in 2019, American Bible Society sponsored a study comparing chronic trauma in both churched and unchurched populations. It is out now and you can learn about it on a free webinar on August 6 at 2 pm EDT. I will be one of the guests talking about the implications of the research findings and how pastors and church leaders can be part of the healing path.
Sign up here. If you attend, Barna will give you a discount code if you want to purchase a print or digital copy of the monograph.
Filed under Uncategorized
If you are looking to become certified in using the Healing Wounds of Trauma curriculum, consider the next Philadelphia equipping sessions, May 8-11, 2019 at the Mother Boniface Spirituality Center.
These sessions are for both initial and advanced participants. If you have not been trained to use Healing the Wound of Trauma healing group curriculum, this would be a great first experience. The 4 days will give you a first-hand experience of a healing group plus the training you need to lead healing groups.
If you have already taken the initial training and you would like advanced training to become a healing group facilitator or to become a trainer in this train the trainer program, then come to the advanced session. You will need to provide proof (in advance) that you have already led two healing groups.
I’ll be present for the training and would love to spend the 4 days with you thinking and experiencing how we make the church a safer place for trauma victims.
But register now. There are both residential and commuter pricing.
Filed under Uncategorized
Check out this opinion piece (rebuttal) published in Psychology Today by Jonathan Shedler. It challenges the notion that randomized control trials (RCTs) are the “gold standard” to determine the best forms of treatment in the real world. While RCTs can answer certain questions, he argues they cannot answer the most important questions. As a result, the APA recommended treatments are all short-term treatments but will not be able to tell us whether those who undergo the treatment really get better and what options are available for those who drop-out of treatment (there is a significant drop-out rate with several of these recommended treatments).
For those interested in this controversy, I’d like to find out if you have (a) heard anyone challenging Shedler’s criticism and (b) what alternatives are offered by them. I’ve seen zero challenges to his piece to date.
Filed under Post-Traumatic Stress Disorder, ptsd, trauma
I write this from Uganda having just completed a Community of Practice conference hosted by the Ugandan Bible Society. This community of practice is for bible-based trauma healing facilitators and local mental and public health experts. I presented on an update to PTSD causes, effects, and treatment. We looked at the value of Scripture engagement around the topics of trauma, loss, and recovery as well as how it fits into the larger picture of trauma counseling.
Much of what we clinicians know and do for treatment for PTSD symptoms is based on partial research but a significant dose of “clinical judgment.” What is that? Well, it is treatment models that may have some empirical support but mostly formed over long-held assumptions in the field. One of those assumptions is that we may be able to prevent PTSD if we provide group or individual debriefing sessions soon after a traumatic experience. These debriefing sessions have been offered for decades to first responders, humanitarians, and missionaries after exposure to traumatic and tragic events. In recent years we have seen some evidence that some may not be helped but these sessions. In fact, some may even be harmed.
The evidence of possible harm is not new. Yet, debriefing is still offered indiscriminately. We find it hard to let go what seems to work. Today I was able to read a 2006 study published in the British Journal of Psychiatry (citation below). This bit of research compared emotional debriefing, educational only debriefing, and no treatment. This study of Dutch civilians who had experienced a single episode of trauma within the last two weeks found that all three groups (emotion oriented debriefing, education only, and no treatment) saw a decrease of symptoms at 2 and 6 weeks post intervention. There was no benefit from either form of debriefing found in this study.
In addition to no benefit, those individuals with high arounsal trauma symptoms who completed emotional debriefing showed higher rates of PTSD symptoms than the those with higher arousal who did nothing or only the educational oriented debriefing intervention. So, some forms of debriefing may actually worsen symptoms. Why? The authors surmise,
In previous studies it has been established that high degrees of arousal in the immediate aftermath of a traumatic event are associated with an increased risk for the development of PTSD, measured both by self-report (Carlier et al, 1997; Schell et al, 2004) and physiologically by means of heart rate response (Shalev et al, 1998; Bryant et al, 2000; Zatzick et al, 2005). Encouraging highly aroused trauma survivors to express their feeling and emotions concerning the trauma might activate the sympathetic nervous system to such a degree that successful encoding of the traumatic memory is disrupted. Moreover, during an emotional debriefing session negative appraisal of one’s sense of mastery may be promoted (Weisaeth, 2000). This is assumed to keep the hyperreactive individual in a state of high arousal which may cause symptoms of PTSD to escalate rather than resolve (McCleery & Harvey, 2004).
