The 4 R’s of the Trauma-Informed Approach (Part 1)

Posted on

Trauma responses are normal reactions to abnormal situations.

The concept of a trauma-informed approach emphasizes the importance of providing support and assistance to individuals who have experienced trauma in a sensitive and empathetic manner. The U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA’s) 4R’s approach is well-established and effective. The 4R’s are:

  1. Realization: Recognize the prevalence and impact of trauma. Understand that trauma can have long-lasting effects on individuals and that it may manifest in various ways, both overtly and subtly.
  2. Recognition: Identify the signs and symptoms of trauma. Be aware of the potential behavioral, emotional, and physical indicators of trauma in individuals, as they may present differently in different people.
  3. Response: Respond in a compassionate and supportive manner. Create a safe and non-judgmental environment where individuals feel heard, validated, and understood. Respond to their needs with empathy and respect.
  4. Resist re-traumatization: Ensure that practices and policies are in place to prevent re-traumatization. Create trauma-informed systems that prioritize safety, autonomy, and the well-being of individuals. Foster an environment that promotes trust, collaboration, and respectful communication.

It’s important to note that while these 4R’s provide a helpful framework, trauma-informed approaches are not implemented as a “one and done,” but rather this is embodied by our hearts and by the heart of our organization as well. It requires ongoing education, self-reflection, and a commitment to creating environments that foster healing, resilience, and empowerment for individuals who have experienced trauma.

#1 Realization

Realization has a few components: prevalence, impact, and how trauma manifests.

(1) Prevalence

According to the Centers for Disease Control and Prevention (CDC) study published in 2020, nearly two-thirds of adults in the United States have experienced some form of adverse childhood experience (ACE) such as abuse, neglect or household dysfunction. The study revealed that 60.9% of respondents reported at least one ACE and 15.6% reported four or more ACEs. Furthermore, the study found higher prevalence of ACEs among certain demographics such as women, racial and ethnic minorities, and those with lower incomes and less education. This underscores the urgent need to address trauma and ACEs to prevent long-term adverse health outcomes.

Some reputable sources that often publish research on trauma and ACEs include:

  1. Centers for Disease Control and Prevention (CDC) – The CDC provides valuable information on ACEs, trauma, and their prevalence. Their website contains data, research publications, and resources related to these topics. (Website:
  2. National Institute of Mental Health (NIMH) – The NIMH conducts research on various mental health topics, including trauma. Their website offers information on the prevalence of trauma and ACEs and provides access to relevant research studies. (Website:
  3. Substance Abuse and Mental Health Services Administration (SAMHSA) – SAMHSA is a government agency that focuses on behavioral health issues. They publish reports and resources on trauma-informed care and may provide statistics on trauma and ACEs. (Website:
  4. The National Child Traumatic Stress Network (NCTSN) – The NCTSN is a collaboration of academic and research institutions dedicated to understanding and treating childhood trauma. They conduct research and publish resources related to trauma and its prevalence. (Website:

(2) Impact

Research has shown that trauma can have a significant impact on society. Traumatic events such as ACEs, natural disasters, terrorist attacks, and war can lead to physical, psychological, and social consequences that can affect individuals, families, and communities.

In terms of physical consequences, trauma can result in injuries, disabilities, and chronic health problems. The psychological impact of trauma can lead to mental health disorders such as post-traumatic stress disorder (PTSD), depression, and anxiety. Social consequences can include disrupted relationships, loss of trust in institutions, and increased rates of crime and violence.

Trauma can also have a long-lasting impact on children, with research indicating that those who experience trauma are more likely to have poor academic performance and behavioral problems. The impact is long-lasting because trauma encodings are ‘meant’ to be indefinite:

The imprints of trauma are also passed down from generation to generation. The epigenetic component of trauma refers to the alterations in gene expression caused by environmental factors.

Studies have shown that traumatic experiences can leave a lasting imprint on the epigenome, which influences the way genes are expressed. For example, a study by McGowan et al. (2009) found that childhood abuse was associated with increased DNA methylation of the glucocorticoid receptor gene, which has been linked to stress response and psychiatric disorders.

Another study by Yehuda et al. (2016) found that epigenetic changes in genes related to stress regulation were associated with trauma exposure in veterans.

