Traumas are very shocking and hard experiences that we live, which end up leaving an important mark on our psyche.
They also cover the consequences of this experience. Psychological therapy for trauma is based on two techniques: exposure and cognitive restructuring.
In this article we will know the usual symptomatology after experiencing a traumatic event, as well as the functioning of psychological therapy focused on treating such traumas. We will analyze the two techniques that compose it, their variants, and how they can be applied in therapy to help the patient.
Trauma related disorders
Before tackling psychological therapy for trauma, we must understand what a trauma is and what implications it has . A trauma is the result of a very shocking event that we experience, and which causes us such stress that it ends up affecting our psychological functioning, interfering in our daily lives and diminishing our psychological well-being. The term “trauma”, however, is also used to designate the traumatic event in question.
The consequences of trauma can vary considerably from person to person; however, when we use this term, we generally refer to the occurrence of PTSD (Post-Traumatic Stress Disorder) or ASD (Acute Stress Disorder). While PTSD lasts for at least 1 month, ASD lasts for a maximum of 1 month; that is, the ASD becomes PTSD when this period of time elapses.
The symptoms of a disorder caused by trauma usually include physical, psychological and behavioral manifestations . On a physical level, the person may manifest remarkable psychophysiological symptoms, and also often re-experiences the traumatic experience, causing the same physical symptoms that were felt at the time of the event.
On a psychological level, you may feel anxious, worried, nervous, irritable, or afraid. Finally, you may behave in a way that avoids any detail related to the traumatic event; this means avoiding talking about it, avoiding going to places close to the event, etc.
Psychological therapy for trauma
As we have seen, suffering a trauma implies considerable suffering for the person, since it stagnates him in many aspects of his life, preventing him from progressing and developing a normalised life. Although it is true that there are different degrees of affectation according to the event and the person, as well as different types of trauma, we can talk about PTSD as the main (and most frequent) disorder caused by a trauma, as we have already seen.
As a result of the different symptoms that PTSD causes, psychological therapy for trauma will be focused on the patient being able to face, process and integrate what they experienced , without repressing anything and working on the aspects that most impacted or overwhelmed them.
It is important that the patient feels comfortable, free and calm in order to be able to express without fear how he feels and to what extent this event is interfering with his normal functioning.
Psychological therapy for trauma is based on two main techniques: exposure and cognitive restructuring.
Exposure to trauma is a fundamental part of psychological therapy for trauma; it can be behavioral or narrative. A more modern type of exposure therapy has also been employed, with promising results: EMDR (Eye movement desensitization and reprocessing). Let’s see what these three types of exposure consist of.
1.1. Behavioral exposure
Behavioral exposure involves the person being exposed to stimuli, events, or thoughts related to the trauma in a direct way.
1.2. Narrative exhibition
The narrative presentation, on the other hand, is focused on the patient narrating and describing (or writing) the traumatic experience in as much detail as possible; that is, explaining in his or her own words what he or she experienced on the day (or days) of the event, how he or she felt, what objects or people were there, etc.
1.3. EMDR (Eye movement desensitization and reprocessing)
EMDR, in Spanish “Desensibilización y Reprocesamiento mediante Movimientos Oculares”, is a type of therapy created by the Jewish psychologist Francine Shapiro. This therapy, like the previous variants of exposure, is used as a psychological therapy for trauma. It is used to decrease the negative symptoms associated with a trauma.
It consists of bilaterally stimulating the patient, through various methods, which may be: eye movements (mainly), sounds or tapping. According to Shapiro and the defenders of the technique, what this stimulation does is to stimulate a cerebral hemisphere.
If we analyze the EMDR step by step, and in a very synthesized way (without going into detail), the first thing the therapist will do is ask the patient to remember the traumatic event, with all possible details (sensations, images, thoughts…). Then the processing phase will start, where the therapist will ask the patient to evoke the event again while stimulating it.
This will be done through sequences containing guidelines in between. Afterwards, the therapist will ask the patient for his thoughts. In addition, positive images will be included that the patient will have to imagine and associate with the traumatic memories. In fact, EMDR consists of several phases (eight to be precise) that the therapist must know in depth in order to apply this type of technique correctly.
Characteristics of the exhibition
On the other hand, it is important to note that exposure should be prolonged and applied gradually. This exposure will be to the patient’s traumatic memories, in relation to the trauma he or she experienced.
But what is the purpose of the exhibition? It is a fundamental part for the patient to process little by little what he has experienced. It is important that the repressed aspects in the unconscious come to light, so that they can be addressed; the aim is for the traumatic experience to be integrated into the patient’s life experience, forming part of it.
We must know that exposure is a very painful process for the patient, since in a certain way he relives very hard and distressing sensations and experiences; moreover, resistance often appears in the patient’s story. That is why the therapist must work from empathy and understanding, validating at all times the patient’s emotions and offering support.
It will also be important for the therapist to give the patient tools to deal with negative thoughts, nightmares, intrusive memories, etc.
2. Cognitive restructuring
Cognitive restructuring as part of psychological therapy for trauma is aimed at modifying the dysfunctional thought patterns manifested by the patient, in order to subsequently provide tools that allow the patient to elaborate alternative and adaptive thoughts.
This component of therapy is essential since PTSD is often associated with negative changes in cognition and mood.
In order for the patient who experiences a trauma to be able to assimilate this experience, it is important that they have a space to express themselves without pressure or conditioning; cognitive restructuring is an essential tool for working through the negative thoughts and feelings of guilt that patients who have experienced a particularly painful and shocking experience often have.
In this way, it is important that the patient can change his way of perceiving and remembering what he experienced, in case it is a maladaptive way . On the other hand, behavioural changes, from cognitive behavioural psychotherapy, are achieved by changing one’s thoughts (and vice versa).
That is why in order for the patient to face the experience, work must be done on the avoidance behaviours already mentioned, since the fact of avoiding and repressing, can end up generating important psychological problems in the future, which may end up coming out in an explosive way at any time or when faced with a trigger related to the trauma.
American Psychiatric Association (APA) (2014). DSM-5. Diagnostic and statistical manual of mental disorders. Madrid: Panamericana.
Horse (2002). Manual for the cognitive-behavioral treatment of psychological disorders. Vol. 1 and 2. Madrid. Siglo XXI.
Laco, E. and Larraz, G. (2012). EMDR: Review of the technique and application to a clinical case. Cuadernos de Medicina Psicosomática, 104: 45-56.
Pérez, M., Fernández, J.R., Fernández, C. and Amigo, I. (2010). Guide to effective psychological treatments I and II:. Madrid: Pirámide.