Talking Through the Body: A Comparative Study of Cognitive-Behavioral and Attachment-Based Treatments for Childhood Trauma

Wayne Munchel posted:

Thanks for posting this, Eric.  One of the interesting points that stood out for me, was the commentary on how CBT aligns w/ Capitalism/individual responsibility (similar to Psychiatry's disease model) & downplays the role of environmental toxic stressors, such as poverty, racism etc...  Had not considered that before.

I've yet to read the thesis...but this comment has piqued my interest and has further encouraged me to!  As a young person and adult CBT never worked for me, other body based modalities did (my personal path of healing was relived reading The Body Keeps Score - only the one I never tried was EMDR).  As a youth and community practitioner I have long thought CBT very much an individual responsibility based concept and that it was not at all helpful for me because of (maybe that's because of how I'm wired )

As a therapist specializing in trauma for over 25 years, I do not feel the same skepticism as Paul. There have been many changes in this time in the approach to trauma—and more data takes time to show up. I was certified in EMDR in the first wave of certification in the country, and at that time, the VA did not recognize it as a form of trauma therapy. Yet, now, it is an accepted and well researched form of therapy for PTSD and trauma symptoms—and used by the VA. EMDR could be considered a body-therapy also as utilizing the sensations in the body and the core beliefs in the body are part of the protocol.

I do know for sure that my clinical experience as a trauma therapist—and at this point, I have provided over 28,000 sessions of therapy—resonates completely with what this author recommends. I have not seen CBT have the same outcome at all as the other body-centered therapies I have utilized. (I am a certified Hakomi therapist and a Somatic Experiencing Practioner—and I was formerly certified in EMDR, but I dropped the certification a few years ago). I understand this is anecdotal, but it still is what I have observed. My interest in other modes of therapy for trauma actually stemmed from seeing that CBT was only taking my clients so far—and I was hoping for more results. I kept wanting to learn more approaches to facilitate a deeper level of healing for clients.

Data is surely important and my thought is that we need more research on therapies like Sensorimotor Therapy and Somatic Experiencing. This may happen in time.

I appreciate this paper’s approach.



> On Jun 7, 2017, at 5:35 AM, ACEsConnection <communitymanager@acesconnection.com> wrote:
>

Some other material people might like to consider include:

(i) the consensus statements on trauma and complex trauma treatment -- from the premier trauma treatment network International Society for Traumatic Stress Studies, which do not include specific inclusion of either attachment-related therapies; or "body therapies"  https://www.istss.org/treating-trauma.aspx

(ii) some material drawn from the ideas of the founder of Cognitive Behavior Therapy, and Multimodal Therapy, who also coined the acronym BASIC ID identifying not a psychodynamic concept but the domains of information he thought were important to address -- attached -- very consistent with drawing information from the sensory "here-and-now" experience of the client

(iii) what also needs to be considered is that the models Eric recommends have so far -- 5 years after his thesis -- failed to produce much in the way of empirical outcome studies of any real quality

(iv) also recommended reading, for all the reasons Eric recommends, but from the viewpoint of "CBT", in this form called Functional Analytic Psychotherapy https://www.amazon.com/Functio...otherapy+made+simple

What is disappointing, given its impact on therapy practices in the VA is that Walser's book came out in 2007 -- surely enough time for it to be considered in Eric's thesis  https://www.amazon.com/Accepta...keywords=walser+ptsd

so, as I said before, like Tom Cruise' "Show me the money!" instead

"Show me the data!!!!"

Until then, imho there seem considerable grounds on which to maintain scepticism about his recommendation.

But good luck to him!

 

Wayne Munchel posted:

I must admit to not fully tracking the debate between Paul & Russell in relation to my comment.  My observation of 1 pt. In Eric's thesis was not about which models/therapists exhibit "higher levels of empathy".  It was about how the models formulate & conceptualize the problem. 

CBT > "By focusing on the individual and locating the source of misery in structures of the individual mind, capitalism was redeemed."  Similar to bio-reductionist Psychiatry, problems of thinking, feeling, behaving are ascribed to diseases & disorders within individuals brains - largely ignoring the social context.  Dr. Ben Carson recently espoused a related view that poverty is a "state of mind".  

 

For that point to be truly understandable, you'd have to have read Linehan's early studies, in those days she was developing DBT -- studies I no longer have but read several decades ago, at the University of Queensland swimming pool, while attending Graduate School, no less -- but you'd be able to find them in a list of her articles -- in Google Scholar? Unfortunately, CBT's critics seem not to have done so. CBT and DBT are both based on Behavior Therapy. Eric also seems to be lacking in his criticisms of attachment-based therapies -- and it has certainly had its trenchant critics, not least of whom being Schnarch and Kagan, people whom Eric doesn't cite.

