What is the most effective therapy for trauma?
There is no one therapy that encompasses all the aspects that need to be included in trauma treatment since there is no such thing as a modality called “Trauma Therapy.” You either find a therapist that had trained to become a trauma clinician, or you may need more than one therapist for your treatment. Most therapists that have gone through some Trauma Studies certification and advertise themselves as trauma therapists may have certifications (or at least training) in several modalities that are trauma oriented, and some of those orientations may be more adequate and effective for one part of the treatment and some for others. The Trauma perspective of the human psyche is a paradigm shift that uses neuroscience as one of its most important foundations. That’s challenging for most therapists that were trained using a psychodynamic framework, and assumed that behavior was what counted in order to assess mental status. The trauma lens sees behavior as a consequence of how the brain is operating, and then adds circumstances. Instead of seeing a person’s behavior defining who they are, the trauma lens sees the traumatized person as someone that went through something that changed the way they function. The trauma lens is highly compassionate, believes in healing, and sees identity as something that can grow organically instead of fixed. In terms of therapies that work on healing trauma, there are so many, and every day some new come up. Some therapies are iterations of modalities that have succeeded, and even when they are not famous or broadly known, in the hands of a good clinician that knows and believes in the modality, they can be as effective. I’ll mention here some modalities that work on specific phases of the trauma treatment: To work with affect regulation and mood issues (anger, rage, etc):
Mindfulness can help you become more in the here-and-now which is calming and develops acceptance
IFS can help to understand the different ego states and which ones are more reactive than others. Differentiating them is the way to start the integration of the psyche;
NFB (Neurofeedback) assist in reprogramming the brain functioning using technology;
BFB (Biofeedback) helps to recover homeostasis, especially combined with other modalities;
CBT (Cognitive Behavioral Therapy) could help to understand the way your thoughts affect your behavior and for some individuals, that could be effective. The more they are understood and experienced, the better outcomes. Understanding alone is not enough, but still useful.
To work with traumatic memories:
EMDR (Eye Movement Desensitization and Reprocessing), ART (Accelerated Resolution Therapy), Brainspotting, and Coherence Therapy to reconsolidate disturbing memories that still feel as if they were happening;
IFS (Internal Family Systems) to deal with fragmentation and dissociated parts;
SMP (Sensorimotor Psychotherapy), Gestalt, SE (Somatic Experience), Hakomi, to deal with some memories stuck in the body, phobias, or fears that manifest somatically like aversion to being touched, or feeling trapped, or not knowing how to reach out;
AEDP to deal with the inability to trust and take in affection, positive feedback, etc.
To work with dissociation: Having the parasympathetic nervous system activated for prolonged periods of time causes more damage than the hyperarousal of the fight-flight mode. Regulation techniques to recover the speed in the brain waves and the fragmentation of the personality are the targets.
Neuromodulation helps stimulating brain waves to give speed to the parts of the brain that shout down.
Neurofeedback to accelerate the process when the person is in great distress and to reprogram the deficient way to operate in difficult moments.
IFS to identified the fragmentation and initiate the integration.
EMDR to heal each part and help meeting each part's needs.
To work with personality and relationship issues:
Schema Therapy to identify the root of the negative thoughts; this is a cognitive modality but combined with a trauma lens could be very effective;
CBT/REBT (Rational Emotive Behavior Therapy) to challenge negative thoughts. This another top-down modality than can be effective when used combined with bottom-up interventions;
Mindfulness to develop resilience, mental space for change, and the capacity to stay present in order to evaluate their own behavior. To develop accountability is a must;
Narrative Therapy to rewrite the defeating story. Some of the other cognitive therapies could be used with the same intention.
Hypnoses to develop ego strengths and resilience;
EFT (Emotional Freedom Technique) is a very useful technique to correct negative thinking;
Neurofeedback to correct the distorted perception;
AEDP to have more stable relationships.
All those modalities could and should be complemented with other types of interventions to help to regulate the activity of the nervous system, like mediation, yoga, theatre, creative writing, exercise (from boxing to Tai Chi), and so on. I could go on, but what’s important is to remember that trauma treatment has phases and that processing traumatic memories is just one aspect, and it should never be the way to start treatment.