Mindfulness in the Treatment of Trauma

People who have experienced traumatic events often experience stress, anxiety, and depression. These aftereffects can last for weeks, months, or years. The treatment of trauma in therapy can greatly reduce the duration of these symptoms.

Some common features of trauma are difficulty in concentrating, racing and intrusive thoughts, and flashbacks of the traumatic experience. My clients often express that these features cause them to experience magnified stress, anxiety, and/or depression. In the treatment of trauma, I have found it important to introduce stabilization skills from the beginning of treatment in order to address these “crisis” features of trauma. These stabilization skills can be helpful to clients between sessions, as the features of trauma can occur at any time.

One treatment component that I have found to be effective in stabilization for my clients is mindfulness. According to Cullen (2011), mindfulness-based interventions have become more commonly used to treat many mental health and medical issues, including (but not limited to) stress, anxiety, and depression. Mindfulness also has been found to be effective in treating these challenges (Cullen, 2011).

According to Jon Kabat-Zinn (1994), one definition of mindfulness is “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally.” I have noticed in using mindfulness exercises with clients that focus improves, stress and anxiety decrease, and insight increases, which can help to reduce depression.

Sometimes a person’s thoughts can race, which can create a chain reaction of related thoughts and emotions. This process is not at all uncommon and can occur with anyone, not just someone who has been through a traumatic experience. For the traumatized individual, however, this process of racing thoughts and a chain reaction of distressed thinking and intense emotion can become more frequent than it was before the trauma and can in fact be more intense and longer lasting. If these thoughts are triggered by something related to the trauma, or if the thoughts by themselves are upsetting, the thought pattern can become negative and can create significant anxiety and depression if not addressed.

Mindfulness skills can help to bring a person back to the present moment. Often when thoughts are racing in this manner, they are thoughts about what happened in the past or what will happen in the future. Mindfulness is a way of grounding oneself to the present moment, which can redirect the thoughts that are producing negative emotion and help a person to address the accompanying anxiety, stress, and depression associated with the thoughts.

Mindfulness can be utilized in several different ways. One mindfulness exercise that I have found to be effective comes from McKay, et al. (2007): taking time to focus on a single object. To begin, I have the client select an object he or she has or an object in my office he or she would like to focus on. I have the person use his or her senses to explore the object, noticing different aspects of the object such as its form, color, and anything interesting about the object. I then have the client hold the object and notice the different textures, temperature, rigidity, shape, and weight of the object. I have him or her explore the object for a set period (usually five to 10 minutes). After the exercise, I discuss with the client what he or she experienced, if he or she noticed anything about the object that may not have been noticed before, and the thoughts he or she noticed while practicing the exercise.

I find it is important to emphasize to clients that they may still have thoughts during a mindfulness exercise. The task is not to eliminate thoughts, but to identify that thoughts are coming up and to then refocus attention on the object or anything else the person has chosen to focus on. I encourage clients to have a small object they can carry with them that they can practice this mindfulness exercise with between sessions, particularly when they begin to notice distressing thoughts, racing thoughts, stress, anxiety, depression, or any other symptom related to trauma.

This is only one of many mindfulness exercises. There is a wealth of information available to clinicians on mindfulness and specific interventions to use with clients. I have received feedback from clients dealing with trauma that it is one of the most useful tools in coping with the distressing aftereffects of trauma during the therapeutic process while they are working through and resolving their trauma, and even after they have completed therapy. I would encourage therapists to do their own research on mindfulness and the applications it may have for their clients.

References:

1. Cullen, M. (2011). Mindfulness-Based Interventions: An Emerging Phenomenon.  Mindfulness, Vol. 2, #3, September, 2011.
2. Kabat-Zinn, J. (1994). Wherever You Go, There You Are. New York: Hyperion.
3. McKay, M., Wood, J.C., & Brantley, J. (2007). The Dialectical Behavior Therapy Skills Workbook: Practice DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, & Distress Tolerance. Oakland, CA: New Harbinger Publications, Inc.

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