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Trauma Healing (and Not All Anxiety is Trauma) With Dr. Megan Johnson

Trauma can feel like having frequent obsessive thoughts about the traumatic events, having dreams, nightmares, or flashbacks about the traumatic event, experiencing a sudden shift in your world view, believing that most things are bad and most people have bad intentions, avoiding all reminders of your trauma, including people, places, smells, and similar circumstances, shutting down when things feel stressful because life feels too overwhelming most of the time, and difficulty having functional relationships because of the ever-present sense of a lack of safety with others.

It can also feel like experiencing depression and anxiety, racing and unwelcome thoughts, foggy thoughts or frequent dissociation, upset stomach, sweaty palms or underarms, unexplained physical symptoms, or getting easily sidetracked with reminders of your trauma.

Dr. Megan Johnson is a clinical psychologist who helps individuals heal from trauma and live a calm and connected life. At the core of the work she does, she helps people break free from their trauma and feel safe in their mind and in their body. In this episode, Megan dives into what trauma is and what it can look like, how not all anxiety is trauma, she helps to define anxiety versus trauma, what trauma healing looks like, the role of self-care, and the different treatments for trauma.

What Is Trauma And What Can It Look Like?

The clinical definition of trauma is any experience that threatens death, serious injury, or sexual violence. Megan shares that a lot of what we know about trauma comes from research with war veterans who have experienced combat. She also shares that trauma is much broader than the clinical definition. Trauma is truly anything that affects our survival. A definition that Megan likes to use for trauma is: “Anything that happens too much or too quick, in such a way that it overwhelms the nervous system.”

When speaking about trauma, it can be helpful to understand what Big T trauma and Little t trauma is. Big T trauma is life threatening events such as war, natural disasters, violence, or near death experiences, whereas little t traumas are things that happen more repetitively and chronically that add up and also affect your sense of your ability to survive and take care of yourself. Some examples of little t trauma are being in an emotionally abusive relationship, being neglected as a child, or living in chronic poverty or violence. However, your brain truly responds to all of it the same.

What The Trauma Response Looks Like

The fight-or-flight response: When your brain responds to a threat by running away or by fighting back. Your brain will always encourage you as your first choice to run or flee. Your brain will then turn to fighting if you can run away or get out. For example, in child abuse situations, you aren’t able to flee your abuser because it’s often your parent or caretaker who is providing for you. So instead of your nervous system telling you to flee, it’ll tell you to fight.

Megan states that an important thing to note about the four trauma responses, is that they are natural and a healthy manifestation of your brain's survival instincts. They aren’t bad, they are survival strategies that contribute to our safety and wellbeing. They just become problematic when we overuse them, or use them to avoid psychological pain that isn’t necessarily threatening.

Fight response: Fighting back.

Adaptive example (helpful response): You’re out on a hike and you encounter a bear, and in this situation your life is potentially at risk. So if you’re in fight mode, you might attack the bear before he can attack you. And this is a way for you to protect yourself.

Maladaptive example (less helpful response): You’re feeling vulnerable in a relationship and so you lash out at your partner before they can lash out at you. You might be aggressive, confrontational, or attacking.

Flight response: You flee.

Adaptive example: You’re out on a hike and you encounter a bear and so you run to protect yourself.

Maladaptive example: If you overuse the flight response, it can look like rushing, being overly goal oriented, obsessive-compulsive tendencies, restlessness, doing things to keep busy in an effort to keep you away from the psychological pain. Speaking to psychological pain or in a relationship, you can’t run away from psychological pain or people and have a rich and meaningful life.

When fighting or fleeing isn’t an option and the nervous system has been in chronic survival mode, you might turn to freeze or fawn.

Freeze response: Laying low and trying to go undetected.

Adaptive example: You’re out on a hike and you encounter a bear and so you stay really still so that the bear doesn’t see you.

Maladaptive example: If you overuse the freeze response, it can look like social anxiety, hiding, tension, or dissociation. It might look like socially isolating so that you aren’t ever triggered.

Fawn response: Aligning and complying with the threat.

Adaptive example: You’re out on a hike and you encounter a bear and so you might throw the bear some food so that he eats the food instead of you eating you. It’s appeasing the threat or the aggressor. And it often works very well for physical threats but not psychological threats.

Maladaptive example: In relationships, this can look like codependency, or not having a sense of self, being passive and lacking boundaries, doing whatever the person says so that you don’t upset them or set them off.

Most people tend towards one of the four, but some people use more than one.

Not All Anxiety Is Trauma

Megan shares that people can have an anxiety disorder without having trauma or a trigger that brought it on. Although the symptoms of anxiety disorders and trauma can be very similar, it’s more about what caused it. Anxiety disorders can develop for a variety of reasons, but they tend to be more chronic and the focus tends to be more on the worry of what’s going to happen in the future. But with trauma, there’s a specific start and you then stay in it. It tends to be more of a worry about something that happened in the past and a replaying of past events.

