Mind-Body Medicine is “How to Heal Psychological Trauma”
Dear Friends,
On a recent trip to London, I was interviewed during Depression Awareness Week about my book Unstuck’s UK release by The Guardian newspaper. The reporter was particularly interested in CMBM’s Global Trauma Relief program and our work to bring population-wide psychological healing to places around the world that are afflicted by war and natural disaster. You can read the piece here:
I’m certainly pleased that the author recognizes CMBM’s groundbreaking efforts to teach and support hundreds of thousands of people in Kosovo, Israel, Gaza, Haiti, Southern Louisiana, as well as US military returning from Iraq and Afghanistan. It’s a shame, however, that his tone is so dismissive of integrative medicine and that he fails to recognize the fundamental importance of self-care for psychological and physical healing.
Please note that as of this writing, corrections are being made online for several factual errors, including the following:
- In Gaza, we trained 90 clinicians initially, only a few of these were “educators” (as the article states)
- CMBM now has 160 groups meeting in Gaza each week, not 48, as reported.
Beyond factual errors, though, I’m disappointed in the tone of the article. I want to emphasize that our approach to psychological trauma relief is not about “belief,” as the article repeatedly implies. It is based on hard evidence that is just as rigorous – actually more so – than most of that provided by the drug companies he seems to accept as the standard.
It is a common misconception (and prejudice) that psychological and nonpharmaceutical research is less stringent and reliable than clinical drug trials. Each of the approaches that we use, including meditation, guided imagery, biofeedback, autogenic training, yoga, self-expression in words and drawings, and movement and exercise, has a significant research base, one which demonstrates decreases in stress levels and improvement in mood. The CMBM approach combines these into a comprehensive program, and The Center for Mind-Body Medicine takes great care in scientifically researching, documenting, and publishing our findings of our approach in peer-reviewed journals. We recently published a randomized controlled trial (RCT) on our work with war traumatized children in Kosovo that shows an 80% decrease in symptoms of PTSD (read the abstract here).
This was the first RCT of any intervention with war-traumatized children, and sometime in the next few months, we will be publishing a study (in the International Journal of Stress Management) that shows similar results—80% decrease in PTSD symptoms, significant decreases in depression and hopelessness—in war-traumatized youth in Gaza. This study is particularly important because the gains that were achieved over ten weeks of once-weekly group sessions were largely maintained at seven months’ follow-up—in spite of ongoing conflict and severe economic hardship.
The point is that this approach is not alternative. It is fundamental. It makes human and scientific sense. We have an approach that works with large groups of people in developed countries as well as those ridden by disaster. It is flexible, inclusive, and culturally acceptable. And the groups in which we train caregivers can be led by anyone—teachers, and religious and community leaders, as well as health professionals; and the scientific evidence for its effectiveness continues to accumulate. And as the article states, CMBM will continue to be there to provide our program of mind-body medicine for people suffering from psychological trauma, to teach them, and help them help themselves.
Gaza Blog Day 4
Gaza City, December 15, 2009
Day 4
Hello Friends,
The Advanced Training Program (we call it, and so do the Palestinians, “ATP”) has a complex structure that is at first a bit daunting. Our 15 Gaza faculty coach the participants in leading the same kinds of small groups that they first experienced in the initial training. The international faculty, passing from group to group provide feedback, later, in supervision, on how the Gaza faculty has helped the participants and what they could do or say more appropriately, clearly or concisely; where they could have been more sensitive to the spoken or unspoken needs of a group member; how their own reticence or preconceptions may have inhibited or biased them in their advice to a participant-leader. “Be honest with us,” our conscientious Palestinian team had repeatedly insisted. “We want to do the best job for our people. We are thirsty for learning.”
The participants lead the ATP groups in pairs; there are ten people in each group and five sessions. Hugely nervous at first, in spite of a day of reassurance and coaching, they conduct the opening meditation, and lead the check-in in which they and the other group members say how they are doing and what they are feeling at the present moment. We have encouraged participant-leaders to let go of self-conscious professional distance, to be honest about their own feelings, to be “real people as well as leaders.” Some do this with admirable courage and humility: “I am a professor at university, but at this moment I feel like I am back in grade school.” Others are more guarded. Everyone in the group speaks in turn – no interrupting, analyzing or interpreting allowed.
The participant-leaders then teach didactic material about, for example, the fight or flight and stress response that are activated by the sympathetic nervous system, and the use of slow deep breathing (which mobilizes the parasympathetic nervous system) to balance this state of hyperarousal which is so common in deeply traumatized and uneasy Gaza. Then they lead an experiential exercise – it could be guided imagery, or drawing one’s problem and its solution or quiet meditation that brings about relaxation or an active meditation of fast deep breathing or shaking and dancing, designed to raise energy in the depleted and depressed and break up fixed patterns of thought and feeling. Then they ask group members to report on their experience: “I feel like a burden is lifted” says one young, bearded school psychologist, after six or eight minutes of charged up, bellows-like arm pumping, deep breathing. “I feel free for the first time since the war to breathe the breeze from the sea.” They conclude each group with a quiet meditation. Afterwards the pair of participant-leaders say how they feel they have done and the other participants share what the experience was like for them; the Gaza faculty member concludes with his or her assessment.
This will go on for five two-hour groups over four days. It is designed to equip our participants to take our model back into their work places where they will offer it to kids and adults, the elderly and the deaf, former prisoners in Israeli jails and ambulance drivers, abused women and confused men, the anxious and angry, those bereaved by violence and those fearful they will be. In a society in which psychological problems are stigmatized and psychotherapy is often viewed, if it is considered at all, with suspicion, our model has wide appeal. It is offered as a way to develop skills and strengths, of mind as well as body, an opportunity to come together without fear of analysis or interpretation, a modern version of traditional, honored communal gathering and healing.
Each day we have a panel where Gaza faculty answer questions from the entire group of participants about the challenges of leading groups and working with individuals, about balancing the need to maintain order in the group with an openness that invites sharing, about presenting didactic material in a way that is accurate but easily comprehensible. In Gaza the questions have a special urgency and poignancy. One male psychologist, slender and graying unfolds slowly from his chair. “How do you,” he asks soberly, “deal with a situation in which during a mind-body group bombs are going off?”
“This has happened to me several times,” replies Mohammed, the psychiatrist, “You find out what is happening – I don’t want to say who is shooting,” he adds to some laughter. “You make sure your group is as safe as it can be. Then you discuss feelings so everyone can get some relief. Then do deep breathing to help everyone, including yourself, to relax. Then continue the group.”
“I was working with kids one time,” Jamil adds. “Every time there was shooting we got up and shook our bodies. Every time a bomb went off we all yelled loudly. It worked pretty well.”
“What about if you are a leader and someone says something that is very tragic and you feel like crying? Is it permitted?”
“In the war terrible things happened” responds Abdel-Hamid, “and the people come to us to talk about it: Women in my groups whose children were killed, men who saw their wives and daughters dying from burns, and I remember the things I myself saw. It is only human for us to cry as well.”
