Psychological trauma, defined as the experience of an event in which a person feels their life is threatened or in danger, may be accompanied by a sense of helplessness, horror, or numbing as the internal alarm system becomes activated.

We react to trauma in a number of ways, and certain factors put us at risk for more severe psychological difficulties. Fortunately, there are qualities we can build on to help us manage our reactions to traumatic events.

There are four main types of reactions we may experience following a trauma: emotional, cognitive, physical, and interpersonal.

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1. Emotional reactions include shock, fear, grief, anger, guilt, shame, helplessness, numbness, sadness, confusion, denial, abandonment, anxiety, and depression.
2. Cognitive reactions might include problems with concentration, indecisiveness, difficulty making decisions, and intrusive or unwanted memories. You may notice thoughts such as, “How could someone do this?” or, “It felt like time stood still.”
3. Physical reactions consist of bodily tension, feeling fatigued, insomnia, startling easily, racing heartbeat, nausea, change in appetite, chills, digestive problems, or profuse sweating.
4. Interpersonal reactions involve feeling a sense of distrust, experiencing a loss of intimacy, increased conflict with others, isolation from others, or problems at work or school.

Other reactions to trauma are less common and more severe, and may require professional intervention. These may include:

• Emotional reactions that include intrusive or unwanted reexperiencing of the event after it has happened such as nightmares, flashbacks, and terrifying memories
• Extreme emotional numbing that leads to a sense of emptiness
• Potentially harmful attempts to avoid intrusive experiences through alcohol or substance use, lying, self-injury, or suicide attempts
• Physical reactions that involve hyperarousal, panic, rage, extreme irritability, agitation, restlessness, or violence
• Ongoing anxiety, uncontrollable worry, helplessness, or obsessive or compulsive behavior
• Dissociation (or a sense of being separate from one’s body), having fragmented thoughts, lack of awareness of surroundings, or involuntarily spacing out

Not everyone will develop a mental health condition or posttraumatic stress (PTSD) following a traumatic event. There are certain risk factors that increase the chances of experiencing more severe reactions to trauma, including severe exposure to a disaster, low socioeconomic status, having a preexisting mental health condition, being part of an ethnic minority, lacking social support, and lacking social resources.

Although there are factors that increase the risk of severe trauma reactions, there are also at least seven personality characteristics, described below, that can help a person successfully cope with or manage trauma.

Locus of Control

Locus of control is the extent to which we believe or expect we can control the outcomes of events that affect us. Our locus of control may be internal or external. If we have an external locus of control, we believe our behavior is guided by fate, luck, or other external forces. If we have an internal locus of control, we believe our behavior is guided by our own decisions and efforts, and that outcomes are related to our actions.

Crises challenge our beliefs and expectations about the level of control we have in the situation. Attempting to assert some degree of control following a crisis can aid in more effective coping and can help create a greater sense of meaning and consistency. Some researchers have observed that an external locus of control is related to learned helplessness, a condition in which a person perceives no sense of control, expects that there can be no escape, and believes any attempt to escape will result in failure.

While an internal locus of control can have positive effects in moderation, those who attempt to unrealistically control events may need assistance adjusting their expectations about outcomes. For instance, someone with an unrealistic belief that they could have prevented a crisis on their own by doing A, B, or C may need help focusing on what they can realistically control.

Self-Efficacy

Self-efficacy is our belief about how capable we are to handle situations. If we have high self-efficacy, we exert effort to overcome challenges. If our self-efficacy is low, we avoid actions we think will exceed what we’re capable of. Self-efficacy builds on itself as we add to our successes. It is thought that people who expect to successfully cope with their emotions and moods are more likely to be proactive in their healing and to seek out something positive in threatening situations.

Optimism

Optimism is holding hope and expecting that good things will happen. Optimism is focused on a desired outcome and not on who is in control or how capable one is in reaching the outcome. Optimists emphasize the positive during difficult situations and have been found by some researchers to be less anxious, hostile, depressed, and self-conscious than those with pessimistic attitudes.

