Trauma and post traumatic stress disorder (PTSD) are words that most people dismiss as not impacting their lives. Frequently they are afraid or ashamed to talk about what has happened to them or their love ones.

Statistically, over 70% of respondents reported a traumatic event; 30.5% were exposed to four or more. Five types – witnessing death or serious injury, sexual assault, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury – accounted for over half of all exposures. 

According to the National Center for Post-Traumatic Stress Disorder, PTSD is a common condition affecting 10% of women and 4% of men at some point in their lives.

Here at Heart, Mind, Body we invite you to the safe space that we have created for survivors of trauma. Why is this dear to our hearts? Both of the founders have experienced traumatic events, and developed PTSD. We understand the journey to recovery and the struggles that go along with it. 

What is PTSD?

Post-Traumatic Stress Disorder (PTSD) is a mental health issue that can affect anyone who has experienced a traumatic event. This might include veterans, childhood abuse survivors, and other people who have endured a shocking or dangerous experience. It is often overlooked or minimized, with people being told to "get over it" or "move on". However, PTSD is a serious matter that deserves attention and care. While PTSD can be debilitating when dealt with alone, treatment is available to help people manage their symptoms and live a fulfilling life.

Common symptoms of PTSD include flashbacks to the event(s), nightmares, intrusive thoughts, feelings of guilt related to the event(s), and/or avoidance of anything that may remind the person of the trauma. For example, if someone was in a severe car accident that led to a diagnosis of PTSD, they may hesitate to drive on their own and may have recurring, relentless memories of the traumatic accident.

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PTSD can feel distracting and overwhelming to the person experiencing it. 

Cognitive behavioral therapy focuses on the relationship among thoughts, feelings, and behaviors; targets current problems and symptoms; and focuses on changing patterns of behaviors, thoughts and feelings that lead to difficulties in functioning.

Cognitive behavioral therapy focuses on the relationship among thoughts, feelings, and behaviors, and notes how changes in any one domain can improve functioning in the other domains. For example, altering a person’s unhelpful thinking can lead to healthier behaviors and improved emotion regulation. CBT targets current problems and symptoms and is typically delivered over 12-16 sessions in either individual or group format.

This treatment is strongly recommended for the treatment of PTSD.

Several theories specific to trauma explain how CBT can be helpful in reducing the symptoms of PTSD.

For example, emotional processing theory (Rauch & Foa, 2006) suggests that those who have experienced a traumatic event can develop associations among objectively safe reminders of the event (e.g., news stories, situations, people), meaning (e.g., the world is dangerous) and responses (e.g., fear, numbing of feelings). Changing these associations that lead to unhealthy functioning is the core of emotional processing. 

Social cognitive theory (Benight & Bandura, 2004) suggests that those who try to incorporate the experience of trauma into existing beliefs about oneself, others, and the world often wind up with unhelpful understandings of their experience and perceptions of control of self or the environment (i.e., coping self-efficacy). For instance, if someone believes that bad things happen to bad people, being raped confirms that one is bad, not that one was unjustly violated.

Understanding these theories helps the therapist more effectively use cognitive behavioral treatment strategies.

Therapists use a variety of techniques to aid patients in reducing symptoms and improving functioning. Therapists employing CBT may encourage patients to re-evaluate their thinking patterns and assumptions in order to identify unhelpful patterns (often termed “distortions”) in thoughts, such as overgeneralizing bad outcomes, negative thinking that diminishes positive thinking, and always expecting catastrophic outcomes, to more balanced and effective thinking patterns. These are intended to help the person reconceptualize their understanding of traumatic experiences, as well as their understanding of themselves and their ability to cope. 

Exposure to the trauma narrative, as well as reminders of the trauma or emotions associated with the trauma, are often used to help the patient reduce avoidance and maladaptive associations with the trauma. Note, this exposure is done in a controlled way, and planned collaboratively by the provider and patient so the patient chooses what they do. The goal is to return a sense of control, self-confidence, and predictability to the patient, and reduce escape and avoidance behaviors.

