Psychologist and psychotherapist specialising in trauma in Brussels
“Traumatic symptoms are not caused by the event itself. They arise when the overwhelmed organism retains an internal tension. This tension remains trapped in the nervous system, where it can wreak havoc on our bodies and our minds”. Peter Levine
What is trauma and what causes it ?
Trauma occurs when we live through very stressful, frightening or distressing events that are difficult to handle or beyond our control. It may be a one-off incident or an ongoing event that takes place over a long period.
Most of us will experience an event in our lives that could be regarded as traumatic. But we will not all be affected in the same way. Trauma can occur at any age. And it can affect us at any time, including long after the event took place.
Traumatic events can be of many kinds. They may involve :
- A recent one-off event (assault, accident) ;
- A one-off event in the past ;
- A repeated and prolonged distressing experience (ill-treatment, abuse, sexual abuse, etc.).
Shall we talk about it?
I am a clinical psychologist and psychotherapist in Brussels, specialising in trauma.
Either the person was directly affected, or they witnessed the ill-treatment of someone else.
Finally, trauma can be experienced indirectly, as in the case of the children of parents who were victims of genocide; we then speak of transgenerational trauma.
What are the different types of trauma ?
When we refer to one or more one-off events, we speak of simple trauma; when the distressing experience is repeated or prolonged, it is then a complex trauma.
Complex trauma is more often the result of chronic victimisation and of being subjected to a person or a group of people without any possibility of escape over a long period. This may involve repeated violence inside or outside the family, hostage-taking, acts of war, harassment, etc.
We speak of trauma when there is a breach in a person’s psychological and physical protection, with no possibility of escape (usually flight or fight), and which is psychologically devastating to the point where the person’s capacity to adapt is overwhelmed.
The circuits involved in the traumatic response
The autonomic nervous system
Danger is part of life, and the brain’s role is to detect it in order to set certain physiological responses in motion. Faced with a stressful event, our organism swings into action and triggers hormonal responses that promote alertness, by way of our autonomic nervous system.
Our nervous system is divided into two branches: the central nervous system, which includes the brain and the spinal cord, and the peripheral nervous system, which is itself divided into the somatic nervous system and the autonomic nervous system.
The autonomic nervous system comprises the sympathetic nervous system and the parasympathetic nervous system. It is these two systems that react in the face of external danger.
The hormonal response to danger
It is first of all our senses that detect danger : the nose, the ears, the eyes or the skin. The thalamus detects these sensations, which are then transmitted along a fast, automatic, so-called unconscious pathway, the amygdala, located in the limbic system, and towards a conscious area by way of the frontal lobes.
The amygdala reacts extremely quickly in the face of danger, well before the frontal lobes; if it detects a threat to the organism, it sends a message directly to the hypothalamus and the brainstem, which mobilise the stress hormones and the autonomic nervous system to set the body in motion, by way of the sympathetic nervous system.
The alarm signal launched by the amygdala triggers the release of cortisol and adrenaline, which raise the heart rate and blood pressure and prepare the muscles for fight or flight by causing vasodilation.
This constitutes our organism’s response to situations of danger or acute stress, through activation of the sympathetic nervous system.
The parasympathetic nervous system, for its part, conserves and restores. It allows the heart rate and breathing to return to normal and the metabolism to slow down in order to preserve energy, once the danger has passed.
This system can be activated at several points during the day in response to events of mild or moderate intensity, but generally the organism will return to normal once the threat has passed. These two systems regulate one another and thereby allow an optimal nervous balance.
It is the dysregulation of this natural response that is at play in trauma.
What are the signs of trauma ?
Faced with a major danger, such as a near-death experience in which our very life is at risk and in which the organism’s capacity to adapt is overwhelmed, an intense shock is created which is devastating both somatically and psychologically : this is the traumatic response, or trauma. Traumatic events push the nervous system beyond its capacity to self-regulate.
