https://citintegral.

com/2015/10/02/a-trauma-sensitive-approach-
to-meditation-part-i/

A Trauma-Sensitive Approach to Meditation Part I (of III)

The purpose of this three-part blog series is to provide support
for those of you who may have suffered trauma and who want to
either deepen or begin your meditation practice. This blog is also
meant to aid psychotherapists and coaches who want to be able
to support traumatized clients who are meditating or who are
considering starting a practice. Hopefully, what well cover will be
useful for both beginner and advanced meditation practitioners.
Well focus on four major topics:
What is trauma?
What is triggering?
The potential benefits of meditation for trauma survivors
9 lessons related to trauma and meditation (Well address
lessons 1-3 in blog 1, and lessons 4-6 in blog 2, and
lessons 7-9 in blog three)
While this blog series will emphasize some of the challenges
traumatized individuals face when practicing meditation, I want to
assure readers that I am strongly pro-meditation for the
traumatized and non-traumatized alike. As a long-term
practitioner of meditation as well as someone who lived through
childhood trauma and its aftermath, I have experienced for
myself some of the profound benefits of meditation despite
running into a number of these issues in my own practice. I
therefore see these challenges not as immutable roadblocks to
healthy meditative growth, but as opportunities that, once
recognized, can be used to cultivate greater discernment and
self-compassion.
For those interesting in knowing more about this work:
This blog series addresses topics found in greater detail in my
next book, Advancing in Integral Psychotherapy. The working
draft of Advancing, along with the previously published Guide to
Integral Psychotherapy, are the core texts of the Certified Integral
Therapists (CIT) Training Program where we teach this material
(and much more) to psychotherapists as well as professional
coaches. We are now enrolling for our 2016 cohort.
What is Trauma?
We can begin with this definition: Trauma is the psychological
damage resulting from uncontrollable, terrifying life events (van
der Kolk, 1987, p. 1). Here, however, we need to understand that
what someone experiences as terrifying is relative to the age of
the person and the specific situation. Some events, such as
experiencing a high speed car crash, are terrifying to most
everyone. Being trapped in a stalled elevator for a few hours
might be terrifying for someone with a fear of closed spaces, but
only be boring and frustrating for others. Walking into your
mothers room to find her her passed out drunk might be deeply
frightening to you if you are a child, but probably not if you are an
adult.
Further, fear and terror are not always related to a single event,
but can build up over time. If a spouse is physically abusive, the
first violent incident may evoke as much anger and confusion as
fear. But if the physical abuse occurs repetitively, the violence
and anticipation of it may easily develop into feelings of terror.
We might therefore sharpen our definition of trauma in this way:
Trauma is the persistent but usually reversible change to the
mind, body, and nervous system that occurs as a result of
overwhelming fear or stress. This definition accounts well for the
fact that traumatic incidents can be single events or they can
involve stresses that accumulate over time to a breaking point.
A second key question on the topic of trauma is this: Have you
experienced trauma? Is this blog meant for you?
There is no easy way to answer this question for everyone.
However, we should be aware that we are going through
something of a renaissance in terms of the cultures view of
trauma and its treatment; therapists are emphasizing it more in
their treatment and lay people and institutions are becoming
more aware of it as a public health and public mental health
problem.
In reality, this is a good news/bad news situation. The good news
is that as awareness of trauma is raised, individuals feel less
stigmatized, treatment options tend to expand, and people are
more likely to receive appropriate care. The bad news is that
when clinical concepts such as trauma become popularized, they
also tend to become over-diagnosed by professionals, over self-
diagnosed by lay people, and often over-medicated as well. This,
ironically, can lead to important mental health issues being taken
less seriously.
The fad-like spread of mental health diagnoses has taken place
in the recent past with ADD and bipolar disorder for example,
where ADD has come to mean something like a little scattered
and bipolar has come to mean my mood can be a little erratic.
(Both conditions when diagnosed properly are more serious than
that). This is now happening to a certain extent with the notion of
trauma, which is starting to signify that one has been a little
shocked by something.
The best way to avoid the cultural-hype and gauge your trauma
accurately is by taking a look at the objective history of your own
life. Trauma is intimately tied to very serious, real-world events,
and the events that tend to cause it are predictable. Here are two
short check-lists to consider:
In childhood, the most common causes of trauma are:
Emotional abuse
Physical abuse
Sexual abuse
Neglect
Abandonment
Experiencing significant health issues, accidents, or fear of
death (i.e., war, violent neighborhoods, natural disasters,
car crashes, etc.)
