In this appendix we have included tools and websites for healthcare professionals. We have also included a section about trauma informed language given the potential of the words we use to be trauma inducing or trauma reducing. Click here for a pdf download of this appendix.

Tools

  • APA Professional Practice Guidelines for Working with Adults with Complex Trauma Histories (2024) - This resource contains seven guidelines for treating complex trauma and prioritize the question “What happened to you?” rather than “What’s wrong with you?”

  • Enhanced skills training in affective and interpersonal regulation (ESTAIR): A new modular treatment for ICD-11 Complex Posttraumatic Stress Disorder (CPTSD).  Karatzias et al. (2023). This article presents Enhanced Skills Training in Affective and Interpersonal Regulation (ESTAIR), a new flexible multi-modular approach for the treatment of CPTSD and its transdiagnostic symptoms. ESTAIR is consistent with trauma-informed and patient-centered care, which highlights the importance of patient choice in identification and sequencing in targeting CPTSD symptoms. https://www.mdpi.com/2076-3425/13/9/1300 

  • “What Lies Beneath: Navigating the Hidden Depths of Complex Trauma” with Dr. Smart - https://continuingstudies.uvic.ca/humanities-social-sciences-and-law/series/deans-lecture-series/what-lies-beneath.  

  • The CARE Method of Screening for ACEs: How and Why to Ask Adult Patients about Childhood Adversity - https://www.youtube.com/watch?v=fc7NBdCYUAE. In this video, Dr.s Maunder and Hunter from Mount Sinai in Toronto, Canada present the CARE method of putting patients at ease and asking them about any history of childhood trauma. 

  • Trauma-Informed Physical Examinations: A Guide for Service Providers, Canadian Public Health Association - trauma-informed-exam-tool-e.pdf.  This tool provides a framework for conducting physical examinations that involves using language and maneuvers to communicate respect and a sense of safety, autonomy, and trust.

  • The International Trauma Questionnaire (ITQ) - https://traumaticstress.nhs.wales/workstreams/data-set-downloads/itq-english/. “The ITQ is a brief, simply worded measure of the core features of PTSD and CPTSD. It is consistent with the organizing principles of the ICD-11 to maximize clinical utility and international applicability through a focus on a limited but central set of symptoms.” (Cloitre et al., 2018). 

  • Glossary: An excellent glossary relating to complex trauma at the website “Complex Trauma Resources” - https://www.complextrauma.org/glossary/

  • Glossary: Another glossary related to complex trauma at the website “Out of the Storm” - https://www.outofthestorm.website/cptsd-glossary 

Websites

  • Blue Knot: Empowering Recovery from Complex Trauma - Blue Knot Foundation. This comprehensive Australian website has resources for both professionals and survivors, and information about the following: Understanding Trauma and Abuse; Coping Strategies, Impacts and Healing; Building a Trauma-Informed World; Facts and Figures.

  • The Complex Trauma Institute (CTI) - https://www.complextraumainstitute.org/. The CTI is committed to empowering professionals working with traumatised individuals through somatic, neurobiological, systemic, and community-based approaches that foster recovery within relationships and communities.

  • [US] National Institute for the Clinical Application of Behavioral Medicine Trauma-Informed Care (NICABM) - Why Is Providing Trauma-Informed Care Critical for Your Patients?  This article includes six principles of trauma-informed care that assist clinicians to effectively recognize and respond to the signs and symptoms of trauma. NICABM has many other articles related to trauma such as “Treating Trauma with Compassion-Based Therapies” and "How the Nervous System Responds to Trauma.” See https://www.nicabm.com/.

  • Complex Trauma Resources – Resources for Survivors and their Helpers. A curated collection of books, videos, articles and more to educate consumers, caregivers and professionals about Complex Trauma. Funded by The Foundation Trust and overseen by Executive Director Dr. Joseph Spinazzola.

Trauma Informed Language

The words we use in speaking or writing can acknowledge people's experiences and set the tone for a positive relationship, or they can convey bias, discrimination or judgement. It is important, therefore, to be mindful of the potential impact and underlying meanings of the words we use. In healthcare when working with people who have a history of trauma it is essential to reduce harm and promote inclusion and safety. Negative language stigmatizes, contributes to health inequities, and can cause avoidance of healthcare. Using accessible, affirming, and inclusive language can reduce discrimination in healthcare settings and support equity by ensuring trauma patients have fair access to opportunities for a healthy life.

For example, the use of the word “disorder” in the diagnosis complex PTSD rankles many survivors who do not want to be seen as disordered or mentally ill. Two examples of less stigmatising words would be “injury” or “response” as these capture the fact we were hurt at the hands of others and the symptoms we develop are natural responses to an abnormal situation. As Rosenthal et al (2016) note, this a more positive, humanistic approach results in better care for trauma patients/clients:

…a shift from pathology to expectable reactions, from disorder to relationship, from an approach highlighting the difference between therapist and sufferer to one emphasizing our common humanity. We offer it in the hope that we can continue to come together in compassion and unity, seeing those who have been betrayed and traumatized as whole human beings rather than as victims with disorders.

Another example in which language reflects a much needed change is the shift from asking patients “What’s wrong with you?” to “What happened to you?” 

When you look at us as fellow human beings who were injured by others, and at our symptoms and comorbidities as helping us to survive traumatic abuse and neglect. This is more than just a semantic shift; it is also a shift in perception and dare we say heart that will carry over into how you treat us, a change we welcome wholeheartedly.  

Here are some links to articles and guides that will help with understanding and using trauma informed language: