Treating Trauma Should Not Be Traumatic

Young hands holding old handsDr. Shannon was a psychiatrist with her own issue, which turned out to be nearly debilitating. Her fellow psychiatrists had not been successful in helping her treat it. She had already diagnosed herself with posttraumatic stress (PTSD). Her days and nights had, for months, been shattered by sickening flashbacks and paralyzing nightmares. She had developed a bizarre phobia.

She cried as she painted a picture of increasing despair. The merest hint of similarity between her horrific memory and innocent daily happenings was enough to spin her into pulsating, gasping panic. She felt useless professionally and was starting to wonder whether she could ever go back to work.

So, of what was Dr. Shannon so afraid?

Bizarre Phobias Are Not So Weird
It might surprise you to know that this woman had developed a sickening terror of the elderly. For her, the sight of a grey head or stooped posture was enough to set off flashbacks and panic attacks so severe she believed she might die.

Dr. Shannon’s life was unbearable.

She had read about the famous ‘rewind technique’ and knew I used it for the treatment of PTSD and phobias. She knew exactly why she had the problem and understood its source. But knowing why you suffer and being able to stop the suffering are two different things.

Dr. Shannon knew that her trauma stemmed from a shocking incident. Something that happened one rainy afternoon in the psychiatric unit in which she worked. She didn’t want to tell me. I didn’t want her to tell me. She told me anyway.

Fear of Death
“He’s an old man. But he nearly killed me,” she told me.

An elderly man, a patient, without warning, had attacked Dr. Shannon. Lacing his arthritic, but strong-as-iron, fingers around her throat that day, he had come within a whisker of ending everything for her.

He had smiled toothlessly while choking her. It was all the more nightmarish for her, because he had never been considered dangerous. He was a frail old man. But this seemingly frail and harmless man in his 70s was murderously strong.

“It was sheer luck that he didn’t kill me.”

Why, even now, months later, was she still having flashbacks?

The Trance of Fear
Dr. Shannon was saved by a young co-worker and another doctor. Even they had trouble releasing the man’s deadly grip.

Other than angry turquoise bruises, she was not physically damaged. But in those few vivid moments, Dr. Shannon experienced the type of trance we all experience at the outer edges of fear. It felt unreal and hyper-real at the same time. Fear focuses and narrows attention. During such states you are wide open to learning, a kind of unconscious programming.

My client had been programmed with the template of that experience. Even as her life was leaking away, her mind had been busy at work identifying and storing the patterns that would alert her to such a dangerous threat in future. That template could encode any aspect of the experience, including the pattern of elderliness.

I’ve seen this kind of caution before in PTSD clients: the war vet who would panic whenever he saw individuals back in England of even faint Middle Eastern appearance, or the woman mugged by a man with a beard who would then fear any man with facial hair.

Nature is concerned with keeping you alive, but sometimes it is too thorough. When this happens we need to change things so that whole lives are not ruined by the brain’s overeagerness to tag harmless things as threatening. The part of the brain that can both save lives and lay waste to them is so small.

How a Tiny Part of the Brain Causes Big Problems
A tiny structure deep within her brain called the amygdala caused a massive fear response for Dr. Shannon. It encoded memories of the near death assault. In future, anything at all that reminded her amygdala of the initial trauma would produce strong feelings of fear, and drive her to take avoiding action. Whenever she was confronted with anything that even vaguely reminded her of the initial trauma, such as seeing any old person,  there would be a kind of posthypnotic trigger, and she would be reliving her experience again.

She knew what was happening, but she didn’t know how to stop it.

It’s a common assumption that your thoughts determine your feelings, but actually your amygdala produces emotion before your thinking brain gets a look in. Strong feelings need to be quicker than thought for basic survival. A colleague had tried to help her with cognitive therapy. But the 25% of people who have persistent PTSD [1] are not able to be helped by changing their thoughts, because their troublesome reactions happen quicker than thought. This is the basis of triggering reactions as part of PTSD.

Any cure would need to work with Dr. Shannon’s preverbal unconscious responses.

Taking Out Trauma
About three quarters of people who experience trauma won’t need any treatment – just love and support as they recover. They’ll dream it out (the brain’s clever way of releasing any kind of emotional arousal) or eventually be able to reflect on it and talk about it. Their memory banks will relocate the traumatic memory into ‘narrative memory’ and, although they’ll know it was bad at the time, they’ll be able to think and talk about the event fairly easily.

The remaining 25% have persistent trauma. Weeks, months, or even years later, it will still feel recent, or even current. The sufferer won’t be recalling it as much as re-experiencing it. The very same people who have persistent flashbacks (which work like post hypnotic suggestions) have been the very same people who respond best to hypnotic suggestion [2]. Trying to get someone who is deeply traumatized to talk things out may only make it worse, as this may recreate the trauma [3, 4].

