hands pulling rope tugWe may have experienced various traumatic experiences in childhood, whether it be abuse, neglect, abandonment, or ongoing misattunements from caregivers that impact our ability to feel safe to attach. Even though the events themselves may be behind us, those internal responses to the traumatic experiences—images, sensations, meanings we create, and emotions—can become “stuck” in the nervous system. They continue to have a “charge.” That charge stays in our system, is stored maladapatively, and is part of our inner world.

At the most unexpected times, this material can push through what we would consider our “normal” day-to-day activities—such as parenting, working, relationship building, and self-care—in the “outside world.” As a result, we may find ourselves in a constant balancing act of pushing back at that charge. Our normal everyday selves, if you will, try to show the world that we are fine on the outside, even though there may be a lot of material that pushes through.

For example, perhaps we are in a discussion with a loved one when, all of the sudden, we interpret that we are being abandoned, even while there is no actual evidence of this. Or perhaps while attempting to set a boundary with a child, we feel feelings of guilt because we don’t feel that we “deserve” to set those boundaries. All of these can be intrusions on day-to-day life, all from past hurts.

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Those feelings and interpretations can actually be the experiences of the past clouding the now, stopping us from truly being in the moment. The nervous system is activated and defending itself from a past injustice. Unfortunately, that charge from the past compels your nervous system to act as if the traumatic experience is still happening.

There can then develop a kind of tug-of-war between who we are on the outside and the charges that remain from the past. If the tug-of-war with the traumatic material becomes too much and we become flooded, we may need to go numb in order to be able to still “do” life on the outside. We may shut down. Even if we do, it doesn’t mean that the material on the inside is gone; it just means that we have had to become more unaware of it in order to function on the outside.

One of the most challenging aspects of complex trauma, whether or not pursuing EMDR therapy, is that we must be able to identify and “own” our feelings and experiences. This allows us to then process traumatic experiences from the perspective of being “here and now” and visiting them versus feeling as if one is flooded and still in those experiences. In EMDR language, we look for one’s ability to maintain dual attention. It expands into making sure we stay within a window of tolerance as we visit those memories.

Often, those starting their healing work find themselves in one of two extremes: flooded by feelings all of the time or feeling completely numb.

For some, this may not seem like such a large step, but for the majority of those who are healing from complex trauma, it is in fact very difficult. Often, those starting their healing work find themselves in one of two extremes: flooded by feelings all of the time or feeling completely numb. The numbness often comes because the material in our inside world becomes unmanageable and we become more fearful of that material. We shut down from the outside world because the inside world is so invasive.

We typically learn to dance this dance of “daily life” vs. “inner stuff” at an early age. In infancy, we learn that our attachment to our caregivers is required; we cannot survive without a caregiver or we will die. Period. We also learn that our attachment relationship is dependent upon us being in tune with our caregiver’s reactions—to know what to do, how to act, and how OK it is (or not OK) to have our emotions be expressed and seen in the outside world.

We also determine whether it is dangerous to really identify, own, and be with the feelings of shame, anger, or sadness, even happiness or calm. We then create certain strategies that seem helpful at the time but show up later as distressing symptoms. As outlined in my previous article on blocking beliefs, it is often those cognitive errors that hold us back from fully realizing and being in tune with our past hurts because it was, at the time, too much to fully realize.

In future articles, I will share more about what it means to fully realize and own what was once unrealized, back when we were experiencing past injustices. Similarly, I will share more regarding what it means to own and process feelings we may have deemed unacceptable in order to survive the past.

If you are a therapist and are interested in expanding your knowledge on this topic, especially as it relates to structural dissociation theory, you are encouraged to read The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization (2006) by Onno van der Hart, Ellert R.S. Nijenhuis, and Kathy Steele.

Emotional eye“…Not all psychological impacts can be encompassed by a list of symptoms or disorders.” —From Principles of Trauma Therapy

Make no mistake about it, Principles of Trauma Therapy: A Guide to Symptoms, Evaluation and Treatment is a psychiatric textbook. However, it is a rare breed of psychiatric textbook. It has a soul. To borrow from the dialectic wisdom of Marsha Linehan, the question in mental health treatment is often “What is being left out?” This book fills the void in terms of a comprehensive examination of the causes of trauma. It is not solely focused on the lists of symptoms. There are some areas where the book has “left out” important information, but emphasis on cultivating compassion for trauma survivors makes up for it.

John N. Briere and Catherine Scott describe how challenging behaviors exhibited by people who have gone through traumatic events are normal and within the context of psychological resilience: “Although therapists may interpret these behaviors as ‘resistance,’ such avoidance often represents appropriate protective responses to therapist process errors.” (p. 170). The adaptive functioning—or attempts to “metabolize” the trauma—is often interpreted as sabotaging or therapy interfering, but in reality, it suggests the clinician is in error (e.g., moving too fast in therapy). Unfortunately for the person in therapy, these attempts to lessen the pain can inadvertently prolong their trauma (this is what’s called the “pain paradox”). The unskillful attempts used to extinguish the pain often produces an increase in pain for the individual.

[fat_widget_trauma_ptsd_right]The pervasive message in Principles of Trauma Therapy is that a person’s symptoms due to a trauma can resolve via therapeutic engagement within a safe, therapeutic environment. The treatment approach is eclectic, and it weaves together strategies from various models (e.g., cognitive behavioral therapy, psychodynamic approaches, and mindfulness). People in therapy are given the opportunity to develop a coherent narrative of their past experiences, while learning stress reduction skills and psychoeducation through validation, respect, and supportive encouragement.

At the heart, Principles of Trauma Therapy comes from the theoretical perspective of exposure therapy and much of the content centers around this orientation for treatment. The clinician invites the person in therapy to develop alternative perceptions to their negative beliefs about themselves (oral and written) and the environment where the trauma manifested, while reducing “conditioned emotional responses” (CER).

To simplify, the recollection of the traumatic memory (i.e., exposure) occurs by activating the emotional states and schemas. The “disparity” that occurs is based on the idea that the therapy space is safe, so the person in therapy is counter-conditioned to realize they will not be harmed by experiencing the intense emotions that surround the memories. The integration of memories and emotions through exposure—along with the inability to avoid (i.e., CER) in the moment—creates resolution. The emotions are no longer as powerful. The positive results occur if the clinician is able to finesse the client’s capacity to “regulate and tolerate the associated painful affect” (p. 267). Briere and Scott advocate a titrated exposure to avoid both undershooting the level of exposure and not overwhelming the person in therapy. This person should be emotionally activated to allow processing to take place, but not to the point that their coping resources are overwhelmed, which leads to avoidant behaviors (i.e., to seek safety from the distress).

Exposure therapy techniques are undoubtedly effective and reliably decrease posttraumatic stress. However, the dysregulated elephant in the room during my review of this book was a question of ethics: is exposure therapy humane?

