CPTSD: 9 Therapy Approaches to Heal Childhood Trauma
Unresolved childhood trauma has significant impact on mental and emotional health.
Childhood traumas can be the result of issues ranging from extreme violence and neglect to experiencing feelings of not belonging or being unwanted.
Facing such situation pushes you to learn to compensate by developing defenses around your most vulnerable parts.
You might oscillate between feelings of anger or fear and shame or despair.
You might suffer from chronic anxiety or depression and other issues, such as self-criticism, emotional suffering, and relationship difficulties.
You might even experience chronic pain.
This article will help you understand your childhood trauma and discover therapy approaches that will help you heal your unresolved trauma.
Ready? Let’s begin!
- Understanding Childhood Trauma
- How To Treat Complex PTSD?
- Other Therapy Approaches
Understanding Childhood Trauma
Post-traumatic stress disorder (PTSD) is often associated with traumatic events such as car accidents, natural disasters, or acts of violence and sexual abuse.
PTSD refers to the presence of symptoms, such as powerful emotions of fear or shame, well after the event is over.
Childhood trauma can cause complex post-traumatic stress disorder (C-PTSD): a form of PTSD that occurs as a result of long-term exposure to traumatic stress during childhood, rather than in response to a single event.
C-PTSD is also referred to as developmental trauma disorder (DTD).
Despite its significant impact on emotional and mental health, C-PTSD is not included in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) used by clinicians, and is considered instead as PTSD given that they share more than 90 percent of the symptoms.
C-PTSD is a learned stress disorder that can be replaced by a positive mind-set and health-promoting behaviors.
What Causes Complex PTSD?
Complex PTSD is the result of pain and stress experienced during childhood.
C-PTSD can be caused by the following types of experiences:
* Childhood relationships with parents or caregivers that are frightening and/or unpredictable
* Ongoing or repeated experiences of neglect or physical, verbal, or even sexual abuse or exposure to domestic violence
* Being raised by a parent or caregiver who has an untreated mental illness or an active addiction
* Facing severe social stress caused by bullying or exposure to traumatic events without being supported by a caregiver
Symptoms of C-PTSD
The ramifications of C-PTSD, whether cognitive, emotional, or physical, can persist into adulthood manifesting in the following:
1. Cognitive distortions: Inaccurate beliefs about yourself, others, and the world.
2. Emotional distress: Frequent feelings of anxiety, helplessness, hopelessness, deep loneliness, shame, unfairness, and depression often triggered by social loss and abandonment.
3. Disturbing somatic sensations: Uncomfortable body sensations, in which psychological distress manifests in the form of physical symptoms.
4. Disorientation: Loss of distinction between the past and the present.
5. Avoidance: Shutting out or pushing away uncomfortable memories, or emotions through denial, dissociation, or addictive behaviors.
Other symptoms might include self-harm, emotional eating or eating disorders, impulsivity or recklessness, excessive risk-taking and promiscuity, etc.
C-PTSD symptoms might look like other disorders.
A child who has been abused or neglected might appear impulsive, anxious, angry, and/or depressed, which can lead to inaccurate diagnoses of bipolar disorder, borderline personality disorder, anxiety disorder, attention deficit hyperactivity disorder (ADHD), body image problems (such as body dysmorphic disorder) or major depressive disorder.
Attachment Theory And C-PTSD
Attachment theory refers to the way young children respond when they’re separated from their primary caregiver.
Secure attachment develops when we can depend on a safe, predictable, and loving caregiver during early childhood.
That doesn’t mean that parenting needs to be “perfect”.
Parents will inevitably misattune to their children on occasions, but these mistakes are essential in providing healthy opportunities for the child to learn that ruptures in connection can be repaired.
The child learns emotion regulation and stress tolerance, and develops healthy boundaries.
However, neglect and abuse that accompany complex PTSD forms insecure attachment styles:
The insecure ambivalent child was raised by an inconsistent primary caregiver who is at times highly responsive but at other times is intrusive and invasive.
