Treating PTSD (Pt. 3)
Updated: Sep 6, 2020
Kolk’s research group, “has been supported by research grants from the National Institute of Mental Health, the National Center for Complementary and Alternative Medicine, the Centers for Disease Control, and a number of private foundations to study the efficacy of many different forms of treatment, from medications to talking, yoga, EMDR, theater, and neurofeedback.” (Kolk, 2014, p. 3) While recovery is obtainable, it does include steps to achieve in some order or plan. Some may be better off utilizing one method, “but most are helped by different approaches at different stages of recovery.” (Kolk, 2014, p. 204)
These different approaches include both conventional mental health and complementary alternative medicines. These approaches include a top-down approach, a bottom-up approach, and utilizing medications and other technologies that change the way the brain organizes information.
The top-down approach focuses on the parts of the brain that are connected to thinking, speaking, and emotional awareness. The top-down approach in therapy begins with how the mind is interpreting information. The intervention is about changing the thoughts into “right” thinking so that one can make healthier choices. (Kolk, 2014) Talk therapy and Cognitive Behavioral Therapy (CBT) are top-down approaches. However, in the documentary Trauma Treatment for the 21st Century (2012), the general statement was clear that talk therapy is not an appropriate treatment for trauma. (PESI Publishing & Media, 2012)
Levine states (1997), that he “learned that it was unnecessary to dredge up old memories and relive the clients' emotional pain to heal trauma. Severe emotional pain could be re-traumatizing.” (p. 31) In an article by Dr. Leskowitz (2016), he discussed how he used to run veteran trauma groups in the 1980s. Within the groups, they would retell their stories. However, “retelling the war stories made things worse because it reactivated the original trauma response again and again.” It also traumatized the therapist from hearing the stories. Luckily over the years, researchers are finding ways to help trauma without re-traumatizing clients. (Leskowitz, 2016)
Talk therapy focuses on cognitive, frontal lobes. The higher brain is the place where logic lives. However as mentioned above, the thinking logic center of the brain in under-active. when someone has trauma. Those who do not have a trauma history, CBT and talk therapy can work well. Those with trauma, thinking through things cannot override the response from the amygdala. This is not always the best thing for the first stages of treating trauma. (Kolk, 2014)
Using prescription drugs is also a tool available in pursuing a top-down approach. Short term use of prescription drugs can be helpful with a person who is severely in trouble. However, Kolk (2014) emphasizes that prescription drug use will often take away the lowest feelings, but it will also take away the higher feelings. He shares his experience of witnessing prescription drugs inhibit or block the trauma from being truly released from the body. He believes that prescription drugs delay or stops the full recovery of the trauma. (Kolk, 2014)
The bottom-up approach focuses on the base of the brain that is responsible for reflexes, memories, and automatic survival responses. Bottom-up therapy integrates the whole brain: left, right, top and bottom. The bottom-up approach begins with acquiring information from the body’s sensations, accepting those feelings and body sensations happen first when we feel unsafe. (Kolk, 2014) The first step is to implement safety and stabilization into the clients' life. This includes having basic needs met and a safe place to live and work, but also identifying a support system that could include a team of practitioners, friends, family, or community services. Before anyone can heal they need to be able to open up to a safe person who can carefully guide them to awareness. It is very important to find a Trauma-informed therapist or practitioner who knows how to create healing relationships through a nurturing, caring, warm, and safe environment. Once there is a developing base for safety and trust, the trauma-informed therapist can guide the client to develop regulation of the body and mind.
At the foundation of healing are the patient and client relationships. According to research, integrative models, team-based and truly patient-centered, help improve patient satisfaction and over-all well being. Implementing these kinds of models can improve the field of medicine and the health care system. (Crocker, Grizzle, Hurwitz, Rehfeld, Abraham, Horwitz, Weil & Maizes, 2017) Since trauma is a growing and recycling epidemic, it is important to get all health practitioners on board with the patient-client relationship approach. If there were more practitioners in tune with the wholeness of the patient, they could direct the traumatized to other informed practitioners.
Continue reading onto Part 4 Healing PTSD.