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Healing Therapies in Trauma

Discussion in 'News, Politics & Debates' started by anthony, Aug 12, 2006.

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  1. anthony

    anthony Silently Watching Founder

    A person’s response to trauma encompasses emotional, physical, mental and behavioural dimensions. Emotional reactions include depression, anxiety, guilt, anger, irritability and helplessness, among others.

    Physical symptoms like palpitations, shortness of breath and headaches may arise indirectly due to the traumatic event.
    In the aftermath of trauma, a person’s thought process feels “out of sync”, resulting in confusion, impaired attention and concentration and distractibility. Moreover, the underlying turmoil may be expressed externally in behaviour changes such as social withdrawal or increased consumption of alcohol or drugs.

    The wide ranges of reactions vary between individuals and evolve differently with the passing of time. Although the reactions are perturbing or disruptive, most actually are normal responses to an abnormal event and these reactions resolve as a person recovers naturally.

    However some reactions can be persistent and severe, profoundly disabling the lives of some traumatised individuals. These extreme responses are part of Post-Traumatic Stress Disorder (PTSD).

    The core symptoms of PTSD are those of re-experiencing, avoidance and hyperarousal. Re-experiencing the traumatic event is evidenced by recurrent recollections, flashbacks, nightmares and excessive physical or psychological reactions to reminders of the event.

    To reduce such distressing symptoms, the individual then extensively avoids any triggers linked to the traumatic event; even thoughts, activities, places and people that are associated with the trauma.

    Avoidance behaviour can also manifest as difficulty in remembering aspects of the trauma, loss of interest in previous activities and detachment from people. Finally symptoms of hyperarousal refer to sleep disturbances, irritability, impaired concentration, hypervigilance and an easily startled response.

    PTSD can be associated with depression, suicidal behavior and substance abuse.

    However, not everybody who experiences trauma will suffer from PTSD. In fact, when given adequate support, most people recover without needing specific psychotherapy. It is when the person’s natural recovery is disrupted that specialised trauma therapies are needed.

    Professional help is indicated when the intensity of trauma symptoms do not subside over weeks or months, when symptoms cause severe distress or when a person’s socio- occupational functioning or daily functioning is compromised.

    Therapies ought to be tailored to suit the needs of the particular individual in that particular circumstance of trauma. In fact the therapy ought to be adapted to the individual, not vice versa.

    Listen first
    However, there are fundamental tenets to therapies for trauma victims. Nothing can replace active listening, the importance of which cannot be understated. In the early phases, it also helps to discuss the normal physiological stress response. The therapist or clinician may share educational books or articles on trauma stress responses.

    Further reassurance that most early reactions are understandable and expected can alleviate the individual’s anxiety over “going crazy”.

    Similar to a physical wound, a psychological wound needs to time to heal. Explaining the healing process and the time to readjustment greatly facilitates the initial recovery. This principle is known as normalisation. Persisting and severe trauma reactions, however, are somewhat akin to a wound infection disrupting normal body healing, in that such reactions are pathological and warrant further management because they interfere with natural recovery.

    For complex traumatic stress or PTSD, a therapist essentially fosters a therapeutic alliance that provides empowerment. By collaborating with the individual to adapt and achieve a sense of mastery and control, the role-shift from victim to survivor is made. The focus on the person’s coping skills, strengths and resources enhances personal restoration and recuperation.

    As mentioned earlier in this article, there are individual differences in susceptibility to PTSD. Therefore each person’s unique pathway response should be appreciated, keeping in mind ethnic expressions of trauma reactions and cultural sensitivities.

    Discerning and respecting cultural differences is especially important when caring for traumatised persons from varying ethnic backgrounds. For instance, when international humanitarian organisations offer psychosocial expert assistance in large-scale disasters, the care must be attuned to the peoples’ local needs and culture.

    Amidst processing the trauma, therapies also include grieving one’s losses e.g. death of a loved one, loss of one’s home, loss of physical function, loss of a relationship. For example, when abuse has occurred within a trusted relationship, one grieves the loss of the innocence of childhood and the loss of such a core relationship. Issues such as guilt and strong sense of responsibility often arise in situations where the trauma involved the death of some one else, either a loved one or even a stranger. These issues need to be addressed.

