More people are reaching out to therapy “for trauma” than ever. But how does trauma therapy work? Is healing after a traumatic event possible? What does healing look like?
The answers to these questions are complex and controversial, even among psychotherapists. Still, there are common threads between therapies created to address the effects of trauma. What follows are five such themes.
1. Facing the Experience
Before a traumatic event has been processed, we tend to become ultra-sensitive to any reminders of the occurrence. Just like how when you’ve broken your arm, any amount of pressure can cause immense pain, posttraumatic stress can cause even indirect encounters with the memory to feel unbearable. It’s natural to avoid these things, for example, by not talking about what happened or altering one’s life to avoid reminders. Sometimes, blocking out the mental echoes of trauma can involve drinking, binge eating, overspending, and other addictions and compulsive behaviors (Levin et al., 2021).
Exposure, or the process of gradually facing the experience, is a component of most trauma therapies. This could look like sharing one’s story in a therapy office, writing it down, or exploring it with bilateral sensory information to aid in processing, as in eye movement desensitization and reprocessing therapy (Shapiro, 2001). Some therapies also utilize virtual reality to create an immersive space for recollection. Initial evidence using virtual reality in trauma therapy for individuals with combat-related trauma has been promising (Beidel et al., 2019).
2. Sharing Stories
When stories are kept silent, it is common for a kaleidoscope of heart-rending emotions to gather. Guilt, anger, and shame can overshadow us. Sharing a story in another person’s presence can prove freeing. Most trauma therapies involve an aspect of story sharing, which can look like anything from group reflection to discussion of a written account. The creation and retelling of narrative can also be a means to identify what cognitive processing therapy labels as “stuck points” (Resick et al., 2017) or areas that have not been fully processed, and work with a therapist to challenge trauma-induced beliefs.
3. Finding Peace
After a traumatic experience, we can be placed on high alert. The body’s threat system can become overactive to protect us against further harm, making it incredibly challenging to relax. Psychotherapies such as compassion-focused therapy and somatic experiencing clue in on this anxious aspect of trauma. Compassion-focused therapy exercises build up our soothing-affiliative system to help us find comfort again and move toward our valued goals (Gilbert, 2009). Similarly, somatic experiencing targets the ripples of trauma in the body (Levine, 1997).
4. New Perspectives
Particularly in the case of childhood trauma, psychoeducation is often a part of trauma treatment. After extreme experiences, we might not know what is “normal” in terms of relationships, violence, or other risks. Someone might think, for example, that they deserved their abuse because it is “OK” to use physical discipline as a punishment. Therapies such as trauma-focused cognitive-behavioral therapy utilize activities to discuss these things, including what is healthy and what is not (Cohen et al., 2012). As such, harmful beliefs can be extinguished, and new beliefs can flourish.
5. Reconnection
Isolation after a traumatic experience is unfortunately common and can further posttraumatic stress (Vlachos et al., 2012). As such, re-engaging with the world is often a part of healing. The final phase of most psychotherapies for posttraumatic stress involves a focus on relationships and new experiences.
Closing
A variety of psychotherapy approaches exist to help heal the effects of trauma. Many of these therapies share common factors. What might work well for one person might not be ideal for another. Healing is a complex process, but it is possible.
