Trauma-Informed Therapy for Healing Traumatic Stress

Trauma-focused therapy aims to help individuals who have experienced traumatic events. A trauma-focused approach to mental health care embraces an understanding of the emotional, neurological, psychological, social, and biological effects of trauma. Trauma-informed therapists help promote healing by providing mental health services and treatment based on each individual's trauma history.

What is trauma?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines trauma as “exposure to actual or threatened events involving death, serious injury, or sexual violation in one (or more) of the following ways:

• Directly experiencing the traumatic events.
• Witnessing the traumatic events in person as they occur to others (i.e., secondary trauma)
• Experiencing repeated or extreme exposure to adverse details of the traumatic events.

Trauma can come about after someone experiences physical, emotional, or psychological danger or harm. Even being close to or witnessing these sorts of traumatic experiences can lead to the development of trauma and related mental health responses.

• Childhood neglect
• Sudden separation from a loved one
• Natural disasters
• Accidents
• Assault
• Poverty and food insecurity
• Violence in one's community
• Living with someone who experiences unmanaged substance use and/or mental health disorders
• Experiences of sexual, emotional, or physical abuse

How trauma affects the body and mind

Regardless of the type or cause, trauma can be a pervasive problem that can have both short- and long-term effects on a person’s functioning and/or emotional, physical, or social well-being.

Trauma responses and the nervous system

Traumatic experiences directly affect the nervous system. When trauma occurs, we go into one of two modes: fight or flight, or freeze/fawn. While symptoms of these two modes differ, they’re both designed to protect us from threats to our physical or emotional safety. 

In the case of long-term trauma, the body can get stuck in fight or flight or freeze/fawn modes, which may result in chronic stress that affects both the mind and body. Chronic stress is one of the most common reasons people seek mental health support. 

Acute trauma vs chronic and intergenerational trauma

How the nervous system is affected by trauma may depend on the type of trauma a person experiences. Acute trauma may be the most well-known type of trauma, involving a single traumatic event like an act of violence or a car crash. 

There are other types of trauma that can affect the nervous system, though, including chronic trauma and intergenerational trauma. Chronic trauma refers to trauma that extends beyond a single event, sometimes lasting months or even years. Someone experiencing ongoing abuse or domestic violence, for example, is a victim of chronic trauma.

Trauma-focused care focuses on addressing the potential effects of a past traumatic event, which may include, but are not limited to:

• Shock and denial due to trauma.
• Unpredictable emotions due to trauma.
• Flashbacks and nightmares due to trauma.
• An inability to feel comfortable due to trauma.
• Physical symptoms like stomach aches and headaches due to trauma.
• Confusion due to trauma.
• Exhaustion and fatigue due to trauma.
• Anxiety due to trauma.
• Procrastination due to trauma.
• Difficulty concentrating due to trauma.
• Risky behavior, such as substance misuse due to trauma.

The toll that trauma takes on an individual’s well-being can be significant. However, people who have had traumatic experiences can also be highly resilient and may develop a sense of perseverance and strength in the face of challenges with the right support. Healing from trauma and living a fulfilling life can be possible with the help of trauma-focused therapy. 

Trauma-informed therapy versus trauma-focused therapy

When beginning your healing journey, it could be important to understand the difference between trauma-informed therapy and trauma-focused therapy. While these two terms are often used interchangeably, there is an important distinction. 

Trauma-informed therapy is therapy that takes into account the effects trauma has had on an individual while addressing other areas of mental and emotional well-being. On the other hand, trauma-focused therapy is therapy that directly addresses the traumatic event(s) that took place. Trauma-focused therapy may involve helping the client process painful emotions and cognitive distortions arising from the trauma itself.  

While trauma-focused therapy tends to be an overarching therapeutic approach, trauma-informed care can be integrated into various therapeutic methods. 

Types of trauma addressed in trauma-informed therapy

Mental health professionals acknowledge that not all trauma is alike. Instead of using a one-size-fits-all approach to trauma-informed therapy, they may tailor their approach to the different types of trauma individuals have experienced.

