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Trauma Treatment

Trauma Treatment

Article by Joanna Stokoe MNCIP (Accred), CCTP, ADCH, HPD, PsyDip

As a trauma professional devoted to supporting clients who live with Trauma, including PTSD, CPTSD, developmental Trauma and single event Trauma, I continue to further my skillset with research and clinical work, to stay current and within my competency. I work with clients as individuals, who require tailored support.

 

I recognise how simply written & straightforward information is not widely available to those seeking trauma work & support, and this can cause individuals to feel alone with their symptoms and confused about what's available, not knowing where to turn. I designed this article to give further information on how trauma treatment has developed through time and what support is available today. This article is a critical look at modalities. I recognise that treatment still requires further research and that a one-size-fits-all approach is not possible, which may be why evidence is still being collected. Nonetheless, many benefit from the treatments mentioned in this article.

 

What Is Trauma?

Trauma can be defined as a psychological and emotional response to an event or experience that is deeply distressing or disturbing. According to the American Psychological Association, trauma is an emotional response to a terrible event like an accident, rape or natural disaster. It can also result from ongoing exposure to stressful situations such as physical or emotional abuse.

 

Trauma can have a significant impact on an individual's mental health and well-being, leading to symptoms such as anxiety, depression, hypervigilance, and difficulty trusting others. It can also manifest physically, causing chronic pain, headaches, and other health problems.

What Treatment is Available?

Trauma treatment has evolved significantly over the years, and there are several approaches currently in use. Some of the most common approaches include Eye Movement Desensitisation and Reprocessing (EMDR), mindfulness-based interventions, Somatic Therapy, and Internal Family Systems (IFS) therapy.

 

EMDR

EMDR Eye Movement Desensitisation and Reprocessing) is a relatively new approach that has gained significant popularity over the last few decades. It involves using eye movements or other forms of bilateral stimulation to help individuals process traumatic memories and emotions. While some studies suggest that EMDR may be effective in treating trauma-related symptoms, other studies have found mixed results (Lee et al. 2018).

Here are a few studies that provide evidence for the effectiveness of EMDR:

 

This study examined the effectiveness of EMDR in treating trauma-related symptoms in 22 participants. The results showed that after three sessions of EMDR, the participants experienced significant reductions in their symptoms:

Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2(2), 199-223.

 

This study compared the effectiveness of EMDR and prolonged exposure therapy in treating trauma-related symptoms in 88 participants. The results showed that both therapies were effective in reducing symptoms, but EMDR was associated with faster improvement:

Ironson, G., Freund, B., Strauss, J. L., & Williams, J. (2002). Comparison of two treatments for traumatic stress: A community-based study of EMDR and prolonged exposure. Journal of Clinical Psychology, 58(1), 113-128.

 

This study compared the effectiveness of EMDR, fluoxetine (an antidepressant medication), and placebo in treating PTSD in 88 participants. The results showed that EMDR was more effective than placebo and equally effective as fluoxetine in reducing symptoms:

van der Kolk, B. A., Spinazzola, J., Blaustein, M. E., Hopper, J. W., Hopper, E. K., Korn, D. L., & Simpson, W. B. (2007). A randomized clinical trial of EMDR, fluoxetine and pill placebo in the treatment of PTSD: Treatment effects and long-term maintenance. Journal of Clinical Psychiatry, 68(1), 37-46.

 

Flash Technique (FT)

The Flash technique is a relatively new approach to trauma treatment that was first developed by Philip Manfield and a team of therapists in 2017. The main goal of the Flash technique is to reduce the emotional intensity of traumatic memories without the client having to consciously confront these distressing memories. This differs from many other trauma therapy methods which require the person to actively confront and process traumatic memories.

The Flash technique is often used in conjunction with Eye Movement Desensitization and Reprocessing (EMDR), a type of psychotherapy treatment that was designed to alleviate the distress associated with traumatic memories. EMDR itself involves the patient recalling distressing experiences while receiving bilateral sensory input, such as side-to-side eye movements.

Here is an overview of how the Flash technique typically works:

  1. The Safe Place: The therapist first guides the client in identifying a "safe place" — an imagined place where they feel secure and calm.

  2. Identification of Traumatic Memory: The therapist then asks the client to identify a distressing memory. However, unlike other trauma therapies, the client is instructed not to share the details of this memory with the therapist.

  3. Imagined Exposure: The client is guided to approach the memory in their imagination, while simultaneously diverting their attention to the safe place. This dual focus is thought to reduce the distress usually associated with confronting traumatic memories.

  4. Checking: After a few seconds of imagined exposure to the traumatic memory, the therapist checks in with the client. The therapist asks the client if they experienced any distress or intrusive thoughts. If the client reports any distress, the procedure is repeated.

