Validating the impact of complex trauma.

2HatsTestersTrauma

This video eloquently describes what happens in our brains as we experience things that happen to us.  How our reactions are a normal response to an abnormal situation.  Dr Haley Peckham describes how our mental health system creates 2 choices. 1) Where we have a diagnosis and can feel that our struggles are validated and we are not responsible, or with no diagnosis, are not validated and we are left just feeling there is something wrong with us.   She presents another option that is somewhere in the middle that can promote compassion for everyone’s struggles as a result of the way life has shaped us.

 

CBT is not the only approach for Anxiety and Depression

2HatsTestersUncategorized

depression, anxiety,

So Why are You Told That it is?

If you went to your GP and told them, you were depressed or suffering from anxiety they would likely suggest medication and CBT therapy. General Practitioners are not psychologists or mental health practitioners, so their knowledge is based on what the medical profession as a whole has come to understand. There is a lack of understanding about other therapeutic approaches and how they might apply to you.

I have to admit that this subject gets me worked up. I have a bias for sure. I am not a CBT therapist. However, I want to be clear that I am not interested in a for/or against CBT discussion. I do believe that every approach has something to offer and that you can learn something from CBT.

 What concerns me, is that you are informed, and realize that many options could work for you.

I want you to understand that a good outcome has less to do with an approach and more to do with your relationship with your therapist.

commonknowledge1) It has become common knowledge.

Everyone is passing it on as the truth, so by default, it becomes the truth. It’s human nature to want to feel like you have an answer to a problem. Passing on information makes you feel knowledgeable and helpful. 

So, you hear from someone that CBT is the therapy for depression. You might read it on the internet. You go to your GP for help, and because that’s what you have understood is effective, you may ask for a referral to someone who does CBT, or your doctor suggests it. You become confident that this is what you need to help your depression or anxiety. It is likely that neither you, your friend or your GP have investigated why CBT might be effective and how it compares to other approaches.

CBT is taught on all graduate counselling courses, whereas training into trauma and other approaches take in-depth training that therapists have to undertake after their degree. CBT is easy to research because it is short term and can be administered following a manual so doesn’t take long specialized training. Many other approaches aren’t as easily researched which gives an unbalanced view of what works and what doesn’t. 

Many organizations practice CBT because it is short term and has this approval of the medical profession. If therapists start up in private practice, they can feel the pressure of providing a therapy that is going to provide them with clients. These pressures can perpetuate the legitimization of CBT above other approaches.

So, from many positions, once you are on this train, you can see how it might be hard to jump off and say, ‘wait a minute I’m not so sure.’

evidence2) You have heard CBT is evidence based

This one, in particular, gets me. If someone told you that CBT is evidence-based, it would not be unusual to think ‘well that sounds legit.’ I mean if there is evidence, then it must work. That’s what it would say to me. So, what does CBT being evidence based mean?

Researchers have tried to apply science to a practice that most therapists understand as more art and relationship than science. The term evidence-based has been co-opted by psychology from the medical profession to medicalize psychology. 

However, there is a big difference, between researching a medical treatment and the effect on blood pressure or reduction in disease, where there is a clear, measurable outcome to successful treatment and a therapeutic method that has so many variables. Those variables include the; skill of the therapist, the motivation of the client, comfort of the client with the therapist, stresses in the client’s life, historical events and traumas and so on. So what are you measuring that is affecting the client?

A little side note here. To try and deal with these variables most of the studies disqualify you from taking part if you are dealing with ‘too many issues.’ In an attempt to make a clearer connection between the problem, and treatment. However, in my experience, the people who come through my door have many challenges, often in addition to, or part of, being depressed. 

The evidence is, therefore, not based on regular clients that walk through therapist’s doors, or at least, only a small proportion of them.

Another problem is that researchers refer to statistical significance as proof that CBT is effective. What this means is, that the results are better than the placebo effect. In real terms, this means that 75% of people in the study showed no improvement, plus improvements decrease over time for a significant proportion of the people. When you think about the term ‘evidence-based,’ I doubt that you would understand it in these term

So What Should You be Looking For?

Firstly, do not let the term ‘evidence-based’ be your guide

If like me, you understand the difficulty of researching a particular approach to proove it’s efficacy, it makes more sense to look at how human beings work and what is a healthy mind and body. As practitioners, we can use this information to develop skills and interventions that facilitate a movement towards health. There is a lot of research and experience that has helped us understand development, how you experience others and the world, how your brain develops and how various experiences interrupt and impact your emotional, mental and physical systems. There are a couple of things that this type of research points to.

