Help for Childhood Trauma Survivors: Acceptance-Based Mindfulness Therapies

‘“reathe. Breathe. You are here now. Rationally you know that the trigger that caused you to switch into frightened non-presence for a moment is not a threat. It’s a well-honed reflex from long-ago trauma…but your nervous system doesn’t know that, and refuses to believe it.

The child-self who developed that reflex couldn’t express, understand, or escape the abuse by someone who should have been a protector. That child-self could only develop coping skills, and survival skills: perhaps responding with anger turned inward, perhaps mentally leaving the body, disconnecting from the experience of abuse, shutting down awareness and memory, then returning with only a trigger to give evidence of the event.

That was then. This is now. You have practiced a full set of tools that will help you to re-ground, re-center, and move forward. So now: acknowledge your experience and come back to your body. Feel your feet on the floor, and other sensations of your body. And now, gently, direct your thoughts to another part of this moment, one that does not cause distress.“

This is a tiny glimpse of how mindfulness counselor/researcher/educator Trish Magyari, MS, LCPC, NCC, RYT-200 trains her clients to use acceptance-based techniques to manage the symptoms of complex post-traumatic stress disorder (C-PTSD, also known as developmental trauma and attachment trauma).

C-PTSD – A Response to Long-Term, Inescapable Abuse

While PTSD often affects combat veterans and survivors of accidents, assaults, and natural disasters, C-PTSD may affect people who endured long-term physical, sexual, psychological, or emotional abuse or neglect by a person in authority, most often in early childhood. Others include victims of domestic violence, human trafficking, and other forms of captivity and abuse. Even when you’re an adult, such abuse can skew your self-worth and survival instincts. If you were a young child at the time, the damage may go far deeper, affecting your character development at a preverbal level, and leaving you with no way to express your suffering, then or later in life. Even years later, you may blank out (disassociate) at moments, have large gaps in your memory, or experience unexpected flashbacks of traumatic events.

According to the advocacy nonprofit, Beauty After Bruises, you as a survivor may wrestle with core beliefs and response patterns…for example, seeing yourself as bad or worthless, or even at fault for the abuse you experienced… swinging between deep sadness and anger, even self-harming thoughts and behaviors, or between numbness and extreme emotion. You may feel anger, sadness, or a desire for revenge against your abuser, or you may still strive to earn their approval and love, even as an adult, even after the relationship is only a memory. Your other relationships bear the brunt: you may feel isolated, not knowing how to connect with others; you may swing between reflexive distrust and excessive trust (mirroring the off-on, abusive/loving treatment you received from your perpetrator). Fearing connection and betrayal, you may abandon even healthy relationships.

Other physical and mental illnesses may arise, ranging from headaches, chronic pain, or hormonal issues to autoimmune, digestive, or cardiovascular disorders on the physical side; and disassociative disorders, borderline and bipolar disorder, eating disorders, anxiety, and agoraphobia on the psychological side. Self-medicating with alcohol and narcotics can lead to addiction.

Hope in Treating C-PTSD: The acceptance-based Behavior Therapies

C-PTSD is not yet listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and knowledge of its symptoms and treatment is limited among mental health professionals (and even more limited among the general public). Due to the complexity of the condition, it is often misdiagnosed; once the correct diagnosis is given, treatment can take a long time. While the possibility of complete healing is not certain, however, the picture is far from hopeless.

Magyari explains: “With PTSD as with diabetes, symptoms might disappear completely with the right type and dose of treatment but the underlying vulnerability is still there so that if treatment stops or another trauma occurs, symptoms can come rushing back in. However, there are different viewpoints on this.”

When you’re in crisis, doctors may respond with prescriptions for antidepressants or anti-anxiety medications, aimed at getting you through the acute symptoms. Many patients, however, are uncomfortable with being on medications long-term and feel driven to find more holistic alternatives. And for patients willing to participate in their healing process, the alternatives are there! Acceptance-based behavior therapies (ABBTs) – also called the “third wave” of cognitive-behavioral therapy - offer a mindful approach to treatment focused on your present experience rather than on your history. While their approaches and practices vary, these therapies generally focus on building your awareness and acceptance of inner experiences and creating a life worth living.

ABBTs, says Magyari, “help one to re-join with their life today instead of being run by the traumas of the past – including the possibility of experiencing joy and even contentment. One method of getting there is to develop self-compassion instead of self-blame and self-loathing.”

“We are not talking about the word “acceptance” as it is used in the last stage of the grieving process,” she adds. “Instead, we’re helping clients to accept and be present to their current experience, being with themselves and accepting where they are each day with a kind and friendly attitude instead of having an internal war with their experience. It’s not just a matter of becoming aware of their experiences but being with them in a different way.”

