Trauma Vs Stress, Breaking Down the Difference

Matt Darrah (00:01)

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It's kind of what we're looking at. We're gonna be talking a lot about trauma responses What is it? How do we overcome it and things like that? So Hannah, thanks for coming. Yeah And so kind of give us a rundown Why? Why do you know what you know? How do you know what you know about trauma and all that kind of stuff? Yeah, well I am

I took a couple year break after high school and worked with human trafficking survivors. That got me really interested in the social sciences. ⁓ And I lived in Kansas City at that point. So I decided to go back to school after my break or my two year break and focus on that. So I actually started just at a community college in the Kansas City area.

and then transferred over to University of Missouri where I studied under Dr. Aaron Hambrick who is one of the top or a top pediatric trauma psychologist in the US. And she worked underneath Dr. Perry. Dr. Bruce Perry, yes. In fact, they still work together regularly. He oversees the Child Trauma Academy down in the Houston area and I believe she still has a lot to do with the Child Trauma Academy that's based there in Kansas City.

So she was my undergrad mentor. I'm still in contact with her occasionally. Went on to do my masters in psychology, still focusing on trauma, but then adding the aspect of suicide and suicidal ideation, how those two things kind of interact and go alongside each other. And now I'm currently working on my PhD in psychology, public policy and law. ⁓ My concentration is trial consultation.

But my dissertation is all based around trauma, specifically sexual assault. And so I do a lot of reading on the topic and just have a lot of knowledge in that area. It's something I'm passionate about and continue to do it to this day. Wow. Yeah. just for you guys listening, Dr. Perry wrote a book that I read last fall with Oprah called What Happened to You. We kind of use a lot of that language.

on the podcast here ⁓ because ⁓ reframing that question, reframing it from what's wrong with you to what happened to you is really critical in understanding and getting over trauma. so we, so I talked about Dr. Perry on the podcast quite a bit. ⁓

But because he developed the neuro sequential model, right? Of therapeutics, he's, mean, he's Robyn Gobbel's podcast that I've talked about in her book that we give to every ⁓ foster family when we do a placement package. It's all about Dr. Perry's work. so he's really kind of out there when it comes to understanding all of this. So that's heavily influenced.

your take on trauma, right? Yeah, it definitely has. You know, my focus is not normally around kiddos, even though was in a pediatric trauma-centered lab in undergrad. I love the older ages, the adults working with those, but I also work with sexual assault survivors. I'm an advocate. In fact, I do that weekly still at this point.

My youngest being about three months old all the way up into her seventies. And so you, really is about what happened to you. That's changing the dialogue from, you know, like you said, what's wrong with you, which is a really shameful phrase into what happened to you. Um, which takes that shame away and helps help people to kind of cope with and like you said, reframe and refocus what they've been through. Yeah.

Man, it's so critical, guys. I'll just tell ya, I was molested and I'm 44 and I'm still dealing with the fallout, right? I mean, is a tough thing to overcome. it's not just, we're not just talking sexual trauma here, we're talking trauma in general. But really, it's, mean, it's...

It's trauma. Trauma is trauma. Right? I mean, you know, physical trauma, neglect, sexual trauma, whatever the trauma is, it's still trauma. And that's what, that's what we're going to spend the next few weeks talking about is, wait, we're going to try to define trauma and, and, ultimately give hope.

that there is healing from trauma. The last episode in this series, the last that we're planning is, what did you call it?

Really the reversibility of trauma that you can't necessarily undo what's been done to you, right? If you were physically abused, emotionally, whatever it is, you can't undo that. But the effects that trauma has on you, there's been a lot of studies that have found there are ways to reverse those effects. And so that's really what the last episode we'll get into today's is going to be focused really heavily on looking at the differences between stress and trauma, the positive stress, negative stress, big

T-trauma, little T-trauma, and just kind of trying to define those because I think

use those words synonymously when they are very different. I'll also talk some about trauma is really more subjective than it is objective, right? So in my field we use the diagnostic statistic manual to diagnose, yeah the DSM to diagnose individuals and they have a very clear definition of what trauma is. I have it in my notes, we'll get to it at some point, but it doesn't cover everything. It doesn't even touch on things like emotional trauma and emotional abuse which very much so has an impact on people.

or religious trauma.

And so I have another resource that defines trauma in what I think is a more appropriate way, because in my opinion, trauma is more subjective than it is objective. Yeah. It's not, there's, there's not some set of specific criteria that says if this, then that, right? Because what's traumatic to you might not be traumatic to me. And what's traumatic to that kid might not be traumatic to that kid because of, because it's developmental, right?

It stacks right if you've experienced some level of trauma then the next thing Builds on it and builds on it and builds on it right that and then also the age at which you experience trauma right if you went your whole life without experiencing any significant trauma, and then you do when you're 25 Versus when you're five that impacts gonna be very different if you experience something in those crucial developmental years

that'll have actually a bigger and longer term impact potentially than if you experience something when you're 25. Right. In what happened to you, they talked about two people experiencing a fire, right? And there's the kid in there where the fire is and then the fireman who comes in, right? It's the same event. Yeah. And two wildly different responses to that event. Yeah. Right. And so, so let's,

Let's talk about how there's this myth, right? Trauma is only big, dynamic, single, identifiable events, right? ⁓ And that's part of kind of what we're trying to do with this series is really kind of break open and kind of disprove some of the myths that are surrounding, that surrounds this trauma conversation, right?

