How long does trauma therapy take?

This is a very difficult question to answer, because everyone is different, everyone’s story is different, and everyone’s trauma is “stuck” in a unique way. 

But clients have a right to know how long things might take. So to show I’m not avoiding the question altogether, I’ll talk about it a little bit.

First of all, many people have spent many years suffering.  It’s natural to want a quick fix, and our society specializes in quick.  Unfortunately, it’s more difficult to do that with therapy than with other things.  That said, trauma therapy used to take many years, and with more modern and powerful therapies, it usually doesn’t.  Trauma therapy length depends on a number of factors, so let’s start there.

What influences how long it takes?

What are the factors?

There are many factors that go into determining this; before our first session, I don’t know any of them, and some of them we’ll never know, or at least not until afterwards.  The good news is that there is an afterwards.  Some things that influence how long it takes to get there:


Your goals

Some people want a deep healing of their symptoms, others are satisfied with some significant changes that help them in their everyday life; sometimes people just want to be well enough to function in a job or a relationship.  This part depends on you.


The type and severity of the trauma

If we’re just working on a single event that happened when you were an adult, then it could be fairly short—possibly between 1-3 months.  The research on childhood trauma recommends 15-30 months, but I’ve had clients who were satisfied with what they accomplished sooner, sometimes much sooner.  But no matter what, we can’t know how it will go until we get started.

How “stuck” is the trauma?

If you’ve read my pages on PTSD, you know that the symptoms we see are natural and reasonable responses to threat.  However, the threat is now over.  So the body seems stuck in a place where it responds as if the trauma is still going on.  We don’t know why.  We just know that there are some things that might help get it unstuck.  If we can do that, the healing process will proceed naturally, although that takes some time.  We can’t know exactly how much time, but we do know that it seems to continue even after therapy is completed, if the therapy was effective.

Resources

There are other factors that make a difference.  We don’t know what they all are, by any means.  We know that having one trauma often makes it more difficult to recover from a second one.  Also, we know that having social resources (good relationships with some family and friends) helps.  There are other things that make a difference, too.  (see my blog on Resources)

How soon will we know?

Not right away.  Sometimes we’ll know a little bit after a few sessions, sometimes it will take longer to determine.  It takes what it takes.  But I’m not interested in dragging things out unnecessarily—the suffering has lasted long enough. 

Here’s my suggestion.  Let’s give it a chance.  Let’s have a few sessions together.  The first thing that should happen is that you should start feeling more comfortable in our session.  If that doesn’t happen by the third session, we’re probably not a good fit.  By then we will have started the first phase of trauma treatment—what I call resourcing.  We’ll work on that for a while, finding and using the tools that seem to work best for you.  When that’s finished and we start into the middle part of treatment, then we will begin to know more about how your system is responding to the things we do.  Then, of course, we’ll keep adjusting as we go along, based on what we find out and what your goals are.

Here’s my promise to you: I’ll always be open about my opinion and my reasons for it.  I’ll also try not to speculate when I don’t know.  That’s my professional commitment to being open with my clients about what we’re doing.  You’re always in charge.

If you’re in or near Colorado Springs, you can contact me using the form below or by calling 970-377-4577.

What is a Somatic Approach to Therapy?

(Need to contact me or get information about therapy right now? Scroll to the bottom of the page.)

Somatic approaches to counseling and therapy pay attention explicitly to the physical reactions that accompany psychological issues or symptoms. They take into account current information about the autonomic nervous system (ANS) and how it works. (The ANS is the part of your nervous system that controls things like heart rate, blood pressure and other non-conscious functions.) Traumatic experiences overwhelm the body’s natural defenses. Sometimes people heal from this on their own; sometimes we don’t. When that happens, we develop some form of PTSD (or something similar to it).

Somatic Therapy: What it Isn’t

When I say that a somatic approach to therapy works with the body, I’m not talking about massage or touch; these things can be helpful, but that’s not what I provide. A somatic approach does involve talking. But we don’t just talk about problems, issues, ideas, solutions, relationships and the other things that more traditional “talk therapy” involves. Instead, we actually work with your ANS to jump-start your natural healing process and move it forward. While this involves talking, we’re talking about you as a whole person–with emotions and physical reactions–not just about your thoughts.

Paying Attention

Everything starts with paying attention. In modern culture, we are used to using (or abusing) our bodies. We feed them, exercise them, allow them to rest–sort of like we do our pets. We think of ourselves as brains that own bodies. But this is a flawed perspective. We are bodies. Our brains are just a part of us, even if they are a very important part.

