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How to Treat Complex Trauma

From childhood bullying to incarcerated family members to patrolling war-torn countries, trauma is everywhere. Some trauma is recognizable to nearly everyone, while other trauma is more secretive or held with great shame. Still, with so many of us experiencing pretty messed up stuff in our lives, we should have an idea of how to best treat it.


Unfortunately, the better we get at thinking circles around our emotions, the less regular talk therapy works. Our logical brains can only take us so far in processing the dark stuff. But before we jump into how to solve our problems, we need to know how to explain our problems. Here’s a quick breakdown:


PTSD vs Complex Trauma: What’s the Difference?

Post Traumatic Stress Disorder is recognized by the American Psychological Association (APA) as a diagnosable mental disorder. This means that it has a specific set of guidelines that professionals can use to make conclusions about why someone acts or feels the way they do.


Some symptoms of PTSD include flashbacks, intrusive thoughts about what happened, avoiding any potential triggers, hyper-awareness, social withdrawal, and self-destructive behavior. You have to have these symptoms for at least a month and they have to impact your everyday life. You can find the full diagnostic criteria for PTSD here.


Official PTSD diagnoses are super picky, and require that you have directly experienced or witnessed a trauma, or heard about the trauma happening to someone you deeply care about. This criteria also considers first responders who are repeatedly exposed to disturbing events as part of their jobs.


Still, this doesn’t account for all of the other traumas we experience in our lives. So what do those fall under?


Complex Trauma

To clarify, there are two types of trauma- acute and chronic. Acute trauma refers to the big events we typically think of as traumatic, like car accidents, assaults, and natural disasters. These events are usually one-offs, but deeply affecting. These are also the events that the APA uses to define PTSD-level trauma.


Chronic trauma is a wider umbrella term that refers to any repeated traumatic event. Complex trauma is a form of chronic trauma. It happens multiple times, is deeply interpersonal, affects your feelings of self-worth, and frequently occurs in childhood.


Because it usually happens so early in life, many people who have experienced complex trauma don’t even realize that they’ve experienced it.You might shrug off your mom being so strict that you’d tense up anytime she walked into the room but those experiences and associated fear make an impact on the body and mind. This is complex trauma.


Complex trauma can be interwoven with some of the standard PTSD traumas, especially when it comes to abuse and death. In these cases, the instances of abuse or death would be able to meet the PTSD standard for trauma, but the lifestyle of fear or grief would be complex trauma.


The APA doesn’t have a separate diagnostic criteria for complex trauma or complex PTSD (C-PTSD), but the symptoms of C-PTSD can be identical to regular PTSD. A big difference, however, is that individuals with complex-PTSD may struggle with experiencing situations where others become angry or aggressive. They may also have extremely low self-esteem with intense feelings of shame or worthlessness and difficulty building meaningful relationships. Dissociation, or feeling disconnected from your thoughts, feelings, actions, and sense of self is also common with C-PTSD.


Treating Complex Trauma

Talk therapy refers to the classic therapy dynamic, which is usually what people think of when they tell someone to go to therapy. It’s just you and the therapist, talking (and thinking) about thoughts and feelings. Maybe the therapist gives you homework or makes suggestions on how to change your actions. When time is up, you come back next week and repeat it all over again.


A lot of therapists are taught to take a somewhat cold, standardized approach, like Cognitive Behavioral Therapy or Dialectical Behavioral Therapy to help treat clients. However, these approaches may be ineffective in treating the more complex side of PTSD. This is likely due to researchers wanting the most ideal clients, which means that those who struggle with basic daily tasks, poor people, or women in abusive relationships were excluded from studies. Notice how those groups of people probably have untreated complex trauma that comes from those situations.


Many who have experienced complex trauma found talk therapy helpful to a certain degree, but found that it could not get rid of unwanted bodily sensations, emotions, or flashbacks. Here’s what might be more helpful than regular talk therapy:




Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is a process where a specially-trained therapist helps you release trauma held in your body through an eight phase process. You may move back and forth between phases as treatment goes on, based on what you need. EMDR works by putting both sides of the brain to work by using stimulation (through eye movement or tapping) to help the conscious and unconscious parts of the brain address the trauma.


Broadly speaking, in EMDR, your therapist will first take an assessment, asking about triggers, goals, and trauma history. Then, your therapist will prepare you for treatment, practicing eye movements or taps and creating a mental escape route if the trauma becomes too overwhelming.


They’ll then work to address a traumatic memory and establish how real the trauma feels when it’s thought of and how disturbing it feels to experience it. Afterwards, you’ll use the eye movements or taps to go back to the memory and see how it’s changed by using the movements. Your therapist will help you hold on to an improved feeling, and then they’ll close out your session.