    There are many modalities of therapy, depending on the patients’ needs and therapist’s training. The usefulness of the therapies varies and is different for different individuals. Hence therapies must be client-centred. Some therapies use a combination of techniques.

    Anxiety management
    Among the common modes of therapy is anxiety management, which includes relaxation training, breathing retraining and positive self-talk.

    During relaxation response training, the individual is taught to counter the increased traumatic stress response by systematically relaxing major muscle groups. Breathing training teaches the individual to do slow abdominal breathing to stop the hyperventilation that tends to occur when one is anxious or frightened. Because hyperventilation itself worsens anxiety, breathing training can break the vicious cycle.

    Exposure therapy
    Exposure therapy is based on the principle of “habituation”, i.e. we become used to things that we previously feared which are actually not dangerous. In PTSD, the patient feels intensely afraid when facing situations, people, places, objects and thoughts that remind him or her about the past trauma.

    Exposure therapy enables patients to confront their fearful memories in a safe way. Rather than avoiding triggers, they are taught to face the triggers so that the intensity and severity of the fear reaction itself slowly subsides.

    One way is exposure in imagination – for example, by retelling the trauma story until the memories themselves are no longer feared. Once mutual trust is established, a good therapist should be able to guide, gently facilitate and re-explore such painful memories.

    Aside from verbal expression, writing and drawing are also means of retelling. Exposure therapy is more effective when done in vivo (real life) compared to in imagination.

    Although the anxiety may escalate with exposure, the patient is taught to continue his exposure to the triggers until the discomfort passes. Thus it is essential for the individual to be equipped with relaxation techniques to attempt this form of therapy. Moreover the therapist must not allow the therapy itself to retraumatise the patient but instead maintain a patient-centred pace of healing.

    Cognitive therapy
    Also effective are cognitive therapy programmes, which teach patients to identify and challenge their dysfunctional thoughts and irrational assumptions. Destructive thoughts and emotions such as shame, self-blame, guilt, feelings of being defiled or subjugated, are barriers to recovery.

    Cognitive therapy helps an individual adopt a more balanced perspective and substitute negative thoughts with more constructive ones.

    Creative therapy: sand-play therapy, art therapy
    Children are a unique population who are often unable to express their feelings or describe the traumatic event(s). Thus they require more creative therapies using toys, art, games, and sand-play. This form becomes a means of non-threatening symbolic communication to express difficult or unspeakable truths and inner conflicts. These therapies have also been used as adjunctive therapies in adults.

    When appropriate, medications are prescribed. Judicious use of specific serotonin reuptake inhibitor (SSRI) antidepressant medication has been found to alleviate symptoms of post-traumatic stress disorders.

    SSRIs are often needed when symptoms are severe and persistent, there is coexisting depression, or when psychotherapy alone has not relieved the symptoms.

    The duration of treatment varies between six months to two years before the medication is tapered off. Recurring symptoms will need more long-term treatment.

    Anti-anxiety medications including benzodiazepines on the other hand should be used only briefly, if used at all, to suppress severe anxiety reactions. These tend to be sedative, impair coordination and induce physical dependence in those who use them for prolonged periods.

    Holistic health
    Alongside main therapies, there are simple therapeutic interventions such as exercise or physical activity, spirituality, reading inspirational literature and ensuring proper nutrition. Adopting a healthy exercise regimen reduces the stress arousal and aids in general wellbeing.

    Social support
    Family support greatly aids healing and facilitates social reintegration of the individual. By being empathetic listeners, the family can help reduce feelings of loneliness, guilt and self-blame.

    Family members also ought not to expect too much or too little from the patient but on instead be realistic during the period of recovery. Working with the family may not always be feasible or beneficial, such as in the case of incestuous sexual abuse wherein family members do not accept the disclosure.

    Support can be provided or supplemented by good self-help groups led by sensitive and trained facilitators. Often, this helps remove a sense of isolation through sharing of experiences.

    Source: Malaysia Star
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  3. Roerich

    Roerich M.D.


    Thank you for posting this. It is an excellent synopsis on this vital topic.

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