And CBT practitioners' are at least as investing in the therapeutic relationship, with accurate empathy being an important part of that, as practitioners of other approaches, despite Eric's views.

I must admit to not fully tracking the debate between Paul & Russell in relation to my comment.  My observation of 1 pt. In Eric's thesis was not about which models/therapists exhibit "higher levels of empathy".  It was about how the models formulate & conceptualize the problem. 

CBT > "By focusing on the individual and locating the source of misery in structures of the individual mind, capitalism was redeemed."  Similar to bio-reductionist Psychiatry, problems of thinking, feeling, behaving are ascribed to diseases & disorders within individuals brains - largely ignoring the social context.  Dr. Ben Carson recently espoused a related view that poverty is a "state of mind".  

 

Paul Metz posted:

Wayne Munchel posted:

Thanks for posting this, Eric.  One of the interesting points that stood out for me, was the commentary on how CBT aligns w/ Capitalism/individual responsibility (similar to Psychiatry's disease model) & downplays the role of environmental toxic stressors, such as poverty, racism etc...  Had not considered that before.

I think not considering that point before is the more rationally defensible position. Did you consider the differences between different forms of CBT, and the extensive literature on CBT therapists' generally higher levels of empathy than practitioners of other forms of therapy?

Come on, Paul, you're showing your age now, but also being a bit "harsh", maybe?  And I understand your difficult position, as a Health Programs manager, concerned about their teams working effectively, and amiably -- which wouldn't happen if they believed in the position Wayne espouses.  Functional Contextual approaches, and their  practitioners, like those who practice ACT (like Walser) and Dialectical Behavior Therapy, might not like to be lumped in with those who practice CBT. And how many people these days know of Lazarus BASIC ID approach -- certainly totally inclusive of "neurobiologically-informed approaches, and even the very same considerations as "body therapists" espouse, less scientifically, today -- Lazarus's foundations are over 35 years old;  Linehan's about the same --- Sadly, Eric cites neither of them. Certainly though, as a result, many would say they practice from the same base; and those who practice from that base might not remember Linehan's early papers where she spoke of the sort of distinction Eric, and Wayne, speak of so disparagingly.  But, yeah, there's a lot of research on which to base a claim that they have certainly become de facto standard treatments outside of medicine for the effective treatment of trauma; and even for Complex Trauma, considering the work of those like Ford. Certainly, the "difference" is more than of emphasis, than one of substance, dependent on client's individual presentation of need, and choice -- clients don't present in the same way as they did 30+ years ago.

So, all in all, there's, really, no insurmountable barriers between the sorts of approaches Eric wishes to distinguish -- if one remembers one's history of psychology. A bit of a strawman, perhaps.

But it's good to see so much discussion occurring.

Best,

Russell

Wayne Munchel posted:

Thanks for posting this, Eric.  One of the interesting points that stood out for me, was the commentary on how CBT aligns w/ Capitalism/individual responsibility (similar to Psychiatry's disease model) & downplays the role of environmental toxic stressors, such as poverty, racism etc...  Had not considered that before.

I think not considering that point before is the more rationally defensible position. Did you consider the differences between different forms of CBT, and the extensive literature on CBT therapists' generally higher levels of empathy than practitioners of other forms of therapy?

Thanks for posting this, Eric.  One of the interesting points that stood out for me, was the commentary on how CBT aligns w/ Capitalism/individual responsibility (similar to Psychiatry's disease model) & downplays the role of environmental toxic stressors, such as poverty, racism etc...  Had not considered that before.

It's important to think about what areas in which you want to work, and who / what is influential in those areas. Robyn Walser, devotee of Acceptance and Commitment Therapy, in the VA has a lot of influence there; and of course the clinical guidelines put out by the IATSS don't include "body therapies", except as "maybe" adjuncts. So, at this stage, you would be seen as proposing an "evidence - informed" approach in favour of evidence - based approaches. 

So, private practice, mainly? 

 

I like your comment. Steven Porges writes a lot about this in his work, as he is identifying that the state of trauma creates a neural platform that limits behavioral repertoire based on our perception of safety. We always believe our body over what we actually “know”—which I think is what you are identifying in looking at interoception. Peter Levine is a master at changing these states—through both awareness and helping the body move to another state by completion of the fight, flight, and freeze responses in the body.
> On Jun 6, 2017, at 9:39 AM, ACEsConnection <communitymanager@acesconnection.com> wrote:
>

Eric Eichler posted:

Russell Wilson posted:

