What are Best Practices for Trauma Treatment?

One question that often comes up is, what are best practices for trauma treatment. In this episode of “Trauma Demystified”, we will delve deeply into this topic. Furthermore, we discuss the importance of an integrative approach, combining top-down and bottom-up methods like Somatic Experiencing, EMDR, and parts work.

Join us as we explore the multifaceted journey of trauma recovery and how integrating different modalities can provide a more tailored and effective treatment. Stay tuned to learn more about the significance of structural dissociations and how to navigate trauma treatment more effectively. If you’re ready to begin your journey toward healing, this episode is for you.

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If you prefer to read, here’s the transcript of this episode

Welcome to Trauma Demystified, a podcast by Bright Horizon Therapies. I am Natalie Jovanic, your host on this journey of personal growth and healing.

Content of the episode

Today’s episode is about best practices for trauma treatment. Have you ever wondered how to find effective trauma counselling? Unfortunately, it’s far more complex than simply finding a mental health professional. In my journey of trauma recovery, I discovered it through trial and error. I was fortunate to find professionals who offered effective treatment. I hope this episode helps you navigate this process more efficiently.

Gain insight about trauma treatment

In this episode, I’m shedding light on the complicated realm of best practices in trauma treatment. Let’s face it, navigating the field of psychology and counseling can feel like walking through a maze with modalities shrouded in mystery. But that’s nothing to be afraid about. I’m here to demystify it for you so that you can make more informed choices.

Talk therapy versus trauma treatment

Let go of traditional talk therapy. When it comes to trauma, we need additional components. A sentence I often hear from my clients is, my doctor recommended EMDR for my symptoms of trauma and I’ll be good to go. But trust me, it’s not that simple. Many modalities mark themselves with innovative slogans promising a quick recovery from trauma. However, how often do we, as a counseling field, make overly simplified promises that set our clients up for disappointment?

I hope this episode gives you a first insight into what’s available and what to consider when choosing trauma treatment. So get comfortable, grab something to drink and get ready for some eye-opening insights. We’ll explore the best practices for trauma and tackle the potential hurdles along the way.

What is the definition of trauma?

But before we dive in, let’s go back to the basics. What exactly is trauma and how do we categorize its various forms? Because let’s be real. The treatment journey depends on what has happened to you and the symptoms you have. The first practice is that any treatment approach needs to be adapted to your unique situation. So now let’s look at what psychological trauma really is.

Since the definition of trauma is constantly evolving, I have noticed that there are many outdated definitions of trauma out there. So here’s a brief summary. Trauma isn’t defined by the event that happened to us, however by our unique experience of the event. One component is that the individual has an experience that overwhelms their capacity to integrate the emotional aspect of it. This can be connected to an event, a series of events or enduring conditions like abusive environments. The other component is that the individual experiences are a threat to their life, integrity or sanity. This can be subjectively or objectively. So one or both of these components need to be applicable.

Trauma can come in many different forms. So we have developmental trauma, relationship trauma, systemic and structural violence and intergenerational or historic trauma. If you want to dig deeper into this topic, please check out the first episode of Trauma Demystified.

So here’s a thing. Trauma treatment is different to general counseling. It requires a specialized and holistic approach. If you want to learn more, please check out the third episode of Trauma Demystified, Thriving After Trauma.

How can we identify that we have experienced trauma?

So how can we identify trauma? Let’s get real. Many people experience symptoms of trauma, but they may not even be aware that they have experienced trauma. Remember, trauma refers to experiences that overwhelm our capacity to cope. And when we live through them, we do the best we can to survive. While I had different symptoms of trauma, I had no idea that I have lived through trauma in my childhood since those experiences were all I knew when I was young. Especially when we have experienced trauma due to enduring conditions, we may have implicit memories instead of explicit memories. Implicit memories means that we experience bodily sensations and emotions, but we cannot connect them to past traumatic experiences. This makes it really, really hard to identify trauma.

Symptoms of trauma

So looking at symptoms can be a first indicator that we have experienced trauma. So how do we identify trauma? The first step is by exploring common symptoms.