These findings suggest that trauma can have lasting effects on the epigenome, which may contribute to the development of mental health disorders.

Overall, the impact of trauma on society is significant and can result in a range of negative outcomes. It is important for individuals and communities to have access to support and resources to help cope with and recover from traumatic events.

#2 Recognition

How Trauma May Manifest in Children

Children who have experienced adverse childhood experiences (ACEs) and trauma may exhibit a variety of overt and indirect behaviors and symptoms. Overt examples may include aggression, anxiety, depression, difficulty with self-regulation and emotional control, hyperarousal, defiance, and withdrawal from social interactions. Indirect indicators may include physical complaints such as stomach aches, headaches, and fatigue, sleeping disorders, poor academic performance, and a lack of interest in activities that used to be enjoyable.

ACEs and trauma may also impact a child’s ability to form and maintain healthy relationships with peers and adults. They may struggle with trust and attachment, find it challenging to communicate effectively, and have difficulty managing conflict and making positive choices.

Other common manifestations of ACEs and trauma in children can include feelings of shame and guilt, difficulty with processing emotions, and a sense of powerlessness or helplessness. These symptoms can have long-lasting effects throughout a child’s life, impacting their mental health, cognitive development, and physical well-being.

Overall, it is important for parents, caregivers, and educators to be aware of the signs and symptoms of ACEs and trauma in children, so they can provide the necessary support for healing and recovery.

How Trauma May Manifest in Adults

Overt ways that ACEs and trauma may manifest in adults include symptoms of post-traumatic stress disorder (PTSD), such as flashbacks, nightmares, and hypervigilance. Additionally, survivors may struggle with anxiety, depression, and other mental health disorders. Physical health problems, such as autoimmune disorders, chronic pain, and fatigue, may also arise. Indirect ways that ACEs and trauma may manifest in adults include difficulties with relationships, including trust issues, difficulties with emotional intimacy, and a tendency to overreact to perceived threats. Survivors may also struggle with self-esteem and feelings of worthlessness, which can lead to self-destructive behaviors such as substance abuse or eating disorders. Finally, survivors may be more likely to experience challenges in employment, financial stability, and housing security.

How Trauma May Manifest @ Work

Overt ways that ACEs and trauma can manifest in the workplace may include frequent tardiness or absences, difficulty concentrating, irritability, outbursts of anger, and poor interpersonal relationships with colleagues. Indirect ways may include decreased job satisfaction, decreased productivity, lack of motivation, and feelings of hopelessness.

These behaviors and attitudes are often connected to individuals’ past experiences of adversity and can have a significant impact on their work performance and career advancement. Moreover, they can also contribute to a negative workplace culture and can trigger or exacerbate conflicts with co-workers or supervisors.

Ultimately, addressing ACEs and trauma in the workplace requires a multi-faceted approach that includes a supportive organizational culture, access to mental health resources, and training for managers and colleagues to recognize and respond to the symptoms of trauma effectively.

Dysregulation (at any age)

In the context of trauma, Polyvagal Theory highlights that traumatic experiences can dysregulate the autonomic nervous system, leading to a chronic state of hyperarousal or hypoarousal. Individuals may become stuck in a heightened state of sympathetic activation (fight-or-flight) or a shutdown state (dorsal vagal), making it challenging to restore a sense of safety and regulation.

Therapeutic interventions based on Polyvagal Theory aim to support individuals in regulating their autonomic nervous system responses, gradually restoring a sense of safety, and promoting resilience. These interventions may include practices such as grounding techniques, breathing exercises, movement, social engagement, and the cultivation of a safe therapeutic environment that supports co-regulation and the reestablishment of a balanced physiological state.

