Psychologist-psychotherapist specializing in trauma in Brussels

"Traumatic symptoms are not caused by the event itself. They arise when the organism, overwhelmed, retains an internal tension. This tension remains trapped in the nervous system, where it can wreak havoc on our bodies and minds". Peter Levine

What is trauma and what causes it?

Trauma occurs when we experience events that are highly stressful, frightening or distressing, difficult to manage or beyond our control. It can be a one-off incident or an ongoing event that occurs over a long period of time.

Most of us will experience an event in our lives that could be considered traumatic. But not all of us will be affected in the same way. Trauma can happen at any age. And it can affect us at any time, even long after the event has occurred.

Traumatic events can take many forms. They may include :

•  A one-off, recent event (aggression, accident);
•  A one-off past event;
• Repeated and prolonged distressing experience (maltreatment, abuse, sexual abuse, etc.).

  

Either the person has been directly affected, or has witnessed the abuse of others. 

Finally, trauma can be experienced indirectly, as in the case of the children of parents who were victims of genocide, in which case we speak of transgenerational trauma. 

What are the different types of trauma?

When we refer to one or more one-off events, we speak of simple trauma; when the distressing experience is repeated or prolonged, we speak of complex trauma. 

Complex trauma is more often the result of chronic victimization by a person or group of people, with no possibility of escape over a long period of time. It may involve repeated intra- or extra-familial violence, hostage-taking, acts of war, harassment and so on. 

Trauma occurs when there is an intrusion into a subject's psychological and physical protection, with no possibility of escape (usually fleeing or fighting), and which is psychologically devastating to the point where the person's coping skills are overwhelmed.

Circuits involved in the traumatic response

The autonomic nervous system

Danger is part of life, and the brain's role is to detect it and trigger certain physiological responses. In the face of a stressful event, our body kicks into gear and triggers hormonal responses which, via our autonomic nervous system, help to put us on the alert. 

Our nervous system is divided into two branches: the central nervous system, which includes the brain and spinal cord, and the peripheral nervous system, which is further divided into the somatic nervous system and the autonomic nervous system. 

The autonomic nervous system comprises the sympathetic and parasympathetic nervous systems. These two systems react to external danger. 

The hormonal response to danger

First, our senses detect danger: nose, ears, sight or skin. The thalamus detects these sensations and then transmits them to a fast, automatic, unconscious pathway: the amygdala, located in the limbic system, and to a conscious zone via the frontal lobes. 

The amygdala reacts extremely quickly to danger, long before the frontal lobes. If it detects a threat to the body, it sends a message directly to the hypothalamus and brain stem, which mobilize stress hormones and the autonomic nervous system to put the body into action, via the sympathetic nervous system. 

The alarm signal from the amygdala triggers the release of cortisol and adrenalin, which raise the heart rate and blood pressure, and prepare the muscles for fight or flight by causing vasodilation.

This is our body's response to situations of danger or acute stress by activating the sympathetic nervous system. 

The parasympathetic nervous system conserves and restores. It allows heart rate and breathing to return to normal, and the metabolism to slow down to conserve energy once the danger has passed. 

This system can be activated at several points during the day in the face of mild or moderate intensity events, but the body will generally return to normal once the threat has dissipated. These two systems regulate each other, ensuring optimal nervous balance. 
It is the deregulation of this natural response that is at stake in trauma.

What are the signs of trauma?

Faced with a major danger such as a near-death experience, where our very life is in danger and the body's capacity to adapt is exceeded, an intense shock is created that is devastating at both somatic and psychological levels: this is the traumatic response or trauma. Traumatic events push the nervous system beyond its capacity for self-regulation. 

The response to danger remains active or mobilized even when the danger has passed. The body remains in a state of alert, ready to react to the slightest signal that might recall the traumatic event. The sympathetic nervous system is over-activated. This physical state of constant hyperexcitation, even in the absence of danger, eventually exhausts the body. The result is constant agitation, irritability, anger and finally depression.

In the traumatic response, one of the two systems becomes dominant and inhibits the functioning of the other. Either the sympathetic (fight, flight) or parasympathetic (paralysis) nervous system is over-activated. 

The polyvagal theory 

The polyvagal theory was developed by Stephan Porges.

Stephen W. Porges is an academic scientist emeritus at Indiana University, where he is the founding director of the Traumatic Stress Research Consortium. He is Professor of Psychiatry at the University of North Carolina and Professor Emeritus at the University of Illinois at Chicago and the University of Maryland.

The polyvagal theory complements the autonomic nervous system's above-mentioned involvement with the role of the vagus nerve, which is embedded in the parasympathetic nervous system. Porges studied the parasympathetic pole of the vagus nerve, which counterbalances the sympathetic system. The parasympathetic system is the brake pedal that calms our nervous system and promotes a return to normal after danger. 

It distinguishes two circuits:

• The ventral vagal circuit, which preserves and restores. It's a state of calm, because we feel safe, and is therefore conducive to relaxation and social engagement. 
• The dorsal vagal circuit, activated in immobilization/paralysis mode. 