Childhood and developmental trauma

Research also suggests that the more a child is exposed to stress and trauma, the greater their risk of experiencing trauma-based chronic health conditions and risky behaviors later in life. Childhood PTSD (childhood post-traumatic stress disorder) is an example of a diagnosable mental health condition and stress disorder that could occur in some children who have had an ACE. There are various types of therapy that may be used to help a child recover from trauma, depending on the type of traumatic experience, from trauma-focused therapy to reunification therapy.

Effects of childhood trauma in adulthood

Interpersonal and relational trauma

Another type of trauma is commonly referred to as interpersonal and relational trauma. This type of trauma can be particularly painful and impactful since it involves trauma inflicted by someone who the person trusts. Often, this type of trauma involves family members, close friends, or significant others. It can include sexual violence, emotional abuse, intimate partner violence, and neglect. 

Cultural and societal trauma

A less recognized type of trauma is known as cultural and societal trauma. This type of trauma refers to trauma inflicted on a group of people as opposed to an individual. Examples of cultural and societal trauma include slavery, racial trauma, natural disasters, discrimination, and poverty.

Trauma-focused therapy techniques

Trauma-focused therapy, like other forms of trauma-informed treatment, takes into account the potential effects of past trauma(s) when administering therapeutic treatment. It was originally designed to help those who had experienced sexual abuse. Still, it has since been expanded to support people who have experienced any number of traumatic situations. 

Common trauma-informed therapeutic techniques 

There are many different trauma-informed therapy techniques that might be used in session. Some of the most common therapeutic interventions include nervous system regulation, emotional regulation, distress tolerance, somatic methods, behavioral techniques, bilateral stimulation, and grounding practices. 

Emotional regulation and distress tolerance skills

When we experience trauma, it can create painful and intense emotions that often follow us as we try to navigate life. Trauma-informed therapy often includes building emotional regulation and distress tolerance skills so that you can control these painful feelings instead of them controlling you. 

Somatic and behavioral techniques

Often, trauma is stored not only in the mind, but in the body as well. Somatic techniques work to help individuals release trauma from the body, and they can include practices such as deep breathing, body scanning, and progressive muscle relaxation. Therapists may combine these with traditional behavioral techniques like cognitive reframing and mindfulness for a comprehensive approach. 

Bilateral stimulation and grounding practices

Other techniques that may be used in trauma-informed therapy include bilateral stimulation and grounding practices. Bilateral stimulation is a relatively new technique that involves stimulating both sides of the brain in order to process trauma more effectively. This is a core component in eye movement desensitization and reprocessing therapy, or EMDR. 

Grounding techniques work by helping individuals remain in the present moment rather than re-experiencing the past. This can include naming sensory stimuli or practicing mindful breathing, for example.

Is trauma-informed therapy right for your mental health needs?

"Is therapy right for me if I’ve experienced trauma?" The way people choose to move through the trauma they’ve experienced is based on the individual’s mental health needs and preferences. However, many people find engaging in some form of trauma-focused therapy to be beneficial. To determine whether this approach is best for your mental health needs, ask yourself the following questions: 

• Are you experiencing trauma-related symptoms such as anxiety, dissociation, flashbacks, or nightmares?
• Do you wish you could reverse the effects of trauma but feel stuck in the past?
• Are you willing to experience painful emotions short-term in exchange for long-term peace?
• Are you committed to the process of therapy and able to devote ample time and energy to it?

Core principles of trauma-informed care

Emotional safety can be considered one of the core principles of trauma-informed care. In order for therapeutic techniques to be effective, it can be important for individuals to feel safe and supported in the therapeutic setting.

A therapist who is trained in trauma-informed care can generally offer a nonjudgmental, welcoming space. Here, the individual can freely express and process their emotions and learn techniques for managing distress and moving forward toward healing.

