The Missing Pieces of Authentic Trauma Healing
I was originally hired to write this piece for a national publication, which provided an opportunity for me to decide who I ultimately want to work with. Turns out, it wasn’t them.
This piece is important. So I decided to publish it here instead of this month’s Nervous System: Before & After. I hope you find value.
“Trauma is not what happens to you. Trauma is what happens inside you, as a result of what happens to you.”
— Dr. Gabor Maté
Traditionally defined as a deeply distressing or disturbing experience, what constitutes trauma has shifted over the last fifty years.
Once limited to events like fighting wars or brain injuries, the term now encompasses experiences like poverty, struggle with sexual identity, living with physical and mental disabilities, childhood neglect, sexual abuse, rape, generational oppression, and marginalization.
How trauma is currently treated
The primary tool clinicians use to diagnose mental health issues is the Diagnostic and Statistical Manual of Mental Disorders (DSM-5TR). Published by the American Psychiatric Association (APA), it’s a medical model that pathologizes symptoms and behavior, classifying them as unhealthy or abnormal and offers a structure to standardize diagnoses.
The most common treatment for disorders typically associated with trauma – Post Traumatic Stress Disorder (PTSD), Acute Stress Disorder (ASD), Reactive Attachment Disorder (RAD), and the symptoms that accompany them – sleep problems, anxiety, depression, agitation, self-destructive behavior, and dissociation, is talk therapy and sometimes medication.
The psychotherapy of choice for many clinicians is Cognitive Behavioral Therapy (CBT), a strategy that focuses on identifying problems and developing solutions. Some now combine CBT with modalities like Eye Movement Desensitization and Reprocessing (EMDR), which uses bi-lateral stimulation to access and resolve painful memories and drugs like ketamine that have been shown to reduce the symptoms of PTSD.
“Some people do benefit from a more psychoanalytic approach like CBT,” says Dr. Christy Gibson, a Canada-based trauma specialist and general practitioner. “But I don’t actually think that the established experts are aware of what trauma feels like and what works to recover from it.”
Gibson is not alone. She notes that there are clinicians choosing more progressive modalities, and even leaving the therapy licensure track behind, for the freedom to use tools and techniques that work best for their clients even if they’re not sanctioned by with current thinking. She, and others in the field treating patients, understand there are elements missing from traditional treatments that are necessary for authentic healing.
The first missing piece
As the definition of trauma has expanded, treatment must as well. The first aspect of healing that traditional psychotherapy, including CBT, does not address is how the nervous system becomes dysregulated by living in the state of fear created from traumatic experiences. Acknowledgment of how this impacts people has led some to a focus on using techniques that bring the nervous system back into balance and allowing people to feel safe, which is necessary for authentic healing.
“Your nervous system is just going to speak louder and louder until it gets your attention,” says Deb Dana, a licensed clinical social worker and author. “You can’t become a truly healthy person, physically and psychologically, until you deal with both.”
The nervous system is part of our body’s autonomic system, which controls things like breathing and the heartbeat. It contains three parts: the sympathetic division – a network of nerves that helps prime the body for action, the parasympathetic division – a collection of nerves that create a calmer state to support rest and digestive functions, and the enteric division – comprised of circuits that control gastrointestinal functions among others.
When trauma is repeated over time, as in cases of childhood abuse, domestic violence or living as a member of an oppressed population, the nervous system can get stuck in either the extremes of sympathetic phase – fight or flight, or get locked in freeze – the deep end of the parasympathetic system. If these maladaptive states become chronic, serious repercussions can occur. These include anything from not being able to hold a job or participate in a healthy relationship to depression or even suicide.
People stuck in a “fight” state can be agitated and literally be ready to fight. But expressions of this state also include a need to have the final say, constantly confronting authority, and the drive to taunt or insult others. The “flight” state is more than the act of running away. It can show up as micromanaging, commitment phobia, or being a perfectionist/overachiever. And “freeze” goes beyond the stereotype of a deer in headlights. Manifestations of freeze can encompass behavior like continuous social media scrolling or binge watching, giving up when things become difficult and isolating.
Occasional behavior like this can be the result of intense stress. While life post-COVID is filled with enormous stress for many, it’s critical to distinguish between stress and trauma, which results from a serious and devastating event or events. If the behavior occurs frequently, it’s a sign trauma is likely involved, and that the nervous system has lost the ability to regulate itself.
There is more than half a century of research that discusses the impact of not feeling safe in one’s environment. Dr. Peter Levine began to examine the impact of threats on the nervous system by studying animals in the wild in the 1970s. Although continually under threat, they showed no signs of trauma as experienced by humans. He came to believe that it’s not the trauma that causes damage, but rather the overwhelming sense of being trapped inside the perceived threat, which results in an imbalanced nervous system.
