Post-Traumatic Stress Disorder and Treatment Alternatives

Monday, June 30, 2014 by Meg   •   Filed under Trauma

Trauma. It's not just for veterans. It can happen to anyone at any time when the stress response gets stuck in the "on" position, though there is usually a triggering event. Last week, we went over some alternative ideas on trauma, specifically Peter Levine’s theory in Waking The Tiger. He believes that traumatic response may be the result of an adaptive freeze cycle that is interrupted by our huge brain and ability to worry1

But what we do about it may depend on a number of factors, including how much people are able to remember, or whether they recall anything at all.

And memory can be a huge jerk.

Distorted Memory and Trauma 

Memory itself can be distorted in many ways as people try to find a coherent story that fits their feelings.  What people ultimately "remember" is the collaborative process between nervous system arousal—which tells us how scary the event was—logical interpretations of the event and any number of cognitive distortions, such as the tendency to see things as all good or all bad.  

The remembering may be particularly difficult in cases of pre-language learning, where the actual event is un-recallable, but later remembered events ultimately get pulled into the story. This is also true in cases of severe trauma where memories fragment or individuals do not store events in their long-term memory at all.  

But why wouldn’t we remember? 

Memory takes energy. If you're in a life or death situation--or your brain thinks you are--there is no use wasting energy forming memories that you may not be around to care about. You can fill in the blanks later. Most people fill in those blanks without realizing which parts are actual memories and which parts are born out of a need to understand or explain the physical sensations.

But none of that matters in Levine's model of treatment. 

Cognitive Exposure, Visualization, Storytelling and EMDR As Treatments For Post-Traumatic Stress Disorder

Whether the memory is present or not, Levine believes that people have to cycle back through the freeze response and into fight or flight before physical release can happen. The intrusive memories and scary thoughts so common in trauma may the the brain's way of trying to complete this cycle and integrate those memories in a more usual way, though people may end up re-traumatized because the story still ends with helplessness and a stress cycle unable to complete. In order to make ourselves more powerful, we need to change the memory, and fight back. And if you don't recall anything, Levine suggests making it up entirely. 

Levine, and numerous other practitioners, encourage a switch from immobility and fear to the possibility of active participation and escape in traumatic memory exercises. To do this, Levine suggests making up a new dialogue to go with the sensations, either using visualization, or writing it out (writing and storytelling as treatments for trauma will be discussed next week in more detail).

The rationale goes like this: remembering events might trigger the panic system, and the high anxiety and uncomfortable physical sensations that go with it. But imagining yourself in a position of power within that memory might allow the cycle to run its course with a different ending, a type of short circuit mechanism. 

Others, including Dr. Ronald Siegel, author of The Mindfulness Solution, would probably agree with the notion of staying with memories and uncomfortable anxiety, regardless of your visuals. He notes that by sitting with a feeling and allowing the sensations to overwhelm you, fear tends to decrease2. This is also similar to cognitive exposure discussed by Dr. David Burns in When Panic Attacks, where traumatic events are to be focused on, often reliving the entire memory of the event3 regardless of whether you change the ending. 

All of these run parallel to standard methods used in therapy circles, where individuals are encouraged to stay in a "window of tolerance" while they discuss events or memories, reprocess those experiences in a way that is less threatening and learn new ways to cope with the physical sensations often with cognitive behavioral therapy. Eye Movement Desensitization and Reprocessing (EMDR) uses some elements of cognitive behavioral therapy combined with eye movement or right/left stimulation (like tapping) and has also shown some promise in helping to "unfreeze" the parts of the brain that are stuck in super stress response mode. (EMDR will be discussed in future posts, or you can purchase Getting Past Your Past, a self help book on EMDR therapy.)

Note that these techniques are used after the fact, sometimes months or years later, and only when someone is prepared. Immediately following trauma, visual replacement is usually preferred to stop intrusive flashbacks until people are able to process the event without being overwhelmed. Those physical symptoms are no joke, and pushing too hard too fast has the ability to re-traumatize, so it is important to work with a someone trained in traumatic responses. 

Whether the memory itself has value probably depends on the individual, the situation —including memory factors and age—as well as the person's ability to cope with the memories. Those with less ability to cope may benefit from taking this process a little bit at a time, instead of forcing the entire process at once. All may benefit from the assistance of a trained professional to help them work through these stages.

Levine, Siegel and Burns all embrace cognition in some regard, even as merely a means to unstick the panic response. But this doesn't work for everyone at any given time. And there are also treatments that activate the nervous system through physical touch as opposed to cognitive processes.

