Addressing Trauma Successfully[1]

Over the years of therapy, I have studied most of the trauma therapy tools that have had success.  All of these listed below are effective and worthy of investigation.  The bottom line is to find one that suits you.  One cautionary note is to get experienced, professional help.  Some would learn a single technique and then profess to have the answer to every issue.  While they may have good intentions, I question any single approach to such a complex problem as trauma. Most have heard the quote:

“If all you have is a hammer, everything looks like a nail.“

EMDR

 “Eye Movement Desensitization and Reprocessing (EMDR) can help you process upsetting memories, thoughts, and feelings related to the trauma. By processing these experiences, you can get relief from PTSD symptoms.”[2]

In 1987, Francine Shapiro was walking in the park when she realized that eye movements appeared to decrease the negative emotion associated with her own distressing memories¹. She assumed that eye movements had a desensitizing effect, and when she experimented with this she found that others also had the same response to eye movements. It became apparent however that eye movements by themselves did not create comprehensive therapeutic effects and so Shapiro added other treatment elements, including a cognitive component, and developed a standard procedure that she called Eye Movement Desensitization (EMD).

Shapiro then conducted a case study and a controlled study to test the effectiveness of EMD. In the controlled study, she randomly assigned 22 individuals with traumatic memories to two conditions: half received EMD, and half received the same therapeutic procedure with imagery and detailed description replacing the eye movements. She reported that EMD resulted in significant decreases in ratings of subjective distress and significant increases in ratings of confidence in a positive belief. Participants in the EMD condition reported significantly larger changes than those in the imagery condition.[3]

Does it work?

EMDR has a broad base of published case reports and controlled research that supports it as an empirically validated treatment of trauma and other adverse life experiences. The Department of Defense/Department of Veterans Affairs Practice Guidelines have placed EMDR in the highest category, recommended for all trauma populations at all times. In addition, the International Society for Traumatic Stress Studies current treatment guidelines have designated EMDR as an effective treatment for PTSD (Foa, Keane, Friedman, & Cohen, 2009) as have the Departments of Health of both Northern Ireland and Israel (see below), which have indicated EMDR to be one of only two or three treatments of choice for trauma victims. The American Psychiatric Association Practice Guideline (2004) has stated that SSRI’s, CBT, and EMDR are recommended as first-line treatments of trauma.  Most recently, the World Health Organization (2013) has stated that trauma-focused CBT and EMDR are the only psychotherapies recommended for children, adolescents, and adults with PTSD. [4]

A Brief Outline of EMDR[5]

EMDR therapy combines different elements to maximize treatment effects. 

EMDR therapy involves attention to three time periods:  the past, present, and future.  Focus is given to past disturbing memories and related events.  Also, it is given to current situations that cause distress, and to developing the skills and attitudes needed for positive future actions.  With EMDR therapy, these items are addressed using an eight-phase treatment approach.

Phase 1:  History-taking session:  The therapist assesses the client’s readiness and develops a treatment plan.  Client and therapist identify possible trauma targets.  These include distressing memories and current situations that cause emotional distress. .

Initial EMDR processing may be directed to childhood events rather than to adult-onset stressors or the identified critical incident if the client had a problematic childhood.  Clients generally gain insight into their situations; the emotional distress resolves and they start to change their behaviors.  The length of treatment depends upon the number of traumas and the age of PTSD onset.  Generally, those with single event adult onset trauma can be successfully treated in under 5 hours.  Multiple trauma victims may require a longer treatment time.

Phase 2:  Skill Building: the therapist ensures that the client has several different ways of handling emotional distress.  The therapist may teach the client a variety of imagery and stress reduction techniques the client can use during and between sessions. A goal of EMDR therapy is to produce rapid and effective change while the client maintains equilibrium during and between sessions.

Phases 3-6:  In phases three to six, a target is identified and processed using EMDR therapy procedures.  These involve the client identifying three things:
1.  The vivid visual image related to the memory
2.  A negative belief about self
3.  Related emotions and body sensations.