There are a couple of areas that should have been addressed more thoroughly in the text. Exposure therapy techniques are undoubtedly effective and reliably decrease posttraumatic stress. However, the dysregulated elephant in the room during my review of this book was a question of ethics: is exposure therapy humane? This form of therapy elicits pain for the person in therapy, often expressed in the form of panic attacks, dissociation, and intense anxiety through a re-experiencing of the trauma. Is it morally right for clinicians to prescribe this approach? Does the end justify the means? Or, are there other treatment approaches that can be used to relieve the immense amount of suffering experienced by trauma victims?

Principles of Trauma Therapy provides only a brief conceptualization of eye movement desensitization and reprocessing therapy (EMDR). In 2004, the APA acknowledged EMDR as a recommended effective treatment of trauma. According to Shapiro (2001), EMDR is the most empirically studied treatment for posttraumatic stress (PTSD). The philosophy of EMDR treatment does not differ drastically from exposure therapy: deconditioning disturbing input, redefining the event, finding meaning in it, and eliminating self-blame, while integrating new skills (Shapiro, 2001). The stark difference between EMDR and exposure therapy is the method of delivery, as well as the path a person in therapy takes toward healing. Exposure therapy is analytical with a narrative-driven process that involves a significant amount of “homework” assignments for the person in therapy. It also runs a risk of vicarious traumatization (for both the therapist and person in treatment) due to repeatedly describing the often horrific events.

The internal process of EMDR utilizes an approach of holding a negative cognition (e.g., “I am unlovable”) paired with what is often an image of the traumatic event (a pre-established target). The person is instructed to focus on the image, negative thoughts, and body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation (e.g., eye movements, auditory stimuli, or tactile sensors). They are witnessing in their mind’s eye what surfaces. The clinician does not hear all of the details of the trauma, nor does he or she provide analysis of the experience. Dialogue is at a minimum. It is provided through repeated, brief check-ins between sets of bilateral stimulation; “What comes up now?” or “What did you notice that time?”

Principles of Trauma Therapy has an agenda in terms of promoting exposure therapy, but it also offers a holistic array of coping strategies—for both the therapist and the person in therapy—to increase one’s awareness of bodily reactions and ways to create a vocabulary for the feelings that arise. This mindful mentality is more than a subtle emphasis. Empirically validated mindfulness interventions are presented (e.g., acceptance & commitment therapy, dialectical behavior therapy, mindfulness-based stress reduction, and mindfulness-based cognitive therapy) as to disillusion the reader from the spiritual, Buddhist connotation. Clinicians are encouraged to maintain an open awareness to their own mental states (e.g., reduction of reactivity) without judgement, in order to mirror this process for people (e.g., attending to the breath, a here-and-now focus). There are also scripts for new clinicians and comprehensive assessment material that is applicable to anyone in therapy.

Principles of Trauma Therapy has a final, comprehensive directory of trauma-centered psychopharmacological interventions with content relative to psychobiology. This is extremely informative, but one has to question some of the research that was referenced. One concluding statement regarding the efficacy of selective serotonin re-uptake inhibitors (SSRIs) as antidepressant medication gave me pause. It was noted that SSRIs “have been found to be equally effective in reducing symptoms and improving quality of life across most clinical trials” for many diagnoses. The example reference was to a 2000 study comparing monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants and some selective serotonin re-uptake inhibitors (SNRIs) for depression. [1] The citation did not match the broad sweeping claim as the study itself notes “clinically insignificant” differences in efficacy as well as tolerability between SSRIs. [1] Read this section with a grain of salt and consider newer research when determining the efficacy of medication for victims of trauma.

Despite the focus on the individual in this book, the reader is walked through the “victim variables”, “characteristics of the stressor”, and “social response and supports” that affect the outcome for the trauma victim, which forces a cultural vista. Briere and Scott implicitly connect to the fact that our society’s disenfranchised groups of individuals (e.g., people of color and in poverty) are much more susceptible to posttraumatic symptoms.

Trauma is no longer just a micro level problem, but an issue of social justice and equality. The book maps out the generational influences and cyclical effects of trauma. There is an “additive effect” of multiple traumatic events throughout one’s life. For example, a survivor of childhood abuse who has residual effects into adulthood will react with “especially severe, regressed, dissociated, or self-destructive responses to the adult trauma” (p. 22). Earlier treatment interventions are essential to desensitize these reactions to stress.

Briere and Scott provide a stylish blend of the metaphysical and tangible aspects of trauma. They do this with learned experience, academic research, and hope as a means to expose the wide-ranging consequences of trauma. If you are a clinician searching for an in-depth examination of the components, conceptualization, causal mechanisms and treatment of trauma, then Principles of Trauma Therapy is here to the rescue.

References:

  1. Mace, S. and Tayler, D. (2000). Selective serotonin reuptake inhibitors: a review of efficacy and tolerability in depression. Expert Opinion on Pharmacotherapy: 1(5). 917-933.
  2. Briere, John & Scott, Catherine. Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment (2nd Edition). SAGE Publications, Inc; Second Edition – DSM-5 Update edition (March 26, 2014).

Couple hugging and holding handsAccording to the Centers for Disease Control and Prevention, in the United States 6.7 million women between the ages of 15 and 55 experience either problems getting pregnant or carrying a pregnancy to term. That is more than 10% of women in this age range. Chances are you or someone you know has experienced or will experience challenges related to fertility.

Infertility often has biological causes, but the emotional effects can be especially devastating for a couple trying to conceive. The National Infertility Association discusses these emotional effects, which may include:

In addition to these symptoms, I have noticed the people I work with in therapy experiencing the following:

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Infertility is traumatic. In addition to depression symptoms, it is quite common that couples experiencing infertility will experience anxiety in response to certain situations or triggers (such as seeing pregnant women, pregnancy tests, babies on TV or in person, etc.). They may experience intense emotion around certain times of the month, particularly the times near ovulation and when a period is due. Going in for fertility treatments may become very triggering and anxiety provoking, particularly if previous interventions failed. Sadness and grieving are common, particularly around holidays and other important life events.

When someone is experiencing infertility, negative beliefs about one’s inadequacy or defectiveness may come up. Both partners may question why their bodies are not functioning like seemingly everyone else’s, especially when those around them are having babies, apparently without any trouble.

If there has been past pregnancy loss, other triggers for anxiety, depression, and intense emotions may come up, including the date a baby was due or times of year associated with the loss. Triggers can seem unrelated or random but still have a profound effect on the emotional reaction of the people going through this difficult situation. For many, infertility feels like riding an emotional roller coaster of anticipation, worry, sadness, grief, and anger.

When someone is experiencing infertility, negative beliefs about one’s inadequacy or defectiveness may come up. Both partners may question why their bodies are not functioning like seemingly everyone else’s, especially when those around them are having babies, apparently without any trouble. People struggling with this issue may question their value and their self-worth can take a major hit, resulting in magnified depression and hopelessness.