So the first aspect of a somatic approach is to learn to simply pay attention to our physical selves. When you’re angry,
for example, what does it actually feel like? What do you feel in your chest, in your arms or legs, on your skin? To work with anger, we don’t just work with the thoughts that go with it, we work with the ANS reactions, the physical reactions that we don’t consciously control. Paying attention is the beginning of this.

Taking it Further

Of course, there is more to a somatic approach than just paying attention. If we are going to change, the physical reactions we have will need to change. This is particularly the case with PTSD. The symptoms of PTSD (whether due to adult trauma or childhood trauma) are mostly not conscious reactions. They are not things we choose. They are things that happen even though we don’t want them to. To change them, we have to involve the system that manages those reactions, the ANS.

There are a number of ways to accomplish this. If you’ve heard of EMDR or Trauma Dynamics, you’ve heard of approaches to therapy that work with the body to heal the effects from past events that still linger with us. There are other approaches, and there are new ones being created all the time, along with modifications of the “old” ones (almost all somatic approaches are new, based on a modern understanding of how the ANS works).

If you live in Colorado Springs and have physical reactions that you don’t like (the agitation of anxiety, the listlessness and muscle pain of depression, flashbacks or uncontrolled anger), then you may benefit from some of the somatic approaches I can provide. Please contact me (below) to see if we’re a good fit.

The sexual abuse of boys

[Looking for support in Colorado Springs now? Fill out the contact form below or call 719-377-4577 for an appointment.]

We hear a fair amount about sexual abuse of girls.  It happens more than most people think, and it does terrible damage.  But we don’t hear much about the sexual abuse of boys.  Let’s hear a little bit.

First of all, it happens a lot.  In fact, it seems to happen to boys almost as often as it happens to girls.  And it’s quite possible that even our most up-to-date estimates are underestimates, due to the wall of silence that surrounds this issue.

The Wall

There are reasons for that wall.  Men are supposed to be stoic and silent and take care of their own problems.  Also, boys are often blamed for what happens to them. Because boys are often aroused at some point during the abuse, people may mistakenly believe they are cooperating (they themselves are often confused by this and can feel that it’s their own fault).  Also, there are forms of abuse that are not acknowledged as abuse.  And then, because no one talks about it, men can sometimes think that they are alone and that it hasn’t happened to anyone else.  Or, they may think that it happens to everyone, that it’s normal, and that they are just supposed to “deal with it,” to “get over it.”  That strengthens the wall.

Another reason for silence about the sexual abuse of boys is that the perpetrators are almost always known to the boys who are violated.  They are either trusted members of the community (teachers, coaches, religious leaders) or, very often, relatives.  Fathers or mothers (yes, mothers), uncles, aunts, cousins or siblings (of both genders).  This means that the abuse is tinged with a sense of betrayal.  And there are consequences for telling.  Not good ones, usually.

Shutting down

So boys learn to shut up.  And when they become men, they stay shut up.  They disconnect from their feelings, they disconnect from the reality of what happened to them. This is a protective response.  But what helps us survive as children often becomes dysfunctional when we become adults.  Even though it’s kept inside, it manifests itself in other ways.  When boys act out constantly, run away from home, are always angry, or are depressed, we are seeing some of the ways that it is manifest.  These things can continue into adulthood.  In addition, it can cause physical problems.  It can also cause a lack of trust (of men, or women, or people in general) and a general sense of emptiness.  It can cause suicidal thoughts and actions (and men complete attempted suicides at a much higher rate than women do).  But still, it may be manageable, for a while.

Shutting up and shutting down and disconnecting works until it doesn’t.  This can happen at any time.  Sometimes there is a trigger, some highly stressful life situation, or hearing about someone else’s abuse.  Sometimes it happens when their own children get to the age they were when it happened.

Letting it out

The first reaction, when the dissociation stops working and things start going badly, is surprise.  “Why is this happening now?  I thought I put this aside, I thought I was over it.  I haven’t thought about it in years. I was OK last year; why am I so depressed (or anxious, or angry) now?”  The answer is simple:  It’s time for this to come out.  Your body, your mind, your nervous system needs to heal from it.

Then it’s time for action.  It’s time to tell your story to someone.  Someone you trust:  a therapist, a spouse, a support group, someone.  There are many ways that people recover. Reading a book about others’ experiences, or joining a support group can help—it’s important to know you’re not alone.  One support group is called “1 in 6”, and they have a number of resources available.