Dr. Besser van der Kolk shared the results of his research about how trauma affects the mind and body in his 2014 book The Body Keeps the Score. The message was that the impact of trauma is just as much, if not more, biological than psychological.
One explanation for how and why this happens is Polyvagal Theory. Developed by Dr. Stephen Porges, an American psychologist and neuroscientist, part of his theory published in 2011 expands our view of the autonomic nervous system by providing a description of three neural circuits that support behaviors associated with social engagement, fight or flight, and shutting down.
When we are in what he calls the ventral vagal state, a part of the parasympathetic nervous system, we feel comfortable and are easily able to connect and socialize. A perceived threat or a feeling of being overwhelmed, whether from a person or situation, can put us into one of two states. First, the extreme end of the sympathetic nervous system where we feel anxious, afraid, or angry – all components of fight or flight. And in some cases, we can end up in what he labels the dorsal vagal state, the edge of the parasympathetic nervous system where we feel numb, trapped, or hopeless. This causes us to shut down or “freeze.”
Repeated trauma can mean we get stuck in those neural loops, creating nervous system dysregulation and, ultimately, dysfunction that can affect every aspect of our lives. Porges contends that continual dysregulation has long-term consequences beyond a sense of belonging and connection. “When the nervous system is primed to be defensive,” he says. “It sets the platform for illness and disease.”
Being able to live in a “window of tolerance,” a concept developed by mindfulness expert Dr. Dan Siegel, identifies the optimal zone of arousal for someone to manage and cope with their emotions. This is necessary to function in a healthy way. A big part of the ability to stay in this window is nervous system regulation.
While there has been pushback to Polyvagal Theory from factions of the scientific community who assert it oversimplifies the human emotions and takes leaps from hypothesis to conclusion, many therapists have seen a variety of nervous system regulation techniques help their patients. “A lot of people are quick to dismiss it because of presumed scientific misunderstandings and I am not enough of a clinical scientist to understand it,” says Gibson. “But what I am is a person who's on the ground working with folks who have these stress responses caught in their body.”
Many of the techniques now used to treat nervous system dysregulation have their roots in cultures that have practiced regulation through techniques that focus on the body to alleviate the negative impact trauma.
A paper by Erwin Schweitzer, a social anthropologist and psychotherapist at the University of Hamburg, discusses the use of self-induced therapeutic tremors to help heal the impact of traumatic experiences in cultures from the Inuit to the Jul/’hoansi people of South Africa. The ancient Indian practice of Ayurveda uses herbs, spices, and specific foods to help the body to return to balance following traumatic events and the Chinese have used qi gong, acupuncture, and other holistic medical practices to release stored trauma for thousands of years.
Modern approaches for returning the nervous system to the ideal territory include the Emotional Freedom Technique, which combines tapping on acupressure points using specific language, Havening Techniques, a psychosensory approach designed to eliminate the negative consequences of traumatic events and Trauma Releasing Exercises, movements that assist the body in releasing deep muscular patterns of tension and stress.
There are many other tools available, some of which are in the resource section at the end of this article.
The second missing piece
To achieve authentic healing, a trauma-informed approach to therapy, rather than the medical model used now that does not permit therapists to bond emotionally with their patients, must be implemented.
Dr. Joi Madison, who holds degrees in kinesiology and clinical psychology, says the current approach, which focuses on identifying what’s wrong with the patient rather than asking what’s happened, doesn’t work for those with trauma in their history.
Nor does the accepted tenet that therapists must be detached support the highest level of healing. “People are often in their darkest, loneliest, scariest, hardest seasons of life when they come to therapy,” she says. “So, when you are wanting me to be stoic and nod and not show up in the fullness of my humanity, to see you breaking down and hide that I’m feeling something too, is almost like we're perpetuating this idea that feeling makes you weak.”
So, what does a trauma-informed model look like? For Dana, it’s about “paying attention to the regulation of the nervous system and helping people feel a neuroception of safety so that they are able to do the work,” she says. “But for others, it may be something different.” Similarly, the US Government’s Substance Abuse and Mental Health Services Administration contends that trauma-informed care is rooted in the assumption that anyone, child, or adult, could have a history of trauma. Their guidelines for trauma-informed care include creating safety through transparency, collaboration, and empowerment.
“Science isn’t always as scientific as we would like it to be,” says Logan Cohen, a licensed marriage and family therapist. “The DSM is the best way we’ve come up with to systemize this process, but the whole concept is about seeking truth, which should be a nonstop, open-ended collaborative approach.”