The stress and trauma that result from infertility can also have a negative impact on a relationship. Because both partners experience their own challenges in infertility, they may be more prone to snapping at each other, taking things personally, or feeling disconnected.

There are steps people who are experiencing the emotional complications of infertility can take in order to cope and eventually thrive through this major life challenge.

1. Seek Professional Assistance

A mental health professional can help address the symptoms one is likely to encounter when experiencing difficulties related to infertility. Coping skills, trauma work, and couples counseling are just a few of the areas a therapist can help someone to work through to make this difficult path more bearable.

When working with people with infertility issues, I often utilize eye movement desensitization and reprocessing (EMDR) therapy to address negative beliefs about worth and defectiveness. EMDR has also been helpful in addressing and reducing disturbance related to fertility treatments, pregnancy loss, and worries about the future. When trying to get pregnant and while pregnant, stress management is essential in helping the body to be at its best to conceive and carry a baby.

2. Give Yourself a Break from Social Media

Social media can be wonderful, but they can be triggering for someone who is going through infertility. People love to make pregnancy and birth announcements through social media. Someone experiencing infertility may be much more sensitive to these announcements, as they can feel like a reminder of the pain that person is bearing.

If such announcements are triggering, give yourself a break and stay off social media for a while. Work with a therapist to decide when and how you will begin to engage in social media again. Working through some of the trauma and practicing coping skills regularly can help reduce the triggering effect of social media.

3. Acknowledge and Feel Your Feelings

Emotions are meant to be felt. One of the main jobs of an emotion is to alert us that we need to pay attention to something. Emotions can do what they are supposed to do only if we are willing to acknowledge and feel them.

The human body and brain are very good at working through difficult material when we stop avoiding emotions and allow ourselves to feel fully. A therapist can help with learning to tolerate and regulate emotions.

4. Celebrate and Enjoy the Little Things

Infertility can consume your life. From your thoughts to your time to your emotions and your relationship, it seems that there is not an area that infertility does not impact.

With your partner, find reasons to celebrate life. Engage in fun activities that you wouldn’t or won’t be able to do while pregnant or with a newborn. Try to soak up the moments of joy, calm, and fun as they come up. Seek out new hobbies or activities you have wanted to try. It is important to find joy and meaning in life, even when you are going through a difficult time.

References:

  1. Centers for Disease Control and Prevention (2006-2010). FastStats: Infertility. Retrieved from http://www.cdc.gov/nchs/fastats/fertile.htm
  2. Dunkel-Schetter, C., & Lobel, M. (1991). Psychological reactions to infertility. In A. L. Stanton and C. A. Dunkel-Schetter (Eds.), Infertility: Perspectives from stress and coping research (pp. 29-57). New York: Plenum.
  3. The National Infertility Association (2014). Emotional aspects of infertility. Retrieved from http://www.resolve.org/support/Managing-Infertility-Stress/emotional-aspects.html

Silhouette of a man on a dune at sunset Have you ever heard that the Chinese word for crisis combines two characters meaning danger and opportunity? This captures the essence of posttraumatic growth—that in traumatic experiences, as upsetting as they are, we can find opportunities for meaning and personal growth.

Posttraumatic growth is not about returning to or recreating the life you had before trauma; rather, it describes the perspective shifts and choices for positive change that often come in the aftermath of significant trauma. Being steeped in the field of resilience myself, the field of posttraumatic growth overlaps and explores not only what helps people get through life’s difficulties, but what helps them thrive as a result of challenge.

Trauma can be simply described as an experience that overwhelms our capacity to cope, so it is no surprise that much of trauma work involves calling in supports that increase one’s capacity to cope with the stress of the trauma. Whether or not we have these aspects of life in place prior to trauma, they can help us to recover, make meaning, and create positive experiences that, while not changing the traumatic situation, give a sense of meaning and purpose to life as it continues on.

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Here are five aspects of posttraumatic growth to reflect on:

1. Personal Strength

What helps you to feel strong and to access resources within yourself? How do you cope with pain, both emotional and physical? There are many ways of dealing with sensations and emotions that feel uncomfortable, and many of us seek out behaviors that have drawbacks—using substances, overworking, or distracting from the pain rather than moving through it. What can you do to help you connect to yourself in a healthy way and process uncomfortable emotions?

Many find strength in sports, exercise, creative endeavors (music, art, theater), or in connecting with and helping others. Take some time to reflect on what could serve you best in this way.

2. New Possibilities

With trauma often comes an organic shift in perspective. Perhaps things that used to be meaningful no longer carry your interest, while other topics feel suddenly more compelling. Take a moment to reflect on what you may want to leave behind and what is pulling your attention moving forward.

Often with trauma, people experience a shift and reprioritization of values; if this has happened for you, what new possibilities exist? How can you shift how you spend your time and energy to reflect these changes?

3. Relating to Others

Social supports are a huge way that we move through difficulty. Trauma may be what leads us to reach out for professional help, or to confide in a friend. We may also have a deeper sense of compassion for others who are suffering, leading us to relate to the world in an entirely new way.

Take a moment to look at your relationships—with family, friends, your community, and society at large. Where do you feel connected, seen, and supported? These are places that can be helpful and healing. If you do not feel you have people who support you, now is a wonderful time to reach out.

Trauma brings us face to face with our mortality and, as such, can lead us to appreciate and even treasure moments of peace or connection we may have taken for granted.

4. Appreciation of Life

I think Hamilton Jordan describes this best in his book No Such Thing as a Bad Day (2000): “After my first cancer, even the smallest joys in life took on new meaning—watching a beautiful sunset, a hug from my child, a laugh with Dorothy. That feeling has not diminished with time. After my second and third cancers, the simple joys of life are everywhere and are boundless, as I cherish my family and friends and contemplate the rest of my life, a life I certainly do not take for granted.”

Trauma brings us face to face with our mortality and, as such, can lead us to appreciate and even treasure moments of peace or connection we may have taken for granted.

5. Spiritual Change

Many trauma survivors report a shift in relating to the spiritual world.

The diagnostic (DSM) definition of trauma explains that many traumatic experiences involve exposure to death or threatened death, which brings to the forefront questions of mortality, afterlife, and spiritual meaning. We may find ourselves asking, “Why did this happen to me?” or “What has become of the person who passed?” These questions and the answers we seek are deeply personal and have significant implications for how we understand ourselves and the world. Allow time for these reflections in the aftermath of trauma.

As Ernest Hemingway so eloquently pointed out, “The world breaks everyone and afterward many are strong in the broken places.” Posttraumatic growth points to those places that become strong through exposure and experience. It may not be a painless process, but seeking opportunities for growth can help create a deeper sense of love, connection, and meaning in our lives.

GoodTherapy | What Makes Some People More Resilient to Trauma Than Others?Why do some people suffer after a traumatic event while others do not?

