How Trauma Treatment Works: Understanding Dissociation and the Path to Recovery

Written by Roland Bal

In the midst of feeling overwhelmed by post-traumatic stress, it seems as though there will never be a way out of suffering — the more so when it is recurring. Your emotional state influences how you perceive reality; therefore, it is normal that at these times, your felt experience is that life has no meaning.

You have also noticed, fortunately, that your intense moments of suffering pass over. You have days that are better than others. Our consciousness appears cyclic in that regard. This movement of going through tough days followed by better days gives us an opportunity. It gives us a breather that allows us to get some things done, or connect with friends, or be with nature.

It also gives us the opportunity to observe our reactions when we are going through triggers, withdrawal periods, and suffering. I am not talking here about analysing. Analysing is something you are likely to be doing already, to no avail. I am talking about observing your approach, which is the essence of trauma treatment and recovery.

Why Avoidance and Problem-Solving Fail

Instinctive reactions, when we suffer, are wanting to forget it all, attempting to get over it, trying to understand, or fixing it. This avoidance or problem-solving attitude works well on a practical level, but fails miserably when we deal with our minds and hearts.

Something else seems to be needed, and this is really about how we approach our emotional issues. Dissociating or disconnecting, consciously or unconsciously, works only temporarily. It makes our psychological symptoms go away for a while, but they might start showing up as physical pain or immune system issues.

Similarly, a problem-solving attitude has a tinge of judgment about it — that something is wrong and needs fixing. This prevents you from observing that your reactions, in the wake of trauma, are normal. Once you neither disconnect, dissociate, go numb, nor get too focused on what you suffer from, that energy will be able to move into awareness.

It is the ability to contain deep wounds with awareness that dissolves our emotional suffering. While we learn and expand in awareness, we are re-establishing our boundaries, our resilience and our capacity to contain.

Adversity challenges us. It pushes us to learn how to contain and hold more of ourselves, increasing our containment and resilience, and thereby sets us free.

What Trauma Actually Is — at the Level of the Nervous System

On a physiological level, trauma is the high energy arousal of the nervous system that hasn't had the possibility to discharge. It thereby interferes with the normal functioning of the nervous system. That interference is most often accompanied by physical symptoms and mental or emotional disturbances.

The impact that leads to high energy arousal of the nervous system can either be incidental — like surgery or a car accident — or develop over time, for example through feelings of incompetence, lack of self-worth, and so forth.

The body is wired to self-regulate back to health. When we are overwhelmed by threat without having the possibility to regulate the high energy arousal of the nervous system through fight or flight, the body freezes the energy as an ultimate survival strategy. When there is no further interference, the body and nervous system will release this energy when space, time, and allowance for it are given and available.

What often happens, however, is that thought interferes with our self-regulating mechanisms, thereby keeping trauma alive within the body and mind. When a value judgment is given to an incidence of high energy arousal, we dissociate from embodiment and move into emotion. In turn, the emotion is coupled to the object, person, experience, or circumstance — thereby furthering the dissociation process.

The Pathway of Dissociation: How Coupling Dynamics Keep Trauma in Place

To illustrate this with an example: Marie has to press on the brakes suddenly for a car stopping in front of her. When she checks in the mirror she sees the car behind her about to impact hers. She braces herself. As there is no time to regulate the energy arousal caused by the impact into fight or flight, her system freezes the high energy arousal of the nervous system. Apart from physical symptoms of the impact, she starts suffering anxiety attacks, sleeplessness, and severely disturbed digestion.

As she is not aware of how to allow the body to release its surplus energy, she is overcome by feelings of helplessness, self-pity, and a sense of loss of control, which is accompanied by thoughts on the causal nature of the accident: "Why did this happen to me?" "What have I done wrong?" "If only that other driver had been a bit more alert!"

In turn, these feelings stimulate her replaying of the event in her memory and dreams. Self-pity and helplessness isolate her from interacting with others and further reaffirm her state. As she is not able to regulate herself back to health and her condition persists, she is not able to commit herself to regular working hours and has started smoking again after not having smoked for more than ten years.

This example gives a clear view of the impact of trauma, coupling dynamics, and dissociation processes. Furthering dissociation leads to more complexity and more coping habits.

Two Layers of Dissociation

The first dissociation happens when there is a negative value judgment given to the high energy arousal in the body. This happens at an unconscious level and can be instantaneous upon the event. When that happens, the high energy arousal is coupled through a negative judgment value — "I don't want to feel like this," "I don't like this" — to emotion such as feelings of helplessness, self-pity, and loss of control, along with guilt, blame, and self-reproach.

The second dissociation is when the event itself becomes interpreted and coloured by the emotional state. Thus the emotional state of self-pity, helplessness, and blame is coupled to the event — recurrent replaying of the event in memory and dreams, infused with feelings of self-pity, helplessness, and blame.

When working with trauma, one must address these coupling dynamics. By doing so, you bring into awareness how trauma is kept in place. Dissociation prevents one from self-regulating back to health. It is the work of the patient and therapist to explore dissociation together, and to work towards release or integration of the high energy arousal of the nervous system.

What Effective Treatment Requires

This is why effective trauma treatment cannot rely on talking about what happened alone. A purely cognitive or top-down approach can help create a road map — it can ease some of the blame, shame, guilt, and self-reproach — but it does not reach the emotional residue itself. You can understand your history perfectly and still be run by the patterns it installed.

The somatic piece — the bottom-up approach — is what allows the nervous system to complete the defensive responses that were interrupted at the time of the trauma. It is where the frozen energy can finally discharge. This is not a dramatic process. It happens gradually, through building enough containment and resilience to meet what was overwhelming without becoming overwhelmed again.

The two approaches — cognitive understanding and somatic processing — work together. The cognitive piece provides context and perspective. The somatic piece processes the charge. Neither alone is sufficient. Together, they form the basis of how trauma treatment actually works.