So

Let's talk difference between stress and trauma. Let's define stress, define trauma and like differentiate. Yeah. So I've got some broad definitions of stress and trauma and we'll kind of break those down a little bit more. You know, when we get into stress, there's acute and chronic. There's eustress, which is a positive type versus distress, which would be negative. And then we'll get into the different types of trauma. But broadly speaking, stress is just this

psychological response to a perceived challenge. Okay, so it's not anything that's necessarily overwhelming the system or keeping you from being able to fully function or threatening your wife. ⁓ You know, I'm working on my PhD, so I often think about my dissertation. Yeah. It's quite stressful, right? I've got chapters. I've got research. I've got to go through the IRB to get it approved, all those things. Those are stressors, but I'm not going to

develop.

like post-traumatic stress disorder as a result. Trauma on the other hand is generally a response to an event. So it can be one individual event or a series that completely overwhelms the person's ability to cope. I can cope with my dissertation, right? I can sit down, make a schedule for these are the weeks I'm going to work on this and then I need to do this and check things off. But trauma would really keep me from being able to do that. So it kind of goes hand in hand with resilience, which is why trauma is a little bit

more subjective. Resilience is your ability to bounce back after experiencing something. So if you have low resilience, which is considered pretty consistent over your life, you're going to get overwhelmed a lot faster than those who have high resilience. And so that trauma might be, ⁓ that trauma threshold, I guess we can say, would be different for different individuals. And so while the DSM again has this very objective definition, anyone

working within the field, in fact my old mentor Dr. Hanbrick, I remember her telling me at one point that trauma is really subjective and she you know pretty exclusively works with kids and so that that has really framed and changed the way I look at the clients that I work with too you know even the sexual assault survivors with whom I work.

I've got some who seem to bounce back and don't seem to be overly impacted by something. And I've got others who, just cannot cope afterwards. Both are completely normal responses just based off the person. It's, it's objectively sexual trauma is trauma regardless, but how somebody responds is going to be, you know, based on their threshold of getting overwhelmed. So how to have, well, we might, I won't ask that question right now because it's probably, we're probably going to answer it at some

point. So let's talk about we talked about stress versus trauma so let's dig in a little bit on stress there's acute and chronic stress and so what are we

What are we doing there? What does that mean? Yeah, so acute stress is normally short term. it's something that, you know, think about finals. Finals is one week out of a semester. So you're going to get stressed, You've got studying, getting ready for it, taking the test. So the fear before presentation, you can think of it like that. If you're going to give a presentation somewhere, you're going

stress before. ⁓ Chronic would be long term. That's all that really means. So if you think about especially in today's just world and economy how things are, the stress of finances, that's pretty chronic for a lot of people. So that's going to be the difference between acute and chronic. So it's really just short term versus long term. But then we get into the fact that there is stress that can be positive. So eustress versus distress.

So

the positive form is stress that can be beneficial for your health, which sounds counterintuitive. when you think about it, you're- that like going to the gym? Yeah, it could be that. Yeah. So it's something that kind of pushes you and motivates you to get something done. Right. So for example, me, when my yard gets too tall, right, I get stressed. I would consider that a form of eustress because now I'm motivated. I need to get out. need to mow a weed eat

take care of everything. Distress will have the opposite effect. It'll have a negative impact on yourself. know, and then it just it could be physiological, especially if it's chronic distress. You could have long-term health implications from that. Those individuals tend to have higher rates of using substances, health issues, you know, we'll get into cortisol and how that impacts the body. But

that's really what those two are and then within stress there's actually something called stress inoculation ⁓ which a lot of people will think of stress immediately as bad when in reality you know I'll use an example from when I was growing up I was super shy introverted kid and I'm still an introvert I've just learned how to kind of come out

shell Ordering at any restaurant terrified me. It absolutely terrified me. And my parents kind of slowly eased me into being able to do that, right? And so the stress inoculation, slowly getting into that, getting me used to that feeling of stress, that angst up to, you know, having to use my voice and speak and ask for something or if something was wrong, say, hey, this wasn't right. It gets you to a point

where your threshold for stress increases so you can handle more of it. It's kind of akin to vaccines if you think of it that way. go get a flu shot. get an almost dead flu or whatever the heck it is. I don't know how that works.

you get a shot so that hopefully you don't get it and if you do, your response to it is lower. Is less severe, exactly. That's exactly what it is. So stress inoculation is very similar to that. Okay, so let's talk about, you've got physiological responses to stress, right? Mm-hmm, yeah.

Absolutely. I do want to kind of go back a little bit and give a couple different definitions of trauma as we move into the physiological. Yeah, let's do that. So I want to talk about what the DSM defines as trauma, but then what there's a different definition that I generally have adopted and like quite a bit more.

And I'm going to read this from my notes, so bear with me, because I don't want to misquote the DSM and get in trouble for that. So the DSM-5 TR is our most recent.

diagnostic manual that's come out. It's added a lot, it's changed a lot, but for the most part, the definition of trauma is stayed the same. So trauma is defined as exposure to actual or threatened death, serious injury or sexual violence. This can occur in one or more ways by directly experiencing the event yourself.

Matt Darrah (17:05)

it, learning about it happening to a close family member or friend, or being repeatedly exposed to it in a professional setting like first responders or people like by myself like mental health professionals. So we're at a higher rate of that as well. So that's how the DSM defines it. And as you can see from that, there's no conversation about emotional abuse or religious abuse, both of which are really becoming bigger topics in the field as well.

