Trauma Archives - Your Mind Matters

Working through trauma from a schema therapy lens

laura on 11/01/2024

My previous blog aimed at providing a brief overview of trauma and posttraumatic stress disorder. Click here to read more: https://yourmindmatters.net.au/a-brief-overview-of-trauma-and-posttraumatic-stress-disorder/. This blog focuses on how therapy can aid in processing past traumatic or upsetting experiences.

There is an abundance of research on various modalities for working through trauma in a therapeutic context. Here we unpack the use of imagery rescripting, a schema therapy intervention. Please note, this is not the sole treatment approach available.

What is Schema Therapy?

Schema Therapy focuses on understanding how our past experiences have shaped our schemas (beliefs specific to ourselves and the world around us). During our childhood, our needs may not have been met (e.g., our need for support, nurturance, safety/protection, emotional connection) which contributed to the development of early maladaptive schemas, unhelpful behavioural patterns and coping mechanisms.

A part of schema therapy is aimed at building attunement (‘tuning in’) to our emotional responses when faced with a triggering situation or event. It is about building awareness of how current life stressors can activate our schemas and lead to strong feelings and behavioural responses. Often, it is not the current event that evokes such an intense emotion, but more about how we interpret this event and the meaning we derive from it based on our early experiences. For instance, exposure to trauma or an upsetting event may lead to interpretations such as “This is my fault”, “I am bad/unworthy/not good enough”.

Preparation for Processing Past Trauma

Prior to moving into imagery rescripting, your clinician will complete a thorough intake and assessment. Often, it may be necessary to build emotion regulation skills and learn relaxation strategies, to ensure that you are ready to move to the part of therapy where rescripting occurs. You might be asked to complete questionnaires, which look at the symptoms you experience and the impact on your daily functioning. This can provide valuable information and can be used to measure your progress throughout treatment.

Imagery Rescripting

Imagery rescripting is a therapeutic technique, where through the guidance of a trained clinician, one re-imagines a past painful memory, entering the image from the perspective of their child self. The aim is to change the way one feels and thinks about the event, by inserting new meanings/interpretations and leading to a corrective emotional response. The focus is on imagining a different outcome where the individual’s needs (for example, for safety, protection, nurturance) are met. During an imagery rescripting exercise, one does not need to relive the traumatic or upsetting event. What occurs is that the image is paused when a ‘hot spot’ (the moment feelings of distress begin to appear) is reached, and the therapist enters the image to support the client and meet their needs.

Now at this point, you may be thinking, “but that doesn’t change what actually happened”. And you are right. We can’t go back and change the past, but what we can do is change how you think and feel about the memory. Brain studies have shown that the brain responds in a similar way to imagining and actually experiencing an event.

The process of imagery rescripting takes approximately 12-15 minutes, but can vary from person to person. Once the image has been rescripted, you will have the opportunity to reflect on the experience of the exercise with your clinician. Many clients have provided positive feedback regarding imagery rescripting and reported a shift in their emotional response and beliefs when they think of the rescripted memory. This includes feeling ‘lighter’ when thinking about the memory, feeling less distressed and reduced anxiety.

If you would like some support in working through past upsetting experiences, our team of psychologists are here to help.

This blog was written by Maria Kampantais – Psychologist and Clinical Registrar at YMM.

Maria has been consulting at YMM since 2016 and has an interest in working with clients presenting with anxiety disorders and past trauma. Maria offers a warm and supportive space to assist clients in navigating their presenting concerns and explore past painful experiences. Maria aims to support clients to build awareness into how past experiences may have shaped their belief system and subsequent emotional responses, and move towards healing through developing helpful coping mechanisms. Maria draws on various evidence-based therapies including Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), mindfulness techniques, and Schema Therapy.

To learn more about Maria, check out the “Our Team” page on our website! https://yourmindmatters.net.au/our-team/

A brief overview of trauma and Posttraumatic Stress Disorder

laura on 09/11/2022

Photo by Susan Wilkinson on Unsplash

What is trauma?

Trauma refers to the emotional response experienced following exposure to a distressing life event or situation. It can result from direct or indirect exposure, i.e., we have experienced the situation first hand, witnessed it, or heard that the event occurred to someone we know. Traumatic experiences may include a serious accident, physical or sexual assault (actual or threatened), sudden violent death, natural disaster, and war.

Common responses to trauma

When we are exposed to a threatening situation, it infringes on our sense of safety and security, leading to a level of psychological distress and belief that our environment is no longer safe. Emotional responses can vary from person to person, but typically include feelings of fear, anxiety, helplessness, hopelessness and impacts to self-esteem.

