8 Aug 2019

What are the limits of TRE?

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Exploring the limits of TRE and trauma therapy

TRE is simple and powerful. For some people not talking, just shaking, coming into their body and working on their own is a life changing. These limits can also be hard for some people; they may benefit from finding a community, social justice, appropriate medication, ongoing one to one talking therapeutic support. In these cases TRE work best as part of a package of care.

No one knows how to treat trauma successfully for all clients. We do not claim TRE is cure for all people, nothing works all the time for everybody, this is the same for any intervention. Treating trauma is complex and evidence is unclear. TRE has some limited research, very good theory, lots of anecdotal evidence and passionate advocates.

Current trends in western medicine of working with trauma are based on finding better medications to dampen down body responses (eg beta blockers and anti-psychotics etc) or CBT as the gold standard therapeutic intervention. The evidence base for CBT is mixed at best. Most trauma theorists are focused on some form of graded exposure to intense sensations and teaching emotional regulation. The better ones appreciate emotions emerge from the body.

There is excellent theory and very good developing evidence about changing body reflexes – the core of the TRE model – and a number of exciting modalities trying to find the best ways of down-regulating over protective reflexes (eg EMDR, Mindfulness Based Stress Reduction MBSR). The goal is changing the body in the first instance; not starting with the mind and focusing on cognitive understanding and tools.

Some of the talking treatments that have been researched – eg brief intervention therapies and talking treatments (famously research on talking treatments post 9-11 in USA was not supportive) – do not come out very well at all in some long term studies. It is hard working with trauma, particularly if people are dissociated. Dissociation is massively under appreciated in the most therapeutic approaches.

The best metaphor for how TRE works is probably not releasing tension, rather, ‘waking your body up’. It is often more effective to frame shaking as a process that safely generates new feelings of connection that are inherently anti dissociative. 

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