This is, of course, also a time that therapy can help.  Seeing a therapist who uses powerful somatic therapies (such as EMDR) can support you to move forward in your healing process.  Childhood trauma, if not addressed, can continue to do damage over one’s lifetime.

There is a lot to say here, far more than I can touch on in this blog. If you live in Colorado Springs, and you’ve survived sexual abuse, please feel free to call me to discuss what options might be available. (719-377-4577) or fill out the contact form below.  If you live somewhere else, click on the link to 1 in 6 above.  You’ve suffered long enough—it’s time to start healing.

EMDR

What is EMDR?

EMDR stands for Eye Movement Desensitization and Reprocessing.  It is a treatment modality that was originally developed to treat trauma/PTSD.  It has an 8-phase protocol that is used to work with the underlying causes of PTSD.

By now, you should have read something about what causes PTSD or how treatment works.  If not, you might want to check out one of those links.

Somatic Psychotherapy

EMDR is a somatic psychotherapy modality, which means that it works with the body (or more accurately, the part of the mind that is most closely connected to the body, the autonomic nervous system, or ANS).  When traumatic events occur, it is the ANS, not our conscious mind, that responds.  The responses are simple and very basic (most animals can do these things):  Fight, Run, Freeze or Disconnect (we call this “Dissociating”).  These responses can be very adaptive, very helpful, when we are in a threatening situation.  Oftentimes, they will save our lives.

The problem comes later–when the threat is gone.  Sometimes (not all the time), people can feel like the threat is still going on.  We call this PTSD.  It’s fundamentally an ANS problem, and to my way of thinking, an ANS problem requires an ANS solution.  That’s why I’m not a fan of just talking about the traumatic events (many therapists, for example, use a Cognitive Behavioral approach, which I don’t generally use for trauma, as I don’t think it really heals the underlying problem).

In somatic approaches (such as Trauma Dynamics and EMDR), you don’t have to talk as much about what happened.  Certainly we need to talk enough so that you can remember and bring up the memory, but it’s not about giving me the details of the event–I don’t need them.  Somatic therapies help allow the body to heal.  We have to somehow convince the body that the traumatic event is over, by allowing that part of the mind to process it.

How does it help PTSD?

EMDR helps the the mind/body resolve trauma by using what’s called bilateral stimulation.  The most common (and preferred) form of this is working with eye movements.  However, it can be done by using sounds or touch, in several ways.  Bilateral stimulation seems to allow the brain to process traumatic memories faster.  It seems to “jump-start” the healing process.

Why does it work?  We don’t know.  Actually, we don’t know for sure why any therapies work–we just know that some of them do.  We think that it has to do with facilitating communication between the two sides of the brain, which process information differently.  The theory behind this is called the Adaptive Information Processing model.  It explains how EMDR helps your brain turn your trauma from something that feels like it’s still happening into something that happened, and is over.

But you don’t need to know this to use EMDR.  All you need is a therapist who is trained in and willing to follow the proper protocol, one that you trust and who has listened well to you as you have described your issues.

Can something as strange as EMDR really work?

Short answer:  Yes.  And when EMDR works, it’s extremely helpful.  It can sometimes remove 100% of PTSD symptoms.  Of course, childhood trauma is tougher than adult trauma most of the time, and can take longer to resolve.  But still, we are talking about much less time than used to be spent on talking therapies.  In fact, many people used to be in therapy just talking for many years, never getting much better.  This doesn’t happen when EMDR works.  And the research says it works well most of the time.

What about when it doesn’t work well?  Usually there are things we can do to enhance it.  But in the final analysis, it’s up to you.  If you are one of the few people it doesn’t work for, or you’d rather not do it, that’s no problem.  There are other ways to work on PTSD that are helpful and promote healing and can allow you to be successful in reaching your goals (a reduction or elimination of PTSD symptoms).

So when we start talking trauma, I’ll start talking about somatic psychotherapies like EMDR or Trauma Dynamics.  I like to go with what works. 🙂

What are the symptoms of PTSD?

Sometimes people wonder if they have PTSD of some sort.  Well, here’s a “quiz” to see if you have classic PTSD symptoms from adult traumas or perhaps complex childhood PTSD.  This list is based on the diagnostic criteria of the American Psychiatric Association, put into non-technical language (to the best of my ability). So it may give you an indication of whether you might want to seek professional help.  However, only a mental health professional can actually diagnose PTSD, after interviewing you regarding your situation.

Also, if your situation is distressing to you and interfering with your ability to live your life, that’s what we usually call “clinically significant distress.”  Then you don’t necessarily need this “quiz”—you can just go ahead and call a mental health provider for some assistance.   If you are in Colorado Springs, I’ll talk with you for 15 minutes at no charge (719-377-4577 or even better, email me at Jeff.Farmer.Therapy@gmail.com).

