What is CPTSD or Complex Traumatic Stress Disorder?

Complex trauma is a type of psychological trauma that occurs as a result of repeated or prolonged exposure to adverse events.

These events are often interpersonal in nature, such as abuse or neglect, and can occur during childhood or adulthood.  

Complex trauma can have a significant impact on a person's mental and physical health, relationships, and overall well-being. It can lead to a range of symptoms, including:  

• Emotional dysregulation  

• Dissociation  

• Difficulty with relationships  

• Negative self-image  

• Physical health problems  

Complex trauma is often associated with other mental health conditions, such as post-traumatic stress disorder (PTSD), depression, and anxiety.  

Treatment for complex trauma typically involves a combination of therapy and medication. Therapy can help people to process their traumatic experiences, develop coping skills, and improve their relationships. Medication can help to manage symptoms such as anxiety and depression.  Therapy is typically provided in stages as part of research evidenced processes or manualised treatment protocols, and usually involves several distinct types of therapy. Single therapiues alone, such as talking therapy, are not usually enough.

Stages of Complex Trauma Therapy

There are three main stages of treatment for complex trauma:

1. Safety and stabilization: This stage focuses on creating a safe and supportive environment for the client. The therapist will help the client to develop coping skills and self-regulation strategies.
   
   
   

2. Trauma processing: This stage involves working through the traumatic memories and experiences. The therapist will help the client to process the emotions and thoughts associated with the trauma.
   
   
   

3. Integration and meaning-making: This stage focuses on helping the client to integrate the traumatic experiences into their life story. The therapist will help the client to make meaning of the trauma and to develop a sense of self that is not defined by the trauma.
   
   
   

The stages of treatment for complex trauma are not always linear. Clients may move back and forth between the stages as needed. The therapist will work with the client to develop a treatment plan that is tailored to their individual needs.

Within these stages are a variety of sub sections. In the first stage a variety of methods to enable better emotional regulation are taught such as mindfulness, EFT, Chi Gung, Trauma informed Yoga, use of sensory aids, self hypnosis, meditation, breathing methods etc. This is tailored to the individual and is not the same for each client.

Also in stage one is the vital process of psychological education or psychoeducation. It is vital to understand how both trauma, and how the human body works in relation to stress and dis-regulation. it is very important to establish a knowledge of physiological self management and to move away from old fashioned "talking therapy" methods that assume understanding = control. In complex trauma self management comes from physiological and somatic control first, and psychological control a distant second. 

Stage one also typically involves the so called "ingredients for health", reviewing Functional and Integrative medicine elements of the case, liaising with medical practitioners (usually through the patient), and supporting with complementary health, supplement, diet, herbalism, movement based and sleep management therapy methods. 

In stage two a range of methods can be used including narrative based therapies for gaining understanding, acceptance, compassion and change, behavioural methods for eliciting new outcomes, memory reconsolidation methods for healing specific areas of the trauma, somatic methods for both memory accessing and understanding and reconsolidation. Stage two is essentially the part of the process where the client gains understanding of how the trauma effected them, usually on multiple levels, in multiple ways, and begins to design and implement a gentle and compassionate change process towards health. This is a health focused or Salutogenic approach. 

The final stage is post trauma growth based and is focused on building a new ife after trauma. This can be overwhelming if not supported since until this point the client has been typically over focused on survival.

A crucial concept to remember is that during the survival of trauma stage we experience adaptation (adapting to an unusual set of events and learning unusual behaviours and perceptions).  After trauma we need to experience readaptation back to what we would have learned had we not had to survive the unusual traumatic events.  Adaptation effects:

• Physical health

• Relationships

• Attachment styles

• Behaviours

• Perceptions

• Attitudes

• Self beliefs and Identity

• Way of perceiving things generally, sometimes called "trauma think", such as feeling no one can be trusted, or always waiting for the next crisis

Adaptation is not an illness, it is a natural survival trait and part of healing is to compassionately accept that it was necessary, and helped us survive. This aids in the natural moving towards re-adaptation and post traumatic growth.

