For trauma survivors, one of the most insidious roadblocks to healing is often the debilitating feeling of shame that can linger after a traumatic experience.
So how can practitioners help clients begin to reclaim a sense of self-worth?
Kerstin Jung, PhD and Regina Steil, PsyD, at Goethe University Frankfurt, in Frankfurt, Germany, wanted to find out whether Cognitive Restructuring and Imagery Modification (CRIM) could empower adult survivors of childhood sexual abuse to move beyond feelings of shame associated with trauma.
CRIM is designed to help patients do two things: change the way they see themselves (Cognitive Restructuring), and change the imagery they associate with their trauma (Imagery Modification).
To test the CRIM method, Dr. Jung recruited 34 women who suffered from PTSD as a result of a childhood sexual assault, and who self-identified with the “feeling of being contaminated” (the phrase Jung used to describe shame associated with trauma).
Next she randomly assigned them to the experimental group or a waitlist control. The experimental group took part in CRIM, a two-session treatment, lasting 90 and 50 minutes.
The patient begins by discussing the feeling of contamination – what that means and whether it is something they experience physically, or just perceive in their mind.
Next the patient is asked to use the internet to research the life cycle of their skin cells. The idea here is that when patients discover it takes about 4-6 weeks for their body to replace all their skin cells, they will realize their body is no longer physically contaminated by their trauma.
Researchers then guide participants through a visualization of their body renewing its cells in order to cement
their understanding.
The final step in CRIM involves asking participants to activate the feeling of being contaminated and allowing any associated imagery to come to mind. They are then taught to replace those thoughts with the images of renewal they just learned.
So what did Jung and Steil discover?
The women in the CRIM group showed significantly greater improvement in overcoming feelings of shame and contamination than did those in the control group. What’s more, the treatment had significant impact on PTSD symptomatology.
Now we do need to keep in mind that this study focused on a small sample size of people who suffered trauma of a specific nature. And its waitlist control design doesn’t account for other factors that may have helped to reduce subjects’ shameful feelings.
I’d be interested to see what future studies might tell us about the impact this intervention could have on PTSD symptoms related to other types of trauma as well.
And if you’d like to know more about the study, it was published online by Psychotherapy and Psychosomatics in May of 2013. It was also published in the June 2013 issue of that same journal.
How have you helped trauma patients deal with feelings of contamination or shame? Please share your experience in the comment section below.
I am claustrophobic and agoraphobic. Is there hope for me with your program.
The shame I have felt is all on the inside..A car accident that was My fault that damaged me physically ..But you can no longer see that..I was left with chronic pain for over 40 years now but the shame of what I’ve had to go through is deep in my core..Definitely better now, since I’ve been practicing mindfulness.. Ruth I appreciate all your talks but this model doesn’t seem to address the core issues..I’m sure its helpful to many..
Also, we need to keep in mind that the “contamination” is not only on the outside for most people but in their core or on the inside.
Renee Michaels, Ph.D, LCSW
The context for the shame experience remains socially justified as child punishment, so I find no relief for the shame, and no empathy.
Part of the problem with Shame, is how we define it. We naturally internalize the “I am bad” message, and intelligent people confirm to us that shame means “I am bad.” I teach that this definition is incomplete. My working definition of shame is this: Shame means “I am bad in this way in this group.” The key is that shame is group relevant. Can you think of something that you’re ashamed of in one group, and not in another? I teach a workshop on shame, where I use a process called Adaptive Inquiry, and a more precise definition of shame that is based on a new theory of emotional causation that is now being validated at a major research university. The study above fits nicely into the methodology I use, though my approach offers more techniques – ones that I’ve found to be effective.
For me, this shame i felt as a child was the result of being so deeply wounded in such a primal way. I never felt is was ” my fault” ever. But that understanding did nothing to ameliorate the wound. I think clinicians need to let clients know that it’s normal to feel ” shame” ie deeply wounded after an assault, especially in childhood. Don’t treat the feeling like an enemy that one needs to be rid of.
I agree with you Sarah, I went into therapy only 4 yrs ago and diagnosed with PTSD, the first time I had a name to go with this disabling disorder. I really needed someone to validate the feelings and thinking that are attached to this illness. I needed validation of the shame, the feeling of inadequacy, the feeling of being a human failure, the feeling of being flawed. I needed one person to display unconditional love toward me as struggle to rise above the inferno of self hate and recrimination. It is just as Dante describes it, the Dark Night of the Soul….but in my case it has been the darkest 2decades of my soul.
Greetings,
Thanks for the note about skin cell replacement. I expect it will be helpful.
A simple demonstration or thought experiment comes to mind, about skin cell replacement. Apply a couple of strips of adhesive tape to some patch of skin that share the same sensitivity. Then take one off in a few hours and record how much it hurts. leave the other one on for two weeks, and then pull it off. the one that has been on longer will not hurt so much because the skin cells attached to the tape have died and been replaced by younger cells growing up. A variation would be to apply one strip and leave it on a week or two, and then apply another and leave it on just a short while… then pull them off at the same time.
Dave
I too really appreciated Dr. van der Kolks talk . . . Earlier this year, I learned in Brene Brown’s course, based on her book, The Gifts of Imperfection, that the feeling of shame itself creates some of the same physiological effect as trauma; the sweating palms, the rapid heart rate, the flushed face, time slows down, and in my own experience with trauma & shame, my mind goes numb, I cannot process information. I have on some occasions with a shame spiral, felt my face, knees and hands go numb and prickly. Dr Bessel van der Kolk describes trauma so well when he states that the brain goes off line. We get pulled back into the past, and words are difficult to retrieve to express the feelings in the body and the mind. the speech centre goes off line. All of this incredible work of your guests is helping me to understand this debilitating dis-ease of the brain & psyche in trauma. It is difficult to avoid exposure to shame in day to day life of interactions with other human beings, we live in a shame based culture, which makes recovery ever more difficult and adds to the feeling inadequacy to deal with these automatic, lightning speed reactions. Learning that much of my child hood trauma has shaped the the neurology of my brain, allows me to be much more compassionate with myself and feel less inadequate as a human being. Thank-you NICABM!
