their partner to do the same. It is at times a tiring and challenging act – to support through recovery, and simply put – you cannot help anyone if you are suffering yourself. There are many support groups available online for partners of survivors which can really help along the arduous road of recovery – we have units dedicated to partners of survivors and helpful files and resources over on our Facebook group; TRUK. It can also be beneficial to receive personal support through counseling as this can not only help how you support your partner; but be a way in which to balance self care and verbal ventilation in order to free yourself to continue to support.

Yes, relationships are a two way street with both parties requiring to make efforts in order to allow the relationship to grow and develop. However some times, relationships require more work from one side than the other. Its not always 50/50 and there are times when your partner (or yourself) may need to take 60/40 for a period of time. Giving that little extra bit when you know your partner may not be able to really acts as a bridge in a way for a survivor to recover, find balance and ultimately give back,

There are various helplines and resources available over on our group which can be accessed HERE – even if you are not struggling, it can be good to talk to someone and know you’re not alone.

It can be helpful when supporting a partner who has experienced trauma(s) to get involved with their treatment. Ask if you can go to a therapy session (if applicable) and use it to learn about trauma and the reaction it has caused, this is of course only on the approval of your partner. Do not try to force your way in to appointments or use therapy appointments to ‘fix’ or blame as this is hugely counterproductive to individual recovery. Going to a therapy session can give you a great insight in to how to support and respond to your partner when they need you to do so.

Remember, these are merely a few approaches to try when you are trying to support a partner of trauma, the most important aspects being validation, consistency, responding over reacting, balance and self care. In times of intense fear such as flashbacks and panic, it may be necessary to have a plan in place which is agreed by both on the best way to respond. I will cover supporting your partner through both flashbacks and panic in the next blog post however there is some very helpful information within our blog which can assist with this.

Support is available to both your partner and yourself if you require it and we can signpost you to relevant services if applicable. As we are survivors of trauma(s) ourselves, the admin team are a wealth of information and support and can be contacted by e-mail or over on Facebook.

Attachment disorders and trauma

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Attachment theory is an area of psychology that is ever evolving; as sociological and psychological advancements replace once early theories by Bowlby (1958), Ainsworth (1970), Lorenz (1935) and Harlow (1958). Bowlby’s theories proved popular (mostly in America) as it was viewed as a nonsensical self explanatory approach. Bowlby and later his student; Ainsworth, provided a positive and achievable theory for parents – if a mother is loving, affectionate and consistent; her child will be protected magically from anxiety and depression in later adult life. This theory was further explored and criticized due to its socioeconomic context and confirmation bias. Attachment can be defined as a deep emotional bond in which each individual seeks closeness and feels a sense of security when in the presence of the attachment figure (an overview of attachment and intimacy can be found here).

Recently, trauma theorists have proposed the notion that complex trauma and developmental trauma are forms of attachment disorder. Individuals who have experienced trauma either within the development phase or later in adult interpersonal relationships face difficulties in forming attachment and maintaining relationships due to the nature of trauma itself. There are obvious difficulties with the notion that trauma is a disorder in attachment, as attachment forms in the first three years of life; it drastically reduces the scope of effect. More research and analysis is needed in this particular field in order to quantify such theories.

Complex trauma (adult interpersonal relationship) and developmental trauma (from child abuse/neglect) do carry issues in attachment however, issues are not solely limited to attachment and relationships – individuals suffering the effects of trauma will also be effected in their reactions to others and the self as well as potentially using a host of maladaptive coping methods in order to function within society (such as; dissociation, disordered eating, control issues and issues with perception). To simplify trauma as far as to say it is solely a disorder of attachment is negating the experiences hundreds of thousands of survivors have had to endure throughout their lives.

Both complex and developmental trauma hold features of attachment difficulties alongside the manifestation and development of individual trauma symptoms. As each trauma differs; each response differs and thus to simply put CPTSD (and developmental trauma) in to the category of attachment disorder dulls its effects and takes away from the suffering of hundreds of thousands of individual survivors worldwide. That is not to say however that attachment issues do not form part of CPTSD, it also does not over take it. Most research which investigates attachment difficulties and disorders focuses on children still within the developmental phase, attachment disorders are said to be experienced by children and research also shows the potential for these childhood psychiatric illnesses to manifest and follow the individual through to adulthood.

Repeated positive experiences with a caregiver/parent helps infants develop a secure attachment and bond. When a parent or caregiver responds to a baby’s cries with feeding, changing, or comfort appropriately and consistently; the baby learns they can trust the adult to keep them safe and care for their needs.
Children who are securely attached tend to form better relationships with others and solve problems more readily. They are willing to try new things, take more risks and explore independently with fewer extreme responses to stress.

Most infants develop secure emotional attachments to their caregivers at an early age (from 0-3). They show healthy anxiety when their caregiver is absent, and they show relief when they’re reunited. Some infants, however, develop attachment disorders because their caregivers aren’t able to meet their needs or through having being placed in care (either through fostering, adoption or orphanages at an early age. These babies are unable to bond with their caregivers and they may struggle to develop any type of emotional attachment which can follow through to adulthood. Infants who experience negative or unpredictable responses from a caregiver may develop an insecure attachment style, they may see adults as unreliable and they may not trust them easily. Children who experience abuse or neglect during the developmental phase(s) may associate attachment with fear as their bond with their own parental figures centers around abusive behaviors. Those children with insecure attachments may avoid people, exaggerate distress, and show anger, fear, and anxiety; they may refuse to engage with others and so have difficulty in forming friendships throughout their school life; often leading to similar patterns in adulthood.

Attachment disorders are psychiatric illnesses which manifest in childhood causing issues with a child’s ability to form emotional attachments to others. This can present as early as a child’s first birthday(and further in to adulthood) and deeply effect a child’s ability to form relationships. Attachment issues in early infancy can lead to severe colic or feeding issues; a failure to gain weight, detached/unresponsive behavior, a difficulty being comforted, preoccupied and/or defiant behavior, hesitant in social interaction and unusual closeness being formed with strangers. Such manifestations do not need to all be present and can occur as a mixture of issues, main symptoms include a difficulty in social interaction; either being introverted or extroverted; inability to be comforted in expected ways (I.e; hugs, soothing tone etc) and signs of detachment and unresponsiveness within social or school settings which could lead to future psychiatric illness.

