Understanding the Importance of Trauma-Informed Care

When we hear the word trauma, most of us have an instinctive understanding of what it means: the severe distress, harm, or suffering that results from overwhelming mental or emotional pain or physical injury. Trauma is also caused by or magnified by discrimination, marginalization, and historical and/or generational trauma. It is no secret that survivors of domestic violence need time to feel safe again even after the danger of abuse is gone. However, meeting the needs of trauma survivors takes a great deal of sensitivity. Trauma-informed care starts with asking the right questions: moving from “What is wrong with you?” to “What happened to you?” and “How has this experience affected you?”

Individualized care is a must. After all, what is traumatic for one person may not be for another, and each person follows their own path to healing. The question then becomes “How do you perceive what happened to you?” or “Where are you in your healing process?”

No matter what type of abuse someone has lived through, research shows that the resulting trauma can have long-term effects on the body. Headaches, joint pain, difficulty sleeping, gastrointestinal, respiratory, and cardiovascular issues may occur.

Trauma-informed care recognizes how trauma affects the brain. Hyperactivity in the lower areas of the brain—the amygdala and hippocampus—overrides the prefrontal cortex, which is in charge of rational choices and modulating emotional responses. This keeps a person in survival mode. Memories can also be stored in the wrong place, keeping difficult memories active. [1]

Post-Traumatic Stress Disorder (PTSD) is a specific set of symptoms that some trauma survivors develop. According to the National Institute for Mental Health, people with PTSD relive the traumatic event, avoid situations that remind them of the past, and have negative thoughts about themselves or the world. They also experience hyper-arousal (being anxious and on the lookout for danger, having trouble sleeping, or getting angry or irritable). [2]

Trauma-informed care takes into account the physical and mental effects of trauma, but it looks beyond what happened to ask another question: “Who do you want to be?” It offers survivors a chance to rebuild the connections and trust that were fractured by abuse and betrayal. Someone who has experienced trauma needs the space to make their own decisions, and this is why the Voluntary Services approach is so important. Otherwise, programs risk re-traumatizing survivors with artificially imposed requirements for receiving services.

The following are five principles of trauma-informed care:

1. Awareness of the effects of trauma on survivors.
2. Safety for survivors on a physical and emotional level.
3. Trustworthiness in processes and relationships.
4. Empowerment in decision-making processes.
5. Inclusiveness for all, including individuals from historically marginalized groups and people with disabilities.

Through trauma-informed care, all experiences and needs are valued, including those of caregivers. This lens reveals a network of relationships between the survivor, service providers, organizations, friends and family, and the community. Individualized approaches must take into account the historical and social forces such as racism that further traumatize survivors.

Trauma & Healing: Tips for Survivors [download pdf]

The following tips encompass some of the ways that people who have experienced trauma have found relief. Explore what works for you.

1. Empower yourself. Look for choices you can make towards greater wellness. [3]
2. Validate yourself. Know that your perspective matters – you can learn to appreciate who you were, who you are, and who you are becoming. [4]
3. Connect yourself. You can decide how much you share and with whom. [5]
4. Appreciate yourself. Notice how far you’ve come. You’re worth the effort it takes to improve your well-being. [6]
5. Forgive your brain. The deeper regions of the brain controlling emotions or fight or flight might be overactive. [7]
6. Seek healing through silence. Nonverbal techniques can be effective because they calm the deep regions of the brain most affected by trauma. [8]
7. Writing can be a safe way to connect with emotions—it may help ease stress and physical symptoms of trauma. [9]
8. Music relaxation can help decrease depression and improve sleep for survivors of trauma. [10]
9. Yoga as a practice of body/mind awareness may be effective for people with chronic PTSD symptoms. [11]
10. Progressive Muscle Relaxation targeting each muscle group one by one is an effective way to calm anxiety and combat stress-related pain. [12]
11. Breathing deeply and slowly can help with the “fight or flight” response. [13] Consider a deep breathing app to help.
12. Exercise has been shown to reduce PTSD symptoms and depression as well as improve sleep. [14]

Trauma: What Friends & Family Need to Know [download pdf]

1. Everyone heals differently. Respect multiple coping styles.
2. Do not force the survivor to talk about it. Survivors who choose not to talk about trauma can be just as healthy as those who do.[15]/li>
3. Some people may wait years to speak about trauma. Reasons might include fear of being labeled a victim or a past experience of being blamed.[16]
4. Healing takes time. Avoid saying that a trauma survivor should just “let it go” and move on.[17] Understand that your relationship with them is valuable to their healing. The relationship may have challenges and moments of strength, but it is normal for the relationship to adjust as the survivor is healing, feeling more empowered, and rebuilding trust.
5. Practice supportive interaction techniques.[18]. Ask open-ended questions. Strive to be nonjudgmental. Point out the person’s strengths. Try not to minimize. Allow for silence. Reflect the emotion being described (“It sounds like…”, “No wonder you feel…”). Join in enjoyable activities to help establish a normal routine.[19]

