mindfulness in trauma work

PTSD, or C-PTSD

but traumatic experiences do leave traces, whether on a large scale (histories and cultures) or close to home, in our families, with dark secrets being imperceptibly passed down through generations. they also leave traces on our minds and emotions, on our capacity for joy and intimacy, and even on our biology and immune systems.

Bessel van der Kolk

most of us may be familiar with the acronym PTSD. posttraumatic-stress disorder is a mental health condition in which a person has difficulty healing from experiencing a traumatic incident. these incidents may be related to natural catastrophe, accidents, abuse, and sexual transgression. the person experiences a range of symptoms including anxiety, flashbacks to the traumatic event, sleep disturbances, and avoidance. the following symptoms are present for at least one month and create significant distress or impairment in functioning:

re-experiencing: intrusive and distressing recollection of the event leading to psychological distress, or physical reactions (nightmares, sweating, heart palpitations, panic).

avoidance and emotional numbing: avoidance of activities, places, thoughts, feelings, or conversations related to the event, loss of interest in activities, feeling detached from others.

hyperarousal: difficulty sleeping, irritability, difficulty concentrating, hypervigilance, exaggerated startle response.

more recently research has been done on complex posttraumatic stress syndrome (C-PTSD). whereas PTSD is often associated with a singular event, C-PTSD refers to longstanding trauma, most often incurred during childhood. many of the symptoms we see here are related to personality disorder, emotional dysregulation, relationship difficulties, and negative self-esteem. it is a shame-based disorder, not because the person has done something shameful, but because of the outcome of chronic trauma. Judith Herman of Harvard university first brought the condition to light, and saw it as a complex PTSD with several clusters specific to the disorder. these may include:

cognitive disturbances: dissociation and memory issues.

emotional disturbances: rage, crying, numbness, anxiety, and depression.

behavioral disturbances: including self-sabotaging behavior, impulsivity and substance abuse.

relationship disturbances: impulsive choices, unstable relationship, or avoidant behaviors.

because the trauma occurs in childhood, it typically has a more profound effect on the development of personality, sense of agency, and perception of the world around you. many people who have grown up with trauma may not even associate with the term, as trauma (often in the form of emotional neglect) was their everyday experience.

ten years ago, i still feared loss enough to abandon myself in order to keep things stable. i’d smile when i was sad, pretend to like people who appalled me. what i now know is that losses aren’t cataclysmic if they teach the heart and soul their natural cycle of breaking and healing.

Martha Beck

the biggest difference between PTSD and C-PTSD is that for complexly traumatized people the trauma becomes their identity. a traumatic incident at the age of 30 may be life-changing, but it does not have the developmental effects of early childhood trauma. the child’s brain is still developing and communicates through emotions and the senses. young children are very sensitive to facial expressions in the parent, as these are the only cues to the child in terms of their safety. attachment experience in early life has a profound effect on our identity and sense of self. in many ways C-PTSD is relational trauma. many traumatic events cannot be accessed as a memory, but are felt as shame, worthlessness, and sometimes physical pain.

the child identifies with being out of control, oversensitive, or reactive. they also suffer direct consequences of the trauma. instead of a mind that is adapting and exploratory, the mind of the traumatized child is constantly focused on survival. this often leads to avoidance, so that normal life-adjustments are not made. this increases the sense of being at fault or broken.

emotional flashbacks for the C-PTSD sufferer are not clear images and feelings, but overwhelming emotional states and reactions, very hard to differentiate from the ordinary experience of self.

for the person suffering from C-PTSD trauma work does not lead to the unlocking of memories as much as feelings. this is normal in prolonged abuse, as the child represses feelings to survive. of course, that is a maladaptive coping mechanism, but for the child it is safer to accept that they are at fault (having the wrong feelings), than to accept that their parent or caregiver may be at fault. for the child’s mind the latter is an uncontrollably dangerous reality. anger and depression often mask their feelings of dread, sadness, anxiety, and hopelessness.

in both PTSD and C-PTSD there are flashbacks. these may be a mix of vivid negative memories, appearing without warning and seemingly unrelatable to the current situation. emotional flashbacks intrude and the person is overwhelmed with toxic shame and a sense of inadequacy. the fight/flight/freeze response is triggered, and the person will act in a dysregulating way. for the person caught in this process, it does not feel like a past memory or feeling, but rather that it is happening right now, in this reality (projected onto current reality).

mindfulness in trauma work

it's your road, and yours alone, others may walk it with you, but no one can walk it for you.

