Traditional Therapy OptionsResearch support exists for some of these treatment approaches.
One of the most prevalent therapies for healing trauma, CBT is based on the premise that changing the way we think changes the way we behave. It’s all about thought monitoring; learning to hear your own internal dialogue, recognize when it’s skewed, and becoming adept at implementing tools that intercept the bad thoughts and replace them with good.
Since CBT teaches us to consciously engage in the moment of our own thoughts it can be a useful tool in our coping & healing bag of tricks. Most importantly, it engages us in the moment, which we tend not to do on our own. Dissociation is often a huge issue for someone experiencing PTSD; CBT helps a person find a way to stay present, and to positively manage that present, too.
For further explanation check out the National CBT Organization for several clinical resources.
(Photo: Felipe Valdevieso)
Eye Movement Desensitization and Reprocessing (EMDR). EMDR therapy is different from the other forms of research supported trauma treatments, because it does not ask the client to describe the memory in detail and it does not involve homework.
The point of EMDR is to facilitate “the accessing of the traumatic memory network, so that information processing is enhanced, with new associations forged between the traumatic memory and more adaptive memories or information. These new associations are thought to result in complete information processing, new learning, elimination of emotional distress, and development of cognitive insights.”
It goes like this: Your brain processes events and stores memories in much the same way as a computer. Pathways are built and constructed for the cataloguing and retrieving of information. Sometimes, the circuitry is a little faulty – the information processing goes a little haywire and has to be, er, rewired. The EMDR Institute describes the process this way,
All humans are understood to have a physiologically-based information processing system. This can be compared to other body systems, such as digestion in which the body extracts nutrients for health and survival. The information processing system processes the multiple elements of our experiences and stores memories in an accessible and useful form. Memories are linked in networks that contain related thoughts, images, emotions, and sensations. Learning occurs when new associations are forged with material already stored in memory.
When a traumatic or very negative event occurs, information processing may be incomplete, perhaps because strong negative feelings or dissociation interfere with information processing. This prevents the forging of connections with more adaptive information that is held in other memory networks. For example, a rape survivor may “know” that rapists are responsible for their crimes, but this information does not connect with her feeling that she is to blame for the attack. The memory is then dysfunctionally stored without appropriate associative connections and with many elements still unprocessed. When the individual thinks about the trauma, or when the memory is triggered by similar situations, the person may feel like she is reliving it, or may experience strong emotions and physical sensations. A prime example is the intrusive thoughts, emotional disturbance, and negative self-referencing beliefs of posttraumatic stress disorder (PTSD).
In EMDR therapy the person thinks of the event briefly as it is paired with sets of eye movements or other forms of stimulation. With the therapist’s assistance, this helps the brain make the appropriate connects and rewire itself in regard to all traumas – that includes every kind of military and civilian experience.
According to Dr. Francine Shapiro, founder of EMDR Therapy:
Clinicians should be trained to EMDRIA standards. If you look at the back of the book, GETTING PAST YOUR PAST, (Appendix B) you’ll see the questions that I recommend people ask prospective clinicians. It’s important to find a clinician who works with survivors, uses the techniques I teach in the book and appropriately prepares the client. Accessing the memories can cause a certain level of disturbance. But the client should be prepared with the techniques to handle it. Also, an initial screening for dissociative disorders is important to see if additional preparation is needed before processing is begun.
Survivors should also have a good relationship and honest communication with the clinician. If they are having a rough time then the clinician can see them on consecutive days (or morning and afternoon) to finish processing the memory that is disturbing. Once the memory is processed it’s no longer disturbing. It’s not necessary to wait a week between treatment.If the memories remain unprocessed they poison life. So I’d advise the survivors to find an EMDR therapist who has been fully trained by a program accredited by EMDRIA who works according to the book. They will then have the techniques needed to handle any disturbance that arises.
Photo: Darrow Inc.
Talk therapy is a good place to begin PTSD healing. If we can’t communicate what’s wrong, if we don’t have a vocabulary or language to express what happened to us, what’s troubling about our symptoms, and how we feel then it will be difficult to get the help we need. It is not necessary to engage in talk therapy in order to discover how to communicate – many practitioners can guide you through the evolution to speech – but should you wish to address trauma from the standpoint of its relation to your whole self, talk therapy is a good place to get going.
First, let’s get a little clinical in our understanding of psychotherapy and its place in the healing mix. A definition of psychotherapy provided by MSN Encarta is as follows:
“…treatment of individuals with emotional problems, behavioral problems, or mental illness primarily through verbal communication. In most types of psychotherapy, a person discusses his or her problems one-on-one with a therapist. The therapist tries to understand the person’s problems and to help the individual change distressing thoughts, feelings, or behaviors.”
A few stats about psychotherapy:
–According to one study summarized by the APA online, 77% of people who entered therapy were better off than those who didn’t.
