Traumatic Stress

This article first appeared in the September 2011 edition of Reflexions Magazine published by The Association of Reflexologists.

Traumatic stress is much more common than was previously understood and is associated with a substantial level of debility. Traumatic Stress as a result of disasters, accidents and shootings – the so called ‘one-off blow’ – have been well-documented by the media. But the effects of  prolonged trauma are less well known. Also known as Complex Stress, this is where there has been an accumulation of traumatic experiences such as in cases of bullying or other emotional or physical abuse where each incident is a trauma in itself. Or, the client may have experienced multiple traumas of different types. People each have a threshold for how much traumatic stress they can contain without dealing with it. Once this threshold is reached the traumatic response begins to spill into everyday life. Should you meet such a client this article may help you to  recognize the signs and help them to contain their feelings until you are able to direct them to specialist help.

The confusing thing about responses to trauma is that one model very definitely does not fit all. Clients present with an assortment of physical and emotional adaptations which could be attributed to a range of conditions, and often both practitioner and client are baffled when advances made during the course of the treatment begin to turn around.

The Client

The physical signs of anxiety can be easily misunderstood and are often misdiagnosed as symptoms of organic illness. Most clients do not present complaining of ‘Traumatic Stress’. Instead they may list a catalogue of symptoms for which there is no apparent medical explanation. Clients may say that they have tried everything, and are now desperate.

Clients may present with:

• Sleep disturbances
• Nightmares
• Waking up more tired than when they went to bed
• Exhaustion and listlessness throughout the day – despite having slept all night
• Feeling ‘spaced out’
• Memory problems
• An inability to concentrate
• Problems with personal boundaries
• Fluctuating symptoms
• Inexplicable aches and pains
• Feeling worse after relaxation
• Feeling worse after exercise

Individually any of these indications can be explained by other means, but you need to be alert to clients presenting with more than one.

The Nervous System

To deal with a stressful situation the body initially goes into full alert to best meet the oncoming threat.  This response is designed to be short-lived and intense. Once the crisis is over, the alarm response is halted and the body returns to normal. However, if the fear continues, as in instances of prolonged trauma, the body moves into Resistance. The alarm response is maintained until the body reaches  Exhaustion, (the stage where the body can no longer function on overdrive). This can be experienced as extreme fatigue and listlessness. Some people develop an increased sensitivity and irritability to external stimuli, such as noise, additional chores or tasks, other people, food, in fact anything which the body regards as one stressor too many. In essence they have reached a state of exhausted hyperarousal – also known as ‘overwhelm’ – where their mind and body are unable to take in or process any further information or stimuli of any kind.

Muscle Tension

General wisdom regards excessive muscle tension as something which needs to be relieved. However, it can play a role in helping a client to contain their experiences. There is a small body of research which indicates that relaxation can increase anxiety in some people.[i] It seems that the relaxation of muscles following calming activities like reflexology can sometimes result in a lowering of defences which have been suppressing the trauma. This can then result in Autonomic hyperarousal sometimes leading to overwhelm.

This may help to explain some forms of sleep disturbances which are so often a part of traumatic stress. The client, feeling tired goes to bed, but upon relaxing they are almost immediately wide awake. In some cases, the relaxation which sleep brings is enough to send the client into overwhelm during the night and they may wake up feeling ‘spaced out’, or with tense muscles or exhausted.

Bearing this in mind, you may be able to detect some additional signs:

• Nervous stumbling speech
• Temperature – Trauma clients often feel cold
• Giving the appearance of some strong emotion (e.g. anger) without seeming to be aware of it – voice, facial expression, eyes, choice of words can be key indicators .
• An inability to relax
• Client may ‘pass out’ as soon as they lie on the couch
• Undue Sensitively
• Signs of an exaggerated startle response (e.g. jittery movements; awkwardness)

As you take their case history be alert for other clues:

• Rapid weight gain or loss
• Overreaction to problems
• Immature Behaviour
• Any suggestion that they may have been bullied or suffered other traumatic experiences
• Age – some people’s defences lessen as they get older and experiences which they have been successfully containing for years can suddenly spill over into daily life.
• Suddenly moving from being very functional to being very dysfunctional

What You Can Do

Of course you must refer clients who are traumatised to a trauma specialist, but what do you do when they begin to tell you about what has happened to them? Be aware that the retelling of their story may be re-traumatizing. If the client has not worked on the issues around the trauma, then  revisiting it could send them into hyperarousal or overwhelm.

Bringing your client back into the present

Verb Tense

Paying attention to verb tense is a good indication of where your client is. If it seems that your client is talking about the past as if is were the present do what you can to bring them back

Client:      I’m frightened

Therapist: Look around the room. Is there anything in here which is frightening you?

And then encourage them to stay in the present by asking them to describe things in the room.

Dual Awareness

Within the Sensory Nervous System there are interoceptors which gather information about what is going on inside the body and there are exteroceptors which gather information about the external environment.  Traumatized clients often use their interoceptors to evaluate their external environment. For example. ‘My heart is beating and I am feeling panicky, so it must be dangerous here and I need to be alert.’

In this case balance needs to be restored and equal weight given to the exteroceptors:

Interoceptors                                        Exteroceptors

“My heart is racing..”                           Tell me three things you can see as you look around the                                                                                 room

“I feel spaced out..”                             Could you describe that picture on the wall?

And not But

It is important that the client honours their own feelings. For Example ‘I am frightened but it happened twenty years ago’ suggests that the speaker feels that they should no longer be feeling frightened. Encourage them to honour the fear by slightly changing their sentence. ‘I am frightened and it happened twenty years ago’. Clients may find this enormously releasing as the internal conflict between what they are feeling and what they think they ought to be feeling begins to ease.

Containment

Babette Rothschild (a psychotherapist and trauma specialist) describes traumatised clients as being – physically and psychologically – ‘thin-skinned’. [ii]   Trauma is often the result of an experience which was somehow  physically or emotionally intrusive and it is often the loss of bodily integrity which accelerates the trauma process out of control. The key word here is safety. Work on your client’s feet with a slow, firm reassuring touch. Try holding the feet firmly with the intention of strengthening their ‘container’ and bringing them back into the present. If it helps think “I am supporting you and helping you feel safe while you tell me this”.

Trauma response can be very debilitating for the client and hard to contain once reawakened. To ensure that you are prepared for this, you might find it useful to have the contact details of a local trauma specialist to hand.

Nayna Kumari is a Reflexologist and Psychotherapist with a special interest in how traumatic stress affects the body. www.nk-bodypsychotherapy.com  To find a practitioner in your area please e-mail:

nayna@nk-bodypsychotherapy.com