Trauma Informed Practice

What is trauma?

Trauma tends to fall into one of three categories:

Acute Trauma which results from a single extreme and distressing event which threatens a person’s 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 does ‘being trauma informed’ mean?

So, what does ‘being trauma informed’ mean? Trauma-informed practice is not designed to treat trauma related difficulties. Instead, it tries to address the barriers that those affected by trauma can experience when accessing the care, support, and treatment they require. It’s about how we understand each other, how we speak with and about each other, how we organise our services, how we manage our meetings and much more.

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.

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.

Prevent Re-Traumatisation

Trauma-informed practice seeks to avoid re-traumatisation, which is the re-experiencing of thoughts, feelings or sensations experienced at the time of a traumatic event or circumstance in a person’s past. Re-traumatisation is generally triggered by reminders of previous trauma, which may or may not be potentially traumatic in themselves.

The purpose of trauma-informed practice is not to treat trauma-related difficulties, which is the role of trauma-specialist services and practitioners; instead, it seeks to address the barriers that people affected by trauma can experience when accessing health and care services.

Fight, Flight, Freeze, Flop & Friend

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 (see 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 other times gradually, our unconscious primitive brain takes over and we lose conscious control of our behaviour.

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 an activity you enjoy, not one which feels like a chore, and can fit into your day.
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.
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.
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.
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.

Trauma Informed Practice Resources

UK Trauma Council have produced the guidance Childhood trauma, the brain and the social world that includes associated resources into some of the latest research looking at how brain changes following trauma and how this can affect a child’s social world.

Further information to develop your understanding of the ACEs, trauma, and their impact:

Breath exercises
10 Breathing Exercises to Try: For Stress, Training & Lung Capacity (healthline.com)
Breathing Exercises: The 10 Best Ones for Anxiety (verywellhealth.com)

Grounding
Grounding Exercises (therapistaid.com)

Window of tolerance
The Window of Tolerance – YouTube
Window of Tolerance Reimagined – YouTube
Window of Tolerance

Useful Apps
https://www.headspace.com
https://www.calm.com

Worksheets and information
Flight, Fight or Freeze Emotional Response – Bing video
How to cope with triggered trauma memories
5 Responses to Perceived Threat
Trauma case studies
Responses to Trauma
A practitioners quick guide to Therapeutic interventions after abuse and neglect

Sowing Seeds: trauma-informed practice for anyone working with children and young people is an animation developed by NHS Education for Scotland, in partnership with the Scottish Government. It aims to support staff to understand the impact of trauma and to know how to adapt the way they work to make a positive difference to the lives of children and young people affected by trauma.

Opening Doors: trauma-informed practice for the workforce is an animation developed by NHS Education for Scotland, in partnership with the Scottish Government. It aims to support staff to understand the impact of trauma and to know how to adapt the way they work to make a positive difference to the lives of children and young people affected by trauma.

Professor Mark Bellis from Public Health Wales makes a presentation on adverse childhood experiences, resilience and equity.