Hardiness

Hardiness as a personality characteristic describes someone who is curious, actively involved, believes they can influence outcomes, expects that life will present changes, and tends to believe that challenges are opportunities for development. People with hardiness have a willingness to learn something of value, and merge those lessons into their lives. Hardiness is also associated with active coping and decreased emotional distress.

Resilience

People with resilience are those who are at risk for failure early on in life but who nonetheless become successful. Resilient people can take responsibility for their own part in a situation and let go of responsibility for the things they cannot change. Some qualities of resilient individuals include active problem solving, perceiving difficult experiences constructively, gaining positive attention from others, and an ability to continue finding meaning in their experience.

Sense of Coherence

People with a strong sense of coherence understand that stress is an inevitable part of life and recognize that dealing with it successfully can be beneficial. Having a sense of coherence means we seek to comprehend, manage, and find meaning in situations. When we attempt to comprehend the crisis situation, we try to make sense of what happened and explain how it occurred. To manage the situation, it can be helpful to utilize available resources. Meaningfulness indicates the situation is worthy of our time and investment. Having high meaningfulness motivates us to search for ways to comprehend the situation and seek out resources to aid in managing the incident.

Creativity

The ability to creatively cope is related to one’s ability to let go of the usual ways of solving problems. People who can produce creative solutions are better able to cope with traumatic events in which there are limited opportunities to exert control. Creativity involves flexibility in dealing with one’s environment.

How we react to a traumatic event can be greatly influenced by a number of factors. There are several common ways we react to trauma, and some reactions are more severe than others. Numerous personality traits were identified here that can be learned or cultivated to deal more successfully with trauma and obtain what is increasingly being recognized as posttraumatic growth.

References:

1. Tedeschi, R.G., & Calhoun, L. G. (1995). Trauma & Transformation: Growing in the Aftermath of Suffering. Thousand Oaks, California: SAGE Publications, Inc.
2. U.S. Department of Veterans Affairs National Center for PTSD. (2010). Mental Health Reactions After Disaster. Retrieved from http://www.ptsd.va.gov/professional/pages/handouts-pdf/Reactions.pdf

What does wellness look like to you? When you envision someone who is “well” and “healthy,” what comes to mind? What factors do you think influence wellness?

The Substance Abuse and Mental Health Services Administration (SAMHSA) has identified eight dimensions of wellness to focus on to optimize health. The eight dimensions include: emotional, spiritual, intellectual, physical, environmental, financial, occupational, and social. Wellness can be compromised by lack of support, trauma, unhelpful thinking styles, chronic illness/disability, and substance use. The eight dimensions are described below and are accompanied by examples and ideas for improving each area.

1. Emotional

SAMHSA identifies emotional wellness as an ability to cope effectively with life and build satisfying relationships with others. People with healthy emotional wellness feel confident, in control of their feelings and behaviors, and are able to handle life challenges. Working through life challenges can build resiliency as we learn that setbacks can be overcome. Emotional health can be maintained or improved by engaging in regular leisure and recreational activities. Do activities that involve each of your senses: smell, taste, touch, sight, and sound. Listen to music, eat your favorite food, light your favorite candle, play with your pet, and watch your favorite movie or the sunset.

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2. Spiritual

Spiritual wellness is related to your values and beliefs that help you find meaning and purpose in your life. Spiritual wellness may come from activities such as volunteering, self-reflection, meditation, prayer, or spending time in nature. Signs of strong spiritual health include having clear values, a sense of self-confidence, and a feeling of inner peace. To improve your spiritual health, it can help to create a quiet space for solitude and contemplation or a place of curiosity and playfulness. Maintaining a playful, curious attitude can help you find experiences that offer hope, purpose, and meaning.

3. Intellectual

Intellectual wellness is when you recognize your unique talents to be creative and you seek out ways to use your knowledge and skills. When you foster your intellectual wellness, you participate in activities that cultivate mental growth. Reading, doing challenging puzzles such as crosswords or Sudoku, debating issues with others who have opposing viewpoints, learning a new language or musical instrument, trying a new hobby, or teaching and tutoring others are all ways to maintain or improve your intellectual wellness. When you challenge yourself to learn a new skill, you are building your intellectual health. People who pay attention to their intellectual wellness often find that they have better concentration, improved memory, and better critical thinking skills.

