I was having a conversation with a program director yesterday and it was brought up that there is still language in the mental health community in regards to intimate partner violence survivors being labeled as “addicted” to their abusers. This led to a discussion regarding co-dependency, addiction and being a person living with an abusive partner in her life.
The definition of addiction, “the state of being enslaved to a habit or practice or to something that is psychologically or physically habit-forming, as narcotics, to such an extent that its cessation causes severe trauma,” does a disservice to the survivors for whom we advocate and does not address the cycle of violence and the desire for the woman to manage her life in a way that keeps her and her children safe. According to the definition of addiction, separation from the habit causes trauma due to the loss and the physical effects of separation. Certain habits, skills, and coping mechanisms may be developed in a relationship in order to attempt to manage the abuser and the violence but these are in no way a sign that the person is addicted to the abuser. If anything, she is addicted to maintaining her safety and is hyper vigilant of the abuser’s activities in order to maintain that safety. This hyper vigilance is a result of complex trauma, not of an addiction.
The term “co-dependency” over the years has evolved and is often used when describing a victim of intimate partner violence who remains living within the cycle of abuse. As a movement, domestic violence advocates work hard to keep from labeling victims with descriptors that blame the victim. The original concept of codependency was developed to acknowledge the responses and behaviors people develop from living with an alcoholic or substance abuser. Like the term “addiction” however, “co-dependency” does not take into consideration the hyper vigilant behavior that arises from the complex trauma of abuse. Someone who is labeled co-dependent is attempting to control another person’s behavior in order to feeling in control and may blur boundaries in order for that to occur. However, a victim of violence has had her boundaries violated by another and has developed behaviors in order to maintain her safety. Again, these behaviors are not due to co-dependency but are survival skills developed while experiencing trauma.
When we think about what trauma does to the brain we understand a little more about how addiction and co-dependency differ. When the brain experiences a traumatic event the “doing” center of the brain, the amygdale, is activated into fight, flight or freeze mode. The pre-frontal cortex or frontal lobe, the “thinking center” assesses the danger and will tell the “doing” center to back down and resume normal activity. However, after many traumatic incidents (complex trauma) the “thinking” area of the brain will stop assessing, assumes the person is always under attack, and will not stop the “doing” center from going into fight, flight or freeze. Therefore, the person is in a heightened state of anxiety and hyper vigilance most of the time and develops strategies to manage that state that would seem foreign and/or maladaptive to the rest of us. To the victim, these strategies feel like the only way to maintain safety. This is not about being co-dependent or addicted it is about wanting to be safe.
While the trauma is occurring and the survivor is developing her skills to maintain safety she may be unable to focus on skills and behaviors for daily living. As stated above, the “thinking” area of the brain has allowed the “doing” center to take over. What we see as manipulative, co-dependent, or addictive behaviors are actually necessary skills to maintain safety and until the chemicals that have flooded the “doing” center of the brain find a healthy way to release and the “thinking” brain can function normally again, these skills will remain as the primary method of maintaining safety. This work cannot occur while trauma is still occurring and requires safe, healthy relationships with advocates and therapists who understand what is happening from a trauma-informed viewpoint. There are many modes of treatment that work to return the brain and body to balance and I recommend that you search out therapists in your area who understand trauma and trauma treatment.
Wednesday, December 30, 2009
Monday, December 21, 2009
Update on Project to Date
Over the past six months there have been approximately twenty three trainings at five local domestic violence crisis center programs to educate advocates about substance abuse, mental illness and trauma and how it affects the empowering work we do with survivors of trauma. In addition, a couple of community collaboration efforts have been organized in areas where very little inter-agency contact had been occurring. Outreach has been made to local homeless programs, social services agencies, private therapists and the department of corrections. Additional training has been offered and accepted by many of these agencies as interest and a desire to know about trauma-informed services grows. In one case, the local domestic violence and homeless shelter programs came together for training on trauma and homelessness and are now collaborating to review policies and procedures in order to have a common voice in the community about providing trauma informed shelter services.
Prevention Innovations, a consulting, training and research unit of the University of New Hampshire, has provided their expertise in evaluating the project and is currently forming focus groups with consumer survivors to determine how crisis centers are meeting their needs.
Over the next few months, another three to four crisis centers will be coming on board the Open Doors project. These centers will receive the same training as the initial five projects and community collaboration will be a goal for their catchment areas. New Hampshire has fourteen crisis centers and the plan is for all fourteen centers to have received training before the end of 2011.
