FORWARD FACING TRAUMA THERAPY HEALING THE MORAL WOUND

FORWARD FACING TRAUMA THERAPY: HEALING THE MORAL WOUND J. Eric Gentry, Ph. D, LMHC Board-Certified Expert in Traumatic Stress Vice-President Arizona Trauma Institute

2 International Association of Trauma Professionals

SATISFACTION WITH LIFE ED DIEINER, 1985 1 = Strongly Disagree / 2 = Disagree / 3 = Slightly Disagree / 4 = Neither Agree nor Disagree / 5 = Slightly Agree / 6 = Agree / 7 = Strongly Agree _____ 1. In most ways my life is close to ideal. _____ 2. The conditions of my life are excellent. _____ 3. I am satisfied with my life. _____ 4. So far I have gotten the important things I want in life. _____ 5. If I could live my life over, I would change almost nothing.

SATISFACTION WITH LIFE ED DIEINER, 1985 OPTIMIZATION Minimal SX focus COPING & RESILIENCE Significant SX reduction SAFETY & STABILIZATION Profound SX reduction – Enhanced coping 35 31 Extremely satisfied 26 -30 Satisfied 21 -25 Slightly satisfied 20 Neutral 15 -19 Slightly dissatisfied 10 -14 Dissatisfied 5 -9 Extremely dissatisfied

20 TH VS 21 ST CENTURY 20 th Century 21 st Century Life is stressful Life is full of perceived threats Work causes stress Painful learning at work causes us to perceive threat and have dysreuglated ANS at work We must address the environment and We must develop interoception and remove stressors to have QOL self-regulation to have QOL (Internal [External LOC) PTSD is psychopathology PTSD is evidence of optimal development to trauma yet remaining “over adapted” in the present context You must face your past to heal trauma Relax the muscles in your body, confront fear, go forward to heal trauma People who breach their integrity have People who breach their integrity are a lower moral character trauma survivors.

FORWARD FACING TRAUMA THERAPY TREATING SURVIVORS IN THE 21 ST CENTURY • Stress (pt. Sd) – caused by increased perception of threat where there is no danger • Chronic perception of threat (21 st Century) = chronic ANS dysregulation • Interoception and acute relaxation is the antidote to SNS dominance • Anyone can learn interoception and self-regulation • Confronting perceived threats with relaxed muscles initiates reciprocal inhibition > desensitization (DTE) • Chronic dysregulation thwarts intention. Reactivity = breach of integrity • With intention made explicit + relaxed muscles anyone can remain intentional. • Increasing intentional behavior via relaxation heals trauma of the past going forward.

RECIPROCAL INHIBITION INTEROCEPTION INTENTIONALITY A new path for trauma treatment

PERCEIVED THREAT + RELAXTION = DESENSITIZATION

Reciprocal inhibition • Joseph Wolpe (1955 -56) • CS (Anxiety) + Relaxation = Extinguished CR • Engine of ALL effective psychotherapeutic treatments for anxiety/trauma • Most trauma survivors confront perceived threats with ANS arousal (i. e. , “brute force”). Treatment proper is teaching them to confront these perceived threats with ANS regulation (left-hand side of Yerkes-Dodson) • BOUDEWYNS promulgated this idea in 1990. He was, however, inconsistent with the use of relaxation with exposure.

DIRECT THERAPEUTIC EXPOSURE • Direct Therapeutic Exposure (DTE) is a behavior therapy technique pioneered by Patrick A. Boudewyns, where stressors are vividly and safely confronted to help combat veterans, and patients suffering from posttraumatic stress disorder (PTSD), panic disorder, or phobias. Exposure therapy has supporting evidence with both simple and complex traumas. • BOUDEWYNS, P. A. , & HYER, L. (1990). Physiological re sponse to combat memories and preliminary treatment out come in Vietnam veteran PTSD patients treated with direct therapeutic exposure. Behavior Therapy, 21, 63 -87

THREE STAGES 1. EDUCTION • Tools for Hope (Perceived Threat/ANS/Self-regulation/Intentionality) • Skills Development for Self-regulation 2. INTENTIONALITY (vs. REACTIVITY) • Covenant/Mission Statement • Code of Honor • Vision 3. COACHING • Confronting Perceived Threats (triggers) with Regulated ANS • Helping client to identify breaches & triggers • Continue confronting triggers with relaxed body

Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom. - Viktor Frankl

TRAUMA: THWARTING INTENTION – BREACHING INTEGRITY • Impatient • Snarky • Resentful Reactivity Covenant Past painful and/or traumatic learning experiences • Loving & Supportive Trigger • See • Hear • Feel • Taste • Smell Eric, you should… Vision • Listening • Supporting • Feeling Love

HEALING TRAUMA WITH INTENTIONAL LIVING • Impatient • Snarky • Resentful Reactivity Past painful and/or traumatic learning experiences Covenant • Loving & Supportive Self Regulation Trigger Intentionality • See • Hear • Feel • Taste • Smell Eric, you should… Vision • Listening • Supporting • Feeling Love

PRACTICE: INTEROCEPTION & SELF-REGULATION • Interoception • Self-regulation vs. relaxation • • Body scan “Wet Noodle” Figural muscle using Jacobsian relaxation Pelvic Floor

FORMULA FOR HOPE Intention into Words + RELAXATION Comfortable Body = Maximal Motor & Cognitive Functioning = Intentional instead of Reactive =

J. Eric Gentry, Ph. D, LMHC PO Box 937 Phoenix, AZ 85001 j. eric. gentry. phd@gmail. com www. compassionunlimited. com www. forward-facing. com www. aztrauma. org www. kleenmusic. com