4. Physical

Physical wellness is affected by physical activity, healthy nutrition, and adequate sleep. There are many examples of physical activity that range in levels of intensity from light to vigorous. Maintaining your physical health can include yoga, bike riding, jumping rope, engaging in sports, running, walking, jogging, skiing, dancing, tennis, and gardening. Many people use smoking as a coping tool. Unfortunately, this method of coping can lead to a number of physical health problems, including heart disease and cancer, and can increase one’s chances of premature death. SAMHSA states that smoking-related illnesses are related to half of all deaths for people diagnosed with a behavioral health condition.

Environmental wellness is related to the surroundings you occupy. This dimension of health connects your overall well-being to the health of your environment. Your environment, both your social and natural surroundings, can greatly impact how you feel.

5. Environmental

Environmental wellness is related to the surroundings you occupy. This dimension of health connects your overall well-being to the health of your environment. Your environment, both your social and natural surroundings, can greatly impact how you feel. It can be hard to feel good if you are surrounded by clutter and disorganization, or if you feel unsafe in your environment. Pollution, violence, garbage buildup, and water conservation are some of the factors affecting environmental wellness. Ways to manage environmental wellness include creating neighborhood watches, recycling, planting a personal or community garden, purchasing products with minimal packaging, avoiding littering, and conserving energy and water by turning off lights and water when not in use.

6. Financial

Financial wellness is a feeling of satisfaction about your financial situation. Finances are a common stressor for people, so being able to minimize worry about this aspect of your life can enhance your overall wellness. Options for managing financial wellness include having a household budget, starting a savings account and adding to it every month even if it is just a small amount, saving some of your income in an emergency account, cutting back or limiting unnecessary expenses, avoiding credit card debt, donating to a meaningful charity, shopping at thrift stores, utilizing the library for free books and DVDs, and cooking your own meals instead of dining out. Try tracking your spending for a month to see where your money is going and set goals based on what you find.

7. Occupational

Occupational wellness is a sense of satisfaction with your choice of work. Occupational wellness involves balancing work and leisure time, building relationships with coworkers, and managing workplace stress. An occupational wellness goal might include finding work that is meaningful and financially rewarding. Finding work that fits with your values, interests, and skills can help maintain occupational wellness. Consider your office culture and determine how supported you feel; if you discover you feel a lack of support, seek out support from others close to you and be sure to engage in recreational activities that can help balance out work stress.

8. Social

Social wellness is a sense of connectedness and belonging. The social dimension of health involves creating and maintaining a healthy support network. Building a healthy social dimension might involve asking a colleague or acquaintance out for lunch, joining a club or organization, setting healthy boundaries, using good communication skills that are assertive rather than passive or aggressive, being genuine and authentic with others, and treating others in a respectful way.

What dimensions do you feel are your strongest? What areas would you like to work on? If you have areas you would like to improve, seeking out support can be helpful, whether it’s from a friend, family member, or counselor. What would life be like if you optimized all eight dimensions? Setting goals for yourself in each area can help you feel more fulfilled and optimize your health.

Reference:

Substance Abuse and Mental Health Services Administration (SAMHSA). (2016, April 28). The Eight Dimensions of Wellness. Retrieved from http://www.samhsa.gov/wellness-initiative/eight-dimensions-wellness

Trauma can be defined as an event that falls outside the range of usual human experience that causes distress. Trauma can be either human-made or from natural causes. Examples of human-made trauma include physical or sexual violence, war, car accidents, or witnessing the injury of someone else. Natural traumatic events might include floods, earthquakes, and volcanic eruptions.

The way people experience trauma can be grouped into two types: big T and little t. A big T event is one that most people would consider traumatic, such as a plane crash or sudden and unexpected loss of a loved one. A little t event is one experienced as traumatic at a personal level, such as the loss of a pet or a relationship breakup.

How Your Body Responds to Trauma

When you experience a traumatic event, your body may respond by going through a sequence of six different actions. Many people have heard of the fight-or-flight response, which is part of the larger picture. Each action is thought to be your body’s way of trying to protect you from potential harm. You may experience the full sequence of events or only part of it, depending on the situation. The response varies depending on how severe you think the threat is in relation to your own power to take action.

