Traumas – how they arise and how to treat them

Severe weather, earthquakes, war, serious accidents - every day many things happen that we describe as traumatic. But what exactly is a trauma? How can and should you deal with it? Is it curable and if so, how? PQ author Margit Hiebl spoke about this with Prof. Dr. Roland Weierstall-Pust.

The psychologist and psychological psychotherapist is internationally active as an expert in the field of stress and trauma-related disorders and has, among other things, contributed to the current revision of the treatment guidelines in Germany.

What is understood by trauma?

Originally, the term "trauma" means wound. In psychotherapy it mainly refers to psychological injuries that arise from experiencing or witnessing threatening or shocking events. Many people initially think of serious experiences such as physical or sexual violence or situations in which someone was directly threatened with death, such as during an assault.

What is a trauma?

But not only man-made Trauma also play a role. Even fateful events like accidents or natural disasters can have traumatic consequences. In a time when environmental changes are increasingly having noticeable consequences, it may therefore also become more important in the future to consider environmental stressors as potential trauma factors - especially when there are fewer places on Earth where people can feel safe from them.

What other forms of trauma are there?

We must not neglect psychological violence in particular, which can extend to the so-called "white torture," where people are exposed to extreme psychological violence without visible physical abuse. This form of violence can be just as devastating to the psyche.

Emotional and psychological abuse, such as severe bullying, is often not classified as classical trauma but can produce symptoms similar to Post-Traumatic Stress Disorder (PTSD). Chronic stress in early childhood, such as abuse or neglect, is particularly severe.

These often leave profound damage in the developing organism. Therefore, it is crucial that children and adolescents grow up under the best possible conditions and are also supervised by qualified professionals in schools or clubs. Considering that an estimated one-third of people experienced neglect or abuse in their childhood, it becomes clear how important it is to protect the little ones.

Life events like divorces, retirement, or pregnancies can also involve significant stress but aren't classified as traumas, though they often come with enormous demands for adjustment, and some individuals may develop psychological distress as a result of such events.

Does one always have to be directly affected by a traumatic event?

No, witnessing or indirect exposure, such as hearing about a relative's terrible accident, can be traumatizing. It is also recognized in professional contexts that first responders or individuals who deal with violent crimes daily can be susceptible to trauma-related disorders.

How do such trauma-related disorders develop, and how are they recognized?

Post-traumatic stress disorder (PTSD) arises when past, horrific experiences continue to dominate the present. After experiencing trauma, it may happen that individuals are repeatedly overwhelmed by memories of the event. This typically manifests as intrusive images or thoughts that occur suddenly during the day or night, becoming so distressing that they severely disrupt or even render daily life impossible.

These memories can feel so vivid and real that affected individuals feel as if the trauma is happening all over again in the present. This often leads to a constant fear that something terrible might happen to them again. To cope with these intense memories and fears, many affected individuals try to avoid situations that remind them of the trauma. They avoid places, people, or circumstances similar to the traumatic experience and develop strategies to suppress or distract themselves from their feelings.

© Mindworld

The so-called trauma-focused approaches are the most effective therapy methods for PTSD, explains Weierstall-Pust.

People often hear about complex PTSD – what is the difference?

Complex PTSD often results from prolonged, repeated traumatic experiences, such as abuse or neglect over an extended period, not infrequently during childhood and adolescence. Compared to standard PTSD, the symptoms in the complex form are deeper. Thus, individuals who have been chronically and over a prolonged phase traumatized often struggle not only with memories and fears but also with issues in emotional regulation, negative self-images, and difficulties in relationships with others.

Especially in the case of chronic trauma in childhood and adolescence, affected individuals are usually unable to develop an internal image of themselves, the world, and others that is not overshadowed by the terrible experiences.

Is there a kind of “first aid”?

Many people who have experienced trauma are severely burdened in the first hours to days afterward. The symptoms of a so-called acute stress reaction can vary greatly. Some affected individuals react with strong emotional agitation, insomnia, or panic attacks, while others fall into a kind of shock state where they appear emotionally numb or absent. There may also be physical symptoms such as palpitations, trembling, or nausea.

Dealing with the trauma

It is important that affected individuals receive support during this phase that they themselves find helpful. Those who seek closeness or wish to talk should have the opportunity to discuss their experiences. It should also be respected if someone tries to quickly return to the daily routine, whether through work or other everyday activities.

A well-known procedure in such situations is the so-called “debriefing,” which is often used by emergency services. However, we should be cautious with this. Encouraging affected individuals to share or process their experiences directly after a trauma can increase the risk of developing post-traumatic stress disorder (PTSD) later. Paradoxically, while debriefing is often perceived as positive by those affected, in its classic form, it tends to have negative long-term effects.

If the symptoms persist longer, whom should one turn to?