We are currently in the beginning stages of planning for a state-wide mental health and trauma training for domestic violence programs and interested mental health clinicians/therapists for sometimes next summer with Carole Warshaw and Terri Pease. A mailing list of therapists is currently being compiled in hopes to reach out to as many providers as possible.
The most exciting part of the initiative is the ongoing conversation about providing trauma informed services to survivors and involving as many community partners as possible. The NH Coalition Against Domestic Violence and Sexual Assault is dedicated to making this a part of its messaging and becoming a voice for trauma survivors.
Prevention Innovations, a consulting, training and research unit of the University of New Hampshire, has provided their expertise in evaluating the project and is currently forming focus groups with consumer survivors to determine how crisis centers are meeting their needs.
Over the next few months, another three to four crisis centers will be coming on board the Open Doors project. These centers will receive the same training as the initial five projects and community collaboration will be a goal for their catchment areas. New Hampshire has fourteen crisis centers and the plan is for all fourteen centers to have received training before the end of 2011.
We are currently in the beginning stages of planning for a state-wide mental health and trauma training for domestic violence programs and interested mental health clinicians/therapists for sometimes next summer with Carole Warshaw and Terri Pease. A mailing list of therapists is currently being compiled in hopes to reach out to as many providers as possible.
The most exciting part of the initiative is the ongoing conversation about providing trauma informed services to survivors and involving as many community partners as possible. The NH Coalition Against Domestic Violence and Sexual Assault is dedicated to making this a part of its messaging and becoming a voice for trauma survivors.
Welcome to the Open Doors to Safety Blog
I am pleased to present the first posting of the Open Doors to Safety NH blog. In lieu of doing a newsletter, I have decided to go the way of the 21st Century and use the blogging world to send out information on what is new in the arena of trauma informed services for domestic violence and sexual assault survivors.
As the Trauma Specialist for the New Hampshire Coalition Against Domestic and Sexual Violence I am responsible for providing training and consultation to New Hampshire's domestic violence and sexual assault crisis centers on working with persons who have issues regarding substance abuse and mental health. The primary goal is to provide all training based on the principles of trauma informed care and the empowerment model.
My goal is to update this blog regularly. You can subscribe to the blog and receive an email notifying you when there has been a new posting. My goal is provide up-to-date information on the Open Doors Project and other relevant information that can be used in your programs. I am also open to suggestions of information that you would like to have in regards to trauma informed services and what is happening in regards to upcoming trainings and community collaborations.
As the Trauma Specialist for the New Hampshire Coalition Against Domestic and Sexual Violence I am responsible for providing training and consultation to New Hampshire's domestic violence and sexual assault crisis centers on working with persons who have issues regarding substance abuse and mental health. The primary goal is to provide all training based on the principles of trauma informed care and the empowerment model.
My goal is to update this blog regularly. You can subscribe to the blog and receive an email notifying you when there has been a new posting. My goal is provide up-to-date information on the Open Doors Project and other relevant information that can be used in your programs. I am also open to suggestions of information that you would like to have in regards to trauma informed services and what is happening in regards to upcoming trainings and community collaborations.
Current Treatment Modalities for Complex Trauma’
Summarized by Linda Douglas
December 15, 2009
Treatment models are presented in alphabetical order with resource information given. Some of the websites have a “Provider Search” in order to be able to find therapists in your area. This list does not recommend any particular approach nor is it comprehensive. New treatment modalities are being developed each year and no approach meets the needs of everyone. The list is intended to be used as a guide to learning more about trauma treatment methods.
Accelerated Experiential Dynamic Psychotherapy
AEDP is a transformation-based, healing-oriented model of therapy. Developed by Dr. Diana Fosha, author of The Transforming Power of Affect it has roots in and resonances with many disciplines amongst them attachment theory, affective neuroscience, body-focused approaches, and transformational studies.
AEDP fosters the emergence of new and healing experiences through the in-depth processing of difficult emotional and relational experiences. Key to this experiential enterprise is the establishment of the therapeutic relationship as secure base, which is sought from the get-go.
http://www.aedpinstitute.com/
Attachment, Self-regulation, & Competency (ARC)
ARC is a framework for intervention with youth and families who have experienced multiple and/or prolonged traumatic stress. ARC identifies three core domains that are frequently impacted among traumatized youth, and which are relevant to future resiliency. ARC provides a theoretical framework, core principles of intervention, and a guiding structure for providers working with these children and their caregivers, while recognizing that a one-size-model does not fit all. ARC is designed for youth from early childhood to adolescence and their caregivers or caregiving systems.
http://www.traumacenter.org/research/ascot.php
Contextual Therapy
Contextual Therapy is based on Judith Herman’s three phase model of psychotherapy in which Phase I helps survivors firmly establish conditions of safety and a sense of interpersonal security before proceeding to direct trauma work in the second phase of therapy, followed by a third phase of integration and reconnection. The capacities gained in Phase I and III – safety, and a sense of security, integration and connection – are usually being developed by survivors of prolonged child abuse for the first time and are the priority in this type of therapy.