Using a trauma-informed approach also applies to healthcare providers other than therapists. Dr. Sam Zoranovich, a chiropractor who specializes in treating bodies that are neurodivergent or that have experienced trauma has discovered that “everybody's trauma is different and distinct. It's an intensely personal experience.” His treatment focus is to establish a foundation of safety, which the nervous system requires to heal. This enables him to get genuine answers when he asks patients, “Is it time to press past this limit or is it time to respect this limit and sit still?”
Dr. Noa Goodman, a physical therapist with the University of Pittsburgh Medical Center, has a similar view. “Patients aren't getting on my path; I'm getting on theirs. To create that therapeutic alliance, the first thing that must happen is building trust, and the only way to do that is to have a shared power dynamic in a world where the medical professional is usually the one in the room with the power.”
Goodman also advocates for trauma screening to be included with the other standard healthcare procedures like checking blood pressure and temperature and asking questions about alcohol consumption, depression, and exercise habits. “Physical therapists see patients more frequently than their PCPs and their other providers,” she says. “We have the opportunity to build a trusting relationship and with training can provide avenues for additional care.”
Where do we go from here?
“Trauma is the invisible pandemic,” says Cohen, who started making content for social media because he realized how much time people spend on the platforms connecting with each other and getting information. There are numerous progressive healthcare providers making educational and informative content on trauma and the healing tools available.
“Not everything works for everyone,” cautions Gibson. An abundance of information provides an opportunity for those who don’t have trauma-informed support to discover information that furthers their healing journeys.
Large numbers of trauma survivors (there are nearly 8-million Instagram posts that contain a hashtag with the word trauma) seeking information from innovative providers is a solid step in gaining the critical mass required for systemic change, which includes the development of a non-homogenous health care system, a mental health protocol that does not pathologize, and providers trained in how to set aside stringent ideologies in the service of collaborative healing. Authentic healing, says Dr. Porges, requires us to recognize that we cannot “separate bodily healing from mental health healing from social healing” because in the end, they are all essential to living as a whole person.
As we reshape how trauma is viewed and include more practices that facilitate authentic healing, we move toward the vision of Dr. Gabor Maté, a Canadian physician who spent decades working with people suffering from addictions and identified a connection between substance abuse and trauma. He believes we can create “a trauma-informed society in which parents, teachers, physicians, policymakers and legal personnel are not concerned with fixing behaviors, making diagnoses, suppressing symptoms and judging, but seek to understand the sources from which troubling behaviors and diseases spring in the wounded soul.”
What a world that will be.
RESOURCES - for Trauma Education and Healing
The Body Keeps the Score by Besser van der Kolk, M.D.
Complex PTSD: From Surviving to Thriving by Peter Walker
How to (Hu)man Up in Modern Society: Heal Yourself and Save the World, Logan Cohen, LMFT
Modern Trauma Toolkit by Christy Gibson, M.D.
Our Polyvagal World: How Safety and Trauma Change Us by Seth Porges and Stephen W. Porges (September 2023)
Polyvagal Practices: Anchoring the Self in Safety by Deb Dana, LCSW
Waking the Tiger by Peter Levin, PhD
AcceleratedResolutionTherapy.com – technique to help reduce and eliminate PTSD symptoms
emdr.com – Eye Movement Desensitization and Reprocessing Institute
Emofree.com – official site of Emotional Freedom Technique (tapping) founder Gary Craig
Havening.org – information on havening techniques
RhythmofRegulation.com – everyday ways to transform the relationship with your body
SAMSHA.gov – Substance Abuse and Mental Health Services Administration
Interviews and PDFs
interview with Dr. Besser van der Kolk on how trauma lodges in the body
Sukie Baxter – Embodiment Coach
Logan Cohen – Trauma-informed therapist
Josh Connelly - One of the most honest humans on the internet
Christy Gibson, M.D – Author, Trauma Advocate
Derrick Hoard – Licensed Marriage and Family Therapist
Irene Lyon – Somatic Experiencing Practitioner
Raquel Martin, PhD – Licensed Clinical Psychologist
Jess Taylor, PhD – Author, Trauma Advocate
Patrick Teahan, LICSW – Childhood Trauma Therapist
Dr. Kate Truitt – Neuroscientist and Clinical Psychologist
Ally Wise – Transformation coach with a focus on trauma resolution
Kina Wolfenstein - LMSW specializing in CPTSD
Sam Zoranovich – Trauma-Informed Doctor of Chiropractic