Episode 249: On this episode of Real Health Radio, it's a solo episode all about healing from trauma. I go through many of the different healing modalities that can be used to process and heal from trauma - explaining what they are and how they work.
Trauma is something that is much more prevalent than most people think. And for the clients I work with, it is often part of their history. On today’s episode, I look at many of the different healing modalities that are evidence-based for processing and dealing with trauma.
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Chris Sandel: Welcome to Episode 249 of Real Health Radio. You can find the show notes and the links talked about as part of this episode at www.seven-health.com/249.
Before we get started, I want to mention that I’m currently taking on new clients. I specialise in helping clients overcome eating disorders and disordered eating and chronic dieting, body dissatisfaction and poor body image, exercise compulsion and overexercising, and also helping clients to regain their periods. If you want help with any of these areas or you simply want to have support improving your relationship with food and body and exercise, please get in contact. You can head over to www.seven-health.com/help, and there you can read about how I work with clients and also apply for a free initial chat. The address, again, is www.seven-health.com/help, and I’ll also include that in the show notes.
Hey, everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. I’m a nutritionist that specialises in recovery from disordered eating and eating disorders, or really just helping anyone who has a messy relationship with food and body and exercise.
Today on the show, it is a solo episode. It has been ages since I’ve done one of these, so I’m excited to be getting back into doing one. This is a topic that I’ve wanted to cover for a really long time, which is looking at the healing modalities with trauma and how to heal from trauma. Over the last handful of years, trauma is something I’ve been diving into in a big way. I think it’s something that is making its way into the public consciousness and awareness, but obviously we still have a long way to go.
With clients, trauma is something that is fairly common, and it can have an impact on the development of things like dieting and restriction and disordered eating and eating disorders and exercise compulsion. It can also have an impact on someone’s ability and their desire to move past or get past these behaviours or disorders.
A number of years ago, I read Bessel van der Kolk’s The Body Keeps the Score, and it’s really an incredible book. The first half of the book is dedicated to looking at trauma and the effects that it can have – how it affects the brain and the nervous system and other systems in the body, how it affects child development and memory and our ability to connect with ourselves and others. So much of what we know about trauma is a really recent thing, and Bessel is someone who has been at the forefront of many of these discoveries.
Then the second half of the book looks at all the various methods that are being used and are successful in the treatment of trauma. Some of these he goes into in a lot of detail and dedicates a whole chapter to because there’s good evidence and scientific support for them, and others are mentioned more in passing or mentioned as possible further avenues for exploration. In it, he has maybe seen the benefits with patients reporting these things back to him, but there just isn’t the studies to back it up yet.
The book came out in 2014; since then, there’s been further developments that have occurred, and I’ve heard Bessel on other podcasts talking about other ideas.
So really what I want to do on today’s episode is go through many of the different modalities that can be helpful with healing trauma. Many of these are ideas from The Body Keeps the Score, but there are other ideas that come from other sources too that I’ll be including. Gabor Maté is someone who’s had a huge influence on my understanding of trauma, so I’ll be referencing him, too.
I’m not going to go into a huge amount of depth on each and every one of them, but what I would like to do is give enough detail that you get a sense of what that modality is, how it works, and how it can be helpful. Where appropriate, I’ll also link to other resources about that specific modality, whether that’s books or podcasts, so you can dive into it in more detail.
I’m thinking of this episode as kind of like a resources page or a resources episode of sorts where if you’re wanting to deal with trauma and heal from trauma, you can listen to the different methods and see which one or ones speak to you. I mentioned that the first half of The Body Keeps the Score is all about how trauma affects the body, and this isn’t something I want to go into in a huge amount of detail with this show except for a basic overview of what trauma is and how it relates to the different modalities and why they can be helpful.
One caveat I want to make – and this is something I always say to clients – is that I’m not a trauma expert. It is something that I’ve read and listened to and watched a lot of content on, so I would consider myself trauma-informed, but I haven’t had any official training on any of these modalities, so when it does come up with clients, it is an area I can talk about but I will always suggest that they then work with a practitioner or a clinician who is trained in EMDR or Internal Family Systems or exposure therapy or whatever the modality is that someone wants to pursue.
00:05:41
Before we get into looking at the different modalities, let’s look at what trauma is. I think it’s a word that comes up a lot and not everyone knows what it entails, or you may have a narrow definition where it’s something that returning soldiers experience, but outside of this you’re not sure what it is.
Let me start with the official definition that comes from the DSM-5. This is the Diagnostic and Statistical Manual of Mental Disorders, and it’s the fifth edition because this is the most recent edition. This is the book that psychiatrists use to give someone an official diagnosis.
I want to add that trauma and how it is defined in the DSM has caused huge amounts of controversy, and in each edition of the DSM, the definition and the boundaries have changed significantly. The most recent version is no exception with this. I’m not going to go into a whole history lesson of these changes or the controversies; rather, I just wanted to mention that despite the DSM being the supposedly definitive book a diagnosis is made from, many people in the field don’t agree with how it is being defined or the criteria it includes.
In the DSM-5, there is a category for trauma- and stress-related disorders. In this category, there are a number of different disorders, and for each of them there are many criteria that you need to receive a diagnosis. What I’ll do now is just briefly describe each of them so you can get a sense of what is included in the totality of the trauma- and stress-related disorder category in the DSM.
The first is PTSD, or post-traumatic stress disorder. For this to have a diagnosis, one of the categories is the person was exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. This can be for themselves or witnessing it in another person.
As part of this, there is also what is known as second-hand trauma or vicarious trauma. This can often happen due to someone’s professional duties – for example, a social worker who is repeatedly exposed to the details of child sexual abuse or a police officer that is dealing with homicide cases.
The next category is ASD, or acute stress disorder. This is similar to PTSD in terms of what someone is exposed to; there’s just a different level of symptoms that occur afterwards. I’ll come to the symptoms part in a moment.
The next category is adjustment disorders. An adjustment disorder is an emotional or behavioural reaction to a stressful event or change in a person’s life. It’s typically diagnosed in children but can be diagnosed in adults too. Some of the events that can be included here are a family move, parents’ divorce or separation, a parent being sent to prison, the loss of a pet or the birth of a sibling, a sudden illness or a restriction to the child’s life due to chronic illness.
The next category is reactive attachment disorder. This can develop if a child’s basic needs for comfort and affection and nurturing aren’t met, and loving and caring and stable attachments with others are not established. There can be many reasons for this; there can be all types of abuse – physical, mental, or sexual abuse, where parents have severe mental health problems, where there’s criminal behaviour or substance abuse that impairs parenting, prolonged separation from parents or other caregivers due to hospitalisation, repeated changes in caregivers due to moving from one foster home to another or through homelessness.
The next category is disinhibited social engagement disorder, or DSED. This has most of the same causes as the previous one, the reactive attachment disorder. The symptoms that occur afterwards are different.
The next is dissociative disorders. There are lots of different subtypes with this one, but one of them relates to bereavement – the trauma of losing a parent or a partner or a friend or a sibling.
Those are the main categories in the DSM-5 relating to trauma. I’ve really focused on the traumatic events or the situations that can then trigger the reaction, but the diagnosis hinges not on the specific event but the aftermath and how this affects someone.
Some of the symptoms that can arise and are then needed as part of a diagnosis are: recurrent involuntary and intrusive distressing memories, dreams, or flashbacks of the event or situation; distress at exposure to internal or external cues that symbolise or resemble the event or situation; persistent avoidance of stimuli associated with the event or situation; negative alterations in cognitions and mood (things like detachment from others, the inability to experience positive emotions, and the persistence of negative trauma-related emotions, so things like fear and horror and anger and guilt and shame); the inability to recall key features of the traumatic event; alterations in arousal and reactivity (things like angry outbursts, hypervigilance, reckless or self-destructive behaviour, substance abuse, suicidal ideation, sleep disturbances); and then persisted or exaggerated negative beliefs or expectations about oneself or others or the world.
So that’s the official definition and diagnosis for the DSM-5. Obviously, I’ve only touched on some of the criteria and some of the symptoms that it covers, but that should give you a bit of an idea of how trauma is thought about from the DSM’s perspective.