I facilitate Primal Therapy (Arthur Janov – The Primal Scream) and Art Therapy. I use cognitive therapy as taught by Recovery International – Dr. Alexander Low. I find that the body, thinking and imagination are all great sources for healing.
Very apt comments indeed. I use a model of hypnosis to reclaim a healthy body
Image and then both existential and SBFT (solution-based focused therapy) are tools to assist in a new concept of the self. That, and the mindfulness of movement and being in the present…
A good assessment is also quite helpful. I like the idea of what CRIM provides too.
Roger
In my experience the client has commonly internalized their relationship with the abuser so that there is a fixated early version of the self (Child Ego State) in thrall to the introjected abusive “other” (Parent Ego State). The spell imposed by this archaic abusive relationship must be broken. In Transactional Analysis we have ways of working within a safe, developed therapeutic relationship to empower the client to reclaim their true self and to decontaminate the power of the abuser. In other words, it is not enough to decontaminate the feelings associated with the trauma; the abusive relationship itself must be decontaminated so that the client may experience liberation. This is not a quick cognitive fix! Techniques such as CRIM may achieve some symptom relief but we must recognize that the effects of childhood trauma are multi-layered and require more subtle and complex therapy.
Yes that makes much sense. How do you typically go about that with your clients when the relationship is adult child and parent with an ongoing relationship of some sort.
I would like to ask Annegret about the ‘one session of cranial osteopathy curing the vagul response’ remark. Sounds wonderful.
I also would like to add as both someone who works with survivors and being a survivor myself, that reframing the trauma incident(s) is really helpful for me. Instead of remembering it with shame and blame and judgement – I carefully reframe it, in its truth, looking at how amazingly my body responded to shut me down, protect me, take care of me and I picture all the people who love me and know what happened to me, being there and just loving me even in the midst of the horror. sometimes they stop it happening but my truth is that it DID happen, so I find it so touching and moving that they ‘witness’ and love me through the worst of it. I did nothing wrong. I was done to. that really helps me. And my loved ones that I came to meet in the future after the events, know those traumas as incidents which show what amazing survivors we are. My traumas happened in private. Somehow making them witnessed – makes the full horror more obvious to me. It WAS horrible what was done to me. If any of us saw that happen in a public place we would intervene. So I feel less isolated. And I have asked every one of my support team: Could you bear to witness? and what would you do? And they all say they will witness (not ‘oh no, it is too awful to see’) and they answer that they would stop it/intervene ( a joy to hear) but as the past is done – they witness and hold me tenderly in their hearts.
don’t know if that helps any of you in your work, but it helps me.
Very powerful! Thank you for sharing Sarah! Being a survivor myself made me think that I hadn’t done this kind of work. I sense that I am completely healed from the work I have done to heal and I can definitely benefit from your kind of work for sure!
Bearing in mind both this therapeutic approach and Dr. van der Kolk’s presentation, here are some points this approach has in common with other helpful trauma integration/recovery work:
1. Revives body awareness in an atmosphere of safety and care
2. Using that awareness to enable one to distinguish between present and past
3. Enable the person to experience the memory of the past events without suffering the physical arousal appropriate to the past events. This is an experience of empowerment, a recapturing and reassertion of oneself, a successful resistance to and termination of the ability of the traumatizing experience and the abuser to do harm.
CRIM is a powerful tool and very helpful for patients who have experienced childhood sexual assault. The ‘dirty’ feeling goes deeper than skin, and the ‘cleaning’ work can be brought in to other renewed cells of the body, too. – It’s a great idea to let the patients do research to find out these facts by themselves!
The patients’ feeling of contamination is very physical, and it is intertwined with a deep feeling of shame that is caused by a strong belief that they are responsible for what happened – since they ‘did not tell anyone’ and ‘did not run away’ etc. I’ve seen the images of (physical) renewal make the feeling of shame dwingle down, also.
Thank you, Ruth, for this article! And all the other ones, too!
I really loved the Bessel van der Kolk talk . . . he is such a good presenter. A man who knows so much he can afford to be simple!!
It is so wonderful that we can now confirm by fMRI what practioners of psychotherapy have known for a long time- especially the much frowned upon body- minded ones, and what they have considered in their treatment plans for many years- : the debilitating role of shame as a consequence of trauma as well as the need for a image/body approach with PTSD.
I was sad to hear Bessel also took the ‘old Doc’s’ line with EMDR- wonder what he would think around cranial osteopathy- a technique that can soothe the vagus nerve in one session??
best, annegret
Really you ought to look up holographic memory resolution. Similar stuff. It works with trauma and alcoholism. Brent Baum has been doing this for years. I just took his training course. It’s an amazing technique.
there is no May issue of that journal, the correct reference is — Jung, K., & Steil, R. (2013). A Randomized Controlled Trial on Cognitive Restructuring and Imagery Modification to Reduce the Feeling of Being Contaminated in Adult Survivors of Childhood Sexual Abuse Suffering from Posttraumatic Stress Disorder. Psychotherapy and Psychosomatics, 82(4), 213–220. doi:10.1159/000348450
Hi Russell,
We’ve made an edit to clarify the reference. Thanks for catching that!
Best regards,
Jeff
NICABM Staff
I myself personally used a similar concept; I learned that every seven years or so, our entire body has renewed itself, each cell is new. It is a ‘new body’, ready for a new life.