Trauma-sensitive mindfulness: PTSD and meditation
If you have some trauma in your life, you may need to take certain precautions when meditating. While meditation can provide deep relief, calm, and even healing, it can also reveal trauma previously repressed or denied.
Trauma is an event or series of events that is so stressful that it makes us feel overwhelmed, helpless, and often fundamentally insecure. In some cases, these do not have to be particularly triggering dramatic situations but are created by prolonged emotional strain or stress.
Trauma is common, and most of us move on without lasting problems. However, about 8–10% develop post-traumatic stress disorder or PTSD. And recent studies suggest that 20% of patients with chronic pain also suffer from post-traumatic stress.
Mindfulness meditation can sometimes make people with PTSD feel “stuck” or poorly manage their emotions. In the worst case, meditation can lead to retraumatization. With retraumatization, strong emotional reactions or destructive coping patterns are activated, without the person having methods to regulate these. Over time, this can lead to a worsening of the condition.
Signs of possible PTSD
If you experience any of the following signs, there is reason to believe that you should adapt your meditation practice and perhaps seek other help:
- Re-experiencing the trauma through difficult memories, flashbacks, and nightmares.
- Emotional numbness and avoidance of places, people, and activities that recall the trauma.
- Elevated nervousness that has a recurring effect in one or more of these:
- sleep problems
- concentration problems
- easily angered
- easily startled
- unable to stop moving or sit still
If this describes what you are experiencing, it may make sense to talk to a trauma-informed meditation teacher and/or your physician or psychologist.
A hypersensitive survival mechanism
A particular challenge for many with PTSD is that their attention tends to be drawn towards what triggers a re-experiencing of their trauma.
During meditation, it can be difficult for many with PTSD not to notice anything other than sensory experiences that have to do with the trauma. This can be in external senses, such as particular smells or places, or internal senses such as specific thoughts or feelings and sensations in the body.
This tendency is a natural survival mechanism called the orienting response, but in PTSD, the response has become hypersensitive.
You can learn to navigate around a hypersensitive orienting response, and over time curb hypersensitivity.
How meditation can make you less aware
At the other end of the scale from hypersensitivity is numbness or dissociation. This is a defense mechanism in which the individual protects himself against overwhelming emotions by not relating to them. Instead, the mind is distanced, and the emotions numb.
Dissociation comes from trauma and is also a normal reaction to stress or boredom that everyone experiences from time to time. Depending on the situation, there may be a normal response. Still, if dissociation becomes a pattern of action to avoid stress and discomfort constantly, it can create many problems in the long run.
We understand dissociation best as a range that goes from everyday dissociation (such as doing something on autopilot, e.g., driving a car while thinking of something else), via a defense mechanism in the case of overwhelm, to dissociative disorders (which in some cases involve fragmentation of personality, memory loss, etc.).
Meditation can also lead to another form of dissociation during certain concentration states. Sometimes concentrated states of mind, whether deep or light, can actually be a subtle way of escaping what is happening in our experience. If you often notice that you feel hovering or distant from the meditation, there may be signs of dissociation.
Escape from overwhelm is not a problem in itself. And creating distance from an intense experience or situation may be just the right thing to do. But constantly fleeing from our emotions does not mean that the underlying problems are gone. They affect us in secret.
Therefore, it is useful to regularly check if what we do in the meditation practice is of lasting benefit. If not, we are doing ourselves a disservice and perhaps exacerbating a tendency that creates problems for us and those around us.
If you have PTSD, what can help?
Meditation is an excellent addition to, but not an alternative to, therapy.
This means that if you have substantial mental challenges, then the rule of thumb is that you should seek a qualified therapist. Meditation may very well be able to help and support therapy, but it is not certain. Or maybe you wait a bit with meditation before you start other therapy.
PTSD is a disorder that requires a therapist with special expertise in trauma.
There are therapists in the complementary and alternative health field who can provide good help, but it is wise to exercise special judgment when looking for a therapist. Authorized psychologists and psychotherapists with special training in trauma treatment may be a safer choice.
Certain treatment methods for trauma include meditation as part of the protocol, particularly dialectical behavior therapy. Other treatment methods have also shown a good effect in combination with meditation, such as cognitive therapy.
How do you meditate if you have PTSD?
In meditation, we have two main strategies — to turn towards and to turn away from.
Due to the orienting response, many people with PTSD experience that their attention automatically turns to traumatic sensory experiences (e.g., memories or emotions). In ordinary meditation teaching, the exercise will be to have equanimity and sensory clarity with this experience. The problem is that for someone with PTSD, this will often only scratch wounds that need more than attentive presence to heal.
Therefore, it is important to start by doing meditation techniques where one turns away. Then over time, gently and gradually turn to sensory challenges.
This involves two steps:
- to choose the right technique
- to apply the brakes if you notice that you have been triggered
Use the right technique
Each individual needs an individually tailored approach for the best possible help with PTSD. Here are just a few general guidelines.
Find a safe focus object, stabilizing, and works well for you.
The meditation technique Focus Out is particularly suitable because it uses only external sensory experiences as focus objects: external sound, external visual experiences, and body sensations that are not emotional in nature.
Here are some suggestions.
Focus outside the body
Pay attention to external sound.
- Meditate on music
- Meditate on natural sounds, such as birdsong
- Pay attention to other external sounds
Pay attention to external visual impressions.
- Notice objects you see around you
- To use a label can often be very stabilizing! Feel free to describe what you see with a mental or spoken label. For example, “blue carpet,” “a round table, white tablecloth, cotton.”
Focus on non-emotional body feeling
- hands against the table
- feet against the rug
- press your hands together
- other non-emotional touch
- focus on the breath if it works for you
- try using labels to see if it helps
NOTE: For some, the focus on the breath stabilizes. For others, it triggers or aggravates the situation. Remember that you do not have to meditate on the breath if it does not work for you.
3. Focus on taste
- meditation at meals
- have something that tastes strong and good in the mouth, such as candy or throat lozenges
4. Focus on smell
- use soothing odor
- hand cream
- essential oils
It is essential to be able to work with trauma at a pace that suits you.
The phrase “putting on the brakes” comes from trauma specialist Babette Rothschild and refers to how you can consciously slow down in a mindfulness practice to feel safe and stable.
Since many people with trauma experience a lack of control, it is important to find strategies to regulate themselves when encountering traumatic triggers. You can learn to slow down if you show signs of accelerating out of control.
A basic rule of thumb in mindfulness is that we do not consciously bring back memories of negative experiences to work with them. There are some exceptions to this rule, but this is extra important in the case of trauma. When meditating, do not consciously recall traumatic memories if possible.
If traumatic memories come up by themselves during meditation, this is different. Then it is up to your discretion and your abilities whether you want to turn away through braking or changing meditation technique or turn toward with other meditation techniques.
There are many ways to apply the brakes:
- Open your eyes during the meditation
- Soothingly touch the body (e.g., holding the heart or stroking the arms)
- Take regular breaks from mindfulness practice (eg go for a walk, do leisurely movements such as yoga, have unstructured time without mindfulness)
- Take a few long, deep breaths. When overactivating, use regular inhalation and long exhalation (NOTE: For some, focusing on the breath stabilizes, for others, it triggers or aggravates the situation.)
- Do shorter meditation sessions
Here are some suggestions for further exploration:
If you want to learn more about trauma-informed mindfulness, I can highly recommend the book Trauma-Sensitive Mindfulness by David Treleaven.
If you want to learn more about trauma in general, another classic is The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk.
You can also contact me if you need to talk about your situation. If necessary, I can help refer on to someone with special expertise.