Education about how trauma can affect the person is quite common as is instruction in various methods to facilitate relaxation. Managing stress and planning for potential crises can also be important components of CBT treatment. The provider, with the patient, has some latitude in selecting which elements of cognitive behavioral therapy are likely to be most effective with any particular individual. Customers have questions, you have answers. Display the most frequently asked questions, so everybody benefits.

DBT for trauma treatment offers increased self-control and can help you feel grounded in your life, here and now. Dialectical behavior therapy (DBT) was originally developed in the 1980s as a specific type of cognitive behavioral therapy for the treatment of borderline personality disorder. More recently, DBT has been applied to treat other disorders, and has been found particularly beneficial for PTSD. This therapy is founded upon principles of Zen Buddhist philosophy and contemplative practices. For example, the term “dialectical” refers to a synthesis of opposites, which is a core aspect of Zen practices. 

So much of the world around us tends to focus on short-term desires rather than long-term goals. However, this approach does not apply to trauma recovery. Instead, the transformational work that moves you from pain to possibility requires a similar mindset to a marathon runner. You will likely experience times when you want to give up. Sometimes, you might feel that this is simply too difficult. You might start to believe that other people have the capacity for growth, but that it is not possible for you. Nonetheless, you have chosen to stay the course. By staying engaged and committed to your healing process, you have acknowledged the fruitlessness of stagnation. You have chosen to reclaim your power. This will help you to harness the energy necessary to create needed changes in your life. 

Typically, DBT for trauma involves learning skills that focus on the development of mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.

Within the context of DBT for trauma, you learn mindfulness skills to develop your capacity to cultivate acceptance. Acceptance helps you recognize that uncomfortable experiences do not necessitate escape tactics or reactivity. DBT offers the concept of “Wise Mind,” which represents the optimal balance of your thinking or “reasonable mind,” and your feeling or “emotional mind”: an integration of logic and intuition that can help you feel calm and centered.

The aim of this approach is not to get rid of your emotions, rather it is to reduce suffering related to ineffective reactions to your emotions. An example would be lashing out at a supportive partner in fear or anger when perhaps they’ve done nothing wrong—this reaction causes additional suffering for you and your partner. DBT for trauma distinguishes that difficult feelings are not destructive or the result of a bad attitude. These emotions are simply meant to be felt, and this is where the mindfulness and acceptance come in. Emotion regulation helps you learn to distinguish between feelings and “action urges,” which encourages you to reflect on your thoughts and emotions before jumping to reactions or behaviors.

Pain and distress are a basic part of life, and sadly, they cannot be entirely avoided. Increasing your distress tolerance in DBT for trauma helps you to handle painful emotions skillfully. Sometimes skillful action involves acceptance—welcoming reality as it is, without needing to resist or change it. Other times, skillful action requires change; such as recognizing when it is important to leave an unhealthy situation.

The DBT skills taught for interpersonal effectiveness emphasize assertiveness, boundaries, and coping with conflict. Assertiveness focuses on developing your capacity to ask for what you need, even though you may be told no or risk feeling rejected. Self-assertion involves building self-respect and cultivating a sense of your own worthiness. Skills for interpersonal effectiveness include learning to address conflicts gently, such as by refraining from put downs or name calling, respecting yourself and others, ensuring that you are behaving fairly, apologizing when you have done something wrong, and being truthful. These basic skills can be powerful catalysts for inner strength and positive self-esteem. 

Engaging a “half-smile” is a valuable way to change your mental state and cultivate a serene feeling in the moment. This practice involves relaxing your face and then slightly turning up your lips. As you smile, imagine your jaw softening and a relaxed feeling spreading across your face, your entire head, and down your shoulders. Start by practicing the half-smile while you feel calm, and eventually engage the practice while reflecting on a difficult event.