In observance of Mental Health Awareness Month, also known as Trauma Awareness Month, Nathan Swaringen, LCSW, Clinical Therapist at The Guidance Center explores the nature of trauma, its profound impact on individuals, and the path towards healing and resilience in this week’s blog.

“Trauma is perhaps the most avoided, ignored, belittled, denied, misunderstood, and untreated cause of human suffering”. -Dr. Peter Levine

If this is the case, it would probably be helpful to understand what is meant by the term, “trauma”. How is it defined? How is it used? A quick internet search produces a wide range of definitions and uses. Quite literally, a “trauma” is a wound to the body. From a traditional mental health lens, a “trauma” is a deeply distressing event. Both of these definitions are correct.

“Trauma is not what happens to you. Trauma is what happens inside of you as a result of what happens to you.” -Dr. Gabor Mate.

In other words, trauma is indeed a physiological wound; one that came as the result of distressing events. “Trauma is an experience, or pattern of experiences, that impairs the proper functioning of the person’s stress-response system, making it more reactive or sensitive.” -Dr. Bruce Perry. To understand trauma, we must focus on physiology, not psychology. There are psychological symptoms that arise from trauma, but the trauma itself is very much how one’s nervous system, or stress thermostat, has been calibrated by the environment.

How is a human’s stress thermostat calibrated?

Genes play a minor role, one we’ve been misled to believe is much larger. The greatest calibrator of our stress response neurobiology is our environment. The first environment we have is the womb. As our fetal cells divide rapidly every second of every day for nine plus months and our developing nervous system is soaking up sensory information about its environment. In an ideal pregnancy, the fetal nervous system is homeostatic and regulated. No stress, no fear, no threats, plenty of calories, and a nice, warm temperature. Co-occurring with this constant state of regulation is the sound and vibration of the mother’s heartbeat. Did you ever wonder why rhythm, music, movement, or exercise can be soothing? Now you know. Our fetal nervous system “remembers” the association. When a child then leaves the comfort of the womb, they are thrust into a very dysregulating world. It’s cold, bright, loud, and new.

An infant has zero capability to self-regulate their own distress, so a caring adult (usually a parent) soothes the terrified, cold, hungry infant. This cycle plays out thousands of times during the child’s development. Distress is met with the soothing comfort of a trusted and loving adult. Slowly over time, the child’s stress response system gets stronger and stronger at tolerating the stressors of the world, as long as those stressors are moderate, predictable, and controlled. The relief of distress isn’t experienced by the nervous system as neutral. Relieving distress actually causes the brain to release feel-good, reward chemicals. Drinking water right now would probably be a neutral experience, but that same water would be incredibly pleasurable if you were hot and dehydrated. The distress, soothing, reward, relationship cycle is what calibrates our stress thermostat. If this dance doesn’t happen as it should or as often, we are likely to have a sensitized and frequently dysregulated nervous system…”trauma.”

By understanding this mechanism, “trauma” isn’t just when bad things happen; it’s also when good things don’t happen.

This necessary developmental dance of distress, soothing, reward, and relationship is grossly overlooked even in the mental health and medical fields when conceptualizing trauma. No human has ever had a perfect developmental experience, and that’s okay, but if this dance doesn’t happen adequately, a sensitized and traumatized brain is likely to follow, even without experiencing “capital T” traumas such as abuse or a life-threatening experience.

So, what if “capital T” traumas do occur? How does it affect our stress response neurobiology?

The Substance Abuse Mental Health Administration (SAMHSA) has developed a very useful way of analyzing whether an incident has caused trauma – the three E’s: Event, Experience, and Effects. As discussed earlier, the event isn’t the trauma, it’s what the event potentially did to the person’s nervous system. The event is merely the starting point. Let’s use the example of a house fire. For most people, this event would be terrifying. We would experience an extreme activation of our stress response; adrenaline, rapid heartbeat, diminished thinking, panic, etc. Since our nervous system had such an extreme activation, it would likely have lasting effects in the form of panic attacks, difficulty sleeping, irritability, intrusive memories, etc. Now imagine if a well-trained firefighter woke up to her house on fire. Her stress response system would be activated, but not nearly as much as the average person’s. She very likely wouldn’t experience any effects of trauma. Why? The stressor was moderate (to her), predictable and controllable (she knew what to do based on years of practice). Trauma can be very subjective.

