Trauma Informed Practice

What is trauma?

Trauma Informed Practice targets developing an understanding of the emotional psychological trauma people experience as they go through life as opposed to the physical trauma of injuries to the body.

Trauma tends to fall into one of three categories:

Acute Trauma which results from a single extreme and distressing event which threatens a persons physical and emotional safety and may include an accident, an assault, a natural disaster.

Chronic Trauma describes trauma which happens repeatedly such as in war and domestic abuse or child abuse.

Complex trauma describes the experience of multiple, long term, usually varied trauma as child abuse and domestic abuse where the person is exposed to a range of traumatic experiences usually perpetrated by a caregiver or partner and includes a sense of betrayal.

Whichever category of trauma is present the person who has been traumatised will find a reduction in their ability to cope when facing perceived threat in the moment.

What is trauma informed practice?

Trauma informed practice looks at how all human beings respond to threat in their environment and how organisations, managers, practitioners and service users can work together to identify and manage threat, empowering each other towards supportive independence.

From birth our brains start to develop neural pathways which determine our values, beliefs and expectations of the world and the people in it.

These pathways are unique to us and are created through our individual experiences.

Neural pathways are then used to interpret the world around us and the experiences and people we encounter as we go through life.

Threat can be an actual physical threat of injury or an emotional threat which triggers, sometimes unconscious, memories.

When our brain perceives a higher level of threat, the survival system, located in our unconscious primitive brain. takes control of our actions and behaviour.

Have you ever walked away from a stressful event and thought to yourself “why can’t keep my mouth shut?” or conversely “why do I just shut down, why can’t I speak and put my point across?”

These responses may be your survival system taking control and, at an unconscious level, based on previous experience, deciding the best course of action in the moment to keep you safe.

By being trauma informed Practitioners are able to understand the reasons threat impairs service users’ ability to engage and support them to overcome those barriers.

Our perception of threat is based in our memory of previous experience which establishes our perspective of the world. This perspective becomes our filter through which we interpret current events. Where high levels of threat are perceived, the primitive, reactive, unconscious brain cuts off access to our rational, thinking brain and takes control, deciding which course of action will keep us safe in the moment.

Our survival system, working in conjunction with our emotional memory, has a limited choice of responses which include:

  • Fight
    In fight mode the person will experience agitation and a quickening of their senses the automatic behavioural response is to attack, verbally or physically.
  • Flight
    In flight mode the person will experience the feeling of being trapped and the behavioural response is to get out.
  • Freeze
    In freeze mode the person will feel themselves shutting down, unable to engage
  • Flop
    In flop mode the body and mind become inaccessible. The brain protects the person from extreme threat by dissociation and, or fainting.
  • Friend
    In friend mode the person feels anxious and will attempt to appease a perceived threatening person by being overly helpful, supportive and may even degrade themselves in order to please the other.

These behavioural responses are universal and unconscious.

The Window of Tolerance (first identified by Dr Dan Siegel – link in resources below) explains how people move from calm and engaged, able to function and achieve, to becoming overwhelmed and disengaged.

The Window of Tolerance falls into three sections with the middle section being the optimal. We feel calm, in control and able to fully function. When our perceived threat increases, we begin to move up towards the fight flight zone feeling ourselves getting more and more agitated, or, down towards the freeze flop zone feeling ourselves slipping away. Sometimes instantly and at others gradually our unconscious primitive brain takes over and we lose conscious control of our behaviour.

As practitioners, we need to be able to recognise where our service users are in their window of tolerance and help them to come back into the middle window before we can do any meaningful work.

There are many ways we can help people to come back to the window of tolerance and remain there, which are freely available online including:

  • Fight or flight – Breath exercises
  • Freeze – get them moving
  • Empowering the service user to remain in, and expand their window of tolerance – grounding techniques
  • Expanding and empowering the service user to remain in their window of tolerance – grounding techniques
  • By being aware of a service users threat response and helping them to return to their window of tolerance we can facilitate meaningful engagement and reduce disguised compliance
  • By explaining trauma responses to service users we can reduce shame and guilt and provide options which empower and motivation change.

Self-help – tools and tactics

As we are all Human, we will all have times when we find ourselves wandering out of our window of tolerance, feeling anxious, frustrated, angry, or depressed, unfocussed and unmotivated.

Fortunately, Mental health and wellbeing are at the top of the agenda across society and so you can find a lot of support and ideas both through local authorities and charities but also online.

It is important you find ways which work for you, a range of ideas which are enjoyable and easy for you to fit into your day.

Exercise – Physical activity burns off the adrenaline we produce when in fight/flight mode and so reduces bodily tension. Choose and activity you enjoy, not one which feels like a chore, and can fit into your day. Yes, dancing around the living room does count.

Eat and sleep well – Keeping our bodies well fuelled and rested builds our resilience and ability to cope with stress. Many people have difficulty sleeping because thoughts get in the way so try distracting your brain by listening to something relaxing such as a relaxation recording and try a relaxing bedtime routine. Wellbeing apps such as Calm and headspace are designed to provide relaxation tips to suit your circumstances throughout the day.

Simple breathing exercises:

Box Breathing – useful to ground yourself in the moment. Imagine a box in front of you (or look at one in your room) and breathe in for a count of four while letting your eyes move up the side of the box. Hold your breath for the count of four while scrolling across the top of the box. Breath out for a count of four as your eyes scroll down the box and hold your breath again and you scroll along the bottom. Repeat as many times as you need to.
7 – 11 breathing – useful for calming yourself. Breathe in for a count of 7, hold for a count of 4, breathe out for the count of 11 hold to a count of 4. Repeat 3 times.

Grounding – There are a wide range of activities we can use to ground us and expand our window of tolerance. Mindfulness, Yoga, Meditation etc and the internet has many useful resources some of which are listed in the resources section

Talking and sharing – Find 5 people you trust; they can be your helping hands. Talk honestly and openly with them about your stresses and fears before they build up and become a problem, also listen to those people, they may well notice you are getting stressed before you do.