On the last track, we discussed the three ways clients
re-experience a traumatic events via sleep disturbances; flashbacks; and emotional
recall. We also
included a technique to help you identify what type of trauma
re-experience your client is undergoing called the "Re-experiencing
Trauma Quiz." found in your manual.
On this track, we will examine types of adaptation reactions
to trauma to include emotional numbing, trigger avoidance, and hypervigilance. In
this track, we will also discuss PTSD resulting from sexual abuse and natural
disasters. As you listen to these ask yourself if playing this track
would be appropriate for your next session with a PTSD client.
3 Adaptation Reactions to Trauma
#1 Emotional Numbing
The first type of adaptation reaction is emotional numbing. As
you are aware, emotional numbing is a survival technique which occurs in much
the same way that physical numbing does. When a client experiences extreme
physical pain, his or her body releases a natural anesthetic that keeps the
client from feeling the wound immediately.
Likewise, those clients exposed
to psychological trauma experience a complete shutdown of
their emotions so that their feelings will not clog their survival instincts.
trauma client, Christie age 18, was raped by a stranger when
she was 16. Christie stated that during the assault, she doesn’t
remember specific feelings. She said, "Right before it happened,
I remember being scared and alert, but while it was happening,
I could only think about how I was going to stay alive. How I was going
to keep him from killing me. He left me
in the back of a truck and went into a gas station. That’s when
I got loose and ran for help."
As you can see, Christie’s
mind sent out an emotional anesthesia that kept the emotion
of fear from taking over her mind. Because she wasn’t overwhelmed
by this emotion, Christie was able to escape from her captor and survive the
of your trauma client. Has he or she experienced emotional numbing, like
Christie had? Would it be beneficial to discuss this in you next session
or play this track in the session.
#2 Trigger Avoidance
A second type of adaptation reaction is trigger avoidance. As
we discussed on track 2, re-experiencing a trauma is a painful reliving of the
ordeal and may call up some of the emotions that a client underwent or numbed during the trauma. As a result, survivors avoid triggers that
might incite the powerful emotions to once again take over.
you found, like I, that each individual trauma client has his or her own set
Joel, a client of mine, had survived an
earthquake which killed two other people, including his fiancée. Because
of this, Joel could not stand the sound of breaking glass or
any sort of rumblings. Such things as construction sights where workers
would be using loud equipment would cause Joel to hyperventilate. As
you can see, loud rumbling noises are clearly Joel’s triggers resulting
from the fatal earthquake. We will discuss triggers more thoroughly on
a later track.
Technique: Calming Breath
To help Joel with his hyperventilation, I suggested he try the "Calming
Breath" exercise which would control his intake of oxygen. Would
calming breaths be a good topic in your next session?
I asked Joel to
listen and complete the following instructions when he felt his breathing getting
- Breathing from your abdomen, inhale slowly to a count
of five. Count slowly as you inhale.
- Pause and hold your breath to a count of five.
- Exhale slowly, through your nose or mouth, to a count
of five, or more if it takes you longer. Be sure to exhale fully.
- When you’ve exhaled completely, take two breaths in your
normal rhythm, then repeat steps 1 through 3 in the cycle above.
- Keep up the exercise for at least three minutes. This should involve
going through at least ten cycles of in-five, hold-five, out-five. Remember
to take two normal breaths between each cycle. If your client starts
to feel light-headed while practicing this exercise, stop for
30 seconds and then start again.
- Throughout the exercise, keep have your client keep breathing
smooth and regular, without gulping in breaths or breathing suddenly.
- If you wish, each time your client exhales, you suggest they
say "relax," "calm," "let
go," or any other relaxing word or phrase silently to yourself. Allow
your whole body to let go as you do this.
The next several times that Joel felt he was beginning
to lose control of his breathing, he used this exercise and later stated, "Incredible. I
felt so much calmer. Not completely calm, but just enough that I wouldn’t
pass out with so much oxygen." As you can see, by sometimes treating
just the symptoms of a re-experience attack, the client may become more in control
of their surroundings and bodily reactions.
#3 Hypervigilance Technique: Easy Questions
The third type of adaptation reaction is hypervigilance. As
you are probably well aware, hypervigilance is the state in which a trauma
client undergoes fight-or-flight and
freeze reactions even when no real danger exists. Adrenalin or
noradrenalin is pumped into the client’s system. When adrenalin
is produced, clients may feel extremely alert and such things as heart rate,
blood-pressure, and blood-sugar are heightened.
This is what is known
as the fight-or-flight reaction. On the other hand,
if a client’s adrenal glands produce noradrenalin, an opposite reaction
Have you ever heard a trauma client say, "I
don’t know what happened, I just froze"? Some have described
it as moving or thinking in slow motion.
Daniel, a 9
year old client of mine, had witnessed his mother raped and beaten by his father. However,
when I asked him if he had been experiencing hypervigilance, he didn’t
To make the concept more comprehensible for the young
boy, I asked him the following, more specific questions. You may consider
using this questionnaire for those young or mentally handicapped clients who
have a hard time understanding these ideas.
I call this
kind of inquiry "Easy Questions".
- Is it hard to fall asleep or stay asleep at night? Do you have
bad nightmares? Do you sometimes wake up and your sheets are all
over the bed?
- Do you sometimes get mad for no reason? Do you sometimes get so
mad that you throw things or break things? If you do get that
mad, do you feel you can’t feel better until you’ve broken
you ever shout at your family or friends?
- Are you always afraid something might happen to your friends or family
now? Do you feel like they are always in danger?
- Do you jump at loud noises, like a bat hitting a ball?
After I had finished asking these questions, I had learned
that Daniel had excessive nightmares, all involving his father. Also,
he had become gradually more irritable over the weeks, throwing
toys, pillows, and pushing over furniture. Most notably, Daniel appointed
himself protector over his family.
Even though he was
living at his grandmother’s house and his father was in jail, Daniel
was always the first one to tell people to buckle up, wear a helmet, look both
ways when crossing the street, and other ways that a nine-year-old knows how
to protect others. As you can clearly see, Daniel was suffering from severe hypervigilance and at such an early age, if not treated, this sense of over-protecting
his loved ones may spill over into his adult life.
On this track we discussed types of adaptation reactions
to trauma. These were emotional numbing, trigger avoidance,
On the next track, we will examine depression and
its various manifestations when linked to PTSD: behavioral depression.
We will link depression to learned helplessness; repressed anger; and loss and
What are three types of adaptation reactions to trauma?
To select and enter your answer go to .