Heightened levels of anxiety as a symptom of trauma

The first symptom of trauma is that individuals may experience heightened levels of anxiety, social anxiety, or panic.

Nervous system dysregulation

A dysregulated nervous system is another common symptom of trauma and can manifest in various ways. Some individuals have a narrow window of tolerance, while others may find themselves stuck in hypo or hyperarousal. Additionally, some people may fluctuate between these two states. Reflecting on my childhood, I spent most of my time in hypoarousal, although I wasn’t aware of it at the time. If childhood trauma has been experienced, individuals may be accustomed to live with a dysregulated nervous system. To learn more about the window of tolerance in our nervous system, please check out the second episode of Trauma Demystified, titled Understanding the Window of Tolerance.

Lack of interest and decreased concentration as a symptom of trauma

Some people experience decreased concentration or lack of interest, and so this can be a symptom of trauma. Other symptoms of trauma are that there are parts of us that feel numb or have a persistent sense of hopelessness, that we have parts that have a sense of shame or self-loathing, and some people have parts that have a sense of hypervigilance or mistrust.

Disordered eating or addictive behaviours

Disordered eating or addictive behaviours are also often a sign of trauma. Some people have suicidal thoughts or use self-injury to regulate a dysregulated nervous system.

Fragmentation of personality

If we have experienced complex trauma, we can have a sense of inner fragmentation of our personality and emotion. This concept is known as structural dissociations, which refers to the division of personality into separate parts, each with its unique set of memories, behaviors, and emotions. It is typically a result of experienced trauma due to enduring conditions. These divisions can occur along different lines, such as emotional, cognitive, and somatic, and they are often a way to cope with overwhelming experiences. I will explain more about this in the next episode.

Mental health diagnoses

Additionally, mental health diagnoses like borderline personality disorder or dissociative identity disorder are also connected with trauma and can be explained with the theory of structural dissociations. Last but not least, chronic pain can also be connected to trauma.

Symptoms seen as adaptive coping mechanism

I’m aware that going through the list of symptoms can be overwhelming. Please keep in mind that our Western perspective on trauma often is not helpful for healing. It views signs and symptoms of trauma as a mental illness, which is stigmatizing and pathologizing. However, other cultures have a far healthier and more hopeful perspective on trauma. With the evolving knowledge around trauma in the Western world, we need to see the signs and symptoms of trauma as a natural response of the mind, body, and nervous system to an overwhelming and extreme experiences. It is a protective coping skill that is necessary to survive these extreme circumstances.

While the voice of stigma may tell us that trauma is a lifelong sentence, this perspective isn’t true. While recovery is a journey that requires persistence and patience, trauma recovery is possible with the appropriate trauma treatment.

General talk therapy versus trauma treatment

While generic talk therapy or counseling can have benefits, they are usually not the most effective practices for trauma counselling. While it is a complex topic to explore, here are the reasons why talk therapy isn’t a best practice for trauma treatment.

If you have experienced trauma, we often have a need to create safety and stability first.

The talking cure may not adequately address the need for safety and stabilization, which is an essential step in trauma treatment. When we talk about traumatic events without the necessary stabilization, there is a risk that the distress in the symptom gets intensified rather than being alleviated.

Talk therapy has a very strong emphasis on verbal communication and does not respect the impact of trauma on our bodies and our nervous system. It is common that there are aspects of the traumatic experience that cannot be expressed in words. Therefore, art therapy, body-based therapies, or mindfulness can be more effective for trauma recovery.

Trauma is often stored in implicit memories, which means they are not consciously accessible. Talking alone usually doesn’t allow access to these deeply embedded memories. Therefore, it’s less effective in treating trauma.

For some individuals, discussing traumatic experiences can lead to dissociations and emotional disconnection, hindering the therapeutic process and preventing integration of the traumatic memories. Without addressing dissociations, effective trauma treatment is impossible.

In cases where the nervous system is dysregulated, hypo or hyper arousal, simply talking about the trauma may not regulate the nervous system and can even increase the dysregulation.