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Another way of looking at this – and there is some overlap here – is through the ACE study, where the ACE stands for adverse childhood experiences. This is something I’ve done a whole podcast on before. It’s Episode 85 of the show. It is something I recorded over four years ago, and I’ve learned a lot since then and would love to do an updated version, but it does give an overview of the study and what was found.
As part of it, there are 10 different ACEs, or adverse childhood experiences. They are: physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, mental illness, divorce, substance abuse, violence, and having a relative who’s been sent to prison or jail.
While as part of the ACE study, this was about events happening in childhood, these events happening in adulthood can be just as traumatic.
I also interviewed Irene Lyon on the podcast before, and it was Episode 111. She’s someone who helps people with trauma of all kinds, and she’s written about many of the traumas that don’t show up in the ACE list but are still deeply traumatic. So let me add some of these in as well. There’s near-death experiences. This can be a choking or a near drowning or a high fever or a serious infection or virus, being knocked unconscious, being in a coma, having your heart stop. Anything that puts a human being’s physiology in a state of preparedness for dying and death can be traumatic.
You then have surgery and anaesthesia, premature birth and/or a highly traumatic birth – so being born prematurely and having to be put in an incubator. While it’s easy to think about birth as being something that happened such a long time ago or the child being so young that they can’t remember it, this experience is remembered by the body.
There is then in utero stress, so the stress of the mother can directly impact the kind of stress hormones that the foetus is experiencing. Or there is insufficient food due to either food scarcity or intentional restriction. This can also create a similar change to the hormones that are experienced.
Societal decency and cultural conditioning is another one that Irene mentions. This is thinking of the common concept ‘children should be seen and not heard’ or the British ‘stiff upper lip’. While this sometimes can be seen as benign and maybe even a good idea so that kids are kept in place and they’re not going to get into trouble, it does often come at a high cost when this occurs with a lot of toxic shaming and belittling of the child, or when this messes with a child’s ability to listen to their body. For example, when someone is forced to eat all the food that is on their plate, or the flipside of this, where they’re not allowed food or drink when they say they’re hungry or thirsty.
The final one that she mentions is intergenerational trauma. Many of us are carrying the genetic imprints of war and famine and inconceivable hardships from our ancestors, and if the work hasn’t been done to heal from this trauma – and for many or most people, that just wasn’t even an option – this is then passed on to the next generation.
So those are some of the extra ideas that can be added to the DSM and the ACE list.
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I mentioned at the top that Gabor Maté has had a large impact on my understanding of trauma, so I think it would be useful to share some of the ways that he defines and thinks about trauma. So let me read out some quotes of things he’s said.
“Trauma is not what happens to you; it’s what happens inside you as a result of what happened to you. Trauma can also be not just what happens to you, but what doesn’t happen to you when it should’ve happened to you, when needs aren’t met.
“The origin of the word ‘trauma’ is the Greek for ‘wound’. Trauma is a wound, and then the meaning you make of that wound. Trauma is that scarring that makes you less flexible, more rigid, less feeling, and more defended. Trauma is a psychic wound that hardens you psychologically, that then interferes with your ability to grow and develop. It pains you, and now you’re acting out of pain. It induces fear, and now you’re acting out of fear. So without knowing it, your whole life is regulated by fear and pain, and you’re trying to escape from it in various sways.
“Trauma is about the disconnection from your authentic self, and this can be restored.”
For Gabor, trauma can take many forms which aren’t contained within the definition and diagnostic criteria in the DSM. I should also add that it’s common for people to talk about capital ‘T’ Trauma and little ‘t’ trauma. Capital ‘T’ Trauma is, for example, seeing a friend get shot, and little ‘t’ trauma is, for example, when you were little and you were crying, you were ignored, or any time you did cry, you were told to stop being a baby and to just stop crying.
Despite trying to separate these things out and say that these are supposedly bigger traumas or these are supposedly smaller traumas, because trauma is so much about an internal thing, what’s more important is how the body reacts and then internalises this. You can have people who have been to war and yet have no symptoms of PTSD, and then there are others who have had a parent who was overly critical and this is just devastating for them.
00:17:59
The final thing I want to mention before I move on to looking at the different healing modalities is the idea of so-called destructive behaviours or maladaptive behaviours. In my line of work, I see many clients who have a history of trauma and go on to develop an eating disorder. For Gabor, he worked in Vancouver’s notorious downtown east side. This is North America’s most concentrated area of drug use. In his TED Talk, he makes reference to a quote from Keith Richards from the Rolling Stones, who has been a notorious drug taker. Keith said something to the effect of “It’s amazing the lengths one will go to to have a brief moment of taking away the pain of being oneself.”
In Gabor’s book In the Realm of the Hungry Ghosts, which is all about addiction and largely focused on the decade he had working in downtown east side, he talks about that in every case of those who are living on the streets and taking drugs, they’d all suffered abuse as children and as teenagers, and their drug use, as destructive as it was, had the positive effect of giving them a brief moment of relief.
Another Gabor quote is, “Instead of asking why the addiction, ask why the pain.” There is power in seeing that someone’s coping skills, however disruptive, are something that have a positive intent. This doesn’t mean that we should be oblivious to the harms that it’s causing, but if all we see is someone making a huge mistake and this is something that is 100% bad, we’re really missing the point, and we’re really missing the opportunity to understand why this is happening and why there is this real need in the first place.
In a sense, this is what these healing modalities are about. It’s about dealing with the trauma that is then driving these coping mechanisms.
With all of that as a starting point, let’s look at the different healing modalities. I’m going to start with six of the modalities that Bessel includes detailed chapters on in The Body Keeps the Score as well as one other that he spends a couple of pages on. With some of these, there are connections with other ideas, and I’ll make reference as I go through, and then after that I’ll include some other ideas from other sources.
00:20:27
The first option is EMDR. This stands for eye movement desensitisation and reprocessing. On the surface, this one can sound very woo-woo, and I can understand the scepticism, but EMDR at this point has a huge amount of research to back up its effectiveness.
With EMDR, you work with a trained practitioner. Together, you’ll identify targets for treatment. These are usually past memories or current triggers or future goals. Then during a session, you’re asked to think of one of these targets. So you bring it to mind, and while that’s happening, simultaneously, you are moving your eyes from side to side where you’re following the direction of the practitioner. They have their fingers in front of your face and they’re moving it from side to side, and you follow these fingers with the eyes.
The eye movement has a direct impact on the memory and is intended to change the way that that memory is stored in the brain, thus reducing and eliminating the problematic symptoms. And it’s not just reducing the intensity; the process can also bring up insights about the event or about one’s actions or about behaviours since the event. So it’s making sense of something that has often felt like it doesn’t make sense.
In some cases, EMDR has the ability to reduce the emotion connected to the memory in the session. So you finish the session feeling better than when you started, and then with each session, the intensity of the targeted memory is being reduced and is being processed. In other cases, it takes a less linear trajectory. I’ve had clients who’ve done EMDR where they focused on a past event, and by doing so, new information or memories surfaced, and they then remembered more about the event. While in some cases this does lead to a fairly immediate processing, in others it doesn’t. It can be distressing or lead to more heightened emotional experiences in the short term.
But one of the key features of trauma is the fractured or fragmented nature of how it’s remembered. Rather than it being like a story, where there’s this clear start, middle, and end, it is more a collection of pieces. One of the ways of healing trauma is by having these fragmented pieces come together, and for the blanks to be filled in so that you can then understand the full story so it can be processed. This is what can happen with EMDR. By doing it, you actually start to remember more, and then with time, it allows this to be processed.
With EMDR, you don’t have to share the content of what you’re seeing with the practitioner. So you’re not filling them in on the story as it’s unfolding in your mind; instead, it’s much more about the emotions and the thoughts and the beliefs and the sensations – which I think is helpful to know, especially if it feels too shameful or overwhelming to share the exact details with the practitioner.
I will add that this isn’t always the case. For some practitioners, they do go through the targeted thoughts and memory and the content of what is coming up, or they are a therapist that uses EMDR as well as other methods, so you have sessions that are EMDR-based and others that are non-EMDR-based, or you may have a block of EMDR but you then continue to work with them after this time, often employing other modalities and practices to further support healing.
