Trauma Therapy Techniques

What is trauma?

Trauma is a complex topic. Trauma itself is not a mental health condition, but experiencing trauma can lead to associated disorders like post-traumatic stress disorder (PTSD) and other mental health issues. It can also provoke concerns like substance abuse or poorer physical health later in life. 

Trauma is about our responses to an event, a series of events or set of experiences that shake and shape our world. It’s not really about the event itself, but more about how the experience impacts our nervous systems. 

“Trauma is any experience that is negative, overwhelming, and unexpected which leaves an imprint on our nervous system. In this sense, someone's experience of their parents divorce can be just as ‘traumatic’ as being assaulted.” - Sebastian Wingfield, Canadian Certified Counsellor, Vernon, British Columbia

This topic is complex because we are complex creatures with extremely high functioning mental and physical systems.

Let’s dive into our brains for a moment: Our brains are made up of sophisticated networks of neurons (nerve cells), which are our powerful little information transmitters between our brain and nervous system—like circuits in a supercomputer. Our neurons receive information from our external world and communicate this as sensory information to the rest of our body. We smell freshly baked bread and our brains tell us we’re hungry; we hear a dangerous noise and we tense up. It’s how we comprehend the world around us. Our brain “computers” store unbelievable amounts of information we’re often not consciously aware of; all of our memories and experiences inform who we are and how we respond to things in the future. Negative experiences can train or even disrupt this information flow, like a short circuit. 

“Trauma isn't an event, it isn't a thing that happens. It’s what happens inside of you as a response … when a person comes into therapy, their whole life is with them, and I think sometimes we see people as just living in their context right now, but what they’re going through, you know, has a whole history.” - Tanya Kowalenko, Registered Psychotherapist

‍“Big T” trauma vs “small t” trauma

You might hear people refer to trauma as “big T” trauma or “small t” trauma. “Big T” traumas are often the more momentous events, such as a plane crash, living through a natural disaster or experiencing unexpected or extreme violence. “Small t” trauma is more distressing at a personal level like prolonged emotional abuse, neglect, chronic work stress, or bullying. We all process things differently, and what might be traumatic to one person, another may cope with it more effectively. 

Using the terms “big T” and “small t” trauma is a casual way to organize trauma, but it is often more formally organized into these three categories:

• Acute trauma: results from a single event or incident.
• Chronic trauma: repeated or prolonged exposure to stressful events, such as abuse or domestic violence, or bullying. Chronic trauma can also result from unresolved acute trauma.
• Complex trauma: being exposed to multiple traumatic events, such as childhood sexual, physical or emotional abuse, medical abuse or a long illness, family instability or disputes. These often have interpersonal threads.

Chronic and complex trauma symptoms often reveal themselves years after the events take place. This can result in a condition called complex post-traumatic stress disorder (c-PTSD). C-PTSD has many of the same symptoms as post-traumatic stress disorder (PTSD), but PTSD is more associated with a specific or single traumatic event.

One potential outcome of chronic/complex trauma, which can make it difficult to manage without some help, is that people can feel more comfortable or “safer” in chaotic or dangerous environments, sometimes unconsciously. Without chaos around us, we are exposed to thoughts and emotions we don’t know how to manage—the chaos within us. This could also manifest in subtler ways, such as leaning on distractions to keep our minds busy and away from traumatic thoughts. Mindfulness therapy approaches can be helpful to bring control to a wandering mind, and often involve physical or body awareness techniques.

Signs and symptoms

We may not necessarily notice how traumatic experiences are affecting us because we are getting by day-to-day, or the results of trauma don’t reveal themselves until years later. It’s not unusual to see people enter therapy because of symptoms of depression or anxiety, but through a few sessions it may become clear that these conditions are related to unprocessed trauma.

Symptoms can be difficult to pinpoint yourself since they can develop over time. Some warning signs to look out for include:

• Chronic sadness or anger
• Fear when there is no danger
• Frequent shame
• Insomnia
• Emotional irregularity
• Physical symptoms like nausea, headaches or digestive issues
• Lack of trust in others

If you experience issues or symptoms like these, especially if they are persisting for prolonged periods of time, they are affecting your relationships with others, or are otherwise disrupting your daily life, consider reaching out to a qualified, trauma-trained therapist to start unpacking why this might be happening. 

What does “processing trauma” mean?

Remember how our “supercomputer” brains are constantly processing and storing our experiences as memories (information)? Those memories are either explicit (facts we can recall) or implicit (how experiences made us feel). Our brains eventually create a unified memory with them. 

When we’re in danger, our brain spends less time coding the memory properly and more time getting us to safety. The memory can become fragmented, not unified. This is why some people who experienced trauma sometimes have gaps in their factual recollection of events. Long-term stress can keep us feeling like we’re in danger, and our stress responses can become sensitive—someone says something, touches us the wrong way, we smell something or see something and we’re flooded with signals that we’re in danger. It’s a trigger. We’re not able to control these or make sense of what’s happening, and our symptoms worsen. This can be characterized as unprocessed trauma—our memories, feelings and ability to cope are out of our control.

“People say trauma happened in the past. However, when people struggle with the trauma, what happens is that you're living in this moment with the trauma. That's why they feel stuck. I know this happened in the past, but why am I feeling this way right now? And that's why it's so frustrating.” - Jinny Kim, Registered Social Worker

Processing trauma is what happens when you gather the skills to rebuild your internal alarm system. You understand when and why your mind and body are reacting as though you’re in danger, and you can successfully get yourself through it and change that process. Then, the source of trauma can be addressed. 