This is an important question in the world of trauma psychology, one that is being extensively researched. We know, both anecdotally and empirically, that, given exposure to a critical incident, some people will be negatively affected by it, while others will move on and be essentially fine. For example, several young people of similar age and background can be deployed on the ground in the same unit in Iraq or Afghanistan, be exposed to roughly similar experiences, and some will return stateside, move ahead with happy and fulfilling lives and be fine, while others will experience some level of disruption associated with their service.

Why is that?

The answer to this appears to be largely the same as the answer to so many other quandaries in the field of psychology: the unique combination of genetic constitution and set of life experiences for any given individual. It’s the old “nature vs. nurture” question, and, as is typically the case, the answer seems to be “yes, both influence outcome significantly.”

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As with so many things, it seems clear that we inherit a genetic constitution that may leave us more or less at risk of developing lasting problems after trauma exposure. Recent studies indicate that, with similar levels of trauma exposure, individuals who have close family members who have struggled with trauma-related problems are more likely than those without such a connection to struggle after trauma. This link seems fairly strong.

However, one generally does not experience trauma-related problems without … trauma. Life experiences do not occur in a vacuum, and trauma-related concerns are certainly no exception. Sometimes when we talk about trauma, we talk about a “dose-response relationship,” which simply means that a person’s response to trauma is directly related to the amount of exposure he or she has. Because of the differing “doses,” a person who experiences a single-incident trauma of brief duration (a car accident, for example) is at less risk of lasting problems than a person who experiences chronic exposure to ongoing traumatizing events for a lengthy period of time (such as child abuse or neglect).

Life experiences do not occur in a vacuum, and trauma-related concerns are certainly no exception.

This is not to say that people who experience a single car accident do not develop significant problems; they can and, unfortunately, sometimes do. However, the likelihood of ongoing struggles increases as the amount and severity of exposure to trauma increases. So, a person’s history of trauma and learned coping skills combines with his or her genetic constitution to create that person’s level of risk and resilience.

Sometimes when we talk about trauma-related struggles, we talk about trying to find ways that we might “inoculate” people against developing serious negative outcomes after a traumatic event. Of course, there is no shot or medicine that will achieve this; what we mean when we say this is that we hope to create a set of life experiences that will reduce a person’s vulnerability to troubles by increasing his or her resilience level. Essentially, we want to start to establish—prior to trauma exposures—habits and ways of being and relating to the world that seem to be associated with better outcomes after trauma exposures. For example, habits of thought are important in structuring how we perceive the world. A tendency to blame extensively or to personalize others’ behaviors may reduce resilience, so, with an eye toward increasing resilience, we may try to shift habits of thought in a different direction.

Of course, unlike “inoculation” in the true sense of the world, none of these will provide any real immunity. At present, there is no such thing—bad things happen to good people unexpectedly, and sometimes, in spite of everything, that person will encounter struggles associated with that. But we know that some habits can and do increase the chances that, upon exposure, the individual will be able to incorporate the experience and continue living life without major disruption.

Our knowledge about this grows every day, and we continue to work toward a more complete understanding of how to assist survivors of trauma. Both before and after traumatic incidents, there are interventions that we have identified that we know can meaningfully reduce suffering; this being so, it seems worth the effort to continue pursuing them as best we can, in spite of the imperfect state of our knowledge.

AdobeStock 489280039“I’ve been fine for years. Now I have nightmares every night and can barely function at work. What’s going on?”

“I thought I was over it. I even went to therapy as a kid! Why is it all coming back again?”

“I feel like I’m falling apart, but the abuse was years ago. Does this mean I’m getting worse?”

One of the first things survivors of sexual abuse ask me when they come into my therapy office is, “Why now? Why are these feelings and memories coming back now?” Often, the underlying question is, “I was fine before, but now I’m struggling. Am I going crazy?”

If you’re having this experience—being suddenly overwhelmed by a past trauma—let me reassure you the same way I reassure the people I work with in my office. No, you’re not going crazy! As difficult as it may be to believe, a sudden reemergence of old feelings is often a sign that you’re ready to heal on a deeper level.

Recovery from Trauma Happens in Stages

Healing from a trauma such as sexual assault or abuse happens in stages. In the first few days after an assault, we tend to shut down because the emotions feel so overwhelming that we can deal with them only in small doses. For ongoing sexual abuse or molestation, this shutdown state may last for the entire time the abuse occurs. Eventually, in the days, weeks, and months after an assault occurred or the abuse ends, we usually find ways to “put the past behind us,” to regulate our emotions and to build a stable life. We may still experience some triggers or have some nightmares, and we don’t typically forget about what happened, but over the years we start to feel “normal.”

Then, sometimes, all those feelings come roaring back. What’s going on?

When the fear, the anger, the sadness, the helplessness, the heartache—all the emotions that were perhaps too painful, too complicated, or just “too” in the immediate aftermath of the trauma—suddenly reemerge, your new task is to sit with those emotions and let them have their say.

In my experience as a therapist, what’s happening is that some deep, inner part of you finally feels safe and stable enough to address the leftover emotional fallout that’s been patiently waiting for years. Your job right after the trauma and in the years since the trauma occurred has been to find stability. You developed successful coping mechanisms that let you function in the world without falling apart. Those are invaluable skills that are going to get you through the next part of your recovery.

You Are Strong Enough to Feel Vulnerable Now

When the fear, the anger, the sadness, the helplessness, the heartache—all the emotions that were perhaps too painful, too complicated, or just “too” in the immediate aftermath of the trauma—suddenly reemerge, your new task is to sit with those emotions and let them have their say. They’ve been patiently waiting for you to develop the strength to cope with them successfully, and if they’ve shown up for you now, after all this time, they think you’re finally ready. You are strong enough to feel vulnerable for a while.

So what do you do? How do you cope without getting overwhelmed?

If you need additional support or resources, a therapist specializing in trauma recovery can help. If you need immediate help regarding sexual assault or abuse and you’re in the United States, you can call the 24-hour National Sexual Assault Hotline at 1-800-656-HOPE (4673) for support, resources, and referrals.

Related Reading: 

Artist painting on paper with a fine paintbrush“The real voyage of discovery consists not of seeking new lands, but in seeing with new eyes.” —Marcel Proust’s Remembrance of Things Past 

While we cannot go back and change the past or erase painful memories, we can make choices in the present. We can choose how we live our lives, change the lens through which we perceive the world, and look for the lessons along the way.

According to the famous Chinese philosopher Confucius, there are three methods to gaining wisdom: reflection, which is noblest; imitation, which is easiest; and experience, which is bitterest. Bitter though it may be, our experience of pain and suffering has the potential to become our ultimate instrument of transformation and creativity. When we are hurt, slighted, or disappointed, it can be all too easy to follow the path of least resistance and wallow in self-pity. We all do this at one point or another, and can easily remain stuck. But we can also choose another path. We can make the conscious decision to embrace our pain and use it to fuel our creative impulses.

