Mindfulness for Trauma Care, by Kelsey Madison Dietrich

Mindfulness for Trauma Care

Disclaimer 

The information presented in this blog post is intended to be educational and is not medical advice. If you are struggling with personal experiences of trauma or are curious about integrating trauma-sensitive mindfulness into your own healing, please seek support from a licensed mental health care provider in collaboration with a certified trauma-sensitive mindfulness facilitator.

Introduction

This blog serves as a brief summary of trauma-sensitive mindfulness. First, the definitions of trauma and posttraumatic stress reactions are reviewed. Then, the rationale for mindfulness as a form of trauma care is provided. Lastly, the purpose, principles, and importance of trauma-sensitive mindfulness are described. Resources for continued learning and references cited in this post are listed at the end for further exploration. 

Trauma

The word “trauma” has become a buzzword in pop culture. A clinical definition of trauma is an event or set of circumstances in which a person perceives a threat to life or safety (American Psychiatric Association, 2022). Some common examples of trauma include motor vehicle accidents, abuse (e.g., emotional, physical, sexual), and medical events. Globally, it has been estimated that about 70% of individuals will experience at least 1 traumatic event during their lifetime (Kessler et al., 2017). Sometimes after living through trauma, an individual starts to have distressing internal experiences related to the trauma (i.e., posttraumatic stress) which can include intrusions (e.g., nightmares, flashbacks), avoidance (e.g., of people/places/reminders of trauma), negative mood (e.g., fear, horror, guilt) or cognition (e.g., persistent self-blame), and increased reactivity/arousal (e.g., hypervigilance, exaggerated startle response). When these experiences are consistent for at least 1 month after exposure to trauma, and cause major distress or disruption to an individual’s daily life, then the diagnosis of posttraumatic stress disorder (PTSD) occurs. About 5.6% of individuals who experience trauma develop PTSD (Koenen et al., 2017). It is also possible to experience posttraumatic stress reactions without a diagnosis of PTSD. Overall, it is important to acknowledge that trauma is a serious experience that can result in a spectrum of posttraumatic stress reactions that will be unique for each individual. 

Mindfulness and Trauma

State mindfulness is the intentional practice of bringing full attention to the present moment through an open, non-judgmental, and nonreactive way (Kabat-Zinn, 2015). Trait mindfulness, an individual’s default use of mindfulness-like qualities such as openness, nonreactivity, and non-judgment in daily life, can be improved by state mindfulness (i.e., mindfulness practices) over time (Kiken et al., 2015). The rationale for using mindfulness in trauma care is that individuals who have greater levels of trait mindfulness report lower levels of posttraumatic stress (Harper et al., 2022). Mindfulness is an antidote to posttraumatic stress as it provides a way to reduce avoidance, support emotion regulation, and increase distress tolerance (Follette et al., 2006) as evidenced by neurobiological markers (Boyd et al., 2018). Furthermore, the philosophical roots of Buddhist mindfulness (i.e., the Buddha’s Four Noble Truths) have also been connected as a way to understand and make meaning from traumatic experiences (Dussault et al., 2022). 

Over the last 20 years, the empirical support for mindfulness as a form of trauma care has increased. Consequently, mindfulness has been integrated within psychotherapy (Bean et al., 2017), offered as a stand-alone intervention (Molteni et al., 2024), and used as a general coping strategy (Garfin et al., 2023). Due to the increased use of mindfulness for trauma care, there is a growing awareness of the safety of mindfulness in order to offer the most effective approach for healing. Research on adverse outcomes of mindfulness for trauma care has emerged with concern about triggering flashbacks, intrusive thoughts, and dissociation during practice (Britton et al., 2021; Lustyk et al., 2009) and a call for facilitators to be aware of potential adverse outcomes and prepare for skillful responses has been made (Treleaven, 2018). When mindfulness is tailored to an individual’s needs by a trained facilitator, the safety and accessibility of mindfulness is enhanced (Dutton et al., 2011).

