“Trauma” is a commonly used word that people often use to convey their emotional experience of a highly stressful and shocking event. While traumatic events are incredibly stressful and shocking, they become “trauma” when a person’s ability to cope is compromised. This often happens in response to events that are perceived as life or body threatening or after witnessing someone else’s life be threatened or taken in a violent or shocking way. Psychological trauma often relies on a person’s subjective experience of an event, and to what extent they believe their life, bodily integrity, or psychological well-being was threatened. People who experience trauma may react with intense fear, horror, numbness, or helplessness. Reactions to trauma vary greatly, from a mild reaction with only minimal interruptions in one’s daily life, to reactions that are more severe and debilitating.
Jon Allen, a psychologist at the Menninger Clinic in Houston, Texas and author of Coping with Trauma: A Guide to Self-Understanding (1995) notes there are two components to a traumatic experience: the objective and the subjective:
“It is the subjective experience of the objective events that constitutes the trauma…The more you believe you are endangered, the more traumatized you will be…Psychologically, the bottom line of trauma is overwhelming emotion and a feeling of utter helplessness. There may or may not be bodily injury, but psychological trauma is coupled with physiological upheaval that plays a leading role in the long-range effects” (p.14).
Common post-traumatic reactions include Acute Stress Disorder, PTSD, Dissociative Disorders, or Unspecified Stressor Disorder (which simply refers to the psychological experience of a person who has experienced trauma but does not meet diagnostic criteria for PTSD). Depression, anxiety, relationship difficulties, and problems with irritability or anger are all common co-occurring problems.
Single Incident vs. Complex Trauma
Single incident trauma is an event that is often unexpected, or occurs out of the blue and that only happens once. Examples of single-incident trauma include an accident (e.g., car or plane accident, chemical spill, etc.), natural disaster (e.g., hurricane, tornado, flood, earthquakes, etc.), or witnessing an act of violence (e.g., robbery, rape, homicide, etc.). As traumatic as single-incident events can be, the most serious and debilitating traumas are repeated and prolonged, and can occur for years of a person’s life.
Complex trauma is trauma that occurs continuously, frequently, and likely increases over time. Examples of complex trauma include ongoing physical or sexual abuse, domestic violence, community violence, or war.
The psychological effects of trauma are more likely to be severe when the trauma is man-made (caused by humans), occurs in childhood, perpetrated by a caregiver, repeated, occurs without choice (as is often the case for combat veterans/active duty personnel), sadistic, and unpredictable. Traumatic reactions develop as a result of the individual’s instinctive, self-protecting, and coping strategies that are used to shield themselves from psychic harm at the time of the event. However, as these strategies instinctively persist, they significantly interfere with the person’s quality of life and ability to live the life they want. Trauma can have long lasting effects on all aspects of your life, whether you remember the trauma or not. You might experience medical complications, physical symptoms such as tension or difficulty sleeping, and emotional symptoms such as anxiety, fearfulness, depression or shame. You may also find yourself avoiding situations that remind you of the trauma. You might numb or soothe yourself with food, alcohol, sex or other substances and may not even know why. Finally, trauma does not necessarily mean one has PTSD, but they can still benefit from treatment aimed to reduce symptoms that are interfering with their quality of life.
Treatment can also help prevent the onset or continuation of other problems, such as depression, anxiety, substance abuse, relationship stress, or difficulties with anger. Trauma-focused therapy can help you restore life to its rightful place, even if you are forever changed by what you’ve experienced. Psychotherapy is the most effective form of treatment for healing from the effects of trauma.
What is Trauma? Is my Experience Considered Trauma?
A question I am commonly asked in my clinical practice at the VA and in private practice is “Is my experience considered trauma?” Most individuals are skilled at describing their symptoms and problems. However, unless experienced with psychotherapy or educated at some point by a professional, most people are unaware of what constitutes a trauma/traumatic experience. Further, the experience(s) may be the driving force behind their problems. Most individuals who have experienced a trauma do not seek help because they are unaware that 1) their problems are related to a traumatic event; and 2) that there are evidence-based (meaning, treatments that are highly effective) therapies available that can help to significantly reduce or eliminate trauma-induced psychological problems.
Trauma in and of itself, relies on a person’s subjective experience of an event and to what extent they believe their life, bodily integrity, or psychological well-being was threatened.
Cognitive Processing Therapy (CPT) is a 12-session trauma focused treatment that has been researched for over two decades and has been shown to be highly effective for treating Posttraumatic Stress Disorder (PTSD) and other related symptoms (Chard, 2005; Monson et al., 2006; Resick et al., 2002, 2008; Resick & Schnicke, 1992, 1993) in a relatively short period of time.
Clients are taught to challenge their beliefs and thoughts through a Socratic therapy method (which helps the individual to understand their reasoning process and beliefs through questions), and then modify extreme beliefs to bring the belief system into balance, which ultimately impacts one’s quality of life. The therapy progresses systematically through common cognitive areas that are disrupted by trauma: safety, trust, control, esteem, and intimacy. Dr. Barbash helps the client to challenge their thoughts and beliefs, while simultaneously teaching skills for independent thought-challenging and restructuring.
Dr. Barbash has extensive experience providing CPT to Veterans during her tenure at the VA. Her experience and clinical research have provided compelling results for this evidence-based treatment, specifically in the treatment of military-related PTSD, where Monson et al. (2006) found that 40% of study participants had complete remission of PTSD symptoms following completion of CPT treatment. Chard (2005) found that CPT was highly effective for survivors of childhood sexual abuse, where 93% of study participants who received CPT no longer met criteria for PTSD at the conclusion of treatment, and that gains were consistent at three-month and one-year follow-up. CPT is recommended at the highest level under the Veterans’ Health Administration Clinical Practice Guidelines for the treatment of trauma and PTSD. Numerous research studies have been conducted on the effectiveness of CPT treatment and Dr. Barbash is one of very few clinicians in Tampa who has been carefully and properly trained, supervised, and is experienced in the administration of this treatment.