How Can Trauma-Focused CBT Help You Overcome Trauma Symptoms?

PTSD is estimated to affect one in three people after a traumatic event. If you are struggling with trauma symptoms it can be useful to begin considering your support options. There are many different therapies available to support trauma and one of those is Trauma-Focused Cognitive Behavioural Therapy, or TF-CBT for short, but what is this type of therapy, and what does it involve? 

Psychologists Ehlers and Clark (2000), in their Cognitive Model of PTSD, propose that there are certain factors that keep the vicious cycle of trauma going, and these factors essentially prevent the trauma memory/memories from being processed. These factors include:

1. Poorly elaborated memory of the trauma and that the memory has not been contextualised (the memory does not equal the situation within which it existed or happened).

2. Excessive negative beliefs and meanings attached to the trauma memory.

3. Behavioural and cognitive strategies. Cognitive strategies include pushing thoughts away (suppression) and dwelling on events (rumination). Behavioural strategies may include withdrawing socially, avoiding internal and external reminders of the event/s, little or no engagement in previous hobbies or interests, use of drugs and alcohol. There can be many more strategies people may use, we recognise every individual has different coping strategies to try to minimise or eliminate their suffering.

Goals in Trauma-Focused CBT

Therefore together our goals in TF-CBT are to:

1. Reduce flashbacks and nightmares by opening up the memory and being able to discriminate with reminders of the trauma what is then (at the time of the trauma) and what is now (in the present moment). We may recall the memory spoken out loud or by use of writing in session using the present tense. Some people may revisit the site of trauma in this part of the work to aid adding context to the trauma memory.

2. Modify excessive negative beliefs of the trauma, changing perspectives to create new more helpful beliefs. For example ‘it was my fault X happened’ becomes ‘it was not my fault X happened’ we may develop a more compassionate response towards the self. In therapy we may do this through careful and gentle questioning to explore different perspectives. We then incorporate the more helpful belief into the trauma memory.

3. Remove unhelpful behavioural and cognitive strategies that maintain intrusions and the current sense of threat and danger. We may do this in therapy by exploring the advantages and disadvantages of each strategy both in the short and long term.

As we come towards the end of treatment we often hear people we support reporting a reduction or ceasing of intrusions, a decreased sense of danger in the present moment and an improvement in mood as the person begins regaining and rebuilding their life after after the traumatic event/s.

Please see the video below if you would like to learn more about the different stages of the therapeutic journey when we work with trauma using TF-CBT. 

Emma McDonald, CBT & EMDR Therapist

•If you are looking for a Trauma Focused-CBT specialist we have a team of therapists who can offer this support face to face or online – further information can be found on our website www.thepsychotherapyclinic.co.uk

Can Your Trauma Really Be Healed?

Image by Roberta Sorge

In the UK alone, we know that millions of people have experienced some kind of trauma in their lives. I think about trauma as being on a spectrum, from mild at one end to severe at the other. So for many of these people, the trauma they experienced is probably at the milder end of the spectrum. This doesn’t mean it wasn’t painful, of course, or that it doesn’t have an effect on their daily life now. But they are still able to function, be mums and dads, have jobs and friends and do all the normal stuff of life.

If your experiences were more severe, then I’m afraid the impact on you will also be much worse. The thoughts, beliefs, emotions and physical symptoms you experience might be so intense that it’s hard to live a normal, enjoyable life. If this is true for you, I am deeply sorry – whatever you experienced was categorically not your fault, so it’s completely unfair that it is affecting you so much today.

It’s never too much and never too late

But whether your experiences were milder, more severe, or somewhere in the middle, I passionately believe that all trauma can be healed. And this belief sustains me in all that I do, from founding my Heal Your Trauma project, to writing blog posts like this, teaching webinars and workshops, recording guided meditations and in my day-to-day clinical work with clients, most of whom come to see me precisely because they have a trauma history.

Something I often tell my clients – and a useful mantra if you have a trauma history – is that it’s never too much and never too late to be healed. Whatever you have been through, whether it happened once or many times; however bad it was; and however long you have been living with the impact of those events. We now have a whole range of cutting-edge, evidence-based therapies that are proven to help.

Alongside trauma-informed therapies such as schema therapy, internal family systems therapy, EMDR, trauma-focused CBT, compassion-focused therapy and sensorimotor psychotherapy, we also have a whole range of techniques and strategies that are research-backed to help with your healing process. Some of these are thousands of years old, but have been adapted to help with the specific problems that trauma survivors face, such as trauma-informed yoga and trauma-sensitive mindfulness.

