Question 1

Can you explain 1 or 2 of your most useful mindfulness activities that you use with trauma clients, including descriptions of how they can be used by clinicians.

David Treleaven · Accepted Answer

Practice one would be using multiple anchors of attention when introducing meditation. Instead of just having a client focus on the breath, for example, guide them through a practice of “trying on” different anchors (e.g., sensations connected to the feet or hearing). This kind of practice has people get curious about how their focus of attention impacts them and increases a sense of choice and agency as well—something that’s important in trauma-sensitive practice.

To build on this, another practice is finding supportive external anchors of attention, as well. This might include something in nature or an object close by. The breath, which is a common anchor in many meditation traditions, is not always neutral for people struggling with trauma—our respiratory system connects to our sympathetic nervous system, which is associated with trauma. So offering these choices around attention not only keeps people safe in practice but grants them the ability to experiment with anchors and increase their sense of agency.

Question 2

Can mindfulness practice change any physical changes in the brain that trauma has caused?

David Treleaven · Accepted Answer

A great (and challenging) question.

First, there’s evidence that suggests mindfulness practice can lead to structural changes in the brain (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704181/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004979/ regarding increased grey matter density through mindfulness meditation and for purchase https://www.nature.com/articles/nrn3916 for a larger review).

In terms of mindfulness practice creating physical changes that are related to trauma, this would be a hypothetical link. For example, where trauma is correlated with increased amygdala activation (for purchase https://www.sciencedirect.com/science/article/abs/pii/S1053811905005422),  mindfulness practice has been shown to reduce amygdala reactivity (for purchase https://psycnet.apa.org/doiLanding?doi=10.1037%2Fbne0000337). We could hypothesize that mindfulness practice would therefore support people struggling with trauma, but at this point, more research is needed.

Question 3

How can you work with someone who has a lot of resistance towards their body and working with their body and feeling their sensations? She changes therapists every time this subject is brought up.

David Treleaven · Accepted Answer

Resistance and aversion to physical sensations is a common struggle with clients in clinical work. In the domain of trauma, this kind of resistance is often hard earned: people struggling with trauma commonly struggle with a host of dysregulating traumatic sensations, making inner-body awareness very challenging to accomplish (despite their best intentions).

A trauma-sensitive strategy here is to become curious about the resistance. What is the client afraid would happen if they connected with sensations? Or what is the disconnection from sensations taking care of? Mindfulness practice, as well, has been shown to increase body awareness (for puchase, https://journals.humankinetics.com/view/journals/jsep/35/6/article-p655.xml, for example), so this can be a helpful intervention.

Question 4

Is basic mindfulness, such as focus on breath, okay for those with a trauma history as opposed to deeper meditation approaches?

David Treleaven · Accepted Answer

Instead of just having a client focus on the breath, for example, guide them through a practice of “trying on” different anchors (e.g., sensations connected to the feet or hearing). This kind of practice has people get curious about how their focus of attention impacts them and increases a sense of choice and agency as well—something that’s important in trauma-sensitive practice.

To build on this, another practice is finding supportive external anchors of attention, as well. This might include something in nature or an object close by. The breath, which is a common anchor in many meditation traditions, is not always neutral for people struggling with trauma—our respiratory system connects to our sympathetic nervous system, which is associated with trauma. So offering these choices around attention not only keeps people safe in practice but grants them the ability to experiment with anchors and increase their sense of agency.

Question 5

What signs are trauma-informed practitioners looking out for that signal that problems are arising for clients or students during a session?

David Treleaven · Accepted Answer

Look for non-verbal signs of dysregulated arousal—a core symptom of post-traumatic stress. This includes signs of physiological hyperarousal (e.g., sweating, hypervigilance, exaggerated startle response) and hypoarousal (e.g., fogginess, dissociation, numbness). While these symptoms don’t necessarily indicate someone is struggling with trauma, they’re an important flag for checking in with a client or student during the class or program.

Question 6

Are you advocating that we advise people against trying mindfulness by themselves at home, even if they want to?

David Treleaven · Accepted Answer

No, not at all. I’d encourage anyone to try mindfulness if they have the motivation! A trauma-sensitive modification here would be to let people know that more won’t always be better when it comes to practice—a kind of Goldilocks principle. If clients know it’s okay to back off if they become overwhelmed in practice, they’ll be safe and self-responsive. It’s the people who double down in home practice that seem to run into trouble, but simply knowing it’s okay to back off often takes care of this.

Question 7

Why is mindfulness meditation potentially risky for people with a trauma history?

David Treleaven · Accepted Answer

Great question! The short answer is reflexive orientation. People struggling with trauma will tend to unconsciously direct their attention towards traumatic stimuli—traumatic sensations, for example, or intrusive images and thoughts. In the same way, we’ll automatically direct attention externally to a loud noise. We’ll do this internally when it comes to traumatic stimuli—all in an effort to keep ourselves safe.

In some forms of meditation, participants are instructed to direct their attention to whatever is predominant in their field of awareness. For people struggling with symptoms of post-traumatic stress, this will often be reminders of the trauma that are pulling their attention. The issue here is that overattending to traumatic stimuli can be too much for a client to tolerate. Unless they are equipped with tools and strategies to work skilfully with their trauma, they can end up reflexively orienting to traumatic stimuli over and over, creating a set-up for overwhelm and distress.

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