So, what should we do with this information? Nothing? No. But what we do should not harm, especially when we know some may be harmed. I suggest a few possible outcomes:
Citation: Emotional or educational debriefing after psychological trauma (Randomised controlled trial) by MARIT SIJBRANDIJ, MIRANDA OLFF, JOHANNES B. REITSMA, INGRID V. E. CARLIER and BERTHOLD P. R. GERSONS. In BRITISH JOURNAL OF PSYCHIATRY (2006), 189, 150-155. doi: 10.1192/bjp.bp.105.021121
Filed under mental health, Post-Traumatic Stress Disorder, Psychology
It is somewhat common for individuals to experiences a period of dissociation and/or perception of being frozen and unable to move during a traumatic experience. Dissociation is a catch-all word to describe experiences where a person is somehow disconnected from a portion of their senses making what is happening feel somehow unreal. Experiences can include emotional numbness, feeling events are not real, not feeling in one’s own body, or not remembering what just happened.
In the April issue of the Journal of Trauma Stress researchers discuss possible connections between experiencing dissociation during a trauma and increased negative beliefs about the self. Dissociation during a trauma is called “peri-traumatic dissociation.” It is already understood that peri-traumatic dissociation is a strong predictor of subsequent PTSD diagnosis.
This short study suggests that those who have dissociative experiences during trauma may be more likely to think negatively about themselves, both about their trauma experiences (e.g., I should have been able to stop it) and their present feelings about themselves (e.g., I’m unreliable). The researchers suggest that therapists ask clients about both forms of negative views of self if the client describes dissociative like symptoms during the trauma experience.
It would have been helpful if the researchers connected their work with that of shame experiences. We continue to try to understand why some people find some experiences more traumatizing and thus have greater difficulty finding recovery. It seems that shame is distinctly tied to chronic trauma and being stuck in negative self-talk narratives. It may be that those who struggle the most with negative self-talk (I should have been able to stop my abuser) experience the most shame. But I have yet to see anyone try to parse that out.
In my experience, negative attributions about the self are just about the hardest things for us to change. We may have developed these well-formed beliefs from failure experiences or we may have had them formed for us by our families. But whatever the cause, they are so very hard to let go. In fact, when others show kindness to our perceived uglyness, we tend to pull back, refusing to allow these parts to be acceptable.
What is it about letting go of our shame and accepting ourselves as normal, as valuable? How would you articulate the problem?
*Thompson-Hollands, J., Jun, J.J. & Sloan, D.M. (2017). The Association Between Peritraumatic Dissociation and PTSD Symptoms: The Mediating Role of Negative Beliefs About the Self. JTS, 30, 190-194.
The current definition of PTSD requires an exposure to an intensely distressing event or events (either witnessed or told about in great detail) resulting in a pattern of intrusive re-experiencing, attempts to avoid such experiences and an ongoing negative cognitive/mood pattern. Such a diagnosis might be made after domestic and sexual violence, accidents, natural disasters, war, betrayal traumas, and even after hearing repeated stories of traumatic experiences to others (called secondary trauma).
Someone experiencing PTSD after life-threatening events might feel disconnected from family/friends, find it difficult to sleep, experience repeated nightmares, have difficulty not thinking about events during and after the traumatic experience, choose unhealthy coping patterns like alcohol abuse, or place themselves in situations where they re-enact parts of their trauma story.
But not everyone who has intrusive thoughts about a challenging situation, feels disconnected from their community (and previous self), drinks too much, or impulsively jumps back into danger have PTSD. Some of these same behaviors and experiences also show up in those who have left dangerous and all-consuming experiences and now do not know how to re-engage in regular life.
Consider these words of Dr. Steven Hatch, who spent time in Ebola clinics in Liberia at the height of the 2014 pandemic crisis in West Africa. He describes his experience after returning to his job at the University of Massachusetts.
To match the outside weather, my mood willingly turned dark. I withdrew from people, wandered about in a daze, and avoided public gatherings. When I did venture out, I carried myself in a completely different manner than I had before in my life.
