October 2, 2015
Mark Forman, PhD
A Trauma-Sensitive Approach to Meditation – Part I (of III)
The purpose of this three-part blog series is to provide support for those of you who may have suffered trauma and who want to either deepen or begin your meditation practice. This blog is also meant to aid psychotherapists and coaches who want to be able to support traumatized clients who are meditating or who are considering starting a practice. Hopefully, what we’ll cover will be useful for both beginner and advanced meditation practitioners.
We’ll focus on four major topics:
- What is trauma?
- What is triggering?
- The potential benefits of meditation for trauma survivors
- 9 lessons related to trauma and meditation (We’ll address lessons 1-3 in blog 1, and lessons 4-6 in blog 2, and lessons 7-9 in blog three)
While this blog series will emphasize some of the challenges traumatized individuals face when practicing meditation, I want to assure readers that I am strongly pro-meditation for the traumatized and non-traumatized alike. As a long-term practitioner of meditation as well as someone who lived through childhood trauma and its aftermath, I have experienced for myself some of the profound benefits of meditation despite running into a number of these issues in my own practice. I therefore see these challenges not as immutable roadblocks to healthy meditative growth, but as opportunities that, once recognized, can be used to cultivate greater discernment and self-compassion.
For those interesting in knowing more about this work:
This blog series addresses topics found in greater detail in my next book, Advancing in Integral Psychotherapy. The working draft of Advancing, along with the previously published Guide to Integral Psychotherapy, are the core texts of the Certified Integral Therapists (CIT) Training Program where we teach this material (and much more) to psychotherapists as well as professional coaches. We are now enrolling for our 2016 cohort.
What is Trauma?
We can begin with this definition: Trauma is “the psychological damage resulting from uncontrollable, terrifying life events” (van der Kolk, 1987, p. 1). Here, however, we need to understand that what someone experiences as “terrifying” is relative to the age of the person and the specific situation. Some events, such as experiencing a high speed car crash, are terrifying to most everyone. Being trapped in a stalled elevator for a few hours might be terrifying for someone with a fear of closed spaces, but only be boring and frustrating for others. Walking into your mother’s room to find her her passed out drunk might be deeply frightening to you if you are a child, but probably not if you are an adult.
Further, fear and terror are not always related to a single event, but can build up over time. If a spouse is physically abusive, the first violent incident may evoke as much anger and confusion as fear. But if the physical abuse occurs repetitively, the violence and anticipation of it may easily develop into feelings of terror.
We might therefore sharpen our definition of trauma in this way:
Trauma is the persistent – but usually reversible – change to the mind, body, and nervous system that occurs as a result of overwhelming fear or stress. This definition accounts well for the fact that traumatic incidents can be single events or they can involve stresses that accumulate over time to a breaking point.
A second key question on the topic of trauma is this: Have you experienced trauma? Is this blog meant for you?
There is no easy way to answer this question for everyone. However, we should be aware that we are going through something of a renaissance in terms of the culture’s view of trauma and its treatment; therapists are emphasizing it more in their treatment and lay people and institutions are becoming more aware of it as a public health and public mental health problem.
In reality, this is a good news/bad news situation. The good news is that as awareness of trauma is raised, individuals feel less stigmatized, treatment options tend to expand, and people are more likely to receive appropriate care. The bad news is that when clinical concepts such as trauma become popularized, they also tend to become over-diagnosed by professionals, over self-diagnosed by lay people, and often over-medicated as well. This, ironically, can lead to important mental health issues being taken less seriously.
The fad-like spread of mental health diagnoses has taken place in the recent past with ADD and bipolar disorder for example, where ADD has come to mean something like “a little scattered” and bipolar has come to mean “my mood can be a little erratic”. (Both conditions when diagnosed properly are more serious than that). This is now happening to a certain extent with the notion of trauma, which is starting to signify that one has been “a little shocked” by something.
The best way to avoid the cultural-hype and gauge your trauma accurately is by taking a look at the objective history of your own life. Trauma is intimately tied to very serious, real-world events, and the events that tend to cause it are predictable. Here are two short check-lists to consider:
In childhood, the most common causes of trauma are:
- Emotional abuse
- Physical abuse
- Sexual abuse
- Experiencing significant health issues, accidents, or fear of death (i.e., war, violent neighborhoods, natural disasters, car crashes, etc.)
- Having a parent with severe mental health issues or an addiction
- Witnessing domestic violence
- Loss of a parent through death or imprisonment
In the adult years, the most common causes of trauma are:
- Rape or sexual assault
- Physical assault or being a victim of other crimes (i.e., robbery, stalking, etc.)
- Emotional, physical, or sexual abuse in romantic relationships
- Major negative change in life circumstance (i.e., bankruptcy, homelessness, incarceration, etc.)
