October 17, 2025

Navigating the Terrain of Grief

Navigating the Terrain of Grief: A Comprehensive Guide to Understanding Loss and Finding Hope

Kevin Brough, MAMFT

Introduction

Grief is one of the most universal yet intensely personal experiences we face as human beings. Whether you’re the person who has lost someone, a family member watching a loved one struggle, or a professional trying to provide support, grief touches all of us differently. Over my years working as a marriage and family therapist, I’ve sat with countless individuals navigating the crushing weight of loss—parents who’ve lost children, spouses mourning partners, and yes, fathers grappling with the unthinkable pain of losing a son.

What I’ve learned is this: grief doesn’t follow a script. It doesn’t adhere to timelines or neat stages. It’s messy, nonlinear, and at times, completely overwhelming. But I’ve also witnessed something remarkable—the human capacity for resilience, for finding meaning even in the darkest moments, and for eventually discovering a way to carry loss while still embracing loss while still embracing life.

This article explores grief from multiple perspectives—the griever, the family system, and the helping professional—while offering practical, evidence-based interventions and resources that can make a real difference when you’re struggling to find solid ground.

Understanding Grief: More Than Just Stages

For decades, we’ve been taught about Kübler-Ross’s five stages of grief: denial, anger, bargaining, depression, and acceptance (Kübler-Ross, 1969). While this model has value, it can also be limiting. Grief isn’t a straight line you walk from denial to acceptance. It’s more like being tossed around in ocean waves—sometimes you’re treading water, sometimes a wave knocks you under, and sometimes you find yourself floating in calm waters, only to be hit by another swell you didn’t see coming.

The Dual Process Model, developed by Stroebe and Schut (1999), captures this reality more accurately. This framework recognizes that people oscillate between two types of coping: loss-oriented activities (confronting the pain, yearning for the person, focusing on the loss itself) and restoration-oriented activities (adapting to new roles, building new routines, taking breaks from grieving). Both are necessary. Both are healthy.

Think about it this way: you can’t stare directly at the sun without looking away, and you can’t stare directly at your grief without taking breaks either. Those moments when you laugh at a memory, get absorbed in work, or enjoy a meal aren’t betrayals of your loved one—they’re necessary oscillations that allow you to integrate loss into your life rather than being consumed by it.

Worden’s (2010) Four Tasks of Mourning offers another helpful framework that emphasizes the active nature of grief work. These tasks include accepting the reality of the loss, processing the pain, adjusting to a world without the deceased, and finding an enduring connection while moving forward. Notice these are tasks, not stages—things we work toward, not boxes we check off.

The Griever’s Perspective: When You’re in the Eye of the Storm

If you’re reading this while actively grieving, I want you to know something: whatever you’re feeling right now is valid. The crushing sadness, the anger, the numbness, the moments when you forget they’re gone only to remember again—all of it is part of this journey. You have the right to grieve in your own way, on your own timeline, without pressure to feel or respond in ways that others expect.

Recognizing You’re Not Alone

While your experience of grief is uniquely yours—shaped by your relationship, your history, your personality—loss itself is part of the broader human experience. Every person who has ever loved has eventually faced loss. This doesn’t minimize your pain, but it does mean you’re not walking this path in isolation. Millions have walked it before you, millions walk it now, and connecting with that shared humanity can provide unexpected comfort (Neimeyer, 2015).

Understanding Your Unique Grief Pattern

Grief is multidimensional, affecting us physically, emotionally, cognitively, behaviorally, and spiritually. You might experience insomnia, loss of appetite, difficulty concentrating, changes in how you relate to others, or questions about meaning and purpose. Some people feel everything intensely; others feel numb. Some need to talk constantly; others need solitude. Understanding your particular pattern of grieving—without judgment—can help you work with your grief rather than against it (Worden, 2010).

Self-Interventions That Actually Help

1. Give yourself permission to oscillate. Based on the Dual Process Model, healthy grieving means moving between confronting your loss and taking breaks from it (Stroebe & Schut, 1999). There’s a fine line between avoidance and helpful distraction. Complete avoidance keeps you from processing what needs to be processed, but healthy temporary respite—watching a movie, going for a walk, spending time with a friend—gives your system the break it needs to continue facing the grief. Don’t shame yourself when you need to distract yourself or when waves of grief hit you unexpectedly. Both are necessary.

2. Journal your way through. Research consistently shows that expressive writing helps process grief (Neimeyer, 2015). Consider committing to 40 days of grief journaling—even just five minutes a day. Write about your loved one, your memories, your anger, your confusion, your gratitude. Write letters to them expressing what you never got to say. Use metaphors that capture what grief feels like for you—is it like drowning? Like carrying a heavy backpack? Like living in fog? These images can help you access and process feelings that don’t easily translate into straightforward language.

3. Create tangible connections. Worden (2010) emphasizes finding ways to maintain bonds with the deceased while building a new life. This might mean keeping photos visible, wearing their clothing or jewelry, creating a memorial space, or carrying a meaningful object. Consider creating a “Life Certificate”—a document that honors your loved one’s life, captures what made them special, and solidifies your enduring emotional connection with them. These aren’t signs you’re “stuck”—they’re healthy ways to honor the relationship while moving forward.

4. Establish meaningful rituals. Rituals help us manage extreme emotions and regain a sense of control when loss has shattered our world (Neimeyer, 2015). This might be visiting their grave on certain days, lighting a candle on their birthday, cooking their favorite meal on holidays, or creating new traditions that celebrate their life. Rituals don’t have to be elaborate—even small, consistent acts of remembrance can provide structure and meaning.

5. Use evocative language. It might sound harsh, but saying “my son died” rather than “I lost my son” actually helps your brain process the reality of what happened (Worden, 2010). The euphemisms we use, while gentler in the moment, can sometimes keep us from fully accepting what we need to eventually comprehend.

6. Practice self-compassion meditation. Research shows that meditation can reduce insomnia, improve concentration, and help manage the complex emotions associated with grief (Black & Slavich, 2016). Even five minutes of compassionate breathing can create space between you and overwhelming feelings. Apps like Insight Timer and Calm offer free guided meditations specifically for grief.

7. Map your support system. Create a visual representation of the people and resources available to you. Who can you call at 3 a.m.? Who brings you meals? Who just sits with you without trying to fix anything? Understanding your support network helps you know who to reach out to and for what (Neimeyer, 2015). And if your network feels sparse, that’s information too—it might be time to seek additional support through grief groups or counseling.

8. Connect with what’s bigger than grief. While grief can feel all-consuming, you are more than your grief. Connecting with your strengths, values, and the parts of your identity that remain intact can prevent complete immersion in loss (Neimeyer, 2015). This isn’t about denying grief—it’s about maintaining the perspective that you’re a whole person navigating a devastating experience, not just a grieving person.

9. Take care of your grieving self. Grief is exhausting work. Assess your current self-care honestly: Are you eating? Sleeping? Moving your body? Connecting with others? Grief often depletes us in multiple dimensions simultaneously. Brainstorm specific, achievable ways to care for yourself—perhaps it’s asking someone to bring groceries, taking a 10-minute walk, or simply giving yourself permission to rest (Worden, 2010).

10. Share your loss with others—when you’re ready. Talking about your grief, listening to others’ stories, and reflecting on these experiences can facilitate healing. But there’s no timeline for when you should be ready to share. Some people need to talk immediately; others need time to process privately first. Honor your own rhythm while remaining open to connection when it feels right (Neimeyer, 2015).

11. Use imagery to reconnect. When you’re ready, guided imagery can help you intentionally connect with the inner presence of your loved one. Close your eyes and imagine meeting them face-to-face. Tell them what you miss. Ask them what you need to know. Say goodbye for now. This isn’t about denial—it’s about accessing the ongoing bond you maintain with them even in their physical absence (Neimeyer, 2015).

12. Restore your broken mirror. Grief shatters us. Use the metaphor of a broken mirror to identify activities that will help you reassemble the pieces of yourself. You won’t be the same—cracks and gaps will remain, and the reflection will look different—but you can create something whole again, perhaps even more beautiful for having been broken and restored (Neimeyer, 2015).

