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In the last few years, I’ve become increasingly interested in the impact of trauma on mental health. As an ER resident and later, as a practicing physician, I didn’t realize just how much the traumatic things I’d seen and experienced had affected me. It wasn’t something that got talked about. In both training and in practice, at least in that era, doctors weren’t taught anything about how to acknowledge or deal with their own traumatic experiences. You just pushed it down, steeled yourself, and kept going.
Works such as Dr. Bessel van der Kolk’s landmark book, The Body Keeps the Score, are stunning in their ability to explain what was previously unexplainable. Research has revealed that many of the deeply challenging, poorly understood mental health symptoms or syndromes that I have seen in patients over the years, can be traced right back to trauma. This, too, wasn’t something that I was taught when receiving my basic training in psychiatry.
In my quest to learn more, I recently took a continuing medical education course from NICABM (National Institute for the Clinical Application of Behavioral Medicine) on Expert Strategies for Working With Traumatic Memory. The main session of this online course was taught by Ruth Buczynski (President of NICABM), Pat Ogden, and Peter Levine, with a few comments from the legendary Dr. van der Kolk himself.
Though the content covered by the course is much greater than the scope of a blog post, I wanted to share four of my favorite points from the main session:
1. You can learn to “safely” visit your past. One of the most awful things about traumatic memories is that it can feel like they'll never fade — that you’ll never be able to think of that episode, that season, that person, that place without feeling awful, despairing, angry or terrified.
We can learn to change our experience of traumatic memories.
According to van der Kolk, “You need to learn to manage to feel whatever that awful feeling in your belly is…and to say, 'Okay. That’s the feeling I have. This has something to do with the past. I’m going to take a deep breath. I can feel my butt in the chair.' And say, 'Okay.' And then they can really think about what happened to that little kid back then.”
He explained this further in advice to clinicians: “You need to really help people to feel safe to feel what they feel in their bodies, and to manage the housekeeping of their bodies."
Now the treatment of trauma is complex, and obviously not as simple as just learning to be comfortable and present in your body, but this is a very significant piece of healing.
2. Memories can be helpful in finding purpose and direction in life. It’s easy to think of traumatic seasons or episodes in our life as all bad, best to be buried and forgotten, but there are riches to be mined from the dark places.
According to Levine, “when you can access episodic memories, they can be very important to help the person find their purpose, their direction in. life. That’s a very important thing that sometimes is neglected in therapy."
Buczynski added: “By nurturing the ideals and values that might be connected to past experiences, it can help clients to continue with their healing and find meaning in life.”
There is so much beauty and hope in this perspective, no?
3. Trauma creates “procedural memories” that are stored in our bodies. Are you someone who goes through the world tightly wound, with your shoulders permanently raised to your ears? It might not just be because you have an “uptight” personality or feel chronically stressed in the present. That posture, that tension, may have taken root in your body, thanks to experiences that happened long ago.
One approach a clinician can take to memories that are stuck as physical postures or patterns is to do what Ogden called “resourcing the pattern." For example, someone who is chronically tense in their upper body can start to notice it for what it is and learn to take a breath and let their shoulders drop. This can be an effective, simple place to start.
However, Ogden cautions that one must be careful “against just shifting the body and leaving the part of the client that is frightened or hiding themselves, leaving that in the dust….we probably want to go back to this part and have these two parts start to communicate, so there can be integration.”
4. Shift your focus from negative to positive environmental cues. This is a great strategy, one that I had already been using for myself and teaching patients. It was great to have it reinforced by these leading experts.
Dr. Ogden shared: “Something I’ve found to be very effective is to help clients be aware of what they’re orienting to, both outside in the environment and inside in themselves because clients who are traumatized start to orient toward threat cues…they start to orient toward those cues of dysregulation inside themselves.”
Anyone who has experienced trauma knows exactly what she means.
You can retrain your orienting habits. For example, Dr. Ogden will give patients this homework: “Go for a walk outside the block and just seek out things that bring you pleasure in the environment.” Colors, the sky, birds, sounds, whatever is pleasing and positive.
I had learned previously that this simple act of retraining yourself to intentionally engage with your world in this positive, grateful, joyful (and simple) way, creates meaningful changes in the biochemistry of your brain. It shifts the balance from a steady state of fear, hyperarousal, and tension, to a fresh sense of ease, well-being, and positive emotions. It teaches your brain a new way to be, that it doesn’t have to be on guard all the time. That it can be safe and even enjoy a new normal.
I hope you’ve found these insights and tips to be useful. I will more than likely share some more pearls from this course in a future post. And of course, none of the information here is meant to be applied without proper professional support or to replace the advice of your therapist or doctor. If you are struggling with traumatic memories or symptoms of PTSD, I would always recommend that you seek the support of a professional trauma counselor or psychologist.
© 2020 Dr. Susan Biali Haas, MD
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