Building a safe and supportive therapeutic relationship

A safe and supportive therapeutic relationship is perhaps the most important building block of trauma-informed care. In many cases, the empathy and compassion a therapist demonstrates in session can be as healing as the therapeutic techniques themselves. 

Trust, collaboration, and empowerment

The therapeutic alliance is a fundamental component of successful therapy. In trauma-informed or trauma-focused therapy, it could be especially crucial. Your therapist will likely start building rapport with you during your first session, and this can be an ongoing process. It may be important that individuals view therapy as a collaborative process and that they feel empowered to make their own decisions in session. Processing trauma can be an intense and painful process, so the therapist may pace sessions strategically and check in with clients frequently to see how they’re coping with their emotions. 

Supporting interpersonal effectiveness and healthy coping mechanisms

Part of the therapist’s role in trauma therapy is to teach healthy coping mechanisms for dealing with the pain of trauma on a daily basis. These coping strategies might include lifestyle changes, relaxation techniques, stress management strategies, and tools for enhancing interpersonal effectiveness. Often, the goal is not to eliminate the effects of trauma (since this is not often possible), but to teach individuals how to cope with the impact of trauma. 

Outcomes and benefits of trauma-informed therapy

While trauma-informed or trauma-focused therapy can require heavy emotional work, there may be many benefits to look forward to.

How trauma-informed approaches improve patient outcomes

Trauma-informed approaches to mental health concerns have been shown to improve patient outcomes, particularly when it comes to post-traumatic growth. These approaches work by acknowledging the impact of trauma on the individual and actively helping them deal with the resulting effects, including painful emotions and mental health symptoms. 

Addressing complex mental health concerns and co-occurring conditions

Trauma-informed care makes the crucial connection between a traumatic event and resulting mental health concerns. Its ability to address complex disorders such as complex post-traumatic stress disorder (C-PTSD) and co-occurring conditions such as substance use disorder and anxiety disorders enhances the overall treatment outcome. 

Evidence-based and clinical research

Trauma-informed care is more than just a good idea. There’s a growing body of research supporting its effectiveness and expanding its possibilities. 

What clinical trials and psychiatric research suggest

In addition to the existing psychiatric research supporting trauma-informed care, clinical trials are currently exploring new possibilities for clinical practice. One such clinical trial is investigating the use of psychedelics in the treatment of post-traumatic stress disorder. 

Trauma-informed care in healthcare and disease control systems

Proponents of trauma-informed care suggest it should be a holistic approach that’s used not just in mental health care settings, but in hospitals, doctors’ offices, ERs, and other disease control settings. These supporters point to potential physical and mental health benefits of a trauma-informed approach.

Getting trauma-informed support via BetterHelp

Those who prefer to meet with a therapist to address trauma face-to-face can contact their insurance company for a list of in-network providers or ask their primary care doctor for a referral. Those who prefer to meet with someone from the comfort of their own home might consider online therapy.

With a platform like BetterHelp, you can get matched with a licensed therapist whom you can meet with via phone, video call, and/or in-app messaging. If your child aged 13–19 has experienced trauma, TeenCounseling can offer the same services with parental consent. Research suggests that online therapy can be as effective as in-person sessions for addressing post-traumatic stress disorder and similar conditions in many cases, so it may be worth exploring if you prefer this format.

How BetterHelp therapists provide trauma-informed care

BetterHelp therapists receive intensive training in trauma and cultural sensitivity in order to provide effective trauma-informed care. These experienced mental health professionals are committed to providing a safe therapeutic setting where you feel comfortable talking about your feelings, whether they’re directly related to a past trauma or they’ve just surfaced as a result of a current situation. 

Flexibility and safety in online therapy settings

Many people may feel safer expressing their emotions in an online setting as opposed to in person.The flexibility of online sessions allows you to schedule therapy whenever you feel most comfortable discussing your feelings, whether first thing in the morning or late in the evening after you’ve fulfilled your responsibilities for the day. Since you can attend sessions anywhere you have an internet connection, you’ll have more control over your environment during sessions.