The first thing I can say about trauma is that our sense of what it is as a category of human experiencing is evolving. Early beliefs of trauma were, for the most part, related to war and combat. There is so much information about trauma and Post Traumatic Stress Disorder (PTSD) Treatment inundating our news with the thousands of soldiers returning home and refugees trying fleeing war torn countries. Those who have lived with complex trauma have normalized their experiences and feel unjust in putting themselves in the category of people who have experienced the devastation of war; thereby keeping them for seeking treatment. Let me explain….
Complex trauma is a term that refers to a person’s exposure to multiple traumatic events, often of an interpersonal nature and the long-term impact of this exposure. Such as living in a home where there is neglect, violence, chronic or terminal illness, addiction, or untreated mental health issues. There is significant data showing that repeated exposure to these experiences in childhood directly and profoundly affects biological health later in life. This is true both in rates of physical disease (heart disease, cancer, diabetes, liver disease, etc.) as well as higher rates of domestic abuse, substance abuse, alcoholism, obesity, etc.
In addition to the serious health issues, there are also significant developmental effects of complex trauma: the disruptions of mood regulation, intimacy issues such as not feeling able to love or be loved, jealously and fears of abandonment, insisting on autonomy, self-protecting through control or perceived control, the aggressive behavior against self and others, poor sleep habits, poor eating and self-care; malformed views of the world; always being prepared for and thinking the worse is yet to come or people have it out for them; somatic problems, from gastrointestinal distress to headaches; normalizing danger resulting in at-risk behaviors; the self-hatred and self-blame and the chronic feelings of not being good enough.2
The good news is we know how to help. We know that traumatic stress is deeply embedded in the body. The implication is that trauma is not only a memory but is held in the nervous system of the body. In Principles of Trauma Therapy: A Guide to Symptoms, Evaluation & Treatment, author John Briere lists five areas for clinicians to focus on when incorporating mindfulness in therapy:3
1.Psychoeducation. Helping the client to understand the nature of trauma and its effects on their daily prospective.
2. Affect Regulation. The development of learning how to shift attention when arousal becomes overwhelming. The ability to remain grounded and not let intrusive mental thoughts dictates reaction.
3. Cognitive Processing. Is exposure and de-sensitization to traumatic memories, emotions and sensations. The ability to “be with” distressing internal thoughts and often physical discomfort that were previously overwhelming is a way of retraining the body and mind to decrease the power of traumatic memories and emotions that previously generated distress and reaction.
4. Emotional Processing. During the therapeutic process it is crucial for clients to understand and believe that trauma-related negative cognitions, feeling and memories are simply products of the mind, brain & body that are not real in the here and now.
5. Trauma Processing. Clients will need to develop an insight into how their feelings and maladaptive behaviors were products of the trauma in an attempt to keep them safe. While rehabilitating their bodies from the internal stress and realigning with a more realistic world view, it is important to continue to discuss and coach how they are responding to everyday trauma related cues such as, “he’s disrespecting me” etc. The gift of this change in perception will result in a decreased need to engage in old impulsive tension reduction behaviors (drinking, food, sex, etc.).
1 See http://www.cdc.gov/violenceprevention/acestudy/. The Adverse Childhood Experiences (ACE)
2 Van der Kolk, B. A. (2005). Developmental trauma disorder: toward a rational diagnosis for children with complex trauma histories. Psychiatric Annals, 35(5), 406.
3 Briere, J. N., & Scott, C. (2014). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment. Sage Publications, Chapter 10.
4 McKenna, C. (2015) UCSD: Bridging the Hearts & Minds of Youth Conference. Mindfulness & Trauma: Cautions, Adaptations & Opportunities.
Vicki Dyar, MA, PCC Intern
The Cafferty Clinic
Under Supervision of Kansas Cafferty, LMFT
For an appointment with Vicki for individual, couples, or family psychotherapy please call True North Recovery Services at 760-517-6544 _