Critical Resources for When Grief Becomes Overwhelming

If you’re experiencing suicidal thoughts:

  • 988 Suicide and Crisis Lifeline: Call or text 988 (available 24/7)
  • Crisis Text Line: Text HOME to 741741
  • The Trevor Project (for LGBTQ+ youth): 1-866-488-7386

These aren’t signs of weakness. Grief can trigger profound despair, especially in the early weeks and months. One study found that approximately 10% of bereaved individuals experience intense, prolonged suffering that can last years (Currier et al., 2008). You’re not alone in feeling this way, and reaching out for help is one of the bravest things you can do.

For ongoing support:

  • GriefShare: Faith-based support groups meeting nationwide (griefshare.org)
  • The Compassionate Friends: Specifically for parents who have lost children (compassionatefriends.org)
  • GRASP (Grief Recovery After a Substance Passing): For those who’ve lost someone to addiction or overdose (grasphelp.org)
  • Open to Hope: Online community and resources (opentohope.com)
  • What’s Your Grief: Practical, accessible grief education and community (whatsyourgrief.com)

Finding a therapist:

  • Psychology Today therapist directory (psychologytoday.com/us/therapists)
  • Your insurance provider’s directory
  • Look specifically for therapists trained in grief counseling or complicated grief treatment
  • If you reside in Utah, call Ascend Counseling & Wellness at 435-688-1111

The Family System Perspective: When Someone You Love Is Grieving

Watching someone you care about drown in grief is its own kind of helplessness. You want to fix it, to take away their pain, but you can’t. What you can do is show up, bear witness, and offer consistent, compassionate presence.

How to Support Someone in Grief

Don’t avoid them. People often pull away from those who are grieving because they don’t know what to say. The truth is, there’s nothing you can say that will make it better, and that’s okay. What matters is showing up. Send a text that says, “thinking of you today.” Drop off food. Offer to sit together in silence. Your presence matters more than your words.

Use direct language. Following Worden’s (2010) guidance, don’t be afraid to say “died” instead of “passed away” or “lost.” While it might feel uncomfortable, direct language actually helps the griever process reality.

Remember the long game. Everyone shows up in the first few weeks. Be the person who checks in at three months, six months, and a year. Grief doesn’t follow our social timelines, and the loneliest time is often when everyone else assumes you should be “over it.”

Offer specific help. “Let me know if you need anything” puts the burden on the griever. Instead, try: “I’m going to the store—what can I pick up for you?” or “I’m free Tuesday afternoon to help with yard work.”

Validate without fixing. When someone shares their pain, resist the urge to minimize it with platitudes like “they’re in a better place” or “everything happens for a reason.” Instead, try: “This is so hard. I’m here” or “I can’t imagine what you’re going through, but I’m here to listen.”

Give them permission to grieve in their own way. Don’t impose expectations about how they should feel or when they should “move on.” Each person’s grief is shaped by their unique relationship, personality, and circumstances. Your role is to support their process, not dictate it (Neimeyer, 2015).

When to Encourage Professional Help

According to research, early high levels of distress are among the best predictors of later difficulties, suggesting the person is at risk for complicated grief (Worden, 2010). Watch for:

  • Suicidal ideation or self-harm
  • Inability to function in daily life (not eating, not sleeping, unable to work) lasting beyond the first few weeks
  • Substance abuse as a coping mechanism
  • Complete withdrawal from relationships and activities
  • No oscillation—stuck entirely in either restoration or loss orientation
  • Grief that intensifies rather than gradually softens over time

Complicated grief affects about 10% of bereaved individuals and can include prolonged, intense symptoms that interfere with the ability to re-engage with life (Currier et al., 2008). This isn’t weakness—it’s a sign that specialized grief therapy might be beneficial.

The Professional Perspective: Providing Competent Grief Support

As clinicians, we occupy a unique position in the grief process. We provide a safe container for emotions that might feel too overwhelming to share with family or friends. We normalize experiences that clients fear mean they’re “going crazy.” We offer evidence-based interventions while honoring the deeply individual nature of each person’s loss.

Effective Clinical Interventions

Assessment matters. Before jumping into interventions, assess where the client is in their grief process. Tools like the Hogan Grief Reaction Checklist (Hogan & Schmidt, 2016) can help evaluate current distress levels and indicators of complicated grief versus normal bereavement responses. Additionally, help clients analyze their own way of grieving by exploring how loss affects them physically, emotionally, cognitively, behaviorally, and spiritually. This multidimensional assessment normalizes the varied manifestations of grief.

Distinguish between counseling and therapy. Grief counseling facilitates normal grief reactions, helping clients move through Worden’s tasks of mourning within a reasonable timeframe (Worden, 2010). Grief therapy addresses complicated grief reactions—prolonged, delayed, exaggerated, or otherwise pathological responses that impair functioning. Knowing this distinction helps determine the appropriate level of care.

Timing is everything. While exceptions exist, grief counseling typically begins about a week after the funeral (Worden, 2010). The first 24 hours post-loss involve shock, logistics, and survival mode. Clients need time to surface before they can dive into the work of mourning. However, if a client reaches out in crisis earlier, meet them where they are.

Guide clients through the Four Tasks of Mourning. Use Worden’s (2010) framework systematically. Help them identify which task they’re currently working on and what concrete steps might move them forward. Task 1 involves accepting the reality—encourage them to talk about the loss using direct language. Task 2 means experiencing the pain—create space for full emotional expression. Task 3 requires adjusting to life without the deceased—problem-solve around new roles and responsibilities. Task 4 involves finding ways to memorialize while reinvesting in life—explore what they want for themselves now.

Facilitate structured journaling. Consider proposing a 40-day grief journaling commitment. This provides structure while allowing flexibility in what clients explore. Prompts might include: “What I miss most today,” “A memory I want to preserve,” “What I wish I had said,” or “How I’m taking care of myself.” The commitment itself becomes a ritual, and the accumulated entries create a tangible record of the journey (Neimeyer, 2015).

Help clients create a Life Certificate. This decisive intervention involves creating a document that honors the deceased person’s life—their values, impact, defining characteristics, and the legacy they leave behind. This process helps clients renegotiate their relationship with the deceased, moving from “they are gone” to “they lived, they mattered, and they remain part of my story” (Neimeyer, 2015).

Map the support system. Work with clients to create a visual representation—perhaps circles of support showing who provides what kind of help. This clarifies available resources and identifies gaps that might need to be filled through support groups, additional services, or expanded social connections (Neimeyer, 2015).

Normalize the right to grieve in their own way. Many clients feel pressure from family, culture, or internalized expectations about how they “should” grieve. Psychoeducation about the individual nature of grief and explicit permission to honor their own process can be profoundly relieving (Neimeyer, 2015).

Contextualize suffering within the human experience. While each person’s loss is unique, grief itself is universal. Help clients recognize that their suffering, while intensely personal, connects them to the broader human experience of love and loss. This can reduce feelings of isolation and abnormality (Neimeyer, 2015).

Use metaphor therapeutically. Ask clients: “If your grief were a landscape, what would it look like?” or “If you could describe this experience in one image, what would it be?” Metaphors access emotional truth that direct language sometimes can’t reach. The broken mirror metaphor, mentioned earlier, can help clients visualize both the shattering impact of loss and the possibility of reconstruction (Neimeyer, 2015).

Teach the distinction between avoidance and helpful distraction. Using the Dual Process Model, help clients understand that taking breaks from grief isn’t betrayal or denial—it’s necessary restoration. Work together to identify genuinely restorative activities (time with friends, hobbies, nature) versus numbing behaviors (excessive alcohol, compulsive work, complete isolation). The goal is intentional oscillation, not permanent escape (Stroebe & Schut, 1999).

Connect clients with what’s bigger than grief. Even in the midst of devastating loss, clients retain strengths, values, and aspects of identity. Help them reconnect with these anchors. What matters to them beyond this loss? What gives them meaning? This isn’t minimizing grief—it’s preventing complete identity fusion with the grieving process (Neimeyer, 2015).

Facilitate ritual creation. Work with clients to design meaningful rituals—visiting a special place on anniversaries, annual charitable donations in the deceased’s name, lighting candles, planting memorial gardens. Rituals provide structure, meaning, and active ways to maintain connection while honoring loss (Neimeyer, 2015).

Encourage sharing stories. Create opportunities for clients to tell stories about their loved one, to say their name out loud, and to share memories. For many grievers, others’ discomfort means the deceased becomes unspeakable. Your office should be a place where the person remains vividly alive in conversation (Neimeyer, 2015).

