Therapies for Trauma-Related Disorders

“Trauma creates change you don’t choose. Healing is about creating change.” – Michelle Rosenthal

Now that we have understood trauma in one of our previous blogs, let us dive into understanding trauma and all the complexities it encompasses.

Treating Trauma and related disorders:

Therapists generally use a combination of psychotherapies within a trusting relationship. It is essential to trust your instincts when choosing the right therapy for you and to speak up when a method feels uncomfortable or ineffective, so your therapist is aware and can help or change the process.

1. Cognitive Behavioural Therapy (CBT)

CBT helps you recognize the relationships between your thoughts, emotions, and behaviors. It assists in replacing distorted or distressing thoughts with more accurate and positive beliefs. Two forms of CBT are most frequently applied: exposure therapy and cognitive processing therapy.

a. Exposure therapy

• It involves desensitizing yourself to the Trauma by repeatedly talking about your traumatic memories until you feel less overwhelmed by them.
• This method also employs relaxation and breathing exercises to calm your mind and body.
• While initially, it may feel uncomfortable to talk about the Trauma, turning toward your past can be empowering.

b. Cognitive processing therapy (CPT)

• It reduces the power of fearful memories by activating a dreadful memory while simultaneously introducing new information that is incompatible with beliefs surrounding the memory. For example, the idea that the Trauma was your fault is challenged when you recognize that you were just a child; you couldn’t have done anything wrong.
• CPT educates about symptoms; helps develop an awareness of your thoughts and feelings; guides you to incorporate new, more positive beliefs; and encourages practicing new skills that propel insights into actions.

2. Dialectical Behaviour Therapy (DBT)

The term dialectical refers to a synthesis of opposites. The primary dialectic within DBT is the polarity between acceptance and change, which recognizes that radical acceptance of who you are is necessary for change and growth. Typically, DBT therapy involves individual and/or group therapy sessions that focus on the development of mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.

a. Mindfulness

• Within the context of DBT, mindfulness skills focus on developing your capacity to observe your mind while cultivating acceptance.
• Acceptance helps you recognize that uncomfortable experiences do not necessitate escape tactics or reactivity. 
• DBT offers the concept of a “Wise Mind,” which represents the optimal balance of your “reasonable mind” (or thinking) with your “emotional mind” (or feeling)—an integration of logic and intuition that can help you feel calm and centered.

b. Emotion Regulation

• DBT emotion regulation skills are based on a context of mindfulness and acceptance.
• This approach aims to reduce suffering related to ineffective reactions to your emotions.
• DBT distinguishes that complicated feelings are not destructive or the result of a bad attitude. These emotions are meant to be felt.
• Emotion regulation helps you distinguish between feelings and “action urges,” which encourages you to reflect on your thoughts and emotions before jumping to reactions or behaviors.

c. Distress Tolerance

• The goal of distress tolerance in DBT is to be able to handle painful emotions skillfully. 
• Sometimes skillful action involves acceptance —welcoming reality as it is without needing to resist or change it. Other times, skillful action requires change, such as recognizing when it is essential to leave an unhealthy situation.

d. Interpersonal effectiveness

• The DBT skills taught for interpersonal effectiveness emphasize assertiveness, boundaries, and coping with conflict. 
• Assertiveness focuses on developing your capacity to ask for what you need, even though you may be told no or risk feeling rejected. 
• Self-assertion involves building self-respect and cultivating a sense of your worthiness. 
• Skills for interpersonal effectiveness include learning to address conflicts gently, such as refraining from put-downs or name-calling, respecting yourself and others, ensuring that you are behaving reasonably, apologizing when you have done something wrong, and being truthful.

