How Does Trauma Show Up for Us? And How Can We Treat It?
How does trauma change us?
We can live our whole lives not knowing that we have experienced trauma. In fact, most of us have experienced some form of trauma at some point in our lives, whether it be a major event that rocked your entire world or a small, constant drip of discomfort that changed you like water carves stone. For most people, trauma needs to be processed and until that happens, symptoms of it can significantly impact your life, even on a daily basis. Let’s explore what trauma looks like in psychiatry and how we address it as mental healthcare providers.
When Trauma Shows Up as Anxiety, Depression, Insomnia, or Anger You Can't Explain
Maybe you've been to therapy. Maybe you've tried three different antidepressants and none of them quite worked. Maybe you just know something is off — you're snapping at people you love, you can't fall asleep or you wake up at 3am and can't fall back asleep, or you feel like you're bracing for something bad to happen even when nothing is wrong.
You might not think of yourself as someone with PTSD. When most people hear those letters, they picture a soldier back from war, or someone who survived a specific, nameable event. But in my practice, trauma rarely announces itself that clearly. More often, it shows up disguised as something else entirely. Panic attacks. Anger outbursts. Insomnia or being a chronic light sleeper. Anxiety or depression that won't respond to medication the way it should. Nightmares that keep coming back, for months or years.
Here's what I look for. When someone's anxiety or depression is genuinely difficult to control — when it's not budging with medications that should be working — that tells me something important. It means the logical, thinking part of the brain isn't the one calling the shots. A deeper part of the brain, the limbic system, is running the show instead. The limbic system is where the brain stores and processes past trauma, and when it's overactive, no amount of rational thinking makes the anxiety go away, because rational thinking was never in charge to begin with.
The other pattern I watch for is nightmares. Everyone has a bad dream now and then, especially during a stressful stretch of life. But recurrent, persistent nightmares — the kind that keep showing up several nights a week — are usually a sign that there's trauma underneath, whether or not the person has ever named it that.
If any of this sounds familiar, you're not broken, and you're not overreacting. Your nervous system is doing exactly what it learned to do. It’s helping you survive in the best way it knows how: it’s keeping you alert all the time, watchful for any harm that may come your way, even during your sleep. The good news is that it can learn a new way. It is treatable, and you don't have to have a predictable, clearly-defined story to get real help.
“Trauma
was not being
able to get
the hands
of the clock
off of me.
Healing
was learning
no one has ever
laid a fingerprint
on the part of me
that’s infinite.”
-Andrea Gibson
How Medication Can Help With Trauma Symptoms
I want to be honest with you about what medication can and can't do, because I think a lot of people have been given vague promises before and are understandably skeptical.
Medication doesn't erase what happened to you. It won't make the memory disappear, and it's not a substitute for doing the deeper work of processing trauma. What it can do is bring your baseline symptoms down to something manageable — whether that's showing up as panic, hypervigilance, insomnia, or anger outbursts — so that you actually have room to use behavioral tools like deep breathing, or the ability to step away from a triggering situation before you hit a full panic state.
I like to describe it this way…
Medication gives you time between the moment something happens and your reaction to it. Instead of going straight to a red-line, all-or-nothing response, you get a few extra seconds — sometimes just seconds — to respond in a way that actually reflects what you think and feel, rather than what your nervous system is reacting to on autopilot.
Sleep, anxiety, and mood symptoms generally respond well to medication, though with PTSD and other trauma-related conditions, it often takes higher doses, or a few adjustments to the regimen, to meaningfully calm an overactive limbic system. That's normal, and it doesn't mean something is wrong with you or that medication isn't working — it just means trauma-driven anxiety often needs a bit more than standard-dose treatment.
In my practice, I almost always recommend starting with medication before adding therapy. Trauma-focused therapy can be genuinely difficult emotional work, and having medication on board first tends to make that process much more tolerable when you get there. For some patients, EMDR in particular has been a powerful tool for long-term symptom management once they're ready for it. As we move through your treatment, we can talk about when it could be a good time to consider adding therapy.