In addition, the client identifies a positive belief.  The therapist helps the client rate the positive belief as well as the intensity of the negative emotions.  After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation.  Eye movements are the main form of bilateral stimulation used for EMDR. Originally EMDR used only visual stimuli and the resulting eye movements to facilitate the therapy process. The creator of EMDR therapy, Francine Shapiro, postulated that eye movements, in particular, were a necessary part of the treatment. However, research found similar efficacy using other types of stimulation and other stimuli are now commonly used by EMDR practitioners.  These alternative stimuli include auditory stimuli that alternate between left and right speakers or headphones, and physical stimuli such as tapping of the therapist’s hands.  During the sets, the EMDR client is instructed to just notice what they are aware of happening.

Depending upon the client’s report, the clinician will choose the next focus of attention.  These repeated sets with directed focused attention occur numerous times throughout the session.  If the client becomes distressed or has difficulty in progressing, the therapist follows established procedures to help the client get back on track.

When the client reports no distress related to the targeted memory, (s)he is asked to think of the preferred positive belief that was identified at the beginning of the session.  At this time, the client may adjust the positive belief, if necessary, and then focus on it during the next set of distressing events.

Phase 7:  In phase seven, closure, the therapist asks the client to keep a log during the week.  The log should document any related material that may arise.  It serves to remind the client of the self-calming activities that were mastered in phase two.

Phase 8:  The next session begins with phase eight.  Phase eight consists of examining the progress made thus far.  The EMDR treatment processes all related historical events, current incidents that elicit distress, and future events that will require different responses.

Traumatic Incident Reduction (TIR)

In the mid-1980s, Dr. Frank A. Gerbode of California developed Traumatic Incident Reduction (TIR) therapy as a person-centered desensitization method for helping people to face traumatic events in their past that have a negative impact on their current lives and learn how to move forward positively. TIR is a nonjudgmental and non-confrontational method of easing the stress of events that have caused physical and/or emotional pain.

Traumatic Incident Reduction therapy is a therapeutic technique performed by trained professionals, called “facilitators,” in a highly structured manner. TIR is considered a rapid therapy form as it may not last as long as traditional methods. Sessions are typically 60-90 minutes in length and generally offered weekly. The number of needed sessions is determined by each individual and their specific needs and progress.

A TIR session will begin with an assessment step. This assessment will evaluate the specifics of what is to be managed during the session. The person receiving treatment will identify either a certain incident or a thematic item to be resolved. Thematic TIR will explore unwanted feelings and emotions that may be related to as-of-yet uncovered reasons or past events. A person may try to close off, or block, painful memories or experiences as a method of self-preservation and can, therefore, repress stressful events. These traumas lie below the surface and can cause a multitude of negative side effects. TIR can help to uncover these repressed traumas and guide people to work through them in a safe and controlled environment.

After the assessment, a TIR session will move on to the viewing step. During the “viewing,” a person will try to look at their life as if from the outside (kind of like watching a movie) in order to objectively see how feelings and actions interact and how the trauma is related to them. Emotions and memories may be distorted, and a person may not be aware of how much, or in what way, previous incidents may be affecting how they feel and act currently. This viewing step can help to provide connections and revelations into the self and why a person may act and feel the way they do. Insights and self-reflection come directly from the person involved and not from the facilitator directly, who is there to act as a guide.[6]

Somatic Experiencing

The Somatic Experiencing® method is a body-oriented approach to the healing of trauma and other stress disorders. It is the life’s work of Dr. Peter A. Levine, resulting from his multidisciplinary study of stress physiology, psychology, ethology, biology, neuroscience, indigenous healing practices, and medical biophysics, together with over 45 years of successful clinical application. The SE approach releases traumatic shock, which is key to transforming PTSD and the wounds of emotional and early developmental attachment trauma.

The SE Approach offers a framework to assess where a person is “stuck” in the fight, flight or freeze responses and provides clinical tools to resolve these fixated physiological states. It provides effective skills appropriate to a variety of healing professions including mental health, medicine, physical and occupational therapies, bodywork, addiction treatment, first response, education, and others.

The SE approach facilitates the completion of self-protective motor responses and the release of thwarted survival energy bound in the body, thus addressing the root cause of trauma symptoms. This is approached by gently guiding clients to develop increasing tolerance for difficult bodily sensations and suppressed emotions.