Sexual Trauma and Physical Treatment Alternatives

Some choose to focus simply on the physical sensations in their body instead of assigning a story to them. This becomes more of a meditative practice closer to Dr. Daniel Siegel's model in Mindsight, where people are encouraged to become an observer and see the symptoms as separate from the self, an experience as opposed to a reality. Other researchers agree that trauma responses may decrease through meditative practice 4, and  meditative practice may be nearly as beneficial as the story-telling or imagining exposure described above5.

But there may be another way.

In an interview transcribed in Naomi Wolf's book Vagina, clinical therapist and trained Tantric practitioner Mike Lousada weighs in on this phenomenon. Lousada's practice revolves around "yoni" (or "sacred space") massage in women who have experienced sexual trauma6. His main goal is to bring women back to peak sexual functioning by finding areas of the vagina that are desensitized, disconnected, or those that trigger high anxiety. Through physical release of these areas, Lousada claims to be able to help women complete the trauma cycle in a practice he calls "Psychosexual Somatics"7

This method is similar to the release functions discussed by Levine, moving from freeze through fight or flight until physical release occurs. Another type of physical exposure therapy is also described by Nicole Daedone in Slow Sex, where vaginal massage (without the expectation of sex) may allow for the release of tensed or traumatized areas8. I actually recommend this book to anyone, regardless of trauma issues. 

But what if the trauma isn't sexual, or you are not comfortable with someone else massaging your vagina?

Physical Exercise As A Treatment For Trauma

Trauma is obviously a very physical process, and symptoms nearly always include heightened stress chemicals including cortisol. Reducing the stress hormones themselves may allow people to reduce those symptoms. Playing with the way we see those stress chemicals may also reduce fear when faced with them, and allow individuals to travel through the cycle more easily.

In my clinical practice, I often recommended a "walk/run" exercise to train the nervous system, though individuals need to be healthy enough for this type of activity.

Here's how you do it:

  1. Walk to warm up.
  2. Run as hard and fast as you can, until you feel like you can't breathe.
  3. Stop.
  4. Wait for the body to process the extra stress hormones and reduce the physical response.
  5. Repeat.

The idea behind the practice is that by accelerating the heart rate, then stopping suddenly, the brain gets used to the heightened physical responses that mirror anxiety in a safe space. Over time, the body learns to release the physical effects of fight/flight more effectively. It also serves to release some of the extra cortisol that builds up in response to anxiety and trauma by improving regulation of the hypothalamic-pituitary-adrenal (HPA) axis, a system involved in stress responses. 

At the very least, people tend to be less frightened by the response itself once they recognize it as a physical process that eventually stops. Yoga also works for this because it is a practice in accepting the physical responses which allows people to decrease the fear they have surrounding them. 

There is also the added benefit of having jogging pants that fit better, which I assume means you can ingest more chocolate. (Score.)

Other research supports the idea that physical exercise can have a pronounced effect on traumatic response. According to one study, a 12-session aerobic program decreased symptoms of post-traumatic stress disorder9. These reductions remained  at a one month follow-up. Another study done on teenagers found similar results10, and noted that the physical activity reduced traumatic responses, anxiety and depression. And one mindful stretching program--similar to yoga--showed that individuals had reduced post-traumatic stress symptoms as their cortisol levels decreased11

There are obviously a number of different ways to work through trauma, though a combination is usually most effective. In any case, individuals may benefit from recognizing that the physical process is a beneficial mechanism, stuck though it may be. 

This isn't easy to understand in a world where we assume that discomfort is something to fight against, that finding an immediate way to “get over it” is the preferred course of action.  Sometimes, it may be in the fighting, that we undermine the innate systems put there to help us. It's a process. And it will pass. Those sticky panic switches just need a little help. 

By understanding the response, and the alternatives available for assistance, more may be able to accept the process and move forward in a way that makes sense to them, a way that will ultimately reduce the symptoms of trauma.

Related Posts:


Topic-Relevant Resources

Waking the Tiger: Healing Trauma: The Innate Capacity to Transform Overwhelming Experiences
Dr. Peter Levine discusses the evolved processes that make us more susceptible to traumatic experiences and offers paths toward healing.

The Mindfulness Solution
Meditative and cognitive techniques for everyday use

When Panic Attacks
Detailed overview of cognitive behavioral techniques for changing negative thought patterns

Everything you ever wanted to know about the connections between your vagina and your brain. It's worth the read.

Slow Sex: The Art and Craft of the Female Orgasm (Paperback) - Common
Sex and increasing the capacity for orgasm. You know you want to read it.

The PTSD Workbook: Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms
A useful tool in exploring personal trauma, with an emphasis on healing.

Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy
Self help techniques using Eye Movement Desensitization and Reprocessing (EMDR) a therapy especially helpful in trauma and anxiety cases.

Trauma and Recovery: The Aftermath of Violence--from Domestic Abuse to Political Terror
Great overview of traumatic reactions (and what to do about them).