The importance of Relationship

Your relationship with a therapist is not just about feeling comfortable and being able to be vulnerable, which is important, but it is crucial to our ability to integrate new information and process trauma. Developmental neurobiology, in particular, has highlighted the brain/body systems that are important in creating safety and how this is related to connection. The ability to self-sooth and be present with our experience relates to a connection with a safe, calm, and self-contained individual. Our safety mechanisms lie within a part of our nervous system that maintains relationships with others.

Working with the body

Working with the body (sensations, emotions, movement, self-regulation ) and not just thoughts, intellectual insight, and interpretation, are increasingly seen as important in the way in which we change unhealthy patterns and work through emotional difficulties.

Look for an approach that makes sense to you, here are some important distinctions to bear in mind

With all the focus these days on neuroscience and how that informs therapeutic approaches, I think a simple comparison is left brain vs. right brain approaches. Another distinction is between a technique or procedure and an overall therapeutic approach.

Techniques vs. Therapeutic Orientationmorequestions

Techniques focus on one aspect of experience such as reducing symptoms of anxiety. Whereas a Therapeutic Orientation is a way of working as a whole. Each Orientation takes into account human behaviour, development and a view of how we change in developing a therapeutic theory.

For example, EMDR (eye movement desensitization reprocessing) is a procedure (technique) to help facilitate a reduction in distress and promote a positive view of oneself. Whereas Gestalt Therapy is an experiential orientation that values self-awareness, present moment, and sees human beings as being driven to complete needs. Gestalt sees one of the main causes of common struggles in life resulting from interruptions to contact with yourself and others. Gestalt sees change as occurring through self-awareness, frustration and owning more of who we are.

Therapists incorporate Techniques into their general Orientation.

Right Brain vs. Left Brain Approaches

When we refer to the right and left brain these are different channels of our brain and body that process the flow of information about our experience. Each channel takes care of integrating various aspects of our experience; both are important and both are to some extent going on at the same time. 

Therapeutic approaches will have both types of processing to some degree but tend to highlight one over the other. What we tend to focus on creates more activity in that area of our brain.

Your Left Brain takes care of language, concepts, intellect where your higher cognitive processes live that plan, set goals, make conclusions about beliefs, values, and meanings in your life.  It is where you evaluate your experience and develop the rules for how you are to do things or live your life.

From this point of view approaches that focus on working things out intellectually and examine how we think about things, the way our thoughts might affect our decisions and actions, use interpretations and analysis, explore the meaning of our lives or goal setting fit into a left-brain process. These include; CBT, Solution Focused, Narrative and Analytic Approaches.

Your Right Brain functions are about being in your experience and describing your experience. When you are absorbed in an experiential awareness in the now moment, when you are focused on your sensations, movement, emotions, and sense of your body, are examples of right brain processes. The right brain is referred to as the emotional brain. It is the world of metaphor, empathy, and bodily wisdom. How we feel connected to others and bond to people.

From this point of view approaches that encourage an emotional, somatic(body) reflection and a focus on the therapeutic relationship, work in the present moment, focus on safety and regulation of our nervous system will fit into a right brain approach. The would include; Somatic Psychotherapies, Gestalt, Emotionally Focused Therapy, music/drama therapy, art therapy.

Both right brain approaches and left brain approaches have something to offer. In my view, there is no one way that is more effective than any other approach. The left brain approaches like CBT focus on your thinking and help you to deal with the way negative thoughts and perspectives are influencing your emotional world. Right brain approaches see depression and anxiety as the way your nervous system either has too much activation or too little and works through experiential means to promote a change. Also, the connection with the therapist is seen as an important condition for change.

In the end trust what feels right, and who feels right for you rather than a prescribed approach.

Transformational moments

Delyse Ledgard, RCCTherapy process

When transformation happens, in some way, we transcend the limitations of who we are or how we are living and experience a kind of waking up to ourselves and life.  It can feel like a jolt into a new perspective or a series of moments where something has been slowly unfolding into our consciousness.  We can notice Read More

Thoughts on being Depressed.

Delyse Ledgard, RCCEmotions

depression, anxiety,

We know what the experience of depression is.  When we are depressed our system shuts down. Our energy, our aliveness, our feelings, our motivation and creativity, and our will to truly live become muted and dampened.  We mostly shut down gradually and imperceptibly. There is a stuck feeling to being depressed.  Our feelings and thoughts come slowly and painfully.   Depression is numbing, deadening, aching agony.

Grief is different.  Grief can very much feel like depression but it usually eases over time.  The gut-wrenching sadness and anger come in waves that get smaller and smaller as we allow ourselves to express the pain.  Depression is thicker and constrained and tends to come with a deeper sense of powerlessness and self-criticism.  Sometimes when we find it difficult to process our grief it can turn into depression.

