Understanding Trauma
PART I: Types of Trauma
Trauma can be classified in multiple ways, including by duration, context, and cause:
A. By Duration or Exposure
Acute Trauma: A single, overwhelming event (e.g., a car accident, assault).
Chronic Trauma: Repeated and prolonged events (e.g., domestic violence, childhood abuse).
Complex Trauma: Multiple, interpersonal traumas, especially in early development, often involving caregivers.
Developmental Trauma: Trauma occurring during critical childhood developmental stages.
Secondary/Vicarious Trauma: Exposure to others’ trauma (common in therapists, first responders).
Intergenerational/Transgenerational Trauma: Trauma passed through family systems and generations (e.g., descendants of genocide survivors).
Historical/Collective Trauma: Trauma experienced by a cultural, racial, ethnic, or national group (e.g., colonialism, slavery, war).
Medical Trauma: Trauma due to medical procedures or health crises (e.g., ICU stays, cancer treatment).
Environmental/Disaster Trauma: Resulting from natural disasters or large-scale environmental events (e.g., hurricanes, wildfires).
Institutional Trauma: Harm caused by systems (e.g., schools, churches, prisons, immigration systems).
Terrorism/War Trauma: Trauma experienced due to war, combat, or terrorist activity.
PART II: Evidence-Based Therapeutic Modalities for Trauma
Each modality targets different aspects of trauma, from physiological dysregulation to cognitive distortions and relational repair.
1. Cognitive & Exposure-Based Therapies
Modality: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Description: Combines CBT with trauma-sensitive interventions. Includes psychoeducation, relaxation, cognitive processing, and trauma narration.
Best For: Children and adolescents
Modality: Prolonged Exposure Therapy (PE)
Description: Clients repeatedly revisit trauma memories in a safe setting to reduce avoidance and fear.
Best For: PTSD, particularly adult trauma
Modality: Cognitive Processing Therapy (CPT)
Description: Focuses on challenging and modifying unhelpful trauma-related beliefs.
Best For: PTSD, combat trauma, assault
Modality: Narrative Exposure Therapy (NET)
Description: Builds a chronological narrative of one’s life, integrating trauma memories.
Best For: Refugees, multiple traumas
2. Somatic & Body-Based Therapies
Modality: Sensorimotor Psychotherapy
Description: Integrates somatic and emotional processing with cognitive awareness.
Best For: Complex/developmental trauma
Modality: Somatic Experiencing (SE)
Description: Works with nervous system regulation by focusing on body sensations and releasing stuck trauma energy.
Best For: Acute, chronic, or shock trauma
Modality: Brainspotting (EMDR / memory consolidation category)
Description: Uses bilateral stimulation and eye position to help reprocess traumatic memories.
Best For: PTSD, phobias, single-incident trauma
3. Attachment-Based & Relational Approaches
Modality: Internal Family Systems (IFS)
Description: Treats the internal system of “parts” (e.g., exiles, protectors) within a person.
Best For: Complex trauma, dissociation
Modality: Attachment-Based Therapy
Description: Strengthens emotional bonds and secure attachment, often by healing early relational trauma.
Best For: Childhood and relational trauma
Modality: Dyadic Developmental Psychotherapy (DDP)
Description: Focuses on creating safety in caregiver-child relationships, often using co-regulation.
Best For: Children in foster/adoptive care
Modality: Relational-Cultural Therapy
Description: Emphasizes healing through mutuality, connection, and understanding power and oppression.
Best For: Relational trauma, marginalized identities
4. Mindfulness & Neuroscience-Informed Approaches
Modality: Mindfulness-Based Stress Reduction (MBSR)
Description: Uses meditation and body awareness to reduce reactivity.
Best For: Anxiety, somatic distress, vicarious trauma
Modality: Neurofeedback
Description: Uses EEG technology to help regulate brain function and stress response.
PTSD, complex trauma, developmental trauma
Modality: Polyvagal-Informed Therapy
Description: Uses Stephen Porges’ Polyvagal Theory to regulate the nervous system via vagus nerve pathways.
Best For: Dysregulation, anxiety, freeze states
5. Creative & Experiential Therapies
Modality: Art Therapy
Description: Uses visual expression to explore and process trauma nonverbally.
Best For: Children, preverbal trauma, dissociation
Modality: Music Therapy
Description: Uses sound and rhythm for emotional regulation and trauma processing.
Best For: Somatic trauma, adolescents
Modality: Drama Therapy / Psychodrama
Description: Uses role play and enactment to explore trauma narratives.
Best For: Complex trauma, grief
Modality: Play Therapy
Therapeutic play allows children to express trauma safely.
Best For: Young children, developmental trauma
Modality: Equine-Assisted Psychotherapy
Description: Builds regulation and trust through interactions with horses.
Best For: Attachment trauma, emotional regulation
6. Group & Community-Based Interventions
Modality: Seeking Safety
Description: Focuses on trauma and substance use by emphasizing coping skills and safety.
Best For: PTSD with co-occurring addiction
Modality: Trauma Recovery & Empowerment Model (TREM)
Description: Group-based, gender-responsive model for trauma survivors.
Best For: Interpersonal trauma, women’s groups
Modality: Community Resilience Models
Description: Promote collective healing and community-level nervous system regulation.
Best For: Collective and intergenerational trauma
PART III: Phases of Trauma Treatment
Most trauma-informed therapies follow a three-phase model (Herman, 1992):
Safety & Stabilization
Psychoeducation (e.g., Window of Tolerance, nervous system)
Coping skills, emotional regulation
Creating safety in the therapeutic relationship
Trauma Processing
Processing traumatic memories (through narrative, somatic, or exposure techniques)
Identifying distorted beliefs and triggers
Reprocessing and integration
Reintegration & Growth
Reconnecting with values, identity, and community
Enhancing autonomy and agency
Post-traumatic growth, relational repair
The Window of Tolerance is a foundational concept in trauma-informed therapy, originally developed by Dr. Dan Siegel. It refers to the optimal zone of arousal in which a person is able to function and respond to stimuli effectively—emotionally regulated, engaged, and present.
What Is the Window of Tolerance?
Think of it like a “zone” where a person’s nervous system is balanced. Within this window, a person can:
Manage daily stress
Engage socially
Reflect and make decisions
Feel a range of emotions without becoming overwhelmed
When inside the window, people are:
Calm
Focused
Emotionally regulated
Able to learn, connect, and respond effectively
Above the Window: Hyperarousal
Fight or Flight State
The nervous system is overactivated.
Symptoms include:
Anxiety or panic
Anger or irritability
Racing thoughts
Hypervigilance
Restlessness
Emotional flooding
Below the Window: Hypoarousal
Freeze or Shutdown State
The nervous system is underactivated.
Symptoms include:
Numbness or emptiness
Dissociation or depersonalization
Low energy, fatigue
Depression
Feeling disconnected from body or emotions:
Trauma & the Window of Tolerance
People with trauma histories often have a narrower window, meaning they may swing into hyperarousal or hypoarousal more quickly and with less external provocation.
How Therapy Expands the Window
Evidence-based trauma therapies help expand this window so individuals can:
Tolerate distress without shutting down or overreacting
Stay connected and grounded in the present
Learn to regulate their nervous systems
Tools therapists use include:
Cognitive restructuring
Grounding techniques
Somatic practices (e.g., breathwork, movement)
Mindfulness
IFS unburdening
Resourcing (connecting to safe internal/external images or memories)
Polyvagal-informed techniques (e.g., vagal toning, co-regulation)
Psychoeducation about nervous system function