Treating trauma

What is "trauma"?

The term "trauma" is subject to diverse interpretations among various individuals. In line with the DSM-5, which serves as the foundation for diagnosing PTSD and other stress-related disorders, trauma is defined based on the nature of the experienced event. Nevertheless, clinicians addressing "trauma," as well as global research and clinical associations concerned with trauma-related injuries and therapies, characterize trauma as an enduring emotional response triggered by a distressing event, without specifying the event's particular type or category causing distress. This acknowledgment stems from the recognition that the traumatic quality of an event is often rooted not in the event itself, but rather in the individual's personal interpretation of its significance.

Determining the traumatic nature of an event hinges on various factors, with the individual's personal resilience weighed against their perceived threat. Should resilience become overwhelmed, leading the individual to feel helpless and overpowered beyond their coping capabilities, the event is likely to induce symptoms associated with trauma.

Treating trauma: a staged approach

The process of recovery from trauma is often described using the three-stage model.

The first stage, known as the Safety and Stabilization stage, focuses on establishing a sense of safety and security for the individual. This may involve developing coping skills to manage symptoms of anxiety or distress, building a support network, and creating a safe and predictable environment. Although working with a trauma therapist is one approach to reaching this stage, there are alternative ways to achieve it through non-trauma-focused group or individual therapies such as Cognitive or Dialectical Behavioural Therapies (CBT or DBT). These alternative treatment modalities aim to enhance emotional awareness, restructure maladaptive thought patterns, improve self-regulation abilities, and strengthen interpersonal relationships, all of which can help reduce the frequency and intensity of emotional reactions.  Acquiring greater emotional stability and regulation skills is crucial before initiating trauma-focused therapy, which may lead to heightened distress both during and between therapy sessions.

The second stage of recovery from trauma is known as the Trauma Processing stage, and involves working through and processing the traumatic event. This stage requires the use of trauma-specific therapy.

The final stage, known as the Integration and Moving On stage, focuses on integrating the individual's traumatic experience into their life story and helping them move forward. This may involve developing a new sense of identity, establishing new goals and priorities, and finding meaning and purpose in life beyond the trauma.  While not always necessary, some people may require therapeutic support during the integration stage of trauma treatment. The goal of therapy during this stage is to help individuals understand and integrate their traumatic experiences into their life story in a way that promotes healing and personal growth. Modalities that may be used during this stage include cognitive-behavioral therapy, mindfulness-based interventions, narrative therapy, and/or psychodynamic therapy, among many others.

Trauma Therapies

The following therapies have established evidence for the treatment of PTSD and related conditions:

Eye Movement Desensitization and Reprocessing Therapy (EMDR)

During an EMDR session, the therapist helps the client focus on a traumatic memory while engaging in dual attention task, such as eye movements or tapping, which helps reduce the emotionality of the memories and improve the brain's capacity to process the information. EMDR is a therapy commonly used to address traumatic or distressing memories. It has been shown to be effective in treating a range of conditions, such as PTSD, anxiety, depression, and phobias.

To read more about EMDR therapy or to find therapist, go to https://emdrcanada.org/

Exposure therapies

Exposure Therapy involves gradually exposing the client to their traumatic memory or fear in a safe and controlled environment until they become desensitized to the experience. It involves various techniques, including imaginal exposure, in vivo exposure (exposure to real-life situations), and breathing retraining. Prolonged Exposure (PE) and Narrative Exposure Therapy (NET) are the most researched and commonly offered exposure modalities. The therapist uses these techniques to help the client process and desensitize from traumatic memories and related emotions. Exposure therapy is a short-term therapy that has been found effective in treating PTSD, phobias, and OCD.

