Recognizing trauma — individually and collectively — is the compassionate paradigm shift we need to help heal the mental health crisis.
In therapy rooms everywhere, we tell our counselors that we’re stressed, anxious, or depressed. What’s not immediately clear is that trauma is often at the root of much of what ails us.
Trauma underlines so much of our daily lives and can impact our relationships, sense of self, and even how we show up at work. What would it be like if we put it at the center of the conversation?
Identifying Trauma
Researchers are beginning to uncover the effects of the pandemic, with one 2021 study classifying it as a traumatic stressor that can bring forth symptoms of post-traumatic stress disorder (PTSD) and worsen mental health conditions, like depression and anxiety.
As our collective traumas mount with each passing month of the pandemic, the need to honor (and tell) our backstories, acknowledge the effects of trauma, and to respond with compassion, is more important than ever.
That's why psychologists like Thema Bryant, PhD, director of the Culture and Trauma Research Lab at Pepperdine University, are advocating for trauma-informed care not just in the world of mental health, but in all areas of society, like schools, hospitals, faith centers, and beyond.
What does trauma really mean?
Trauma is a word often surrounded by shame and stigma, and it's notoriously difficult to talk about. It’s also more common than many realize, with 70 percent of U.S. adults having faced at least one traumatic event, according to the Sidran Institute.
Bryant, author of the upcoming book “Homecoming: Overcome Fear and Trauma to Reclaim Your Whole, Authentic Self,” says that trauma involves “life events and life circumstances that can make it very difficult for us to survive, for us to function, for us to relate to other people, for us to feel good about ourselves.”
"Trauma isn't just about what happened to you. It's also how you (and your nervous system) responded to what happened."
There's a widely held belief that the term is reserved for the “worst circumstances possible.” While perspective matters, many people dismiss their experiences as “not that bad.”
But trauma isn't just about what happened to you. It's also how you (and your nervous system) responded to what happened.
When a major stress overloads the nervous system, it can lead to symptoms of post-traumatic stress, like feeling anxious, being easily startled, or feeling overwhelmed. These lasting changes are silent indicators of trauma.
The Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma as an event(s) that was experienced as “physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.”
While trauma includes major events, like physical or sexual assault, accidents, abuse, and violence, it also includes repeated events, such as domestic abuse or childhood neglect, which is known as complex trauma.
Thema Bryant, PhD, director of the Culture and Trauma Research Lab at Pepperdine University
How trauma impacts people and communities
“I wish that people understood how pervasive and detrimental trauma can be on all of us holistically. It affects us not only psychologically. It affects our physical health,” says Bryant, who’s also the president-elect of the American Psychological Association.
When left unaddressed, the effects of trauma on individuals and society are vast, and according to Bryant, the “consequences are often long term without some type of intervention or healing pathway.”
With this in mind, now is the time for us to start recognizing the impacts of the pandemic on us all and considering what we need in order to heal.
"One research review shows an association between childhood trauma and medical conditions in adulthood, such as heart disease, stroke, cancer, chronic pain, and fibromyalgia."
Trauma not only affects the mind, but it impacts the body, too. Experiencing extreme stress can actually change the brain, leading to symptoms including:
Research has shown that trauma is linked to major mental health issues, including substance use disorders, self-harm, borderline personality disorder, and suicidality.
Trauma places a huge strain on our physical bodies, especially when stress occurs over a longer period of time.
This stress can also show up in our physical health. A 2020 review shows an association between childhood trauma and medical conditions in adulthood, such as heart disease, stroke, cancer, chronic pain, and fibromyalgia.
Trauma has substantial cultural impacts too, with marginalized communities experiencing higher rates of trauma — including Black, Indigenous, and People of Color (BIPOC) and LGBTQIA+ folks — and so cultural competence is a crucial aspect of being sensitive to trauma.
The Startling Prevalence of Trauma
Trauma is more prevalent than many people realize:
Adverse childhood experiences (ACEs) — potentially traumatic events that occur in childhood — have been described as an epidemic due to their major impacts on individuals and society:
- About 61 percent of adults surveyed across 25 states reported that they had experienced at least one ACE.
