Trauma Handout Understanding the responses to trauma Trauma is obviously a MASSIVE topic to begin to unpick so with this handout and the accompanying podcast, we’re just beginning to scratch the surface. That said, we hope that the content helps you develop a better understanding of why the situation we’re in with Covid-19 is a traumatic one and why some of the ways in which you’re responding may be understood differently when you look at them through the lens of trauma. Much like we talked about allowing space for your emotions and not placing value judgments on them in the previous two sessions, the same applies here and in fact for everything we talk about. The beauty of psychology is that it can take you to a place of understanding rather than blaming. It requires you to engage in meta-cognition, to be a witness of your whole self; and not just any old witness but a kind and compassionate one. This view point is incredibly valuable – from here we can be spacious, we can give our emotions and ourselves space to be, and not suffocate ourselves with judgments and critical thoughts. What is traumatic about Covid-19? Trauma isn’t actually about the things that happen externally but relates to the impact of those things within ourselves. We’ll explore that idea in a bit. The thing that unites traumatic events is that they are unexpected, we don’t see them coming, and – crucially – they are out of our control. Someone we love dying is of course traumatic but there is a difference between a loved one dying of cancer for instance, where we know it’s going to happen, see it coming and can even begin the grieving process before they’ve actually passed away and someone who dies suddenly and unexpectedly of a heart attack. Both will be difficult situations of course, but the second is likely to be much, much harder to deal with than the first, primarily because of how sudden it is. We didn’t see Covid-19 coming. We didn’t anticipate the lockdown or how much the virus would turn our everyday lives completely upside down. So many of the things we take for granted were stripped away from us in a matter of days. That in itself will have had an impact. The word trauma means ‘wound’ and there’s a definition of it we use that really captures what trauma is: Trauma is something that hijacks our body’s ability to function Lots of people are finding that they are unable to concentrate at this current time, that they are experiencing high levels of anxiety, that they are unable to watch/read/listen to anything that isn’t corona specific or in some way apocalyptic. And that they weren’t experiencing these things previously. They offer examples of how a traumatic event can literally take over – hijack – our everyday functioning. The traumatic event leaves an imprint. A wound. Trauma is painful – physically so in the case of the bodily trauma experienced after a car accident. But pain can be emotional and psychological too. And as our bodies don’t want us to experience pain – this is one of the reasons we evolved to have natural pain killers in our own bodies and why some people might gravitate towards something heroin when our natural substances aren’t enough - we try to avoid feeling the pain. A guiding principle to understand here is that the trauma response is a positive response. It is not a display of weakness, it is your body’s way of protecting itself. It is your body’s way of stopping you from experiencing pain. Your body wants you to survive and will do what it can to make that happen. Behavioural responses to Covid-19 What are some of the ways you have been finding yourselves responding to the current situation? Have you noticed yourself doing or experiencing anything at this time that you weren’t before? We talked in earlier sessions about the constant hum of anxiety at this time, the feelings of uncertainty, the feelings of grief and loss. But now, just over 5 weeks into lockdown, what are you aware of? Some examples might be: Constantly reading the news Cleaning, cleaning and then cleaning some more A feeling of being constantly ‘switched on’ Excessively reading horoscopes Staying busy Writing lots of to do lists Eating more? Eating less? There are of course the more serious responses: lapses in drinking or taking drugs, self-harming, OCD, disordered eating… all very much connected to wanting to restore a sense of control at a time when so much feels so out of our control. Bodily responses Perhaps you’ve noticed differences in your body? There are overlaps here of course, it’s not possible - and nor should we try to – separate mind from body but it’s useful to pause and have a think about your body. Some examples might be: Indigestion or Irritable Bowel Syndrome Stomach ulcers, diarrhoea, acid reflux Insomnia or excessive sleeping Comfort eating/not eating Eczema It’s useful to mention ego defence mechanisms here, a topic covered next week. The mechanisms tend to be quite focused on the mind and by and large, don’t take into account the body. Looking at trauma in a broad way does. Although our minds may be employing various defence mechanisms to prevent us from the psychological pain of a situation, our bodies will still be feeling and responding