Most of our intensive therapy clients achieve profound healing from their trauma and loss memories. This typically leads to a dramatic reduction of symptoms, which in turn enables them to pursue their goals more effectively. Once in a while, though, there’s a glitch. Days, or even weeks or months, after the trauma work is done, the client reports feeling destabilized.
There are three common reasons this can happen:
1. The trauma work was not complete. Either we knew it wasn’t complete, or we thought it was, but learned otherwise. For example, several weeks after treatment appeared to be completed, one client recalled an additional perpetrator of his childhood abuse, leading to a spike in distress. This type of situation is best remedied by the client returning to complete the work.
2. The trauma is not over; or it recurs. For example, one pre-teen appeared to have fully recovered from her childhood sexual abuse by her father, whom she had not had to see for the previous two years. But then he challenged the abuse finding in court and obtained a court order for a new evaluation of the child. When the child learned that she was going to be re-evaluated, she (accurately) felt vulnerable to further abuse, and her prior symptoms re-activated. This type of situation is best remedied by supporting and advocating for our clients’ safety.
3. The client’s secondary gain has not been addressed, so the client is unwilling to relinquish the symptoms. For example, a client made considerable progress in treatment, which led to increased tensions in his marriage. He reverted to his previous symptom level rather than continuing to rock the marriage boat. This type of situation is best remedied by openly addressing the symptoms’ possible benefits (secondary gains) and making realistic choices.
The other reason this can happen? Pavlov’s dog. Ivan Pavlov, a pioneer in behavioral psychology, had the habit of ringing a bell to summon his dog to mealtime. The dog came to associate the ringing of the bell with onset of eating, and salivated when the bell rang. Even when the bell was rung at random times – no longer associated with mealtime – the dog persisted in salivating in response (Pavlov, 1928).
Similarly, the human mind and body can persist in certain responses or habits even after they are no longer needed, or no longer associated with the stimulus that created them. This is probably why, on occasion, trauma treatment can be effective in eliminating the avoidance and intrusion symptom clusters while leaving the hyper-arousal symptoms intact. The person has been dysregulated for so long that, in some cases, the dysregulation persists as an autonomous habit.
I have come to believe that, for some therapy clients, trauma healing in itself may not be sufficient for full recovery. They also need to acquire a new habit of psycho-physiological regulation, to replace the old habit of dysregulation, in case such replacement does not happen automatically following the trauma healing.
Unfortunately I have no way to predict which people might or might not need the extra work to develop self-regulation, post-trauma-healing. You’d think it would be those with disrupted attachment, early abuse or neglect, and/or complex trauma, but many such people do quite well following our standard treatment.
There are a number of methods out there to assist people in improving their self-regulation. We now recommend that our clients consider practicing at least one of the following, starting as soon as they know that they’re planning to come to us for therapy.
We don’t have a favorite yet, and we may never. At present, it seems best to have an array of options and let individual clients choose what suits them the best. We’ve set up a web page to provide guidance on how to pursue any of these.
The methods listed above are all research-supported, in most cases specifically for mitigation of post-traumatic stress symptoms. Our plan, though, is to use one or more of these, not as a stand-alone symptom management strategy, but as an adjuct to trauma healing therapy (e.g., via PC, EMDR, etc.), to assist clients in retraining their brains/bodies to self-regulate. Some preliminary research has addressed related ideas. For example, one study found that adjunctive biofeedback did not increase the effectiveness of trauma therapy (Lande et al, 2010), whereas another study, in which the biofeedback was administered during the trauma therapy session, may have increased effectiveness (Rosaura et al, 2015).
I’m not looking for a strategy to boost trauma therapy’s effectiveness; we’re using EMDR and PC, which are effective already. I’m interested in the use of self-regulation practices as an adjunct to trauma therapy, to promote stability and maintenance of treatment gains. I am hopeful that we and/or others will eventually publish research on this strategy. And meanwhile, we’ll be recommending these helpful practices to our clients.
References
Lande, R. G., Williams, L. B., Francis, J. L., Gragnani, C., & Morin, M. L. (2010). Efficacy of biofeedback for post-traumatic stress disorder. Complementary Therapies In Medicine, 18, 256–259.
Pavlov, I. P. (1928). Lectures on conditioned reflexes. (Translated by W.H. Gantt) London: Allen and Unwin.
Rosaura, P. A., Witteveen, A., Denys, D., & Olff, M. (2015). Breathing biofeedback as an adjunct to exposure in cognitive behavioral therapy hastens the reduction of PTSD symptoms: A pilot study. Applied Psychophysiology & Biofeedback, 40, 25–31. https://doi.org/10.1007/s10484-015-9268-y
Trauma Institute & Child Trauma Institute
285 Prospect Street Northampton, MA, 01060 USA