[If the things you’re having trouble with happened to you as a child, then things might not look exactly like this. There’s a different set of criteria for what we sometimes call complex childhood PTSD.  You can read more about childhood trauma here.]

To have “official” PTSD, each letter category below should apply to you.

A. Exposure

You were exposed to one of the following: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in one the following way(s).

[This is “the traumatic event.”]

  1. It happened to you or you actually (physically) witnessed it happen to someone else.
  2. You found out that it happened to a close family member or close friend.
  3. You have been repeatedly exposed to details of these kinds of traumas, even if you didn’t know the people. This typically happens in war or to first responders—police, firefighters, etc., as well as with medical and mental health professionals.

B. Intrusion

At least one of the following things persistently continues to happen:

  1. You have unwanted distressing memories of the event (not just sadness).
  2. You have nightmares about it.
  3. If you have flashbacks (you feel like you are re-experiencing some aspect of the event—visually, auditorially, emotionally—or the whole event).
  4. You feel distressed whenever you see or experience certain reminders of the event.
  5. You have unpleasant physical reactions when you are reminded of the event (body tension, nausea, sensations of heat or cold, agitation, elevated heart rate, etc.)

C. Avoidance

You avoid some of the following things that are related to the traumatic event:

  1. Thoughts or feelings related to the event, or
  2. Physical objects or events that remind you of it.

D. Negative changes in thoughts and emotions (you need two of these)

With regard to the traumatic event, you

  1. have difficulty recalling important details of the event
  2. have more negative thoughts about yourself or the world
  3. inappropriately blame yourself or others for the trauma (even though you know it really doesn’t make sense to)
  4. feel bad emotions more often
  5. have less interest in doing things
  6. feel more isolated
  7. have trouble feeling good emotions

E. Negative changes in how you react to things (you need two of these also)

After the event, you

  1. became more irritable or aggressive
  2. engaged in more risky or destructive behavior
  3. are always watching out for bad things (hypervigilance)
  4. are more easily startled
  5. have more difficulty concentrating
  6. have more difficulty sleeping

F. The symptoms above have lasted for more than one month.

The natural process of recovery after a traumatic event usually lasts a few weeks.  If this has gone on for more than a month without getting better (sometimes it gets worse over time), then check this one off.

G. The symptoms are distressing to you or interfere with your functioning.

This is how we define mental health problems.  If it bothers you significantly, it’s a problem.

H. The symptoms are not due to medication, substance use, or other illness.

This is where you probably need a medical or mental health professional to help.  If it’s not obviously caused by something else, then go ahead and check this one off.

That’s it. If you marked one in each of A,B and C, at least two in each of D and E, and then F,  G and H are also true, then your situation may fit the American Psychiatric Association’s definition of PTSD.  In this case, you might want to see a mental health professional to be sure.  That’s because the above list is simplified in some ways. You may also wish to seek treatment.  PTSD can be successfully treated—there are a number of good therapies available for it, such as Trauma Dynamics or EMDR

[Learn more about what we believe PTSD really is and how many of us think it works.]

More information about PTSD from the National Institutes of Mental Health

How Trauma Therapy Works

What should I expect from trauma therapy?  How will I feel?  Will it take long?  How do I know if it’s going well? These are natural questions about how trauma therapy works.  Let’s dive in.

A thousand kinds of trauma

Because trauma can come in many different forms–physical, psychological, sexual, short-term or long-term–trauma therapy will look different for each person.  Some of it will depend on the symptoms you’re facing.  It will depend on your resiliency and your resources.  Yet, no matter what kind of trauma and exactly how it affected you, there are some important similarities.  (For a list of classic PTSD symptoms, read here. Or learn about childhood trauma and its impacts.)  Because of these similarities, all effective trauma treatments share some basic themes.

How trauma therapy works–safety first

The first thing that’s needed to address trauma is safety.  Without it, there can be no recovery.  Why should there be?  Trauma reactions are adaptive–they are actually helpful if you are under threat.  If you’re in the war zone, you’d better wake up at the slightest noise and grab your rifle without thinking.  If you’re in an abusive relationship, you’d better be hypersensitive to your abuser’s moods.  And if you’re being repeatedly beaten or raped week after week, then it’s best if your brain finds a way to just not be there.  Your mind checks you out of reality–it’s the only way to tolerate the intolerable.

