A Guide To The Five Stages Of Trauma

Traumatic events can have a significant, long-lasting, and even debilitating effect on your life. Whether you’ve experienced the loss of a loved one, physical harm, or a threatening event, trauma can be hard to deal with.

However, understanding the different stages of trauma can help you be better prepared for the road ahead and help you manage your response to trauma.

What is trauma?

Trauma refers to an emotional response to a significant, negative event. Traumatic events often include physical attack or harm, sexual assault, or wartime combat. Traumatic events can also include ones you witness rather than those that physically harm you.

Witnessing a death, experiencing grief, and being present at a terrorist attack can all be traumatic. 70%¹ of US adults will have experienced a traumatic event at least once. 

Effects of trauma

Trauma can have long-lasting, significant effects, particularly on your mental health. Reactions to trauma can be varied in their symptoms, severity, and length of time. Typical emotional responses to trauma include shock and denial. 

Other side effects can also occur from trauma, including the following:

• An outburst of emotions such as anger

• Flashbacks

• Trouble sleeping

• Feeling on high alert and worried that another traumatic event would occur

• Feelings of guilt or shame

• Engaging in reckless behavior, such as excessive drinking or speeding 

Trauma can have such an impact that it can lead to the development of physical symptoms such as the following:

• Body aches

• Muscle tension 

• Increased heart rate 

• Fatigue

• Sexual dysfunction 

Types of trauma responses

When trauma starts to go awry, we start to see the development of more harmful trauma symptoms that can require treatment to resolve them. While a bit of trauma from a terrible event is normal, people sometimes struggle to move on from the event and have their emotional response return to normal. Below are some of the more typical responses to trauma:

Resistance

With resistance, people respond to trauma without any major issues. Resistance tends to be more common in trauma that does not involve sexual abuse. 

Natural resistance

Many people who experience a traumatic event have post-traumatic stress disorder (PTSD) with symptoms in the immediate aftermath of the event. However, these symptoms disappear without any treatment intervention for those with natural resistance. 

PTSD

If the symptoms of natural resistance do not go away on their own, an individual may likely have developed PTSD. A PTSD response to trauma can have serious, negative results on your mental health, physical health, and ability to complete even day-to-day tasks. People with PTSD require treatment, which could involve talking therapy and/or medication. 

Other types of trauma disorders

Besides PTSD, other trauma disorders that can occur after experiencing a terrible event include the following:

Acute stress disorder

Acute stress disorder symptoms are similar to PTSD, except they begin almost immediately after a traumatic event and last up to one month. Acute stress disorder can resolve independently without treatment, although treatment options are available. 

Adjustment disorders

Adjustment disorders exist in response to stressful and traumatic stimuli, much like other trauma disorders. Typical symptoms include feelings of sadness, excessive crying, reduced appetite, and sleeping issues. Adjustment disorders can manifest as acute or chronic symptoms.

The five stages of trauma

Experiencing trauma can result in similar emotions to grief, including loss, despair, withdrawal, and more. The loss of a loved one can be a traumatic stressor in itself, and many traumatic events can bring on feelings of grief.

Because of the overlap between grief and trauma, it is possible that trauma can result in people experiencing the five stages of grief (also the five stages of trauma). 

Stage 1: Denial

The first stage of trauma is denial. A traumatic event can change your outlook on the world, and it can even remove people in your life and change your physical body and abilities, depending on the trauma you experience. The often overwhelming experience of trauma can therefore be the result, allowing your mind to delay thinking about the traumatic event.

Denial is the first stage of trauma because it acts as a defense mechanism that allows you to reduce the initial blow of what you experienced and give you more time to come to terms with what has happened to you.

While denial is a protective measure, this first stage won’t last forever. Eventually, you will have to face the reality of the traumatic event and the emotions and reactions tied to it.

How to deal with stage 1

Denial can be useful in keeping confronting and scary emotions and memories at bay, but it also numbs you to your real feelings and stops you from being able to connect with others. To move through the denial stage of trauma and be able to process the trauma you have experienced, you need to face what has happened to you and the realities of your experience. 

