**3. Trauma in CCC**

This section will take a more CCC adherent definition of trauma. The therapy is founded on felt sense; how the individual manages their subjectively experienced internal state. This is impacted by trauma in the present because of the way the threat system operates across time. What is significant here is the individual perception and experience of threat. Frequently, this originates in an identifiable trauma, such as child abuse, rape, violent relationship etc. However, it is not always possible to pinpoint its origin so precisely. Memory is impacted by such circumstances. Family and other interpersonal dynamics that would not be identified objectively as constituting trauma can be experienced at a level of acute threat, particularly allied to individual sensitivity. CCC judges trauma by current presentation; disproportionate response to events in the current environment evidences triggering of earlier experience that has sometimes become hazy or lost to consciousness. Validating the likelihood of this explanation is the first step to someone being able to take responsibility for distancing themselves from threat driven reactivity.

A total number of (n = 32) participants were recruited into the Culture Free study as per study protocol. However, the majority of the participants had suffered earlier adversity that impacted on their current functioning as identified within the formulation, and many of these fell within or near the category of Complex Trauma, that is included in the (draft) ICD 11 (but not DSM V). ICD-11 CPTSD includes the three PTSD clusters and three additional clusters that reflect 'disturbances in self-organization' (DSO): (1) affective dysregulation (AD), (2) negative self-concept (NSC), and (3) disturbances in relationships (DR). These disturbances are proposed to be typically associated with sustained, repeated, or multiple forms of traumatic exposure, including childhood sexual abuse and severe domestic violence, represented in some of this sample, reflecting loss of emotional, psychological, and social resources under conditions of prolonged adversity [57]. It is the effects as opposed to the originating circumstances that are treated in the current study.

#### **3.1 How Trauma activates the body's threat system across time**

An important element of CCC is communication and motivation, so that a way of presenting the interference of past trauma in current functioning that is both true to the facts, easily graspable and translates into practical management is key. There are two fundamental processes that need to be understood and communicated relevant to response to trauma. One is the autonomic arousal response, mediated by the parasympathetic nervous and poly vagal systems. The other is the singular nature of trauma memory.

To start with memory, dual processing models of human cognition provide a straightforward way of understanding the phenomenon of involuntary and immediate trauma recall. Brewin [58] reviews studies of animal conditioning and concludes: 'This evidence points to an important distinction between hippocampally-dependent and non-hippocampally-dependent forms of memory that are differentially affected by extreme stress.' This leads to the identification of separate memory systems underlying vivid re-experiencing versus ordinary autobiographical memories of trauma. Brewin [58] refer to these as verbally accessible memory (VAMS) and situationally accessible memory (SAMS). The differential effect of stress elucidates the facilitation of access to SAMS through high arousal states in the present. Ehlers & Clark [59, 60] incorporate the same sort of distinction into their widely adopted model of PTSD, using Roediger's [61] distinction between conceptual and data-driven memory processing, to explain this phenomenon of re-experience of past events.

Since that time, there has been extensive investigation of the nature and precursors of such intrusive memories, often using analogue studies of individuals shown traumatic film under various conditions. The wider role of hormones, including stress hormones and more precise information about the areas of the brain involved through use of fMRI images have been studied [62].

As well as featuring in time violating, intrusive memory, trauma disrupts the autonomic nervous system, leading to sensitization to perceived threat, and heightened vulnerability. This is aversive, and so in turn leads to avoidance, both of an ever generalising pool of triggers and reminders, and of close relationship, which disrupts the very sources of support people normally rely on. Early and repeated trauma, leading to overactive cortisol production, leads to lasting disruption to these systems [63].

#### *Culture Free CBT for Diverse Groups DOI: http://dx.doi.org/10.5772/intechopen.93904*

As well as the heightened atunement to threat this represents, dissociation; involuntary mental absence; is another result of trauma. Physically this can be traced to the poly vagal response to extreme trauma; the freeze response. This has the additional effect of shutting off the affiliative arm of the poly vagal system [64].