But when it’s over, and the traumatic experience isn’t happening anymore, these things, these things that were so helpful while it was happening–they suddenly become symptoms.  You’re avoiding crowds and jumping at small noises, you’re hypersensitive to those around you and fly off the handle at tiny provocations.  Or you find yourself constantly checking out of work, checking out of your marriage.  You don’t feel like you’re there; and that’s because you aren’t.

So where are you?  Well, you’re back in the trauma.  You know it’s over, but your body doesn’t.  It’s not enough for it to actually be over.  You have to somehow fully experience that.  That’s why we start with safety.

Safety means several things.  First, you have to feel safe with your therapist.  If you don’t, find a different one.  Second, you have to be safe in your life.  You can’t still be living with your abuser, you can’t still be tolerating their denial.  You also have to get free from toxic relationships that will trigger your abuse reactions.  For some reason, when we’ve been traumatized, we sometimes unknowingly seek out situations that are similar.  That’s got to stop.  You have to be in control of your life in order to heal.

Remembering

Next comes the heart of how trauma therapy works.  In the past, we used talk therapy alone.  This can work, but it takes a long time (sometimes many years).  Nowadays, we have powerful techniques which are based on working with the body, such as EMDR.  They’re often very effective, and usually shorter.  Sometimes a lot shorter.

Trauma therapy helps your brain/body process the memory of the trauma.  Even though you may not remember it well, your body remembers it.  Your body remembers every blow, every word, every move your perpetrator made, and it remembers not only what happened and what you did to try to help and defend yourself, but also what your body wanted to do.  The problem is, this memory is stuck.  The brain hasn’t put it into place, the way it does with normal memories.  Once it has done this, the trauma goes from being something that is still happening to something that happened in the past.  It’s a bad thing, for sure, but a bad thing that is finally over.

Why use special techniques?

There are a number of special techniques that can be helpful here.  I’m trained in several of them, and they can be very effective.  They work with what is happening in the body–I teach you how to pay attention to it, and how to start letting it resolve itself (remember, the body wants to heal).  So in our sessions, we’ll jump-start that positive, healing process. The techniques help us get “unstuck.”

There’s a lot to do here.  The charge has to be let out of the body, and the sadness has to be let out of the soul. Trauma therapy work takes some time and effort.  You don’t feel better after every session.  Sometimes you feel a bit worse.  But gradually, as you go through the process, you begin to get relief.  As a result, you begin to feel lighter, more clear, more present, more confident and capable, more (dare we say) normal.  You begin to feel more like yourself.

Reconnecting

Once this happens, you can begin to rejoin your life.  You reconnect with others, build new relationships, engage in new activities (or dust off the old ones).  Love, work and play:  All the things that were on hold while you were suffering so much.

How long does it take?  No one can say.  But if it’s going well, there should be things happening at almost every step that are helpful to you.  And it can take a lot less time than it used to, again, if it’s done well.  Some of the modern therapies seem strange (actually, all of the ones that seem to work well seem strange), but they’re pretty powerful.  If you don’t feel anything is happening or changing after a few months, you might want to re-evaluate.  On the other hand, you can’t put a time limit on it, either.  It takes what it takes. Just keep walking downhill and you’ll eventually make it to the river.

Trauma and Resiliency

Trauma is an everyday occurrence in our world.  Everyone experiences it at some point or another.  Whether it’s something “normal” like an auto accident or surgery, or whether it’s something more unusual, like an attack, abuse, combat or seeing someone killed, it happens to a lot of people.  But most people recover fairly well, and don’t develop severe symptoms of PTSD.  Aftereffects are limited to a few days or weeks after the event, and people soon return to living their lives as before, at least mostly.  We say these people have more resiliency.

However, for many others, the effects last longer and are more disruptive.  They manifest as physical illnesses and sudden thoughts and feelings that can make normal functioning difficult, if not impossible. What makes the difference?  Why is it that two people who experience the same thing see such different results?

Differences that make a difference

Well, first let’s address that word same.  No two people are the same in terms of body chemistry, personality and life experiences or many other factors.  That means that no two people ever experience the same trauma in the same way.  Even if we’re sitting next to each other when the car goes into the pole, it’s not the same event for us.  And some of the differences can make all the difference in the world, in terms of resiliency.

First, there are differences in how things went down.  People who are able to do something about what’s happening, who are able to maintain some level of control, are not nearly as traumatized.  Perhaps you got away from one threat but succumbed to something else.  Maybe you were able to soften the blows somehow.  Perhaps someone came to your aid, or you were able to come to someone else’s.  These aspects of being in control are important.  The less control, the more severe the trauma.

