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Information and education about psychology, gender, and trauma.

Advice and reflections on writing, research, and life in academia. 

Posts written by Dr. Jem Tosh and Dr. Lucy Thompson. 

When Anxiety and Fear Prevent You From Accessing Trauma Therapy

By Dr. Jem Tosh CPsychol AFBPsS RCC



Avoidance can be one clue that trauma is showing up in your life. This can be because you're dealing with so much stress and so many trauma responses that the very idea of something that could be slightly stressful (like meeting a new person, going to a new place, or starting therapy) might feel like too much. It can also be that the thing we are avoiding is a trauma trigger - so opening up and that sense of vulnerability might be triggering a past trauma when we were hurt or humiliated for talking about how we feel, or maybe we disclosed something and weren't believed.


This is one of the ways that trauma can become a bit of an annoying cycle - such as wanting to start therapy to reduce or stop trauma responses, but those very responses are getting in the way of us accessing help. So if you find that you want to do something, like start therapy, but you can't or the thought of it seems overwhelming (such as ruminating about it, anxiety, shallow breathing, increased heart rate and body temperature etc.) or that you find ways to avoid it (such as distraction, keeping busy, or keeping it on the to-do list but it never quite makes it to the top), that can be a clue that trauma is present and impacting on your actions.


What to do when your trauma responses get in the way of you accessing trauma therapy


While working with a therapist will likely involve learning some new coping strategies for managing difficult emotions, that's not all that helpful when you can't get to therapy in the first place. So let's say you're thinking about scrolling Psychology Today looking for possible therapists to contact. First of all, how intense does that thought feel? Where do you feel it in your body? Is it a tension in the chest? Does it feel like panic or dread? If you're having these kinds of responses, chances are the very idea of accessing support is triggering for you, and the best way to reduce that is to have trauma therapy. So rather than put it off, or push through and make that response more intense, we can find ways to reduce those sensations temporarily, making therapy more accessible for you. Then you can let your therapist know that attending sessions is triggering and you can ask about potentially focusing on that trigger first to make sure that you can access support regularly.


Tapping


As an Eye Movement and Desensitiztion and Reprocessing (EMDR) and Observed and Experiential Integration (OEI) therapist, I use tapping for calming a traumatised nervous system as well as reprocessing traumatic memories. It's such a simple movement that is so beautifully powerful at healing trauma. From the outside it can look like a very small gesture but on the inside tapping encourages the two hemispheres of your brain to communicate with each other, in a way that they missed out on when it froze during your trauma. So, when you're triggered, the parts of your brain that store a trauma memory and the sights and sounds and feelings connected to it, are activated. We can help the brain begin to process them by eye movement, sounds, and tapping. We can even do it with drawing, dance, and sports. It just takes the right context and preparation, paired with the movement that works best for your neurological makeup, and supports in place for helping you manage any difficult feelings or reactions that come up. And violà! Healing occurs.


So, if you're thinking about looking for a therapist, scrolling Psychology Today profiles, or have your inbox open while you write a message to a counsellor, you could try doing the butterfly hug before and/or after the task to help calm that nervous system down.



Alternatively you could try playing some Bilateral Stimulation Music while doing the task. This music plays a tone in one ear at a time (not all headphones allow this, so make sure to check first).


Covering your dominant eye


This technique is based on OEI therapy, which originated in Vancouver, BC in the mid 1990s and continues to be developed by Dr. Rick Bradshaw and Audrey Cook. It is an advancement of EMDR methods and similar to a later approach known as 'brainspotting'. Because trauma memories don't get stored in the brain like non-traumatic ones do, and that dialogue between the two hemispheres didn't get completed, one side of your brain tends to experience a trauma more intensely. So, like tapping, we have another very simple way of reducing the intensity of the trauma response that is showing up and making it difficult for you to access therapy. Keep both eyes open, cup one hand and cover one of your eyes so that it is in complete darkness. Don't press on your eye, keep you hand curved so that there is space between the palm of your hand and the surface of your eye. Keep that eye open but covered. Pay attention to how to you feel now about whatever task you are struggling with - whether that's looking for a therapist or showing up to your appointment. How difficult does it feel? Now switch eyes and do the same. How does it feel on this side? Which side does the task feel easier or more possible? Try staying on that side while you complete the task. If keeping you hand up isn't possible or is uncomfortable, you can try using an eye patch.



Visualisation


I often advise my clients to take moments during the day to bring intense emotions down and to calm their nervous system. This is because triggers accumulate. So, if you go through your day getting triggered by a million tiny unnoticeable things (or perhaps some big and noticeable things too) by the end of the day you're going to feel pretty overwhelmed and those trauma responses (like anxiety, rumination, irritability, binge eating, avoidance, insomnia, and so on) will be in full force. But let's say in the morning, maybe before you've had breakfast, you do some tapping to counter any triggers that happened while you were asleep. Then maybe you cover your dominant eye for a few moments during lunch time, and you do some restorative yoga when you get home from work. Instead of all those triggers piling on top of each other until you're at breaking point, these moments help to 'reset' the nervous system and can reduce that intensity each time.


You could try doing a guided visualisation (if visualising is something that you find helpful) like the container exercise, to reduce intense feelings before trying to contact a new therapist or before leaving your home to attend a session. If visualising is difficult for you, or you experience aphantasia (when your brain doesn't create mental images for thinking or imagination), you can try using an object to hold in your hands or a picture to look at. Instead of imagining a container, you can concentrate on the container you are holding or that you can see in front of you.



In session


When I work with clients who are struggling with attending sessions because they are a trigger, I tend to approach this in three ways (depending on the client and the unique aspects of their case). Firstly, I'll likely use an OEI technique to address transference. This is to make sure that any trauma that is showing up doesn't get projected onto me and therapy begins to feel like a safe space. I will then often use a combination of a particular form of questioning that helps us find the root trauma that is causing this issue to show up. We find the core memory (or memories) and begin to plan together our strategy to address those memories with EMDR and OEI reprocessing. If needed, I sometimes address that avoidance directly with the EMDR avoidance protocol. This is in addition to helping build up the client's resources for managing difficult emotions, some of which you can find here.


[These strategies are offered as possible suggestions only and may not work for everyone. Please evaluate whether or not these techniques are appropriate for your individual and unique experience and stop any activity if intensity of emotions increases.]

 

About the author


Dr. Jem Tosh (they/she) is a Chartered Member of the British Psychological Society, a Member of the Canadian Psychological Association, and a Registered Clinical Counsellor in British Columbia, Canada. Jem is a Doctor of Psychology, a therapist, an educator, consultant, and an award-winning researcher and author.


Jem provides affirmative, anti-oppressive, and trauma-centred counselling in Langley, BC and online to BC residents (and/or visitors). They specialise in working with survivors of violence and abuse, 2SLGBTQAI+ and neurodivergent clients.




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