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Trauma-Sensitive Research for User Researcher

Introduction

In a dim room, a faint chill brushes against my skin. The eerie silence is only broken by the distant hum of an air conditioner. My heart, usually steady, starts racing, echoing in the stillness. My palms are clammy, and a shiver races down my spine. I attempt to speak, but words betray me and stick in my throat.

This is the territory of an activated nervous system, a scene of instinct overriding reason, in which the body narrates the tale of trauma in a language beyond words.

Figure 1: Brain activity. (Credit: Adimas@Adobe Stock)

As a full clinical member of the UK Council for Psychotherapy with a specialization in trauma treatment, I’ve seen how trauma unfolds. Thousands of clinical hours and postgraduate training in contemporary trauma practice and Eye Movement Desensitization and Reprocessing (EMDR) have deepened my understanding of trauma’s impact on people. The term trauma-informed research, which I came across in October 2022, propelled me to bridge the discourse between trauma and research settings. This article, built on my dual roles in clinical psychotherapy and user research, aims to dispel common misconceptions by spotlighting the necessity of a trauma-informed lens in research settings, particularly when interacting with potentially traumatized research participants.

To understand trauma and its implications on research, let’s first look at some foundational theories.

Trauma Theory in Brief

The domain of trauma-informed care traces its roots to Judith Herman’s seminal work, Trauma and Recovery (Herman 1992). Herman describes understanding trauma’s profound effects, empowering survivors, and refining support mechanisms with this knowledge. Numerous scholars in the trauma field frequently acknowledge Herman’s foundational work (Levine 1997; Rothschild 2000; Levine 2010; Porges 2011; Ogden 2015; van der Kolk 2014; Fisher 2017; Schwartz and Sweezy 2019), which underscores the enduring relevance of her contributions to contemporary trauma practices.

The Profound Effects of Trauma

Trauma is typically triggered by stress that surpasses our capacity to cope or process the affiliated emotions. A single event or continuous exposure to distressing circumstances (Herman 1992) like violence, neglect, loss, marginalization, disaster, warfare, or accidents can cause trauma. Much like a physical injury, trauma embeds itself deeply within our physiological framework. Our bodies tend to retain memories of traumatic events, often activated by sensory experience: Sounds, smells, or touch linked to the original trauma can evoke profound bodily responses.

The Five F’s: Fight, Fight, Freeze, Fawn, Friend

The core mechanism orchestrating these responses is our nervous system, a sophisticated electrical network designed to instinctively react to threats. Upon detecting danger, it catapults us into a heightened state of alertness for self-preservation, commonly termed the “fight or flight” response (Siegel 1999). Furthermore, individuals may exhibit a freeze response (Bracha 2004) when resistance or escape seems futile, a fawn response (Walker 2013) involving appeasing behaviors during complex trauma scenarios, or a “tend and befriend” response (Taylor et al. 2000) that seeks social connections to mitigate stress.

Dissociation

Pierre Janet introduced the concept of dissociation into psychiatry during the late 19th and early 20th centuries (Spitzer et al. 2006), articulating it as a psychological defense mechanism against overwhelming circumstances, although mentions of the concept had existed prior in philosophical and medical discourses. Dissociation creates a disconnection within an individual’s consciousness, perception, memory, and identity; it often emerges as a coping mechanism during traumatic events to create mental distance from distressing realities.

Secondary Traumatic Stress: Vicarious Trauma

Secondary trauma, also referred to as vicarious trauma (McCann and Pearlman 1990), is a phenomenon that stems from empathetic engagement with traumatic narratives or materials. It’s notably prevalent among professionals like researchers, therapists, and social workers who interact closely with trauma survivors (Pearlman and Saakvitne 1995). Such engagement can trigger symptoms akin to those experienced in direct trauma, including heightened anxiety and emotional numbness (Baird and Kracen 2006). Recognizing vicarious trauma entails a vigilant observation of subtle emotional and behavioral shifts, which highlights the critical role of self-awareness and professional consultation to navigate indirect trauma encounters. The potential for vicarious trauma necessitates the integration of self-care techniques alongside stress management strategies (Trippany, Kress, and Wilcoxon 2004).

Trauma Sensitivity in Research Sessions

User researchers excel at observing human behavior to grasp the user-product relationship. They are often empathic, intuitive, and bright. However, these skills alone, although helpful, may not suffice when encountering trauma in a research session. The profound and embodied impact of trauma on affected individuals, along with the potential for vicarious trauma, should not be underestimated. While the Dunning-Kruger effect (Kruger and Dunning 1999) is well-known among researchers, it highlights the risk of overestimating one’s competence when facing trauma, underscoring the importance of trauma-informed approaches in user research.

Figure 2: A 3D illustration of the human brain (Credit: Jezper@Adobe Stock).

