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Few people live without experiencing trauma. What are the types of trauma? What are the causes of trauma? Which techniques help recovery from trauma? 

Trauma, even though it is a universal experience, seems to have no universally agreed definition. In fact, there are multiple ongoing debates around how to define trauma.

Is trauma about the objective events, or the subjective experiences that come from those events? 

Can people be traumatised by events that are not life-threatening? 

Speak to anyone who has been subjected to false accusations, or has gone through an acrimonious divorce, or had a miscarriage, or any others on the long list of adverse events, and many will tell you that the event/s were deeply and enduringly traumatic. 

Yet, the latest iteration of the ever-moving definitions in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition), asserts that trauma is: 

Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: directly experiencing the traumatic event(s); witnessing, in person, the traumatic event(s) as it occurred to others; learning that the traumatic event(s) occurred to a close family member or close friend (in case of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental); or experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (p. 271).

SAMHSA, (the Substance Abuse and Mental Health Services Administration is a branch of the US Department of Health and Human Services) defines trauma in a way that seems to be more closely matched with everyday lived experience: 

A particular event may be experienced as traumatic for one individual and not for another. (SAMHSA, 2012, p. 8).

That makes perfect sense. A person who has been preconditioned (by prior trauma) to be more sensitive to a particular type of adverse event, is likely to experience more trauma from any given adverse event that someone who has been trained to deal with that adverse event. For instance, accident and emergency medical and other staff are faced with ‘directly experiencing the traumatic event(s); witnessing, in person, the traumatic event(s) as it occurred to others’ on a daily basis. Yet, most cope well and are not traumatised by seeing death after death in horrible circumstances. 

Throughout history, there have been large numbers of documented reports of the huge variation in human reaction to adversity or trauma in war.

• Some members of the military who have volunteered to take on the most dangerous missions, over and over again; have seen colleagues killed in battle, repeatedly, and yet do not suffer from trauma. A rare few seem to thrive in such conditions, it gives them an adrenaline kick, and when not at war, they feel a sense of loss, of aimlessness. 
• Some combatants face battle well until a close friend is killed, and that seems to change their ability to deal with war without being traumatised. 
• Others, faced with the realities of the battle for the first time, never recover from the trauma. 

Trauma, it seems, cannot be adequately defined because there are so many external, internal and mediating variables interacting in a myriad of ways that cannot be shaped into a ‘one-size-fits-all’ definition. 

It is much more likely that there are multiple types of trauma, many causes of trauma, large numbers of different manifestations of trauma, even more ways of coping with trauma, and building resilience against future trauma.

There are three types of trauma: acute, chronic, and complex trauma. Acute trauma refers to a single incident or event.  Chronic trauma describes repeated and prolonged incidents or events, for example, domestic violence or abuse.  Complex trauma denotes being subjected to various and numerous traumatic events, and can often be of an intrusive and interpersonal type.

Of course, there are many exceptions and caveats to the above. For instance, sometimes if a person is subjected to the same trauma over and over again, they can develop effective coping strategies. Alas, at the other extreme, some of those “coping” methods do serious long-term harm, such as drug or alcohol use as self-medication, or developing dissociative identity disorder.

When trying to understand trauma, or provide help to those who have experienced trauma, the Three Es can be useful: event, experience, and effects.

The event

Four external variables seem to, in part, determine the impact of the traumatic event(s). Expressed in an acronym to help remember, DIFI trauma event variables seem to be (at least, in part), responsible for the differing trauma experience and effects.

• Duration. The longer a traumatising event continues the more likely it is to cause health damage.
• Intensity. the more intense the trauma, the more likely it is that traumatisation will follow. For instance, being blown off your feet in a bomb blast is less intense than being severely injured in the same blast. The intensity of trauma seems to be related to the proximity to the event. 
• Frequency. The more frequent the trauma event(s), the more risk of long-term traumatisation.
• Immediacy. The closer in time the event is to the perceived or actual harm, the more likely it is to damage. 

The experience

How any two people deal with the same traumatic event(s), varies hugely. A person’s thoughts and emotional habits are highly involved in how, and how well, or not, they deal with trauma. Their prior experience and belief structure determine how the trauma is processed, and thus experienced. That can explain why one person’s life-changing trauma can be another’s adrenaline kick. 

