Trauma therapy is a psychiatric treatment used to manage traumatic disorders, particularly post-traumatic stress disorder (PTSD). Trauma therapy is based on a combination of supportive-stabilizing and confrontational treatment strategies. Trauma is classified according to the ICD-10 classification (English : “international statistical classification of diseases and related health problems”) of the WHO (World Health Organization), a trauma is defined as: “A stressful event or situation of shorter or longer duration, of extraordinary threat or catastrophic magnitude, that would cause profound distress in almost anyone (e.g., natural disaster or man-made disaster – man-made disaster – combat deployment, serious accident, witnessing the violent death of others, or being a victim of torture, terrorism, rape, or other crime).”
Treatment for post-traumatic stress disorder includes initial interventions, trauma-specific stabilization, trauma-informed care, and psychosocial reintegration. This classification runs significantly through the concept of trauma therapy.
Indications (areas of application)
- Posttraumatic stress disorder (PTSD) – disorder preceded by one or more stressful events of particular severity or catastrophic magnitude and occurring within six months of that event. Symptoms of this disorder include intrusions (leading symptom; so-called “flashbacks” or repeated, vivid re-experiencing of the triggering event), avoidance behavior, overexcitement (hyperarousal), and psychological numbing.
- Partial PTSD (partial symptomatology).
- Complex trauma sequelae disorders – These include anxiety disorders, depressive disorders, dissociative disorders (pathological separation from normally associated perceptual and memory content with loss of integrative function of consciousness and identity), eating disorders, and somatization disorders (physical symptoms, e.g., pain, that are not due to an organic cause but to a psychiatric cause).
In addition to the indications, conditions must be met that make trauma therapy possible in the first place. The patient should not suffer from any serious physical illness, furthermore, there should be a security of external circumstances. Emotional-cognitive coping strategies (emotion control) should be successfully applicable as well as the patient should be sufficiently stable.
Contraindications
- Acute psychosis – severe mental disorder with loss of reference to reality.
- Persistent perpetrator contact
- In addition to therapeutic attachment, no other positive attachments in everyday life
- Severe substance abuse (substance abuse).
- Severe eating disorder
Before therapy
The above initial measures include protection from further traumatization, as well as education about normal trauma reactions, possible self-harm, such as substance abuse, and treatment options. Prior to therapy, the patient is also given careful psychoeducation about the diagnosis and the typical symptoms of stress (e.g. helplessness, feelings of powerlessness, physical stress symptoms). In cooperation with the patient, therapy goals are defined and a therapy plan is developed. Furthermore, agreements or a contract should be made between therapist and patient on how to deal with crisis situations such as suicidality (suicide risk). A treatment contract is concluded and the patient is also informed about risks, e.g. in the context of confronting the trauma. In particular, the hierarchization of therapy goals is helpful for trauma therapy:
- Ending self-harming behaviors such as suicidality, substance abuse (drug use), or self-injurious behavior.
- Improving the ability to function in everyday life, for example, by strengthening resources.
- Therapy of trauma sequelae (intrusions/recollection and re-experiencing of psychotraumatic events, hyperarousal/symptoms of overexcitement: e.g., sleep disturbances, jumpiness, lack of affect tolerance, increased irritability).
- Treatment of comorbid disorders (depression, anxiety disorders, etc.).
The procedure
The emergence of trauma is based on the assumption that due to a stress-induced overload of information processing in combination with protective mechanisms running (For example, dissociative mechanisms: the event is split off from consciousness and inaccessible, so that the patient may no longer be aware of the trauma.), it is difficult to integrate the stressful memory into the biography (life story) of the affected person. This means that traumatic memories are initially inaccessible and unprocessable, so that an actualization of the trauma is necessary to enable therapeutic influence. As a result, the trauma enters an unstable state and dysfunctional evaluations or a misguided self-assessment, e.g., guilt, can be unlearned or modified. For such learning processes to be successful, the confrontation with the trauma must be designed to be as low-stress as possible. To this end, the patient must learn emotional-cognitive coping strategies. In trauma therapy, however, the focus is not on working through the trauma, but rather on reducing the characteristic symptomatology. A variety of methods and concepts are available to trauma therapy. Basically, the following sequence of steps can be summarized:
- Stabilization – building a trusting doctor-patient relationship, emotion control, resource mobilization, psychoeducation, self-soothing.
- Trauma exposure/ trauma processing – reconfrontation; trauma events are made experiential and thus processable.
- Integration – integration of the trauma into the life story of the patient.
For the stabilization phase, the trauma processing and the integration phase, a number of cross-method therapeutic procedures are available:
- Debriefing (Psychiatric interview intervention immediately after the trauma; or direct debriefing).
- EMDR – Eye Movement Desensitization and Reprocessing; While actively remembering the trauma, the patient simultaneously, following the therapist’s finger, rhythmically moves the eyes. The goal is anxiety reduction based on bilateral stimulation of the central nervous system (brain) by means of synchronization of the right and left hemisphere (brain hemisphere).
- Group therapy
- Cognitive behavioral therapy (CBT)
- Creative therapies (eg, art therapy).
- Medical hypnosis (synonym: hypnotherapy).
- Couple and family therapy
- Pharmacotherapy (e.g., drug therapy for an accompanying depressive disorder).
- Psychodynamic therapy (psychoanalysis, depth psychology).
- Psychosocial rehabilitation
- Inpatient therapy
After therapy
If trauma therapy is successful, this is indicated by an elimination of trauma-specific symptoms and a reduction in distress. Depending on the success of therapy, psychiatric follow-up or accompaniment may be indicated.
Potential complications
- Emergence of memories regarding trauma content of which the patient was previously unaware.
- Therapy failure
