Trauma is a word that has been gaining more attention and importance in our society and in the therapy treatment world. We (therapists) all know what trauma is... an overwhelming psychological and emotional response to an event or series of events that causes the brain to “push the panic button”. By now we all know trauma can come in many forms. It could be a natural disaster, a car accident, physical abuse, or emotional neglect. But the type of trauma that shows up most often in the therapy room is developmental trauma, which occurs in childhood and has a profound impact on a person's life.

The effects of developmental trauma, if not treated, can last well into adulthood. This is why it is so important that we therapists, understand the biology of the brain and mental health symptoms associated with developmental trauma. Especially important is understanding stabilization skills that are the foundation of treating developmental trauma and can be used at any level of therapist development.

Developmental Trauma is: 

    • Trauma that occurs during a child's formative years, from birth to adolescence
    • Repeated over time and often causes the child to feel unsafe, insecure, and helpless
    • It physiologically affects the brain's development and neural pathways 
    • Severe and repeated trauma can cause the brain to develop in unhealthy ways, inhibiting healthy emotional and behavioral responses later in life. For instance, the amygdala (responsible for fear and emotional responses) may become overactive, triggering unnecessary and heightened fear, anxiety, and PTSD (Post-Traumatic Stress Disorder) symptoms.
    • The mental health symptoms that often accompany developmental trauma are complex. They may present themselves differently depending on the person and often show up years after the initial trauma occurred:
       
      • Anger and irritability- even survival rage 
      • Emotional numbness / Dissociation
      • Depression
      • Difficulty sleeping
      • Behavioral patterns such as over-explaining, over-apologizing, people pleasing, perfectionism, worrying about being a burden, over-preparing, mixed boundaries, passive or passive aggressive patterns of behavior, etc. 
      • Other physical symptoms
Understanding how these symptoms are related to trauma is paramount in providing proper treatment to those affected by it.

Stabilization skills are The Core OF treating trauma

Stabilization skills refer to the ability to manage the present day emotional dysregulation or numbing that brings our clients to therapy.  This emotional dysregulation and numbing is often rooted in their trauma history. A caregiver’s primary job is to model, and assist their children in emotion regulation so that they grow up being able to feel, and regulate their emotions. If a parent can’t get their child to calm (because they, themselves are not able to be calm), the child grows up with dysregulated emotions and a heightened sense of alertness. So the therapeutic focus in building stabilization is often on assisting individuals in coping with their present day symptoms in order to build a stronger foundation so they can later address the source of the trauma. The goal is to help individuals gain proficiency in regulation of their feelings, thoughts, and behaviors to allow them to achieve a sense of equilibrium. Stabilization skills are essential in helping individuals build resilience, a quality necessary for overcoming the effects of trauma.

A variety of treatment methods are used to treat developmental trauma but it all starts with stabilization. Once a client is stable emotionally and is somewhat able to manage their triggers and responses, then trauma reprocessing can proceed. These trauma reprocessing methods aim to help individuals with trauma to gain a better understanding of the source of their trauma and process their emotions and thoughts in a healthy and supportive environment. Trauma-focused therapy frameworks such as EMDR (Eye Movement Desensitization and Reprocessing), DBR (Deep Brain Reorienting) and ImTT (Image Transformation Processing) have shown promising results in the ability to do this for clients.

Complex Trauma -CPTSD

Complex Trauma, or Complex PTSD (CPTSD), is most often related to experiences of developmental trauma in which an individual’s environment was emotionally unstable or unpredictable.  A client has symptoms of PTSD plus symptoms of intense emotion dysregulation, markedly irrational views of the world, dissociation, depersonalization, or derealization symptoms. Individuals with CPTSD are more likely to abuse substances to regulate their consistent states of overwhelm. It is these clients who are most likely to benefit from a thorough implementation of stabilization skills prior to starting any reprocessing therapy or somatic therapy techniques. They are either simply too easily triggered or dysregulated or they are so skilled at “ignoring and forgetting” what happened so going into the trauma material too much too soon can destabilize the client.

Neurodivergence and CPTSD

Clients that fall under the Neurodivergent umbrella are neurologically diverse (ADHD, Autism, Learning Differences, and many more) and statistically are more likely to be polyvicitimized which means they will have multiple traumatic events throughout their lifetime.  These individuals are at risk for CPTSD.  Understanding how to meet Neurodivergent needs therapeutically is an integral part of being a trauma informed therapist.  