The effects

If the perceived experience can vary so much between individuals faced with the same trauma event(s), it is entirely reasonable to expect that the effects will vary, too. That is exactly what is seen in response to almost all causes of trauma.  

What are the seven most common causes of trauma?

Threats or actual harm to:  

• Life or physical health. Most people are aware that a near-death experience can be highly traumatising, as can violence, sexual assault and all other crimes against the person.
• Mental health. In any one year 25% of the population experience mental health problems, the vast majority of which are related to traumatic experiences.
• Emotional health. Separating emotional from mental health can be very tricky. Usually, traumatic experiences have an impact on mental and emotional health. 
• Spiritual health. For people of religious and other faiths, spiritual life is very important, and harm or threats to their faith can be deeply traumatic.
• Career. For those people who live for their career, any threat or harm to it can be very damaging. 
• Finance. When people lose control of their lives through lack of finance the trauma can scar them for life. 
• Reputation/identity. Many people’s lives are wholly dependent on their reputation and/or identity, and any true or false attacks on their reputation/identity can be deeply traumatic, and life-changing. 

Any one of the above can be traumatic. When two, three or more happen simultaneously the level of trauma and stress can be life-changing or even life-ending. In many instances, the words ‘stress’ and ‘trauma,’ in their popular use, are interchangeable. In many practical ways, too, there are striking similarities. Stress and trauma overlap considerably, and exhibit remarkably similar symptoms, as is implied in the label PTSD, post-traumatic stress disorder, or PTSI post-traumatic stress injury. Indeed, the label that a person gives to their experience can have a huge effect on their recovery.  