Issues in attachment arise due to problems or difficulties within a *child’s early relationships. Common factors leading to disorders of attachment include physical, emotional or sexual abuse in childhood, neglect, inadequate care, institutional care – foster home, adoption, care home or orphanage. The physical, emotional and social problems associated with attachment disorders may persist as the child grows older.

Children who have attachment issues can develop two possible types of disorders: Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) – recent research however puts forward the notion of FOUR different types of attachment disorder, the DSM-IV is yet to recognize any more than the two listed below.

Reactive Attachment Disorder (RAD)

Children with RAD are less likely to interact with other people because of negative experiences with adults in their early years (This could be due to abuse, neglect or trauma). They have difficulty calming down when stressed and do not look for comfort from their caregivers when they are upset, they may in fact shy away from comforting techniques or become reactive in defense. These children may seem to have little to no emotions when interacting with others, and can be confused with having learning disabilities such as ADHD, Autism or Aspergers. Children who have RAD may appear unhappy, irritable, sad, or scared while having normal activities with their caretaker or parent and this may carry through to insecurity over adult figures in general and manifesting in to issues with all social interaction. The diagnosis of RAD is made if symptoms become chronic.

Disinhibited Social Engagement Disorder (DSED)

Children with DSED do not appear fearful when meeting someone for the first time. They may be overly friendly, walk up to strangers to talk or even hug them. Younger children may allow strangers to pick them up, feed them, or give them toys to play with. When these children are put in a stranger situation, they do not check with their parents or caregivers, and will often go with someone they do not know. Again DSED can be confused with other disorders and disabilities and should never be diagnosed without the support of a trained child psychologist.

Signs that a child may have an attachment disorder include:

Intense bursts of anger
Extreme clinginess
Poor impulse control
Failure to smile
Oppositional behaviors
Lack of affection for caregivers
Lack of fear of strangers
Lack of eye contact
Bullying or hurting others
Withdrawn or listless moods
Self-destructive behaviors
Watching others play but refusing to join in

Treatment

Children who exhibit signs of RAD or DSED need a comprehensive psychiatric assessment and individualized treatment plan. Treatment involves both the child and the family. Therapists focus on understanding and strengthening the relationship between a child and his or her primary care givers. Without treatment, these conditions can affect a child’s social and emotional development. Treatments such as “rebirthing” strategies are potentially dangerous and should be avoided. Reactive Attachment Disorder and Disinhibited Social Engagement Disorder are serious clinical conditions. However, close and ongoing collaboration between the child’s family and the treatment team will increase the likelihood of a successful outcome.

Researchers agree there is a link between attachment disorders and significant neglect or deprivation, repeated changes in primary caretakers, or being reared in institutional settings. Some other possible risk factors for attachment disorders include: caregivers with poor parenting skills, anger issues and/or psychiatric conditions. Attachment issues may also form due to parental neglect, exposure to drugs or alcohol or due to being placed within foster care, institutionalized or having experienced multiple traumatic events (including being removed from caregiver).

Most children who form attachment disorders have experienced serious neglect, have experienced trauma or have had frequent changes in caregivers. Children who have been in foster care or children who have been institutionalized have been found to be at the greatest risk of developing an attachment disorder as well as those children who have endured a traumatic event(s), spent time in an orphanage or have been removed for a period of time from their primary caregiver.
There is no formal diagnosis for attachment disorder in adults however; you can certainly experience issues relating to attachment in adulthood. For some, these may be lingering symptoms of RAD or DSED that went undiagnosed in their childhood.

Although presently there are two formal attachment disorders, research has opened the possibility of other attachment related disorders which is not currently recognized within the DSM-IV. As attachment styles can be broken in to either secure or insecure we find some additional difficulties which coincide with insecure attachment evolving from developmental trauma. Within examples of developmental trauma there is a common trend which is said to result in further difficulty – that being the response of caregivers to ones innate needs as an infant. Survivors of trauma who faced caregivers who responded inconsistently or abusively (neglectful etc) to their needs commonly develop insecure attachment as a result. This can carry through to adulthood where it becomes increasingly difficult to form intimate bonds with others due to past experience and trust issues. There are several subtypes of insecure attachment styles in adults;

Anxious-preoccupied attachment

Individuals with an anxious-preoccupied attachment style may have a tendency to idolize romantic partners, spending a considerable amount of time thinking and prioritizing said relationships – even over self needs. Commonly, individuals with AP attachment difficulties have an increased need to feel wanted and may experience jealousy or irrational fears. There is a deep need for reassurance; if this need is not met however, individuals may begin to doubt how others feel about them; commonly interprating anger and disdain from relationships/partners. Those with AP attachment fear abandonment and such fears can actually serve to drive sensitivity surrounding relationships leading to misinterpretation and the break down of future relationships/friendships.

Dismissive-avoidant attachment

Individuals with a Dismissive-avoidant (DA) style of attachment may prefer to be on their own, isolated within their own world. DA attachment difficulties include issues with feeling dependent on others and a worry that forming close bonds may make their life less independent. Individuals with DA attachment issues commonly believe that relationships are troublesome and dangerous and so may behave in ways to prevent a loss of perceived independence. These behaviors can make it difficult for others to support you or feel close to you.In addition to this, if someone does put in extra effort, individuals may react by closing off completely.
Individuals who face issues with DA attachment do not necessarily have little care for others rather than undertake said behavior as a self protection mechanism which ensures individual self sufficiency.

Fearful-avoidant attachment

Individuals with fearful avoidant (FA) attachment styles may have a deep desire to build relationships however fear being abandoned or hurt by said relationship and so push feelings and emotions aside in order to try and avoid feeling them (blocking). This results in short bursts of intense and overwhelming emotion as a negative pattern begins to form in relation to others. It is common for individuals with a FA style of attachment to have conflicting feelings about intimacy and relationships; fearing self inadequacy leads to poor relationships.

Further research

Leading attachment theorists have recognized the limitations of the DSM-IV and so proposed broader diagnostic criteria in terms of attachment issues. There is as yet no official consensus on these criteria. Boris and Zeanah (1999) have offered an approach to attachment disorders that considers cases where children have had no opportunity to form an attachment, those where there is a distorted relationship, and those where an existing attachment has been abruptly disrupted. This would significantly extend the definition beyond the DSM-IV definitions (those definitions are limited to situations where the child has no attachment or no attachment to a specified attachment figure).