Watch on YouTube

Note: For more posts on polyvagal theory, click here

Recognizing Dysregulation

Recognizing a dysregulated nervous system can involve observing a range of physical, emotional, and behavioral signs. Here are some common indicators:

  1. Physical signs:
  • Increased heart rate or palpitations
  • Rapid or shallow breathing
  • Sweating or clammy skin
  • Muscle tension or tremors
  • Digestive issues, such as stomachaches or nausea
  • Fatigue or restlessness
  • Difficulty sleeping or disrupted sleep patterns
  1. Emotional signs:
  • Heightened anxiety or fearfulness
  • Irritability or easily triggered anger
  • Feeling overwhelmed or unable to cope
  • Mood swings or emotional instability
  • Difficulty concentrating or making decisions
  • Hypervigilance or feeling constantly on edge
  1. Behavioral signs:
  • Avoidance behaviors or withdrawal from social interactions
  • Increased sensitivity to noise, light, or other stimuli
  • Difficulty regulating emotions or emotional outbursts
  • Impulsive or risk-taking behaviors
  • Changes in appetite or eating patterns
  • Increased use of substances (e.g., alcohol, drugs) as a coping mechanism

It’s important to note that these signs may not be exclusive to a dysregulated nervous system and can also be associated with various other conditions or situations. If you or someone you know consistently experiences these symptoms and they significantly impact daily functioning or well-being, it’s recommended to seek professional help from a healthcare provider or mental health professional for a proper evaluation and guidance.

Using IFS to Recognize Parts and Self

According to the science-backed IFS Model (Internal Family Systems) proposed by Richard Schwartz, PhD we are not of monomind, but rather there is multiplicity of mind. We have parts. We are born with parts, and each part brings different resources to the table. We experience this day-to-day, and we say things like “Part of me wants ____, but another part of me thinks ______.” We truly have an internal family, and all parts have helpful intent. Trauma occurs when an individual experiences severe emotional or physical harm that exceeds their capacity to cope with the situation at hand. This often leads to parts jumping into action — taking on new roles, with the intent of helping the system. At the time of the experience, this new role may have been truly helpful and lifesaving. But as life goes on, these extreme roles may not be all that helpful. What this often looks like is an individual who has developed defensive mechanisms that aim to protect the individual from being overwhelmed by the pain of the past traumatic experiences. These defensive mechanisms are the action of protector parts. They seek to protect the system from getting flooded with pain. These parts may manifest as intense emotions, distressing memories, or reactive behaviors. Recognizing these parts and understanding their role can help identify the presence of trauma.

In IFS, trauma is often associated with the presence of exiles, which are wounded and vulnerable parts that have been isolated or suppressed as a result of traumatic experiences. The exile holds the pain of the trauma and, on top of that is now being hidden away (hence exiled) while carrying this burden of fear, shame, guilt, and/or despair. Exiles may hold memories, emotions, and beliefs related to the trauma. We see protector parts pop up, for example firefighter parts, which aim to distract, numb, or suppress the exiles’ pain — to keep that exile hidden away. These firefighters may manifest as addictive behaviors, dissociation, or other coping mechanisms. Recognizing the presence firefighters can be indicative of underlying trauma. Even suicidal parts have helpful intent — to keep that pain that the exile holds from flooding the system.

Trauma can create patterns of interaction between different internal parts. There’s that saying: A mind at war with itself knows not eternal peace. Parts can also be in cahoots with each other.

Another type of protector part we see is called a manager. Certain manager parts may indicate the presence of trauma. Manager parts in IFS are protective aspects of the internal system that aim to maintain control, avoid vulnerability, and prevent the reemergence of painful experiences. Here are some manager part roles that may suggest underlying trauma:

  1. Hyper-Vigilant Manager: This part is constantly on alert, scanning the environment for potential threats. It may manifest as heightened anxiety, hypervigilance, or an excessive need for control. The hyper-vigilant manager may indicate a history of trauma where the individual learned to be constantly watchful and prepared for danger.
  2. Perfectionistic Manager: This part strives for perfection and imposes high standards on oneself and others. It may manifest as a critical inner voice, an obsession with details, or an intense fear of failure. The perfectionistic manager can be indicative of trauma where the individual learned to maintain control by seeking external validation and avoiding mistakes.
  3. Avoidant Manager: This part aims to avoid painful emotions, memories, or triggers associated with trauma. It may manifest as emotional numbing, avoidance of certain situations or topics, or a tendency to dissociate from present experiences. The avoidant manager attempts to protect the individual from overwhelming or retraumatizing experiences.
  4. Rationalizing Manager: This part uses logical reasoning and intellectualization to distance oneself from emotions or traumatic experiences. It may manifest as minimizing the impact of trauma, intellectualizing emotional experiences, or dismissing the need for emotional vulnerability. The rationalizing manager serves as a defense mechanism to maintain a sense of control and avoid overwhelming emotions.