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Maya Angelou, Frida Kahlo, Marcel Proust, and Edvard Munch, all recognized as masters in their respective disciplines, are just a handful of the many talented artists throughout time who turned unfathomable human suffering into riveting works of art. Through the process of personal catharsis and healing, each also transformed a society.

No work of visual art so simply and yet so poignantly depicts psychic pain more than Munch’s painting The Scream. Whether inspired by Munch’s sister, hospitalized for insanity at the time, or Munch’s own pain, this work is relatable as a portrait of universal human suffering. Munch shows us that when in the trenches of despair—anxiety, depression, or any number of other mental health issues—our perception of the world around us can shift wildly. In this piece, Munch’s view of his outer as well as inner landscape comes literally screaming off the palette.

When we are hurt, slighted, or disappointed, it can be all too easy to follow the path of least resistance and wallow in self-pity. We all do this at one point or another, and can easily remain stuck. But we can also choose another path.

The works of Kahlo hauntingly depict both the excruciating physical and psychological pain she experienced throughout much of her lifetime. From a deforming childhood illness and, later, a disfiguring accident which led to chronic pain, to the psychic scars of a tumultuous marriage and a social revolution, Kahlo takes unimaginable circumstances and transforms them into what are now renowned works of art—and potentially therapeutic tools. According to the American Medical Association’s Journal of Ethics, Kahlo’s work has been used by psychologists to empower women to talk about their experiences of physical and emotional pain, as in the cases of interpersonal violence, infertility, and chronic illness.

Artistic expression and exploration are invaluable tools in cases of childhood trauma. How does one reconcile that the same hand that betrays, wounds, and abuses is the one that he or she most needs? For countless victims of childhood abuse and neglect, violence, and other crimes of the soul, making sense of the world can seem an impossible task. Scottish poet John Burnside’s own painful and abusive childhood became the catalyst to several established literary pieces, most notably his memoir, A Lie About My Father. In this tale of forgiving, though certainly not forgetting, Burnside seeks to understand his father, an abusive man with alcoholism for whom “cruelty was an ideology,” and in this process comes to forgive the man who raised him.

Angelou’s Caged Bird is perhaps one of the finest poetic expressions of the injustice of racial oppression. Utilizing nothing more than language, she speaks to the pain of discrimination and the “shackles of racism and misogyny.” Also a victim of childhood rape, Angelou describes the “caged bird” whose “wings are clipped” or freedoms deprived, yet who chooses to use his voice for change:

But a bird that stalks
down his narrow cage
can seldom see through
his bars of rage
his wings are clipped and
his feet are tied
so he opens his throat to sing.

The caged bird sings
with a fearful trill
of things unknown
but longed for still
and his tune is heard
on the distant hill
for the caged bird
sings of freedom.

In seeking to solve the “puzzle of inequality and hate,” Angelou’s transformation of her experience paved the way for not only personal healing and liberation but, as a fierce civil rights activist, was instrumental in fueling societal change.

One need not be a poet, painter, or activist to implement the tools of creative transformation. Whether it is simply taking a course in painting or starting a journal, expressing rather than repressing may prove invaluable in the healing process. Whether out of societal or personal oppression, every caged bird has a voice—and the potential to transform a society or simply heal a soul.

References:

  1. Angelo, F. (2013). Pain and the Paintbrush: The Life and Art of Frida Kahlo. AMA Journal of Ethics, 15 (5), 460-465. Retrieved from http://journalofethics.ama-assn.org/2013/05/imhl1-1305.html
  2. Burnside, J. (2006). A Lie About My Father.
  3. Lubow, A. (2006). Edvard Munch: Beyond The Scream. Smithsonian Magazine. Retrieved from: http://www.smithsonianmag.com/arts-culture/edvard-munch-beyond-the-scream-111810150/
  4. Sethis, A. (2013). I Know Why the Caged Bird Sings by Angelou, Maya-Review. Retrieved from http://www.theguardian.com/books/2013/aug/18/maya-angelou-caged-bird-review

Young Girl Staring out WindowAs a therapist, I’ve used eye movement desensitization and reprocessing (EMDR) therapy to treat many adults with mental health issues resulting from trauma. This method of therapy is also safe and effective for children and adolescents, provided that the therapist is skilled and trained in working with this population and in this modality.

What Is EMDR?

When a painful or upsetting experience happens, the memory of the experience sometimes stays “stuck” in the body and mind. Over time, the occurrence may manifest anew in disturbing and invasive ways.

Dr. Ricky Greenwald, a pioneer in developing EMDR therapy for children and teens, describes EMDR as “a non-drug, non-hypnosis psychotherapy procedure. The therapist guides the client in concentrating on a troubling memory or emotion while moving the eyes rapidly back and forth (by following the therapist’s fingers). This rapid eye movement, which occurs naturally during dreaming, seems to speed the client’s movement through the healing process.”

After experiencing trauma, a child may have recurring nightmares or cope by avoiding things associated with the disturbing experience. For example, a child who experienced a car accident may exhibit defiant behavior when in a vehicle, or protest having to travel in the first place.

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Essentially, EMDR can help the brain “digest” the memory of the traumatic event.

How Does EMDR Help Children?

EMDR is effective and well supported by research evidence for treating children with symptoms accompanying posttraumatic stress (PTSD), attachment issues, dissociation, and self-regulation. It has also been effective in treating symptoms related to guilt, anger, depression, and anxiety, and can be used to boost emotional resources such as confidence and self-esteem.

During the past five years, the World Health Organization and the California Evidence Based-Clearinghouse for Child Welfare recommended two psychotherapies for children, adolescents, and adults with PTSD: trauma-focused cognitive behavioral therapy and EMDR. Of the two modalities, some of the research describes EMDR as “significantly more efficient.” My experience as a therapist echoes these recommendations.

One Therapist’s Experience with EMDR

I have personally witnessed children and teens improve in their overall functioning after being treated with EMDR, sometimes after only a few sessions. These children experienced PTSD symptoms as a result of bullying, psychological abuse, sexual abuse, and invasive medical procedures. Some of these traumas occurred at the hands of someone with malicious intent; others were formed from the child’s perceived intent.

Since our emotional states are a result of how we perceive the world, a child may have stress related to a memory that, to anyone else, would not seem to be a “big deal.” In an effort to help their children “get over it,” parents often tell them things such as, “It’s not that bad,” or, “He wasn’t that mean to you.” But if the experience was traumatic to the child, it was traumatic—period.

In an effort to help their children “get over it,” parents often tell them things such as, “It’s not that bad,” or, “He wasn’t that mean to you.” But if the experience was traumatic to the child, it was traumatic—period.

Trauma can result from one event, multiple events, or a series of them. These events can cause children to see the world as dangerous and can alter their ability to function. A child may experience anxiety, fear of death, panic, powerlessness, anger, and deep sadness. When the trauma is a result of violence perpetrated by a caregiver they trust, it becomes overwhelming and can cause a child to be in a constant state of worry. This, of course, interferes with the child’s ability to trust or to sustain and maintain relationships.

