Adopting a Trauma-Informed Approach to Self Care
The COVID-19 pandemic, social justice and racial equity has significantly impacted most aspects of our life. We’ve all been challenged and collectively we’ve experienced loss, anxiety, isolation, grief, boredom, anger, and fear. For many of us, this year has been overwhelming, affecting our mental and physical health. However, for some this past year has been even more challenging, especially for those who suffer from trauma. So what is trauma? How do I know if I or a loved one is suffering from trauma? What are some barriers to seeking support? And what is possible in terms of self-care and healing?
What is Trauma?
According to the guidance from the Substance Abuse and Mental Health Services Administration (SAMHSA) identifies trauma in the following way:
“Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual 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.”
In other words, trauma is an EVENT that you EXPERIENCE that has a negative EFFECT on you. The keyword in SAMHSA’s definitions is the three E’s of trauma. Let’s look at what each mean-
Event- a thing that happens to you directly or have witnessed happen to someone you are close to. It can include actual or extreme threat of harm, or severe, life-threatening neglect for a child. Events can occur once or repeatedly over time (eg. car accident, sexual abuse, bullying, natural disaster, domestic violence…)
Experience-how the individual perceives, labels and assigns meaning to an event or situation. This helps determine if the event is experienced as traumatic. What one person considers to be traumatic in his/her life may not seem traumatic to someone else and vice versa.
Adverse Effect – the outcome or consequences from the experience of the event that interfere with an individual’s ability to live a normal life.
Trauma comes in many forms including:
Acute trauma- a single traumatic event that is time-limited (eg. loss of a loved one, an ER visit that leads nowhere, invasive medical procedures, rape, natural disaster, etc.)
Chronic Trauma- a set of traumatic experiences that are repeated over time. (eg. bullying, prolonged physical, sexual, or emotional abuse, neglect)
Complex Trauma- repeated exposure to multiple types of trauma over time. (eg. sexual, physical, or emotional abuse, domestic abuse)
Chart by the Institute of Trauma and Trauma-Informed Care (2015)
What are some risk factors that may make people more sensitive to trauma?
Exposure to adverse childhood experiences from childhood and the teenage years such as-
experiencing or witnessing emotional, physical or sexual abuse or neglect
living with a parent with mental illness or substance misuse disorder
death or absence of a parent because of imprisonment
domestic and sexual violence
natural disasters
car, train, and airplane crashes
experiencing or witnessing violence in the community or while serving in the military
becoming a refugee or homelessness
medical trauma
poverty and systemic discrimination
Exposure to such events increases levels of stress, impedes healthy brain development and coping skills, and results in profound health, behavioral, and social consequences.
In addition, genetics, cultural barriers, limited/lack of coping skills, having limited social support or a lack of caring family and friends, and having ongoing life stressors such as moving to a new home or new school, loss of job, low income, and food insecurity.
How do I know if I am experiencing stress vs traumatic stress?
Stress is a normal reaction or response a body has when there are changes and/or demands. As long as one can manage and deal with stress effectively, a low level of stress is normal, and the response passes relatively quickly.
On the other hand, traumatic stress is an emotional, cognitive, behavioral, and psychological response to a traumatic event that overwhelms once ability to cope and problem-solve. It is important to note that, not everyone that experiences the above event experiences traumatic stress. Many people who experience a traumatic event will be able to recover and go on with their lives without lasting negative effects. However, for some, it can have a long-term effect.
What are the signs and symptoms of trauma?
Trauma can look and feel different for everyone. Sometimes the symptoms are obvious and other times not so much. At times, people don’t even realize they are experiencing symptoms of trauma. Especially in Habesha culture, any signs of mental health are ignored or minimized due to social/cultural stigma. Trauma symptoms can be mental, physical, and behavioral, examples include but not limited to:
depression, anxiety, and sleep problems
flashbacks, nightmares
cognitive distortions, paranoid thoughts
intense emotional episodes that do not match the situation
isolating from family and friends
Problems with relationships such as not wanting to be around others, difficulty trusting others
avoiding thinking or reminders about the trauma
physical and emotional numbness
constantly looking out for danger or quick startle responses
Complain of physical problems (headache, digestive symptoms, sweating, fatigue)
Using drugs, alcohol, and/or tobacco
Inappropriate physical, social, or sexual boundaries
over or under-eating to cope with feelings
It is also important to know that symptoms look different in children and adults. Symptoms in children can include but are not limited to:
Cling to parents or caregivers.
Cry and be tearful.
Have tantrums and be irritable, angry, or disruptive.
Have nightmares or refuse to go to bed.
Show increased fearfulness (for example, of the dark, monsters, or being alone)
Have problems in school.
Be unable to concentrate.
Lose interest in fun activities.
Chart by the Institute of Trauma and Trauma-Informed Care (2015)
What are some barriers to seeking support in our community?