When seeking out a practitioner, you can ask about this and find out if you’ll need to share the content of what you’re seeing and remembering.
With EMDR, there are 8 phases. This information comes from the American Psychological Association and their page on EMDR. Phase 1 is history taking; Phase 2 is preparing the client; Phase 3 is assessing the target memories; Phases 4 to 7 is processing the memory to adaptive resolution; and then Phase 8 is evaluating treatment results.
Phases 4 to 7, which is the processing the memory to adaptive resolution – the first part of this is desensitisation, which is thinking of the target thought and doing the eye movement. The next part is installation, which is installing a positive cognition. The next phase is a body scan, where you’re checking how this feels now compared to when you first started and if there’s any residual somatic distress, and if there is, you then do further eye movement to continue working on it. Then the final step is closing the session. If the targeted thought or memory was not fully processed in the session, the practitioner then offers specific instructions and techniques to provide containment and ensure safety until the next session.
While there are those for whom it feels like each EMDR session is reducing the reaction to traumatic events, for others it can be messy, and it can be some messiness to get to that place. I want to mention this because EMDR can often be portrayed as this very straight forward thing, and for many clients this just has not been the case. And this isn’t anything against EMDR; I think it is wonderful. It’s just more of an expectation management and people having a realistic sense of what’s involved and what can occur as part of this.
Bessel references research that EMDR tends to do better for trauma that is related to specific events, where there was a traumatic accident or an incident of humiliation or some specific event that feels significant. And it doesn’t have to be just one event; there can be many, but where these are discrete events. If someone’s whole childhood was traumatic because of a narcissistic mother, for example, it may be less effective. But this comment is based on one piece of evidence that Bessel mentions, and I’m not an EMDR expert, so if EMDR does sound like it appeals to you and your trauma is more diffuse, then please do find a practitioner in your area or online and ask them if they think it would be helpful.
Bessel also talks about the connection between EMDR and REM sleep. I actually think this is less about EMDR specifically and more about all trauma processing more generally. Sleep is hugely important for how we make sense of the world; it’s how we tag and catalogue experiences. One of the key features of trauma is having nightmares, and with these nightmares, these aren’t resolved. So rather than the event being processed, it doesn’t, and years and years later the same nightmares are persisting.
EMDR is able to do something to the memory so that when sleep does happen, particularly the REM sleep, the event is finally able to be processed properly. While EMDR and REM both are connected to the movements in the eyes, other healing modalities can still lead to the same changes that allow processing to happen during REM sleep.
EMDR is something I’m a huge advocate of, both because of the amount of research that is supporting it as well as anecdotes from clients I’ve had. Despite my comments that sessions aren’t always pleasant and that things can get a little worse before they get better, EMDR is incredible at allowing someone to deal with a traumatic event without being traumatised. EMDR was also something that I touched on during my interview with Victoria Welsby, so I will link to that episode in the show notes and you can hear about her experience with using it.
So that is the first healing modality, EMDR.
00:28:44
The next modality that Bessel references is yoga. I think I need to preface this because there are many clients who come to me and they are already doing yoga, but yoga for them is hot yoga and is about pushing their body, or yoga is like some other form of exercise, or they have taken on many of the other practices that have become associated with yoga, so they’re vegan or vegetarian or they’re doing detoxes or water fasts. So it’s yoga as a lifestyle or yoga as a way of manipulating their body, and this way is being approached often basically as a tool of the eating disorder.
Yoga for trauma is a healing modality and is very different. One of the effects of trauma is to create a disconnection between yourself and your body, and this isn’t conscious. This is an automatic response of the nervous system, and this response can continue long after the traumatic event. There can be a triggering of this disconnection very regularly, and this can happen irrespective of how positive a current situation may appear on the surface. It can be easy to think it makes sense for this to happen when there’s obvious danger and there’s something that feels very similar to the event that occurred, but for someone who has experienced trauma, everything can appear like a threat.
In The Body Keeps the Score, Bessel gives an example of a client who was molested by her father, and then during the session with Bessel, she had the realisation that now at any point when she’s with someone she loves, she instantly feels the terror of being molested. This betrayal of trust had now robbed her of the ability to experience love without terror also arising. This means that people can live a life of disconnection and of numbness where they’re constantly bracing themselves for some moment or situation that will lead to this unwanted sensory experience that seemingly hits out of nowhere.
One of the areas that is explored in this chapter connected to this is the idea of heart rate variability, or HRV. Your heart rate variability measures the relative balance between the sympathetic and parasympathetic nervous system. In layman’s terms, the sympathetic nervous system is known as the fight and flight and the parasympathetic is known as the relax and digest. There’s these two sides that regulate our ability to be calm and relaxed as well as our ability to deal with a stressor.
Let me quote the book to further explain HRV. “When we inhale, we stimulate our sympathetic nervous system, which results in an increase in heart rate. And when we exhale, we stimulate our parasympathetic nervous system, which decreases the heart rate. In healthy individuals, inhalation and exhalation produces steady, rhythmical fluctuations in the heart rate, so good HRV is a measure of basic wellbeing.”
So with HRV, we’re actually wanting a good degree of variability, meaning the difference between the high and the low or the change between the in breath and the out breath. The reason for this is because it then shows a connection between breathing and heart rate. But for those with PTSD, for example, the opposite happens. There is a very low HRV. Someone with PTSD can have very rapid and shallow breaths, but have a slow heart rate. Or they’re triggered by thinking of a trauma memory and their heart rate can really speed up, way out of sync with their breath, but as time goes on the heart rate falls back down to being slow even though the breath is still rapid.
In simple terms, because I understand that HRV can be a little confusing, in healthy individuals there is a strong connection between breathing and heart rate, and by the actions of the sympathetic and parasympathetic nervous system and how these are connected with each inhale and exhale. For those with PTSD or someone who has experienced trauma, there can be this mismatch between breathing and heart rate and a blunting of the impact of the parasympathetic and sympathetic nervous system connected to in and out breath.
Back to yoga. The reason that yoga can be so helpful for trauma is threefold. One is that it’s about various stretches and poses and allows someone to come back into their body. Two is it’s about breath practices, and it allows the retraining of how to breathe and being aware of one’s breath and retraining that HRV. Three, it’s also about mindfulness, which is the ability to notice sensations of the body – so noticing what is as opposed to the need to disconnect and get out of one’s body.
Its strength really is about self-regulation. The automatic response has been one of disconnection, and for the nervous system to instantly pull the ripcord. What yoga then teaches is an ability to experience the sensations and the discomfort and to stay with it, and relearning how to self-soothe and self-regulate, and learning to listen to the body without fear, and knowing that you can survive whatever feeling is arising.
I’m a huge advocate of intuitive eating, and in a sense, this is what the steps and practices of intuitive eating are about, but with a food perspective. It’s about learning interoceptive awareness, which is hearing what the body is saying. Rather than making food choices from a place of external information or a place of fear, you learn to truly listen to your body – which at first can be scary, but in the end is incredibly liberating. Like yoga, it’s the path back to knowing oneself and real true self-awareness.
I should add that while my focus here and in the book is about yoga, this is simply because it’s the modality that has the most amount of scientific study. There’s no reason to think that other practices that also have this focus on movement and breathing and mindfulness can’t have the same effect. Many practices that fall under the banner of martial arts – aikido or judo or taekwondo or jiujitsu – can have a similar effect, or other slower movement practices, so Taichi or Qigong or Feldenkrais can do the same. Or even something like rhythmical drumming in a circle, which can feel like a very different category to the rest, has the same combination of breathing and movement and mindfulness.
In interviews, I’ve heard Bessel talk about the benefits of all of these things. While they may not have the same scientific studies to back them up right now, I think this is more a matter of the fact that they haven’t been studied.
So that is the second modality for healing trauma, which is yoga for trauma.