Because the child cannot depend upon the caregiver for predictable connection, he consequently feels overly dependent and suffers from abandonment anxiety.
The insecure avoidant child was raised by a distant or disengaged caregiver who is emotionally unavailable and/or rejecting.
This child adapts by disconnecting emotionally, avoiding closeness and becoming overly self-reliant.
As an adult, he tend to be dismissive of their own and other people’s emotions and find it hard to enjoy a deeper, more intimate connection.
This child was raised by a caregiver whose behavior is chaotic, and/or abusive.
This creates a sense of alarm and confusion, which makes the child paradoxically seek closeness from the very source of the terror that they are trying to escape.
This is often referred to as “fright without solution.”
As an adult, he tends to act in an impulsive or aggressive way to manage uncomfortable emotions. Relationships interactions can mimic the abuse they experienced with caregivers, so they either act abusive themselves or choose abusive partners.
C-PTSD is associated with unsecure attachment styles.
How To Treat Complex PTSD?
There’s no single therapy approach that works best for healing C-PTSD. A combination of psychotherapies are used by therapists, including CBT, DBT, EMDR therapy, and somatic (body-centered) psychotherapy
1. Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) is considered one of the most effective types of counseling for PTSD.
CBT helps you recognize the relationships between your thoughts, emotions, and behaviors and assists you in replacing distorted or distressing thoughts with more accurate and positive beliefs.
There are two forms of CBT that are frequently applied to treat PTSD: exposure therapy and cognitive processing therapy.
Exposure therapy helps you desensitize yourself to the trauma by repeatedly talking about your traumatic memories until you feel less overwhelmed by them.
This method also uses relaxation methods and breathing exercises to help you calm down your mind and body, while exposing yourself to your traumatic memories.
Cognitive Processing Therapy (CPT)
Cognitive processing therapy (CPT) helps you correct any cognitive distortions around your traumatic memories and guides you to incorporate new, more accurate beliefs.
For example, if you believe that the abuse you experienced as a child was your own fault, you can challenge that belief by recognizing that you were just a child – you couldn’t have done anything wrong.
Practical Exercise 1 – Exploring Your Inaccurate Beliefs
In your journal, write down negative beliefs attached to your childhood trauma. Common negative beliefs might include:
- I am unlovable
- I am unworthy
- I do not deserve to exist
- I am helpless or powerless
- I cannot trust anyone
Challenge these beliefs by recognizing that as a child you couldn’t have done anything wrong.
Work with a therapist on challenging any beliefs you find hard to change.
Replace negative beliefs with positive ones:
- I am lovable
- I am worthy
- I deserve to exist
- I am strong
- It is safe to love and trust now
2. Dialectical Behavior Therapy (DBT)
DBT, originally developed as a specific type of CBT for the treatment of borderline personality disorder, has been found particularly beneficial for C-PTSD.
The term dialectical refers to a synthesis of opposites.
The primary dialectic within DBT is the polarity between acceptance and change – it’s only when you accept who you are that you can change and grow.
DBT therapy focuses on the development of mindfulness, distress tolerance and emotion regulation, and interpersonal effectiveness.
Within the context of DBT, mindfulness focuses on developing your capacity to observe your own mind while cultivating acceptance.
This acceptance helps you recognize that you don’t need to escape or suppress uncomfortable experiences and thoughts.
DBT emotion regulation skills help you reduce suffering related to ineffective reactions to your emotions, rather than escaping them.
Emotion regulation encourages you to reflect on your thoughts and emotions before jumping to reactions or behaviors.
DBT distress tolerance skills help you handle painful emotions in a healthy way without needing to resist or changing them.
DBT interpersonal effectiveness skills emphasize assertiveness, boundaries, and coping with conflict.
It encourages you to address conflicts gently by refraining from put-downs or name-calling, respecting yourself and others, apologizing when you have done something wrong, and being truthful.
