Based on TIP 57: Trauma-Informed Care in Behavioral Health Services|SAMHSA A single counseling CEU course is available at https://www.allceus.com/member/cart/index/product/id/393/c/ or the complete Trauma Informed Care Training Certificate are available at https://www.allceus.com/member

1. Trauma-Informed Care
Impact of Trauma
Instructor: Dr. Dawn-Elise Snipes, PhD, LPC-MHSP
Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery
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2. Objectives
 Learn About The Sequence of Trauma Reactions
 Explore Common Immediate and Delayed Experiences and
Responses to Trauma (Emotional, Physical, Cognitive,
Behavioral and Existential)
 Identify Specific impacts of Trauma
 Explore the Impact of Trauma on the Family
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3. Delayed Traumatic Response
 There can be a delay of months or even years before symptoms
appear
 Trauma symptoms can appear suddenly, even without conscious
memory of the original trauma or without any overt provocation
 Clients who are experiencing a delayed trauma response can
benefit if you help them to:
 Create an environment that allows acknowledgment of the trauma.
 Discuss their initial recall or first suspicion that they were having a
traumatic response.
 Draw a connection between the trauma and presenting trauma-
related symptoms.
 Explore their support systems and fortify them as needed.
 Identify their triggers.
 Develop strategies to navigate and manage symptoms and triggers.
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4. Biology of Trauma
 Changes in limbic system functioning.
 Hypothalamic–pituitary–adrenal axis activity
changes with variable cortisol levels.
 Neurotransmitter-related dysregulation of arousal
and endogenous opioid systems.
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5. Emotional Reactions to Trauma
 Immediate
 Numbness and detachment
 Anxiety/fear/ helplessness
 Guilt (including survivor guilt)
 Exhilaration as a result of
surviving
 Anger
 Sadness
 Feeling unreal; depersonalization
 Disorientation
 Feeling out of control
 Denial
 Constriction of feelings
 Feeling overwhelmed
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 Delayed
 Irritability and/or hostility
 Depression
 Mood swings, instability
 Anxiety/Fear of trauma recurrence
 Grief reactions
 Shame
 Feelings of fragility and/or vulnerability
 Emotional detachment

6. Cognitive Reactions to Trauma
 Immediate
 Difficulty concentrating
 Rumination or racing
thoughts
 Distortion of time and space
 Memory problems
 Strong identification with
victims
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 Delayed
 Intrusive memories or flashbacks
 Reactivation of previous traumatic events
 Self-blame
 Preoccupation with event
 Difficulty making decisions
 Magical thinking: belief that certain
behaviors, including avoidant behavior,
will protect against future trauma
 Belief that feelings or memories are
dangerous
 Generalization of triggers

7. Behavioral Reactions to Trauma
 Immediate
 Startled reaction
 Restlessness
 Sleep and appetite
disturbances
 Difficulty expressing oneself
 Argumentative behavior
 Increased use of alcohol,
drugs, and tobacco
 Withdrawal and apathy
 Avoidant behaviors
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 Delayed
 Avoidance of event reminders
 Social relationship disturbances
 Decreased activity level
 Engagement in high-risk behaviors
 Increased use of alcohol and
drugs
 Withdrawal