Rumi

imagine being criticized. depending on personality and level of maturity, we would all experience it differently. for the mindful person, however, there will be the recognition of defensive thoughts and painful emotions if they arise. the body may go into reaction, or we may find ourselves holding back the reaction. ruminating on it can last for hours, if not days.

with mindfulness we learn to become even more keenly aware when we recognize the signs of being triggered. we may notice sensations of discomfort or wanting to get away. we may notice the reaction as a way of trying to escape from the emotional pain. we may become aware of the way the nervous system responds. when we understand and see these processes, it also becomes possible to regulate the experience. we develop the ability to notice the dysregulation in all its forms, and develop the knowledge of how to self-soothe, ground, and bring ourselves back into our window of tolerance, or wellness.

as we discussed in self-regulation, mindfulness is naturally self-regulatory, because it is aware of what is taking place. there is emotional self-awareness and regulation of attention, meaning that if i become trapped in seeing what is “wrong,” i can deliberately focus on what is “right.” in time, i become aware of my orientation towards this experience or situation. therefore, i know what my attitude is, and how changing this attitude regulates my emotion. i regularly pay attention to thought, feeling and action as part of being mindful.

orientation to experience

there are many forms of mindfulness practice out there, and many more teachers of mindfulness. there is also some research indicating that mindfulness practices can be harmful and triggering for people who have experienced trauma (if you are interested you can follow the work of Dr. Willoughby Britton). the main culprit does not seem to be the practice itself, but rather the teacher (or understanding) of the practice. it seems that the greatest difference between “good” and “bad” mindfulness training is the teacher’s capacity to understand and practice observing awareness with non-judgment and non-reactivity. when mindfulness is correctly taught and practiced, it balances the content of awareness, however painful, with nonjudgment, acceptance, curiosity, and kindness. if you work with a therapist or meditation teacher, make sure this person knows trauma and how to work with it, and knows mindfulness foundationally.

you may remember from the practicing mindfulness programs that we defined mindfulness as the awareness that arises through paying attention, in the present moment, and nonjudgmentally. we are therefore continually creating or cultivating an open and accepting attitude to experience. when we reflect on what healing from trauma means, it inevitably includes being able to be with the feared experience or memory of it, without reacting. since this is not a suppression of feeling, it means that we’ve become accepting of the experience as part of our life. we can recognize the experience and are able to contain it, even gaining insight from it.

for the traumatized person, mindfulness has very direct advantages. an enhanced sense of well-being stems from being fully aware of your experience. the greatest benefit of the practice seems to be an increase in prefrontal control over the limbic system and amygdala. this allows for psychological decentering, so that one is looking at the thought-feeling-action, rather than being trapped in the thought-feeling-action.

if you remember the practice of bare attention, you will note how it is the ideal practice in terms of working with trauma. the object of the practice is to perceive experience directly and not via interpretation, or to simply notice the interpretation without identifying with it. even though interpretation and re-triggering may happen, there is enough awareness grounded in the current experience, and this helps to alleviate the intensity of the memory and its reaction. i can recognize that i’m scared, rather than being possessed by the fear.

remember that you may find some details on referenced books in our about section.