Boris and Zeanah use the term “disorder of attachment” to indicate a situation where the child has no primary caregiver and may be indiscriminately sociable and approach all adults. Alternatively however, a child may be emotionally withdrawn and fail to seek comfort from anyone. Boris and Zeanah also describe a condition in which they term; “secure base distortion”. Where the child has a preferred familiar caregiver, but the relationship is such that the child cannot use the adult for safety (I.e; in cases of developmental trauma or neglect) while gradually exploring the environment. Such children may endanger themselves, may cling to the adult, may be excessively compliant, or may show role reversals in which they care for or punish the adult. The third type of disorder proposed is termed; “disrupted attachment”. This type of problem, which is not covered under other approaches to disordered attachment, results from an abrupt separation or loss of a familiar caregiver to whom attachment has developed. The young child’s reaction to such a loss is parallel to the grief reaction of an older person, with progressive changes from protest (crying and searching) to despair, sadness, and withdrawal from communication or play, and finally detachment from the original relationship and recovery of social and play activities.
Most recently, Daniel Schechter and Erica Willheim have shown a relationship between maternal violence-related PTSD and secure base distortion which is characterized by child recklessness, separation anxiety, hypervigilance, and role-reversal

The Downward spiral for trauma survivors

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Most trauma survivors also experience depressive symptoms to the extent that the diagnosis of depression or anxiety may come prior to the realisation of having a trauma disorder or even experiencing trauma itself. It is a common trend in the uk to unsuccessfully treat depression or anxiety in potentially millions of patients primarily suffering unresolved trauma. That initial diagnosis of depression, anxiety, borderline, bipolar, OCD, anorexia and a whole host of separate psychiatric illness may instead be a symptom of trauma, of the progression of maladaptive coping and reliance or of a plethora of other issues stemming from unknown or ‘silent’ trauma’s. Therefore it is not only common for individuals to attend psychiatric treatment for a symptom of trauma, but to feel unsuccessful after treatment as many underlying issues still remain. That being said, the addition of developmental trauma and a developed ACE screen would have the potential to change not only the face of mental illness but the statistics that come as a result of said treatment.

When looking at the depressive symptoms of trauma related illnesses; symptoms do not always follow along a clear cut line of the criteria for diagnosis of depression. Clinically, depression is diagnosed as a feeling of hopelessness and despair on most days – lasting at least 2 years, which leads to avoidance, sell harm or suicidal behaviour, memory issues, Insomnia or oversleeping and the lack of interest or over interest in food. On a scale; depression can range from mild, moderate and severe and as recently researched – “high functioning”. High functioning depression is similar to the standard definition of depression however the individual experience a less ‘severe’ symptom type and can or is a functioning member of society (Ie holding a job, has a support structure, can maintain social life etc).

The NHS look and treat depression over a 6-week course of CBT as a standard protocol as well as introducing medication to stabilize an individuals depressive/reactive symptoms; making it ‘easier’ to work through and be successful at therapy provided. This is not always the case for a variety of reasons; however during this particular article, I intend to focus on how unresolved trauma causes relapses in a trauma survivors recovery journey – or as the NHS have stated; how depression causes a Downward Spiral.

Therapy provided by the NHS regarding The Downward Spiral of mood (1) looks at how an individuals depression and low mood causes a downward spiral and a potential relapse in treatment. I tend to view the latter differently, I view it as how unresolved trauma causes relapses in a trauma survivors recovery journey. With focus shifting away from an individual’s “faulty cognition” and onto the potential that an individual may have developed maladaptive coping a response to (unresolved) trauma. That being said; I would like to dissect the downward spiral model further and apply it to trauma in a more trauma informed way

NHS UK shows the downward spiral to be concurrent with depression however one could easily apply it to many other psychiatric illnesses. The notion being when an individual is depressed they experience low mood which leads to negative thinking and low self-worth. This is said to cause an individual to behave in ways that maintain the depressive mood, causing a downward spiral (1).

This notion is based on the CBT method of treating depression. Even within intensive trauma therapy programs set by NHS; depression is viewed as a sub disorder or comorbidity to individuals with trauma. Having looked at developmental trauma previously, we know that both complex trauma and childhood trauma cause an individual to feel shame, low self-worth and to have a negative mindset imprinted within them. One that is difficult to deconstruct in terms of trauma symptoms. Applying the model explained by the NHS to trauma can be destructive; placing some blame on the individual for experiencing a downward spiral of mood due to their own “faulty cognition” and not as a relapse or awakening of unresolved trauma can serve to retraumatise and compound feelings of low self-worth and shame in survivors.

The downward spiral as applied to unresolved trauma – gives a survivor a greater understanding of why they seem to frequently feel like they are in cycles of coping vs crisis.

The NHS further state that is through responding to a low mood with negative thinking or unhelpful behaviours that can result in an individual being stuck in a downward spiral of negative thoughts and unhelpful behaviours leading to another episode of depression. It is through “not being able to tolerate a mild state of depression and avoid negative thinking and behaviours” which creates this downward spiral and thus having the ability to challenge negative thoughts and behaviours with safer coping will allow an individual to maintain theur mood positively and safely.

With regards to ‘pure’ depression with no other comorbidity or trauma being involved; this is in many ways correct and a little bit of common sense. However with regards to the fact that 1 in 13 individuals suffer traumatic events in the UK within their life – the standard depression that the NHS diagnose may not be the full picture. For those individuals who had “high functioning depression” or a “depression” diagnosis turn to the realisation that they actually experienced trauma; the standard treatment and explanation may be counterproductive and dangerous.

Trauma survivors are notoriously hardened to being able to withstand others negative tactics and projections. It’s not so much the case that a trauma survivor cannot ‘tolerate’ a mild and negative state than a trauma survivor unknowingly may use negative coping which can eventually manifest to a secondary illness. Many individuals of Childhood trauma or interpersonal relationship trauma may have been taught at one point that these coping mechanisms brought safety. In terms of brain development and function; we already know trauma changes neural pathways and volume in areas of the brain. Therefore it is not through low tolerance that a survivor may enter a downward spiral rather than that is all they are wired to know at that point in time – unresolved trauma thus needs to be explored to understand the reasons why an individual may repeatedly experience cycles of coping vs crisis.

In many instances, a trauma survivor may not always be aware of everything traumatic that ever happened to them. This could be either due to memory changes in the brain, dissociation or age and developmental stage at the time of traumatic events. In fact, it is very common for a survivor of trauma to be hit by either new nemories or new triggers on a day-to-day basis – even hour to hour in some instances. The triggering of one memory or one small aspect may set off a chain reaction of memories and triggers; flooding the body, making it feel at times that the event has just happened all over again and is just as raw as it once was.

