A tangible equation as road map for working through trauma.
SAMHSA, the substance abuse and mental health service administration, outlined “The 3 E’s” of trauma to be “Events, Experiences, and Effects” in their 2014 publication describing a trauma-informed approach to client care. In 2019, I created a Trauma Impact Equation (TIE) that further explores five key elements to understanding the traumatic impact. It is a tool for clinicians to organize trauma theory and research for more effective treatment of underlying trauma.
The symptoms of trauma can manifest as addictive behaviors, eating disorders, depression, anxiety symptoms, and medical issues from prolonged stress. What brings an individual into therapy or to methods of self-help are often the symptoms. Helping an individual discover the roots of the problem often is the solution to long-term resolution and recovery.
As we expand our understanding of trauma and traumatic impact, we stimulate each individual’s innate ability to heal from trauma. The Trauma Impact Equation is a roadmap to use with any of the various clinical approaches to treating trauma.
In math, we shift the outcome of an equation by increasing or decreasing the value in the denominator. Similarly, the impact of trauma on an individual’s life can shrink by increasing their resilience. Resilience includes everything from enhancing a social support network to integrating therapeutic tools to teaching breathing exercises that stimulate the parasympathetic nervous system.
In the Trauma Impact Equation or TIE, I have placed the resilience factor in the denominator position to make it the factor that minimizes the traumatic impact. Conversely, a deficit or absence of resilience will compound the traumatic impact.
1. The first key is understanding the traumatic impact (TI) is “Severity.” Some clinicians use the concept of small “t” and capital “T” trauma. I have moved away from this description in recent years for reasons described in number two below.
I prefer to explain trauma as existing on a subjective spectrum from mild to more severe traumatic experiences. A hurtful or confusing comment that impacts development is an example of the mild end of the spectrum, and chronic sexual or physical abuse is an example of the severe end of the spectrum. It is important to note that discrimination and stigma, such as weight stigma or gender identification stigma, is trauma. The individual must define the severity, and the clinician must listen and receive the individual’s assessment of trauma severity.
2. The lens for any traumatic event is the Subjective Experience of the individual: i.e., how he/she/they experienced the event and assessed the severity of the event. The mistake clinicians make is assigning severity to the client’s experience, which can create a missed opportunity for reprocessing and desensitizing key events.
We know that with complex trauma, it is sometimes the first and not the worst trauma that has the largest impact. For example, a war veteran who has experienced tragedy in active war zones may be most impacted by a traumatic event in early childhood. If a clinician, who has not experienced war firsthand, assigns their objective assessment to the trauma timeline, the individual’s subjective experience is overlooked.
3. What was the developmental stage in which the trauma occurred? How developed was the individual’s sense of identity? How did it impact their trust? The prefrontal cortex, the slower but more sophisticated center of thought in the brain, isn’t fully developed until age 25 or 26. Trauma that occurs before this age, and especially trauma in the first 6 to 7 years of life, can have a more serious impact on the development of identity and self-esteem, thus influencing the lens through which the individual sees the world.
Is the world a safe place? Are people out to get me? Do bad things happen to good people? Can I trust you… myself… my body? Did I deserve what happened? Individuals can become emotionally frozen in the developmental stage from which the trauma occurred, creating an age-regressed emotional reaction (e.g., anger outburst, tantrum, emotional meltdown, intense fear) when the traumatic memory is triggered in the present day.
4. The evolving field of neuroscience provides us with a great resource for understanding how trauma impacts our nervous system. Trauma rewires our brain circuitry, and we store traumatic impact in the cell memory of our bodies. In traumatic impact, our brains may have difficulty consolidating and storing memories in the hippocampus, and difficulty regulating emotions in the limbic system of the brain.
The amygdala, our brain’s smoke alarm that senses danger, is also rewired in trauma. You can imagine how unnerving it would be to live in a house that had a constantly activated smoke alarm. When our minds and bodies feel under attack in this way, whether real or perceived, the elevated allostatic load creates a nervous system imbalance.
The autonomous nervous system (ANS) is out of balance with an over-activated sympathetic nervous system (SNS) that is ready for fight or flight throughout the day. The prolonged imbalance of our adrenaline and hormone levels, the tension of the muscles, and exhaustive alarming from the amygdala create mental and physical exhaustion and fatigue. When we are out of balance in this way, we are not getting the gifts of the parasympathetic nervous system (PNS), which serves to promote rest, digestion, and cell repair.
Our bodies need downtime, sleep, and meditative practices, like deep breathing, to properly digest our food and to restore damaged cells. In a go, go, go world with unimaginable statistical rates of trauma, we have a society that desperately needs information about transforming underlying traumatic impact, and integrating daily practices to restore parasympathetic balance.
5. Resilience Factor—Traumatic impact, from environmental stress to more severe trauma, leads to disease and disorder in the body, mind, and spirit of the individual. Empowering individuals and enhancing resilience is the key to reducing traumatic impact, which results in symptom reduction, enhanced daily functioning, improved relationships, and better health outcomes. Thus, we return to the denominator, which holds the power to shift the whole equation.
In a strengths-based approach, we explore the individual’s innate resilience that got them through the traumas of their life and highlight their strengths. We also explore resilience factors that can be enhanced via the therapeutic alliance, support system, faith-based community, addressing financial resources, access to health care, community resources, support groups, etc. Additionally, post-traumatic growth (PTG) anchors us in the potential to surpass the pre-traumatic impact level of functioning. During the process of overcoming traumatic impact, one can find gifts in post-traumatic growth, such as deeper meaning and purpose in life, greater empathy for others, deeper capacity for love, and a more meaningful spiritual or religious connection.