Preparation, Supervision, and Skills Practice

Trauma-informed research begins from the outset—crafting a research brief and developing recruitment screeners—and it extends through facilitating the research and reporting the findings. A clinical supervisor’s support can be invaluable to identify potential pitfalls. In clinical settings, supervision entails a seasoned professional guiding a less experienced one to ensure quality service. This support is often missing in non-clinical research settings dealing with trauma, which creates gaps in preparation, risk assessment, safeguarding, and ongoing guidance. Bridging this gap with supervision, either from clinical professionals or peer networks—alongside honing key skills on power dynamics, consent, confidentiality, and trauma recognition and interventions—significantly uplifts the ethical integrity and safety of research processes to provide a supportive environment for both participants and researchers.

Negotiating Consent and Limits to Confidentiality

The emphasis on consent, particularly in trauma-sensitive research, addresses the power imbalances and control issues often faced by trauma survivors. Consent practices strive to empower participants with autonomy. Informed consent transcends procedural formality, laying the groundwork for ethical engagement. During consent discussions, clear explanations of the research, confidentiality limitations, and the option to slow down or pause if distress arises, cater to participant well-being.

Here is an example of seeking consent, slowing down, or pause:

Researcher: Before we begin, I’d like to go over some processes we have in place to ensure your comfort and well-being during the session. Is it okay if we talk about that briefly?

Participant: Yes, that’s fine.

Researcher: Thank you. Sometimes, when we discuss certain topics, it’s possible that it may bring up difficult feelings or memories. In those moments, I would like to slow down our conversation and potentially pause for a moment to ensure you are comfortable. Would that be all right with you?

Participant: Yes, that’s ok.

Researcher: Thank you. Please feel free to let me know if there are any specific topics you would prefer not to discuss. It’s always okay to choose not to answer questions or to stop this interview if the questions cause any discomfort or stress.

Participant: I appreciate that. Thank you.

Critical Skill: Interrupting the Trauma Narrative

Trauma survivors often seek justice by sharing their experiences, yet retelling trauma can heighten distress. Contrary to the norm of empathetic listening, interrupting the trauma narrative is a critical clinical skill, delicately steering dialogue away from graphic details and prioritizing psychological safety. Since trauma is embodied, direct queries on feelings can reinforce re-experiencing. Interruptions aim to slow the pace and help participants re-anchor in the present. Consent to interrupt ensures balance between acknowledgment and psychological well-being.

Here is an example of halting the trauma narrative:

Participant: “It was just a regular day, you know, I was on my way to work. I remember I had just stopped at a red light and then… I heard this loud crash, and everything just… just…”

Researcher: “May I stop you for a moment?”

Participant: “Uh… sure, yeah.”

Researcher: “I want to acknowledge the significance of this experience and express my gratitude for your willingness to share it. It’s important to keep in mind that recounting difficult events can be distressing. May I suggest taking a moment to focus on something else?”

Late interruption can escalate distress, triggering a 5F response or dissociation in participants, and vicarious traumatization in researchers. Despite the unease in interrupting, early intervention is preferable in trauma narratives, prioritizing safety over discomfort. Honing skills through practice is essential to gain comfort in navigating such sensitive interruptions, ensuring a balance between empathic engagement and the psychological safety of all involved.

Anchoring in the Present

In trauma therapy, clients may find themselves overwhelmed, especially early on. During such times, practitioners need to remain grounded, helping clients reconnect with the present. Sensory input activating the prefrontal cortex, responsible for information processing, proves effective. Engaging in sensory activities like touch, sound, or smell can aid in grounding the participant, with consent being a prerequisite before initiating these activities.

Here is an example of anchoring in the present:

Researcher: [continuing from the previous vignette] May I suggest taking a moment to focus on something else?

Participant: Yes, please.

Researcher: What is your favorite color?

Participant: Blue.

Researcher: Could you find three blue objects in the room that you like and describe them to me?

Engaging visual senses by surveying the room helps reorient individuals to the present. Describing objects activates the cognitive brain, aiding the participant’s return to their window of tolerance. Extending this technique to other senses like touch, smell, and taste provides further grounding opportunities, which promotes a sense of safety.

Post-Session Support for Participants and Researchers

Effective post-session support ensures the well-being of participants and researchers. Preparing comprehensively for participant needs, like offering additional support contacts, fosters a safe space post-session. Researchers, too, need support to process encounters, mitigate potential vicarious trauma, and reflect on experiences. Supervision or peer support sessions can be instrumental in this. Prioritizing post-session support enhances sensitivity in the research process, acknowledges the trauma exposure impact, and promotes long-term well-being for everyone involved.

