The word “trauma” means different things to different people. There is a more restrictive definition, but for our purposes, we can say it refers to an incident or series of incidents that is so bad it overwhelms a person’s ability to cope. When that happens, it can have lasting negative effects on the person’s psychological and emotional functioning—and can even lead to physical health problems.
The effects of trauma can be different depending on when it occurred. An adult who was functioning well before the trauma faces the challenge of recovering their former sense of security and peace of mind—but at least their brain possesses the ability to do that. In children, the brain has not yet formed the connections that give one security and peace of mind to begin with, and trauma interrupts that process. Thus, adults who have been traumatized as children have a much harder time experiencing the world and other people as trustworthy and safe.
In either case, the person often responds to “triggers”—things that remind them (even unconsciously) of the trauma—with either anger and hostility or fear and avoidance; they may even freeze, go numb, and seem to space out. This happens because the part of the brain whose function is to scan for danger (known as the amygdala) interprets the triggering event as a danger signal and sets off the fight/flight/freeze response.
To appreciate why the treatment of trauma often requires a special approach, consider how the fight/flight/freeze response works. If you’re startled by what looks like a snake in the grass, it’s probably not a good idea to analyze it right away (“Is that really a snake? Hmm, let me see…”). If we did that, many more people would probably have died by snakebite throughout history. Instead, we are wired to act first, think later. By the time you realize it was just a coil of rope, you’re already five blocks away. In fact, research shows that when the amygdala takes over, the prefrontal cortex (the part of the brain that thinks rationally) largely disconnects. That’s why, if someone is in the middle of a panic attack, it won’t do a bit of good to reason with them. And that’s also why some otherwise effective forms of therapy that work by helping people recognize cognitive distortions, irrational fears, and so on, might not work for trauma: reasoning with someone whose rational brain is temporarily offline can’t help.
But a comforting hug might. Or if the person is able to take slow, deep breaths. Because just as the brain sends messages to the body (such as by initiating the fight/flight/freeze response), the body also sends messages to the brain. And when the brain detects that the body is breathing slowly and calmly, it interprets that as a sign the threat is over. After all, if the snake were still chasing you, you’d still be running and screaming, right?
In fact, try this experiment: take a moment to get yourself seated comfortably, and take a few slow, deep breaths. Don’t breathe strenuously and don’t expand your chest, like Superman might do. That’s not natural for humans. Instead, breathe like you were in bed and about to go to sleep. The breath should be slow and unforced, and your belly—not your chest—should gently rise with each inhalation and fall with each exhalation. Try to breathe in through your nose for a count of four, then pause for a moment before exhaling (we naturally pause between breathing in and out). Then breathe out through your mouth just as slowly and gently, for a count of six. Take that natural, fleeting pause again, and repeat the whole cycle for four or five breaths.
Do you feel a physical sensation of calmness in your body? Most people do (but don’t worry if you don’t!). That’s the physiological effect we mentioned earlier: slow, deep breathing tells your brain it’s OK to be calm now.
Now, if only that effect would last, no one would need therapy. But unfortunately, it only works for a moment or two. Yet it illustrates that while it may be difficult to calm the amygdala using the (rational) mind—known as the “top down” approach—it is entirely possible to do so using the body—the “bottom up” approach. (Note that this does not usually involve touching the patient’s body. Instead, the patient is guided to be more attuned to bodily sensations and either modify or accept them in ways that help the brain realize they aren’t dangerous.)
Trauma treatment often takes advantage of this “bottom up” principle. For example, somatic experiencing is a form of treatment that helps the patient tune in to the physical sensations in their body and discharge built-up energy from the fight or flight response. Another example is so-called “polyvagal” treatment, which focuses on the part of the nervous system (the vagus nerve) that reacts to environmental cues of danger or safety.
Numerous other modalities exist as well, such as mindfulness meditation, EMDR (eye-movement desensitization and reprocessing), and IFS (internal family systems), with varying degrees of bottom-up focus. And sometimes, a top-down approach is the best fit for a particular person. A good therapist can help you understand the options and find an approach well suited to your personality and circumstances. It is definitely possible to recover from trauma.
Brooklyn