Post-traumatic Stress Disorder (PTSD) first came to the attention of doctors during the First World War when relatively large numbers of soldiers returned from combat exhibiting intense emotional distress in which they seemed to re-live the terrifying events of war long after the event. However, war is only one context in which PTSD arises. Later, it became clear that this phenomenon of delayed emotional reactivity could result from many other contexts such as accidents and illness, physical assault, rape or witnessing acts of violence and devastation, natural or man-made. Childhood abuse is now recognized as one of the major sources of PTSD.
In general PTSD can be defined as severe recurrent emotional anxiety reactions that originate from an intense and traumatic experience. A trauma occurs when there is a combination of sensory and emotional overload that cannot be processed and integrated into the psyche. A war scenario provides many intense visual, auditory and contextual stimuli that are completely foreign to the average person, as does sexual abuse, rape or witnessing a car accident. Context plays a very important part as in the case of childhood abuse, where the child’s model of how his parents should behave cannot be reconciled with the parent’s actual behavior. The experience of intense fear that accompanies trauma becomes encoded into the internal memory imprint of the associated sensory experiences. The unprocessed sensory experiences and associated emotional reactivity become submerged and repressed in the subconscious mind as a core emotional complex. When the appropriate stressors are present or when the suppressive activities of the ego are weakened, as is the case during sleep this repressed emotional complex is activated leading to a repeat experience of the emotional trauma, often with the associated visual imagery in the form of flashbacks. Like other core emotional complexes, the repression is never complete and negative emotional energy leaks into present experience leading to general anxiety, phobias, recurrent anger, sleep difficulties, depression, obsessive-compulsive behaviours and substance abuse. These can be described as the layers of secondary reactivity that form around the primary trauma reaction and which, in their own way, shield the core emotional complex from further processing and integration by the psyche.
There are many approaches to treating PTSD, some involving medication and others focussed on psychotherapy. Cognitive Behavioral Therapy (CBT) is a particularly useful approach, because it focuses on the client’s actual patterns of habitual negative thinking and beliefs and attempts to change these into more positive and functional forms. The form of cognitive therapy described in this article is called Mindfulness Meditation Therapy (MMT), which can be defined as the direct application of mindfulness to an emotional complex to facilitate transformation and resolution. Mindfulness describes a particular form of awareness that is present-centered, direct and non-reactive towards an object of awareness. It is best described as the combination of PRESENCE and INVESTIGATION in which there is an openness of mind and heart to fully experience and know what is present in our field of awareness. Presence is one of the most important components of sensitive listening as when we are listening to a friend who is suffering. As we know from experience, simply being there with him or her in this way with complete attention and presence is often more important than what we say or do. In this same way, learning to be fully present for our emotional suffering is highly therapeutic and is perhaps one of the major contributions to the healing process. The other aspect of mindfulness is simply learning to recognize all the patterns of habitual reactivity that takes us away from being fully present for our emotional suffering. Meditation in the context of MMT refers to the direct application of mindfulness and presence to the emotional suffering itself, which becomes the object of our meditation. In general, during MMT, we allow the emotional complex to unfold and differentiate into more and more subtle content. This differentiation into specific feelings, memories and sensory content leads to direct transformation of emotional complexes and literally makes the complex easier to digest.
Traumatic memories have a specific internal structure in the form of intense imagery. This imagery may be photographic in quality, revealing the actual memory of the traumatic event, but more often it also includes abstract elements of color, shape and movement in something resembling a surrealistic collage. Whatever the form of the imagery, this internal representation is an essential part of what is required to produce intense emotional reactions. This is referred to as the Structural Theory of Emotions, where emotional energy is encoded in the specific sub-modalities of size, color, intensity, movement and texture. An intense emotion is likely to be encoded in intense colors such as red and orange and the imagery is likely to be large and close in the person’s inner visual field, whereas neutral emotions are likely encoded in neutral colors such as pale blue or white and appear small and far away. It is by becoming aware of this internal structure of the imagery that encodes the emotional energy of the trauma that we can explore the possibility of changing the imagery and thus changing the emotional intensity of a traumatic memory. This concept is developed to an art in the therapeutic modality called Neuro-Linguistic Programming, or NLP. Just as language is made of words that represent internal experience, imagery represents the natural language of the mind – the mind thinks in pictures and uses inner imagery to organize experience and memory.
The Structural Theory of Emotions proposes that by changing the structure of the imagery it is possible to change the intensity of the emotional reaction. Thus, if the color changes from intense red to soft yellow and the imagery becomes smaller and further away, it is very likely that the emotion will be much less intense. However, for this to work effectively the imagery must arise experientially from the emotional felt sense, rather than be created through deliberate visualization. Similarly, the direction of change must arise experientially, rather than be imposed externally. In this way, the client maintains close presence with his inner experience and knows that what happens is meaningful and relevant to his or her specific transformational process. This is why mindfulness is such an important part of the transformational process, because it allows us to be exquisitely sensitive to what is meaningful and what is not. The investigative dimension of mindfulness also provides the best approach to uncover the detailed inner structure of the emotion and provide meaningful content.
A central focus in MMT is to uncover this internal structure of the traumatic memory and then to investigate this experiential content. There is no attempt to interpret what arises, only to experience fully and know completely whatever arises. This process essentially de-constructs the emotional complex into smaller parts that the psyche can digest and integrate into more stable configurations that do not continue to generate emotional suffering. Of course, this requires considerable preliminary preparation so that the client can experience the internal imagery without becoming overwhelmed by it. This preliminary phase of MMT is focussed on establishing the Mindfulness Based Relationship (MBR) in which there is sufficient stability and non-reactivity to allow the imagery to unfold into present awareness. There are many approaches to achieve the right MBR, such as watching the imagery as if projected on a screen or placing the imagery at some distance in front. Through mindfulness and careful investigation, the client can discover for himself what works best for establishing the MBR. However, once a client begins to witness specific details about the imagery, he inevitably finds it much easier to establish the MBR, because the specific content gives him a specific focus and this tends to prevent hyper-reactivity. The MBR is an essential part of the transformation process for many reasons, the primary reason being that it allows the compacted emotional complex to unfold into more manageable parts. At another level, the MBR allows the client to fundamentally change the way that he relates to his inner emotional experience and he begins to break free from seeing himself as a victim of the emotional trauma. This in itself is an essential requirement for change.
Throughout the whole process of MMT, the client is repeatedly exposed to the source of his fear, but in new ways that don’t involve being overwhelmed. This exposure desensitization effect is regarded by most schools of psychotherapy as an essential part of overcoming PTSD and Mindfulness Meditation Therapy provides a very subtle and specific way of doing this.
Peter Strong, PhD is a scientist and Buddhist psychotherapist who specializes in the study of mindfulness and its application in Mindfulness Meditation Therapy. He teaches mindfulness meditation (vipassana) and works with individuals and couples using Mindfulness Meditation Therapy for resolving difficult emotional problems, including anxiety, depression, phobias, grief and trauma and the management of anger and stress. Besides face-to-face work, Peter also works with individuals and couples online via email and web conferencing. Visit http://www.counselingtherapyonline.com