And so it really narrows down trauma ⁓ in an unfair way, in my opinion. think in some ways it can be a bit invalidating to individuals who maybe grew up in a household that was verbally and emotionally abusive, but maybe not physically. They'll still have some effects from that. sure. According to the Substance Abuse and Mental Health Services Administration, and this was from about 2014,

This is how they define trauma. I like this one a little bit more. Trauma is an event or a set of experiences ⁓ that an individual perceives as physically or emotionally harmful. And I want to point out the keyword perceives here. ⁓ that's really all what trauma boils down to is the way someone perceives an event or their situation.

so it's how they perceive something as being physically or emotionally harmful and or life-threatening and That has lasting adverse effects on functioning in mental physical social and or spiritual areas of well-being

This definition makes clear the impact of trauma is neither time limited nor restricted to only some parts of an individual's existence. And that comes from what you said? It came from the Substance Abuse and Mental Health Services Administration. That was the definition as of 2014. We're really quite slow to change definitions in the world of psychology. So that looked like the most recent and

Again, it doesn't restrict the person to just what the DSM says is trauma. Right. And that's how most trauma therapists I know, that's really the definition and how they're going to view and work with those individuals. Yeah. That perceived threat. Yes. It's the perceived threat. if you, if you, you know, the DSM says actual or threatened, right. Versus, ⁓

The substance abuse and mental health admin is saying it's perceived. It's really perceived. So you could have a gun in your face or you could have somebody say that they're going to shoot you and it's too different. The DSM would say, well, that's different, right? To an extent. So actual or threatened death, the DSM might say, well, if you were threatened, then that's traumatic.

you know, I think about my sexual assault survivors that I work with and those clients. A lot of them go on to press charges against their offenders, right? And those offenders still live here more times than not, unfortunately. They bond out within 24 hours. They're out living. And so now this individual, my client, is left living with this perception that they could show up on their doorstep at any point in time or run into them in public at any point in time.

the DSM, the sexual assault, yes, would be trauma, but that constant fear of running into their offender may not be considered traumatic. When in re it might, some people might say it's a trauma response, but in my opinion, I would say that that is a perceived threat to your wellbeing and to who you are. Yeah. Okay.

Okay, so let's, so do want to get into big T, little T trauma? Yeah, we can. Like I said, I have a bunch of notes, so you all bear with me as I look through them. So big T, little T, I don't want to...

I don't want to invalidate the little T traumas. Yeah, because it's still traumatic. Yes, both are still traumas, but there is a little bit of a difference between them. Using the term big T versus little T has kind of been a newer thing over the last few years, at least when I was doing my undergrad, was those terms were not used really at all. ⁓ So big T trauma generally is a major life threatening event. It's

obviously and very easily recognized as traumatic. Whereas little t is generally this chronic repetitive stressors that aren't necessarily per the DSM traumatic, but they're still perceived as life threatening or they're perceived as being a threat to your well-being. And regardless, both of these cause some significant emotional and physiological responses. ⁓

So for big T examples might be natural disasters, accidents, a physical or sexual assault, combat exposure, so going to war. Examples of little T would be chronic criticism, ⁓ bullying, think about kids in school getting bullied over and over and over again, ⁓ financial instability, emotional neglect, right? So the DSM doesn't even touch on emotional neglect or abuse in the definition of trauma.

But we within the field recognize that it can be just as traumatic and just as impactful to individuals. Yeah. Yeah. Personal experience. know it can. Yeah, absolutely. these two, little t's generally more repetitive and ongoing, whereas big T is a major incident, right? So for example, I had a really bad car accident a few years ago and

somebody t-boned me and almost flipped my car. was a whole thing. I had to have surgeries and the ER a few times. That would be considered big T trauma, right? It's clearly that identifiable event. So if we go back to that myth that we talked about early on, that traumas are clear identifiable events, that would be a big T. But then to bust that myth is, we have little T traumas. It may not be as identifiable, right?

emotional trauma is very much so the perception of that person experiencing it. Somebody looking in may not see the way a parent's talking to a kid and perceive it as emotionally abusive, but the way the child's perceiving it may very well be. Yeah, I remember ⁓ this was kind of a consistent theme growing up that my mom would get upset and she'd be like, you know, then don't live here.

go out. I remember I was probably six and this would kind of be that big T as an example of the continuous little T. So I remember a scenario where she told us, my parents adopted five boys and at one point she told us, and I was around six is my guess, to go pack a bag that we were leaving.

And I remember being terrified that I was like, where am going to live? Right? So that was the big, the big single event. then that was, that was a theme that was repeated over and over and over again. I remember that one specifically. And then I remember feeling throughout that we didn't, we didn't have a

safe stable place to live permanently. There was always the threat that we might not.

Right. Continue living. Yeah, that's a great example of Big T versus Little T. The Big T being when you were being forced to pack a bag and then that ongoing lack of stability. Yeah. You know, that lack of safety, especially for kiddos is really, really impactful. know, research has found that if kids, especially those who have experienced trauma, but really regardless, I'd say any of them have one to two stable, consistent, safe, those are the key.

the three key words stable, consistent, adults in their life, even if they experience trauma, be it big T, little t, multiple, single, whatever it is, ⁓ those stable, consistent, safe adults really make an impact and can help to reduce how their trauma affects them both in the short term and long term. And I know we'll get into that a lot more in the-

episode when we talk about the reversibility of trauma but kind of just giving a little bit of hope right now that like there there is hope for for those who have experienced trauma multiple traumas one big one whatever the case may be yeah yeah okay so let's neurobiology of trauma mm-hmm okay I love this topic so yeah let's talk about that

Well, I might use a lot of big words, but I'll break them down hopefully. And if there's any questions, feel free to stop me. I'm happy to go into it a more. ⁓ so there's something called the HPA axis, the, ⁓ hypothalamic pituitary adrenal axis. You really don't need to remember any of that. You can just call it HPA. Think of it as the fight, flight, freeze, fawn response. So HPA axis. said fight, flight, freeze. Those are the three I've heard. was the four?

actually it's fawn and I have those yes well we'll get into them a little bit more yeah very few people know about the fawn and I want to bring it in because it's tied in a lot more with the chronic trauma and that chronic stress and potentially the little T's it's less talked about most people know the big three but the fourth one it's really unless you're a social scientist like myself or a mental health professional you're not as aware of it