The fact being in this case the already heightened survival mode becomes activated and an individual initially relies on their 4f or cross type responses. Frequent reliance on these responses is known to have the ability to manifest into secondary psychiatric illnesses, however in terms of the downward spiral, we see a survivors use of these responses as being the cause of.

In cases of Childhood trauma and developmental trauma, it is common to have a variety of unresolved traumatic events manifest suddenly and without warning. Similarly, in cases of adult complex trauma; dissociation and numbing during the event can we lead to effects manifesting years later leading to a downward spiral in TRAUMA symptoms.

It is also common for survivors of trauma to experience subtle emotional or somatic flashbacks or to be inadvertently triggered; unaware of the cause. A survivor of trauma can have hundreds of different triggers, some of which they are unaware until they are faced with suddenly. With regards to the downward spiral, it may not be caused solely by a low mood and negative behaviour but instead caused by the sudden realisation of events once unresolved being triggered and awakened.

With regards to the NHS treatment protocol, focus is placed on overcoming negative thoughts and behaviour through fixing ‘faulty cognition’ either via behavioural strategies, acceptance or cognitive strategies. If the NHS were however to take a more trauma informed approach to treating all mental illness – we may find a massive change in the current statistics of mental health in the UK.

A trauma informed approach is necessary for screening for the true effects of trauma in individuals. Further normalising what a large proportion of the UK may inadvertently suffer from and removing some of the stigma of ‘poor’ mental health. Instead of solely treating depression or depressive SYMPTOMS through behavioral and cognitive modification, identifying past unresolved issues when they arise or giving an individual the knowledge and understanding of that possibility could serve to benefit millions of people in the UK.

Our research group can be found here;
https://www.facebook.com/groups/2348717965433957/?ref=share

Currently we are conducting research into the causes of trauma. I have included a link to the survey here : https://surveyheart.com/form/5f06e63b3ed8765392fe12d0

If you would be interested in taking part, please feel free. If you would like to share this study i would also welcome you to use the link, many thanks!

References

1. Dr. Lisa Reynolds (2012), the downward spiral. NHS UK therapy options for CBT

Emotional armouring

Psychological armouring

A common hurdle to recovery: emotional (or psychological) armouring has the potential to not only negatively impact an individuals future relationships and inner psyche; but produce a plethora of related physiological symptoms within the body.

Armouring refers to a maladaptive coping method whereby a survivor of trauma holds back or represses natural emotions or expressions in order to conform to expected societal norms. Over time, armouring results in an altered character which manifests as a coping mechanism in defense from pain experienced due to not expressing ones inner desires. The conflict between our basic needs/desires or feelings becomes heightened with unnatural attitudes and conditioning placed upon us.

Armouring is a common tool used by survivors of early developmental trauma and adult interpersonal relationship trauma and many survivors may use this without the realisation of the fact. When armouring manifests in to a survivors inner character, it causes a range of effects with regards to one’s personality, physiological systems and desires (Personal dreams, goals, wants, needs etc).

Emotional body armouring forms in response to chronic trauma; the fracture of a relationship or the disintegration of one’s values. For adult survivors of Childhood abuse or neglect (and cases of adult interpersonal relationship trauma); armouring can become deeply enmeshed within one’s developed characteristics. This is to state that neural pathways may have been forged in a way that would not have been. It is not to say that such pathways cannot be altered.

Adult survivors of Childhood developmental trauma may have been punished during times of self expression. The potential is that self expression which is not deemed appropriate or acceptable by an abuser may be termed so because it creates feelings of deep insecurity and lack of control within the abuser(s). When this fear is met with a lack of perceived control, it causes a heightened reactive response. That is in no way to say that an abusers actions are deemed acceptable or normal, as an adult they are just as responsible as others (including ourselves) to react appropriately and without abuse. Each time a survivor may have attempted to express their needs or desires, this cycle is most likely to have been repeated and so the child (or adult) becomes conditioned in to learning not to express, not to feel and not to show weakness.

We know the mind and body are connected; dis-EASE of the mind leads to DIS-EASE of the body systems. Repressed feeling that commonly accompanies emotional armouring is seen to be stored within body systems and thus seen to manifest as tightness, tension or illness.

Armouring is an accumulative process and as time passes; the addition of further dis-Ease plagues the survivor in the form of chronic pain, fybromialgia, hip/joint issues, jaw issues, shoulder and muscle spasms.

The psoas is the largest hip mover of the body. It is the muscle that moves our legs to run (fight/flight) and to draw our knees up to go into the fetal position (freeze). For people with C-PTSD or PTSD the psoas becomes shorter and tight because it’s never allowed to relaxed due to the sympathetic nervous system being always in fight/flight/freeze. Which leads to lower back pain, hip pain, and inner and outer thigh pain, knees, pain in the glutes, and possibly even difficulty breathing because the diaphragm is impacted by the psoas muscles.

Learning to relax the SNS (sympathetic nervous system) will help to relax the psoas muscle. Learning to relax the psoas muscle may also contribute to relaxing the SNS.

Breathe work, visualization techniques, along with somatic yoga practices will help release, relax, strengthen, and lengthening the psoas muscles will help alleviate back, glutes, hips, legs, and knees and improve the breath. Learning to relax the body and move from the sympathetic nervous system to the parasympathetic nervous system. The parasympathetic nervous system is responsible for our bodies ability to rest and digest. More information regarding recovery of the psoas can be found within our group.

Focusing awareness to the body sensations associated may help when practicing feeling and reducing armouring behaviors. Recovery from armouring requires body and breathe work as well as relaxation and cognitive skills/therapy or support.

More information about the intricacies of armouring can be found on our group.

Using feeling to recover from past trauma

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Grieving ingests our most painful experiences and feelings. This can cause the downward spiral, Flashbacks, suicidal ideation and active suicidality. It is imperative to have insight as to whether this recovery type is appropriate at the present moment. If one struggles with any of the four methods of grieving (anger, feeling, crying, verbal ventilation) prior work must be explored or adequately supported from a trauma informed therapist.

Through recovery, a survivor must appropriately grieve and reparent the self; leading to nurturing self thought and insight (an overview of recovery through grieving can be found here).

