Trauma Therapy: Basics from Some Expert Clinicians
For many years trauma therapist have used many approaches in their psychotherapy. Most of these approaches lack strong empirical support for outcomes, and are often the “favorites” of these therapists. One might wonder what benefits therapists derive from using approaches that are not evidence-based. If an intervention fails to support timely positive changes in people suffering from trauma, WHY would a professional use it? It is common for therapists to use psychodynamic therapy, cognitive therapy, behavior therapy, and cognitive-behavioral therapy (including dialectical behavior therapy). While it is quite true that people suffering from serious trauma 
requires an exceptional therapeutic alliance (psychodynamic therapy), modifications in automatic negative thoughts (cognitive therapy), changes in unhelpful behaviors, like self-medication of pain (behavior therapy, and combinations like very well executed cognitive-behavioral therapy), commonly long-term healing outcomes have been somewhat disappointing. Perhaps an experienced and skilled therapist able to develop a high quality psychodynamic clinical alliance as well as highly effective cognitive-behavioral interventions may achieve admirable outcomes; however, that specific combination of skills is not common. I am suggesting that a high quality helping alliance and successful interventions in thinking and behavior problems may be helpful for people suffering from serious trauma. However, most of these approaches (other than informed and skilled DBT) miss the mark when it comes to integrated positive impact on the mind-body system. Even in DBT (and CBT), it is common for it to be used as a form of cognitive therapy – leaving the important behavioral and body-based areas out all together. To take a new look at the traumatized mind-body, witness current successes in trauma-informed yoga and meditation for PTSD. Recent meta-analytical reviews have noted that meditation (and yoga to a lesser degree) do improve depression, anxiety, physical pain (emotional pain?), and emotion regulation. Therefore, such body-based approaches improve three (depression, anxiety, self-medication) of the common clinical conditions associated with serious trauma.
Clinicians like Bessel van der Kolk remind us to pay attention to trauma-formed brain changes: the amygdala, the hippocampus, and the prefrontal area (especially medial PFC). These areas have been impacted, possibly sensitized, to trauma and its sequelae. Such changes may strongly impact the person’s future-orientation to life as less than hopeful, and cause sensitized body-based emoltionaland bodily reactions to conscious and unconscious (autonomic) traumatic cues. MRI research supports the trama-caused changes in both limbic and executive brain centers. It is believed that trauma causes changes in the neurocircuitry of the brain. Such important processes as interoception (mindfulness) and neuroception (polyvagal implications) play important roles in post-traumatic experience. The suggestion is that mindfulness, body-based interventions (meditation, yoga, body scanning, etc.) may be helpful in the experienced therapists’ hands. Recall, however, when it comes to using body-based and 
mindfulness-based interventions in trauma, the best therapists are also practitioners in these practices. Limbic and prefrontal interventions, NOT psychodynamic and cognitive interventions, may be highly helpful in effective trauma-informed psychotherapy.
Peter Levine reminds us that the body-based implantation of trauma may be used to slowly assist people suffering from trauma to be one with their memories without becoming powerless over them. Thus, specifically designed body movement with their associated emotional and memory components as well as verbal processing may be utilized to support recovery from even the most severe traumatic experiences. He does not forget the role the body plays in trauma and recovery from it.
Stephen Porges of Polyvagal Theory fame, notes that traumatic experience impacts the brain and the central nervous system. He notes a keen focus on the huge implications of the vagal nerve systems. It is possible to use neuroception, which functions as a risk detection system in people with trauma, to slowly help people adjust to the way their body responds to any form of traumatogenic cues – both internal and external. Utilizing adult attachment theory and process in therapy, as well as the possibility of feeling safe in social interactions, helps people with trauma move if slowly into recovery. Physical gestures, body reactions, voice quality, posture, and facial emotions – all part of post-trauma deficits – may be modified so as to assist people to enter recovery.
Pat Ogden, famous for her unique body-based and movement-based approaches, explains how habitual, conditioned body-based reactions may be modified as a new story of the body. These new experiences help to form a new better integrated story about trauma that guides the recovery process and reduces fear. She suggests that very specific forms of body movements may be most helpful here. Perhaps, the brain’s insula and thalamus have also been sensitized to reminders of traumatic experience, thus rendering their typical functions less adaptive.
Note that all of these leading trauma specialists have shifted to interventions with the body rather than typical “talk therapy” that is so often used. Yes, we do need to have important conversations with people suffering from trauma, but the real power for change comes from working with their bodily memories, reactions, and impulses along with limited verbal interactions. Inner peace, interpersonal safety, and slow readjustment to life are all part of recovery.
For more details and available clinical training refer to www.nicabm.com/holiday 2016… retrieved on December 28, 2016. See also Harrison, P. (August 13, 2014). Long-term course of PTSD revealed. www.medscape.com/viewarticle/829872…retrieved on August 14, 2014. Also refer to Buczynski, R. (October 23, 2014). PTSD, the hippocampus, and the amygdala – How trauma changes the brain. www.nicabm.com…/ptsd… Retrieved on October 24, 2014.
Anthony R. Quintiliani, PhD., LADC
From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont
Author of Mindful Happiness
New Edition of Mindful Happiness in Production…Coming soon!
Skinner in his explanation of operant conditioning explained negative reinforcement as a behavioral response being strengthened by avoiding or removing a negative (in this case emotional) consequence or aversive stimulus. Behaviors are negatively reinforced when they enhance escape from aversive stimuli. Here the behavior of avoidance is reinforced; such conditioning leads to habitual avoidance of trauma-related cues and stimuli. This conditioned behavior is adaptive in that it reduces painful emotional suffering. In a sense, it is a form of emotional self-medication: short-term emotional relief by avoidance behavior but long-term suffering continues. The removal of a punishing experience is a highly reinforced, conditioned outcome. Therefore, a person suffering from psychological trauma learns that avoiding trauma-related stimuli leads to less suffering. Thus avoiding traumatic stimuli reduces emotional suffering activated by those same stimuli. Avoidance is learned as an adaptive coping response to 
traumatic fear of suffering on-going traumatic symptoms and reactions. In behavioral chain analysis, the person suffering from trauma learns avoidance improves their emotion state because it reduces consequential emotional suffering. The positive consequence is often immediate, making the reinforced conditioning stronger; habit formation occurs quickly. The behavior becomes stronger over time. As avoidance becomes habitual, the person cannot benefit from successive approximations – the slow, safe. steady approach behaviors related to facing and being with traumatic cues and stimuli. Longer-term, slow and safe exposure to these traumatic cues and stimuli improves emotional coping as it reduces negative physiological and emotional reactivity. The consequence of learning the avoidance cycle implies little progress will occur in recovering from powerful traumatic experience/s.
regulation, and recovery process. People suffering from trauma can get well, but only if their therapists and medical providers understand how to treat psychological trauma. It is not just prescribing another medication. Co-occurring conditions (depression, other forms of anxiety, substance abuse) often mean that the treatment of trauma is NOT unidimensional in nature.