Trauma-Informed Care (TIC) is a game changer for mental health and wellbeing. It acknowledges that trauma has widespread impacts on individuals that has a significant influence on mental, emotional and physical health . This article looks at the neurobiology of trauma, the principles of TIC and the evidence-based therapies that can help healing occur.
Understanding Trauma’s Impact on the Brain and Body

Trauma isn’t just an event; it’s a deep experience that changes the brain and body. Adverse experiences, especially childhood ones, can derail the development of neural pathways and keep the stress response systems on overdrive. Research has shown that our mind-body connection, otherwise known as the autonomic nervous system (ANS), is often dysfunctional in people with trauma,where hyperactivation can result in symptoms such as hypervigilance, anxiety and difficulty regulating emotions. Conversely, hypoactivation can present as symptoms including dissociation or emotional numbness .The hypothalamic-pituitary-adrenal (HPA) axis, the body’s primary stress response system is also impacted by trauma. Chronic stress can lead to HPA axis dysregulation resulting in an over or under response to stress . These neurobiological changes can show up as physical and psychological symptoms like chronic pain, fatigue, depression and anxiety. Understanding these complex dynamics is key to developing trauma informed interventions.
Defining Trauma-Informed Care: How Highlands Recovery Integrates Core Principles

Trauma-Informed Care is an organisational and systems approach that acknowledges the prevalence of trauma and aims to create safe, supportive and empowering environments. According to the Substance Abuse and Mental Health Services Administration (SAMHSA’s) a trauma-informed approach may be defined by 4 key assumptions, known as the ‘4 R’s’:
- Realise: Understanding trauma and its prevalence.
- Recognise: Identify signs of trauma across different ages, genders and settings.
- Respond: Integrating trauma awareness into policy, procedure and practice.
- Resist Re-traumatisation: Avoid prevent practices or environments that might trigger or worsen trauma for both clients and staff,
These assumptions translate into six principles:
- Safety: Physically and emotionally safe spaces for clients and staff.
- Trustworthiness and Transparency: Clear communication, consistency and ethics.
- Peer Support: Shared experiences to build connection and hope.
- Collaboration and Mutuality: Client and provider partnerships and shared decision making.
- Empowerment, Voice and Choice: Client control of treatment and recovery.
- Cultural, Historical and Gender Issues: Challenging stereotypes and gender responsive services.
By incorporating these principles into our culture and practice Trauma-Informed Care wants to create spaces that promote healing, resilience and well-being.
The Significance of Safety and Stabilisation in Trauma Treatment
Before we go deep into trauma work, we need to create a safe and predictable space where clients feel secure and supported, where we emphasise safety and stability before all else. That means clear boundaries, consistent care and teaching clients how to manage acute stress responses.
Mindfulness and grounding exercises can help clients increase awareness, and start to regulate their thoughts, feelings and behaviours. Psychoeducation about trauma and its effects can be empowering, helping clients understand what’s happening to reduce shame and self blame. A strong therapeutic alliance, with empathy, respect and trust, is key to feeling safe and the healing process.
Trauma Reprocessing Therapies: EMDR, Cognitive Processing Therapy and Prolonged Exposure Therapy
Trauma reprocessing therapies are evidence based treatments to help clients process traumatic memories and reduce symptoms. These therapies involve accessing and processing traumatic memories in a safe and controlled environment so clients can integrate the experience and reduce the emotional impact.
Eye Movement Desensitisation and Reprocessing (EMDR) is a structured therapy that involves bilateral stimulation (e.g. eye movements, tapping) while clients focus on traumatic memories. This is thought to help integrate the memories and reduce distress (Shapiro, 2017).
Cognitive Processing Therapy (CPT) is a cognitive therapy that helps clients identify and challenge negative thoughts and beliefs about the trauma. By examining and changing these cognitive distortions clients can develop more balanced and adaptive ways of thinking about the experience (Resick et al., 2017). Prolonged Exposure (PE) therapy involves repeated exposure to trauma related cues and memories in a safe and controlled environment. This helps clients habituate to the anxiety associated with the cues and reduce avoidance behaviours (Foa et al., 2007).
The modality used will be determined by a clinical team and what is most likely to work best for each individual client.
The Role of Cognitive Behavioural Therapy (CBT) in Trauma Recovery