When we look at recovery through grieving as a whole, we see anger and crying to be the primary first stages of the journey. Both anger and crying as methods of recovery are essential in reducing inner critic attacks and increasing self compassion. Working through both anger (found here) and crying (found here) can give a survivor of trauma varying safe coping mechanisms in which to further their recovery journey. Progression of this journey leads an individual to working through verbal ventilation (found here) as a primary fundamental step prior to using feeling as a way to release one’s body from repressed memories and emotions.

Feeling emotions can be feared by both survivors of developmental trauma and adult interpersonal relationship trauma due to any previous experiences (or attempts) to express oneself having been met by further punishment or abuse. It can take a great deal of time for a survivor of trauma to begin to accept that both feeling and expression are natural instinctual forms of experience which need not be approached or dealt with by fear (and fear related behaviours).

Feeling is normal; just as angering and sadness are. Experience in full leads to the destruction of pain and associated body sensations. Through using the first three methods of grieving (anger, sadness and verbal ventilation); feeling can become accessible once more.

It is important to note the difference between feeling and emoting (reacting). Walker (2013) explains the 4 processes of grieving in his book; “CPTSD; From surviving to thriving” – this resource is freely available on our group and can be purchased online. It is an informative resource for survivors of Childhood developmental trauma who are on their recovery journey. Emoting is the reactive response one exhibits during grieving from past trauma. This takes in to account reactions of angering, sadness (crying) and verbally ventilating. Feeling however is the process of sitting with the feelings that accompany past trauma. Feeling involves the surrender of control and allowing experience of inner emotions devoid of reaction or falling back to maladaptive coping, dissociation or flashbacks.

In order to use feeling, not reaction; a survivor must shift focus from active thought to one’s body effects/sensations; being one with the body as emotions rise in order to begin to process them in a different way.

This is a step up from reacting by angering, crying and venting. Feeling in order to grieve involves passive acceptance in this final stage of the grieving process. Grieving through feeling requires an ability to place direct attention to emotionally/mentally painful states and surrender to the self without resistance. An individual must relax in to the pain of past trauma in order to absorb the energy and sensations left behind.

We know the mind and body are connected. Research shows that repressed emotions are stored within the body and produce physiological bodily symptoms in the form of chronic pain, tension and disease. These symptoms can be a symptom of emotional armouring, a common coping mechanism used by survivors of both childhood developmental trauma and adult interpersonal relationship trauma. Over time, armouring becomes accumulative and brings with it a plethora of physical manifestations.

Adult survivors of Childhood developmental trauma and adult interpersonal relationship trauma who may have been punished for self expression face increased rates of chronic disease, muscle tension, pain and spasms all said to be due to emotional armouring over what could potentially have been a lifetime of trauma(s). Feeling as a grieving method can aid a survivor in reducing the tensions and illness caused by trauma’s outside of our control.

Emotional armouring is the repression of natural expression in order to conform to expectations of family, friends or partners. This can result in an altered character; constructed to protect from the pain of not expressing by forming defenses. As our basic needs are compromised, bodily expressions ensue due to the conflict of inner desire and unnatural outer expectation conditioning attitudes placed upon us.

Emotional body armouring forms in a response to chronic trauma or the fracture of relationships/values. Recovery from trauma through feeling involves body/breath relaxation alongside cognitive work/therapy. Armouring results in symptoms such as obsessive jaw clenching, withholding of breathe/shallow breathing and tension in upper back/shoulders. More information regarding armouring and its effects can be found here.

Focusing awareness to the body sensation which accompanies emotions helps in practicing feeling. Paying attention to body sensations increases awareness of feeling and aid in the processing of emotions. Early work may include reaction responses to feelings however as work progresses; practice of being present without resistance brings optimal recovery through grieving.

Recovery is not linear. Feeling will at times bring repressed memories or emotions back to the forefront. Such new emotions and memories require to be grieved in full through all grieving methods and so recovery through grieving can be seen as a winding and unpredictable path. This journey although easy feared, is essential in order to fully accept past trauma.

Research shows that remembering events in full is not necessarily required in order to recover from past trauma. The importance is in merging both cognitive processes with body sensations and patiently and compassionately allowing oneself to grieve the injustices of the past.

With practice, feelings become less intense and more manageable. The journey of time and patience continues as an individual grieves past trauma through fully being present within ones feelings. Approaching one’s recovery in such a way is one of the most compassionate acts possible. It becomes the final gift that one can present when moving forward with life. Practice brings a sense of safety in knowing and comfort in the knowledge of one’s ability to sit with uncomfortable feelings for longer than once possible.

There are various ways in which a survivor can learn to grieve their past trauma. Using each of the four methods of grieving as an appropriate and balanced approach can transform one’s recovery journey and allow a survivor to become comfortable with the emotional distress which often accompanies trauma.

Using feeling in passive acceptance is described by Walker (2013) as being the penultimate step to recovery from trauma through grieving. His work can be found both within our Facebook group and online as he remains one of the most influential theorists within the field of trauma. Importance is placed on working through each method slowly and consistently and if required; with the help of group support or a trauma informed therapist.

Using verbal ventilation for recovery from trauma

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Verbal ventilation is a term which has been taken from literature by Pete Walker – “complex PTSD from surviving to thriving“, 2013. Walker describes each of the four methods used in grieving from trauma as a recovery tool in great detail. I intend to further provide an overview of verbal ventilation for grieving trauma (both developmental and interpersonal abuse) and provide some strategies for achieving such recovery tactic.

Verbal ventilation concerns the writing or speaking of one’s trauma and emotions in order to fully release/reflect on the repressed painful feelings associated with such event(s). Primarily; speaking holds the greatest yield in terms of recovering from trauma – writing ones feelings and experiences can be an optimal way to begin to embark upon fully ventilating through speech.

By attaching meaning to words; an individual can begin to release pain associated with past trauma. When reflecting through written word, it switches one’s left brain to become functional allowing reduced right brain symptoms (hyper vigilance, racing thought, flashbacks, emotional avoidance/flashbacks, dissociation etc) and an ability to reflect appropriately on the event(s) concerned.

Determined practice of this method can result in a survivor of trauma having a newfound ability to begin to speak their pain and hear the emotional response in their own voice. This allows for further reflection and acceptance but should be worked towards. It is not an easy method to perfect, speaking ones pain can be difficult for many survivors of trauma as they have faced abusive behavioural conditioning in response to voicing their basic human rights. For survivors of Childhood developmental trauma who have in many cases developed in such a way that speaking without self judgement becomes incredibly difficult; using writing first in order to practice a form of verbal ventilation can be helpful when working towards having the self confidence and compassion required to voice that pain.