Van Vreeswijk et al. summarizes the underlying Buddhist model for mindfulness, as follows:

the stream of subjective experience is actually a rapid sequence of sensory impressions, feelings, and thoughts of which we are mostly unconscious. each experience carries an immediate, spontaneous “feeling tone,” which can be neutral, pleasant, or unpleasant, and which precedes all emotions, such as fear or anger, and their associated behavior. this process can be short-circuited in two ways: through mindfulness training and through insight. increased mindfulness allows one to recognize dysfunctional processes more quickly, disengage attention from performing habitual emotional reactions, and focus on goal-driven behavior. insight occurs when, through direct experience, one becomes aware of the three most fundamental attributes of existence, which are present throughout all experience: impermanence, suffering, and not-self.

from the Buddhist psychological view, the insights we may gain from working with our trauma are:

• impermanence: mental events and experiences are transient, and we do not need to hold on to them.
• suffering: is universal and based on habitual reactions to the feelings, thoughts, and sensations we experience.
• no-self: sense impressions and mental events do not contain or constitute any lasting self or identity.
• empathy: warmth, acceptance and the absence of criticism, neglect or rejection are qualities that can be developed, and mindfulness is proven to give rise to brain activation of areas associated with empathy.

affect dysregulation

whoever fight monsters should see to it that in the process he does not become a monster.

Friedrich Nietzsche

the main objects of mindfulness, in working with trauma responses, are affect dysregulation and our window of tolerance. for the person who suffers from trauma a dysregulation of the autonomic nervous system happens through experiencing constant stress, confusion, fear, and strong emotions like shame and overwhelm from which the person cannot escape. later in life any trigger may set off affect dysregulation. affect is the felt part of our emotional experience, for instance turning red, sweating, or shaking. these are signs that the sympathetic nervous system is activated, and the person is experiencing a threat. dysregulation is the inability to manage the intensity and duration of strong emotions like fear, sadness, or anger. a person is dysregulated when they cannot find ways to manage their behavior or mood, are unable to feel emotion, or when overwhelm remains unresolved for a prolonged period.

the autonomic nervous system

the autonomic nervous system (ANS) controls all involuntary functions of the body (breathing, heart rate, etc.) and supplies energy to the internal organs.

it has two branches. the sympathetic nervous system (SNS) is constantly active and maintains an equilibrium of the nervous system. among its tasks are accelerating heart rate and blood pressure, constricting blood vessels, causing pupil dilation, perspiration, and piloerection (goosebumps). it is also responsible for the fight/flight response to prepare the system for threat.

the second branch is the parasympathetic nervous system (PNS). it keeps equilibrium through activating the rest and digest response, slowing the heart rate, increasing glandular activity, etc. in extreme situations it is responsible for defensive actions like fainting, immobilization, or torpor.

the freeze response comes through simultaneous action of the two branches and is typically activated before the fight/flight response.

optimal arousal

in regular circumstance our ANS acts all day long, going between increased physiological activity and resting as required, moving between activity and inactivity to balance the nervous system. do you remember Dan Siegel’s Window of Tolerance, from our self-regulation program? Dan introduced this term for the first time in his book MindSight, and it helps us to make sense of affect dysregulation. when we’re functioning within our window of tolerance, we may experience joy, stress, or a bleak mood without dysregulation. it functions as a natural resilience helping us to bounce back from difficulties.

trauma response arousal

in a trauma response, the ANS alters its normal functioning, causing the following possible states:

consistent triggering of the trauma response leads to a decrease in the width of the window of tolerance. in working with our trauma, we keep working at the width of the window of tolerance, as well as being aware of the intensity of emotion. what this means is that we begin to accustom ourselves to our emotion. when i feel low, i increase my tolerance for this feeling (without acting out), and when i get angry i increase my capacity to be with anger, without acting out. at the same time, we work with lowering the intensity of the emotion. both processes are involved in self-regulation.

increasing affect tolerance: pause, breathe, assess and “host” the emotion without reacting. we learn to notice the arising of the emotion early on, and keep our attention on it. when we attend to emotion there is a sense of being in control, which helps the nervous system to relax. pushing the feeling away, or ignoring the mounting feeling, the nervous system will just act automatically, making us feel out of control. just by noticing and becoming aware of the state, we’re already back in the seat of this wild horse.

