Trauma-Informed Care: Recognizing & Treating Toxic Stress, Part 1

What is trauma, and why do we need trauma-informed care?

When a person feels overwhelmed, threatened and endangered, the mind and body react for survival. If the person can’t find ways to feel safe again, the threat-response system tends to stay active, even if it’s not obvious. That person is likely to experience traumatic stress.

The journey toward mental wellness and self-care can be especially challenging for people with traumatic stress — trauma survivors.

A person struggling with trauma is “left with a host of intense responses and symptoms that ‘tell the story’ without words and without the knowledge that we are remembering events and feelings from long ago,” says Janina Fisher, PhD, therapist, author and educator.

Unhealed trauma impacts physical, emotional and psychological health. “The survival response system may become chronically activated, resulting in long-term feelings of alarm and danger, tendencies to flee or fight under stress, debilitating feelings of vulnerability and exhaustion, or an inability to assert and protect ourselves,” explains Fisher.

What does that mean for trauma-informed therapy?

Common Trauma Symptoms

Trauma-informed therapists know that trauma shows up in every day life in countless ways. Some common symptoms include:

·       Trouble sleeping

·       Trouble managing intense emotions

·       Self-harming behavior

·       Substance abuse

·       Relationship difficulties

·       Recurring fights with loved ones

·       High blood pressure

·       Depression

·       Anxiety

Yet people with these symptoms may believe the symptoms are the problem. We need to advocate for healing trauma and for trauma survivors, even if they don’t recognize trauma’s role.

What makes a person a trauma survivor?

·       “Trauma literally means ‘wound, injury, or shock,’” says the International Society for the Study of Trauma and Dissociation (ISSTD).

·       “It refers to extreme stress that overwhelms a person’s ability to cope,” writes Esther Giller of the Sidran Institute.

Far More People Experience Trauma Than Even Experts Imagined

A well-known study in the 1990’s shocked the medical world by shedding light on trauma’s tremendous reach.

Researchers used the phrase Adverse Childhood Experiences — or ACEs — to represent 10 different types of traumatic experiences. They took a survey of 17,500 adults enrolled in a healthcare system to learn how common these events were. They asked these adults 10 questions about childhood experiences such as domestic violence, verbal abuse, sexual abuse, or feeling understood at home.

The study found that far more people grew up with trauma than anyone ever expected.

“What they found was striking. Two things: Number one, ACEs are incredibly common. Sixty-seven percent of the population had at least one ACE, and 12.6 percent, one in eight, had four or more ACEs. The second thing that they found was that there was a dose-response relationship between ACEs and health outcomes: the higher your ACE score, the worse your health outcomes.”

The study found that people with more ACEs also had “dramatically increased the risk for seven out of 10 of the leading causes of death in the United States,” says Dr. Nadine Burke Harris. Dr. Harris, a pediatrician, became a TED speaker and founder of the Center for Youth Wellness.

A Wide Range of Adverse Events Can Cause Trauma

Some causes of trauma are easy to recognize. We easily link trauma with:

·       Combat or war experience

·       Witnessing someone being hurt or killed

·       Sexual abuse of any kind or

·       Physical abuse of any kind

·       Domestic violence for the person experiencing it

·       Domestic violence for anyone seeing or hearing it

·       Rape  

However, people can experience trauma in ways that are subtle and hidden as well. A trauma-informed therapist knows that even hard-to-see conditions can cause trauma, especially in childhood.

Many People Don’t Recognize Adverse Events That Cause Trauma

An experience does not have to be abusive or violent to inflict trauma. Trauma can occur from:

·       Neglect of a child’s emotional experience

·       Emotionally unresponsive parenting (even when physical and financial needs are met)

·       Bullying

·       Shaming

·       A caregiver’s substance abuse

·       A parent’s angry outbursts

·       Inadequate protection from danger

·       Any experience that leaves a child feeling abandoned, threatened or helpless  

The survivor — not witnesses or doctors — defines when trauma occurs. The experience of getting lost in the mall as a child may not seem traumatic to adults. But it is the impact on the child that defines the occurrence of trauma.

Exposure to Tragedies and Images of Violence Can Trigger Trauma

Watching devastating events on the news can be traumatizing for people at any age.

For some, repeatedly viewing broadcasts showing terrorist attacks and shootings can trigger overwhelming stress and a sense of despair.

Trauma-informed therapists are aware of these sensitivities, and can help clients take better care of themselves by developing ways to recognize traumatic stress and manage it.

How Does a Trauma-Informed Therapist Work Differently?

A trauma-informed therapist is aware that many people are not able to see how their present difficulties relate to past experiences.

Many people never think of their life experience as trauma.

But, moving too fast to review overwhelming emotions can be traumatic itself.   So trauma-informed therapists move skillfully and slowly. They do so even when that person does not believe anything especially “bad” or hurtful happened to them.

A trauma-informed therapist creates a safe space to look at thoughts and feelings under the symptoms of traumatic stress.

The first priority is the foundation of safety. “If people don’t feel safe here, nothing else is going to happen.” notes Pamela Woll, MA, CADP, in her presentation, A Strength-based Approach Toward Trauma-informed Treatment and Recovery Support for Women.”

Therapy starts slowly. The therapist does not start by asking about the details of the trauma. Asking for details without tools to manage the emotions can be re-traumatizing.

A trauma-informed approach is about building a relationship of safety and trust first. Next, the therapist and client work together to build more resources to explore what happened, and manage the tremendous challenges of traumatic stress.


Trauma-Informed Care: Recognizing & Treating Toxic Stress, Part 1

Robyn Brickel, MA, LMFT

Robyn E. Brickel MA, LMFT, is the founder and director of Brickel and Associates, LLC in Old Town Alexandria, Virginia, which she established in 1999. Her insights for parent and teens appear in interviews in The Washington Post, and Washington Parent magazine, and she presents educational workshops for clinicians on the treatment of adolescent substance abuse and trauma. Her counseling and psychoeducational services provide treatment for recovery from trauma and/or abuse, including dissociation; addictions; adult children of alcoholics (ACOA) issues; body image issues and eating disorders; self-harming behaviors, including emotional intensity and instability; anxiety, depression, and other mood disorders; challenged family systems; chronic illness; co-dependency; dysfunctional relationships; life transitions; loss and bereavement; relationship distress; self esteem; GLBTQ and sexual identity issues/struggles; and stress reduction. She is a trained trauma and addictions therapist who has helped countless clients make and maintain positive changes in their lives. To learn more about Robyn E. Brickel, visit her website.


APA Reference
Brickel, R. (2018). Trauma-Informed Care: Recognizing & Treating Toxic Stress, Part 1. Psych Central. Retrieved on September 19, 2020, from


Scientifically Reviewed
Last updated: 5 Jun 2018
Last reviewed: By John M. Grohol, Psy.D. on 5 Jun 2018
Published on All rights reserved.