to our environment. This is a good time to share an analogy that might help: Holding trauma in our bodies is similar to the feeling of a fizzy drinks bottle being shaken up. A tonne of energy builds up inside. There is a charge that you can even feel if the bottle is plastic. The charge needs to escape but ideally not too quickly otherwise we would get covered in Coca Cola or whatever we’re drinking. If the drink represents charged up emotions, releasing them too quickly would be overwhelming and terrifying and our first instinct may be to shut down completely as a way of not feeling. A softer approach would be to recognise that there is a build-up of energy inside that needs to come out and that it needs to come out S L O W L Y. Undo the cap a little but close it as soon as things start to feel overwhelming. Open it again another time but put the brakes on whenever you need to. Open it in the company of someone else if that helps too. We hold trauma in our bodies and need to discharge it where we can. Keeping the lid fully closed all the time takes energy in itself and can lead to exhaustion over time. Gentle movement like walking, yoga, tai chi, even gardening, help us move the charge outwards. Movement helps to burn up the stress hormones that keep us in a state of fight or flight and help discharge the charge. It’s useful to recognise that we have developed lots of different coping responses to help us survive. We wouldn’t be the species we are without these defences. These are healthy in the short term and the body is incredibly resilient at coping with acute stress, with stress that may be intense but doesn’t last for too long. What we haven’t evolved to deal with are long bouts of chronic stress, ongoing situations where our bodies pump a continuous supply of stress hormones into our bloodstreams. There is a reason why stress is now one of the biggest killers. The impact of this long term, chronic stress on our bodies even has a name: physiological suicide. So a short term response might be healthy but in the long-term, there is a high risk of it being unhealthy. We will look at the physiological effects of trauma, the impact of trauma on the body, in a later episode. Factors that affect our individual responses to trauma Why do some people seem to be coping better than others? There are lots of different factors that can impact how we are experiencing the current situation. Most of them relate to our pasts: If you’ve experienced Adverse Childhood Experiences – traumatic events when you were a child – you are likely to have a far more sensitive nervous system than someone who doesn’t. What those experiences were, how often they happened and the age(s) at which they happened will also impact how you relate to trauma in the present. Similarly - previous diagnoses of Post-Traumatic Stress Disorder and unresolved, unhealed or unprocessed trauma will make what you are experiencing now seem several times harder. The type of trauma being experienced in the present: NHS doctors and nurses working on the frontline will undoubtedly be experiencing more intensely traumatic situations (regularly) than someone who is in lockdown and who is not experiencing what they are. Though it may feel uncomfortable to compare trauma, there is a spectrum of severity that can help us get some perspective. The resources we have around us to help us process the trauma – if we are in lockdown, are isolated, have no ability to speak to professionals or friends about what we are going through, it will be incredibly difficult to process and ‘move out’ the trauma. Our own individual sensitivity and temperament, which is impacted by: The bond of attachment we formed as a child and our ability to self-regulate and contain our emotions In-utero trauma - exposure to high levels of stress hormones if your mother was going through traumatic or stressful situations when she was pregnant with you. This leads to a very high base level of stress hormones in your own body from birth. Evolutionary psychologists believe we evolved this so that if the threat the mother is experiencing when pregnant is present from birth, the newborn baby will have the capacity to at least be in a state of fight/flight even if neither are possible. This can create a template for our fight/flight/freeze response that can become a long-term coping strategy. Healthy ways of working with the trauma response There is a lot online about how to stay healthy during the current period. It is not possible for everyone to be able to buy fresh vegetables and healthy food, to buy vitamin supplements. Not everyone has a beautiful home they are grateful to be locked down in or be in relationships with people they are grateful to be in lockdown with. A couple of things that are useful to do if possible are: Recognise how much certainty and predictability have been stripped from your external life and how far out of your control this is. Acknowledge what you can control in your inner life: try to create order in your room or home, routine, structure, and boundaries (eg. switching off from the news). Monitor whether you are feeding yourself with a lot of stimulants - and feeding an over-active fight/flight nervous