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What is a Complex Trauma?

Trauma can be characterized as a state of extreme arousal in which a person's usual coping abilities cannot be accessed in response to a perceived or actual danger. Unresolved Trauma can leave someone with traumatic experiences that they cannot reconcile. Trauma can manifest in various forms, such as attachment problems due to a lack of consistent care, developmental Trauma caused by long-term abuse and neglect in childhood, single-incident Trauma such as a natural disaster or interpersonal abuse, Complex Trauma resulting from recurrent abuse, Collective Trauma affecting a whole society, and Ancestral Trauma.

Single Trauma Incidents, Commonly Referred to as PTSD, contrast with Complex Trauma.

Single-incident Trauma often referred to as PTSD, is characterized by a beginning, middle and end. In contrast, complex Trauma is repetitive, cumulative, and typically has no end, leaving long-term consequences for the person, family, and community. Complex Trauma is caused by continual stressors generated in interpersonal environments through sustained abuse or neglect. This could include familial relationships, community violence, war, or genocide. While both can result in PTSD, complex Trauma's effects are more far-reaching and damaging than PTSD alone.

What is a Complex Trauma?

Complex Trauma, especially if experienced in childhood, carries different consequences than single-incident PTSD; clients affected by complex Trauma often have developmental or Attachment deficits that necessitate more treatment than those with PTSD alone. People with single-incident PTSD often had a sense of safety and well-being before their traumatic event. Clients with complex Trauma often have to learn how to self-regulate as they may have lacked this capacity in their early life, which poses unique challenges in finding a Trauma-informed therapist. On 18th June 2018, the World Health Organisation (WHO) released the ICD-11, which included a diagnosis of Complex PTSD (CPTSD) set to effect on 1st January 2022. But it is important to remember that complex Trauma is more than just PTSD and Complex PTSD. Therefore, an inclusive diagnosis is necessary to accurately capture the scope of complex Trauma.

What is a Collective Trauma?

Collective Trauma is a psychological response to a traumatic event a society has experienced. It is not just the recollection of a tragic event but rather a reconstruction of the Trauma which persists in the collective memory of the group, even for those who were not directly affected. This ongoing representation of the tragedy is used to help make sense of it and is a reminder of its impact on the community.

The Influence of Attachment on Complex Trauma

We come into the world with a predisposition to form attachments. Our first breath is the beginning of a lifelong journey in which we develop a sense of security in our bodies, in our environment, and in our relationships with others. According to Stephen Porges, we crave not only safety, but safety in the presence of another human being. Co-regulation is a survival necessity because we are born with the need to be cared for by another person, and this need remains with us throughout our lives. This principle was articulated by evolutionary biologist Theodosius Dobzhansky, who wrote: "The strongest can also be the gentlest, because survival often requires mutual aid and cooperation."

Attachment styles formed in childhood persist into adulthood. When a secure attachment is formed between an infant and its primary caregiver, the child can respond to stress in a calming manner. This secure relationship allows the child to learn verbal and non-verbal communication while instilling positive expectations of others. As a result, the child develops a healthy social engagement system, which helps them distinguish when they are safe in their environment. Unfortunately, those who have experienced Trauma often struggle to recognize safety, as their social engagement system is impaired. This inability to sense security results in a person's defensive systems being triggered without proper control, resulting in fight, flight or freeze responses. These responses can cause deep shame and hopelessness, making it difficult to cope with everyday life.

Thus, the role of attachment in coping with Complex Trauma is critical, as therapists can provide the support and safety necessary to cultivate a functioning neuroception and curb defense mechanisms.

What is Neuroception?

Neuoception is a term coined by Stephen Porges, a professor of psychiatry at the University of North Carolina and an expert in developmental neurobiology. It refers to the ability of the nervous system to monitor, interpret, and respond to signals from the body's internal and external environment. It is a concept closely related to the autonomic nervous system and homeostasis, and it has implications for understanding how humans respond to and adapt to their environment.

Neuoception is also believed to be important in developing emotional regulation and social behaviour. It allows the body to detect and respond to subtle changes in the environment, such as changes in facial expressions, body language, and tone of voice. This ability is essential for developing empathy and understanding the emotional states of others.