But the HPA axis is our neuroendocrine system.

plays a crucial role in our stress response. ⁓ Trauma is a type of stress. Not all stress is trauma. So it's kind of like all boxes or parallelograms, but not all parallelograms or boxes. Kind of the same mindset there. So it communicates between our hypothalamus, our pituitary gland and adrenal glands, which I'm sure we've all experienced it, right? We get anxious or we're about to jump out of an airplane, right? I've gone skydiving a few times and you feel that adrenaline dump. That's part of the HPA

access. So, your brain is communicating with the body that ⁓ we're about to fall out at eighteen and a half thousand feet. I sure hope this parachute works. Right. You know, I hope the guy strapped to my back knows what he's doing because I don't. so, they all work together though to regulate our stress hormones.

and is really vital for maintaining balance in our body, especially during stressful situations. The problem you run into is when you have any type of chronic stress or chronic trauma is, know, generally speaking, you're going to see this up and down over the course of your life, right? ⁓

Fear is a natural human emotion. Anxiety is mourning, grief, happiness, right? So we have ups and downs in our normal emotions and our stress, cortisol specifically, that'll go up and down as we experience this life in general. Well, if you're severely traumatized, your body thinks that you're always in fight, flight, freeze, fawn mode. Your cortisol is just always staying up. You're always kind of in this heightened awareness, ⁓ just state.

and that has to do with HPA axis. And so during a stressful event,

When we experience it, the HPA axis will help the hypothalamus to release cortisol, which is our stress hormone. You can think of it that way. Our pituitary gland ⁓ releases a different one. I'm not going to break all these down because it just gets in the weeds. But the HPA axis, like I said, is essentially, it goes in with the neurobiology and the neuroendocrine.

system of our body. So that's the physiological part of stress and trauma. Okay. So that's essentially how our bodies work. I wish I can control my HP access a little more sometimes, but unfortunately I can't. Cortisol, when you're always at a hundred percent.

Right. Your body can only stay there for so long without having negative impacts. Cortisol is really beneficial, right? If you have a bear chasing you, the flight response, very beneficial. Right. Absolutely. Freeze is a natural response. In fact, I think it's about 85 % of people when they experience something about 85 % of their natural response is to freeze. really have to train the fight mode into yourself. Very few people go immediately into.

that. ⁓

I know over the years I've kind of transitioned from the flight into fight more like I'm ready to start, you know, let's rumble. Yes. Like I'm not the one for you to touch kind of thing. but cortisol is really beneficial. But when you're at a hundred, all of the time, it's not going to be good. Right? So you're going to start to have, it'll impact your metabolism. There's long-term health and mental health impacts.

So inflammation, you're gonna have more issues with it. It's gonna have an impact on your heart, your cardiovascular system, your blood pressure. So cortisol can help to maintain blood pressure within a healthy range. But if you think about your cortisol is out of whack, what's that doing to the blood pressure?

Sleep-wake cycle is another one. If you're always at a hundred percent of cortisol, like what do you think's happening to the sleep? You're not sleeping, right? It's going to be horrible. Or even if you doze in and out, you're not getting that good REM sleep, which is what actually helps your body to recover. And so having an HPA axis and cortisol levels that are off the charts all of the time is not uncommon in trauma survivors. So is it possible to do like a blood test or something to measure?

the cortisol levels? I believe there's actually saliva tests. Okay. Yeah, were you and I you know the research I was doing at my former institution ⁓ they had looked at doing some research on cortisol. They were gonna do a saliva test. I don't know if that's something that you can buy yourself or if you would have to go through

some doctor to have done or whatever, but it is something that you could have done potentially. I do believe blood test is possible as well. I know, ⁓ are you familiar with Karyn Purvis? I'm not. Okay, so there's, ⁓ she's the one, she and Dr. Cross created Trust-Based Relational Intervention. Okay. And so I know that she did some studies, she passed, but it was out of TCU and they created the K...

KPCID, think, Karyn and Purpose, KPICD, Karyn Purvis Institute of Child Development. And I know that they did some studies ⁓ measuring cortisol levels in babies' diapers, right? Really? Yeah, it's really interesting. But what they would do is...

they had some videos they used to do this big conference and they still have the conference called Show Hope but they they've we used to sign we simulcasted it a few times ⁓ now it's kind of gone to if you don't go to the conference you can get a thing and just watch 'em at your leisure

But they showed some videos of some kids and then what they would do, they were little ones that were in diapers. And so they would bring, they would put the baby there and then they would bring the caregiver in. ⁓ And then the caregiver would like ignore them.

know, interact with them and things like that. And then they would measure the levels of cortisol in the kiddo's urine. And so they, they, one of the reason that it stands out to me is that what they found was that the child that didn't...

demonstrate the cortisol response, the crying, the upset thing, that the kid that was just like what everybody would consider the good baby, that was just chill or whatever. The cortisol levels in that child was quite a bit higher than the ones that had the cry response that did the thing, right? And I don't understand all the science behind it, but it was just, it was interesting to me that they, because they were measuring,

the cortisol levels and showing what...

what was happening. don't know if it you might you could probably tell me better. But to me if the if the baby's crying there, they're releasing some of that stress, right? As opposed to the kiddo that's just like sitting there and it's not demonstrating the stress. I don't I don't know. But anyways, it's just I remember that being they showed videos of where the caregiver would come in and sit and like read or something and just really not pay attention to the kid. And we're not talking not talking. They did it for like 30 minutes.

like 30 seconds or something like that. They're not creating trauma They still have an ethics board to to go through. Yeah, they're not like, you know, abusing the children. I mean it was just, you know, seconds worth of stress type situations and so I didn't know if there was ways that like parents could... ⁓

figure out a way to, do they have to go to an endocrinologist to have it measured or something like that? I'm just curious if that's something that, you know, I mean, and I don't know if it's like, well.

the cortisol level is, know, like testosterone is supposed to be around this level, right? I don't know if there's that for cortisol or if it's all dependent on the person or whatever, I don't know. It's so curious. Generally it should fluctuate. I don't know the exact ranges it should be within and I'm sure it's also very circumstantial. And like if you're in a high stress situation, we'd expect your cortisol to be higher versus not. I'm not familiar with that study.