Bullying
Having a parent with severe mental health issues or an
addiction
Witnessing domestic violence
Loss of a parent through death or imprisonment
In the adult years, the most common causes of trauma are:
Rape or sexual assault
Physical assault or being a victim of other crimes (i.e.,
robbery, stalking, etc.)
Emotional, physical, or sexual abuse in romantic
relationships
Major negative change in life circumstance (i.e., bankruptcy,
homelessness, incarceration, etc.)
Death of a spouse or child
Experiencing significant health issues, accidents, or fear of
death (i.e., war, dangerous neighborhoods, natural
disasters, car crashes, etc.)
If you think you have been traumatized, and have one or more of
these events in your life, there is a good chance you share some
of the key characteristics discussed in this piece and that that will
impact your meditation practice.
Traumatic Triggering
Next we need to explore the concept of triggering. Triggering
refers to the self-protective reaction that occurs when a person is
exposed to a reminder of a trauma. Triggered mental states are
marked by reactive/impulsive behaviors and often unyielding,
vehement emotions. In general, the more severe or repetitive our
previous traumatic experiences, and the earlier they occur in our
life, the greater the intensity and complexity of our triggered
responses (see van der Kolk, 2005; van der Hart et al., 2006).
Therapists divide responses to trauma into four categories that
appear to be hardwired in us by evolution (see Fisher, 2001).
They are sometimes referred to as the Four Fs. They are:
1) Fight responses, which are angry responses towards self or
other
2) Flight responses, which are panicked or anxious
3) Freeze responses, which are dissociated or depressed
4) Fawn responses, which are clinging and submissive
All of these responses arise for a good reason: They can highly
protective and adaptive at the time of the trauma and can help
prevent bodily or psychological damage. However, problems
arise when the original trauma is not worked through or
emotionally discharged. Ongoing traumatic reactions in the
present when there is no threatening situation can have a deep
negative impact on ourselves, our loved ones, and our
functioning in the world (Levine, 1997).
Here are a few additional points which are key to understanding
triggering:
Triggering reminders need not be obviously related to the original
trauma, such as when a person with combat-related war-trauma
is triggered by hearing a gun shot in his neighborhood. Instead,
triggers may also be tangentially related, symbolic, or just
emotionally consistent with the original traumatizing situation. An
example might be having a loud (but otherwise typical) argument
with a significant other that triggers earlier traumatic interactions
with an angry, abusive parent. Another would be financial
struggles which trigger early feelings of instability due to having
an unreliable, alcoholic parent.
Triggering may also occur even if the survivor does not
consciously remember the trauma. This is possible when the
trauma happens prior to age 4 or 5. Past that age, people almost
always remember traumatizing events. (The idea of repressed
traumatic memories is mostly a myth, and we should be very
wary of any claims that we can hypnotically or otherwise
recovered). In other words, very early traumatic experiences can
be stored in other forms of memory besides what is known as
episodic memory (see Forman, 2010, Chapter 3; Poulos, et al.,
2013). If you believe you might be a victim of early life trauma,
speaking to family members or caretakers who remember that
period of your life will usually lead to the best and most helpful
information.
Triggers it also must be emphasized need not always be
negative. Many trauma survivors are triggered by positive
experiences. While this may seem counterintuitive, trauma
survivors often have a great deal of difficulty acclimating to
happiness as a psychological and physiological state. Thus good
feelings may serve more as reminders of what went wrong than
as a chance to feel upbeat. For trauma survivors happiness,
intimacy, and love can trigger significant amounts of
unprocessed grief, anger, or fear that the source of the positive
feelings may leave (such as being abandoned by ones romantic
partner).
Finally, it is important to understand the temporal dimensions of
triggering. Short-term triggering can last minutes, hours, or days.
But because of the way that traumatic reactions are incorporated
into the individuals mind and body, triggering may also be
chronic. In other words, we can have lower-grade fight, flight,
freeze, and fawn reactions that occur over years or even
decades post-trauma.
It would not be a mistake to say that some of you reading this
blog who have experienced trauma are triggered right at this
moment but are not consciously aware of it because of how
deeply normal the triggered feelings have become. You will just
know that you are somehow uncomfortable or vaguely in pain.
Your trauma may also have been masked and labeled by its
symptoms depression, anxiety, ADD, or other more commonly
understood mental health issues. Without work specifically on the
underlying trauma, it will be difficult for you to resolve these
symptoms.
The Potential Benefits of Meditation for Trauma
Now that we have discussing triggering, lets briefly consider how
meditation may be able to help. We can do this in a simple way
by considering trauma in its cognitive and somatic (bodily)
impacts.