00:36:17
The next option is Internal Family Systems, or IFS. I think the name of this one can be a little confusing and actually can put a lot of people off because the word ‘family’ is in the title, and it’s easy to think that this is going to be family therapy, that you’re having sessions with your parents or your siblings. Considering that it’s often these family members that are connected to the trauma, the instant reaction when hearing about Internal Family Systems is to think ‘hell no’. So let me just clarify up front that IFS does not involve any members of your family and is not family therapy.
IFS is about the different parts within you. For example, during a challenging conversation with a partner, there can be a part of you that is angry, there can be a part of you that is scared, there can be a part of you that is loving and nurturing, there can be a part of you that is generous. While these feelings can arise and be thought about as transitory, in IFS each of these parts is seen as an individual that has a rich story, who has wants and needs and has been impacted upon by specific life events.
So the word ‘family’ in IFS is all about these different parts. They are like a family inside of you. If there really was a family member who is angry or scared, you want to get to the root of why this is happening, what is the positive intent with this, rather than just telling them to stop being the way they are. For someone with trauma, certain parts of them get in the way of accessing inner resources and an ability to be resilient in the moment. Instead, certain parts are then able to take over and control the situation.
I should add that one of the central tenets of IFS is that all parts are welcome. All parts were formed in an attempt to protect the system, so even parts that are suicidal or are destructive were created from a place of good intent.
The way that IFS works is with a therapist engaging with all of these various parts, getting to understand their roles, noticing all the different parts that arise in different situations, and either teaching these parts how to react differently or having other parts come in and support this part.
One facet of IFS is it includes aspects that feel similar to Jungian shadow work, where the word ‘Jungian’ refers to Carl Jung, the Swiss psychiatrist and psychoanalyst. Jung talks about our shadows being the parts of ourselves that we have rejected or hidden away or buried deep in our unconscious mind. In IFS, these are known as exiles. The work with this is then to bring these shadows or these exiles out so you can then work with them.
As I was trying to put this part together, I realised just how difficult IFS is to talk about in a short amount of time. I remember when I read the book thinking the same. I remember when I read the chapter, I was just a little confused, and I didn’t really understand it so well. It definitely didn’t jump out at me in the way that EMDR or some of the other modalities did.
But I then heard Richard Schwartz, who is the creator of IFS, on Tim Ferriss’s podcast, and all this really changed. It’s a longform interview with him where the first part is him explaining the background and how IFS came into being, and the second half is him then doing a session with Tim where Tim where Tim is incredibly open and honest, and you get a real sense of what IFS is about.
I have a bit of a love-hate relationship with Tim Ferriss. I’m dubious of many of the nutritional and lifestyle advice that he makes, but in recent years I’ve been really impressed with the many things that he has done – disclosing about his own childhood abuse, talking about the things that he’s done to help with this in terms of various therapies he’s been trying, putting a huge amount of his own money into psychedelic research. This interview and the session that he does with Richard Schwartz is incredible and was invaluable in helping me to fully understand what IFS is.
I will link to that interview in the show notes, but if you Google ‘Richard Schwartz and Tim Ferriss’ or ‘IFS and Tim Ferriss’, it is the first link that comes up. So that is Internal Family Systems, or IFS.
00:41:06
The next healing modality is called PBSP psychomotor therapy. The PBSP stands for Albert Pesso and Diane Boyden Pesso, who are the two people who developed this back in the 1960s. There are two parts to this, known as micro tracking and structures. In fact, it’s often just called ‘structures’, which is a much shorter and less clunky name, so from here on I’ll just refer to it as structures as well, and I’ll point out when I’m referring to the micro tracking part.
Structures actually feels like a combination of a couple of other trauma healing modalities. It’s like IFS, which I just talked about, in terms of different parts, but in these parts with structures it’s referring to actual different people in someone’s life. It’s then combined with a form of therapy that I haven’t referred to yet, which is communal theatre.
Micro tracking and structures is done in a group environment. As part of the group, a participant is then picked and is asked to talk about a troubling or a traumatic event from their past. To start with, as they talk about the event, the therapist will then pause the participant as they are going through and they’ll tell them what they’re noticing. For example – and this was taken from The Body Keeps the Score – the therapist may say, “A witness can see how crestfallen you are when you talk about your father disowning your family.” This is the micro tracking. It’s noticing the subtle shifts in body posture, in facial expression, in tone of voice, in eye gaze and nonverbal expression. It’s validating someone’s experience, and doing so with real exquisite precision based on the cues that the body is giving you.
As Bessel comments in the book, each time the participant hears these witness statements, their face and their body relax a bit, and they felt comforted being seen and being validated. It gave them a strength to go on and to go deeper and keep talking about the experience.
The second part relates to the structures. As the participant tells their story, various people arise. It could be a father, a mother, an aunt, an ex-boyfriend, or whoever is part of the story. Let’s say it is a father, and this father has been verbally abusive to the participant’s mother. I’m going to use this as an example as we go through this. The participant is then asked to pick someone from within the group to come up and play the role of their real father. And remember, as I said, this is done in a group setting, so there’s lots of people there, and they pick someone who they think can play the role of their real father.
Then they are able to confront their real father and say the things or ask the questions that they’d always wanted to be able to but were too scared to do so. Again, there is then pausing with this often for the therapist to make witness statements about what they’re noticing in the participant’s body language or the tone of voice or whatever it is, and also being able to inquire into their inner experience and what they’re thinking and feeling and noticing.
For example, the participant is finally able to stand up to her father and tell him that he’s being mean or he’s being a bully, and the therapist can then witness how strong and fierce they’re being and that the mother would see the courage that they’re expressing. Then the therapist invites the participant to select another person from the audience to play the role of the mother, but this time, instead of the real mother, it is the role of the ideal mother – the way she wished her mother could’ve acted. The participant then gets to direct the ideal mother and what she wishes she could’ve done and what could’ve happened. Again, there are statements and feedback by the therapist about what they’re witnessing.
And then the participant is asked to pick another person to play the role of their ideal father. This person then is interacted with in a way that they wish they could’ve with their ideal father, and the father is instructed to interact with the other in the way that they wanted that to happen.
This process is role play. However silly it may sound, it’s incredibly helpful, and it allows someone to tell their full story rather than just snippets. As I mentioned earlier, part of the healing with trauma is having a start, middle, and end rather than the fragments. It also helps them to create new stories or narratives that sit beside or next to this painful memory of what happened. In a similar way to EMDR, it alters the impact of the memory and how it’s thought about. Rather than being shameful and debilitating, someone feels that they have more strength or mastery or safety or connection. It demonstrates the power and importance of imagination and how these can really transform our inner world.
This is similar to people who have been subject to a mugging and going and doing a class that deals directly with this, but where they’re able to beat off the mugger and have a very different experience to what happened the first time around. It shifts their feeling of agency and the shame connected to the event. Structures is similar to this, but obviously a lot more elaborate and with all the micro tracking and all the other stuff I’ve talked about.
So that is micro tracking and structures, with a reminder that the formal name of this is PBSP psychomotor therapy.
00:46:59
The next modality is neurofeedback. Of all the modalities I’m going to cover, this for me is the one that feels the most futuristic or science fiction like, or at least the kind of science fiction written in the 1950s.
Neurofeedback works by impacting on our brain waves. Brain waves are produced by synchronized electrical impulses from masses of neurons communicating with each other. I found an analogy for thinking about brain waves on a site called BrainWorks: “Brain waves are best thought of as a continuous spectrum of consciousness; from slow, loud and functional to fast, subtle, and complex. It’s a handy analogy to think of brain waves as musical notes. The low frequency waves are like a deeply penetrating drumbeat while the higher frequency waves are like a subtle high-pitched flute. Like a symphony, the higher and low frequencies link and cohere with each other through harmonics.”
It’s this idea of thinking about brain waves as an orchestra and playing in unison that is key. In The Body Keeps the Score, Bessel references a study done in 2000 looking at normal subjects versus those who’d suffered with PTSD. They used a test called the Oddball Paradigm where subjects are connected to an EEG, which traces their brain waves. Then they’re shown a series of objects, and they have to detect the odd one out. When they’re doing this, I should note that none of the objects or the images that they’re shown are related to the trauma. This is items that are non-triggering.
