Bárbara Kanter: "There are very common situations capable of generating trauma".

Psychologist Bárbara Kanter talks to us about trauma and the mental alterations associated with it.

Although we may not notice it, our brain is constantly changing depending on the experiences we are exposed to during the day. Even the most banal situations are capable of producing small transformations in the way our neurons connect to each other, and over time, these modifications accumulate.

This is normal: it is this phenomenon that allows us to be constantly learning, whether we are aware of 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 often have emotionally painful situations as their origin. We talked about it with today's interviewee, psychologist Bárbara Kanter.

Interview with Bárbara Kanter: understanding the psychological trauma

Bárbara Kanter is a General Health Psychologist, expert in the treatment of trauma, and based in Barcelona, Spain.She is based in Barcelona, where she has her practice. In this interview she talks to us about the nature of psychopathologies associated with traumatic experiences.

How can something as complex as psychological trauma be defined in a simple way?

I think the best way to understand trauma is with the example of kintsugi, it is a very graphic and simple example. Traumatic situations present themselves 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, our trust in ourselves and in the world around us, etc.

This break in our system gives us the possibility to incorporate this experience in our way of facing situations and our personal tools, and to repair the crack that is generated in us.

Some authors use the example of the earthquake, as a shake that modifies forever our vital situation. Because even if we are not able to grasp at first sight the effects of the earthquake, there is a displacement and a new equilibrium.

What kind of experiences are more capable of giving rise to these traumas?

The experiences are very diverse. In fact, we tend to think that only major events can generate trauma, but this is not so. There are very common situations capable of generating trauma. For example, someone who is locked in a toilet can develop a trauma that can lead to an Anxiety Disorder such as Claustrophobia.

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

In fact, trauma theories have their beginning by evaluating the symptomatic presentations of war veterans, who among them showed similar emotional and cognitive affectations. This is where PTSD comes from.

How does trauma relate to the functioning of the brain and the way it gives rise to the processes of memory and memory recall?

This is a frankly complex issue, since trauma intervenes in several mental processes. Some studies seem to show that an alteration is produced in the amygdaloid circuit, generating a constant activation of the cerebral amygdala. This explains intrusive memories, the state of hyperalertness, etc.

The former refers to when the person is not able to remember some elements of the traumatic situation, the memory is choppy as when we play a broken record and we miss parts of the song; while the latter refers to the fact that the emotions do not match the memories of the experiences, this is extremely common and is called dissociation, it helps the system to better tolerate the information of what has happened. The opposite pole can also happen, given by the emotional hyperactivation before stimuli that could have some type of nexus with the traumatic event, whether or not in a clear way, awakening an exacerbated emotional response.

In turn, there may be recurrent and intrusive memories, these are parts of the traumatic situation that constantly appear in the person's daily life, either in dreams or in daytime activities, they disperse the person from daily activities, and generate a lot of anxiety because there is a 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 lived through very violent situations; they are characterized by perceptual problems, such as feeling or seeing things that are not present at that moment, but which are linked to the traumatic situation.

Somewhat linked to the previous question, we will give an example of how an event to which we have not been exposed, such as attacks or natural events (earthquakes, hurricanes, tsunamis, etc.) can affect the world. I am sure that today we are able to remember what we were doing and where we were when we heard that the Twin Towers collapsed in New York City (USA), or when the Atocha bombing in Madrid (Spain), or when the earthquake and tsunami in Fukushima (Japan), etc. happened. Even if we have not been directly affected by these events, they leave an imprint on us because they alter the normal course of our lives and, therefore, of our cognitive and emotional processes.

Do trauma-related psychopathologies affect many people, and to what extent are they frequent?

The prevalence will depend on the population we are referring to. In general, it is common to find trauma in people evaluated by mental health services who are undergoing treatment, and will be less frequent in the general population. This does not mean that they have not experienced a traumatic situation or that they do not have some 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 symptomatology (interpersonal victimization, natural disasters, wars, exposure to violence, etc.), but do not take into account less obvious situations that can also generate discomfort in the person.

At the level of the clinical picture of trauma itself, there is the PTSD that I mentioned before. However, without the need to have such a complex picture, many people who live with a trauma situation have anxiety, depression, learning problems, suicidal ideation and behavior, etc.

If we look at the type of consequences of this type of situation, we can see that they are very diverse and cover different stages of life. Here I have only mentioned the mental ones, but we also have physical consequences such as a greater propensity to risky behaviors (addictive behaviors, sexually transmitted diseases, unwanted pregnancies, etc.) as well as various chronic diseases (diabetes, cancer, etc.). Obviously, some of the above-mentioned consequences can have a great influence on the person's life and generate secondary consequences, such as job instability, problems in interpersonal relationships, difficulties in engaging in different situations, 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 (TF-CBT) and Eyes Movement Desensitization and Reprocessing (EMDR).

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

There are other types of interventions that have demonstrated their efficacy, although they are not the first therapeutic choices as in the cases mentioned above. All of them are centered on the idea of traumatic processing, of linking memories to emotions, favoring the double way of expression of the situation that occurred. This is important to bear in mind since, as I said before, one of the main deficits that arise are traumatic amnesias. These, when they are unblocked, can generate a very high level of 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. In the last few weeks a member of parliament has spoken about the issue of mental health and the effects that the pandemic is having in this area (it should be noted that the current situation is likely to be considered traumatic) and has been the target of criticism. If I can be honest, this worries me a lot. There are people who are not well, who are having a hard time and the necessary care is not guaranteed.

The system is set up so that, in many areas, having lived through a traumatic situation is endorsed when the person is not 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 traumatic unless it is a very grotesque situation, when a trauma can be caused by very simple things such as family "jokes" that have hurt us, difficulties in establishing relationships that have generated discomfort, etc.