Shining a Light on Trauma-Informed Care

by Lara Stewart-Panko

Shining a Light on Trauma-Informed Care

by Lara Stewart-Panko

Trauma-informed care is becoming a standard approach in most forms of caregiving, and end-of-life doula support can be greatly enhanced by applying this perspective to our work.  Here are some foundational elements:

What is trauma?

This means that two people can be involved in the same situation yet only one of them might suffer trauma. Some things can increase the odds of a person (or animal) sustaining trauma, but ultimately, every one of us is vulnerable to this emotional response. For this reason, it’s wise to bring a trauma-informed perspective to all our interactions with others (and even ourselves). We won’t cause harm in doing so, and we’ll likely create much goodness in the process.

A common misunderstanding is that events  are “trauma.” However, trauma is not defined solely by event details. It’s about the effect events have on someone—how their system processes what happened to them. 

When we experience something threatening that might or does overwhelm our ability to feel safe physically or psychologically, we stand a chance of developing trauma. It’s how our nervous system—body and mind—does its best to protect us in the moment and in the future. Trauma is manifested in our thoughts, feelings, bodily reactions, and behaviors.

 

What are Post-Traumatic Stress Disorder (PTSD) and Complex Post-Traumatic Stress Disorder (CPTSD)

PTSD and CPTSD are clinical diagnoses, but let’s be clear: We don’t need to meet formal criteria in order to have the subjective experience of trauma. Caring well for ourselves and others when we’re having a rough go, label or no label, is a sensible thing to do.

PTSD is a diagnosis that can be given when a number of symptoms result from direct or indirect exposure to death, threat of death, and actual or threatened serious injury, including accidents, illness, childbirth, and physical or sexual violence. 

CPTSD is a diagnosis that can be given when a number of symptoms result from repeated, ongoing trauma, most often of an interpersonal nature. Examples of causes include abusive relationships of all types, imprisonment, witnessing ongoing abuse (such as what children experience when domestic violence is occurring in the home), and abandonment.

It is entirely possible for someone to have both PTSD and CPTSD, and it’s common for people with either condition to develop other forms of mental illness, and to use substances or addictive behaviors to soothe their distress.

 

A note about collective trauma

People can also experience trauma from nonindividual processes, such as war, natural disasters, genocides, and ongoing or historical oppression, to name a few. Often, trauma of this nature has multigenerational impact, and an entire family group you work with could be affected.

 

What are some of the symptoms of trauma?

One useful way to view trauma is recognizing that trauma is held in a person’s nervous system. The vagus nerve, which runs from the brain stem to part of the colon, regulates internal organ functions. Its name is derived from the Latin term for “wandering,” as it makes essential connections throughout the body. This nerve is greatly responsible for three responses: ventral vagal (calming and social), sympathetic (fight and flight), and dorsal vagal (shutdown and collapse). When the nervous system feels threatened or overwhelmed, the vagus nerve allows certain feelings, sensations, and behaviors to arise. It transmits 80% of its signals from the body to the brain, and only 20% of its signals from the brain to the body. This is important in understanding why body-based soothing efforts carry more power than cerebral tools, such as logic or reasoning. According to the polyvagal theory, this can lead to determining whether we feel safe or not.  

 

Symptoms of trauma appear as:

• Anxiety, fear, terror

• Agitation, impatience, anger

• Sadness, confusion, fogginess, numbness, hopelessness

• Disassociation, a sense of being disconnected from one’s body or that life doesn’t feel real

• Urges to hit, kick, throw

• Sharp tone of voice, verbal aggression, yelling

• Shaking, difficulty being still, impulse to run or do things quickly

• Withdrawn, frozen, immobilized, collapsed

• Tense muscles, thirst, can be hard to catch one’s breath

• Hypervigilance, can misread safe or neutral cues as dangerous

• Competitive, critical, judgmental, negative, conflict-seeking

A variety of these symptoms can be expressed right when a difficult event is occurring as well as after the fact. One common guideline for the diagnosis of traumatic disorder is that symptoms persist more than one month after the catalyzing event. However, whether or not a person meets diagnostic criteria, if you are witnessing these signs, apply a compassionate lens and honor that, in that moment, a person’s nervous system could use some care. We can also turn this symptom check onto ourselves.

 

What is trauma-informed care?

In recognizing that any of us can carry the effects of traumatic experiences simply by being alive, we can approach and understand ourselves and others with greater sensitivity and skill. For example, rather than criticizing myself for avoiding the intersection where I witnessed a car accident, I can honor that my system needs less stress as I find an alternate route. Instead of taking it personally and judging clients if they snap at me, I can imagine that they are feeling overwhelmed and are being reminded of some very difficult prior experiences. I can then take steps to increase psychological safety for both of us.

 

What helps?

For end-of-life doulas, a variety of tools can be applied within our scope. As a wise mentor once said to me: “While you may not have been the cause, you can still be the target. While you may not be the cure, you can always be therapeutic.” I strongly encourage you to emphasize body-based soothing techniques before using more cerebral tools, unless your client leads otherwise.

Many common-sense measures can help to maintain the balance of our nervous systems—think proactive, preventative regulation for ourselves and others—or to regain a sense of safety. Consider incorporating these evidence-based techniques into your work.

 

Techniques and tools for dealing with trauma:

• Spaces that are warm, private, and have a small number of people in proximity

• Dim lighting or sunlight

• Silence, gentle music, bird and water sounds

• Safe touch, including with pets

• Aerobic exercise, dance, lifting or carrying heavy things (like books or small children)

• Singing, humming, chanting, making music

• Taking a bath or shower, swimming

• Hydration, calming and soothing foods

• Controlled breathing

• Being spoken to with gentle tone by someone who is tilting his or her head

• Smiling and being smiled at

• Ritual, repetitive activities, including cleaning, reading, tapping rhythmically

• Talking out a problematic situation, prayer, journaling, ceremony

 

Networking with local trauma therapists would be excellent so you can make referrals when clients want them.