For the normal individuals, shortly after seeing the series of items, their brain waves start to organise and synchronize, which is what helps them to discern the information and make sense of which is the odd one out. But for those with PTSD, there is less coordination and organisation. The brain has more trouble filtering out irrelevant information and has trouble attending to the problem at hand.
This points to one of the big problems with trauma in that it’s not just an issue when someone is experiencing something that is re-traumatising or triggering. It has an impact on how the brain constantly functions. But the dysregulation of the brain waves isn’t permanent and immutable. This is the role of neurofeedback.
The way that it works is that in a session, you are connected to a neurofeedback device. These are a hat that has electrodes that are attached to your hat, and these can then be moved to different locations depending on what regions or areas are being targeted. The neurofeedback machine is then able to change the brain wave frequencies that a person is experiencing. When this has shifted, they get to feel what that shift feels like and are able to see that they think about situations differently.
In the book, Bessel talks about a lady called Lisa. She was someone whose father had left when she was three years old, and then she was abused and tortured by her psychotic mother. At age 12 she ran away and then spent time in various mental hospitals, foster homes, and was also living on the streets. She understandably had huge amounts of symptoms connected to these horrible experiences. She would attack herself or attack her environment or the surroundings she was in, but she would do it in a blacked-out state so that afterwards, she couldn’t remember what happened. She couldn’t sleep. Any time she tried to talk about her childhood, she’d have a breakdown. She was jumpy and nervous, and even when in a room with someone she could trust, she just couldn’t relax. She was just waiting for something to happen. She couldn’t even recognize herself in a mirror.
For Lisa, the neurofeedback sessions were about giving her more coherent brain patterns in the area of the brain that is connected to fear. Within a couple of weeks, she noticed she was less uptight. Then with more time using it, she noticed that she’d stopped disassociating. Then as she had more time, she had a more continuous sense of self. She was able to start talking about her upbringing. She said she then reached a point where she was finally able to do therapy. As Bessel states, she went from someone who was in the depths of despair and confusion to a place of clarity and focus.
There’s an often-repeated phrase that ‘cells that fire together, wire together’. In this sense, the brain has learned to behave in a certain way and simply habituated. What neurofeedback does is lets someone experience a different kind of firing together. By doing this repeatedly, this new way becomes wired together and the default, which has the knock-on effect of changing someone’s reaction and perceptions to a situation, but also the choices they then make when certain situations arise.
Something that can also be done as part of the neurofeedback is to show the participant the pattern of the brain waves during the session, so they can see what it’s like before the machine is turned on and then what happens once the neurofeedback starts modulating their brain waves.
Let me quote Bessel on this: “Our patients find it very helpful to be able to see the patterns of localized electrical activity in their brains. We can show them the patterns that seem to be responsible for their difficulty focusing or their lack of emotional control. They can see why different brain areas need to be trained to generate different frequencies and communication patterns. These explanations help them shift from self-blaming attempts to control their behaviours to learning to process information differently.”
I should also add that this is a modality that has scope way beyond trauma. For example, the AC Milan football team use neurofeedback with its players, helping them to stay relaxed while they watch footage of their errors, and the next year they won the Champions League and many of the members of the Italian National side then went on to win the 2006 World Cup. Britain’s Royal College of Music has also used it with its students, and it’s improved their performances. So while the focus, obviously, this episode is all about trauma, I do see neurofeedback is something that could be widely beneficial for many different areas of life.
One thing I do want to add – and this is somewhat speculative, as neurofeedback isn’t something I have personal experience with, and I have very limited client experience with, but it’s connected to the importance of trust. For someone who has a history of trauma, there would still need to be a really good level of trust with the therapist who is performing neurofeedback.
I’ve previously done an episode on polyvagal theory when I chatted with Deb Dana. It’s Episode 233; I’ll link to it in the show notes. If you haven’t listened to it, I’ll give you a very brief description of polyvagal theory now.
What polyvagal theory looks at is the autonomic nervous system, which is the part of the nervous system that is outside of our conscious control. There are three places that you can be as part of this. One is called ventral vagal, but it’s easier remembering this as called ‘safe and social’. This is where we are calm and we’re able to engage with ourselves and others from a positive and relaxed place. The next is sympathetic or more commonly known as fight or flight or stressed. Deb often calls it ‘mobilised’. In this place, we’re more attuned to danger signals and are preparing to react or we are reacting. And then the final place is dorsal vagal, or shutdown. This is more of a place of apathy and hopelessness.
Depending on where your nervous system is on this continuum, certain thoughts or feelings will naturally arise. So if you are in a state of safe and social, there are thoughts and ideas and emotions that naturally arise, and they are consistent with this state.
Given these descriptions, it may sound like getting into safe and social would be highly pleasurable, and that when someone can return here, they love it and they instantly want to keep doing things to keep themselves there. But for someone who spends 90% of their time in fight and flight, entering into safe and social doesn’t instantly feel good. It can feel odd or even discombobulating. This place can feel threatening. It can take time to have this change feel like a place they want to stay, and this can be a gradual process.
What I’m speculating is the same may be true with neurofeedback – that going into a supposedly calmer wavelength may not instantly feel better. It may feel odd. It may feel unsafe. So having a therapist that you trust and who creates the right environment is going to be really important.
As I said, this is simply a speculation based on what I’ve noticed with polyvagal theory, so if you are someone who is a neurofeedback practitioner or you have experienced it yourself, I would love to hear your feedback. You can email me at info@seven-health.com.
The final thing I want to mention before moving on to the next modality is that my recent conversation with Sasha Gorrell, towards the end of it she actually referenced something similar to neurofeedback called repetitive transcranial magnetic stimulation (RTMS). It’s a machine that can stimulate different parts of the brain and has been shown to be useful in the treatment of depression. I don’t know about its use with trauma, but given the similarities, it wouldn’t surprise me if it was also effective.
00:57:02
The next modality is somatic experiencing. Bessel doesn’t dedicate a whole chapter to this but does spend a couple of pages going into it, and I’ve also heard him talk about it in other interviews, so I want to cover it here.
Somatic experiencing was developed by Peter Levine and is covered in his book Waking the Tiger. This therapy works on the principle that trauma gets trapped in the body, leading to some of the symptoms that people with PTSD or people who’ve experienced trauma might experience. The aim for practitioners working this way is to help the person release the stress from the body.
As Bessel says, in this approach the story of what happens takes a backseat to exploring the physical sensations and discovering the location and the shape of the imprints of the past trauma on the body. So there is this focus then on becoming more in touch with the subtleties of the internal experience, kind of like the micro tracking that I already talked about, but where this is an internal thing, or where someone is becoming much more aware of the real subtle shifts.
Before dealing with the trauma itself, patients are helped to build up the internal recognition and the internal resources that then foster a safe access of the sensations and emotions that have overwhelmed them in the past or overwhelmed them at the time of the trauma. Then, in a pendulum type fashion, they can start to move in and out of accessing those internal sensations and the traumatic memories and doing this where they gradually expand the window of tolerance.
Somatic experiencing practitioners can use a framework known as SIBAM. This stands for sensation, imagery, behaviour, affect, and meaning. This feels like a combination of internal noticing combined with the input of the practitioner, in a similar way to micro tracking.
As I mentioned earlier, part of the somatic experiencing is the idea that trauma gets trapped in the body. For example, during an attack, someone enters into the freeze response, so they couldn’t fight back. In the wild, an animal may enter into the freeze response, and this is a state of attentive immobility. It serves to avoid detection by a predator and to then also enhance perception. If this works and the predator then moves on, to help the animal move out of this freeze response, they shake their whole body and/or they run. Upon completion of this physical release of the shaking and the running, they then quickly return back to their normal state. So they in a sense have released the trauma.
But for humans, so often this freeze response doesn’t have a successful completion. Not only does the trauma of the attack, for example, take place while they’re still in that freeze response, once it’s over, there is no discharging. So the trauma gets lodged in the body.
One of the features when doing somatic experiencing work is that at some point there are these powerful tendencies to want to physically move the body – to want to hit, to push, to run. By allowing someone to make these changes or these actions, it then helps to complete the stress cycle so they can experience the trauma in the present, where they’re then able to restore their agency and actively protect themselves or defend themselves.