Pretty "ballsy" putting your thesis up on line in this way -- some of us are more professional sceptics than others, and you know what sceptics can do. What struck me at first is "Whatever happened to a focus on temperament?" Though, when you start thinking that way, the importance of body therapies perhaps becomes even greater. At the same time, one has to wonder why the thesis / abstract -- must admit I haven't read the whole thesis yet ;-D  -- phrased it as if it's a one or the other, and as if it's meant to apply for all. Whatever happened to (a) an integrative approach, combining elements across therapies -- Spinazzola's Component-Based Therapy? and (b) Whatever happened to the importance of the therapeutic relationship, perhaps even more important than type of therapy (and there's a LOT of evidence for that)? What is this beast called "CBT" (a medusa); or for that matter, are all attachment-based therapies the same? Therapy for what disorder -- are all survivors of childhood adversity the same in terms of what they need, what they want, and isn't client choice the ultimate decision; and  with some suffering PTSD, and others that "non-existing" (in DSM 5)  "Complex Trauma" / Complex PTSD. Even for PTSD, don't the different therapies have important elements in common Schnyder DOI: 10.3402/ejpt.v6.28186 which would render such comparisons somewhat uninterpretable?

So, I give you credit for taking on such an ambitious topic, but personally I'd be cautious about rushing to the same conclusion as you did, but congratulations on the work you've done, and on getting licensure. Hope your career goes well.

btw for citation purposes (just in case) Where'd you get your degree? 

Thanks for responding. I graduated from Smith College School for Social Work. I acknowledge there are limitations in my comparative approach, and with nailing down what a "disorder" of childhood trauma means (when the effects of traumatization are so varied), but if you look over my paper I hope you'll see that I spend considerable time advocating just the sort of skepticism that you encourage. I also believe my claims are consistent with an integrative approach. I do think that attention to disrupted attachment vis a vis the therapeutic relationship is often crucial in helping people with histories of childhood trauma, and ongoing distress related to that, to move towards recovery.

The main problem you will have, unless you address, and show you have, the other issues I raised, up front, is convincing mainstream clinicians of your argument. Bessel, bless him, hasn't been mainstream for many years. Nor is this website. Clearly, from the other responses you've received, you'll not have to convince those already converted, and you'll make a living following the line you've got, but... 

Depends what you want. 

I too wish you well. 

Hi Eric,

I very much appreciated your thesis subject. Because contemplative science suggests that interoceptive processes and the common concept of the ‘subtle body’ is important for adaptive behavior —disrupting over learned perceptual and interpretive habits formed throughout developmental years—especially as a result of trauma, it seems that interoception should be viewed as foundational to social and emotional learning, enhancing awareness and regulation of emotional responses to stress. It is my intention to continue to understand, access and articulate how attention to energy within the body helps to determine well-being.

I would love to hear more of your thoughts on the interoceptive process. 

Rebecca A. Tavangar, M.A., C.C.T.P.
Psychotherapy | Trauma Recovery Skills

Impressive Eric, thank you for sharing.  The depth of the research is stunning, very informative!

 

I appreciate the conclusion this author points to--as CBT is seen as one of the best treatments out there in the literature.  For me, I started my career over 25 years ago in trauma with CBT as one of my approaches-- with a developmental/relational emphasis.  I can say that working with body-based treatments made my clients progress more quickly and fully.  I first got certified in EMDR (which is body-based) but then learned and got certified in hakomi, and then finally Somatic Experiencing.  I also studied the Organic Intelligence model, also a somatic therapy.  Based on my experiences as a therapist, I can say that the body-based therapies have taken my clients the furthest, particularly in learning nervous system states and neurobiology.  As Bessel Van der Kolk says, "Trauma is a disorder of being in the here-and-now."  The body-based approaches are often working with what is occurring in present moment.  I have an appreciation of this author's awareness of the power of working this way.  When you change physiological responses, you change things more deeply--at least, that is my bias.  I thought the paper and research were great.  

Russell Wilson posted:

Pretty "ballsy" putting your thesis up on line in this way -- some of us are more professional sceptics than others, and you know what sceptics can do. What struck me at first is "Whatever happened to a focus on temperament?" Though, when you start thinking that way, the importance of body therapies perhaps becomes even greater. At the same time, one has to wonder why the thesis / abstract -- must admit I haven't read the whole thesis yet ;-D  -- phrased it as if it's a one or the other, and as if it's meant to apply for all. Whatever happened to (a) an integrative approach, combining elements across therapies -- Spinazzola's Component-Based Therapy? and (b) Whatever happened to the importance of the therapeutic relationship, perhaps even more important than type of therapy (and there's a LOT of evidence for that)? What is this beast called "CBT" (a medusa); or for that matter, are all attachment-based therapies the same? Therapy for what disorder -- are all survivors of childhood adversity the same in terms of what they need, what they want, and isn't client choice the ultimate decision; and  with some suffering PTSD, and others that "non-existing" (in DSM 5)  "Complex Trauma" / Complex PTSD. Even for PTSD, don't the different therapies have important elements in common Schnyder DOI: 10.3402/ejpt.v6.28186 which would render such comparisons somewhat uninterpretable?