Assess and enhance self-care. Systematically review how clients are caring for themselves physically, emotionally, socially, and spiritually. Grief depletes resources across all domains. Brainstorm specific, achievable self-care strategies and problem-solve around barriers. Sometimes permission to rest or to prioritize basic needs is itself therapeutic (Worden, 2010).

Use imagery work. Guided imagery exercises that help clients “meet” the deceased, say what was left unsaid, or revisit meaningful memories can facilitate both connection and closure (Neimeyer, 2015). This technique taps into our brain’s powerful visual processing capabilities and can be particularly helpful for working through unfinished business.

Incorporate body-based practices. The research on meditation and yoga for grief is compelling, showing reduced insomnia, improved concentration, and better emotional regulation (Black & Slavich, 2016; Desbordes et al., 2012). Teach clients simple breathwork or recommend gentle yoga classes designed for those in grief.

Facilitate letter writing. Writing to the deceased allows clients to express unsaid thoughts, articulate regrets, seek forgiveness, or simply say goodbye. These letters can be read aloud in session, kept private, or even symbolically delivered through burning or burial. The act of writing creates both expression and resolution (Neimeyer, 2015; Worden, 2010).

Employ role-play carefully. Empty chair work and other role-play techniques can be powerful for expressing unsaid words or working through complicated emotions toward the deceased (Worden, 2010). However, ensure the client is ready for this level of emotional engagement.

Educate about the Dual Process Model. Normalize the oscillation between grief and restoration activities (Stroebe & Schut, 1999). Clients often feel guilty when they have “good” moments or need breaks from grieving. Psychoeducation about this model can be profoundly relieving.

Managing Countertransference and Self-Care

Working with grief can activate our own losses and fears. Regular supervision, personal therapy, and honest self-reflection about our triggers are essential. Notice when you want to rush a client through their pain or when you’re avoiding specific topics. These reactions contain crucial information about our own work.

Conclusion: Holding Space for Hope

Grief transforms us. It marks a clear before and after in our lives. But here’s what I’ve witnessed again and again in my work: people don’t “get over” profound loss, but they do learn to integrate it. They find ways to carry their loved one forward while building meaningful lives. They discover that honoring the past and embracing the future aren’t mutually exclusive.

If you’re in the depths of grief right now, please know that what you’re feeling—however intense, however strange—is part of the human experience of love and loss. You have the right to grieve in your own way. Reach out. Use the resources. Give yourself permission to both grieve and to take breaks from grieving. Be patient with yourself. Healing isn’t linear, and it doesn’t mean forgetting.

If you’re supporting someone in grief, your consistent, compassionate presence is more powerful than you know. Keep showing up. Keep saying their loved one’s name. Keep holding space for the reality that grief is love’s other face. And remember—you can’t fix their pain, but you can walk alongside them through it.

And if you’re a professional working with bereaved clients, thank you for holding space for one of life’s most difficult passages. Your work matters profoundly. Continue refining your skills, seeking supervision, and taking care of yourself so you can continue offering this sacred service.

Grief is the price we pay for love, and while that price can feel unbearably high, it’s also a testament to the depth of our connections. In honoring our losses, we ultimately honor what—and who—matters most.

Ascend Counseling and Wellness – ascendcw.com – 435.688.1111 – kevin@ascendcw.com

References

American Cancer Society. (2019). Hospice care. https://www.cancer.org/treatment/end-of-life-care/hospice-care.html

American Psychological Association. (2022). Grief. In APA dictionary of psychology. https://dictionary.apa.org/grief

Black, D. S., & Slavich, G. M. (2016). Mindfulness meditation and the immune system: A systematic review of randomized controlled trials. Annals of the New York Academy of Sciences, 1373(1), 13–24. https://doi.org/10.1111/nyas.12998

Brown, E. J. (2021). Complicated grief. American Psychological Association. https://www.apa.org/topics/grief/complicated

Currier, J. M., Neimeyer, R. A., & Berman, J. S. (2008). The effectiveness of psychotherapeutic interventions for bereaved persons: A comprehensive quantitative review. Psychological Bulletin, 134(5), 648–661. https://doi.org/10.1037/0033-2909.134.5.648

Davies, B. (2013). Supporting families in palliative care. In B. R. Ferrell & N. Coyle (Eds.), Oxford textbook of palliative nursing (4th ed., pp. 613–627). Oxford University Press.

Desbordes, G., Negi, L. T., Pace, T. W., Wallace, B. A., Raison, C. L., & Schwartz, E. L. (2012). Effects of mindful-attention and compassion meditation training on amygdala response to emotional stimuli in an ordinary, non-meditative state. Frontiers in Human Neuroscience, 6, Article 292. https://doi.org/10.3389/fnhum.2012.00292

Hogan, N. S., & Schmidt, L. A. (2016). An overview of the Hogan Grief Reaction Checklist: Applications for researchers and clinicians. OMEGA—Journal of Death and Dying, 73(2), 89–102. https://doi.org/10.1177/0030222815598099

Kübler-Ross, E. (1969). On death and dying. Macmillan.

Myers, A. E., & Donley, A. M. (2022). COVID-19 and online memorial culture. OMEGA—Journal of Death and Dying, 85(1), 231–251. https://doi.org/10.1177/00302228211039784

Neimeyer, R. A. (Ed.). (2015). Techniques of grief therapy: Assessment and intervention. Routledge.

Robinson, S., & Pond, R. (2019). “Do I deserve to feel better?” Deservingness as a barrier to accessing online support for complicated grief. OMEGA—Journal of Death and Dying, 79(4), 343–364. https://doi.org/10.1177/0030222817715983

Rogalla, K. B. (2020). Anticipatory grief, proactive coping, social support, and growth: Exploring positive experiences of preparing for loss. OMEGA—Journal of Death and Dying, 82(1), 107–129. https://doi.org/10.1177/0030222818761461

Stroebe, M., & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23(3), 197–224. https://doi.org/10.1080/074811899201046

Worden, J. W. (2010). Grief counseling and grief therapy: A handbook for the mental health practitioner (4th ed.). Springer.

October 15, 2025

Trauma and the Mind-Body Connection

Understanding Trauma and the Mind-Body Connection: A Guide to Healing

Introduction

Trauma has long been misunderstood as an experience limited to combat veterans or survivors of extreme violence. However, research and clinical practice reveal a far more common reality: trauma touches the lives of countless individuals through accidents, childhood adversity, medical procedures, emotional abuse, and sudden losses. Three groundbreaking works—The Body Keeps the Score by Bessel van der Kolk, The Emotion Code by Dr. Bradley Nelson, and The Body Code by Dr. Bradley Nelson—offer complementary perspectives on how trauma embeds itself in our bodies and minds, and more importantly, how we can heal.

This article explores the convergence of these approaches, examining how trauma becomes stored in our physical and energetic systems, and how various therapeutic modalities can support the journey toward recovery and wholeness.

What Is Trauma? Beyond the Battlefield

The Prevalence of Trauma

Van der Kolk (2014) fundamentally reshapes our understanding of trauma by demonstrating that it extends far beyond combat experiences. Trauma results from any experience of extreme stress, pain, or helplessness that overwhelms an individual’s capacity to cope. This can include:

  • Physical or sexual abuse
  • Neglect during childhood
  • Serious accidents or injuries
  • Medical procedures, especially in childhood
  • Sudden loss of loved ones
  • Natural disasters
  • Witnessing violence
  • Chronic emotional invalidation

Research indicates that approximately 60% of men and 50% of women experience at least one traumatic event in their lifetime, with many experiencing multiple traumas (Kessler et al., 1995). The Adverse Childhood Experiences (ACE) Study revealed that childhood trauma is widespread, with two-thirds of participants reporting at least one adverse childhood experience (Felitti et al., 1998).

How Trauma Differs from Stress

While stress activates our body’s alarm system temporarily, trauma represents a fundamental breakdown in our ability to process and integrate overwhelming experiences. Van der Kolk (2014) explains that trauma occurs when our natural stress response systems become dysregulated, leaving us stuck in patterns of hyperarousal or dissociation. The experience isn’t just remembered—it becomes encoded in our bodies, nervous systems, and even our sense of self.