I'd be interested to read it a little bit more. Some of that with the quote unquote good kid, just kind of reminds me of the freeze response. I could be completely off on this. And like I said, I haven't read this research at all, but that's still a stress response. And so it could make sense that they just freeze, especially that being the most common trauma response, one of the most common, you know, of the big four F's that we talk about.

You know, there's been other research done as well in monkeys. I remember both in undergrad and grad school, this study coming up a lot where they put monkeys in a room and there was one fake mother monkey that would give the child, the baby monkey food, but was not comfortable to hang on or it was essentially like a mechanical metal.

fake mother. Right. And then there's another one that's been provided that is soft and comfortable and while the baby monkey would go over and seek out the food when hungry, it would hang on to the one that that was providing comfort. Interesting. And I'd have to dig into that and refresh my memory a little bit more but

You know, that's something that maybe I'll have prepared for the next episode or whatever. But there's been a lot of research around the cried out method that I know some people adopt. I've actually, I've been watching The Handmaid's Tale recently. And it's been a few episodes, but one of the main characters has her infant

We're talking like a one or two month old and they're crying in the other room and the adoptive mother makes the comment of she just needs to cry it out.

And it's like, well, that's not actually age appropriate. Generally when infants are crying, there's something wrong and they need something, it a diaper change, they need to be fed, they're in pain, they're sick, whatever the case may be. And even Dr. Bruce Perry in his book, A Boy Who Has Raised a Dog, he talks about...

An individual who was as an infant, as a small toddler and child who was kind of raised that way of like just neglected and the impact that had on them. And so I do want to give a disclaimer talking about the boy who was raised as a dog. I highly recommend the book. ⁓ but do some research before you start reading it. couldn't get past the first chapter. Yeah. He talks about some really, really heavy topics and he does go into the neuro sequential model of therapeutics in the book, but that whole book is based on

his past experience working with clients and it's some really heavy topics, especially if you're a trauma survivor yourself. Yeah, I could handle a lot more what happened to you as opposed to the boy who was raised as a dog.

I think people should read it and I think at some point I'm gonna read it. I couldn't make it past the first chapter. Yeah, he really hits the ground running. And hard. First page. Yes. God dang. Poor little girl. Yes. Yeah. But he, and he talks about everything from his individual clients to his work in Waco with the Davidians. ⁓

because he was called out to Waco, know, and us being in Texas, most of us are aware of the Davidians. But yeah, so I recommend the book, but yeah, know your limitations and know what... Yeah, I have it on the audio and I have it on my... I bet I just...

I haven't gotten back to it, because man, like you said, he does. He hits the ground running. He sure does, yeah, 100%. So yeah, that, and I'm constantly saying this, but we talk with so many of the folks that are on here, because I try to have...

I try to have some folks come on, talk about their personal experiences with foster care and adoption. And then some others that have resources available and then just learning. And we talk a lot about books and things. And so I definitely would encourage you, if you can, to pick that one up. But like I said, just...

Or if you just go Google Dr. Bruce Perry, a lot of his theoretical stuff will pop up too. So I do want to make sure we chat real quick about the four F's. Yeah, we haven't really gotten there yet. Yeah. So fight, flight, freeze.

Most people know about those, right? So fight, don't want to punch you in the face kind of thing. Um, freeze. There was actually, uh, was going through some trainings. Also, fair warning, I have extra notes that you may not. So I was going to say, I'm looking for that and I'm not. No, no, no. I added an extra. Yeah. So the four F's five, five threes, Fawn. Fawn is the lesser known one. And it's generally something at least that I got taught in my education. So if you're not, like I said, in the social sciences or.

or mental health world that may be less known to you. So fight is going to be that, you know, something happens. Your initial reaction is I'm going to start fighting somebody, something, punch the wall. Right. Yes. It's just you, your cortisol jumps and you're like, I'm going to start beating things up or punching holes and balls, whatever the case may be. Flight is the complete opposite. I'm going to run. Right. And so I always tell people, like, if I'm running, somebody's chasing you you should run.

to, because at this point flight is just not really my personality. Because of the situations I deal with and work in, ⁓ especially working with sexual assault survivors, there are times that even in those situations I get stressed because maybe my client's not being given all of their rights or just something that is unjust is happening. That's going to spike my cortisol. Right. And I go into fight mode of how do I advocate for this person?

And I'm doing it respectfully and professionally, but instead of just sitting there kind of freezing or trying to run away from it, I'm actively engaging in the situation. Freeze, like I said, is generally the most common one. About 85 % of people...

For the most part, you I grew up in a military family and I've seen, and it seems like, again, this is just more of an availability heuristic, but most of the military people I know don't really freeze a whole lot. I think it's kind of trained and built in, beat out of you in basic training or whatever. So ⁓ it's either fight or flight for a lot of them, but for about 85 % of the population, you're going to see them freeze. And they might freeze just for a short time.

and then switch on to something else, but they'll see that freeze first. Fawn again, lesser known. A lot of people are unaware of this. Fawn tends to go with the chronic stress. So that long-term or chronic trauma, those things that are ongoing or long-term, I think of it as people pleasing. ⁓ So I'm going to read the definition here. Fawn is the response. ⁓ This response involves accommodating others to seek approval and avoid conflict.

often at the expense of one's own needs. It can involve people pleasing, submission, or attempting to gain favor in this source of danger.

