Trauma Demystified: Big ‘T’, Little ‘t’, and the Best Trauma Therapy
We hear about trauma all the time, but what is it? And what qualifies as a traumatic event?
In therapy, it is not unusual for clients to tell me they have not had trauma in their life, only to later relay a story about a traumatic event they endured. Sometimes, people are not aware that these experiences from the past have a lasting impact. So let’s talk about it.
What is trauma?
Trauma is an emotional response to a distressing event (or series of events) that overwhelms your ability to cope. Trauma is an emotional wound or injury. It can leave you feeling horrified, helpless, unsafe, or stuck, long after the event has passed. Trauma isn't just about what happened—it's about how your mind and body respond to it. What is traumatic for one person might not be traumatic to another. Your body and mind respond differently to different situations at different times. Once you have experienced a traumatic event, your body remembers it, even if your mind doesn’t. The next time you experience something that reminds your body of a past trauma, your body responds in the same way it did during the traumatic event. Traumatic events turn on the fight or flight system and you may react to those reminders with anger and fighting, fear and running away or avoiding, freeze and shutting down or fawning and people pleasing. This can happen without you remembering the past trauma or realizing that this cue is a reminder of a past traumatic event.
Trauma comes back as a reaction, not a memory.” Bessel van der Kolk
When you experience a traumatic event, it is an overwhelming experience for your brain to be able to fully process. The memory gets stored differently in your brain than other memories. A traumatic memory often is unable to connect with the part of the brain that tells you that the event happened in the past. As a result your body reacts to the reminder of the trauma by acting as if the trauma is happening now. You are not remembering a traumatic event, you are reliving it emotionally.
What Experiences Are Considered Traumatic?
Big “T” Traumas.
People often think trauma is something that only happens to soldiers that have been in war. Yes, war is a traumatic experience. We call it a big “T” trauma. These types of traumas are big, intense, often life threatening and horrifying. You can have trauma from experiencing these things directly, from witnessing it happen to someone else or even from hearing about it happening to a loved one. Other examples of big “T” traumas are:
Natural Disasters
Serious Accidents
Physical or Sexual Assault
Life Threatening Illness or Injury
Sudden Loss of a Loved One
Witnessing Violence or Death
Childhood Abuse or Neglect
Little “t” Traumas.
These traumas are less overtly life threatening, but still have a significant impact on your mental health or emotional wellbeing especially when experienced repeatedly or in combination. These are often the lesser known traumas that people are unaware have an impact on them. Rather than thinking they are having a trauma response, they often think they have a character flaw. Other examples of little “t” traumas include:
Relational Challenges (Frequent arguments with a partner or friend, experiencing a painful breakup or divorce, being excluded or feeling rejected in social settings)
Workplace Stress (Losing a job or being demoted, experiencing ongoing workplace bullying or microaggressions, chronic job-related stress or feelings of inadequacy)
Childhood Experiences (Being teased or bullied at school, feeling unimportant or overlooked by caregivers, having overly critical or emotionally unavailable parents)
Minor Accidents or Injuries (A non-life-threatening car accident, breaking a bone or having a minor medical emergency)
Academic or Performance Pressure (Failing a significant test or course, feeling embarrassed or humiliated in a public setting)
Loss or Change (Moving to a new city or school, losing a pet, ending a meaningful friendship)
Financial Stress (Struggling to pay bills or facing minor financial setbacks, unexpected expenses creating anxiety)
Cultural or Societal Experiences (Microaggressions related to identity, race, or gender, experiencing subtle forms of discrimination or exclusion)
On the surface it may appear that these types of traumas are less severe, but they can accumulate over time and feed feelings of insecurity, self-doubt and anxiety. This can have a major impact on how you function in the world. Remember, trauma comes back as a reaction. These traumas resurface when triggered in your life and impact the way you perceive and respond in relationships, work, and life. Situations other people may feel are benign, may cause you to go into fight, flight, freeze or fawn mode if it triggers the trauma your body remembers.
Read more about the fight or flight response here.
Complex Trauma
Complex trauma refers to the ongoing or repeated exposure to distressing experiences, often occurring during critical developmental periods, such as childhood. Unlike a single traumatic event, complex trauma results from chronic stress or harm in relationships, environments, or circumstances that leave a deep and lasting impact on a person's emotional, mental, and physical well-being.
Common Trauma Response Symptoms
After a trauma, people experience a combination of physical, emotional and mental symptoms.
