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It’s Not What You Say, It’s How You Say It

At some point in our past, we all have been guilty of responding in an insensitive manner. Our spoken words were not intended to hurt or criticize, and yet were hurtful and critical, nonetheless. In these moments, we often react defensively, not understanding how our spoken words were misperceived, misinterpreted, or twisted. We present, as evidence, the literal interpretation of our spoken words to this upset person as justification that our words were harmless. Despite our best efforts, the sting for them lingers. There are moments of clarity, however, when we sometimes understand how our words were perceived as indifferent, insensitive, or even offensive. In other instances, we remain ignorant to the perception of our messages by others. Let’s face it: communication between individuals is complex. What further complicates the crossing of our wires is our culture’s heavy reliance on direct, rather than indirect communication.

Direct communication is comprised of our spoken words and their meanings. For example, the words “I love you” express our affection towards another person. Most of the time, we expect the meanings of our spoken words to accurately express our messages. Rarely is this the case. Think of all the different ways that “I love you” can be said—softly, loudly, angrily, ecstatically—and how meaning is expressed differently by each of these variations. Each subtle difference highlights indirect, or nonverbal, aspects of communication. Now, here is the important part: most of the meaning we interpret from messages is derived from the nonverbal aspects. An early series of studies conducted by one of the contemporary experts on social communication, Dr. Albert Mehrabian, identified that approximately 93% of the total meaning of a message is conveyed nonverbally via facial expressions and vocal cues like volume, tone, pitch, and inflection (Mehrabian & Wiener, 1967; Mehrabian & Ferris, 1967). Thus, verbal content may only represent a small portion of message meaning. While there are certainly methodological limitations to this series of studies and alternative studies that cite lower rates for nonverbal message interpretation (65%; Birdwhistell, 1959), nonverbal communication skills require much more attention for efficient communication within our culture.

Outside of the miscommunications and misunderstandings that occur in everyday social interactions, nonverbal communication is critically important for effective trauma-informed care. Trauma survivors may exhibit symptoms of hypervigilance or hypersensitivity to cues that remind them of their trauma within their environment. This hypersensitivity can generalize to communication with others, as trauma survivors may exhibit an attentional bias towards any threatening environmental cues (see Bomyea, Johnson, & Lang, 2017, for a review). Now, how does a survivor of trauma differentiate between signals, events, and environmental stimuli that are threatening versus those that are not? That likely depends on the unique aspects of their socialization, personality, and their history of trauma. What we do know is that trauma survivors are more likely to experience neutral events as threatening versus individuals who have not experienced a trauma (Vasterling & Hall, 2018). Thus, if our well-intended words are paired with neutral nonverbals, our message may be misinterpreted as threatening by trauma survivors. If our nonverbal behavior conveys most of our spoken messages, then we can assume that trauma survivors will be attending more closely to our nonverbals than others. This serves as a vital survival function, which allows trauma survivors to quickly gather information about current threats to facilitate quick decisions on their behalf. To relate to a trauma-survivor in a trauma-informed manner, we must maintain a keen awareness of this dynamic and our own nonverbal behavior.

The first step to trauma-informed nonverbal communication is self-monitoring and reflection. Often, we are told to think before we act or speak. We are less often told to think after we act or speak. Doing so can allow an individual to evaluate how their message was received based on the reaction of the other individual and identify which components of their message were misinterpreted. Some components worth reflection include our facial expressions, paralinguistics, body language and posture, proxemics, eye gaze, haptics, and appearance. Presented below these components and some guidelines for how to improve your nonverbal communication in a trauma-informed environment for each.

  1. Facial expressions. The emotional reactions we convey with our face are core components of nonverbal communication. When talking with a trauma survivor, it is important to convey interest and avoid strong, sharp facial emotions such as shock or disgust. Try to convey kindness and compassion through a soft smile, open or relaxed lower face, and loose, slightly raised eyebrows (Falconer et al., 2019).

  2. Paralinguistics. Paralinguistics refers to all the vocal elements of speech except for spoken words. For example, speech volume, speech pace, intonation, tone, pronunciation, articulation, pause, and emphasis of punctuation are all elements of paralinguistics. When speaking with a trauma survivor, use a soft tone with audible volume, speak clearly at a relaxed pace with enough pauses for processing and reflection, and avoid strong intonation or punctuation. Refrain from raising your voice.

