Knowledge

Aprenda sobre la prevalencia de la violencia sexual, comprenda las reacciones a los eventos traumáticos y cómo la cultura, los estereotipos de género, la culpa y la vergüenza impactan las experiencias de los sobrevivientes.

Trauma

Objetivo. Clarificar el concepto de «trauma» y los «eventos traumáticos» y sus efectos en las personas.

Trauma significa herida. Tanto en medicina como en psicología, se refiere a lesiones físicas o mentales graves, incluyendo amenazas a la vida o la integridad física. Como lo expresó la psiquiatra Judith Herman (1992, p. 33), un trauma es «un encuentro personal con la muerte y la violencia».

• La situación es abrumadora, ineludible y muy aterradora.
• Amenazar la vida y la integridad
• Loss of control and beyond what we are prepared to deal with
• Most people will struggle with serious reactions such as intrusive memories, re-experiences, flashbacks and sleeping problems afterwards

A traumatic event is one that has the capacity to cause mental or physical trauma. Faced by such an event, the immediate response of the body and the mind is to struggle for survival. Behaviorally this is expressed by four survival strategies:

A severe traumatic event often changes the way in which survivors understand the world around them. They may lose their sense of safety and feel vulnerable and helpless. If the event involves acts of violence and the intention to hurt, trust in other people may be lost and the survivor’s interrelation world seriously disturbed. Personal encounters with human or man-made violence are considered the most disturbing forms of trauma, likely to have the most lasting impact. It is important to emphasize that the reactions that survivor experience are normal reactions to an abnormal event. The survivor is not crazy!

Sexual violence is a specific form of trauma because it is an extremely invasive offence that gives rise to feelings of shame, self-blame, and guilt. When it is combined with fear of being injured or killed, it is traumatic in almost all cases. Being exposed to sexual violence, and surviving rape, often triggers serious trauma reactions, and many people who are raped develop a disorder within the trauma spectrum. It is estimated that people who experience or survive such events are more likely to develop PTSD than people who are exposed to other forms of trauma.

Loss of safety, control and trust commonly leads to depression (deep sadness, loss of the will to live, etc.) or anxiety. A personal encounter with violence and death may also haunt the survivor, who may painfully re-experience the event in dreams or daily life (also called intrusion). In the toolbox, we call the reminders that cause intrusion triggers. Triggers, or trauma-reminders, are events or situations that remind victimised persons of their painful experiences and memories. Such reminders may elicit trauma reactions over and over again. They can be extremely distressing and create such anxiety that people are afraid to go out, see people, hear certain sounds, or do many ordinary usual things. Flashbacks are sudden, often strong, and uncontrollable re-experiences of a traumatic event or elements of that event. Survivors may feel disconnected from their bodily sensations and feel numb or may be unable to recall traumatic memories. A state of heightened arousal is also quite usual. Survivors may be on their guard all the time, startle easily, sleep poorly, be irritable, or find it difficult to remember and concentrate (called hyper-arousal).

Window of tolerance and optimal arousal

Aim: Introduce a model for understanding our reactions to stress and trauma.

The window of tolerance is a therapeutic metaphor that we can use to explain trauma reactions. It is based on the idea that every person has a ‘window of tolerance’, an amount of arousal or feeling that he can tolerate or manage. The toolbox and the training provide information through which survivors can understand their trauma reactions. It also provides tools and grounding techniques that can help them to stay within their window or return to their window when they lose control.

The part between the two lines shows the level of activation. All people have a zone or a kind of window in which they are perfectly balanced – where the person is in a state of mind where he able to be present in the situation, able to concentrate and to learn.

If you are above the window of tolerance, over the upper line, we say that you are hyperactivated. This means that your activation is too high. If you are below your window of tolerance, under the lower line, we say that you are hypo-activated. This means you are under-activated; your energy is too low. Traumatic memories can trigger a flight/fight response. This is a hyper-activation reaction, where the activation is extremely high and the body is ready to flee or fight the threats. If we are frightened of something, the body reacts automatically by shutting off certain activities and reinforcing others. We may, for example know that the heart is beating louder and faster and that we breathe faster. The body feeds blood to the brain, arms and legs. Muscles prepare for fight or flight, while activity in the brain shifts from the parts that help us think through complex problems to the parts that help us to respond to life-threatening situations.

If it is not possible to fight or flee, for example if you are a small, unprotected child, you will rely on the most basic survival strategy that we have – to freeze. This is the same mechanism that we see in many small animals that become totally inactive when they are attacked. This is a hypoactivation reaction in which activation falls to a minimum: you shut yourself down, become what we call immobilized.

Most of us are occasionally high and low on the window of tolerance. When this happens, we often have some strategies that allow us to regulate ourselves back into the window of tolerance before the discomfort becomes too unbearable. For a traumatised person, however, it is harder to maintain their activation in the window of tolerance, which is why it is important to learn effective techniques that help return to the window of tolerance.