This prevents the avoidance patterns common among C-PTSD patients, she says, in which you might shun experiences similar to the original trauma because they bring up uncomfortable feelings…and then related experiences trigger you, leading to more avoidance, and your life gets progressively smaller.

By helping you to increase awareness of your experience, and increasing nonjudgmental acceptance of your thoughts and emotions, the ABBTs ultimately aim to help you live a larger life with greater meaning and compassion for yourself and others.

The acceptance-based therapies include:

• Acceptance and Commitment Therapy (ACT)
• Dialectical Behavioral Therapy (DBT)
• Mindfulness-Based Interventions (MBI) such as Mindfulness-based Stress Reduction (MBSR) and Mindfulness-based Cognitive Therapy (MBCT)

Acceptance and Commitment Therapy

According to Matthew Tull, Ph.D., “ACT is based in the idea that suffering comes not from the experience of emotional pain, but from our attempted avoidance of that pain. Its overarching goal is to help people be open to and willing to have their inner experiences while focusing attention not on trying to escape or avoid pain (because this is impossible to do) but instead, on living a meaningful life.”

To achieve this, ACT therapists teach a blend of mindfulness and purposeful living through six core principles:

• Cognitive Defusion - Seeing your thoughts as just that – thoughts – thus separating them from their emotional charge.
• Acceptance - Allowing yourself to experience unpleasant feelings, sensations, and urges, and letting them pass, rather than spending energy on resisting or suppressing them.
• Connection - Being fully present with whatever you are doing or experiencing in this moment, rather than focusing on the past or the future.
• The Observing Self - Understanding that you can step back from your thoughts and watch yourself thinking them. This allows you to experience both pleasant and unpleasant thoughts, memories, feelings and urges with openness, curiosity, and interest, rather than triggering into terror, anger or depression.
• Values Clarification - Identifying the values that guide you at a core level, making it easier to navigate even unpleasant experiences with a sense of purpose and meaning.
• Committed Action - Setting goals and taking positive action based on your values, as well as learning to understand and address the things that may block you from doing so.

You may pursue ACT therapy in a group, one-on-one, or couple formats, and the duration of therapy may range from long-term to very short-term.

Dialectical Behavioral Therapy

DBT combines one-on-one sessions, group therapy, and phone coaching with a 4-module behavioral skills training, teaching you how to shift from trauma-based reactions to healthier responses:

• Mindfulness – being present in the here and now through meditation, identifying your state of mind as “wise mind, logical mind, (or) emotional mind.”
• Distress Tolerance— accepting yourself and the current situation through a comprehensive series of skills including distraction, self-soothing, imagery and relaxation, radical acceptance, and thinking of pros and cons.
• Interpersonal Effectiveness— expressing your needs and setting boundaries while keeping a relationship positive and healthy.
• Emotion Regulation—identifying and coping with negative emotions while strengthening your ability to return to positive feelings.

“The core mindfulness module is repeated between each of the other three modules; it is a critical piece of the program,” says DBT therapist/pastoral counselor/educator Theresa Robertson, Ph.D., LCPC, NCC, CBTC. “DBT is mindfulness-informed rather than mindfulness-based – the meditation component is not as formal or structured as it is in MSBR and MSCT, but the mindfulness piece is essential. We’re teaching people to be aware of their emotions at any given point…using the mind and intention to access parts of the self more compassionately and with more sensitivity to suffering.”

Mindfulness-Based Interventions

Since Jon Kabat-Zinn established Mindfulness-Based Stress Reduction (MBSR) in 1979, followed by his best-selling book Full Catastrophe Living in 1990, the concept of mindfulness has flooded the culture in business, religion, education, and medicine as well as mental health. More than 29,000 people have taken the 8-week MBSR course at the University of Massachusetts Center for Mindfulness in Medicine, Health Care, and Society, and the course has been profiled on PBS, NBC, ABC, CNN, and Al Jazeera, and the Japanese network NHK.

It has also become an entry point for people to discover mindfulness-based therapeutic techniques such as Mindfulness-Based Cognitive Therapy (MBCT).

Originally developed to help people to change patterns of recurring depression, the intensive 8-week MBCT group program adds techniques from cognitive-behavioral therapy and somatic experiencing to the MBSR practices. The goal is to help you to respond consciously and intentionally to unpleasant or triggering thoughts, feelings, and sensations, rather than reacting reflexively or with avoidance.

While MBSR and MBCT are both 8-week group programs ending in an intensive retreat, they have distinct differences (MBSR is designed to the general public; MBCT requires a clinical intake. Insurance will cover MBCT, but not MBSR). Each has been the subject of clinical research to determine its specific effectiveness in treating (C)PTSD.