UNDERSTANDING COMPLEX TRAUMA

What is Complex Trauma?

Complex trauma is a type of trauma that is caused by prolonged or repeated exposure to traumatic events, particularly during childhood or early adulthood. These events often involve:

• Interpersonal violence, such as physical or sexual abuse
• Neglect
• Abandonment 

The effects of complex trauma can be severe and long-lasting. Research has shown that complex trauma impacts the brain and body in several ways.

Impact on Brain Development
Perry and Pollard (1997) found that individuals who experienced chronic childhood trauma had decreased activity in the prefrontal cortex, an area of the brain responsible for executive functioning, decision-making, and emotion regulation (control of impulsive behaviors). 

Studies have shown that complex trauma can also have a significant impact on brain development, particularly in the areas of the prefrontal cortex, the hippocampus, and the amygdala. These regions of the brain are responsible for a wide range of cognitive and emotional processes, including memory, attention, emotion regulation, and stress response. 

Additionally, the hippocampus, an area of the brain responsible for memory consolidation and retrieval, was found to be smaller in individuals who experienced complex trauma. These changes in brain structure and function can lead to difficulties with attention, memory, and emotional regulation.

Impact on the Body
Complex trauma can have a profound impact on the body, particularly the immune and nervous systems. Trauma activates the body’s stress response system, leading to chronic activation of the sympathetic nervous system and the release of stress hormones such as cortisol. This prolonged stress response can lead to: 

• Chronic pain
• Cardiovascular disease
• Inflammation
• Increased risk for chronic illness
• Weakened immune system and autoimmune disorders (van der Kolk, 2014).

This may be due in part to the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which is responsible for the body’s stress response.

Impact On Sense of Self and Identity

In addition to these physical and cognitive impacts, complex trauma can also have a significant impact on an individual’s sense of self and identity. Studies have shown that individuals who have experienced complex trauma often struggle with feelings of:

• Shame
• Guilt  
• Worthlessness
• Diminished sense of self-esteem and self-worth 

This can make it difficult for them to:

• Form healthy relationships
• Trust others
• Feel a sense of belonging in their communities

Hope for Recovery: Evidence-based Therapies

Despite the significant challenges associated with complex trauma, there is hope for recovery. Research has shown that evidence-based treatments such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Somatic Experiencing (SE) can be effective in helping individuals to heal from the effects of complex trauma. These treatments focus on helping individuals to:

• Process their traumatic experiences
• Develop coping skills
• Build resilience

Safe and Supportive Therapeutic Environment
One important factor in recovery from complex trauma is the establishment of a safe and supportive therapeutic environment. This may involve working with a therapist who has specialized training in trauma-informed care, as well as participating in group therapy or support groups with other individuals who have experienced complex trauma. 

The use of mindfulness practices, such as meditation and yoga, can also be helpful in promoting relaxation and stress reduction.

Specialized Treatment for Complex Trauma

Specialized effective treatment modalities for complex trauma involve a combination of evidence-based psychotherapies, such as Eye Movement Desensitization and Reprocessing (EMDR), Accelerated Resolution Therapy (ART), Cognitive Processing Therapy (CPT), and mindfulness practices. These therapies are designed to help individuals address the negative impact of trauma on their mental and physical well-being.

EMDR
EMDR is a psychotherapy approach that was specifically developed to treat trauma-related disorders. It involves the use of bilateral stimulation, such as eye movements or taps, while the individual recalls traumatic memories. The goal of EMDR is to reprocess traumatic memories, reduce their emotional intensity, and replace negative beliefs with positive ones. A meta-analysis of 26 randomized controlled trials found that EMDR was an effective treatment for post traumatic stress disorder (PTSD) and that the benefits were sustained over time (Bisson et al., 2013).

ART
This is another evidence-based psychotherapy that was developed to treat trauma-related disorders. ART combines elements of cognitive-behavioral therapy, exposure therapy, and eye movement desensitization and reprocessing (EMDR). ART uses rapid eye movements to help the individual reprocess traumatic memories and replace negative beliefs with positive ones. A randomized controlled trial found that ART was an effective treatment for PTSD and depression, and that the benefits were sustained over time (Kip et al., 2017).

CPT
CPT is a cognitive-behavioral therapy that focuses on changing negative thoughts and beliefs that result from traumatic experiences. CPT involves identifying and challenging negative thoughts and beliefs and replacing them with positive ones. A meta-analysis of 18 randomized controlled trials found that CPT was an effective treatment for PTSD, and that the benefits were sustained over time (Chard et al., 2010).

Mindfulness
Mindfulness practices, such as meditation and yoga, have also been found to be effective in treating the symptoms of complex trauma. Mindfulness practices help individuals develop awareness and acceptance of their thoughts and emotions, which can reduce the impact of trauma-related symptoms. A randomized controlled trial found that a mindfulness-based stress reduction program was an effective treatment for PTSD (Niles et al., 2012).

Do I Have Complex Trauma?

Complex trauma can present in a range of ways and often manifests in both psychological and physiological symptoms. It is important to note that experiencing trauma is a normal response to abnormal events and does not reflect any personal weakness or moral failing. 

According to the National Child Traumatic Stress Network, individuals who have experienced complex trauma may present with a wide range of symptoms, including but not limited to:

• Depression
• Anxiety
• Dissociation
• Hyper-vigilance
• Nightmares
• Flashbacks
• Substance use disorders 

Additionally, those with complex trauma may:

• Struggle with interpersonal relationships
• Have difficulty regulating their emotions
• Experience feelings of shame or guilt

With help from trained professional therapists in a supportive environment, there are successful routes to a healthier life.

Sources

Perry, BD and Pollard, D. 1997. Altered brain development following global neglect in early childhood. Society For Neuroscience: Proceedings from Annual Meeting,New Orleans.

van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

Bisson, J. et al.  2013. Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev. Dec 13;2013(12):CD003388. doi: 10.1002/14651858.CD003388.pub4.

Kip H. et al. 2017. Accelerated Resolution Therapy (ART): a Review and Research to Date. Military Mental Health (CH Warner, Section Editor). Published: 13 March 2017. Volume 19, article number 18, (2017).

Chard, K. et al. 2010. Dissemination and experience with cognitive processing therapy. Veterans Affairs. JRRD. Volume 49, Number 5, 2012

Niles, B. et al. 2012. Comparing mindfulness and psychoeducation treatments for combat-related PTSD using a telehealth approach. Psychological Trauma: Theory, Research, Practice, and Policy, 4(5), 538–547. https://doi.org/10.1037/a0026161