Trauma

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What is Trauma?


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. While these feelings are normal, sometimes for a variety of reasons, people have difficulty moving forward and find trauma is stealing their joy. A well trained therapist can help trauma survivors move from surviving to living once again.

In therapy we use the phrase Big 'T' or Little ‘t’ as shorthand to communicate differences between traumatic event. 

When most people think about trauma, they tend to think about those who have been exposed to war, combat, natural disasters, physical or sexual abuse, terrorism, and catastrophic accidents. These are some of the most profound, and some may argue the most debilitating, experiences one can endure. However, a person does not have to undergo an overtly distressing event for it to affect them. An accumulation of smaller “everyday” or less pronounced events can still be traumatic, but in the little 't' form. An example of a big T event is one that most people would consider traumatic, such as a plane crash or sudden and unexpected loss of a loved one. An example of a little t event is one experienced as traumatic at a personal level, such as the loss of a pet or a relationship break-up. From a trauma therapists point of view, anytime a a personal need is not met there is opportunity for a micro trauma. In theory, we have all experienced personal traumas, what determines treatment is the degree to which they are getting in your way. 

Small ‘t’ Trauma

Small ‘t’ traumas are events that exceed our capacity to cope and cause a disruption in emotional functioning. These distressing events are not inherently life or bodily-integrity threatening, but perhaps better described as ego-threatening due to the individual left feeling notable helplessness. Some examples of small ‘t’ traumas include:

  • Conflict with significant others or children

  • Infidelity

  • Divorce

  • Conflict with supervisor/boss or colleagues

  • Abrupt or extended relocation/move

  • Planning a wedding

  • Starting a new job

  • Having or adopting a child

  • Legal trouble

  • Financial worries or difficulty

  • Expensive and unplanned home repairs

Large ‘T’ Trauma

A large-T trauma is distinguished as an extraordinary and significant event that leaves the individual feeling powerless and possessing little control in their environment. Such events could take form as a natural disaster, terrorist attack, sexual assault, combat/war zone, car or plane accident, etc. Helplessness is also a key factor of large ‘T’ traumas, and expectedly the extent of experienced helplessness is far beyond that of a small ‘t’ trauma. Large ‘T’ traumas are more readily identified by the experiencer, as well as those who have any familiarity with their plight.

Avoidance takes a much different form with large ‘T’ traumas. The individual tends to more overtly and decisively engage in actions that are classified as avoidance. They may deliberately avoid phone calls from investigators, bury their military uniform and memorabilia in the attic, or avoid crowded places. Their attempts to minimize distress and reduce reminders of the traumatic event are time and energy-consuming, as opposed to the more passive avoidance that occurs with small ‘t’ traumas. One large ‘T’ trauma is often enough to cause severe distress and interfere with an individual’s daily functioning, and this effect is intensified the longer avoidance behaviors endure and treatment is circumvented.

Symptoms of Trauma


We all react in different ways to trauma, experiencing a wide range of physical and emotional reactions. There is no “right” or “wrong” way to think, feel, or respond, so don’t judge your own reactions or those of other people. Your responses are NORMAL reactions to ABNORMAL events.

Emotional & Psychological Symptoms:

  • Shock, denial, or disbelief

  • Confusion, difficulty concentrating

  • Anger, irritability, mood swings

  • Anxiety and fear

  • Guilt, shame, self-blame

  • Withdrawing from others

  • Feeling sad or hopeless

  • Feeling disconnected or numb

Physical Symptoms:

  • Insomnia or nightmares

  • Fatigue

  • Being startled easily

  • Difficulty concentrating

  • Racing heartbeat

  • Edginess and agitation

  • Aches and pains

  • Muscle tension

The Future is Hopeful


If you have endured multiple small ‘t’ traumas or even one large ‘T’ trauma and are aware of its impact on your life, there is good news. You don’t have to suffer in silence and there are many available treatments that can help. Trauma-focused therapy typically includes evidence-based treatments such as prolonged-exposure and cognitive-processing therapy, as well as EMDR. These are effective (and research-based) treatments that can reduce, if not eliminate, trauma-symptoms and PTSD. 

American Psychological Association Recommended Treatment Approaches for Trauma: 

  • Cognitive Behavioral Therapy

  • Cognitive Processing Therapy

  • EMDR

  • Cognitive Therapy

  • Prolonged Exposure

Conditionally Recommended: 

  • Brief Eclectic Psychotherapy

  • Narrative Exposure Therapy

  • Medications

There is no quick fix or ‘cure; but these therapies are facilitated with the goal of decreasing trauma symptoms, and therefore distress, while simultaneously increasing the client's quality of life. Each treatment is quite different, and includes strategies from recalling and fading the memory of the trauma to addressing and reprocessing memories, thoughts, and beliefs.

When Should I Seek Help for Trauma?


Recovering from trauma takes time, and everyone heals at their own pace. But if months have passed and your symptoms aren’t letting up, it's time to seek professional help from a trauma expert. 

Seek Help If You Are:

  • Having trouble functioning at home or work

  • suffering from fear, anxiety, or depression

  • unable to form close, satisfying relationships

  • experiencing terrifying memories, nightmares, or flashbacks

  • avoiding more and more things that remind you of the trauma

  • feel emotionally numb and disconnected from others

  • using alcohol or drugs to feel better

Working through trauma can be scary, painful, and potentially re-traumatizing, but ultimately rewarding and freeing. This work is best done with the help of an experienced trauma specialist. If you think you may benefit from trauma focused treatment please contact us today to schedule a consultation with one of our trauma specialists. Together you can to determine the right course of treatment for you.  


Source www.apa.org,  www.psychologytoday.com