So, I give you credit for taking on such an ambitious topic, but personally I'd be cautious about rushing to the same conclusion as you did, but congratulations on the work you've done, and on getting licensure. Hope your career goes well.

btw for citation purposes (just in case) Where'd you get your degree? 

Thanks for responding. I graduated from Smith College School for Social Work. I acknowledge there are limitations in my comparative approach, and with nailing down what a "disorder" of childhood trauma means (when the effects of traumatization are so varied), but if you look over my paper I hope you'll see that I spend considerable time advocating just the sort of skepticism that you encourage. I also believe my claims are consistent with an integrative approach. I do think that attention to disrupted attachment vis a vis the therapeutic relationship is often crucial in helping people with histories of childhood trauma, and ongoing distress related to that, to move towards recovery.

Thanks for sharing this paper.  I really enjoyed reading it.  I am certified in both Somatic Experiencing and Hakomi.  I have a bias towards bottom-up therapies at this point in my career--but  I do use CBT also in my work at times.  I appreciate your perspective.  

Kaci May posted:

Thank you for sharing. I'll take your paper with me when I speak with adopted children's therapists next time. I'm always questioning best practice. 

I'd like more time spent on current behavior and sensory awareness than past trauma memories. I realize all are important, but we are living now and must function today, appropriately. The old stuff prevents that. Ugh, the trauma cycle. 

Remember the important thing about trauma memories is how they're CURRENTLY affecting the individual, and how the client is processing them, and how they might come to construct their life in the future because of their current and future perspective of those past events. I was wondering if there's somewhere on this site where it is discussed just what the current effects of trauma "really" are -- as you say, sorta, it's how they're currently operating in the survivor's life that's really what the focus needs to be on -- a trap in beginner therapists' practice, but it needs to go way beyond just sensory awareness, at least for those with chronic / complex trauma. This irks me about some people's approach to memories -- different from a block of clay that's been shaped by past experiences, but instead memory is a constructive process -- building something each time it occurs and this process can be brought under control and shaped by the person, not just experienced by them.

David Dooley posted:

"...including models that centralize childhood trauma as the cause of much of the spectrum of mental illness we see today."

If childhood trauma is indeed the cause of much of the spectrum of mental illness today, what in the way of primary prevention should communities be doing to prevent mental illness?

Is this meant to be answered "in 50 words of less"? Somewhere there's a diagram, one triangle on top of another, which sums it up pretty well, a combination of both community, and individual work -- identifying and supporting those likely to be less resilient because of family and community resources and attitudes, and building caring communities in which those community attitudes and actions are reinforced. If we can work to stop childhood "adversity" we'll be a long way towards reducing, but maybe not preventing mental illness. If you can remember that talk / review by John Reed, where he talks about reducing childhood adversity leading to a 30% reduction in later psychosis -- in other words "even in the best of times" some things will get away from us.

 

Pretty "ballsy" putting your thesis up on line in this way -- some of us are more professional sceptics than others, and you know what sceptics can do. What struck me at first is "Whatever happened to a focus on temperament?" Though, when you start thinking that way, the importance of body therapies perhaps becomes even greater. At the same time, one has to wonder why the thesis / abstract -- must admit I haven't read the whole thesis yet ;-D  -- phrased it as if it's a one or the other, and as if it's meant to apply for all. Whatever happened to (a) an integrative approach, combining elements across therapies -- Spinazzola's Component-Based Therapy? and (b) Whatever happened to the importance of the therapeutic relationship, perhaps even more important than type of therapy (and there's a LOT of evidence for that)? What is this beast called "CBT" (a medusa); or for that matter, are all attachment-based therapies the same? Therapy for what disorder -- are all survivors of childhood adversity the same in terms of what they need, what they want, and isn't client choice the ultimate decision; and  with some suffering PTSD, and others that "non-existing" (in DSM 5)  "Complex Trauma" / Complex PTSD. Even for PTSD, don't the different therapies have important elements in common Schnyder DOI: 10.3402/ejpt.v6.28186 which would render such comparisons somewhat uninterpretable?

So, I give you credit for taking on such an ambitious topic, but personally I'd be cautious about rushing to the same conclusion as you did, but congratulations on the work you've done, and on getting licensure. Hope your career goes well.

btw for citation purposes (just in case) Where'd you get your degree? 

Thank you for sharing. I'll take your paper with me when I speak with adopted children's therapists next time. I'm always questioning best practice. 

I'd like more time spent on current behavior and sensory awareness than past trauma memories. I realize all are important, but we are living now and must function today, appropriately. The old stuff prevents that. Ugh, the trauma cycle. 

"...including models that centralize childhood trauma as the cause of much of the spectrum of mental illness we see today."

If childhood trauma is indeed the cause of much of the spectrum of mental illness today, what in the way of primary prevention should communities be doing to prevent mental illness?