Welcome to Issue 370 of Institute Inbrief
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Issue 370 // Institute Inbrief
Dear <<First Name>>,

Welcome to Edition 370 of Institute Inbrief. In this edition's featured article we define trauma and investigate its prevalence, impacts and associated risk factors. 

Also in this edition:
  1. AIPC Upskill Micro-Credentials
  2. The Neurobiology of Trauma
  3. Trauma: The Therapeutic Window
  4. Post-Disaster Resilience: Who Survives Better?
  5. Quotations, Seminar Timetables & More!

Enjoy your reading!

Kind regards,



Sandra Poletto
CEO, Australian Institute of Professional Counsellors.
 
Diploma of Counselling
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Understanding Trauma and its Impacts

To understand trauma, we must first consider: what does trauma mean? Nowadays, the term ‘trauma’ is often used loosely to refer to an event or experience that is emotionally upsetting or distressing. For example, you may hear someone discussing a ‘hair trauma’ when they are having a ‘bad hair day’. On the other hand, you may have come across deeply distressing trauma narratives that leave you feeling unsettled for days. You may also have lived experiences of trauma that are too daunting to recall. As our understanding is likely to affect the way we approach and communicate about trauma, it is necessary that we take time to consider what trauma means, to you and to your clients.

Defining Trauma

Defining trauma is not an easy task; the definition of trauma has shifted and expanded over the last centuries. According to the Merriam-Webster dictionary (n.d.), trauma originates from the Greek word for wound, which was used mainly to refer to physical injuries; however, it is now more frequently used to refer to “emotional wounds” that could potentially lead to a range of psychological symptoms. While the first definition of trauma remains in use within the medical field (e.g., ‘head trauma’ can be used to describe injury to skull or brain), the second definition of trauma – as emotional injury – has risen to become the common understanding of trauma in the public as well as the human services field. This article will be exploring trauma from this second perspective.

While we are on the topic, it is worth noting that the word ‘trauma’ has been popularised, and possibly over-used, to indicate almost any kind of unpleasant or stressor experienced by an individual (Haslam, 2016). We need to be aware that people could be labelling many stressful life experiences as trauma or traumatic experiences, which is not necessarily beneficial to their mental health. While both stress and trauma can impact on our wellbeing, there is a need to differentiate traumatic and stressful events: 
 
"When something traumatic happens, it is often overwhelming, and it can be hard to come to terms with what has happened. The experience is likely to be very different from anything you have gone through before. It can mean you question things that you have always thought were true. For example, you might no longer believe that the world is a safe place, that people are generally good, or that you are in control of what happens to you. When people talk about their world being turned upside down after a traumatic event, it might mean these big picture beliefs have been shattered.

It’s important to realise that trauma is very different to other stressful events, like a relationship breakdown or the death of a loved one through natural causes. These events can affect a person’s mental health, but they are not the same as the traumatic events described above. Recognising this difference is important, because the recommended treatments to help people recover from trauma are different to those generally used for mental health problems caused by stressful life events." (Phoenix, 2021)

As described above, traumatic events often involve situations that are life-threatening, overwhelming, and devastating for the person. Comparably, stress is a common reaction to life events and changing circumstances, including potentially traumatic events. An important point to remember is that stress is not necessarily harmful, but trauma nearly always is (Australian Institute of Health and Welfare, 2020). 

Another common term that is mentioned alongside trauma is posttraumatic stress disorder (PTSD). While PTSD is the most popularly discussed trauma-relevant disorder, it is actually not the only one; another one is called acute stress disorder (ASD). However, remember that these are psychological disorders that have specific diagnostic criteria. Even when a client develops post-traumatic symptoms, they may not be meeting the respective diagnostic criteria. More importantly, many people do experience and/or recover from trauma without developing PTSD or symptoms. So, we need to be very mindful when discussing reactions to trauma, posttraumatic stress, and PTSD.

Trauma Definition

In common usage, ‘trauma’ is more often associated with major unexpected incidents that are, or perceived as, threatening to a person. The most recognised examples of traumatic events include natural disasters (e.g., bushfire), war, rape, a serious car accident, or losing a loved one. Such experiences are often described as overwhelming and deeply distressing, from which adverse short- or long-term impacts are commonly experienced. While these traumatic events form an important part of the definition of trauma, helping professionals and service providers need to recognise ‘trauma’ as a more comprehensive concept that encompasses a broad range of adverse experiences and impacts.