Practical Exercise 2 – Radical Self-Acceptance
The following exercises will facilitate self-acceptance:
Accepting reality involves anchoring your mind in the sensations of your body, observing your breath is one way to help you do that.
Start noticing the subtle sensations of your breath coming in and out of your nose and the rise and fall of your belly.
You can practice breath awareness while sitting or walking.
Once you feel comfortable, start engaging your breath practice to help you deal with difficult feelings and calm yourself down.
Practicing a half-smile can help you change your mental state and cultivate a serene feeling in the moment.
Start by relaxing your face and slightly turning up your lips.
You can start practicing the half-smile while you’re feeling calm, and eventually engage the practice while reflecting on a difficult event.
Sometimes feeling the body can stir up uncomfortable sensations, emotions, or memories. Explore the concept of loving and accepting the pain. However, if this practice ever becomes too difficult, know that you can also pace yourself by sensing a body part and then bringing your awareness back out to your external environment.
Doing a body scan with the intention of accepting every sensation in your body will help you with radical acceptance:
* Sit in a comfortable and take a moment to tune into each area of your body, increasing your awareness of your sensations and the experience.
* Focus on your breath and relax every part of your body.
* Bring acceptance and love to each part of your body by imagining rays of love permeating your body going through your feet, your legs, your pelvis, your belly, your back, your chest, your arms, your hands, your shoulders, your throat, and your head.
You can place your hands over each part of your body.
To further develop deep appreciation for yourself, use positive self-statements.
Try saying, “I love myself just as I am in this moment.”
You can get more specific and extend this acceptance toward your defenses and vulnerable emotions by saying “I love myself even though … I hurt myself sometimes, I push people away,” and, “I love myself even when I am … ashamed, sad, afraid.”
3. EMDR Therapy
Eye movement desensitization and reprocessing (EMDR) therapy is a therapy approach developed by Dr. Francine Shapiro.
EMDR therapy helps you identify triggering memories, emotions, beliefs, and sensations and process traumatic events.
The desensitization phase helps you remain aware of your present moment while simultaneously recalling memories of the traumatic event.
Dual attention is amplified using stimulation in the form of eye movements, tapping, or tones that alternate between the left and right side of your body.
During the reprocessing phase, traumatic memories are processed along with the negative beliefs associated with them and later replaced with positive beliefs.
4. Somatic Psychotherapy
Somatic psychotherapy is a set of therapy approaches that focus on the body rather than the mind.
Reasoning and logic alone might not be sufficient to treat trauma. Traumatic events not only lead to negative beliefs, but also to physiological changes, such as tension and rapid heart rate.
They help you engage body awareness to release the psychological and physiological impact of traumatic events.
Practical Exercise 3 – developing somatic awareness
The following exercise will help you cultivate awareness of your body without judgment:
* Sit in a comfortable position and take a moment to tune into each area of your body.
* Bring your attention to your breath. Notice any areas of tension, heaviness, or constriction.
* Next, Bring your attention to your feet, legs, and pelvis. Notice the sensations in your muscles and on your skin.
* Take a deep breath as you bring your attention into your torso. Notice any sensations across your abdomen, lower back, chest or upper back.
* Bring your attention to your shoulders, arms, and hands. Notice any areas of tension or relaxation.
* Last, bring your attention to your neck, throat, and face. Notice the general sensations of your head.
* Now, take a final moment to notice your body as a whole.
* In your journal, write down your notes about your experience.
This awareness exercise helps you deepen your curiosity about your sensations, relax and release holding.
Other Therapy Approaches
5. Vagus Nerve Stimulation
Mind-body therapies work by regulating your autonomic nervous system (ANS).
Your ANS consists of sympathetic and parasympathetic nervous system states.
The vagus nerve plays a central role in ANS regulation because it connects your brain to your digestive system, heart, lungs, throat, and facial muscles.