Trauma is often processed in sensory and emotional parts of the brain rather than the cognitive areas. Traditional talk therapy primarily engages cognitive processing, which may not effectively address the sensory and emotional aspects of trauma.

What are best practices for trauma treatment

To address these limitations, trauma therapy often involves a combination of different approaches, such as EMDR, eye movement, desensitization, and reprocessing, somatic experiencing, or sensory motor psychotherapy to more effectively process and integrate traumatic memories. In general, it is best practice to integrate any evidence-based modality into the three stages of trauma recovery as defined by Judith Herman and trauma-informed practice. To learn more about this, please check out the third episode of Trauma Demystified.

Prolonged exposure therapy as a best practice for trauma treatment

So now that we have learned why traditional talk therapy isn’t the best practice, let’s look at the evidence-based best practices for trauma treatment.

And here I start with Prolonged Exposure Therapy, a widely recognized trauma treatment. It’s the only methodology I’m not trained in or have used it for my own trauma recovery. Therefore, it’s difficult for me to discuss its benefits and limitations, because I don’t have any experiences with the modality. If you’re considering this modality, please consult with a counselor who has the appropriate professional expertise or do your own research about its benefits and limitations.

How prolonged exposure therapy works

In general, Prolonged Exposure Therapy assists individuals in gradually confronting their trauma-related memories, feelings, and situations. Through this process, they recognize that these memories and triggers are not inherently harmful and can be faced without avoidance. It is recommended by major PTSD treatment guidelines such as the American Psychological Association and the International Society of Traumatic Stress Studies.

Limitations of prolonged exposure therapy

One of the trainings I attended stated that the studies that supported Prolonged Exposure Therapy excluded people who were suicidal, living with addiction or dissociative symptoms, as well as people who have symptoms of self-injury or psychosis. Additionally, Prolonged Exposure Therapy isn’t recommended if there is an imminent threat of suicidal or homicidal behavior, recent serious self-injury, and current psychosis. If you have any of these symptoms, I suggest that you explore the treatment approach more deeply with your mental health professional.

Prolonged Exposure Therapy as a top-down approach

Prolonged Exposure Therapy belongs to the group of top-down therapy approaches, which means that they use cognition which takes place in the prefrontal cortex of the brain. While top-down approaches can provide some relief, they are usually not able to completely resolve childhood trauma due to the way that trauma affects our brain. For example, trauma responses happen in our body before the prefrontal cortex even registers that it happened.

Therefore, we usually don’t have access to the prefrontal cortex in those moments. Due to the way how trauma affects our mind and body, bottom-up approaches come into play. They focus on the sensation and the movements in the body, and they use the wisdom of the body to access the trauma that is held in it. Therefore, we don’t need a conscious memory of the traumatic experiences to process and hear the with bottom-up approaches.

Some examples of bottom-up approaches are somatic experiencing, EMDR, yoga, or sensorimotor psychotherapy. In my own healing journey from childhood trauma and systemic violence, the majority of approaches I used were bottom-up.

What are best practices for trauma treatment? Somatic approaches

So now let’s start with the first bottom-up approach, which is a somatic approach. So somatic approaches are recognized as best practices for trauma treatment. There are different somatic approaches to work with trauma, two of which are somatic experiencing and sensorimotor psychotherapy.

Somatic experiencing

Somatic experiencing was developed by Dr. Peter A. Lewine. This therapeutic modality seeks to alleviate symptoms of stress, shock, and trauma that manifest within our bodies. When individuals find themselves trapped in cycles of fight, flight, or freeze responses, somatic experiencing assists in releasing, restoring, and enhancing resilience. Somatic experiencing doesn’t require a full or extensive retelling of the traumatic stories.

The therapeutic goal is to decrease the distress and symptoms caused by post-traumatic arousal and restore healthy functioning in daily life. It is to some degree similar to mindfulness practices, however it focuses more on bodily sensations and how they change.

