Why Trauma Often Goes Unseen

Many people live with patterns of anxiety, stress or physical symptoms without realising that past experiences may still be shaping how they feel today.

In this episode of The Choice Space, Dr Lee David speaks with Dr Susanna Petche, GP and founder of Trauma Sense, about why trauma is often missed – and how it can affect both mind and body in ways that are not always obvious.

The conversation explores how trauma is frequently minimised or overlooked, both by individuals and within wider systems of care. They discuss how experiences that were never fully acknowledged can continue to influence how safe life feels, how we relate to others, and how we see ourselves.

They also reflect on how trauma responses can show up in everyday ways – through anxiety, physical symptoms, or reactions that don’t seem to make sense. This includes the role of the body in holding stress, and how triggers can operate outside of conscious awareness.

They explore how trauma can remain unrecognised for many years, sometimes being understood as anxiety, depression or physical health problems. This can make it harder for people to make sense of their experiences, and to find the right kind of support.

The discussion highlights the importance of being seen and believed, and how simple, human responses can support healing. They explore the role of self-compassion, curiosity and body-based approaches in helping people begin to make sense of their experiences.

This is a thoughtful conversation about recognising trauma, offering a more compassionate and realistic way to understand ourselves and others.

Key moments

00:00 Personal experience of trauma
04:16 Why trauma is often missed
05:03 Minimising and dismissing trauma
07:28 Trauma and loss of safety
09:17 Why validation matters
10:12 Trauma, shame and self-blame
17:36 Signs of trauma responses
21:57 Understanding triggers
24:01 The Choice Pause
27:46 Self-compassion and healing
32:05 Starting to make sense of trauma

About the guest

Dr Susanna Petche is a GP with over 25 years’ experience and the founder of Trauma Sense. Her work focuses on improving understanding of trauma and its wider impact on health. She integrates insights from neuroscience, functional medicine and coaching to support individuals and professionals. Through her teaching, speaking and clinical work, she aims to bring greater awareness to how trauma can be recognised and understood in everyday life.

You can contact Susanna via her website, Instagram and watch her TEDx talk

About the host

Dr Lee David is a GP, CBT therapist and author specialising in mental health and wellbeing. Lee has written many books on CBT, mindfulness and teen wellbeing, and speaks regularly at conferences and in the media. Away from work she enjoys running, hiking, singing in a choir and spending time outdoors with her family. You can find Lee through her website and on Instagram, TikTok (@dr.lee.david), Facebook and LinkedIn.  You can find more about her books, wellbeing courses and therapy here:  https://linktr.ee/dr.lee.david 

Transcript

SPEAKER_01 0:00

And I thought I really understood mental health until I found out I didn't. And so it was through my own personal experience that I got really interested in trauma. And basically, about 10 years ago, I became really unwell after having really two decades before that, so my adult life, my 20s and 30s, being told that I had depression, seeing lots of different doctors and therapists had antidepressants various times. And I just accepted that because it kind of fit the medical model that I'd been taught as well. And then 10 years ago, I became very unwell, and I saw a therapist who was different to the previous ones and said, actually, I think you might have post-traumatic stress disorder. I was completely shocked, didn't believe her. And then through working with her, I realized that actually I completely did. And yet I didn't know about this. I didn't recognize it. And I found it really difficult that not just the symptoms that I was experiencing and how unwell I was, but that as a doctor who was particularly interested in mental health, I didn't recognise this at all in myself.

Dr Lee David 1:32

These are not always recognised or named as trauma, but they can have a lasting effect on how safe life feels, how we relate to others, and how we see ourselves. Recognizing experiences as trauma and learning to respond with understanding and compassion can start to change how they affect us and open up new ways to move forward. I'm joined today by Dr. Susanna Pecci, a GP and founder of Trauma Sense, who's also given a powerful TEDx talk on the impact of trauma. Susanna, welcome. Could you start by telling us a little about your work and what first drew you into this area?

