How Common is the Experience of Trauma?

by Andrea Kapeleris Ph.D

More common than you think! About 20-50% of children and teens who have experienced trauma meet criteria for Post-Traumatic Stress Disorder (PTSD), and nearly 75% also experience depression and substance use (Elwood, Hahn, Olatunji, & Williams, 2009). Statistics also show that about 14% of people exposed to a major stressor go on to develop PTSD (Terhakopian, Sinaii, Engel, Schnurr, & Hoge, 2008), and women are about twice as likely as men to develop PTSD after a trauma (Kessler, Berglund, & Demler, 2005). Stressors can be one-time events that cause actual or threatened death or harm to yourself or a loved one (such as, a car accident, sexual assault, mugging, natural disaster), or they can include on-going negative and damaging experiences – such as, chronic stress resulting from military service, or childhood experiences in which there was repeated damage to the attachment relationship between you and your caregiver. These chronic experiences can shatter a child’s sense that the world is benign, the world is meaningful, and the self is worthy, and often results in avoidance coping and an increase in overall level of arousal and anxiety (Roth et al., 1997).

Symptoms of PTSD are Normal Reactions to a Non-Normal Experience

• Re-experiencing the event in a number of ways including, flashbacks, nightmares, or vivid memories that come to you unexpectedly 
• Avoiding any reminders of the event (people, places, or things associated with the event), and a feeling of numbness
• Increased feelings of anxiety or emotional arousal

Treating Trauma

Overstuffed Cupboard Metaphor

The mind is like a pantry cupboard. When a traumatic event occurs, it is as if very large and oddly-shaped boxes were hurriedly stuffed into the pantry. Since there was no time to properly place the boxes in the pantry in an organized fashion, each time you open the pantry to get something you need, a box suddenly and unexpectedly falls on you – startling you and possibly hurting you! The same thing happens when our mind experiences trauma. Due to the sudden and overwhelming nature of the traumatic event, the mind doesn’t have the opportunity to process all of the emotions associated with it, and as a result, unpleasant memories or emotions may come to us when we least expect them too. For example, you may become startled by an unsettling memory or emotion when you are relaxing at home, watching TV, or spending time with friends. As a result, you may begin to avoid things you previously enjoyed. 

The purpose of therapy is to help you organize this pantry. We need to take each box out of the pantry slowly and carefully, examine its contents, and then place it in its proper place. Once all of the boxes are organized accordingly, you will be able to enter the pantry without fear, and will no longer need to avoid that part of your home. Similarly, the goal is to slowly process the trauma and place events and their accompanying emotions into sequential order. In this way, your mind will be able to integrate the trauma and make sense of it. You will be able to think more freely and move forward with your life. 

Fight or Flight mode

When we encounter a traumatic event (something that threatens our physical or psychological integrity) our bodies enter a process called the “Fight or Flight” mode. This mode is evolutionarily necessary and served an important purpose – in the times of cavemen and women, when our ancestors were being chased by predators (e.g., a tiger) all of the resources in their bodies left the frontal cortex (the part of our brain used to reflect on our thoughts and feelings, and make decisions) and automatically went to their muscles (to prepare them to flee or fight the predator), and also went to pump up their heart rate, breathing, and overall adrenaline (again, to make it easier for them to flee or fight predators). In modern times, when we are faced with a trauma, our bodies go into ‘Fight or Flight’ mode in order to protect us. Later, any experiences, people, places, or things that remind us of the trauma stimulate our body to again go into this fight/flight mode in case we need to be protected again. Part of our work in therapy is to help your body and mind recognize that this threat occurred in the past and that you are no longer in danger. We foster this safety on many different levels:

1) Physiologically. We must help the physical body itself feel safe, and come down from overarousal. This may partly be achieved through learning relaxation strategies or overcoming avoidance-coping strategies that maintain and intensify anxiety.
2) Emotionally. We must help the mind itself feel safe, and come down from overarousal. This is achieved through:
a) processing the trauma as described above in ‘the cupboard metaphor’;
b) learning Emotion Regulation strategies


Emotion Regulation
Emotion regulation is a process of 1) identifying and increasing awareness of your feelings (e.g., what are the names/labels for the vague and sometimes uncomfortable sensations that happen inside?), and 2) ‘sitting with’ the sensations that go on inside and experiencing the waxing and waning of your feelings – all feelings do wax/wane, come and go – the only thing we can be certain of is change from moment to moment. Physiologically, our bodies experience of any emotion follows a bell-shaped curve (i.e., it must come down from it’s peak) – our bodies can not maintain the high emotional arousal indefinitely – but sometimes, our feelings about our feelings (feeling angry that we are sad, for example) may intensify our original emotion. In therapy, we help to disentangle this, and in effect, help you to regulate your emotions. Importantly, we also begin to look at your feelings as an important signal that there is something inside that needs our attention.

