Four things that can be confusing about trauma

These four things include:

Burn-out,

Vicarious Trauma,

Post Traumatic Symptoms (PTS), and

Post Traumatic Disorder (PTSD).

Given that trauma responses encourage a lot of people into therapy,  I wanted to comment on this subject. In December 2021 I had an opportunity to hear Bessel van der Kolk talk on post-trauma treatment for two whole days.  This was quite a feat given that he did the training entirely on his own (with only a host to his 2 day x 8 hours presentation).  There was a lot to learn in that time.

Fortunately, on my website, I have only to whittle down his words to focus attention on small, safe experiments; a topic he touched on a few occasions.

This page sets out to make a distinction between ‘burn-out’, vicarious trauma, post-trauma symptoms and the ‘label’ of PTSD. The latter is a label designed by committees for manuals such as the Diagnostic and Statistical Manual (DSM) and the International Classification of Diseases (ICD).

These four terms invite different responses:

  • the first and second can benefit from small, safe experiments.
  • the third may respond to safe experiments, but ones best negotiated with an informed and suitably-qualified person.
  • the fourth, a label, requires help from people with specific training.  The label helps you get treatment, often paid for by the state or an insurance company.

So, to begin: can I put ‘burnout’ in its place. It can be important not to confuse ‘burnout’ with either vicarious trauma or PTS symptoms. “Burnout” is concerned with your own state of physical and emotional exhaustion.  True, there are common symptoms between burnout and trauma symptoms,  but the key feature of burnout is that it is a long-term stress response, usually specifically work-related.  Burnout can arise when your work is physically or emotionally draining role over a long time. For the record, typical common signs of burnout are when you feel

  • tired or drained most of the time
  • helpless, trapped and/or defeated
  • detached/alone in the world
  • you are taking longer to get things done
  • overwhelmed, and/or possessing
  • a cynical/negative outlook
  • a pervading self-doubt

Small, safe experiments for these signs of burn-out are contained throughout this website and there is a list of pages you can visit further down this page.

Now I want to mention ‘vicarious trauma’. This is a feature I mention to folk from time to time.  It manifests in its own sub-set of symptoms.

It is an emotional residue from exposure to other peoples’ traumatic experiences. It is commonly observed in the professions – health, teaching, therapy and social services as well as the emergency and legal services.  When professionals work with people, they see traumatic events and may go on to hear stories, time and time again. They can become witnesses to pain, fear, and terror and it can become difficult to make sense of it all.

Members of the public are not immune from this, especially if persistently exposed to neglect or observing regular abuse within their own family and community. Common features of vacarious trauma include:

  • lingering feelings of anger, rage and sadness about the fate of another person.
  • becoming overly-involved emotionally with the other.
  • experiencing bystander guilt, shame and feelings of self-doubt.
  • being preoccupied with thoughts of others outside the work situation.
  • this can lead to over-identification with those others and developing a wish to have done more for them.
  • visible loss of hope from a previous time, alongside growing pessimism or cynicism.
  • difficulty in maintaining professional boundaries with others; e.g.  overextending ourselves and trying to do more than is required.

This build up of self-protective cynicism is observed in several professional settings.
a tendency to distance self from others along with feelings of numbness, detachment and staying busy. At the other end, we may avoid listening to stories of traumatic experiences.

Note the italics as this highlights that ‘vicarious‘ means doing it on behalf of another. The British Medical Association has something useful to say on this subject.

True, such signs and symptoms could indicate a treatable response. Indeed, if after a month or two of just noticing such responses,  and if they persist, seeking treatment might be appropriate. Please do not the ‘label’ these responses; simply consider what to do about them? 

I want to move on now to trauma symptoms. It’s a brief comment as you can do your own research into this large topic. My own focus, here,  is on do-able things, in the face of some symptoms. As before, I will suggest a cautious approach;  if in doubt, seek out professional help. I make this point lest any reader thinks that their lived experience will provide them with enough resources to see you through. That experience might be enough. Indeed, for a large minority of people involved in a single incident, nature has a way to get you through shock and distress in just a few weeks, if all goes well. Even so, do you want to take that risk? There is a lot about post-trauma healing that is not common sense!

Let’s consider what happens during a traumatic incident. Something can get changed, and we can feel ‘stuck’. This uncomfortable experience seems to arise from our ‘wiring’ that is, our built-in neurological defence systems. What are the symptoms that can arise?

Post traumatic symptoms;  typically include: avoidance, intrusive memories, changes in emotional reactions, and negative changes in thinking and mood.

Other symptoms include nightmares, involuntary flashbacks to an event, jumpiness (literally “jumping out of one’s skin”) and emotional detachment.

Other things include:  noticing unwanted repetitive and distressing images or sensations; as well as physical sensations, such as pain, sweating, feeling sick or trembling. Note how these symptoms tell you something about the workings of our Vagus nerve.

Some people report specific and persistent negative thoughts about themselves, other people or the experience in which they were immersed. For example, they may ask why the event happened to them, and if they could have done more to stop it. Such thoughts can promote feelings of guilt or shame.

All these symptoms can come and go and vary in intensity.

What kind of actions can be shaped into a small, safe experiment?

Acting OUT and Acting IN

Approaching Anxieties

Controlled Breathing and Relaxation

How do you use neuro-science in small, safe experiments?