system - particularly if you aren’t moving much. Cut down on caffeine, sugar, energy drinks and cigarettes where you can. At least several hours before you sleep to try to give yourself as restful a sleep as possible each night. Try to factor some kind of movement into your daily routine to allow yourself to discharge the charge you may be holding inside. Rhythmical movement that involves your arms and legs like walking, jogging, some forms of yoga, or dancing around with some music on, really help with this. Recognise that you are holding a charge and think about what you might be able to do to gently release some of it. This usually involves acknowledging your feelings, recognising what may be triggering your feelings, and checking whether you have the strength to undo the cap a little or whether it needs to stay shut for a little longer. You will have some days where you have the energy to process what you’re feeling and others where you can’t. Acknowledge when you can’t and be OK with keeping the brakes pressed fully down. Talk to people. Connect with people. And process what’s going on with others. The points about have been put into a useful and easy to remember model by the GP Dr Jonathon Tomlinson. Before we look at the model, it’s interesting to look at the ‘umbrella’ his model sits under: Healing trauma is an ongoing process sitting in the larger sphere of ‘salutogenesis’ – an approach that focuses on factors that support health and wellbeing. It literally means ‘the origins of health’ and is a term coined by Aaron Antonovsky in 1979 whose research focused on the impact of stress on health. The salutogenic model is concerned with the relationship between health, stress and coping. Antonovsky was interested in how people manage stress and stay well, given that stress is ubiquitous and is something that will never go away. He was curious to find out why some people achieve health despite their exposure to particularly stressful situations (part of his work focused on survivors of Nazi concentration camps). Dr Tomlinson’s description of his model and the relevance of it in his work as a GP is well worth reading. A summarised version is presented below. Before we start, it’s worth bearing in mind that there are six different areas that contribute to overall health in this model but the aim is to achieve or strive to achieve balance across all six. Neglect one or two areas and you’ll need the others to be robust enough to compensate but that isn’t sustainable for long… Mind / The little finger – refers to feelings, emotions, memories, thoughts. It includes shame and anger, depression and fear, heart ache and grief, confusion, hope and despair. Taking care of your mind depends on how overwhelming (or numbed) your feelings are. In this area, therapy is often the most helpful thing to help improve your mental wellbeing. Body / The ring finger – refers to taking care of your body in whichever way suits you. For some this might be running, for others yoga. Creating art, sewing, baking bread, dance – all sit under this category. Many people that have experienced trauma have a difficult relationship with their bodies. Activities in this section relate to changing that relationship so that your body isn’t a source of shame or dread but something that belongs to you. To feel, to be physical is your birth right but for many, experiences of trauma mean that you have to take steps to re-establish a healthy relationship with your body. Biology / The middle finger – refers to everything you consume: food, drink, medication, supplements, alcohol, drugs. Many people with histories of trauma have a complicated and often strained relationship with food: it is frequently either a reward or a punishment. Cutting down or stopping cigarettes, alcohol, drugs, caffeine and sugar has a significant positive impact – improved sleep, clarity of thought, higher energy levels and more. Human relationships / The first finger – are there people in your life who know you well, who you love and trust, and who love and trust you back? Loneliness is one of the worst things anyone can suffer from, particularly in this time of the global pandemic. Social security / The thumb – refers to security of housing, finance, employment, and safety from violence, intimidation and all forms of abuse. The tip of the thumb touches every other finger – with adequate social security, it is so much easier to access therapy, to join a gym or yoga studio, to eat healthily and to socialise. This can be challenging for a student but is still important to reinforce here in terms of the role it plays in providing a sense of stability. Crisis management / The wrist – when the pain becomes too difficult to bear, self-harm in its many forms and suicide are ways to bring it to an end. A crisis plan should be written, shared with others and referred to in a crisis. It should include warning signs that a crisis is coming – perhaps based on a similar situation occurring in the past – and a note on people to speak to, places to go to, specific things to do. It is useful to have a crisis plan or ‘rescue pack’ for these times. Take it one day at a time. Reach out where you can. And be kind to yourself.