Post‐traumatic stress disorder (PTSD) can occur following a traumatic event. It is characterised by symptoms of re‐experiencing the trauma (in the form of nightmares, flashbacks and distressing thoughts), avoiding reminders of the traumatic event, negative alterations in thoughts and mood, and symptoms of hyper‐arousal (feeling on edge, being easily startled, feeling angry, having difficulties sleeping, and problems concentrating).
Previous reviews have supported the use of individual trauma‐focused cognitive behavioural therapy (TFCBT) and eye movement desensitisation and reprocessing (EMDR) in the treatment of PTSD. TFCBT is a variant of cognitive behavioural therapy (CBT), which includes a number of techniques to help a person overcome a traumatic event. It is a combination of cognitive therapy aimed at changing the way a person thinks, and behavioural therapy, which aims to change the way a person acts. TFCBT helps an individual come to terms with a trauma through exposure to memories of the event. EMDR is a psychological therapy, which aims to help a person reprocess their memories of a traumatic event. The therapy involves bringing distressing trauma‐related images, beliefs, and bodily sensations to mind, whilst the therapist guides eye movements from side to side. More positive views of the trauma memories are identified, with the aim of replacing the ones that are causing problems.
TFCBT and EMDR are currently recommended as the treatments of choice by guidelines such as those published by the United Kingdom’s National Institute of Health and Clinical Excellence (NICE).
Randomised controlled trials of individual trauma‐focused cognitive behavioural therapy (TFCBT), eye movement desensitisation and reprocessing (EMDR), non‐trauma‐focused CBT (non‐TFCBT), other therapies (supportive therapy, non‐directive counselling, psychodynamic therapy and present‐centred therapy), group TFCBT, or group non‐TFCBT, compared to one another or to a waitlist or usual care group for the treatment of chronic PTSD. The primary outcome measure was the severity of clinician‐rated traumatic‐stress symptoms.
EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences. Repeated studies show that by using EMDR therapy people can experience the benefits of psychotherapy that once took years to make a difference. It is widely assumed that severe emotional pain requires a long time to heal. EMDR therapy shows that the mind can in fact heal from psychological trauma much as the body recovers from physical trauma. When you cut your hand, your body works to close the wound. If a foreign object or repeated injury irritates the wound, it festers and causes pain. Once the block is removed, healing resumes. EMDR therapy demonstrates that a similar sequence of events occurs with mental processes. The brain’s information processing system naturally moves toward mental health. If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can cause intense suffering. Once the block is removed, healing resumes. Using the detailed protocols and procedures learned in EMDR therapy training sessions, clinicians help clients activate their natural healing processes.
More than 30 positive controlled outcome studies have been done on EMDR therapy. Some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions. Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six 50-minute sessions. In another study, 77% of combat veterans were free of PTSD in 12 sessions. There has been so much research on EMDR therapy that it is now recognized as an effective form of treatment for trauma and other disturbing experiences by organizations such as the American Psychiatric Association, the World Health Organization and the Department of Defense. Given the worldwide recognition as an effective treatment of trauma, you can easily see how EMDR therapy would be effective in treating the “everyday” memories that are the reason people have low self-esteem, feelings of powerlessness, and all the myriad problems that bring them in for therapy. Over 100,000 clinicians throughout the world use the therapy. Millions of people have been treated successfully over the past 25 years.
EMDR therapy is an eight-phase treatment. Eye movements (or other bilateral stimulation) are used during one part of the session. After the clinician has determined which memory to target first, he asks the client to hold different aspects of that event or thought in mind and to use his eyes to track the therapist’s hand as it moves back and forth across the client’s field of vision. As this happens, for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and the clients begin to process the memory and disturbing feelings. In successful EMDR therapy, the meaning of painful events is transformed on an emotional level. For instance, a rape victim shifts from feeling horror and self-disgust to holding the firm belief that, “I survived it and I am strong.” Unlike talk therapy, the insights clients gain in EMDR therapy result not so much from clinician interpretation, but from the client’s own accelerated intellectual and emotional processes. The net effect is that clients conclude EMDR therapy feeling empowered by the very experiences that once debased them. Their wounds have not just closed, they have transformed. As a natural outcome of the EMDR therapeutic process, the clients’ thoughts, feelings and behavior are all robust indicators of emotional health and resolution—all without speaking in detail or doing homework used in other therapies. https://www.emdr.com/us-basic-training-overview/
According to the Donald, this poem describes how the inner world comes to the rescue of the trauma survivor. In terms of the psyche, trauma is any experience that causes unbearable pain or anxiety. Anything that leaves the child feeling that the essence of who they are is defective or missing in essential value and therefore at risk of annihilation is traumatic. Dissociation is necessary for the individual to go on living; the pain is distributed to make it more manageable. It also saves something of spirit for later growth. This is a self-care system that allows one part to regress and the other part to progress.
