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Trauma Therapy

What is trauma?

Psychological trauma is defined as an event that overwhelms a person’s nervous system to the point that it becomes difficult for the person to deal with. Trauma can be a big event, like a plane crash or a robbery. Trauma can also be a smaller event that gets repeated often, like bullying in school or being ignored when in need of attention. These events may be less extreme, but when they happen many times over the course of a person’s lifetime, they can become traumatic.

How is trauma therapy different?

Trauma therapy is different from traditional talk psychotherapy in that trauma therapy involves the body, since the trauma is stored in the brain and the body. When therapy involves the body, it is called somatic. Trauma therapy also uses the limbic part of the brain (the emotion and memory center of the brain), whereas most other therapies use the prefrontal cortex (the language and logic center of the brain).

What types of trauma therapy have been proven to be effective?

EMDR and Brainspotting have both been proven to be effective in the treatment of trauma. Typically with trauma somatic therapies are much more effective than traditional talk therapy because of how trauma is wired in our brains and bodies.

Window of tolerance

When doing trauma work, it is important to have a sense of whether you’re in or out of your “window of tolerance” (WOT), also called the “resilient zone.” As we go through our lives we have some ups and downs. We may get excited about good news, or feel sad about a loss. However, if we’re relatively comfortable, then we’re in our WOT. If we get triggered, we can get bumped out of our WOT, either into the high zone or the low zone.

Working within the WOT

The high zone is nervous system hyperarousal, which includes breathing quickly, sweating, racing heart, and feelings of panic, anxiety, or anger. The low zone is nervous system hypoarousal, which is manifested as  fatigue, low energy, sleepiness, and at the most extreme, feeling numb or even catatonic. During therapy for trauma we’re typically working at the edge of our WOT or just outside of it. However, before we begin trauma work we need to make sure that the client has developed the skills to regulate their emotions sufficiently, so that they know how to bring themselves back into their WOT when they get bumped out of it.

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Resourcing is the act of using healthy coping skills to bring ourselves back into our WOT when we notice we are either in the high zone or the low zone. It is very common for trauma survivors to develop maladaptive coping mechanisms to try to regulate their emotions and get themselves back into their resilient zone. These attempts to cope may include abusing substances, self-harming, disordered eating, or compulsive sexual behaviors. 

Why do we develop these habits?

We develop these habits because they work in the short term to alleviate distress; however, they usually end up causing more distress in the long term. Resourcing is about developing ways to get back into our resilient zone that don’t also cause other problems. 

How is resourcing done?

Resourcing can encompass breathing exercises, grounding exercises (such as noticing everything in the room that’s the color blue), and sensory exercises (such as mindfully noticing the feeling of our feet on the ground or the sensation of playing with silly putty or sand). Resourcing can also involve guided imagery and going to a “safe place” or “peaceful place” in our minds, or tapping into feeling comforted by a protective, nurturing, wise, or mentoring figure. The possibilities are endless. Basically, a resource is anything that helps you self-soothe and feel comfortable.

Turning the heat up or down

Another metaphor that I like to use to describe resourcing is that doing trauma work is like putting a pot of water on the stove and turning the heat up, so that the water boils. However, we want to make sure the water doesn’t boil over, spilling onto the stove. Resourcing is like turning the heat down. We will work on resourcing before we introduce trauma processing, because we want to make sure that you have the resources to be able to turn the heat down, so to speak, if the trauma work becomes too intense.

Safety and containment

It is important when processing trauma that we create a sense of safety and containment around the trauma work. Failure to do so can result in the patient becoming emotionally dysregulated, and the patient may feel strong urges to engage in self-harming behaviors to attempt to regulate their own emotions. Respecting the therapeutic container can look like talking about or working on our trauma in therapy but not talking about it casually with family members or friends. The reason for this is that talking about the trauma and focusing on the trauma outside of the safe container of the therapeutic environment can result in flooding, a feeling of being overwhelmed.

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