EMDR helps you in a few ways. First, it doesn’t ask you to keep revisiting the trauma, which keeps you from repeated freakouts related to it. There’s no homework, and you don’t have to try to make sense of what comes up for you. You know how in therapy movies, the therapist asks, “So what do you think that means?” Yeah, EMDR doesn’t make you do that. Basically, the tapping or eye movements help you get out of your own head to help untie the knots of trauma rolled up in it.


In EMDR, your therapist will get to know you and your unique needs before starting treatment, building trust to help you heal.


Internal Family Systems (IFS)

In order to explain Internal Family Systems (IFS) work, let’s use our imagination. Imagine that each part of your body represents a part of your personality or mind. Let’s say that your left hand represents your confidence and you experience a trauma to your left hand. Now, every time you move your left hand, you experience that trauma again. It becomes so unbearable to you that you try desperately to not move your left hand. In fact, you try to act as if you don’t have a left hand at all. When you become curious about your left hand, your left arm becomes angry while your right shoulder becomes scared. The trauma to the left hand has now affected the entire body, with each part expressing concerns and desires for what should happen to the left hand.


IFS seeks to help you take back control of your life through gentle, compassionate, curious, and courageous self-action. Using our example, IFS will help you poke at your left hand, remove shame and judgment from the trauma it experienced, and highlight its strengths. It’ll help the rest of the body come to certain conclusions as to how to help with the left hand, and quiet everyone else’s concerns. Eventually, you’ll re-integrate your left hand back into your life, both as its own isolated unit and as an extension of the rest of the body.


EMDR and IFS Together- A Winning Approach

Both IFS and EMDR operate from the standpoint that you can’t truly be healed from your trauma if you don’t feel safe in your body. Since your body and mind are in constant communication with one another, the mind is using countless resources to both protect you from experiencing trauma again and put out the constant fires of being triggered. It’s a lot to handle and it keeps your head barely above the water. You’re stuck in survival mode instead of embodying the superstar that you were always meant to be.


Using EMDR and IFS together, you can best treat the trauma that has snuck into the nooks and crannies of the mind. By looking at each trauma’s different parts and pieces using IFS, the therapist can get a better sense of how to address the different parts of your mind competing for control and emotions management. The therapist can then use EMDR to “sneak” past your inner defense systems and help speak to the more vulnerable parts. This will help you face the state of fear that the trauma has been keeping you in and work past it so that it no longer hangs over your head.


Once you’ve relieved the symptoms and made peace with your inner self, it’s just a matter of taking the next step towards who you have always wanted to be.


Freedom from trauma can make you feel lighter, more empowered, and more like yourself than you ever have been.


Complex Trauma Treatment at In Vivo Center

At In Vivo Center, we specialize in Complex PTSD treatment, integrating EMDR and Internal Family Systems work to help you process your trauma, liberate yourself from shame and despair, and thrive beyond survival mode. We are skilled, compassionate, and identity-affirming. If you’re in the Houston, Texas area, contact us here to get started on your healing journey today!



References

American Psychological Association. n.d. “Exhibit 1.3-4, DSM-5 Diagnostic Criteria for PTSD - Trauma-Informed Care in Behavioral Health Services.” NCBI. Accessed August 9, 2023. https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/.

Boyer, Stacey M., Jennifer E. Caplan, and Lisa K. Edwards. 2022. “Trauma-Related Dissociation and the Dissociative Disorders: Neglected Symptoms with Severe Public Health Consequences.” Delaware Journal of Public Health 8, no. 2 (May): 78-84. 10.32481/djph.2022.05.010.

Corrigan, Frank M., and Alastair M. Hull. 2015. “Neglect of the complex: why psychotherapy for post-traumatic clinical presentations is often ineffective.” British Journal of Psychiatry Bulletin 39, no. 2 (April): 86-89. 10.1192/pb.bp.114.046995.

Forgash, Carol, and Margaret Copeley, eds. 2007. Healing the Heart of Trauma and Dissociation with EMDR and Ego State Therapy. New York, New York: Springer Publishing Company. https://books.google.com/books?hl=en&lr=&id=fhii5zA-AG4C&oi=fnd&pg=PA295&dq=emdr+ifs&ots=oBCvm3dno_&sig=PnB5fsrWAv9WD1R9grrT3nIH_Kw#v=onepage&q=emdr%20ifs&f=false.

Forgash, Carol, and James Knipe. 2012. “Integrating EMDR and Ego State Treatment for Clients With Trauma Disorders.” Journal of EMDR Practice and Research 6, no. 3 (August): 120-128. 10.1891/1933-3196.6.3.120.

Korn, Deborah L. 2009. “EMDR and the Treatment of Complex PTSD: A Review.” Journal of EMDR Practice and Research 3 (4): 264-279. DOI: 10.1891/1933-3196.3.4.264.

O'Shea Brown, Gillian. 2020/2021. “Internal Family Systems Informed Eye Movement Desensitization and Reprocessing.” International Body Psychotherapy Journal 19, no. 2 (Fall/Winter): 112-122. ISSN 2168-1279.

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