This helps you to become aware of what is going on. That alone can make a big difference. Especially important is the explanation that the consequences of trauma are really the remains of earlier survival mechanisms that you developed.

Dealing with survival mechanisms

Trauma is in the body

Emotions and behaviour are not there ‘for no reason’; they always have to do with something. Finding out what that is can already help you a lot in learning to deal with them.

The idea that these are survival mechanisms that have ‘got out of hand’, and that may have saved you during the trauma, more than pure pathology, can help you to develop a more constructive perspective on your feelings and your distress.

It is also important to understand that many of the manifestations of early trauma are physical: that trauma has, as it were, settled ‘in the body’ and shows itself at that level at all sorts of moments.

Take housing, work and education into account

It is also important to address relationship problems and problems with housing, work and education directly. If someone starts ‘tinkering’ with you without taking your system and your social environment into account, it usually makes little sense.

Treatment for trauma

There are many treatments for trauma and they can all be effective, provided that…

There is a variety of therapeutic approaches and treatments for PTSD. They range from mindfulness to EMDR, with many other options not named here.

For example:

• Mindfulness and meditation
• Somatic experiencing
• Psychomotor therapy
• Shamanic work
• A psychedelic journey
• Animal-assisted therapy
• Interpersonal therapy
• Antidepressants (and sometimes antipsychotics)
• Cognitive behavioural therapy
• EMDR

The good news is that they can all help you

It is certainly not the case that one trauma treatment or therapy is clearly better than another. It is a matter of finding what suits you best and which therapist you get on with best. That differs enormously from person to person.

The click with your therapist

More important than the type of therapy is whether you click with your therapist and how well the specific treatment suits you.

Therapy only works if:

• You believe in the type of therapy concerned;
• The therapy is based on an explanatory model (of the symptoms and experiences) that fits your personal view and your view of the world;
• The therapy is based on a theory of change (of improvement) that you can agree with;
• The therapist is able to develop a good relationship with you, based on involvement, availability, authenticity, kindling motivation, repairing friction and connecting with your world of experience;
• The treatment is offered to you in the context of a powerful therapeutic ritual (EMDR, for example, has a strongly ritual character that appeals to many people).

So it is important that the therapist works out together with you what is most likely to work in your specific case. There has to be a range of options from which you can choose, depending on what best fits your values, experiences and preferences.

The therapist should not hide behind a discourse of ‘evidence-based practice’ or ‘specialist treatment’. After all, the evidence shows that the quality of the therapeutic relationship, and how well the therapist fits your view of the world, are what tip the balance.

Important ways of working that can help in the treatment of trauma

In the treatment of trauma, a number of elements in the therapy are of great importance. You can look out for these.

Some important elements in your therapy:

• A safe and supportive setting
• Presence (someone really being there for you)
• Offering perspective (so that you can see a bit of a future again)
• Psychoeducation (becoming aware that these are old survival mechanisms, that your feelings mean something)
• Sometimes, if it is possible and if it can help: working with ‘exposure’ (exposing yourself to things you anxiously avoid)
• Helping you become aware of reaction patterns that come from old survival strategies
• Working, in the relationship with your therapist, on interpersonal patterns of behaviour (how you react to other people, from old traumas)
• Transpersonal and spiritual elements
• Body-oriented elements (looking for the connection with your body again)
• Working with the imagination
• Working with the multiplicity of the personality (recognising that the trauma has given you several patterns of feeling and behaviour). In this context it is often assumed that you have several parts, such as a ‘healthy part’, a ‘survival part’ and a ‘traumatised part’.

Exposure

EMDR is not always possible or desirable

An important factor is the degree of ‘exposure’ that is used to help you. In therapies such as EMDR you have to travel back to the trauma in your experience, as part of ‘exposure’. But it may be that you cannot do that or do not want to, and sometimes it makes things worse instead of better.

Especially with what is called ‘complex’ trauma (for example chronic severe sexual abuse in childhood), simple exposure treatments such as EMDR are often not possible or desirable. In that case other ways of working, for example a body-oriented form of therapy, are often more suitable for you.

Trauma ‘in the body’

If trauma has settled ‘in the body’, it seems logical to try body-oriented ways of working first.

Bottom line:

EMDR is suitable for you if you have had an acute trauma, for example after an accident or a robbery. EMDR is often less fitting if you have (complex) PTSD in the context of severe trauma in childhood.

References

Read J, van Os J, Morrison AP, Ross CA. (2005) Childhood trauma, psychosis and schizophrenia: A literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112, 330-50.
Read J, Bentall RP. (2012) Negative childhood experiences and mental health: theoretical, clinical and primary prevention implications. British Journal of Psychiatry, 200, 89-91.
Frueh BC, Grubaugh AL, Cusack KJ, Kimble MO, Elhai JD, Knapp RG. (2009) Exposure-based cognitive-behavioral treatment of PTSD in adults with schizophrenia or schizoaffective disorder: a pilot study. Journal of Anxiety Disorders, 23, 665-675.
Mueser KT, Rosenberg SD, Xie H, Jankowski MK, Bolton EE, Lu W, Hamblen JL, Rosenberg HJ, McHugo GJ, Wolfe R. (2008) A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology, 76, 259-271.
Varese F, Smeets F, Drukker M, Lieverse R, Lataster T, Viechtbauer W, Read J, van Os J, Bentall RP. (2012) Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophrenia Bulletin, 38, 661-671.

Do you need help now?

PsychosisNet offers information. We do not offer a chat, a helpline or crisis support. If you or someone else is in immediate danger, call the emergency number in your country. If you are thinking about suicide, or you need to talk to someone now, see Need help now? for helplines by country.

Prof. dr. Jim van Os, Chair Division Neuroscience, Utrecht University Medical Centre. Jim works at the interface of ‘hard’ brain science, health services research, art and subjective experiences of people with ‘lived experience’ in mental healthcare. 

Jim has been appearing on the Thomson-Reuter Web of Science list of ‘most influential scientific minds of our time’ since 2014. In 2014 he published his book ‘Beyond DSM-5‘, and in 2016 the book ‘Good Mental Health Care’. In 2026 he published 'Wat psychisch lijden is'.

Want to read more?

Blogs by Jim van Os can be read here

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