229 -Trauma Informed Care: The Impact of Trauma | SAMHSA TIP 57
Counselor Toolbox

 
 
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Trauma-Informed Care
Impact of Trauma

Instructor: Dr. Dawn-Elise Snipes, PhD, LPC-MHSP
Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery
Objectives
~ Learn About The Sequence of Trauma Reactions
~ Explore Common Immediate and Delayed Experiences and Responses to Trauma (Emotional, Physical, Cognitive, Behavioral and Existential)
~ Identify Specific impacts of Trauma
~ Explore the Impact of Trauma on the Family
Delayed Traumatic Response
~ There can be a delay of months or even years before symptoms appear
~ Trauma symptoms can appear suddenly, even without conscious memory of the original trauma or without any overt provocation
~ Clients who are experiencing a delayed trauma response can benefit if you help them to:
~ Create an environment that allows acknowledgment of the trauma.
~ Discuss their initial recall or first suspicion that they were having a traumatic response.
~ Draw a connection between the trauma and presenting trauma-related symptoms.
~ Explore their support systems and fortify them as needed.
~ Identify their triggers.
~ Develop strategies to navigate and manage symptoms and triggers.
Biology of Trauma
~ Changes in limbic system functioning.
~ Hypothalamic–pituitary–adrenal axis activity changes with variable cortisol levels.
~ Neurotransmitter-related dysregulation of arousal and endogenous opioid systems.

Emotional Reactions to Trauma
~ Immediate
~ Numbness and detachment
~ Anxiety/fear/ helplessness
~ Guilt (including survivor guilt)
~ Exhilaration as a result of surviving
~ Anger
~ Sadness
~ Feeling unreal; depersonalization
~ Disorientation
~ Feeling out of control
~ Denial
~ Constriction of feelings
~ Feeling overwhelmed
Cognitive Reactions to Trauma
~ Immediate
~ Difficulty concentrating
~ Rumination or racing thoughts
~ Distortion of time and space
~ Memory problems
~ Strong identification with victims
Behavioral Reactions to Trauma
~ Immediate
~ Startled reaction
~ Restlessness
~ Sleep and appetite disturbances
~ Difficulty expressing oneself
~ Argumentative behavior
~ Increased use of alcohol, drugs, and tobacco
~ Withdrawal and apathy
~ Avoidant behaviors
Specific Impacts of Trauma
~ Attachment and Relationships
~ Trauma can impacts people’s ability to develop a strong healthy attachment to caregivers.
~ People who do not have healthy attachments and relationships have been shown to
~ be more vulnerable to stress
~ have trouble controlling and expressing emotions
~ may react violently or inappropriately to situations.

Specific Impacts of Trauma
~ Physical Health: Body and Brain
~ When a child grows up afraid or under constant or extreme stress, the immune system and body’s stress response systems may not develop normally. Later on, when the child or adult is exposed to even ordinary levels of stress, these systems may automatically respond as if the individual is under extreme stress.
~ Stress in an environment can impair the development of the brain and nervous system.
~ An absence of mental stimulation in neglectful environments may limit the brain from developing to its full potential.

Specific Impacts of Trauma
~ Physical Health: Body and Brain
~ People with trauma histories may develop chronic or recurrent physical complaints, such as headaches or stomachaches.
~ Trauma survivors may suffer from body dysregulation, meaning they over-respond or underrespond to sensory stimuli. For example, they may be hypersensitive to sounds, smells, touch or light, or they may suffer from anesthesia and analgesia. As a result they may injure themselves without feeling pain, or, may complain of chronic pain in various body areas for which no physical cause can be found.

Specific Impacts of Trauma
~ Emotional Responses
~ Difficulty identifying, expressing, and managing emotions, and may have limited language for feeling states.
~ Internalize and/or externalize stress reactions and as a result may experience significant depression, anxiety, or anger.. Their emotional responses may be unpredictable or explosive.
~ Since the traumas are often of an interpersonal nature, even mildly stressful interactions with others may serve as trauma reminders and trigger intense emotional responses.
~ Having learned that the world is a dangerous place people are often vigilant and guarded in their interactions with others and are more likely to perceive situations as stressful or dangerous.
Specific Impacts of Trauma
~ Dissociation
~ Once people have learned to dissociate as a defense mechanism they may automatically dissociate during other stressful situations or when faced with trauma reminders.
~ Dissociation can affect people’s ability to be fully present in activities of daily life and can significantly fracture a child’s sense of time and continuity.
~ It can have adverse effects on learning, classroom/work behavior, and social interactions.
~ It is not always evident when someone is dissociating and at times it may appear as if the person is simply “spacing out,” daydreaming, or not paying attention.

