Table of Contents
Introduction and Thesis Statement
The traditional psychotropic approaches towards treatment of trauma such as Cognitive Behavioral Therapy (CBT) or Eye Movement Desensitization and Reprocessing (EMDR) are top-down techniques that do not directly deal with negative sensations caused by the traumatic experiences. A novel approach has been introduced in the past few decades that is based on the understanding of the effect of trauma or less severe cases of stressful circumstances on the neurobiology of the brain.
The treatment process in this approach, initially called Somatic Experiencing and later evolved to Trauma Resiliency Model, is to bring awareness to the patients about sensations and somatic symptoms associated with the trauma or distress as well as sensations of well-being to help them get back to their place of calmness and comfort. The purpose of this paper is to provide research evidence to answer the PICO question: “In individuals dealing with trauma and stress, how does the Somatic Experiencing (SE) and Trauma Resiliency Model (TRM) help in regaining their ability to live a more resilient life?”
Nursing Literature Researched to Support Thesis
A thorough search of various online databases were conducted regarding the topic of the PICO question focusing on peer-reviewed articles published in nursing journals in recent years, while articles in journals in other disciplines were also considered if they provided evidence- based research related to the topic. The main article reviewed and used in this study is entitled The Trauma Resiliency Model: A “Bottom-Up” Intervention for Trauma Psychotherapy, authored by Linda Grabbe and Elaine Miller-Karas published in 2017 in the Journal of the American Psychiatric Nurses Association. It is a brief, yet, comprehensive presentation of the Trauma Resiliency Model (TRM) as a novel somatic approach for treatment of patients suffering from trauma in both forms of acute cases such as Post Traumatic Stress Disorder (PTSD) and chronic cases like Adverse Childhood Experience (ACE). This article will be fully described in this paper, after which results of several studies published in peer-reviewed journals will be briefly presented to answer the PICO question. But first an introduction to SE/TRM is presented in the next two paragraphs using other references.
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The somatic approach is a biology-focused therapy method, which is based on the concept that “symptoms of trauma are the result of biological processes in the autonomic nervous system (ANS) rather than evidence of ‘mental weakness’ or cognitive pathologies, although patterns of dysregulation caused by trauma can indeed result in physical or psychological illnesses” (Compson, 2014). More recent biological research of the human brain has shown that frequent exposure to trauma will cause the hypothalamic pituitary adrenal (HPA) axis to have repeated and sustained activation resulting in consistently high levels of stress hormones (glucocorticoids). The long-term presence of these hormones would chronically affect the immune and inflammatory processes, which in turn would result in somatic symptoms in various body systems (Lacona, 2018).
The objective of SE/TRM techniques is not to cure the patient by completely removing the memories or effects of the trauma in the brain. Instead, the idea is to provide the clients, with help from clinicians such as psychiatrist nurses, with the skills to widen their Resilient Zone (RZ). The RZ is the range of internal mental and emotional experiences, where the individual can deal with ups and downs of life experiences without interfering with normal life activities. It is the state, in which the individual is calm, has an optimal capacity for adequate and adaptive reaction to the environment.
That is because in the RZ the neocortex, which is responsible for higher-order brain functions, is “online” (Compson, 2014). When facing with stress and trauma, we all experience being thrust into a state of hyperarousal called the “high zone”, due to excessive reaction of our sympathetic nervous system; or into a state of hypo arousal called the “low zone”, due to excess parasympathetic activation. The goal of TRM skills is to help clients become aware of the associated body sensations that accompany high and low zones.
According to the main article used in this paper (Grabbe and Miller-Karas, 2017), the Trauma Resiliency Method (RM) includes nine skills, to help individual stabilize the ANS, widen their RZ and bring them back into RZ when facing stress or trauma, resulting in reduction or prevention of symptoms of traumatic stress, and reprocess traumatic experiences. The first six skills of TRM, also known as Community Resiliency Model (CRM), are self-regulation skills of TRM that are learned and practiced by the client and are fundamental throughout TRM therapy. The additional three skills are for reprocessing traumatic experiences, which are adapted from Somatic Experiencing (SE) psychotherapy model first presented by Dr. Peter Levine (2003), and later developed further by him and his colleagues (Payne, Levine, & Crane-Godreau 2015).
Skill one is Tracking, in which “the client describes the ‘felt-sense’ of internal and external body sensations. The client reads and monitors the physical reactions to stress, and is able to distinguish between sensations of distress and those of well-being” (Grabbe & Miller-Karas, 2017).