Courtois, C.A., Ford, Judith; Treating Complex Traumatic Stress Disorders,
2009, The Guildford Press, pgs. 227-242
Contextual Behavior Trauma Therapy
Using behavior analysis and acceptance and commitment therapy, CBTT interventions identify and modify stimulus-response changes underlying traumatic stress disorder symptoms with a foal of enhancing mindfulness, acceptance, and the therapeutic relationship. The term contextual indicates a focus on the function of behavior rather than the form and incorporates radical acceptance and behavioral activation as primary mechanisms for changing trauma-related patterns of avoidance. It includes components of Acceptance and Commitment Therapy, Dialectical Behavior Therapy, and Functional Analytic Psychotherapy. Brief descriptions of ACT and FAP follow and DBT is described in another section.
Acceptance and commitment therapy emphasizes the enhancement of acceptance, willingness, psychological flexibility, and “valued living” as a mean of challenging and reducing avoidance of experiences.
Functional analytic psychotherapy emphasizes clinically relevant behaviors that occur within the therapy relationship that functionally parallel problematic behaviors occurring outside of the session.
Courtois, C.A., Ford, Judith; Treating Complex Traumatic Stress Disorders,
2009, The Guildford Press, pgs. 264-285
Cognitive Behavioral Therapy (Trauma Focused)
CBT seeks to improve functioning and emotional well-being by identifying the beliefs, feelings, and behaviors associated with psychological disturbance and revising them through critical analysis and experiential exploration to be consistent with desired outcomes and positive life goals. It expresses an optimism about human nature, holding the belief that new ways of thinking, behaving, and feeling are possible and that the client can effect change. It incorporates psychoeducation about how the symptoms that a client experiences have evolved from trauma and engenders a sense of hope by educating about how skills training can result in change and mastery. Client and therapist are seen as co-investigators in identifying the goals of therapy.
Currently seen as treatment of choice for children and adolescents.
Courtois, C.A., Ford, Judith; Treating Complex Traumatic Stress Disorders,
2009, The Guildford Press, pgs. 243-263
http://tfcbt.musc.edu/index.php
http://www.goodtherapy.org/trauma-focused-cognitive-behavioral-therapy.html
http://www.nctsn.org/nccts/nav.do?pid=hom_main
Dialectic Behavior Therapy
DBT is a broad-based psychosocial treatment model primarily developed by Marsha Linehan primarily as a treatment for persons diagnosed with Borderline Personality Disorder. It incorporates psychotherapy in individual sessions and skills training done in group sessions. Skills training incorporates many elements of mindfulness and emotional regulation in order to assist clients in being able to manage extreme emotional dysregulation due to triggers of trauma and intense feelings of abandonment and invalidation.
Cognitive Behavioral Therapy for Borderline Personality Disorder, Marsha Linehan, 1993
http://behavioraltech.org
EFT – Emotional Freedom Technique
EFT combines the two well established sciences of Mind Body Medicine and Acupuncture/Acupressure.
It is an emotional version of acupuncture wherein meridian points are stimulated by tapping on them with fingertips. This addresses a new cause for emotional issues (unbalanced energy meridians). Proponents claim that when properly done, this frequently reduces the therapeutic process from months or years down to hours or minutes. And, since emotional stress can contribute to pain, disease and physical ailments, EFT users claim it provides physical relief. EFT practitioners teach clients about the meridian points and encourage them to use the tapping techniques at times of emotional distress in order to decrease anxiety and emotional dysregulation.
www.emofree.com
Energy Treatments
There are a number of “Energy Medicine” modalities out there that lay claim to providing relief from emotional stress. There is a lot of anecdotal evidence in regards to the effectiveness of these various modalities and more research is showing positive results. It is recommended that practitioners of these models be researched in regards to their education and training. Two schools of energy medicine that have long histories and good reputations are the Donna Eden Energy Medicine Program http://www.energymed.org and the Barbara Brennan School of Healing http://www.barbarabrennan.com/
Experiential and Emotion Focused Therapy
EEFT is related to AEDP (see above) as an experiential approach that offers a systematic template for understanding and achieving renewed emotional experiencing in the wake of psychological trauma. Both AEDP and EEFT work to enhance client’s abilities to access and explore emotional experience within an affirming empathy-based therapeutic relationship. Adaptive processing of intense emotions in the context of a safe relationship is a foundation for enlarging the trauma survivor’s perspective from preoccupation with danger and damage to a full experiencing of oneself as alive and of one’s life and relationships as having fundamental worth and meaning.
