I attended an amazing course today on how to work with Trauma, which was run by Mark Brayne. Mark is a psychotherapist, journalist, and author. After a first career as a foreign correspondent, when he worked as a BBC and Reuters foreign correspondent and editor, he qualified in psychotherapy and since 2002 has specialised in working with trauma. His enthusiasm for his work knows no bounds and his lectures and courses seem to end so soon – such is the level of engagement with the material.
I was the only trainee there, as most participants were experienced therapists. One had flown in from Dubai especially to attend the course, another from Switzerland and another had just returned from North America. I attended the course primarily because Mark had given a 90 minute lecture on trauma a few weeks back at my College but I wanted more.
This one day event offered an opportunity to explore the issues in greater depth than in a standard lecture. Trauma, it could be argued, is behind so much of the presenting issues that clients bring to therapy whether in the form of anxiety, depression or addictions and should be prioritised in psychotherapy training. Indeed, I would welcome a weekend or a week on treating trauma.
So what is trauma?
Trauma is any threat to life or identity, mostly unexpected and which overwhelms the defences. There is extreme helplessness involving fear and horror. Trauma is the piercing of body and psyche defences and survival involves fight/flight/freeze.
Traumatic symptoms will invariably comprise of the following: Intrusion (the inability to keep memories of the event from returning), Avoidance (or numbing) (an attempt to avoid stimuli and triggers that may bring back those memories), Hyper Arousal (similar to jumpiness. It may include insomnia (trouble sleeping), a tendency to be easily startled, a constant feeling that danger or disaster is nearby, an inability to concentrate, extreme irritability, or even violent behaviour).
Part of the course involved watching videos of the Twin Towers attack from 2001 and the G8 Summit that took place in Genoa, when riot police dished out savage beatings to protesters on the streets of the Italian city. We were asked to monitor our thinking processes, feelings and physical sensations whilst we watched the videos. The videos showed graphic close up footage. I felt dizzy as I witnessed the Italian riot police pound their batons into the protesters who were dragged along the street like pieces of dirt. Therapists need to be able to survive the trauma brought by clients in order to create a safe containing space.
The course dealt with EMDR as a treatment model. EMDR, it was noted, should only be practiced by a qualified mental health professional – with additional accredited training in EMDR. That professional will most usually incorporate the therapy into their usual practice such as a Cognitive Behavioural Psychotherapist who may include EMDR in their CBT practice, particularly when treating trauma. So, if you are in training you will need to wait until at least two years following qualification before applying for EMDR licensing.
I have always been fascinated by the brain. Did you know that the Amygdala performs primary roles in the formation and storage of memories associated with emotional events. When assessing the role of the Amygdala think of it as the control desk in the brain. It will flash red warning lights at perceived threats.However, sometimes an event occurs, such as a trauma, which is simply too large or difficult for the brain to process.
EMDR also has the potential to cause serious psychological damage by triggering extreme traumatic memories. It is, therefore, not an appropriate approach for a self-help book. So, be careful about engaging with bilateral tapping on your own.
How EMDR works
EMDR therapy is only interested in feelings NOW. What is in the past is done with. During EMDR sessions you will remain in control, fully alert and wide-awake. This is not a form of hypnosis and you can stop the process at any time. It is possible to use EMDR as a stand-alone treatment, but most often this would be for treating the psychological consequences of single event traumas.
Think of the mind as being like a factory or a massively complicated control centre. One of its jobs is to process life events so that they can become memories. Because the event isn’t processed, it is prevented from becoming a memory and, therefore, it remains a current problem, rather than one that’s in the past. Memory involves what happened, an image association, negative thought, feeling and physical sensation. What usually happens with an unprocessed event? We get ‘flashbacks’ when present day situations or events that remind us of the original trauma get triggered. During periods of distress, we tend to press the factory’s STOP button. We also avoid situations which are likely to trigger these ‘flashback’ experiences, reinforcing the lack of processing.
We need to expose ourselves to thinking about and imagining the traumatic event, and/or gradually exposing ourselves to real situations which we normally avoid – if we are to effectively treat the traumatic event so that our ‘factory’ can process them into memories.
This process will result in experiencing distress, but will also cause the factory to effectively process the traumatic event, which will greatly reduce the distress in the long-term.
When the brain is profoundly threatened it will imagine the worst. When wounded or injured it generates massive amounts of opiates. Sometimes, people become adrenaline junkies. Do you know people who are almost addicted to the high they receive from engaging in extreme sports activities, or high risk sexual behaviour? This behaviour may well be covering up untreated trauma.
What helps recovery?
The most valuable recovery tool for anyone suffering from the effects of trauma is a support system of family and friends. Most people will not need counselling after a traumatic event as they will heal through their own processes. Professor David Richards research from 1997 on the prevention of post-traumatic stress after armed robbery showed that 80% of those who witnessed an armed robbery will heal on their own.
I sense I will go on to research this area and will try to get more training in treating trauma, as it fascinates me.
I learned more about mirror neurons at the course
Attending courses such as the one I attended help you see things more clearly. For instance, have you ever seen people working with corpses? They can appear to be very matter of fact in how they deal with the body. This is possible if they don’t know any personal details of the dead person. It would be harder if they knew the person. Furthermore, I learned more about mirror neurons during the course (or counter transference). Researchers argue that mirror neurons may be important for understanding the actions of other people, and for learning new skills by imitation. Emergency services workers will try not to talk about their work to family at the end of a working day or they risk dragging loved ones into the circle of trauma.
What is NOT recommended for the treatment of trauma
- Psychological debriefing: This risks retraumatizing people who might not have been directly affected by an event.
- Ineffective psychological treatments
- For PTSD, drug treatments NOT a first line treatment (different for depression)
What IS recommended
- Watchful waiting
- Checking in after a month (Professor David Richards research from 1997 on the prevention of post-traumatic stress after armed robbery showed that 80% of those who witnessed an armed robbery will heal on their own within a month)
- If PTSD, then trauma-focused treatments (CBT & EMDR)
- If acute in first weeks, CBT/sleep support can help.
Resources
DSM IV criteria for Post Traumatic Stress Disorder
The European Society for Traumatic Stress Studies (ESTSS)
The International Society for Traumatic Stress Studies (ISTSS)
The European Network for Traumatic Stress (TENTS)
United Kingdom Psychological Trauma Society (UKPTS)
The IES-R is a 22-item self-report measure that assesses subjective distress caused by traumatic events
The Master and his Emissary Iain McGilchrist is a psychiatrist and writer who works privately in London
Mark Brayne is a psychotherapist specialising in trauma