Traumatic triggering has a number of cognitive manifestations:
guilt, negative self-evaluations, fearful anticipation, angry
judgments of others, and flashbacks in memory. Meditation, by
teaching nonattachment to thoughts as well as non-attachment to
self-concept, offers trauma survivors an additional route to cope
with these reactions. It teaches us to let reactions go and pass
rather than reactively clinging to them. (The more intense the
triggering, the harder this is by the way).
Meditation also increases our ability to focus, pay attention, and
be mindful. This can be a serious challenge for trauma survivors
when they are triggered. Triggered states are what is known as
hypofrontal. This refers to the frontal cortex of the brain, which is
responsible for effective thinking, planning, and regulation of
emotions.
In hypofrontal states, the frontal cortex actually loses effective
functioning (Koenig & Grafman, 2009; van Harmelen et al.,
2010). This is the common experience people have of losing it
in a triggered state of fear, anger, dissociation, or grief. This also
accounts for why trauma survivors so often struggle with
addictions and compulsive behavior. In triggered states they lose
the ability to think straight and look impulsively to outside
compulsions or substances to help them regulate their emotions.
Meditation may counteract this by directly strengthening the
capacity to focus and even increasing the physical thickness of
the frontal cortex. This can help us stay more present during
triggering and support us to make more appropriate self-soothing
choices (see Lazar et al., 2005).
We can also see the potential of meditation to treat trauma
through a somatic lens. Traumatic reactions have a very distinct
physicality feeling or body memories that come forth quickly
and without conscious intermediary thought (see Levine, 1997;
van der Kolk, 2014). These are often highly uncomfortable and
can even rightly be called physically painful. Meditation teaches
us the capacity to relax the tensions underlying some of the
reactions and to enter positive states of bodily experience. While
even deep meditative experience will not fully erase these
trauma-related body memories, it can offer a means to learn to
regulate our nervous systems and to enter restorative states of
pleasure (Benson & Klipper, 1976/2000).
Combining its cognitive and somatic components, meditation can
be said to encourage a state of alert, present-centered, and calm
wakefulness in experience. We can summarize the goals of
meditation this way:
To learn to be in the present as opposed to the past or the
future
To learn to be alert without moving into fear, clinging, or
hyper-vigilance
To learn to be relaxed without moving into numbness,
sadness, or dissociation
Meditation would seem to be one of the best and perhaps the
most direct ways to learn this kind of state.
A Trauma Sensitive Approach to Sitting
All this said, meditation is not a panacea for trauma. Instead, a
traumatized persons practice of meditation must take into
account additional issues.
Here I would like to offer some lessons I have learned from
working with traumatized clients, taking part in many meditative
practices and groups, and from my own personal experience as
a trauma survivor. Naturally not every lesson below will apply to
you if you are a trauma survivor or to a client of yours if you are a
therapist or coach.
Lesson #1: Meditation by itself is never enough. As a trauma
survivor, you will also need to do multiple forms of
psychotherapy.
We will begin with the most basic lesson and probably the most
familiar to readers about trauma and meditation:
While meditation can be profoundly helpful in the face of trauma,
meditation by itself is never going to fully erase the presence of
trauma in the mind or body or teach you all the tools you will
need to cope with or heal trauma. If a spiritual teacher or tradition
tells you that meditation or another spiritual practice can deliver
total healing from trauma, I would recommend ignoring that
specific teaching. As a trauma survivor, you will learn to need to
question teachings that are spiritually absolutist in this way. We
will touch on this more below in a later lesson.
The wiser approach is to take for granted that you will need to
engage therapy at least intermittently post-trauma in order to
heal. The support for trauma recovery will be much higher in a
therapeutic contexts than in almost any meditation community,
who will tend to leave you to your quiet, solo practice. They will
typically not account for traumatic reactions in how they teach
their practices. Meditation communities may you offer you
wonderful ideals and goals about how you want to live in the
world, but you will need to add therapy in order to help actualize
those ideals.
It is also almost certain unless your trauma was relatively minor
that one period in one type of therapy is not going to be
enough. I have simply never met or worked with a serious trauma
survivor who could get all they needed from one therapist or from
one form of therapy.
The good news is that much is out there to be tried, and you
likely have years in front of you to try it. There are cognitive
approaches to trauma, such as trauma-focused cognitive-
behavioral therapy (TF-CBT), somatic approaches such as
Somatic Experiencing (SE) and Sensorimotor Psychotherapy
(SP), approaches that focusing on traumatic memories such as
EMDR, integrated-experiential approaches such as Evocative
Psychotherapy (EvoPsi), and even emerging approaches that
utilize psychedelics substances such as MDMA and psilocybin
(e.g., Catlow et al., 2013; Mithoefer et al., 2013). With some
searching you will certainly be able to find an approach that is
right for you at this stage of your life.