Skill two, called Resourcing and Resource Intensification, is gained through a process in which client identifies “a person, animal, place, memory, activity, belief, or personal strength that brings a sense of comfort, peacefulness, or joy” (Grabbe & Miller-Karas, 2017). The idea is for the client to notice and describe the sensation in his or her body corresponding to that object, topic, person, and so on. If the sensation is clearly pleasant or at least neutral, the client will try to experience it for a dozen second or more, during which it will be transferred from short-term memory to long-term storage (Hanson, 2010). Introduction and Thesis Statement
The traditional psychotropic approaches towards treatment of trauma such as Cognitive Behavioral Therapy (CBT) or Eye Movement Desensitization and Reprocessing (EMDR) are top-down techniques that do not directly deal with negative sensations caused by the traumatic experiences. A novel approach has been introduced in the past few decades that is based on the understanding of the effect of trauma or less severe cases of stressful circumstances on the neurobiology of the brain.
The treatment process in this approach, initially called Somatic Experiencing and later evolved to Trauma Resiliency Model, is to bring awareness to the patients about sensations and somatic symptoms associated with the trauma or distress as well as sensations of well-being to help them get back to their place of calmness and comfort. The purpose of this paper is to provide research evidence to answer the PICO question: “In individuals dealing with trauma and stress, how does the Somatic Experiencing (SE) and Trauma Resiliency Model (TRM) help in regaining their ability to live a more resilient life?”
Nursing Literature Researched to Support Thesis
A thorough search of various online databases were conducted regarding the topic of the PICO question focusing on peer-reviewed articles published in nursing journals in recent years, while articles in journals in other disciplines were also considered if they provided evidence- based research related to the topic. The main article reviewed and used in this study is entitled The Trauma Resiliency Model: A “Bottom-Up” Intervention for Trauma Psychotherapy, authored by Linda Grabbe and Elaine Miller-Karas published in 2017 in the Journal of the American Psychiatric Nurses Association.
It is a brief, yet, comprehensive presentation of the Trauma Resiliency Model (TRM) as a novel somatic approach for treatment of patients suffering from trauma in both forms of acute cases such as Post Traumatic Stress Disorder (PTSD) and chronic cases like Adverse Childhood Experience (ACE). This article will be fully described in this paper, after which results of several studies published in peer-reviewed journals will be briefly presented to answer the PICO question. But first an introduction to SE/TRM is presented in the next two paragraphs using other references.
The somatic approach is a biology-focused therapy method, which is based on the concept that “symptoms of trauma are the result of biological processes in the autonomic nervous system (ANS) rather than evidence of ‘mental weakness’ or cognitive pathologies, although patterns of dysregulation caused by trauma can indeed result in physical or psychological illnesses” (Compson, 2014). More recent biological research of the human brain has shown that frequent exposure to trauma will cause the hypothalamic pituitary adrenal (HPA) axis to have repeated and sustained activation resulting in consistently high levels of stress hormones (glucocorticoids). The long-term presence of these hormones would chronically affect the immune and inflammatory processes, which in turn would result in somatic symptoms in various body systems (Lacona, 2018).
The objective of SE/TRM techniques is not to cure the patient by completely removing the memories or effects of the trauma in the brain. Instead, the idea is to provide the clients, with help from clinicians such as psychiatrist nurses, with the skills to widen their Resilient Zone (RZ). The RZ is the range of internal mental and emotional experiences, where the individual can deal with ups and downs of life experiences without interfering with normal life activities. It is the state, in which the individual is calm, has an optimal capacity for adequate and adaptive reaction to the environment. That is because in the RZ the neocortex, which is responsible for higher-order brain functions, is “online” (Compson, 2014). When facing with stress and trauma, we all experience being thrust into a state of hyperarousal called the “high zone”, due to excessive reaction of our sympathetic nervous system; or into a state of hypo arousal called the “low zone”, due to excess parasympathetic activation. The goal of TRM skills is to help clients become aware of the associated body sensations that accompany high and low zones.
According to the main article used in this paper (Grabbe and Miller-Karas, 2017), the Trauma Resiliency Method (RM) includes nine skills, to help individual stabilize the ANS, widen their RZ and bring them back into RZ when facing stress or trauma, resulting in reduction or prevention of symptoms of traumatic stress, and reprocess traumatic experiences. The first six skills of TRM, also known as Community Resiliency Model (CRM), are self-regulation skills of TRM that are learned and practiced by the client and are fundamental throughout TRM therapy. The additional three skills are for reprocessing traumatic experiences, which are adapted from Somatic Experiencing (SE) psychotherapy model first presented by Dr. Peter Levine (2003), and later developed further by him and his colleagues (Payne, Levine, & Crane-Godreau 2015).
Skill one is Tracking, in which “the client describes the ‘felt-sense’ of internal and external body sensations. The client reads and monitors the physical reactions to stress, and is able to distinguish between sensations of distress and those of well-being” (Grabbe & Miller-Karas, 2017).