Here are a few other specific suggestions you could develop.

A THREE PART EXPERIMENT: if you are tempted to miss some parts out,  then please leave this experiment to one side. On this occasion, it is important to complete each part.

PART ONE: Go back and consider the experience of the impala. Notice his actions in response to the major change of being grasped by a leopard.  Then consider this page with its account of the changes forced on us as human beings.

After that, take a look at mother and baby at the very top of this page.  How we can get from that first state of immobilisation to the second state when you see the impala move on. Please make a note of your own reactions to the material and, indeed, my explanation that follows:

Mammals nurture their off-spring. Pup rats lie on top of each other, and their mother; the pups appear to feel safe. I am told that interrupting these day-to-day caring acts means that opioid receptors in the anterior cingulate do not develop so well. Neuro-scientists and doctors, people like Stephen Porges and Bessel van der Kolk, suggest it is likely that the opioid receptors give you and me a sense of safety, calm and connection. If we do not get held and nurtured, then certain parts of your brain can become under-developed. In time, we struggle with intimacy and feeling close.  Some of this ‘under-development’ – at critical times in our lives – can have a semi-permanent impact (if not a permanent impact).  In some ways, this ‘explains’ the deterministic view of child development followed by Freud and his later follows such as John Bowlby.  If you are sharp-eyed, you will observe that I make some points that contradict this view when discussing cycles of change,  It may help to keep on researching. For instance, there is another video to demonstrate how these attachment mechanisms work in the real world.  Here is an example on YouTube. It is not easy to watch. The actions demonstrated there, when oft repeated, can manifest in attachment trauma.

PART TWO: Does thinking about this lead you to a personal example for a moment? Can you select an experience that is ‘right’ for you, at this time?  Choose carefully and recall a time when you were upset. We all feel that sometime. Recall, also, a time when you had a partner, or a friend to talk with, or feel close to you. Did you feel better after the talk, and that ‘connection’?  Most of us can feel that difference, but consider what happens if, for whatever reason, I do not have a ‘map’ of what it is like to feel immobilised-without-fear from my early years?  Then kindness and closeness may not be a trigger that ‘works’ to make me better. Indeed, for some, such responses can trigger even more vigorous efforts to pull away.

CONCLUSION: What this caring process is called is being ‘in sync’ with each other. van der Kolk places much emphasis on promoting change – not through words,  but through actions – dancing, running, giggling and pretty well any non-threatening movement. He says “the core of trauma and abuse and neglect is that you are not in sync with people and if you have a parent that beats you up on a regular basis [then] you are a kid; somebody is threatening and you start crying”

The  unlikely ‘positive’ from this unhappy scenario, from my point of view, is that van der Kolk goes on to recommend that we learn from our failures. My readers known that I prefer the term small defeat. Which ever way you view it, I can learn well (maybe, better?) from things that go wrong.  This is possible if I ‘just notice’ when I stop protecting myself, or others, on auto-pilot.  If I can seek out even a little something different that may be in my reach, now, then I may find relationships and opportunities in adulthood bring me more options. That includes a growing confidence in my ability not to feel shamed and unconfident because it is difficult to do this.  This is helped by any safe experiment built around self-compassion.  Experimenting, as I say elsewhere, is not a new strategy in therapy, especially in the world of body psychotherapy and psycho-drama where much emphasis is placed on actions, whether movement, dance or play. I  share Bessel’s sceptical stance on ‘models’ even though he values EMDR as a treatment for trauma. I think he’d be impressed by Mark Brayne’s work integrating EMDR with traditional Attachment theory and ‘parts’ work.

Just before I leave this page, can I return to the diagnosis of post-trauma disorder (PTSD)?

I have a diagram to offer you now. It may well explain my interest in attending to symptoms, rather than labels. Labels come easy and they can be difficult to remove. That said, the diagram, below, take from the work of Anke Ehlers & David Clark (2000) Cognitive Behavioral Model Of Post-Traumatic Stress Disorder (PTSD). Their text has a lot to say about the nature of PTSD. It can throw some light on potential experiment – for folk interested in illustrations and diagrams. What would be possible for you, tomorrow, if not today?

If that’s not you, then do feel free to finish with this page.

This image has an empty alt attribute; its file name is Ehlers-and-Clark-on-PTSD-252x300.jpg

For all readers who have struggled through to this point, I want to end with an enigmatic small, safe experiment.

Please read John Roedel’s poem, and

….. then sit the examination I have set for you!

Only kidding; it’s supposed to be a fun thing.

If some of this material puzzles you, then do follow the leads and find practical ways of working out what your lungs can do for you!div>

So what can you, the reader, do to make a small difference when just noticing any such symptom that is uncomfortable?

Whatever causes discomfort deserves attention. This is the focus of the rest of this page.  You can revise what might make up a small, safe experiment and examine some pages that may get you acting a little bit different. do these pages offer anything relevant?

Return to:

Welcome

What is a nudge

A route you may find interesting

A list of possible safe experiments

Designing a safe experiment

Obstacles to safe experiments

What kind of actions can be shaped into a small, safe experiment?

Acting OUT and Acting IN

Approaching Anxieties

Controlled Breathing and Relaxation

How do you use neuro-science in small, safe experiments?

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