Trauma Recovery Skills 2

Teaching Trauma Recovery Skills 2

Noticing: Noticing is one of the most important of the trauma recovery skills I teach. Noticing uses the medial prefrontal cortex (the mindful brain). The medial prefrontal cortex sends inhibitory fibers to the amygdala, thus “dampening down” the amygdala, which allows more mindful presence, which inhibits the amygdala more in a positive feedback loop.

I encourage noticing body sensations, images, movements, behaviors, emotions, thoughts, and the environment.

I use the questions “What do you notice?” or “What are you noticing now?” many, many times throughout the session. For instance, when the patient tells me bout some positive event or experience, I will ask “What are you noticing now as you tell me this? The first question is open ended in that I am not asking about sensation, thoughts, emotions etc.

This is doing several things. It slows us down. It promotes mindfulness. But most importantly. it brings the positive experience into the now, the present, here with us. And because it is in the room and the here and now, it becomes relational.

When the patient reports a negative event or experience, the same question is asked, What do you notice as you tell me about this ?” Now. when it is a negative experience or event I will often go immediately to one of the five areas of Levine’s SIBAM, or Ogden’s organization of experiences such as “What do you notice about your thoughts as you tell me this, or “What happens in your body as you tell me this?”

Again, this slows us down. It promotes mindfulness. Because noticing inhibits the amygdala it decreases the anxiety or “threat” of what the patient is experiencing in the room.

At this point we can link things together such as, “when you have these thoughts are there any emotions that go with this? or “any images/memories” or “any body sensations” or when you have these thoughts do you notice what your body is doing?”

This linking of the SIBAM channels stitching together the organizations of experience starts a process of meaningful (not just cognitive) insight.

As we do this with the patient, we can do several things. Here is where your instinct, or creativity or therapeutic acumen comes in. We can add more organizations of experience or we can go deeper in the therapy such as “Can you tell me more about this image/memory?” or “Do you mind just holding that feeling or emotion?” or “In your mind as those fists and shoulders are tight, what would you like to do? Not actually do but in your imagination (or mind, or fantasy)?”

Then, whether we are going deeper into the memory or linking more channels together (maybe even all five) the following question afterwards is, “What was it like to tell me about this memory?” or “What is it like for you to see, with me, how all these things link together?”etc.

Now we are not only expanding the use of the noticing brain, we are also solidifying the new insight and making the whole experience relational, which solidifies it even more. So, this is the general idea of noticing.

Depending upon the type of therapy, we can continue this process, or just keep it brief. such as “What do you notice as you are reading your thought log to me?” or “What do you notice when you tell me you only cut yourself once this week?’ or “What do you notice when you tell me you used your new communication skills with your mother?”

Whatever type of therapy I am doing, I have found that a short moment with a mindful question like “what do you notice?” or “What is that like for you?” can reap good benefits.