Bárbara Kanter: «There are very common situations capable of generating trauma»

Although we may not notice it, our brain is constantly changing depending on the experiences to which we expose ourselves during the day to day. Even those most banal situations are capable of producing small transformations in the way in which the that our neurons connect to each other, and with the passage of time, these modifications go away accumulating.

It is normal that this is the case: this phenomenon is what allows us to be constantly learning, whether we realize it or not. But this set of mechanisms also makes it possible for certain experiences to leave an emotional mark on us that gives rise to psychopathologies. This is what happens with traumas, phenomena capable of damaging us on a psychological level and that usually originate from emotionally painful situations. We talked about this with today's interviewee, the psychologist Bárbara Kanter.

• Related article: "Post Traumatic Stress Disorder: Causes and Symptoms"

Interview with Barbara Kanter: understanding psychological trauma

Bárbara Kanter is a General Health Psychologist expert in the treatment of trauma, and based in Barcelona, ​​where you have your query. In this interview he talks about the nature of psychopathologies associated with traumatic experiences.

How to define in a simple way something as complex as psychological trauma?

I think the best way to understand trauma is with the example of the kintsugi, it is a very graphic and simple example. Traumatic situations appear in our lives in a disruptive, abrupt way. We do not expect them, but they do have a great influence on us. They break us. They break our cognitive schemes, our belief system, trust in ourselves and the world around us, etc.

This break in our system gives us the possibility of incorporating this experience in our way of face situations and our baggage of personal tools, and repair that crack that generate.

Some authors use the example of the earthquake as a shock that forever modifies our vital situation. Because even if we are not able to capture the effects of the earthquake with the naked eye, there is a displacement and a new balance.

What kinds of experiences are most capable of giving rise to these traumas?

The experiences are very diverse. In fact, we tend to think that only great events can cause us trauma, but this is not the case. There are very common situations capable of generating trauma. For example, someone who is locked in a sink can develop a trauma that leads to an Anxiety Disorder such as Claustrophobia.

However, if we must think about life events that can generate a Post-Traumatic Stress Disorder (PTSD) or a interference, I would opt for interpersonal victimization (various forms of psychological, physical, sexual, etc. here we could include armed conflicts and witness violent situations as well) or for all the most accidental and / or natural events (hurricanes, fatal accidents, tsunamis, etc.).

In fact, theories of trauma have their beginning evaluating the symptomatic presentations of war veterans, who among them showed emotional and cognitive impairments similar. That's where PTSD comes from.

How is trauma related to the functioning of the brain and its way of giving rise to memory processes and the recall of memories?

This is a frankly complex issue, since trauma intervenes in various mental processes. Some studies seem to show that there is an alteration in the tonsil circuit, generating a constant activation of the brain amygdala. Which explains intrusive memories, the state of hyperalertness, etc.

In turn, memory or emotional blocks may occur, the former refer to when the person is not able to remember some elements of the traumatic situation, the memory is choppy as when we put on a broken record that we miss parts of the song; while the latter refer to the fact that the emotions do not agree with the memories of the experiences, This is extremely common and is called dissociation, it helps the system to tolerate information better than it has happened. It can also pass the opposite pole, given by emotional hyperarousal before stimuli that could have some kind of nexus with the traumatic event, whether or not clearly, arousing an emotional response exacerbated.

In turn, there may be recurring and intrusive memories, these are parts of the traumatic situation that constantly appear in the person's day-to-day life, since whether in dreams or during daytime activities, they disperse the person from daily activities, and generate a lot of anxiety because they have the feeling of lack of control. Finally, the famous flashbacks, which are not present in a large part of the population affected by trauma, but are present in those who have experienced very violent situations; They are characterized by perceptual problems, such as feeling or seeing things that are not present at the moment, but that are linked to the traumatic situation.

A little linking with the previous question, we will give an example of how an event can affect we have not been exposed, such as attacks or natural events (earthquakes, hurricanes, tsunamis, etc.) in the world. I'm sure that today we are able to remember what we were doing and where we were when we found out that the Towers collapsed Twins in New York City (USA), or when it was the Atocha attack in Madrid (Spain), or when it was the earthquake and tsunami in Fukushima (Japan), etc. Although we have not been directly affected by these events, they leave a mark on us because they alter the habitual course of our life and, therefore, of our cognitive processes and emotional

Do trauma-related psychopathologies affect many people? How frequent are they?

The prevalence will be marked according to which population we refer to, in general it is common to find trauma in people evaluated by mental health services who are undergoing treatment, and it will be lower in population general. This does not mean that they have not experienced a traumatic situation and that they do not have any consequence of it, but simply that it has not been recognized as such. It should also be clarified that the studies carried out are on events that are more likely to generate trauma symptoms (interpersonal victimization, natural disasters, wars, exposure to violence, etc.), but it does not take into account less obvious situations that can also generate unrest in the person.

At the level of the actual clinical picture of trauma, there is the PTSD that I mentioned earlier. However, without the need for a picture of such complexity, many people who live with a trauma situation have anxiety, depression, learning disabilities, suicidal ideation and behavior, etc.

If we observe the type of consequences that this type of situation entails, we can observe that they are very diverse and that they cover different stages of life. Here I have only named the mental ones, but we also have physical consequences such as a greater propensity for risky behaviors (behaviors addictions, sexually transmitted diseases, unwanted pregnancies, etc.) as well as various chronic diseases (diabetes, cancer, etc.). Obviously, some of the named consequences can have a great influence on the person's life and generate consequences secondary, such as job instability, problems in interpersonal relationships, difficulties in committing to situations various, etc.

What are the most effective forms of psychotherapeutic intervention to help people with trauma?

There are two that have high evidence in favor, Trauma Focused Cognitive-Behavioral Therapy. Therapy, TF-CBT) and Eyes Movement Desensitization and Reprocessing (EMDR).

Both work on traumatic processing from different perspectives and tools. The first, the TF-CBT is specially designed in cases of childhood trauma, it works with the environment of the affected person favoring a narrative of trauma that allows its processing from the cognitive triad (thought, emotion and conduct); EMDR is used mainly in adults although it is also valued as a second therapeutic choice in children and focuses on the processing of trauma through coherence and communication between memories and emotions, it has a more biological foundation since it appeals to the interconnection of the hemispheres cerebral.

There are other types of interventions that have proven their efficacy, although they are not first therapeutic choices as in the aforementioned cases. All of them focus on the idea of ​​traumatic processing, of joining memories with emotions, favoring the double way of expressing the situation that occurred. This is important to take into account since, as I said before, one of the main deficits that arise are traumatic amnesias. Which, when unlocked, can generate a very high discomfort.

As a psychologist, have you noticed that the way we perceive psychological trauma has improved due to awareness of mental health issues?

Unfortunately I don't think we are very willing to change the mentality at the mental health level. For example, a button is enough... in recent weeks a parliamentarian has spoken about the issue of mental health and the effects is leaving this terrain (it should be clarified that the current situation is plausible of being considered traumatic) and has been the target of critics. If I can be honest, this worries me a lot. There are people who are not well, who are having a bad time and the necessary assistance is not guaranteed.

The system is set up so that, in many areas, it is endorsed having experienced a traumatic situation when the person does not is able to carry out their daily activities, but it is not valued when the person is functional despite the discomfort. In fact, in some areas, there is a certain stigmatization in relation to this problem. For example, a situation is not considered to be traumatic unless it is a very grotesque situation, when a trauma can be given by very simple things such as family “jokes” that have hurt us, due to difficulties in establishing relationships that have generated discomfort, etc.