Read more about our Trauma Psychology & PTSD Treatment Service.

Talking to Your Child About Tragedy

Talking To Your Child About Tragedy

Posted by Ali Goldfield, M.A., Therapy Stew (www.therapystew.com), on Saturday, September 21st 2013   

Ali is a psychotherapist at the Centre for Interpersonal Relationships. She provides assessment and treatment services to children, families and adults in her private practice.

It’s always difficult as a parent to know how much to share with your child and how much to shield them from the tragedies that happen in the world around them. While it may seem like a good idea, at times, to try and protect them from all the bad things, depending on their age, it’s not always possible. Children pick up information from other kids at school, from the television and from social media. Talking to your child about a tragedy can help her understand what’s happened and actually help them begin to process the events and feel a bit safer.

It’s a personal decision whether or not to talk to your kids or not. It also depends on their age, their level of maturity and how closely they are affected by the tragedy. Every parent knows best for their own child. If you’re struggling with how to start, here are some ways to help:

Let Your Child Be The Guide

Find out what questions or concerns your child might have. Let your child’s answers guide your discussion. Let your child know that you will always be there to listen and to answer them. Try to make your child feel comfortable asking questions and discussing what happened but don’t force your child to talk if they aren’t ready.

Tell The Truth – In Moderation

When talking to your child about a tragedy, tell the truth. You can focus on the basics but it’s not necessary to share all the unnecessary and gory details. Try no to exaggerate or speculate about what happened and avoid dwelling on the magnitude of the tragedy. Listen closely to your child for any misinformation, misconceptions or underlying fears. Take time to provide accurate information. Share your own thoughts and remind your child that you’re there for him. Your child’s age will play a major role in how he or she processes information about a tragedy.

Talk to Them at Their Level

Talk in a way that’s appropriate to their age and level of understanding. But don’t overload the child with too much information. Elementary school children need brief, simple information that should be balanced with reassurances that the daily structures of their lives will not change. Middle school children will be more vocal in asking questions about whether they truly are safe and what is being done at their school.  They may need assistance separating reality from fantasy. High school students will have strong and varying opinions about the causes of violence and threats to safety in schools, community and society.  They may share concrete suggestions about how to prevent tragedies in society. They will also be more committed to doing something to help the victims and affected communities.

Be Ready to Have More Than One Conversation

Some information can be very confusing and hard to accept so asking the same question over and over may be a way for your child to find reassurance. Try to be consistent and reassuring, but don’t make unrealistic promises that nothing bad could ever happen.

Acknowledge and support your child’s concerns

Explain that all feelings are okay when a tragedy occurs.  Let children talk about their feelings and help put them into perspective.  Even anger is okay, but children may need help and patience from adults to assist them in expressing these feelings appropriately. Let your child know that all his feelings, reactions and questions relating to the tragedy are important.

Limit Media Exposure

Don’t allow young children to repeatedly see or hear coverage of a tragedy. Even if your young child appears to be engrossed in play, he or she is likely aware of what you’re watching or listening to — and might become confused or upset. Older children might want to learn more about a tragedy by reading or watching TV. However, constant exposure to coverage of a tragedy can heighten anxiety.

Monitor your own stress level

Don’t ignore your own feelings of anxiety, grief, and anger. Talking to friends, family members or mental health counselors can help. It is okay to let your children know that you are sad, but that you believe things will get better. You will be better able to support your children if you can express your own emotions in a productive manner. Get appropriate sleep, nutrition, and exercise. Kids learn from watching the grown-ups in their lives and want to know how you respond to events.

We have all awoken to disasters before, whether natural, manmade, accidental and terrorist-induced and it’s inevitable that we will wake to them again in the future. What you say to your kids and how you say it will change as they get older but the one thing that shouldn’t change is your validation of your child’s feelings and the fact that you will always love them and do your best to keep them safe.

Read more about our Child, Adolescent & Family Psychology Service & our Trauma Psychology & PTSD Treatment Service.

The Impact of Traumatic Events in Our Life: Healing in the Aftermath

by: Darcy Minick, Masters Candidate and Dr. Dino Zuccarini, C.Psych.

Are you struggling with the after-effects of past traumatic experiences in your present day? Many of us will experience at least one traumatic incident in our lifetime --- an unpredictable, out of the ordinary experience or incident that yields overwhelming helplessness, fear, powerlessness or intense isolation from others. The emotional residue of these traumatic incidents can wreak havoc inside of us, and interfere with our capacity to be intimately engaged in our important relationships. Traumatic incidents can shatter our sense of self and identity and our sense of the world around us.

