Although the body has a variety of ways to promote survival and overall health, at times, some of the methods it employs can bring about the opposite results. Trauma is a very good case in point. Because traumatic experience by definition is understood by the body as a threat to the very survival of the individual, the brain has critically important methods of responding to such trauma. Much like the process of physical shock, that protects the body from pain but also makes the body vulnerable to system failure, the brain’s significant response to trauma can produce temporarily positive results, but long-lasting problems as well.
Since trauma is perceived by the brain as a threat to survival, it responds in an all-out crisis mode. Normal functioning is displaced by an immediate and complete system response to the threat. This can be called the stress response cycle. In this response the brain activates a complex system of glands, hormones, and neurotransmitters for the purpose of responding as effectively as possible to the perceived threat.
In Figure 1 below the stress response cycle is depicted. Briefly explains the hypothalamus within the brain picks up sensory input that is perceived as a threat. At this point corticotropin release factor signals the pituitary and adrenaline glands to release hormones such as adrenaline, epinephrine and cortisol. The body then shuts down non-emergency systems to put energy into large muscle groups for the fight or flight response. This response is a cycle because if the threat is not neutralized it repeats continually.
Although the brain and arousal system of any healthy human being is going to have a stress reaction that can be explained in this diagram, traumatized individuals have the most to lose from this pattern of responding to stress. This is because the center of the brain, the limbic system, sets off this stress cycle many times more often if the individual has experienced significant trauma in the past. This cycle can produce a habitual response to major or minor stress that can bring a host of psychological and even physical problems that we will soon see.
Stress is inherent in living. In fact, one definition of life is the ability to measure some stress responses in brain activity. Stress is all around us, and most of the time we learn to live with it. After a significant traumatic experience, the brain’s ability to work effectively with stress can be seriously compromised. Stress is detected by the hypothalamus in the brain. The hypothalamus has the function to prepare the organism to respond as needed to achieve survival from the threat that has caused the stress. The way the hypothalamus does this is to produce a chemical called a cortical release factor or CRF that stimulates the pituitary (the body’s master gland) and the adrenal glands. The stimulated glands release hormones such as adrenaline, epinephrine and cortisol. These hormones stimulate the legs, arms and back of the individual to either run from the threat or fight the threat.
The chemical signals that race through the body in a blink of an eye send the message that unless immediate action is taken, survival is threatened. To the body, a threat to survival is the most serious signal received by the brain, and it will always take precedence over any other signals being received. For example, the sex drive is one of the brain’s strongest drives and aids in the survival of the species. However, when a mountain climber nearly falls and is holding onto a ledge for dear life, the odds are very good that thoughts of survival are taking immediate precedence over any sexual thoughts. The fight or flight response involves chemical signals throughout the body to shut down all non-essential functions and send immediate energy to the areas of the body needed to handle the threat. Essential parts of the body, for example the large muscle groups in the legs and arms, receive additional blood, oxygen, and adrenaline. At the same time, blood rushes to the brain’s sense receptors making the organism hypersensitive to the surroundings.
When the stress response cycle is initiated, and the result is a significant traumatic experience, meaning the response of the body has not prevented nor adequately addressed the threat, this experience is coded as a traumatic memory in the limbic system. This form of memory is designed to help the individual by having an intense reminder of a traumatic event so anything like it in the future can be avoided. However, this cycle can work as a hindrance as well as a help by making the brain more hypersensitive to reminders of the stress that caused the traumatic experience, and once repeated, to any related stress or any stress at all. This pattern can develop into an ongoing cycle of stress and overreaction causing the fight or flight response, and the experience of powerlessness over the threat and the stress being stored in the limbic memory.
While the release of hormones, such as cortisol, are helpful in responding to a real crisis (fighting off an attacker, or running for help), sustained release of cortisol in the body damages cells, particularly neurons. Continued release of cortisol begins to break down the cells of the body that can produce a wide range of emotional or psychological damage initially and, over time, can produce significant physical damage.
