“In Classic Behavioral Deconditioning, the subject, after repeated harmless and inconsequential exposures to a fear trigger, readjusts his autonomic system away from its state of fright and anxious anticipation back towards a state of equilibrium.
Cognitive Behavior Therapy adds a dimension where the individual is encouraged to recognize how fearful thoughts are triggered, and the domino effect caused by fearful perceptual distortions that are constantly biased in the direction of threat and danger.
CBT traditionally did not encourage delving into past traumas. That was too much in the realm of the Psychodynamic school of “uncovering.”
But when it comes to trauma recovery, the Cognitive Behavioral school promotes the crucial role of “returning to the scene of the crime” in order to regain a calm sense of self, even when re-exposed to trauma reminders (triggers).
In other words, the Cognitive Behavioral school insists that repeated narrations of the trauma, in graphic detail, reported in the subjective tense, and repeated frequently, is both necessary and ultimately proof of recovery.
However, not all survivors remain sufficiently calm and focused enough to uncover, confront, and finally become freed of their demons.
Many severely traumatized victims may need to learn a variety of new survival strategies.
In some cases, survivors may have to learn a variety of new “self-help” strategies that will allow them to face trauma triggers without becoming overwhelmed by excessive fright.
Biologically, as long as the emotional (limbic) brain remains overly stressed, it will remain flooded by stress-induced neurotoxins.
This will be discussed in more detail, and reliably referenced in an article covering the neurobiology of PTSD.
As I will explain in more detail, a consequence of the excessive activation of multiple stress circuits is the dysregulation of the Hypothalamic-Pituitary-Adrenal Axis.
Severe psychological trauma also causes the hippocampus to lose its capacity to perform the multiple complex tasks required to integrate a “trauma narrative.”
As a result of the ground-breaking research by Marylene Cloitre and colleagues, a comprehensive treatment methodology has evolved that allows overly-stressed victims to develop new skill sets that enable the victim to switch-down these unmanageable emotions.
The recovery model that they developed requires the victim to acquire the capacity to master several strategies in stress management as a prerequisite to “trauma narrative exposure” in those victims whose symptoms are severe or longstanding.
Given the ubiquitous nature of stress, this can be an ongoing challenge, as much as staying “clean and sober” is a lifetime challenge for members attending any “Twelve Step” Program.
In contrast to “normal life experiences,” repeated exposure to severe violence or abuse tends to have a disorganizing effect on neural pathways. Rather than being integrated like healthy experiences, traumatic events remain amorphous, distorted, and set apart from dynamic brain function.
The narration of your trauma identifies the source and uncovers the mystery of how any survivor feels and behaves in daily life.
Furthermore, it demystifies previous irrational fears and exposes their origin.
Identifying and sharing one’s trauma removes its power. It becomes relocated to the past, no longer hovering as an imminent, frightening threat.
Using Cloitre’s approach of Skills Training in Affect Regulation (STAIR), trauma narration provides an alternative to the traditional model of exposure therapy, where the patient is almost immediately exposed to any fear trigger.
Rather, it prepares the victim to revisit the past in the safety and companionship of the present, while armed with the coping tools of the present.
Once these conditions are met, the victim is allowed to safely tell their story without being re-traumatized (Cloitre, Marylene. Treating Survivors of Childhood Abuse. Guilford Press, 2006).
The therapeutic goal is to allow the victim to talk about their traumatic experience in order to expose and confront its fearful elements and dissolve its power to elicit fear.
Another goal is to put the memory into a narrative form with a chronological order. Narratives convey a story about a life that has a past, present, and future. The victim needs to learn to create a life story about what happened that both anchors this terrible event clearly in the past while anchoring the person in the present.
Another goal is to create a present safe haven that frees the victim from the grip of past traumatic memories.
A sign of successful outcome is when the survivor can once again engage playfully in present creative living. This could be accomplished through prayer, sport, art, theatre, gardening, music, crafts, joining a gym or yoga class, or attending lectures, among many other possibilities.
Successful therapy will require the victim to have access in their personal life to a “safe place.”
What works for each individual, however, is different: for some, meditation may be best, for others gardening, for others prayer, music, yoga, and so on.
One can, in fact, find a variety of techniques to help anchor oneself in the present.
This is the safety zone in which one can always seek refuge when faced with intolerable visitations of flashbacks or resurgence of fear or anger.
It is only possible, once re-anchored in the safety of the present with a sense of personal sovereignty and empowerment, that many victims possess a readiness to confront a trauma from the past with the perspective of the present.
Dual awareness is another strategy that is vital for recovery from trauma during the process of creating the trauma narrative.
This is a learned strategy that enables the victim to remain connected with the present (with the firm conviction that “nothing bad is happening to me now”) while visiting the past.
This is where “role-playing” can often be useful. Using the therapist or recovery group as a support, one can try to confront the old demon, now as a mature adult.
Sometimes roles can be switched, where others role-play you as the victim, or one can change the understanding of the script to one that the victim can make peace with.
The idea is to demystify and disempower the “tyrant” or demon that has hovered so long over the victim’s landscape.
This point is well illustrated in “The Wizard of Oz” when Dorothy confronts the tyrannical mystic as a total sham.
In the world of trauma, symptoms can cover a wide spectrum. Recovery has to be guided, at least to some extent, by the victim.
I have seen both trainees and non-trauma specialists exacerbate symptoms with premature trauma exposure. In other words, victims should not be encouraged to revisit the “crime scene” before they are ready.
In summary, the newer therapies recognize that the victim has to narrate the trauma in order to process the material, but first needs to feel sufficiently safe and emotionally prepared to do so.
What has emerged in psychological literature is the value of learning recovery strategies from clinicians who have been trained to use a modified form of cognitive behavior therapy, and whose skills include use of empathy, knowledge of relationship therapy, and meditation techniques (referred to by some as “mindfulness”).
Marylene Cloitre and co-workers developed much of the work done in this field. The objective of this hybrid recovery model is to allow the trauma or abuse survivor to trust and be guided by a therapist.”
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The way the brain works is that once there`s a “trauma-narrative”, the brain is able to “download” those triggers that evoke the internal “trauma cascade”.
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Un Curs Valutar de The Narration Phase of
Therapy
The author believes that terms such as “trauma narrative, and “therapeutic narrative” constitute the modern Cognitive-Behavioral equivalents of Victor Frankel`s concept of “Meaning Therapy” as described in Frankel`s “Man`s Search for Meaning”. It has unique clinical significance for victims of emotional trauma. Many symptoms of PTSD (such as heightened startle-responses and flashbacks) represent unresolved trauma-generated memories. Such memories become “over-consolidated” because the Hippocampus (a component of the “limbic”, or “emotional brain”) promotes memorization of those events that are associated with powerful emotions (such as threat) for purposes of self-preservation.
However, as long as traumatic events remain “unprocessed”, they persist as memory fragments which are prone to resurfacing (as daydreams, unwanted thoughts and images), causing distress, lingering fears and insecurity.
The role of the therapist in such circumstances is to assist the victim create a trauma narrative as well as a healing narrative, in order to put the trauma-event safely in the past. This allows trauma-victims to re-engage their work and social environments in a more spontaneous and creative way.