Stage 2: Anger

Once you have moved past the first stage of trauma, the realities of your terrifying experience can start to hit home, leading to the second stage of trauma—anger. 

As you experience the emotions and memories related to your trauma, anger can be a natural response. You may be angry over losing people or previous abilities or possibly angry about the injustice of your experience. Whatever the reason behind your anger, it is a common response to trauma.

Interestingly, the anger stage is also a coping mechanism, just in a slightly different way than denial. Anger allows you to overwhelm your feelings of sadness, grief, and pain, helping you mask their full effects.

Many people find that this second stage of trauma can be quite lengthy and often manifests in ways you may not expect, including the following: 

• Sarcasm

• Irritability

• Defiance and opposition

• Isolation

You may also experience more typical signs of anger, such as angry outbursts in response to stimuli that remind you of your trauma or even irrational anger at inanimate objects.

How to deal with stage 2

Therapy can be a useful way to help you understand the cause of your anger and what other emotions it may be masking. Anger can have a serious, negative impact on your personal and professional relationships. If your anger due to trauma is starting to get out of hand, you may need professional help, such as anger management therapy, to help you create better-coping strategies when feelings of anger arise. 

Stage 3: Bargaining 

The third stage of trauma is bargaining. After working through the stages of denial and anger, the real emotions tied to your trauma become clearer. These feelings can be intense and overwhelming, allowing you to see the real scale of what you have lost or what has happened to you.

When this occurs, a natural response can be to want to regain control of your situation through bargaining.

There are various ways that bargaining can manifest. You may want things to be different, pray for your trauma to be reversed, or even get lost in what-if-this-had-happened-instead scenarios. 

It can be easy to get lost in the bargaining stage as a way to postpone the reality of what has happened to you. Many people — especially those of religious backgrounds — lean heavily on religion and the powers of their deity to fix their trauma.

How to deal with stage 3

While it can be easy to distract yourself from the realities of your trauma by bargaining for change or imagining what-if scenarios, it won’t help you face your trauma and move on. If you’re in the bargaining stage of trauma, you may want to evaluate what bargaining and what-if scenarios can change. You can move away from the bargaining stage by challenging these distracting thoughts. 

Stage 4: Depression

After bargaining, the next stage of trauma is depression. The anger and bargaining stages can be quite lively, while depression moves you into a quieter and slower stage of trauma.

The depression stage comes nearly at the end of the trauma process after you have moved through the previous coping stages of denial, anger, and bargaining. Once the shields of other distracting emotions have passed, the overwhelming weight of what you have lost and the pain of what you have experienced can result in feelings of depression.

Depression can result in a variety of symptoms, including the following: 

• Feelings of sadness, hopelessness, and emptiness

• Trouble sleeping, which could include sleeping too much or not being able to sleep

• Lack of energy

• Loss of interest in things you once found enjoyable, e.g., social events, sports, hobbies)

• Anxiety and restlessness

• Feelings of guilt, blame, and worthlessness

• Changes to your appetite, such as reduced appetite or increased food cravings

• Foggy brain and slower thoughts

• Reduced reaction time and slower body movements

• Memory issues, e.g., struggling to remember everyday things

• Problems being decisive, e.g., deciding what food to eat

• Irritability, anger, or frustration with trivial matters

• Reduced libido

• Withdrawal from relationships

• Thoughts of self-harm, death, or suicide

How to deal with stage 4

Depression can have a serious, negative impact on your ability to carry out everyday tasks. If left untreated, depression, in serious cases, can even put your life at risk. Because of the seriousness of depressive symptoms, it’s important to reach out to a medical or psychiatric professional who will be able to help you decide on the best treatment option for you.

