The phrase “time heals all wounds” is a common one. But is there any truth to this? In this article I’m going to try to shed light on this question, drawing on the published research and my clinical experience and expertise.
What is psychological trauma?
Psychological trauma is a response to experiencing a traumatic event or situation.
Symptoms fall into three categories. Firstly, hyperarousal which means our body’s threat response is on high alert, which will result in symptoms including difficulties sleeping, irritability and anxiety. Secondly, intrusive thoughts and memories about the event or situation. Lastly there will be some level of avoidance of reminders of the event/situation or difficulties in talking or thinking about it. When avoidance is not possible, many people will find ways of cutting off from their feelings or talking about what happened in a detached way.
To be considered psychological trauma, these symptoms will be present for more than a few months after the event or situation. When this occurs it is because the person is unable to effectively process what has happened. This Youtube video provides a helpful explanation for why this can happen Brain Model of PTSD
How do trauma symptoms change over time?
There is huge variation in whether these symptoms will resolve naturally, whether they will continue or whether they will change over time. This is due to differences in the traumatic event, the person experiencing it and how they cope, and what else happens in their life.
Differences in traumatic events
There are many different types of traumatic events and these often impact differently. No two experiences are the same, and we are all unique and so the ways that traumatic events impact each of us requires a nuanced understanding of the person and the circumstances.
Common traumatic events that I see include accidents, serious medical events, being exposed to traumatic situations at work, assaults and sexual assaults. Sudden bereavements or losing someone you love in difficult circumstances can also lead to psychological trauma.
The effects of childhood trauma can be long lasting, especially when there are multiple traumatic experiences. These kinds of experiences can impact in many different ways.
Individual differences
In psychology individual differences is the idea that we all vary in terms of our personality, characteristics and ways of coping. We will also differ in our previous experiences and upbringing. These differences mean that we will often respond to the same situations differently. Understanding our unique characteristics and experiences helps us to understand the ways in which we have coped and how to move forward.
We know that in general terms, social support and active coping can be beneficial to processing a traumatic event in the weeks and months after it has happened. Active coping means recognising the need to process the event, and taking steps to do this by talking to other people and finding strategies that help you to cope practically and emotionally. This is not always possible for many different reasons.
Whilst coping in an active way can be helpful, it is not always sufficient to heal trauma. There are often factors related to the traumatic experience itself that may get in the way of processing what happened.
Cumulative trauma
The effects of traumatic events are cumulative. If you have been exposed to traumatic events in the past, you are more likely to develop psychological trauma to more recent events.
Unfortunately this may also mean that a recent event brings up difficult feelings from past events unexpectedly. Many clients can understandably find this overwhelming. In these situations the individual is dealing with the recent situation and feelings and memories that they thought they had dealt with.
What does the research in this area say?
There has been some high-quality research into how psychological trauma develops over time, focusing on veterans exposed to combat (Solomon et al., 2006& 2021). These studies found variation in how veterans responded to what they had been exposed to. A proportion did not develop psychological trauma symptoms. Another group did develop these symptoms and later recovered. A smaller proportion developed symptoms and continued to experience these over the long term.
It was also found that a small proportion of those who participated experienced a delayed trauma reaction. In these cases, individuals appeared to cope well initially but began to experience a trauma response many years later. This certainly matches my clinical experience in which psychological trauma can begin to manifest many years after the initial traumatic experience.
Another study looked at the experiences of young people in Germany over a period of years. It was found that a substantial proportion of those who experience traumatic experiences will recover from the psychological trauma associated with this. However, a significant proportion will continue to experience trauma symptoms in the long term (Perkonigg et al., 2005).
So does time help us to heal from trauma?
As we have seen, the course of psychological trauma symptoms can vary depending on many factors. So in a nutshell the answer to this question is ‘it’s complicated’.
Anecdotally many people report that coping with the effects of trauma can feel easier over time. Sometimes this is related to being exposed to fewer reminders or feeling that life has moved on and that the feelings are no longer so ‘raw’.
If you have experienced psychological trauma and this is not fully resolved you may find that periods of stress, life challenges or transitions bring up difficult feelings related to your trauma. This is due to the memories and feelings related to your trauma being ‘locked away’ in a box in your mind. When you are coping well and life is settled, you may find that this has little impact. However when you are stressed or other life events happen, you may find that these feelings and memories surface.
Some people may find that their trauma fully resolves over time. This is certainly possible and in this case you will have a sense that you have ‘come to terms’ with what has happened. You will generally feel ok talking about it and will have a sense that it no longer impacts you to the same degree as it once did.
Should I consider trauma therapy?
Therapy can be very helpful in treating psychological trauma. In my practice, I mostly use a therapy called EMDR. You can find out more about this in my previous post here
If you have experienced a traumatic event, I would advise that you consider trauma therapy in the following circumstances.
Firstly, if psychological trauma is impacting on your day to life. This might include experiencing feelings that are difficult to manage in response to triggers or reminders. Alternatively you might be feeling a general sense of not having come to terms with what happened or finding that certain feelings manifest in times of stress.
Secondly, if you feel ‘ready’ to face what happened. Trauma therapy can be particularly effective when this is the case. There is no fixed timeline for this and no right or wrong. Many people will seek therapy several years after the traumatic event. This is often when life is more settled and they feel more able to face difficult memories and feelings that they have ‘locked away’.
I hope this information has been helpful. Please Contact me if you have any questions or would like to book in.
References
Perkonigg, A., Pfister, H., Stein, M. B., Höfler, M., Lieb, R., Maercker, A., & Wittchen, H. U. (2005). Longitudinal course of posttraumatic stress disorder and posttraumatic stress disorder symptoms in a community sample of adolescents and young adults. American Journal of Psychiatry, 162(7), 1320-1327.
Solomon, Z., & Mikulincer, M. (2006). Trajectories of PTSD: a 20-year longitudinal study. American Journal of Psychiatry, 163(4), 659-666.
Solomon, Z., Horesh, D., & Ginzburg, K. (2021). Trajectories of PTSD and secondary traumatization: A longitudinal study. Journal of psychiatric research, 138, 354-359.