When Trauma Symptoms Escalate: A Clinical Perspective on Trauma Triggers, Trauma Care, and Support
Trauma doesn’t always show up immediately after a difficult experience. For many people, symptoms can resurface months—or even years—later, often during times of stress, transition, or emotional strain. What once felt manageable may suddenly feel overwhelming, leaving people unsure what’s happening or where to turn next.
To better understand why trauma symptoms can escalate over time, and when a higher level of trauma care may be helpful, we spoke with Natalie Gela, PhD, Trauma Program Director at Compass Health Center – Northbrook. In this conversation, Dr. Gela shares insights on common trauma triggers, how to tell the difference between a lapse and a relapse, and why stabilization and support matter—especially when trauma processing hasn’t been possible yet.
This interview has been lightly edited for grammar and clarity. The speaker’s original meaning and intent have not been changed.
Q&A
When trauma symptoms escalate
Britt Teasdale: Dr. Gela, thank you so much for meeting with me today. We’re excited to speak with you about trauma and what to do when symptoms feel unmanageable. I want to jump right in: if someone has experienced trauma and is struggling, what does it mean when those symptoms seem to escalate?
Natalie Gela, PhD: That can mean a number of things. Someone who experienced a traumatic event(s) in the past and was coping effectively for a period of time may experience a stressor(s) that leads to new symptoms. It could be the case that they experienced symptoms in the past, however the experience of the stressor(s) causes symptoms to increase. Those could be symptoms consistent with more of a post-traumatic stress presentation, perhaps even reaching the threshold of clinically significant posttraumatic stress disorder or PTSD. Those could be symptoms more indicative of anxiety or depression. We tend to see people show up for treatment when these symptoms are severe enough that someone’s daily functioning is impaired in important life domains such as work, school, their relationships, and their self-care.
Lapse vs. relapse: when it may be time for more support
Britt Teasdale: How would you differentiate between someone having a hard week—maybe they’ve done treatment in the past and had their symptoms under control—and more sustained, elevated symptoms where they might need more support? Could you give a real-life example of what that could look like?
Natalie Gela, PhD: This brings to mind the concept of lapse versus a relapse. A lapse means someone is aware that they’ve experienced a decline or that they’re in distress. They notice they’re able to use skills and pick themselves back up—returning to whatever that new baseline was that they established from treatment, where they did feel like they were functioning more effectively. Versus a relapse where we are really struggling. Maybe we don’t feel like we can access skills, and/or we’re trying to access skills and we’re still not noticing any shift in those exacerbated symptoms. If we are noticing this for a sustained period of time, or at an intense enough level that it’s significantly impacting our functioning across important areas of life, it might be a time to seek a higher level of care.
Why trauma symptoms can worsen long after an event
Britt Teasdale: Why is it that symptoms can worsen long after someone has experienced trauma?
Natalie Gela, PhD: One of the things we know can maintain symptoms of post-traumatic stress is an avoidant style of coping. Avoiding thinking about and talking about and feeling the emotions associated with trauma can be extremely necessary for survival and coping during and in the immediate aftermath of trauma. Sometimes that’s the only resource and option that someone has.
However, the downside is that we don’t actually have a chance to fully process through what has happened. And if we aren’t able to do that, down the line there’s a greater chance that a trauma-related trigger occurs or some other stressor occurs, and that those symptoms can come back and present in a way that impacts functioning.
That’s not always everyone’s experience. Not everyone experiences a trauma and has clinically significant symptoms that linger. However, if we have been pushing away symptoms and then experience a significant enough trigger and/or another traumatic event and/or significant stressor, that can create a space where symptoms are more likely to (re-)surface when we are more vulnerable.
Trauma triggers: life transitions, sensory cues, and stress
Britt Teasdale: Could those triggers be life transitions, anniversaries, or heightened responsibilities? And can someone prepare for them ahead of time?
Natalie Gela, PhD: A trauma-related trigger could be anything that evokes a thought, feeling, memory, and/or sensory experience tied to someone’s trauma. Trauma-related triggers can come in a lot of forms. Separate from trauma-related triggers, any transition moment or other stressor—where our resources are really taxed—can create the space for symptoms to come to the surface.
If someone has a lot of insight into and awareness of their trauma-related triggers, then there is the opportunity to cope ahead, sometimes.
However, sometimes unexpected things are going to happen, or we don’t even realize something is a trauma-related trigger for us, and there’s no way to cope ahead for it.
What kinds of trauma does Compass treat?
Britt Teasdale: Could you tell me about the types of trauma Compass treats so someone reading can understand whether they might be a fit?
Natalie Gela, PhD: The best answer is to say all types of trauma. We are able to support and treat folks who have experienced a singular traumatic event and/or multiple traumatic events. I think it’s important to point out that the type of event(s) that brings someone to Compass is less important than how someone approaches their treatment at Compass. There is the opportunity to find support and to learn and heal regardless of the exact event(s) that brings someone to this program.
