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On Trauma Pt 3

How our minds perceive the world, process, and interpret experience varies for each of us. So it makes sense that there is no one “magic bullet” trauma treatment that works for everyone. When surveying the options for trauma-focused treatments you’ll likely come across as many as twenty or thirty different styles of therapy. Sifting through all that information can feel really dizzying. How on earth are you to know what type of therapy is “right” for you? To help simplify and streamline the process I’m going to discuss three different trauma therapies. If you’re considering trauma therapy try to really hone in on your reactions to each description, noticing if one seems to make sense to you in way the others may not. Each approach I describe integrates the three main components to be considered when healing trauma: the cognitive, emotional, and experiential aspects of recovery. Each therapy differs primarily in the emphasis placed on these different areas.

CPT, or Cognitive Processing Therapy, emphasizes cognitively working through trauma. But don’t let the name to fool you: cognitions are used as the doorway to access emotions and create new experiences. CPT is designed to be a twelve-week treatment with weekly sessions from sixty to ninety minutes. The first sessions focus on the therapist providing cognitive therapy psycho-education and targeting any faulty beliefs that have resulted from the traumatic experience. Beliefs around trust, safety, power, control, intimacy, and self-esteem are explored. CPT uses a combination of journaling and talk therapy to help patients intellectually integrate what happened to them while emotionally releasing and moving beyond the stuck patterns their trauma has them trapped in.

Another trauma therapy to consider is Somatic Experiencing. SE therapy is based upon the assumption that during trauma the nervous system becomes dysregulated and fails to fully resolve the experience, thus resulting in mental, emotional, and physical disturbances. As the name implies this therapy focuses largely on the physical experience of trauma and uses bodily responses as the primary guide to release emotions and heal. An SE therapist will encourage a client to very slowly share the story of their trauma while noting and exploring minute shifts in emotional and physical sensations. Often, to prepare clients for the powerful emotions the work may evoke, SE therapists will teach clients a simple guided meditation to encourage feelings of safety and emotional calm before engaging in the heavy work of releasing trauma. There is no one way to do SE, and practitioners will use modalities such as dance, healing touch, breathwork, and expressive movement to help clients find this physical and emotional release.

The third therapy of interest is EMDR, or Eye Movement Desensitization and Reprocessing. EMDR weaves together the cognitive, emotional, and experiential aspects of therapy. Much like SE, EMDR posits that trauma disrupts the nervous system and leads to varied emotional and physical complications as a result. With the use of binaural stimulation EMDR aims to help a person resolve dysregulation by targeting and altering distorted core beliefs that are a result of trauma. Using either a light bar (see here) or vibrating hand tappers, the therapist helps the person connect those beliefs to memories or feeling, then verbally processes what they discovered within. The final portion of this therapy involves instilling new positive beliefs while continuing to use binaural stimulation. Though this may sound like an odd process, as with the previous therapies mentioned there have been multiple studies that demonstrate the efficacy of EMDR for those struggling with PTSD (Shapiro, F., 2014; Moreno-Alcázar, et. al., 2017).

The road to healing is a unique one. When choosing a trauma therapy it’s helpful to think about the structure of your personality and the ways you experience your body, your emotions, and your mind. Often the therapy that will heal you is the one you feel makes the most sense for who you are, and if none seem to fit then I suggest doing further research. Trauma is a tricky beast to escape, but maintaining hope that it can be overcome is the first step to recovering.

References

Moreno-Alcázar, A., Treen, D., Valiente-Gómez, A., Sio-Eroles, A., Pérez, V., Amann, B. L., & Radua, J. (2017). Efficacy of Eye Movement Desensitization and Reprocessing in Children and Adolescent with Post-traumatic Stress Disorder: A Meta-Analysis of Randomized Controlled Trials. Frontiers in Psychology, 8, 1750. http://doi.org/10.3389/fpsyg.2017.01750

Brom, D., Stokar, Y., Lawi, C., Nuriel‐Porat, V., Ziv, Y., Lerner, K., & Ross, G. (2017). Somatic Experiencing for Posttraumatic Stress Disorder: A Randomized Controlled Outcome Study. Journal of Traumatic Stress, 30(3), 304–312. http://doi.org/10.1002/jts.22189

Dossa, N. I., & Hatem, M. (2012). Cognitive-Behavioral Therapy versus Other PTSD Psychotherapies as Treatment for Women Victims of War-Related Violence: A Systematic Review. The Scientific World Journal, 2012, 1-19. doi:10.1100/2012/181847