Finally, it is important to emphasize that most psychotherapies
have a strong interpersonal element which is lacking (for obvious
reasons) in meditative practices. And relational healing is deeply
pertinent to most forms of trauma. The sad truth is that fully 80%
of childhood trauma takes place at the hands of a parent or
caretaker (van der Kolk, 2005) and much adult trauma also takes
with people we know (i.e., emotional or physical spousal abuse,
date rape, etc.). It is not simply what you learn from your therapy
in terms of skills or self-awareness that will help you heal. It is
also the safe, supportive relationships that will you form with
them.
Lesson #2: Having a devotional meditation practice or another
form of devotional spiritual practice can be crucial for healing.
As a trauma survivor, psychotherapy should be the first tool you
use to help you learn to form healthy, positive relationships.
However, I would also strongly suggest that you take up a form
of meditation or spiritual practice (such as centering prayer or
chanting or ritual) that has a devotional element to it; something
that moves your emotions in connection or surrender to a greater
Other be that a spiritual teacher or leader, saint, or God/Spirit
Itself. You can take this as a main practice or a supplement to
your main practice. Because loneliness and isolation are such
major factors in trauma, with the wounds of early trauma going
particularly deep, it is important for most trauma survivors to
relate to spirituality personally, not just impersonally.
In other words, many popular forms of meditation particularly
those derivative of Buddhism will emphasize being in the
moment, concentrating on a mantra, following your breath,
noticing your thoughts, scanning your body and so on. These are
deep and wonderful practices, but they are not particularly
heartful practices. And from a neurophysiological perspective,
these are unlikely to produce marked increases in oxytocin and
vasopressin, which are the hormonal keys to the feelings of
bonding and attachment. But there is a strong argument to be
made that devotional spiritual practices will produce this effect
(see Grigorenko, 2011; Holbrook, Hahn-Holbrook, & Holt-
Lunstad, 2015).
While such states are not substitutes for interpersonal
relationships with other people, feelings of spiritual attachment
are comforting, healing, and grounding to trauma survivors and
can make the obstacles to healthy real-world relationships more
passable. It will feel good to surrender yourself not just to some-
thing larger than yourself, but to some-one (so-to-speak). If you
are uncomfortable with this, I would suggest trying it anyway.
Spiritual development without a corresponding development in
your ability to feel safe and attached with others will leave you
unbalanced as a person. More on this in a later lesson.
Lessons #3: Sitting when traumatically triggered must be done
with great care or temporarily avoided. Dont be a hero.
Almost everyone who tries to learn to meditate struggles at first.
Meditation calls upon us to sit with quietly with ourselves, turn
our attention inward, and become more aware of internal objects
(thoughts, feelings, sensations, breath, etc.). The common
challenges of meditative practice are well-known: Becoming
easily distracted, impatient, frustrated, bored, or feeling insecure
about how well we are doing. Most teachers and communities
give a great deal of encouragement and reassurance to
beginners to keep them motivated through these awkward, early
phases of practice.
But psychological trauma introduces an additional challenge,
especially when we are triggered. The turning-of-attention-inward
required by meditation is something many trauma survivors have
had special reason to avoid. Most trauma survivors are all-too-
aware of looming painful memories, intense feelings of
loneliness, self-punishing internal dialogue, and potent non-
verbal moods. And most will go to great lengths to quell or
distract themselves from these states.
If we are looking for an analogy, the difference between sitting
with traumatic reactions occurring in ones mind as opposed to
sitting without them can be likened to the difference between
guiding ones boat through mildly stormy seas versus sailing
headlong into a hurricane. Most meditation teachers and
instructors are not aware of this, and proceed to teach meditation
without any special instructions for those with trauma.
What to do? As a trauma survivor, issues of timing when we sit
to mediate and how long to sit become very important. Trauma
survivors who meditate do best when they are aware and when
therapists can help them become more aware of the underlying
emotional context they are sitting in on a given day. Trauma
survivors must learn their triggers and trigger-and-recovery
cycles extremely well so that they can approach sitting with their
traumatic reactions in mind.
Along these lines, here are a few concrete suggestions:
Consider meditating for shorter periods, such as 10-20
minutes. This approach encourages us to learn to sit with
traumatic feelings in small doses without overwhelming
ourselves or eventually dissociating.
