Section 2: Trauma and the trauma-informed principles

In this section, we will define trauma and its different types, and how it can impact on relationships. We will examine the significance of different trauma responses and the concept of our window of tolerance. You will also learn about trauma-informed principles and how to apply them in everyday interactions.

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What comes to mind when you think of the word ‘trauma’?

Unfortunately, we come across so many incorrect notions of trauma through the media when in effect it is as follows:

You may find it helpful to look back at the origins of the word since ‘trauma’ is the Greek word for ‘wound’. Therefore, rather than referring to trauma simply to describe an event or series of events, we can refer to trauma more accurately as the wound or wounds that the event creates.

These wounds can be short-term, or long-term, but crucially many who have experienced trauma highlight difficulties in finding the safety and trust in others which might then help them begin to heal the scars left behind from traumatic experiences they have encountered.

The three Es of trauma is a framework (SAMHSA, 2014) which we can use to understand the impact of traumatic events on individuals.

If we look at the current picture highlighting the number of people in the UK experiencing a range of traumatic events, we find the following four pieces of information.

Click on each number to learn more.

It is important to note that not all ACEs will be experienced as trauma.

Trauma can be something which happens to oneself (direct), or it can be witnessed as something happening to another person (indirect). It may have occurred recently or happened in the distant past.

Trauma types can be described as the following:

• Type 1 trauma – one off, unexpected incidents and events.
• Type 2 or complex trauma – those which are repeated. Complex trauma is sometimes referred to as relational or developmental trauma and this occurs due to negative interpersonal experiences in relationships which should have been protective.
• Vicarious trauma – describes the indirect trauma that can occur when exposed to traumatic images and stories second-hand. This is often experienced by those in helping professions as they are regularly exposed to the trauma experienced by others.
• Collective trauma – refers to the psychological impact experienced by a group of people who have undergone a shared traumatic event or series of events. Unlike individual trauma, which affects a single person, collective trauma impacts entire communities, societies, or nations. This type of trauma can result from natural disasters, wars, genocides, terrorism, pandemics, or other catastrophic events that affect large groups of people simultaneously.

The diagram below shows different types of trauma experiences.

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Type 1 Trauma examples. Car accident. Natural disaster. Physical and sexual assault. Violent crime. Traumatic loss of a loved one or close person. Surgery. School violence. Type 2 Trauma examples. Physical abuse. Emotional abuse. Sexual abuse. Neglect. Domestic abuse. Attachment trauma. Bullying. Religious trauma. Poverty. Vicarious Trauma examples. Police officers. Firefighters. Doctors and nurses. Social workers. Anybody supporting a person who has experienced trauma. Collective Trauma examples. Race-based trauma. Refugee trauma. War and acts of terrorism. Genocide and mass violence. Forced displacement. Natural disaster. Pandemics.

While many people go through stressful and traumatic events without lasting effects, others may face ongoing difficulties. The reactions and responses to trauma are highly individual and subjective – an event that one person finds stressful might be experienced as traumatic by another.

Single, one-off traumas can cause short-term difficulties, depending on the incident's severity.

However, recurring trauma – referred to as type 2, complex, relational, or developmental trauma – is more likely to have significant and enduring long-term effects, impacting a person's ability to manage even everyday tasks and activities.

The following diagram shows different reactions and responses to trauma.

Physical

Aches and pains, tiredness, shaking, sweating, dizziness, headaches, disrupted appetite, memory difficulties, panic attacks, sleep problems, fatigue, increase in medical problems.

Emotional

Anger, numbness, scared, worried, irritable, confused, restless, shock, shame, self-blame, grief, overwhelm, anxious, loneliness, depressed mood, denial, concentration difficulty.

Behavioural

Self-neglect, sleep problems, panic attacks, flashbacks, intrusive thoughts, suicidal feelings, alcohol and substance misuse, resisting change, protective of personal space.

Relational

Difficulty trusting others, fear of intimacy, social isolation, attachment difficulties.

The body's response to fear is automatic and instinctive. When the brain detects a frightening experience, it sends signals throughout the body’s nervous system, triggering various physiological changes to protect us from harm.

There are five common reactions which have been identified through the cumulative work of psychologists, therapists and physiologists over the course of decades (Cannon, 1915; Levine, 1997; Walker, 2013; Van der Kolk, 2014).

These are: fight, flight, freeze, friend, and flop and are shown in the following diagram.

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A table of information. Fight. Description. The fight response involves confronting and attempting to overcome the threat. Physiological responses. Increased adrenaline, heightened alertness, muscle tension and readiness to engage in physical combat. Behavioural signs. Aggression, assertiveness, anger and defensive actions both verbally and physically. Flight. Description. The flight response involves escaping from the threat to ensure safety. Physiological responses. Surge of adrenaline, increased heart rate, rapid breathing and mobilisation of energy to run or move quickly. Behavioural signs. Avoidance, running away, withdrawing from the situation or finding a safe space. Freeze. Description. The freeze response involves becoming immobile or 'playing dead' in the face of threat. Physiological responses. Decreased heart rate, muscle stiffness and temporary paralysis. Behavioural signs. Inability to move or speak, feeling stuck, still and silent and becoming unresponsive to stimuli. Friend. Description. The friend response involves appeasing or pleasing the threat to avoid conflict and ensure safety. Physiological responses. Activation of social engagement systems, reduced fear response. Behavioural signs. People please, compliance, excessive helpfulness and prioritising other people needs over one's own. Flop. Description. The flop response involves becoming completely passive (flop) in the face of danger. Physiological responses. Can involve a state of dissociation (flop). Behavioural signs. Flop, collapse, submission and a sense of helplessness.