Courtois, C.A., Ford, Judith; Treating Complex Traumatic Stress Disorders,
2009, The Guildford Press, pgs. 286-311.
Eye Movement Desensitization and Reprocessing (EMDR)
Eye Movement Desensitization and Reprocessing (EMDR)1 is a comprehensive, integrative psychotherapy approach. It contains elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2.
EMDR is an information processing therapy and uses an eight phase approach to address the experiential contributors of a wide range of pathologies. It attends to the past experiences that have set the groundwork for pathology, the current situations that trigger dysfunctional emotions, beliefs and sensations, and the positive experience needed to enhance future adaptive behaviors and mental health.
During treatment various procedures and protocols are used to address the entire clinical picture. One of the procedural elements is "dual stimulation" using either bilateral eye movements, tones or taps. During the reprocessing phases the client attends momentarily to past memories, present triggers, or anticipated future experiences while simultaneously focusing on a set of external stimulus. During that time, clients generally experience the emergence of insight, changes in memories, or new associations. The clinician assists the client to focus on appropriate material before initiation of each subsequent set.
http://www.emdr.com
Gentle Reprocessing
Gentle Reprocessing™ is a complete therapy made up of a unique integration of guided imagery, inner child work, cognitive therapy and EMDR components, among other proven therapies. It is designed to gently and rapidly dissolve trauma symptoms that prevent clients from living fully. Gentle Reprocessing™ reduces symptoms of PTSD, Anxiety, Depression, OCD, phobias, abuse, and Dissociation. Gentle Reprocessing™ has also been used with success for Performance Enhancement and Anger Control.
During the development of Gentle Reprocessing™ an external and an internal approach were developed. The internal approach worked well for most adults to release traumas and mental health symptoms. The external approach was developed for children as young as 2 ½ and has been proven to work well with fragile adult clients. – from the website http://www.gentlereprocessing.com/Welcome.html
Hypnotherapy
Given that many traumatic memories are stored in the subconscious or at a cellular level, it is believed that hypnotherapy can access these memories and bring them back to the conscious so that the negative belief systems associated with the trauma can be disabled. Not all hypnotherapies are educated in trauma and possible hypnotherapies should be interviewed as to their ability to provide trauma informed services.
Internal Family Systems
The IFS Model views a person as containing an ecology of relatively discrete minds, each of which has valuable qualities and each of which is designed for, and wants to play a valuable role in the life of the person. The model evolved on the premise that the parts were forced into extreme and sometimes destructive roles when a person’s family of origin values and interactional patterns created internal polarizations that escalated over time and played out in other relationships. In therapy, the parts are recognized for their value in assisting the patient in being functional and safe. Through treatment, the Self is revealed at the center of all of the parts and is eventually able to assume leadership through negotiation with the other parts.
http://www.selfleadership.org/
Mindfulness Meditation
More of a skill rather than a treatment mode, the number of practitioners incorporating mindfulness meditation into their practice is expanding. Mindfulness meditation is body center in that the person remains completely present and focused on their body and surroundings, assessing all body sensation and emotions in a nonjudgmental manner. Research is expanding on the usefulness of mindfulness meditation on relieving symptoms of complex trauma and more information is becoming available.
http://www.umassmed.edu/Content.aspx?id=41252
Movement Therapies including Dance and Yoga
Exercise can be an important part of treatment of symptoms related to trauma. Often those experiencing difficulty with anxiety can benefit from regular cardiovascular exercise (including dance) which allows the opportunity for the body to learn recovery from arousal. On the other hand, yoga has been researched as a treatment for PTSD, or post-traumatic stress disorder. In two studies, the PTSD sufferers that were taught and practiced yoga experienced greater symptom reduction than those that were only a part of more traditional treatment.