SPEAKER_01 2:09

Thanks for inviting me here. It's really great to be able to have this conversation today. I'm a GP by training. I've been a doctor for 26 years now. And as you know, within general practice, so much of what we see is to do with mental health. There's always been something that I've been interested in my entire career. And I thought I really understood mental health until I found out I didn't. And so it was through my own personal experience that I got really interested in trauma. And basically about 10 years ago, I became really unwell after having really two decades before that, my adult life, my 20s and 30s, being told that I had depression, seeing lots of different doctors and therapists had antidepressants various times. And I just accepted that because it kind of fit the medical model that I'd been taught as well. And then 10 years ago, a series of things happened and I became very unwell. And I saw a therapist who was different to the previous ones and said, actually, I think you might have post-traumatic stress disorder. I was completely shocked, didn't believe her, and looked it up myself. And then through working with her, realised that actually, I completely did. I had something called complex post-traumatic stress disorder from incidents that happened to me as a young woman. And yet I didn't know about this. I didn't recognize it. And I found it really difficult that not just the symptoms that I was experiencing and how unwell I was, but that as a doctor who was particularly interested in mental health, I didn't recognize this at all in myself. And so that led me to research around trauma, what it was, how to recognize it, like is it really a thing? Can we even get better from it? And that led me to studying about trauma. I did ended up doing a master's in psychological trauma and found all of this research out there that we just don't hear about, we don't learn about. It's not really that much in the public domain. And so I started a business four years ago, um, Trauma Sense, to do that education piece for health and well-being professionals to understand about trauma.

Dr Lee David 4:16

Thank you for sharing that. And it just highlights the impact of having experiences of trauma often many years ago in life that we may not be consciously aware of. It's challenging to remember them because of the experiences and the way that our memory can be impacted by the experience of trauma itself, which makes it harder to have memories that are clear. And so we may have uncertain memories of these very challenging experiences that then have a lasting impact later in life that are not recognised. And it really highlights if if medical professionals who are very trained, who are, as you say, very interested in mental health and incredibly knowledgeable and still find it hard to recognize, can really understand why so many people would also find it hard to notice or name their experiences as trauma.

SPEAKER_01 5:03

It's a it's a normal trauma response to minimize whatever happens. Because if we fully acknowledge and we're fully present to the horrors of whatever it is that's happening, it's very difficult to cope. And especially if that is something that is happening at the hands of another human. So if it is an assault or an attack or interpersonal violence or emotional abuse from another person, if that's from somebody in a position of authority that you should be able to trust, or if it is uh a partner, an intimate partner violence or coercive control, or if it is from a parent or caregiver, they kind of should be safe. So to really embody and be fully present to that that breach and rupture of that relationship is so hard, so and and you know, more than hard, horrific. So what we we do as a protective mechanism is to kind of minimize what's happened, minimise it, dismiss it, kind of make it small, and often dissociate. So even not be fully present, so kind of a part of us kind of splits off so that we can kind of get carry on with normal life, um, as well as have had this experience. So it's it's really common that people who've experienced something traumatic will say, Oh, it's not such a big deal, you know, it's you know, other people are far worse off than me. And then society compounds that by dismissing trauma. We don't want to acknowledge how how common abuse is and how often trauma has happens to people. And we can see that playing out all the time in the news. You know, things are dismissed and blamed on the victims. So it's it's just really normal that people just totally push it away, often to the point of barely remembering it, because almost what's the point? Because they need to carry on with normal life, and often they're not believed. So it's kind of as a self-protection to just not talk about it, not mention it, not acknowledge it.

Dr Lee David 7:08

There's almost two elements there. And one is the trauma itself and the events that occurred, which are very distressing, they're extreme, they're harmful physically and emotionally. And then on top of that, there's the impact of the experience on the relationship. There's that recognition, especially when the trauma is perpetrated by somebody who should be safe, by perhaps a parent or caregiver, by somebody in a position of trust in some way. Then we've not only been experienced trauma, but we've also experienced a breach in our sense of safety in the world, in our sense of that relationship. And it feels like that's also very significant.

SPEAKER_01 7:47

So there's the traumatic event or the stressor, which we can split into whether that is something that is perpetrated by a human or whether it is kind of an external event. So let's say some kind of abuse situation with another human, or whether it is a car accident or a natural disaster, which, you know, both of these are horrific. But the one that is say a natural disaster, it doesn't break our trust and our confidence in other human beings. Then the other thing is not just the traumatic event, it's how that person was met afterwards. For example, somebody is involved in a car accident, there's like visible evidence that that has happened. And so often the way people are met after a car accident, police and if there's medical people involved, people can see it and there's acknowledgement that something horrific has happened and that's validated. Whereas if, say, somebody is in an abuse situation with a with say their partner, no one sees that. That's behind closed doors. So there's an element of people not, even when they do disclose it, that they're not necessarily acknowledged, that's not necessarily met. And so trauma is not just what happened, but it's what happens inside of us as a result of what happened. And that's further compounded when people are not met and acknowledged afterwards.

