LukeNotes, Spring 2021
Over the past few decades, trauma has become increasingly understood to cause or contribute to emotional and behavioral disorders. The Adverse Childhood Experiences (ACE) study1 documents the relationship between ten adverse childhood events and problematic outcomes. The more adverse events a child has, the greater the probability of serious problems later. The extensive literature on child abuse and neglect also reflects the long-term results of such exploitation or maltreatment.
Many psychological symptoms, including anxiety, depression, and nightmares, may reflect unresolved trauma. Some traumas, such as a car accident, may relate to a single incident while others may reflect an ongoing and inescapable set of conditions in which a child is raised. The latter are referred to as “developmental” trauma. Many of our clients have both developmental and single incident trauma, making treatment complex and challenging.
Fight, Flight, or Freeze
At an individual level, trauma occurs when an event exceeds a person’s capacity to respond. That capacity depends on factors such as age, developmental level, external support, and personal strengths. Under threat, our nervous system takes over and enacts biological survival strategies, such as fight, flight, or freeze. If one of these strategies is successful, the individual is less likely to experience trauma’s aftermath.
Children are vulnerable to trauma because their survival strategies are often blocked. If freezing and submitting are a child’s best option for survival when fighting or fleeing are not possible, the nervous system “learns” that freezing is the way to go. The nervous system’s learned preference for freezing can persist into adulthood when the individual might otherwise be physically able to fight or flee. For example, an adult might freeze when a threatening individual approaches rather than run away and then report confusion or shame at freezing in situations when he or she could have acted. The nervous system does not “know” that the person is an adult with greater abilities. Part of therapy is to restore blocked strategies so the adult can employ the full range of survival options under threat.
Research Leads to New Methods for Treatment
Prior to major advances in neurobiology and treatment methods, the standard approach to treating trauma was to have the client tell the trauma story to a validating and supportive therapist who would help the client put the experience into perspective. While this approach was sometimes helpful, often the client was retraumatized by reliving the traumatic experience. Talk therapy often led to an intellectual understanding: “I know where my intense reactions come from, but that doesn’t help me not have the reaction or manage it when it comes.”
We have since made progress in our understanding of brain functioning. Threat responses are managed by the brain stem, while the cortex handles thinking and the limbic system processes emotions. Under threat, survival reactions are instant, and the cortex is temporarily shut down, since taking time to reason out the best option could well lead to death. The traumatic emotions and physical sensations are stored in the limbic system and the body, often as fragments of experience.2
This “sequestering” of the traumatic material allows the individual to continue functioning in day-to-day life. For some individuals, the full impact of the trauma may stay buried; for others it eventually emerges. Individuals may consciously recall the traumatic event but usually not with its full experiential impact, including mental pictures, emotions, physical sensations, meaning, and movement. Some trauma survivors sound like detached reporters when they describe traumatic events, while others avoid any mention of the trauma to avoid being emotionally overwhelmed.
Several newer therapies, usually called “somatic” or “limbic system” therapies, access the parts of the brain where the traumatic material is stored so it can be reworked, resolved, and integrated into the person’s narrative understanding of their history. These therapies enable neural connections to be made between the older (brain stem and limbic system) and newer (cortex) parts of the brain. These approaches share the view that humans have a built-in capacity to heal unless trauma cuts off the brain’s processing.
Unpacking the Healing Process
Treatment usually begins with education about trauma. Comprehending the brain processes involved in handling trauma relieves shame and alleviates the sense that “there is something wrong with me and it is my fault.” The fragmented nature of trauma recall makes it possible to function in the world without constantly feeling overwhelmed, but this also prevents updating the traumatic memory with the understanding and increased coping resources of the adult.
Understanding and compassion are often needed to heal childhood trauma; however, when trauma is triggered, these resources are not immediately available. Ironically, the needed help may be literally inches away in the brain, made inaccessible by the lack of sufficient neural connections between the stored trauma and adult coping skills.
Eye Movement Desensitization and Reprocessing
Eye Movement Desensitization and Reprocessing (EMDR), formulated by Francine Shapiro in the late 1980s and greatly enhanced by research and innovations since then, facilitates access to trauma material in the emotional brain and strengthens neural pathways connecting the emotional brain to adult resources from the frontal lobes of the brain. A trauma resolved is experienced as something that happened in the past without the previous emotional pain. Dr. Shapiro found that stimulation of the brain through eye movement, listening to alternating tones or holding tappers that buzz in each hand alternatively, enhances processing of the traumatic material.
EMDR therapy is a modality SLI therapists have been using since the late 1990s. Through it, traumatic material is brought into working memory, and processing that got stuck years ago is reactivated, with careful titration so the client is not overwhelmed. In working memory, new material, such as the adult’s compassionate perspective, can be accessed and integrated with the old material into a new configuration. The memory is then “reconsolidated” with the new material and no longer feels as though it is happening in the present. The individual knows that the event happened in the past and no longer feels hijacked by experiencing it as though it is happening now.3 A client once described an upsetting traumatic incident when resolved as “a closed book to put on the shelf.”
1The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998 May;14(4):245-58.
2MacLean, Paul D. (1990). The triune brain in evolution: role in paleocerebral functions. New York: Plenum Press.
3Shapiro, Francine. (1995). Eye Movement Desensitization and Reprocessing. New York: The Guilford Press.
Carol Farthing, Ph.D., has been a Clinical Psychologist at Saint Luke Institute since 1989, serving for many years in clinical leadership. Since her retirement from full-time work in 2014, Dr. Farthing has offered EMDR therapy to SLI residents and outpatients.