Trauma-Informed Engagement, Part 2: The Effects of Trauma
By Carolyn Shimmin
In previous blog posts we’ve discussed the importance of incorporating a trauma-informed intersectional analysis in patient and public engagement in health research. In the next few posts, we’re going to delve deeper into what the practice of trauma-informed engagement might look like. Typically, trauma-informed practice has four main principles: 1) trauma awareness; 2) emphasis on safety and trustworthiness; 3) opportunity for choice, collaboration, and connection; and 4) strengths-based approaches and skills building. In Part 1, we discussed what trauma is — in this follow-up post, we talk about the effects of trauma on individuals’ health and well-being, and the implications for engagement.
The Effects of Trauma
The effects of trauma are diverse and vary from person to person ―from minor disruptions in an individual’s life to debilitating responses. People may experience anxiety, terror, shock, shame, emotional numbness, disconnection, intrusive thoughts, helplessness, and powerlessness. All of these responses can interfere with an individual’s sense of safety, self, and self-efficacy as well as the ability to regulate emotions and navigate relationships.
Coping or adaptation skills that people develop in response to trauma and perceived ongoing threats can produce the following: difficulty controlling or regulating emotional reactions or behaviours, which often results in either hyperarousal and hypervigilence (where an individual seems to overreact to every situation), or listlessness and dissociation (where an individual seems numb and disconnected in stressful or dangerous situations).
Physical health can also be affected ― trauma survivors may experience:
- Chronic pain
- Gynaecological difficulties
- Gastrointestional problems
- Asthma
- Heart palpitations
- Headaches
- Musculoskeletal difficulties
Recent evidence demonstrates that the biological processes associated with post-traumatic stress disorder (PTSD) cause cellular and even genetic changes in brain and hormone functions. Early life stress and trauma, in addition to being associated with increased risk of mental disorders such as PTSD, are also associated with physical diseases (cardiometabolic disorders, inflammatory diseases, and chronic pain syndromes).
The pervasive and harmful impact of traumatic events on individuals, families, caregivers and communities, and the unintended but similarly widespread re-traumatizing of individuals within our public institutions and service systems ― not only healthcare but also education, corrections, child welfare, government interactions, etc. ― makes it necessary for all health researchers and patient/public partners to have an understanding of trauma.
Traumatic events by their very nature set up a power differential where one entity (whether an individual, an event, a system or a force of nature) has power over another. An individual’s experience of these events or circumstances are shaped in the context of this powerlessness and feelings of humiliation, guilt, shame, betrayal or silencing often shape the experience of this event. It is important in interpersonal interactions — which play a large role when it comes to patient/public engagement in health research — that these feelings of powerlessness are not reproduced or reconstituted in any way.
In Part 3: Safety & Trustworthiness, we discuss more pragmatic issues related to trauma-informed approaches in patient and public engagement and research partnerships.
Need Help?
- Please refer to the Canadian Association for Suicide Prevention’s list of crisis centres across Canada.
- First Nations and Inuit Hope for Wellness Help Line: 1–855–242–3310. It is toll-free and open 24 hours a day, 7 days a week.
About the Author
Carolyn Shimmin (@CarolynShimmin) is the Patient and Public Engagement Lead at the George & Fay Yee Centre for Healthcare Innovation (CHI). Her experience includes stakeholder engagement, research, writing and reporting on various health policy issues including mental health, addictions, trauma and the sexual exploitation of children and youth. Areas of interest include patient engagement, lived experience research, knowledge translation, trauma-informed approaches, intersectional analysis, and post-structuralist queer theory.
