{"id":63911,"date":"2025-06-19T11:27:16","date_gmt":"2025-06-19T17:27:16","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=63911"},"modified":"2025-07-07T12:22:31","modified_gmt":"2025-07-07T18:22:31","slug":"trauma-is-a-leading-mental-health-challenge","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/trauma-is-a-leading-mental-health-challenge\/","title":{"rendered":"Trauma is a leading mental health challenge that tests both mind and body\u00a0\u00a0"},"content":{"rendered":"
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Trauma and stress-related mental health disorders require specialized treatment to prevent long-term problems. Photo: Getty Images.<\/figcaption><\/figure>\n

Millions of people of all ages face roadblocks to health such as depression, anxiety, sleep disturbances, eating disorders and other stressors that can make everyday life difficult and sometimes debilitating.<\/p>\n

One of the most important of these challenges is trauma: a reaction to a highly stressful event<\/a>, like a serious accident, disaster, or death. Many of the sources of trauma have long been with us: wars, natural disasters, varieties of abuse and gruesome accidents among them.<\/p>\n

For a better understanding of what trauma is, how it affects people and how to treat it, we spoke with Dr. Steven Berkowitz<\/a>, professor of Psychiatry at the University of Colorado School of Medicine<\/a>. Berkowitz directs CU\u2019s START Center<\/a>, which is staffed by a clinical team<\/a> that aims to provide \u201coptimal treatment for people of all ages suffering from the effects of loss, trauma, chronic stress and adversity.\u201d<\/p>\n

\"Dr.
Dr. Steven Berkowitz directs the CU Department of Psychiatry\u2019s START Center, which specializes in treating trauma- and stress-related mental health disorders. Photo by University of Colorado.<\/figcaption><\/figure>\n

From a psychological perspective, what is trauma?<\/strong><\/h2>\n

The word itself comes from the Greek for \u201cwound\u201d or \u201cinjury,\u201d Berkowitz said. A trauma, therefore, is a person\u2019s reaction to an event, not the event itself.<\/p>\n

\u201cOne way we talk about what we mean by trauma is that it\u2019s an injury that is caused by an experience or experiences that results in a negative change in functioning,\u201d Berkowitz said.<\/p>\n

A person traumatized by surviving a mass casualty event, for example, might suffer recurring bouts of fear and paralyzing anxiety, while another who experienced the same event may be able to integrate the disruption and return to their normal activities.<\/p>\n

Do events around the world, scary news or financial challenges increase stress for people with traumatic injuries?<\/strong><\/h2>\n

Berkowitz said he and his colleagues hear from more people when scary news or life challenges from pandemics to financial difficulties increase, but trauma is more complex.<\/p>\n

\u201cThere are so many stressors in the world,\u201d he said. \u201cI think what people are talking about is this general, ongoing, cumulative and unrelenting stress. These stressors have made people feel like they are not functioning like they did before the pandemic.\u201d<\/p>\n

How does post-traumatic stress disorder (PTSD) fit into the picture?<\/strong><\/h2>\n

Berkowitz stressed that a PTSD diagnosis relies on a specific set of criteria<\/a> laid out in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or DSM-5. These include \u201cexposure to actual or threatened death, serious injury, or sexual violence,\u201d accompanied by reactions like avoidance, negative changes in mood, hypervigilance, difficulty thinking, or reckless behavior, among many others. The reactions last at least one month. The disturbances also must \u201csignificantly impair\u201d a person\u2019s social life and occupation and other important areas of daily activity.<\/p>\n

If my symptoms don\u2019t meet the criteria for a PTSD diagnosis, does that mean I haven\u2019t suffered trauma?<\/strong><\/h2>\n

No. Trauma and repeated stress can cause many other disruptive mental and behavioral issues, including depression, anxiety and substance use disorders, Berkowitz said. The key point for providers is to diagnose not only the specific disorder, but also to identify the source of the trauma or stress and the effects these pressures have on a person\u2019s life.<\/p>\n

\u201cAt the START Center, we develop an assessment based on major stressors, and for PTSD, anxiety, depression and many other factors, including substance use disorders,\u201d Berkowitz said. \u201cWe know that all these disorders can be caused by stress and trauma.\u201d<\/p>\n

How are trauma- and stress-related mental health disorders treated?<\/strong><\/h2>\n

For PTSD, Berkowitz said, \u201ca host\u201d of recommendations by the American Psychological Association<\/a> that include variations of cognitive therapy and other approaches, as well as anti-depressant medications, generally work well. These approaches may also help to treat anxiety and depression<\/a>. However, he added that people suffering trauma-related disorders might face other challenges, such as poverty, lack of access to care, difficult family situations and other social determinants of health, that must be addressed.<\/p>\n

\u201cWe know that people who have had complex trauma and had [mental health disorder] episodes throughout their lifetimes typically have other problems and are harder to treat,\u201d Berkowitz said.<\/p>\n

Are new treatment methods being studied?<\/strong><\/h2>\n

Yes. Berkowitz said that standard therapies don\u2019t work well for a \u201csignificant number\u201d of PTSD patients. \u201cOther interventions are being explored,\u201d he said. These include psychedelic drugs, such as psilocybin<\/a> and ketamine. \u201cWe are actively working on that\u201d and exploring approaches to body therapy, such as therapeutic massage, yoga, and breathing techniques, he said.<\/p>\n

The sources of trauma are so varied. What is the START Center’s fundamental method in approaching each person\u2019s experience?<\/strong><\/h2>\n

\u201cWe believe that traumatic exposures and reactions are all too common and probably represent the majority of patients who request psychiatric treatment,\u201d Berkowitz said. He noted that a majority of adults have a history of childhood trauma and maltreatment<\/a>, which makes it imperative to take a \u201clifespan approach\u201d to working with patients of all ages.<\/p>\n