- Death of a spouse or child
- Experiencing significant health issues, accidents, or fear of death (i.e., war, dangerous neighborhoods, natural disasters, car crashes, etc.)
If you think you have been traumatized, and have one or more of these events in your life, there is a good chance you share some of the key characteristics discussed in this piece and that that will impact your meditation practice.
Next we need to explore the concept of triggering. Triggering refers to the self-protective reaction that occurs when a person is exposed to a reminder of a trauma. Triggered mental states are marked by reactive/impulsive behaviors and often unyielding, vehement emotions. In general, the more severe or repetitive our previous traumatic experiences, and the earlier they occur in our life, the greater the intensity and complexity of our triggered responses (see van der Kolk, 2005; van der Hart et al., 2006).
Therapists divide responses to trauma into four categories that appear to be hardwired in us by evolution (see Fisher, 2001). They are sometimes referred to as the “Four Fs”. They are:
1) Fight responses, which are angry responses towards self or other
2) Flight responses, which are panicked or anxious
3) Freeze responses, which are dissociated or depressed
4) Fawn responses, which are clinging and submissive
All of these responses arise for a good reason: They can highly protective and adaptive at the time of the trauma and can help prevent bodily or psychological damage. However, problems arise when the original trauma is not worked through or emotionally discharged. Ongoing traumatic reactions in the present when there is no threatening situation can have a deep negative impact on ourselves, our loved ones, and our functioning in the world (Levine, 1997).
Here are a few additional points which are key to understanding triggering:
Triggering reminders need not be obviously related to the original trauma, such as when a person with combat-related war-trauma is triggered by hearing a gun shot in his neighborhood. Instead, triggers may also be tangentially related, symbolic, or just emotionally consistent with the original traumatizing situation. An example might be having a loud (but otherwise typical) argument with a significant other that triggers earlier traumatic interactions with an angry, abusive parent. Another would be financial struggles which trigger early feelings of instability due to having an unreliable, alcoholic parent.
Triggering may also occur even if the survivor does not consciously remember the trauma. This is possible when the trauma happens prior to age 4 or 5. Past that age, people almost always remember traumatizing events. (The idea of repressed traumatic memories is mostly a myth, and we should be very wary of any claims that we can hypnotically or otherwise recovered). In other words, very early traumatic experiences can be “stored” in other forms of memory besides what is known as episodic memory (see Forman, 2010, Chapter 3; Poulos, et al., 2013). If you believe you might be a victim of early life trauma, speaking to family members or caretakers who remember that period of your life will usually lead to the best and most helpful information.
Triggers – it also must be emphasized – need not always be negative. Many trauma survivors are triggered by positive experiences. While this may seem counterintuitive, trauma survivors often have a great deal of difficulty acclimating to happiness as a psychological and physiological state. Thus good feelings may serve more as reminders of what went wrong than as a chance to feel upbeat. For trauma survivors happiness, intimacy, and love can trigger significant amounts of unprocessed grief, anger, or fear that the source of the positive feelings may leave (such as being abandoned by one’s romantic partner).
Finally, it is important to understand the temporal dimensions of triggering. Short-term triggering can last minutes, hours, or days. But because of the way that traumatic reactions are incorporated into the individual’s mind and body, triggering may also be chronic. In other words, we can have lower-grade fight, flight, freeze, and fawn reactions that occur over years or even decades post-trauma.
It would not be a mistake to say that some of you reading this blog who have experienced trauma are triggered right at this moment but are not consciously aware of it because of how deeply normal the triggered feelings have become. You will just know that you are somehow uncomfortable or vaguely in pain. Your trauma may also have been masked and labeled by its symptoms – depression, anxiety, ADD, or other more commonly understood mental health issues. Without work specifically on the underlying trauma, it will be difficult for you to resolve these symptoms.
The Potential Benefits of Meditation for Trauma
Now that we have discussing triggering, let’s briefly consider how meditation may be able to help. We can do this in a simple way by considering trauma in its cognitive and somatic (bodily) impacts.
Traumatic triggering has a number of cognitive manifestations: guilt, negative self-evaluations, fearful anticipation, angry judgments of others, and flashbacks in memory. Meditation, by teaching nonattachment to thoughts as well as non-attachment to self-concept, offers trauma survivors an additional route to cope with these reactions. It teaches us to let reactions go and pass rather than reactively clinging to them. (The more intense the triggering, the harder this is by the way).
Meditation also increases our ability to focus, pay attention, and be mindful. This can be a serious challenge for trauma survivors when they are triggered. Triggered states are what is known as hypofrontal. This refers to the frontal cortex of the brain, which is responsible for effective thinking, planning, and regulation of emotions.
