Trauma is comparable to an inner shattering. shattering of safety. shattering of beliefs. shattering of identity. or shattering of a role in life. You world has changed, and often you are changed, forever. If you are a trauma survivor, you have the brave yet powerful job to rebuild. Rebuild yourself, your life and a new sense of hope and meaning.
You reach out for therapy because research proves that good therapy will help you. Which it does.
However, trauma work goes beyond the walls of your warm, wise and skillful therapists office. You have your life before you walk into your therapy session, and your reality is with you as you walk out into the world, the world that you live in.
Your brain keeps working through the traumatic material you've processed in session. Processing is the brains way of attempting to heal, however, when something distressing happens the brain may experience flashbacks, nightmares or body memories after a frightening experience.
Because of this, it's important to have effective coping skills at your fingertips that you can use between sessions. Here are some six coping skills that can be used to support you, both in and out of session while you're engaged in trauma therapy.
1. Body Scan
A body scan is an exercise where you bring attention to your body, while not trying to change anything you may notice. The goal is not specifically for you to relax, it is simply about raising awareness about what is happening in the present moment. The body often experiences continued trauma symptoms, even long after the traumatic event has passed. Trauma responses include the body preparing to go into flight, fight or freeze, tensing the body, which takes an exhausting toll on you.
It might sound funny that this exercise isn't about changing anything, yet sometimes just noticing the tightness or the sensation is enough. When your body is already in stress mode, adding another "to do" often gets you trapped, so being able to engage in a mindful exercise is often the best option (Shapiro, 2001).
You start the body scan by either focusing on the top of your head, forehead, ears, cheeks, neck, and go down to each section of the body, or you can start from you hands or feet and slowly pay attention to other areas, noticing any tingling or sensations that come up. There's no wrong way to do the exercise.You might notice an itch, tightness, discomfort or you might not feel anything that all. Just notice. Breath through it and you've done the scan!
Safety switches are physical techniques that use different body senses to help you cope with difficult feelings. Experiment with different techniques until you find a specific posture, stance or even eye gaze that brings you back to a place of strength, a feeling of "grounded-ness" or in touch with your inner wisdom. You can try to sit up, square your shoulders, and open your posture, maintaining a boundary between yourself and whatever you are facing. You can also try gently turning your lips up to something that is called "Half Smile". Just turning the edges of your lips upwards sends a neurological shift to the brain and releases feel-good-hormones, tricking your brain into thinking you are actually happy, or have something to smile about. Try it, it may offer even just a subtle shift (Linehan, 2015).
3. Cope Ahead
Coping ahead is a skill to use when you are worried about how you might feel, react or respond to a specific situation or event that is coming up. What you do is to slowly imagine the exact scenario or situation, what difficulties you may have, including any urges, emotions or fears that you may experience. You then imagine what skill, belief or action plan you may need in order to get through. For example, if you are going to visit a place where something traumatic happened, or even if you associate a location with something more subtle like it simply being a reminder to a time in your life that was hard or where you were ignored when you needed to be seen, imagine what it may be like to visit that place. Imagine practicing a mantra, checking in with a loved one or making sure to take breaks to see how you're doing, keeping yourself back from flooding into emotions that can override the present day experience. Rehearse what you can do and say in any specific scenario. Doing this lets your brain use this as a quicker 'go-to' when stressed because you had practiced in advance (Linehan, 2015).
Containment is a skill that is foundational to beginning any kind of trauma work, as it is effective in utilizing the brain's natural ability to hold and "contain" material. Containment requires the use of imagery, creating some kind of container that can hold upsetting material until you are steady and able to properly process it. You begin this exercise by imagining a container such as a box, a vault, a safe, a trunk, a storehouse or the like. The container should have a lid or a door that can be opened and closed by you, and it also needs to be big, deep and strong enough to hold whatever it is that is causing distress. You practice using the container first with something of lesser stress, and see if your brain can imagine gently sweeping, scooping or placing the information, thoughts, feelings and worries into the container until it can be addressed.
Practicing with less distressing information gives you information on what you may need to add. Do you need a lock, chains, or do you need windows, and a copy of a key to share with a loved one? A thermometer or timer that tells you when to take a break? You can take time finding the right "container" for yourself. To be clear, this exercise is not about shoving away or ignoring information that is important. Rather, it's a method to allow the brain to set aside information when there are trauma symptoms that are becoming overwhelming such a s thoughts, images and memories.
In session with my patients, we practice this and use ways to take a sliver at a time, eventually processing all that is important and necessary to be processed so that you can feel relief and reduction in the intense symptoms. Containment is an original skill that I learned in my earlier years of training in EMDR (Eye Movement Desensitization and Reprocessing) which is a wonderful, scientific-based tool that helps the brain process trauma memories (Shapiro, 2001).
4.Grounding for 5
When you begin noticing you are flooding or experiencing an overwhelmingly distressing feeling, use your senses and drop the memories or body sensations, rather throw yourself into doing the following.
Look around you and name 5 colors (green, red, yellow, blue, pink). Yes, say it out-loud, it helps.
5 sounds (car honking, baby crying, shuffling paper, A/C, phone buzzing)
5 things you can touch (my skin, my nails, the blanket, my purse, my tie)
5 things you can taste (a piece of gum, mint candy, sip of coffee/tea, chocolate chip, ice cube)
5 things you can smell. (scented candle, freshly baked goods, fresh laundry, scent of a flower, perfume,)
Sometimes the images won't go away, and in those instances you may want to use a distancing technique, which creates distance between your inner and outer world. This stops the flooding as you become aware of where your body is, and brings you mind in the here-and-now, separating you from the memory or past event. One way to do this is by putting the thoughts, memories or sensations on a conveyer belt and slowly watch the image, sound and thoughts fade, ever so slowly. You can also imagine putting whatever is coming up onto a TV screen and dimming the image so it gets smaller and smaller, or even just use an imaginal remote and switch the channel.
6. Body Movement
Bessel van der Kolk, one of the world's trauma experts has done extensive research that proves that our body is our most underutilized resource. His specific research is about body movement and PTSD, and how yoga has been found to drastically decrease symptoms related to trauma. Yoga slowly teaches trauma survivors to learn to tune in, feel themselves in their skin and begin to connect mind and body in a gentle fashion. Since trauma forces the mind and body to form a split to survive (often referred to as dissociation), using yoga is a great way to slowly bridge that gap, while also teaching the body how to feel emotions in a non threatening way (Van der Kolk, 2007).
If you're not up to doing yoga, I encourage you to even just integrate a practice of stretching, taking a short walk or engage in another form of movement. Any kind of movement shifts things in the body and offers positive effects, such as biking, dancing, running, or even singing and slightly moving your body to the beat of the song. Find your own way to feel your body and lean on the inherent capabilities your body has to self nurture and sooth.
For today, give one of these skills a try. And hey, try it even when you're not stressed, your brain may be more responsive, and receptive to giving it a go when you are in a trauma heated moment.
Blessings to you on your road to healing!
Shapiro,R (2001): Eye Movement Desensitization and Reprocessing (EMDR): Basic Principles, Protocols, and Procedures, 2nd Edition Second Edition
Linehan, M (2015): DBT® Skills Training Manual, Second Edition Second Edition, Available separately: DBT Skills Training Handouts and Worksheets, Second Edition
Van der Kolk, B (2007):Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society 1st Edition