Dr Lee David 9:16

I think we'll talk later about how we might support people who have experienced a traumatic event. And I think it makes such a difference in how people do respond, whether that's within the workplace, whether it's somebody had a car accident, or whether someone discloses something to us about something from their past life, which may have which may have been very challenging. And I think how we respond to that is is incredibly important as a health professional in particular, but actually also in day-to-day life, and people often get quite scared about what to say. So we'll we'll come back to that. We've talked a bit about how people tend to minimize trauma, and and that's one reason why it makes it harder to pick up. Are there any other aspects of the trauma experience that make it more difficult for people to recognize so that we we're not really recognising that was a traumatic event that's having an impact that may be quite lasting?

SPEAKER_01 10:12

The answer comes down to being trauma informed. So if someone is trauma-informed and understands trauma and sees behaviour patterns, emotions, symptoms through a trauma lens, then all of this makes sense. So I've talked about this in the TEDx talk that you alluded to at the start. So I experienced sexual violence when I was a young woman. And what happened to me, and what happens to unfortunately so many women and girls who who were exposed to sexual violence or experienced sexual violence is that you're blamed for how you look, what you dressed, what you wore, what you did, what you said. And that happened to me. So rather than being acknowledged, I was blamed, and so therefore I turned that inwards. And so I then experienced huge amounts of shame of what happened and that it was my fault. And I completely internalized that. And so that made that shame, lack of self-worth in one of the instances my boss really turned on me and blamed me. So this wasn't personal authority, it really impacted my mood and my my sense of worth. And so that led me to develop symptoms of depression. Because one of the things that happens in that immediate event of a traumatic experience is it would become really hyper-vigilant. And so that looks like anxiety. So what I was depressed, anxious, and struggled with interpersonal relationships because I struggled with trust because of what had happened to me. So that all fitted with what I was being told. Well, you're depressed and you're a bit anxious, and you need to work on yourself, on your interpersonal skills. I just even more took it on board that it's a problem with me, there's something wrong with me. No one made the link with trauma, no one said that until decades later. Then you can see why you just internalize it and don't even recognize actually, maybe these are consequences of trauma of something that maybe happened a long time ago. And I see this being played out over and over and over now in my clinical work because I can spot it, I can see it. And so when I gently ask questions around that, the shoulder drop and the kind of exhale from people, and people literally use the words, thank you for seeing me, because it's just, we just don't want to acknowledge it, we don't want to see it.

Dr Lee David 12:35

Having our experiences acknowledged and heard and validated, how important that is to say, I believe you, I hear you, and and this is something that that is real, it happened. I think people are sometimes fearful. We have a desire to change bad stuff, and and this isn't something that we can change, but what we can do is meet it with care and compassion and say, I I hear it. That that sounds incredibly difficult, and I'm so sorry that happened. Do you think that is important in how people respond?

SPEAKER_01 13:06

It's crucial, and it's so small, it seems like such a small, almost insignificant thing, but it's everything. So for somebody to say, I'm so sorry this happened, and this this was not okay, none of what happened is your fault. You didn't make this happen, or whatever words kind of feel right to you, but that kind of sentiment is so crucial because so having someone else validate and say, Yeah, this isn't okay, and yes, that did happen. It's like then the recovery can start to happen, then the healing can start to happen. Having somebody externally say, I see you, it happened, it wasn't your fault, it's huge. It's everything.

Dr Lee David 13:48

We don't need to be a specialist to be able to say, I hear you, I believe you, and that wasn't your fault. It feels like that's something that's within the power of all of us to offer to people around us if for some reason we have some awareness that that's something difficult that has happened to them. So it feels like something that we can all do that might make the world a little more trauma-informed and a little more supportive and compassionate for people. People sometimes say to me, I don't know if that's trauma, you know, is it bad enough? You know, was this bad enough to be trauma? I think what's important to say is if someone's affected by an experience and we can say that, we can say that sounds really difficult and I'm so sorry. And it feels like we can say that no matter what. We don't need to lean into how how to judge it because that feels really unhelpful. So I'm I'm just wondering if we need to be just saying that more often to it to everybody a lot of the time.