Trauma Response No. 1: Freeze

[fat_widget_trauma_ptsd_right]During the freeze response, your body stops to heighten your awareness of what’s going on around you. Your hearing and vision will likely seem heightened as your brain attempts to gauge how threatening the situation is.

Trauma Response No. 2: Flight

Once you’ve perceived that a situation is threatening, your body goes into an “alert” mode. Your muscles tense up and your body readies itself to flee if necessary.

Trauma Response No. 3: Fight

The third response many people experience in a traumatic situation is to feel like fighting or confronting the situation or perpetrator. Your heart rate will increase and you may attempt to counteract the danger.

Trauma Response No. 4: Fright

The fright response occurs when your emotions peak with the feeling of fear and your ability to think or concentrate becomes limited. Your body may become immobile, and parts of the event may start to be “blocked out” as you come to realize that there may be no way to escape or counter the situation.

Trauma Response No. 5: Flag

The flagging response is when your biological systems begin to shut down, your blood pressure drops, and your emotions become numbed.

Trauma Response No. 6: Faint

The final response to trauma is fainting, which happens in extreme cases and includes losing the ability to send any messages to your body to take action.

Why Your Brain Holds on to Traumatic Experiences and How To Let Them Go

When I speak with survivors of sexual assault, they often mention experiencing the first or fourth responses and describe feeling frozen or dissociated from the violence happening to their bodies. Trauma survivors often say they aren’t able to remember the entire traumatic event, which makes sense. When you’re scared, unable to concentrate, and your body’s systems are shutting down, it’s highly unlikely that you will remember everything that is going on or recall the order in which things happened. Other people, however, can remember vivid details about the event but still may notice gaps or have trouble accurately describing what happened.

Counseling may not be able to help you fill in all the missing pieces as a result of the trauma, but it can help piece together a fuller image of your life and create greater clarity about where the trauma fits within the bigger picture.Two areas of the brain that manage memory and emotions are commonly affected by traumatic events, which can help explain why memories become fragmented and emotions may feel overwhelming even after the trauma has ended. The brain seems to pick and choose memories and feelings it thinks are the most helpful for your survival, and it wants you to retain that information.

Although your body is designed to protect you during a trauma, your brain might be sending unhelpful messages that keep your body in constant protection mode long after the trauma is over. It’s almost as if your brain thinks if it can hold on to those bits and pieces of scary memories and not let go of all the feelings after a traumatic experience, maybe you will stay safe and not get hurt again. However, constantly remembering the event and feeling worried, numb, and hypervigilant can be exhausting and frustrating. This is when you may feel the need to seek help from a therapist or other mental health professional.

By talking about the event with a counselor, you can process it at your own pace and put words to what you experienced to help your body and mind let go and quit trying to protect you unnecessarily. Counseling may not be able to help you fill in all the missing pieces as a result of the trauma, but it can help piece together a fuller image of your life and create greater clarity about where the trauma fits within the bigger picture.

References:

1. Bremner, J. D. (2006). Traumatic stress: effects on the brain. Dialogues in Clinical Neuroscience, 8(4), 445–461.
2. Schauer, M., Neuner, F., & Elbert, T. (2011). Narrative exposure therapy (2nd ed.). Cambridge, MA: Hogrefe.

October is Domestic Violence Awareness Month. The more we talk about domestic violence, the more likely it becomes that we build awareness, identify abusive behaviors, and take action to prevent harm to people in our communities who may be family, friends, neighbors, or coworkers.

So let’s talk about it.

What Is Domestic Violence?

Let’s start by talking about what domestic violence is and is not. We can define domestic violence as a pattern of behaviors used by one person in a relationship to exert power and control over the other person in that relationship.

Domestic violence is not a “relationship problem” or a “rough patch” in a relationship. It is ongoing. It is a pattern of behavior that tends to begin with something seemingly minor, which then escalates over time and becomes increasingly dangerous in nature.