Adult interpersonal relationship trauma often results in similar conditioning with a survivor or victim being punished for speaking out, having an opinion and judged accordingly. Both examples are what differs PTSD from complex trauma and developmental trauma as both include deep brain changes (in volume/pathways) and complex interpersonal difficulties. However both survivors of developmental trauma and adult interpersonal relationship trauma can effectively work towards finding their voice through writing to reflect. An individual can use journaling, interview style question/answers and art and creative means in order to begin processing the pain associated with the past – and slowly working towards having an ability to verbally ventilate without judgement and fear.

As one begins to hear the words, meaning becomes attached in a new way; different from the written word previously used. When we speak about our past; the words become tinged in emotion and memory and can identify repressed feeling attached ultimately removing shame and guilt from a survivor with self blame and inner critic attacks.

Speaking in an uncensored manner without fear of judgement while simultaneously focusing on feelings or body sensations provides release of the emotion of the past. For some individuals beginning their journey or using verbal ventilation for the first time; emotional identification may not come so easily. As each trauma differs; each response differs – what one recovering individual is able to attain does not equate to the other. Trauma is a multidimensional illness which differs for each and every survivor. Those survivors who can not easily identify their emotions may benefit from working on emotional labeling and processing (either alone or alongside a trauma informed therapist).

Verbal ventilation provides the same release as anger (found here) the or crying (found here) but also helps to expose the critic driven attacks which become commonplace for a survivor. When a survivor is able to increasingly verbalise and communicate their needs they take a step closer to peace. These needs that were once unmet (and unjustly so) can be attained through appropriate verbal ventilation and recovery through grieving methods. Used in succession with anger and crying; verbal ventilation serves to propel an individual with regards to recovery.

Using verbal ventilation for recovery from trauma requires courage. When hearing those words that flow from a newly freed place within; they are individually tinted and descriptive, carrying alongside anger, guilt, fear, sadness and shame. That can turn in to a dark place where the survivor may lack emotional regulation to fight off the critic attacks that can blend sneakily in to what one believes to be verbally ventilating.

Using ventilation alongside crying and anger can propel recovery through grieving and help a trauma survivor to become free from previous emotional constraints. Regular practice of this method not only increases intimacy but actually helps to remediate the brain changes which are caused by CPTSD and developmental trauma (brain changes info can be found here)

During an emotional flashback, the right side of the brain (emotion) becomes overstimulated and hyperactive while the left side of the brain function reduces considerably leading to an inability to process the emotional reaction required at that time. Verbally ventilating brings the left brain back to function. With an acquired ability to think and feel simultaneously; words translate to feelings which can be processed and resolved. There is an increase in ones ability to interpretate and communicate not only with the self but with others.

The repeated pattern of using verbal ventilation for recovery allows the formation of new neural pathways which allows the left brain and right brain to finally balance and work together ultimately leading to an ability to reflect and recover.
Such results have been seen throughout research and theorists can now see these brain changes being present on an MRI following successful verbal ventilation and reflection.

The actual practice of verbal ventilation allows alignment of both the right an left hemisphere. Whenever the right side becomes activated (I.e flashbacks); the left side can provide steps to reduce and manage the reaction.

Proficiency of verbal ventilation leads to an ability to think and feel and ultimately creates appropriate healthy responses to inner feelings. Survivors practicing verbal ventilation have shown to begin to show their selves compassion and respect the – a core trait required in ones ability to appropriately label and react to emotions.

This type of grieving method is only effective when the critic (both inner and outer) has no control over the survivor. Using anger and sadness as a first step in recovering has been proven successful in reducing critic driven attacks. Work should be completed here prior to verbal ventilation so in order to reduce the risk of oversharing or to reduce the potential from a shift from healthy ventilation to critic driven attacks (which can easily blend in to attempts to ventilate).

Verbal ventilation easily turns in to self attacking, criticism, triggering or intensifies flashbacks. For these reasons; practice in verbal ventilation should be approached slowly and if possible with support (from a recovered spouse, friend or therapist). It is common for survivors of trauma to be unaware of this shift from ventilation to critic attacks. This may be due to the nature of trauma itself and how an individual may have been forced to develop over the course of their life and trauma.

Practiced alone, verbal ventilation can be helpful. There is no other person available to hear or judge the emotive words and memories held by a survivor and can be a great starting point in recovering from trauma through grieving. It is important to note that verbal ventilation should only be completed alone if the survivor is fully aware of critic attacks.

Support can be beneficial in helping a survivor to recognise and neutralise critic driven attacks, through repeated practice; this healthy response becomes formed in those new neural pathways and thus becomes second nature in which to practice.

Verbal ventilation heals trauma and abandonment by improving our connection to others. Sharing what is important to us through ventilation forges new healthy connections with others. Completed within a safe environment and relationship; humans have an instinctual desire for verbal-emotional intimacy. Doing so creates connection and friendship increasing one’s positive experience and fueling desire to repeat successfully.

Sharing itself can be triggering for a trauma survivor. A survivor of developmental trauma may have spent their entire childhood being taught that it is not beneficial to share or open up. In fact, many cases of both interpersonal abuse and childhood trauma impacts an individual’s ability to voice opinion never mind inner most feelings. In cases of trauma with no clear beginning, middle or end; difficulties arise with perception and interpersonal relationships. This can be the hardest hurdle to recovery however can be efficiently counteracted through group or individual support (or more preffered; from a trauma informed therapist).

Trauma survivors who have successfully terminated relationships with abusers often re enter toxic relationships and can over share as a coping mechanism to past trauma. This type of verbal ventilation is not effective in recovering from trauma through grieving. Oversharing causes vulnerability and actually harms relationships by not only providing others with fearful information but by causing others to question life and their own self in the process. When an individual over shares; they reduce the strength of their personal boundaries. Boundaries which are set in order to protect.once those boundaries become blurred; it becomes more likely that the individual in question will face further trauma from interpersonal relationships.

Verbal ventilation increases intimacy through bringing comfort and restoring connection between oneself and others. Sharing appropriately produces a bond through mutual sympathy and a desire to connect. This can aid a survivor in being more emotionally intimate with their partner or within common relationships.

Grieving through verbal ventilation also reduces the abandonment fears and depression associated with past trauma. Through cognitive work and practice of verbal ventilation techniques a survivor can not only build neural pathways but form new connections and experience further positive outcomes as a result.