SPEAKER_01 14:38

Couldn't agree more, and I it really made me smiley so it could make the world a better place. Absolutely. I I genuinely believe that because it doesn't take much, it doesn't cost anything to say that, and it can be anyone, you don't need to be a therapist or a doctor or a psychiatrist to just human to human say that and just acknowledge that. And the other thing you you said is is just again so important to just not judge for us not to make assumptions about what is difficult or what is traumatic. None of us know what that other person has been through. We haven't walked through life in their shoes. So we don't know. A couple of examples where often we expect the older generation to die before us, and that that is something that is the the natural course of life, and of course it's sad, but it's something that we expect. So when somebody's grandparent dies, of course it's sad, but we understand that's the nature of the world. But who are we to say that somebody is grieving too much? I hear this so many times that actually it's that grandparent who was the parent figure, and that's why. But they haven't said that. We're just projecting our own assumptions of we don't know what happened in that person's life. And, you know, giving a different example of something that someone might not think of being traumatic, somebody getting a medical diagnosis. Now, often we will acknowledge somebody getting a terminal medical diagnosis that that's something that's traumatic. And if it's not terminal, well, you know, what's the problem with it? But if, for example, somebody gets a diagnosis of something like epilepsy, which means they can't drive, but they live completely rurally and they are 100% dependent on their car to get anywhere, to take their kids to school, to take their kids to activities for social interaction, for shopping, for caring for their elderly parents. If that's taken away and they're not able to drive, that completely shatters their world. Potentially, they could find that a really traumatic situation. So we can't say this is traumatic and that isn't. We don't know that. So we can't just make those assumptions and those judgments.

Dr Lee David 16:57

I think grief and trauma may often go hand in hand and they're very interwoven, and there's a lot of complexity where there may be experiences of loss which can also be extremely intense. I've also seen people with perhaps an early miscarriage where people just assume that it's something they should get over quickly, and actually, for various reasons, it can be an intensely distressing experience and lead to intense grief, and it may be a traumatic grief as well. So we know that the two can can link to one another. Just thinking about trauma itself, what would be the signs? Are there any symptoms that would help us to recognise that this may be a trauma response?

SPEAKER_01 17:36

The key things that I would look for is someone who is a working-age adult who has varying physical symptoms that just kind of don't quite make sense, or who's under like more than one specialist. If we go backwards and think about how the body physiologically responds when somebody is in an event that is really traumatic, all of us can identify, and if we're in in a really, really heightened stress situation, like say before an exam, that our heart rate increases, our breathing changes, we might feel a bit sick, kind of have butterflies in our tummy and anxious and feel that kind of nervousness. So we've already talked earlier about how hypervigilance can be a real part, and that can then look like anxiety. But then also after that traumatic event has happened, if the brain and body don't recognize that that has finished, or if there are repeated exposures to trauma, whether that's say in childhood abuse or in bullying or intimate partner violence, where things are happening frequently or repeatedly, the brain and body doesn't quite switch off. And there's a constant anticipation of something happening, of something, you know, something horrendous about to occur. And so when that stress response, that survival response doesn't get switched off properly and someone stays partially stuck in it, then their heart rate's gonna have a tendency to always be a bit increased. Their breathing's gonna have a tendency to be more shallow and a bit more erratic. When we're in that survival response, our gut gets switched off or or blood gets diverted away from the gut because we don't need to digest food in that immediate situation. Our immune system gets primed because if we are gonna be in a fight or flight situation, if we're gonna get cut, we don't want our skin to be breached. Um and if it does, well, we want our immune system to be ready and alert so that we don't get any infection. So our immune system's primed, our plotting system gets primed so we don't bleed too much, and we're gonna need more energy potentially, so we're gonna have our blood sugar metabolism gets primed. All of these things are primed. And if they don't get switched off, they're gonna be partially on to see a link between autoimmune conditions or gut issues. So things like heartburn, indigestion, constipation, IVS, if we're kind of ready to fight and our muscles are kind of ready like that, pain syndromes or or tension headaches, migraines, all of these things just hugely overlap with trauma. And so even things like people having palpitations or breathing issues, there's research showing about how asthma exacerbations in adults are linked with stress and trauma, and certainly with children. So it's not an absolute, but if you see somebody who has a number of different things presenting and they don't quickly go away, and especially with those terms resistant depression, resistant anxiety, like if simple interventions with therapy, with medication, they often don't work. And and so we need to just have that broader lens that trauma could be underneath us.