Posttraumatic stress disorder

Psychological distress is a common experience following exposure to a traumatic event however for some individuals the impact of trauma can be long lasting and lead to the development of a trauma-related disorder, such as posttraumatic stress disorder (PTSD). Symptoms of PTSD include:

Recurring distressing memories and dreams of the event
Feeling as though the distressing event was happening again (flashbacks)
Avoidance of situations that remind you of the event
Difficulty remembering important aspects of the event
Negative beliefs about self and others
Persistent fear, anxiety, guilt or anger
Feeling detached from others
Loss of interest in enjoyable activities
Feeling hypervigilant and easily startled
Reduced concentration
Impacts to sleep patterns

Please note, this is not an exhaustive list of symptoms, but provides a snapshot of some of the impacts of PTSD. Diagnosis is based on many factors and not solely on experiencing the above symptoms.

Does exposure to trauma result in PTSD?

The experience of trauma may lead to the development of PTSD however, this is not always the case. Development of a trauma-related disorder, such as PTSD, is influenced by more than just exposure to a traumatic event. As individuals, we all have different ways of coping, which is related to our personality and past personal experiences. Often, exposure to trauma can severely rattle our perception of self and can impact on our sense of self-worth and self-esteem. Other factors to consider include the nature and severity of the event. In addition, the way in which the incident is interpreted and understood immediately following the trauma, and the way in which we store the incident in our memory, can play an integral role.

How trauma memories are stored

The hippocampus is the part of the brain that stores memories. It encodes memories and takes a bird’s-eye view of a situation, which incorporates a lot of detail. When you remember something, you don’t recall it exactly the way it was encoded. Every time you remember something, you are re-creating it every single time. Your hippocampus time stamps the memory with when it happened and how long it lasted. And as you move further into the future, the memory becomes more distant. This relates to a good/pleasant memory.

When you are in a threatening situation, the way in which memories are encoded and stored becomes impacted. When faced with a traumatic event, you are under enormous stress and your cortisol levels increase, which means that the hippocampus cannot function in the same way it does when you are not stressed. The hippocampus is covered in cortisol receptors and when you are stressed, the cortisol floods into the hippocampus. This means that the hippocampus is not fully activated when you are encoding this memory. You are therefore encoding things differently to what you would otherwise. It changes how you remember things and how you recall them later. In stressful situations, the hippocampus does not take a bird’s-eye view of the situation, rather, it takes smaller close-up detailed pictures, almost like ‘zooming in’ on a camera lens. This happens because the brain starts to focus on pieces of information it perceives as important, in that situation. Therefore, the information that gets encoded is the close-up pieces. Another thing to note is that when faced with a traumatic situation, the hippocampus may fail to put a time stamp which tells you how long something lasted. The memory may seem out of order and all over the place because of the way it was encoded. If your hippocampus didn’t time stamp, then instead of remembering things you re-experience them, and therefore every time you think of that situation, you feel as though it is happening again. Thus, trauma memories do not age appropriately.

Treatment

Psychological therapy can help to manage symptoms following exposure to trauma. This includes, but is not limited to, building emotion regulation skills, relaxation strategies, shifting negative beliefs, increasing self-esteem, and reprocessing trauma memories.

If you are seeking support following exposure to a traumatic incident, our team of psychologists are here to help. Feel free to give our clinic a call on 9802 4654 and our friendly admin team can assist by recommending the best practitioner for your care.

References

Kessler, R. C. (1995). Posttraumatic Stress Disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048.

Nijdam, M. J., & Wittmann, L. (2015). Psychological and Social Theories of PTSD. Evidence Based Treatments for Trauma-Related Psychological Disorders, 41– 61. doi:10.1007/978-3-319-07109-1_3

Sweeton, J. EMDR skills for trauma. Training workshop (completed Nov 2021).

Yehuda, R. (2004). Risk and resilience in posttraumatic stress disorder. Journal of Clinical Psychiatry, 65, 29-36.

This blog was written by Maria Kampantais – Psychologist and Clinical Registrar at YMM.

Maria has been consulting at YMM for many years and enjoys working with clients through the use of evidence-based therapies such as Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), mindfulness techniques, Motivational Interviewing (MI), and Solution Focused Therapy (SFT).

To learn more about Maria, check out the “Our Team” page on our website! https://yourmindmatters.net.au/our-team/