He subsequently reported digestive and sleeping difficulties that were traced in origin to his self-prescribed regimen. The clinician recommended that he seek advice from a good nutritionist, Body-Based Adjunct Treatment Team Members A good supportive relationship with a primary care physician is often crucial for coordinating aspects of treatment that address medical problems that may coexist with, or be contributing to, emotional distress. Other mind–body professionals who can provide useful adjunctive collaborative therapies, in lieu of or in addition to medical intervention, are acupuncturists, body workers, energy workers, nutritionists, spiritual leaders or directors, expressive therapists, and exercise coaches. Direct attention to, and assistance with, areas of physical and spiritual health helps clients create health and healing at all levels of being. Basic self-care related to eating, sleeping, and exercise may be handled within the primary therapy or may need to be addressed in another venue. Alternative mind–body approaches may help eliminate conditioned fear responses that have infiltrated the body by teaching clients to orient in the present moment and to increase their control over powerful emotions and reactions (Rhodes et al., 2016). Yoga—a combination of gentle stretches, “body movements, breath exercises, and mindfulness” (Rhodes et al., 2016, p. 189)—is one type of mind–body therapy that can treat trauma symptoms. Yogic practice encourages greater body awareness and can be particularly effective in improving the dysregulation commonly observed in trauma survivors through improved self- regulatory capacities and a realignment of the stress response system (Rhodes et al., 2016). Rhodes and colleagues (2016) found that after 10 sessions of yoga, clients with posttraumatic stress disorder (PTSD) exhibited symptom reduction, loss of PTSD diagnosis, and improved self-regulation. Interim results from a recent study even found that a trauma-sensitive yoga intervention showed faster symptom relief and lower dropout than Cognitive Processing Therapy (Kelly et al., 2021). Clients interested in experimenting with yoga as an adjunct or primary PTSD treatment can start with basic classes and later decide whether to embrace the more integrated yoga practices that are available. However, it may be beneficial for clients to consider seeking practitioners who have specialized training in trauma- sensitive yoga to facilitate a safe environment (Ong, 2021). Mindfulness-based stress reduction (MBSR) incorporates mindfulness principles into an operationalized, third-generation cognitive-behavioral approach. This intervention teaches clients “to attend to the present moment” (e.g., any physical or emotional state that arises) in a “nonjudgmental and accepting manner” (e.g., observing rather than reacting or responding to
herbalist, or homeopathic physician before self-medicating with such herbal remedies in the future.
thoughts; Polusny et al., 2015, p. 457). This stance can allow individuals to experience aspects of traumatic recall without trying to change them, which can “decouple the experience from neuronal firings that code for defensive maneuvers and judgments about the experience” (Davis et al., 2019, p. 2). Mindfulness-based stress reduction starts with didactic education sessions and then progresses into practice sessions in which clients may engage in a variety of mindfulness-based intervention activities. For instance, a body scan progressively guides the client to directly attend to various areas of the body, slowly observing physical, cognitive, and emotional awareness in the moment (Polusny et al., 2015). Rather than avoiding symptoms, trauma survivors can practice attending to their intrusive thoughts and memories, linking those thoughts to their physiological arousal, and then start to connect mind and body in a more integrative and reparative way. In a randomized controlled trial (RCT) by David and colleagues (2019), MBSR was shown to have positive effects, but it is noted that these effects were not comparable to trauma-focused therapies. They support use of MBSR as a supplement, not a replacement, for trauma- focused therapy. General exercise can also directly treat trauma symptoms. Many trauma survivors struggle with dysregulated or hypersensitive fear–response systems, despite the absence of a fear stimulus (e.g., combat fears despite no longer being in a war zone). Research has demonstrated that exercise can stimulate synaptic plasticity (i.e., growth and strengthening of neural connections and cells) in areas of the brain involved in fear. This plasticity can diminish automatic fear responses, making exercise a form of fear extinction therapy (Tanner et al., 2018). Preliminary evidence suggests that the use of aerobic activity following exposure- based interventions may help enhance the consolidation of memories and improve the efficacy of such interventions (Crombie et al., 2021). Additionally, moderate aerobic exercise has been shown to improve general mood states (Crombie et al., 2021) and can be useful in managing other physiological impacts of PTSD, such as elevated blood pressure (Fonkoue et al., 2018). Part of a clinician’s ethical and professional care for clients involves knowing to whom, when, and how to refer clients for adjunctive services. Particularly with complex trauma cases, clinicians need to build a treatment team in the service of both their clients and themselves, to prevent burnout or vicarious traumatization, which will be addressed at length in the final chapter. (2019a) documents neurobiological research that supports the importance of secure attachment to the development of significant areas of the brain. Attachment disorder in children and adults is likely to manifest with problems in relationships, emotional development, behavioral control, and cognitive development (van der Kolk, 2014). A clinician who is familiar with attachment theory will be able to consistently and purposefully offer repeated experiences of mutual attunement, connection, caring, and vitality within the therapeutic relationship in order to counteract the disrupted attachment schemas generated by ongoing trauma. The attachment relationship can be harnessed to facilitate trauma healing with short-term dynamic psychotherapies. This type of treatment is a deep, psychoanalytic approach that can facilitate the uncovering of unconscious material related to traumatic experiences (Iwakabe et al., 2020). Short-term dynamic psychotherapies emphasize the “here-and-now” experience of previously suppressed affect (e.g., early attachment failures), using the current client–therapist relationships as a secure base for unresolved feelings.
Theoretical Perspectives That Inform and Enhance Trauma Treatment Clinicians in the field of trauma assessment and treatment need to be educated in and able to apply a variety of theoretical perspectives in order to provide a comprehensive and broadly informed treatment approach. The more tools clinicians have in their clinical toolboxes, the greater the likelihood that they can provide comprehensive and individualized treatment for a wide range of individuals who have experienced traumatic
events. Clients will have individualized responses to their traumatic experiences and also to what methods of healing work best for them. In addition to a solid understanding of the field of trauma studies (also referred to as traumatology), the following orientations provide important theoretical and practical perspectives for an integrated and holistic approach to healing. Attachment Theory Basic understanding of the nature of human attachment, previously discussed in Chapter 3, provides the clinician with the key to understanding the nature of a healing therapeutic relationship (Schore, 2019a; Siegel, 2012; van der Kolk, 2014). Developmental attachment patterns emerge throughout a child’s early years of life (van der Kolk, 2014). Allan Schore
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