This final part, this taking action and completing the cycle, is where there can be, as I mentioned earlier, that practice class for muggings – someone who has never been mugged can learn to stay out of that freeze response in these situations, but equally, it can be important for people who have been a victim of this kind of event because they’re then able to play out a different outcome where they’re able to complete the cycle. But obviously, with somatic experiencing, there’s a lot more that goes into it before you reach this final point, and it’s about guiding someone back into that internal awareness and that interoceptive awareness of being in their body.
01:01:29
The next area, and this is the final area that Bessel covers, is communal and rhythms and theatre. This is less a specific practice like EMDR and is more a collection of methods that fall under the banner of communal acting and singing. I think the best way to address this is to go through a number of the examples and explanations that Bessel gives in the chapter.
One of the reasons that acting can be so helpful is it gives a person an ability and an opportunity to play a character that is not themselves. So even though they may be timid and shy, they have the ability to play someone who is extroverted and confident. Or even though they’re someone who is easily enraged and likely to lash out, they can play a character who is vulnerable and tender and able to sit with difficult emotions. They get to embody it and feel what it’s like to act and feel differently. Much like neurofeedback, once you do this long enough, you can notice there are different ways to be, and that you’ve got to feel what it’s like to have this difference and have that happen.
There can be a benefit as well to being in unison with another person. Bessel talks about the role of dance and group singing and military drilling to create ‘muscular bonding’. There is something healing about being in unison with another person. This could be with ballroom dancing or tango dancing; it could be in unison because you’re in choral or choir singing; it could be because of military marching or being part of a marching band. It can allow you to feel supported and part of something bigger than yourself.
And physiologically, there’s something healing about being in tune and in accordance with other people. My wife, Ali, goes to a local community choir every Saturday, and when we lived in London, she had a number of different singing groups that she was part of over the years. For her, this is amazingly healing. There’s the warmth that comes from singing with other people; there’s also the feeling part of a community, that they get to laugh together, to eat cake together, to talk together. It’s not just the singing. And it’s much more than just the singing. It’s that kind of thing where the whole is greater than the sum of the parts.
Theatre can be a way of learning to trust others and to change habits, but in a safe environment. Bessel gives the example of a theatre company that works with troubled teenagers and burnt-out military vets. These are people who are easily triggered, so the director starts by having them walk around and look at the floor. Then he asks them to start noticing one another, but doing so very subtly and not letting other people notice that they’re noticing. He then asks them to make eye contact, but to do it for just one second. Then he gets them to make eye contact and hold it, but not for too long. He says, “You’ll know when it’s too long because you’ll either want to start dating the person or start fighting them.”
He points out that these people have trouble making eye contact in their everyday life, and this is providing a safe environment for them to relearn how to do this. And when they get it wrong, it’s likely that it ends in laughter. Another exercise they do is being blindfolded and then led around by another participant. This is something that helps to build trust, and outside of this environment they’d never be able to do it.
Bessel talks about a company called Urban Improv that works with kids and teenagers. This is where they do skits connected to situations and issues that are relevant to them – exclusion from peer groups, jealousy, rivalry and anger, family strife, dating, STDs, homophobia, peer violence. Because of the props and the costumes and being told to play a certain role, these kids get to act in ways that they never normally would. They also stop scenes halfway through and have a discussion about it.
There’s an example where there are scenes in which someone is in physical danger, and the kids would all side with the aggressors because any sign of weakness cannot be tolerated, whether this is with themselves or others. But the company was able to get the students to, reluctantly at first, try out new roles and to try out what it’s like to be in this other role. As the programme went on, more and more of the students were volunteering for the parts that involved showing vulnerability or showing fear.
This programme has a knock-on effect that outside of improv, there are changes. In the classroom at school, there were fewer fights and angry outbursts. There was more cooperation and more attentiveness. There was more engagement in the classroom.
Another example that Bessel gives is the Possibility Project. This is a group that works with foster care youth. Understandably, they have great difficulty trusting due to abandonment. They’re kids who needed to be independent because they knew they were the only ones who were looking out for themselves. What this project is about is teaching them to work with others, to trust, and how to be interdependent. Over the period of nine months, they meet for three hours a week and they write a full-length musical. Then they have to perform it in front of several hundred people.
Another example is Shakespeare in the Court, where kids who are young offenders learn the plays of Shakespeare and then perform them in front of family and friends and representatives of the juvenile justice system. Using the experience of acting and the lines of dialogue, they’re able to explore emotions and how they feel.
Really, this collection of methods for helping trauma, from my perspective, is about three things. One, it is about experiencing other ways of being and doing this in a safe environment. When you do this enough, you can start to break out of the rigidity and automaticity that is such a hallmark of trauma.
Two, it’s about the healing of others. This is similar to the idea of co-regulation, where you notice how the actions of others impact on your nervous system, which can occur when you’re playing opposite someone, say in a scene for a play, or where you’re in unison with others in a choir, or in unison with someone while you’re dancing. In all of these instances, the connection with other humans elevates the nervous system.
Three, there is a sense of achievement. When I read through all of these examples in the book, I couldn’t help but notice how incredible it must feel for these participants that they worked on these projects. To notice that their acting is improving, to feel how all their voices are now coming together like an orchestra or like a choir. Getting to act out a play or a skit that you wrote yourself, or understanding Shakespeare for the first time and being able to present this on stage.
Hopelessness is such a common feature of trauma, and in many cases lives unravel and completely fall apart because of it, so to have this arena where things are actually improving and you’re able to be in the moment with other people – this is huge, and I can see how this would then have a cascade effect01:09:17 on other areas of life.
Those were the ideas that Bessel covered in The Body Keeps the Score. What I’d like to do is add in some extra suggestions.
01:09:17
The first is exposure therapy. This is a form of therapy that helps someone to confront their fears and their anxiety and the trauma that has happened. I have actually done a whole previous podcast episode on this where I interviewed a listener who had reached out to me. She had 10 to 12 weeks of exposure therapy as part of a trial; she had been raped as a teenager and had tried to ignore this experience, but decades later she was having nightmares and flashbacks, and she decided this was something she wanted to deal with.
As part of her therapy, there was going back through the events where she’d have to tell the story over and over again, and with each time she was adding in more and more detail as she remembered more. She would have to go to the places where this event had happened. To start with, she did this in her mind in practice, and then with time she did this in real life. She also looked at the beliefs that had been created connected to the events – the beliefs about herself, about the role she played, about her attacker.
It connects with something I’ve said numerous times, which is the fragmented aspect of trauma. Through all these different aspects of exposure therapy, she was able to have a full story that had a start, middle, and end, and this allowed the processing to happen. I think the interview was a great example of what prolonged exposure therapy looks like. It’s Episode 238, and I’ll add it to the show notes.
Something that wasn’t part of her therapy but is another form of exposure therapy is virtual reality exposure therapy. Honestly, this wasn’t something I was aware of until I started putting together this episode, so I have no personal experience or client experience with it, but what VR does is allows someone to confront a feared situation or location that they may not be safe encountering again in real life, like going back to a battlefield. This style of therapy then falls under the bracket of exposure therapy, but I hadn’t covered it in the podcast, so I just wanted to mention it here.
01:11:33
The next option is psychedelic therapy. This one is a bit of a grey area, and I say a grey area because it’s something that is still becoming legal. Psychedelics are a class of hallucinogenic or psychoactive drugs whose primary effect is to trigger non-ordinary states of consciousness. These substances alter perception and mood and sense of time and emotions and affect numerous cognitive processes.
Psychedelics include LSD and psilocybin, mescaline, ayahuasca, and DMT. MDMA, which is officially considered an empathogen rather than a psychedelic, and ketamine, which is officially considered a dissociative rather than a psychedelic, also do get lumped into this same psychedelic category when we’re talking about psychedelic therapy because both MDMA and ketamine are substances that are used in a similar way.
At the moment, psychedelics are having a renaissance. A lot of them were outlawed back in the 1960s, but they’re now making their way back into science and into medicine, and there are many trials that are going on at the moment. It looks like these substances will once again be used legally in therapy like they had prior to the ban.