- Nearly 1 in 6 reported experiencing four or more ACEs.
- About 1 in 7 children experienced childhood abuse.
- 21 million cases of depression and up to 1.9 million cases of heart disease may have been avoided by preventing ACEs.
- ACEs have economic and social costs to families and communities, adding up to hundreds of billions of dollars each year.
The above data was collected before the pandemic. It’s widely known the pandemic has exacerbated our mental health crisis. Mental health professionals expect these numbers to be even greater now.
What's Different About a Trauma-Informed Approach?
Bryant tells us that a large part of being trauma-informed means giving people grace and compassion, and understanding that we don't know a person's whole story.
“When society looks at someone struggling, they say: What's wrong with them? And when a trauma-informed person sees them, they say: What happened to them? And from a multicultural standpoint, what happened to them and their community?” Bryant says.
The same sentiment is offered by Oprah Winfrey and Bruce D. Perry, PhD, in their book, an accessible breakdown of the impacts of trauma, titled “What Happened to You?”
Acknowledging the impact of trauma
Trauma is notoriously difficult to talk about, and yet it's shaping our interactions with those around us at work, school, and elsewhere. Part of a trauma-informed approach is to realize the effects that trauma may be having on others around you.
"When I am trauma-informed… I’m intentional about creating space for us to speak about things that seem to be unspeakable."
When the person leading the conversation raises the issue of trauma, it removes the stigma and gives people permission to share.
Trauma-informed care seeks to support you in feeling safe, uses transparency to build trust, shows up without pressure, and makes sure that you have a choice in what happens to you.
This could be as simple as a teacher offering choices on where to sit in a classroom rather than assigning seats. For some, a sense of safety can come from having their back to a wall or sitting near an exit.
“When I am trauma-informed… I’m intentional about creating space for us to speak about things that seem to be unspeakable,” says Bryant.
Trauma-informed care in therapy: An example
According to Bryant, a trauma-informed approach can help therapists (and others) interpret a person's actions in ways that others don’t, giving access to new levels of awareness and compassion.
“Trauma survivors can be what we call hypervigilant, or very guarded. And if you're not tuned in to that, some therapists might say they're resistant to care or they're not invested in their treatment.”
“But what I see is someone who is afraid. When people come in and they have given me the one-word answer, in my mind, I'm not thinking, oh, this is a waste of my time, they don't need to be here. I am aware that [they’re] trying to figure out — is she safe?”
To create a safe space, a trauma-informed therapist will recognize and respond with gentle curiosity to signs of trauma, such as fear or avoidance, and understand there are good reasons why the person is showing these behaviors.
Toward a trauma-informed world
A trauma-informed mindset is important in the mental health sphere, but it's not specific to mental health. Any system, organization, or process that involves interacting with people can benefit from this approach.
“Trauma-informed cannot just be an expertise of some. Because trauma is so pervasive… even if it’s not your area of expertise, you are going to work with trauma survivors,” says Bryant.
According to SAMHSA, there are four key pillars of a trauma-informed approach:
Any institute can apply these principles to help people grow and thrive, regardless of what they've been through.
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Where can Trauma-Informed Care Show Up?
Trauma-informed care is important in areas we don’t typically associate with it in everyday life — doing our taxes, going to a yoga class, or even going to the dentist.
In a dentist’s office, you’re asking people to lay down in very vulnerable positions, Bryant explains. “For some people, it’s not just you don’t like going to the dentist, it can really be triggering.”
Doctors and nurses also use trauma-informed practices in their bedside manner — which might look like showing compassion, sensitivity, and moving at that person’s own pace.
"There's also great work being done about being a trauma-informed faith institution… how your mosque, your temple, your church, your spiritual group can be more tuned into trauma."
Educators can find literature into what a trauma-informed school looks like. In the midst of the pandemic, Bryant has been doing virtual presentations for universities about how to work in a trauma-informed way with their students, their staff, and themselves.
