Trauma Therapy Models: What To Expect In Treatment
While most people who experience trauma have no long-lasting effects, others may experience severe symptoms that persist in the long term. Trauma tends to be associated with several mental health disorders, including post-traumatic stress disorder (PTSD), mood disorders, substance use disorders (previously referred to as “substance abuse”), and various anxiety disorders.
Trauma therapy is a type of psychotherapy primarily designed to help people address and reduce the impacts of trauma. There are multiple approaches to trauma therapy, and each usually aims to help individuals overcome their traumatic experiences so that they no longer affect their ability to function in their everyday lives. However, each trauma therapy model tends to have a unique approach.
Accelerated experiential dynamic psychotherapy
In general, the ideas behind accelerated experiential dynamic psychotherapy (AEDP) are that people are inherently resilient and have a natural ability to cope with emotional pain, and that people who have experienced trauma cannot access the skills they need to meet these challenges. The goal of AEDP is usually to help people who have experienced trauma gain access to these coping mechanisms to manage the impacts of trauma and move forward in their lives.
During AEDP sessions, a trauma therapist may help people process painful past experiences by uncovering difficult emotions and the defense mechanisms they’ve used to manage them. In addition to building trust with the person, the therapist can also reassure the client that they are not alone in experiencing these complicated feelings. In time, clients typically learn new coping skills and become more comfortable with their own emotions.
AEDP is a relatively new treatment approach, and more large-scale studies are needed to determine its efficacy, but the results of some smaller studies “provide empirical support for the long-term effectiveness of AEDP for alleviating a variety of psychological problems and enhancing positive functioning.”
Cognitive processing therapy
Another type of trauma therapy is cognitive processing therapy (CPT), a type of cognitive behavioral therapy that can treat PTSD that develops after a variety of traumatic events, like rape, child abuse, and natural disasters. In CPT, a therapist usually helps clients learn to identify, challenge, and change unhelpful beliefs related to the trauma they’ve experienced. The person can then develop a new understanding of the event, which may reduce its negative effects on their daily lives.
In CPT sessions, the therapist usually first works with the person to help them become more aware of any automatic thoughts contributing to their trauma-related symptoms. The person may write a statement detailing their understanding of why the event occurred and its impact on them.
Next, the person typically writes a more detailed account of the traumatic event and reads it out loud in sessions to overcome the pattern of avoiding the emotions related to the trauma. The therapist may ask questions to help the person identify and modify any unhelpful thoughts about the experience.
After the person can identify and address any unhelpful thought patterns, the therapist can help them continue to use those skills outside of treatment to improve their ability to function in everyday life.
Dialectical behavior therapy
DBT normally involves four types of sessions. The first is a pre-assessment, during which a licensed therapist can determine whether DBT is an appropriate approach to treatment and explain the time commitment and process.
People in DBT usually attend one-on-one therapy sessions once a week for about 60 minutes. In these sessions, therapists may focus on helping the person sense they are safe, identify what is hindering their progress, and learn new skills to replace unhelpful behaviors. In DBT, therapists often ask people to keep a diary where they can track their daily emotions and actions to look for patterns and help the therapist develop a personalized treatment plan.
In DBT groups, therapists typically teach skills in group settings. These meetings are not group therapy sessions; they normally resemble a classroom setting. Therapists generally focus on teaching four skills: mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation. These meetings usually occur in addition to the one-on-one weekly sessions.
The fourth type of session is telephone crisis coaching, where the therapist is available to support the person day to day. People are encouraged to call their therapists for support between sessions and group classes if they need help with an immediate crisis or guidance using a skill they’ve been taught. Calls are usually brief, and therapists normally establish clear boundaries about when to call and what to expect.
Eye movement desensitization and reprocessing
Eye movement desensitization and reprocessing (EMDR) was developed in 1987 as a treatment specifically for PTSD. EMDR usually involves individual therapy delivered once or twice per week for a total of six to 12 sessions. It’s based on the Adaptive Information Processing model, which proposes that PTSD and other mental health conditions can result from traumatic memories not being adequately processed. When triggered, these memories can lead to the person retaining the beliefs, thoughts, emotions, and physical sensations that occurred during the event.
During EMDR sessions, people usually focus on the memory while using eye movements and other types of stimulation to reduce the emotion and vividness associated with the memory. There are multiple stages to EMDR: history-taking, preparing, assessing the target memory, processing the memory to reach an adaptive resolution, and evaluating results.
The therapist may talk to the client to get a full history and work with them to set treatment goals, then introduce the concept of EMDR, practicing the eye movements and other components. Next, they may activate the targeted memory, identifying its components and how it affects the mind and body.
The person usually continues to focus on the memory while using guided horizontal eye movements or other bilateral stimulation exercises, and they may report any changes that emerge in their thought processes. People in EMDR therapy may also focus on their physical responses, doing body scans to understand the physical sensations that arise while thinking about the incident. The therapist can help clients focus on the positive changes that occur during each session.
Prolonged exposure therapy
Prolonged exposure therapy typically teaches people to approach feelings and memories related to the trauma they’ve experienced to understand that they aren’t dangerous and, therefore, don’t need to be avoided. This form of cognitive behavioral therapy can help people approach traumatic memories gradually so as not to reinforce their fears. It tends to be a strongly recommended treatment for PTSD.
This type of therapy normally involves weekly individual sessions over a few months. Generally, people attend eight to 15 sessions of 60 to 120 minutes each. The therapist may first provide an overview of treatment and get to know the person’s past experiences. Exposure can be anxiety-provoking for many people, so the therapist normally works to create a safe, supportive space for treatment.
Two types of exposures are commonly used in prolonged exposure therapy: imaginal and in vivo. Imaginal exposure usually begins with the person explaining the event in detail. Together, the therapist and the individual may talk through the event and process the emotions that arise when thinking about the memory. The session is normally recorded so people can listen to the recordings between sessions to work on processing their emotions and practicing breathing and other relaxation techniques.
For in vivo exposure, the person may be asked to confront stimuli related to the event outside of therapy, including specific people and places. The therapist and individual can work together to decide which stimuli to confront between sessions.
Finding a trauma-informed therapist
Finding a therapist with experience treating trauma can be challenging if you face barriers to treatment, such as a long commute or lack of available local providers. Online therapy can be a flexible and accessible way to access mental health care from the comfort of your home at a time that suits your schedule. With an online therapy platform like BetterHelp, you can meet with a licensed mental health provider via phone, video chat, or live chat sessions. There are more than 30,000 providers on the platform, and you can switch therapists at any time until you find one who is a good fit.
Research has found that online therapy can be an effective way to treat PTSD. A 2021 study comparing the results of online and in-person treatment for PTSD found that symptoms improved equally after either treatment, and that both treatment approaches led to results that were sustained for one year.
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