Our Approach: Medication Alongside Therapy, Not Instead of It
I want to be clear about what I offer and what I don't: I'm not a trauma therapist, and I don't provide EMDR or talk therapy myself. My role is the psychiatric and medication piece — getting your nervous system to a place where you can actually engage with the deeper work, whenever you're ready for it.
Not everyone is ready for therapy right away, and I don't think that's something anyone should be pushed into. Some patients have had a poor experience with therapy in the past. Others find the idea of talking through their feelings overwhelming, or just don't see how it would help. I don't try to talk anyone out of that. What I usually do is mention what the research shows: even just talking about your stressors and feelings — whether that's with a therapist, a friend, or a family member — tends to improve emotional wellbeing.
Getting things out, in whatever form that takes for you, matters.
If someone isn't ready or willing to start therapy, we simply focus on managing symptoms with medication for as long as that's the right fit. What I've seen happen, more often than not, is that people eventually notice their symptoms need more medication than they're comfortable taking, or they realize medication isn't addressing everything that's going on for them — and that's usually when they start asking about therapy on their own. It's rarely something I need to push. People tend to come around to it when they're ready.
When patients do want a referral, I keep a short list of therapists in the Denver area that I trust. I also point people toward psychologytoday.com, which has a genuinely useful search tool — you can filter by specific issues like PTSD, panic, ADHD, or autism, and see clinician bios, photos, reviews, and whether they're currently accepting new patients. It's one of the better resources out there for finding the right fit.
There's no one-size-fits-all approach in psychiatry, and I don't practice as if there is. Some people want to start with medication. Some want to start with therapy. I base my recommendations on what you're comfortable with and what will actually address your symptoms — because if you're not comfortable with a treatment, whether that's a medication or the idea of therapy itself, it's not going to work well. Getting you to feel better is a collaboration, not something I hand down.
What to Expect From Your First Visit
Trauma doesn't always look the way people expect, and it doesn't always come from the kind of event we typically associate with PTSD, like combat, witnessing a death, or surviving an attack. Just as often, it's slower and quieter. This is called Complex PTSD, or cPTSD, and many people carrying it have no idea that what they experienced even counts as trauma — they just know something in their life today isn't working the way it should.
Complex trauma can come from things like:
A parent who made you feel like an outcast in your own home
A sibling who bullied you growing up
A family not willing to see your personal truth or refusing to accept you for who you are
A boss who degraded you over years
A partner who made you feel small or replaceable
A parent who struggled with addiction
During your first visit, I'm listening for these patterns. I may ask about things like:
Your childhood home life
Any major life events, like the death of a parent or a serious accident
Your current relationships with family members and siblings (Broken relationships or distance within a family can often point to trauma that happened long before, even if no one ever called it that.)
I'll also gently ask about any history of sexual or physical assault or abuse, but I always preface that by saying you never have to share anything you're not ready to talk about. I don't need the details of what happened to know that it was traumatic and that you're still carrying it. What matters more is understanding how it's showing up for you now.
If you become emotional during our conversation, that's okay — more than okay. I'll usually remind you that crying is actually one of the fastest ways to help regulate your nervous system, and that all of us cry when things get hard. There's no need to hold it together in my office. Because these are the kinds of conversations we're often having, I give every first visit a full hour. That's enough time to actually understand your history, not just check boxes on a symptom checklist.
In-Person in Denver or Telehealth Across Colorado
Most of my patients don't choose in-person for their first visit. In my experience, people usually prefer to start with a telehealth visit, which gives them a chance to get a feel for me as a provider before deciding whether they want to come in person later on — and we're always happy to accommodate that shift either direction. For a lot of people dealing with trauma, the convenience and privacy of telehealth actually removes a barrier rather than adding one.
There's a common assumption that being in the same room fosters more connection, and for some people that's true. But I've found that I'm able to connect with patients just as well over telehealth as I can in person. Whether we're meeting on a screen or across a desk, my goal is the same: to help you feel at ease, heard, and completely unjudged.
Whichever format works best for you, we offer both in-person appointments in Denver and telehealth across Colorado.
We are never far away.
Our office is in Cherry Creek, centrally located in Denver with free parking for visitors — no hunting for a spot or feeding a meter before an appointment. We want finding us to be as easy as we can make it. We hope to see you soon.
