Trauma, PTSD, and CPTSD
Experiences of extreme stress and trauma can result in Post-Traumatic Stress Disorder (PTSD), Complex PTSD (CPTSD), depression, anxiety, and relationship difficulties. Dr. Deniz provides evidence-based treatments that have been shown to be effective in healing trauma and it’s effects, including Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE), as outlined by the National Center for PTSD. Dr. Deniz integrates "top-down" processing (cognitive therapies) with "bottom-up" processing (mindfulness and somatic awareness) to address the impact of trauma on mind and body. Bottom-up therapies focus on the body, the felt sense, and the instinctive responses as they are mediated through the brain stem and move toward higher levels of brain organization.
Dr. Deniz takes an individual approach to trauma treatment by obtaining a thorough background history, assessing current symptoms and personal goals, and considering individual and systemic factors to determine the best course of treatment.
Types of Trauma
Relationship Trauma: This includes emotional, verbal, or sexual abuse. Other relational traumas include living with a narcissistic or borderline partner or family member, or the loss of a loved one
Physical Trauma: Injuries such as car accidents, falls, or other extreme events
Acts of Violence: Experiencing crime, rape, assault, robbery, or witnessing such acts
Military Service: Witnessing and experiencing combat or other traumatic incidents while serving
Racial Trauma: Experiences of racism and micro aggressions have been linked to symptoms of trauma, depression, anxiety, and other mental health concerns
Natural Disasters: Earthquakes, floods, hurricanes, and other extreme weather events out of an individual’s control
Medical Trauma: The life-changing impact of a new medical diagnosis or long-term illness can present as trauma
Symptoms of PTSD
Nightmares, flashbacks, unwanted thoughts or images
Strong emotion & physiological reactions to reminder of the trauma
Avoid people, places, activities, sights, sounds smells, or thinking about the event. May use drugs/alcohol, or isolate and withdraw
Cognition & Mood
Guilt/shame, anger, sadness, fear, self-blame, emotional numbing, difficulty experiencing positive emotions or remembering parts of the event
Complex Trauma or cPTSD
Many traumatic events are of time-limited duration. However, in some cases people experience chronic trauma that continues or repeats for months or years at a time. Oftentimes, the current PTSD diagnosis does not fully capture the severe psychological harm that occurs with prolonged, repeated trauma. Examples include, repeated, severe, interpersonal trauma such as sexual, emotional and physical abuse; neglect during childhood; repeated loss and abandonment; domestic abuse, community violence or being held hostage for a prolonged period of time. Complex PTSD, or cPTSD, is a subset of PTSD. Whereas PTSD is a fear-based disorder, cPTSD is often referred to as a shame-based disorder originating from a history of chronic, and long-term exposure to traumatic events.
The symptoms associated with Complex PTSD can be seen as the person’s best possible ways of surviving an unsafe and harmful environment. However, they become unhealthy and dysfunctional when the trauma is over.
Symptoms of cPTSD
Emotion regulation: Problems in regulating your feelings and actions – leading to extreme emotional highs and lows and self-destructive behaviours to cope with daily life.
Memory & Sense of Self: Difficulties in memory and making sense of yourself – leaving you with a poor or
fragmented sense of identity, memory gaps and a confused ‘life story’
Attachment: Difficulty trusting others, issues with boundaries, social isolation, interpersonal difficulties, difficulty attuning to others' emotions, difficulty with perspective taking, difficulty enlisting others as allies
Cognitive Processing Therapy (CPT)
Cognitive Processing Therapy (CPT) is an evidence-based Cognitive Behavioral Therapy recommended by the National Center for PTSD shown to be effective in treating symptoms of PTSD and trauma. It is a time-limited psychotherapy, consisting of 12-20 sessions. CPT recognizes that trauma tends to impact beliefs and emotions related to 5 areas:
Through this structured treatment, you will learn how to identify and modify trauma-related beliefs or “stuck points,” (e.g. "I am a bad person" or "I did something to deserve this”) that contribute to current life difficulties, which leads to changes in how you feel.
Unresolved trauma and attachment issues sit in both the mind and the body. Somatic (body) therapies, such as trauma-informed mindfulness and Sensorimotor Psychotherapy utilize the body as a primary entry point in treatment, while integrating cognitive and emotional processing. These approaches consider the body to be an integral source of information which can guide resourcing and the accessing and processing of challenging, traumatic, and developmental experience held in the nervous system.
Self-Image: Experiencing a long-lasting negative self-image, which often includes feelings of guilt, shame, badness and being ‘flawed’ beyond repair.
Somatic: Body complaints which are often medically unexplained – the body remembers trauma, which sometimes our minds try hard to forget.
Sensory processing: Difficulties processing sensory experiences and regulating the body
States of consciousness- experiences of dissociation, feeling detaching from one's body or emotions
Prolonged Exposure (PE)
Prolonged Exposure is another evidence-based trauma treatment recommenced by the National Center for PTSD that helps people process the trauma that occurred, and find meaning in the experience. PE has been shown to be an extremely effective treatment that significantly reduces the symptoms of PTSD as well as depression, anger, shame, and anxiety that often accompany trauma. PE also helps you feel more confident and increases the ability to discriminate between safe and unsafe situations, opening you up to improving many aspects of life.
PE works from the premise that the brain is overloaded when a trauma occurs, and this causes problems processing and encoding the information in the brain. PE remedies this through recounting the trauma in session, reducing the emotional dysregulation caused by memories of the trauma, and finding new ways of thinking about how it fits into one’s own personal narrative. Additionally, PE helps people reduce avoidance of situations and trauma reminders that cause fear and anxiety through safe and graded exposure.
Standard treatment consists of 9-15 sessions conducted once or twice weekly for 90 minutes each. The duration depends on needs and rate of progress. This treatment is intensive, and I have helped many patients safely and successfully overcome their trauma. I am happy to discuss whether this treatment may benefit you in our initial consultation.
What about Eye Movement Desensitization and Reprocessing (EMDR)?
Although EMDR is a popular treatment for trauma, Dr. Deniz utilize's CPT and PE described above, as they have stronger research support and and more evidence-based interventions. Per the American Psychological Association, the research on the effectiveness of EMDR is controversial and the actual mechanisms of change may not actually be the eye movement piece of treatment, but the exposure to the trauma. Thus, Dr. Deniz utilizes CPT and PE , which directly target what has shown to be effective in trauma treatment. For more information on EMDR from the American Psychological Association, click here
Listen to Dr. Thema, current president of the American Psychological Association (APA), discuss CPT for sexual trauma.