A widely cited definition of trauma is one provided by the Substance Abuse and Mental Health Services Administration (SAMHSA), who is the leading agency in the United States on reducing impact of substance abuse and mental illness on communities: 

"Individual trauma results from an event, a series of events or a set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being." (SAMHSA, 2014a, p. 7)
 
Deriving from SAMHSA’s definition above, trauma constitutes of three fundamental components, also referred to as the “3 ‘E’s of trauma” – Events, Experiences and Effects.

Events

This component encompasses single or repeated exposure to traumatic events and circumstances that may involve actual or perceived threat of harm to a person, including when their needs are severely neglected (e.g., child neglect). In addition, source of trauma covers beyond one-off major traumatic events to include circumstances such as, prolonged exposure to domestic and family violence as well as structural violence an individual is subjected to under political, economic or social culture that promotes injustice, inequality and marginalisation (Women’s Health Victoria, 2019). 

Examples of events that may be traumatic include: 
  1. Physical, sexual, and emotional abuse;
  2. Childhood neglect;
  3. Having a family members with a mental health or substance use disorder; 
  4. Violence in the community; 
  5. Natural or human-made disasters and forced displacement; 
  6. Sudden, unexplained separation from a loved one; 
  7. Poverty and discrimination (Center for Health Care Strategies, 2017, p. 1).

As such, when you come across the term ‘traumatic events’, keep in mind that it does encompass single or repeated events, as well as ongoing circumstances that may involve exposure to traumatic events over time.

Experience

Whether an event is traumatic is also partly determined by the individual’s experience of the event. Something that is traumatic to one person may not be perceived the same way by another person. A shared traumatic event (e.g., bushfire; epidemic) is also likely to be a different experience to individuals in the community. Factors that may affect such experience include how individuals interpret their circumstances, their developmental stage, cultural beliefs, availability of resources and support, and the physical and psychological disruptions they experienced (SAMHSA, 2014b). Subsequently, the process of recovery, and what recovery looks like, will also vary depending on the individual.

Effects

The third critical component of trauma is the adverse effects resulting from the event/s. These effects may be short- or long-term; may take place immediately after the event or later in life (i.e., delayed onset); and can manifest in all dimensions of a person’s wellbeing including physical, emotional, cognitive, behavioural, social, and spiritual. 

"Traumas can affect individuals, families, groups, communities, specific cultures, and generations. It generally overwhelms an individual’s or community’s resources to cope, and it often ignites the “fight, flight, or freeze” reaction at the time of the event(s). It frequently produces a sense of fear, vulnerability, and helplessness." (SAMHSA, 2014b, p. 7)

Prevalence of Trauma

Apart from its definition, a key shift in current understanding of trauma is that trauma is almost an universal experience. This is the fundamental idea that gives rise to the trauma-informed care perspective. 

It may have been commonly thought that trauma is “an abnormal experience” that occurs only to a minor group of unfortunate people in our society (SAMHSA, 2014b, p.8). Nonetheless, the numbers suggest quite the opposite. In an international survey study conducted across twenty-four countries (including Australia), with a sample of 68, 894 adults, the researchers found that over two-thirds of the respondents reported at least one traumatic event (Benjet et al., 2016). Additionally, about one-third of the respondents in the study have been exposed to four or more traumatic events in their lifetime. This is in line with the following snapshot of Australia’s health, which also indicates that trauma is a common part of human experience in Australia. 

Based on these statistics, it is reasonable to assume that majority of Australians would have experienced at least one traumatic event in their lives. What does this actually mean? Imagine that in every four people you know, three of them would be able to recite one or more life events which would have been overwhelming for them to live through, and there are likely consequences from which they are still actively coping with. It is also possible that they had been affected by one of these three most common traumatic events experienced by Australians (Phoenix, 2019, cited by AIHW, 2020): 
  1. A person they are close to had died unexpectedly. 
  2. They were a witness to someone being badly injured or killed, or had an unexpected encounter with a dead body.
  3. They had been involved in a serious car accident.