When Talking Hurts
Dr. Shannon couldn’t talk about the initial attack without shaking and becoming tearful. I got the gist of what had happened that day then told her that was it. She need never speak of it again, or she need not speak of it until it felt fine to do so, which would be soon.

I was going to use the Rewind technique on her, a natural and painless way of lifting trauma. It uses relaxation and dissociation powerfully and comfortably, to allow the brain to reprocess memories from being contained within the ‘fight or flight’ part to the higher cortical centres where it can be reviewed without strong emotion and where, like many other memories, it will start to fade in time.

Twenty minutes after she’d arrived, we set to work lifting her trauma.

New Life for Old
Dr. Shannon looked a different woman. After Rewind treatment she was — to use a very nonpsychiatric term — blissed out. She was calm and appeared younger, as the creases of tension had melted from her face.

She described with wonder how the memory seemed distant now, bad at the time but no longer bad to think about. She was liberated from that particular prison of memory. She had hoped this was the case, but hadn’t really dared believe it. Some of her colleagues had scoffed. How could such a condition be treated without Dr.ugs? How could something so serious be treated in one session by a man who didn’t own a white coat? But Dr. Shannon was so desperate she didn’t listen to them. And as I said to her: “The PTSD was learned in a matter of a few seconds. Why should it take that much longer to unlearn it?”

Three days later she was back at work. Many co-workers could barely conceal their surprise. Some still doubted her cure would last.

She texted me the following weekend to tell me she was having tea with her 80 year old aunt, surrounded by elderly faces. It was the best text I got all week.

References:

  1. Wilson, J.P. and Keane, T.M. (1997). Assessing Psychological Trauma and PTSD. The Guidford Press.
  2. Spiegel, D., Detrick, D., and Frischholz, E.J. (1982). Hypnotizability and psychopathology, The American Journal of Psychiatry, 139, 431-437
  3. Wison, J.P., and Keane (1997.) Assessing psychological trauma and PTSD. The Guildford Press.
  4. Rose, S., Bisson, J., Churchill, R., Wessely, S. (2002). Psychological debriefing for preventing post traumatic stress disorder (PTSD). Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12076399.

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  • Kelda

    Kelda

    April 27th, 2013 at 12:44 AM

    Weird how a few moments can bring in fear about certain things or people for a long long time and to a great extent.

    While this may happen due to strong emotions,is there any technique that can be used soon after the traumatic moments to help the cause?

  • Betty P

    Betty P

    April 27th, 2013 at 5:46 AM

    I bet that therapists have to listen to a lot of different things, and I have never given thought to how listening to the problems of others could impact you if you are too dealing with your own issues. Hearing something from a client could indeed spark and bring back the memories of something that you have been running from in your own past. I can definitely see how this could cloud your view on how much you might be able to help someone else when you are dealing with your own issues. I hope that therapists know that there is an entire community out there to help them too, just in the same way that they are currently helping others. They need to seek out these resources so that they can provide the ebst possible care for their own patients.

  • drew

    drew

    April 29th, 2013 at 4:52 AM

    Why would I even want to listen to others woes when I have gone through this myself?
    This does not seem like it would be a healthy life decision at all.

  • Mark Tyrrell

    Mark Tyrrell

    April 29th, 2013 at 7:05 AM

    Hi Kelda
    That’s a good question. As I say in this piece around 75% of people will be okay after a traumatic event. They are the ones who generally are able to talk about it without (the talking about it) deepening the trauma further unk.com/blog/no-need-to-relive-the-trauma/ but for the other 25% so called ‘critical incident debriefing’ in which victims are encouraged to discuss what happened or to ‘open up’ can be a disaster. Asking people what happened, not how they felt about what happened or what their emotions were but just, factually, what happened can be a simple way of helping people turn a traumatic memory into a ‘narrative’ (and therefore non-threatening) one-as can asking someone to write down what happened. But as I say for the 1 in 4 people who cannot do this without re-traumatisation something else is needed.
    I hope that’s useful, Mark.

  • Tim

    Tim

    November 14th, 2013 at 6:38 AM

    Is there any scientific evidence to support that the rewind technique works?

