Cognitive Behaviour Therapy (CBT) is a short term, focused approach to the treatment of many types of emotional, behavioural and psychiatric problems. The application of CBT varies according to the problem being addressed, but is essentially a collaborative and individualised program that helps individuals to identify unhelpful thoughts and behaviours and learn or relearn healthier skills and habits.
As for CBT however, Trauma Focussed Cognitive Behavioural Therapy addresses the emotional, cognitive and behavioural sequelae following exposure to traumatic events.
Exposure Therapy utilises the clients own thoughts, images and physiological symptoms and self reported level of nervous tension to assist them to cope with their anxieties. By dealing directly with the clients own thoughts and distortions of thoughts, the client can learn that their predictions of future events are necessarily accurate.
Motivational interviewing helps people resolve ambivalent feelings and insecurities and find the motivation to change or address their targeted or problematic behaviour. It is a practical, empathetic, and short-term process that takes into consideration how difficult it is to make life changes.
Assertiveness training assists in the development of behaviour patterns wherein the client learns to communicate their feelings, thoughts and beliefs in and open, honest manner without violating the rights of others. By being more assertive, the client can improve their sense of identity, confidence and self-esteem.
Using both the Behaviourist Theories of Classical Conditioning and Operant Conditioning, the client is assisted to understand how they have learnt, managed and maintained dysfunctional behavioural patterns.
Strong, intrusive negatve emotions can hijack our thoughts and cause cognitive, emotional and social distress. Emotional Intelligence training aims to manage the emotional hiacking by learning how and why we tend to experience the same negative emotions and develop strategies to regulate and manage our negative emotions.
Schema Therapy aims to identify and manage early maladaptive coping styles from childhood. Maladaptive coping styles can lead to unhealthy life patterns of avoiding, surrendering and overcompensating as ways of managing the emotional needs that were not met during childhood or adolescence. The goals of Schema therapy are to help clients weaken the early maladaptive coping styles, disrupt the unhealthy patterns and strengthen their healthy adult coping modes in order to address/meet their core emotional needs.
Biofeedback is a process of training the mind to refocus negative emotions using direct physical feedback. Rebalancing the mind, body and emotions helps to reduce stress and build resilience through improved health and well being.
EMDR is a procedure used in psychological therapy to reduce the impact of past traumatic experiences that intrude into your present life. Specifically, EMDR focuses on the traumatic memories and seeks to resolve the effects of the trauma. Trauma memory consists of three components – (1) the sensory memory, (2) the emotional memory, and (3) the meaning.
- The sensory memory is stored in the sensory cortex of the brain, where the details of sight, sound, smell, etc. are encoded. There are many different sensory elements which make up a traumatic event, and our recollection of a recent trauma often consists of sensory fragments of the event, rather than a complete and coherent memory. A traumatic memory is often vivid and detailed however trauma memories may also be lacking in detail. For example, a person in a holdup may recall the detail of the weapon, but not recall what the robber was wearing. Traumatic memories are often recalled with a sense of being present and are accompanied with and array of intrusive psychological and physical behaviours, i.e., flashbacks, disturbing dreams, anxiety.
- The emotional memory is often called the ‘body memory’, as activation of this part of the trauma memory reactivates the body sensations associated with the event. The emotional / bodily components of the event are activated in a different area of the brain known as the amygdala. Recalling the sensory memory generally reactivates the emotional memory, which is why many people try to avoid talking of the event, or avoid possible reminders of the event. A person may experience a general sense of over-arousal, in the form of increased irritability, sleep disturbance, concentration difficulties, being easily startled, and being on guard. The person’s mind may try to distance the emotional component of a traumatic memory by a process called dissociation, which may be experienced as a sense of emotional numbness.
- After the trauma occurs the third component is formed in yet another part of the brain, the prefrontal lobes. This third component of the traumatic memory is the meaning that the event has for the person. These are not the thoughts we had at the time of the trauma, it is the meaning that that event has afterwards. This is then applied to other situations subsequent to the traumatic event, triggering emotional and behavioural reactions long after the original traumatic event.
|Traumatic Event||Sensory Memory||Emotional/Body Memory||Meaning|
|Motor vehicle accident||Sound of tearing metal, sight of the car in the rear-view mirror||Fear, tensed muscles, neck aching||I am not safe in cars
I am not safe on the road
During EMDR the client is guided to deliberately bring into conscious awareness the sensory memory, their thoughts, and the accompanying emotions and bodily sensations. Clients need to be willing to experience the emotions and body sensations that accompany the recall of a distressing memory and associated thoughts. However, many clients are unable or unwilling to speak about the traumatic event/s. It is for this reason that EMDR is highly advantageous as it is unnecessary for the client to actually speak about the trauma, rather they are guided to bring the trauma memories into conscious awareness.
The distressing memory and associated thoughts are then processed using bilateral attentional stimulation. The most common attentional stimulation is eye movement, however tactile and audio attentional stimulation can also be utilised if necessary. Attentional stimulation involves bilateral activation of the right and left brain hemispheres. This produces a distinctive and naturally occurring patterns of electrical activity in the brain, which causes the stored trauma memory to quickly change. The regions of the brain involved with sensory storage, emotional activation and reasoning all become more active, with changed patterns of nerve cell firing.
EMDR is not suitable for all clients and care is taken to ensure that it is utilised when and if appropriate. For further information www.emdr.com