Yoga is used as a relaxation technique because it focuses the mind and slows down the body. Simply learning to control your own breathing can allow you to feel more in control of yourself. PTSD can leave a person with constant anxiety. Those that feel they must be prepared at all times to prevent future trauma often have difficulty controlling their thoughts and focusing on the present moment. A coping skill for dealing with certain types of trauma can be disconnection from one’s own body. Although protective in certain situations, it is not generally very functional. Perhaps more than other forms of exercise, yoga encourages body awareness and connection. All of these aspects of yoga can be very healing.
http://www.yogajournal.com/health/2532
Neurofeedback
In a neurofeedback session, a computer records EEG activity (brain wave patterns) using electrodes pasted on the scalp surface. This non-invasive "listening" device is painless and comfortable. In conventional NF, an assessment of the EEG activity is done. This allows the neurotherapist to determine the pattern of training that will be most beneficial for the individual. The computer is then adjusted so that it creates a musical tone as the person begins to generate more of the desirable brain rhythms. This “neuro-feed-back” literally guides the person to a more and more calm state. Clients begin to feel a tremendous sense of empowerment as they take back what they were deprived of by the trauma — a good night’s sleep, feelings of calm and confidence, and a general sense of well-being.
The results of controlled studies, as well as clinical experience with this therapy have been tremendously encouraging. People who have been suffering from PTSD for ten and twenty years are often completely relieved of their symptoms. Follow-up testing has shown that the person becomes markedly less anxious, depression is reduced or eliminated, and the person is generally more comfortable and relaxed. The power of the traumatic incident is removed, reducing an all-consuming experience to a simpler factual memory.
http://www.traumacenter.org/clients/neurofeedback.php
Sensorimotor Psychotherapy
Most human behavior is driven by procedural memory -memory for process and function-and is reflected in automatic responses and well-learned action patterns: movements, postures, gestures, and autonomic arousal patterns, which in turn both influence and sustain emotional biases and meaning making. The emerging understanding from neurobiology about the impact of both trauma and early attachment dynamics underscore the importance of physical action to initiate new ways of perceiving reality and promote new behavior patterns. Simple actions, such as pushing away, reaching out, grasping, holding on, grounding, containment, self-touch, and orienting, correspond to psychological functions. When clients experience and practice actions specifically related to a psychological symptom or issue, the issue can be brought into present moment experience, and adaptive functioning can be positively affected. For example, exploring the physical act of reaching out can stimulate emotional pain and early memories related to reaching out, and/or fortify confidence in the possibility of asking for help and increasing social contact; experiencing the physical capacity to define one's personal space by executing the action of pushing away can strengthen the ability to secure boundaries and lessen helplessness, but might also evoke memories and feelings of boundaries not being respected or accepted in the past. – from a training announcement for the Cape Cod Institute promoting a Sensorimotor Training by Pat Odgen, the found of Sensorimotor Psychotherapy.
http://www.sensorimotorpsychotherapy.org/home/index.html
http://www.traumaresources.org/article_ogden1.htm
Somatic Experiencing
Somatic Experiencing® is a body-awareness approach to trauma being taught throughout the world. It is the result of over forty years of observation, research, and hands-on development by Dr. Levine. Based upon the realization that human beings have an innate ability to overcome the effects of trauma, Somatic Experiencing has touched the lives of many thousands. SE® restores self-regulation, and returns a sense of aliveness, relaxation and wholeness to traumatized individuals who have had these precious gifts taken away. Peter has applied his work to combat veterans, rape survivors, Holocaust survivors, auto accident and post surgical trauma, chronic pain sufferers, and even to infants after suffering traumatic births. – from the website
Also see information on Sensorimotor Psychotherapy.
http://www.traumahealing.com/
Yoga Nidra
Yoga Nidra is another form of mindfulness meditation that incorporates breathing techniques with awareness of the body. There are techniques that visualize a scan of the body to increase relaxation and lessen anxiety.
http://irest.us
http://www.swamij.com/yoga-nidra.htm
December 15, 2009
Treatment models are presented in alphabetical order with resource information given. Some of the websites have a “Provider Search” in order to be able to find therapists in your area. This list does not recommend any particular approach nor is it comprehensive. New treatment modalities are being developed each year and no approach meets the needs of everyone. The list is intended to be used as a guide to learning more about trauma treatment methods.
Accelerated Experiential Dynamic Psychotherapy
AEDP is a transformation-based, healing-oriented model of therapy. Developed by Dr. Diana Fosha, author of The Transforming Power of Affect it has roots in and resonances with many disciplines amongst them attachment theory, affective neuroscience, body-focused approaches, and transformational studies.