Classic Heller Model of Staged Trauma Treatment

The Heller model of trauma treatment, also known as the NeuroAffective Relational Model (NARM), is a cutting-edge approach to healing complex trauma.

Developed by Dr. Laurence Heller, NARM focuses on the impact of early childhood experiences on the development of the nervous system and the ability to connect with oneself and others.  This model is generally accepted as the core of most other models now in use and is for example the core model taught by both the Trauma Institute International and most PESI trainers (both of which are core certifications held by Stuart and Denise at Scotlandtherapy Partners).

NeuroAffective Relational Model (NARM)

NARM integrates various therapeutic approaches, including psychodynamic psychotherapy, attachment theory, and somatic experiencing, to address the root causes of trauma-related symptoms. It emphasizes the importance of working with the body's wisdom and innate capacity for healing.  

The NARM approach is based on several key principles:  

• Focus on connection: NARM recognizes that trauma often disrupts the ability to connect with oneself and others. The therapy aims to restore this connection by fostering self-awareness, emotional regulation, and healthy relationships.  

• Mindfulness and self-awareness: NARM encourages clients to develop a deeper understanding of their thoughts, feelings, and bodily sensations. This awareness helps them identify and regulate their emotional responses, reducing the impact of trauma-related triggers.  

• Somatic experiencing: NARM incorporates somatic techniques to help clients release trapped energy and emotions associated with past traumas. This can involve gentle movement, breathwork, or guided imagery.  

• Emphasis on strengths and resilience: NARM focuses on clients' inherent strengths and resilience rather than solely on their deficits or symptoms. This approach empowers clients to tap into their inner resources for healing.  

The NARM treatment process typically involves the following stages:

1. Assessment: The therapist gathers information about the client's history, symptoms, and current challenges. They also assess the client's nervous system functioning and capacity for connection.  

2. Stabilization: The therapist helps the client develop self-regulation skills and coping strategies to manage difficult emotions and sensations. This stage focuses on creating a sense of safety and stability.  

3. Exploration and processing: The client and therapist collaboratively explore past traumas and their impact on the client's present life. This may involve revisiting memories, emotions, and bodily sensations associated with the trauma.

4. Integration and healing: The client integrates the insights gained from therapy into their daily life, developing healthier patterns of relating to themselves and others. This stage focuses on building resilience and fostering a sense of wholeness.  

NARM has been shown to be effective in treating a wide range of trauma-related issues, including:

• Post-traumatic stress disorder (PTSD)  

• Complex PTSD  

• Attachment difficulties

• Anxiety and depression

• Relationship problems

• Chronic pain

• Autoimmune disorders

Classic Therapies uses during the Stages of Trauma Treatment

For most of the 20th Century trauma treatment was unfortunately very, very primative. In fact because of misunderstandings rooted in the biases held largely by Sigmund Freud, Trauma Treatment was less advanced than in the 19th Century, when there was a better acceptance of Mind-Body treatment and use of methods like hypnosis for memory reconsolidation.

Towards the end of the 20th Century leading experts such as Bessel Van Der Kolk began compiling quality published and peer reviewed research into how complex trauma really works, the neurology behind it, and how to effectively treat it. This has led to pioneers like Heller developing the staged approach known as NARM,  Stephen Porges developing Polyvagal Theory to explain much of the Mind-Body link, treatment specialists like Pat Ogden developing Sensorimotor Psychotherapy to enable better somatic tracking and processing, and many other experts that accompanied or followed them.  methods like Compassionate Inquiry from Gabor Mate, Somatic experiencing from Peter Levine, Interpersonal Neurobiology from Dan Siegel, all blew apart the myth that conventional talking therapy alone was either suitable or sufficient to work with complex trauma.

Memory reprocessing returned in both the original hypnosis based forms and new modified forms including EMDR, Brainspotting, Sensiomotor, Somatic, MEMI and many more.  

It should be noted however that these should never be used to rush into trauma processing and should be used patiently and compassionately as part of a stage by stage approach, otherwise harm can occur!

