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Complex trauma Trauma characteristics

Impacts

Chronic posttraumatic stress

Negative schema

Self-capacity disturbance

Identity

Relationship

Affect regulation

The avoidance triad: Substance abuse, dissociation, and tension-reduction

Perspective shift: Trauma-mindfulness philosophy

Pain (trauma) versus suffering (effects)

Pain as actual experience (inevitable)

Suffering as psychological interpretation (optional)

Kabat-Zinn

Cultural contributions

The effects of labeling experience as good or bad

Pain as negative, wrong, pathological, to be avoided

Support for avoidance and externalization

The Pain Paradox: Convergence of Western and Eastern Psychology

Paradox: Solutions to pain often sustain them

Avoidance continuing suffering, intrusion

Data on substance abuse, dissociation, avoidance

Focused awareness relief, resolution

Exposure tx, mindfulness, emotional expression, psychotherapy

Implications of the Pain Paradox

Mindfulness: Changed relationship to experience

Nonjudgmental acceptance (rather than rejection/suppression) of thoughts, feelings, and memories

Disturbing thoughts, feelings, and memories allowed to come and go without undue preoccupation or attachment

Reduced identification with emotional and cognitive experience (metacognitive awareness)

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Dharma

Impermanence, interconnectedness and dependent arising

Meditation and trauma survivors Potential benefits

Efficient mindfulness training

Reduced hyperarousal

Equanimity: emotional stability arising from awareness and acceptance of the present moment

Potential contraindications or cautions

Overwhelming internal states/processes

Dissociation/”pseudo-samadhi”

Therapist is not experienced in meditation

Teaching meditation: Role of therapist

Benefits of therapist mindfulness Empathy training

Increased “bare” attention to client and client’s experience

Being fully heard

Increased non-egocentric compassion and caring

Metacognitive awareness reduces “countertransference” and vicarious trauma

Compassion Nonjudgmental awareness and appreciation of the predicament and suffering of

others (and oneself)

The felt desire to relieve that suffering and increase well-being

Versus pity

Physiologic effects: Activation of attachment circuitry and modulation of distress

The therapeutic relationship The primary finding of treatment outcome studies

The therapeutic relationship as antidote to trauma-related isolation

Relational triggers for early implicit attachment schema

Relational processing

The vehicle for compassion

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Reconsidering trauma – cognitive aspects of trauma therapy Seeing differently

Nonjudgmental self-observation and awareness

Metacognitive awareness

De-identification: Just thoughts

Monkey mind

Dependent arising of thoughts: “The past talking”

Letting go

Versus suppression

The white bear

Reconsidering trauma – cognitive aspects of trauma therapy Reversing other-directedness

On not setting people straight

Interpretations

“New information”

Psychoeducation

Doctors versus personal trainers

Reconsidering trauma – cognitive aspects of trauma therapy Cognitive reconsideration versus the hunt for thinking errors

Detailed exploration of details of trauma, focusing on thoughts, attributions, inferences

Hearing one’s own words: Time travel

Unexamined beliefs

Epiphanies

Self-generated normalizing and reframing

Trigger identification and intervention Teaches a version of metacognitive awareness

Triggers versus perceptions

The trigger grid

What are triggers?

Have you been triggered?

What are your triggers?

How do you know you have been triggered?

What could you say/do?

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Development of affect regulation Grounding

Relaxation

Progressive

Breath training

Trigger identification and intervention

Labeling and discrimination of emotional states

Emotional detective work

Development of affect regulation Mindfulness

“Just feelings” – reduced identification

Acceptance of feelings without needing to act

“Inviting pain to tea”

Brach’s sacred pause

Learning how to “let go” of emotional processes (versus suppression)

Learning to sit with emotional pain

Loving kindness as overbridging affect

Toward self

Toward others

Emotional processing Titrated exposure and the therapeutic window – broadening the paradigm

Targets, implicit activations, and parallel processing

The components of trauma processing

Exposure

Activation

Disparity

Counterconditioning and attachment activation

Resolution

The therapeutic relationship and activation of relational gestalts

Working within the Therapeutic Window Overshooting vs. undershooting the window

Repetitive exposure to trauma memories via questions/facilitation of disclosure

Activation control

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Target trauma (momentary)

Greater vs. lesser detail

Emotional vs. cognitive

Extent of intervention in avoidance

Mindfulness and therapeutic exposure

Nonavoidance and sustained attention often increases memory access, including trauma memories, yet also reduces emotional reactivity

Steps

Breath, attention, orientation

Description of memory

Focus on mindfulness

Decatastrophizing activation

Breath, attention, reorientation

Processing relational gestalts Therapeutic relationship as activator and resolver of negative relational schema

Titrated exposure to relational gestalts in the context of the therapeutic relationship

Countertransference and disparity

Activation of attachment affects and neurobiology

Special topics in emotional processing “Hot spot” processing

When

How

Working with “date rape drug” effects

Drug/alcohol effects: Explicit versus implicit memories

Context reinstatement and “shrinking” the amnestic portion

Working with intrusions as emotional processing

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Suggested readings Briere, J., & Scott, C. (2006). Principles of trauma therapy: A guide to symptoms,

evaluation, and treatment. Thousand Oaks, CA: Sage.

Briere, J. (in press). Compassion and mindfulness in psychotherapy for trauma survivors. In C.K. Germer and R.D. Siegel (Eds.), Compassion and wisdom in psychotherapy. New York: Guilford.

Cloitre M., Cohen, L.R., & Koenen, K.C. (2006). Treating Survivors of childhood abuse: psychotherapy for the interrupted life. New York: Guilford.

Germer, C.J., Siegel, R.D., & Fulton, P.R. (2005). Mindfulness and psychotherapy. New York: Guilford Press.

Kabat-Zinn, J. (2005). Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life . New York: Hyperion.