The question of a chemical imbalance.  Doctors focus on this aspect of the cause of depression.  The truth is no-one really knows.  That probably surprises many of you but this is just a theory.

The truth is that there is no test that one takes to verify that you have a chemical imbalance and exercise or sleep deprivation is just as likely to create a change in your brain’s chemistry.  We are all made up of chemicals and lots of things affect the presence or depletion of chemicals in our body.  Food, exercise, touch, smell, laughter, stress, trauma, alcohol and drugs and yes, medications.  No-one has identified a cause to depression because emotional struggles are dependent on so many factors.  The brain/body systems and connectivity are complicated in ways we are only beginning to understand. This isn’t to say that medication doesn’t have an effect and if you have major depression it can be helpful.

Depression is a response.  This idea makes more sense to me as a way of understanding depression.  A response to the world that hurts and discriminates and weighs us down.  Oppressive forces of inequality and lack of opportunity leave a person feeling inadequate, and longing for what they can not have.  A slow painful resignation can take over.  A response to the responsibilities of living our own life when we have lost touch with what that means.  A response to the inability to regulate our emotions.  A response to the general pressures and disappointments of life.  These responses can continue to eat away at a person unless they find a way to develop resilience and joy within the life they have rather than wanting somebody else’s life.

In this fast past, results-oriented culture we are often left with little time for exercise, healthy eating and cultivating meaningful relationships.  When we get on this treadmill we can begin to feel controlled by our circumstances rather than making considered decisions about how we want to live.  Powerlessness is a consistent feeling for people who are depressed.

The reason a person is depressed is as varied as the complexities of each person’s life and how they respond to it.  How they are equipped or not by their histories and the traumas they have faced.  What losses and disappointments they have faced.  What their lifestyle is like and whether they are living a healthy life all round.  The kinds of stress they face or pressures to support others’ desires.

So what does cause depression?

Here’s what we know so far based on experience and some soft and hard science here and there.   We know that our brain/body is built to respond to the world and our experiences shape our brain.  This is particularly crucial early in our life but also throughout our life and can change with practice and integration of new experience.  If we are responding to an unsafe, insecure and threatening world then our brain and body learn to respond in certain ways and not others.   Trauma whether a single incident or ongoing experiences that dismiss, belittle and dis-empower us can cause us to shut down.  This dampening process is part of our nervous system’s response to being unable to fight back or leave a stressful and threatening situation.  When we shut down our energy it helps us to not be overwhelmed by this stress but also means we have less available to cope with life.  For the majority of people who are depressed, this is the cycle of depression.  No energy – can’t take action or deal with things – feel a failure and powerless – leads to less energy.

This depletion in the system overall has consequences to the brains chemistry and psychological systems such as motivation, attachment, consciousness, concentration.  Throwing some man-made chemicals at the system is going to have a limited effect because the person has to recover and heal the depleted areas.  For example; if a person feels powerless and stuck then it is going to be more effective to find ways that they can experience their empowerment which has an effect over time on creating new pathways in the brain that affect motivation,  connection, and meaning.

Being Depressed doesn’t mean there is something wrong with you.

It means that you are searching and struggling with hard questions about your life.  That you are poised on the brink of collapse, feeling the pull of giving up.  This is a hard struggle and one that you have every possibility of coming through stronger. We often learn early on to keep our feelings and experience to ourselves or need to because we are overwhelmed. We may be used to performing and pretending to be ok that one day it occurs to us that we don’t know our truth or what our desires are. Did we ever know what was real?  Were we ever taught how to be real? Many of us are constricted and oppressed into a powerless state that would defy anyone NOT to end up depressed.

One of the advantages of seeing depression as a chemical imbalance is that you have something to blame other than yourself.  We all know how easy it is for depressed people to blame themselves for everything.  I often think that this tendency to turn things inwards is a result of the powerlessness we feel.   When we are immobilized and unable to act it is easy to feel that there is something wrong with us.

This is not true.  The more you can see it as a call to make changes in your life,  to change your lifestyle, environment or work through the trauma’s you have experienced, the more you can start to come alive.   The many people I have known that have struggled through the effects of depression often have a depth to their life.

Depression in many ways forces us to stop and ask hard questions.  What is the meaning of my life? What is the point to the things that I do? How can I live with disappointment and betrayal? Am I ok as I am?  These questions can open up a much-needed reflection and find our way towards a life full of meaning and energy.

Books on treating depression without medication

The Depression Cure



Dealing with Depression Naturally.

Surviving America’s Depression Epidemic.

The Mindful Way Through Depression.