Despite our culture being known for family unity and community support, when it comes to mental health there is a lack of understanding, spoken and unspoken stigma and shame within our family and community. Many people see mental illness as a personal weakness, failure or a family course. Due to such belief, Habesha people often fail to admit to their mental illness and seek support, which then worsen the mental illness and prolongs the recovery. Oftentimes, individuals with mental illness feel isolated, hopeless and helpless despite having loved ones around them. It is important for our Habesha community to educate and understand mental illness and encourage ourselves and others to seek support from our community as well as professionals.
Strategies of trauma-informed self-care
Awareness and understanding- according to the Trauma informed care approach there are 4 key assumptions
We recognize how common trauma is
We recognize the signs and symptoms of trauma
We respond to potential trauma history by integrating knowledge and understanding,
We resist re-traumatization
Safety and trust– when trauma occurs it affects the individual's perception of sense of self, others and the world. Trauma impacted individuals need a safe and trusting relationship in order to feel calm.
Be aware of your tone and language (verbal and body)
Blame vs understanding
“what happened” vs “what’s wrong”
Give choices
Maintain healthy boundaries (how and where you are standing)
Communication- learn to just listen, reassure, validate, and respond when needed. It is important for the supportive person to learn to listen and practice the nonjudgmental observer role.
Practice self-care and self-regulation skills
Deep breathing
Validation
Self -compassion
Visualization and grounding activities
Meditation
Get moving- going for a walk, light exercise, dancing, singing
Journaling
Sleeping
Eating healthy
Social support – social support is considered to be a key factor and an important part of a trauma informed approach. Social support/relationships are critical to our well-being and can be the difference between surviving and thriving.
Identify trusted and safe person you can talk about your feelings and emotions with
Sometimes you might not want to talk about your trauma but identifying a person you can be around is helpful.
Seek professional help- If you or loved ones have experienced a traumatic experience and do not feel the symptoms have reduced over several months or the symptoms are interfering with your daily functioning or relationship with others, it is important to seek professional support.
How do I find a provider and how do I know if I am picking the right therapist or provider?
Whether this is your first time or have been to therapy, finding a therapist is not an easy task; however, there are resources you can utilize to find a therapist or provider in your area. The first thing to consider is to see if your primary care doctor could give you a referral. They often have a list of providers they have worked with before. Second, utilize your city and county resources. Most cities and counties have websites full of resources or you can call them and find out what support and resources they have. Third, you can call your insurance provider and ask to give you a referral and lastly you can search it yourself by either going to psychology today's website or by simply googling for what you are looking for on google search engine.
Once you are able to narrow it down to a few therapists or providers who fit your needs it will be time to make the call. Most therapists offer a 15 minutes consultation to see if they or you are the right fit. Make sure you ask questions. Some questions to consider- have they worked with an individual with your cultural background, do they have the tools to solve your issues, what is their qualification or credential, what kind of approaches they take to therapy, what is their area of expertise. Most therapists have websites and social media you can look into to learn more about them before you make the call. After a few weeks if you have not noticed any changes it might be time to move on. Make sure you communicate and see if it's something that could be resolved if not it's okay to terminate and find a different therapist. This is about you and your treatment!
There is so much going on in our world. This past year has not been easy, and we still have more to overcome. For some it has been traumatizing or triggering past wounds. Having to experience a traumatic event or having an adverse childhood experience is not a life sentence. With appropriate support and treatment, trauma can be treated so that you can live a healthy and quality life.
References
Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-14884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
Trauma-Informed Care in Behavioral Health Service, Treatment Improvement Protocol (TIP) Series, No. 57, Center for Substance Abuse Treatment (US). Rockville, MD, 2014.
Centers for Disease Control and Prevention, Kaiser Permanente. The ACE Study Survey Data [Unpublished Data]. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2016.
Post-traumatic stress disorder. Mayo clinic. https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967 Accessed May 10, 2021
Trauma signs and symptoms. Center for early childhood mental health consultation. https://www.ecmhc.org/tutorials/trauma/mod3_1.html Accessed May 10, 2021
Esther Giller “what is psychological trauma?” (April 2021) Retrieved from http://theannainstitute.org
Healing childhood trauma in adult. Highland spring clinic. https://highlandspringsclinic.org/blog/healing-childhood-trauma-adults/ Accessed May 9, 2021
Chart retrieved from the University of Buffalo School of Social Work. http://socialwork.buffalo.edu/content/dam/socialwork/social-research/ITTIC/trauma-informed-care-infographic.pdf Accessed May 9, 2021
Jennings A. One page chart on Adverse Childhood Experiences and Health and Well-Being over the Lifespan. (April 2021) Retrieved from http://theannainstitute.org
Lawrence Robinson, Melinda Smith, and Jeanne Segal. “Emotional and psychological trauma.” (February 2020) helpguide.org
If you want to learn more about ACE’s and find resources you can check out CDC’s website