Emotional Freedom Technique (or Tapping)

I’ve talked about EFT previously, as a coping skill for all types of issues.  It is my favorite tool to use for almost everything  It is the first thing I work with when I have any emotional issue, physical pain, or just difficulty getting to sleep.  In my clinical practice almost every client hears about this tool and, if willing, learns to use it for themselves.  What I like is that my clients can use this on their own, and not be dependent on another to solve their issues.  [7]

EFT or Tapping provides relief from chronic pain, emotional problems, disorders, addictions, phobias, post-traumatic stress disorder, and physical diseases. While Tapping is rapidly revolutionizing the field of health and wellness, using the healing concepts that have been in practice in Eastern medicine for over 5,000 years. Like acupuncture and acupressure, Tapping is a set of techniques which utilize the body’s energy meridian points. You can stimulate these meridian points by tapping on them with your fingertips – literally tapping into your body’s energy and healing power.

So How Does It All Work?

All negative emotions are felt through a disruption of the body’s energy. And physical pain and disease are intricately connected to negative emotions. Health problems create feedback – physical symptoms cause emotional distress, and unresolved emotional problems manifest themselves through physical symptoms. So, the body’s health must be approached as a whole. You cannot treat the symptoms without addressing the cause, and vice-versa.

The body, like everything in the universe, is composed of energy. Restore balance to the body’s energy, and you will mend the negative emotions and physical symptoms that stem from the energy disruption. Tapping restores the body’s energy balance, and negative emotions are conquered.

The basic technique requires you to focus on the negative emotion at hand: a fear or anxiety, a bad memory, an unresolved problem, or anything that’s bothering you. While maintaining your mental focus on this issue, use your fingertips to tap 5-7 times each on 12 of the body’s meridian points. Tapping on these meridian points – while concentrating on accepting and resolving the negative emotion – will access your body’s energy, restoring it to a balanced state.

You may be wondering about these meridians. Put simply, energy circulates through your body along a specific network of channels. You can tap into this energy at any point along the system.

This concept comes from the doctrines of traditional Chinese medicine, which referred to the body’s energy as “ch’i.” In ancient times, the Chinese discovered 100 meridian points. They also discovered that by stimulating these meridian points, they could heal. Call it energy, call it the Source, call it life force, call it ch’i… Whatever you want to call it, it works.

In some ways, Tapping is similar to acupuncture. Like Tapping, acupuncture achieves healing through stimulating the body’s meridians and energy flow. However, unlike Tapping, acupuncture involves needles! “No needles” is one of the advantages of Tapping.

Tapping is simple and painless. It can be learned by anyone. And you can apply it to yourself, whenever you want, wherever you are. It’s less expensive and less time-consuming. It can be used with specific emotional intent towards your unique life challenges and experiences. Most importantly, it gives you the power to heal yourself, putting control over your destiny back into your own hands.


Because of this, thousands of people have used Tapping for illnesses and to resolve emotional problems. Tapping practitioners have studied the techniques and trained to take on more complicated and difficult cases, and these dedicated practitioners report more successful applications daily. More and more people are discovering and exploring Tapping. Many are discovering how Tapping can change their lives.

In conclusion

In addition to these primary tools research is being done using Art therapy, Yoga, Hypnosis, Neurolinguistic Programming, Group therapy and movement. I have explored most of these, with moderate success, so I tend to stick with the ones listed above.

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[1] A cautionary note:  Any trauma technique should be facilitated by a trained therapist.  Self-processing is Not recommended.

[2]VA » Health Care » PTSD: National Center for PTSD » Treatment » Eye Movement Desensitization and Reprocessing (EMDR) for PTSD

[3] http://www.emdr.com/history-of-emdr/

[4] http://www.emdr.com/efficacy/

[5] A full description of the theory, sequence of treatment, and research on protocols and active mechanisms can be found in F. Shapiro (2018) Eye movement desensitization and reprocessing:  Basic principles, protocols, and procedures (3rd edition) New York: Guilford Press. 

[6] https://www.treatmentsolutions.com/therapies/traumatic-incident-reduction/

[7] The one exception to this is trauma.  I strongly recommend that the client find a trained and experienced therapist to do trauma work.