Trauma is complex and unique to each individual. While every case of trauma is different, it can often lead to destructive or addictive behaviors such as eating disorders, substance misuse, or self-harm. This can make it a sensitive condition to treat, as often addressing trauma involves exacerbating those symptoms of trauma in the patient — and occasionally, the self-destructive behaviors.
It was because of this complex problem that therapist Janina Fisher developed Trauma-Informed Stabilization Treatment (TIST) as a way to help survivors of trauma with destructive and addictive behaviors. In this blog, we’ll dive into everything you need to know about TIST and when it is used.
What Is TIST?
TIST is a trauma-informed approach to treating self-destructive behavior that comes as a result of trauma. It was developed by Janina Fisher, LCSW, of the Trauma Center. It combines modalities such as mindfulness-based cognitive behavioral therapy (CBT), sensorimotor psychotherapy, ego state techniques, and internal family systems (IFS). It has been used to treat a number of complex mental health disorders, including:
- Complex post-traumatic stress disorder (CPTSD)
- Borderline personality disorder (BPD)
- Bipolar disorder
- Addictive and eating disorders
- Dissociative disorders
This method of treating patients is centered around the underlying trauma at the heart of the destructive or addictive behaviors. Without treating the trauma itself, it can be difficult for the patient to truly break free of the maladaptive behaviors.
How TIST Differs From Other Treatments
TIST was developed as a way to treat trauma survivors who were resistant to other forms of treatment. Fisher felt that many other forms of treatment for destructive or addictive behaviors could actually heighten those behaviors. For instance, typical talk therapy requires patients to create a detailed narrative of their trauma. However, for some patients, this could be emotionally troubling as memories need to be transformed and not just remembered in order to heal.
Fisher also saw value in dialectical behavioral therapy (DBT) for treating patients with destructive behaviors, but found that it required skills that could be distressing to patients facing trauma. Patients with addiction, for instance, tend to have an inhibited prefrontal cortex that could make those skills less accessible. The solution was to treat the trauma first and then move on to those skills.
The Impacts of Trauma
Fisher noticed that many patients with addictive or self-destructive behaviors were labeled as “manipulative” or “attention seeking,” which lacked compassion to their situation. She found that destructive behaviors are often automatic and instinctual for trauma survivors, rather than an intentional and manipulative grab for attention.
To understand this, it’s important to understand traumatic memories themselves. Traumatic memories are anything that overrides the ability to cope. They can have lasting somatic and psychological effects on the patient long after the actual impact of the trauma. In these cases, the prefrontal cortex and hippocampus are suppressed and the mind goes into survival mode. This allows patients with trauma to survive, but not gain any wisdom from the experience. It’s essentially raw, emotional data rather than chronological evidence and awareness of how the patient survived.
Trauma patients who were able to find immediate shelter and support after the fact were able to get the sense that their trauma had ended. However, for patients who experienced their trauma young or didn’t have a support network to turn to, the body’s threat response often remains present. One example would be a child with an abusive caregiver, caught between the need for connection and fear of safety.
Trauma Responses and Traumatic Transference
Trauma can result in a fragmentation and alienation of self, due to feeling pulled in different directions or going into survival mode. For patients in this survival mode, there is a sense of hypervigilance, with trauma responses ready to go at any moment.
The Four Main Trauma Responses
The four main trauma responses are:
- Fight – defensiveness, anger, and aggression (directed at others or the self)
- Flight – emotional suppression, avoidance, addictive or reading disorders, or acting on impulses to numb emotions
- Attach – preoccupation with another person or thing, fawning over them, a deep desire to please
- Freeze – shutting down, avoidance (tying into flight)
The attachment response in particular can be interpreted as manipulative, when in fact, for trauma patients, it is a survival reflex.
Traumatic Transference
In some cases, therapy can evoke one of the trauma responses. This is known as traumatic transference. Some examples might include:
- Trying to please the therapist or “do well” in therapy
- Trouble leaving the office
- Difficulty building rapport with the therapist
- Constant need for reassurance
- Mistrust of the therapist
- Repeated request in change of time frame with the therapist
Dr. Margo Rivera of Queen’s University in Kingston, Ontario describes crisis and self harm as “relational negotiating currency” to trauma patients with destructive behaviors. Patients often feel that they have no value to their therapist unless they are in crisis.
Segmentation
Trauma can also lead to segmentation, a divide between the left and right hemispheres of the brain. Those who experience childhood trauma often have much smaller left hemisphere volumes, so their right hemisphere tends to receive more information than the left.
This impacts the patient’s ability to cope with their trauma. While the right hemisphere of the brain is responsible for emotional responses and traumatic memories, the left brain is the part of the brain responsible for “going on with normal life.” This can lead to patients with smaller left hippocampal volumes experiencing:
- Inexplicable fear
- A desire to withdraw
- Impulses to run away
- Secondary dissociation (in which the emotion becomes compartmentalized and the patient can’t access normal responses to danger)
How Does TIST Help Patients
In order to be able to cope without jumping to one of these trauma responses, patients need to be able to activate their prefrontal cortex, thus allowing them to learn from their experiences. When the prefrontal cortex is activated, they are better able to invite curiosity into their thought process. They can notice thoughts and feelings without reaction.
Therapists working from a trauma informed place can help bring this about by setting an example for mindfulness and slowing down. Ask patients things like, “Let’s think it through together” when they mention their impulses based on trauma responses. When discussing feelings, it can help to separate their feelings from their identity. Ask specifically, “What part of you feels this way? What happens when you feel this way to cause that feeling?”
Through TIST, patients can accept that their trauma responses have value and intention to help them survive, but might not be necessary in this situation; or that they had value in the past, but not now. For instance, patients who self-harm may have done so because that self-harm gave them an adrenaline rush and a feeling of immediate relief. But overtime, the body builds a tolerance, requiring more and more harm in order to achieve that relief.
There is no judgment or condemnation of trauma responses in TIST. Rather, accepting their value in the past while also admitting that they aren’t needed in the present can create a mindful distance from present experiences. TIST sessions are about grounding the patient in the present moment and not avoiding it, but allowing them to experience that present moment in a space of calm safety.
At Rivia Mind, we utilize trauma informed therapy techniques like TIST and others to meet survivors of trauma where they are. There’s never any judgment in our therapy sessions, just compassion and a guide to help you find the skills to process your trauma and achieve your life’s worth living goals. Contact Rivia Mind today to learn more or to schedule a free 15-minute consultation.
Resources:
- Trauma-Informed Stabilization Treatment – Janina Fisher
- Childhood Trauma Associated With Smaller Hippocampal Volume in Women With Major Depression – American Journal of Psychiatry
