Top Mental Health Experts Reveal Everything You Need to Know About Trauma

Dan Pierce from Mentally Fit and Dr. Kate Balestrieri, PSYD talk about the answer to the question "What is Trauma?" as well as a number of related topics--including a few types of trauma that are often overlooked. Trauma Experts respond with their take on the subject.

Trauma Experts respond

Kelley Kitley, LCSW

I’m a cognitive behavioral therapist who specializes in women’s mental health. I have 2 practices, I’m a bestselling author, and media expert.

I think this is a great video and simplistic way to understand trauma especially the little t and big T traumas. DBT and CBT are excellent ways to help clients work through trauma especially if they are symptomatic and feel increased anxiety, startle response, difficulty sleeping, racing thoughts. Many times people minimize trauma. Even when I do a diagnostic interview with my clients they will disregard trauma because they were never in a "car accident” or “saw someone die.” It’s important to understand the many different layers and varieties of trauma and how it can impact someone-witnessing a parent be verbally abusive to their spouse, emotional abuse, putting someone down over and over again, etc.

Rachel wall, at Feeling is Healing

I am a wellness coach, who predominantly works with those who have been in toxic and abusive relationships. I hold a degree in medical sciences from the University of Cambridge.

People who have been in abusive relationships, whether that be during childhood, or in an adult relationship, develop complex PTSD. Since 2018, the ICD-11 (International Classification of Diseases) has recognized complex PTSD as a distinct disorder. However it does not yet appear as an individual diagnosis in the DSM (Diagnostic and Statistical Manual).

As Dr. Kate was saying, there is a drip feed effect in complex PTSD. It can be likened to boiling a frog in water. If you were to put the frog in boiling water, it would leap straight out. However if you put the frog in the water and heat it up gradually, the frog will stay in the water and die.

There have been quotes from war veterans who state that being in an abusive relationship was more difficult to recover from than the trauma of being on the battlefield. At least on the battlefield, the person knows who the enemy is. Once the fighting is over, the person knows they can take off their armor and go home to safety.

This is not the case for someone who is being abused in a relationship or domestic setting. Abusers normally have an agenda to engender confusion is their victim or target. The abuser ends up becoming both the perpetrator and the savior. The victim is often isolated from friends and family. The perpetrator may create this situation on purpose. For example, the abuser may get angry when the person spends time with others and so the victim becomes conditioned not to want to do that anymore. The target therefore becomes dependent on the abuser for their sense of safety, security and self-identity.

There is a typical cycle of abuse, in which the perpetrator goes through phases of appearing loving and caring. This part of the cycle, in a way, is more harmful than the actual abuse. It causes cognitive dissonance. The target starts to doubt their own perceptions. The target may turn against themselves and start to believe that they are the ones who have the problem.

It is a subconscious psychological coping strategy to blame ourselves for abuse that we have received. If we were at fault, or did something to cause the abuse, then we had some control over the situation. To acknowledge that a person could be so cruel, calculated and sadistic, forces us to recognize that we were powerless to the abuse.. This is very uncomfortable and painful to understand, especially when we love the person who is doing this to us.

Dr. Kate touched on the subject of trauma bonding. Being with an abuser can be highly addictive. It is difficult to escape from. This is explained by the cycles of abuse. At the times that the abuser refrains from punishing us, we receive a rush of dopamine, a chemical associated with reward and craving. When the abuser is hurting us, our bodies are full of cortisol, the stress hormone. We desperately crave the next shot of dopamine.

Seeing as we receive this reward when the abuser gives us a period of respite from the abuse, our bodies are conditioned to associate the abuser as the source of this dopamine relief. This pattern gets worse the more that the cycle repeats. Studies have shown that there are changes to the person's brain structure during prolonged abuse, such as a decrease in hippocampal volume. (

Dr. Kate also touched upon how people repeat patterns of abuse. The tragic thing is that people tend to repeat these cycles. Even if they leave an abuser, they may unconsciously be drawn towards someone similar. The body is wired to want to resolve past traumatic events. Therefore it will seek out similar experiences, searching for a different outcome this time.

This is particularly tragic for those who have experienced trauma during childhood from their primary caregivers. The Adverse Childhood Experiences (ACE) Study speaks in more depths to the effects of traumatic events during childhood.

In order to break these patterns, the person needs to take some time for themselves. They need to find the space to develop a strong sense of self-identity and self-compassion so that they are no longer suitable prey for an abuser in future.

Dr. Shoshana Aal, at Watermark Counseling

I agree with her on a lot of what she said. She is attempting to provide our society with a much needed, more inclusive, definition of trauma. As a trauma therapist I am highly aware of how our stunted definition of trauma gets in the way of people finding the help they need. All too often I will hear from a highly traumatized client that they did not seek support because their trauma did not “seem like a trauma” or that trauma was only omething that happened to people in the military.

While she does a great job giving us a little jump forward on our definition of trauma I think it’s important to expand it even further. I want our society to be aware that trauma can be a result of even more situations.