Dr Lee David 20:45

Yeah, so body and mind can go into a chronic state of stress where we're constantly on the alert, both physically. I need to keep my body safe, we need to be ready to cope with this, and also emotionally, and we become hyper-vigilant, we become agitated, stressed easily, you know, we might be very sensitive to sound, for example. People can be triggered, they'll experience a sudden rush of anxiety in certain circumstances, and it's not always clear why it links back. There is a link. Often, when you work with people and the people I've worked with, we've we kind of slowly make our way down and we realise, oh, it was the colour, actually. It was the colour of the door, uh, or it was the colour of the car, it was a sound that reminded me. But it's often these links that are not direct. So we're something a little bit similar, and our brain is able to link that up. It's a it's an incredible sign that our brain is able to make these amazing links, but it's also so challenging because then things that sort of slightly remind us about the event, even we're trying not to think about it, but then something happens and we're reminded, and then we get this emotional reaction. And I I wondered if that if that's something that you've also come across with people.

SPEAKER_01 21:57

Absolutely, and I think it's it's it's important. Important to say it's not necessarily like a remembering, it's not conscious. It's not that someone kind of consciously thinks, oh, that kind of looks like, you know, that colour of the car is the same as a car that drove into me. It's a subconscious, immediate response that bypasses our thinking brain. And people kind of use this language, it like then hijacked my brain and how I react and respond. So that people have no conscious control over it. Once we we become more aware, and that's where working with somebody and working with the body and understanding that, then people can develop some space from that. So it's totally possible to initially, absolutely, these triggers will just completely hijack somebody that they're just not kind of aware that that was happening. It's really common that people think about a trigger as being like a sound, say, for example, the classic one is a car backfiring and a soldier thinking that they're on the combat field. But it can also be physical sensations. So, for example, something that I've seen a lot is that people really struggle with exercising and don't understand why. And especially being in an environment, say in a gym where they're surrounded by a lot of people exercising. And when we break it down, it's that body feeling, that somatic feeling of the heart racing and breathing faster that is the trigger that takes them back to wherever that whatever that experience happened. And hearing people breathing fast, it again is the trigger. So it's the sound and also the physical sensation of those that can really impact somebody. It can even be like a piece of music. So I remember working with somebody who, when a particular song came on, that it will take them back to when they were in the tunnel in the tube when the bombs went off. So it was something that, like you say, it can seem not very obvious on the surface, but it immediately takes somebody back when we start to unpick it.

Dr Lee David 24:01

This is the choice pause, a short tool you'll hear in every episode, drawn from my books and therapy practice. Today is a pause for creating a small sense of safety. Take a slow breath in and a longer breath out. Let your shoulders be heavy and hang down. At times your threat system may become active. This may be in response to a sound, a tone of voice, a memory, or something in your surroundings. You might feel tense, anxious, or agitated, and perhaps not even be sure why. Your heart may start to race, your face feels warm, or your body may become tense or rigid. Taking a moment to pause can help your body begin to settle. Notice your feet on the ground, the support beneath you. Bring your attention to one thing that you can see around you. A colour, a shape, or the way the light falls around you. You might even say it out loud: a red book or a blue mug. And notice one thing you can feel. Wriggle your toes or push your feet into the floor. Stretch your arms up above your head or give yourself a big hug and feel your hands on your shoulders. Take a long slow sigh. Let the breath out very slowly and repeat if you need to. And you might say to yourself, I'm feeling unsettled right now. That's okay. I can be kind to myself in this moment. This will pass. You might choose to move your body to help regulate some of that energy or tension. Go for a walk, do some yoga, jump up and down, run on the spot. Remember that you can pause and settle yourself at any point when you need to. I think trauma is an area where it really is important to have somebody safe to work through traumatic experiences. It's particularly important to have a trusting relationship with the therapist. Do you think that recognition of actually, yes, that is something, that's a thing? And just to be able to name it of, oh well, actually, it is understandable. It's my body responding to certain stimuli, it's to sounds, to sensations, to things that I see or hear, might be things that people say, or the tone of voice. I've I've had people where in the workplace, maybe a boss, perhaps a male boss was quite authoritarian in their tone, and that brought back traumatic experiences where they were a young child. And it can be quite subtle, but it's quite empowering to be able to say, okay, it makes sense that this is happening.

SPEAKER_01 26:48

Absolutely. And I think when people make sense of that and can understand that, because fundamentally what we were saying earlier, trauma is not acknowledged really. There's so much then with these symptoms and behaviors that don't kind of quite make sense that that one can feel you're either imagining it, making it up, or that you're just kind of going mad, your brain's not working properly. And that's terrifying, like really terrifying. So when we can understand that initially it was about our body and and minds trying to protect us and look after us, then we can turn it and have more compassion with ourselves of actually, I'm not going mad. There's an entirely plausible reason why this has happened. In the first place, it happened to keep me safe and keep me alive. And now it's no longer serving me. But when I can recognize it, it just takes that edge, that sting, that tension out of it, that then we can start to gradually build some space from it.

