Topic
Description
Trauma
- The emotional response that can result from experiencing a very distressing or scary situation
- Experienced as a threat to the safety of the person
- People may experience a sense of powerlessness during the traumatic event or experience, which can later cause feelings of guilt and shame, threatening a person’s very identity
- Traumatic events/experiences:
- Are unpredictable and unexpected
- Are beyond a person’s control
- Exceed a person’s ability and/or capacity to manage the threat
Types of trauma
- Interpersonal: Childhood abuse, sexual assault, domestic abuse, elder abuse
- External: War, sudden death of loved one, extreme poverty, natural disaster, accidents
- Developmental: Child abuse and neglect, witnessing violence at home
- Historical: Residential schools, Holocaust
Trauma impacts
- Physical: Obesity, diabetes, myocardial infarction, stroke, sleep disturbances
- Mental: Depression, alcohol, and substance use
- Cognitive: Difficulty reading faces and social cues, difficulty with attention and concentration
- Social: Decreased trust, difficulty with relationships
- Physiological: Fight, flight, freeze
Mental health impacts
- PTSI: Mental illness, diagnosable using specific criteria. Symptoms are significant and impact the person’s day-to-day-functioning
- Delayed PTSI: May occur weeks, months, or even years after the event. Symptoms same as PTSI. Can be frightening or confusing as there may not be a clear connection with traumatic event
- Complex/developmental PTSI: Prolonged trauma experience at early age, involving a person close in relationship. Profoundly disruptive, with most severe symptoms
PTSI diagnostic criteria
- T: traumatic event
- R: re-experiencing traumatic event
- A: avoidance and emotional numbing
- U: unable to function
- M: symptoms last for month or more
- A: increased arousal (increased startle reaction, poor concentration, irritable mood, insomnia, hypervigilance)
PTSI: Dissociation
- A disconnection between a person’s thoughts, feelings, actions, or sense of who and where they are
- Subtypes:
- Depersonalization: their body may feel unreal
- Derealization: the world may feel unreal
PTSI: Co-occurring disorders
- Mood disorders (e.g., depression)
- Anxiety
- Substance use
- Personality disorders
Trauma exposure response
- Impact of working directly with individuals who have experienced or been affected by trauma
- Can be seen as an occupational hazard for healthcare providers and emergency medical services
Impact of trauma exposure on healthcare provider mental health
- Burnout: Physical, mental, and emotional exhaustion caused by high levels of stress over a prolonged period
- Vicarious trauma: Witnessing neglect, others’ intense and excessive loss and pain
- Secondary trauma: Trauma of patients triggers memories of personal trauma history
- Moral injury: Profound distress arising in the aftermath of situations in which one’s moral or ethical beliefs are violated
Trauma-informed care
- Care adjusted to accommodate the needs of individuals who have experienced trauma
- Based on knowledge of the impact of trauma, and what is required for the patient to feel safe and able to receive care being provided
- A treatment and organizational approach
- Benefits patients, staff, and organizations
- Person-centred care that focuses on overall well-being of the person, rather than simply treating symptoms
Trauma-informed vs. trauma-specific care
- Trauma-informed care: Service delivery approach. Requires changes to practices, policies, and culture of the entire organization
- Trauma-specific care: Clinical treatment designed to address trauma-related symptoms. Usually delivered in specialized programs by clinicians with advanced training
TIC foundational principle: Become trauma aware
- Anticipate the possibility of a history of trauma
- Be sensitive to the impact of trauma
- Explore with your client/trauma survivor the best way to view or define their experience
- Ensure safety, trustworthiness, choice, collaboration, empowerment
TIC foundational principle: Recognize that some health practices can be traumatizing
- Treatment procedures and practices can be triggering for clients with histories of trauma
- Re-traumatization can leave the client feeling as if the past trauma is reoccurring
- Examples: Diagnostic procedures that require the client to wear ill-fitting patient gowns, personal care in hospital or long-term care settings, breast exams, pelvic exams, rectal exams
TIC foundational principle: Create a safe environment
- Consistency in client interactions and treatment processes
- Following through with what has been reviewed and agreed upon
- Honest and compassionate communication
TIC practice tip 1: Routine query about trauma history
- Routinely ask about a client’s trauma history on initial assessment or at any time during the intervention
- Provide brief psychoeducation about the prevalence and consequences of trauma to normalize the experience and open the door for the client to disclose later, if not ready in the moment
TIC practice tip 2: Recognize signs and symptoms of trauma history
- Recognize that client behaviours and symptoms may be potentially linked to a trauma history
- Rather than viewing the client as “noncompliant” (or using other labeling language), recognize that signs and symptoms may be associated with trauma history
TIC practice tip 3: Respond to signs and symptoms of current self-harm
- Self-harm refers to a person harming their body on purpose. The intent is not to kill oneself
- Determine intent and level of risk to determine whether the behaviour was an instance of non-suicidal self-injury or whether it was a genuine suicide attempt
TIC practice tip 4: Recognize when someone is being triggered
- A trigger is any sensory experience that reminds the person of the original traumatic event or experience
- Once triggered, the person is pushed back to the traumatic memory and may lose awareness of the present moment
TIC practice tip 5: Responding to disclosures
- Disclosing a trauma history requires trust on the part of the survivor
- Honour this trust by responding with respect, belief, and compassion
- Expressing shock, pity, or anger at the perpetrator are not helpful
TIC practice tip 6: Risk assessment and referral
- Suicidality is common among those with PTSI
- The presence of major depression further increases the risk of suicidal behaviour
- Determining risk and what action to take is critical for the healthcare provider
Trauma-informed organizations
- Trauma-informed organizations promote:
- Physical safety: Safe physical spaces which are well-lit with signage, minimize environmental triggers, ensure privacy and personal space, provide appropriate interpretation services
- Emotional safety: Trauma-informed policies that promote change in thinking, change the language that is used to describe clients, share power and control