“My trauma wasn’t as bad as someone else’s”
Britt Teasdale: You often hear people say, “My trauma wasn’t as bad,” or “I’m not sure I’m a candidate for a trauma program.” What would you say to someone who feels that way?
Natalie Gela, PhD: That can unfortunately be an obstacle to people seeking treatment, those myths and misconceptions around what trauma means and how trauma impacts us. And we really don’t want that to be the case.
If you as an individual have experienced something as traumatic and it has significantly shaped and altered the way you think, the way you feel, the way you engage in the world—your functioning, your relationships, your view of yourself—then that might be something to look at and seek support around.
We focus much less on what the event is that brought you here. We focus much more on what the impact is: how are you able to move forward and live a life that feels values-aligned and authentic to you, and what do you want out of life now and moving forward.
Why specialized trauma care matters in PHP and IOP
Britt Teasdale: If someone is stepping up from outpatient care or stepping down from inpatient care into PHP or IOP, why is specialized trauma treatment so important compared to a generalized program?
Natalie Gela, PhD: If recovery from trauma is a main focus for someone and that isn’t addressed—how trauma can impact sense of self, relationships with others, the way we see the world—something would be lost by not providing an environment that recognizes and supports that healing.
Although we teach similar skills across all of our programs here at Compass, one big difference in our Trauma Program is that we are consistently integrating a trauma lens, so to speak, into our groups. For instance, we’re asking: if we’ve experienced trauma, how might we think differently about using this skill? How might this concept impact us a little differently? We also provide a significant amount of psychoeducation to allow patients and loved ones to better understand how past trauma may continue to impact and show up in the present. Once we have this understanding, we can begin (or continue) to develop a foundation of self-compassion that can lead to real change.
How Compass approaches trauma care and trauma processing
Britt Teasdale: How does Compass do trauma care differently? How are the Trauma PHP and IOP different from other programs?
Natalie Gela, PhD: We really focus on the first stage or phase of trauma work in our program, which involves psychoeducation about trauma and responses to trauma, teaching skills to cope with our symptoms and responses more effectively (whatever that means for the individual), focusing on increasing safety and on stabilization. There are programs out there that focus more on the second stage or phase of trauma treatment which is more intensive trauma- focused processing work. That’s not our focus here, even though processing does happen to various degrees, of course, as a human begins to integrate psychoeducation and skills. At Compass, we work to give folks a solid foundation of support, knowledge and skills so that, if intensive trauma-focused processing treatment is indicated as part of their journey and recovery, then they are much more prepared to benefit from that work, down the line.
Integrated trauma care for co-occurring concerns
Britt Teasdale: Compass emphasizes integrated care. Why is that important for trauma treatment?
Natalie Gela, PhD: We work very hard to individualize care here at Compass. For example, we know that, statistically, a lot of folks who struggle with trauma can also struggle with substance use. A lot of folks who struggle with trauma can also struggle with chronic pain and illness.
For folks who may be dealing with trauma and substance abuse or pain/illness, we have other programming that we offer that can supplement what they are learning and working on in the Trauma Program.
What Dr. Gela wishes more people understood
Britt Teasdale: What do you wish more people understood about seeking more support?
Natalie Gela, PhD: It can feel very isolating when someone is struggling. And there can be a lot of stigma around mental health, which can be an obstacle of course to seeking support and treatment.
I wish people knew how helpful it can be to step into this level of care and immediately start to challenge what they might be saying to themselves about their abilities, their self-work, their value. Having the opportunity to connect with others who have also experienced trauma—in a safe supportive environment—allows people the opportunity to see that they are human and have value and deserve compassion. Folks are able to learn that they are experiencing responses to trauma, not that they are bad or wrong or unlovable…or whatever other messaging the brain gives us when we are struggling. Being here—learning skills, being in groups where people share vulnerably with each other—is an incredible part of the healing process and of re-connecting someone to themselves and what matters to them.
Bios
Natalie Gela, PhD, is the Director of the Trauma & OCD/CA Programs at Compass Health Center in Northbrook. Dr. Gela received her doctorate in Clinical Psychology from the Illinois Institute of Technology in Chicago. She then completed her internship at Edward Hines Jr., VA Hospital, followed by her post-doctoral fellowship at Jesse Brown VA Medical Center in Chicago, specializing in trauma/PTSD, chronic pain, and substance use.
Britt Teasdale is a writer, photographer, and creative strategist. As Associate Director of Brand and Content at Compass Health Center, she has spent nearly a decade shaping narratives that translate complex clinical ideas into stories that resonate, reduce stigma, and help families access care. She holds a degree in Broadcast and Investigative Journalism, an MFA in Creative Nonfiction Writing, and began her career as a reporter. She is also co-host of Compass’s forthcoming podcast, You Only Know What You Know.