Trauma-Sensitive Mindfulness

David Treleaven coined the term “trauma-sensitive mindfulness” which is conceptualized by offering options for mindfulness practices that strive to bring balance to the individual’s experience through the use of external and internal anchors (2018). The principles of trauma-sensitive mindfulness include realization of trauma’s prevalence and effects; recognition of trauma reactions during mindfulness practice; responding to trauma reactions in a compassionate, skilled, and appropriate way; and making a continued effort to prevent the recreation of trauma paradigms or retraumatization (Treleaven, 2018). These principles are achieved through prioritization of informed consent, clear boundaries, safety planning, titration, and offering options for practice with the aim to hold space for individuals to stay within, and eventually expand, their window of tolerance (Treleaven, 2018). 

A review of studies found that mindfulness interventions offered in a trauma-informed way were more effective than mindfulness interventions that did not consider trauma-informed principles (Taylor et al., 2020). Given how common trauma is worldwide, it is expected that individuals may be navigating posttraumatic stress reactions when participating in mindfulness practice spaces. In general community settings, facilitators will not know the lived experiences of all practitioners in the room; in fact, doing so is beyond the scope of practice for a mindfulness facilitator. Thus, it is recommended that facilitators implement a default trauma-sensitive approach: a mindset that acknowledges the likelihood of the breadth of traumatic experiences in the space in which facilitation occurs, and intentional guidance of practice in trauma-sensitive ways. 

Conclusion

Most individuals will experience at least 1 trauma throughout their lifetime, and experiences of posttraumatic stress, such as dysregulation, intrusive memories, and negative thoughts are expected reactions to surviving trauma. The intersection of ancient philosophy and modern science supports the use of mindfulness for trauma care; simultaneously, there is a recent growing awareness of the possible adverse outcomes of mindfulness when managing posttraumatic stress. A trauma-sensitive mindfulness approach promotes an individualized practice for the participant to engage in present moment experience via internal and external cues within their window of tolerance. Through recognition of the prevalence and impacts of trauma, offering mindfulness in a trauma-sensitive way is crucial for promoting safety, inclusivity, and empowerment for individuals navigating trauma who choose to practice mindfulness. 

If you are interested in exploring these topics further, you’re welcome to attend the upcoming DiabetesSangha 2-part series: Trauma and Diabetes (June 23 from 7-8pm EST) and Introduction to Trauma-Sensitive Mindfulness (July 14 from 7-8pm EST). The workshops are free and open to all via Zoom. No registration required. 

References

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders–5th Edition–Text Revision. American Psychiatric Association.

Bean, R. C., Ong, C. W., Lee, J., & Twohig, M. P. (2017). Acceptance and commitment therapy for PTSD and trauma: An empirical review. The Behavior Therapist, 40, 145-150. https://psycnet.apa.org/record/2017-32652-002

Boyd, J. E., Lanius, R. A., & McKinnon, M. C. (2018). Mindfulness-based treatments for posttraumatic stress disorder: A review of the treatment literature and neurobiological evidence. Journal of Psychiatry & Neuroscience, 43(1), 7–25. https://doi.org/10.1503/jpn.170021 

Britton, W. B., Lindahl, J. R., Cooper, D. J., Canby, N. K., & Palitsky, R. (2021). Defining and measuring meditation-related adverse effects in mindfulness-based programs. Clinical Psychological Science, 9(6), 1185–1204. https://doi.org/10.1177/2167702621996340

Dussault, É., Lafortune, D., Fernet, M., & Godbout, N. (2022). Mindfulness in survivors of cumulative childhood interpersonal trauma: A Buddhist conceptualization of suffering and healing. Mindfulness, 13(7), 1816–1828. https://doi.org/10.1007/s12671-022-01922-7 