Physical:
Nervous System Deregulations
Digestive Issues
Muscle Tension and Pain
Sleep problems
Immune System Changes
Breathing Difficulties
Skin Reactions
Mental:
Intrusive Thoughts
Confusion/ Disorientation
Negative Thinking
Difficulty Making Decisions
Difficulty Concentrating
Feelings of Low Self-Esteem/ Self-Worth
Disociation
Emotional:
Anger
Fear
Sadness
Depression
Irritability
Numbness
Behavioral:
Avoidance
High Risk Behavior
Hypervigilance
Read more about what to do when trauma makes you a perfectionist or people pleaser.
PTSD and Complex PTSD
Post Traumatic Stress disorder (PTSD) and Complex Post Traumatic Stress Disorder (C-PTSD) develop when trauma symptoms do not resolve in a certain period of time. Not everyone that experiences trauma develops PTSD. Most people expereince trauma symptoms after a traumatic event. These symptoms often resolve on their own. If they don’t resolve on their own, that is when we start looking at a PTSD diagnosis. If symptoms continue for 4 weeks after the trauma, worsen over time, impact your functioning in relationships, work, sense of self or if there is a history of feeling safe, stable or connected to others, it is time to talk to a professional. It could be that your brain and body are unable to process and integrate the traumatic experience, leading to lasting symptoms that are interfering with your daily life. There are several therapies that can help you to process the traumatic experience so you can heal.
Effective Trauma Therapy
The most effective therapy treatments for trauma are not traditional talk therapy. Coming in and talking about anything you want in therapy has it’s benefits, but true trauma treatment entails more. The following are effective trauma treatments:
Cognitive Processing Therapy (CPT):
This is a structured 12 session program where you identify the beliefs that are keeping you stuck in your trauma. Through multiple tools CPT, guides you to deconstruct the thinking patterns that are causing you to stay stuck in your trauma. It requires homework in between each session to be effective. Therapy time is important, but the work needs to happen in between therapy sessions on a regular and consistent basis in order to be effective.
Pros -
Short, concise and can be effective. I have used it with numerous clients and had great results.
Each week we measure PTSD symptoms and you can monitor the effectiveness of the treatment.
Cons -
You have to do homework. This can be extra challenging because one of the symptoms of PTSD is avoidance. If you are avoiding doing the homework, the treatment takes longer and can be ineffective.
While this therapy does a beautiful job of helping people shift their perceptions and therefore improves how they feel, sometimes, people change their perception and understand things from a logical point of view but emotionally and physically the symptoms don’t completely go away.
This therapy only focuses on one event, the worst one you have experienced and does not address the others.
Eye Movement Desentisation an Reprocessing (EMDR):
Another effective therapy for trauma is EMDR. In this therapy, your brain does the work for you and we get out of the way. We stop when your brain has processed the information and we don’t get to decide when that is. In EMDR, we use bilateral stimulation to stimulate your right and left hemisphere of your brain at an alternating rhythmic pace, while you recall the traumatic memory. Often this is done through moving your eyes from right to left watching a dot go across a screen, but it can also be done with sound or touch. Bilateral stimulation helps you mimic your brains natural information processing system, similar to the REM state when you sleep, and allows you to process and integrate the memory. You will still remember the event, but you will not be activated physically or emotionally when you encounter a trigger because your brain has processed it. There are 8 phases to this process that help you to become desensitized to the memory, rewire negative beliefs, release physical tension and facilitate emotional regulation.
Pros -
There is no homework.
It addresses the physical and emotional manifestations of trauma as well as the beliefs.
Cons -
There is no way to know how long it will take.
Complex trauma takes longer to recover.
It can be a bit weird watching a dot go back and forth on a screen to address trauma.
It can be intense at times.
Trauma may be impacting you more than you think. If you have experienced trauma, you can recover. The right type of treatment can help you thrive in life instead of merely surviving and coping. If you are ready to treat your trauma, schedule your free consultation with me so we can get started.
Did you learn something new about trauma? Do you have more questions about trauma? Let me know in the comments!
Disclaimer: The information provided in this blog post is for educational and informational purposes only. It is not intended to be a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your therapist or other qualified healthcare provider with any questions you may have regarding a medical or mental health condition. Never disregard professional advice or delay in seeking it because of something you have read in this blog post. The author and publisher of this post are not responsible for any actions or inaction you may take based on the information presented in this post.