Donald spoke of the split between the innocent part of the self that has been saved by an ‘imaginal inner world of companions’. This self is now in hiding from the real world with its undependable attachments. This is a world of tyrannical infantilism where the victim becomes the perpetrator, where the personal is projected onto the general and vice versa. He describes a ‘Self-Care System’ that protects the personality from disintegration, a system that a) makes meaning for child’s life, b) that regulates distance from the world of others – ‘all by myself’ might be the catchword, c) establishes self-regulation to control aggression towards the other and d) promotes self preservation by keeping feelings at bay, very often through addictions – a slow suicide. This is a world where there are no memories, only flashbacks and repetition. Relationship is the conduit through which this painful work can be repaired. He articulates what we as humanistic and integrative psychotherapists have held – that relationship is the way through this impasse. https://iahip.org/inside-out/issue-55-summer-2008/the-inner-world-of-trauma-the-lost-and-recovered-soul-public-lecture-and-seminar-with-donald-kalsched-ph-d-4th-and-5th-april-2008
There’s an old adage: “Teach what you know.” I know about trauma because I survived childhood in the war zone of a severely dysfunctional family in NYC in the 1950’s. The frontline was definitely in my house, but there were many traumatizing skirmishes on the streets and in the Catholic school where I was held captive by mean, red-faced, yardstick-wielding women in penguin suits. I escaped my family into the Viet Nam era army, and although I only went there briefly, my year of training to be a combat platoon leader helps me see the parallels between war-induced trauma and dysfunctional family begotten trauma.
By the time I was 25, I had survived a decade of high risk activity peppered with what now look like unconscious suicide attempts, before I finally realized that I was seriously hurting. I have spent four decades personally exploring varied psychological and spiritual approaches to healing my trauma, and the personal gains I have made coupled with the healing I have witnessed in my clients and students over the last 30 years has given me, I believe, a unique perspective and set of tools to share with my fellow PTSD sufferers. I have pieced together a map and an eclectic blend of perspectives and techniques that can significantly ameliorate Complex PTSD. My approach helps manage the complex symptomology of emotional flashbacks and provides encouragement to endure the long, arduous, Sisyphean climb out of being continuously triggered into unresolved childhood abandonment pain. (For more on the map, see “Managing the Abandonment Depression” on this website.)
In my ongoing work with PTSD recovery, I repeatedly experience much gratitude toward the many clients who’s authenticity and vulnerability while in flashback help me further illuminate the map; and I am further grateful for how they validate to my inner child that: “Yes it’s true, there really are parents who were so mean and/or so out to lunch, that they installed in us this painful, stubborn syndrome of Complex PTSD”.
Post-traumatic stress disorder (PTSD) has become an important public health problem. However, the conventional therapeutic strategy, including pharmacotherapy and cognitive behavioral therapy, has limitations. Neurofeedback is a technique that utilizes electroencephalography (EEG) signaling to monitor human physiological functions and is widely used to treat patients with PTSD. The purpose of our study is to assess the efficacy and safety level of neurofeedback treatment in patients with PTSD using quantitative EEG.
Neurofeedback is widely used for various psychiatric diseases, including PTSD. It has an advantage over CBT because it does not re-expose patients with PTSD to the traumatic event. Several studies have reported on the effects of neurofeedback on patients with PTSD. However, most of these studies used a relatively small sample size.11, 58, 59 Additionally, some did not feature a control group and, therefore, could not account for the natural history effect of the disease, regression to mean, and several non-specific effects.15, 16 Some studies did not report the exact location of the electrode.18 Several studies did not report the neurofeedback protocol, which limits their reproducibility and the clinical utility of their results.17, 26
Neuroplasticity is most active in childhood as a part of normal human development, and can also be seen as an especially important mechanism for children in terms of risk and resiliency. Trauma is considered a great risk as it negatively affects many areas of the brain and puts a strain on the sympathetic nervous system from constant activation. Trauma thus alters the brain’s connections such that children who have experienced trauma may be hyper vigilant or overly aroused. However a child’s brain can cope with these adverse effects through the actions of neuroplasticity.
There are many examples of neuroplasticity in human development. In an article written by Justine Ker and Stephen Nelson, the effects of musical training on neuroplasticity is looked at. Musical training is a form of experience dependent plasticity. This is when changes in the brain occur based on experiences that are unique to an individual. Examples of this are learning multiple languages, playing a sport, doing theatre, etc. A study done by Hyde in 2009, showed that changes in the brain of children could be seen in as little as 15 months of musical training. Ker and Nelson suggest this degree of plasticity in the brain’s of children can “help provide a form of intervention for children… with developmental disorders and neurological diseases.”
Psychological Trauma: Theory, Research, Practice, and Policy® publishes empirical research on the psychological effects of trauma. The journal is intended to be a forum for an interdisciplinary discussion on trauma, blending science, theory, practice, and policy.
The journal publishes empirical research on a wide range of trauma-related topics, including
Psychological treatments and effects
Promotion of education about effects of and treatment for trauma
Assessment and diagnosis of trauma
Pathophysiology of trauma reactions
Health services (delivery of services to trauma populations)
Epidemiological studies and risk factor studies
Trauma and cultural competence
The journal publishes articles that use experimental and correlational methods and qualitative analyses, if applicable.
All research reports should reflect methodologically rigorous designs that aim to significantly enhance the field’s understanding of trauma. Such reports should be based on good theoretical foundations and integrate theory and data. Manuscripts should be of sufficient length to ensure theoretical and methodological competence. Continue reading “Psychological Trauma: Theory, Research, Practice, and Policy “→