Tips for ventilation

Start by writing – if you have never experienced verbal ventilation it can be beneficial to build a fundamental base through first writing ones experiences. Writing for ventilation includes journaling, writing poetry, creating song lyrics, writing personal memoirs and using an interview style structure in order to aid processing and reflection.
When writing it can be helpful to write without worry of spelling, punctuation or structure. Ventilation through writing concerns an individual writing everything and anything that comes to mind – no matter how insignificant it feels at the time. Worrying about one’s punctuation or structure is incredibly counterproductive and causes the left side brain to take over from feeling.

Music as a tool – a mediator step between writing and speaking emotions would be to use music to express how you feel. When reflecting on past abuse; assigning a particular music type to it can really aid a survivor in beginning to become used to hearing the sounds of emotions as a protective step prior to verbally ventilating.
Different genres may touch you in different ways. Try all genres of music until you find one that feels right. Whether that be classical, rock, dance, pop, piano, rain sounds or meditation – assigning meaning to music can be a productive tool especially during flashbacks.

Practice – using any of the four grieving tools as a recovery tool is not a quick process. Accept that such practices of recovery can take a while to adopt. Over time it can be helpful to reflect on the progress that you have made over your time grieving.
Reflection – write down or journal emotions and feelings for the day, it may be helpful to follow a script or pre written interview when reflecting. Journaling is an effective way to set small; attainable goals whilst tracking them as well as providing opportunities for self reflection, offloading of thoughts and allowing an alternative response to be explored. Journaling or reflecting can also be useful for a survivor of trauma when attempting to replace negative self talk and behaviour.

Replace negative with positive (the key is balance) – it can be common for a trauma survivor to become enmeshed with one’s negative inner critic.
The inner critic can manifest to one’s own personality and become enmeshed in ones identity making it difficult to separate. As life continues, the critic begins to take the driving seat in ones own reactions and perception. Fighting the critic reduces such attacks by substitution of thought (replacing negative self talk with positive) and thought correlation (when i revert to; “shut up!” I will instead ask for a break etc). Such reflection leads to an increased sense of personal likeability and desire for interpersonal boundaries.

Feel, accept, reflect – feel the emotion and label it, whatever it be it is important for recovery to fully accept that its ok to be feeling in this way. It can be helpful to remember our key phrase; “I feel – – – and because I choose to feel this way.” and repeat that until emotions return. Focusing on one’s breath can be beneficial in aiding the body to physically return to normal in the sense of its biological processes.

Work with support

Support gives a survivor a second set of eyes and opinion, in many cases support can be helpful in allowing a survivor of trauma to face difficulties with conflict (either self or relationship). Support from a trauma informed therapist can be important to work through the various issues which survivors of trauma face in their day to say life, providing validation and building confidence and ultimately helping build a strong foundation for which to recover. Many survivors may not feel comfortable using a therapist for support or may not be in the place to do so. Support can come in all forms, our group supports survivors by providing knowledge and information about our own trauma in order to help others feel less alone, online friendship can be beneficial for a survivor beginning their recovery journey as it removes the uncontrolled aspects of making and maintaining “real world” friendships.

Focus on the little things

Focusing on the small positives on one’s life can also aid a survivor in managing to balance anger appropriately. Reflecting on the reason behind the anger as well as balancing with reasons they are still OK in this moment can really cement a survivors recovery especially during difficult times.
This can be achieved by replacing negative self talk with more positive affirmations and balancing the in-the-moment anger that a survivor of trauma experiences. Practicing gratitude can be helpful in building these skills.

Build a positive circle

In this age of technology and at a time of lockdown restrictions and recommendations, a circle can be a small number of online relationships and friendship. There is no neccesity in meeting face to face, the goal primarily is to form a positive trusting circle with similar individuals of whom you can open up and reflect with. Reflecting in a group can propel recovery as the brain reacts to the opinions of one’s “pack” more intensely than individual thought.

Work on staying in the present

It is common for a survivor of trauma to over analyse the past in an effort to try to understand it. This is an important aspect of recovery however focusing on just one aspect leads to an imbalance and uneven recovery. Working on staying in the present not only helps an individual from basing present day decisions on past experience but gives a sense of freedom from past abuse. As the singular event(s) is over (and in some cases ongoing); the only fuel that can be given to it is that of a survivors own mind.

Although it is imperative to process the symptoms of trauma and at times the event that occured; it must not be forgotten to balance this with healthy expression in all forms. A balanced approach stops a misdirected recovery and helps a survivor of trauma to begin to live again.

Using crying to recover from past traumatic experiences

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The opposite to anger (recovery through anger can be found Here), crying and grief/sadness usually follows angry expression and has a close relationship in terms of recovering from trauma through grieving.

Recovering from trauma through crying

In recovering from trauma, survivors face a phase of grieving in order to propel and resolve overwhelming feelings associated with past trauma. Recovery through grieving allows an individual to work through the loss associated with experiencing trauma. Grieving effectively aids trauma recovery and helps a survivor of trauma with the death-like feeling of being lost/trapped within trauma flashbacks and memories (am overview of recovering from trauma through grieving can be found here)

Crying as a recovery tool brings relief in the same sense as anger and both work alongside the other in achieving total release of repressed emotion. Both anger and crying free a survivor from the abandonment which trauma caused.

Although both crying and anger are the main tools in recovering from trauma through grieving, an unbalanced approach is not only difficult for others to react to but can lead to negative outcomes with regards to maladaptive coping and interpersonal relationship issues. Having this in mind; the utilisation of both anger and sadness (grief or crying) can actually be socially deviant. In terms of socioeconomic culture and gender perceptions – using anger and sadness fully (in their full spectrum of feeling) can be viewed by others negatively.

Many cultural differences can impact the ability to use grieving methods throughout recovery. It does not however negate the importance of both methods being required in order to grieve effectively and fully. The British culture is renowned for its stereotypes just as any other country is. Typically, British culture is viewed as individuals who have a stiff upper lip. This refers to the concept that the British are quite reserved; keeping their emotions and feelings to themselves. With regards to the authenticity of this stereotype I am not going to debate, however generally speaking as a culture; we tend to not express ourselves as fully as we perhaps should and this will have implications when recovering through grieving.