The Body Keeps the Score: Neurobiological Foundations

The Brain Under Siege

Van der Kolk’s (2014) seminal work demonstrates how trauma fundamentally alters brain function and structure. Three key brain regions are particularly affected:

The Amygdala: This alarm system becomes hyperactive in trauma survivors, triggering fear responses to neutral stimuli and making it difficult to distinguish between past threats and present safety (Rauch et al., 2006).

The Hippocampus: This memory center, responsible for contextualizing experiences in time and place, often shrinks in trauma survivors. This helps explain why traumatic memories feel timeless and present, rather than safely relegated to the past (Bremner, 2006).

The Prefrontal Cortex: This executive control center becomes underactive, reducing our ability to regulate emotions, make rational decisions, and maintain perspective during triggering situations (Lanius et al., 2010).

The Body’s Memory System

Perhaps van der Kolk’s (2014) most profound contribution is demonstrating that trauma is stored not just in explicit memories, but in the body itself. Trauma survivors often experience:

  • Chronic muscle tension and pain
  • Gastrointestinal problems
  • Cardiovascular issues
  • Immune system dysregulation
  • Chronic fatigue
  • Heightened startle responses

These physical symptoms represent the body’s attempt to complete defensive responses that were thwarted during the traumatic event. When we cannot fight or flee, our nervous system remains frozen in an incomplete stress response (Levine, 1997; van der Kolk, 2014).

The Emotion Code: Trapped Emotions and Energetic Imbalances

Understanding Trapped Emotions

Dr. Bradley Nelson’s The Emotion Code (2007) introduces a complementary framework for understanding how emotional experiences become literally trapped in the body. Nelson proposes that intense emotional experiences create energetic disturbances that can become lodged in specific organs, tissues, or body systems.

According to Nelson (2007), trapped emotions:

  • Distort the body’s energy field
  • Create physical pain and dysfunction
  • Interfere with emotional well-being
  • Sabotage relationships and success
  • Block the body’s natural healing abilities

While Nelson’s energy-based model differs from conventional neuroscience, it shares common ground with research on emotional processing and somatic experiencing. The concept that unprocessed emotions can create physical symptoms aligns with psychosomatic medicine and the growing field of psychoneuroimmunology (Ader, 2007).

The Heart-Wall Phenomenon

Nelson (2007) describes the “Heart-Wall”—a protective energetic barrier constructed from trapped emotions surrounding the heart. This metaphorical wall serves to protect against emotional pain but simultaneously:

  • Reduces our ability to give and receive love
  • Numbs emotional experiences
  • Creates feelings of isolation and disconnection
  • May contribute to physical heart problems

This concept resonates with attachment research showing how early trauma can create defensive patterns that protect against further hurt while simultaneously limiting connection and intimacy (Mikulincer & Shaver, 2016).

Releasing Trapped Emotions

Nelson’s (2007) approach involves using muscle testing (applied kinesiology) to identify trapped emotions, then releasing them through therapy. While the specific mechanisms used remain debated in scientific literature, the approach incorporates elements found in other somatic therapies:

  • Body awareness and attention
  • Acknowledgment of specific emotions
  • Intentional release and letting go
  • Physical interventions to complete the process

The Body Code: A Comprehensive Healing System

Expanding Beyond Emotions

In The Body Code (2013), Dr. Nelson extends his framework to address six key categories of imbalance that can contribute to physical and emotional symptoms:

1. Emotional Wellness: Building on The Emotion Code, this includes trapped emotions, Heart-Walls, and other emotional energies affecting health.

2. Body System Balance: Addressing imbalances in organs, glands, chakras, meridians, and the body’s energetic systems.

3. Toxins: Identifying heavy metals, free radicals, chemicals, and electromagnetic frequencies that burden the body.

4. Pathogens: Recognizing fungal, bacterial, viral, mold, or parasitic infections contributing to symptoms.

5. Structural Balance: Correcting misalignments in bones, nerves, connective tissue, and musculoskeletal systems.

6. Nutrition and Lifestyle: Identifying nutritional deficiencies, sleep issues, dehydration, and other lifestyle factors affecting wellness.

Integrative Implications

While Nelson’s (2013) comprehensive system operates from an energy medicine paradigm, it acknowledges the multifactorial nature of health and illness—a perspective increasingly validated by integrative medicine research (Maizes et al., 2009). The recognition that physical symptoms may have emotional roots, and emotional symptoms may have physical contributors, aligns with biopsychosocial models of health (Engel, 1977).

Bridging Neuroscience and Energy Medicine

Points of Convergence

While van der Kolk’s neuroscience-based approach and Nelson’s energy-based framework use different language and methodologies, they share several core insights:

1. The Body Stores Emotional Experiences: Both perspectives recognize that emotional experiences, particularly traumatic ones, become encoded in bodily systems beyond conscious memory (van der Kolk, 2014; Nelson, 2007).

2. Incomplete Processing Creates Symptoms: Whether described as dysregulated nervous system responses or trapped emotions, both models suggest that unprocessed experiences create ongoing physical and emotional symptoms (Levine, 1997; Nelson, 2007).

3. Healing Requires Body Engagement: Both approaches emphasize that cognitive insight alone is insufficient; healing must involve the body through movement, awareness, or energetic interventions (van der Kolk, 2014; Nelson, 2013).

4. The Heart of Connection: Van der Kolk (2014) emphasizes the importance of safe relationships in healing, while Nelson (2007) focuses on the Heart-Wall that blocks connection. Both recognize that trauma disrupts our capacity for intimacy and that healing involves restoring this capacity.

Scientific Support for Mind-Body Approaches

Research increasingly validates mind-body approaches to trauma treatment:

  • Yoga and mindfulness: Studies demonstrate significant reductions in PTSD symptoms through yoga interventions (van der Kolk et al., 2014; Emerson et al., 2009).
  • EMDR (Eye Movement Desensitization and Reprocessing): This somatic therapy shows efficacy comparable to cognitive-behavioral approaches for trauma (Shapiro, 2014).
  • Somatic Experiencing: Levine’s (1997) body-based approach demonstrates effectiveness in resolving trauma symptoms by completing interrupted defensive responses.
  • Neurofeedback: Direct training of brainwave patterns shows promise for regulating traumatized nervous systems (van der Kolk et al., 2016).

While energy-based approaches like those described by Nelson lack the same empirical validation, they share theoretical frameworks with established somatic therapies and may operate through similar mechanisms of body awareness, emotional acknowledgment, and nervous system regulation.

Practical Implications for Trauma Recovery

A Comprehensive Approach

Integration of these perspectives suggests that effective trauma treatment should address multiple dimensions:

1. Safety and Stabilization: Before processing trauma, establishing safety in one’s environment, relationships, and nervous system is essential (van der Kolk, 2014).

2. Body Awareness: Developing the capacity to notice bodily sensations without becoming overwhelmed—a skill called interoception—is fundamental to healing (Payne et al., 2015).

3. Emotional Processing: Whether through traditional therapy, energy work, or somatic approaches, identifying and releasing trapped emotional experiences is crucial (Nelson, 2007; van der Kolk, 2014).

4. Nervous System Regulation: Learning techniques to shift between activation and calm, including breathwork, movement, and mindfulness, helps restore flexibility (Porges, 2011).

5. Meaning-Making: Creating coherent narratives about traumatic experiences helps integrate them into our life story rather than leaving them as fragmented, overwhelming memories (Pennebaker & Chung, 2011).

6. Connection and Community: Healing happens in relationships; safe, attuned connections with therapists, support groups, or communities provide the interpersonal regulation that trauma disrupted (van der Kolk, 2014).

7. Physical Health Foundation: Addressing inflammation, nutrition, sleep, and physical health creates the biological foundation for psychological healing (Nelson, 2013; Maizes et al., 2009).

Working with Your Therapist

If you’re currently working through the past with trauma therapy or considering it, these insights suggest essential questions to discuss:

  • Does your treatment address both psychological and physical dimensions of trauma?
  • Are you learning body-based skills for managing activation and distress?
  • Does your therapy include processing emotional experiences, not just talking about them?
  • Are you developing awareness of how trauma shows up in your body?
  • Is the therapeutic relationship itself helping you experience safety and attunement?

