Types of Trauma Therapy and How They Work
A traumatic event is defined as exposure to death, threatened death, actual or threatened serious injury or actual or threatened sexual violence. Traumas can be experienced in any one of four ways:
directly experiencing the event
witnessing the traumatic event, in person
Learning that a traumatic event occurred to close friend or family member (violent/accidental)
Experiencing first-hand repeated or extreme exposure to aversive details of trauma (not via media, unless work-related)1
Traumatic events can impact people in a multitude of ways. Some people naturally recover from traumas while others may struggle with debilitating trauma-related symptoms for years. Given the heterogeneity recovery trajectories following trauma, clinicians need to be equipped with a multitude of tools and interventions to appropriately address individual client trauma-related symptoms and needs. In this post, readers will learn about different types of therapy for trauma related symptoms and how different trauma therapy types work.
Different types of therapy for trauma
The impact of trauma can vary widely; therefore, it is recommended that clinicians conduct a thorough assessment of trauma-related symptoms before jumping into any treatment. These assessments can include gold-standard measures such as the Clinician-Administered PTSD Scale-5(2) (CAPS-5). The purpose of this evaluation is to ensure that we fit a client’s goals, needs and symptoms to the appropriate type of therapy. If clinicians need a refresher on assessment and differential diagnosis, the webcourse below can help:
https://learning.simplepractice.com/courses/trauma-exposure-differential-diagnosis
PTSD Treatments
For clients who meet criteria for Posttraumatic Stress Disorder (PTSD), including Complex-PTSD, there are several short-term effective treatments that can lead to full remission of symptoms. PTSD is characterized by:
Recurrent re-experiencing of the trauma(s) during daytime or at night, in the form of nightmares.
Avoiding thinking or feeling about the trauma(s) and any reminders of the trauma(s).
Changes in thinking and changes in mood, including significant trauma-related blame and changes in thinking about safety, trust, power/control, esteem and intimacy.
Changes in physiological arousal and reactivity, such as exaggerated startle reaction, being super-alert and on-guard, hypervigilance, and trouble with concentration and sleep.
These symptoms must be present for at least one month following the trauma(s), they must lead to significant impairment and/or distress and they cannot be accounted for by another mental or physical illness(1).
The most effective treatments for PTSD are Cognitive Processing Therapy (CPT), Prolonged Exposure therapy (PE) and Eye Movement Desensitization and Reprocessing (EMDR). These treatments have over two decades of research showing that they lead to clinically significant improvements that are long-lasting3. All of these treatments are specific subtypes of Cognitive Behavioral Therapies (CBT) and address avoidance and problematic beliefs that form after trauma(s), as both of these factors are known to maintain PTSD.
Treatments for interpersonal difficulties
After traumatic events, some clients may struggle with power/control dynamics in relationships. This may be evidenced by difficulties appropriately setting limits/boundaries with others, trouble asking for their needs to be met in relationships and challenges with asserting themselves. For clients with these types of challenges there are several different types of trauma therapy that can be beneficial. Specifically, Skills Training in Affective and Interpersonal Relations (STAIR), Dialectical Behavior Therapy (DBT) and Schema Therapy all focus, to some degree, on relational skill building and on addressing problematic beliefs and behaviors that inhibit healthy power-sharing in relationships. These types of trauma therapy help clients clarify their relational wants, need and limits and teach clients language for communicating more effectively what their needs, wants and limits are with others.
Treatments for mood and anxiety disorders following trauma
Two very common sequela following traumatic events is the experience of mood and anxiety-related issues. For mood disorders, such as Major Depressive Disorder, Cognitive Behavioral Therapy for Depression (CBT-D) and Interpersonal Therapy for Depression (IPT) have a robust evidence base. For anxiety disorders, CBT methods, such as Exposure-Based Treatments can be very effective at assisting clients in overcoming fears and anxieties. Another type of trauma therapy that addresses mood and anxiety symptoms following trauma is Acceptance and Commitment Therapy (ACT).
One thing to keep in mind is that there are many different trauma therapy types that are advertised broadly, but are lacking empirical basis. Meaning that even though some trauma therapy types may get a lot of visibility or seem popular in media, they may not actually have any sound science showing that they are effective for trauma-related symptoms. Therefore, clinicians are encouraged to become competent consumers of the scientific research on different trauma therapy types in order to provide the most ethical and effective clinical care.
How trauma therapy techniques can help
Trauma therapy can help with a lot of different symptoms and difficulties. The benefits of trauma therapy can include decreased trauma-related intrusive images or nightmares, increased ability to effectively manage negative thinking or rumination, decrease in painful mood states like depression, anxiety and guilt and improvements in assertiveness and interpersonal effectiveness.
Decrease in trauma-related intrusive images and nightmares
Trauma therapies that treat PTSD, like CPT, PE, and EMDR, significantly reduce daytime and nighttime trauma intrusions and re-experiencing symptoms of PTSD(3). In PTSD, trauma-related intrusions are typically very impairing and/or distressing. However, effective treatments for PTSD facilitate emotional processing of the traumatic events and facilitate making meaning of trauma in such a way that trauma-related intrusive imagery can be a thing of the past.