8. Specific Impacts of Trauma
 Attachment and Relationships
 Trauma can impacts people’s ability to develop a strong
healthy attachment to caregivers.
 People who do not have healthy attachments and
relationships have been shown to
 be more vulnerable to stress
 have trouble controlling and expressing emotions
 may react violently or inappropriately to situations.
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9. Specific Impacts of Trauma
 Physical Health: Body and Brain
 When a child grows up afraid or under constant or extreme
stress, the immune system and body’s stress response
systems may not develop normally. Later on, when the child
or adult is exposed to even ordinary levels of stress, these
systems may automatically respond as if the individual is
under extreme stress.
 Stress in an environment can impair the development of the
brain and nervous system.
 An absence of mental stimulation in neglectful environments
may limit the brain from developing to its full potential.
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10. Specific Impacts of Trauma
 Physical Health: Body and Brain
 People with trauma histories may develop chronic or
recurrent physical complaints, such as headaches or
stomachaches.
 Trauma survivors may suffer from body dysregulation,
meaning they over-respond or underrespond to sensory
stimuli. For example, they may be hypersensitive to sounds,
smells, touch or light, or they may suffer from anesthesia
and analgesia. As a result they may injure themselves
without feeling pain, or, may complain of chronic pain in
various body areas for which no physical cause can be found.
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11. Specific Impacts of Trauma
 Emotional Responses
 Difficulty identifying, expressing, and managing emotions,
and may have limited language for feeling states.
 Internalize and/or externalize stress reactions and as a
result may experience significant depression, anxiety, or
anger.. Their emotional responses may be unpredictable or
explosive.
 Since the traumas are often of an interpersonal nature, even
mildly stressful interactions with others may serve as trauma
reminders and trigger intense emotional responses.
 Having learned that the world is a dangerous place people
are often vigilant and guarded in their interactions with
others and are more likely to perceive situations as stressful
or dangerous.
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12. Specific Impacts of Trauma
 Dissociation
 Once people have learned to dissociate as a defense
mechanism they may automatically dissociate during other
stressful situations or when faced with trauma reminders.
 Dissociation can affect people’s ability to be fully present in
activities of daily life and can significantly fracture a child’s
sense of time and continuity.
 It can have adverse effects on learning, classroom/work
behavior, and social interactions.
 It is not always evident when someone is dissociating and at
times it may appear as if the person is simply “spacing out,”
daydreaming, or not paying attention.
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13. Specific Impacts of Trauma
 Behavior
 A person with a complex trauma history may be easily
triggered or “set off” and is more likely to react very
intensely.
 He or she may struggle with self-regulation and may lack
impulse control or the ability to think through consequences
before acting, and may behave in ways that appear
unpredictable, oppositional, volatile, and extreme
 Traumatized people are more likely to engage in high-risk
behaviors, such as self-harm, unsafe sexual practices, and
excessive risk-taking such as operating a vehicle at high
speeds
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14. Specific Impacts of Trauma
 Cognition: Thinking and Learning
 Traumatized people may have problems thinking clearly,
reasoning, or problem solving. They may be unable to plan ahead,
anticipate the future, and act accordingly.
 When people live under conditions of constant threat, all their
internal resources go toward survival.
 They may struggle with sustaining attention or curiosity or be
distracted by reactions to trauma reminders.
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15. Specific Impacts of Trauma
 Self-Concept & Future Orientation
 People learn their self-worth from the reactions of others, particularly
those closest to them. (Caregivers, spouse)
 Caregivers have the greatest influence on a child’s sense of self-worth
and value. Abuse and neglect make a child feel worthless and
despondent.
 Shame, guilt, low self-esteem, and a poor self-image are common among
people with trauma histories.
 People exposed to violence learn they cannot trust, the world is not safe,
and that they are powerless over their circumstances.
 Negative expectations interfere with positive problem-solving, and the
ability to make a difference in their own lives.
 A traumatized person may view himself as powerless, “damaged,” and
may perceive planning and positive action as futile.
 They have trouble feeling hopeful. Having learned to operate in “survival
mode,” lives from moment-to-moment without pausing to think about,
plan for, or even dream about a future.
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16. Specific Impacts of Trauma
 Long-Term Health Consequences
 Results demonstrated the connection between trauma
exposure, high-risk behaviors (e.g., smoking,
unprotected sex), chronic illness such as heart disease
and cancer, and early death.
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17. Impact of Trauma on the Family
 Trauma changes families as they work to survive and adapt to
their circumstances and environment.
 Adult relationships can be a source of strength in coping with a
traumatic experience and its aftermath
 When coping resources are stretched too thin and the stress is too high,
partners can have problems communicating, managing emotions and
intimacy; increasing the chances for separation or even violence.
 Parent’s protection, nurturance and guidance speeds recovery and
supports their child’s coping in the face of trauma.
 When parents are not available or struggling with their own reactions
they have difficulty effectively responding to and parenting children.
 Sibling relationships are important sources of daily support,
especially when living under stress or impacted by trauma.
 When sibling relationships become over-taxed, developmentally normal
rivalries can turn into more intense conflict or feelings of rejection.
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18. Impact of Trauma on the Family
 Extended family can offer the day-to-day assistance as well as
emotional support.
 Families separated from their extended family often develop a new
“kinship” network.
 The family as a whole provides resources to meet the basic
needs of each family member (safety, love, food, shelter,
health, education, etc.) and support the family’s well-being
and day-to-day functioning.
 Traumatic circumstances drain families of resources, such as time,
money and energy, interfering with growing, learning and working.
 Burdens often associated with trauma (e.g. costly court proceedings,
moving, changing schools, etc.) result in cascading effects such as loss
of income, as well time with family and friends.
 When trauma limits access to needed resources and social support,
families have difficulty carrying out daily routines and sustaining
important traditions that bind them together.
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19. Advice for Counselors
 Educate your clients:
 Frame reexperiencing the event(s), hyperarousal, sleep
disturbances, and other physical symptoms as physiological and
adaptive reactions to extreme stress.
 Communicate that treatment and other wellness activities can
improve both psychological and physiological symptoms
 Discuss traumatic stress symptoms
 Explain links between traumatic stress symptoms and substance
use disorders, if appropriate.
 Normalize trauma symptoms. For example, explain to clients that
their symptoms are not a sign of weakness, a character flaw, being
damaged, or going crazy.
 Support your clients and provide a message of hope—that
they are not alone, they are not at fault, and recovery is
possible and anticipated.
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20. Resilient Responses to Trauma
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 Increased bonding with family and community.
 Redefined or increased sense of purpose and meaning.
 Increased commitment to a personal mission.
 Revised priorities.
 Increased charitable giving and volunteerism.

21. Summary
 Trauma impacts the person
 Emotionally
 Cognitively
 Physically
 Developmentally
 Interpersonally
 Spiritually
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