Over the past 20 years, mental health researchers have come to better understand trauma and post-traumatic stress syndrome (PTSD) and have developed significantly improved treatment options. Trauma can include childhood abuse, adult physical and sexual assault, natural disasters, war, major accidents, life-threatening illness, and sudden loss of a loved one.
In the U.S., 70-90% of adults have been exposed to trauma, with 30% experiencing 4 or more and approximately 10% of adults qualifying for PTSD diagnosis at any given time. Women have higher rates of trauma, with 20% of women reporting a history of sexual abuse, and nearly 30% reporting intimate partner (domestic) violence. Nearly 20% of veterans return from duty with PTSD.
New technology enables us to better understand the physiological changes, particularly in the brain, after trauma. This brain-based understanding enables trained therapists to significantly reduce the length of treatment needed to address trauma.
The great news is that although the symptoms can be severe, trauma is one of the most treatable mental health issues, with a better prognosis the depression or anxiety. Thus, with the right treatment, you can return to a normal, balanced life.
I begin with a comprehensive assessment that includes not only standard DSM diagnosis, but also consider specific brain-based subtypes of trauma and depression/anxiety; relational dynamics that inform choice of treatment; and hormones and other physical factors that may contribute to the symptoms. Beginning with a comprehensive understanding of the psychological, relational, and physiological factors ensures that treatment is focused on the right issues.
Treatment of trauma should begin by addressing any severe or crisis-inducing symptoms, such as flashbacks, nightmares, and self-harm, as well as symptoms that impede normal activities, such going to work or school. This phase involves increasing coping skills, understanding the nature of trauma, and psycho-education. I draw from several well-established evidence-based treatments for trauma, including trauma-focused cognitive-behavioral therapy, emotionally focused therapy, dialectic behavioral therapy. mindfulness, and brain-informed approaches.
Once a client is stable, I work with them to resolve trauma by developing a coherent trauma narrative that integrates the memories that were scattered during the overwhelming event. This enables the brain to properly process the event, thus addressing issue such as flashbacks, nightmares, and panic triggers. During this phase, any lingering issues related to guilt or self-blame are also addressed and resolved.
Once the trauma is resolved, therapy focuses on on-going emotional and relational wellness and resilience, along with integrating the trauma experience into a person's larger identity and sense of purpose. For many, once resolved, trauma opens a door to a richer and more meaningful life.
Most clients find that reading books on the topics of trauma help support them in addressing their initial symptoms and helps them to work through the traumatic memories. No one book works for everyone. So, select those to which you are personally drawn. It's part of the healing journey.
Healing from Trauma provides a thorough orientation to the physiological and psychological dynamics of the trauma experience as well as a practical guide for healing. It's a great place to start.
The Dialectic Behavioral Therapy Workbook teaches the life skills we all should have learned more of earlier in life: distress tolerance, emotional regulation, interpersonal effectiveness, and cognitive versions of mindfulness. Based on a leading evidence-based therapy model, DBT was specifically designed to help people learn to cope with overwhelming emotions, even one never learned to do so early in life. DBT is also helps with trauma recovery, especially when do to childhood abuse.
The Body Keeps Score provides a comprehensive overview of current trauma treatment. The book provides a user-friendly explanation of the neurobiology of trauma, which helps one understand the reason for symptoms such as flashbacks and nightmares, and specifically addresses what happens to children’s development when they experience trauma that goes untreated. The book then lays out numerous leading approaches to treating trauma, providing survivors the option to identify what works best for their personal needs, circumstances, and preferences.
As the title implies, The PTSD Workbook provides trauma survivors with a practical guidebook for working through difficult symptoms such as flashbacks, nightmares, hypervigilance (i.e., living on eggshells), and dissociation. When combined with psychotherapy in which memories are reprocessed, these techniques can be very helpful in quickly learning to manage these difficult situations and return to a more normal life.