Dr Lee David 27:45

I love that you've mentioned compassion there. And I think when it comes to trauma, it's very fundamental. And I think there is evidence that developing self-compassion can help people to learn to process trauma more effectively. And that good proportion of people who develop skills in self-compassion, which is really about learning to meet ourselves with kindness without blame, with acceptance and understanding, and maybe to regulate some of the distress that comes up because we're able to be compassionate to ourselves, that actually means that people don't always need to do trauma processing therapy, that it may be enough to learn to be kind. And I think it's about how the memories and the experiences were able to hold them and then maybe make space for the part of us that's gone through trauma and hold that part with kindness and that part gently starts to heal. What's your experience of the role of self-compassion and being kinder to ourselves in terms of the trauma journey?

SPEAKER_01 28:43

I I completely agree with you that that compassion and self-compassion, they're just so important. So compassion from the person who is with the person who's experienced trauma, and whether that is a doctor or a therapist or a friend or a family member, just holding that compassionate space is so healing. And then that self-compassion is just the best medicine, really. Because earlier, when I was saying how it's such a normal response after experiencing trauma to turn it inwards, and then it's like there's not just the traumatic thing that happened, it's all of the shame and blame, the self-criticism that we that we throw at ourselves, that's what really perpetuates that lasting damage. And self-compassion helps dissolve that. So it takes time, it's not quick, but with self-compassion, that shame starts to dissipate and self-worth can start to build again. And that's ultimately what we're heading towards. And we can't make this not happen. What's happened has happened. But our reaction to it, the story we tell ourselves around that and how we blame ourselves, that's what we can change. And so that's where self-compassion is so incredibly powerful to help shift that.

Dr Lee David 30:00

I sometimes think about the brain being like if you throw all your shopping into a cupboard because you're very stressed, then every time you open the door, all the tins fall out and it's all very disordered and it feels quite stressful every time you go past the cupboard, and every time you notice the cupboard, you think, oh, there's all that stuff in there and I don't like it. And so ordering, taking the tins out and putting them back in is a bit like trauma therapy where you're starting to work through the memories. But actually, if we had a more elastic cupboard that just had some space and stretch and capability, then we might be able to have them in there and actually they'd sit quite comfortably and they wouldn't keep falling out. And it's almost like that, where we've got more room to have the stuff that's happened and hold it in a kind of more caring space, and actually it doesn't then have so much impact on us.

SPEAKER_01 30:44

I think it's also really important to say that the brain in the body has huge capacity and capability for healing. And what we want to do is to create the right environment that the brain and body can kind of do its thing. And it can be working with somebody, but it's also possible to heal without necessarily working with somebody. And it's also possible to heal from trauma without talking about the trauma. What stops a lot of people from getting help is that they don't want to talk about it. But there's a lot of different therapies, even some kinds of talking therapy that focus more on the reactions and self-compassion rather than going over and over and over the traumatic events, which just is re-triggering and just often makes people worse. I love that idea of this spacious cupboard. Then I kind of think when you shut the doors, it kind of can sort itself out a bit. It's got the space to rearrange itself so that when you come back to it, it doesn't all topple out.

Dr Lee David 31:47

Thinking about next steps, I think it's really helpful to highlight the fact that seeking trauma therapy doesn't have to mean going straight for all the trauma memories straight away, which can really be scary for people and put them off wanting to engage in therapy. And so there are lots of options, aren't there?

SPEAKER_01 32:05

Absolutely, yeah. So there's there's so many different options. And I think just knowing that people don't even need to talk about it and don't, you know, that there's lots of even body therapy, so body work or somatic therapies that literally work with shifting that stuckness through the body in different ways. And it starts with that we acknowledge that trauma is held in the body, it's not just up here in the mind. So therefore, we need to work with both.

Dr Lee David 32:33

So if someone was recognising there may be some trauma experiences, what would be a starting point for them to do some self-work? It may be enough, it may be the starting point. It's it's always helpful, in my view, to look after ourselves, no matter what other steps we might need as well. So, what would you be recommending that people might do to start that process of self-care in the in the context of trauma?

