The aftermath of trauma is often isolating. There may be emotional, cognitive, physical, and behavioral changes that seem confusing. For folks who experienced trauma as a young child, these impacts are at times a part of life as far back as they can remember. Sometimes it can be hard to believe that others who have not experienced these effects can truly understand what you are experiencing as a survivor. Individual therapy is hugely impactful, if not vital, to help heal from trauma. However, having an individual therapist tell you that what you are experiencing is a normal reaction to trauma feels different than hearing another person describe an experience you recognize. This is one of the reasons that group therapy can be so impactful for survivors.
 
One of the best-known writers on group therapy is Irvin Yalom. He identified 11 curative factors in group therapy. All of these factors have a deep, resounding impact on trauma healing in the group setting. However, I want to focus on just 2 in this post: instillation of hope and universality.
 
What is instillation of hope? It is the process of increasing belief that life can be better, or even good. This process is driven by watching the successes of other group members and having one’s own accomplishments recognized by the group. When you bear witness to the healing of others it can help you truly know that healing is possible.
 
Universality is the concept that you are not alone in your suffering. Being in a group with other survivors normalizes your experiences and helps people to feel less alone. When isolation is a part of your daily existence, it can be monumental to be truly seen and heard by another person with a similar experience of walking through the world. 
 
So, at what point in the healing journey does it make sense to participate in group therapy? Groups can play a role at all points in the healing journey, but different types of groups work better at different stages of healing. Acute debriefing groups give opportunities to share experiences of trauma directly after the fact and are most often offered when a community has experienced some type of disaster that impacts many of its members. Support groups are generally time-limited, help survivors cope with the impacts of trauma, and begin to establish safety. Support groups can be found at many agencies in Philadelphia, such as WOAR Philadelphia’s Center Against Sexual Violence. There are also longer-term processing groups. These groups are most helpful later in the trauma healing journey when some baseline ability to handle anxiety and stress has been established. They can provide a space for members to reconnect to the here and now, reconnect to community, further understand and change the way trauma is carried within the self, and make meaning of the traumatic experiences.
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Whether it’s a friend, relative, or partner, we sometimes find ourselves with someone who suddenly begins to experience the acute effects of trauma. This typically presents as sudden fear or panic, flashbacks, intrusive negative thoughts related to the trauma, or dissociative states where the person appears to “not really be there” anymore. Of course, these experiences may be frightening, confusing, and overwhelming for the person experiencing them, and they may also be for the person witnessing them as well. If you are in a relationship with someone who frequently experiences these symptoms in your presence, it may be beneficial and empowering to have a sense of what might be helpful for the person in that situation.

However, it is important to note that the purpose of this article is to highlight some quick and concrete strategies to help the person re-orient or “ground” during or after an acute trauma reaction, and it is not intended to imply that anyone in a personal relationship with another trauma survivor should take on the role of being an actual therapist. Think of the information in this article as a “first aid kit” for flashbacks – it’s to help you when you need it and should not be used in place of actual treatment from a trained professional.

What to Look For:

• Sudden difficulties communicating or responding
• Person seems disoriented
• Frozen, wide-eyed stare, clenched or fluttering eyes
• Inability to make eye contact
• Dysregulated, uncontrollable flood of emotions, such as crying, screaming, shaking (panic)
• Calling out for help, repeatedly saying “no” or trying to run away
• Curling into a fetal position or trying to hide
• Seemingly unaware of or disconnected from the present
• Making movements or gestures as if responding to something that is not really there

What to Do:

 1. DO NOT TOUCH someone (even a loved one) in an active flashback. 
This may be extremely triggering for them and the physical touch may inadvertently be experienced as part of the traumatic memory/flashback. As they are starting to come out of it and are becoming more oriented, it’s ok to ask permission to touch them (for example, placing a hand on their shoulder, a safe embrace, or using touch to guide the person to a better location). If they say “no” or appear to shutter or recoil, respect this as an indication the person does not want to be touched at that time.

2. Do not ask them to talk about the flashback details.
It’s ok to ask if they are having a bad memory or if they feel like something bad is happening to them right now. It’s important to keep in mind that if a person is having a flashback, they are overwhelmed and flooded. This is not the time to try to get them to talk about anything related to the trauma. They need help coming back to the present moment, regulating their nervous system, and feeling safe again.