To address trauma through the IFS Model, it is essential to identify and heal exiled parts through a process of internal dialogue and self-reflection. This involves the development of a compassionate and empathic relationship between the individual and their exiled parts, and each step along the way achieves buy-in from all parts involved. If an individual has (or perhaps has) a diagnosable disorder, then it is best that IFS sessions are carried out by licensed professionals (e.g. a licensed therapist who is also IFS certified).

This is a super quick nod to the IFS Model, but it’s important to comprehend how this model explains trauma as an experience that leads to parts taking on burdens and/or extreme roles. What we notice would be psychological symptoms and behaviors. To address trauma, the IFS model emphasizes the importance of compassion, empathy, and self-reflection towards the healing of protector and exiled parts. Once healed, parts can take on a more productive role in the system.

When we truly realize what is going on with trauma physiology, we start to ask the classic question “What happened to you?” (versus “What’s wrong with you?”). We realize that the psychological and behavioral symptoms are parts in action. 

This section is called Using IFS to Recognize Parts and Self because in the IFS model, the concept of Self is central. Self refers to a core, essential, and unburdened aspect of an individual’s inner being that possesses certain qualities and characteristics.

In the image below, the internal system of both parties are flooded with parts. Protector parts in each individual are being defensive and angry.

One important quality of the self in the IFS model is its calmness and centeredness. The Self is described as being grounded, compassionate, and non-reactive. It embodies a sense of curiosity, wisdom, and clarity. When individuals are connected to Self Energy, they can approach their thoughts, emotions, and experiences with a greater sense of balance and openness. Self is always present, but can be covered over by extreme parts. For people with severe trauma and mental disorders, they may be so disconnected from Self that they cannot access its energy, qualities, and wisdom. In the image below, both parties are showing up with Self Energy.

Another crucial aspect of Self in the IFS model is its ability to provide healing, guidance, leadership to the various parts of an individual. How do you know if you are showing up with Self Energy? You can assess whether or not these 8 C’s are present.

As we close out this Part 1 post, here are the key takeaways:

  • Trauma encodings are widespread; As trauma expert and pioneer Bessel Van Der Kolk explains notes “after trauma, the world is experienced with a different nervous system…every new encounter or event is contaminated by the past.”
  • Trauma impacts the individual, social groups, and society; trauma is also passed down from generation to generation
  • Trauma manifests as psychological and behavioral symptoms
  • Burdened parts (parts that took on extreme protective roles as the time of trauma) have helpful intent; the “part that’s not a part” is Self/Self energy
  • When we ask “What happened to you?” versus “What’s wrong with you?” we are really embodying realization when it comes to trauma and its effects.
  • Understanding trauma physiology and the protective nature of parts can help us to be compassionate, curious and co-regulate those around us, vs getting activated ourselves. Check out the “When our calm meets their storm,” image in this post.

The Light Never Goes Out

This video is from the Superconscious Leadership perspective, where we acknowledge that “human being” can be considered as human (form) + being (formless). The biological spacesuit represents the form we take on as earthlings. The suit is always adapting in helpful ways (at least the intent is helpful) to help to keep us alive. The light in the video below represents the formless aspect of us — the most foundational, perfect aspect. This would be equivalent to Self/Self Energy in the IFS Model. As we become more and more trauma-informed we better see the suit-stuff for what it is.

Related Resources

More on “The Ladder” (The 3 states we covered plus blended states, eg sports and meditation)

Window of Tolerance (article with excellent graphics)

Window of Tolerance (PDF assessment)

Hand Model (for purchase on Amazon)

Polyvagal Flip Chart (for purchase on Amazon)

6 Guiding Principles to a Trauma-Informed Approach (CDC)

How Stress Affects the Brain (YouTube)

Responding to Stress and Dysregulation in our Nervous System (YouTube)

Relias has a lot of great resources, for example this video and slide deck

For regulation vs dysregulation, see Figure 2: Dynamic patterns of regulated and deregulated autonomic arousal. Adapted from Porges (1997)

Mental Health Trends to Watch in 2022