The goal of the stress response cycle, as seen in the above explanation, is two-fold. First, the body is prepared to meet the present threat with a survival response of fight or flight. Second, the traumatic memory function of the brain’s limbic system stores the information of the experience and adds it to the internal memory of situations and events that the brain wants to avoid in the future. However, both of these goals can be problematic at times. For example, fight or flight may not be of much use to the young child who experiences a situation beyond his or her control or ability to respond with effectiveness. In such cases, the most typical response of the brain is to institute a type of flight known as psychic numbing or dissociation. In these cases, the individual is taken away from the stress emotionally and psychologically due to the inability of the body to flee physically. However, this is not sufficiently effective to protect the body either physically or psychologically, and further ramifications are likely for the individual.
The second goal of insuring a traumatic memory to avoid similar situations can also be problematic for the individual. If a child has an unfortunate run-in with the family cat who did not appreciate having its tail pulled while it was eating dinner, the angry response of the cat along with the pain of the scratches may help the child avoid a similar painful situation in the future. However, traumatic memories are not always specific in a way that is helpful to the individual. For example, the traumatic memory of the angry cat and the slashing claws to a young child may generalize to all cats in all situations or even all animals in all situations. When it comes to traumatic memories, the brain always errs on the side of false positives, or if in doubt, sounds the alarm from past traumatic experiences. When this takes place, it may be the start of a serious and even an eventually catastrophic series of events.
The problem with the brain’s response to perceived trauma is that it can and often does overdo the protective response. The brain may overstate the threat faced by the individual and over respond to the situation. In fact, the short and long-term consequences of trauma come down to just this issue. The seriousness of the initial threat to the survival of the individual causes the brain to overreact to future threats. This is even more likely with children than it is with adults. Because trauma is a function of the internal experience as to the nature of the external threat, children are least equipped with the experience and understanding necessary to fully assess the level of threat being faced in an accurate way. After a significant trauma, young children may internally experience such an intense threat to survival that they continue to perceive, and thus experience, the event repeatedly, like a flashback that doesn’t seem to end.
The alarm response and even the fight or flight mechanism of the autonomic nervous system are designed to aid survival and avoidance of threat. However, with some individuals, the internal alarm response and the initiation of the fight or flight sequence of hormones and neurotransmitters actually becomes more of a threat to the individual than any external threat. When an individual is caught in the continual cycle of experiencing and reacting to stress that is perceived as more threatening than it actually is, this can produce mental illness or dis-ease within the mind-body of the individual. Some names for this are posttraumatic stress disorder, and various forms of depression, anxiety disorder, panic attacks, phobias, or even becoming so overwhelmed with panic that the individual cannot leave their home, called agoraphobia. As bad as these problems are, if this negative cycle of stress continues, it ceases to be helpful to the individual and can cause major breakdowns of the body’s physical systems resulting in physical disease and even premature death.
How We Heal from Traumatic Experience
We don’t heal from trauma until the conditions that brought about the trauma are no longer a threat to the individual. This does not just mean that the threat is gone, it means that the individual must experience that the threat is gone, and this can be a very different thing. For children, trauma is experienced as never-ending. Particularly for young children, their sense of time is subjective. When they are having fun, time goes very quickly, when they need to wait for something, time crawls by at an intolerably slow pace.
After a serious trauma occurs, and particularly if it occurs more than once, the child is waiting, or said more specifically, the child’s limbic system is waiting, for the threat to reappear. Since the brain’s fear center, the amygdala, sounds the alarm to any related stress, the child experiences that the trauma has returned. This can also be true for adolescents and even adults. The emotional developmental level of the traumatized individual is often arrested at the age that the trauma first occurred. This means that for many traumatized teens and adults, their emotional level may be stuck in childhood years. Healing cannot begin until the individual is safe and experiences the safety that includes the absence of any threat that reminds the individual of the initial trauma.