“There's also great work being done about being a trauma-informed faith institution… how your mosque, your temple, your church, your spiritual group can be more tuned into trauma,” she explains.
Even practices like mindfulness can be challenging for people with a trauma history. Sitting still and focusing on your thoughts can be triggering. So if you find typical meditation practices difficult to manage, trying trauma-informed mindfulness could be a game-changer.
Culturally competent trauma-informed care
For trauma-informed therapy to be culturally competent, the traumatic impact of oppression must be named and recognized in a similar way that abuse or neglect is recognized as traumatic.
Bryant shares the importance of viewing marginalized communities as holding keys to healing in their lineage.
For therapists working with people from marginalized groups, it's important to recognize the impact of oppressive systems like racism, heterosexism, and ableism.
“Especially if you are not from the same community as your client, [culturally competent care is about] being willing to raise it and name it, because people don't know if the person who is sitting across from them gets it,” she says.
"For me, it's like Black church grandmothers, rocking, humming, and singing so that you can settle, to ‘calm your nerves.’"
In modern trauma theory, people talk about soothing the nervous system — specifically the vagus nerve, which transmits information between the brain and the body — and ushering people back into their window of tolerance, an ideal brain space that we need for optimal functioning when facing a trauma response.
Two major strategies modern psychology talks about are breathing, such as deep breathing exercises, and humming.
“For me, it's like Black church grandmothers, rocking, humming, and singing so that you can settle, to ‘calm your nerves,’” says Bryant.
"Marginalized communities are not just trauma recipients and carriers of wounds. They are carriers of wisdom."
Often, Western psychology takes cultural wisdom and divorces it from its cultural origins. Part of what it means to be culturally informed is to find out the diverse ways that people healed themselves before psychology — a relatively young field of study — was around.
Expressive arts are another example.
“Arts predate psychotherapy,” Bryant explains. “People’s culture of telling stories, or writing rap songs and rap lyrics, playing instruments, theater, dance, and movement are all ways of healing that are to be acknowledged.”
She adds, “Marginalized communities are not just trauma recipients and carriers of wounds. They are carriers of wisdom.”
How does being trauma-informed impact our daily lives?
When we face problems at work, in love, and at school, we often focus on what’s happening in the present instead of the past.
"Be patient with each other… there are recognized and unrecognized losses, visible and invisible losses."
To be trauma-informed is, in part, to locate the source of our pain, to name trauma when it appears, and start making a connection between our present struggles and past trauma.
The pandemic is a collective trauma worthy of collective healing. “Be patient with each other… there are recognized and unrecognized losses, visible and invisible losses,” Bryant says.
Patience in the age of trauma might look like:
- Your friend giving you grace when you need to reschedule plans for the third time
- Your dentist giving a gentle heads-up about what will happen during your appointment
- Your boss asking for your input before they make a decision that will impact you
- Your accountant acknowledging how personal questions on a routine form could be triggering
One simple way anyone can seek trauma-informed healing is by talking about it.
“Transparency is often contagious. So sometimes when one person shares, other people will open up,” Bryant says, referencing people in her community who opened up about everything from miscarriage to medical trauma.
"Trauma-informed is the new path we must embrace in order to revise how we relate across all spheres of life, whether in therapy, over lunch, or in the halls of power."
Consider how the #MeToo movement broke the silence on sexual assault. The more people shared, the more people felt comfortable sharing.
Part of trauma-informed living, in a sense, is about breaking the silence and letting our individual experience become a shared one.
Consider how the world finally opened itself to diversity, inclusion, and equity work. We won't solve inequality without that effort.
Trauma-informed is the new path we must embrace in order to revise how we relate across all spheres of life, whether in therapy, over lunch, or in the halls of power.
With willingness to learn and gentle curiosity guiding us, we can begin to heal not just from the trauma of the pandemic, but all of the trauma seen and unseen.
Bryant says, “Even if our experiences are unique, there are those who have kind of been on a similar path or journey. Be patient and compassionate with ourselves and with others.”