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This article appeared in FSMTA's June, 2019, Massage Message:

COMPLIMENTARY THERAPIES FOR PTSD

PTSD is finally getting the attention it deserves. While there is no one technique or therapy that fits everyone every time, there are many forms of bodywork that can be extremely helpful in helping the body resolve trauma. As body workers, it is important that we educate ourselves on this disorder and be aware of the challenges when working with those who suffer with it. This article will present the big picture of trauma and the role and scope of the body worker in the healing process.

The Big Picture of Trauma

There is very little in this life that prepares us for traumatic events. Even with an intellectual understanding, the exposure to trauma can bring us face to face with some of the darker elements of human life. While it is still often referenced to returning soldiers, it is now understood that
victims of all types of violence and those in professions such as law enforcement, firefighters, rescue workers, doctors and nurses can develop the symptoms of PTSD.

Trauma is often perceived as the result of experiencing a highly stressful event which overwhelms a person's ability to cope and is the individual's subjective experience that
determines whether an event is or is not traumatic. Psychological trauma is the result of an individual's experience of an event or series of events which:

 The individual’s ability to integrate his/her emotional experience is overwhelmed, or  The individual perceives a threat to life, bodily integrity, or emotional sanity.
Words often used to describe PTSD are:

*Shattered, broken, empty
*Losing one's sense of self
*Dead, lost or without hope or purpose
*No longer happy and engaged in life
*Disconnected from light or Source (God)

DSM-5 Diagnostic Criteria:

According to the DSM-5 (2015), a diagnosis of PTSD must be precipitated by exposure to a traumatic event that involves a loss of physical or emotional integrity, or risk of serious injury or death, to self or others. Re-experiencing through flashbacks or distressing dreams must also be
present as well as avoidance to stimuli associated with the trauma; alterations in mood or discernment (such as anhedonia or a distorted sense of self; insomnia and hyper-arousal. These symptoms must last for more than 30 days and result in clinically significant distress or
impairment in multiple domains of life, such as relationships, work, or other daily functioning.

Trauma Transference Syndrome

Memories of the trauma remains stored in the system until a ‘trigger’ occurs. Often, the real
cause of the original trauma is not recognized and can be transferred to a new stimuli or trigger.

This is important to remember, especially for therapists, because they can essentially become the new stimuli for the client to transfer blame for the trauma onto the therapist. It can be a complex and sensitive issue but essential for anyone working with this population. It is the inability to separate the past from the present that causes the ‘transference effect’ to take place and if the therapist is unaware of what their client is experiencing they will be ill-equipped to deal with the manifestations.

A form of "freezing," dissociation is a response to any type of threat and is a normal response to trauma. Because trauma and any form of dissociative state influences memory processing, it may not be until that person is well into adulthood that the incident is remembered. Stored
emotions may have been manifesting through a variety of negative perceptions or behaviors which can eventually result in major eruptions resulting in behavior that can leave the survivor (or those around them) to wonder what may be causing them to react that way.

The Role of a Body Worker in the Healing Process

Trauma is a thief. It steals from a person and takes away their sense of wellbeing, security, predictability and safety. Compassion and empathy is needed. This is the ability to view a situation from another person's perspective and objectively be present to someone's suffering
without taking on those emotions. Body workers who are experienced in various forms of energy work are familiar with the need to consciously take steps to set clear boundaries and this can be difficult if the therapist has unresolved trauma issues themselves.

However, many PTSD sufferers often feel more comfortable in the company of others who have experienced similar types of trauma, especially if they believe they will be verbalizing sensitive issues surrounding the trauma. This is particularly true with veterans and first responders. It's
one thing to empathize; it's another to have experienced it yourself. Under most circumstances however, it can sometimes be helpful to establish a connection by matching his or her style of thinking and speaking. The principal here is: "commonalities create comfort; differences
produce distance." Working within our scope of practice and the individual's needs and preferences are also important considerations when creating an atmosphere of safety and trust.

Working with Trauma--Treatment Options

Re-association with the body is possible through body therapies and may be a key to healing dissociation and improving mental and physical health in those who have been traumatized. In his book Dr. Bessel Van der Kolk believes that people can heal from trauma without having to talk about it. One of his colleagues, Dr. Spencer Eth, conducted a survey of 225 people who had escaped from the Twin Towers in 2002. When asked what had been the most helpful in overcoming the effects of their experience, the survivors credit acupuncture, massage, yoga, and
EMDR, in that order.