[1] National Institute for the Clinical Application of Behavioral Medicine, “PTSD, the Hippocampus, and the Amygdala – How Trauma Changes the Brain,”Ruth Buczynski, Ph.D.
https://www.nicabm.com/ptsd-the-hippocampus-and-the-amygdala-how-trauma-changes-the-brain/ 

[2] National Institute of Mental Health, “Post-Traumatic Stress Disorder.”
https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

[3] Adapted from SAMHSA.gov, Dealing with the Effects of Trauma—A Self-Help Guide,
https://store.samhsa.gov/shin/content/SMA-3717/SMA-3717.pdf

[4] Adapted from SAMHSA.gov, Dealing with the Effects of Trauma—A Self-Help Guide,
https://store.samhsa.gov/shin/content/SMA-3717/SMA-3717.pdf

[5] Adapted from SAMHSA.gov, Dealing with the Effects of Trauma—A Self-Help Guide,
https://store.samhsa.gov/shin/content/SMA-3717/SMA-3717.pdf

[6] Adapted from SAMHSA.gov, Dealing with the Effects of Trauma—A Self-Help Guide,
https://store.samhsa.gov/shin/content/SMA-3717/SMA-3717.pdf

[7] Jennifer Sweeton, PsyD, “How to Heal the Traumatized Brain,” Psychology Today, March 13, 2017.
https://www.psychologytoday.com/blog/workings-well-being/201703/how-heal-the-traumatized-brain

[8] Dawn McClelland, PhD, and Chris Gilyard, MA, Calming Trauma – How Understanding the Brain Can Help,” Phoenix-Society.org.
https://www.phoenix-society.org/resources/entry/calming-trauma-how-understanding-the-brain-can-help

[9] Psychosynthesis Trust, “The benefits of writing about trauma,”
https://psychosynthesistrust.org.uk/the-benefits-of-writing-about-trauma/

[10] Blanaru, M., Bloch, B., Vadas, L., Arnon, Z., Ziv, N., Kremer, I., & Haimov, I. (2012). “The Effects of Music Relaxation and Muscle Relaxation Techniques on Sleep Quality and Emotional Measures among Individuals with Posttraumatic Stress Disorder.” Mental Illness, 4(2), e13.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4253375/

[11] Mara Santilli, “How Sexual Assault Survivors Are Using Fitness As Part of Their Recovery,” Shape.com, November 10, 2017.
https://www.shape.com/lifestyle/mind-and-body/how-sexual-assault-survivors-are-using-fitness-recover

[12] WebMD, “Stress Management: Doing Progressive Muscle Relaxation.”
https://www.webmd.com/balance/stress-management/stress-management-doing-progressive-muscle-relaxation

[13] Christopher Bergland, “Diaphragmatic Breathing Exercises and Your Vagus Nerve,” Psychology Today, May 16, 2017.
https://www.psychologytoday.com/blog/the-athletes-way/201705/diaphragmatic-breathing-exercises-and-your-vagus-nerve

[14] Matthew Tull, “The Benefits of Exercise for People With PTSD,” VeryWellMind, January 6, 2018.
https://www.verywell.com/exercise-for-ptsd-2797465

[15] Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.)
https://www.ncbi.nlm.nih.gov/books/NBK207201/

[16] Joan Cook, “Why many people don’t talk about traumatic events until long after they occur,” TheConversation.com, August 1, 2016.
https://theconversation.com/why-many-people-dont-talk-about-traumatic-events-until-long-after-they-occur-63248

[17] Támara Hill, MS, LPC, “7 Ways to Avoid Re-Traumatizing A Trauma Victim,” PsychCentral,
https://blogs.psychcentral.com/caregivers/2015/06/7-ways-to-avoid-re-traumatizing-a-trauma-victim/

[18] Melissa Ming Foynes and Jennifer J. Freyd, “The impact of skills training on responses to the disclosure of mistreatment,” Psychology of Violence, 1(1) 2011, 66-77.
http://psycnet.apa.org/record/2011-01402-007

[19] Phoenix Australia Centre for Posttraumatic Mental Health, “Recovery: Helping Others.”
http://phoenixaustralia.org/recovery/helping-others/