What is it to be traumatised?

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Clients often report feeling fraudulent entering therapy, stating that they had a happy childhood and no significant traumas in their life to date. In their mind, it is they who are fully responsible for their ongoing depression or anxiety. We tend to think of traumatic events as those extremes we hear about in the media: rape, assault, terrorism etc. In reality, the link between trauma and a traumatized brain is less clear cut.

Life is littered with uncertainties and perceived threats, to our lives, self-esteem and confidence. In the face of such threats, some of us are simply unequipped to deal with the psychological fall out – through no fault of our own. To assume full responsibility for how we react to these events, is inaccurate and disregards all that we now know about the brain. Brain imaging has revealed our limitations as human beings to differentiate between perceived and real danger. As a result, it may be more accurate to attribute some responsibility to our innate physiology.

I prefer to use the word ‘traumatized’ in therapy rather than labeling specific events as the moment trauma occurred. This allows clients to identify behaviors, emotions and thoughts that may indicate a ‘traumatized brain’. Put simply, a traumatized mind is a ‘confused or disorganized’ mind, involuntarily firing on all cylinders and largely out-with our control due to our evolution.

A traumatized mind is separate from the traumatic event. We are not born with the skills to self-soothe in the face of danger (perceived or real). We may seek them out in infancy but there is no guarantee these needs will be met through our environment. We have to learn these skills, to enable our brain to successfully access the parasympathetic nervous system, which essentially sends in the ‘para’-troupers in times of stress to calm the flames of anxiety and fear.

We learn key nurturing skills in early childhood, largely from care givers. Given that care givers are only human, and may well be inexperienced at managing their own emotions, we may find ourselves vulnerable to developing self-compassion. This is not to say our parents or peers are to blame for our underdeveloped brains rather that it is in no way our own fault as individuals for getting trapped in a traumatized mindset.

The good news is, no matter how traumatized our brains may be, brain imaging has shown that these key nurturing skills can be learnt at any age with the help of psycho-education and/or appropriate psychotherapy. Schema Therapy, Cognitive Behavioural Therapy, Psychoanalysis and Mindfulness all offer ways to calm the traumatized mind and gain essential self-regulatory skills.

It might be useful to consider the mindset that is engaged in the face of danger for you personally? Remember, our brains may be limited by insufficient development, but they are also extremely flexible, allowing new neural pathways to develop and arming us with more efficient and effective skills. A traumatic event can never be eradicated from our memories but we can significantly re-wire how our brains relate to these memories.

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Shame and Compassion Focused Therapy

I wrote a while back about the impact of shame and how often this can lie at the root of psychological distress. Here’s a few more pointers on how shame can be tackled with compassion focused therapy.

Shame often disguises itself in more easily identifiable emotions, including, anger, disgust, anxiety, and depression. When shame is unresolved it can lie dormant for a long time. Typical behaviours that we might find ourselves caught up in are, self harming and aggression (attack), submissiveness to other’s demands (submit), and withdrawal from others (hide).

Shame is a normal human emotion, essential for the survival of social evolution, however, if left to eat away at us, it will often raise its ugly head again and again when we are feeling vulnerable or stressed. The power of shame is such that it can feel like a knife in the back, knocking our confidence and sense of direction and self worth. We can feel shamed socially, leaving us vulnerable and highly alert to other people’s judgments, and shamed internally, where we become our own worst and punitive critic, irrelevant of other people’s comments.

The good news is, no matter when or where our sense of shame comes from, the shameful mindset has been learned and therefore, we have the opportunity to learn a new mindset, one based on compassion.

The compassionate mindset involves first looking at the root cause, usually a situation or comment from others in the past, that first sowed the seeds of shame. This is followed by skills based training in Mindfulness, a meditative technique, which opens the door to a new way of interacting with our emotions, behaviours and thoughts. In a nutshell, Mindfulness increases self awareness of the shameful mindset, promotes self healing, and nurtures our ability to develop kindness, compassion, and a non-judgmental stance towards ourselves.

A great book for anyone struggling with shame and looking for an alternative path to freedom is The Compassionate Mind Approach to Recovering from Trauma by Deborah Lee.

Mindfulness as a powerful adjunct to cognitive behavioural therapy

Presently there is a lot of talk about the practice of Mindfulness in the media as one of the ‘new’ forms of treatment for depression and anxiety. Ironically, mindfulness as a form of meditative practice is in fact as old as the hills. It is only recently, that evidence-based studies have brought to the fore the powerful effects this practice can have in reducing some of life’s most difficult problems – rumination and worry.

I have been using mindfulness techniques myself for about 6 months and I for one can testify to the beneficial effects they have had on reducing my own inner world. It is important to note here that I am not implying that I no longer find myself caught up in worries and pessimistic thoughts. In fact, I think I have become even more aware of how often my mind tends to lead me down this old familiar path of negativity. The effect  of practicing mindfulness has led me down a completely different path, one where I am able to relatively quickly spot these thoughts as they float into my consciousness and then take a decidedly different course of action. In the past I would only become aware of such intrusions after having acted on them in some way, whether it be to try and ignore them or to act in a way that would suggest that such negative thoughts were truths rather than thoughts or opinions.  Now I am not only able to spot them as they arise, I am happy to let them be, safe in the knowledge that they are just that – thoughts.

The practice of mindfulness appears in theory to be a very simple meditative act but the truth is it is a difficult and sometimes elusive skill to acquire. I have started to introduce mindfulness into my private clinical practice with great effect. Those who fully apply themselves to regular (daily) practice do appear to reap the benefits associated with a grater sense of self and greater ability to let unhelpful thoughts pass by without engaging or trying to escape.

As a cognitive behavioural therapist, there can be a tendency to stick with the evidence-based route, helping clients to challenge negative and unhelpful thoughts. Having incorporated mindfulness into my practice, I now recognise that this approach is not a one-size fits all solution to the problem of depression and anxiety. We cannot ever truly eradicate free thought, which in itself can be a great tool and without which we would lead much less richer lives. We can however, choose to cultivate that part of ourselves that is innately human; the ability to observe our own thoughts. Coupled with a non-judgmental acceptance of our inner ‘chatter’, we might just find ourselves on the path to better mental health and greater contentment despite the ever more chaotic and frantic world we find ourselves in.