Massage and other forms of bodywork can be of great benefit when it comes to retraining the brain and muscles to become rebalanced and respond in positive and healthy ways. But it takes time to create new connections and for the brain to remember original pre-trauma neuronal
pathways and it's critically important for therapists to give their clients the space to do this. Even a basic Swedish massage can provide healing and growth if the individual is allowed to access and process the trauma in their own way and time.

This may be a challenge for those therapists who feel they must be doing something other than just performing a "relaxation massage." In my experience, there are two types of clients who present with PTSD: those who know they have it and are coming to you to work directly or indirectly with that and those who either don't know they have it or will not say they have it. This is why understanding the manifestations of trauma is so important; either way you will be more aware and able to tailor your techniques to accommodate them. It is possible that any type of bodywork can trigger traumatic response but there are a few energetic approaches that are ideal for healing somatic trauma and releasing negative experiences from the body. From a basic Swedish massage to advanced kinesiology or acupressure techniques, each can be as effective if it is presented in the right way at the right time.

Bilateral Stimulation

A well-known form of bilateral stimulation, Eye Movement Desensitization and Reprocessing (EMDR), is considered a standard treatment option for many counselors working with traumatized individuals. Developed by Dr. Francine Shapiro in the early 90’s, it is considered by some to be a variation of eye rotations developed from other modalities. Today, EMDR is an empirically supported form of therapy used to treat PTSD but is not limited to eye movement. It
can be auditory or physical and the only requirement for use outside the psychotherapeutic framework is for the person to focus on the distressing thought or emotion while experiencing the bilateral stimulation.

Acupressure Points for Trauma and Grief

Acupressure and auricular therapy is a variation of acupuncture. Pressure is applied over ‘acupuncture points’ which provides a stimulus similar to needling and can be just as effective relieving a wide variety of issues including pain and depression. There are several advantages to acupressure:

• it can be used for self-treatment or those with needle phobia
• it is painless and less invasive
• when incorporated within a massage therapy treatment it could be cheaper.

Even more effective is the tapping of meridian endpoints (usually located on the face or hand) while thinking of or saying a phrase describing a negative thought or feeling. Originally developed by Roger Callahan using basic muscle testing, it was revamped and renamed Emotional Freedom Technique by Stanford engineer Gary Craig. It has become a well-studied and validated therapy used by many in a variety of fields. Other effective treatments include Reiki, Shiatsu and the many systems using manual muscle testing.

If the past 25 years as a massage therapist have taught me anything, it was my training and experience in a wide variety of modalities and a solid foundation in the many different systems of Kinesiology that provided me with the skills to not only help myself heal, but to help my loved ones and clients heal as well. My hope is that you explore the wide variety of bodywork techniques applicable to PTSD and trauma and use them wherever and whenever you find
someone in need of them and within the scope of your professional body work practice.

References:

Amano, T., & Toichi, M. (2016). The Role of Alternating Bilateral Stimulation in Establishing Positive Cognition in EMDR Therapy: A Multi-Channel Near-Infrared Spectroscopy Study. PLoS ONE, 11(10), e0162735. http://doi.org/10.1371/journal.pone.0162735
Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P. P., & Keane, T. M. (2015, December 14). Psychometric Properties of the PTSD Checklist
for Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (PCL-5) in Veterans.
Chen, Y., Wang, H., (2014). The effectiveness of acupressure on relieving pain: a systematic review. Pain Management Nursing. (2):539-50. doi: 10.1016/j.pmn.2012.12.005. Epub 2013 Feb 15.
Church D. & Feinstein, D. (2017). The Manual Stimulation of Acupuncture Points in the Treatment of Post-Traumatic Stress Disorder: A Review of Clinical Emotional Freedom
Techniques Medical Acupuncture. 29(4): 194-205. doi.org/10.1089/acu.2017.1213
Engel, C., Cordova, E., Benedek, D., Liu, X., Gore, K., Goertz, M., Freed, M., Crawford, C.,
Jonas, W., Ursano, R. (2014) Randomized Effectiveness Trial of a Brief Course of Acupuncture for Posttraumatic Stress Disorder. Medical care 52 (2014): S57-S64.
Levine, Peter (2012) Waking the Tiger. Old Saybrook, Ct.: Tantor Media, Inc.
Van der Kolk, Bessel (2014). The body keeps the score: brain, mind, and body in the healing of trauma. New York, New York: Penguin Books. Pages 233, 255.
Van der Kolk, B., McFarlane, A., and Weisaeth, L. (2007). Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society. New York, NY: Guilford Publications,
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Wright, N. (2011) The Complete Guide to Crisis and Trauma Counseling. Ventura, CA: Regal Publishing, p. 124.