3. Orient to present time and surroundings.
Identify yourself and announce where you are and say something present-oriented, such as your name and relation to the person, even if they know you well. Let them know where you are and remind them they are safe in the present moment. For example: “Laura, this is Sarah, your sister. You are here with me in your house in Florida. It’s May, 2019. It’s just me and you and nothing bad is happening to you right now. You’re safe here with me.” 

4. Use a warm, but firm voice to give instructions.

• Ask them to listen to the sound of your voice. Ask them to indicate they can hear you and know who are.
• It’s very helpful to get a person in a flashback to open their eyes and begin looking around the room. This is key in helping them gradually be able to realize they are in the present (where it’s safe), as opposed to in the past when the traumatic experience actually occurred. Repeat this in a calm, but firm voice until they are able to do so.
• Ask the person to look around the room and name as many colors as they can, name the objects they see, find something close by that makes them feel safe and comforted (e.g., a beloved pet, a favorite blanket, an article of clothing or a piece of jewelry) and ask them to hold on to it and describe it to you in as much detail as possible.
• Instruct the person to put both feet on the floor to literally “ground” them in the present moment. I like to ask people to wiggle their toes, gently press their heels into the floor, and to notice what it feels like to be supported by the ground beneath them. 
  
  

5. Repeat grounding or safety phrases as much as needed.
Again, continue to use a warm, but firm voice consistently. The person may be relying on the presence of a supportive voice to “guide” them out of the flashback experience. You can continue to say things like:

• It’s ok, you are here with me now.
• It’s all over, you have already survived this.
• He/she/they can’t hurt you anymore.
• You are safe, you aren’t in danger anymore.
• You are no longer in __________ (e.g., parent’s house, city or country of traumatic event, etc.)
• You are an adult now, which means you are safer, you have more resources, you have more choices.
  
  

6. If necessary, continue with more structured breathing or grounding exercises.

• If the person is hyperventilating or appears to be panicking, you can ask them to take some slow, deep breaths with you. It can help to mirror this for them and do it along with them. Ask them to notice what their breath feels like as they breath in and then to notice what it feels like to breathe out. See if they can take a deep breath in for the count of 4 and then breath out for a count of 4. Repeat until breathing has stabilized.
• For further grounding strategies, continue to ask the person to look around the room as much as possible. You can transition to using all 5 senses (sight, sound, smell, taste, and touch) if something “stronger” is needed. Ask the person to name 5 things they see, 4 things they touch, 3 things they hear, 2 things they smell, and 1 thing they taste. Feel free to offer assistance by giving access to scented candles or lotions, mints or chewing gum, or anything else that would likely be soothing.

 
Key Points to Keep in Mind:

• Be warm, firm, and consistent
• Be calm and patient and don’t give up
• Do not push and try not to get scared or frustrated yourself
• Repeat as much as necessary and don’t worry about sounding like a “broken record”

• Once the person is fully out of the experience, you can ask the person for feedback about what was helpful and what wasn’t. Make a plan for next time and please follow up with professional help if needed. 

 

Traumatic experiences profoundly affect us in deeply personal ways, in part, because they make us feel out of control in this world, feel unsafe with others, and even unsafe with ourselves. We start to feel unsafe with ourselves, for example, when we question our own judgments, lose trust in ourselves, or carry a sense of inner badness, defectiveness, or self-disgust. We may find ourselves asking questions like, “Why did this happen to me?” or “What did I do to deserve this?” Sometimes, this inner sense of being to blame or of having some kind of inner “badness” is so significant, it makes us question or lose faith in our spiritual belief system. For example, we may say “I’m so awful, not even God could love me.”
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Inevitably, those who have experienced trauma find themselves trying to sit with and make sense of a tangled knot of intense emotions. These can include feeling anxious, frightened, alone, angry, sad, depressed, guilty, and ashamed. When these emotions are accompanied by thoughts of self-blame or self-hatred, it’s like pouring gasoline on a blazing fire. For example, when we are already feeling sad and alone, to think thoughts like, “It’s all my fault” or “I should have done something different” only makes us feel more depressed and isolated from others. So, in this way, a vicious cycle of negative, intense emotions and social isolation is perpetuated.

Why is blaming oneself for traumatic experiences so common even though it can make us feel so much worse? To outsiders, it may seem obvious it is not our fault or even absurd that these kinds of thoughts could be believable to us. But, the truth is, there are many understandable reasons why we can tend to blame ourselves. These reasons often center around themes of either 1) Needing to have a sense of control or 2) Needing to have a sense of meaning. Following is a list of some examples of underlying (or unconscious) reasons why we can hold on to self-blame after traumatic experiences:

• It feels better to believe we either did have control (e.g., I caused this because I am bad) or that we could have had control (e.g., if I didn’t make him angry with me, he wouldn’t have hurt me). Essentially, if we feel like we have control then it can feel like we can prevent future traumas from happening and we will ultimately be safer.