The response to danger remains active, or mobilises itself, even once the dangerous situation has passed. The organism remains in a state of alert, ready to react to the slightest signal that might recall the traumatic event. There is an over-activation of the sympathetic nervous system. This constant physical state of hyperarousal, even in the absence of danger, ends up exhausting the organism. There is then constant agitation, irritability, anger, and finally depression.
In the traumatic response, one of the two systems becomes dominant and inhibits the functioning of the other. Either the sympathetic nervous system (fight, flight) or the parasympathetic (paralysis) is over-activated.
Shall we talk about it?
I am a clinical psychologist and psychotherapist in Brussels, specialising in trauma.
Polyvagal theory
Polyvagal theory was developed by Stephen Porges.
Stephen W. Porges is a Distinguished University Scientist at Indiana University, where he is the founding director of the “Traumatic Stress Research Consortium”. He is Professor of Psychiatry at the University of North Carolina and Professor Emeritus at the University of Illinois at Chicago and at the University of Maryland.
Polyvagal theory complements the involvement of the autonomic nervous system described above with the role of the vagus nerve, which is embedded in the parasympathetic nervous system. Porges studied the parasympathetic pole of the vagus nerve, which counterbalances the sympathetic system. The parasympathetic system is the brake pedal that calms our nervous system and encourages a return to normal after danger.
He distinguishes two circuits :
- The ventral vagal circuit, which conserves and restores. It is a state of calm, because we feel safe, and it is therefore conducive to relaxation and social engagement.
- The dorsal vagal circuit, which is activated in immobilisation/paralysis mode.
Indeed, when a predator attacks an animal in the wild, if the animal can no longer flee, it will become immobile and “play dead” in a final attempt at protection.
This also applies to human beings faced with a threat against which they cannot defend themselves. When mortal danger is detected and we feel powerless in the face of the threat, the dorsal branch of the parasympathetic or vagal system is activated. We then remain stuck in this paralysis mode. There is then an over-activation of the parasympathetic nervous system, which in the long run will bring about depression, disconnection, fatigue and lethargy.
A “healthy” nervous system is one that fluctuates between these 3 states depending on life’s ups and downs. The traumatic response is the over-activation of the flight or immobilisation response, because our organism has been completely overwhelmed by the intensity of the traumatic event or events.
We can be overwhelmed by the occurrence of a single traumatic event, in which case we generally speak of post-traumatic stress disorder, but also by the repetition of traumatic situations, in which case we speak more generally of complex trauma.
Post-traumatic stress disorder.
Post-traumatic stress disorder occurs in the aftermath of exposure to an extreme event that threatened a person’s life or physical integrity.
In PTSD, there is no longer any distinction between past and present.
The person relives the traumatic situation over and over, as though they were still there. These flashbacks are expressed through re-experiencing, intrusive thoughts, nightmares and a permanent state of hypervigilance
The thalamus goes out of action, which means there is no longer any discrimination between neutral stimuli (background noise, music) and stimuli suggesting danger.
The organism is constantly on alert and the stress hormones are secreted even in the absence of danger. For example: someone who has lived through war and is returning from combat will suddenly feel all the symptoms of stress at the sound of a door slamming, which will be identified as the noise of a bomb, because the discrimination normally carried out by the thalamus no longer takes place.
Avoidance behaviours are put in place to prevent any resurgence of the trauma, but they often lead to total isolation, because when the trauma is severe, any stimulus can put the organism on alert and bring back the intense panic felt during the event.
People suffering from PTSD often develop anxiety-depressive disorders and addictions alongside it, but other more significant comorbidities can also be associated with it. As a result, PTSD can significantly impair a person’s personal, social and professional life.
What all people suffering from post-traumatic stress have in common is that they experienced the traumatic event as a source of intense stress or terror in the face of which they felt powerless.
