Assessing and Treating Trauma

This article explores what trauma is, how to identify its symptoms and diagnose it in your clients, and what some of the common treatment approaches are.

Related articles: Epigenetics and Intergenerational Trauma, Case Study: Healing from Trauma as a Soldier, Assessing and Treating PTSD.

Overview of trauma

Trauma refers to a deeply distressing or disturbing experience that can have lasting effects on an individual’s mental and emotional wellbeing. Traumatic events can include, but are not limited to, physical or sexual abuse, exposure to natural disasters, combat, terrorism, or serious accidents. The psychological effects of trauma can be severe and can include symptoms such as depression, anxiety, post-traumatic stress disorder (PTSD), or prolonged grief disorder.

Individuals who have experienced trauma may also have difficulty regulating their emotions and may engage in harmful coping mechanisms, such as substance abuse or self-harm. Trauma can also have a significant impact on relationships, as individuals who have experienced trauma may have difficulty trusting others or maintaining healthy boundaries.

Trauma-informed care is an approach that understands and acknowledges the impact of trauma in individuals seeking services. This approach includes a holistic understanding of the individual and their experiences, and seeks to actively address the potential triggers and re-traumatisation in the therapeutic process. The main goal of trauma-informed care is to empower the individual and support their journey towards healing and resilience.

As a mental health clinician, it is essential to have a thorough understanding of trauma and its effects on individuals, as well as an understanding of the importance of trauma-informed care. It is also important to be aware of the different treatment options available for individuals who have experienced trauma, including cognitive-behavioural therapy (CBT), prolonged exposure therapy (PE), and eye movement desensitisation and reprocessing (EMDR).

What is trauma?

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) defines trauma as “exposure to actual or threatened death, serious injury, or sexual violence.” This exposure can occur through experiencing the event directly, witnessing the event, learning that the event occurred to a close family member or friend, or repeated or extreme exposure to aversive details of the event(s). This can include events such as military combat, physical or sexual assault, serious accidents, and natural disasters. The DSM-5-TR also notes that the experience of trauma can result in the development of a number of different mental health conditions, including posttraumatic stress disorder (PTSD), acute stress disorder, and other specified or unspecified trauma- and stressor-related disorders.

The DSM-5-TR recognises that some individuals may experience trauma that does not fall within the above definition; however, it will still result in significant distress or impairment in social, occupational, or other areas of functioning.

What are the symptoms of trauma?

Trauma refers to a deeply distressing or disturbing experience that can have long-lasting effects on an individual’s mental and emotional wellbeing. The symptoms of trauma can vary widely, and can include both physical and psychological symptoms. Some common symptoms of trauma include:

• Intrusive thoughts. Trauma survivors may experience repeated, involuntary memories of the traumatic event, which can be distressing and disruptive to their daily lives.
• Avoidance. Many individuals with trauma may avoid reminders of the traumatic event and engage in behaviours that are designed to help them avoid these reminders.
• Emotional numbness. Trauma can cause individuals to feel emotionally detached from others and from their own experiences, leading to feelings of apathy, lack of interest, and difficulty forming close relationships.
• Anxiety and fear. Trauma can result in symptoms of anxiety and fear, including panic attacks, difficulty sleeping, and constant worry or agitation.
• Depression. Trauma can lead to depression, which can cause individuals to feel hopeless, helpless, and have a lack of energy or motivation.
• Irritability and anger. Trauma can also result in irritability and anger, which can manifest as mood swings, outbursts, and difficulty controlling one’s temper.
• Physical Symptoms. Some individuals with trauma may experience physical symptoms, such as headaches, fatigue, changes in appetite, and difficulty sleeping.

Note that everyone reacts differently to trauma, and the symptoms and severity of trauma can vary greatly from person to person. Those who believe they are experiencing symptoms of trauma should seek help from a mental health professional or trauma specialist. With the right support and treatment, it is possible to overcome the effects of trauma and move forward toward a more fulfilling and healthy life.

How to diagnose trauma

Trauma can be diagnosed by conducting a thorough assessment of an individual’s symptoms, experiences, and medical history. There is no single test or procedure that can diagnose trauma. Instead, the clinician will rely on a combination of tools and methods to gather information.

The first step in diagnosing trauma is typically a comprehensive clinical interview. During this interview, the clinician will ask the individual about their experiences and any symptoms they may be experiencing. The clinician may want to know about the individual’s medical and psychiatric history, as well as any current or past treatment they may have received.

The clinician may also use diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR) as a guide to determine if an individual meets the criteria for a trauma-related disorder such as post-traumatic stress disorder (PTSD). The DSM-5-TR criteria for PTSD include the following:

• Exposure to actual or threatened death, serious injury, or sexual violence
• Re-experiencing symptoms, such as flashbacks or nightmares
• Avoidance of reminders of the trauma
• Negative alterations in mood and cognition, such as feeling guilty or having negative beliefs about oneself
• Hyperarousal symptoms, such as being easily startled or having trouble sleeping

In addition to the interview and the use of the diagnostic criteria, the clinician may use other assessment tools, such as questionnaires or self-report measures, to gather information. These tools can help the clinician to further evaluate the individual’s symptoms and determine the severity of their condition.