In hypofrontal states, the frontal cortex actually loses effective functioning (Koenig & Grafman, 2009; van Harmelen et al., 2010). This is the common experience people have of “losing it” in a triggered state of fear, anger, dissociation, or grief. This also accounts for why trauma survivors so often struggle with addictions and compulsive behavior. In triggered states they lose the ability to think straight and look impulsively to outside compulsions or substances to help them regulate their emotions. Meditation may counteract this by directly strengthening the capacity to focus and even increasing the physical thickness of the frontal cortex. This can help us stay more present during triggering and support us to make more appropriate self-soothing choices (see Lazar et al., 2005).
We can also see the potential of meditation to treat trauma through a somatic lens. Traumatic reactions have a very distinct physicality – feeling or “body memories” that come forth quickly and without conscious intermediary thought (see Levine, 1997; van der Kolk, 2014). These are often highly uncomfortable and can even rightly be called physically painful. Meditation teaches us the capacity to relax the tensions underlying some of the reactions and to enter positive states of bodily experience. While even deep meditative experience will not fully erase these trauma-related body memories, it can offer a means to learn to regulate our nervous systems and to enter restorative states of pleasure (Benson & Klipper, 1976/2000).
Combining its cognitive and somatic components, meditation can be said to encourage a state of alert, present-centered, and calm wakefulness in experience. We can summarize the goals of meditation this way:
- To learn to be in the present as opposed to the past or the future
- To learn to be alert without moving into fear, clinging, or hyper-vigilance
- To learn to be relaxed without moving into numbness, sadness, or dissociation
Meditation would seem to be one of the best – and perhaps the most direct – ways to learn this kind of state.
A Trauma Sensitive Approach to Sitting
All this said, meditation is not a panacea for trauma. Instead, a traumatized person’s practice of meditation must take into account additional issues.
Here I would like to offer some lessons I have learned from working with traumatized clients, taking part in many meditative practices and groups, and from my own personal experience as a trauma survivor. Naturally not every lesson below will apply to you if you are a trauma survivor or to a client of yours if you are a therapist or coach.
Lesson #1: Meditation by itself is never enough. As a trauma survivor, you will also need to do multiple forms of psychotherapy.
We will begin with the most basic lesson – and probably the most familiar to readers – about trauma and meditation:
While meditation can be profoundly helpful in the face of trauma, meditation by itself is never going to fully erase the presence of trauma in the mind or body or teach you all the tools you will need to cope with or heal trauma. If a spiritual teacher or tradition tells you that meditation or another spiritual practice can deliver total healing from trauma, I would recommend ignoring that specific teaching. As a trauma survivor, you will learn to need to question teachings that are spiritually absolutist in this way. We will touch on this more below in a later lesson.
The wiser approach is to take for granted that you will need to engage therapy at least intermittently post-trauma in order to heal. The support for trauma recovery will be much higher in a therapeutic contexts than in almost any meditation community, who will tend to leave you to your quiet, solo practice. They will typically not account for traumatic reactions in how they teach their practices. Meditation communities may you offer you wonderful ideals and goals about how you want to live in the world, but you will need to add therapy in order to help actualize those ideals.
It is also almost certain – unless your trauma was relatively minor – that one period in one type of therapy is not going to be enough. I have simply never met or worked with a serious trauma survivor who could get all they needed from one therapist or from one form of therapy.
The good news is that much is out there to be tried, and you likely have years in front of you to try it. There are cognitive approaches to trauma, such as trauma-focused cognitive-behavioral therapy (TF-CBT), somatic approaches such as Somatic Experiencing (SE) and Sensorimotor Psychotherapy (SP), approaches that focusing on traumatic memories such as EMDR, integrated-experiential approaches such as Evocative Psychotherapy (EvoPsi), and even emerging approaches that utilize psychedelics substances such as MDMA and psilocybin (e.g., Catlow et al., 2013; Mithoefer et al., 2013). With some searching you will certainly be able to find an approach that is right for you at this stage of your life.
Finally, it is important to emphasize that most psychotherapies have a strong interpersonal element which is lacking (for obvious reasons) in meditative practices. And relational healing is deeply pertinent to most forms of trauma. The sad truth is that fully 80% of childhood trauma takes place at the hands of a parent or caretaker (van der Kolk, 2005) and much adult trauma also takes with people we know (i.e., emotional or physical spousal abuse, date rape, etc.). It is not simply what you learn from your therapy in terms of skills or self-awareness that will help you heal. It is also the safe, supportive relationships that will you form with them.
Lesson #2: Having a devotional meditation practice or another form of devotional spiritual practice can be crucial for healing.
As a trauma survivor, psychotherapy should be the first tool you use to help you learn to form healthy, positive relationships. However, I would also strongly suggest that you take up a form of meditation or spiritual practice (such as centering prayer or chanting or ritual) that has a devotional element to it; something that moves your emotions in connection or surrender to a greater Other – be that a spiritual teacher or leader, saint, or God/Spirit Itself. You can take this as a main practice or a supplement to your main practice. Because loneliness and isolation are such major factors in trauma, with the wounds of early trauma going particularly deep, it is important for most trauma survivors to relate to spirituality personally, not just impersonally.