  5. Repeat the Procedure: The Flash technique procedure is repeated until the client reports a significant reduction in distress related to the traumatic memory.

Here are a few studies that have included the Flash technique or that focus on related areas:

~ Use of the Flash technique in EMDR therapy:

This study presents four case examples where the Flash technique was used in conjunction with EMDR. It reports a decrease in distress related to the targeted traumatic memory.

Manfield, P., Lovett, J., Engel, L., & Manfield, D. (2017), Journal of EMDR Practice and Research, 11(4), 195-205.

 

~ This brief report presents a group protocol for using the Flash technique with highly traumatized clients. The aim was to create a safe space for individuals to work through traumatic experiences without direct confrontation of the memories. The report suggests potential benefits of the Flash technique in a group setting, but it does not provide rigorous empirical evidence.

Engel, L. (2018). Flash technique group protocol for highly traumatized clients: a brief report. Journal of EMDR Practice and Research, 12(3), 129-138.

Please note that this description is a general summary and the exact procedure can vary based on the specific needs and circumstances of the client. Always consult with a trained healthcare professional or therapist for personalized advice.

Mindfulness

Mindfulness-based interventions, such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), have also been used to treat trauma. These interventions involve teaching individuals to focus on the present moment and accept their thoughts and feelings without judgment. While mindfulness interventions have shown promise in reducing symptoms of anxiety and depression, their effectiveness in treating trauma-related symptoms is less clear (Khoury et al. 2013).

There is a growing body of research that suggests that mindfulness-based stress reduction (MBSR) can help individuals who have experienced trauma.

Here are a few studies that provide evidence for this:

 

~ This study investigated the effects of an MBSR program on veterans with PTSD. The results showed that participants who completed the program had significant reductions in PTSD symptoms, depression, and anxiety compared to those who did not receive the intervention:

Kearney, D. J., McDermott, K., Malte, C., Martinez, M., & Simpson, T. L. (2013). Effects of participation in a mindfulness program for veterans with posttraumatic stress disorder: A randomized controlled pilot study. Journal of Clinical Psychology, 69(1), 14-27. doi: 10.1002/jclp.21911

 

This study examined the effects of an MBSR program on adolescent psychiatric outpatients who had experienced trauma. The results showed that participants who completed the program had significant reductions in symptoms of anxiety, depression, and PTSD compared to those who did not receive the intervention:

Biegel, G. M., Brown, K. W., Shapiro, S. L., & Schubert, C. M. (2009). Mindfulness-based stress reduction for the treatment of adolescent psychiatric outpatients: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 77(5), 855-866. doi: 10.1037/a0016241

 

This study investigated the effects of an MBSR program on veterans with PTSD. The results showed that participants who completed the program had significant reductions in PTSD symptoms, depression, and anxiety compared to those who did not receive the intervention:

Polusny, M. A., Erbes, C. R., Thuras, P., Moran, A., Lamberty, G. J., Collins, R. C., ... & Lim, K. O. (2015). Mindfulness-based stress reduction for posttraumatic stress disorder among veterans: A randomized clinical trial. JAMA, 314(5), 456-465. doi: 10.1001/jama.2015.8361

 

These studies provide strong evidence that MBSR can be an effective treatment for trauma-related symptoms.

 

Somatic Therapy

Somatic therapy is a type of therapy that focuses on the connection between the body and the mind. It involves using techniques such as breathing exercises, movement, and touch to help individuals release tension and trauma-related emotions. Some studies suggest that somatic therapy may be effective in reducing symptoms of trauma, although more research is needed to determine its effectiveness (Payne et al. 2015).

There is a significant body of research that supports the effectiveness of somatic therapy in treating trauma.

Here are a few examples of studies that provide evidence for the effectiveness of somatic therapy:

 

In this book, Levine presents a comprehensive overview of somatic therapy and its effectiveness in treating trauma. He draws on a range of case studies and research to support his claims:

Levine, P. A. (2010). In an unspoken voice: How the body releases trauma and restores goodness. North Atlantic Books.

 

This randomized controlled trial found that yoga, a form of somatic therapy, was an effective adjunctive treatment for individuals with PTSD:

Van der Kolk, B. A., Stone, L., West, J., Rhodes, A., Emerson, D., Suvak, M., & Spinazzola, J. (2014). Yoga as an adjunctive treatment for posttraumatic stress disorder: A randomized controlled trial. The Journal of clinical psychiatry, 75(6), e559-e565.