The prevalence of PTSD is thought to be 5 to 12% in the general population, but these data come mainly from studies carried out in the United States; studies on the subject are rarer in France and in other countries. (INSERM, 2024)
“People with post-traumatic stress syndrome have their floodgates wide open. Deprived of a filter, they are constantly in sensory overload. To bear it, they try to shut themselves down by developing narrowed vision and intense focus. If they cannot manage it naturally, they may turn to alcohol or medication. The tragedy is that this shutting down also excludes the sources of pleasure and joy” (Bessel Van Der Kolk, 2017).
Shall we talk about it?
I am a clinical psychologist and psychotherapist in Brussels, specialising in trauma.
Complex trauma
We speak of complex trauma when the event at the origin of the difficulties was repeated or was constantly present over a long period. Domestic violence, sexual abuse and acts of war fit this definition.
Complex trauma took a long time to be recognised; for many years only post-traumatic stress disorder was discussed.
It was only in 1992 that Judith Herman, an American psychiatrist, took an interest in a group of adults who had lived through trauma but who presented a whole train of symptoms different from those usually experienced in post-traumatic stress disorder.
What they all had in common was having lived through prolonged or repeated trauma in a climate of total powerlessness. She mentions imprisonment, concentration camps, situations of religious coercion, organised sexual exploitation and certain family situations.
All of these people presented disturbances of emotional regulation (emotional numbing, dissociative symptoms or emotional hyperactivity and impulsivity), relational difficulties (difficulty trusting others or social isolation) as well as disturbances of self-perception (a negative view of oneself, shame, guilt).
These complex psychological traumas represent a major public health problem affecting people of all ages. They are thought to affect around 8% of the world’s population.
Complex trauma also includes developmental trauma, which relates specifically to trauma experienced during childhood. This may involve physical and/or psychological ill-treatment, sexual abuse, but also neglect.
The repercussions of complex trauma are extremely serious and pose a real public health problem, linked to all the comorbidities they bring about, such as depressive, anxiety, borderline, psychotic and dissociative disorders, and addictions.
Complex traumas that have their origins in childhood also give rise to physical disorders in adulthood.
Gabor Maté, a Canadian doctor of Hungarian origin who has devoted his career to the question of trauma and has written many books on the subject, discusses this in depth in his 2017 book “When the Body Says No”.
He works within a biopsychosocial framework, emphasising that biological, psychological, social and environmental factors are inseparable if we are to understand the development of certain chronic illnesses.
In it he explains the link with intense or traumatic stress and shows how adverse experiences lived through during childhood have an impact on the immune system. The body too can become depressed and signal its distress through the development of certain illnesses.
He writes in particular about the dysregulation of the autonomic nervous system described above and demonstrates how increased secretion of cortisol under the effect of stress can underlie the development of multiple illnesses such as sclerosis, intestinal conditions, rheumatoid disorders and cancers.
Finally, we cannot end this section on complex trauma without mentioning the remarkable work of Bessel Van Der Kolk, an eminent psychiatrist and trauma specialist who, in his bestseller “The Body Keeps the Score” (date), likewise underlines how far trauma affects not only the mind but also how deeply it takes root in the bodies of traumatised people.
Exposure to abuse and violence encourages the development of a hyperactive alarm system and shapes a body that remains stuck in fight/flight and freeze. Trauma interferes with the brain circuits involved in concentration, flexibility and the capacity to remain emotionally in control. A constant feeling of danger and powerlessness encourages the continuous secretion of stress hormones, which disrupt the immune system and the functioning of the body’s organs. Only by allowing trauma victims to inhabit their bodies safely, to tolerate feeling what they feel, and to know what they know, can lasting recovery be achieved.
Therapies for trauma.
In the light of what we have just been through, it seems clear that trauma can only be resolved by treatments that include both body and mind.
Treatment must also include somatic methods that have proved their worth, such as yoga, which allows bodily sensations to be reclaimed, dance as a way of reconnecting with others, and meditation to calm the constant flow of intrusive thoughts associated with trauma.
Certain therapeutic methods such as neurofeedback, EMDR or Internal Family Systems have also proved their worth in the field of trauma.