And so fawning, if you think about children growing up in abusive homes, fawn might actually be the most common response, right? They're going to do whatever they can to keep their parents, their foster parents, their grandparents, whoever's raising them happy. Because they're trying to avoid conflict. They're trying to avoid a physical beating or whatever the case may be, having to do physical labor as punishment. They're trying to avoid all of that.

So that's the fawn. So like I said, lesser known. But when you're in this population, right, we're largely speaking to foster families, people interested in fostering. You might see fawn a lot. You'll still see the other three. All four of these are honestly part of us being human. I would argue that sometimes people fawn even at work, right? They're just trying to make their bosses happy.

Trying to figure out how to manage and avoid conflict And so yeah, that's what that last one is That's interesting. I've done so much. I don't mean to Make out like I have this all like I know all this stuff, but I have done a lot of research a lot of reading

stuff and I have not ever heard that one. that's really and that's what that little world did on page one. Yes. Yes. And so yeah, it makes sense. It's just interesting that nobody talks about it. mean, I've never heard it and that's just interesting. Well, I would argue it's because people see them as the good kitten, right? Like we've got this foster kid who came in and they're making their bed and they're doing all these things and

There's never they never leave behind a mess. I don't have kids, but I've got a nephew and oh my gosh one weekend with him and my house is just a wreck. complete and total wreck. So if a nine year old is never causing a mess creating a scene never being a nine year old a developmentally normal nine year old.

I would argue it could potentially be fawn. They could be fawning just trying to avoid conflict. know, trauma research is backed that experiencing trauma happens and it can impact you long before you even have and start to form memories, which is generally around the age of five. So in infancy and in utero, we don't know what happened. We are. Yeah. Yes. Yeah. We'll dive in quite a bit more on another.

specifically about that but we can't assume that they weren't through trauma just because they don't remember it. Yeah. You know if we see the fight fly freaze fawn I think it's a good indication that there's some level of of trauma that's happened in the past unless there's a stressor right in front of them right then. Yeah.

It's heavy stuff guys. It's heavy stuff. I'm not gonna I'm not gonna deny that but I feel like this is conversation that's so important to have to really not have a master's and doctor's level understanding of things but have a Groundwork to understand what's going on with the kids that are in our care and that's why I do

amount of research and reading and things that I do because you know and I don't remember when we were doing our outlines if we talked about did we put something in there about vicarious trauma? Yeah we sure did. Yeah that's a whole that's a whole thing that's so so many foster families face vicarious trauma because they're they're doing the best that they can to

provide a loving and safe home for these kiddos and then the stories that the kids are telling and then the whole process and all the things. We as foster parents developed vicarious trauma. yeah, I'm glad we, I thought we had but I couldn't remember. So yeah, we absolutely So yeah, it's just really important for us to understand.

some of the things that are going on in us and in our kids and we can hopefully recognize what's going on and then figure out how to help them through it and stuff like that. Yeah, I think recognizing Fawn would be a really big one. Yeah, because like you said, it's just not really talked about. They're labeled as the good kids straight A's and it's like if they're never rebelling, right?

that could be a red flag. I'm not saying all of it's a red flag. Sure. You know, I've got my old roommate grew up in a really great home. She was a single child and she was a good kid. She never really rebelled a lot and she didn't go through any significant trauma.

you know, there's some loss. Everybody experiences loss at some point in time in their life of parents, grandparents, whatever the case may be. so for her, it wasn't necessarily fawn Yeah. So again, I'm not trying to say every good kid has experienced trauma and you need to psychoanalyze everything, you know, take it with a grain of salt and please, you know, don't don't ascribe everything to trauma. But with that being said,

There's a lot of research that does back how much trauma does impact individuals.

It's not just about let's get into the weeds of the HPA access and cortisol for the heck of it. It's about becoming trauma informed as ⁓ a foster care community as you know, even myself as someone in the mental health field, trauma informed care, how to work with clients, especially in crisis. Most of the time I'm working with clients in a crisis situation. You know, I've had clients who ⁓

who've come in and been very clearly struggling with their mental health and to me because I've done this work for over five years of working with sexual assault survivors it's clear to me that they probably experienced sexual assault as a child and maybe they've experienced it again as an adult but that that might have been the precursor to the break that they're having now.

And so it's just being trauma informed in the situations you're in. Yeah, the difficulty part about that, ⁓ I think it was what happened to you, could have been something else, was talking about that being trauma informed isn't really defined anywhere, right? We can slap a label on an organization because they had it.

half a day seminar on trauma and so they are now a trauma informed thing right but I mean so there's not really ⁓ a good criteria or definition of being trauma informed right has that changed? I would say like if you look up on the APA website they probably have a definition which the APA stands for the American Psychological Association and so they're the ones who

created the DSM right and so you know take it with with

The grain of salt or however you feel about the APA. They do a lot of great research. fact, just recently, and I say recent, it's been less than a year since they came out really acknowledging the existence of complex post-traumatic stress disorder. remember when we were looking at, you said that they're, the CPSD is not even in the DSM. No, so it's not in the DSM, but August of 2024, the APA put out

article essentially for mental health providers on how to work with adults who have CPTSD. So it's not in the DSM now.

But I bet money that our next edition be it DSM-6 or DSM-5, XYZ, whatever it's going to be, it'll be in there. And more and more research is going into really differentiating between what happens when it's a single identifiable event, which a lot of people think is trauma versus long ongoing.

like you talked about of packing a bag and then that consistency of I don't know if I'm gonna have somewhere to live tomorrow, that constant chronic trauma stress.