The simple explanation was that I had post-traumatic stress disorder, and a few people, including some whose job it is to make such diagnoses, thought this to be true. (p. 239, Inferno)
He goes on to dispute his experience fighting Ebola as trauma. While difficult, he did not think it rose to the level of trauma experienced in war or even other more overwhelming Ebola clinics.
I could, however, recall the event [death of a toddler] in my mind without being emotionally overwhelmed, but also just as importantly I was able to still experience emotions about it, feeling appropriately somber. I just didn’t feel traumatized. (p 240)
So, what was his problem?
What I did share with many other volunteers was a sense that I didn’t belong in the States, for the work in West Africa was far from over. I desperately wanted to return, and almost within days of coming home I was trying to figure out how I could get back to an ETU [crisis Ebola center]. What I missed was the profound sense of purpose that such work had provided, and I slowly realized why people talked of “missing the war,” a phrase that always seemed discordant to my ears. You miss being in the midst of senseless butchery? Great. But I belatedly realized it was that purposefulness, the sense that you were doing something that was deeply and truly meaningful, that drove people back to such unstable situations. (p. 240-41)
There you have it. The seeming loss of crystal clarity or purpose in life can be very painful. When you are in an intense helping situation as Dr. Hatch was, every movement leads towards life or death. At the end of a day, you can count who lived and who died. No ambiguity. In addition, you are doing it with a team of people all committed to the same thing. You share the same vision, goal, and daily experience. You do not have to explain anything. And in these intense situations, you can have the kinds of intimacy not often experienced even in your immediate family. Also subtract mundane activities (grocery shopping, cleaning, taking care of children, etc.) that may not need to be done.
This is a recipe for distress upon return.
Return to regular life where you are expected to do these seemingly inconsequential activities AND where you have no one around to save AND no one who was present with your toughest experience…and you have a recipe for trouble. You may find it difficult to find joy in light of intrusive thoughts of recent emotionally intense experiences. You may long for a return to that sense of purpose and value. Because others do not understand and aren’t part of your “tribe” you may withdraw or find other ways to numb the pain.
Loss of identity and intensity may mimic trauma symptoms. They may be significant to need treatment. Military ending tours of duty, missionaries returning from field, humanitarians returning from doing crisis work, church planters leaving high stakes urban church plants, and trauma healing trainers returning from intense experiences may be at risk.
What can be done to prevent this distress?
I have some very small personal experience with this. I’ve had intense experiences in international settings. When I have returned, I have sometimes found it hard to be at home when my head was still overseas. Being able to share with Kim and others helped. Practicing lament helped. Learning to be mindful of the present also helped me remember what has meaning and value in everyday life.
Filed under Post-Traumatic Stress Disorder, Psychology, trauma, Uncategorized
What if you read the bible through the lens of trauma? Some passages are quite obvious–catastrophes are all throughout the bible. But are these stories of trauma in the bible merely keeping a record of pain or attempts to deal with the trauma, to put the world back proper perspective after chaos?
Consider this 2015 video by Rev. Dr. Robert Schreiter entitled: Trauma in The Biblical Record. He gives some background about this newer way to read the bible through this lens and then ends with 3 examples. I’ve just ordered this book on the subject, but those wanting to jump ahead may wish to know about it as well.
Does a resilient individual appear as if stress and trauma has not lasting impact? Does it mean we bounce back as if it never happened? Are there better ways to think about resilience in real life?
In 2014 I gave a presentation reviewing the topic of resilience (definition, examples, threats to, and helps) at our annual Trauma Healing Community of Practice hosted by the American Bible Society.
Sometimes we consider only resilience as an individual trait. I spend a bit of time talking about community resilience. Video is 25 minutes and associated slides (not embedded in the video) can be found here: 2014 COP Resilience.
Researchers Liberzon and Abelson at the University of Michigan have published an essay articulating a new way of conceptualizing what is happening in the brains of those with Posttraumatic Stress Disorder. While you can’t read their essay for free, you can read this good summary here.
What is their new theory? the neurobiological problem of PTSD is “disrupted context processing.” In simple terms, I fail to respond to the “stimulus” in its proper context when I am triggered by old experiences in a new setting. Even more simply, when I wake up on full alert in the middle of the night after smelling wood-smoke in my sleep I initially fail to recognize the context (my neighbor burns wood) and immediately think my house is on fire (as it once was). Thankfully, the alertness is less than it used to be and I don’t always get up to check on my house.
