Trauma-based therapy (also known as trauma-focused therapy) is an effective treatment for individuals with a history of trauma, such as those with post-traumatic stress disorder (PTSD).
Trauma-focused therapies use experiential, cognitive, and behavioral techniques to facilitate the processing of traumatic memories and reduce avoidance behaviors.
Four effective trauma-focused therapies are briefly described below.
Eye movement desensitization and reprocessing
A widely used trauma-focused therapy is eye movement desensitization and reprocessing (EMDR). The goal of EMDR is to help patients access and process the traumatic memories that have been inadequately processed or improperly stored.
EMDR is known for using a special technique called bilateral stimulation. This technique typically requires the patient to think about the trauma while tracking the therapist’s rapidly moving finger from side to side. Bilateral stimulation reduces the intensity of emotions associated with the trauma memories.
EMDR has eight phases:
- History taking. Obtaining information and making a treatment plan.
- Preparation. Stabilizing the patient.
- Assessment. Accessing the traumatic memories or experiences.
- Desensitization. Processing the traumatic experiences.
- Installation. Installing positive beliefs.
- Body scan. Processing residual body sensations related to the trauma.
- Closure. Ensuring the patient is stable at the end of the session and between sessions.
- Reevaluation. Evaluating the results of the treatment.
Prolonged exposure (PE), which is a type of exposure therapy, is another effective trauma-focused therapy for the treatment of PTSD.
The goal of PE is to reduce PTSD symptoms and enable the traumatized individual to return to normal life (e.g., go back to school or work).
The core elements of treatment are in vivo exposure and imaginal exposure.
In vivo exposure refers to gradual exposure to reminders of the trauma. It involves real-life exposure to situations that have been avoided because they are associated with the trauma (and not because they are inherently dangerous).
Imaginal exposure refers to vividly imagining and recounting a detailed account of the traumatic memory. It is believed that revisiting the traumatic memory and discussing it in therapy can facilitate the processing of trauma-related thoughts and emotions.
Cognitive processing therapy
After experiencing a traumatic event, people tend to engage in the process of meaning-making. For people who develop PTSD, however, the process often results in distressing maladaptive beliefs (e.g., self-blame). The goal of cognitive processing therapy (CPT) is to correct these dysfunctional beliefs.
CPT teaches patients to identify irrational beliefs (called “stuck points”) about the traumatic event, the world, and themselves. Some examples of stuck points are:
- “The trauma was my fault.”
- “Nobody can be trusted.”
- “I am damaged forever.”
- “The world is completely dangerous.”
Patients learn to challenge stuck points and replace such beliefs with more accurate and balanced ones. In later sessions, the therapist focuses on areas most commonly affected by trauma—particularly beliefs about safety, control, self-esteem, trust, and intimacy.
Trauma-focused cognitive behavioral therapy
Trauma-focused cognitive behavioral therapy (TF-CBT) is an intervention often used in the treatment of traumatized children and adolescents. The acronym “PRACTICE” summarizes the main components of TF-CBT:
- Psychoeducation. Education on the effects of trauma, and education on parenting skills (e.g., praise, contingency management).
- Relaxation skills. Deep breathing, progressive muscle relaxation, guided imagery, etc.
- Affective regulation. Modifying emotional expressions and experiences.
- Cognitive processing skills. Replacing irrational thoughts with rational ones.
- Trauma narration processing. Processing the trauma by thinking and talking about it.
- In vivo mastery. Exposure to feared or avoided situations.
- Conjoint child-parent sessions. Improving communication between the parent and the child.
- Enhancing safety. Addressing safety concerns in relation to sexuality, domestic violence, substance use, and bullying….