Rethinking Trauma: The Third Wave of Trauma Treatment

As someone who’s been practicing for a while, I’ve seen our view on the treatment of trauma go through substantial development. Our research, theory and treatments have all advanced considerably in the last 40 years.

And as I reflect upon this, I’m seeing 3 waves in the evolution of our outlook.

Looking back at when I first began to practice (in the late 70’s) our understanding of trauma was really quite limited. Of course we recognized the fight / flight response ever since Hans Selye introduced the notion back in the 50’s.

Our Prevailing Treatment Option for Trauma Was Talk Therapy

But our prevailing treatment option was talk therapy.

The thinking at the time was that by getting clients to talk about their traumatic event, we could “get to the bottom of” their issues and help them heal.

We were aware of the body and knew it held some power. But few practitioners used it in treatment (except the relatively few who worked with Bioenergetics, Rolfing, Feldenkrais, Rubenfeld, and to some extent Gestalt therapy).

But we were very limited in our ability to explain how body work, or for that matter, a talking treatment, affected the brain (and we had very little evidence-based research for it either). We just didn’t have much of a roadmap to guide us where we wanted to go.

That was the first wave.

Over time, researchers and clinicians started to recognize the limits of talk therapy. We realized that talking about a traumatic event held certain risks. At times, we inadvertently re-traumatized patients, especially if interventions were introduced too soon, before the patient was ready.

We also saw the memory of trauma as more often held in the right brain, the part that doesn’t really think in words.

So we began to use interventions that weren’t as dependent upon talking, interventions like guided imagery, hypnosis, EMDR, and the various forms of tapping.

We began to use interventions that weren't dependent upon talking
And as the science surrounding the brain’s reactions to trauma became more sophisticated, clinicians grew to understand more about what was going on.

We began to realize that not everyone who experiences a traumatic event gets PTSD. In fact, most people who experience a traumatic event don’t get PTSD.

And so researchers started to develop studies to determine who did and who didn’t get PTSD. We looked for what factors might predict greater sensitivity to trauma.

And we modified our thinking to add freeze (later known as feigned death) to the fight/flight reaction.

Just adding that piece clarified our thinking about what triggers PTSD.

It also began to expand our treatment options to include sensory motor approaches.

And we started to see how more vastly intricate and multifaceted multiple trauma was compared to single incident trauma.

But I believe a third wave of trauma research and treatment innovations has just begun to crest.

And it’s only come recently.

We continue to see advances in the field of trauma therapy that are opening up more effective methods for working with trauma patients.

Because of all the research that’s been done, we are much better able to predict who gets PTSD and who doesn’t. Not only that but we’ve got a good handle on why certain people get PTSD.

And as brain science has revealed how different areas of the brain and nervous system respond to traumatic events, we don’t think so often about whether trauma is stored in the left vs right brain.

We think in terms of three parts of the brain, the pre-frontal cortex, the limbic brain and the lower, more primitive brain. And we’re much more sophisticated in thinking about which part needs our intervention.

Brain Science is Changing What We Know about Trauma

We understand that the lower brain can command the shutdown response, totally bypassing the prefrontal cortex, totally bypassing any sense of “choice” for the patient.

And we see more clearly the part that the vagal system plays in this shutdown response.

We understand more of the role neuroception plays in feeling safe.

Knowing how the body and brain react to trauma opens the door for the third wave.

We are now beginning to use techniques like neurofeedback (based upon but a long way from the biofeedback we used years ago,) limbic system therapy, and other brain and body-oriented approaches that include a polyvagal perspective.

These are techniques I couldn’t have dreamed of when I began clinical practice.

But these are powerful tools that can offer hope to those who have been stuck in cycles of reactivity, shame, and hopelessness.

And now I’d like to hear from you:

What changes have you seen in your work with the treatment of trauma? Please leave a comment below.