  3. Body language and posture. Body language and posture refers to the movements and positioning of your body during your interaction. Relaxed posture and body language can convey over-confidence, indifference, or lack of attention. Sit in an upright, alert posture while slightly leaning forward to convey interest in communication with a trauma survivor. Avoid sudden movements or dramatic gesturing that might catch the survivor off guard.

  4. Proxemics. Proxemics characterizes the need for personal space. While some individuals may prefer conversing in close physical proximity to another person, this is often not the case for most people. If you are speaking with a trauma survivor in a room, arrange the furniture so that they will be seated approximately 3-5 feet away from you. Give the survivor permission to make themselves more comfortable by moving their seat as they see fit. If you will not be seated, try to maintain this distance with the survivor while standing or walking. Always ask permission to enter their personal space (i.e., if you need to reach across them). If you enter their personal space, this may be interpreted as threatening and may immediately cause discomfort. Try to provide verbal instructions that maintain this physical distance between the survivor and you to avoid this situation.

  5. Eye gaze. This refers to the target of your vision, which can be perceived by another person during verbal communication. Try to maintain consistent eye contact with trauma survivors, but pause to reflect and look around the room occasionally. While they may not engage consistently in eye contact, you should continue to do so to encourage connection. Intense eye contact can be perceived as threatening or intimidating, so do not stare. Your gaze should be attentive, not burning.

  6. Haptics. Haptics is comprised of all forms of communication through touch. Some common examples of haptics include handshakes, hugs, or a comforting touch on the shoulder. When communicating with a trauma survivor, understand that touch may act as a traumatic reminder for that individual. Unprompted or unexpected touches may violate the survivor’s boundaries and cause significant distress. If you choose to use haptics to communicate nonverbally and the situation calls for it, exercise your best judgement and always ask the survivor’s permission. A hug can be very powerful for a trauma survivor at the right moment, but it can also be retraumatizing at the wrong moment.

  7. Appearance. Your appearance conveys numerous nonverbal messages that inform the perceptions of others of your social status, lifestyle, hygiene, among a host of other characteristics. If working professionally with trauma survivors, proper hygiene and grooming is recommended. Don’t overdress for the occasion, as a high-profile suit or dress may convey a power differential that intimidates a trauma survivor. Business casual attire is recommended.

While many of these recommendations seem like common sense, we often do not give them a second thought in our interactions with each other. The characteristics of our nonverbal behavior become more critical in communication with a trauma survivor, as their prior experiences lead them to make quick interpretations of our messages to avoid danger or negative emotional experiences. Misassumptions are going made about our nonverbal behaviors, and these assumptions absolutely affect the quality of our interactions. Our nonverbal behavior may be the determining factor in a person feeling safer versus feeling threatened or seeking mental health services at our organizations versus withdrawing. Through self-monitoring and reflection, we can identify our potentially problematic nonverbal habits and address them to enhance our communication with trauma survivors. Think after you speak. Finally, don’t forget about the verbal content of the message. Words indeed can hurt and have a lasting effect. What we say and how we say it can heal, or cause further harm.


Birdwhistell, R. (1961). Paralanguage: 25 years after Sapir. Lectures on experimental psychiatry, 43-64.

Bomyea, J., Johnson, A., & Lang, A. J. (2017). Information Processing in PTSD: evidence for biased attentional, interpretation, and memory processes. Psychopathology Review, 4(3), 218-243.

Falconer, C. J., Lobmaier, J. S., Christoforou, M., Kamboj, S. K., King, J. A., Gilbert, P., & Brewin, C. R. (2019). Compassionate faces: Evidence for distinctive facial expressions associated with specific prosocial motivations. PloS one, 14(1), e0210283.

Mehrabian, A., & Ferris, D. (1967). Inference of attitudes from nonverbal communication in two channels. Journal of Consulting Psychology, 31, 248-252.

Mehrabian, A., & Wiener, M. (1967). Decoding of inconsistent communications. Journal of personality and social psychology, 6(1), 109-114.

Vasterling, J. J., & Hall, K. A. A. (2018). Neurocognitive and information processing biases in posttraumatic stress disorder. Current psychiatry reports, 20(11), 99.

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