Post-traumatic stress disorder (PTSD) can be defined as recurrent episodes of anxiety and panic reactions triggered by memories of a past trauma. A trauma in this context is an experience that is overwhelming at both the sensory and emotional levels to such an extent that the mind cannot process and assimilate the experience. The trauma, which is the combination of both the intense sensory memory along with associated emotional energy, becomes repressed as an emotional complex, only to reoccur in the future when the appropriate sensory triggers are activated. The basic direction in psychotherapy is, therefore, to help the client re-process and re-assimilate both the sensory and emotional memory.
One approach, which I have found particularly helpful, is a form of psychotherapy that combines mindfulness and experiential imagery, in what I call Mindfulness Meditation Therapy (http://www.mindfulnessmeditationtherapy.com/). In this approach, the client is guided to form a unique relationship with the felt-sense of the emotional trauma. The felt-sense can be defined as the general feeling tone of the experience, which is quite distinct from the complex structure of an emotional reaction and does not involve thinking, but rather sensing.
Mindfulness describes a particular quality of conscious relationship with an experience, which is open and accepting. Mindfulness is being completely present with whatever is being experienced as an interested observer eager, to investigate and learn. Mindfulness is the absence of reactivity, either in the form of identification with the story line of our experience, or aversion to what we are experiencing. These qualities are invaluable in psychotherapy, because they allow the client to investigate the deep structure of his trauma, rather than staying stuck at the superficial surface structure. If we do become reactive, or start identifying with an emotion, then mindfulness also teaches us to recognize what is happening so that we can stop the reaction in its tracks and return the primary relationship of mindful-observation. Mindfulness has both active and receptive aspects, and both are needed. When both are functioning, then the individual is able to establish a dynamic relationship with his inner memories and emotions, and this mindfulness-based relationship creates a highly transformative therapeutic space.
When one begins to investigate the internal structure of a traumatic memory, it is surprising to discover the wealth of subtle feelings that lie just under the surface. Differentiation of the feeling structure of an emotion like anxiety or panic is an essential part of any successful therapy, and the conscious experience of this inner structure is transformational. This is one of the key effects of mindful-awareness: we see more, and experience more, which allows the repressed emotional complex to surface into consciousness for re-processing..
In addition to feelings, traumatic memories also have a specific internal structure in the form of intense experiential imagery. This imagery may be photographic in quality, revealing the actual memory of a traumatic event, but more often the memory-imagery has been processed post trauma, and takes on a more abstract structure with considerable symbolic meaning. This experiential imagery has an internal structure in the form of specific colors, shape and size, and often occupies a specific position in the inner visual field. Emotional energy is encoded in each of these specific sub-modalities of position, form, size, color, texture and movement. An intense emotion is likely to be encoded in intense colors, such as red and yellow, and the imagery is likely to be large and close-up in the person's inner visual field, whereas neutral emotions are encoded in neutral colors, such as grey or white, and appear small and distant.
After the client becomes aware of this inner experiential imagery, he can begin to investigate what changes need to happen in the imagery that allow the emotion to be transform and resolve. Mindfulness helps this transformational process by creating a safe therapeutic space in which there is no interference from the ego, or judgemental mind. The client begins to discover intuitive changes that can be very subtle and beyond rational deduction, but are clearly felt to make a difference. It is also worth noting that as the client begins to see the specific details of his traumatic imagery, he is actually better able to maintain a relationship with the trauma, without becoming overwhelmed. This may seem counter-intuitive, but it is always what we don't see that causes most mischief, and part of what sustains PTSD is the inability of the client to see the details of his inner imagery. The total experience is overwhelming, but the experience of its parts is not, and the more detail he can see, the less reactive he will become. The fear of the unknown is our worst enemy, and mindfulness is the process of making the unknown known, by paying close attention and investigating what arises.
One female client came to me to work on recurrent anxiety and fearfulness that formed part of her PTSD to the childhood sexual abuse inflicted by her father. When she focused mindfulness on the felt-sense of anxiety, it took a very specific position in her lower throat. With continued mindful-investigation, she became aware of a very clear image of a tightly wound tangle of prickly string, and this imagery that seemed to resonate very strongly with the feeling. When asked what needed to happen next, which is a question that is frequently asked by the therapist during mindfulness work, the tight ball clearly needed to untangle. She spent several minutes investigating how this might happen. At one point, she burst out with rage at what had been done to her, and it became clear that the unwinding ball of string had symbolic meaning and facilitated the release of all this repressed emotional energy. The imagery continued to unfold in many subtle ways, and during this process she discovered a new sense of inner strength and empowerment that allowed her to move significantly towards the completion and re-integration of these traumatic memories. Over the following weeks, she continued to work with unwinding the tangled ball in her throat, and each time she discovered more inner strength and more freedom from this traumatic episode in her past. Strand by strand, the ball unwound and eventually the trauma became just a bad memory that could be put to rest.
One could spend many hours trying to interpret and understand this imagery, but what was much more important, was her direct experience of the resolution process at the subtle and concrete level of her own experiential imagery, and this is made possible by mindfulness. The psyche thinks in pictures, not words, and experiential imagery is the natural language of the psyche. When we make this content conscious, the psyche uses imagery to heal itself. It is not what we do that matters, but how well we listen, with an open mind and open heart. Throughout the whole process of MMT, the client is repeatedly exposed to the source of his or her fear, but in new ways that don't involve being overwhelmed or becoming emotionally reactive. This exposure desensitization effect is regarded by most schools of psychotherapy as an essential part of overcoming PTSD, and Mindfulness Meditation Therapy provides a very subtle and specific way of doing this through the client's internal experiential imagery. The imagery helps clients form new ways of relating to their traumatic memories and emotions that promotes transformation, resolution and healing, and is often far more effective than what we as therapists say to our clients.