Shares

Please Leave A Comment

*

161 Comments

  1. Billy T says:

    Hi,
    Billy here and I enjoyed your article,
    I work in the field of mental health with people who are DTO/DTS, unknown to my colleagues, I am the victim of a kidnap and near death experience in late Sept 2015, naturally I have severe ptsd, and unfortunately sometimes I am even triggered at work.
    I am excited to find any new ideas on the subject, and would like any additional information as to where I may get procedures/support as my struggle has been a difficult one, even therapy doesn’t seem to help much.
    I am pro med and have always have been.
    I wish there were more effort to develop a medication that would really help those of us suffering from trama/ptsd, sometimes I just want to be ok and feel safe.
    Could it at least suppress the fight or flight response?
    I have tried medical marijuana, which seemed to help some (moderate at best), but I am not allowed to test positive for any substances while working in the field (which I understand and respect).
    What I experience, even in therapy, is people really don’t know what a life or death experience is truly like, in relating to the client they are trying to support.
    Every time I speak those words of that horrible event, it not only recreates the trauma, but it sets off thoughts and emotions of distrust and once again feeling unsafe, which can and does lead to all types of desperate behaviors (Including fight or flight), until once again I can try to forget and push it down in my being.
    So in summery I guess what it is really like is that I am left with the feeling that I just have to get through this just by myself, true time does heal all things and I cannot say that I have not improved greatly from where I started, and by God’s Grace am I alive.
    Hopefully, and at times I think to really be able to relate, and help another trauma/ptsd victim.

  2. JUDITH THORNE says:

    I have been both therapist and client. Having ME in 1987 gave me much time for reflection in which I felt that the many of us who were afflicted were “the pit canaries of the Earth” living in social conditions and environments creating seriously disturbed vibrational damage. Two months ago my legs collapsed and I was an inpatient for two weeks when no diagnosis could be found. So no treatment given. Once home I was helped by homoeopathy, herbal remedies and sprays which work with the aura and using Bach Flower Remedies both orally and topically. This topical treatment is explored and explained by the German naturopath Dieter Kramer and has been a major turning point in my life. All the zones of weakness in my left leg, ankle and foot totally correspond to the degrees of emotional damage created throughout my life. I am now very much healed using these gifts of nature.

  3. Jane says:

    Where can I get some help/therapy for my child hood trauma and CPTSD in Brighton, UK please?

  4. Joe Casey says:

    Practitioners of Rebirthing have realized since 1975 that this method is useful for resolving trauma. Intended at first to help resolve birth trauma, it soon became evident that all traumas can be aided. What is strange to me, having been practicing Rebirthing for 42 years, is the seemingly deliberate ignorance about its usefulness among psychologists and others who say they want to know how to help those in trauma. Whatever the excuse, it is harmful to sufferers to omit, dismiss, or degrade such a useful practice.

  5. Srishti. Nigam says:

    Brain based therapy help understand the neurobiology , physiology at molecular level and thus lead to resolution of traumatic experience
    Multiple therapies now have a good rationale
    Thank you

  6. Hala Buck says:

    I’ve been integrating the body with art therapy and mindfulness to unlock traumatic memories that are stored in the body and I still believe in the right hemisphere as well. Integrative and creative approaches are what helps clients recall and heal trauma without re-traumatizaiton.
    Energy Psychology has also been a tremendous help.

    I also find that many times we have to also address intergenerational and collective trauma inspired by Bert Hellinger.

  7. an article about robert grant, that i mentioned previously……http://www.ptsdsupport.net/gazette.html

  8. I did an all day workshop yesterday with Robt Grant, phd entitled “The Spiritual Impact of Trauma”. he talks about how complicated it is to treat, that it’s really about an opportunity to develop spiritually with the right kind of therapy and how reticent so many are to entertain that possibility including institutions as well as care givers…he also mentions how unpopular folks can become when proposing it. you can google him to see more about his approach and the books he has written…..

    I had heard much of this before thru michail harner and stan grof…..and was reminded again.

    it brings up for me my annoyance of how i practiced mindfullness under the radar from 1980 after i was swept out to sea and did several Conscious Living Conscious Dying workshops with the levine’s. then, FINALLY, psychology decided to validate what the ancients had known forever and now it’s all of a sudden valid and mainstream. it just takes too long for institutions to move forward.

    • Sally Ramsey says:

      Trauma as an opportunity to develop spiritually….. As we change our focus on trauma treatment and integrate the organic spiritual intelligence of each individual person we create the ground for potentially rapid and enlightened healing.

    • Sally Ramsey says:

      Trauma as an opportunity to develop spiritually….. this is so true! As we change our focus on trauma treatment and integrate the organic spiritual intelligence of each individual person we create the ground for potentially rapid and enlightened healing.