21 Techniques to help recovery from trauma

1. Apply well-practised defence mechanisms. Most of us have a large armoury of ways to deal with trauma in the form of psychological defence mechanisms, which we use in everyday life. For example, compartmentalisation – the process where a person will contain any thoughts or feelings about, in this case, a trauma, to a restricted number of times and contexts.
2. Accept the reality of the situation. William James asserted: ‘Acceptance of what has happened is the first step to overcoming the consequences of any misfortune.’ Alas, that is faster and much easier said than done. Most traumas can, eventually, be better dealt with by accepting the new reality. 
3. Change your perspective. One way to help accept the reality of trauma is to change the way it is perceived, as Wayne Dyer noted: ‘If you change the way you look at things, the things you look at change.’
4. Choose what meaning to give your trauma; choose a meaning that gives you strength. Alfred Alder said about a century ago: ‘No experience is a cause of success or failure. We do not suffer from the shock of our experiences, so-called trauma – but we make out of them just what suits our purposes.’
5. Focus on the positive. As we face triumphs and tragedies of life, we always have a choice, (not an easy one to make in the face of trauma): do we focus on the thorns or on the heart of the rose? Walt Whitman, no stranger to trauma, counselled: ‘Keep your face always toward the sunshine, and shadows will fall behind you.’
6. Harness your trauma. Turn lemon into lemonade.  Many creative people have reported that trauma can be harnessed. For example, Sting said: ‘I don’t need to manufacture trauma in my life to be creative. I have a big enough reservoir of sadness or emotional trauma to last me.’
7. Try detaching yourself from the events.  View the trauma as if watching it as a member of an audience, and see the traumatic events, as just that, only some of many events in your life. Peter Capaldi observed: ‘The difference between movies and TV is that in TV you have to have a trauma every week, but that event may not be the biggest event in the characters’ lives.’
8. Remind yourself that the event has passed, and you can ‘rebuild your windshield’. ‘Rebuild your windshield,’ comes from Jane Leavy’s insight on how quickly trauma can jade our perspective on all of life: ‘Trauma fractures comprehension as a pebble shatters a windshield. The wound at the site of impact spreads across the field of vision, obscuring reality and challenging belief.’
9. Laugh at the events. Few traumas escape the therapeutic benefits of comedy. How many times in your life have you looked back at adversity and laughed? For most people, the answer is, often. At the time, laughter can be difficult to find. Just knowing that, someday, laughter may come, can help. Robin Williams, who faced his own traumas said: ‘Comedy can be a cathartic way to deal with personal trauma.’
10. Recognise and change disempowering thoughts. After traumatic experiences, it is to be expected that negative thoughts and feelings will take hold. People who recover well, admit the negative effect of any emotions and change the thoughts that lead to those emotions. If you choose to have empowering thoughts, you will have empowering emotions. As Earl Nightingale said: ‘You become what you think about.’
11. Choose how you want to feel. Few people have the opportunity or motivation to reach emotional mastery. Recovery from trauma presents both. Many people of wisdom have and continue to encourage us to choose our attitudes and our emotions. Maya Angelou’s version: ‘If you don’t like something, change it. If you can’t change it, change your attitude.’ Thomas Jefferson’s take: ‘Nothing can stop the man [person] with the right mental attitude from achieving his goal; nothing on earth can help the man [person] with the wrong mental attitude.’ Brian Tracy offers another approach: ‘You cannot control what happens to you, but you can control your attitude toward what happens to you, and in that, you will be mastering change rather than allowing it to master you.’ Viktor Frankl, who suffered the most horrendous traumas said: ‘When we are no longer able to change a situation – we are challenged to change ourselves.’
12. Seek support. No person is an island; as humans, we depend on each other, in good times and bad. Misty Copeland said it well: ‘Believe that anything is possible when you have the right people there to support you.’
13. Believe that there is a route to recovery and that things will eventually get better. What we believe about our recovery from trauma influences or even controls whether and how well we recover. William James said: ‘Believe that life is worth living and your belief will help create the fact.’
14. Choose optimism, even if you have to trick yourself into believing it. Here is some great news. People who choose optimism live longer, have a better quality of life and achieve more than pessimists. If you need words from someone who has overcome multiple adversities, through the choice of optimism, here is Helen Keller: ‘Optimism is the faith that leads to achievement. Nothing can be done without hope and confidence.’
15. Focus on solutions. When we are subject to trauma, it is very common for that trauma to dominate our thinking and block the search for solutions, or adjustment. Those who recover best seem to focus on solutions. Susan L Taylor expressed it well: ‘Stress and worry, they solve nothing. What they do is block creativity. You are not even able to think about the solutions. Every problem has a solution.’
16. Embrace self-responsibility. People who recover best from trauma, and many other adversities, are those who take the most self-responsibility for their recovery and work on finding and applying solutions. Jim Rohn encapsulated it: ‘You must take personal responsibility. You cannot change the circumstances, the seasons, or the wind, but you can change yourself. That is something you have charge of.’
17. Keep on keeping on. Persistence in the face of trauma or adversity has been advised by some of the people who have had that principle tested to extremes. For instance, Winston Churchill said: ‘If you’re going through hell, keep going.’  And William J Clinton noted: ‘If you live long enough, you’ll make mistakes. But if you learn from them, you’ll be a better person. It’s how you handle adversity, not how it affects you. The main thing is never quit, never quit, never quit.’
18. Set goals or set new ones. People who set goals and pursue them are happier and achieve more than those who do not. Goals focus the mind in constructive ways. Venus Williams applied this principle to good effect: ‘I don’t focus on what I’m up against. I focus on my goals and I try to ignore the rest.’
19. Learn from mistakes. On the journey to recover from any adversity, there will be mistakes and learning opportunities. Bit by bit, we become more and more skilled at recovering from adversity. Indeed, it seems that many of the most successful people of all time became so because they have learned how to overcome trauma and adversity. Constant learning helps in almost every area of life. Albert Einstein advised: ‘Learn from yesterday, live for today, and hope for tomorrow.’
20. Engage in hobbies and physical exercise. People who exercise regularly recover better from all sorts of adversities, as do those who immerse themselves in hobbies. It seems that the more immersive the hobby the more it provides psychological benefits. Bill Malone put it in a nutshell: ‘Hobbies are great distractions from the worries and troubles that plague daily living.’
21. Be gentle with yourself. We all suffer trauma, and we all need time to heal. On your journey to recovery from trauma, be kind to yourself. Let’s give the last word on techniques to recover from trauma to Sue Bird: ‘Be kind. Be nice to yourself. You miss a shot, it’s OK.’

Professor Nigel MacLennan runs the performance coaching practice PsyPerform.

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