AEDP fosters the emergence of new and healing experiences through the in-depth processing of difficult emotional and relational experiences. Key to this experiential enterprise is the establishment of the therapeutic relationship as secure base, which is sought from the get-go.
http://www.aedpinstitute.com/
Attachment, Self-regulation, & Competency (ARC)
ARC is a framework for intervention with youth and families who have experienced multiple and/or prolonged traumatic stress. ARC identifies three core domains that are frequently impacted among traumatized youth, and which are relevant to future resiliency. ARC provides a theoretical framework, core principles of intervention, and a guiding structure for providers working with these children and their caregivers, while recognizing that a one-size-model does not fit all. ARC is designed for youth from early childhood to adolescence and their caregivers or caregiving systems.
http://www.traumacenter.org/research/ascot.php
Contextual Therapy
Contextual Therapy is based on Judith Herman’s three phase model of psychotherapy in which Phase I helps survivors firmly establish conditions of safety and a sense of interpersonal security before proceeding to direct trauma work in the second phase of therapy, followed by a third phase of integration and reconnection. The capacities gained in Phase I and III – safety, and a sense of security, integration and connection – are usually being developed by survivors of prolonged child abuse for the first time and are the priority in this type of therapy.
Courtois, C.A., Ford, Judith; Treating Complex Traumatic Stress Disorders,
2009, The Guildford Press, pgs. 227-242
Contextual Behavior Trauma Therapy
Using behavior analysis and acceptance and commitment therapy, CBTT interventions identify and modify stimulus-response changes underlying traumatic stress disorder symptoms with a foal of enhancing mindfulness, acceptance, and the therapeutic relationship. The term contextual indicates a focus on the function of behavior rather than the form and incorporates radical acceptance and behavioral activation as primary mechanisms for changing trauma-related patterns of avoidance. It includes components of Acceptance and Commitment Therapy, Dialectical Behavior Therapy, and Functional Analytic Psychotherapy. Brief descriptions of ACT and FAP follow and DBT is described in another section.
Acceptance and commitment therapy emphasizes the enhancement of acceptance, willingness, psychological flexibility, and “valued living” as a mean of challenging and reducing avoidance of experiences.
Functional analytic psychotherapy emphasizes clinically relevant behaviors that occur within the therapy relationship that functionally parallel problematic behaviors occurring outside of the session.
Courtois, C.A., Ford, Judith; Treating Complex Traumatic Stress Disorders,
2009, The Guildford Press, pgs. 264-285
Cognitive Behavioral Therapy (Trauma Focused)
CBT seeks to improve functioning and emotional well-being by identifying the beliefs, feelings, and behaviors associated with psychological disturbance and revising them through critical analysis and experiential exploration to be consistent with desired outcomes and positive life goals. It expresses an optimism about human nature, holding the belief that new ways of thinking, behaving, and feeling are possible and that the client can effect change. It incorporates psychoeducation about how the symptoms that a client experiences have evolved from trauma and engenders a sense of hope by educating about how skills training can result in change and mastery. Client and therapist are seen as co-investigators in identifying the goals of therapy.
Currently seen as treatment of choice for children and adolescents.
Courtois, C.A., Ford, Judith; Treating Complex Traumatic Stress Disorders,
2009, The Guildford Press, pgs. 243-263
http://tfcbt.musc.edu/index.php
http://www.goodtherapy.org/trauma-focused-cognitive-behavioral-therapy.html
http://www.nctsn.org/nccts/nav.do?pid=hom_main
Dialectic Behavior Therapy
DBT is a broad-based psychosocial treatment model primarily developed by Marsha Linehan primarily as a treatment for persons diagnosed with Borderline Personality Disorder. It incorporates psychotherapy in individual sessions and skills training done in group sessions. Skills training incorporates many elements of mindfulness and emotional regulation in order to assist clients in being able to manage extreme emotional dysregulation due to triggers of trauma and intense feelings of abandonment and invalidation.
Cognitive Behavioral Therapy for Borderline Personality Disorder, Marsha Linehan, 1993
http://behavioraltech.org
EFT – Emotional Freedom Technique
EFT combines the two well established sciences of Mind Body Medicine and Acupuncture/Acupressure.