A question that Megan often asks clients when exploring a trauma reaction versus an anxiety disorder is, When did this come on and what was going on at that time in your life? Was there a lot of instability and insecurity and a lot of worry about an upcoming transition? This sounds more like anxiety. Or did something acutely happen, or had something been going on for a very long time that was traumatizing to you, and this was your nervous system breaking point? This sounds more like trauma.

Even though anxiety disorders and trauma can look very similar, the root causes are often different. And Megan says, “Not all anxiety is trauma. In fact, most anxiety is not trauma.”

Anxiety Vs. Trauma

Trauma is going to have some extra symptoms that may not be present in anxiety. This can be things like flashbacks, re-experiencing, possible dissociation. Both are an overwhelm or a misfiring of the nervous system. And in our brains, we have a structure called the Amygdala. The Amygdala can be thought of as a fire alarm. And when the fire alarm goes off, we experience anxiety. And when you struggle with an anxiety disorder, the alarm often gets accidentally randomly triggered, like somebody accidentally pulled the fire alarm and then you start to respond as if there were a fire. And then you develop this internal narrative of having to prevent the fire alarm from ever going off because it’s incredibly stressful.

With trauma, the same sort of process is going on in the brain, however it’s triggered by an actual traumatic event. And the obsession then becomes less about the fire alarm being accidentally triggered, and it’s more about not being in a situation where you feel so threatened or the heat gets so hot or the smoke gets so thick that the fire alarm goes off again. It’s linked to a particular event.

Trauma often looks like replaying the past, living in the past, rehearsing past events, whereas anxiety often looks like worrying about the future, having what-if thoughts, preparing to make sure that something bad doesn’t happen. But in practicality what you might be experiencing in your body is very similar (avoiding threats, being on edge, having trouble sleeping, a lot of restlessness). It can all feel really similar but the actual focus of what’s going on internally is quite different.

What Trauma Healing Actually Looks Like

Trauma healing is a series of four phases that you move through. And it’s important to note that the steps within the phases will look different for everyone.

01. You have to confront what happened to you and acknowledge that it was traumatic. Without naming it, there’s no way you can confront it.

02. You have to establish both physical and relational safety. Trauma comes from a lack of experiential safety. It’s next to impossible to heal from trauma while in the midst of a traumatic or chaotic situation. Establishing safety can be through grounding techniques, and having a therapist who can contain you, or a support group to help regulate you.

03. Remembrance and mourning. This is processing all of the feelings that came with the trauma. And Megan highly recommends having a trauma expert to help walk you through this phase and not doing this phase alone.

04. Reconnecting and integrating what you learned along your healing journey into your day to day life and in your relationships. Megan says, “You’re never going to go back to the life and the mindset you had prior to your trauma. You can't unsee what you’ve seen, you can’t forget what you now know, but you can integrate it into your life in a way where it’s no longer controlling you. And that’s what the reconnection phase is.”

The Role Of Self-Care

The truth is, telling somebody to just do some self-care and it’ll solve their struggles can really minimize the struggle of what somebody is going through. Megan shares that self-care has become a buzzword that’s really misunderstood. It’s not just about taking a nap, or a bubble bath, or pouring a glass of wine and watching your favorite TV show.

The analogy that Megan likes to use in reference to self-care is asking yourself… What would mothering yourself look like, or what would a good, loving mother suggest here? Sometimes mom is going to drop all of her responsibilities and play with you just to experience joy, and sometimes mom is going to say no, we’re not having cookies before bed and you need to brush your teeth because that’s what’s healthiest for you.

Self-care isn’t always about indulging yourself. It’s really stepping back and saying, what’s going to make my life more manageable and sustainable? There are a lot of unsexy elements of self-care, like going to the doctor or dentist, getting your oil changed, returning a phone call. There are lots of things that we don’t want to do but doing them makes our lives better and more comfortable.

Megan shares that self-care doesn’t treat trauma. You can’t self-care your way out of a trauma reaction. However, you can practice self-care to give yourself a safety net and baseline to return to so that you can incrementally walk through the four phases. Self-care helps to create a comfortable space so that you can feel safe enough to confront the hard stuff.

Different Treatments For Trauma

A good trauma therapist will listen to your trauma narrative and suggest the best therapy to you, based on who you are and the type of trauma you’ve experienced.

  • Cognitive processing therapy: Works well for people who have had more a singular incident like a sexual assault or a violent incident.

  • Prolonged exposure: This treatment can help you to become desensitized to your triggers so that they don’t dysregulate you quite a much, which can be good for discrete single incident traumas.

  • EMDR: Works well for all types of trauma and in particular more chronic traumas.

  • Trauma focused cognitive behavioral therapy

  • Talk therapy

  • Psychodynamic therapy

  • Attachment focused therapy

  • Acceptance and commitment therapy

If you’re looking to start trauma therapy, it’ll be helpful to research therapists in your area or in your state that practice any of these evidence based practices, and reach out and have an honest conversation with them. Tell them what happened to you, what you’re working on, and ask which therapy is best for you.

Some helpful resources:


Therapy services, courses, resources, all the things:

On Instagram: @drmeganjohnson



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