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Mental Health: How to deal with different types of trauma

From 'Big T' to 'Little T', recognising the diversity of experiences that shape mental well-being is paramount

Trauma has long been associated with life-altering events — the kind that shake one's very foundation and leave indelible scars on the mind, body, and soul.

Yet, as our understanding of mental health continues to evolve, a quieter realisation is taking root: trauma is not always a singular, seismic event. It can manifest as a series of smaller, seemingly innocuous occurrences that accumulate over time, stealthily eroding our sense of self and well-being.

Counselling psychologist, Tanya Dharamshi, The Raymee Grief Centre and community support services lead at the Lighthouse Arabia, Dubai, explains the ways in which every day experiences can permeate our daily lives, shaping our thoughts, beliefs, and behaviours in ways we may not even realise.

Traditional ‘Big T’ trauma

Trauma is not the story of something that happened in the past, but rather the current imprint of that lasting pain, horror, and fear living inside of us. Trauma refers to the impact experiences have on our emotional and psychological health.

Trauma in the way most people think about it is identified as ‘Big T’ trauma, when significant events occur that trigger lasting feelings of powerlessness and loss of control in a person’s life and environment. Some examples of Big T trauma can include physical and sexual assault, accidents, natural disasters, and war. Big T trauma significantly impacts one’s functioning across the physical, emotional, cognitive, behavioural, and spiritual space.

Understanding ‘Little T’ trauma

‘Little T’ traumas are quite often not acknowledged and not seen as significant enough to respond to. Some examples of Little T trauma range from feelings of neglect, rejection, or betrayal to experiencing toxic relationships or enduring microaggressions.

Experiencing these events singularly can be attributed to normal life stressors and may not impact our functionality. But repeating and layered Little T traumas can become chronically overwhelming, painful or distressing and create an ownership of various core beliefs that are based on not feeling valued or seen, and/or feeling ‘not good enough’. This can result in depression, anxiety, feelings of shame, and low self-worth. Left unaddressed, this can significantly impact long-term functionality in various areas of our life.

Cultural and societal beliefs about how Little T traumas are understood and endured not only lead to developing and internalising negative core beliefs, but also hinder our access to the resources that promote well-being. There is a stigma attached to receiving emotional support or acknowledging emotional distress, which can be viewed as weakness and at times ‘over dramatic’.

Communities that are marginalised due to socioeconomic status, ethnic or racial minorities, children, those with previous mental health conditions, and those that have experienced Big T traumas are more susceptible to experiencing Little T traumas because they are more likely to be repeatedly exposed to them without knowing how to regulate and get help.

How to deal with ‘Little T’ trauma

Developing our tool kit to respond to stressors is key to mitigating the impact of Little T traumas. To start, never underestimate the power of a strong support network. The ability to share our experiences and have them validated is a foundation to mental well-being.

By bringing mental health to the forefront at work, school, and home, we invite the normalisation and exploration of the impact our experiences have on us in a psychologically safe space with compassion and care.

Engaging in self-care is also critical to cultivating and maintaining the resilience. Self-care includes the three non-negotiables: adequate sleep with healthy sleep hygiene, eating healthy food, and engaging in healthy movement/exercise. Vagal nerve toning can also calm and relax our five senses to promote mindfulness and helps regulate thoughts and feelings. Examples of this would be to use aromatherapy candles, with soothing sounds and light, and make time for somatic sensations such as walking barefoot, stroking a pet, or holding a soft pillow.

Psychologists or trained professionals can also help navigate negative beliefs that surface. Having access to qualified mental health clinicians as well as trauma-informed clinicians is a key component to treatment. Additionally, having trauma-informed doctors who have awareness and understanding of the somatisation of trauma is also a very important part of improving care and removing the stigma that we experience with mental illnesses and disorders.

Common misconceptions

Each one of us responds to trauma in our unique way, like our own fingerprints. We each have our own life experiences, cultural influences, personal and environmental beliefs and values, and distress tolerance. It’s important to not compare your reaction and how you process a similar experience to others, as a multitude of external factors can influence how it impacts you.

Perhaps one of the biggest misconceptions we are viewing given the current global situation since the onset of the pandemic is that the traumatic experience must happen to the individual. Secondary trauma is real and can occur in those who are simply witnesses or even in those who hold space for others’ traumas.

Finally, not every trauma will result in post-traumatic stress disorder (PTSD), anxiety disorder, acute stress disorder or any other disorder. Many of us experience trauma and are equipped to manage with our coping skills, support structure, and by receiving therapy in a timely manner.

Empirically-based evidence has shown that experiencing trauma impacts the brain and nervous system. As humans, we are built to want to heal. Thankfully, the neuroplasticity of our brain allows it to change, modify, adapt, and shift responses to our experiences. Given this understanding, various therapeutic approaches support healing from traumatic events.

Narrative therapy: Narrative therapy provides a safe space for the client to share their story, gain more clarity around it, and create a new narrative that can enhance and create empowerment and regain control over their experience.

Cognitive Behavioural Therapy (CBT): CBT focuses on changing the thoughts, behaviours and emotions that we develop around a particular event. Clinicians will use various techniques to identify and challenge negative thought distortions and unhelpful behaviour patterns to re-evaluate and rescript their conceptualisation of their trauma and themselves.

Dialectical Behavioural Therapy (DBT): DBT for trauma is an evidence-based therapy and is based on the Polyvagal theory. It utilises tools such as distress tolerance, mindfulness, interpersonal effectiveness, emotion regulation, exposure and response prevention, validation, self-acceptance and opposite action.

Eye Movement Desensitisation Reprocessing (EMDR): Developed by Francine Shapiro, it is recognised as an effective treatment for anxiety, depression, OCD, trauma, grief, phobias, and chronic pain among others. EMDR allows communication between the amygdala, hippo campus and frontal cortex through bilateral stimulation to process experiences thus resolving and disengaging the fight/flight/freeze response.

Brainspotting: Like EDMR, this also uses bilateral stimulation to activate the brains’ limbic system to process the emotions of a particular event. It is a patient-led therapy and has significant positive results in the outcome of treating trauma.

(As told to Ghenwa Yehia)

wknd@khaleejtimes.com