If symptoms continue to appear about a month after the traumatic event, solidifying into PTSD, it is advisable to seek professional help. One should turn to therapists who have a recognized certification in psychotraumatology.

What therapies are available to treat trauma-related disorders?

Scientific evidence clearly shows that trauma-focused approaches are the most effective therapy methods for PTSD. These methods focus directly on processing the traumatic experience as the centerpiece of treatment. There are various trauma-focused approaches that all achieve similarly good results and have proven effective in practice. PTSD can generally be treated very well and sustainably.

Does suppression help?

Although many affected individuals initially have the understandable desire to suppress their experiences, this is not helpful in the long term to overcome PTSD. Stabilization techniques that aim for short-term coping are also not sufficient to treat the disorder. However, stabilization plays an important role in supporting those affected in trauma therapy.

Good social support, a stable physical condition, and the reduction of additional stress factors strengthen the resources necessary for the often challenging work in therapy.However, there is no way around confronting the trauma.

Such confrontation with distressing experiences is a central part of therapy and has proven to be extremely effective. Even severe PTSD can be successfully treated with targeted therapy in a manageable number of sessions.

A crucial first step is thorough patient education. Once they engage in the therapeutic process, many later report great relief at having taken this path.

What role do social support and networks play in healing?

Social support is a central resource, especially for trauma victims who were injured or harmed in interpersonal relationships during their childhood or adolescence. Often, these individuals have difficulty establishing and maintaining functional relationships.

For example, they may find it difficult to build trust, allow closeness, or respond appropriately to criticism. It is also not easy for them to assert their own needs if, for example, they have not been able to learn through experience that their own boundaries or feelings are respected or protected in the wake of traumatization.

These challenges can lead to those affected having negative experiences in interpersonal contacts again, which in turn weakens the social connections. Thus, a vicious circle can develop in which the social network continues to erode. It is therefore important to break this cycle and build stable, supportive relationships.

© Adobe Stock

Weierstall-Pust: "The key to successful coping lies in the active engagement with the trauma."

What should relatives and friends know and do?

People with PTSD or complex PTSD often find it difficult to behave openly or trustfully in social contacts. This behavior should not be taken personally - it is an expression of the trauma experienced. Instead, the environment should enable a corrective and trauma-opposite experience that shows those affected that the current situation is safe and different from the trauma.

How can trauma be overcome?

If someone has experienced boundary violations, it is particularly important for this person to now have the experience that their boundaries are respected and valued.Ebenso sollten Betroffene nicht das Gefühl haben, sich für das Erlebte schämen oder schuldig fühlen zu müssen. Allein das Ansprechen des Traumas kann eine große Herausforderung darstellen. Angehörige und Freunde können unterstützend wirken, indem sie mit Verständnis und Wohlwollen reagieren.

Wie können Betroffene ihren Alltag besser bewältigen?

Bei der PTBS steht die Angst oft im Mittelpunkt. Diese Angst führt dazu, dass Betroffene versuchen, Situationen oder Auslöser zu vermeiden, die sie an das Trauma erinnern. Dadurch gestalten viele ihren Alltag so, dass sie den Kontakt mit Triggern vermeiden – was kurzfristig Erleichterung verschaffen kann, langfristig jedoch die Problematik verstärkt.

Der Schlüssel zur erfolgreichen Bewältigung liegt jedoch im Gegenteil: in der aktiven Auseinandersetzung mit dem Trauma. Dies sollte unbedingt mit qualifizierter therapeutischer Unterstützung geschehen. Durch diese Konfrontation und Bearbeitung des Erlebten können Betroffene nach und nach neue Perspektiven in ihrem Alltag entwickeln und ihre Lebensqualität verbessern.

Eine frühzeitige Behandlung ist hierbei entscheidend, um einer Chronifizierung oder dem Auftreten von weiteren Folgeerkrankungen wie Depressionen oder Süchten vorzubeugen.

Gibt es neue Forschungsergebnisse und Entwicklungen in der Traumatherapie?

Glücklicherweise ist das Feld der Psychotraumatologie sehr gut erforscht. International renommierte Experten arbeiten kontinuierlich daran, die Erklärungsmodelle und Behandlungsansätze weiterzuentwickeln und neue, wertvolle Erkenntnisse zu gewinnen.

Ein bedeutender Meilenstein ist sicherlich die aktuelle Überarbeitung der in Deutschland gültigen Behandlungsleitlinie, die bald verfügbar sein wird. Ich durfte selbst in einem Teilbereich an diesem wichtigen Projekt mitwirken. Diese Leitlinie fasst die neuesten wissenschaftlich fundierten Empfehlungen für Therapeuten zusammen und gewährleistet, dass Betroffene die bestmögliche Behandlung erhalten. Daher legen wir im Premium Medical Circle auch wert darauf, dass alle unsere Expertinnen und Experten entlang dieser fundierten Qualitätsstandards tätig sind.