Sensorimotor psychotherapy

Sensorimotor psychotherapy was founded by Pat Ogden and is another significant somatic approach for trauma and attachment issues. This approach combines traditional talk therapy with body-centered techniques to help individuals explore and understand the connections between the bodily sensation and emotional experiences. By integrating body awareness into the therapeutic process, sensorimotor psychotherapy aims to resolve trauma-related symptoms, improve emotional regulation, and promote healthier attachment patterns.

Benefits of somatic approaches

By incorporating somatic approaches such as somatic experiencing and sensorimotor psychotherapy into trauma treatment, individuals can develop a deeper understanding of how trauma is held within the body and work towards healing on a physical, emotional, and psychological level.

Limitations of somatic approaches

While these approaches are essential for trauma recovery, they need to be adapted to the unique situation of the client. In my professional experience, I’ve noticed that the more complex a traumatic experience was, the more useful it can be to combine this approach with parts work.

We need to be aware that reconnecting with the body is not only a goal of recovery but also a crucial step in the healing process from trauma. However, we need to stay away from idealized, unrealistic views like we have to be in our bodies to 100% all the time. Reconnecting with our bodies is an inner process that needs to be adapted to the specific situation of the individual.

Importance of pacing while using somatic approaches

If we have experienced childhood trauma like sexual abuse, it is common that we have parts that are scared to be in our body. It is essential to collaborate with these parts while improving the connection with the body. Sometimes reconnecting with the body needs to happen in incremental steps like 1% more at one time. Therefore, it’s a process that requires patience and consistency. Pacing is very important for trauma recovery and it needs to respect the rhythm of the clients to get back into their bodies.

Additional modalities that nurture trauma recovery

While it is not a counseling modality, I want to emphasize the importance of yoga as a practice to reconnect with the body. Yoga has become an essential part in my own journey for trauma recovery. Yoga can teach us many important lessons about trauma recovery like observing what is happening within our body, respecting the boundaries of our body and creating an internal locus of control instead of an external one.

Parts work as evidence-based best practice for trauma treatment

Now let’s look at the next best practice for trauma treatment, which is parts work. In this context, I see human being as having different parts. Parts in this context can be our emotions, our roles, our memories or different ages. Maybe you remember that sometimes you said like my one part of me is angry and the other part of me is calm. So sometimes you have complex inner emotions and we can see all of them as different parts.

Structural dissociations as theory behind parts work

Parts work is significant for trauma recovery due to the concept of structural dissociations that describes how our brain responds to trauma. In my own trauma recovery, parts showed up naturally. When I started therapy, I began to recognize different parts of my personality and I did a lot of healing with my inner child.

There are many different modalities that use a parts perspective, such as inner child work, special trainings by mental health professional like trauma-informed stabilization treatment and the complex trauma certificate by Janina Fischer, internal family system therapy and some approaches of diagnosis.

Benefits of parts work

In general, I noticed the following benefits of parts work.

Greater sense of empowerment

By working with different parts, individuals can gain a greater sense of control and agency over their lives, leading to greater self-confidence and empowerment. Client empowerment is one of the principles for trauma-informed practice, so it’s essential for trauma treatment.

Increased emotional regulation

Part work often supports clients during the stabilization phase to improve their emotional regulation by understanding the needs and concerns of the different parts. Individuals can learn healthier ways to regulate their emotions and respond to outside triggers in the environment.

Reconnecting to sense of self

If we have experienced trauma, we often feel disconnected from our sense of self. Different parts may take over at different times. The self in this context is the adult self that remains steady and calm amidst life’s ups and downs. Through parts work, individuals can separate their adult self from the parts, connect more deeply with their adult self by caring for the different parts. This often leads to a greater sense of wholeness, authenticity and fulfillment.

Nurturing a healthy inner relationship with all aspects of us

Through parts work, individuals can develop a healthy relationship with their different parts. The more we can have healthy relationships with our parts, the more we can respond to our world in an empowered way. Therefore, parts work can also improve our interpersonal relationships.

