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  • Writer's pictureAmna Khan, LCSW

How DBT Skills Are Used in Trauma Therapy




What is Trauma? 


Trauma is complex. And everyone responds to trauma differently. At Maverick, we are trained and aware that trauma is at the intersection of what is unexpected and overwhelming, which can be different for everyone. Trauma can leave a devastating impact on people mentally, emotionally, and physically. 


Trauma is an emotional response to something terrible that has happened in your life. It can be a single event or series of events. Some examples can be any one- time event, such as a car accident, unexpected loss or an on going series of events, like emotional abuse, verbal abuse, physical abuse, childhood abuse,  unstable environment, domestic violence, medical problems, natural disasters, or military combat.


There are many symptoms that can come from trauma and many can deny, avoid or numb these symptoms. 


Emotional & psychological symptoms:

  • Shock

  • Disbelief 

  • Denial

  • Confusion

  • difficulty concentrating

  • Anger

  • irritability

  • mood swings

  • Anxiety and fear

  • Guilt

  • shame

  • self-blame

  • Withdrawing from others

  • Feeling sad or hopeless

  • Feeling disconnected or numb


Physical symptoms:

  • Insomnia or nightmares

  • Fatigue

  • Being startled easily

  • Difficulty concentrating

  • Racing heartbeat

  • Edginess and agitation

  • Aches and pains

  • Muscle tension


As a result trauma can cause symptoms and diagnoses like anxiety, depression, PTSD, BPD, and several others. 


How Do We Address It?


An important part of trauma therapy is creating a safe and supportive environment for our clients. We do this first by building trust, validating experiences, and maintaining confidentiality. We ensure our clients feel heard and not judged. 


We lean on our therapeutic relationship to assist clients in building resilience, so they can better understand their trauma. To manage the symptoms of trauma effectively skills and coping strategies are crucial and a trained trauma therapist can empower clients to learn these new skills and tools. Self-care practices like mindfulness, exercise, and healthy relationships can all contribute to resilience.


Trauma-informed approaches are crucial when working with trauma survivors. It is important to recognize the prevalence and impact of trauma, understand how it affects the brain and body, and then use that knowledge to help clients overcome their obstacles. My priority as a therapist is to make sure my clients can trust me, feel safe in therapy, collaborate and participate in their treatment planning, and feel empowered. I believe these are the foundations of trauma-informed care.


My Treatment Approach:


I like to utilize evidence-based trauma therapies like Cognitive Behavioral Therapy (CBT), and Dialectical Behavior Therapy (DBT), which focuses on changing negative thought patterns, integrating traumatic memories, and finding healthy coping mechanisms.

A powerful tool for helping clients cope with distressing symptoms is mindfulness and grounding. Mindfulness and grounding techniques are recommended for the promotion of mental well-being and resilience as they can help individuals manage stress, anxiety, and overwhelming emotions. These techniques help with sensory experiences and focusing on the present moment. Many times we can live in the past or future and mindfulness helps with being in the present moment. Guided imagery, progressive muscle relaxation, and deep breathing are some other effective grounding and mindfulness techniques.


Mindfulness


Mindfulness is the first skill I teach in DBT and is the core skill upon which all others are built. Without mindfulness is it impossible to shift long standing patterns of behavior, feeling, and thought. Being mindful is central to the skill of emotion regulation, overcoming life’s crises, and successfully handling interpersonal relationships, which will always include conflict. By paying attention to the present moment and connecting with the environment, one can achieve this goal. Mindfulness is the practice of focusing on purpose to what is happening right now- you focus on the present moment within yourself, admitting your feelings, thoughts, and bodily sensations without judgement and then observing what is going on outside of you. Sitting quietly and observing the sensation of inhalation and exhalation is one of the best ways to practice mindfulness. 


Additionally, guided visualization exercises can be practiced as part of mindfulness meditation to focus attention on different parts of the body. In addition to improving self-awareness and reducing stress, mindfulness practices can enhance one's ability to handle life's challenges with equanimity and clarity. Mindfulness may seem complex to achieve, but with practice many of life’s realities can become “mindful”, such as going for a walk, cooking a good meal, or listening to your partner talk about their day. Mindfulness is not complex, but it is a commitment as it involves minute by minute practice. 


Grounding 


A grounding technique, on the other hand, can be beneficial to individuals who are experiencing overwhelming emotions or are experiencing dissociation, as it enables them to reengage with their immediate surroundings and the present moment. For grounding exercises, I often instruct clients to focus on five things they can see, four things they can touch, three things hear, two things they can smell, and one thing they can taste. This technique is known as 5-4-3-2-1. As a grounding technique, deep breathing exercises can be combined with the visualization of feeling supported. A grounding technique should be practiced regularly in order to reduce anxiety, gain control, and manage distressing emotions.


Again, we know people’s perceptions of trauma and attitudes toward seeking help are influenced by many factors including past experiences, personality, and culture. Therapy must be culturally sensitive, taking into account clients' unique experiences and backgrounds; Therefore, my treatment plans are unique to each individual with respect to cultural differences.


As a clinician my main goal is to understand that working with clients who have trauma requires empathy and a deep understanding of their experience. That is why I believe navigating trauma and healing requires evidence-based therapies, trauma-informed approaches, and a safe, supportive environment. I feel privileged to accompany clients on their journeys as they heal from trauma. If you are not seeking help regarding your trauma and it’s impact on your life, but believe you may benefit from it feel encouraged! There are many excellent and qualified trauma informed clinicians who understand what you need and would be delighted to help. 

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