Virtual reality (VR)-enhanced exposure therapies are also being developed. These are conducted within a VR environment that helps to keep the person focused on aspects of the trauma, therefore combating avoidance that can hamper exposure therapy. 3MDR (Multi-modal, Motion-assisted Memory Desensitization and Reconsolidation) is a new VR enhanced therapy that combines aspects of exposure, cognitive therapy and EMDR, and which occurs on a treadmill within a personalized VR environment (read more about 3MDR here: https://www.ualberta.ca/rehabilitation/research/heroes-in-mind-advocacy-and-research-consortium/projects1/3mdr.html)

Cognitive Processing Therapy

Cognitive Processing Therapy (CPT) is a short-term (typically up to 12 weeks) type of cognitive behavioural therapy that is used to treat individuals with PTSD (posttraumatic stress disorder) and other trauma-related conditions. The therapy focuses on the individual's beliefs and attitudes about the traumatic experience and aims to help them challenge and change negative or distorted thoughts. The therapist may use techniques such as Socratic questioning and written exercises to help the client examine and reframe their thoughts. 

 Read more about CPT here: https://cptforptsd.com/

Accelerated Resolution Therapy

Accelerated Resolution Therapy (ART) is a relatively new and evidence-based form of psychotherapy that helps individuals process traumatic memories and emotions. ART typically involves identifying a specific traumatic memory or experience, followed by guided imagery with a series of eye movements or other forms of bilateral stimulation to help the client process the memory and reduce its emotional intensity. Positive emotions and beliefs are then installed into the memory to replace negative associations. 

ART is a short-term trauma-focused treatment that is typically delivered over 6-12 sessions, and is generally considered to be more contained and less intensive than some of other evidence-based trauma therapy approaches. The most extensive research on ART has been conducted on its effectiveness in treating PTSD and depression. However, it has also been used as a treatment for various other mental health conditions. 

Read more about ART here: https://acceleratedresolutiontherapy.com/

Brief Eclectic Psychotherapy

This is a manualized approach combining elements of CBT, imaginal exposure, psychodynamic psychotherapy, and grief therapy. It emphasizes the expression of trauma-related grief, as well as addressing anger, shame, and guilt, including making meaning of the traumatic experiences. It also includes a ritual of closure (e.g., writing a virtual letter to the perpetrator in the case of sexual trauma and burning it at the end of treatment).

Other trauma therapy options

There are many new trauma therapies being developed, with variable research to support their use.  Our team recently completed a PTSD State-of-the-art review, which outlines many of these novel interventions.

Body-oriented psychotherapy for trauma

These novel body-oriented therapies listed below are yet to be adequately researched; however, they are rapidly being used in clinical practice. 

The following novel body-oriented therapies are known for their personalized and gradual approach, which both clinicians and patients tend to appreciate.  Compared to other trauma-focused therapies, the somatic and movement-based therapies below work more directly with embodied emotions, sensations, and movements than trauma narratives or thoughts. Individuals with complex trauma presentations who find traditional trauma-focused treatments overwhelming or insufficient often find these therapies particularly beneficial for both the first and second stages of their trauma recovery.

Sensorimotor Psychotherapy

Sensorimotor Psychotherapy is a form of psychotherapy that integrates mindful, in-the-moment awareness with body-oriented interventions. It is based on the idea that traumatic memories are associated with bodily sensorimotor experiences (urges, sensations, and defensive movements), and that working with the body can help individuals process traumatic memories and experiences in a more effective way. The therapy centres on paying mindful attention to bodily sensations, emotions, and movements. It may involve allowing sensorimotor urges to "complete", in a controlled and empowering way.  At times, it may involve working with physical experiments or with "child parts" of experience, linked to implicit memories. Goals include building awareness and tolerance of bodily experiences and processing somatosensory aspects of traumatic memory, which, when resolved, naturally lead to associated emotional and cognitive shifts ("bottom-up" processing).  To read more about SP or find a therapist, go to https://sensorimotorpsychotherapy.org/

Somatic Experiencing Therapy (SE)

Somatic Experiencing Therapy (SE) is a type of psychotherapy that helps individuals overcome trauma and stress-related disorders. SE focuses on the physical sensations and emotions associated with traumatic experiences and helps clients "complete" unresolved defensive action patterns and release trapped energy associated with traumatic memories through physical movement and other techniques. The therapy teaches techniques to regulate the nervous system and manage emotions in daily life. SE is thought to be effective in treating PTSD, anxiety, depression, and chronic pain. To read more about SE or to find a therapist, go to https://traumahealing.org/

Finding a Alberta based therapist

Psychologists' Association of Alberta