Limitations of parts work

On the downside, parts work can be complex and emotionally intense if the client has not yet implemented the practices to widen the window of tolerance. Therefore, pacing is also very important for parts work. This also means to understand the needs and concerns of those parts that don’t want to work with the trauma. It’s about finding the right balance between growth and accepting where we are at.

Usually, we are stuck in our recovery process, there is an inner conflict between different parts.

Additionally, parts work may not be a concept that works for everyone and sometimes it can take time to grasp the concept. Therefore, it is another modality that may not fit everybody and it can require patience and persistence.

Furthermore, parts work may not always be necessary. If people have experienced trauma during an event like an accident and they have the capacity to be in the window of tolerance, they may not need to do parts work but could process a traumatic experience with EMDR.

EMDR as best practice for trauma treatment

So now last but not least, let’s look at EMDR, which is also called eye movement, desensitization and reprocessing. EMDR is an important element to the answer of what are best practices for trauma treatment. EMDR has proven effective in working with trauma due to numerous research studies. Additionally, EMDR therapy is an effective way to address the psychological and physiological symptoms of adverse childhood experiences.

Scientific evidence that EMDR works

EMDR is scientifically supported. EMDR is one of the most research and evidence-based treatments for trauma. It is recognized as an effective therapy for PTSD by numerous international organizations, including the World Health Organization and the American Psychological Association.

Unlike some other therapeutic modalities, EMDR typically does not require clients to extensively retell or relive traumatic events. This can be particularly beneficial for individuals who find it distressing to recount their trauma. Here are some of the benefits of EMDR.

Benefits of EMDR

Effective for trauma-related disorders

EMDR is highly effective in treating trauma-related disorders, including post-traumatic stress disorder, PTSD. It helps individuals process traumatic memories, reducing their emotional charge and allowing them to integrate these memories more adaptively.

Faster results possible

EMDR often produces faster results compared to other treatment modalities. Many individuals experience significant relief from symptoms in a shorter time frame, and so it’s becoming a particularly efficient approach to trauma treatment. EMDR facilitates the integration of traumatic experiences into the individual’s overall life narrative. By transforming these memories into less distressing and more adaptive forms, individuals can move forward with a greater sense of peace and resolution. I have witnessed clients who have achieved a level of integration that they never believed possible prior to using EMDR.

Limitations of EMDR

While I find EMDR effective in my work with my clients, I believe it’s essential to integrate it into the stages of trauma recovery. EMDR is not a treatment for stage one of trauma recovery, but stage two. Depending on the symptoms, other practices and methodologies are required to prepare clients for the memory integration. Especially if people have experienced complex trauma, it may take a longer time until they can process their experiences using EMDR.

Importance to combine EMDR with other modalities

Therefore, I use an integrative approach to trauma treatment which combines EMDR with parts work and somatic approaches. So to give you a little bit more context, sometimes clients come to me and tell me their doctor told them to try EMDR. EMDR, which in this context is the eye movement aspect of EMDR, is only effective if the client can be in the window of tolerance while doing it, and has the capacity to go back into the window of tolerance if they get dysregulated.

For example, if the client has parts that dissociate frequently, it may be necessary to do more stabilization before EMDR can even be started. So the symptoms of trauma need to be respected when it comes to using EMDR. Often people experience EMDR as ineffective if the preparation phase wasn’t deep enough. It is also a warning sign if people try EMDR and notice that the nervous system gets more and more dysregulated. It’s usually a sign that it’s better to go back into the stabilization phase and just add more practices and tools to regulate the nervous system.

Overall, I’m passionate about EMDR. I’ve witnessed profound transformations in my clients and I had my own transformations by being a client and using EMDR. And I also believe that it needs to be integrated with other modalities to optimally respond to a client’s need.

Integrative approaches as best practice for treating trauma

As you might have noticed, all the evidence-based practices for trauma treatment come with benefits and limitations. Therefore, an integrated approach of different evidence-based practices is seen as best practice for trauma treatment.

