Psychological therapy for trauma: what is it and how does it work?

We analyze which treatments are most effective in these cases.

Traumas are very shocking and hard experiences that we live, which end up leaving an important mark on our psyche.

In addition, they also include the consequences of that experience. Psychological therapy for trauma is based on two techniques: exposure and cognitive restructuring.

In this article we will know the usual symptomatology after experiencing a traumatic event, as well as the functioning of psychological therapy focused on treating such traumas. We will analyze the two techniques that compose it, its variants, and how they can be applied in therapy to help the patient.

Trauma-related disorders

Before addressing psychological therapy for trauma, we must understand what trauma is and what implications it entails.. A trauma is the result of a very shocking event that we experience, and that causes us such stress that it ends up affecting our psychological functioning, interfering in our day-to-day life and diminishing our psychological well-being. The term "trauma", however, is also used to designate the traumatic event in question.

The consequences of trauma can vary considerably from person to person; however, when we use this term, we are generally referring to the onset of PTSD (Post Traumatic Stress Disorder) or ASD (Acute Stress Disorder). While PTSD lasts at least 1 month, ASD lasts at most 1 month; that is, ASD becomes PTSD when this period of time has elapsed.

Symptoms

Symptoms of a trauma-induced disorder often include physical, psychological and behavioral manifestations.. At the physical level, the person may manifest noticeable psychophysiological symptoms, and also often re-experiences the traumatic experience, causing the same physical symptoms as those felt at the time of the event.

On a psychological level, she may feel anxious, worried, nervous, irritable or fearful. Finally, behaviorally she may have avoidance behaviors of any details related to the traumatic event; this translates into avoiding talking about it, avoiding going to places close to the event, etc.

Psychological therapy for trauma

As we have seen, suffering a trauma implies considerable suffering for the person, since it stagnates him/her in many aspects of his/her life, preventing him/her from moving forward and developing a normalized life. Although it is true that there are different degrees of affectation depending on the event and the person, as well as different types of trauma, we can speak of PTSD as the main (and most frequent) disorder caused by trauma, as we have already seen.

As a result of the different symptoms caused by PTSD, psychological therapy for trauma will be focused on the patient being able to confront, process and integrate what he/she experienced, without repressing anything and working on the symptoms of PTSD.without repressing anything and working on the aspects that most impacted or overwhelmed him/her.

It is important that the patient feels comfortable, free and calm to be able to express without fear how he/she feels and to what extent the event is interfering with his/her normal functioning.

Psychological therapy for trauma is based on two main techniques: exposure and cognitive restructuring.

1. Exposure

Trauma exposure is a fundamental part of psychological therapy for trauma; it can be behavioral or narrative. A more modern type of exposure therapy has also been used, with promising results: EMDR (Eye movement desensitization and reprocessing). Let's see what these three types of exposure consist of.

1.1. Behavioral exposure

Behavioral exposure involves exposing the person to the stimuli, events or thoughts related to the trauma directly.

Narrative exposure

Narrative exposure, on the other hand, is focused on the patient narrating and describing (or writing) the traumatic experience in as much detail as possible, that is, explaining in his or her own words what he or she experienced on the day (or days) of the event, how he or she felt, what objects or people were there, etc.

1.3. EMDR (Eye movement desensitization and reprocessing)

EMDR, in English "Eye Movement Desensitization and Reprocessing", is a type of therapy created by the Jewish psychologist Francine Shapiro. This therapy, like the previous variants of exposure, is used as a psychological therapy for trauma. It is used to diminish the negative symptoms associated with a trauma.

It consists in stimulating the patient bilaterally, through various methods, which can be: eye movements (mainly), sounds or tapping. According to Shapiro and the defenders of the technique, what this stimulation does is to stimulate a cerebral hemisphere.

If we analyze EMDR step by step, and in a very synthesized way (without going into detail), the first thing the therapist will do is to ask the patient to remember the traumatic event, with all possible details (sensations, images, thoughts...). Then the processing phase will be set in motion, where the therapist will ask you to re-evoke the event while stimulating it.

This will be done by sequences containing patterns in between. Subsequently, the therapist will ask the patient for his or her thoughts. In addition, positive images will be included, which the patient will have to imagine and associate with the traumatic memories. In reality, EMDR is made up of several phases (eight to be precise) that the therapist must know in depth in order to apply this type of technique correctly.

Characteristics of the exposure

On the other hand, it is important to note that the exposure should be prolonged and applied gradually. This exposure will be to the patient's traumatic memories, in relation to the trauma he/she experienced.

But, what is the purpose of the exposure? It is a fundamental part for the patient to gradually process what he/she experienced. It is important that the repressed aspects in the unconscious come to light, so that they can be addressed; the objective is that the traumatic experience is integrated into the patient's life experience, becoming part of it.

We must know that the exposure is a very painful process for the patient, since in a certain way it relives very hard and distressing sensations and experiences; in addition, it is frequent that resistances appear in the patient's account. This is why the therapist should work with empathy and understanding, validating the patient's emotions at all times and offering support.

It will also be important for the therapist to provide the patient with tools so that he/she can deal with the negative thoughts, nightmares, intrusive memories, etc.

2. Cognitive restructuring

Cognitive restructuring as part of the psychological therapy for trauma is oriented to modify the dysfunctional thought patterns that the patient manifests, in order to subsequently provide tools that allow the patient to develop alternative and adaptive thoughts. that the patient manifests, in order to subsequently provide tools that allow the patient to develop alternative and adaptive thoughts.

This component of the therapy is essential since PTSD is often associated with negative alterations in the patient's cognitions and mood.

In order for the patient who has experienced a trauma to assimilate the experience, it is important that he/she has a space to express him/herself without pressure or conditioning; cognitive restructuring is an essential tool to work on the negative thoughts and feelings of guilt that patients who have experienced a particularly painful and shocking experience often have.

In this way, it is important that the patient can change his or her way of perceiving and remembering what he or she experienced, in case it is a maladaptive way.. On the other hand, behavioral changes, from cognitive-behavioral psychotherapy, are achieved by changing one's own thoughts (and vice versa).

That is why for the patient to cope with the experience, work should be done on their aforementioned avoidant behaviors, since the fact of avoiding and repressing, can end up generating significant psychological problems in the future, which end up coming out explosively at any time or before a trigger related to the trauma.

Bibliographical references:

• American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and statistical manual of mental disorders. Madrid: Panamericana.

• Caballo (2002). Manual for cognitive-behavioral treatment of psychological disorders. Vol. 1 and 2. Siglo XXI.

• Laco, E. and Larraz, G. (2012). EMDR: Review of the technique and application to a clinical case. Cuadernos de Medicina Psicosomática, 104: 45-56.

• Pérez, M., Fernández, J.R., Fernández, C. and Amigo, I. (2010). Guide to effective psychological treatments I and II:. Madrid: Pirámide.