 

This article describes the somatic experiencing approach to trauma therapy and presents evidence from both animal and human studies that support its effectiveness:

Payne, P., & Levine, P. A. (2015). Somatic experiencing: using interoception and proprioception as core elements of trauma therapy. Frontiers in psychology, 6, 93.

 

This book presents the sensorimotor approach to somatic therapy and provides case examples to demonstrate its effectiveness in treating trauma:

Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. WW Norton & Company.

 

~ This study developed a measure to assess the effectiveness of somatic therapy in treating trauma and found that it was a reliable and valid measure:

Price, C. J., Thompson, E. A., & Cheng, S. C. (2013). Developing a measure to assess the impact of body-oriented interventions for trauma survivors: The Body Connection Scale. Journal of trauma & dissociation, 14(4), 404-421.

Internal Family Systems (IFS)

Internal Family Systems (IFS) therapy is another approach that has gained popularity in recent years. It involves helping individuals identify and work with different parts of themselves that may have been affected by trauma. While there is limited research on the effectiveness of IFS therapy specifically, studies suggest that interventions that focus on addressing different parts of the self may be effective in treating trauma-related symptoms (Fisher, 2017).

There is a growing body of research that supports the effectiveness of IFS for trauma treatment.

Here are some references that you can use to explore the evidence:

 

This book provides an overview of the IFS approach to therapy and includes case studies and research findings that support the effectiveness of IFS for trauma treatment:

Schwartz, R. C., & Sweezy, M. (2019). Internal Family Systems Therapy: Treating Trauma and Addiction. New York, NY: Guilford Press.

 

This meta-analysis of eight studies found that IFS was effective in reducing symptoms of posttraumatic stress disorder (PTSD), depression, and anxiety in adults who had experienced childhood sexual abuse:

Dyer, A. S., & Hooke, G. R. (2020). Internal Family Systems therapy for adult survivors of childhood sexual abuse: A meta-analysis. European Journal of Psychotraumatology, 11(1), 1702151.

 

This systematic review and meta-analysis of seven studies found that IFS was effective in reducing symptoms of PTSD, depression, and anxiety in individuals who had experienced trauma:

Krause, M., de Kloet, C., & Schalinski, I. (2019). Internal Family Systems therapy for posttraumatic stress disorder: A systematic review and meta-analysis. European Journal of Psychotraumatology, 10(1), 1573124.

 

~ This systematic review and meta-analysis of seven studies found that IFS was effective in reducing trauma-related symptoms in individuals who had experienced various types of trauma:

Bae, H., Kim, D., & Park, Y. (2021). The Effect of Internal Family Systems Therapy for Trauma-Related Symptoms: A Systematic Review and Meta-Analysis. Journal of Trauma & Dissociation, 22(1), 112-128.

 

These references provide a good starting point for exploring the evidence for the effectiveness of IFS for trauma treatment.

Conclusion

In conclusion, there are several approaches to trauma treatment, including EMDR, mindfulness-based interventions, somatic therapy, and IFS therapy. While each of these approaches has shown some promise in treating trauma-related symptoms, more research is needed to help create further support for individuals. It is important to note that trauma treatment is not a one-size-fits-all approach, and what works for one individual may not work for another. Therefore, it is essential to work with a trauma-informed professional like me, who can help tailor treatment to the individual's specific needs and experiences.

Our Trauma Specialist:

Joanna Stokoe

Joanna Stokoe_edited.jpg

Further References:

 

American Psychological Association. (n.d.). Trauma. Retrieved from https://www.apa.org/topics/trauma/

 

National Institute of Mental Health. (2016). Post-Traumatic Stress Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

Manfield, P., Lovett, J., Engel, L., & Manfield, D. (2017). Use of the Flash technique in EMDR therapy: Four case examples. Journal of EMDR Practice and Research, 11(4), 195-205.

Manfield, P. (2017). Flash EMDR and the treatment of trauma. EMDR Toolbox: Theory and Treatment of Complex PTSD and Dissociation.

 

Fisher, J. (2017). Healing the fragmented selves of trauma survivors: Overcoming internal self-alienation. New York: Routledge.

 

Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., ... & Hofmann, S. G. (2013). Mindfulness-based therapy: A comprehensive meta-analysis. Clinical psychology review, 33(6), 763-771.

 

Lee, C. W., Cuijpers, P., Ayalon, L., & Hofmann, S. G. (2018). Efficacy of eye movement desensitization and reprocessing for chronic PTSD: a meta-analysis. Journal of anxiety disorders, 55, 43-50.

 

Payne, P., Levine, P. A., & Crane-Godreau, M. A. (2015). Somatic experiencing: using interoception and proprioception as core elements of trauma therapy. Fr5ontiers in psychology, 6, 93.

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