Overview of Conference Program

Based on his newest book, Principles of Trauma Therapy (with Catherine Scott, MD), Dr. Briere will present a nonpathologizing, developmentally-informed approach to the treatment of complex posttraumatic presentations.

This model incorporates cognitive-behavioral interventions, relational principles, and aspects of Buddhist philosophy to support:

(a) the processing of implicit and explicit traumatic memories through carefully titrated exposure

(b) a focus on mindfulness as an antidote to reflexive avoidance

(c) the development of increased affect regulation capacities, and

(d) the reworking of activated relational schema and other implicit memories within the therapeutic relationship.

A central premise of this perspective is that dissociation, substance abuse, self-mutilation, and many other "dysfunctional" behaviors are adaptive strategies that cannot be cured as much as rendered unnecessary by effective treatment.

Special topics will include the etiology and dimensionality of dissociative response, specific interventions in disturbed attachment schemas, “hot spot” processing, and the role of mindfulness/meditation in trauma processing and affect regulation training.

In addition, John will include a reevaluation of the phenomenology and function of dissociation, a discussion of pain versus suffering from Buddhist versus Western perspectives, and a critical evaluation of the benefits and limitations of psychoactive medications in complex trauma treatment.

Learning Objectives

At the end of this workshop, participants will be able to:

1. Outline the primary psychological impacts of early, sustained, relational trauma

2. Describe the five components involved in processing traumatic memories

3. List three approaches to the development of affect regulation capacities

4. Outline a mindfulness approach to psychological trauma

Program Outline

1. Impacts of trauma

• Cultural and cross-cultural issues
• The special problem of chronic posttraumatic stress
• Self-capacities: identity, relationality, and affect regulation
• The avoidance triad: Substance abuse, dissociation, and tension-reduction
• Psychosis and trauma: Misidentification, inadequate working models, and true comorbidity
• “Cluster B” personality disorders: Borderline and antisocial

2. Philosophy of trauma

• Integrating a Buddhist model of suffering, attachment, and mindfulness
• “Bad feelings:” The negative impacts of labeling experience
• Perception versus activated implicit memory: Source attribution errors and the complexity of personal experience
• The problem with solely symptom-based models
• Natural systems of trauma recovery; Intrinsic processing
• Posttraumatic growth, acceptance, and integration: Altering the paradigm

3. Assessing trauma and impacts in the clinical interview

• Assessing trauma exposure
• Evaluating trauma effects: Process responses and intra-interview signs

4. Distress reduction and affect regulation training

• Dealing with acute intrusions and dysregulation: Grounding and breath training
• Affect identification and emotional detective work
• Trauma-relevant meditation
• Mindfulness as affect regulation/tolerance training
• Trigger identification and intervention: The trigger grid
• “Process” affect regulation training  

5. Cognitive interventions

• Normalizing and reframing
• Cognitive reconsideration: An empowering alternative to cognitive restructuring
• Mindfulness training
• Nonjudgmental self-observation and awareness
• Nonattachment to thoughts, feelings, and memories
• No self: Altering self-esteem through a changed relationship to identity
• Insight and the development of a coherent, nonpathologizing narrative

6. Emotional processing

• Titrated exposure and the therapeutic window
• The components of trauma processing
• Mindfulness as implicit exposure
• Processing “hot spots” with focused CBT or EMDR

7. Increasing identity and relational functioning

• Self-exploration, inner directedness, and identity training
• Cognitive processing of relational schema
• Capitalizing on client-therapist attachment dynamics

8. An integrated approach to the use of psychiatric medications in trauma therapy

• Can trauma psychopharmacology “fit” with growth models of trauma recovery?
• Limits and uses of medication in trauma therapy

9. Therapist issues in trauma treatment

• Mindfulness and activation awareness: Making the work effective, meaningful, and growth-enhancing