Another thing that matters is how connected you are to other people.  The more positive personal and social relationships you have, the greater your resiliency.  Being able to call someone up, to share the burden of the event with others who care—this is important.  We are social animals, and social connections are a vital part of our mental health.  If you want to be able to survive the slings and arrows of outrageous fortune, stay connected.  (It’ll actually help you live longer, too.)

One more important thing—your history of previous unresolved trauma is important.  People who have experienced a lot of prior trauma seem to be more susceptible to being harmed by new traumas.  Things that might be a difficult bump in the road for someone with an ACE score of zero and a supportive group of friends and family can be overwhelming to someone with a score of four or five—especially if they are socially more isolated.  The bottom line is that life is very unfair in this regard.  People who’ve been badly hurt before are less resilient in the face of new traumatic experiences.

Getting in front of the problem

You can think of resiliency as PTSD pre-treatment.  It is preventative.  If we are more resilient we can do better regardless of what difficulties we face tomorrow.  So is there anything we can do about that?

The short answer is yes.  Let’s look at a few.

First, take control.  Perhaps we couldn’t avoid the car accident.  But what can you do now?  Finding a way to empower yourself in the situation is extremely important.  Regaining control helps us feel more normal after difficult events.  We can’t change the past, but we can do something to make today better.

Then, create and strengthen social connections.  This is extremely powerful.  Healing takes place in a context of social support.  And one of the unfortunate things about experiencing traumatic events is that sometimes they can interfere with our sense of security, and along with that, our willingness to trust others.  We also tend to isolate ourselves when we feel bad.  These reactions, while natural, just don’t help.  We need to find some people we can trust, we need to reach out for help.

One thing that can actually increase both of these (empowerment and connection) is to help others who have gone through similar circumstances.  Join a support group.  Volunteer. Collect donations.  Spread the word. This gives us a sense of control as well as connections with people we can relate to.  That’s a double-dose of resiliency right there.

Getting past the past

The last thing I’ll mention is also an important one.  We need to address the past traumatic events we have faced which have reduced our resiliency, our flexibility, our capacity to “bend in the wind.”  The past often isn’t really past, in terms of how it has impacted us.  If we’re functioning well, have some good times as well as tough ones, usually feel pretty happy with ourselves and our lives, that’s good—perhaps we can let sleeping dogs lie.  But many of us are far from that description.   Depression, anxiety, addiction, constant self-sabotage—these are signs that something is out of balance, even if we don’t have full-on PTSD.  It means that there is some work to do—not so that we dwell in the past, but so we can finally live free from its continuing harmful effects.

The goal of trauma treatment is just that—for the past to become the past.  A part of us, for sure, but a part that no longer frightens or paralyzes us.  The traumatic experiences become chapters in our story, just like all the other chapters, albeit not as sunny.  But once we[ve told the stories and written the chapters, once our bodies have really become convinced that the nightmare is over—then it’s time to get back to living a fulfilling life.  Work, love, serve and play.  That’s the point, right?

PTSD is not (exactly) an illness

Flashbacks.  Avoiding public places.  Hiding in the closet.  Jumping at sounds.  Nightmares.  Waking up shaking or screaming.  Yelling at loved ones for no reason.  Feelings of fear, anxiety, shame, rage.  These are some common symptoms of PTSD.  (Childhood trauma can manifest itself a bit differently.) There may also be depression, numbness, lack of ability to focus or concentrate and many similar symptoms.  People feel unreal, the world feels unreal.  These are painful things, bad things.  But still, I’ll say that PTSD is not (exactly) an illness.  It’s not quite that simple.

Why PTSD is not (exactly) an illness

How can anyone say that, especially when PTSD sometimes requires hospitalization?  Well, let me explain.  It starts with an understanding.  We are creatures with bodies and our brains are part of our bodies.  When bodies are injured, they immediately do several things.  First, they marshal protective resources.  If you are cut, the blood begins to clot.  The body may withdraw bloodflow back to your core (this is the physical reaction called shock).  Next comes inflammation—the body sends white blood cells to the site to fight any infection that may have intruded.  Finally, over the next few days or weeks, many restorative healing processes reconstitute the skin, the flesh and the blood vessels in the injured area.  Protection, then healing.  It’s what bodies do.