Individuals within the Neurodivergence spectrum may exhibit variations in attention and sensory processing, which play a crucial role in tailoring therapeutic interventions. This concept is well-recognized in the realm of Occupational Therapy, where sensory sensitivities, both hypo and hyper, influence how individuals perceive and respond to stimuli in their surroundings.

In the field of trauma treatment, we understand that individuals with sensitive nervous systems are more susceptible to experiencing heightened trauma responses. Delving deeper into these differences allows us to gain a comprehensive understanding of how these unique sensory and attentional variations impact the way individuals navigate traumatic experiences.

Sensory Differences:

  • Sound - Individuals can have hyper or hypo sensitivity to sound. Some individuals are diagnosed with Misophonia (selective sound sensitivity syndrome, sound-rage) is a disorder of decreased tolerance to specific sounds or their associated stimuli, or cues. These cues, known as "triggers", are experienced as unpleasant or distressing and tend to evoke strong negative emotional, physiological, and behavioral responses that are not seen in most other people 
  • Hyper / Hypo Touch, Sight, Vestibular- Balance, Smell
  • Taste
    • Hyper taste- Avoidant/Restrictive Food Intake Disorder (ARFID)
  • Proprioception - Body Awareness of where you are in space
    • Proprioceptive hyposensitivity- need constant input of where they are in space
    • Proprioceptive hypersensitivity- become overwhelmed by constant input
  • Interception - the ability to be aware of internal sensations in the body, including heart rate, respiration, hunger, fullness, temperature, and pain, as well as emotion sensations
  • Alexithymia - significant challenges in recognizing, expressing, and describing one's own emotions. It is associated with difficulties in attachment and interpersonal relations.
  • Pathological Demand Avoidance- 
    • Some individuals find themselves avoiding everyday tasks simply because they feel overwhelmed by the expectations placed upon them, whether by others or themselves. This sense of pressure often triggers a loss of control, escalating into anxiety and even panic.
    • A sense of irrationality often accompanies avoidance behaviors, such as reacting dramatically to a small request or being unable to eat due to an overwhelming feeling of hunger.
    • Avoidance behaviors may differ based on an individual's current ability to handle responsibilities, their anxiety levels, their overall health and well-being, or the surrounding environment (including people, locations, and circumstances).

Individuals exhibit a range of sensory variations, some of which may extend to the point of significantly impacting their functioning and having a Sensory Processing Disorder. As therapists, it is our responsibility to discern and pinpoint the factors that influence our clients' overall well-being and functioning.

Understanding sensory differences is crucial in how individuals perceive and interact with the world around them. By incorporating these unique sensory variations into our therapeutic approach, we can provide more effective care for our clients. When addressing trauma, it is essential to consider all aspects of our clients' functioning to develop effective coping strategies.

Treating developmental trauma is essential for a person's overall well-being and future success. It is often a complex and sometimes uncomfortable process, but it is necessary for individuals to achieve effective emotional and behavioral responses. Understanding the biology of the brain, mental health symptoms that accompany trauma, and stabilization skills are paramount in treating trauma. It is important to remember that trauma treatment is a delicate dance, where together we build resilience, and empower our clients to live a fulfilling life.

If you would like to learn more about treating Developmental Trauma, check out our live webinar for any level of professional development; where we (KD Holmes, LPC and Marielle Babb, LPC, and Brynne Angelle, LCSW) will delve into the biology of the brain, dissociation, neurodivergence, stabilization skills, and briefly describe forms of Trauma Treatment. 

Therapists and Transcare: An Interview with Zach Hebert, LPC, NCC, PhD

Therapists and Transcare: An Interview with Zach Hebert, LPC, NCC, PhD

One of the greatest pleasures I have in life are the friendships I've made along the way in my journey to becoming a therapist. For the most part,...

Read More
The Dance of Therapy: Attunement, Undertreating and TIBs

The Dance of Therapy: Attunement, Undertreating and TIBs

In the realm of therapy, there exists a dance, a rhythmic ebb and flow, where connection is fostered through attunement. This dance is a crucial part...

Read More
The Potential for Harm: Ethical Considerations in Counseling

The Potential for Harm: Ethical Considerations in Counseling

As I continue to evolve in my professional identity, a lingering question has begun to consume my thoughts. Despite the extensive training and...

Read More