The authors suggest that 3 separate and current brain models are inadequate in their scope of understanding the brain’s activities in PTSD. From their perspective the “fear model” (Fight/flight learning), the “overactive threat detection model” and the “executive functioning model” work best when integrated into one unified theory with their new label. And, in true humble researcher fashion, they request help in testing this model to see if indeed it can carry the freight.
An Old But Essential Treatment?
It is good to have a better handle on what is happening in the brain when someone experiences PTSD. Neurobiological research is growing by leaps and bounds. It is hard, frankly, to keep up. And yet, let us not forget an old but essential part of PTSD treatment, the person of the therapist. Humans are designed to be in relationship. PTSD has a way of shattering connections with others and thus the treatment must reverse the disconnect. Being present and bearing witness to trauma will always be the first and primary intervention every therapist must learn. Our temptation is that we want to move beyond the bearing witness phase into change phases. While this is understandable (we want others to get better as fast as possible), we sometimes want this for our own reasons–to avoid the pain we experience in sitting with traumatic experiences of others.
Let us remember that we therapists (and pastors, friends, etc.) are the primary intervention when we are present with those who suffer, when we become a student of their suffering. All other treatment activities stem from this foundation. To use a different analogy, consider Dr. Diane Langberg’s meditation, “Translators for God” (Day 26 of In our Lives First). In this meditation she describes the experience of being translated in a seminar. The translator must fully understand both languages in order to accurately communicate the speaker’s words into the heart language of the hearers. Counselors are translators for God and for healing. And yet, if they do not deeply learn the heart language (pain and trauma experience) of the client, they will not be able to connect the client to healing and to the God who heals.
[Note: broken link fixed. If anyone is interested in taking this course with me this summer, see here.]
As a psychologist I have had a front row seat to observe the destruction that traumatic experiences have on individuals and families. And as a professor training future counselors I see the necessity of passing on best practices for treating those with symptoms of posttraumatic stress disorder (PTSD). New understandings of trauma’s impact on bodies, minds, souls, and relationships appear on the pages of our academic and clinical journals. As a result, I read daily about innovative attempts to hasten trauma recovery for individuals and even whole communities.
With a world filled with trauma, it is clear to me we need an army of psychologists and mental health practitioners. How else could we address problems faced by 60 million displaced peoples in the world at present? How else could we address the scourge of sexual abuse, where worldwide 1:4 women and 1:6 men have experienced sexual violation before they reach the age of 18?
So, given the needs I have just mentioned, why would I spend considerable time and effort to promote a bible-based trauma healing training program? Let me tell you four key reasons I think this program is essential to address the world-wide problem of trauma. [Note, this is NOT a paid advertisement.]
Trauma disrupts faith and identity. The church must be at the center of the response
While many practitioners recognize the physical and psychological symptoms of PTSD, fewer have noticed that trauma disrupts and disables faith and connection to faith practices. Just now the scientific community is beginning to track this problem and acknowledge the role faith plays in the recovery process. Some are brave enough to suggest that failing to utilize faith practices and communities in the recovery process is tantamount to unethical practice! But most mental health practitioners have had zero training and experience engaging faith questions as part of treatment. The field of psychology is waking up from more than 100 years of training practitioners to ignore, even reject, faith as essential to healthy personhood. If faith is essential to most people on the planet then any intervention must engage faith and spiritual practices if it is going to consider the whole person.
Dr. Diane Langberg recently reminded a world gathering of national Bible Society leaders that trauma needs in the world are far too large for any government to handle. The only “organization” in the world situated to respond to at both a micro and a macro level is the Church. But is the church prepared? We need the church willing to understand the nature of trauma and participate in supporting faith and Bible-based healing responses. These responses include practices the church has not always been known for: validating, supporting and comforting victims, speaking up about injustice, inviting individual and corporate lament, re-connecting oppressed people to God. We need the church to be a safe community for victims.
The Healing the Wounds of Trauma (HWT) program fills this void. It offers basic trauma education, illustrates how God responds to traumatized peoples and provides simple yet effective care responses average believers can enact without being professional caregivers.
