By Dr. Allison Kawa
In an ideal world, all of us would go through life feeling safe and secure because nothing too bad has ever happened to us. Sure, a bit of adversity and challenge is needed in order to develop grit, but sometimes, events or circumstances in our lives are so profound that they literally change the architecture and therefore the functioning of our brain. We often refer to these events as trauma. Most people are familiar with the notion of “Big T” trauma: an acute event that profoundly compromises a person’s safety and well-being. This includes things like a plane crash or natural disasters. Since we have an awareness of acute trauma as a construct, we typically know to expect fallout from it and will often put supports into place to help the victim cope.
What people have less knowledge of is “Little T” trauma: distressing events that can occur over time or in combination with each other that compromise a person’s safety and well-being. There are a number of different Little T traumas, which we will get to in a moment. First, let’s think a bit about how our brains and bodies detect and experience danger.
Your Internal Traffic Lights
We have a whole branch of our nervous system, called the Autonomic Nervous System or ANS, that is designed just to keep us alive. It works instantaneously and behind-the-scenes to scan for signs of safety or danger in the environment. You know that gut-instinct that a person is either charming or creepy that you get within seconds of meeting them? That is your amazing ANS at work, alerting you to your surroundings. Depending on what your ANS is registering, your sensory experiences are altered. Your sense of smell, taste, vision, and hearing will all be fine-tuned based on your ANS state.
There are three ANS states that represent your internal traffic lights. When you are in the “green zone,” you feel safe and secure in your environment. A body in the green zone has a slow heart rate and is busy digesting food. Muscles in the middle ear are activated, helping you to pick up human voices so that you can take advantage of social opportunities. Similarly, you are more likely to make eye contact with others, and to interpret direct eye contact as a friendly gesture. The prosody of your voice is animated and the range of your facial expressions is wide. In short, you are open for the business of connecting with others. The green zone is also the place to be for learning, critical thinking, creativity, and productivity.
Your traffic light switches to the “yellow zone” when your ANS senses danger. Your brain and body prepare for fight-or-flight. Your heart rate elevates, your pain tolerance increases, your affect gets serious, and your breathing quickens. Those middle-ear muscles deactivate so that your hearing is more attuned to extreme high and low frequency sounds- the so-called predator sounds. You are more likely to interpret direct eye contact as threatening, and your body language is likely to be defensive and closed. A person in the yellow zone is in a very favorable position to run from or fight against something dangerous. This is an incredibly useful position, such as if you see a snake on the hiking trail or if the car in front of you stops short. The yellow zone body and brain will keep you alive and safe.
The “red zone” is reserved for those (hopefully) extremely rare times when you sense that the level of danger is so high that you might die. When our lives are threatened, we freeze, shut down, and dissociate. This is a very primitive response not unlike the proverbial possum who pretends to be dead when threatened. Dissociation or “mentally checking out” is a common red zone response, especially for children. In the red zone, the ability to connect with others and the capacity for critical thinking is completely offline.
Your ANS chooses your zone depending on your surroundings; it is not something that you can consciously choose because it is neurological. Moreover, we mirror the ANS of those around us; this is very helpful for pack animals because we can benefit from someone else’s quick detection that danger is coming. Healthy people can shift between the green zone and the yellow zone with good flexibility. We need the instinct to move away from the snake on the hiking trail, but then we want to calm down and enjoy the rest of the hike. Unfortunately, both Big T trauma and Little T trauma can recalibrate our ANS.
Trauma Lurks In All Sorts of Places
In working with families through the years, it seems to me that Big T Trauma is on people’s radar. People will make mention of a bad car accident or a home being destroyed in an earthquake. What may not be as readily apparent are the complex traumas and pre-verbal traumas that children sustain. Issues within the family can constitute complex trauma, such as death or life-threatening illness of a family member, severe psychiatric or behavioral issues, substance abuse, emotional abuse and neglect, or extremely acrimonious divorce. Medical trauma is another important yet often overlooked issue. Children who have required numerous or painful surgeries and medical treatments often show signs of trauma, as do children coping with chronic or life-threatening illnesses. Many children with anaphylactic food allergies have some degree of medical trauma; imagine being four-years-old and being rushed to the emergency room after eating a cookie with nuts in it. Finally, pre-verbal trauma is trauma that occurs in the first two years of life or so. This is a special form of trauma because the child has no episodic memory of the events. Rather, they re-experience their trauma when it is triggered as confusing sensations and emotions that are impossible to explain or organize with words.