Importance of an integrated approach

While each modality in itself can be useful, trauma counselors who combine different modalities usually can better respond to the needs of a client. Despite the modalities, the client’s capacity to be in the window of tolerance and being able to return to it if the nervous system gets dysregulated is crucial for successful trauma treatment. Therefore, each modality would need to include tools and practices so that the client can build and expand their capacity to be in the window of tolerance.

Each trauma counselor is likely to create their unique integrative approach to trauma treatment, which is adding an additional layer of complexity to the maze of trauma treatment and doesn’t make the journey easier for clients.

Example of an integrative approach for trauma treatment

Personally, I find Janina Fisher’s integrative work around trauma treatment very beneficial. I attended some of her trainings and her perspective on best practices for trauma treatment really resonated with me. In her work, she draws from theoretical principles from neuroscience about trauma as well as structural dissociation theory. Her treatment approach integrates modalities for mindfulness-based therapy, sensory-motor psychotherapy, and internal family systems.

Integrative approach at Bright Horizon Therapies

Based on all the different trauma treatments I have received and the different modalities I’m trained in, I have created my own integrative approach for trauma treatment. And so just to give you a simplified summary of this approach, I use an integrative approach that combines EMDR in a trauma-informed phase model, parts work that is IFS-informed, mindfulness, and parts work based on Janina Fischer’s trauma certifications, and several tools from somatic approaches in addition to the tools and practices to work with the autonomic nervous system. Overall, it is an integrative model that I have expanded over the years and that I will continue to expand over the years, depending on the different trainings I’m attending.

It might give you an idea on how complicated trauma treatment is and also how different trauma counselors may approach trauma treatment. Therefore, I would invite you to ask mental health professional questions about the treatment approach they use for trauma and also how they really integrate that into their practice.

Benefits of efficient trauma treatment

So let’s look at the benefits that trauma treatment can offer you. Efficient trauma treatment can offer you a variety of benefits dependent on where you add on your healing journey.

Better coping skills and higher degree of resilience

First of all, trauma treatment equips individuals with effective coping skills and resilience building techniques to deal with life’s challenges. Through their inner process, individuals learn healthier ways to regulate their emotions, manage stress, and cope with triggers, leading to an increased emotional stability and adaptability.

Improved quality of life

Trauma treatment significantly improves an individual’s overall quality of life. By addressing the root cause of trauma-related symptoms, individuals can experience greater fulfillment in their relationships, work, and daily activities. Trauma treatment empowers individuals to reclaim control over their lives and move forward with a renewed sense of hope and purpose. Last but not least, trauma treatment moves beyond coping skills and promotes emotional healing and resolution.

Facilitating healing

Trauma treatment helps individuals process and heal from past traumatic experiences, reducing the emotional distress and the symptoms associated with trauma-related disorders such as PTSD, anxiety, and depression. By addressing and resolving trauma, individuals can experience emotional relief, improved self-esteem, and a greater sense of well-being. While we cannot change the fact of what has happened to us, we can integrate these experiences and move towards post-traumatic growth.

Conclusion 

As a conclusion, trauma treatment has different layers of complexity and it requires a multi-faceted approach. By integrating traditional top-down methods with bottom-up approaches like somatic experiencing, yoga, EMDR, art therapy, and sensory motor psychotherapy, individuals can find a path to healing that suits their unique needs. Remember, if one treatment approach doesn’t work for you, it doesn’t mean that there’s something wrong with you. It was just not the right approach for you at this time. Trauma recovery is about more than just learning coping skills.

Long-term objective of trauma treatment

The long-term objective is to integrate the traumatic experience, which means that the traumatic experience loses the power they have over you and that they remain in the past. With the right combination of therapeutic modalities, individuals can move towards a life of healing, resilience, and growth.

Well, I hope that today’s episode gave you an overall idea to the question “What are best practices for trauma treatment.” Thank you today for listening to me, and I hope you enjoyed this journey. In the next episode, I’ll delve deeper into parts work and theory of structural dissociations to just explain to you the significance of parts work in trauma recovery. Remember to subscribe to Trauma Demystified to stay up to date with new episodes, and I hope I see you next time. Take care and be well.