Specific Impacts of Trauma
~ Behavior
~ A person with a complex trauma history may be easily triggered or “set off” and is more likely to react very intensely.
~ He or she may struggle with self-regulation and may lack impulse control or the ability to think through consequences before acting, and may behave in ways that appear unpredictable, oppositional, volatile, and extreme
~ Traumatized people are more likely to engage in high-risk behaviors, such as self-harm, unsafe sexual practices, and excessive risk-taking such as operating a vehicle at high speeds

Specific Impacts of Trauma
~ Cognition: Thinking and Learning
~ Traumatized people may have problems thinking clearly, reasoning, or problem solving. They may be unable to plan ahead, anticipate the future, and act accordingly.
~ When people live under conditions of constant threat, all their internal resources go toward survival.
~ They may struggle with sustaining attention or curiosity or be distracted by reactions to trauma reminders.

Specific Impacts of Trauma
~ Self-Concept & Future Orientation
~ People learn their self-worth from the reactions of others, particularly those closest to them. (Caregivers, spouse)
~ Caregivers have the greatest influence on a child’s sense of self-worth and value. Abuse and neglect make a child feel worthless and despondent.
~ Shame, guilt, low self-esteem, and a poor self-image are common among people with trauma histories.
~ People exposed to violence learn they cannot trust, the world is not safe, and that they are powerless over their circumstances.
~ Negative expectations interfere with positive problem-solving, and the ability to make a difference in their own lives.
~ A traumatized person may view himself as powerless, “damaged,” and may perceive planning and positive action as futile.
~ They have trouble feeling hopeful. Having learned to operate in “survival mode,” lives from moment-to-moment without pausing to think about, plan for, or even dream about a future.

Specific Impacts of Trauma
~ Long-Term Health Consequences
~ Results demonstrated the connection between trauma exposure, high-risk behaviors (e.g., smoking, unprotected sex), chronic illness such as heart disease and cancer, and early death.

Impact of Trauma on the Family
~ Trauma changes families as they work to survive and adapt to their circumstances and environment.
~ Adult relationships can be a source of strength in coping with a traumatic experience and its aftermath
~ When coping resources are stretched too thin and the stress is too high, partners can have problems communicating, managing emotions and intimacy; increasing the chances for separation or even violence.
~ Parent’s protection, nurturance and guidance speeds recovery and supports their child’s coping in the face of trauma.
~ When parents are not available or struggling with their own reactions they have difficulty effectively responding to and parenting children.
~ Sibling relationships are important sources of daily support, especially when living under stress or impacted by trauma.
~ When sibling relationships become over-taxed, developmentally normal rivalries can turn into more intense conflict or feelings of rejection.
Impact of Trauma on the Family
~ Extended family can offer the day-to-day assistance as well as emotional support.
~ Families separated from their extended family often develop a new “kinship” network.
~ The family as a whole provides resources to meet the basic needs of each family member (safety, love, food, shelter, health, education, etc.) and support the family’s well-being and day-to-day functioning.
~ Traumatic circumstances drain families of resources, such as time, money and energy, interfering with growing, learning and working.
~ Burdens often associated with trauma (e.g. costly court proceedings, moving, changing schools, etc.) result in cascading effects such as loss of income, as well time with family and friends.
~ When trauma limits access to needed resources and social support, families have difficulty carrying out daily routines and sustaining important traditions that bind them together.

Advice for Counselors
~ Educate your clients:
~ Frame reexperiencing the event(s), hyperarousal, sleep disturbances, and other physical symptoms as physiological and adaptive reactions to extreme stress.
~ Communicate that treatment and other wellness activities can improve both psychological and physiological symptoms
~ Discuss traumatic stress symptoms
~ Explain links between traumatic stress symptoms and substance use disorders, if appropriate.
~ Normalize trauma symptoms. For example, explain to clients that their symptoms are not a sign of weakness, a character flaw, being damaged, or going crazy.
~ Support your clients and provide a message of hope—that they are not alone, they are not at fault, and recovery is possible and anticipated.
Resilient Responses to Trauma
~ Increased bonding with family and community.
~ Redefined or increased sense of purpose and meaning.
~ Increased commitment to a personal mission.
~ Revised priorities.
~ Increased charitable giving and volunteerism.

Summary
~ Trauma impacts the person
~ Emotionally
~ Cognitively
~ Physically
~ Developmentally
~ Interpersonally
~ Spiritually