Self-Care Strategies

While professional support is often necessary for trauma recovery, several evidence-based self-care practices can support your healing:

  • Mindfulness meditation: Regular practice reduces symptoms of anxiety and depression while improving emotional regulation (Khoury et al., 2013).
  • Physical movement: Yoga, walking, dancing, or other embodied activities help discharge stored stress responses (van der Kolk, 2014).
  • Journaling: Expressive writing about traumatic experiences facilitates processing and integration (Pennebaker & Chung, 2011).
  • Nature exposure: Time in natural settings reduces stress hormones and promotes nervous system regulation (Bratman et al., 2015).
  • Social connection: Maintaining relationships with safe, supportive people provides co-regulation and counters isolation (Porges, 2011).
  • Creative expression —art, music, and other modalities —can access emotional experiences that may be difficult to verbalize (Malchiodi, 2020).

Understanding Different Healing Modalities

Evidence-Based Trauma Therapies

Several therapeutic approaches have strong research support:

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): This structured approach helps individuals process traumatic memories while developing coping skills (Cohen et al., 2006).

Eye Movement Desensitization and Reprocessing (EMDR): Using bilateral stimulation, EMDR facilitates processing of traumatic memories with reduced distress (Shapiro, 2014).

Internal Family Systems (IFS): This approach works with different aspects of the psyche affected by trauma, helping integrate fragmented parts (Schwartz & Sweezy, 2020).

Sensorimotor Psychotherapy: Combining talk therapy with body-based interventions, this approach addresses how trauma manifests somatically (Ogden et al., 2006).

Complementary and Alternative Approaches

Some individuals find benefit in approaches that lack extensive research validation but align with holistic or energy-based paradigms:

Energy Psychology: Techniques like Emotional Freedom Technique (EFT) combine exposure therapy with acupressure points (Church et al., 2013).

Body-Based Energy Work: Approaches such as Nelson’s Emotion Code, Reiki, or therapeutic touch focus on energetic imbalances (Nelson, 2007, 2013).

Somatic Experiencing: Levine’s (1997) approach focuses on releasing stored survival energy through body awareness and gentle movements.

When considering complementary approaches, look for practitioners who:

  • Have appropriate training and credentials
  • Work collaboratively with conventional mental health providers
  • Recognize limitations and make appropriate referrals
  • Respect your autonomy and informed consent
  • Avoid promises of miracle cures

The Role of Neuroplasticity in Healing

One of the most hopeful insights from neuroscience is that the brain changes caused by trauma are not permanent. Neuroplasticity—the brain’s ability to form new neural connections—means that healing is possible throughout our lives (Doidge, 2007).

Research demonstrates that:

  • Therapy can normalize amygdala hyperactivity (Peres et al., 2007)
  • Mindfulness practice increases hippocampal volume (Hölzel et al., 2011)
  • Secure relationships strengthen prefrontal cortex function (Coan et al., 2006)
  • Body-based therapies restore interoception and self-awareness (Price & Hooven, 2018)

This means that regardless of when trauma occurred or how severe its impact, the brain and body retain the capacity to heal, reorganize, and develop new, healthier patterns.

Special Considerations: Complex Trauma

While this article has discussed trauma broadly, it’s essential to acknowledge that complex trauma—repeated traumatic experiences, particularly in childhood—presents unique challenges (Herman, 1992). Complex trauma affects:

  • Identity development and sense of self
  • Capacity for emotional regulation
  • Relationship patterns and attachment
  • Physical health across the lifespan

Recovery from complex trauma typically requires longer-term, phase-based treatment that addresses not just specific traumatic events but the developmental interruptions they cause. Both van der Kolk’s (2014) comprehensive approach and Nelson’s (2007; 2013) attention to multiple layers of emotional and physical imbalance can be particularly relevant for complex trauma survivors.

Moving Forward: Hope and Healing

Perhaps the most important message from all three works—The Body Keeps the Score, The Emotion Code, and The Body Code—is that healing is possible. Trauma may be stored in our bodies and brains, but these same systems possess remarkable capacities for reorganization, release, and renewal.

Key principles for your healing journey:

1. Be Patient with Yourself: Healing happens in layers, not linearly. Trust your own timing and process.

2. Honor Your Body’s Wisdom: Your symptoms, though uncomfortable, represent your body’s attempts to protect and heal you. Approach them with curiosity rather than judgment.

3. Seek Support: Healing from trauma rarely happens in isolation. Find therapists, practitioners, and communities that feel safe and supportive.

4. Integrate Multiple Approaches: Different healing modalities address different dimensions of trauma. What works for one person or one phase of healing may differ from what’s needed at another time.

5. Celebrate Small Victories: Healing isn’t always dramatic. Notice and appreciate subtle shifts in your capacity to feel safe, connected, and present.

6. Stay Curious: Both conventional and complementary approaches offer valuable insights. Remain open to what resonates with your experience while maintaining discernment.

Conclusion

The convergence of neuroscience-based understanding and holistic healing approaches offers trauma survivors multiple pathways to recovery. Van der Kolk’s (2014) demonstration that “the body keeps the score” validates what many survivors intuitively know: trauma lives in our bodies, not just our minds. Nelson’s (2007; 2013) frameworks for identifying and releasing trapped emotions and other imbalances provide accessible tools for addressing these somatic dimensions.

Whether you resonate more with neuroscientific explanations or energetic models, the essential truth remains: trauma can be healed. Your body, which has faithfully stored these experiences, also holds the wisdom and capacity for release and renewal. With appropriate support, patience, and compassionate attention to both psychological and physical dimensions, you can move from being haunted by the past to being fully present in your life.

The journey of healing is profoundly personal and uniquely yours. May you find the approaches, practitioners, and communities that support your path toward wholeness.

Kevin Brough, MAMFT
Marriage and Family Therapist

Ascend Counseling and Wellness – ascendcw.com – 435.688.1111 – kevin@ascendcw.com

References

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Bratman, G. N., Hamilton, J. P., & Daily, G. C. (2015). The impacts of nature experience on human cognitive function and mental health. Annals of the New York Academy of Sciences, 1249(1), 118-136. https://doi.org/10.1111/j.1749-6632.2011.06400.x

Bremner, J. D. (2006). Traumatic stress: Effects on the brain. Dialogues in Clinical Neuroscience, 8(4), 445-461. https://doi.org/10.31887/DCNS.2006.8.4/jbremner

Church, D., Yount, G., & Brooks, A. J. (2013). The effect of emotional freedom techniques on stress biochemistry: A randomized controlled trial. Journal of Nervous and Mental Disease, 200(10), 891-896. https://doi.org/10.1097/NMD.0b013e31826b9fc1

Coan, J. A., Schaefer, H. S., & Davidson, R. J. (2006). Lending a hand: Social regulation of the neural response to threat. Psychological Science, 17(12), 1032-1039. https://doi.org/10.1111/j.1467-9280.2006.01832.x

Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. Guilford Press.

Doidge, N. (2007). The brain that changes itself: Stories of personal triumph from the frontiers of brain science. Viking.

Emerson, D., Sharma, R., Chaudhry, S., & Turner, J. (2009). Trauma-sensitive yoga: Principles, practice, and research. International Journal of Yoga Therapy, 19(1), 123-128. https://doi.org/10.17761/ijyt.19.1.h6476p8084l22160

Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129-136. https://doi.org/10.1126/science.847460

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258. https://doi.org/10.1016/S0749-3797(98)00017-8

Herman, J. L. (1992). Trauma and recovery: The aftermath of violence—from domestic abuse to political terror. Basic Books.

Hölzel, B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, T., & Lazar, S. W. (2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging, 191(1), 36-43. https://doi.org/10.1016/j.pscychresns.2010.08.006

Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048-1060. https://doi.org/10.1001/archpsyc.1995.03950240066012

Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., Chapleau, M. A., Paquin, K., & Hofmann, S. G. (2013). Mindfulness-based therapy: A comprehensive meta-analysis. Clinical Psychology Review, 33(6), 763-771. https://doi.org/10.1016/j.cpr.2013.05.005

Lanius, R. A., Vermetten, E., Loewenstein, R. J., Brand, B., Schmahl, C., Bremner, J. D., & Spiegel, D. (2010). Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype. American Journal of Psychiatry, 167(6), 640-647. https://doi.org/10.1176/appi.ajp.2009.09081168

Levine, P. A. (1997). Waking the tiger: Healing trauma. North Atlantic Books.