Assessment and care

Trauma treatment requires a therapist who is trained and experienced. They’ll be more careful to not retraumatize someone by having them relive distressing events prematurely. They’ll know it’s about creating a safe environment and motivating empowerment and control for the person in therapy.

Those who have experienced trauma could benefit from cognitive or talk therapy techniques such as: 

• Cognitive behavioural therapy (CBT), a form of psychotherapy that helps reframe thought patterns for better emotional and behavioural management; 
• Dialectical behavioural therapy (DBT), a form of CBT that focuses more on tolerating distress, acknowledging harsh realities and working on self compassion and coping; or 
• Exposure therapy, which involves gradually facing the memories of a traumatic event to learn they’re not to be feared and there are no remaining consequences.

Counselling therapy or talk therapy approaches, such as these, are effective in so many mental health situations, including trauma. However, reframing thought patterns often helps reduce symptoms associated with trauma, rather than truly process trauma.

Processing trauma needs to involve the body. Because of the connection between our brains and nervous system, trauma memories can have a real impact on our physical selves—trauma is stored in the body and that informs our cognitions (thinking, perceptions and outlook on life).

We have a natural “fight, flight, freeze” response when our brains perceive danger. Traumatic experiences can make us feel in danger when we’re actually safe. We over-assess normal events to be dangerous (critical feedback from a boss, a partner who is angry with us for not doing the dishes, a speeding car in the distance). We can hold this stress and tension in our bodies and this can lead to our nervous systems being charged up all the time. Over a long period of time, this can cause very tangible issues like chronic pain, heart issues, chest tightness, etc. 

Somatic therapy is focused on how our bodies are reacting to stress. Somatic therapy shows us how our emotions are making us physically feel, and teaches us methods to discharge it and calm ourselves to better cope with new stressors as they come. When exploring somatic therapy or working with a therapist on these techniques, you might encounter these two specific areas of somatic therapy: Sensorimotor Psychotherapy (SP) and Somatic Experiencing (SE). Both SP and SE involve bringing awareness to how the body is reacting to stress, trauma experiences, memories, or trauma “materials.” This could include awareness of shallow breathing, muscle tension, jaw clenching, or shoulders rising, during stressful situations, or when talking about certain memories. Learning these cues and how to calm those reactions physically can be helpful in managing stress on an ongoing basis as well. The power of the mind-body connection to regulate the nervous system is also why exercise, yoga practice or even dance therapy can be effective components of therapy. 

Another common method for trauma is eye movement desensitization and reprocessing (EMDR). Developed specifically for patients experiencing PTSD, EMDR draws from CBT and somatic therapy, and is based on neurological science. A therapist will address one memory or fragment of a memory, and talk through it while moving a pen or another object in front of your eyes, tapping alternative shoulders while you move your eyes, or another similar exercise. This physical action helps the brain create new neurological connections with a memory—it retrains the brain to process that memory.

You might encounter other specific approaches within either cognitive (mind) or somatic (body) therapies that are shown to be effective for trauma. These could include observed experiential integration (EOI), an evolution of EMDR; lifespan integration (LI), focused on addressing memory gaps or resolving repressed trauma by going through a timeline of your life and viewing those memories from different angles; or accelerated experiential dynamic psychotherapy (AEDP), a form of psychotherapy focused on building belief in yourself to heal, and having trust in yourself and the therapist (as your guide) to experience uncomfortable emotions.

Trauma-informed care vs. trauma-trained care

With any approach, therapists who are trained to work with clients who are suffering from trauma will practice trauma-informed care (TIC). TIC is not a specific method, but an approach to treatment. This concept is used in the medical community as well. Therapists will be more aware of how trauma presents itself in their someone’s behaviour and they’ll be careful to honour any coping mechanisms that have been adopted to-date (perhaps the therapist is better able to withstand angry outbursts, or moments of disassociation in a session: aka fight and freeze). They’ll also work in stages before bringing up a specific memory. Even with EMDR treatment, there are phases before a memory is brought to the surface to reprocess. 

Importantly, there is a difference between trauma-informed care and trauma-trained/trauma-specific care. 

Trauma-trained or trauma-specific care uses more evidence-based approaches to directly help someone recover from trauma. This will still be conducted in a trauma-informed way, with compassion, empowerment and safety as a priority. An example of a trauma-trained approach is Trauma Recovery and Empowerment Model (TREM). Originally designed to treat groups of women who were survivors of physical, emotional and sexual abuse, it involes teaching strategies for self-comfort and how to set boundaries, then focuses more on the consequences of trauma, then shifts to skills-building. There are now models designed for men (M-TREM) and adolescent girls and young women (G-TREM) 

Healing and processing trauma can look different for everyone, depending on individual experiences and how you or someone else has coped with trauma so far. Whatever path you take, finding a good therapist fit—someone with whom you can build a trusting relationship—will be an integral first step in your mental health journey.

Find therapists that specialize in trauma therapy on First Session.

This content has been professionally reviewed by Sebastian Wingfield, Canadian Certified Counsellor (January 2022). Corrections or comments? You can get in touch with us here.