For my part, I believe that an in-depth psychotherapy allowing the person to rebuild a bond of trust through which traumatic content can be discharged, combined with an innovative somatic method such as therapeutic Breathwork, allows deep work through the engagement of both mind and body. The therapeutic results obtained by combining these two working methods are remarkable and lasting.
Psychotherapy
When you are suffering from trauma, it is all the more important to choose your therapist carefully. Not all practitioners are trained in trauma. It is clear that a traumatised person will find it difficult to trust again and to rebuild the intimate bond necessary for any therapeutic work. If the therapist is not aware of this particular sensitivity, they will not be sufficiently attentive to the quality of the therapeutic relationship. The patient will need time to rebuild a bond of trust and a sense of safety within the relationship. It is only in a relational climate experienced as sufficiently reassuring that the person, with the help of their therapist, will be able to mobilise all their resources in order to approach the painful events and free themselves from them.
Therapeutic Breathwork
Therapeutic breathing is a conscious and intentional form of breathing that releases the trauma stored in the body. It supports the treatment and healing of trauma by bypassing the conscious mind, deactivating the sympathetic nervous system and having a restorative effect.
It gives access to altered states of consciousness in which one can feel free to express any emotions or physical movements that arise during a session ; allowing everything that is present to be expressed, processed and released.
During a session, conscious connected breathing takes the person where they need to go, because it allows a deep connection with their unconscious by bringing about various somatic and emotional states.
Using the breath in spiritual practice or for healing is not a new concept. Since time immemorial, every culture, in its spiritual dimension seeking to understand human nature, has regarded the breath as a crucial link between nature, the human body, the psyche and the spirit.
But it is only recently that scientists have begun to take an interest in this ancient knowledge and to study the impact of breathing on traumatic experiences, on healing and on the nervous system.
When we are faced with a threat, we unconsciously change the way we breathe.
If our nervous system goes into “fight or flight” mode, breathing becomes rapid. If we go into “paralysis/immobilisation” mode, breathing becomes shallow, because we hold our breath in order to go unnoticed.
Much of this experience is automatic and escapes consciousness.
Some researchers suggest that changes in breathing are not only a response of the nervous system, but also a way of keeping an emotion or a sensation suppressed when it exceeds our capacity to cope with it.
Inhibited breathing is a safety mechanism of the body, so as not to be flooded with uncomfortable and painful emotions and sensations. It is an unconscious defence mechanism that deprives us of a sense of genuine presence in the world. Consciously deepening the breath can allow emotional integration and thereby restore a sense of safety and calm so necessary to a fulfilling life.
Conscious connected breathing makes it possible to bypass the conscious mind so that unconscious content can emerge, and thereby allows a sense of safety in the body to be restored.
Its power lies in the fact that it allows the body to do what it already knows how to do naturally: to release and to restore itself.
Conscious breathing is a practice that involves rhythmic diaphragmatic breathing. Diaphragmatic breathing has, in many contexts, been associated with a variety of positive outcomes, reducing anxiety, depression, blood pressure, PTSD symptoms and insomnia. Diaphragmatic breathing is also associated with stimulation of the ventral vagus nerve, inducing deeper relaxation.
During breathwork, many people report a greater awareness of the body and of sensations. Living in your body means living in a place where abuse and suffering have occurred. Breathwork brings up somatic sensations and makes it possible to reconnect with your body, with its sensations and emotions, in a safe environment.
Part of the healing process consists of learning to express one’s anger, pain, sadness and fear in ways that support our growth and our relationships.
All the emotions and sensations that arise are all allowed to exist. With acceptance, resistance diminishes, our tolerance for discomfort and uncertainty increases, and we become gentler with ourselves.
Breathwork has the potential to bring about altered states of consciousness, similar to deep meditation. In this state, we have the potential to bypass the mental stories, projections, judgements and resistances that prevent us from healing. Breathwork opens up the space that allows the body’s inner intelligence to emerge and gives us access to our own innate wisdom.
Shall we talk about it?
I am a clinical psychologist and psychotherapist in Brussels, specialising in trauma.