Monday, December 21, 2009

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

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