Shame is a huge barrier to accessing support for trauma, according to a clinical and forensic psychologist who has recently returned to Ireland, following work in specialist trauma services in the UK.
“Shame is carried by people as a result of trauma. That sense of shame might be buried quite deep and there is a huge self-stigma about bringing it up as an adult,” says Dr Louise Canacott, who now works with adolescents at the St John of God Hospital in Stillorgan, Dublin.
“For most people, trauma is a set of reactions which make them more agitated, on edge with difficulty focusing or sleeping. Adults who seek help are often dealing with a lot of childhood trauma,” says Canacott, who will give a free public lecture on Trauma: What Does it Mean for Mental Health, on Monday (April 7th) at 7.30pm at St John of God Hospital, Stillorgan.
She suggests there is a high prevalence of trauma in people seeking help with depression, anxiety or personality disorders, yet the trauma itself isn’t always focused on. “Trauma is everywhere. It’s a reaction, a collection of experiences following a distressing, frightening or overwhelming event,” says Canacott.
While she concedes that people are often encouraged to seek help following big traumas such as sexual assault, bullying, death of a loved one by suicide or homicide or a traumatic childbirth, she suggests people don’t always consider the effects of smaller traumas.
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“But there is also a cumulative effect of smaller traumas – such as not feeling accepted, not belonging or not being loved – which knocks people’s confidence,” says Canacott who worked with children at risk of going into care or already in the criminal justice system in the UK.
Bullying, difficulties in dealing with changes in the family structure such as parental separation, and physical or sexual abuse or neglect are common issues faced by adolescents she now sees.
‘Adults who have experienced trauma feel very anxious or have feelings of guilt, responsibility or shame. They may have intrusive memories, during which they relive the event’
— Dr Louise Canacott
She advises parents to be alert to a range of symptoms which, if they come together, could be a sign that the child has experienced some sort of trauma. These include big changes to their behaviour such as becoming more clingy, more fearful, their sleep or eating is affected, they are having nightmares or start wetting the bed, they become withdrawn or detached, or are more reactive.
She also says parents should not be reactive, but instead sit with their children and listen. “Children need co-regulation to help them deal with a trauma. It’s also important to help them prioritise eating and sleeping well and doing the things they enjoy.”
Adults may develop more complex mental health problems as a result of trauma. “Adults who have experienced trauma can feel very anxious or have feelings of guilt, responsibility or shame. They may have intrusive memories, during which they relive the event. They may also numb out the memories or dampen down their emotions with drugs or alcohol,” says Canacott.
In treatment, Canacott says the emphasis is on stabilising the person before delving into the trauma itself. “We need to help people develop the capacity to tolerate their own distress without self-medication with drugs/alcohol or self-harm,” she explains.
This involves a therapeutic process to help them develop good habits – such as a healthy diet, better sleep patterns and being more organised. “These lifestyle factors can help stabilise someone and act as a buffer against being overwhelmed by strong emotions.”
Only after a person has stabilised does she suggest trauma-focused cognitive behaviour therapy as a way for someone to go through their emotions and allow the trauma to come up. “It helps people look at the meaning they made of things following the traumatic event and look at their feelings and behaviours, such as avoidant behaviours that are limiting their lives.” Therapies which work on the mind/body connection are also useful to help symptoms in the body come to the surface safely as the emotions are reprocessed.
Minding the Mind is a free series of public lectures on Monday evenings in April at 7.30pm in St John of Gods Hospital, Stillorgan, Dublin. The topics are trauma, eating disorders and strategies for keeping calm and confident for exams