Physical based therapies have also been shown to have great effectiveness as part of an overall approach, such as EFT (tapping) as a self regulation method, trauma informed yoga as a self regulation and somatic awareness exercise, Chi Gung as a self regulation and emotional self regulation process.

Gut health and other physiological knowledge advances have increased the awareness of nutrition, gut health, sleep patterns, movement, energy management, immune system management and other integrative and functional medicine areas in working with a client group who frequently have long term medical conditions from system dysregulation.  Knowledge of these fields in order to provide complementary health support, and to help the patient seek and maintain effective medical practitioner advice and support is essential.

The way that trauma effects how we experience self means that a critical thinking or philosophical approach or Socratic Challenging approach is important to enable clients to compassionately strip back trauma based though and discover their repressed dreams, identities and sense of self. 

Behavioural change is also vital in trauma recovery, and needs to be neurologically informed. Just changing things as one would in basic CBT work is not enough. Ingrained habitual thought and behaviour needs gradual stepped and neurologically informed processes for change to be compassionate and sucessful!

Any therapist who does not have a full complement of these areas of change is a bit like a guitar with missing strings!

So what therapies can be used in Complex Trauma Treatment?

The most important consideration is a range of therapies. Many therapies are more like "brand names" than actually different processes. For example EMDR, relational EMDR, MEMI, NLP and some hypnosis based memory reconsolidation methods are virtually identical.  Narrative based methods again have great similarities. Therefore here we have tried to group them together.

Talking therapies and Psychological therapies

• Hypnotherapy:  cognitive behavioural

• Hypnotherapy:  conversational

• Hypnotherapy:  NLP based

• Hypnotherapy:  Counselling skills

• Counselling:  Stress management focused

• Psychotherapy: Trauma focused

• Compassionate Inquiry

Behavioural and Psychological Analysis therapies:

• Hypnotherapy:  analytic

• DBT: Dialectic Behavioural Therapy

• RO-DBT: Radically Open DBT

• ACT: Acceptance & Commitment Therapy

• CBASP: Cognitive Behavioural Analysis System Psychotherapy

• Mindful Analysis

• Integrative Psychological Analysis

• Behavioural Analysis

• Applied Behavioural Analysis

Relaxation & Self Regulation

• Meditation

• Mindfulness

• Self Hypnosis

• Autogenics

• Breathing Exercises

• Somatic Exercises

• Chi Gung

• Yoga

• EFT

• Polyvagal Exercises

Somatic Mind-Body therapies

• Somatic Experiencing

• Mindfulness

• Hakomi

• Integrative Somatic Exercises /  coaching

Narrative Therapy

• Narrative based CBT

• Integrative Narrative Therapy

• Philosophy based therapy

• Sidereus

• Narrative /  Story based Hypnosis

Integrative & Functional Medicine

• Various Specialist Trainings

• Health Education

PsychoEducation

• Coaching

• Health Education

Complementary & Nutritional Medicine

• Naturopathy

• Nutritional Medicine

• Herbalism

Qualifications to expect

Qualifications vary from State to State, Country to Country.

In the Country the practitioner is based in check for:

• Core qualification for each therapy area

• Trauma related specialist training for the use of that therapy area

• Professional registration for the therapy

• Insurance for use of the therapy

• Registration as a Certified Trauma Specialist

For example, Stuart uses nutritional advice as a complementary therapy to ensure the ingredients of health supporting recovery. He has qualifications in Nutrition and Naturopathy, Post Graduate Specialist Certification in Nutrition for Mental Health, is registered with the Complementary Therapy Association (CTHA), and is insured to provide this therapy. Similar combinations apply to al therapies provided by Stuart, and you should expect no less from any trauma specialist. Stuart is an Advanced Clinically Certified Trauma Specialist with both Trauma Institute International, and Evergreen Certifications, as well as having completed the Trauma Research Foundation PG Certificate in Traumatic Stress Studies.

Stuart's other full quafications and biography at the main website under competencies, updated regularly HERE