It is an emotional version of acupuncture wherein meridian points are stimulated by tapping on them with fingertips. This addresses a new cause for emotional issues (unbalanced energy meridians). Proponents claim that when properly done, this frequently reduces the therapeutic process from months or years down to hours or minutes. And, since emotional stress can contribute to pain, disease and physical ailments, EFT users claim it provides physical relief. EFT practitioners teach clients about the meridian points and encourage them to use the tapping techniques at times of emotional distress in order to decrease anxiety and emotional dysregulation.
www.emofree.com
Energy Treatments
There are a number of “Energy Medicine” modalities out there that lay claim to providing relief from emotional stress. There is a lot of anecdotal evidence in regards to the effectiveness of these various modalities and more research is showing positive results. It is recommended that practitioners of these models be researched in regards to their education and training. Two schools of energy medicine that have long histories and good reputations are the Donna Eden Energy Medicine Program http://www.energymed.org and the Barbara Brennan School of Healing http://www.barbarabrennan.com/
Experiential and Emotion Focused Therapy
EEFT is related to AEDP (see above) as an experiential approach that offers a systematic template for understanding and achieving renewed emotional experiencing in the wake of psychological trauma. Both AEDP and EEFT work to enhance client’s abilities to access and explore emotional experience within an affirming empathy-based therapeutic relationship. Adaptive processing of intense emotions in the context of a safe relationship is a foundation for enlarging the trauma survivor’s perspective from preoccupation with danger and damage to a full experiencing of oneself as alive and of one’s life and relationships as having fundamental worth and meaning.
Courtois, C.A., Ford, Judith; Treating Complex Traumatic Stress Disorders,
2009, The Guildford Press, pgs. 286-311.
Eye Movement Desensitization and Reprocessing (EMDR)
Eye Movement Desensitization and Reprocessing (EMDR)1 is a comprehensive, integrative psychotherapy approach. It contains elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2.
EMDR is an information processing therapy and uses an eight phase approach to address the experiential contributors of a wide range of pathologies. It attends to the past experiences that have set the groundwork for pathology, the current situations that trigger dysfunctional emotions, beliefs and sensations, and the positive experience needed to enhance future adaptive behaviors and mental health.
During treatment various procedures and protocols are used to address the entire clinical picture. One of the procedural elements is "dual stimulation" using either bilateral eye movements, tones or taps. During the reprocessing phases the client attends momentarily to past memories, present triggers, or anticipated future experiences while simultaneously focusing on a set of external stimulus. During that time, clients generally experience the emergence of insight, changes in memories, or new associations. The clinician assists the client to focus on appropriate material before initiation of each subsequent set.
http://www.emdr.com
Gentle Reprocessing
Gentle Reprocessing™ is a complete therapy made up of a unique integration of guided imagery, inner child work, cognitive therapy and EMDR components, among other proven therapies. It is designed to gently and rapidly dissolve trauma symptoms that prevent clients from living fully. Gentle Reprocessing™ reduces symptoms of PTSD, Anxiety, Depression, OCD, phobias, abuse, and Dissociation. Gentle Reprocessing™ has also been used with success for Performance Enhancement and Anger Control.
During the development of Gentle Reprocessing™ an external and an internal approach were developed. The internal approach worked well for most adults to release traumas and mental health symptoms. The external approach was developed for children as young as 2 ½ and has been proven to work well with fragile adult clients. – from the website http://www.gentlereprocessing.com/Welcome.html
Hypnotherapy
Given that many traumatic memories are stored in the subconscious or at a cellular level, it is believed that hypnotherapy can access these memories and bring them back to the conscious so that the negative belief systems associated with the trauma can be disabled. Not all hypnotherapies are educated in trauma and possible hypnotherapies should be interviewed as to their ability to provide trauma informed services.
Internal Family Systems
The IFS Model views a person as containing an ecology of relatively discrete minds, each of which has valuable qualities and each of which is designed for, and wants to play a valuable role in the life of the person. The model evolved on the premise that the parts were forced into extreme and sometimes destructive roles when a person’s family of origin values and interactional patterns created internal polarizations that escalated over time and played out in other relationships. In therapy, the parts are recognized for their value in assisting the patient in being functional and safe. Through treatment, the Self is revealed at the center of all of the parts and is eventually able to assume leadership through negotiation with the other parts.
http://www.selfleadership.org/
Mindfulness Meditation
More of a skill rather than a treatment mode, the number of practitioners incorporating mindfulness meditation into their practice is expanding. Mindfulness meditation is body center in that the person remains completely present and focused on their body and surroundings, assessing all body sensation and emotions in a nonjudgmental manner. Research is expanding on the usefulness of mindfulness meditation on relieving symptoms of complex trauma and more information is becoming available.
http://www.umassmed.edu/Content.aspx?id=41252
Movement Therapies including Dance and Yoga
Exercise can be an important part of treatment of symptoms related to trauma. Often those experiencing difficulty with anxiety can benefit from regular cardiovascular exercise (including dance) which allows the opportunity for the body to learn recovery from arousal. On the other hand, yoga has been researched as a treatment for PTSD, or post-traumatic stress disorder. In two studies, the PTSD sufferers that were taught and practiced yoga experienced greater symptom reduction than those that were only a part of more traditional treatment.