Breathing yourself better

Breathing techniques can also be incredibly powerful and helpful for reducing stress and anxiety, as well as soothing and stabilising dysregulated nervous systems (one of the hallmarks of trauma). I teach a few of these techniques to my clients, in webinars and on the Insight Timer app, such as Compassionate Breathing and Box Breathing. Again, some of these techniques (such as pranayama breathing) have been around for thousands of years, but we are incorporating them into evidence-based Western psychology and finding them highly effective and helpful for hard-to-treat problems like trauma.

It’s important to note that, especially if your experiences were up the higher end of that spectrum, you will definitely need the help of a kind, skilled, trauma-informed therapist. Programmes like Heal Your Trauma will be helpful, but cannot replace the systematic, step-by-step healing of warm, compassionate, effective psychotherapy. But attending webinars and workshops like mine, reading self-help books, meditating, listening to podcasts, doing yoga and other exercise you enjoy, having a loving partner, supportive friends and meaningful work is all part of your healing journey.

And I will do all I can to help – starting with the first of my bi-monthly Heal Your Trauma webinars on Saturday 26th February, from 3-5pm, which you can find out about in the video and book using the button below. I hope to see you there.

Warm wishes,

Dan

What are Anxiety Disorders?

Image by Nathan Dumlao

In either cognitive or schema therapy we first try to understand exactly what is causing someone’s problems, before going on to help solve them. If someone is struggling with anxiety, part of this understanding is making a diagnosis of exactly which ‘anxiety disorder’ someone is struggling with.

Some people find this idea a little uncomfortable, but it’s just like your GP diagnosing whether you have the common cold or flu, so they can prescribe the right treatment.

There are seven anxiety disorders, which I summarise briefly below – map your symptoms on to the disorder to see whether you might have one. If you are unsure, please get an assessment from a cognitive or schema therapist; and remember that it’s common to suffer from more than one of these disorders at the same time, as well as other problems like depression or low self-esteem.

Panic disorder and agoraphobia

A panic attack involves a sudden increase in anxiety, accompanied by physical symptoms of anxiety, such as a racing heart rate, breathlessness or dizziness. Panic disorder involves recurrent panic attacks and may or may not lead to agoraphobia – anxiety about being in situations in which escape would be embarrassing or help would not be available in the case of a panic attack. People with agoraphobia may struggle to leave the house or be in open or public places, like shopping centres.

Health anxiety

Health anxiety (also called ‘hypochondriasis’) involves a fear of having a serious illness, like cancer or heart disease, and a preoccupation with bodily symptoms. The problem will not go away with medical reassurance and is often extremely distressing – you may be convinced you have a serious health problem but that no-one believes you, which is understandably frustrating and upsetting.

Social phobia

People with social phobia have a fear of social or performance situations, or both; you may feel comfortable with one trusted friend, but become anxious if their friend joins you. You might be fine in small groups, but the bigger the group the more your anxiety grows. And you might struggle in performance situations, like public speaking or university seminars – you may hate being put on the spot or have the feeling that everyone can see how anxious you are and will think badly of you in some way.

Specific phobia

This involves the persistent fear of a particular object of situation – it’s ‘specific’ because you fear that and not a wide range of things. The most common phobias are a fear of heights, public speaking, snakes, spiders, being in enclosed spaces, mice, needles and injections, crowds, clowns, darkness and dogs. Of course, some people struggle with more than one phobia. And it’s worth noting that specific phobias are relatively easy to treat with CBT – in around six sessions or less.

Generalised anxiety disorder (GAD)

GAD is defined as excessive anxiety and worry occurring more days than not for a period of at least six months and about a number of events or activities. The two key features of this disorder are ‘free-floating’ anxiety, which attaches itself to one thing after another; and persistent worry, which is more severe than normal worry, seems hard to control and causes distress and/or makes it difficult to function.

Obsessive-compulsive disorder (OCD)

If you are suffering from OCD, you will experience obsessions (intrusive images, impulses or thoughts) and/or compulsions (repetitive behaviours engaged in to minimise the anxiety or upset caused by the obsessional thought or because of rigid rules). Although the compulsion – which could involve checking, washing, prayers or replacing negative thoughts/images with positive ones – is intended to reduce distress or prevent a feared outcome, like someone you love being harmed. Unfortunately, the compulsion only provides short-term relief and is a key element of what maintains the OCD.

Posttraumatic stress disorder (PTSD)

PTSD occurs as a reaction to a profoundly distressing event that threatened death or serious injury to yourself or other people; a response that involved intense fear, helplessness or horror; and key symptoms of re-experiencing, avoidance and hyperarousal. There is some debate over whether PTSD is an anxiety or stress/trauma disorder, but as it does involve very high levels of anxiety, I have included it here.

Warm wishes,

Dan