Supporting someone recovering from trauma

How do we effectively support someone who is recovering from trauma?

Firstly, hats off to you if you are doing this.  It is such an emotionally charged issue, being there for a trauma survivor.  We see their confusion, their mood swings, their frustration, their odd reactions, their moments of freeze, or dissociation, when they shut off and can't communicate.  Sometimes there's anger, sometimes there's terror, and often there is just numbness, nothing at all.

What we do see is that everything has changed.  Whatever happened to them, it feels as if they will never be the same again, that they will never make it back to who they were before their trauma reactions started.  The fact is, after trauma we do not go back to exactly who we were before.  We can heal and recover, but we will be changed.

In the meantime, this is enormously distressing:  for the person themselves, and for you, the friend, colleague, or family member.  Everything has been disrupted:  your relationship;  their ability to respond to everyday life with a healthy level of 'normal';  maybe even the plans and dreams you had together;  and, if you are a work colleague, the flow of productive work.  So many people are affected, from close friends and family to just about anyone else who was communicating with them on any level, before their brains finally started to react.  

It's really important to understand what trauma is, and how it affects us.  I've put together some of the main facts about trauma here.

• Trauma happens in the unconscious (survival) mode of the brain.  It is our unconscious brain's reaction to overwhelming events or circumstances, whatever they are, that it has not recovered from. 

That means that although some events, like childhood emotional neglect, abuse and domestic abuse are highly likely to be traumatising, trauma is not defined by the event, but by our brains' reactions.

• We have evolved to handle dangerous and threatening events and circumstances with very high levels of orientation, fight and flight, and with freeze and dissociation.  All these are normal and expected, totally automatic and immediate, and we have no rational control over them. 

The key concept here is 'very high levels' of fight and flight.  Fight is just engaging with something or someone, and flight is just avoiding something or someone.  Not hostile, aggressive, panicky, or fearful at all, except when at high levels.  We need fight and flight every single day, and we usually don't realise we have engaged them.  It's the wording - fight! - that is so misleading.

• When the danger, threat, or event is, or has been, overwhelming, causing very high levels of activation, our brains may remain in those very high levels of orientation, fight, flight, freeze, or dissociation.  They may remain there for years or decades.

There is no expected timeline for trauma to either resolve itself, or to appear in the first place.  Some instances of traumatic reactions appear decades after the events or circumstances.  There is also no timeline for recovery.  

• Trauma is our overwhelmed brain's inability to return to a healthy level of 'normal' responsiveness after having reacted to dangerous or threatening events.  It will return to healthy 'normal' if given emotionally safe space and time.

This means we have to put in place circumstances which are safe enough for the traumatised brain to return to low levels of fight and flight, and a healthy 'normal' response to everyday life.

• The more overwhelming events, adverse childhood events, or ongoing threatening or dangerous circumstances we experience, the more likely we are to be traumatised.

Trauma stacks itself, one event after the other, in our brain's ongoing battle to recover from the first event, whilst being clobbered by the subsequent ones.  If something happens, and our brain doesn't have time to recover before the next thing happens, we have less chance of recovering from either event.  That's why some people can sail through challenging experiences with no long term problems, but others, who have been battling several layers of overwhelm, find themselves unable to recover after comparatively mild experiences. 

• Because our brain is 'stuck' in a traumatic reaction, it cannot see that the event is over (if, indeed, it is).  'Over' to the brain's survival mode means that the reaction has finished, that the activation has decreased.  Our brains in unconscious survival mode assess the event or circumstances as still ongoing, because there has not been a physiological/neurological resolution.  

People suffering from PTSD will often say 'it feels as if it is still happening, or could happen again at any second'.  This is not their inability to comprehend rationally, it is their survival brain stuck in trauma.

• Our brains' unconscious modes do not know what words are, let alone understand them, so thinking and rational argument have no effect at all.  We can't persuade ourselves, or anyone else, that the danger is over.

We can't talk ourselves, or anyone else, out of a traumatic response.  Thinking rationally will not help, because it's not happening in the rational part of the brain.  Trying to make someone (or yourself) see that 'it's all over now', is useless.

Some key concepts to bear in mind:

• Remember that the trauma reaction is not chosen or intentional.  It is automatic, unconscious, and the person recovering from trauma doesn't want it to happen, either.
• There is no timeline for appearance of symptoms, or for recovery.  It can be weeks, months, or years.
• There is also no one universal treatment method which is effective for trauma.
• Words, unless accompanied by something the survival brain can understand, do not help.
•  

So, what can we do to support someone who is recovering from trauma?

The main, most important, and most effective thing we can do is to create an emotionally safe environment for them to recover.  Their brain will repair itself, but only if it feels safe.  Here's how to create emotional safety for someone:

• Believe them.  Take them seriously.  
• Validate their feelings about what happened.  If they say it was terrifying, that means it was terrifying.
• Listen without trying to fix anything.  Silence is ok, too.
• Keep your own boundaries.
• Ground yourself and regulate your own emotions.  

Being there for someone without becoming a therapist, or having your own life consumed by it can be really tricky, and as I said before, if you are doing this, you are awesome!  If you are supporting someone as they recover from trauma, and feel you need extra help with this, I have something for you that will help.  Click below for more information.

In the meantime, keeping yourself emotionally regulated, and ensuring an emotionally safe environment, will do wonders!

Friends and Family Toolkit for supporting those recovering from trauma 

Please do get in touch with a mental health professional if the person you are supporting has flashbacks, panic attacks, or thoughts about suicide.   It is important that they get as much help as possible, and you can't do this on your own.  Your GP, or the NHS will point you in the right direction.

Also do get help for yourself, if supporting becomes too much for you.  Your GP, again, will be able to help.

If you are in the UK, this website has further help NHS

If you are in the US, this website may help:  Mayo Clinic