To illustrate how the nervous system works in influencing the ways we respond to frightening experiences, consider each of the following two scenarios.

You may wonder why people react to fear and threats with the five F responses.

It is important to understand that these reactions are not a matter of choice – they usually stem from past trauma and the ways in which the individual has responded to similar events experienced.

This can result in complex trauma or post-traumatic stress, causing the five F responses to recur as the nervous system becomes formed and ready to be activated.

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(Siegel, 1999)

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An infographic. Window of tolerance. Optimal zone for communication and connection. Regulated. Can access both reason and emotion. Open and empathic. Patience. Can tolerate difficult emotions. Above the Window of tolerance is Hyper-arousal. Fight/flight. Anxiety/panic. Anger. Defensive. Pursue or walk away. Below the Window of tolerance is Hypo-arousal. Freeze. Depression. Shut down, withdraw. Numb, flat effect. Hopeless/give up.

The window of tolerance was developed by Dan Siegel M.D. (1999) who is a renowned American psychiatrist. According to this concept, we each have an optimal zone in which we can function well and cope with stress without feeling overwhelmed. Within the optimal zone, daily tasks and life are easier to manage because stress and emotions can be dealt with effectively.

Everybody has a unique window of tolerance which is shaped by a combination of factors including genetics, life experiences, attachments, social support, and past trauma. Some people can experience high levels of emotional intensity without becoming overwhelmed. Somebody like this could be said to have a wide window of tolerance.

On the other hand, somebody with a narrow or disrupted window of tolerance is less likely to be able to tolerate difficult emotions, resulting in possible upset or withdrawal. Over time, sometimes even daily, the size of our windows can change but overall, the wider our window, the less opportunity for our tolerance to be pushed outside.

The following video animation, The River of Life and the Tale of Two Lands (Farrell, 2018), provides an illustration of how the window of tolerance works.

When pushed outside of the window, a physical imbalance occurs. Two opposing states then emerge, these are ‘hyper-arousal’ and ‘hypo-arousal’, as shown in the model below.

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(Siegel, 1999)

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An arrow pointing upwards. Hyper-arousal: Just as it sounds – hyper, lots of energy. This response is characterised by excessive emotion and energy and is a fight or flight response. It can be difficult to relax, sleep, concentrate and manage emotions. Symptoms include panic, fear, anxiety, anger and agitation. An arrow pointing downwards. Hypo-arousal: This response is the opposite of hyper-arousal and is a freeze or friend response. This response is characterised by shutting down, withdrawing and isolating where emotionally there are feelings of flatness and disconnect. Symptoms include depression, numbness, isolation, shame and hopelessness.

It is important for us all to recognise others' window of tolerance so that we can help them stay within what feels safe and comfortable or get back into their window if they have been pushed out. Knowing your own window of tolerance will also help you to understand when you are feeling overwhelmed, so you can take steps to work more effectively with your own emotions and regain a more balanced state.

The nervous systems of children are more easily influenced than those of adults, as they are still in the process of developing.

As a result, even being in an environment where there is tension, or being left to manage difficult feelings alone, can trigger the range of five F responses. We need to be aware that this type of activation of the nervous system is a helpful and natural survival response to manage physical, mental and emotional overwhelm.

However, when certain ways of coping become habitual and continued, even when there is no ongoing threat, they can be unhelpful, especially as learned coping mechanisms as a child can impact on our ways of coping throughout our lives.

In the interactive table below are eight examples of how children affected by trauma may respond.

Click on each number to learn more.

The following video (Freud, 2020) explains how trauma can affect children and the way that they might respond in different situations.

Now that we have begun to look at trauma and the different responses individuals may have in relation to traumatic experiences, we can see how important it is for all of us, particularly when interacting with children and young people, to have a keen sense of how our own reactions might have a further and hopefully more positive impact.

To be trauma-informed, means to be aware of the impact that trauma might have on people, being able to identify it and respond in a reciprocal way that is supportive of another person’s strengths.

There are five trauma-informed principles which reflect the original definition developed by the United States Substance Abuse and Mental Health Service Administration (SAMHSA, 2011 and 2014). The more you become familiar with them, the easier it will be to think about whether you are using them in everyday interactions, connections and relationships.

The following model illustrates the five trauma-informed principles.

Click on each circle below to learn more.

Let us now consider good approaches in professional practice which include the five trauma-informed principles when interacting with children and young people and which also help develop positive conditions for more effective communication.

In the following video (NHS Education for Scotland, 2019), see if you can identify where trauma-informed principles have been adopted.

Consider examples of supportive environments, fostering trust, promoting collaboration and empowering individuals based on their strengths and experiences.

In this section you have learned about trauma and in particular:

• How we might define and describe trauma, including distinct types of traumas, and the range of both short-term and long-term impacts it can have.
• How to recognise the symptoms and effects of trauma in different contexts.
• The five trauma responses and the window of tolerance.
• The five trauma-informed principles and what it means to be trauma-informed.