\u201cThere is no question that our treatments need to be individualized to each patient,\u201d he emphasized. \u201cWe meet everybody where they are at and meet with each other regularly to discuss how best to do it.\u201d<\/p>\n

Given that each person\u2019s circumstance is different, are there some underlying principles you apply to treating trauma?<\/strong><\/h2>\n

Yes. \u201cThere are some universals,\u201d Berkowitz said. These start with \u201cgrounding\u201d patients. That means helping them \u201crecognize where they are in time and space\u201d and keeping their perceptions in the \u201chere and now\u201d rather than retreating to memories of \u201ccatastrophic events\u201d about the past or projecting negative thoughts into the future, he said.<\/p>\n

Therapists at the START Center also concentrate on helping patients decrease their stress and the physical symptoms it produces with effective breathing. Berkowitz said mindful breathing helps to engage the parasympathetic nervous system, which regulates the body during periods of rest and calm. It\u2019s the counterpart to the sympathetic nervous system, which takes hold during times of stress and releases hormones like adrenaline and cortisol. The results, like increased heart rate and arousal, are obviously counterproductive for a person struggling with PTSD and other trauma-related disorders.<\/p>\n

Finally, the center works to engage patients\u2019 families in therapy, Berkowitz said. \u201cI think one of the things that we do poorly in the mental health field generally is we don\u2019t help to work on the \u2018microsystem\u2019 that they live in. If a patient\u2019s support system isn\u2019t part of the treatment, it\u2019s unlikely that the person is going to be able to fully recover \u2013 even if it\u2019s not a toxic environment.\u201d For example, Berkowitz said, a patient\u2019s family might not be hostile to their struggle with trauma but \u201cjust not get it,\u201d leaving them unable to provide much positive support.<\/p>\n

What about professionals who experience stress and trauma? Is there support for them?<\/strong><\/h2>\n

Yes. Berkowitz noted that the University of Colorado Department of Psychiatry created the Past the Pandemic program to help clinicians cope with the ever-present pressures of health care delivery that the COVID-19 pandemic ramped up to even higher levels. The department also launched the Colorado Educator Support initiative to assist teachers, administrators and other school workers dealing with the disruption and uncertainty caused by the pandemic.<\/p>\n

Can trauma-related and other mental health disorders be linked to medical problems?<\/strong><\/h2>\n

Yes. Berkowitz pointed to the landmark 1998 Adverse Childhood Experiences (ACE) study<\/a>, which concluded that adults who were exposed in childhood to varieties of abuse, violence and mental illness were more vulnerable as adults to leading causes of death, including heart, lung and liver disease.<\/p>\n

\u201cWe know that people with PTSD have high rates of cardiovascular disease, high blood pressure, breathing problems and sleep apnea,\u201d Berkowitz added.<\/p>\n

Why is this so? The answer \u2013 at least in part \u2013 goes back to the sympathetic nervous system and its effects on the rest of the body.<\/p>\n

\u201cOne way I explain it simplistically is our physiology responds to potential threats of injury \u2013 regardless of whether the danger is physical or psychological \u2013 in the same way,\u201d Berkowitz said. That response, simplified as \u201cfight or flight,\u201d is a necessary short-term survival reaction. But if the body\u2019s danger light stays on frequently or permanently, the stress can be damaging on many fronts, including the immune system.<\/p>\n

\u201cThe stress response occurs whether you get sick or you are psychologically exposed,\u201d Berkowitz said. \u201cWhen you have a disorder like PTSD, where you are constantly in a dysregulated stress state, you\u2019re dysregulated in your entire body. This can result in a wide range of chronic illnesses.\u201d<\/p>\n

What are the long-term ramifications of trauma- and stress-related mental health disorders?<\/strong><\/h2>\n

Berkowitz pointed to the knotty connections between mental health and medical problems he described above. He also noted the Dunedin Study<\/a> from New Zealand, which has tracked 1,000 infants born in the city of the same name in 1971 and 1972. The study, which recently marked its 50th<\/sup> anniversary, has produced mountains of research, including a 2009 report<\/a> suggesting that individuals who endured adverse childhood events were at higher risk for \u201cage-related disease.\u201d<\/p>\n

Berkowitz also noted that a new Dunedin study<\/a>, released 2022, found that adverse childhood events were a predictor of vaccine hesitancy and resistance and thus a contributor to the defining public health challenge of our time. The authors believe that mistrust of authority, built up by early episodes of mistreatment and abuse, explains the possible link.<\/p>\n

In the long run, Berkowitz said, the key to mitigating trauma- and stress-related disorders is building healthier communities that recognize the importance of mental health and address questions about it openly.<\/p>\n

\u201cHow do we create more resilient and cohesive people and not wait until they are symptomatic to help them?\u201d he said. \u201cWe are not going to treat our way out of this crisis.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

  Millions of people of all ages face roadblocks to health such as depression, anxiety, sleep disturbances, eating disorders and other stressors that can make everyday life difficult and sometimes debilitating. One of the most important of these challenges is trauma: a reaction to a highly stressful event, like a serious accident, disaster, or death. […]<\/p>\n","protected":false},"author":2143,"featured_media":83938,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[6],"tags":[113,3479,3654,9187,851],"class_list":["post-63911","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-healthy-living","tag-behavioral-health","tag-counseling-services","tag-outpatient-psychiatric-services","tag-readysetco","tag-trauma"],"acf":[],"yoast_head":"\nTrauma is a leading mental health challenge - UCHealth Today<\/title>\n<meta name=\"description\" content=\"May is Mental Health Awareness Month. 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