Vagus nerve stimulation helps you calm down when anxious and feel nurtured by your capacity to rest and feel nourished, by keeping your digestive system functioning optimally and your immune system in check.
Your vagus nerve passes through your belly, diaphragm, lungs, throat, inner ear, and facial muscles. Therefore, stimulating your vagus nerve is done through stimulating these areas of your body.
Practical Exercise 4 – Stimulating Your Vagus Nerve
The following strategies will help you stimulate your vagus nerve from the comfort of your home:
Because the vagus nerve passes by the vocal cords and the inner ear, vibrations of humming help soothe your nervous system.
Choose your favorite tune and notice the sensations in your chest, throat, and head.
Slow, conscious breathing is one of the fastest techniques to soothe your nervous system.
Vagus nerve stimulation happens when the breath is slowed down from the typical 10 to 14 breaths per minute to 5 to 7 breaths per minute.
This is one of the best vagus nerve stimulation techniques.
The diving reflex slows the heart rate, increases blood flow to the brain, which reduces anxiety, and relaxes the body.
To stimulate the diving reflex, splash cold water on your face from your lips to your scalp line.
6. Working With Parts
“Parts work” is an approach to healing that recognizes that you develop different parts of yourself to hold unwanted or unacceptable feelings and memories.
Parts can reflect younger developmental phases of your life, such as the wounded child or a rebellious teenager, and it can also represent an internalization from your family of origin, such as the critical parent from childhood as your inner critic.
Internal Family Systems (IFS) therapy, developed by Dr. Richard Schwartz identifies three kinds of parts:
Exiles: Exiles are the parts of yourself that you cut off from conscious awareness in an attempt to distance yourself from painful memories and emotions, such as rage, shame, fear, loneliness, or grief. Often these parts reflect the wounded child
Managers: Managers are the overly rigid and self-critical parts of yourself that attempt to protect you from vulnerable feelings by staying in control.
Firefighters: Firefighters work on repressing exiles as they attempt to emerge. To do that these parts use substances, self-harm, or dissociation to distract you from your underlying emotional pain.
The goal of IFS therapy is to develop your relationship to the Self – your own source of wisdom or inner knowing.
When you’re living from this center, you are able to regulate the other parts of you and feel calm, confident, and compassionate.
7. Positive Psychology And Resilience
Positive psychology focuses on strengths rather than deficits. It recognizes your ability to be resilient despite your traumatic history.
Resilience is a set of strategies that are learned and practiced. These strategies include:
* Cultivating a growth mind-set that helps you use positive and negative life events to grow as an individual
* Staying connected to your community
* Working through difficult emotions
* Taking responsibility of your life and believing that you have the capacity to shape the course of your life
* Supporting your physical health through exercise, proper diet, and good sleep quality
* Expressing yourself through journaling and creativity
8. Relaxation Techniques
Some of the most common and well-researched relaxation techniques include progressive muscle relaxation (PMR), visualization, and diaphragmatic breathing.
These practices focus on calming down your body.
In PMR, you sequentially tense and relax muscle groups throughout your entire body (e.g., arms, legs, torso, neck).
Visualization involves recalling memories of times when you felt relaxed, which helps your body respond accordingly and relax.
Slow and rhythmic diaphragmatic breathing, or “belly breathing,” helps calm you down if your body, especially when it is in a fight-or-flight state.
9. Therapeutic Yoga
Therapeutic yoga helps you explore physical postures within a context of mindfulness, conscious breathing, and somatic (body) awareness.
Therapeutic yoga focuses less on the outer look of a pose and more on supplying yourself with an environment that feels emotionally and physically safe, minimizing the use of mirrors, and setting a tone of self-compassion.
Assuming standing postures such as warrior pose or downward dog helps you explore strength-building.
Restorative postures such as child’s pose help you practice the art of surrender and letting go.
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- Portions of this article were adapted from the book The Complex PTSD Workbook, © 2017 by Arielle Schwartz. All rights reserved.