In other words, many popular forms of meditation – particularly those derivative of Buddhism – will emphasize being in the moment, concentrating on a mantra, following your breath, noticing your thoughts, scanning your body and so on. These are deep and wonderful practices, but they are not particularly heartful practices. And from a neurophysiological perspective, these are unlikely to produce marked increases in oxytocin and vasopressin, which are the hormonal keys to the feelings of bonding and attachment. But there is a strong argument to be made that devotional spiritual practices will produce this effect (see Grigorenko, 2011; Holbrook, Hahn-Holbrook, & Holt-Lunstad, 2015).
While such states are not substitutes for interpersonal relationships with other people, feelings of “spiritual attachment” are comforting, healing, and grounding to trauma survivors and can make the obstacles to healthy real-world relationships more passable. It will feel good to surrender yourself not just to some-thing larger than yourself, but to some-one (so-to-speak). If you are uncomfortable with this, I would suggest trying it anyway. Spiritual development without a corresponding development in your ability to feel safe and attached with others will leave you unbalanced as a person. More on this in a later lesson.
Lessons #3: Sitting when traumatically triggered must be done with great care or temporarily avoided. Don’t be a hero.
Almost everyone who tries to learn to meditate struggles at first. Meditation calls upon us to sit with quietly with ourselves, turn our attention inward, and become more aware of internal objects (thoughts, feelings, sensations, breath, etc.). The common challenges of meditative practice are well-known: Becoming easily distracted, impatient, frustrated, bored, or feeling insecure about how well we are doing. Most teachers and communities give a great deal of encouragement and reassurance to beginners to keep them motivated through these awkward, early phases of practice.
But psychological trauma introduces an additional challenge, especially when we are triggered. The turning-of-attention-inward required by meditation is something many trauma survivors have had special reason to avoid. Most trauma survivors are all-too-aware of looming painful memories, intense feelings of loneliness, self-punishing internal dialogue, and potent non-verbal moods. And most will go to great lengths to quell or distract themselves from these states.
If we are looking for an analogy, the difference between sitting with traumatic reactions occurring in one’s mind as opposed to sitting without them can be likened to the difference between guiding one’s boat through mildly stormy seas versus sailing headlong into a hurricane. Most meditation teachers and instructors are not aware of this, and proceed to teach meditation without any special instructions for those with trauma.
What to do? As a trauma survivor, issues of timing – when we sit to mediate and how long to sit – become very important. Trauma survivors who meditate do best when they are aware – and when therapists can help them become more aware – of the underlying emotional context they are sitting in on a given day. Trauma survivors must learn their triggers and trigger-and-recovery cycles extremely well so that they can approach sitting with their traumatic reactions in mind.
Along these lines, here are a few concrete suggestions:
- Consider meditating for shorter periods, such as 10-20 minutes. This approach encourages us to learn to sit with traumatic feelings in small doses without overwhelming ourselves or eventually dissociating.
- A somewhat contrasting perspective is this: The first portion of any particular meditation period is when the most uncomfortable emotions and thoughts tend to arise. The longer you sit, the calmer you are likely to become. However, you have to learn to gauge for yourself when you have the stamina to push through for a longer sit. A general rule is: Don’t be a hero. Approach yourself with care and compassion.
- Consider using a more active form of meditation if you are triggered, such as internal repetition of a prayer or mantra, moving meditation, noting out loud, or chanting. This is as opposed to more passive/receptive approaches to meditation which may just leave you swimming in a sea of traumatic reactions. The more activity you can provide yourself in the meditation, the more you will be distracted (in a positive sense) from traumatic reactions.
- Consider skipping meditation and doing another form of self-soothing care for a day. If you are on a lengthy retreat, you should think about taking some meditation periods fully off to rest or unwind. Again, don’t be a hero.
On a good day – or during a non-triggered period – a trauma survivor will likely experience the same calming, positive benefits from meditation that a non-traumatized person will. However, on a hard day, and during extended periods of triggering, additional care is necessary.
Meditation is almost never an easy practice, but nor is it intended to be about sitting through unrelenting emotional pain, numbness, or dissociation. If we ask our clients (or ourselves) to simply push through – or if they are unaware that they are consistently sitting in triggered states – then over the longer term we run the risk of having them associate the trauma with meditation and meditation teachings. This negative association may interfere with some of the benefits of meditative practice, or eventually cause a trauma survivor to stop sitting altogether. A trauma-sensitive approach to meditation, which sees trauma as a special type of internal state which must be negotiated, is a wiser approach.
Lessons 4-6 coming soon! Stay tuned!
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