Maizes, V., Rakel, D., & Niemiec, C. (2009). Integrative medicine and patient-centered care. Explore, 5(5), 277-289. https://doi.org/10.1016/j.explore.2009.06.008

Malchiodi, C. A. (2020). Trauma and expressive arts therapy: Brain, body, and imagination in the healing process. Guilford Press.

Mikulincer, M., & Shaver, P. R. (2016). Attachment in adulthood: Structure, dynamics, and change (2nd ed.). Guilford Press.

Nelson, B. (2007). The Emotion Code: How to release your trapped emotions for abundant health, love, and happiness. Wellness Unmasked Publishing.

Nelson, B. (2013). The Body Code: Unlocking your body’s ability to heal itself. Wellness Unmasked Publishing.

Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. W. W. Norton & Company.

Payne, P., Levine, P. A., & Crane-Godreau, M. A. (2015). Somatic experiencing: Using interoception and proprioception as core elements of trauma therapy. Frontiers in Psychology, 6, Article 93. https://doi.org/10.3389/fpsyg.2015.00093

Pennebaker, J. W., & Chung, C. K. (2011). Expressive writing: Connections to physical and mental health. In H. S. Friedman (Ed.), The Oxford handbook of health psychology (pp. 417-437). Oxford University Press.

Peres, J. F., Newberg, A. B., Mercante, J. P., Simão, M., Albuquerque, V. E., Peres, M. J., & Nasello, A. G. (2007). Cerebral blood flow changes during retrieval of traumatic memories before and after psychotherapy: A SPECT study. Psychological Medicine, 37(10), 1481-1491. https://doi.org/10.1017/S003329170700997X

Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W. W. Norton & Company.

Price, C. J., & Hooven, C. (2018). Interoceptive awareness skills for emotion regulation: Theory and approach of mindful awareness in body-oriented therapy (MABT). Frontiers in Psychology, 9, Article 798. https://doi.org/10.3389/fpsyg.2018.00798

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van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

van der Kolk, B. A., Stone, L., West, J., Rhodes, A., Emerson, D., Suvak, M., & Spinazzola, J. (2014). Yoga as an adjunctive treatment for posttraumatic stress disorder: A randomized controlled trial. Journal of Clinical Psychiatry, 75(6), e559-e565. https://doi.org/10.4088/JCP.13m08561

van der Kolk, B. A., Hodgdon, H., Gapen, M., Musicaro, R., Suvak, M. K., Hamlin, E., & Spinazzola, J. (2016). A randomized controlled study of neurofeedback for chronic PTSD. PLOS ONE, 11(12), Article e0166752. https://doi.org/10.1371/journal.pone.0166752

October 9, 2025

Breaking the Cycle: Understand ADHD, Stress, and Compulsive Behaviors

Breaking the Cycle: Understanding ADHD, Stress, and Compulsive Behaviors

By Kevin Brough, MFT

If you’re reading this, you might be caught in a cycle that feels impossible to break. You tell yourself you just need more discipline, more willpower, more self-control. You promise yourself—and maybe your partner—that this time will be different. But when boredom hits, or stress overwhelms you, you find yourself right back where you started. And with each setback, the shame deepens, your self-esteem takes another hit, and your relationships suffer.

I want you to know something important: This isn’t a character flaw. This is neurobiology.

As a marriage and family therapist who works extensively with adults with ADHD, I’ve seen this pattern countless times. And I’m writing this article to help you understand what’s really happening in your brain and body—and more importantly, to give you a roadmap out of this cycle.

The Neurobiological Foundation: It’s Not About Willpower

When you have ADHD, particularly inattentive type (F90.0), your brain operates with chronically lower levels of dopamine and norepinephrine—two neurotransmitters that are essential for motivation, focus, attention, and impulse control (Volkow et al., 2009). This isn’t something you can simply overcome with discipline. Your brain is literally seeking these neurochemicals, and it will gravitate toward behaviors that provide quick dopamine hits.

This is why compulsive behaviors—whether pornography use, excessive gaming, social media scrolling, or other high-stimulation activities—become so problematic for individuals with ADHD. These behaviors provide rapid dopamine surges that your understimulated brain desperately craves (Blum et al., 2012). It’s not that you lack character; it’s that your brain is trying to self-medicate a neurochemical deficit.

The Stress Connection: Why It Gets Worse Under Pressure

Here’s where the cycle becomes particularly vicious. When you experience stress, your body activates the hypothalamic-pituitary-adrenal (HPA) axis, releasing corticotropin-releasing factor (CRF) and adrenocorticotropic hormone (ACTH), which ultimately leads to cortisol production (Smith & Vale, 2006). This stress response system, while designed to help us survive threats, creates additional challenges for individuals with ADHD.

Chronic stress actually impairs the prefrontal cortex—the very brain region responsible for executive functions like impulse control, decision-making, and self-regulation (Arnsten, 2009). So when you’re stressed, the part of your brain that would normally help you resist compulsive urges becomes even less effective. Meanwhile, stress increases your need for dopamine to feel balanced, making those quick-fix behaviors even more appealing.

This creates a devastating feedback loop:

  1. ADHD creates low baseline dopamine → 2. You seek high-dopamine behaviors → 3. These behaviors create shame and relationship problems → 4. Shame and problems create stress → 5. Stress impairs impulse control and increases dopamine-seeking → 6. The cycle intensifies

The Impact on Relationships and Self-Esteem

I see the toll this takes. The secrecy erodes trust. The broken promises create distance. Your partner feels hurt, confused, and often personalizes your behavior, wondering if they’re not enough. And you? You internalize the shame, believing you’re weak, broken, or fundamentally flawed.

But here’s what I need you to understand: Shame is not a motivator. Shame is fuel for the cycle.

When you’re drowning in shame, your brain becomes even more dysregulated, your stress levels spike, and you become more vulnerable to the very behaviors you’re trying to avoid (Tangney et al., 2007). Healing begins when we replace shame with understanding and strategic intervention.

A Comprehensive Path Forward: Evidence-Based Interventions

The good news—and there is genuinely good news here—is that with the right combination of interventions, you can break this cycle. This isn’t about willpower; it’s about working with your neurobiology instead of against it.

Important Disclaimer: The following information is educational in nature. Please consult with appropriate healthcare professionals—including your physician, psychiatrist, and therapist—before implementing medical, nutritional, or significant lifestyle changes. This article does not constitute medical advice or replace individualized treatment.

Medical Interventions

Medication Management: For many adults with ADHD, properly managed medication is transformative. Stimulant medications (like methylphenidate or amphetamine-based medications) and non-stimulant options (like atomoxetine or viloxazine) work by increasing dopamine and norepinephrine availability in the brain (Faraone & Glatt, 2010). This isn’t masking the problem—it’s correcting an underlying neurochemical imbalance.

When dopamine levels are adequately supported through medication, many individuals experience:

  • Reduced impulsivity and improved impulse control
  • Better ability to engage in delayed gratification
  • Decreased compulsive behavior-seeking
  • Improved emotional regulation
  • Enhanced ability to benefit from therapy

If you’re not currently on medication, or if your current regimen isn’t effectively managing your symptoms, please discuss this with a psychiatrist who specializes in adult ADHD. If you are on medication but still struggling significantly, your dosage or medication type may need adjustment.

Addressing Co-occurring Conditions: ADHD frequently co-occurs with anxiety, depression, and trauma histories (Kessler et al., 2006). These conditions interact with and exacerbate each other. Comprehensive psychiatric evaluation can help identify and treat the full clinical picture.

Nutritional Approaches

Your brain is a biochemical organ, and what you feed it matters profoundly.

Protein and Amino Acids: Adequate protein intake is essential for neurotransmitter production. Tyrosine, an amino acid found in protein-rich foods, is a precursor to dopamine (Fernstrom & Fernstrom, 2007). Aim for protein at every meal, particularly breakfast, to support stable dopamine production throughout the day.

Omega-3 Fatty Acids: Research suggests that omega-3 supplementation, particularly EPA and DHA, may improve ADHD symptoms and support brain health (Bloch & Qawasmi, 2011). Fatty fish (salmon, mackerel, sardines) or quality fish oil supplements are excellent sources.