–91% of Americans are likely to consult or suggest that a family member consult with a mental health professional
–50% of Americans believe the stigma surrounding mental health services has decreased
–Long-term psychotherapy accounts for only 15.7% of psychotherapy
For further reading:
1 – ‘To Reap Psychotherapy’s Benefits, Get a Good Fit’ – A terrific article by Howard Friedman in the New York Times about the importance of finding the right therapist.
2 – American Therapy: The Rise of Psychotherapy in America – This new book by Jonathan Engle traces the evolution of American mental healthcare covering contributions of personalities, theories and techniques in psychiatry, psychology and social work.
(Photos: SCSSAPICS, Pascale PirateChickan)
One of PTSD’s most extreme symptoms is our tendency to avoid anything and everything that reminds us of our trauma. However, avoidance only feeds our traumatic feelings and encourages us to continue to embrace and act upon them. Exposure therapy – the opposite of the typical, self-prescribed avoidance approach – aims at ending the cycle once and for all. While avoidance may provide temporary relief, it just doesn’t last. Facing these triggers is the key to reducing the frequency and severity of PTSD symptoms. According to an article on Medical News Today exposure therapy has proven to actually intercept the progression of trauma survivors from Acute Stress Disorder to PTSD. Now that’s something to think about. Very popular with all kinds of trauma and particularly the military, PTSD Facts For Health defines exposure therapy this way: Exposure therapy is based on the principle that we get used to things that are just annoying and not truly dangerous. This is called habituation, and it occurs naturally in over 95% of people…. Exposure therapy is based on the idea that this kind of habituation must occur in the person who has been traumatized if they are to overcome PTSD. Exposure therapy asks patients to confront, in a safe way, the very situations, objects, people and memories they have attached to the trauma (and are probably very consciously avoiding).
(Photo: The U.S. Army)
In group therapy, you talk with a group of people who also have been through a trauma and who have PTSD. Sharing your story with others may help you feel more comfortable talking about your trauma. This can help you cope with your symptoms, memories, and other parts of your life. Group therapy helps you build relationships with others who understand what you’ve been through. You learn to deal with emotions such as shame, guilt, anger, rage, and fear. Sharing with the group also can help you build self-confidence and trust. You’ll learn to focus on your present life, rather than feeling overwhelmed by the past.
Run by a mental health practitioner (whose goal is to guide the group in self-discovery and evoltuion) group therapy is either structured around a time frame or a topic; a group agrees to meet for a set number of sessions, or meets indefinitely about a controlled topic. Most groups contain up to 12 members. Time limited groups have a distinct beginning, middle and end and are usually closed. Meaning, once the group begins others cannot join. They usually meet for 8 – 20 sessions and is geard toward the accomplishment of a goal set at the beginning. Group members are homogenous in that they all share some similar background traits, diagnoses and are working toward the same end. These groups tend to be skills management and development oriented. Topic focused groups are more heterogenous; members come from varying backgrounds and bring varying psychological issues to the group forum. These groups are more open-ended in their approach to the time frame of achieving goals. These groups tend to be single-issues groups, ie. PTSD, depression, anxiety disorders, etc. Since these groups are unending people leave and enter the group at any time.
Benefits of group therapy include:
- connection with community
- exchange of personal experience
- learn you are not alone
- experiment with relating to different people in a safe environment
- experience other worldviews
- learn to openly and honestly discuss issues
- gain identity and social acceptance from the group
- some people are more comfortable being outside of the one-on-one environment of traditional therapy
- gain insights to problems by observing how others have handled them
- feedback from a variety of sources
- development of self-esteem by helping others solve their problems
Self-help groups (i.e. Alcholics Anonymous, etc.) are group oriented but are not run by trained mental health professionals. While they maintain the benefits of social support, identity development and belonging they do not address issues through any restorative psychological guidance.
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Taking as its base the idea that undesirable behavior can be unlearned or changed, BT is a psychotherapy that engages the client in identifying objectionable, maladaptive behaviors and replacing them with healthier actions. BT is also known as Behavior Modification Therapy. While Cognitive Behavior Therapy focuses on discovering and eliminating thoughts and emotions that lead to unhealthy behavior, BT solely aims to change the behaviors themselves. (Cognitive Behavioral Therapy is a strategy that marries the two therapies.)
BT is often used to address such conditions as depression, Attention Deficit Disorder, Attention Deficit Hyperactive Disorder, Obsessive Compulsive Disorder, several addictions. insomnia, chronic fatigue, anxiety disorders and phobias. BT usually begins with the therapist analyzing the harmful behaviors in a client and then deciding which method most appropriately addresses them.
Treatment techniques include assertiveness training, systematic desensitization, environment modification, relaxation, exposure and response, positive reinforcement, modeling/observational learning, contingency management, habit reversal training, flooding, operant conditiong, covert conditioning and social skills.
In terms of trauma, BT can address the idiosyncratic or addictive behaviors although it does not address the underlying cause of those behaviors.