SPEAKER_01 32:56

The biggest thing, the first thing, is just being curious. So it's that curiosity about our own reactions and our own responses in different situations. So if we maybe are really impatient with somebody at work, rather than that, oh gosh, it's just so terrible that I did that and how awful that I was like that, and that usual self-blame, it's uh, oh, that's really interesting. Like, what else was going on around there? What was it about that interaction that made me respond in that way? Oh, so it was actually the way that that person spoke to me was in a really aggressive tone. Oh, that's really interesting because other people have spoken to me in aggressive tones. Why was it that particular person? Why was it that particular tone? So it's just really slowing down moments and really kind of teasing them out with curiosity and with a whole load of compassion around that, to just be really kind and gentle as we start to explore that. Then the other thing that could be so helpful is literally just shaking, like shaking it out, like literally moving the body physically to discharge that excess adrenaline. So, with animals, when they have gone through a traumatic experience, they'll shake to get rid of that excess adrenaline. But as humans, we rarely do that. We push it all in and hold it in and turn it inwards and blame ourselves. So it can be really helpful if we literally just shake it off. I worked in AE throughout COVID, and you can imagine that was ridiculously stressful. Periodically, I would, if something really bad happened, I would take myself to the toilet, lock the door, and literally just shake my arms and legs for 10, 20 seconds, do a couple of rounds of breathing, like with the exhalation being longer than their inhalation, which is a mechanism of grounding. And so just doing that shaking can be really helpful. And so what I suggest to people is to do it in really small amounts. So even setting a timer of like 20 seconds to just stand there and shake and to just consciously think you're like letting go of stress or rage or hurt or grief or frustration, whatever it is that you're letting it go, the alarm goes off, and then you do something to calm the self down. So with whether it's breath work or meditation or listening to a piece of music, just something that's more calming. If people can't move, if movement is difficult for them, then doing like a toddler tantrum on a bed. So on a bed where they're lying down, so they're supported, and then like toddlers like punching the mattress and like kicking with your legs, like think of a toddler tantrum in a supermarket. Doing that on a bed, literally just for a short amount of time. So way of thinking about it is if you have like a fizzy Coke bottle, if you shake it, if you take the lid off, it'll explode. So we're not encouraging people to suddenly look at all of their deepest, darkest, horrible most horrific traumas and rip the plaster off. It's about very slowly undoing that Coke bottle and letting a bit of fizz out and then doing it up. And then again a little bit more and doing it up. So it's about pacing and that individual person being in charge, in control about how slowly they explore what's going on, explore with curiosity maybe how they're behaving, and maybe doing something, this practice of shaking out that that kind of excess adrenaline that's held in the system.

Dr Lee David 36:22

I really love the emphasis on physical movement because I think often when we're feeling stressed or anxious and something's happened, we try and think our way out of it. We try and rationalise, we try and tell ourselves, don't think that, calm down. Why are you getting so upset or whatever? We might start being critical of ourselves and the blame system then kicks in. I don't think at that point when we're very activated, when our threat system has been turned on and we're feeling maybe hyper-vigilant and it feels like the threat may be happening again just for a moment, we're just not in that space where our brain is able to think sensibly and look at the big picture. And I just don't think our brain's got that capacity in that moment. And so I just think movement is much more helpful as a way to regulate. And I love the idea of being on the bed and doing a toddler tantrum. I think I might have to try that. Next time I'm feeling stressed, it sounds amazing. And then once we're then discharged some of the adrenaline and the cortisol and things are settling down, at that point we can start to think and maybe do something soothing, as you say, do something compassionate, do a mindfulness practice or go for a walk. I think more movement, I the more we do the better. And and just to finish, at what point do you think someone might, what are the clues that someone may well benefit from seeking more support with their trauma? Either seeing their doctor, seeking out a therapist, just seeking a bit more input and support to find their way through?

SPEAKER_01 37:45

I think that's personal preference because there's two ways of looking at it. It can be when somebody is either feeling that they're ready, because exploring trauma is hard and it's it's exhausting. Often so it can be when someone's in a place where they feel relatively resourced to be able to go and do that, and that they make a choice that actually they want to go and do something about it. But it's often it's when it starts really impacting life and they're not able to live life in the way that they want to. And again, that varies for different people. It may be that it's really starting to affect them physically, or that emotionally they're really struggling for various reasons. You know, it may be things like extreme depression, but it can be that they're really struggling with interpersonal relationships, or they're aware that they just don't feel safe. So they really struggle to speak up and say no to things at work, to go for any kind of promotion, to put themselves out there in some way. They're finding that too hard. So they're keeping themselves small as a kind of as a response and they they want to look at working through that. Usually people tend to, for reasons we spoke about earlier, not really acknowledge the trauma's problem and know something's not right. But unfortunately, often it happens when people really are overwhelmed and that it's it's a crisis that tips them to seeking help. If people can do it a little bit earlier, it can be less less destructive in a way.