Blood Sugar Regulation: Unstable blood sugar creates stress on your body and brain, triggering cortisol release and impairing executive function. Focus on:

  • Complex carbohydrates paired with protein and healthy fats
  • Regular meals (don’t skip breakfast)
  • Minimizing refined sugars and processed foods

Micronutrients: Deficiencies in zinc, magnesium, and iron are associated with ADHD symptoms (Rucklidge et al., 2014). Consider having your levels checked and supplementing as recommended by your physician.

Limit Stimulants and Depressants: Excessive caffeine can increase anxiety and disrupt sleep. Alcohol impairs impulse control and interferes with medication effectiveness. Both disrupt the very systems you’re trying to stabilize.

Exercise and Movement

Physical exercise is one of the most powerful non-pharmaceutical interventions for ADHD (Ratey & Loehr, 2011). Exercise increases dopamine, norepinephrine, and serotonin—providing natural symptom relief. It also reduces cortisol, improves stress resilience, and enhances executive function.

Practical Recommendations:

  • Cardiovascular Exercise: Aim for 30-45 minutes of moderate to vigorous activity most days. Running, cycling, swimming, or brisk walking all provide significant benefits.
  • Strength Training: Resistance training 2-3 times per week supports overall brain health and provides structure.
  • Morning Exercise: If possible, exercise early in the day. This floods your brain with neurochemicals when dopamine is typically lowest, reducing compulsive behavior-seeking throughout the day.
  • Movement Breaks: If you work a sedentary job, take brief movement breaks every hour. Even 2-3 minutes of movement helps regulate your nervous system.

Sleep Hygiene

Sleep deprivation is catastrophic for ADHD symptoms and impulse control (Cortese et al., 2013). When you’re sleep-deprived, your prefrontal cortex essentially goes offline, making compulsive behaviors nearly impossible to resist.

Essential Sleep Practices:

  • Maintain consistent sleep and wake times (even on weekends)
  • Eliminate screens 1-2 hours before bed (blue light suppresses melatonin)
  • Create a dark, cool sleeping environment
  • Avoid caffeine after noon
  • Consider melatonin supplementation (discuss with your doctor)

Therapeutic Interventions

Cognitive Behavioral Therapy (CBT): CBT helps you identify and restructure the thought patterns that maintain compulsive behaviors. It’s particularly effective when combined with medication (Safren et al., 2010). You’ll learn to:

  • Recognize triggers and high-risk situations
  • Challenge shame-based thinking
  • Develop alternative coping strategies
  • Build behavioral activation when motivation is low

Mindfulness and Self-Compassion: Mindfulness practices strengthen the prefrontal cortex and improve emotion regulation (Hölzel et al., 2011). Self-compassion—treating yourself with the kindness you’d offer a good friend—is a powerful antidote to shame. Research consistently shows that self-compassion increases motivation and resilience while reducing avoidance behaviors (Neff, 2003).

Start with just 5 minutes daily of mindfulness meditation. Apps like Insight Timer or Headspace can guide you. When you notice the urge to engage in compulsive behavior, try the “RAIN” technique:

  • Recognize what’s happening
  • Allow the experience to be there
  • Investigate with kindness
  • Nurture yourself

Couples Therapy: If your relationship has been impacted, couples therapy is essential. Your partner needs support processing their hurt, and you both need to rebuild trust and intimacy. A therapist can help you:

  • Develop transparent communication
  • Establish healthy boundaries and accountability
  • Understand the neurobiological components (this isn’t personal)
  • Reconnect emotionally and physically in healthy ways
  • Address underlying relationship issues that may increase vulnerability

ADHD Therapy: ADHD specialized therapists can help you build systems and structures that work with your brain. They can help you:

  • Create environmental modifications that reduce temptation
  • Develop routines that support executive function
  • Build in stimulation and novelty in healthy ways
  • Set realistic goals and maintain accountability

Environmental and Behavioral Strategies

Structure and Routine: Your ADHD brain functions best with external structure. Create consistent daily routines for morning, evening, work, and self-care. Use:

  • Visual schedules and reminders
  • Time-blocking techniques
  • Habit stacking (linking new habits to established ones)

Reduce Accessibility: Make compulsive behaviors harder to access. Install website blockers, keep devices out of private spaces, and create friction between impulse and action. Even small barriers significantly reduce impulsive behavior.

Increase Healthy Stimulation: Your brain needs stimulation. Instead of trying to exist in understimulation, flood your life with healthy, engaging activities:

  • Pursue hobbies that provide flow states
  • Engage in novel experiences regularly
  • Connect with friends and community
  • Learn new skills
  • Listen to music or podcasts during mundane tasks

Identify and Manage Triggers: Work with your therapist to identify your specific triggers:

  • Boredom triggers: What times of day or situations leave you understimulated? Build in healthy stimulation during these windows.
  • Stress triggers: What creates stress in your life? How can you address root causes or develop healthier stress management?
  • Emotional triggers: What feelings precede compulsive behaviors? Develop emotional regulation skills and alternative coping strategies.

Build Accountability: Isolation feeds compulsive behavior. Consider:

  • Regular check-ins with your therapist or coach
  • Support groups (either ADHD-focused or recovery-focused)
  • Accountability partners
  • Transparent technology sharing with your spouse (when appropriate and agreed upon)

Addressing the Relationship

Your relationship has been hurt. That’s real, and it needs attention. But healing is absolutely possible.

For You:

  • Take full responsibility without drowning in shame
  • Understand that changing behavior takes time—be patient with yourself while remaining committed
  • Show through consistent action, not just words
  • Be genuinely curious about your partner’s experience
  • Recognize that trust is rebuilt slowly through reliability

For Your Partner:

  • Your pain is valid, and their behavior impacts you deeply
  • This isn’t about you or your desirability
  • Understanding the neurobiology doesn’t excuse behavior, but it provides context
  • Your partner’s recovery journey may not be linear
  • Your own therapy or support group can be invaluable
  • Set boundaries that honor your needs while supporting their recovery

Together:

  • Rebuild emotional intimacy before focusing solely on physical intimacy
  • Create shared positive experiences
  • Practice vulnerability and authentic communication
  • Celebrate small victories
  • Remember why you chose each other

The Path Forward: From Shame to Hope

I want to return to where we started. You are not weak. You are not broken. You are not fundamentally flawed. You have a neurodevelopmental condition that makes certain behaviors particularly challenging to manage, and you’ve been caught in a cycle that feeds on itself.

But here’s what I know from years of working with clients just like you: Change is possible. Recovery is real. Better relationships await you.

The interventions I’ve outlined aren’t quick fixes, and they won’t all resonate equally with you. But when you approach this comprehensively—addressing the neurobiology through medication and nutrition, supporting your brain through exercise and sleep, building skills through therapy, and creating structures that set you up for success—the cycle begins to break.

Progress won’t be linear. You’ll have setbacks. But each time you implement these strategies, you’re strengthening new neural pathways, building resilience, and moving toward the person you want to be.

Next Steps: Your Action Plan

  1. Medical: Schedule an appointment with a psychiatrist specializing in adult ADHD to discuss medication options or optimize your current regimen.
  2. Therapeutic: Begin or continue individual therapy with a therapist experienced in ADHD and compulsive behaviors. Consider adding couples therapy if your relationship has been impacted.
  3. Physical: Start a consistent exercise routine this week. Even 20 minutes counts. Make this non-negotiable.
  4. Nutritional: Audit your diet. Are you eating adequate protein? Are you skipping meals? Consider consulting with a nutritionist.
  5. Environmental: Implement one environmental change this week that reduces access to compulsive behaviors.
  6. Support: Research ADHD or recovery support groups in your area. Connection matters.
  7. Self-Compassion: When you notice self-critical thoughts, pause and ask: “What would I say to a good friend struggling with this?” Extend that same compassion to yourself.

A Final Word

I believe in your capacity for change. I’ve seen it happen countless times. The brain is remarkably neuroplastic—it can form new patterns, new connections, new ways of being. But it needs the right support, the right interventions, and the proper understanding.

You deserve a life free from the shame-and-compulsion cycle. Your relationship deserves honesty, intimacy, and trust. And the version of yourself you’re working toward? That person is already within you, waiting for the right conditions to emerge.

Be patient with yourself. Be strategic in your approach. Be willing to ask for help. And be hopeful, because hope is not naive—it’s grounded in the reality that with comprehensive intervention, people recover and relationships heal.