Skill two, called Resourcing and Resource Intensification, is gained through a process in which client identifies “a person, animal, place, memory, activity, belief, or personal strength that brings a sense of comfort, peacefulness, or joy” (Grabbe & Miller-Karas, 2017). The idea is for the client to notice and describe the sensation in his or her body corresponding to that object, topic, person, and so on. If the sensation is clearly pleasant or at least neutral, the client will try to experience it for a dozen second or more, during which it will be transferred from short-term memory to long-term storage (Hanson, 2010).
A condensed version of TRM was used in a study on 147 business major students to determine the effect of mindfulness on their stress level (Rodgers & Kettering, 2017). The training was arranged in a two-hour classroom intervention in Mental and Emotional Self-Management (MESM), followed by three weeks of home practice. The goal was to teach the students how to incorporate tools to regulate the stress response prior to engaging metacognitive stress management techniques (Rodgers & Kettering, 2017). Evaluation of the results of the study showed that after three weeks of practice, students scored higher in mindful attention and well-being as well as in training of their business subjects.
Trauma could also be related to long term continuous exposure to distress due to social and cultural pressure on individual not fully accepted by their society. One example is people with their gender identity/expression different from the sex assigned at birth, also described as “transgender” or “gender variant”. It has been shown that individuals in this category have a higher incidence of depression, anxiety, victimization, and discrimination. A pilot study was conducted as a pretest/posttest evaluation on a group of 7 participants, who were exposed to 10 sessions of SE/TRM treatment for depression, anxiety, somatic symptoms, quality of life, and coping with discrimination (Briggs, Hayes, & Changaris, 2018). Participants reported significant increase in psychological quality of life after the treatment, as well as trend toward reduction in depression and somatic symptoms.
Traumatic experiences not only affect people facing them, but they would also impact the mental, psychological, and physical status of the health care providers including nurses, doctors, and social workers. So, these individuals can experience Secondary Traumatic Stress (STS). As the result, the health care and social service providers, themselves, would need some type of therapy. There have been studies on these individual regarding their trauma-induced somatic issues and their treatment including SE/TRM approach.
A within-groups, longitudinal study assessed a group of 18 health care providers including psychologists, social workers, medical doctors, psychiatrists, and physical therapists over a three-year period while they were taking SE training (Windblad, Changaris, & Stein, 2018). Their SE training was focused on increased ANS, physical, and emotional regulation skills. The objective of the study was to determine the effect of this training. The results showed significant reductions in anxiety symptoms, somatization symptoms, health-related quality of life (a measure of physical well-being), and social quality of life (a measure of interpersonal well-being).
One of the earlier field research based on somatic approach using TRM was conducted on social service workers after Hurricanes Katrina and Rita (Leitch, Vanslyke, & Allen, 2009). A control group of 51 social workers were treated using a traditional psychoeducation approach by providing them with information about normal responses to disaster and coping strategies. The treatment group of 91 social workers received the same education, but additional went through on or two individual sessions of 40 to 60 minutes by professional clinicians with at least two years of SE/TRM training. During these sessions the clients were taught skills primarily for self-regulation (restoring nervous system equilibrium) and secondarily for dealing with somatic symptoms of hyper- and hypo-arousal of their nervous system.
This included identifying, tracking, and adjusting breathing rate, heart rate, muscle tension, shifts in posture, changes in skin color, and so on. Various skills mentioned for TRM was used including resource use, grounding techniques, titration and pendulation. They were also encouraged to use the skills on their own after the treatment sessions. The measures for evaluating the effect of SE/TRM treatment versus traditional treatment were self-reporting by all subjects about how hurricane had affected their ability to deal with stressful situations, carrying out their daily life activities, their relationships with friends and family, as well as physical and psychological symptoms of distress, symptoms of PTSD, and resilience. Results showed lower PTSD symptoms and increased resilience compared with the control group.
In summary it can be said that since Dr. Peter Levine presented the idea Somatic Experiencing in the form of the strong two-way interaction between trauma and biology of brain (Levine, 2003), several studies including field research have been conducted to support the theory. The references presented above provided the evidence in answering the PICO question by showing that using Somatic Experiencing in general, and Trauma Resiliency Model in particular, could be efficient tools in helping patients with acute or chronic traumatic experiences. Along with our advanced knowledge and understanding of the function and reaction of brain in response to trauma, we are now convinced that adjusting the somatic effect of trauma would be a powerful approach to increase the resiliency of such patients and to assist them in overcoming negative effects of their bad experiences and being able to get closer to having a more resilient and therefore more enjoyable and productive life.
References
- Somatic Experiencing for PTSD: A Complementary Approach to Trauma-Focused Cognitive-Behavioral Therapy
- The Efficacy of Somatic Experiencing Therapy on Treating Posttraumatic Stress Disorder: A Randomized Controlled Trial
- A Comprehensive Review of the Psychometric Properties of the Somatic Experiencing Scale