Therapy can be a scary prospect to a child. When I explain to a child that our brains are amazing things that have the ability to heal themselves, and that I will help their brains do just that, they usually react with curiosity and intrigue and the process becomes much less scary.

What to Look for in an EMDR Therapist

The safety of any treatment modality depends on the practitioner’s aptitude to administer it. A licensed therapist who is fully trained in EMDR is well equipped to help a child or teen. The therapist should have training in how to apply the method to the child’s specific developmental needs and an ability to explain the process to the child in a way he or she will understand. A full history should be obtained from the parents, who should be considered partners in tracking changes in the child as the treatment progresses.

EMDR is often used in combination with other therapeutic modalities, such as art therapy, sand tray therapy, play therapy, yoga therapy, and even animal-assisted therapy. A therapist who offers a multifaceted approach, based on the child’s unique needs and interests, is ideal.

If interested in seeking the help of an EMDR-trained therapist, search GoodTherapy.org’s directory for a therapist near you.

References:

  1. California Evidence-Based Clearinghouse for Child Welfare. (2010). Retrieved from http://www.cebc4cw.org
  2. Gomez, A. (2008). Beyond PTSD: Treating depression in children and adolescents using EMDR. Paper presented at the annual meeting of the EMDR International Association, Phoenix, AZ.
  3. Jaberghaderi, N., Greenwald, R., Rubin, A., Zand, S. O., and Dolatabadi, S. (2004). A comparison of CBT and EMDR for sexually abused Iranian girls. Clinical Psychology and Psychotherapy, 11,358-368.
  4. Trauma Institute & Child Trauma Institute. (2015). Eye Movement Desensitization & Reprocessing. Retrieved from http://www.childtrauma.com/treatment/emdr/
  5. World Health Organization. (2013). Guidelines for the Management of Conditions Specifically Related to Stress. Geneva, Switzerland. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK159725/

GoodTherapy | The Brain in Defense Mode: How Dissociation Helps Us SurviveAccording to Ross and Halpern (2011), there are several definitions of dissociation. One of them (referred to as “the general systems meaning of dissociation”) is “the opposite of association” or the disconnection of two or more things that were once associated with each other. Another definition, presented by Steinberg and Schnall (2001), defines dissociation as “an adaptive defense in response to high stress or trauma characterized by memory loss and a sense of disconnection from oneself or one’s surroundings.”

Dissociation occurs when someone disconnects from some part of himself or herself or the environment. It can occur in a number of different ways, including disconnection from one’s emotions, body sensations, memories, senses, etc. A normal and common phenomenon, dissociation can happen in mild forms even when there is not imminent danger or stress. Think of a time you drove somewhere, arrived, and then couldn’t remember the drive because your mind was wandering; an instance when you lost track of time because you were engrossed in a riveting television show; or when you disconnected from body sensations to avoid going to the bathroom when you were on a tight deadline at work.

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Dissociation is something we all do, and it is a vital part of our ingrained survival system. It is a part of the system that helps us to cope with stressful situations, which may otherwise feel overwhelming (Steinberg and Schnall, 2001). It is built in and is not pathological (Ross and Halpern, 2011). However, when a trauma occurs, sometimes this built-in system disconnects to a greater degree in an effort to protect the individual from traumatic material, body sensations, emotions, or memories that may be overwhelming.

Dissociation related to trauma occurs in varying degrees. On the lower end of the dissociation spectrum, for example, let’s say someone was in a car accident. A few days after the accident, the person finds that he or she cannot recall parts of the accident, even though reports of others were that he or she was conscious and responsive during those times he or she cannot recall. On the other end of the spectrum, someone who was severely abused throughout life can dissociate to the point that he or she has more than one personality, all of whom display and contain their own characteristics and who hold different memories associated with the trauma.

The goal in therapy is not to eliminate dissociation completely, but rather to help the brain and body to update to the current circumstances. Specifically, this would include helping a person to integrate current information about the present circumstances in which they live.

For the traumatized individual, dissociation may help him or her to survive circumstances that may have otherwise been intolerable. Dissociation can help a person feel as if situations, his or her body sensations, emotions that would have been overwhelming, etc., are muted and distorted so he or she can then go into “autopilot” mode and survive extreme situations and circumstances. When trauma is ongoing, dissociation can become “fixed and automatic” (Steinberg and Schnall, 2001). When this is the case, integration of memories becomes difficult for the brain, and the brain also continues to send of signals of danger, even when the traumatic situation is over (Steinberg and Schnall, 2001). This can continue for years after a traumatic situation has ended.

According to Steinberg and Schnall (2001), the five central symptoms of dissociation are:

For someone who is concerned that he or she is experiencing a more-than-normal incidence of dissociative symptoms, help is available. Several accurate tests are available through therapists and psychologists who have been specially trained in diagnosing and treating dissociation and trauma.

The goal in therapy is not to eliminate dissociation completely, but rather to help the brain and body to update to the current circumstances. Specifically, this would include helping a person to integrate current information about the present circumstances in which they live. If no danger currently exists, helping the brain and body to learn how to be safe would be one part of treatment. Working toward being able to maintain awareness of the present moment, body sensations, emotions, surroundings, etc.—also known as mindfulness—is one way to start to address dissociation, especially prior to any trauma work that needs to be addressed.

As a therapist, I appreciate dissociation as a valuable gift our brains are able to give us when we endure trauma. I emphasize to the people I work with in therapy that dissociation has helped them to survive, and we can acknowledge that this is a defense that has perhaps worked for longer than it was intended. It is important to remember that experiencing more than a regular level or type of dissociation as a result of trauma does not make a person defective. Rather, it shows that he or she has been able to live through and survive extraordinary circumstances that no one would be able to endure without the brain’s ability to dissociate.

References:

  1. Ross, C., and Halpern, N. (2009). Trauma Model Therapy: A Treatment Approach for Trauma, Dissociation and Complex Comorbidity. Richardson, Texas: Manitou Communications.
  2. Steinberg, M., and Schnall M. (2001). The Stranger in the Mirror. New York, New York: Harper.

Watercolor portraitIn recent decades, neuroscience and psychotherapy have joined forces in seeking to understand the biological bases of behavior. The brain is a complex organ, and as we study its function and adaptations we create a window of understanding into how our brains, bodies, and psyches respond to traumatic stimuli.

Have you ever heard of the triune brain? This is a simplified, three-part model of the brain, as originally explained by Dr. Daniel Siegel, that helps us to understand the neurological development of our species and clarifies both the reactions to and treatment of trauma.

Try this with me: Hold your dominant hand out in front of you. Have your palm facing you and look at your wrist and the base of your palm. We will call this your brain stem. (Stay with me now; we’ll explore what that means below.)

