Culturally Competent Psychotherapy for African-American Individuals, Couples, and Families
Trauma is the response to a deeply distressing or disturbing event that overwhelms an individual’s ability to cope, causes feelings of helplessness, diminishes their sense of self and their ability to feel the full range of emotions and experiences. Trauma is an emotional response to a terrible event like an accident, rape or natural disaster. Immediately after the event, shock and denial are typical. Longer term reactions include unpredictable emotions, flashbacks, strained relationships and even physical symptoms like headaches or nausea.
Common Responses and Symptoms of Trauma
Response to a traumatic event varies significantly among people, but there are some basic, common symptoms.
Emotional signs include:
These may lead to:
- difficulty with relationships
- emotional outbursts
Common physical symptoms:
- altered sleep patterns
- changes in appetite
- gastrointestinal problems
Psychological disorders may include:
- dissociative disorders
- substance abuse problems
Types of Trauma
As mentioned above, trauma is defined by the experience of the survivor. But there is a delineation of trauma levels. Broadly described, they can be classified as large ‘T’ traumas and small ‘t’ traumas.
Small ‘t’ traumas are circumstances where one’s bodily safety or life is not threatened, but cause symptoms of trauma nonetheless. These events set one off-kilter and disrupt normal functioning in the world. They certainly don’t seem small at all when they occur, but most will have an easier time recovering from them than a large ‘T’ trauma. On the other hand, small ‘t’ traumas are sometimes disregarded since they seem surmountable. This can be perilous as the cumulative effect of an unprocessed trauma or traumas may trail a person relentlessly. Examples are: life changes like a new job or moving; relationship events like divorce, infidelity, or an upsetting personal conflict; life stressors like financial troubles, work stress or conflict, legal battles, exposure to racial microaggressions.
Large ‘T’ traumas are extraordinary experiences that bring about severe distress and helplessness. They may be one-time events like acts of terrorism, natural catastrophes, and sexual assault. Or, they may be prolonged stressors like war, child abuse, neglect or violence. They are much more difficult or even impossible to overlook, yet they are often actively avoided. For instance, people may steer clear of triggers like personal reminders, certain locations, or situations like crowded or even deserted places. And they may resist confronting the memory of the event. As a coping mechanism, this only works for so long. Prolonging access to support and treatment prolongs healing.
Therapies for Trauma
There is no cure for trauma nor any quick fixes for the suffering associated with them. But there is hope. A wide range of effective therapies exists and access to them is widespread. Trauma survivors are best served by working with a therapist or therapy that is trauma-focused or trauma-informed. Most trauma-informed therapists will employ a combination of therapy modalities.
Psychotherapy alternatives include exposure therapies to help with desensitization, Cognitive Behavioral Therapy which helps change thought and behavior patterns and reprocessing therapies like Eye Movement Desensitization and Reprocessing (EMDR) that allow the survivor to reprocess memories and events. Somatic therapies that use the body to process trauma include Somatic Experiencing and Sensorimotor Psychotherapy. Hypnosis, mindfulness, craniosacral therapy, trauma-sensitive yoga, art therapy and acupuncture can all also help. And last, many people use medications – primarily antidepressants and anti-anxiety medications – which can make symptoms less intense and more manageable.
POST TRAUMATIC STRESS DISORDER (PTSD)
PTSD (posttraumatic stress disorder) is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault. It's normal to have upsetting memories, feel on edge, or have trouble sleeping after a traumatic event. At first, it may be hard to do normal daily activities, like go to work, go to school, or spend time with people you care about. But most people start to feel better after a few weeks or months. If it's been longer than a few months and you're still having symptoms, you may have PTSD. For some people, PTSD symptoms may start later on, or they may come and go over time.
Who Develops PTSD?
Anyone can develop PTSD at any age. A number of factors can increase the chance that someone will have PTSD, many of which are not under that person's control. For example, having a very intense or long-lasting traumatic event or getting injured during the event can make it more likely that a person will develop PTSD. PTSD is also more common after certain types of trauma, like combat and sexual assault. Personal factors, like previous traumatic exposure, age, and gender, can affect whether or not a person will develop PTSD. What happens after the traumatic event is also important. Stress can make PTSD more likely, while social support can make it less likely.
