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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

Phase-Based Approach

Trauma treatment is recommended to occur in three phases:

1. Safety & Stabilization

2. Trauma-Focused Therapy

3. Reintegration

Types of Trauma

  • Relationship Trauma: This includes emotional, verbal, or sexual abuse. Other relational traumas include emotional neglect, 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

Re-experiencing

Nightmares, flashbacks, unwanted thoughts or images

Arousal

Strong emotion & physiological reactions to reminder of the trauma

Avoidance

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’

  • AttachmentDifficulty 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)

  • Self-Image: Experiencing a long-lasting negative self-image, which often includes feelings of guilt, shame, badness and being ‘flawed’ beyond repair.

  • SomaticBody 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

Mindfulness & Somatic Therapy

Cognitive Processing Therapy (CPT) is an evidence-based treatment 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, emotions, and behaviors related to 5 areas:

  1. Safety

  2. Trust

  3. Power/control

  4. Intimacy

  5. Esteem

 

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. Nonverbal, bottom-up modalities can be effective in treating trauma symptoms, especially when there is no memory to reprocess, such as from early childhood or in the case of drug-facilitated sexual assault (DFSA). While explicit (conscious) memory isn't always available, the implicit (unconscious/subcortical) memory expressed through the body can be given a voice through the use of bodily based, somatic therapy. 

 

The body is 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. 

Inner Child Work

As a psychologist specializing in trauma, I deeply understand how past experiences, particularly those from childhood, shape our present selves. Inner child work and reparenting approach, also known as "parts work," recognizes that the wounds we carry into adulthood often stem from unmet needs or unresolved emotions from our childhood. By nurturing and healing your inner child — the part of you that holds these early experiences — we aim to release the pain, beliefs, and patterns that have been carried for years. This process involves acknowledging and validating past experiences, understanding their impact on current behavior and emotions, and learning to provide for yourself the compassion, care, and love that may have been missing in your early years.

 

Reparenting involves learning to provide for yourself what you might not have received from your caregivers. This means developing self-care and self-compassion practices, setting healthy boundaries, and creating a nurturing inner dialogue. Through reparenting, you can begin to fulfill your emotional needs in a way that promotes healing and personal growth. This approach is not about dwelling on past pain; instead, it empowers you to take active steps towards building a self-supportive and understanding relationship with yourself. The aim is to help you move from merely surviving to thriving, with a newfound sense of resilience and self-awareness.

Dr. Deniz offers a guided approach to this work in her virtual self-paced course here.

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

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