To start with, let’s talk about “little t trauma”. We need to recognize that calling some trauma "little t traumas" may be doing them a disservice. Little t traumas can be just as destructive as big T traumas. They can also be more likely to cause trauma in the long run. Just as you are more likely to run into several aggressive drivers in one day then one giant car accident you are more likely to accumulate a trauma response from little t traumas then from one big T trauma. And people are less likely to seek help for it, since we don't tend to identify "little t traumas" as traumas.This can cause them to be more destructive overall on our mind as these traumas build up and effect the way we interact with our loved ones, spreading the trauma responses of anger or sadness around us. I think it’s better to use the term used by therapist. We now call accumulated little t trauma complex trauma. This term is less likely to make trauma sound like no big deal.

Additionally, she talked about how we can be traumatized by a lot of things that people don’t really talk about. She gave the example of betrayal,vicarious trauma, iatrogenic trauma. These are all active interactions, but you can get trauma from even more things. You can be traumatized by things that didn’t even happen to you, things that happened to your ancestors, your parents, and you grandparents, and we call that historical trauma. Because trauma is all about taking yesterday’s pain and using it to interpret the world today. That kind of detrimental habit can last generations. Really trauma is about how the brain responses, and if you are conditioned from childhood to interact with the world through a traumatic lens then you are experience a traumatic response.. It effects a large portion of our culture daily, and it goes almost unidentified.

Dr. Colleen Cira, at Cira Center for Behavioral Health

My name is Dr. Colleen Cira and I am a Licensed Clinical Psychologist who specializes in Trauma and Women, so I've worked with hundreds of people with histories of trauma.

In addition to being a Psychologist and Small Business Owner, I am a trauma survivor, having survived sexual trauma, medical trauma, traumatic grief and loss and relational/developmental trauma. I’ve needed to struggle with and eventually recover from Complex Post Traumatic Stress Disorder as a result of all of these profound stressors I also struggle with anxiety and have addictive tendencies due to my family history. Finally, I meet criteria for something called a “highly sensitive person”, which basically means that my nervous system is simply built differently than about 80% of the population due to a specific gene that I carry.

Because of all of these things, I have felt “different” all of my life. When I decided to leave community mental health to start my own business, I dreamed of a place where people would see the world as I do.

Where tears are a sign of strength, not weakness. Where genuine human connection, with your clients and colleagues, is seen as an asset, not a liability. Where being honest about the things that matter to you is seen as courageous, not unprofessional. Where vulnerability is seen as brave, not as overly sensitive or unhinged. Where periods of anxiety, sadness, or relational upset - all of which may lead to less productivity at work - are seen as HUMAN, not pathological. Essentially, I wanted to have a place that accepted me at my messiest - flaws, quirks and all - and accepted everyone else as human beings as well.

I very much agree with Dr. Kate's definitions of little t and Big T trauma. I think she did a great job of hitting key points of differentiation between the two when she discussed little t trauma as being death by a million cuts and something that is less obviously traumatic, but becomes so due to the chronicity of it. And identifying Big T trauma as a single event that is far easier to name is something traumatic. These concepts are often quite misunderstood and can be confusing where Big T sounds worse than little t, but that's simply not the case and I think she did a solid job of explaining that.

I also agree with her thoughts about betrayal, vicarious trauma, and intergenerational trauma as more invisible trauma, which is important to shed light on as these are things we don't often think of when we hear the word "trauma".

While I don't necessarily disagree with anything that Dr. Kate said, I do think some important aspects of trauma were not discussed.

While there are many different kinds of trauma that were not covered in this brief video (medical trauma, traumatic grief and loss, etc), I think one of the most common kinds of invisible trauma that was not addressed is Relational/Developmental Trauma.

This is basically when a child’s caregiver/parent is anywhere from abusive to neglectful to emotionally unavailable.

This manifests as physical, emotional, verbal or sexual abuse, all things we might think of when we hear the word “trauma”, but can also include a parent/caregiver being emotionally unavailable/unpredictable due to substance use/abuse, a physical illness or their own mental health struggles.

This is important to recognize, label and discuss because most people’s traumatic histories begin in their childhood homes at the hands of their parents yet it’s often not something we recognize as trauma because it’s far more difficult to label it than a Big T trauma event, such as a car accident, a death or a sexual assault.

Dr. Kate offered some recommendations about how to better manage traumatic responses including mindfulness, distress tolerance and emotional regulation and all of these things are incredibly effective.

I would add that become safely embodied is necessary for just about any of this to be possible.

Trauma happens in our bodies - in our nervous system specifically - and as a result, sometimes just having to live in the traumatized body we have can feel really tricky.

For people who have experienced chronic trauma, one of the first things they need to do is learn how to feel safe again in their bodies and this is often something that they cannot do alone. So finding a trauma-informed, warm, relational therapist who is trained in “bottom up” processing is a great place to start.