Therapy options for trauma survivors
As we are aware, the NHS uses cognitive behavioral therapy in their blanket approach to treating mental illness. However in recent years, trauma specialist have contested that the use of this therapy alone is ineffective in treating trauma and a multi-level approach is needed. Trauma informed therapy is gaining in recognition as trauma researchers begin to examine the best approach for therapy.
Cognitive Behavioral Therapy
Cognitive behaviour therapy (CBT) has an exceptionally high Dropout rate and from those who complete this therapy; we see 30% feeling benefit. CBT is described as therapy which evaluates an individual's faulty cognition through evaluation of an individual's thoughts and feelings about their trauma and lives. I don't believe that in the case of trauma; survivors have faulty thoughts, what we think and feel is completely natural: what happened to us is the only faulty thing. It is our abusers who are faulty not us. We do not need to change how we think and act about a situation that was clearly horrific for us and so we see the rate of retraumatization in this type of therapy as being high. CBT is more effective for treating PTSD, not complex or developmental trauma, however alongside other therapy methods it can be effective. CBT attempts to restructure an individuals thought patterns through reflection and self-analysis over a short time frame (6 to 10 weeks). Many theories have debated that this is too simplistic in treating trauma and especially complex and developmental trauma's. Those are issues that won't be solved in two months of therapy. Bearing in mind that CBT therapy Sessions are short, lasting around 45 minutes to 1-hour. That equates to roughly 6 to 10 hours of "cognitive reprogramming" of which to heal what could be a lifetime of trauma.
CBT use exposure to feared or avoided situations, however depending on your personal life situation; an individual may find themselves retraumatised. It is common for individual survivors of trauma to enter and remain in relationships that are similar or toxic in nature. Using CBT to expose oneself to our "faulty" thinking in these situations can actually be counterproductive. When we are faced with adversity that we are required to work through, it can cause feelings of guilt and shame to manifest. Such sudden changes in this relationship dynamic can lead to a pull from those toxic members who once benefited from our lack of boundaries. This can cause a huge backside in an individual's recovery journey.
Of course, there are positives to using CBT therapy in treating our trauma symptoms however, I do believe that it has to be used in a trauma informed way and through a multi-leveled approach. Some of the benefits of CBT can be found in Unit 10 in the group as they are relatively easy to find. There is limited research in the negatives of CBT, I am unsure if this is because the NHS use this in the UK as their main method of treatment. From what I have researched, top trauma specialists such as professor van der Kolk, Walker, Herman and Schwartz all agree that in treating complex trauma more than one approach is necessary.
EMDR (Eye movement desensitisation and reprocessing)
EMDR is also commonly used within the NHS. EMDR is often now included along with CBT and involves a therapist sitting close to you whilst passing their hand back and forth across your field of view. This type of therapy also has mixed reviews and although it can be very valuable in treating trauma, Schwartz, 2017; states this therapy requires careful modification for survivors to work on any dissociative symptoms or complex trauma events involved.
EMDR involves and 8 phase treatment model which is constructed to allow individual to resolve and process traumatic experiences by processing their emotional, somatic and mental distress. EMDR must be paced appropriately and tailored to suit an individual - this therefore leaves responsibility with the individual therapist; which can lead to either success or failure in terms of therapeutic intervention.
EMDR's main goal is to allow a trauma survivor to process and control their emotions and feelings of vulnerability. This places a responsibility on individual therapists to understand how developmental trauma can affect individuals. With regards to PTSD, this type of therapy has a high success rate. However; that trend tends to dip as more trauma is added. I have included EMDR as described by Arielle Schwartz into our unit 10 which explains each phase of EMDR therapy and more detail.
Trauma has never been a quick fix and the lack of awareness regarding trauma in the UK can result in longer term treatment being required. Single incident trauma benefits greatly from EMDR's 8 phase model in a straightforward manner, but for survivors of complex interpersonal trauma and childhood trauma it relies heavily on the therapists awareness to modify accordingly.
For survivors with multiple traumas at various ages and developmental stages, symptoms tend to be driven by foundational experiences which removes feelings of personal and environmental safety. When working with EMDR it is essential that the therapist involved has extensive knowledge regarding trauma and how this manifests into adulthood.
EMDR has been criticised due to its need to modify its 8-phase model to individual needs. Many professionals are not fully aware of how adverse childhood experiences affect individuals or how complex trauma at different developmental stages can manifest into Adulthood. Therefore, its success rate dips due to misinformed care. In order for therapy to be successful in treating trauma; there must be a multimodal trauma informed approach in order to obtain benefit.
EMDR on its own worjs well in treating depression, anxiety, panic attacks, eating disorders and addiction and so can help alleviate many maladaptive coping mechanisms used by an individual with multiple traumas. Using EMDR alongside different therapies can provide a higher success rate in terms of relief from symptoms. Studies on EMDR each have very small sample sizes and limited follow-up information.
Currently, the NHS offer both CBT and EMDR as well as group therapy in treating trauma. It is important to note that these are not the only therapy options and treatments and I am looking at using the coming week to detail each one further.
I would be interested to find out members experiences with CBT and EMDR and if you found any other treatment or therapy helpful.