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Group therapy

Trauma and its symptoms are more prevalent in society than is often thought. Nearly half of us, that is about 6 of every 10 (or 60%) of men and 5 of every 10 (or 50%) of women experience at least one trauma in their lives. About 7 or 8 out of every 100 people (or 7-8 per cent of the population) will have post-traumatic stress disorder (PTSD, the most full-blown grade of trauma), at some point in their lives. 

Women are more likely to suffer from trauma: about 10 of every 100 (or 10%) of women develop PTSD sometime in their lives compared with about 4 of every 100 (or 4%) of men. This is because the most damaging forms of trauma are those conducted by one person to another, i.e. rape or sexual assault/abuse, and this is more likely to happen to females than males (US figures, National Centre for PTSD). We can begin to see from this evidence the fateful function of trauma, childhood or otherwise, to the fabric of society.

Trauma may result from a wide range of stressors such as being in a serious accident; having surgery or surgical procedures; the break -up of a significant relationship; the discovery of a life-threatening illness or disabling condition;  being in war zones or being in a major natural or technological disaster; being physically punished by parents as a child; being attacked, mugged or beaten by anyone; being pressured into having unwanted sexual contact; having a close family member die violently ie in a serious car crash, mugging or attack.

Trauma develops through the failure of the body, psyche and nervous system to process adverse events. All of us will have experienced some traumatic experiences during our life, however not everyone who has a traumatic experience ends up being traumatised.  Trauma has a different impact at different ages and stages, and a child who experiences a trauma before the age of 7 years experiences more far reaching consequences than an older child or an adult, and is also more vulnerable to later trauma and being re-traumatised.

The most insidious and damaging forms of trauma occur in the context of interpersonal relationships; the most devastating being relational traumas experienced in childhood such as physical, emotional and sexual abuse. The worst type of trauma of all is childhood neglect, not just physical but emotional neglect. Hence trauma in families is more prevalent than trauma in war.

Trauma can have devastating consequences. The symptoms of trauma include anxiety, depression, substance abuse, mood disorders, suicidal ideas or attempts, self-harm, obsessive compulsive disorder (OCD), anorexia, flashbacks, avoidance behaviour, a feeling of being detached from other people, trouble sleeping, a feeling of frequently being ‘on guard’ or an exaggerated ‘startle response’, restlessness, distraction and trouble concentrating, irritability and outbursts of anger. However the major faculty that trauma interferes with is the ability of our higher brain to connect with a sense of meaning or purpose – what is called ‘the instinct of privilege’. So traumatised people are poor at goal setting, feel like their future has shrunk or they don’t have a future, have an overriding sense of purposeless or lack of meaning.

People suffering from trauma often behave in inappropriate ways, they can scare others and embarrass themselves and drive people away. Because they have no idea of where these powerful feelings that are still with them come from, they experience greater degrees of shame and self-loathing and have a sense of being out of control and becoming a ‘monster’ who no one can be safe with.

In a trauma survivor, awareness is being constantly hijacked by their limbic system and the amygdala (basal brain that does the fear, fight, flight response) in the state of high arousal, constant alert and affect (high emotional) state. In this respect the rational, executive brain has very limited capacity to control the emotional arousal or change fixed action patterns of the emotional brain. The frontal lobe shuts down, which means that trauma sufferers are constantly ‘associated’ in the event (reliving it) and consequently overwhelmed by feelings, sensations and emotions.

Sensory input – such as sounds, images, smells – can act as reminders of the past event, automatically stimulating hormonal secretion and activate the brain regions involved in attention and memory. When this happens trauma survivors react with irrational responses which are irrelevant, even harmful in the present. They may over-react or blow up in response to minor provocations; freeze when frustrated or become helpless in the face of trivial challenges. Any external sensory input can trigger this response, as the inner system is now primed. Nevertheless, in the absence of this context the emotions and reactions of trauma survivors seem out of place and bizarre.

Recent neuroscience research has found that the precuneus is also negatively affected. The precuneus is in the back, mid portion of the parietal lobe, flopping over the inner wall of both hemispheres, and it is responsible for the most basic seat of the ‘self’; from here comes the observing ego, or the “I”. It is the healthy functioning of the precuneus which is associated with self-reflection and self-awareness. The precuneus shows the highest rate of activity when we close our eyes and turn self-awareness inward and become aware of our self, and when taking awareness into the body, sensations and feelings (interoception). This doesn’t apply when moving the body (it only applies to ‘motor imagery’, not movement) and is greatly reduced when we are asleep or during tasks that make no reference to the self.