Now fold your thumb in toward your palm, as if you are signaling the number four with your extended fingers. This thumb will be your limbic brain. Lastly, cover your thumb with those four fingers, wrapping them over the thumb. This third part, the fingers, we’ll call the prefrontal cortex.

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Look at that: your brain is in your hands! You now have a portable brain model that you can carry with you and use to share this information with others. Now let’s explore the function of each of these three parts of the brain.

Your brain stem, located at the base of your neck at the top of your spinal cord, is the most primitive part of the brain. It governs the functions that keep you alive—your breathing, heart rate, and basic physiological functioning. Fight-or-flight responses involve this area in that they are automatic (not consciously chosen) responses to stress and traumatic situations.

Your limbic brain is where emotional responses register. When you get angry, reactive, or experience intense emotion, this area of the brain tends to have more activity. Scientists can actually see this on functional MRI brain scans.

Often, when trauma occurs we are captivated by the activity in the brain stem and limbic brain and our access to executive function feels difficult, if not impossible. Knowing this, we can make it a goal to reengage the prefrontal cortex in a helpful way.

Lastly, we come to your prefrontal cortex. This is the frontal lobe of the brain, that area just behind the skin and bone of your forehead. This is the area of executive function, the place in the brain where we make conscious decisions.

You may be wondering: how does all of this relate to trauma? Let’s start with what happens to these parts of the brain when something traumatic occurs. I mentioned earlier that the fight-or-flight response is not a conscious choice, but a biological reaction initiated in the brain stem area. Your body experiences the impulse to fight or flee (or freeze, as it may be). This trauma response feels, and is, out of your conscious control.

The limbic brain may hold intense emotion related to the traumatic experience—particularly when the trauma involves a relationship with another person. You may feel sad, angry, overwhelmed, or helpless.

Now here is the catch—and an opportunity for deep learning. Often, when trauma occurs we are captivated by the activity in the brain stem and limbic brain and our access to executive function feels difficult, if not impossible. Knowing this, we can make it a goal to reengage the prefrontal cortex in a helpful way. Here are some examples of how to practice this:

There are some therapeutic techniques of grounding and orienting that can help you to cope with some of the overwhelming emotions associated with trauma. Try them with small things in life—counting down from 10 to one while in traffic, looking for orange objects when you find yourself pulled into a past memory, or focusing on the center of your forehead as a point of meditation. These practices can help build your ability to access the prefrontal cortex during upsetting and even traumatic moments.

Remember, your brain is in your hands! You can look at this hand model any time by creating a fist with your thumb tucked in, then asking yourself, “What part of the brain am I living in?” This simple question begins to engage your prefrontal cortex. We know that our brains are resilient and respond to our thought patterns and habits, so the more you exercise your brain in this way, the stronger the neural connection can become. Cheers to you and your triune brain!

Reference:

Siegel, D. J. (2010). Mindsight: The new science of personal transformation. New York: Bantam Books.

GoodTherapy | Between Therapy Sessions: 3 Handy Coping Skills for TraumaWhile it’s true that working with a good trauma therapist enhances healing, not all trauma work happens in the therapy room. Even when a person regularly sees a therapist, the trauma work does not stop because a therapy session has ended. On the contrary, the brain keeps working and sorting through traumatic material in an effort to heal and move forward.

The brain is incredible in its resiliency and natural tendency toward healing. The brain wants to heal, but in doing so, sometimes distress happens. For example, when the brain has nightmares or flashbacks after experiencing a traumatic event, it is in fact attempting to heal by trying to bring forth information related to the trauma. But the distress and anxiety from experiencing these intrusions and related trauma symptoms can cause a person to want to (understandably) push away the memories and other intrusive symptoms related to the trauma.

It is not uncommon for intrusive symptoms to sometimes increase at the beginning of trauma therapy. As much as trauma therapy helps, it can also cause discomfort and intense emotions as a person faces and works through the traumatic memories. Therefore, having effective coping skills to use between therapy sessions is imperative. Below are three skills that can be used in or out of therapy sessions.

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1. Body Scan

The body often tenses as it prepares to fight, flee, or freeze due to continued trauma symptoms, even long after the traumatic event has ended. The body holds onto trauma, which can cause it stay on “high alert” status. This is exhausting and can take a toll on your health. Body scan is an exercise during which you pay attention to parts of your body without changing anything you notice. The objective of this exercise is not to relax. It is simply to be aware of what is happening in a particular moment.

Why doesn’t the body scan encourage relaxing the tension or pain you find? Because sometimes just noticing the tension you find is enough. Also, releasing any expectation of what is supposed to happen during the exercise can relieve anxiety about the exercise itself and make it more effective. If you have the expectation that you are supposed to feel relaxed during the exercise and that is not what you experience, negative thoughts about “not doing it right” may come up, which can cause distress.

During this exercise, you can start at the head, feet, or any other part of the body, and then pay attention to each part or section of the body at a time, noticing any sensations that come up. You may notice tension, itching, discomfort, or no sensation at all. The key is to just pay attention and to be aware. If you get distracted, simply notice that you got distracted without criticizing yourself, and gently redirect your attention back to the part of your body you were focused on.

2. Containment

Containment is one of the skills I was taught early in my EMDR training and it has become one of the stabilization skills I teach most frequently. This exercise is effective in utilizing the brain’s natural ability to contain material. It involves imagery of a container of some type that can hold onto material that is distressing or disturbing, until the time you feel better able and prepared to deal with it.

To utilize this exercise, imagine a container of some type: a box, safe, vault, trunk, etc. Whatever the container is, it should have a door or lid that you can open and close as you please. The container needs to be big enough and strong enough to hold anything that is causing distress. When something distressing comes up and it is not possible or optimal to address whatever is coming up in that moment, imagine letting the traumatic material go into the container temporarily, until it can be addressed at a later time.

The objective of this exercise is not to disregard or ignore the important information that the brain is trying to communicate. Rather, it is meant to allow the brain to set aside distressing information for the time that it is optimal to address the material. This helps to prevent becoming too overwhelmed by trauma symptoms, which often include intrusive thoughts, images, and memories. It is beneficial to discuss with your therapist the thoughts/images/memories/etc. you contain between sessions so that he or she can help you sort through the material in the container, a little at a time.

3. Body Movement

Sometimes the body is our most underutilized resource. Recent research by Bessel van der Kolk, et al. (2013) found that a yoga practice as a supplementary treatment for posttraumatic stress (PTSD) dramatically decreased symptoms of PTSD in participants. The researchers in this study theorize that yoga practice may help individuals with trauma to learn to more effectively tolerate and cope with body and sensory sensations, in addition to helping them to learn to tolerate intense emotion.

It is my belief and experience that, whether it is yoga or some other form of exercise, moving the body has major benefits and enhances trauma healing. The exercise or body movement you choose does not have to take a great deal of time or money. Some people report that simply walking and stretching has positive benefits on their ability to cope between sessions. People often report that engaging in some form of exercise or body movement also is helpful in gaining self-appreciation and the ability to self-soothe and nurture.

