Trauma: Big ‘T’, Little ‘t’. Top-down and bottom-up: What the heck does this all mean?

Trauma. Trauma. Trauma. Repeat this until it sounds familiar and is a word you can comfortably use to describe what happened to you. Like mental illness or mental health, trauma is stigmatized and often isolated to individuals who have experienced “horrendous, abusive, and near-death experiences.” This is Big ‘T’ Trauma. Everything else falls under Little “t” trauma, which is highly distressing and can have significant effects on our emotional and social well-being.

I recently attended a virtual training workshop on Addiction and Trauma with Dr. Gabor Mate and during the first session he eloquently shared his definition of trauma: “Trauma: it’s not what happened to you, it’s what happens inside of you as a result of what has happened to you.” As I furiously wrote this in my notes, I found myself drawn to it and physically sensed a shift in my body. What is happening? In a moment of reflection, I was flooded with memories of little ‘t’ traumas and recognized how my own vicarious trauma had interfered in my understanding of how to incorporate trauma-informed therapy with my clients and myself.

Little ‘t’ trauma often goes unnoticed and unrecognized because it is not connected to a catastrophic or life-altering event. We can feel it in our body and it follows us like a shadow, however, our little ‘t’ trauma is trapped inside, unworthy of mentioning. Once you are able to acknowledge that what happened to you is trauma, your body can start to welcome new experiences. Examples of little ‘t’ trauma include non-life threatening injuries, emotional abuse, bullying or harassment, death of a pet, financial worries, loss of relationships, to name a few.

Traditionally, trauma was treated using a top-down approach using modalities like Cognitive Behaviour Therapy (CBT), focusing on cognitions and how to change thoughts in the brain. However, research has shown that simply having insight into one's traumatic experience is not enough. According to Dr. Dan Siegel, Clinical Professor of Psychiatry, the relational experience is key. He explains the significance of biological synchronicity and how having someone to help resonate an individuals’ emotional state can promote change. The goal is to down regulate fear and shame and upregulate positive emotions.

Bottom-up approaches have gained interest and practice in Western culture with the focus on Dr. Gabor Mate’s, “What happens inside of you.” It is where you feel trauma in your body and how the implementation of movement and play can assist in the process of creating new experiences and calming the body. According to Dr. Bessel van der Kolk,Neuroscientist and Leader in trauma research, these new experiences can change how a traumatized person is wired. I highly recommend reading The Body Keeps the Score by Dr. Bessel van der Kolk and The Polyvagal Pocket Book by Dr. Steven Porges, Neuroscientist, to fully understand how trauma affects the body.

This post is poetically timed with the release of Dr. Bruce Perry and Oprah Winfrey’s book, What Happened to You? Conversations on Trauma, Resilience, and Healing. I have yet to read this book, however, I did listen to the Podcast on Brene Brown’s, Unlocking Us, and had another ‘ah-ha’ moment (to be shared in another Blog post). The shift in language is key, as Perry and Winfrey introduce a relational approach to trauma, as opposed to the traditional and detrimental practice of pathologizing clients by asking “What is wrong with you?”

Nothing is wrong with you. Repeat this over and over.