some individuals. PTSD has been found to be the most highly co-occurring psychiatric disorder with cannabis use disorder, and a recent study by Metrik and colleagues (2020) found cannabis use to be linked to increased severity of trauma-related intrusion symptoms over time. Considerations may be needed for how cannabis use can be a facilitator of treatment rather than being relied upon as a stand-alone intervention. For example, some evidence has shown cannabis to increase fear extinction and disrupt fear memory consolidation, which could be utilized to enhance the efficacy of exposure-based psychotherapies (Krediet et al., 2020). Integrating Body and Spirit into the Healing Process In addition to the previously discussed theoretical perspectives, attention to the client’s body and spirit will provide the healing approach that is most likely to aid in integration and consolidation of a healthy self (Levine, 2015). The body is the scene of the crime for survivors of interpersonal violence. There are a number of means by which one can incorporate the body into the treatment. The Limitations of Talk Therapy for Trauma Survivors Talk therapy for trauma survivors is only one aspect of an overall healing protocol. Although somatosensory intrusions and memories need to be transformed into language and named, thus engaging the thinking brain and disengaging the limbic system from its habitual instinctual response, language alone can also be a tyranny and a trap. If traumatized people talk only about the trauma, without enlisting help from “the imaginal, emotional, sensory, and somatic capabilities of their right brain, the symptoms can get worse instead of better” (Naparstek, 2004, p. xviii). The language centers in the brain have been compromised by the flood of neurochemical responses released at the time of the trauma because Broca’s area, responsible for the production of speech, becomes inhibited during states of high arousal (Cozolino, 2014). To quote the title of Bessel van der Kolk’s 2014 book, “the body keeps the score” in regard to trauma. Effective treatments must, at times, sidestep the logical brain and treat the ingrained biology. Guided Imagery and Dreamwork The use of dreamwork, guided imagery, and certain hypnotherapeutic techniques can gently guide the client into an experience of calm, mastery, and the ability to access internal resources. According to Naparstek (2004), guided imagery is: a form of deliberate directed daydreaming—a purposeful use of the imagination, using words and phrases designed to evoke rich multi-sensory fantasy and memory, in order to create a deeply immersive receptive mind-state that is ideal for catalyzing desired changes in mind, body, psyche, and spirit. (p. 150) The traumatized brain is compelled to move away from language and verbal cues in order to focus on the nonverbal cues—such as body movements, facial expression, and tone of voice—and to search and scan for threat-related information embedded in the environment (van der Kolk, 2014). Guided imagery, with its calm, soothing tones, images of safety, and (often) use of music, can settle down a hypervigilant brain, which then allows the higher brain functions to do their jobs.Dreams are the body’s built-in imagery system, and most come in symbolic and image- laden form. They may contain trauma-specific imagery in the form of posttraumatic nightmares and memories of buried trauma as well as keys for renewing safety and directions for healing. One approach, based on Carl Jung’s method of active imagination (Jung, 1963), is called the guided active imagination approach (Schiller, 2008). This method attends
carefully to preliminary and concurrent issues of client safety when doing deep dreamwork, using a form of guided imagery. Understanding and using the concept of felt sense can help clients to reorient themselves in their own bodies. The concept of felt sense is based on ideas put forward in Eugene Gendlin’s (1982) book Focusing. It implies a perceived bodily experience that is visceral and cognitive at the same time. Gendlin describes felt sense as “a bodily awareness, a non-linear experience . . . the medium through which we experience the totality of sensation” (Gendlin, 1982, p. 32). Ann Weiser Cornell (2005, p. 89) describes felt sense as “a freshly forming holistic sense that has a more- than-words-can-say quality to it.” It is the ability to tune into one’s body sensation and to describe it in relation to the cognitive context and the emotions being generated. (For example, if a client says, “I feel so ashamed when I think about what happened,” the clinician can respond with the questions “Where do you feel that sense of shame in your body?” and “How would you describe the sensation?”) Many practitioners have begun integrating mindfulness as a component of their treatment or as a separate, adjunctive treatment for PTSD. Mindfulness is an umbrella term that can encompass a number of mind–body interventions, and there is increasing empirical support for its utility for individuals with PTSD (Williston et al., 2021). One meta- analysis of recent studies showed that mindfulness-based approaches led to a reduction of PTSD symptoms with low rates of dropout from treatment (Boyd et al., 2018). Stress Inoculation Training Some trauma survivors are either uninterested in or unable to remember their traumas and therefore are incapable of engaging in trauma processing or narrative work. Stress inoculation training (SIT) represents an evidence- based “here-and-now” approach that aims to minimize hyperarousal symptoms without requiring deeper trauma processing (Jackson et al., 2019). SIT focuses on teaching and practicing coping skills to improve clients’ confidence in their ability to cope with, manage, and reduce stress. Clients work through three primary stages of SIT: Education, skill introduction, and skill practice (Jackson et al., 2019). During the education stage, clients receive psychoeducation about their trauma symptoms and collaboratively identify their sources, levels of stress, and current coping mechanisms (Meichenbaum, 2017). In the second stage of treatment, clients learn new coping skills—relaxation training, cognitive coping, assertiveness skills, guided self-dialogue, and mindfulness—that can replace or supplement their existing tools. Finally, in the third stage, clients practice the newly learned skills either in in-vivo sessions or during stressful conditions outside of the sessions (Meichenbaum, 2017). In addition to practicing skills, clients can create plans for handling future stressful situations or work to change or remove aspects of their lives contributing to stress (Meichenbaum, 2017). SIT is often used in conjunction with other therapies (Meichenbaum, 2017; Society for Clinical Psychology, 2016). Sensorimotor Psychotherapy One of the most useful systems for body-oriented work is sensorimotor psychotherapy. Building on the work of Ron Kurtz, who pioneered a therapeutic system called Hakomi (which emphasizes mindfulness), Pat Ogden and her colleagues (2006) designed a system of therapeutic work that approaches the body itself as central to the therapy and includes a variety of observational skills, theoretical perspectives, and interventions that are different from those employed in traditional models of psychotherapy. This system incorporates somatic (body-based) interventions within therapy, with the goal of unifying body and mind in
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