lowering the intensity: here we have two possibilities. the first is reaching out to someone you trust and sharing the experience with them. the nervous system is experiencing danger and a natural response would be to call out to someone. the second is learning to release the energy that has built up in the body. we can do this through dancing, kicking, running, or walking. for the person who is hypo-aroused, it is important to move. begin with simple movement, rather than submitting to the sense of defeat and immobilization. we want to activate the SNS to compensate for the freezing. initial movements can be a simple as smiling, moving your arms, or clapping hands. direct awareness of breathing also regulates, increases tolerance, and helps to lower the intensity of the reaction.

with everything that has happened to you, you can either feel sorry for yourself or treat what has happened as a gift. everything is either an opportunity to grow or an obstacle to keep you from growing. you get to choose.”

Wayne W. Dyer

initially, before it has become habit, the work is hard. then it is helpful to be reminded by the words of someone who knows the path.

you are safe, always, my love

you are safe, always, my love. your thoughts will not hurt you. ever. thoughts themselves are safe. even the darkest of thoughts, the most violent, vicious, hateful, ‘unspiritual’ thoughts, they are just pictures, images, flashes and impressions of light and colour and sound playing out on the movie mind-screen of awareness, and awareness cannot be damaged by any image, any sound, any memory, any fantasy, however vivid, however convincing. and so you can offer permission to your mind to go wild today, to do its worst, to be as dark and as loud and as scary as it can be, to try to convince you of how the movie ends (it doesn't know and it cannot know), and you can rest as awareness, the calm in the midst of the storm, the ultimate safety and solace and security, as thoughts dance their strange, sacred, silly and unpredictable dance.

your bodily sensations will not hurt you, my love. ever. sensations themselves are safe. it is the thoughts we have about sensations, and our attempts to escape the body and its wild intensity, that create that terrible internal war that feels so unsafe. but sensations themselves are safe. even the most acute and intense sensations - that piercing grief in the belly, the fire of anger in the heart, the terrible contraction and constriction of fear – are natural, and harmless, and totally safe to experience fully and courageously today.

this is all very hard to trust, sometimes, of course, as we have not been taught to meet the body, which is why we need to go slowly, and remember that we are only ever called to digest a single moment of intensity at any one time. we are spared from having to heal “all at once”. even that “unsafe” sensation, that crushing dread in the pit of your stomach, those butterflies and jitters and dark and terrible longings – they are utterly safe to feel. healing doesn’t mean that you’ll be “free from” these sensations, it means that you’ll know how to meet them, that you’ll be free and clear and sane in the midst of them, that you’ll offer them freedom to arise and fall away in their own time. you’ll learn to trust them, you will, you’ll make room for them in your day or night, you’ll grant them safe passage as they move through you, and you’ll no longer be ashamed to feel them, no longer be ashamed of your vulnerability and your sensitivity and your wide open heart.

yes, my love, you’ll learn to celebrate your thoughts, feelings and intense sensations as they pass through your body and your awareness. your old spirituality will shatter, of course, but it will be replaced by something bigger and more true: a deep respect for all of life, the pleasure and the pain of it, the contraction and the expansion of it, those moments of joy and the ones of terror. all will be your children, finally, as they were in the beginning; all will be waves in your vast oceanic heart. you will be humbled and brought to your knees and you will laugh, lovingly, at your old self.

you will be vast like a galaxy, strong like obsidian, as soft as fontanelle, and as trusting as god herself on the first day.

yes, you are safe, always, my love.

you are safe.

and i love you, more than i could ever say.

Jeff Foster

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external resources

Hurt People Will Hurt People. But Healed People Heal People, Too. — Courtney Christine
(Courtney Christine vulnerably reconciles her parental responsibility as caregiver)

Polyvagal Theory: Getting Back to Safe and Social — Audrey Batterham
(Audrey Batterham unpacks polyvagal theory and its usefulness in both understanding and managing our body's defensive system in working with trauma.)

Mindfulness for Healing from Complex posttraumatic Stress Disorder — Shirley Davis
(Shirley J. Davis discusses the benefits of mindfulness practice for anyone who learns it.)