Now that we understand what trauma is, we can begin to talk about how it affects us.

What does it mean to have a sensitized stress response system?

Our stress-response neural networks are very low and deep in primitive areas of our brain. These networks are like “Grand Central Station”, getting first dibs on all incoming data and how it will be processed before passing along these signals to other, inter-connected networks in the brain. In other words, almost all brain functioning, from thoughts, emotions, learning, memory, behaviors, and even bodily and immune functions are at the mercy of our stress response neurobiology being properly calibrated.

A sensitized stress-response system is going to be overly active, frequently misinterpreting the sensory world and seeing threats where none may exist. This area of the brain can’t tell time, so a war veteran experiences a car backfiring as an equal threat to a bomb exploding 30 years prior. A child growing up with an abusive, loud and scary parent can’t differentiate the raised voice of a friendly and excited teacher. These are called evocative cues; remnants of the past, “the body continuing to fight the unseen enemy” – Dr. Bessel Van Der Kolk.

In addition to specific evocative cues, a sensitized nervous system has difficulty navigating and managing the normal everyday stressors that we all endure. Being hungry, tired, or bored are types of stress. Having to focus, sit still, learn something new, and delaying gratification are all types of stressors. No one likes these things, but most of us can tolerate them. A sensitized nervous system is frequently using so much mental “bandwidth” just making sure things are safe, that there’s not much left to deal with these unavoidable, daily life stressors; and they unravel. When ANY of us run out of bandwidth, we aren’t ourselves. We have a harder time concentrating and remembering. We’re more emotional or irritable and less rational. We also tend to seek relief of this distress by seeking external reward in the form of sweet/salty/fatty foods, drugs or alcohol, or other guilty pleasures. It doesn’t feel good to be dysregulated and out of bandwidth.

When stress is moderate, predictable, and controllable, we have enough bandwidth to tolerate it. When stress is unpredictable, uncontrollable, or extreme, we become dysregulated, and subconsciously manipulate our environment to make it more moderate, predictable and controllable. When conceptualized through this lens, it seems most mental health impairments are actually attempts to regulate distress. A dysregulated nervous systems explains depression, anxiety, PTSD, mood disorders, personality disorders, addictions, and more.

Knowing what trauma is and what it does to us, helps us begin to understand healing.

Since trauma is in our nervous system, not our cognition, we must focus on recalibrating our stress response neurobiology. Changing neural networks requires specificity, or activation of those specific neural networks to change them. Our brain tries to do this on its own, activating trauma-related cues such as intrusive memories, flashbacks, and the subconscious needs to reenact or recreate our traumas. These usually cause more harm because our brain tries to relive them without the proper antidotes to what caused the trauma in the first place. The stressor was traumatic because it was extreme, prolonged, unavoidable, uncontrollable, and inescapable. And most importantly, because we didn’t have someone to soothe our distress.

“We don’t get traumatized because we get hurt. We get traumatized because we’re alone with our hurt.” -Dr Gabor Mate.

If we can figure out what is a tolerable and what we can control with the support of someone safe, we can activate those painful neural networks in a new way that’s not so scary. Connectedness is the key ingredient to growth and resiliency. We cannot heal in isolation.

“Research on the most effective treatments to help child trauma victims might be accurately summed up in this way: what works best is anything that increases the quality and number of relationships in the child’s life.” -Dr. Bruce Perry.

Nathan Swaringen, LCSW, has worked as a Clinical Therapist at The Guidance Center for more than 10 years. In this role, Swaringen helped guide children and families toward positive and productive futures through mental health treatment. In 2016, Swaringen developed and launched our trauma-informed pilot program based on ChildTrauma Academy’s Neurosequential Model in Education, called It’s About T.I.M.E. He is passionate about working with school staff to create nurturing environments where all students can thrive. Swaringen earned a Master of Social Work from University of Southern California, and Bachelor of Arts in Psychology from California State University, Fullerton.