This does not mean that these people are all living a miserable life; some might, though many others would have ‘recovered’ or developed various strategies to cope with the situations and effects. You may even know a few stories of trauma recovery and growth that are of great resilience and inspiration. Trauma may be common, but it is important to remember that recovery is not impossible.

Although trauma does not discriminate and can happen to anyone regardless of their age, developmental status, cultural background, or socioeconomic status, some members in our society are, regrettably, prone to experiencing trauma due to higher exposure to violence or risky situations. 
Who Are at Risk of Trauma Exposure?

Perhaps unsurprisingly, people who are living in broader contexts of isolation and disadvantages are at higher risk of “being victimised, abused, marginalised, excluded, and/or experiencing unsafe situations”, which makes them more vulnerable to potentially traumatic experiences (Orygen, 2020). This includes, but are not limited to:
  1. People with disabilities.
  2. Homeless persons.
  3. Young people in out-of-home care or under youth justice supervision. 
  4. Refugees and asylum seekers.
  5. Culturally and linguistically diverse minorities.
  6. Women and children experiencing family and domestic violence. 
  7. LGBTIQ+ community. 
  8. Aboriginal and Torres Strait Islander people who are being impacted by historical and current trauma. (AIHW, 2020; Bateman et al., 2013; Orygen, 2018).

In addition, Wall, Higgins, and Hunter (2016) suggest a strong need for AOD and mental health services to develop an understanding of trauma, particularly those arising from interpersonal violence, even when the services are not specifically set out to deliver treatments for trauma-relevant disorders. 

It is important to remember that, despite its common and overwhelming nature, most people do recover from trauma. By supporting clients in a sensitive and trauma-informed way, you can play a part in guiding clients on their paths of recovery.

On the other hand, we must not forget that people who work in trauma-relevant occupations, such as emergency services, armed forces, mental health services, are also prone to trauma exposure due to the nature of work environment. The occupational risk resulting from indirect exposure to trauma is known as vicarious traumatisation. This suggests that learning about trauma and relevant concepts is also immensely beneficial for those in the helping profession in managing occupational risk and maintaining wellbeing.

Editor’s Note: This is an excerpt from the unit Work Effectively in Trauma Informed Care in AIPC’s Diploma of Alcohol and Other Drugs. We also have a unit on implementing trauma informed care in the Diploma of Mental Health.  

References:
  1. Australian Institute of Health and Welfare. (2020). Stress and trauma. From website.
  2. Bateman, J., Henderson, C., & Kezelman, C. (2013). Trauma-informed care and practice: Towards a cultural shift in policy reform across mental health and human services in Australia, a National Strategic Direction. Mental Health Coordinating Council (MHCC). 
  3. Benjet, et al. (2016). The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium. Psychology Medicine, 46(2), 327-343. https://doi.org.au/10.1017/S0033291715001981 
  4. Center for Health Care Strategies. (2017). Understanding the effects of trauma on health. Retrieved from website. 
  5. Haslam, N. (2016, August 15). The problem with describing every misfortune as ‘trauma’. Chicago Tribute. From website. 
  6. Merriam-Webster. (n.d.). Trauma. In Merriam-Webster.com dictionary. Retrieved January 24, 2021, from website.
  7. Orygen. (2018). Trauma and mental health in young people: Let’s get the facts straight. Retrieved from website. 
  8. Phoenix Australia. (2021). What are traumatic events? From website. 
  9. Substance Abuse and Mental Health Services Administration (SAMHSA, 2014a). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. Substance Abuse and Mental Health Services Administration. From website.
  10. Substance Abuse and Mental Health Services Administration. (2014b).  A treatment improvement protocol: Trauma-informed care in behavioral health services TIP 57. From website.
  11. Wall, L., Higgins, D., & Hunter, C. (2016). Trauma-informed care in child/family welfare services. From website.
  12. Women’s Health Victoria. (2019). Spotlight on trauma-informed practice and women. From website. 
The Neurobiology of Trauma

This article focuses on the neurobiological side of things i.e., what happens to the brain during the course of trauma.

READ MORE 
Trauma: The Therapeutic Window

Early models for treating trauma asked clients to talk about their traumatic experiences. However, research suggested that while some people were helped by going over the trauma again with a counsellor or other “de-briefer”, many others’ trauma symptoms were exacerbated by the insistence on going over the event.

READ MORE 

More articles: www.aipc.net.au/articles
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