Protection

Traumatic stress occurs when our brains are overwhelmed with events that threaten us or those we are close to in some way.  The first thing we do under threat is fight or run.  If either of those works, then we’re usually pretty much ok afterwards.  But sometimes they don’t work.  Something is too much for our defenses.  The beating happens, the person is ejected from the car, the dog tears at the face.  When this happens, our brains protect us.  We dissociate, that is, we check out in some way.  Numbness, freezing, shutting down, forgetting, out-of-body experiences—these are the realm of the body’s defenses.  These are examples of defenses against threats that overwhelm our fight and flight responses.  If we can successfully fight, flee, or get help, we don’t need them. But when those strategies don’t work, our brains protect us from the too-intense experience of harm.

And as long as the threat remains active, the body (the brain) is in protection mode.  We do whatever it takes to survive.  But eventually the threat is gone (in cases of child abuse, domestic violence, war or imprisonment, this may take years).  Once we are safer, it’s time for the body to heal.  It’s time for the broken bone to mend, for the slashed skin and flesh to knit itself back together again.   So what does it look like when the brain is healing trauma?

Healing

In the last 50 years, we’ve begun to discover some answers to this.  We know, for example, that unhealed traumatic memory is very different from normal memory.  So the healing process must involve the brain constructing a normal memory of a situation that was unbearable at the time.  We also know that there is some kind of “charge” held in the body.  The body must somehow “ramp down” from its protective state back to a resting state.   This involves changes in physiology, in muscle tension, in the levels of stress hormones in the blood and many other things.

In the vast majority of people, the brain heals itself.  Some people are even stronger after the traumatic experience.  But some people do not quite heal on their own.  We don’t know completely why, but there are probably many reasons.  One is unresolved trauma from childhood.  Another is that the trauma might have been so massively overwhelming that the brain can’t heal just by itself.  There are other reasons, and often we don’t know exactly why.

Stuck in “protection mode”

So what then is PTSD?  A modern view is that it is nothing but a situation the brain’s attempts to heal that are stuck in one place–the brain is still trying to protect us, even though the event is over.  If you look at the PTSD symptoms, they are all about protection.  (The two major modes of protection involve being more agitated in some way, or checking out in some way.)  So there is nothing “crazy” or even wrong with a person who is suffering from PTSD, except for the fact that somehow, things are not healing (yet).  Like a scab that is constantly picked, like an unbandaged wound that keeps getting torn open, there is something that keeps the PTSD sufferer from healing naturally.  Some part of the brain doesn’t know that it’s over.

Supporting a natural process

The goal of trauma therapy is not fixing people who are broken.  It’s more like putting casts on broken bones, bandaging bad cuts, supporting immune responses with antibiotics.  We create a space for healing and facilitate the process.  Therapy puts a container around the wound and protects it.  We even jump-start the healing process, but then it unfolds of its own accord.  We try to keep from re-injuring the body while that happens.

So in some important sense, PTSD isn’t quite an illness–it’s more like and unhealed wound–the body’s attempts at healing are stuck for some reason.   There are many things that can help—arts as simple as massage or as complex as acupuncture have been shown to be helpful.  And there are a number of therapies that can be very helpful in getting the process going.  But let’s be clear:  The therapy doesn’t completely heal the trauma, and I don’t heal the trauma, any more than the cast or the doctor heals the bone.  The body heals, the brain heals, the person heals.

But sometimes, we can help.

The impact of childhood trauma

I’ve worked with a lot of people with addiction (and I’ve struggled with addiction myself).   At some point I realized that among the people I knew well with addiction, the only ones who hadn’t told me about awful things that happened to them as children were the ones who hadn’t told me anything about their childhood.  That thought got me interested in childhood trauma, and I began reading and trying to learn more, as well as listening (which I’d already been doing).  I then ran across the ACE Study.

ACE Study

ACE stands for adverse childhood experiences.  This study took the medical records of over 17,000 people and correlated them with the results of a survey.  The survey asked them questions about negative things that may have happened to them as children.  The negative things were actually categories of things.  They involved physical, verbal or sexual abuse, neglect, divorce, having a parent die, seeing your mother struck, living with a person who had a mental illness or substance abuse problem or who became incarcerated.  They counted how many categories (of the 10) that each person had experienced.  Then they looked at the medical records.

The results were a bit stunning.  The main finding was that higher the person’s ACE score, the more at risk they were for developing a host of physical and psychological problems as adults.   That’s right, physical problems.  Not only were the folks with higher scores more likely to fall into addiction, anxiety or depression, they were also more likely to develop heart disease and obesity.  Now, this data has been looked at very closely and many research papers have been written about it.  Problem after problem, condition after condition, including antisocial behavior–all are more likely to befall people who had painful and awful things happen to them as children.  It’s pretty shocking.