Psychedelic therapy is more than just about taking the substances. It’s done in conjunction with therapy that helps someone to prepare for the psychedelic experience as well as to integrate the experience. Or in the case of something like MDMA, you do the therapy session while you’re on the substance.
If you’re a regular listener, you’ll know I’ve done a number of episodes on psychedelic therapy, interviewing researchers who are involved with the trials with these substances. There’s Episode 188 with Will Siu, Episode 198 with Natalie Gukasyan, and Episode 240 with Adele Lafrance. I’ll include all of these in the show notes.
Michael Pollan wrote an incredible book called How to Change Your Mind all about psychedelics and the resurgence in the research around it, so if you’re interested, I suggest checking it out. Gabor is a proponent of them, which he talks about in a great interview on Tim Ferriss’s podcast. There’s also a scene in a documentary all about Gabor called The Wisdom of Trauma in which he’s doing MDMA-assisted therapy with a patient. There’s also a fantastic documentary called Trip of Compassion that shows footage of three different people undergoing MDMA-assisted therapy and really demonstrates what the process looks like. I’ll have included all of those links in the show notes for each of those.
01:14:24
Another suggestion would be the Hoffman Process. This is a week-long process that works on the basis that, to quote their site, “an intense, condensed experimental programme can speed up someone’s healing journey and is considerably less time-consuming than months or years or traditional one session a week therapy.”
It’s hard to describe the Hoffman Process because it’s best to know little going into it so you have no expectations. This means that for people who do or have done the process, they are fairly vague about what happens as part of it. I’ve had a number of friends who’ve done it, but they haven’t told me much about it. I’ve also heard people like Gabor talk about it, but again, going into very little detail – just saying that he feels it’s beneficial. The same thing with Dr Andrew Huberman talking about how helpful it was for him, even a decade after, but again, being fairly vague about what is involved.
There’s a thing called the Landmark Forum, which is another one I kind of put in the same category. This is over three days instead of seven. I’ve also heard Gabor talk about its usefulness. So both the Hoffman Process and the Landmark Forum, I’m being rather vague on because I don’t know a lot of the details about them, and I think that’s the way it’s meant to be so you aren’t aware of what to expect.
01:15:50
Another option is hypnotherapy. When you’re hypnotised, you’re in a trance-like state, and although this state appears similar to sleep, you are fully awake and aware of what is going on around you. While in this trance-like state, the therapist can then help you safely access memories to better understand the emotions surrounding your trauma.
Sometimes hypnosis can involve combining access to traumatic memories with positive restructuring of these memories, or simply providing suggestions for positive change. For example, on one site I found talking about trauma-informed hypnotherapy, they mentioned it could help with activating the mind’s inner healing state, building tools for resilience in the face of adversity, self-soothing when faced with troubling situations, helping with reprocessing traumatic memories, and how to look towards the future with hope for positive change.
01:16:53
Another option is inner child work. Rather than being a distinct therapy, this can actually use many of the modalities that I’ve already reference. The point of inner child work, as the name would suggest, is to get in touch with your inner child. There were things that happened to you or I when we were 5 or 15 in which we were hurt in some way. We might not remember exactly what happened; we might not even remember exactly who was there, but we remember something about it. We remember the feeling of shame, perhaps the tears rolling down our face or how we reacted in the moment.
What happened with that reaction in the moment then shows up as an adult. Something can trigger us as an adult, and that hurt that we experienced when we were 5 or 15 rises to the surface, and we act as if we were back in that place. We are trying to protect our 5-year-old or 15-year-old self.
So it is about getting in contact with the inner child and working through those past experiences. This is done by using elements or parts from attachment therapy and somatic experiencing and Internal Family Systems and EMDR and polyvagal theory, which I’ve already talked about.
So those are the main healing modalities that I wanted to go through. But these aren’t the only things that you can do. There are many smaller practices that can help with trauma. These can be done alongside one of these other methods or could be done independently. Many can be thought of as ways of learning how to see and experience things differently, or as ways of modulating the nervous system when it becomes over-aroused – ways that are more constructive and come with less destruction or collateral damage.
01:18:49
The first is breathwork, which I’ve already referenced in its connection to yoga or other movement and breathing practices, but here it’s just breathwork on its own. This can take many forms.
It can be diaphragmatic breathing, which is really belly breathing. This can be done by placing one hand on the belly and one on the upper chest, and you can be seated or lying down, and then you can take breaths where you’re conscious of the rise and the fall of the abdomen.
It can be box breathing, where you have breathe in, hold, breathe out, hold. You can start where for each of these, you do it for four seconds, so you breathe in for four, you hold for four, you breathe out for four, you hold for four. Then over the space of 5 or 10 minutes, you slowly increase it, so it goes from 4 seconds to 6 seconds to 10 seconds to 15 seconds, however long you can start to increase it. You can do this also as triangle breathing, so breathe in, hold, breathe out. It’s the exact same as box breathing but you don’t have the hold after the out breath. You can have it where you have extended out breath. So you breathe in for 5 seconds, you breathe out for 10 seconds.
Really, there are many different options with this, but the point is about bringing you back into the present where you’re intentionally regulating a system with breathing that has a massive impact on the nervous system.
Another idea is called dropping the anchor. This is something I first read about in Russ Harris’s The Happiness Trap, which is all about acceptance and commitment therapy. Dropping the anchor is about the acronym ACE. A stands for acknowledge your thoughts and feelings; C stands for come back into your body; and E is for engage in what you’re doing.
As I mentioned earlier, disassociation can be something that happens because of trauma, so you’re disconnected from the body or the current situation. Someone can also be triggered where they get trapped in their head, so they’re thinking and ruminating. This can be about past events or future worries. The nervous system is creating certain thoughts and feelings because of where you are on the polyvagal ladder, and you’re just being swept up in this stuff.
So dropping the anchor is a way of coming back into the present moment. It’s acknowledging that there are these thoughts and feelings that are going on, so it’s not about denial, but it’s then taking some agency to do something. It’s then about doing things that bring you back into the present – noticing five things that you can see in the room or in the environment that you’re in, noticing different sounds in your immediate environment, noticing smells, getting you to clench and unclench your fists or push your feet into the floor or straighten your sitting or standing position and becoming aware of your physical body.
It’s doing these things to then become connected to your senses that then brings you back into the present moment. After you’ve done this for 5 minutes or 8 minutes or however long, you then work out, “What is the next step? How can I now use this presence to deal with whatever is at hand or then be able to put the thoughts and the rumination to the side so I can get on with what I need to get on with?”
Russ Harris has done recordings of dropping the anchor. There’s four of them. They range from 40 seconds to 11 minutes, and I’ll add them to the show notes. You can then listen to them as an initial starting guide, and then with time you may get to a place where you’re like “I don’t need to listen to them.”
In a similar vein to dropping the anchor, there is the acronym of RAIN, which I’ve learnt from Tara Brach. The R is recognise what is happening, the A is allow for the experience to be just as it is, the I is investigate with interesting care, and then N is nurture with self-compassion. Like dropping the anchor, this is a practice of mindfulness where you become aware of your internal experience without trying to silence it or ignore it or disassociate from it, where you learn to tolerate it through taking an approach of openness and curiosity.
This is very much a practice where the more that you do it, the more you’re able to do it. Really, this is about mindfulness, whether that is meditation or acceptance and commitment therapy; all forms of mindfulness can be helpful with trauma.
Tara Brach has done many meditations, and she’s got quite a few on RAIN as well. I’ll link to one of the RAIN meditations in the show notes. She has a beautiful voice for meditation and cadence for meditation, and over the 20 minutes of the meditation, I can feel myself shift as I hear her guide me through the process.
Another tool that can be used is a category that Bessel labels as ‘sensory integrations’. These are external structures and materials that can have a calming influence on the nervous system. They are a cloth swing that you can hang from the ceiling or a tree branch, kind of like a hammock, but where it envelops you and it wraps and pushes on the skin, or you can have a huge ball pit and the sensation of the balls pushing on the skin, or a weighted blanket and the pressure this puts on the body and how this affects the nervous system. These sensory integrations can have a calming effect.