3. EMDR therapy

Eye movement desensitization and reprocessing (EMDR) therapy, developed by Dr. Francine Shapiro, is a comprehensive approach to therapy that integrates elements of several different treatments. It relies on the concept that with sufficient support, you’ll have the capacity to process and digest traumatic events. As a result, you’ll be able to let go of self-critical beliefs and painful emotions.

a. Eight-phase treatment model

• EMDR therapy uses a treatment model split into eight phases.
• The initial phases prepare you to process the Trauma by identifying traumatic memories and the negative beliefs associated with them.
• The desensitization phase incorporates a dual awareness state, in which you are asked to remain aware of your present moment experience while simultaneously recalling memories of the traumatic event. Double attention is amplified using stimulation in the form of eye movements, buzzers, or tones that alternate between the left and right sides of your body.
• Later phases of EMDR therapy focus on strengthening positive beliefs.

b. Resources for EMDR-based trauma-recovery

• The preparatory phase of EMDR therapy involves building resources to attend to the frightening and sometimes overwhelming Trauma related memories. These resources include:
  • Safe space: Here, you identify a place that is either real or imaginary and where you feel safe, allowing your body and mind to have a reference place that supports relaxation and ease.
  • Containment: Here, you develop an imagined container: a place or item that is big and strong enough to hold painful thoughts, feelings, and memories. The container is meant to be used temporarily during times when you are not actively engaged in processing your traumatic memories.
  • Allies: Here, you identify imagined or real beings that you associate with nurturance, protection, and wisdom. Allies can be people, animals, or spiritual or religious figures.

c. Future Installation

• EMDR therapy also identifies the necessary positive beliefs to facilitate greater choice in the present. 
• For example, once an individual no longer holds the misconception that they are unlovable, they can begin to develop and integrate a new positive belief that they are worthy of being loved.

4. Somatic Psychotherapy

Somatic modalities are therapy approaches that focus on the body rather than the mind. Therapies such as Somatic Experiencing (developed by Peter Levine) and Sensorimotor Psychotherapy (developed by Pat Ogden) engage body awareness to release the psychological and physiological impact of traumatic events. When exposed to frightening experiences, your breath quickens, and tension builds throughout your body. To process Trauma, you need to breathe and move. When body awareness is not included in trauma processing, you inhibit your ability to work with your innate healing capacities.

a. Somatic Awareness

• Mindfully staying connected to the body in the midst of powerful emotions or sensations helps clients regulate and respond more effectively to emotional intensity. 
• Simply bringing awareness to physical tension and breath patterns begins the process of healing.

b. Sequencing 

• Sequencing refers to the movement of tension out from the core of your body through the extremities.
• It can be involuntary but can also be facilitated through mindful movements such as following an urge to move something.
• Sequencing is helpful, as it allows the releasing of tension patterns related to freeze, fight, or flight responses in the body. 
• Sometimes sequencing occurs as a visible trembling in the arms or legs. Other times it is experienced as a movement pattern.

c. Grounding

• Grounding refers to your ability to sense your body, feel your feet on the earth, and as a result, calm your nervous system.
• Grounding is a key resource for Trauma and emotional overwhelm. 
• Your senses (hearing, seeing, smelling, tasting, touching) are tools for anchoring yourself in the present moment.

5. Complementary and Alternative Medicine (CAM)

Complementary and alternative medicine (CAM) interventions, such as relaxation, mindfulness, and yoga, have been integrated as supportive treatments. They work by regulating your autonomic nervous system (ANS). Moments of feelings of worry, frustration, or hopelessness can interfere with your ability to take care of yourself and your relationships in healthy ways. 

a. Polyvagal theory

• The vagus nerve plays a central role in ANS regulation because it connects your brain to your digestive system, heart, lungs, throat, and facial muscles. Dr. Stephen Porges introduced the polyvagal theory, which proposes your nervous system reflects a developmental progression with three evolutionary stages:
  • When you experience a stressful event, your ANS responds with sympathetic nervous system mobilization into the fight-or-flight response. This process aims to protect you and help you re-establish safety.
  • If you can’t resolve a stressful situation or are facing a life-threatening event, you will resort to an earlier set of evolutionary mechanisms maintained by the dorsal vagal complex (DVC). This parasympathetic branch of your vagus nerve puts an abrupt, unrefined brake on your sympathetic nervous system by promoting immobilizing defensive actions such as fatigue, depression, or dissociation. 
  • In order to regulate your ANS, you need to engage the most recently evolved parasympathetic branch of the vagus nerve called the ventral vagal complex (VVC) or, alternatively, the social nervous system. This branch functions as a highly refined brake on sympathetic activation and has a calming and soothing effect.