Trauma Affects Our Brain, Body, and Mind

We can understand Trauma as an experience that profoundly impacts the brain, body, and mind. Traumatic events can lead to changes in the way we think, feel, and behave. In response to Trauma, we often develop adaptive patterns to cope with and regulate our emotions. While normal, these behaviours can create trauma symptoms that can be difficult to manage. It's essential to recognize that those who have experienced Trauma are not weak or to blame for their responses. Trying to push through without adequate support and understanding can lead to intense shame and frustration. We know that simply having the strength of will and determination is not enough to heal Trauma. Whilst resilience and inner strength are qualities we can cultivate, a person who has not had these resources modelled for them growing up has not developed the capacity or ability to self-regulate. As Dr Peter Levine puts it: "Traumatized people cannot simply 'move on' - the time-honoured expression 'time heals all wounds' simply does not apply to Trauma."

Trauma and The Stress Response

People with complex Trauma often have an active sympathetic nervous system, part of the involuntary autonomic nervous system (ANS) that responds to potentially dangerous or threatening situations. This system is responsible for the fight-flight-freeze response and begins with the amygdala, the brain's fear detector, sending signals to the hypothalamus, which activates the ANS. Depending on which system dominates, you may react differently. The sympathetic nervous system initiates the fight-or-flight response, while part of the parasympathetic nervous system (dorsal vagus nerve) initiates the freeze response. Depending on which system overpowers the response, either fight or flight or freezing will occur. It can be difficult to change these automatic behaviors because the brain tends to cling to negative memories, especially when trying something new; the brain remembers the ways we learned to survive, even if there are better strategies available today.

We must remember that, along with new skills and support, we need many repetitions of positive experiences to learn how to respond differently. Complex Trauma is like a fire alarm that never stops ringing; the hippocampus draws on historical memory to make sense of what we are experiencing today. Triggers can cause us to enter "trauma time", where our body and mind perceive the past as if it were occurring in the present.

Flipping the Lid

When Dr. Daniel Siegel coined the phrase "flipping the lid," he referred to how the brain processes traumatic events and experiences. The hand model is a useful visual tool to help you understand what's happening inside your brain and body. Imagine your brain stem, represented by your wrist, controls basic functions such as breathing and heart rate. The amygdala, represented by your thumb, is the centre of the brain responsible for sensing danger and sending danger signals. Your pre-frontal cortex, represented by your fingers, helps you manage emotions and make decisions. When your amygdala is triggered and sets off the fight or flight response, your pre-frontal cortex is opened, resulting in an intense emotional response with little regard for reason or logical thinking. This is referred to as "flipping the lid." To reduce the intensity of these reactions and expand your window of tolerance, it's essential to recognize the signs that you're outside your window and practice calming techniques to help you stay within it.

How do you work with the Window of Tolerance?

Many trauma clients have difficulty regulating their arousal regarding trauma symptoms, emotions and behaviour. Without the capacity to stay within their Window of Tolerance, which can be narrowed as a result of Trauma, one may become overly hyper- or hypo-aroused. This can lead to physical and psychological dysregulation, causing distressing bodily sensations, thoughts and feelings. Dysregulation can often lead to triggering and the inability to integrate and understand bodily states.

Hyper-arousal is characterized by agitation and is a response to extreme anxiety. In contrast, hypo-arousal generally manifests as a more passive flat or numb affect where the person shuts down and becomes withdrawn. Your therapist's role is to help you remain mindful of the present moment and observe internal experiences that promote emotional regulation while also expanding your capacity to regulate intense emotions. The objective is to identify feelings of safety while experiencing some level of emotional dysregulation. Therapy should occur within the "Window of Tolerance," where a person can tolerate their sensations without moving into a state of hyper- or hypoarousal. Over time, you can increase your window of tolerance by acquiring the skills and resources necessary for self-regulation.