In this post, we will provide you with some basic facts about trauma, and how these difficult life experiences may be affecting your life in the present day.

The good news though is that trauma can be healed. As Peter Levin has put it: “Trauma is a fact of life. It does not have to be a life sentence ... And there are so many things that we can do in prevention and healing."

What is Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder?

In the fields of medicine, psychiatry, clinical and counseling psychology, two different diagnostic categories have been used to understand trauma:

Post-Traumatic Stress Disorder (PTSD) develops after an overwhelming life experience, such as accidents, war, abductions, sexual assault and violence, or natural disasters such as floods or earthquakes. These types of traumatic incidents involve us experiencing either actual physical harm or the threat of physical harm to ourselves.

Complex Post-Traumatic Stress Disorder (Complex PTSD) results from stressors that may have occurred repeatedly and chronically in our lives. Sexual or physical abuse, often from early in life, over the course of childhood and in the context of the family, domestic abuse or military deployments into dangerous locales can all be causes of Complex PTSD. 

As a result of these experiences, our bodies and minds employ their natural defense systems --- our fight, flight, freeze responses --- to offset the threat. It is important for us to be able to eventually relinquish this natural defense system and return to normal levels of emotional and physiological arousal in our bodies --- that allows us to feel safe in the world again. Our ability to do so, however, can be impaired as a result of momentary or chronic traumatic experiences. Traumatic experiences can create a basic rupture, or loss of connection --- to our self, our family, and the world around us. Instead, we can be left with a sense of danger, insecurity, and disconnection in our lives. Restoring a sense of safety and security, learning how to make sense of the traumatic experience that we’ve endured, and re-connecting to our self and others again in the aftermath of this incident is critical to the healing process. Without such healing, many physical and psychological symptoms can emerge in our lives.

Common Symptoms of Trauma

Physical reactions can include the following:

• Bodily aches and pains
• Sudden sweating and/or heart palpitations
• Changes in sleep patterns, appetite, interest in sex
• Easily startled by noises or unexpected touch
• Tensions that some people will soothe with the use of alcohol or drugs and/or overeating

Emotional reactions can include the following:

• Flashbacks --- feeling like the trauma is happening now
• Feelings of guilt and shame
• Fear and/or anxiety, or depression
• Attempts to avoid anything associated with trauma
• Hyper-alertness or hyper-vigilance
• Feelings of detachment, or dissociation
• Inability to trust self or other
• Upsetting memories of the trauma, or lost memories
• Suicidal thoughts

How Can an Unresolved Trauma be Healed?

"When treated thoroughly, healing can lead not only to symptom reduction, but long-term transformation.” Peter Levine.

People are usually surprised when they begin to understand that some of the psychological and physical symptoms they have experienced are caused by previous traumatic experiences. Many people will get through this period with the help of family and friends, and the support of a therapist.

Here are some tips on how to cope, or diminish emotional and physical distress associated with trauma-related symptoms:

1. Mobilize a support system --- reaching out and connecting with others
2. Commit to an exercise routine --- energetic exercise like jogging, aerobics, bicycling, walking --- can help modulate our natural defence system.
3. Explore exercises and strategies to promote relaxation and diminish the impact of traumatic stress, including - breathing, relaxation, or exercise like yoga, stretching, massage hot baths prayer and/or meditation, listening to relaxing guided imagery, listening to music and viewing art or progressive deep muscle relaxation.
4. Try to find humour and the brighter, lighter sides of life -- doing so can counter the negative effects of traumatic stress;
5. Maintain a balanced diet and sleep cycle as much as possible, which includes not over-using stimulants like caffeine, sugar, or nicotine --- increasing arousal can create negative effects for individuals whose natural defence systems are in overdrive as a result of traumatic stress.

Psychotherapy is an essential component of your healing process. Research affirms that therapy can help you to process the intense emotions associated with traumatic incidents and diminish trauma-related symptoms.

CFIR's Trauma Psychology & PTSD Service offers individuals and couples assessment and treatment of different types of traumatic stress. A comprehensive psychological assessment is conducted to understand the psychological impact of trauma on an individual’s self-development and personality, his or her present-day distressing cognitions, emotions and behaviours, and relationship functioning.

We employ a phase-specific treatment model that integrates trauma-focused, cognitive-behavioural, psychodynamic, ego-state, mindfulness-based, and experiential strategies to address the debilitating symptoms associated with traumatic stress. Our phase-specific and compassion-focused approach allows us to develop customized treatment options that meet the unique needs of every individual or couple.


Read more about our Trauma Psychology & PTSD Treatment Service.