 Indeed, when a predator attacks an animal in the wild, if it can no longer flee, it will stand still and "play dead" in a last-ditch attempt to protect itself. 

This also applies to the human being when faced with a threat against which he cannot defend himself. When a life-threatening situation is detected, and we feel powerless in the face of the threat, the dorsal branch of the parasympathetic or vagal system is activated. We then remain stuck in this mode of paralysis. The parasympathetic nervous system is then over-activated, leading in the long run to depression, disconnection, fatigue and lethargy. 

A "healthy" nervous system is one that fluctuates between these 3 states in response to the vagaries of life. The traumatic response is the over-activation of the escape or immobilization response, because our body has been completely overwhelmed by the intensity of the traumatic event or events. 

We can be overwhelmed by a single traumatic event, generally referred to as post-traumatic stress disorder, or by repeated traumatic situations, generally referred to as complex trauma. 

Post-traumatic stress disorder.

Post-traumatic stress disorder is caused by exposure to an extreme event that threatens a person's life or physical integrity.

In PTSD, there is no longer any distinction between past and present. 

The person relives the traumatic situation over and over again, as if they were still there. This reliving is expressed in flashbacks, intrusive thoughts, nightmares and a permanent state of hypervigilance.

The thalamus goes out of action, so there is no longer any discrimination between neutral stimuli (background noise, music) and stimuli evoking danger. 

The body is constantly on the alert, and stress hormones are secreted even when there is no danger. For example. If you've been to war and are returning from battle, you'll suddenly feel all the stress hormones you need. stress symptoms when faced with a slamming door, which will be identified as the sound of a bomb, because the discrimination normally made by the thalamus no longer takes place. 

Avoidance behaviors are put in place to prevent any recurrence of the trauma, only they often lead to total isolation, because when the trauma is severe, any stimulus can put the body on alert and bring back the intense panic felt during the event. 

People suffering from PTSD often develop anxiety disorders and addictions in parallel, but other more significant comorbidities may also be associated with it. As a result, PTSD can significantly alter personal, social and professional life.  

What all post-traumatic stress sufferers have in common is that they have experienced the traumatic event as an intense stressor or frightening factor, and felt powerless in the face of it. 

The prevalence of PTSD is estimated at 5 to 12% in the general population, but these data are mainly from studies carried out in the United States, with studies on the subject being rarer in France and other countries. (INSERM, 2024)

"People with post-traumatic stress disorder have their floodgates wide open. Deprived of a filter, they are constantly in sensory overload. To cope, they try to shut themselves off by developing narrowed vision and hyper-concentration. If they can't cope naturally, they may resort to alcohol or medication. The tragedy is that this closure also excludes sources of pleasure and joy" (Bessel Van Der Kolk, 2017). 

Complex trauma

Complex trauma occurs when the event at the root of the disorder is repeated, or has been present continuously over a long period of time. Intra-family violence, sexual abuse and acts of war meet this definition. 

It took a long time for complex trauma to be recognized, and for a long time we only talked about post-traumatic stress disorder.  

It wasn't until 1992 that Judith Herman, an American psychiatrist, took an interest in a group of adults who had experienced trauma, but who presented a range of symptoms far removed from those usually experienced in post-traumatic stress disorder. 

What they all had in common was prolonged or repeated trauma in a climate of total powerlessness. She recalls imprisonment, concentration camps, religious oppression, organized sexual exploitation and certain family situations. 

These people all had emotional regulation disorders (emotional anesthesia, dissociative symptoms or emotional hyperactivity and impulsivity), relational difficulties (difficulty trusting or social isolation) and self-perception disorders (negative self-view, shame, guilt). 

These complex psychotraumas represent a major public health problem affecting all ages. They affect around 8 % of the world's population. 

Complex trauma also includes developmental trauma, which is specific to childhood traumas. This may involve physical and/or psychological abuse, sexual abuse or neglect. 

The repercussions of complex traumas are extremely serious, posing a real public health problem in terms of all the comorbidities they engender, such as depressive, anxiety, borderline, psychotic, dissociative and addictive disorders. 

Complex traumas originating in childhood are also the cause of physical disorders in adulthood. 

Gabor Maté, a Hungarian-Canadian doctor who has devoted his career to the issue of trauma and written extensively on the subject, discusses it in depth in his 2017 book, "When the Body Says No".  

It is set in a biopsychosocial context, emphasizing that biological, psychological, social and environmental factors are inseparable in understanding the development of certain chronic diseases. 

In it, he explains the link between intense or traumatic stress and how adverse childhood experiences have an impact on the immune system. The body, too, can become depressed and signal its distress through the development of certain illnesses.

In particular, he discusses the deregulation of the autonomic nervous system, described above, and demonstrates how increased cortisol secretion under stress can underlie the development of multiple diseases such as sclerosis, intestinal pathologies, rheumatoid disorders and cancers. 