The cycle of abuse typically begins when tension builds and the abusive person becomes angry. Some form of abusive behavior follows—it could be name calling, it could be throwing a dinner plate, or it could be any number of other actions. After the abusive incident, there may be a “honeymoon” or make-up phase in which the abusive person apologizes, promises to change, and/or swears the abuse will never happen again. The honeymoon phase is typically followed up by a time of calm in which the abusive person and possibly even the victim behave as if the abuse never happened.

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Types of Abuse

Domestic violence exists in various forms, but the common thread among them is the aim to maintain power and control. Abuse may take the form of physical, sexual, emotional, financial, spiritual, or stalking.

Technological abuse is becoming increasingly common as well. Technological abuse may include the abusive person posting pictures online of the victim or sending threats via text message or email. According to the National Coalition Against Domestic Violence, a woman is assaulted or beaten every nine seconds in the United States. The Coalition also reports that one in three women and one in four men is physically abused by an intimate partner, with the most common occurrence of domestic violence victimization found in women between the ages of 18 and 24.

Effects of Abuse

Abuse can have a variety of effects on the victim, children in the home, and on the community. Long-term effects of abuse on the victim differ from one person to another and may include flashbacks, panic attacks, anxiety, trouble sleeping, broken bones, head trauma, low self-esteem, eating disorders, depression, suicide ideation, and chronic pain.

According to the National Coalition Against Domestic Violence, a woman is assaulted or beaten every nine seconds in the United States.

Children who are exposed to domestic violence also respond in different ways and may show symptoms that vary by age. Infants may be easily irritated, difficult to soothe, and exhibit continuous fussiness or crying. Toddlers may use profanity, have frequent nightmares, show meanness toward others, or seem to not know how to play. Some children may bully other children, earn low grades, be unable to complete homework or other tasks, show an inability to follow directions, or even show regressive behaviors such as thumb sucking or bed-wetting.

Teens who witness or experience violence in the home may show aggressive or violent behavior toward others, develop depression or anxiety, isolate, or engage in self-destructive behavior. They may also engage in obsessive-compulsive behaviors or appear to be overachieving and perfectionistic.

Domestic violence also impacts the community as a public health problem. It reduces productivity in the workplace. Many victims miss work because of abuse-related injuries or because of fear that the person abusing them will know where to find them. Victimization is also associated with costs for hospital care, emergency room visits, physician care, dental care, ambulance transport, physical therapy, and mental health care. The Centers for Disease Control and Prevention estimates that the total health care cost associated with domestic violence each year is nearly $4.1 billion.

Why Victims Stay

A recent online campaign known as #WhyIStayed became popular among domestic violence survivors following a widely publicized incident involving then-NFL player Ray Rice knocking his then-fiancée (now wife) unconscious in an elevator. Instead of focusing on why someone would hit a partner, many in the media and on the Internet asked, “Why would she stay with someone who abuses her?” Survivors took to social media to share their stories about what kept them in abusive relationships.

People may have many reasons for staying with an abusive partner, including:

• Fear of retaliation from the abusive person or the abusive person’s friends and family
• Having nowhere else to go
• Lack of adequate finances, or reliance on the abusive person financially
• Fear of losing custody of the children
• Fear that their immigration status will be reported
• Religious or cultural beliefs
• Hope that the abusive person will change
• Threats that pets will be harmed if the victim leaves

The moment a survivor decides to leave an abusive partner is often the most dangerous point. By deciding to leave, survivors are essentially making an effort to remove themselves from the control of their partners. When the abusive person recognizes that his or her partner is trying to leave, he or she may behave in dangerous ways to maintain their control, such as threatening suicide or by displaying or using weapons.

Safety Planning and Seeking Help

Whether a person decides to leave or stay with an abusive person, precautions can be taken to minimize risk and maximize safety. Packing an emergency bag with important items can help if someone needs to get away from an abusive situation quickly. The bag should be kept with a trusted person, such as a close friend or relative, and should include copies of important documents such as protection orders, bank account information, cash, extra keys, medication, and copies of birth certificates. If you’re not in an abusive situation but suspect someone you know is, you may offer to keep an emergency bag ready for when the timing is safe and without the abusive person present.