Some of the most commonly used assessments and diagnostic tools include:

• Clinician-administered diagnostic interviews: These are structured interviews conducted by a trained clinician and based on the diagnostic criteria for a specific disorder, such as PTSD. Examples of such interviews include the Clinician-Administered PTSD Scale (CAPS) and the Structured Clinical Interview for DSM-5 (SCID-5).
• Self-report measures: These are questionnaires or surveys that are completed by the individual and are designed to evaluate symptoms related to a specific disorder. Examples of self-report measures used to assess PTSD include the PTSD Checklist (PCL) and the Post-traumatic Diagnostic Scale (PDS).
• Trauma exposure questionnaires: These questionnaires evaluate the types and frequency of traumatic events an individual has experienced, such as the Life Events Checklist for DSM-5 (LEC-5) or the Trauma History Questionnaire (THQ)
• Psychological assessment tools: These tools can help to assess the individual’s overall psychological wellbeing, including symptoms of depression, anxiety, and other conditions that may be related to trauma. Examples of psychological assessment tools include the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI).
• Behavioural observation: The clinician may also observe the individual during the assessment, such as by noting the individual’s behaviour, body language, and manner of speech, which can provide additional information to aid the assessment.

Note that no single assessment or diagnostic tool is considered to be definitive in the diagnosis of trauma and trauma-related disorders. The clinician will likely use a combination of tools to gather information and will consider the individual’s unique experiences, symptoms, and overall mental health status before making a diagnosis.

Common treatment approaches for trauma

Mental health clinicians can use a range of treatment approaches to help individuals who have experienced trauma, commonly including:

• Cognitive-behavioural therapy (CBT). This is a type of therapy that focuses on helping individuals to understand and change their thoughts, feelings, and behaviours. CBT for trauma often includes techniques such as exposure therapy, which involves gradually confronting and facing the traumatic memories and emotions, as well as cognitive restructuring, which involves learning to challenge and change negative thoughts and beliefs related to the trauma.
• Prolonged Exposure therapy (PE). This is a specific type of CBT for PTSD, which focuses on helping the individual to process and come to terms with the traumatic event. PE involves gradual exposure to the traumatic memories and feelings associated with the event through talk therapy, writing, and/or imagery exercises. The goal of PE is to help the individual to overcome their avoidance of the trauma and decrease the distress associated with the trauma-related memories and triggers.
• Eye movement desensitisation and reprocessing (EMDR). This form of therapy involves the therapist guiding the individual through a set of eye movements while they focus on the traumatic memory. The theory behind EMDR is that this process can help the individual to process and integrate the traumatic memory, reducing its emotional impact.
• Mindfulness-based therapies. Mindfulness-based therapies, such as mindfulness-based stress reduction (MBSR) and acceptance and commitment therapy (ACT), can help individuals develop the ability to focus their attention on the present moment and acknowledge their thoughts and feelings without judgement. This can help individuals to reduce their symptoms and improve their overall wellbeing.
• Medication. Medications, such as antidepressants and antianxiety medication, can also be used to help alleviate symptoms related to trauma. These medications can be prescribed by a psychiatrist or a primary care physician.
• Psychedelic-assisted therapies. Evidence for the therapeutic benefits of psychedelic-assisted therapies can best be described as emerging, but promising. To date, psilocybin and MDMA have been the most well studied substances.

The treatment approach chosen will depend on the individual’s specific needs and symptoms, as well as their preferences, goals, and other factors. It’s quite common for clients to receive a combination of different treatments, such as therapy and medication, to address all the different dimensions of the trauma and its effects. When designing a treatment plan, the clinician must address any co-occurring conditions, such as depression or substance abuse, and also consider the cultural and personal context of the individual.

Trauma courses

Parts of this article were adapted from Mental Health Academy’s trauma course, Working with Trauma. This 3-hour course briefly defines Acute Stress Disorder (ASD) and Post-traumatic Stress Disorder (PTSD), examines assessment tools for trauma, explains the neurobiology of trauma, and describes the chief psychotherapeutic interventions for working with traumatised clients.

Other trauma courses you may be interested in:

• Emotionally Focused Individual Therapy (EFIT) for Trauma: Dancing Tango and Reshaping Self
• Diagnosing Trauma-Related Disorders
• The Traumatic Effects of Disasters
• Principles of Trauma-informed Practice
• The Treatment of Trauma and the Internal Family Systems Model
• Understanding the Link Between Trauma and Addiction
• Counselling Trauma Affected Clients with Diverse Abilities
• Non-Combat Post-Traumatic Stress Disorder (PTSD) in Veterans: A Focus on Non-Combat Military-Related Trauma
• Case Studies in Trauma
• Systemic Oppression and Traumatic Stress: Evidence-based Social Justice Interventions for Clinicians
• Using Play to Provide Multicultural Trauma Treatment to Adolescents and Kids
• Intimate Partner Violence Solution-Focused Trauma Care
• First Do No Harm: The Need for Trauma-Sensitive Mindfulness

Note: Mental Health Academy members can access 500+ CPD/OPD courses, including those listed above, for less than $1/day. If you are not currently a member, click here to learn more and join.

Key takeaways

• Trauma refers to a deeply distressing or disturbing experience that can have lasting effects on an individual’s mental and emotional wellbeing.
• Trauma can result in a range of psychological and physical symptoms, including intrusive thoughts, avoidance, emotional numbness, anxiety and fear, depression, irritability and anger, and physical symptoms.
• Trauma can be diagnosed through a comprehensive clinical interview and using diagnostic criteria from the DSM-5-TR. Other assessment tools, such as questionnaires and self-report measures, may also be used.
• Treatment for trauma include (but is not limited to) cognitive-behavioural therapy (CBT), prolonged exposure therapy (PE), eye movement desensitisation and reprocessing (EMDR), mindfulness-based therapies, and medication.
• When designing a treatment plan, therapists must address any co-occurring conditions, such as depression or substance abuse, and also consider the cultural and personal context of the individual.