Using therapy to deal with Trauma

There are big “T” traumas and small “t” traumas. There are some traumatic experiences that are so overwhelming that it seems impossible to recover. And then there are events that might be traumatizing to one person but not traumatizing to another. Some people will have post traumatic symptoms that are temporary (post-traumatic stress). Others may have symptoms that become chronic (PTSD: post traumatic stress disorder). Whether or not a person will suffer ongoing symptoms is determined by personal history, personal constitution, and the extent of support and resources following trauma. It is also determined by whether a person is able to complete the action of flight or fight when facing the traumatic event.

Definition of Trauma:

an event in which a person experiences, witnesses or is confronted with an actual or threatened death, serious injury or damage to physical integrity. Also, the person’s response to the event involves intense fear, helplessness, or horror. Imagine, also, how threatening it would be to, perhaps suddenly and unexpectedly, lose a loved one, a job, your home, reputation, and/or community.

Reference: The American Psychiatric Diagnostic and Statistical Manual (DSM IV-TR)

Post traumatic stress disorder 

PTSD is diagnosed if the person experiences the following for more than one month.

 

  • Persistent re-experiencing of…

    *Person experiences 1 or more of the following:

    • recurrent and intrusive memories, images, thoughts, perceptions
    • recurrent distressing dreams
    • acting or feeling as if the traumatic event were recurring ( illusions, hallucinations, flashbacks)
    • intense psychological distress when exposed to internal or external cues that remind one of the traumatic incident. For example, someone taps you on the back reminds you of being robbed at knifepoint and you freeze, scream or cry.
  • Persistent avoidance of stimuli associated with the trauma and numbing of responsiveness

    *Person experiences 3 or more of the following:

    • efforts to avoid thoughts, feelings, or conversations associated with the trauma
    • efforts to avoid activities, places, or people that arouse recollections of the trauma
    • inability to recall an important aspect of the trauma
    • markedly diminished interest or participation in significant activities
    • feeling of detachment or estrangement from others
    • sense of a future that will not last long
  • Persistent symptoms of increased arousal (not present before the trauma)

    *Person experiences 2 of more of the following:

    • difficulty falling or staying asleep
    • irritability or outbursts of anger
    • difficulty concentrating
    • hypervigilence
    • exaggerated startle response

 

The disturbance causes significant distress or impairment in social, occupational or other important areas of functioning..

PTSD is acute if symptoms last less than 3 months, chronic if they last more than 3 months. PTSD can be of delayed onset if symptoms begin at least 6 months after the event.

Examples of trauma:

Combat, sexual or physical assault, surgeries, medical procedures, terrorism, torture, natural and man-made disasters, being held hostage (including body cast), accidents (falls, crashes), diagnosis of a life-threatening illness, unexpected loss (life of loved one, job, divorce, limb), emotional violence.

 

Treatment

Up until a number of years ago, offering compassion and a safe place to talk about trauma was what most therapists did to help a person cope. In fact, there was also the abreactive approach, wherein people re-lived their trauma, perhaps in dramatization. This often only reinforced the traumatic material in the body’s memory. In recent years, brain research has allowed new insights into the phenomenon of trauma. These insights have led to new ways of working with trauma. Now many therapists have developed skills to help when compassion and talking is not enough.

According to trauma expert, Dr. Bessel van der Kolk:

“When people get close to re-experiencing their trauma, they get so upset that they can no longer speak. It seemed to me that we needed to find some way to access trauma, but help [people] stay physiologically quiet enough to tolerate it, so they didn’t freak out or shut down in treatment. It was pretty obvious that as long as people just sat around and moved their tongues around, there wasn’t enough real change. . .  The imprint of trauma doesn’t sit in the verbal, understanding, part of the brain, but in much deeper regions [sub-cortical brain, nervous system, body]… then to do effective therapy, we need to do things that change the way people regulate their core functions, which probably can’t be done by words and language alone.”

 

Many therapists have incorporated body-oriented approaches into trauma work. These include such therapies as Bodynamics, Somatic Experiencing, EMDR and Self-Regulation Therapy. I have been trained in both EMDR and Self-Regulation Therapy (SRT) and tend to use SRT when working with trauma.

Self Regulation Therapy    www.cftre.com
SRT is a non-touch mind/body approach to healing trauma. Essentially it is a desensitization technique whereby the client deals with different aspects of the trauma in tiny and tolerable doses, always in the context of a safe and supportive environment. Eventually balance is restored to a shaken nervous system. The client gradually moves from a fixed state to a state of flow. It is again possible to enjoy closeness in relationships, openness to what life has to offer and a sense of calmness and resilience in the body.