A somewhat contrasting perspective is this: The first portion
of any particular meditation period is when the most
uncomfortable emotions and thoughts tend to arise. The
longer you sit, the calmer you are likely to become.
However, you have to learn to gauge for yourself when you
have the stamina to push through for a longer sit. A general
rule is: Dont be a hero. Approach yourself with care and
compassion.
Consider using a more active form of meditation if you are
triggered, such as internal repetition of a prayer or mantra,
moving meditation, noting out loud, or chanting. This is as
opposed to more passive/receptive approaches to
meditation which may just leave you swimming in a sea of
traumatic reactions. The more activity you can provide
 yourself in the meditation, the more you will be distracted (in
a positive sense) from traumatic reactions.
Consider skipping meditation and doing another form of
self-soothing care for a day. If you are on a lengthy retreat,
you should think about taking some meditation periods fully
off to rest or unwind. Again, dont be a hero.
On a good day or during a non-triggered period a trauma
survivor will likely experience the same calming, positive benefits
from meditation that a non-traumatized person will. However, on
a hard day, and during extended periods of triggering, additional
care is necessary.
Meditation is almost never an easy practice, but nor is it intended
to be about sitting through unrelenting emotional pain,
numbness, or dissociation. If we ask our clients (or ourselves) to
simply push through or if they are unaware that they are
consistently sitting in triggered states then over the longer term
we run the risk of having them associate the trauma with
meditation and meditation teachings. This negative association
may interfere with some of the benefits of meditative practice, or
eventually cause a trauma survivor to stop sitting altogether. A
trauma-sensitive approach to meditation, which sees trauma as a
special type of internal state which must be negotiated, is a wiser
approach.
Lessons 4-6 coming soon! Stay tuned!
References
Benson, H., & Klipper, M. (1976/2000). The relaxation response.
New York: Harpercollins.
Catlow, B., et al. (2013). Effects of psilocybin on hippocampal
neurogenesis and extinction of trace fear conditioning.
Experimental Brain Research, 228(4), 481-491.
Forman, M. (2010). A guide to integral psychotherapy:
Complexity, integration, and spirituality in practice. Albany, NY:
SUNY Press.
Fisher, J. (2001). Dissociative phenomena in the everyday lives
of trauma survivors. Paper presented at the Boston University
Medical School Psychological Trauma Conference: May 2001
Koenigs, M., & Grafman, J. (2009). Post-traumatic stress
disorder: The role of medial prefrontal cortex and amygdala.
Neuroscientist, 15(5), 540548.
Lazar, S., Kerr, C., Wasserman, R., Gray, J., Greve, D.,
Treadway, M., McGarvey, M., Quinn, B., Dusek, J., Benson, H.,
Rauch, S., Moore, C., & Fischl, B. (2005). Meditation experience
is associated with increased cortical thickness. Neuroreport,
16(17), 1893-1897.
Levine, P. (1997). Waking the tiger Healing trauma. Berkeley,
CA: North Atlantic Books.
Mithoefer, M., Wagner, M., Mithoefer, A., Jerome, L., Martin, S.,
Yazar-Klosinski, B., Michel, Y., Brewerton, T., & Doblin, R.
(2013). Durability of improvement in post-traumatic stress
disorder symptoms and absence of harmful effects or drug
dependency after 3,4-methylenedioxymethamphetamine-
assisted psychotherapy: A prospective long-term follow-up study.
Journal of Psychopharmacology, 27(1), 28-39.
Poulo, A., Reger, M., Mehta, N., Zhuravka, I., Sterlace, S.
Gannam, C., Hovda, D., Giza, C., & Fanselow, M. (2013).
Amnesia for early life stress does not preclude the adult
development of posttraumatic stress disorder symptoms in rats.
Biological Psychiatry, 76(4), 306-314.
van der Hart, O., Nijenhuis, E., & Steele, K. (2006). The haunted
self: Structural dissociation and the treatment of chronic
traumatization. New York: Norton.
van der Kolk, B. (2005). Developmental trauma disorder: Toward
a rational diagnosis for children with complex trauma histories.
Psychiatric Annals, 35(5), 401-408.
van der Kolk, B. (2014). The body keeps the score: Brain, mind,
and body in the healing of trauma. New York: Viking Adult.
van Harmelen, A., van Tol, M., van der Wee, N., Veltman, D.,
Aleman, A., Spinhoven, P., van Buchem, M., Zitman, F.,
Penninx, B., & Elzinga, B. (2010). Reduced medial prefrontal
cortex volume in adults reporting childhood emotional
maltreatment. Biological Psychiatry, 68(9), 832-838.