  9. Mike Stapleton, M.S. says:

    Hi, It appears that trauma is a very complex dx to treat and it is working some part of the problem that little by little one could act upon the deep issue. I have found CBT and stress techniques can at first hand help very much to relieve it. I have been once told to learn more about neuro biofeedback. And recently I have found that they are selling a watch that you can wear daily to observe your mood changing. It relatively costs less than the sessions that usually aren’t paid by the insurance. Thank you for these updates that are very informative to most of us.

    • Mike,

      While the “one size fits all” products such as the watch you mention can be useful, they are in no way a substitute for neurofeedback (neurobiofeedback). Neurofeedback is tailored to the individual and uses medical grade equipment. It is also accompanied by a qualified professional who can provide the proper support throughout the process.

      • Mike says:

        Thanks. I’ve just wondered if anyone has heard about it.

  10. Amanda says:

    I’m not a therapist but a ‘client’ and have to say I am so relieved that after 14 years of psychotherapy at last my condition makes sens to me in the context of complex PTSD. Everything I have read about it fits and that iin itself makes me feel nirmal. I’m starting a new treatment and look forward to making some improvements.

  11. Roby Abeles says:

    Like you, I began as a trauma therapist a long time ago – ( the mid a1980’s)

    We now have Brainspotting (BSP), developed by Dr David Grand. BSP is a brain and body based relational therapy, leaning heavily into relational attunement at its core, = interpersonal neurobiology, as researched by (Dan Siegel). which uses the brains own capacity to heal itself within a highly attuned relationship with the therapists moment by moment.
    Ive developed ways of using this amazing therapy to help addicts prevent relapses.

    We also have Somatic Experiencing developed by Dr Peter Levine. We know we have to include the physical body in the recovery and now we know exactly how to do that

    BSP + SE are powerful tools for full trauma recovery.

  12. Waki says:

    Obviously, the attachment theory is the great framework today for therapies, in particular the Developmental PTSD which is epidemic and which we did not know how to treat well and is still the part that we don’t handle so successfully currently. I love the blog of dr. effery Smith, howtherapyworks, because it’s right on the spot: relational therapy. Neurofeedback is far too expensive, sorry, and we need to stay grounded in basic common sense. Therapy works when the therapeutic relationship is healthy, supportive, dynamic, etc. The only thing is that hands-on work needs to be added in many cases, otherwise, that basic key is quite simple. All the research leads to that point. For shock PTSD, Somatic experiencing, TRE etc are doing wonders. All is said now in this matter, I mean, far enough to help clients heal effeciently and rather quickly.

    • Carolyn says:

      I agree that touch is often useful. And, I also have certain exercise equipment in my therapy room for mobilization and transformation of the trauma. (Such as Bosu, balance bars, Pilates rings, rollers, and physio balls.) It expands the energy of a client so they resource and not collapse into the trauma and its negative sense of self. I think “processing” is old school, I teach transformation from an integrative approach. Bridging the worlds of mindfulness practitioners, somatic trauma specialists and hands on energy healing is quite a powerful support for clients. I find they heal quicker and deeper. Is it the next evolution of trauma work? Maybe, for me it is. Thx for all the work you do Ruth/NICABM!!!! It is nice to have platforms to discuss the outer edges of where I think things are evolving toward.

  13. yes that is the reason I studied Sensorimotor Psychotherapy and became a certified advanced practitioner.

  14. Larisa Kompelmakher says:

    Love all sharing about healing trauma….found that just words is not effective in my cause any way…..looking for
    different approaches and want to try TMS THERAPY….Please keep sharing,you are doing great in shaking old approaches…..I was healed and delivered from arrested development by accepting JESUS CHRIST as a savior in my 55years old….Interesting, but true.

    • You might also look into a Christian approach Immanuel Lifestyle. See kclehman.com.

  15. Moreen Halmo says:

    Ruth. This is very helpful. I’m thinking in terms of an “eclipse” of the prefrontal cortex and am working on an article about this. Also, I am seeing that there needs to be a “We” in the relationship that helps the patient feel less shame and reactivity that maintains healthy boundaries yet allows for an experiencing of the relationship as a true partnership in the journey. This focus stays away from transference and requires the therapist to have “extraordinary presence” as referred to in Castonguay and Hill’s edited book recently released. Another piece that I hope to discuss in an article focused on what makes a good trauma therapist.
    Thank you
    Moreen Halmo Ph.D.

  16. M. Hayden says:

    Very Enlightening

Please Leave A Comment

*

Free Report on "What Resets Our Nervous System After Trauma" Click Here