 

• If we were raised in families where, as children, we were blamed when bad things happened, this may feel like a natural “role” we readily take upon ourselves.

 

• It can feel easier to blame ourselves than to ponder philosophical or spiritual questions about why bad things happen to good people. We can preserve our spiritual beliefs or our framework for how we make meaning out of life that way.

 

• It can feel safer to be angry at ourselves than others that we love or even at God or the world.

With this being said, it makes perfect sense to me why some end up carrying around this sense of self-blame despite how much worse it can make things feel. On the other hand, it has been my experience that those who carry these feelings around the most are also the ones who carry a tremendous amount of shame and who are the most likely to be suffering from other serious symptoms of Post-Traumatic Stress Disorder (PTSD). This may be because the shame is so powerfully painful, it can keep us from talking about or coping with the traumatic experiences in ways that could ultimately be healing and freeing. The shame keeps us wanting to avoid the trauma-based thoughts, feelings, and memories and from sharing these with potentially helpful others because it can be so frightening and painful. However, the avoidance only ends up keeping us trapped inside ourselves, without being able to get the support needed to face, process, and ultimately resolve the feelings of shame or guilt and to heal from the traumatic experiences themselves.

If you find yourself relating to these experiences of self-blame, I encourage you to find someone you can trust (even just a little bit at first), whether that is a friend, a relative, a spiritual or religious leader, or a licensed therapist and start to take the healthy risk of sharing your story with someone. Its going to feel very scary and painful at first, but over time, having someone hear your story and accept it without judgement can help you start to resolve these feelings of shame, self-blame, and self-hatred and to move forward in your life. 

These days it seems there is a misconception, or even a “watering down” of what the word trauma actually means. In everyday conversations, the word “traumatic” can be used in the same way as words like “stressful” or “upsetting.” For example, we have all seen the dramatized, reality tv-show star say something to the effect of, “Finding out my wrinkle cream has been discontinued has been really traumatic for me.” But, if you have lived through a traumatic experience, you know on a deep level that trauma and stress are not the same thing.

​On the other hand, when most people think about trauma, they often think about those who have survived a natural disaster, been physically or sexually assaulted, or been exposed to war or combat. Understandably, these kinds of experiences can be extremely traumatic for a lot of people who go through them. However, a person does not have to have undergone an experience as obviously profound as these for it to cause a traumatic reaction or response. ​

Some trauma experts like to distinguish between “big-T” traumas and “little-t” traumas. Big-T traumas are what most people typically think of, as I just described. They create a terrifying sense of being completely overwhelmed, are often sudden, and leave the person’s life or sense of well-being feeling physically threatened.  

​Little-t traumas, on the other hand, may not be life threatening or as horrifying or terrifying as the typical list of qualifying traumatic events. Nevertheless, many kinds of events or experiences can be traumatic even if there was no threat of physical injury or death. These types of traumas include experiences that threatened the person’s sense of psychological integrity or well-being.

​Of course, neither of these lists are exhaustive and represent only a small fraction of life events or experiences that a person can experience as being potentially traumatic. Big-T traumas, by nature, are very severe. Yet, it also makes sense to me that these less obvious forms of trauma (i.e., little-t traumas) can have a profoundly traumatizing effect on people and can create many of the same post-traumatic responses as the Big-T traumas. This becomes more and more true with experiences that are chronic, repetitive, or having survived multiple types of traumas, as this tends to have a “cumulative” traumatizing effect.

Even if what you have experienced has not been mentioned in this blog, it does not mean you have not suffered a trauma or that what you have experienced did not result in post-traumatic reactions. What these different types of trauma have in common is the lasting impact they can have on people, which includes experiences such as being emotionally, physically, and mentally overwhelmed and feeling shocked, horrified, helpless, damaged, or fractured in some deeply profound way.
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The important thing is not to focus on what type(s) of trauma(s) you have survived and to try to quantify it in some way, but to recognize the ways you have been affected and what all of this means to you. There is hope for recovery, and it begins with recognizing and coming to terms with what has occurred and the many ways it has impacted your sense of self, your experience of the world, your perspectives, your ability to connect with others, and to engage in a quality of life that feels personally meaningful.