Gender stereotypes also play a part in an unbalanced grieving response and of course age, life experience and socioeconomic status. As far as gender perceptions are concerned; males commonly show an imbalance with favouring anger as a grieving response as opposed to females who tend to use grief and crying in an attempt to fully express oneself and ultimately recover from using such grieving methods. As helpful as one method can be, an imbalance of one or the other can lead to reactionary behaviour and further repressed emotion. If possible; a survivor of trauma should attempt to balance both anger and grief when recovering. Of course only one emotion can be felt at any one time and that is completely natural. Each phase should be fully experienced on their own and in conjunction in order to fully express emotions which may have previously been unresolved. There is a cut off where coping solely with anger or grief turns maladaptive, a balanced approach has shown to be more effective in terms of recovery.

Incomplete release comes from an unbalanced grieving response. That is in terms of emotions being stored in the body and resulting in reactionary responses to both the outside world (outer critic) and self (inner critic).

Having the ability to cry without judgement actually serves to stimulate relaxation and self growth. For a survivor of trauma; ones grief and sadness may have been met by disdain or an increase in abusive events and or punishments. This can result in many survivors of trauma having great issue in terms of dealing with grief and the emotional issues that arise from said response. Crying however balances the parasympathetic nervous system; which Walker (2013) states helps to balance hyperarousal commonly experienced during flashbacks and associated trauma symptoms.

When a baby is born; it first expresses fear/anger and loss of safety as it initially screams. This is more often than not followed quickly by sadness and grief over the loss of the womb – its safe place. The newborn is quickly consoled by direct skin contact from its parental figures – more importantly; the mother. That bond that formed over 9 months is finally met in environment and the familiar smells and breathing of the mother provides an alternative nurturing comfort which was once provided in utero.

Humans are built to connect, to feel safe and to express freely. Over the developmental period however this free expression becomes stifled. Although it becomes more difficult to express in terms of sociocultural difficulties, it is still one of the most important aspects of recovering from trauma through grieving.

Using crying aids a survivor who also deals with negative self critic attacks. Crying stops the inner critic by releasing fear before it turns to a trauma response (I.e a flashback). Crying as a grieving tool actually dissipates fear, shame, guilt, self abandonment and increases a survivors ability to process anger (which in turn aids grieving).

Recovery from trauma through crying allows a survivor to grieve and provides a cathartic release which leads to fully mourning the losses associated with past trauma and abuse. This may take the form(s) of grieving over lost relationships, a lack of nurture or sense of self. When a survivor is able to feel the natural sorrow of the horrors of their past; it leads to experience and connection with not only the self but with others.

It is important that a survivor who is using grieving as a recovery tool has an ability to accept crying and sorrow whilst simultaneously riding the wave of emotion in its entirety. Fully experiencing sorrow leads to an increase in self compassion as the survivor forgives oneself for the myriad of trauma events that occurred at the hands of another.

Repeated practice of fully expressing emotions allows said practice to become habitual and this becomes the cornerstone in recovery. The increased self esteem and reduction in flashbacks and trigger reactions leads to a reduction in personal abandonment fears. As crying increases self compassion; a survivor begins to see a positive correlation with regards to maintaining healthier relationships.

With the newfound ability to be present and available begins to aid a survivor in developing new friendships which are healthier than previous experience. The release of repressed grief increases self allegiance and strengthens confidence and self esteem while providing a solid foundation in which to lay boundaries. These new additions to one’s recovery toolbox serves an individual in their personal relationships with others and the self.

In reference to a survivor who faces incomplete expression; tension may build within the body and the mind. This can range from self hate (controlling behaviour), outer critic attacks, 4f response reliance or maladaptive coping. This blocked anger or sadness usually results from repressed crying or feeling resulting in decreased lower limb activity, avoidance, headaches, dry mouth, fatigue, chest pain, chronic pain, stomach pain, nausea, behavioural overreaction, self harming behaviour and substance abuse/reliance or addiction.

Denied feelings result in limited beliefs, a lack of appropriate risk taking and poor connection. It can be helpful to use the phrase; “I feel – – – the because I choose to feel this way.” when dealing with emotional reactions that feel overwhelming.

In order to completely grieve, an individual must gain some form of closure. As is the case with anger; a survivor who is not able to fully process either sadness or anger should not continue trying to recover from past trauma through grieving. Support should be sought from a trauma informed therapist in order to complete the fundamental background work required prior to continuing their recovery journey.

Other helpful ways in which to grieve through sadness include;

Reflection – write down or journal emotions and feelings for the day, it may be helpful to follow a script or pre written interview when reflecting. Journaling is an effective way to set small; attainable goals whilst tracking them as well as providing opportunities for self reflection, offloading of thoughts and allowing an alternative response to be explored. Journaling or reflecting can also be useful for a survivor of trauma when attempting to replace negative self talk and behaviour.

Replace negative with positive (the key is balance) – it can be common for a trauma survivor to become enmeshed with one’s negative inner critic.
The inner critic can manifest to one’s own personality and become enmeshed in ones identity making it difficult to separate. As life continues, the critic begins to take the driving seat in ones own reactions and perception. Fighting the critic reduces such attacks by substitution of thought (replacing negative self talk with positive) and thought correlation (when i revert to; “shut up!” I will instead ask for a break etc). Such reflection leads to an increased sense of personal likeability and desire for interpersonal boundaries.

Motion releases emotion – simply getting up and moving your body can switch uncomfortable feelings to a more tolerable level. This can be helpful when fully expressing grief in order to ride the wave but also provide relief. As trauma and unresolved emotions are stored in our body; it is as equally important to work on releasing repressed trauma from the body through muscle release or meditation. Participation in trauma release exercise can really aid a survivor in letting go of the pent up emotions which become stored within our body. More info and examples of TRE can be found in our Facebook group.

Feel, accept, reflect – feel the emotion and label it, whatever it be it is important for recovery to fully accept that its ok to be feeling in this way. It can be helpful to remember our key phrase; “I feel – – – and because I choose to feel this way.” and repeat that until emotions return. Focusing on one’s breath can be beneficial in aiding the body to physically return to normal in the sense of its biological processes.

Heightened emotional states produce biological reactions similar to those experienced in a flashback. Breathing and taking mindful breaths can return one’s heart rate, blood pressure, cortisol and adrenaline to lower levels. Focusing on any abdominal sensations can be helpful when dealing with grief as it is stored within the GI system as well as mind.

Using both anger and grief in order to recover from past trauma can be liberating and freeing; however it is not a quick fix. Using appropriate grieving methods in which to recover can take years in order to fully process however does provide a survivor of trauma with that release necessary for both the body and mind to recover.