Finally, we can't end this section on complex trauma without mentioning the remarkable work of Bessel Van Der Kolk, an eminent psychiatrist and traumatologist whose best-selling book, "Le corps n'oublie rien" (The body forgets nothing), also highlights the extent to which trauma not only affects the psyche, but is also deeply rooted in the bodies of traumatized people. 

Exposure to abuse and violence fosters the development of an overactive alarm system and shapes a body that gets stuck in the fight/flight and freezes. Trauma interferes with brain circuits that involve concentration, flexibility and the ability to remain in emotional control. A constant sense of danger and helplessness promotes the continuous secretion of stress hormones, which disrupt the immune system and the functioning of the body's organs. Only by allowing trauma victims to safely inhabit their bodies, to tolerate feeling what they feel, and to know what they know, can lasting healing take place. 

Trauma therapy. 

In view of what we've just gone over, it seems clear that trauma can only be resolved by treatments that include both the body and the psyche. 

Treatments should also include tried-and-tested somatic methods such as yoga, to help you reappropriate bodily sensations, dance as a way of reconnecting with others, and meditation to calm the constant flow of parasitic thoughts associated with trauma. 

Therapeutic methods such as neurofeedback, EMDR and the Internal Family System have also proved their worth in the field of trauma. 

For my part, I believe that in-depth psychotherapy, enabling the person to recreate a bond of trust through which to evacuate traumatic content, combined with an innovative somatic method such as Breathwork therapy, enables in-depth work to be carried out by bringing the psyche and the body into play. The therapeutic results obtained by combining these two methods are surprising and long-lasting. 

Psychotherapy

When suffering from trauma, it's all the more important to choose the right therapist. Not all practitioners are trained in trauma therapy. It's obvious that a traumatized person will find it difficult to regain trust and recreate the intimate bond necessary for any therapeutic work. If the therapist is unaware of this particular sensitivity, he or she will not be sufficiently attentive to the quality of the therapeutic bond. It will take time for the patient to recreate a bond of trust and security in the relationship. Only when the relationship is sufficiently reassuring will the patient, with the help of the therapist, be able to mobilize all his or her resources to deal with painful events and free him or herself from them. 

Breathwork therapy

Visit therapeutic breathing is conscious, intentional breathing that releases traumas stored in the body. It helps to treat and heal trauma by bypassing the conscious mind, deactivating the sympathetic nervous system and having a restorative effect. 

It provides access to altered states of consciousness where you can feel free to express any emotions or physical movements that arise during a session; allowing whatever is present to be expressed, processed and released.

During a session, connected conscious breathing takes the person where they need to go, as it enables a deep connection with their unconscious, provoking different somatic and emotional states. 

Using the breath in spiritual practice or for healing is not a new concept. Since time immemorial, all cultures, in their spiritual dimension seeking to understand human nature, have considered the breath as a crucial link between nature, the human body, the psyche and the spirit. 

But it's only recently that scientists have begun to turn their attention to ancient knowledge and study the impact of breathing on traumatic experiences, healing and the nervous system.

When faced with a threat, we unconsciously change the way we breathe. 

If our nervous system goes into "fight or flight" mode, breathing becomes rapid. If we go into "paralysis/immobilization" mode, breathing becomes shallow as we hold our breath to go unnoticed. 

Much of this experience is automatic and escapes consciousness. 

Some researchers suggest that changes in breathing are not only a nervous system response, but also a means of maintaining the suppressed emotion or sensation when it overwhelms our ability to cope with it. 

Inhibited breathing is the body's safety mechanism to avoid being flooded with uncomfortable and painful emotions and sensations. It's an unconscious defense mechanism that deprives us of a sense of real presence in the world. Consciously deepening our breathing can help us to integrate our emotions and regain the sense of security and calm that is so necessary for a fulfilled life. 

Connected Conscious Breathing bypasses the conscious mind to bring unconscious content to the surface, restoring a sense of security in the body.

Its power lies in the fact that it enables the body to do what it already knows how to do naturally: release and restore itself.

Conscious breathing is a practice that involves rhythmic diaphragmatic breathing. Diaphragmatic breathing in many contexts has been associated with a variety of positive outcomes, reducing anxiety, depression, blood pressure, PTSD symptoms and insomnia. Diaphragmatic breathing is also associated with stimulation of the ventral vagus nerve to induce deeper relaxation.

During breathing, many people report a heightened awareness of their body and sensations. Living in one's body means living in a place where abuse and suffering have occurred. Breathing elicits somatic sensations and enables you to reconnect with your body, its sensations and emotions, in a safe environment. 

Part of the healing process is learning to express anger, pain, sadness and fear in ways that support our growth and relationships. 

All the emotions and sensations that arise are allowed to exist. With acceptance, resistance diminishes, our tolerance for discomfort and uncertainty increases, and we become gentler with ourselves.

Breathing has the potential to induce altered states of consciousness, similar to deep meditation. In this state, we have the potential to bypass the mental stories, projections, judgments and resistances that prevent us from healing. Breathing opens the space for the body's inner intelligence to emerge and access our own innate wisdom.