Dr Lee David 39:14

So it's recognising for me, is this something that I am seeking? And do I feel resourced and and and ready to be able to do this work? Which, as you say, it does take some energy, it can be fatiguing. And I think it can be quite disruptive at times in that if you open that box that you mentioned, then we're more exposed to some of the memories and the experiences that can be quite difficult. So we need to have a enough space to be able to manage that because we might need time the day after therapy session. People are not always able to work, for example, because of the impact of doing that experience of opening the box and starting to face stuff that was was just so genuinely challenging. So I think it does sound like it's about recognising what what are my needs, but also perhaps not putting it off and off and off to the point that then we get to a crisis point and overwhelm, and then it's probably a little bit harder because then we're very stressed and depressed, and life is perhaps challenging. And so then we're blaming ourselves even more.

SPEAKER_01 40:12

And I think it's it's recognizing that doing those smaller things like being curious about you know how we're how we're responding to things, doing something physical, like I said, whether it's shaking, whether it's putting the radio on and dancing around the kitchen, going out for walks, focusing a bit more on how we're sleeping, making sure we have little space to do things that we enjoy just because it's it's fun rather than because you know it's to do with work or anything else. Looking at what we're eating, you know, limiting alcohol and caffeine, all of those things make a huge impact on just calming our nervous system, calming an inflammation in our body. And all of those things help. They're things that people can do on their own, or they can invite and suggest a partner or a friend to do those. And when people are doing those practices, it actually makes any kind of therapy that they then choose to do much more effective. It will work much quicker because they're they're able to, you know, they're resourced to be kind of present and to manage themselves after the session. Because, like you say, it can be that one session just opens up so much that someone might find it difficult to work for the rest of that day and the next day, which is which is a lot. So if if people can start to resource themselves before that in a very gentle way, then that can make a massive difference.

Dr Lee David 41:34

I think that is really key. It's the foundation. And I think that's the thing we can do without necessarily needing so much support, is start to putting the building blocks of self-care into place. So it's looking after ourselves really well, moving our bodies, trying to seek out connections with people that that we care about and who are supportive and who don't lean into maybe being critical, trying to look for people who actually lift us and that we come away feeling more supported and more held after we've interacted with them. If if we're able to find a tribe who can support us, I think that's really powerful. And I think for me, there's also something about how we go about self-care, trying not to let that lean into a blamey kind of, you know, you don't do enough. Why aren't you doing more? This is all your fault. But actually, very much like I'm doing this because I matter and because my well-being matters, and I want to care about myself and I want to look after myself as well as I can in the complex situation that I'm in, whatever that may be. And so that's why I'm making these choices, which sometimes it's harder to choose that the stuff that looks after us than than the stuff that we've kind of maybe got into habits, maybe we're avoiding social situations, maybe we're drinking too much to numb ourselves from some of the memories. And it's harder to try and take a breath and and look after ourselves, but it's doing it because we matter.

SPEAKER_01 42:51

Yes. And I think the doing it because we matter is so true. And unfortunately, for a lot of people who've experienced trauma, they don't think they do matter. So then it's thinking, okay, it's so that I can be more present for my kids, or that I can be more present for my partner, or so that I can do my work better until we get to the point where we recognize that we're enough. All of those things that you've said are so crucial and seem so small. A lot of these things are free, and we think then, well, then it's it's not going to have a big impact. But actually, they're massive. And just really making these small changes and building on all of those things you talked about with self-care, just gradually building a layering on more and more of these practices just is life-changing. Thank you so much. So, Susanna, how can people connect with you? I'm on LinkedIn and on Instagram, Dr. Susanna Petchi. It would be yeah, it would be great for people to get in touch and to continue the conversation.

Dr Lee David 43:51

Thanks for listening to the Choice Space podcast. I hope this conversation has offered a little room for you to pause and find your way forwards. We've included links to To Susanna's website, Instagram, and LinkedIn in the show notes. If this episode has been helpful, please download and share with somebody else who might find this space supportive as well. And please do leave a rating or review on whatever podcast platform you listen on. It really does help people find our show.