Trauma does not get better with time, and it does not heal from distancing oneself from memories of one’s traumatic past. To just stop thinking about it does not work for a very specific reason. The limbic system of the brain does not need the explicit or factual memory, to think about the trauma; the traumatic memories in the limbic system handle this function. The difference in the two is that the individual has some control over explicit memories, while implicit memories in the limbic system are not under conscious control. This can make a big difference. The more the individual can begin to experience some control over trauma memories, the sooner healing is possible.
Traumatic memories of events that go beyond the person’s ability to cope are not the real problem. We can all remember events in our lives that we wish did not happen. But unless these memories carry with them the baggage of emotional reactivity, they are just unpleasant memories. The problem with traumatic memories is how they carry harmful affective and physical responses from past events. We begin to heal as we learn how to turn off the stress response cycle and remember the past as an unpleasant memory, not one that carries significant emotional content and stress in the present.
There are a variety of ways that we can learn to turn down the volume on our internal reactivity brought on by stress. All healthy people have learned ways to lighten their load, find enjoyable pursuits and, at least for a time, relax and enjoy the moment. For many people this is called a weekend. The pressures and stress of the work week will all be back soon enough, but for some precious hours we turn it off through recreation and activities that have the ability to recharge our batteries. The healthiest people don’t wait for a weekend because they have learned immediate ways to turn off or de-condition harmful internal reactivity.
Once we can remember our traumatic past and learn to turn off the emotional reactions to a large or small degree, we can begin to put the past in perspective. It happened, it was painful, it was unfortunate, and it is over. At times, the brain needs to hear a continual message that the traumatic experience is over. It helps when memories trigger emotional reactions, and the individual can hit the off button of the internal response. This goes a long way to conveying the message to the fear center of the brain that the trauma is in the past and not in the present or around the next corner.
Chronic perceptions of feeling unsafe or still at risk usually result in some form of dysfunctional behavior. It may be to fight or run from a situation where neither response is helpful. It may be to reach for the anesthesia that always works, at least in the short run, such as drugs, alcohol, food, nicotine, sex, gambling or other addictions. Therefore, the next step to healing is to gain internal control over our behavioral reactions to trauma. These behaviors run the continuum from isolation and solitary inactivity to frantic and even high-risk behavior that is meant to distract the individual from the ever-present fear for one’s life. When we learn to think more clearly about our traumatic past and learn to de-condition harmful emotional reactivity, we can then learn more positive adaptive behaviors that help us rather than make our lives more difficult.
When we are able to get our negative thoughts about the past, our incapacitating emotions, and our maladaptive behaviors all behind us, we have a much better chance to engage life in fulfilling ways. This can lead to a positive spiral in the same way trauma can lead to a negative spiral. When we successfully engage life, several things usually happen. We begin to like ourselves, we run into people who find us more enjoyable, and we begin to feel that others enjoy us. Each of our successes helps us to build a more positive internal view of ourselves and our world.
But not all traumas can be relegated to the past. There will always be more stress in life and perhaps more traumatic experiences both small and large. When new stresses come up, we must learn to be skillful at using real time strategies to prevent further traumatizing events. The best way to do this is to develop coping styles sufficient to keep life’s challenges from overwhelming us. The more we practice our new and more successful coping styles, the more we insulate ourselves from the traumatic events in life. We cannot avoid the many stresses that come to everyone, but we can keep the stresses from becoming bigger than our ability to handle them.
There are ten steps involved in the healing process:
1. Establish safety, trust, and exploration.
2. Explore how trauma is perceived, experienced, and acted upon.
3. Explore trauma memories.
4. De-condition harmful affective responses.
5. Re-exposure to the trauma.
6. Cognitively restructure the meaning of the trauma.
7. Replace problematic behaviors with adaptive behaviors.
8. Build a new internal self-perception.
9. Learning coping strategies.
10. Practice self-mastery.
These ten steps are a guide to the process of overcoming the harmful effects of trauma. A lengthy discussion of these steps can be found in Achieving Success With Impossible Children (Ziegler, 2005).
[Excerpt from Beyond Healing, The path to personal contentment after trauma. (2009). D. L. Ziegler]