Increased ability to manage negative thinking and rumination
Several different trauma therapy techniques provide skills for identifying problematic and unhelpful thinking patterns that can develop after a traumatic event. In addition to skills for identifying unhelpful and problematic thoughts following traumatic events, there are numerous additional skills for modifying how one thinks about things. For example, thought records are a technique that supports recognizing thoughts that fuel painful emotions, while cognitive restructuring skills and related worksheets facilitate arriving at different conclusions based on the facts of a situation. These skills build on each other and are often practiced over time until they become automatic.
Improved interpersonal effectiveness
Trauma therapy can provide scaffolding for interpersonal effectiveness skills, which are often negatively impacted by the experience of trauma, particularly if one’s trauma type was interpersonal in nature. Clients can learn numerous skills for reflective listening, assertiveness, setting boundaries, making requests for change and giving positive and negative feedback. In addition, clients can learn about power-sharing healthfully in relationships and how different relationships may offer them different things.
Answering your questions about different types of therapy for trauma
Even with access to the internet, it can be really challenging to know about all of the options available for trauma therapy. It can also be a challenge to decide which treatment approach is right for you. Below, I will answer some frequently asked questions about different types of trauma therapy available.
What’s the most effective type of therapy for trauma?
There is no one-size fits all approach when it comes to trauma therapy as people are affected by traumatic events in different ways. When it comes to PTSD, however, there are several treatments that have been shown repeatedly to be superior to other therapies; namely, CPT, PE and EMDR. However, for other post-trauma reactions (e.g., depression, trouble with concentration, anxiety, low self-esteem), there may be different approaches that could be a great fit for clients.
When selecting a provider for trauma therapy, consumers should look for therapists who have had coursework, supervised practica and/or mentorship by experts in the field of traumatic stress. In addition, consumers are encouraged to look for providers who have had specialized training in evidence-based trauma treatments. Simply having the “experience” of working with traumatized clients will not ensure that a therapist is truly an expert; experience can pertain to the number of clients seen, while expertise speaks to specialized knowledge and competence in addressing specific mental health needs.
In general, the most effective forms of trauma therapy types are those that have been extensively evaluated and tested on hundreds or thousands of clients, and those treatments that, when scientifically compared to other trauma therapy types, show that they are more effective at reducing specified post-trauma difficulties and/or symptoms. Consumers can prepare themselves to ask their prospective trauma therapists about the clinical research supporting the interventions that are suggested.
How can people choose the type of therapy for trauma that’s best for them?
Consumers can be empowered with knowledge by doing research into different evidence-based treatments for trauma-related symptoms. They can arm themselves with questions to ask prospective providers during initial consultation calls and during their first appointment.
First, consumers should work with a competent, well-trained mental health professional who can aid them in discerning which trauma therapy is right for them. Other factors that a person may consider when choosing which trauma type is a good fit include what goals they have for therapy, any specifications/limitations regarding the frequency or length of treatment and modality of trauma treatment they prefer.
Goals for therapy
It is essential that consumers spend time determining what their goals are for therapy. While some individuals will want to eliminate trauma-related nightmares or flashbacks, in the case of PTSD, others may wish to improve their self-esteem or feelings of guilt or shame following the trauma. The client’s goals for treatment are an essential component of collaborative treatment planning in therapy.
Frequency of sessions and length of treatment
Some clients may be eager to engage in intensive treatment that takes place multiple times each week, whereas some clients- due to finances or psychosocial constraints- may only be able to attend therapy sessions each month. These factors will help determine which treatment to undertake as some therapies work best in a specified frequency.
Modality of treatment
Some trauma therapies can only be delivered individually, while other trauma therapies can be conducted in other modalities, such as group therapy, family therapy or couple therapy. Therefore, client preferences regarding the modality of trauma therapy delivery can be a great aid in ensuring that a client’s needs are met in trauma therapy.
Learn more about different trauma therapy techniques
There are a number of very effective therapies for trauma-related symptoms. These trauma treatments vary in their focus, length and modality. Consumers can do a great deal to ensure that they work with a provider with expertise in the trauma therapy. Below are several resources that consumers may use to learn about trauma treatments and to find providers who are trained in evidence-based trauma treatments.
International Society for Traumatic Stress Studies (ISTSS)
National Center for PTSD
Child Traumatic Stress Network
For therapists who are looking to enhance their expertise in trauma-informed care and in the provision of trauma therapy, the Trauma Therapist Training Course provides an excellent training opportunity. The Trauma Therapist Training Course provides a breadth and depth of learning about trauma therapy techniques; it includes live group and individual consultation to support the application of skills learned during the course into clinical practice. For more information, see the link below:
https://www.howtobecomeatraumatherapist.com/
References
(1) American Psychiatric Association. (2013). Trauma and Stressor-Related Disorders. In
Diagnostic And Statistical Manual of Mental Disorders (5th Ed.). Arlington, VA: Author.
(2) Weathers, F.W., Blake, D.D., Schnurr, P.P., Kaloupek, D.G., Marx, B.P., & Keane, T.M.
(2013). The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5).
(3)Forbes, D., Bisson, J.I., Monson, C.M., & Berliner, L. (2020). Effective Treatments for PTSD
Third Edition: Practice Guidelines from the International Society for Traumatic Stress Studies. Guilford Publications.