Dutton, M. A., Bermudez, D., Matas, A., Majid, H., & Myers, N. L. (2011). Mindfulness-based stress reduction for low-income, predominantly African American women with PTSD and a history of intimate partner violence. Cognitive and Behavioural Practice, 20(1), 23–32. https://doi.org/10.1016/j.cbpra.2011.08.003 

Follette, V., Palm, K. M., & Pearson, A. N. (2006). Mindfulness and trauma: Implications for treatment. Journal of Rational-Emotive & Cognitive-Behaviour Therapy, 24(1), 45–61. https://psycnet.apa.org/record/2006-11571-004 

Garfin, D. R., Amador, A., Osorio, J., Ruivivar, K. S., Torres, A., & Nyamathi, A. M. (2023). A multi‐method exploration of mindfulness as a coping tool: Perspectives from trauma‐exposed, unhoused women residing at a drug treatment facility. Stress and Health, 39(2), 347–360. https://doi.org/10.1002/smi.3188 

Harper, L., Jones, A., Goodwin, L., & Gillespie, S. (2022). Association between trait mindfulness and symptoms of post-traumatic stress: A meta-analysis. Journal of Psychiatric Research, 152, 233–241. https://doi.org/10.1016/j.jpsychires.2022.05.027 

Kabat-Zinn, J. (2015). Mindfulness. Mindfulness, 6, 1481-1483. https://doi.org/10.1007/s12671-015-0456-x 

Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Benjet, C., Bromet, E. J., Cardoso, G., Degenhardt, L., de Girolamo, G., Dinolova, R. V., Ferry, F., Florescu, S., Gureje, O. Haro, J. M., Huang, Y., Karam, E. G., Kawakami, N., Lee, S., Lepine, J., Levinson, D.,…Koenen, K. C. (2017). Trauma and PTSD in the WHO world mental health surveys. European Journal of Psychotraumatology, 8(5), Article 1353383. https://doi.org/10.1080/20008198.2017.1353383 

Kiken, L. G., Garland, E. L., Bluth, K., Palsson, O. S., & Gaylord, S. A. (2015). From a state to a trait: Trajectories of state mindfulness in meditation during intervention predict changes in trait mindfulness. Personality and Individual Differences, 81, 41–46. https://doi.org/10.1016/j.paid.2014.12.044 

Koenen, K. C., Ratanatharathorn, A., Ng, L., McLaughlin, K. A., Bromet, E. J., Stein, D. J., Karam, E. G., Ruscio, A. M., Benjet, C., Scott, K., Atwoli, L., Petukhova, M., Lim, C. C. W., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Bunting, B., Ciutan, M., de Girolamo, G.,…Kessler, R. C. (2017). Posttraumatic stress disorder in the world mental health surveys. Psychological Medicine, 47, 2260-2274. https://doi.org/10.1017/S0033291717000708 

Lustyk, M. K., Chawla, N., Nolan, R. S., & Marlatt, G. A. (2009). Mindfulness meditation research: Issues of participant screening, safety procedures and researcher training. Advances in Mind Body Medicine, 24(1). https://meditatinginsafety.org.uk/wp-content/uploads/2017/05/Lustyketal_MM_safety.pdf 

Molteni, L., Gosling, C. J., Fagan, H. A., Hyde, J., Benatti, B., Dell’Osso, B., Cortese, S., Baldwin, D. S., & Huneke, N. T. M. (2024). Effects of mindfulness-based interventions on symptoms and interoception in trauma-related disorders and exposure to traumatic events: Systematic review and meta-analysis. Psychiatry Research, 336, 115897. https://doi.org/10.1016/j.psychres.2024.115897 

Taylor, J., McLean, L., Korner, A., Stratton, E., & Glozier, N. (2020). Mindfulness and yoga for psychological trauma: A systematic review and meta-analysis. Journal of Trauma and Dissociation, 5, 536-573. https://doi.org/10.1080/15299732.2020.1760167 

Treleaven, D. A. (2018). Trauma-sensitive mindfulness: Practices for safe and transformative healing. New York: W. W. Norton and Company