Trauma therapy not working so well? Here's one possible reason why!

Good afternoon. I'm Dr. Jennifer Sweeten, a licensed clinical psychologist. And I am just in my office today between sessions and was thinking it could be a good idea to do a quick, hopefully a quick video on a topic that I've been thinking a lot about for the past couple of years or so, and something that I've been writing fairly extensively about that I wanted to share in a video that might be helpful either for people who have suffered trauma themselves or for mental health clinicians and psychologists who are treating clients who have suffered from trauma. And the topic really is what is the order of operations with trauma treatment. So if you're a therapist, somebody comes into your office and they're looking for help and integrating a trauma and moving forward in their lives. If you have suffered from a traumatic event, maybe the challenge has been to find a therapist and who is helping you heal using methods that are of course evidence based, but also in a way that really works for you. So I wanted to say a little bit about evidence based treatment and specifically what the limitations can be of evidence based treatment. And if it's not been working for you or if you're a therapist and these treatments have not been working as promised as the research says they should, what might be going on? So first, evidence based treatments for trauma, for ptsd. Some of the Alphabet acronyms that you probably hear quite a bit about are going to be emdr, sit, Stress Inoculation Training, cpt, different variants of cbt, PE with kids, tf, cbt, to some extent, act, also even eft tapping. So it's not important, I think that you understand all of these acronyms, but what I want you to know is that there are a lot of treatments out there that are either evidence based or maybe evidence based informed. EFT is not like an evidence based therapy for ptsd. But some of the other ones that I mentioned are, but these are some of the, some of the treatment approaches that therapists are commonly using to treat trauma. And I think a lot of them are very promising, especially if you look at cognitive processing therapy or prolonged exposure or emdr. Those are really some of the top ones out there right now, with some new ones always coming on the scene as well. And know that the research behind these are fantastic. So if you're a therapist and you're trained in some of these modalities, then good for you. And if you're a client or a potential client looking to complete therapy, if you find a therapist who are using those approaches, then that's probably a really good thing. Something That I get asked a lot in seminars though is why sometimes are they not going to work? You have to keep in mind that with these therapies and the research behind them, that we're looking at averages, we're looking at large numbers of people and we're looking at changes not necessarily in a specific individual, but across these groups of people in these studies. And so even if something has been shown to reduce clinical symptoms by x percentage and 50% of that group, that doesn't necessarily mean that that change is going to extend to you or going to apply to you necessarily. Nonetheless, I think evidence based and evidence informed approaches are really important, important to know and important to be using. I'll cut to the chase. I think one of the biggest reasons why sometimes these are not effective is because they're being done at slightly the wrong time in treatment. So let me give an example. As a VA psychologist, I was trained in some of these modalities, prolonged exposure being one of them. And in prolonged exposure, it's quite stressful, it's quite effective, but it's quite stressful for the client where they have to go through some of the worst moments of their lives over and over again for about 90 minutes straight, recording the experience on their phone right here, recording their own voice for 90 minutes straight, just repeating the trauma. And then they go home and they listen to this recording every day for 90 minutes and they come back and they do it again. And you do this for eight, 10 weeks. And there are some fantastic results for from it. Why might it not work? I can tell you there have been times that PE pronged exposure or some of these other approaches really have worked first time right away with clients that I've had. And then there have been times when they really haven't reason why it may not work is because they may not be ready to be doing some of the techniques and exercises that these therapies are asking them to do. The biggest mistake that I feel like I see and I hear about when I'm doing consultation and coaching and I'm speaking with other therapists is that people will sometimes jump very quickly into these therapies without first knowing if the client is able specifically to connect with their body. So this is really the main thing that I'm concerned about. Now keep in mind my subspecialty is working with sexual trauma. And so that in particular you're going to have a lot of issues connecting with the body. And I know that that doesn't necessarily apply to all trauma, but that's been the Biggest cause for something like prolonged exposure not working right away that I've seen. So what ends up happening is you start prolonged exposure, you have the person go into great detail about the worst moments of their lives. And what they start to do is they start to kind of mentally peace out. They might dissociate, they might be going through the facts, but they're not actually feeling what it is that they're saying. So they're not actually connecting to this memory. They're stating it sort of like a cold, hard facts way where almost it's like there's this shield