Khan, K. (2016, June 10). How Somatic Therapy Can Help Patients Suffering from Psychological Trauma. Retrieved from https://psychcentral.com/blog/how-somatic-therapy-can-help-patients-suffering-from-psychological-trauma/

Lenz, S., Bruijn, B., Serman, N., & Bailey, L. (2014). Effectiveness of Cognitive Processing Therapy for Treating Posttraumatic Stress Disorder. Journal of Mental Health Counseling, 36(4), 360-376. doi:10.17744/mehc.36.4.1360805271967kvq

Osadchey, S. (n.d.). GoodTherapy.org. Retrieved March 18, 2018, from https://www.goodtherapy.org/learn-about-therapy/types/somatic-experiencing

Shapiro, F. (2014). The Role of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in Medicine: Addressing the Psychological and Physical Symptoms Stemming from Adverse Life Experiences. The Permanente Journal, 18(1), 71–77. http://doi.org/10.7812/TPP/13-098

What is EMDR? (n.d.). Retrieved August 20, 2018, from http://www.emdr.com/what-is-emdr/

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On Trauma Pt 2

It’s 3 a.m. and Lyla is awake again. Her heart is racing, and her body is soaked in cold sweat. Was it the sound of a neighbor’s car pulling in that woke her this time? “Could have been anything, really,” she thinks to herself, feeling a sense of helplessness and defeat because she knows that hours are going to pass before she’s able to fall back asleep. When she finally succeeds, it’s only a few moments later that her alarm goes off—time to get up. She groggily slaps the “off” button, but it’s already done its job; she’s awake. A sharp shock of dread ripples through her mind as she remembers the previous day and simultaneously fears the day to come.

She can’t rid herself of the memory of her coworker’s face, and the sense it conveyed that she was somehow abnormal and strange. “Why did she have to have a panic attack when he took out a pocket knife to open a box of office supplies?” she bemoans silently. “Why did she have to run off frantically staggering toward the bathroom like some kind of drunken zombie?” She aches with shame as she recounts the event over and over again.

What Lyla isn’t aware of is the deep connection that lies nestled within the cordoned off regions of her unconscious, between cars pulling into the driveway late at night, cardboard boxes and pocketknives, and the physically abusive stepfather she no longer speaks to. These connections are too dangerous to make contact with her conscious mind, so she’s closed them off, placed them behind a firewall that’s far away from conscious awareness. Now their only expression is through insomnia and a panic that overwhelms her body while protecting her mind from the more frightening recollections they represent.

At first glance it may appear that Lyla is struggling with anxiety, and while she likely is what is more pressing is the presence of her trauma history. Lyla’s physical abuse is likely the root of her disturbances, which only manifest as insomnia and anxiety. Trauma has many faces and is often not what it seems. It’s easy for clinicians to be blinded by the surface expressions of trauma, because they present as almost every disorder that is listed in the DSM. Thus, it’s of the utmost importance that an initial screen for trauma is conducted when working with any client.

The example given with Lyla is just a brief snapshot of what a person experiencing PTSD may go through through on a daily basis. The full-fledged disorder is multifaceted, consisting of eight criteria each with multiple expressions. (For more information on PTSD criteria and diagnosis you can look here.)

Regardless of whether a person suffers PTSD, or a lesser form of trauma that does not meet diagnostic criteria, any trauma that leaves its negative stain upon a person has the ability to change one’s perception of reality. It can steal away a person’s ability to feel safe and trust others, which can manifest as being easily startled or feeling an intense free-floating anxiety both when alone and in the presence of others. On the other hand, it can leave a person feeling numb and disconnected from their surroundings with a lingering sense that something “just isn’t right”. Or it can manifest in an entirely different way, as these are just two examples of what ultimately is a very complex, isolating, and unique experience.

So what do you do if you suspect you are struggling with the after effects of traumatic experiences? In the next and final segment of this series I’m going to talk about a few trauma-focused treatment options that have the potential to greatly alleviate the negative after-effects of lingering trauma.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

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On Trauma Pt 1

Often when people hear the term “trauma” their minds turn to the terrible. They picture escaping from a war zone, physical or sexual abuse, or surviving a natural disaster. While these are examples of severely traumatic events, or what we call “big T trauma”, the truth is trauma’s scope is far broader and subtler than many are led to think.

Some examples of subtler trauma, or “little t trauma”, are the abuse of power, a betrayal of trust, feelings of helplessness, feelings of entrapment, pain, confusion, and loss of any kind; divorce, a break up, moving, death of a family member or pet, etc. “Little t trauma” occurs on a personal level, and while a person’s reaction may not warrant a diagnosis of PTSD its negative impact can reverberate through many realms of their experience.