While I believe we psychologists with specialized skill sets are essential to trauma recovery, much of what we do can be done by every day individuals. I tell my students that most of counseling is not rocket-science. Being present, listening well, building trust, validating, asking good questions, and walking with someone in pain is largely what helps counselees get better. With a little training, the church can be at the forefront of the trauma healing.
But we need an army…of capable trainers who reproduce
There are approximately 2.2 Billion Christians in the world today. If we decided (and I am not suggesting this AT ALL!) to only serve traumatized Christians, we do not have enough capable practitioners to serve those in need. The ONLY way we would be able to serve this population is to train up capable trainers (wise, able to work well with others, understand group dynamics, know when to be quiet, etc.) who are then able to reproduce themselves and make even more trainers who subsequently serve ever increasing populations. This creates a cascade effect—1 trains another who each, in turn, trains others. Conservatively speaking, one training of 35 future trainers could reach up to 15,000 traumatized people in 3 training generations.
To maintain quality, the program must be able to be delivered and passed on in a consistent manner. The HWT program is designed not merely to educate participants regarding trauma symptoms and good care/healing practices but how to pass on such knowledge and skill to others. The facilitator (trainer) handbook provides a wealth of information to ensure that the quality does not erode as the information is passed on.
Experiential learning trumps lectures every time
In the West, we cherish academic lectures as the primary training mode. Lectures enable a speaker to give a large amount of information in a short period of time, with minimal interruption. A good lecture casts vision, identifies problems, and points to effective responses. But a lecture cannot produce skilled practitioners. Any academic mental health program worth attending will require practicums where head knowledge is put into repeated practice.
Consider this scenario. My father is capable of building a house. He sits me down and he spends hours gong over the steps to building an addition to my house. I listen, take notes, and even handle the tools that will be used. Am I prepared now to build the addition? No! If I am to build a proper addition, I will need to do so under his close supervision. In fact, most of the hours of lectures are not necessary at all. What will be more effective is his teaching me as we build together.
The HWT program is all about experiential learning. Participants learn as they experience trauma and trauma healing through story, dialogue, and practice. First applied to self and then in consideration of others. This is in stark contrast to most continuing education programs that amount to little more than monologues and passive audiences. While the monologue may give more information, it is highly unlikely that participants can in turn teach what they heard to others. The HWT program is not designed to deliver large amounts of new academic information. And yet, what participants get via experience and practice will be far more easily passed on when they become the teacher. There will be no army of trainers if we cannot quickly get experience and practice and pass on what we learn in simple everyday language.
Good training hinges on contextualization
If trauma is universal, then it might be thought easy to deliver trauma healing training across cultures. This is not so. If I prepare a lecture or training on trauma in my context (the megalopolis of the Northeastern seaboard of the United States) but deliver it on a different continent, my training may be of minimal value. The reason it is sure to fail is that what I had to offer didn’t fit the context; it didn’t speak to the heart of that audience. Good training must be contextualized so that participants immediately recognize trauma in their settings and that interventions make sense. Imagine if I deliver a talk on good conflict skills to a hierarchical society but emphasize the need to speak in “I” language (I need, I feel, I would like)? Such interventions will rightly be rejected as inappropriate. And if experience holds, whatever else I say will also be rejected.
The HWT program is founded on contextualization. Not only has it been translated into many different heart languages, the central stories and illustrations are also contextualized so that the participants can see themselves in the stories and interventions. At heart of each lesson, participants are asked about their own culture’s take on the particular problem. In dialogue, they compare responses to that of biblical passages highlighting trauma, grief, loss, and pastoral care. Nearly every major training point addresses context and encourages participants to develop creative interventions in keeping with key biblical and psychological foundations.
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Is the HWT program all a traumatized person needs? No, it doesn’t assume this. Is the HWT program perfect? Of course not. I continue to make suggestions for improvement and the authors and developers are some of the most flexible I know, always looking for ways to improve the materials and training program. There are many other solid programs out there, but few programs I know have refined the content and delivery systems to be able to scale out across the globe. I’m grateful for the opportunity to serve the Mission: Trauma Healing team at the American Bible Society as co-chair of their advisory council and occasional trainer.
For a more visual exposure to this training, see this downloadable documentary.
Musings on Faith and Psychology 