What is trauma?

Trauma is a psychological, emotional response to an event or an experience that is deeply distressing or disturbing and can have lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, and/or spiritual well-being.

Immediately after the event, shock and denial are typical. Longer term reactions include unpredictable emotions, flashbacks, strained relationships and even physical symptoms like headaches or nausea.

Because trauma reactions fall across a wide spectrum, psychologists have developed categories to differentiate between types of trauma. Among them are complex trauma, post-traumatic stress disorder (PTSD), and developmental trauma disorder.

Symptoms of trauma
Many people experience strong physical or emotional reactions immediately following a traumatic event. Most people will notice their feelings dissipate over a few days or weeks. However, for some individuals, the symptoms of psychological trauma may be increasingly severe and last longer. This may be the result of the nature of the traumatic event, availability of emotional support, past and present life stressors, personality types, and available coping mechanisms

We all react to trauma in different ways, experiencing a wide range of physical and emotional reactions. There is no “right” or “wrong” way to think, feel, or respond.

Emotional & psychological symptoms:

• Shock, denial, or disbelief
• Confusion, difficulty concentrating
• Anger, irritability, mood swings
• Anxiety and fear
• Guilt, shame, self-blame
• Withdrawing from others
• Feeling sad or hopeless
• Feeling disconnected or numb

Physical symptoms:

• Insomnia or nightmares
• Fatigue
• Being startled easily
• Difficulty concentrating
• Racing heartbeat
• Edginess and agitation
• Aches and pains
• Muscle tension

Causes of trauma
Trauma can be caused by an overwhelmingly negative event that has a lasting impact on the victim’s mental and emotional stability. While many sources of trauma are physically violent in nature, others are psychological.

Trauma is often but not always associated with being present at the site of a trauma-inducing event. It is also possible to sustain trauma after witnessing something from a distance.

Experiences that may be traumatic include:

• Physical, sexual, and emotional abuse
• Childhood neglect
• Living with a family member with mental health or substance use disorders
• Sudden, unexplained separation from a loved one
• Poverty
• Racism, discrimination, and oppression
• Violence in the community, war, or terrorism

People have different reactions to traumatic events. For example, those who live through the same natural disaster can respond very differently despite experiencing the same event.

PTSD
PTSD develops when the symptoms of trauma persist or get worse in the weeks and months after the stressful event. PTSD is distressing and interferes with a person’s daily life and relationships.

Symptoms include severe anxiety, flashbacks, and persistent memories of the event.

Another symptom of PTSD is avoidance behaviors. If a person tries to avoid thinking about the traumatic event, visiting the place where it occurred, or avoiding its triggers, it can be a sign of PTSD.

PTSD may last for years, although treatment can help people to manage their symptoms and improve their quality of life.

Risk factors for developing PTSD include:

• previous trauma
• physical pain or injury
• having little support after the trauma
• dealing with other stressors at the same time, such as financial difficulty
• previous anxiety or depression

How to treat trauma
Having a positive coping strategy and learning something from the situation can help you recover from a traumatic event. So can seeking support from friends, family, or a support group.

Talking with a mental health professional can help someone with post-traumatic stress symptoms learn to cope. It’s important for anyone with PTSD-like symptoms to be treated by a mental health professional who is trained in trauma-focused therapy.

There are multiple types of therapy that can help treat trauma including:

• Prolonged exposure (PE): This form of therapy involves exposing you to the source of your fear, until you are not afraid of it anymore.
• Cognitive processing therapy (CPT): CPT involves challenging your perspective about why the traumatic event occurred and the thoughts and beliefs you’ve developed since. This form of therapy can be performed in an individual or group setting.
• Trauma-focused cognitive behavior therapy (TF-CBT): This form of therapy is for children and adolescents. It can help address inaccurate beliefs and unhealthy behavior patterns.
• Eye movement desensitization and reprocessing (EMDR): This form of treatment involves using rhythmic left-right (bilateral) stimulation to help release emotions that have been blocked by trauma.

PE and CPT are the front-line treatments for trauma as they have the most research evidence demonstrating their effectiveness.

Techniques
The techniques used to treat trauma can vary depending on the type of therapy. Some techniques your therapist might employ include:

• Imaginal exposure: This is an exposure technique where you imagine the trauma and describe it aloud to your therapist. If you have been avoiding thoughts or memories related to the trauma you faced, this technique helps you confront it.
• In vivo exposure: This is also an exposure therapy It occurs outside the therapy session, in real-life situations. It is intended to help you gradually approach day-to-day situations you may avoid because of the trauma associated with them.
• Written account: Your therapist may ask you to write a descriptive account of the trauma you have experienced.
• Impact statement: A common CPT technique is writing an impact statement that explains why you believe the traumatic event occurred and the impact it has had on your life.
• Cognitive restructuring strategies: CPT can also involve cognitive restructuring strategies that help you change unhelpful thoughts into more helpful thoughts.

Telehealth opens the door to better treatment
Telehealth may be the perfect solution for the older population that may be restricted by quarantine in a nursing home, health issues or transportation issues. Also called telemedicine, there are several ways that people with depression may benefit from telehealth.

Telehealth is Convenient
Telemedicine eliminates the hassles of securing transportation and traveling to the doctor’s office. This works because your appointment is made on your smartphone or laptop, so you can be anywhere in the world and still see your doctor. It also frees up more time to take care of other daily tasks and duties.

Telemedicine Increases Accessibility
Many people who are depressed must travel more than 10 miles to see their health care provider. This can be especially difficult for those who do not have a car as riding public transportation can be very time-consuming. Furthermore, those with mobility challenges do not have to worry about if the doctor’s office is accessible.

Telepsychiatry Offers More Privacy
Making your appointments online means more privacy because you can easily do them from the comfort of your home or workplace.

Insurance Should Cover the Cost
One of the positive outcomes of the pandemic is that insurance companies have been forced to cover the cost of telehealth appointments. If you are on Medicaid or Medicare, there is much more flexibility in getting your appointments covered than at any time in the past. Additionally, if you do not have access to insurance, you may find more opportunities to work with a clinic that has a sliding fee scale.

Telehealth Is More Comfortable
Most patients with depression report that they feel more comfortable seeing the doctor online because they are surrounded by their things and in their own space. This may help you dive deeper into the challenges you are facing to find workable solutions sooner.