When this kind of sensory work involves a second human being, we call it body work, and this is another suggestion. Getting a massage or craniosacral therapy or Bowen therapy or acupuncture or doing Feldenkrais where someone is attuning to your body and helping you pay attention to the micromovements and the subtleties of these changes.
These can all, when done correctly and with someone who is trauma trained informed, allow someone to come back into their body – for the body to relax and get relief from the physical burdens that are generated by the trauma, but also for someone’s mind to learn to relax and to learn how to trust another human being, especially during an act that can be so vulnerable and bring up so many connections to trauma.
Another option to help is writing. This can be journalling, expressive writing, stream of consciousness, short stories, poetry. Writing can help make sense of what happened or the thoughts and feelings connected to what happened. In my interview with Denise Bossarte (Episode 242), she talks about many of the things that she did as part of her healing from abuse that she suffered as a child, and writing poetry was one of these things.
The psychologist James Pennebaker has been looking into the power of writing for many decades and is referenced in The Body Keeps the Score. Pennebaker has written a number of books all about writing to heal from trauma and the power of expressive writing. So if you’re wanting some direction on this, I’d suggest checking out his books, and I’ll link to his Amazon page in the show notes.
Just like writing can be helpful, so can other forms of creative expression. There is both art therapy for trauma and music therapy for trauma. I’ve already touched on some parts of music therapy, looking at things like singing groups or rhythmical drumming circles or being part of a marching band, but it can also be a solo project where a therapist helps someone to create music as a way of expressing emotions, or by listening to certain music and looking at the imagery or the emotions or the subconscious feelings that then come up.
With art therapy, it can be a way of accessing memories or experiences but without having to talk about them. Or the talking part comes later on, but first there is the process through which the art is made and where the expression of emotion is done in this form. The act of actually creating the art – the using of the hands, the touching of the clay, the holding of the paintbrush – also helps someone to move back into their body, but in a safer way because there’s a task at hand. This can allow someone to access trauma while also staying in the present and knowing that this event is in the past.
But in both cases, with art therapy and music therapy, you want to be working with someone who is specifically trained for dealing with trauma or with PTSD. You want to make sure that that is their background.
Another idea would be the healing power of support groups, so going to meetings and hearing the stories and witnessing others who have suffered in the same way that you have. Again, in the Denise Bossarte episode, she talked about how helpful it was finding support groups connected to incest and how this helped her feel less alone and helped her understand other people’s experience connected to this.
This also connects with the work of Brené Brown around shame. She talks about shame needing three things to grow: secrecy, silence, and judgment. Being in a group setting where you are sharing your story and you’re hearing the stories of others can help with all of these. It may not reduce the PTSD, for example, but it can definitely reduce the shame connected to it.
Self-compassion would be another suggestion, particularly the work of people like Kristin Neff and Tara Brach and Paul Gilbert. I would say that many humans can struggle with being self-compassionate, but with the clients that I’ve worked with who have experienced trauma, it’s an even greater struggle. In my episode with Beverly Engel, which is Episode 227, we talk about her book, It Wasn’t Your Fault, where the subtitle is ‘Freeing Yourself From the Shame of Childhood Abuse with the Power of Self-Compassion’. Beverly has written many books all about recovering from abuse, and at the heart of them is the idea of compassion and how important it is.
Really, I like her approach with compassion because it’s for someone who has come from a background of abuse and with helping other people who have that as part of their story. It deals with many things that can arise because of this specific context. Where much of the more general self-compassion content can be just that – more general – this is specific in its approach. Again, I will link to both that book and our episode in the show notes.
The next suggestion is nature and the healing power of the natural world. This can be done in a very structured way or in a much more diffuse way that works in healing through repeatedly being in nature.
An example of a structured way is whitewater rafting trips that are done with veterans. They do a four-day whitewater rafting trip, and part of the healing comes from reconnecting with their power – being able to complete something like this, and possibly connected to my earlier comments about somatic experiencing, where they feel stressed and fearful as they’re going through these rapids, but they’re able to then move their body and be productive and escape this danger and see that they’re able to make it out the other side and help them have a different experience than the one they had previously.
But a big part of this as well is actually the emotion of awe and being in an environment that triggers this feeling of awe and the positive impact that this has on their sense of wellbeing. The research also seems to indicate with this that this emotion is contagious, so the other people in the raft feeling of awe then affects everyone else. I’ll link in the show notes to the article that talks about this research with the rafting trips.
While it’s not the exact same as the rafting trips, this idea of the healing power of nature makes me think of the documentary My Octopus Teacher. It’s a documentarian who was hitting a wall; he’d hit a mid-life crisis of sorts, so he returns home to South Africa and he starts swimming in the sea each day, and at some point he discovers an octopus. The next day, he goes back and it’s there again. So he starts to film this, and over the course of a year, he develops this relationship with this octopus, as strange as this may sound. You get to see and hear as the documentary goes on just how healing this experience is for him and what he learns through the natural world. I think it’s a great documentary, and I’ll add it to the show notes.
My Octopus Teacher is an example of a more diffuse experience of nature – something that happens over time. But this also could be something much more mundane than swimming with an octopus. It could be doing a garden, whether that is a vegetable patch or creating an ornate Japanese garden. Gardening, for example, can be a tool of teaching you to be in the present moment – again, being in the present, getting back into your body, to be able to use the body in a productive way, to be able to see the seasons of nature, much like the seasons of life, to be grounded and calmed by the natural world.
I’ve heard and read interviews with astronauts who’ve spent time in space, and seeing the Earth from a distance as this big blue ball is a profound experience, and it dramatically changes how they see the world and think about their own struggles and the struggles of the world. I don’t think that you need to go to space for this to happen. The same can happen by spending time in nature. Being somewhere where you’re seeing an incredible vista or lying on the ground and looking at the stars or swimming in a lake that is in the middle of nowhere – it’s probably the same emotion of awe that I mentioned earlier that is happening in these instances as well, and why these can be so healing.
The final suggestion is healthy and supportive relationships. This is not going to erase the trauma or be a substitute for any of the other modalities that I talked about earlier on, but having healthy relationships where you are loved for who you are, and by someone who is well-regulated, can make a huge difference.
This can be a partner, but it can also be a parental relationship too. Gabor talks about this in two of his books specifically. One is called Scattered Minds, which is all about ADD but I think is about so much more than just this, and I think is completely relevant for all parents to read, not just those who have kids with ADD or have ADD themselves. The other book is called Hold On to Your Kids, which is another one that he’s written. These cover the role of parents or guardians and the role they can play in regulating a child’s nervous system through attunement and attachment.
If someone isn’t going to have a parent or a guardian, finding a teacher or a mentor or someone who can provide part of this role – this role of being caring, of helping someone be seen, of someone believing in them – the difference this can make in someone’s experience is huge.
01:35:14
So those are all the additional ideas that can be helpful on top of the other modalities that I talked about, and is really everything I wanted to cover today. Undoubtedly, I have missed out ideas or suggestions. This is by no means a comprehensive dive into every possible method for dealing with trauma. But hopefully you found the episode useful, and if you’re looking for trauma therapy, you have a better idea of many of the options that are available.
Obviously, trauma is a single word that describes a wide array of experiences, and based on these experiences and the ensuing body and mind reactions, these will determine which modality is going to be most useful. For one person, doing some art therapy is exactly what they need to process an event from the past, while for someone else, this is not going to be enough. Maybe they need to be doing neurofeedback for the course of a year, and then after this they need to start doing some other form of therapy.
But I want to mention this because I’ve gone through so many different options, but not every one is going to be right for every situation or only one approach is needed. It’s often that there may be multiple approaches needed.
So that is it for this week’s show. As I mentioned at the top, I’m currently taking on new clients. If you want help with an eating disorder or disordered eating, chronic dieting, poor body image, exercise compulsion, getting your period back, or any of the other topics I cover on the show, then please reach out. You can head over to www.seven-health.com/help for more information.
Next episode is the 250th, and it is going to be an Ask Me Anything episode. I have all the questions for this already, and I’m looking forward to answering them. I will catch you then.
Thanks so much for joining this week. Have some feedback you’d like to share? Leave a note in the comment section below!
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