It’s also terribly unfair.  Unfortunately, we all often participate in making it more unfair.  Every time we think that addiction or overeating is about willpower, every time that we assume heart disease is all about diet, we are neglecting one major thing that (for many people) can cause or worsen all of them:  adverse childhood experiences.  Trauma and loss.  Bad stuff.

What to do?

We go to doctors to get better, to feel better, and they often give us pills.  Not just pills for heart disease, but pills for anxiety and depression and many other things.  But there’s often a missing piece–the unacknowledged and untreated pain and damage created a long time ago.  If there was ever an argument for the need for trauma treatment, this study is it.   (I’m not at all putting down the good work doctors do–and I should note that the principle investigator on the ACE study is a medical doctor.  Many of us get significant help through medical treatment.  But many of us also need more than that.)

Of course, not every child has a high ACE score.  But a lot of us have a few, and a few of us have a lot.  The impact of childhood trauma is something we should acknowledge, something we should look at.  It’s something we should try to address.

A Personal Story

How to do that?  Well, we can start by not blaming children for what happens to them.  Years ago, I was teaching high school, and I had a student who “gave me a lot of trouble.”  I sent him to the office a lot.  Over and over.  Then one day I was talking with the assistant principal about him, and I found out what had happened.  My student, 16, and his 15 year old brother had been abandoned by their parents.  Just left.  They were living with their 19-year old brother who was working and trying to keep it all together so his brothers could stay in school.  How’s that for an adverse childhood experience?  After I learned that, I had a bit of a different attitude about my student.  I started trying to connect with him a little more.  I was young and didn’t know a lot about how to do that, but it was something.  So things went a bit better after that.  I didn’t just stop enforcing rules, and he didn’t completely stop breaking them, but things got better.

If you want to find your ACE score and read about the study, there’s a great website here.

We’ll keep talking about this problem.  And about what can be done to address it.

 

 

Childhood Trauma

What is complex childhood trauma?

Childhood usually involves a few traumatic events: accidents or injuries, unintended separations, grief over minor losses, etc. Events such as these can have some long-term impacts, but often they don’t. However, some children experience things that are usually more serious: divorce, death of a parent, ongoing abuse or neglect, a parent with addiction or mental health problems, etc. These usually involve a disruption or difficulty with an important relationship. In these cases, we talk about complex childhood trauma (or developmental trauma). [Look forward to my talking about this regularly in later posts.]

Impacts

It turns out that these kinds of events or situations can have very damaging long-term impacts on a person’s health. They can increase your chances of developing things like heart disease, obesity and other physical problems as well as mental health issues like depression, anxiety or addiction. [More about the research on this.] In other words, some childhood events can create many different ongoing difficulties. Many people are unaware of this connection, including some in the health fields.

Why is this connection important? For a simple reason: treating the wrong health condition doesn’t always help. If you go to the doctor for a broken arm and she gives you antibiotics, well, your arm won’t get infected, but it also won’t heal correctly. This can happen in therapy. A person will try to get help for depression or anxiety, and they may get medication for it (which can be helpful) and may get some therapy or counseling to gain some coping strategies (which is also helpful). But if the underlying cause is childhood trauma, and that doesn’t get treated, problems often persist.

Treatment

Some people say, “well, you can’t change the past, so you might as well figure out how to live with it.” In my view, that’s both true and false. It’s true that we can’t change past events, and we can’t change the way we reacted at the time, or the effects it has had up to now. But there is a lot more that can be done than just “learning to live with it.” It turns out that we can actually change what has happened in our bodies as a result of trauma.

Our bodies? That sounds weird. But let’s think about it carefully. Heart disease happens in the body. Depression affects the brain and the chemistry of the blood. Anxiety is mostly physical—heart and thoughts racing, tightness in the chest, shaking, sweating.   And most PTSD symptoms are things we can’t consciously control—flashbacks, feelings of unreality, fear, hopelessness, intrusive thoughts about the situation, etc.

Working with the body

For this reason, many of the modern, cutting-edge approaches to trauma treatment are based in the body (we say they are “somatic”).   Things such as EMDR, Yoga, acupuncture and massage all have been found to be helpful. I work with a somatic trauma therapy called Trauma Dynamics. It targets the effects that events and situations have had on our nervous systems, particularly the parts we can’t control. This somatic PTSD therapy is only a few decades old, and is still developing. But there is evidence that it’s extremely powerful, even in cases of complex childhood trauma.

So it turns out that healing is possible. We can’t change the past, but we can change the effects it has had on us. That’s good, good news for everyone.