  • Mark Tyrrell

    Mark Tyrrell

    November 14th, 2013 at 11:04 AM

    Hi Tim
    There has been some research on Rewind method’s efficacy

    ‘Until recently there has been little research into the rewind technique. However a new study of four years’ use of the technique at the Nova Trauma Support Services (part of the Barnardo’s charity) has shown remarkable results. The Nova team provide therapeutic support to individuals and families who have been psychologically traumatised, primarily as a result of their experiences in Northern Ireland.’ uncommon-knowledge.co.uk/training/online/rewind-technique.html there was another small study done more recently: hgi.org.uk/archive/rewindevidence.htm#.UoUQdvltZqh All best wishes, Mark

  • Margaret Walsh

    Margaret Walsh

    February 20th, 2014 at 10:38 AM

    Hi Mark
    Uncommon Knowledge trained me in the Rewind Technique, giving me great confidence in treating PTSD and phobias. Use of this technique can, literally, be life changing as some of my clients testify.
    I’d like to share with you two experiences of treating clients with Rewind. One of my clients, an attractive young lady in her early twenties, had suffered cruelly from social media bullying when she was at school, only to find out that it had been perpetrated by her ‘best friend’ and another close friend. When she came to me, she was unable to hold down a job or travel too far from home. She was fearful of many things, severely lacking in self-confidence and her life was very limited. After establishing the experience felt more recent and scaling how she felt about it now, I used the Rewind Technique. Directly after the first ’round’ of Rewind, she sat forward, head in hands, weeping. I hadn’t experienced this before but ‘relaxed with uncertainty’. She then lifted her head and, smiling through the tears streaming down her face, said “It’s gone! It’s gone! These are tears of joy!” The memory had already lifted.
    Another lady had been receiving extensive therapy for four traumas she had suffered over the course of her life. During her first session, I rewound the one most difficult to deal with. After the session she put herself at a 3 on a scale of 1-10 with 10 being the most terrified she could feel about anything. Beforehand, she had put herself at 10. She also said that she felt separate from it now and agreed that it felt longer ago, whereas beforehand it seemed like yesterday. She will be returning to address the other two traumas that she scaled at 7 and 10 (the other she scaled at 1, having dealt with that in trauma therapy).
    Do you have advice on how one could ‘specialise’ in lifting trauma without a medical/scientific or degree background? Would it be a good idea even? It’s something I’ve thought I’d like to do whilst continuing to treat other conditions.

  • Margaret Walsh

    Margaret Walsh

    March 1st, 2014 at 6:22 AM

    Hi Mark
    I’d like to share a couple of experiences as an UNK practitioner with you. My client, an attractive, intelligent young lady was not working, not socialising much for fear of going to new places and using public transport and she imagined that people were talking about her and laughing at her. Her life had become severely limited as a result of being badly bullied on a social media website. It turned out the perpetrators were her ‘best friend’ and another ‘friend’. Naturally, she was devastated and her self confidence had plummeted. I used the Rewind technique to disassociate her from that memory and to bring the anxiety around it right down. After the first ’round’ of rewind, she sat forward, put her head in her hands and sobbed. I was taken aback at this as I hadn’t encountered this before and I was a little unsure of what to do. However, taking a tip from your good self, I relaxed with uncertainty. My client then lifted her head and, smiling through her tears, cried “It’s gone! It’s gone! These are tears of joy, Margaret.” She has since made excellent progress and has even become self-employed, starting up her own business as a solo practitioner.
    If I may, I will send you separately a synopsis of fantastic work I’m doing currently with a lady who has suffered four separate traumas from the age of three. She had been self-harming, binge eating & starving, abusing laxatives, had put her heart at risk with bulimia and losing 7.5 stone and could only eat in her car or at home due to her fear of eating and drinking in front of others. She has had only three sessions and her progress has been little short of miraculous. Margaret.

  • Kathy S

    Kathy S

    February 19th, 2015 at 10:52 AM

    Again we have a confirmation of the reality of soft therapeutic methods being helpful in the recovery from traumatic events.

  • Lydia S

    Lydia S

    June 23rd, 2018 at 2:23 PM

    I have concerns about the long term effects of the rewind technique which is a ,’quick fix ‘ approach to trauma.

    Yes it does work almost magically and does relieve symptoms in the short term. This is the beauty of dissociation, you separate out thoughts, feelings , memories. There is a continuum for trauma where PTSD is at one part and further along in severity is dissociative disorders. With your double dissociation hypnotic technique all you are doing is pushing someone further along that continuum in my opinion . Of course it works because dissociation enables you to separate of trauma but you do not have the evidence that this trauma has been processed . I have concerns about the long term efficacy of this technique when this dissociative barrier breaks down under some future stress. I agree it does enable respite from distressing symptoms and someone to continue with their life and who wouldn’t want that . It doesn’t mean though you have processed their trauma in my opinion . I am concerned this is short term quick temporary fix . The NICE guidelines for PTSD do not advice rewind technique and I would caution anyone to tread carefully using techniques which are not evidence based. Just because it works does not mean it works for example if i had pain in my toe , you would not advocate cutting of my foot . It would solve the pain in my toe but it is not necessarily the right solution.
    Dissociation should always be the last resort and used in situations when there is no escape.

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