For numerous people, their life experiences fall into more than one of these categories. An infant born very prematurely and requiring significant medical care in the NICU who then goes home to parents who have been traumatized by the unexpected, near-loss of a beloved child is one example. This baby has pre-verbal medical trauma and complex trauma all at the same time. Yet, there is often little recognition and few psychosocial supports in place for the family who has collectively sustained a pretty significant trauma.
Life in the Danger Zone
When a person experiences any kind of trauma, there are physiological changes in the brain. The threshold for safety signals increases, meaning that it is neurologically harder to feel safe. Simply telling a person that they are safe and to stop worrying isn’t helpful because the experience of safety isn’t a choice they can make. Our bodies already have a bias toward interpreting vague cues as being dangerous because it helps to keep us alive. When we are faced with significant and/or chronic threats, we become that much more likely to experience neutral or ambiguous events as dangerous. Over time, this results in anxiety because we are running everyday scenarios through pathways that are normally reserved for emergency situations.
Children who are exposed to trauma in their early years can experience disruption in normal neurological development. As we talked about above, these kids show abnormal responses to threat and are highly sensitized to any perceived danger. Moreover, children who experience trauma at home are re-calibrated in a way that makes it harder than usual for them to feel safe. Trauma in the context of intimate relationships, such as the parent-child one, are especially damaging. Complex trauma is associated with neurological changes including problems with attention, executive functioning, working memory, processing speed, sensory processing, learning, and emotional regulation. Any or all of these areas can be impacted, and we are not yet at a place where we can predict who will experience which challenges and to what degree.
Living with the fallout of trauma can be confusing for everyone close to the victim. Remember the red zone response of dissociation? A threatened person’s conscious awareness may go offline, but their body continues to release stress hormones that result in the body feeling activated (e.g., fast heartrate, muscle tension, quick breathing). What this feels like is that you’re restless, keyed up, and unable to relax but you have no idea why. You might have trouble sleeping or you might have mood swings. You might misinterpret interpersonal cues and feel antagonized or threatened by simple requests or benign comments. Emotionally, you might feel lost, overwhelmed, abandoned, disconnected from yourself and the world, unloved, empty, and hopeless.
As we learn more about trauma, the way we describe individuals who have chronic difficulty coping with the fallout of their experiences. Developmental Trauma Disorder is a diagnosis that is currently being researched as a more developmentally sensitive and accurate way of capturing the symptoms observed in traumatized children than Post-Traumatic Stress Disorder (PTSD). Developmental Trauma Disorder is characterized by repeated dysregulation in response to trauma cues that can include problems with mood, somatic difficulties, behavioral issues, cognitive distortions (e.g., confusion, dissociation, depersonalization, etc.), relational difficulties, and self-attribution. The net result is that the child’s attributions and expectancies are distorted such that she comes to distrust others, blame herself, or feel that future victimization is inevitable.
The Collective Trauma of the COVID-19 Pandemic
We are all embroiled in a once-in-a-lifetime experience that has been traumatic to many. Constant anxiety associated with the COVID-19 pandemic has produced layer upon layer of stress and worry ranging from very real threats to our lives to financial devastation to unhealthy social isolation. Increasingly, there is a pervasive fear that we will never get back to “normal,” which is fostering hopelessness, frustration, and anger. Prolonged activation of fight-or-flight is becoming a universal experience; we are all going through this trauma together and yet we feel so alone and isolated. It is not hyperbole to think of this pandemic as a complex trauma, and children and adolescents are at high risk for the types of developmental disruption and neurological reorganization that we know occurs with it.
Can We Get Back to Safety?
One of the benefits of deepening our understanding of trauma and its long-term consequences is that we can begin to find ways to promote healing. The brain is an incredibly flexible organ that can and will rewire under the right conditions. The first step is to understand a person’s experience in the world and how it has altered their physiological and neurological functioning. Then, we implement treatments to help get as close to possible to baseline functioning. This might include trauma-specific therapies such as EMDR, brainspotting, trauma-informed CBT, or sensorimotor psychotherapy. Occupational therapy, neurofeedback, yoga, and other types of bodywork can also be helpful. It is important that the treatment plan is highly individualized so that the victim is not re-traumatized over the course of therapy; working with trauma-informed providers is essential. But there is hope! Repairing trauma is not unlike Kintsugi, the Japanese art of mending broken pottery pieces with gold. At the end of the process, the reconstructed piece is stronger and more beautiful than before.
For more information about childhood trauma and its treatment, the National Child Traumatic Stress Network is a great resource and can be accessed at https://www.nctsn.org. For information about trauma in general (and pertaining to adults), The International Society for Traumatic Stress Studies has a very informative website https://istss.org/home.