You know how that impacts somebody really does make a difference. You know, they, they, this was years ago. think it was an undergrad. learned about it. Had tried to put in the DSM, something called developmental trauma disorder, ⁓ because researchers and therapists alike were seeing that how trauma presents in kids. It's very different than how it presents in adults. ⁓ it ultimately didn't get put in, ⁓ for whatever reason. I honestly don't know the reasons.

But I think there's a lot of research and reality that's going into what trauma-informed care is and what the golden standard is. Because you're right, a lot of times I'll see organizations that do a training and they call it trauma-informed care for ex-population, for healthcare workers, for social workers, for whoever, know, put a...

whatever occupation in there that you want. And it's a half a day training. And they might have the knowledge, but it really comes down to the implication of those things. So as a foster parent, you might understand the HPA axis, you might understand the four F's, and you might understand the difference between stress and trauma, but are you implementing that in

showing that you have the knowledge and you can apply it to the situation. So I think that's the difference between there's trauma informed knowledge. So maybe you know the trauma informed care where you're actually applying it. Yeah. think it's going to be let's pause for a sec because we've talked about CPSD but I don't think we really define that. So complex post traumatic stress disorder. That's what CPSD

And so ⁓ I think we're going to probably dig into that more, but just a broad quick...

definition for us? Well, because it's not in the DSM, we may not have like the most specific and I will say it's it's really subjective. it's very, very subjective. In fact, most things trauma related are very subjective. Yeah, we can't say that. Yeah, it's really about perception, how you perceive what's going on. From my readings and understanding complex post traumatic stress disorder is

I'd like to say it's the long-term absence of hope is what leads to complex post-traumatic stress disorder. So think about a kid who maybe was sexually abused by, you know,

someone outside their family. So they don't live with them, but was abused by them. They were able to make outcry that person's maybe put in prison or they're just out of their life. Right. So that was a one time event. Yes, that does have a huge impact on them. Yeah. Highly recommend therapy, all the things.

but, and they might develop post-traumatic stress disorder versus a child who is actively living in a constant abusive environment. Their parents are abusive, maybe they're alcoholics, maybe they're... ⁓

you know, fill in the blank. It's just not a safe, stable environment. That tends to be when we see complex post-traumatic stress disorder. That and then also when people are repeatedly traumatized. So this is why I, and I'm really open about it. I go to therapy every other week because I am sitting with clients just about every weekend. Maybe a little less and started my PhD because I don't have as much time, but I've been sitting with clients just

about every weekend for the last five years who are sexually assaulted ranging from three months old so holding a three month old who had been assaulted all the way up into I think the oldest was in her 70s right and so working with those clients I am predisposed to any and every trauma and stress disorder right and so I'm taking care of myself so that I can still show up for clients. The other example I like to use with CPTSDMP

PTSD is imagine ⁓ two veterans who go to and see combat, right? We could use Afghanistan, the war in Iraq.

as an example, one goes, you know, they see a lot, they're still with their squad and they get back to the base every day versus someone who is maybe taking captive and a prisoner of war. They don't know if they're going to make it home ever. Right. Right. And so that hope is kind of stripped away and that that stress and trauma is more consistent and chronic and just always there. And so from the root, again, this is all just from the readings I've done and they're

There's not a whole lot of literature yet on CPTSD, ⁓ but I do think it's a growing area of conversation. ⁓ I would love to see it called something other than complex post-traumatic stress disorder, because PTSD has its own, like when people say that, they immediately think of...

like X, and Z, right? Whereas complex post-traumatic stress disorder, the symptomology of it, I would argue is very different from PTSD as well. ⁓ And I think we're going to talk about this if I remember right, but the...

What happens to a lot of folks when they get the diagnosis? we talk about that? Yeah. And that'll be a different episode, like talking about labels. So definitely want everybody to stick around for when we talk about that, because that's a big thing, especially in this area, right? Mental health is still really stigmatized here. You know, even when I lived in Dallas, so still in the state of Texas, the way we view and work with

mental health ⁓ is so different. I feel like I'm constantly fighting an uphill battle to help people realize that something happened to them that's not like, know...

I think about individuals who maybe struggle with borderline personality disorder, right? More times than not BPD is the result of trauma. I'm never going to use the word prove or caused because in social sciences, we can't really prove that A causes B. Yeah, right. It's not like math or physics or biology. It's an applied science, right? And there's so much variability in human nature. ⁓

But yeah, just, like I said, very passionate about this and wanting to get this information out and hopefully help people understand the impacts of trauma so that if they go into the foster care world, they can actually apply the things that they learn. But not only that, I think about, you know, there's been some researchers who have said everyone's experienced trauma at some point in time in their life.

So if that statistic is true, everyone has been traumatized at some point, statistically speaking, whether it be in childhood, when they were adults, whatever the case may be. So if that statistic is true, why are we not applying more trauma-informed practices across society? So trauma-informed care within mental health organizations is more common.

But why is that not something that's talked about in, let's say, academic settings or in corporate jobs, whatever the case may be? Yeah, so change the conversation. That's definitely something we need to fix. Implications and takeaways. ⁓ Why understanding the difference between trauma and stress matters?

What are your thoughts there? I think it's important because...