between themselves and the memory. Now, this is not necessarily all bad. It doesn't mean that therapy is not going to work at all. But if you notice, you start to pick up on just the fact that they're not connecting very much with the memory. What that means is that it's not really getting processed. You may not get the habituation through the exposure that you're looking for. For those of you out there who are not clinicians, but maybe you suffered a trauma. Basically, what I'm saying is that if you get overwhelmed by memories of something really bad that happened to you, sometimes what you do to protect yourself is you mentally remove yourself from that situation. And so even though you're talking about the memory and you might be recalling it in quite a bit of detail, what happens is that you actually. It's kind of like your brain gets disconnected from the body. The two detach so that you don't have to feel any feelings about what happened. When we think about feeling feelings, we think, oh, you know, it's all in your brain. But keep in mind that emotions actually originate in the body. To learn more about this, you may want to watch my video on the insula and how you feel your feelings and connect with internal experiences. But basically, if we experience something that's overwhelming, especially if we've had trauma to the body, where the body is the site of the crime, what we end up doing is we end up disconnecting from the body. And then when we remember these things that were so terrible from our past, maybe where the body was violated or you were hurt in some way, what happens is you start to disconnect and you numb. So again, this is very protective. It's something that in some circumstances can be really adaptive. But in the context of therapy, what it can result in is you not healing as quickly. So, clinicians, what you're going to see is that people are going to go through the motions of this, but their symptoms are not changing. If you give them something like the PTSD checklist, you may not see a whole lot of movement. You might see some resistance, some pushback. So quick solutions to this, I want to make this pretty short. I want to make this 10 minutes or under. So solutions to this. So number one thing I would recommend is in therapy, if you're a client, look for a therapist who can start out with really emphasizing what we call stabilization. Another way to think about this is bottom up techniques. And what I mean by that is techniques where you're working through your body to change the brain and you're working through the body to reconnect with the brain. A big way you're going to do this is two things. You're going to learn how to turn down the knob on the fear center of the brain called the amygdala, so that you can down regulate it. When you down regulate it, what that does is it actually opens up some of these top areas of the brain so that you can begin to think a little bit more rationally so you can process through some of these memories. The second goal with this is to stabilize and activate the insula, which is another little area of your brain in your limbic system, meaning your emotional brain. You strengthen this area and what it does is it allows you to develop what Peter Levine calls felt sense or a sense of embodiment. A sense that you are connected to your body. So you might feel temperature more in a more sensitive manner. You might notice when you're hungry, little bit easier, you might notice the joy of laughter. This is something that often trauma survivors are robbed of. They don't feel much in the body. So you can learn to feel those things. And believe it or not, when you open yourself up through strengthening that area of your brain, you're opening yourself up to feel the not so great things too. The perk of being able to do that is that you can then begin to work with those not so great sensations and those not so great memories. You can begin to reconstruct them, it's a word that we use, or reconsolidate them. So you can do something like EMDR and really benefit from it. Maybe some of those cognitive exercises and cognitive processing therapy where you know what you think and what you feel are kind of two different things. And it always feels like your head and your heart are competing, but it's actually different areas of your brain competing. And you can actually reconcile those differences a little bit easier if you're connected with the body. And it will allow you to get through therapies that are exposure based, such as prolonged exposure in a much better way where you're not just kind of going through the motions and then never getting anywhere and still feeling on some level distress, but rather the pain that you go through. It's almost like a bone resetting where you're actually healing in that process. So it makes these evidence based therapies that we love to do as clinicians, it makes them more effective. If you're interested in this concept of bottom up techniques, you can look on my website. It's just my name, jennifersweetin.com I have a few ebooks up there about bottom up techniques and ways that you can connect with your body and how that actually helps with the broader picture of treatment. And if you have any questions about this, you can also email me. I'm happy to answer questions about these bottom up techniques or give examples of what these are. You can email me. I'm@drjennifersweettenifersweetin.com and it looks like I'm already at about 11 and a half minutes. So I went on a little bit longer than I would like. But again, I think this is an important issue and it really is that disconnect from the body. That disconnection is the reason that I've seen these therapies not work quite as well as I think they could be. Okay, have a good day. Thanks.