Magazine article Addiction Professional

Graduated Exposure Valuable in Addressing Trauma

Magazine article Addiction Professional

Graduated Exposure Valuable in Addressing Trauma

Article excerpt

Many times survivors of trauma present as angry, depressed, anxious, passive, or otherwise unlikeable. Counselors too often dismiss them as uncooperative or unmotivated, when these behaviors most often are not conscious choices. Rather, the unwanted behavior results from the clients' "survival brain" responding to cues of previous traumatic experiences. As in my previous column (July/August 2014 issue), I am avoiding the more precise terminology used by brain scientists and am instead using language that is easy for clients to understand.

Therapeutic techniques that help the "intellectual" brain are often less helpful to the survival brain. Suggesting that clients are making a conscious choice to engage in offensive behavior, when they are not, can irreparably harm the therapeutic relationship. This column will discuss a therapeutic technique that has proven helpful in these situations.

Our intellectual brain responds well to cognitive therapy, narrative therapy, solution-focused therapy, and a host of other talk therapies, because our intellectual brain thinks in words. But talk therapy is of less direct use to our survival brain, since the actions that it drives are often unchosen and without conscious thought. The most helpful interventions here are often behavioral.

Our survival brain needs to "learn" more helpful choices through experience. While a wide range of considerations influence our intellectual brain, our survival brain has only two goals: to pursue pleasure and to avoid pain. Any behavior that provides a reward likely will be repeated. Any behavior that provides an immediate punishment likely will be avoided.

The survival brain has no long-term memory, or sense of reason. When injecting heroin helps increase pleasure or decrease pain, the survival brain encourages repetition of that behavior. The long-term consequences of this choice stand outside the scope of the survival brain's functioning. (That's why the intellectual brain is equally important to our survival.)

The survival brain can "learn" to make more appropriate choices, but since the choices are not made consciously, the survival brain can't be "talked" into anything. Graduated exposure therapy offers one of the best ways to accomplish more helpful survival brain behavior. It is based on the principle that inappropriate responses to stimuli (tendency to fight/flee/freeze) decrease with each non-problematic exposure.

To offer an example, veterans of the battlefield are often most comfortable sitting in a restaurant seat positioned against a wall, looking out over the entire room. Many of the rest of us prefer the same seat, from which we can see what is going on, but it is much more uncomfortable for people whose lives depended on awareness of their surroundings to have their backs to the action.

Once the veteran returns home, the same behavior that protected during combat may cause practical problems. If the veteran arrives at a business meeting and a preferred seat is already occupied, this may affect the quality of the person's presentation. Depending on the survival brain's experience, the person may be so distracted and uncomfortable that he/she is unable to give the presentation at all.

If the veteran has an awareness of the cause of the discomfort, one option is to explain the situation and ask for the preferred seating. But prejudice and stigma still exist in the business world, and this request could easily be misunderstood. …

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