• Your social nervous system is strengthened by repeated practice. This can occur within healthy relationships in adulthood, such as with a psychotherapist. CAM therapies such as relaxation, mindfulness practices, tai chi, qigong, and yoga all strengthen the social nervous system.

b. Relaxation techniques

• Some of the most common and well-researched techniques include progressive muscle relaxation (PMR), visualization, and diaphragmatic breathing. In each of these practices, you focus on calming down your body.
• In PMR, you sequentially tense and relax various muscle groups (e.g., arms, legs, torso, neck) throughout your entire body.
• Visualization involves recalling memories of times when you felt relaxed and allowing your body to respond accordingly.
• Slow and rhythmic diaphragmatic breathing, or “belly breathing,” helps calm you down if your body is in a fight-or-flight response.

c. Mindfulness

• Mindfulness in psychotherapy involves engaging in practices that encourage awareness of the present moment, a mindset of non judgment, focus on bodily felt senses, relaxation techniques, and awareness of breathing patterns.
• Two well-known programs include mindfulness-based stress reduction (MBSR), developed by Dr. Jon Kabat-Zinn, to manage stress and anxiety, and mindfulness-based cognitive therapy (MBCT), developed by Dr. Zindel Segal and colleagues, which applies mindfulness to treat the major depressive disorder.

d. Therapeutic Yoga

• Yoga is an opportunity to explore physical postures within a context of mindfulness, conscious breathing, and somatic (body) awareness.
• You go into this with the intention of becoming aware of your moment-to-moment experience while cultivating self-compassion.
• Key components of a therapeutic yoga practice include supplying yourself with an environment that feels emotionally and physically safe, minimizing the use of mirrors, and setting a tone of gentleness and non judgment.

6. Other Therapies:

a. Internal Family Systems

• Internal Family Systems (IFS) therapy was developed by Dr. Richard Schwartz. He identified three kinds of parts:
  • Exiles: Exiles carry the burdens of Trauma. They are the parts of yourself that you cut off from conscious awareness as a way to distance yourself from painful memories and emotions such as rage, dependency, shame, fear, loneliness, or grief. Often these parts feel young.
  • Managers: Managers attempt to protect you from vulnerable feelings by staying in control. They tend to be overly rigid and self-critical or rely heavily upon prescribed roles such as planning or caretaking.
  • Firefighters: Firefighters act out in order to repress exiles as they attempt to emerge. This part employs substances, self-harm, or dissociation to distract you from your underlying emotional vulnerability.
• The goal of IFS therapy is to develop your relationship with the Self as the core of who you are. When you reside in the Self, you are able to regulate the other parts of you, allowing for an internally felt sense of trust, harmony, and connection.

b. Acceptance and Commitment Therapy

• Developed by Dr. Steven Hayes, ACT is a form of cognitive behavioral therapy that uses acceptance and mindfulness strategies to increase psychological flexibility and your capacity to live in the present moment with wisely chosen behaviors.
• ACT uses metaphors to support healing. It can also allow you to notice your need to attend to feelings of vulnerability. 

c. Narrative Exposure Therapy (NET)

• Here you identify significant events, which are deemed “flowers and stones” within the context of your life story. Flowers are positive events, such as loving people or personal accomplishments. Stones are your difficult or traumatic life events.
• The aim of this therapy is to be able to develop a complete biographical narrative, inclusive of both stones and flowers, to strengthen your sense of personal identity.

d. Neurofeedback

• Neurofeedback uses EEG monitoring to improve brain functioning as you learn to alter your brain activity. 
• By using computer imaging, you receive direct feedback through a “brain map” that indicates areas of your brain with excessive activity associated with your symptoms. 
• Here you learn how to relax your body and mind to activate the outermost layer of your brain, that which is associated with thinking and decision-making. 
• Typically, 20 sessions will give you enough feedback to understand how to facilitate the regulation of your body and mind on your own.

Read More:

Trauma: Causes, Reactions and Theories

Understanding Somatic Symptoms and Related Disorders

Trauma: Types, Causes, Symptoms and Major Disorders of Trauma

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