That may include therapy and/or medication. Medications used in the treatment of depression include the following:

• Selective serotonin reuptake inhibitors (SSRIs), such as Zoloft or Lexapro

• Serotonin and noradrenaline reuptake inhibitors (SNRIs), such as Effexor or Cymbalta

• Tricyclic antidepressants (TCAs), such as amitriptyline or imipramine

• Monoamine oxidase inhibitors (MAOIs), such as Nardil

• Norepinephrine and dopamine reuptake inhibitors (NDRIs), such as Wellbutrin

• Noncompetitive N-methyl-D-aspartate receptor antagonists, such as esketamine 

Stage 5: Acceptance

The final stage of trauma is a positive move toward healing—acceptance. Arrival at stage 5 of trauma means you have reached a place in your trauma reaction where you have processed and acknowledged what happened to you and are in a better place to deal with the emotions and consequences of the traumatic event. 

Acceptance seems to entail forgiving the person who hurt you or accepting what happened to you. But that isn’t the case. Instead, it means you’ve come to terms with your experience and how it has changed your life.

While reaching the acceptance stage is a positive step, it does not always feel good to be in this final stage of trauma. Acceptance of your trauma can bring moments of sadness, grief, and anger, but by reaching this point, these emotions are likely to be more manageable and put you in a better position to deal with them.

How to deal with stage 5

It’s important not to put too much pressure on yourself to be better or dive into acceptance before you are ready. Reaching acceptance of your trauma can take a long time—years in some cases—and you may move in and out of acceptance as emotions and realities hit you. 

To help yourself through the acceptance stage, it’s important to reach out for help when you need it from friends, family, or mental health professionals. You should be proud of the work you have done to reach a stage of acceptance of your trauma.

Trauma treatment options

No matter where you are in the stages of trauma, various treatment options can help you manage your symptoms. Typical treatment options largely center on psychotherapeutic and pharmaceutical options.

Psychotherapeutic options for trauma

Cognitive therapy

Cognitive therapy is talking therapy that can help you manage your thoughts and emotions related to trauma. Cognitive therapy can help you develop coping strategies to help you overcome your trauma and improve your symptoms.

Exposure therapy

Exposure therapy is a therapy treatment that is especially useful in treating anxiety. It encourages you to face the traumatic event or memory and learn to control your response to it.

This type of therapy isn’t meant to put you in a state of fear or danger but to help you overcome the emotions related to your trauma so you can better deal with them when they appear outside of therapy. Exposure therapy can be especially useful in managing nightmare or flashback symptoms.

Eye movement desensitization and reprocessing therapy (EMDR)

EMDR therapy uses a series of guided eye movements alongside exposure therapy to help you process your triggering memories. This structured therapy encourages you to focus on your trauma memory and, at the same time, participate in eye movement.

The types of eye movements used in EMDR have been associated with reduced emotion linked to trauma memories. They thus may be able to help reduce the severity of the impact of your trauma.

Medication options for trauma

Medication can also help you manage your trauma responses and is often used alongside psychotherapy. Medications that your doctor may discuss with you as treatment options for trauma include the following:

• Antidepressants (SSRIs, SNRIs, TSAs)

• Anti-anxiety medications (benzodiazepines)

• Prazosin, although research into its benefits for PTSD is mixed 

It’s important to receive medical advice on appropriate medications for trauma before starting treatment and to only take prescribed medicine. 

When to reach out for help

Regardless of which stage of a trauma you are in, if your trauma-related symptoms are starting to feel overwhelming, unmanageable, or negatively impact your life, you should consider reaching out to a doctor or mental health professional.

If your trauma symptoms aren’t improving and have been present for longer than a month, you may be experiencing the early stages of a trauma disorder.

If you are having thoughts of self-harm or suicide, reach out to emergency services immediately. 

The lowdown

The stages of trauma are a graded defense mechanism that allows you to eventually reach a point of accepting the trauma you have experienced. If you’re struggling with any of the five stages of trauma, there are coping mechanisms and treatment options available. Be sure to reach out to friends, family, and medical professionals if you feel like you need help or support in dealing with your trauma.