By John Lee, LMHC, Post Traumatic Stress / Trauma Topic Expert Contributor

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Peter Strong, PhD. is an expert in the treatment of PTSD. His theory in the treatment of PTSD is “The key to changing habitual reactivity is to learn how to relate to the underlying emotional energy that compels you to react.” Peter also bases his practice near Boulder, Colorado on using core mindfulness in the treatment of PTSD.

Interestingly, Peter Strong PhD. and this writer make use of the mindfulness treatment strategy. For many years while treating people with schizophrenia I taught core mindfulness as part of my group therapy. Surprisingly, many who practiced learned to tune out the voices they were hearing. The first step what leads up to the reaction of hearing voices? And what many have said they have done. One popular technique many began to practice was using the self talk “Stop, This isn’t me, This is My Illness.” For a few this began to really work, and then the few who really applied it were ready to take it a step further. What I taught them next was the brain receives its information was through their five senses. What one saw, felt, heard smelled sometimes could trigger a reaction. Interestingly, this small group really got into this as they were realizing and experiencing saying “Stop, this isn’t me” seemed to help. I then would take them for a walk to get into the moment. By totally focusing on the experience of what the rose smelled like, what the trees looked like, what the chirping of the birds sounded like, and what the lemonade tasted like, people with schizophrenia began to experience the voices weren’t as loud. That by focusing on the experience of the moment they were also slowly training their minds new habits which could lead to tuning down the volume of the voices. Continuing to practice focusing on the wind against their chin and hearing the birds they slowly began to experience when they would even talk to another person their voices would become softer and not as noticeable. By learning to turn down the voices by practicing in the moment techniques, many began to stay out of the inpatient unit.

I had one case of a person who was on the list to go to the state hospital because of multiple inpatient episodes in one year. After time spent building a relationship, establishing trust and teaching the person to experience what happens to the voices while saying “Stop” “This isn’t me” This is my illness” and began practicing and experiencing the moment, the person began to realize the voices weren’t as loud. Today this person in no longer a risk for more intensive treatment. In fact, there have been years now without an inpatient episode.

Practicing core mindfulness works. Dr. Peter Strong is absolutely right! If practicing core mindfulness can work with the voices of schizophrenia it certainly can work with the reactions of PTSD. In fact, often the intrusive houghts and intrusive images related to trauma are often misdiagnosed as psychosis when in reality intrusive thoughts are based upon trauma. The difference is that the intrusive thoughts of PTSD are more focused and related to trauma. Psychotic voices are part of a disorganized thought process and are more outside of the body like one would hear sounds through a set of headphones. Intrusive thoughts are inside one’s head.

Just as Peter Strong writes, PTSD is a reactive disorder. The brain uses the same senses to send and receive information as in core mindfulness training. In the transmission of information to the perception part of the brain, traumatic thoughts and memories emerge from the amygdala, the part of the brain where they are permanently stored. This process is also connected to one’s fight or flight response and one’s sense of perception. When a dog sees fire, the dog runs away. The dog smelled the smoke long before it saw or felt the heat of the fire. The same is true with humans. The transmission of information from the sensory system is about self protection. That self protection is heightened in a person with PTSD.

I have a case of a 35 year old woman who suffers from moderate to severe symptoms of PTSD and provided writer with a release to share her recent experience with Core Mindfulness Therapy and this writer. She was terminated from a job she had for 2 years and she had difficulty finding a new job. She was recently hired by another company and had a PTSD reaction when she saw the word job performance review as her previous company used performance reviews making a paper trail which led to her termination. She saw the word review and instantly was overcome with the intrusive thought “I am going to be fired!” The review was a standard procedure used on all new hires. Once she had her 30 day review, she had the feeling of being watched, of evidence being collected to justify firing her. She also began to be very hyper vigilant and hyper aroused and became very sensitive and as she put it “paranoid.”

She said one of her jobs is sorting. Her boss thinks she doesn’t sort fast enough and the more pressure she feels the more immobilized she becomes and the more “stuck” she feels. This is a PTSD reaction to a symbolic event. She would say in previous sessions that PTSD feels like a time bomb in her head encased by a brick wall and she never knew when the time bomb would go off. In this instance the time bomb was ignited by taking a 30 day post hire review.

In her session, we processed the precipitating event. She then explained what bugged her the most was focusing on a performance review with a corrective action rather than a regular 30 day post hire review.

One of the things we did was go for a walk. As she walked I asked her to focus on feeling her feet as she took each step. Total focus was in the moment, being aware of where she was walking, and emphasizing she is safe. I then asked her as she made each step to inhale counting up to four steps, then hold her breath for four steps, then exhale slowly for the next 8 steps and do this for a cycle of ten. Then she sat down and we processed how she was feeling as compared to the beginning of the session. She stated, “Much more relaxed and focused.” Her face had more color, she was breathing more slowly, and she was taking deeper breaths rather than short constricted breaths. I then asked to focus on the moment by experiencing what the wooden bench felt like, the warm wind against her face, to smell the smell of the air, and to look at the trees. I asked her to focus on the experience of the moment and to maintain the focus for 3 minutes. Even three minutes for a person in a PTSD reaction could be very difficult to accomplish. However because of the trust established between writer and the client she felt safe and she had a very positive outcome.

There was some resistance when I asked her to practice core mindfulness at least five times during the day. She said people would look at her like she was weird. Writer responded by saying, “As you walk just focus on your safety and feel your feet touch the ground. As you take a drink totally focus on the taste of the drink, as you sit in your chair totally focus on the feel of the chair fabric and no one will know”.

She then said, “I get it and I will practice what you just taught me.” She is also going to practice her daily self hypnosis which she got away from. I made a parting comment, “You look so focused and I bet you could sort right now with the speed of lightning.” Her response was, “Yes I am relaxed and focused, and yes I could! It is when I am pressured that I react!” Writer then asked her to keep a voice journal and to tell me at the next session of any differences at work

Teaching her to practice a combination of breathing exercises and core mindfulness is also helping her practice a new behavior of being more in control of the way her brain habitually reacts to similar events. The more she practices core mindfulness the more her brain will be trained to respond rather than to react. Core mindfulness re-teaches the brain how to respond to information received by the sensory system of touch, vision, hearing, taste and smell.

She is learning to understand the “Why” behind the “time bomb encased with bricks” She is teaching herself and forming a new habit of responding to familiar stressors by practicing breathing exercises, self hypnosis and core mindfullness behaviors. The more these new behaviors are practiced the more reprogrammed the brain becomes to respond rather than to react.

References:
Peter Strong, PhD.

©Copyright 2009 by John Lee, LMHC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact John and/or see his GoodTherapy.org Profile