Yoga is used as a relaxation technique because it focuses the mind and slows down the body. Simply learning to control your own breathing can allow you to feel more in control of yourself. PTSD can leave a person with constant anxiety. Those that feel they must be prepared at all times to prevent future trauma often have difficulty controlling their thoughts and focusing on the present moment. A coping skill for dealing with certain types of trauma can be disconnection from one’s own body. Although protective in certain situations, it is not generally very functional. Perhaps more than other forms of exercise, yoga encourages body awareness and connection. All of these aspects of yoga can be very healing.
http://www.yogajournal.com/health/2532
Neurofeedback
In a neurofeedback session, a computer records EEG activity (brain wave patterns) using electrodes pasted on the scalp surface. This non-invasive "listening" device is painless and comfortable. In conventional NF, an assessment of the EEG activity is done. This allows the neurotherapist to determine the pattern of training that will be most beneficial for the individual. The computer is then adjusted so that it creates a musical tone as the person begins to generate more of the desirable brain rhythms. This “neuro-feed-back” literally guides the person to a more and more calm state. Clients begin to feel a tremendous sense of empowerment as they take back what they were deprived of by the trauma — a good night’s sleep, feelings of calm and confidence, and a general sense of well-being.
The results of controlled studies, as well as clinical experience with this therapy have been tremendously encouraging. People who have been suffering from PTSD for ten and twenty years are often completely relieved of their symptoms. Follow-up testing has shown that the person becomes markedly less anxious, depression is reduced or eliminated, and the person is generally more comfortable and relaxed. The power of the traumatic incident is removed, reducing an all-consuming experience to a simpler factual memory.
http://www.traumacenter.org/clients/neurofeedback.php
Sensorimotor Psychotherapy
Most human behavior is driven by procedural memory -memory for process and function-and is reflected in automatic responses and well-learned action patterns: movements, postures, gestures, and autonomic arousal patterns, which in turn both influence and sustain emotional biases and meaning making. The emerging understanding from neurobiology about the impact of both trauma and early attachment dynamics underscore the importance of physical action to initiate new ways of perceiving reality and promote new behavior patterns. Simple actions, such as pushing away, reaching out, grasping, holding on, grounding, containment, self-touch, and orienting, correspond to psychological functions. When clients experience and practice actions specifically related to a psychological symptom or issue, the issue can be brought into present moment experience, and adaptive functioning can be positively affected. For example, exploring the physical act of reaching out can stimulate emotional pain and early memories related to reaching out, and/or fortify confidence in the possibility of asking for help and increasing social contact; experiencing the physical capacity to define one's personal space by executing the action of pushing away can strengthen the ability to secure boundaries and lessen helplessness, but might also evoke memories and feelings of boundaries not being respected or accepted in the past. – from a training announcement for the Cape Cod Institute promoting a Sensorimotor Training by Pat Odgen, the found of Sensorimotor Psychotherapy.
http://www.sensorimotorpsychotherapy.org/home/index.html
http://www.traumaresources.org/article_ogden1.htm
Somatic Experiencing
Somatic Experiencing® is a body-awareness approach to trauma being taught throughout the world. It is the result of over forty years of observation, research, and hands-on development by Dr. Levine. Based upon the realization that human beings have an innate ability to overcome the effects of trauma, Somatic Experiencing has touched the lives of many thousands. SE® restores self-regulation, and returns a sense of aliveness, relaxation and wholeness to traumatized individuals who have had these precious gifts taken away. Peter has applied his work to combat veterans, rape survivors, Holocaust survivors, auto accident and post surgical trauma, chronic pain sufferers, and even to infants after suffering traumatic births. – from the website
Also see information on Sensorimotor Psychotherapy.
http://www.traumahealing.com/
Yoga Nidra
Yoga Nidra is another form of mindfulness meditation that incorporates breathing techniques with awareness of the body. There are techniques that visualize a scan of the body to increase relaxation and lessen anxiety.
http://irest.us
http://www.swamij.com/yoga-nidra.htm
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