How Trauma focused therapy works
Trauma therapy is not simply about talking repeatedly about what happened.
Effective trauma-focused therapy involves understanding how the experience has affected you, developing sufficient safety and emotional regulation, and then working therapeutically with the memories, beliefs, emotions and responses that continue to cause difficulties
1. Understanding and stabilisation
The first step is understanding what you are experiencing and what may be maintaining your difficulties.
Depending on your circumstances, therapy may initially focus on establishing comfort and safety within the therapy space, learning about your nervous system, emotional regulation, grounding, coping strategies, identifying triggers, improving your sense of safety and developing an understanding of your responses.
This does not mean that everyone needs a long period of stabilisation before trauma processing. The approach is individualised according to your needs and level of stability.
2. Processing traumatic experiences
Once you have sufficient resources to engage safely in trauma-focused work, therapy may involve processing memories and experiences that continue to trigger distress.
The aim is not to erase memories or pretend that what happened did not matter. Rather, trauma processing can help the brain and nervous system integrate experiences that may continue to feel emotionally or physically present.
3. Integration and moving forward
As trauma responses become less dominant, therapy can also focus on how you want to live now.
This may include relationships, confidence, boundaries, identity, emotional regulation, values, purpose and developing a stronger sense of safety and choice in your life.
Understanding how the Nervous system and the Brain respond to and deal with stress is an important part of healing
How does Trauma affect the Brain and the Nervous System?
Trauma can affect more than your thoughts and memories. It can also influence how your Nervous System responds to perceived threat.
You may notice that your body reacts before you have consciously identified what is happening - your heart rate increases, muscles tense, you become highly alert, feel an urge to escape, become irritable, or alternatively feel numb, detached or shut down.
Understanding these responses can help make sense of experiences that may otherwise feel confusing or frustrating.
Fight / Mobilisation
anger
irritability
tension
restlessness
feeling on guard
Flight / Avoidance
anxiety
overthinking
avoidance
constant activity
difficulty relaxing
Freeze / Shutdown
numbness
disconnection
dissociation
exhaustion
difficulty accessing emotions
Therapy can help you develop greater awareness of these responses and build ways of responding that support safety and regulation.
How the Brain deals with stress and trauma
Threat detection — The brain is constantly scanning for signs of danger, often outside conscious awareness. After trauma, this threat-detection system can become more sensitive, causing the person to react to situations that resemble aspects of the original experience.
Amygdala — The amygdala is involved in detecting potential threats and triggering the body’s protective response. Following trauma, it can become more easily activated, contributing to fear, anxiety, irritability and hypervigilance.
Memory processing — Traumatic experiences can sometimes be stored and recalled differently from ordinary memories. Parts of the memory may remain strongly connected to sensations, emotions or beliefs, so the experience can feel emotionally present even when it happened years ago.
Fight, flight, freeze and shutdown — These are protective responses activated when the nervous system detects threat. Fight may involve anger or confrontation, flight can involve escape or avoidance, freeze can involve feeling stuck or unable to act, while shutdown can involve emotional numbness, disconnection or feeling detached.
Hypervigilance — Hypervigilance is a heightened state of alertness where someone continually scans their environment for potential danger. It can make it difficult to relax, sleep, concentrate or feel comfortable around other people.
Emotional and physical triggers — A trigger is something in the present that reminds the brain or nervous system of a previous threatening experience. It may be an obvious reminder, such as a place or conversation, or something less obvious such as a tone of voice, smell, facial expression, bodily sensation or feeling of being trapped.
Why someone can intellectually know they’re safe but still feel unsafe — Knowing you’re safe logically and feeling safe are not always the same thing. Trauma can create automatic protective responses that occur before conscious reasoning has time to intervene. This is why someone may understand, “I’m safe now,” while their body is still experiencing fear, tension, alertness or the urge to escape.