Domestic violence often involves isolating victims from friends and family, so seeking support can be difficult. When the timing is right, seek out, or help someone seek out, assistance from local domestic violence agencies or access other help, such as counseling or legal aid. Agency workers and providers can offer options, help you explore choices, create a safety plan, and help survivors feel a sense of connection by providing support.

References:

1. Liptak, J. J., & Leutenberg, E. A. (2009). The domestic violence survival workbook: Self-assessments, exercises & educational handouts. Duluth, MN. Whole Person Associates.
2. National Coalition Against Domestic Violence. (2015). Domestic violence national statistics. Retrieved from http://www.ncadv.org

I was recently reading a blog post and noticed that someone in the comment section asked the question: “What does it mean when we refer to someone as a survivor?” We hear about “survivors” of domestic violence and “survivors” of sexual assault all the time, but what does it mean when we refer to people in this way? I thought this was a good question to explore.

The description provided by the National Crime Victim Law Institute states a survivor is “a person who endures adversity, moves through it, and perseveres, or a person with resiliency who remains undefeated.” I like that definition. Below, I describe how this definition applies to the four stages that trauma survivors might experience as they heal.

Stage 1: Silence

People who experience adverse situations, such as a traumatic event involving actual or threatened danger, face incredible challenges. The initial stage following a traumatic event is often a time of silence for the victim. It’s common for recently victimized people to refuse to talk about what happened. This may be due to a number of things, including stigma, isolation, shame, guilt, confusion, or denial about the event.

A person emerging from trauma may have low self-esteem at first and may feel overwhelmed and disconnected from the rest of the world.

Stage 2: Victimhood

[fat_widget_right]Eventually, the traumatized self may start to long for change as the ongoing suffering interferes with daily life tasks and a need to grow and recover begins to form. As this need grows, it allows the person to begin exploring ways to move through the trauma. According to available research, there is often a tug-of-war taking place within the individual between a need to be safe and protect emotions and a need to grow and confront the traumatic memories.

The person may feel compelled to talk openly with everyone about what happened and the suffering he or she experienced. Some people will likely be more willing than others to listen. For people working their way through the stage of victimization, having someone to listen and support them as they process the event can be critical to their ability to move forward into survivorhood. Many people find support groups helpful during this stage and may seek counseling or other support.

Stage 3: Survivorhood

Once a person processes the traumatic event and continues transitioning away from the victim experience, he or she often begins identifying as a survivor. During this stage, a person has had an opportunity to talk about his or her experience and has gained some sense of clarity. He or she may begin to identify the ways in which he/she persevered and the strengths that helped make moving forward possible. The person hasn’t forgotten the event, but he or she has a greater understanding about what the event means and the impact it has made on his or her life.

Reaching the stage of survivorhood doesn’t happen overnight. It may take months or even years to work through the victim stage and reach the point where one feels that the wounds are healing and a sense of relief is possible. Also, the process of healing is not linear. Survivors take one step forward and two steps back sometimes, and moving through it all and persevering may coincide with feeling hopeful one day and damaged and wounded the next. People in the survivor stage tend to spend less and less time feeling wounded as they continue learning new tools and recognizing themselves as resilient.

Stage 4: Thriving and Transcendence

Most people I’ve worked with seem content reaching the stage of survivorhood. They feel like they are managing challenges better and have a greater awareness about themselves and their experiences. Other people, The person hasn’t forgotten the event, but he or she has a greater understanding about what the event means and the impact it has made on his or her life.however, have told me they’re not done growing, and some of them have even said they don’t want to be called a survivor.

This group becomes the thriving group, people who transformed their experiences into a meaningful personal narrative and will not be defined by their adversity. They feel healed and safe, and take appropriate risks in seeking connection with others, such as asking a new neighbor out for coffee. They don’t feel the need to tell their stories unless it benefits someone else. “Thrivers” feel motivated to take part in the community and may seek out volunteer opportunities or other ways to help others.

Of course, this is only one model of healing and one definition of what it means to be a survivor. Every person who experiences a distressing event may have his or her own ideas about what it means to pull through a traumatic time or event.

Reference:

Matsakis, A. (2003). The rape recovery handbook: Step-by-step help for survivors of sexual assault. Oakland, CA: New Harbinger.