Complex Trauma and Dissociation

People who have experienced complex trauma often have dissociative symptoms that disrupt their normal psychological functioning. Dissociation is the brain's way of protecting us from what is happening. In this state, we don't pay attention and may feel "out of the body" or "going blank". We dissociate to protect ourselves from the fear of interacting with others, including therapists. Although daydreaming is normal, frequent defensive dissociation can negatively impact our health and well-being. It's important to differentiate between mild and severe dissociation. Structural dissociation is a severe form of dissociative personality division. Trauma-informed therapists should watch for clients who "zone out" and offer them support to stay present.

Complex Trauma Therapy

There is no one perfect treatment approach for trauma therapy. Clinical and neurobiological insights, including the role of the body informed by psychodynamic and somatic work, an understanding of trauma-based dissociation, mindfulness, and Eastern principles are all considered in treatment approaches. When treating complex trauma, the focus needs to be on the relational aspect, regardless of the modality adopted. Trauma disrupts different aspects of a person, including the body and brain, so therapists need to reconnect emotions, sensations, awareness, and thoughts by fostering connections. This requires a bottom-up and top-down approach, using a somatic process and working with a person's emotions and thoughts.

How long does it take to treat Complex Trauma?

There is no fixed timeline for treating complex Trauma, but it is generally long-term. For some, treatment may last years or decades; for others, it may be shorter and more episodic. Both meaningful and effective treatment usually requires at least 10-20 sessions, and even modalities where treatment may be completed in 20-30 sessions may need to be repeated.

The Five Trauma-Informed Care Principles

The Five Trauma-Informed Care Principles aim to address what a traumatized person did not have at the time of their trauma: safety, trustworthiness, collaboration, choice, and empowerment. A trauma therapist strives to create a safe environment that is welcoming, engaging, and respectful. They provide clear and consistent information and collaborate with the client, considering their preferences. The therapist maximizes client choice and control, offers various options, and prioritizes empowerment and skill-sharing. These principles are essential for creating an effective trauma-informed care experience.

A three-phase treatment approach is used to work with Complex Trauma.

Phase 1 of Trauma therapy focuses on safety, stabilization, resourcing and self-regulation. The primary task is to build the capacity to tolerate emotions and self-regulate, including developing strategies to become mindful and self-soothe. Through collaboration with a therapist, individuals can learn to recognize the effects of trauma and build safety and stability by becoming comfortable in their own bodies, calming themselves, establishing a safe living environment, and building stable relationships, careers, and support systems. This stage aims to create more safety and stability so that individuals can safely remember the trauma and access internal and external resources for well-being. Self-regulation depends upon the capacity to access internal resources and is also the pre-condition for trauma processing, which can be achieved through practices that produce physical calmness.

Phase 2: Processing of traumatic memories. Complex Trauma processing is a Stage 2 task and should never be attempted before the foundational work of Phase 1 has been done. When addressing Trauma, the emphasis is on its effect on the person rather than the details of the Trauma. The aim is to overcome the fear of these memories so they can be integrated, allowing the individual to appreciate who they have become due to the Trauma. Neuroscience highlights the significance of implicit memory. There is increasing awareness that allowing traumatic memories to come to the surface naturally rather than concentrating on the details (which can be destabilizing and retraumatizing) is the most effective way to heal. It isn't necessary for a person's memory to be complete to recover from Trauma. The impact of what happened is what matters.

Acknowledging traumatic material differs from focusing on it; Trauma processing involves developing enough resources before engaging. Breaking the silence of denial and validating one's distress is critical to acknowledging Trauma. Alluding to traumatic material is not the same as discussing it; it is never harmful. One can say that 'bad things happened' without eliciting the details or using triggering language. A therapist can help differentiate between past dangers and present triggers and recognize when one feels triggered vs unsafe.

Phase 3: Consolidation of treatment gains & Integration of new self. Once you have processed trauma from the past, you can focus on developing a new self and reducing feelings of shame and alienation. This phase of treatment enables you to overcome fears related to everyday life, healthy challenges, changes, and intimacy as you move forward in your daily life. As your life is reorganized around a healed self and a healthier present, trauma becomes part of your integrated understanding of self, rather than a daily focus. You can recognize how trauma has changed you and begin to move forward with who you are now, after experiencing trauma.

Book online for our body therapy services or make a request for therapy options at Holistic Practice.

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