What Are the Symptoms of PTSD?
PTSD symptoms usually start soon after the traumatic event, but they may not appear until months or years later. They also may come and go over many years. If the symptoms last longer than four weeks, cause you great distress, or interfere with your work or home life, you might have PTSD. There are four types of PTSD symptoms, but they may not be exactly the same for everyone. Each person experiences symptoms in their own way.
- Reliving the event (also called re-experiencing symptoms). Memories of the traumatic event can come back at any time. You may feel the same fear and horror you did when the event took place. For example: You may have nightmares. You may feel like you are going through the event again. This is called a flashback. You may see, hear, or smell something that causes you to relive the event. This is called a trigger. News reports, seeing an accident, or hearing a car backfire are examples of triggers.
- Avoiding situations that remind you of the event. You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event. For example:You may avoid crowds, because they feel dangerous. You may avoid driving if you were in a car accident or if your military convoy was bombed. If you were in an earthquake, you may avoid watching movies about earthquakes. You may keep very busy or avoid seeking help because it keeps you from having to think or talk about the event.
- Negative changes in beliefs and feelings. The way you think about yourself and others changes because of the trauma. This symptom has many aspects, including the following: You may not have positive or loving feelings toward other people and may stay away from relationships. You may forget about parts of the traumatic event or not be able to talk about them. You may think the world is completely dangerous, and no one can be trusted.
- Feeling keyed up (also called hyperarousal). You may be jittery, or always alert and on the lookout for danger. You might suddenly become angry or irritable. This is known as hyperarousal. For example:You may have a hard time sleeping. You may have trouble concentrating. You may be startled by a loud noise or surprise. You might want to have your back to a wall in a restaurant or waiting room.
What Are the Symptoms of PTSD in Children?
Children may have symptoms described above or other symptoms depending on how old they are. As children get older, their symptoms are more like those of adults. Here are some examples of PTSD symptoms in children:
- Children under 6 may get upset if their parents are not close by, have trouble sleeping, or act out the trauma through play.
- Children age 7 to 11 may also act out the trauma through play, drawings, or stories. Some have nightmares or become more irritable or aggressive. They may also want to avoid school or have trouble with schoolwork or friends.
- Children age 12 to 18 have symptoms more similar to adults: depression, anxiety, withdrawal, or reckless behavior like substance abuse or running away.
Will People with PTSD Get Better?
After a traumatic event, it's normal to think, act, and feel differently than usual—but most people start to feel better after a few weeks or months. Talk to a doctor or mental health care provider (like a psychiatrist, psychologist, marriage and family therapist, or social worker) if your symptoms:
- Last longer than a few months
- Are very upsetting
- Disrupt your daily life
"Getting better" means different things for different people. There are many different treatment options for PTSD. For many people, these treatments can get rid of symptoms altogether. Others find they have fewer symptoms or feel that their symptoms are less intense. Your symptoms don't have to interfere with your everyday activities, work, and relationships.
What Treatments are Available?
There are two main types of treatment, psychotherapy (sometimes called counseling or talk therapy) and medication. Sometimes people combine psychotherapy and medication.
Psychotherapy for PTSD
Psychotherapy, or counseling, involves meeting with a therapist. Trauma-focused psychotherapy, which focuses on the memory of the traumatic event or its meaning, is the most effective treatment for PTSD. There are different types of trauma-focused psychotherapy, such as:
- Cognitive Processing Therapy (CPT) where you learn skills to understand how trauma changed your thoughts and feelings. Changing how you think about the trauma can change how you feel.
- Prolonged Exposure (PE) where you talk about your trauma repeatedly until memories are no longer upsetting. This will help you get more control over your thoughts and feelings about the trauma. You also go to places or do things that are safe, but that you have been staying away from because they remind you of the trauma.
- Eye Movement Desensitization and Reprocessing (EMDR), which involves focusing on sounds or hand movements while you talk about the trauma. This helps your brain work through the traumatic memories.
Medications for PTSD
Medications can be effective too. Some specific SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors), which are used for depression, also work for PTSD. These include sertraline, paroxetine, fluoxetine, and venlafaxine.