Support Matters

I described key steps for handling trauma-sensitive research, highlighting the need for a tailored approach given trauma’s complexity. It’s clear that clinical supervisory support, currently missing in non-clinical research settings, is crucial for researchers working with vulnerable groups, both for participant well-being and to reduce vicarious trauma risks. How can researchers tackle trauma in sessions without vital support, skills, and training? Through ongoing learning, ethical practice, and a humble approach that recognizes our knowledge limits, we all can approach trauma-informed research thoughtfully and safely to ensure everyone’s well-being.

References

Baird, Katie, and Amanda C. Kracen. 2006. “Vicarious Traumatization and Secondary Traumatic Stress: A Research Synthesis.” Counselling Psychology Quarterly 19 (2): 181–188. https://doi.org/10.1080/09515070600811899

Bracha H. Stefan. 2004. “Freeze, Flight, Fight, Fright, Faint: Adaptationist Perspectives on the Acute Stress Response Spectrum.” CNS Spectrums 9 (9): 679–685. https://doi.org/10.1017/s1092852900001954

Fisher, Janina. 2017. Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation. New York: Routledge.

Herman, Judith Lewis. 1992. Trauma and Recovery: The Aftermath of Violence. New York: Basic Books.

Kruger, Justin, and David Dunning. 1999. “Unskilled and Unaware of It: How Difficulties in Recognizing One’s Own Incompetence Lead to Inflated Self-Assessments.” Journal of Personality and Social Psychology 77, 1121–1134. https://doi.org/10.1037/0022-3514.77.6.1121

Levine, Peter. 2010. In an Unspoken Voice. Berkeley: North Atlantic Books.

Levine, Peter. 1997. Walking the Tiger: Healing Trauma. Berkeley: North Atlantic Books.

McCann, I. Lisa, and Laurie Anne Pearlman. 1990. “Vicarious Traumatization: A Framework for Understanding the Psychological Effects of Working with Victims.” Journal of Traumatic Stress 3, 131–149. https://doi.org/10.1007/BF00975140

Ogden, Pat, and Janina Fisher. 2015. Sensorimotor Psychotherapy: Interventions for Trauma and Attachment (Norton series on interpersonal neurobiology). New York: W. W. Norton & Company.

Pearlman, Laurie Anne, and Karen W. Saakvitne. 1995. Trauma and the Therapist:  Countertransference and Vicarious Traumatization in Psychotherapy with Incest Survivors. New York: W. W. Norton & Company.

Porges, Stephen W. 2011. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. New York: W. W. Norton & Company.

Rothschild, Babette. 2000. The Body Remembers. New York: W. W. Norton & Company.

Schwartz, Richard C., and Martha Sweezy. 2019. Internal Family Systems Therapy. New York, London: Guilford Press.

Siegel, Daniel J. 1999. The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are. New York: Guilford Publications.

Spitzer, Carsten, Sven Barnow, Harald J. Freyberger, and Hans Joergan Grabe. 2006. “Recent Developments in the Theory of Dissociation.” World Psychiatry 5 (2): 82–86.

Taylor, Shelley E., Laura Cousino Klein, Brian P. Lewis, Tara L. Gruenewald, Regan A. R. Gurung, and John A. Updegraff. 2000. “Biobehavioral Responses to Stress in Females: Tend-and-Befriend, Not Fight-or-Flight.” Psychol Rev 107 (3): 411–429. https://doi.org/10.1037/0033-295x.107.3.411

Trippany, Robyn L., Victoria E. White Kress, and S. Allen Wilcoxon. 2004. “Preventing Vicarious Trauma: What Counselors Should Know When Working With Trauma Survivors.” Journal of Counseling & Development 82 (1): 31–37. https://doi.org/10.1002/j.1556-6678.2004.tb00283.x

van der Kolk, Bessel A. 2014. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. London: Penguin Books Ltd.

Walker, Peter. 2013. Complex PTSD: From Surviving to Thriving: A Guide and Map for Recovering from Childhood Trauma. Lafayette: Azure Coyote Publishing.

After a two-year research hiatus during the pandemic, when Ayhan Alman served as a psychotherapist in Spain, he returned to find the landscape of the research profession significantly altered by the collective trauma of the pandemic. In 2022, Alman encountered the term "trauma-informed research" for the first time, which echoed persistently in community meetings and beyond. As a researcher who also happens to be a clinician with specialization in trauma, Alman learned a crucial lesson: Intuition and common sense alone are insufficient when dealing with trauma. A deep understanding of trauma is imperative to navigate this complex field. Alman holds an MSc in Gestalt Psychotherapy from Middlesex University, with further training in contemporary trauma practice and EMDR. He is also the co-editor and co-author of Queering Gestalt Therapy: An Anthology on Gender, Sex & Relationship Diversity in Psychotherapy, published by Routledge in March 2023.

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