Safety and stabilization are core components of trauma-related work. For individuals who have experienced trauma, memories may present as intrusive– showing up, repeatedly and without notice as a reminder of a traumatic event (s). They may show up like an uninvited guest coming to your home or an unwelcome visitor joining when you least expect it.

It can be difficult to find relief since. Memories might show up as distressing dreams. It may feel as though you are reliving a nightmare. It is not uncommon to wake up in a state of panic. You may find yourself experiencing physiological sensations such as sweating and racing heartbeat in addition to psychological responses of distress such as feelings of fear or disgust upon awakening. It can be difficult to fall back asleep, especially when the body is in a hyper-state of alertness.

Children may express trauma-related memories through play such as the re-enactment of a traumatic event or within their artwork. Play is such as powerful modality for children as it is another way to express oneself without words. Play is often incorporated into trauma treatment for children.

For those who have experienced trauma, avoidance of trauma-related memories is common. It may be difficult to remember aspects of a traumatic event; especially when dissociation is present. Individuals who have experienced trauma may avoid thinking or talking about memories associated with trauma. In addition, they may avoid conversations and people who may stir up trauma-related memories. Places, activities, objects, and situations that could trigger a traumatic memory may also be avoided.

For children and adults who did not have a consistently safe, protective, and stable home environment as part of complex-trauma may develop ways of coping focused on survival. While these coping mechanisms may have served a purpose at the time, they can interfere with future attachments and even interfere in relationships that are considered healthy and supportive.

Trauma can alter the way one views the self and others. Changes in cognition and mood can begin or worse after trauma is experienced. These thoughts and feelings can lead to unhelpful, or maladaptive ways of coping.

Common maladaptive coping strategies include the following:

• Substance misuse
• Self-injury/ self-harm
• Disordered eating
• Escape and avoidance
• Blame or self-blame
• Reckless or risky behaviors

While it may be tempting to dive right into trauma processing in therapy work, it is important to first focus on establishing safety and stabilization. This can start in the context of a safe and supportive therapeutic relationship. When maladaptive coping strategies are present, it is important to build a solid foundation to replace these with healthier ways to cope.

Psychoeducation to normalize trauma-related responses, working with emotions and triggers (e.g. awareness, identification, labeling, and regulation), and using relaxation and coping skills are some great starting areas to address in therapy before moving to cognitive processing as part of trauma management. Grounding techniques, especially sensory-calming interventions, and body-based strategies are also helpful. Here are some additional Tools-for-Managing-Traumatic-Stress.

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Written By: Charlotte Johnson, MA, LPCC