Again, we often use those words synonymously, stress and trauma. ⁓ You know, I've heard kids who have talked about their schoolwork as though it was traumatic. And don't get me wrong, as a PhD student, I know how horrible it can be. You know, my weeks for school start every Monday and I haven't even looked at this week and I know I'm already overwhelmed. I've got like a whole

chapter due for my dissertation and edits, all these things. And so I get how much it sucks sometimes, but that's not actually trauma. And so helping people understand this difference can help them to understand how do I handle this situation with this kiddo, right? Are they stressed? Do we need to help them navigate stress, build some resilience, right? Going back to that stress inoculation, help to raise that threshold.

or is this trauma for them? In which case, maybe they need therapy or maybe they just need to be held by you, right? Like that human contact is really important too. There's a lot of research around hugs. That's not my area of specialty or expertise. So I would encourage y'all to go, you know, Google the research around it, but that human contact is huge. ⁓ It also helps to de-stigmatize ⁓

mental health in a way. When we're able to differentiate between what is stress and what is trauma. It helps us to approach people differently, right? Who have different backgrounds. think about...

You know, I've only had a handful of clients who I've worked with that are ⁓ from the refugee population. And it's, I often think about when I've had those clients, they have a history of trauma that I will never understand if they're here as a refugee. Cause I've never had to flee my country. Right. ⁓ And so it's, you know what, ultimately it develops empathy and compassion.

for sure. Period. Empathy is so different from sympathy and being able to be empathetic towards maybe a child that you're fostering or to your co-worker or to a friend or a neighbor. It goes back to just caring for other people and being able to differentiate between these two. If it's trauma and you're a lay individual

You might have some tools, but it's more likely that you're going to need some outside help as well. If it's stress, then you're more equipped to handle it and help that individual through it. Right? Like if my neighbor's stressed because they have bills to pay and they're working a lot and they don't have time to mow their yard, that's stressful. You know, I have time to mow. I'll mow your yard for you. It's not a big deal. Right? So help with the stress. But if they've been traumatized and this wasn't my area of expertise, I

can provide them resources. But ultimately I also can't be their therapist because of dual relationship issues. So we're gonna wrap up a little bit because we're getting we're getting over

So ⁓ let's kind of come back to the approach thing maybe later because we're over an hour and I think we want to... ⁓

There's only so much we can absorb in a given podcast.

What key takeaway?

top of the mind, what do think we need to say to foster and adoptive families? Wrap all this up together and say, what are your thoughts there? Well, I think it comes down to our call to action that we have in the notes is two things. So encouraging all of the listeners, all of those in foster care, thinking about it, or even those who are just listening because they stumbled upon the podcast and they're interested in the topic ⁓ to reflect on your own experiences. So being able to be empathetic

I personally believe starts with self-reflection, right? So I can't empathize or put myself in other people's shoes until I understand my own experiences and on some level have dealt with them. Yeah, right. So that would be one and then normalize seeking support for stress and trauma. And I talk about this a lot with some of my therapist friends because when you're in the field, most of your friends are also therapists. ⁓

that.

It really frustrates me if I want to go see a therapist per insurance, she has to diagnose me with something. Even if I don't need the criteria for something, she has to put what's called a CPT code with it. So they'll, they'll fit, find out whatever fits you best and attach it to that. But if I want to go have a wellness exam, you know, do blood work, make sure my blood, my, my blood pressure is good, everything. There's a code for that. Just a wellness exam. It doesn't mean.

anything's wrong with me I'm just taking care of myself and so if I'm sick and I have the flu I'm gonna go to the doctor if I'm stressed or and or traumatized I should seek help as well right so normalizing asking for help yeah just like you would if you're sick with the flu or you know right now

are bad for a lot of people. So getting help with that. So those would be the two things. You can't help someone when you're pouring from an empty cup. Yeah, you can't pour into other people if your cup isn't full. And so it really starts with taking care of yourself first, reflecting on your own experiences, understanding your boundaries, understanding...

even your capabilities, right? If you're gonna go into foster care, do you have the capacity to take in a pair of siblings or are you really only able to take in one kid at a time? So reflect first and then in that reflection.

if you're like, man, I haven't dealt with what happened when I was, you know, let's say six years old, maybe go talk to therapists a little bit first. So just normalizing that conversation. Yeah. I mean, it's not, there's nothing wrong.

seen a counselor. Nothing at all and I would argue that everybody at some point in their time needs therapy. Yeah I saw my counselor this morning. I don't mind it's based out of Dallas. just yeah. I just I mean the reality is it's given my background given the circumstances of where we're at. have have a

Yeah, and ⁓ you know and and I do I think so many foster families that I talked to they have vicarious trauma they do and and there's nothing wrong with getting help. Yeah, there's just not no and it models that for for your family to that It's okay to ask for help and and tell people when when you've reached your limit. Yeah. Yeah, it's just it's critical. So So

Trauma, stress, they're different, they're similar, and it's important to know the difference. we're gonna have some, we've got four more episodes planned. ⁓ If you've got... ⁓

questions, stick them in the comment below. We'll try to respond. ⁓ We'll post links to the books by Dr. Perry ⁓ and things like that down in the show notes. ⁓ Thank you so much for coming on. Absolutely. ⁓ I'm super excited to...

dig in more into the other things that we talked about, but keep in mind guys, keep in mind, there is hope. There is hope. ⁓

We have seen, I personally have seen some stories of families that brought kiddos in. ⁓

As a matter of fact, we're talking about talking with happened to lady on for the last episode who her little girl had some some really she had a tough start and And now that little girl is doing well. She's you know, she's she's stable. She's loved she's adopted She's this that near the thing there there is hope and so I really look forward to that last episode where we talked about the reversibility of trauma because

can it is possible to get over it or maybe that's not the right word. Move on with it. cope with it. Cope with the things that you've been through that your kids have been through and stuff like that. So come back next week as we as we talk more about

this whole conversation. Thanks again so much to Notability, Designs by Notability for their sponsorship. ⁓ so have a great week. We'll see you next week. And ⁓ catch you on the flip side. Thanks.