I have found with the people I work with in therapy that, when used consistently, the above skills help to move trauma work forward as they begin to feel more confident in their ability to tolerate intense emotion and distress. Contact a qualified trauma therapist if you think you might benefit from some guidance.

Reference:

Van der Kolk, B. A., Stone, L., West, J., Rhodes, A., Emerson, D., Suvak, M., and Spinazzola, J. (2013). Yoga as an adjunctive treatment for posttraumatic stress disorder: A randomized controlled trail. Journal of Clinical Psychiatry, 75, e1-e7. Retreived from http://www.traumacenter.org/products/pdf_files/Yoga_Adjunctive_Treatment_PTSD_V0001.pdf

 

GoodTherapy | Resensitization: Coming Back to Life after Trauma

Trauma dysregulates the body. It moves energy levels away from baseline to extremes of hyperarousal (“too much,” panic, overwhelm) and sometimes hypoarousal (“low,” lethargy, emptiness), not only alternating but sometimes getting stuck in either extreme.

When we experience overwhelm in the body, one natural response to this dysregulation (and accompanying confusion or relational struggles) is to just get away—perhaps through drinking, sex, anxiety medication, working out, or power-watching television series online. For some, especially when trauma occurs early in life or when physical escape is not an option, dissociation (mentally drifting, wandering, “spacing out”) becomes the path to something that approximates peace or safety. Whatever route you take to numbness, it ultimately leads to separation from overwhelming sensory input coming through the body. Studies have shown that even when mental denial occurs, when we tell ourselves we are not upset, our body still shows all the standard symptoms of activation and overwhelm.

Big names in trauma, including Peter Levine and Bessel van der Kolk, advocate not for desensitization approaches that dull perception (repetitive reprocessing of trauma), but for practices that resensitize somatically to awareness of the present moment, the physical narrative, and an embodied experience of safety and control.

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“Traumatized people chronically feel unsafe inside their bodies: the past is alive in the form of gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside. They learn to hide from their selves.”
—Bessel van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

From Numbness

When we split from Self, we become our own enemy. We deem some core part of Self unacceptable or unsafe and expend huge amounts of energy in an effort to contain and subdue that part.

Sometimes the numbness soothes.

Sometimes it smothers.

Especially in trauma, we move to extremes.

Where we once sought freedom from overwhelming sensations, we eventually embody the separation: fully numb, divorced from life, split from Self, desperately seeking a way to feel real again, to feel connected to others and to life … to feel anything but the empty nothingness we sought and created.

The experience changes from one person to the next. For some, it may be less conscious or intentional. Maybe awareness of behaviors comes from the feedback of others as they accuse you of being irritable or irrational. Maybe they point out how analytical you’ve become, how rigid you’ve become in your rules and boundaries in some apparent quest to manufacture security.

Sometimes the extremes seem less extreme. Especially from a patterned “freeze” response or “learned helplessness,” the only noticing may be more of a familiar giving up, an acceptance of circumstance, buying in to the belief that this is all there is. From the perspective of onlookers—seeing your shoulders fall, your head drop slightly—it might look like a physical collapse.

Character development over the years, adapting around ongoing waves of trauma, commonly moves toward extremes of highly responsible or irresponsible behavior—rigid or chaotic. It might be a complex blend of both, creating artificial structure to protect and control, then engaging in high-risk behaviors to drown out or anesthetize the pain.

Sometimes there’s just the safety of the same old patterns.

Sometimes an anger rises against that monotony. That part contains screams out from inside of you.

Whether it feels safe or not, that unknown, incessant core part of Self keeps making itself known, keeps drawing your attention.

To Overwhelm

Coming back into your body often means a return to the original overwhelm.

Sometimes we can feel it coming. Other times, we are so split from our bodily senses that we don’t feel the pain until it’s too intense to ignore. It might feel like an instant move from “just fine” to overwhelm. What would it be like to drive a car with a speedometer that shows zero or 100 but nothing in between?

“Trauma changes the insula, the self-awareness systems. Traumatized people often become insensible to themselves. They find it difficult to sense pleasure and to feel engaged. These understandings force us to use methods to awaken the sensory modalities in the person.”
—Bessel van der Kolk

Sometimes the only way out is through … through the natural physical sequence of fight or flight—whatever motor pattern that represents in your body, whatever unfinished story it represents in your behavior. Sometimes this requires the help of a trauma therapist, including a therapeutic process of training and resourcing, developing a bond of trust and a mindful grounding in the present moment. The accessing of uncomfortable physical sensations (and state-dependent beliefs that come with the sensations) can become a healing experience rather than a confirmation of negative beliefs formed at a time when you felt incapable of meeting the occasion.

Some people find a grounding, resensitizing support in nature. Others find a necessary social/attachment support in structured groups. For some, it might be yoga or martial arts that return your body to a felt sense of control. Many therapists, particularly those trained in trauma or body-based experiential approaches, come equipped to help a person internalize (to gradually take in, to incorporate into his or her character) an experience and a knowing of safety and control with Self and with Other (the therapist). Whatever the method, for those who have separated from their bodily self, the move to incorporate bodily sensation into their awareness often proves to be a life-altering process.

To Manageable Pain

Sometimes it’s in the shower, cooking a meal, sitting in a garden, or “being” with a therapist. The nervous system drops to a calm hum, the physical containment ceases, and the memories process, unbidden, unstopped. And finally, in stillness, with internal safety and compassion, we observe, feel, accept, and integrate. Sometimes the body shakes—with or without tears. And after all the years of struggle, sometimes a gentle sadness lingers.

Once the overwhelm is past and underlying truths are part of present awareness, only grieving remains. Each new level of awareness brings with it a comparison between what was and what could have been—grieving for the time lost, missed opportunities in life, unmet wishes, past distractions from this centered place of living.

There may be decades of fighting the overwhelm of grieving, and then just the simple, natural, bodily directed process of grieving. No longer does one part of the body expend energy containing the “unwanted” energy of another part. No longer is it “too much” to bear. It just is. We are able to sit with the experience without reaction, without separation, with nonjudgmental presence. It might be less letting go and more letting be.

To Joy

Emerging on the other side of pain, many people find new connections. Many find that the quality of external integration echoes the quality of internal integration, and once Self is internally acceptable, we begin attracting others who also accept and value those parts of Self that we truly value, that perhaps we preserved in hiding so many years.

“If you are divided from your body, you are also divided from the body of the world, which then appears to be other than you or separate from you, rather than the living continuum to which you belong.”
—Philip Shepherd, author of New Self, New World

References:

  1. Siegel, D. J. (2010). Mindsight: the new science of personal transformation. New York: Bantam Books.
  2. Van der Kolk, B. (2014). The Body Keeps the Score. New York: Viking.
Important Notice

GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.