So what exactly is trauma? Oxford’s Living English Dictionary defines trauma as, “A deeply distressing or disturbing experience.” To elaborate, trauma is a very stressful event that ultimately overwhelms a person’s ability to cope. The impact of trauma is determined subjectively. How a person perceives what happened to them, in part, determines its impact.

Research shows that the frequency of trauma tends to impact a person’s ability to cope. Those who experience a one-time trauma, however devastating it may be, are more likely to retain resilience than those who are exposed to multiple traumas or ongoing trauma, such as continued child abuse, which is the most difficult type of trauma to recover from.

An important detail to keep in mind is that different people respond differently to all types of trauma. While one person may walk away from a traumatic situation relatively unscathed, another may struggle emotionally and physically for years to come. This difference in response does not reflect any type of personal or moral strength, but rather is a result of the interplay of an incredibly complex system of genetic, psychological, and sociological factors in which a person continuously exists that is largely outside of one’s personal control.

The long-term effects of untreated trauma can be physically and psychologically devastating. Studies have shown exposure to stress is damaging on various systems of the body, and untreated trauma affects the body in a very similar manner by creating a perpetual state of physiological stress. After an extended amount of time exposed to the inflammatory stress hormones triggered by this state, a person’s body becomes more susceptible to a host of unwanted disorders and diseases such as autoimmune disorders, high blood pressure, liver disease, chronic pain, arthritis, fibromyalgia/chronic fatigue syndrome, heart disease, dementia, and so on. It’s a scary list backed by a hefty body of scientific literature (McFarlane, 2010; Andreski, Chilcoat, & Breslau, 1998; Kessler, 2005; Korte, Koolhaas, & Wingfield 2005). Trauma may also manifest as a myriad of psychological disorders. These include but are not limited to: anxiety, depression, eating disorders, substance abuse disorders, and OCD. These secondary issues are, in part, what makes identifying trauma so difficult both for clinicians and for clients; it has many faces, and it’s often not what it seems.

If you’ve experienced a seriously life disrupting disturbance, large or small, it’s wise to consider the potential impact of unresolved trauma free from any of the stigma and judgment we so often heap upon any kind of “mental illness”. Trauma is something most people have experienced on some level and to some extent. If you suspect you’re suffering the negative after effects of trauma, consulting with a trained and credentialed mental health professional may help you get to the root of whatever issues have been plaguing you. With help, courage, and dedicated self-work, it is possible to alleviate—and even eradicate—many of the unwanted disturbances initiated by unresolved trauma.

 

In part two of this three part series I’ll describe in greater detail what clinically significant traumatic symptoms (PTSD) look like. Then in part three I’ll discuss treatment options designed specifically for working with trauma.

 

 

References

Andreski P, Chilcoat H, Breslau N. Post-traumatic stress disorder and somatization symptoms: a prospective study. Psychiatry Res. 1998;79:131–138. [PubMed]

 

Center for Substance Abuse Treatment (US). (2014, January). Understanding the Impact of Trauma. Retrieved July, 2018, from https://www.ncbi.nlm.nih.gov/books/NBK207191/

 

Giller, E. (1999, May). What Is Psychological Trauma? Retrieved July, 2018, from https://www.sidran.org/resources/for-survivors-and-loved-ones/what-is-psychological-trauma/

 

Kessler RC, Berglund P, Demler O. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:593–602.[PubMed]

 

Korte SM, Koolhaas JM, Wingfield JC. The Darwinian concept of stress: benefits of allostasis and costs of allostatic load and the trade-offs in health and disease. Neurosci Biobehav Rev. 2005;29:3–38.[PubMed]

 

Andreski P, Chilcoat H, Breslau N. Post-traumatic stress disorder and somatization symptoms: a prospective study. Psychiatry Res. 1998;79:131–138. [PubMed]

 

Mager, D., MSW. (2016, February 8). Trauma Tips for Understanding and Healing-Part 1 of 4. Retrieved July 19, 2018, from https://www.psychologytoday.com/us/blog/some-assembly-required/201602/trauma-tips-understanding-and-healing-part-1-4

 

McFARLANE, A. C. (2010). The long-term costs of traumatic stress:  intertwined physical and psychological consequences. World Psychiatry, 9(1), 3–10.

 

“What’s the Difference between Big ‘T’ and Little ‘t’ Trauma.” JourneyPure River, 12 Oct. 2017, journeypureriver.com/big-t-little-t-trauma/.