Cognitive Behavioural Therapy (CBT) is a popular therapy that looks at changing negative thoughts and behaviours. For trauma recovery, CBT can help address some trauma symptoms such as anxiety and depression, however, some trauma-focussed adaptations to CBT are often recommended.
CBT can help clients to challenge negative beliefs about themselves, others and the world that may have developed as a result of the trauma. By identifying and changing these unhelpful thinking patterns clients can develop more helpful and positive ways of thinking. CBT also includes behavioural techniques like exposure therapy and relaxation training to help clients manage anxiety and avoid avoidance. CBT can help you take control of your recovery and develop skills for long term well being.
Integration and Reintegration: Navigating Life After Trauma Treatment
The integration phase is the key to helping clients get back into their daily home and work lives. This phase looks at the challenges clients face when they come out of intensive treatment. During this time we need to provide ongoing support and resources to help clients maintain their progress and not relapse.
Managing exposure to, or responses to triggers, building healthy relationships and working towards increasing mental resilience are key components to integration. Clients may benefit from continued individual or group therapy sessions to process ongoing challenges and reinforce coping skills. Building a support network and self-care activities are also important for long term well-being.
The integration phase is like a gentle “step down” from a fully therapeutic environment, we “hand hold” and support a gentle journey back to real life. This is a critical phase of recovery because this is where the “new normal” of healthy recovery from trauma is being tested.
Addressing Co-occurring Disorders in Trauma-Informed Treatment

People with trauma histories often have co-occurring mental health or substance use disorders. These must be addressed comprehensively and integrated. A trauma informed approach recognises that substance use or other mental health symptoms are often an attempt to cope with the effects of trauma.
Treatment for co-occurring disorders needs to address the trauma as well as the symptoms. This might mean integrating trauma focused therapies with substance use or mental health interventions. A collaborative and supportive treatment environment is key to helping clients to address these complex issues and achieve long term recovery.
Measuring Outcomes and Ensuring Quality in Trauma-Informed Services
It’s important to measure the effectiveness of trauma informed care so services are meeting client needs and achieving good outcomes. This means using standardised tools to measure changes in symptoms, functioning and quality of life.
Organisations should also have continuous quality improvement processes in place to monitor and improve trauma informed services. This might mean collecting feedback from clients and staff, analysing data on service use and outcomes and making changes to policies and practices based on that information. By continuously evaluating and improving trauma informed services, you can ensure you’re providing the best possible care.
The Future of Trauma-Informed Care: Research and Innovation
The world of Trauma-Informed Care is always evolving as new research emerges and new approaches are developed. Research is ongoing into the neurobiological mechanisms of trauma and what works.
The future of TIC may involve expanding trauma-informed services to diverse populations and settings, using technology to enhance treatment and more personalised and culturally responsive interventions. By embracing research and innovation TIC can continue to evolve and benefit individuals and communities affected by trauma.
Highlands Recovery is located near Sydney in Australia and uses a behavioural medicine model to address trauma and related disorders. The four phase program focuses on stabilising the autonomic nervous system, reprocessing trauma, getting clients back into their environment and consolidating long term recovery. With a maximum of 10 clients and a high staff to client ratio Highlands Recovery provides individualised care in an intensive residential setting.
Reviewed by: Dr. Emma Bardsley

Dr Emma Bardsley is a neuroscientist with a PhD from Oxford and a post doctorate from Auckland University, along with an undergraduate degree in Pharmacology from King’s College London. She has lectured extensively on neuroscience, physiology, and pharmacological interventions, bridging foundational research and its clinical applications. With a strong record of publications in high-impact journals and extensive experience in scientific writing, editing, and peer review, she excels at translating complex research into practical insights. Based in New Zealand and collaborating internationally, Emma is dedicated to advancing understanding and treatment in the fields of trauma, addiction, and recovery.
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