Understanding Trauma and its Treatment

“Long-lasting responses to trauma result not simply from the experience of fear and helplessness but from how our bodies interpret those experiences.”

—Rachel Yehuda

We don’t survive trauma as a result of conscious decision-making. At the moment of life threat, humans automatically rely upon survival instincts. Our five senses pick up the signs of imminent danger, causing the brain to “turn on” the adrenaline stress response system. As we prepare to fight or flee, heart rate and respiration speed oxygen to muscle tissue, and the “thinking brain,” our frontal cortex, is inhibited to increase response time. We are in “survival mode,” in our “animal brains.” Later, we may pay a price for these instinctive responses: we have ‘made it’ without bearing witness to our own experience.

As the price for survival, then, we are left with an inadequate record of what happened and how we endured it. If we have adequate support and safety afterward, we may be left shaken, but the events will feel “behind” us. If the events have been recurrent or we are young and vulnerable or have inadequate support, we can be left with a host of intense responses and symptoms that “tell the story” without words and without the knowledge that we are remembering events and feelings from long ago. Worse yet, the survival response system may become chronically activated, resulting in long-term feelings of alarm and danger, tendencies to flee or fight under stress, debilitating feelings of vulnerability and exhaustion, or an inability to assert and protect ourselves. To make the challenge even greater, therapeutic approaches that emphasize talking about the events often result in more, not less, activation of trauma responses and symptoms.

Since the 1980s and ‘90s, newer treatment paradigms have developed that more directly impact the somatic and emotional legacy of trauma. Sensorimotor Psychotherapy, developed by Pat Ogden, PhD, directly addresses the effects of trauma on the nervous system and body without the need to use touch. Easily integrated into traditional talk therapies, Sensorimotor utilizes mindfulness techniques to facilitate resolution of trauma-related body responses first before attempting to re-work emotional responses and meaning-making. Clients report an appreciation of its gentle and empowering interventions and find it equally or more effective than either narrative approaches or EMDR. Eye Movement Desensitization and Reprocessing (EMDR), developed in the 1980s by Francine Shapiro, is today one of the most popular and well-researched methods of trauma treatment. Like Sensorimotor Psychotherapy, EMDR does not focus on narrative recall but on reprocessing key elements of traumatic events, i.e, the legacy. Finally, Internal Family Systems, developed by Richard Schwartz in the early 1990s, is rooted in the assumption that symptoms and unresolved issues reflect disowned and unintegrated parts of the self. This assumption of inherent multiplicity is helpful to trauma survivors baffled by the paradoxical symptoms with which they struggle, while its mindful pace creates a feeling of safety for the client.

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