You’re not fighting this battle alone anymore.

Kevin Brough, MFT
Marriage and Family Therapist

Ascend Counseling and Wellness – ascendcw.com – 435.688.1111 – kevin@ascendcw.com

References

Arnsten, A. F. (2009). Stress signalling pathways that impair prefrontal cortex structure and function. Nature Reviews Neuroscience, 10(6), 410-422. https://doi.org/10.1038/nrn2648

Bloch, M. H., & Qawasmi, A. (2011). Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: Systematic review and meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 50(10), 991-1000. https://doi.org/10.1016/j.jaac.2011.06.008

Blum, K., Chen, A. L., Braverman, E. R., Comings, D. E., Chen, T. J., Arcuri, V., Blum, S. H., Downs, B. W., Waite, R. L., Notaro, A., Lubar, J., Williams, L., Prihoda, T. J., Palomo, T., & Oscar-Berman, M. (2012). Attention-deficit-hyperactivity disorder and reward deficiency syndrome. Neuropsychiatric Disease and Treatment, 4(5), 893-918. https://doi.org/10.2147/NDT.S2627

Cortese, S., Faraone, S. V., Konofal, E., & Lecendreux, M. (2013). Sleep in children with attention-deficit/hyperactivity disorder: Meta-analysis of subjective and objective studies. Journal of the American Academy of Child & Adolescent Psychiatry, 48(9), 894-908. https://doi.org/10.1097/CHI.0b013e3181ac09c9

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October 8, 2025

Turning ADHD into a Superpower

When Your Brain Won’t Let Go: Turning ADHD Perseveration Into a Superpower

By Kevin Brough, MFT

I’m going to let you in on something that took me years to understand about my own ADHD brain: that laser-focus intensity that helps me solve complex problems? The same trait that makes me an effective therapist at times. It has a shadow side that can make collaboration feel like someone’s throwing wrenches into a perfectly running machine.

I call it my “autopilot mode,” and maybe you know exactly what I’m talking about.

The Double-Edged Sword of Perseveration

Here’s what happens in my head: Once I’ve mapped out how to approach something—whether it’s a therapy intervention, a home project, or even planning dinner—that plan becomes the plan. My brain locks onto it with the intensity of a heat-seeking missile. And when someone suggests a different approach? Even if I intellectually agree with them in the moment, five minutes later, I’ve entirely forgotten we changed anything. I’m back on my original track, steamrolling forward like we never had that conversation.

Sound familiar?

This is perseveration, and it’s one of those ADHD traits that lives in the grey area between strength and struggle. When I’m working alone, this tunnel vision is my secret weapon. I can hold a complex problem in my mind, rotate it, examine it from every angle, and persist until I find the solution. But what about adding another person to the mix? Suddenly their input feels less like collaboration and more like… well, like interference with the perfect plan already running in my head.

The hard truth I’ve had to face: Sometimes I subconsciously dismiss others’ ideas as “dumb” or label them as arguments rather than contributions. Even when my approach might be the best one (and let’s be honest, sometimes it is), that rigid certainty costs me something valuable—connection, collaboration, and often better solutions I couldn’t see from inside my tunnel.

Understanding Why Our Brains Get Stuck

Before we discuss turning this challenge into a strength, let’s first understand what’s actually happening. Adults with ADHD don’t just deal with distraction—we also struggle with persistent thoughts and beliefs that our brains won’t release. This shows up in several ways:

Intrusive thoughts arrive uninvited and set up camp in our minds, creating anxiety and pulling our attention away from what we’re trying to focus on.

Rumination traps us in thought loops, replaying past mistakes or catastrophizing future scenarios. Our ADHD brains have a hyperactive Default Mode Network—the part responsible for mind-wandering—which makes it incredibly hard to turn off these repetitive thought patterns.

Cognitive distortions warp our thinking into extremes. We fall into all-or-nothing thinking (“I always mess things up” or “I never get it right”) and catastrophizing (turning minor setbacks into disasters). Years of struggling without understanding why can solidify negative self-perceptions that become a constant backdrop to everything we do.

Perseveration—my particular nemesis—is the inability to shift away from a thought or approach, even when it’s no longer serving us. Unlike rumination that loops on emotions, perseveration locks onto plans, methods, and ways of doing things.

Why This Happens: The Neuroscience Briefly

Our ADHD brains have some unique wiring:

  • Executive dysfunction impairs our brain’s command center, making it harder to flexibly shift between thoughts and regulate our responses
  • DMN hyperactivity keeps our minds churning, making it challenging to let thoughts go
  • Neurotransmitter imbalances (particularly dopamine and norepinephrine) affect how we process and release information
  • Co-occurring anxiety or depression can amplify these patterns exponentially

The result? Once we lock onto something—an idea, a plan, a way of doing things—our brains struggle to unlock, even when we consciously want to.

My Personal Battle with Perseveration

Let me paint you a picture of how this plays out in my life. I’m working on a home project with my wife. I’ve already figured out the approach—measured twice, researched the best method, and mapped the steps. It’s a solid plan. She suggests a modification. I nod, agree it’s a good idea, and we decide to incorporate it.

Ten minutes later, I’m executing my original plan, as if our conversation never happened. She asks, “I thought we were doing it differently?” And I’m genuinely confused. In my head, we’re still following the plan—the one I created before she spoke.

In my practice, I’m collaborating with another therapist on a treatment approach. They share an insight I hadn’t considered. I acknowledge it, genuinely appreciate it, and even feel excited about it. In the next session, I reverted entirely to my original conceptualization. Their input vanished like morning fog.

The really tricky part? I often don’t notice I’m doing it. I slip into what I call “robotic mode”—unconsciously dismissive, operating from the script in my head, experiencing others’ contributions as threats to overcome rather than gifts to receive.

Sometimes I’m already in “robotic mode” intensely enough that I reject input from others as not just interruptions but Interferences. Interfering (arguing) with my train of thought, my process, my “doing”. Heaven forbid someone else would give us directions or attempt to teach us something while we are in that mode.

The Awareness That Changes Everything

The first breakthrough occurred when I began to catch myself in those moments. Not afterward, during the self-recrimination phase, but in the moment. I started noticing the physical sensations—a slight tightening in my chest when someone suggested a different approach, a subtle speeding up of my thoughts as my brain rushed to defend its plan.

That awareness doesn’t fix the problem, but it creates a tiny pause. A microsecond where choice becomes possible. Hopefully, this pause and openness can become a natural part of your routine.

Strategies: From Struggle to Strength

Here’s what I’ve learned and am still learning about managing perseveration and other persistent thought patterns, both personally and in working with clients:

1. Acknowledge Without Judgment

The moment you notice you’re stuck—whether in a thought loop or locked onto a rigid plan—acknowledge it without beating yourself up. “Oh, there’s that perseveration again,” or “My brain is really holding tight to this idea.” Resistance makes it stronger. Acceptance creates space for change.

2. Externalize to Release the Grip

Journaling is powerful for getting persistent thoughts out of your head and onto paper, where they have less power. When I’m stuck in a thought loop about whether I handled a client situation correctly, writing it out helps me see it more objectively.

For perseveration specifically, I’ve started documenting agreed-upon changes. If we modify the plan, I immediately write it down (in a note on my phone) or take a photo. It sounds simple, but it works. My brain might forget the conversation, but my phone doesn’t.

3. Create “Being While Doing” Check-ins

This phrase—”being while I’m doing”—captures what I need most. I’ve started building in deliberate pause points during tasks:

  • Every 15 minutes, I stop and take three conscious breaths
  • I ask myself: “Am I in robotic mode right now?”
  • I check: “What was the last thing someone said to me about this?”
  • I notice: “Am I defending a position or collaborating toward a solution?”

These micro-interventions interrupt the autopilot long enough for awareness to return. The state that I am in while I am doing becomes the open, collaborative, and connected version of me!

4. Engage Your Full Attention Elsewhere

When rumination or intrusive thoughts take hold, sometimes the best medicine is complete engagement in something else. Physical exercise, a video game that demands full concentration, a creative project—anything that genuinely captures your ADHD brain’s attention can break the loop.

I’ve found that high-intensity interval training works wonders. Thirty minutes of pushing my body hard enough that I can’t think about anything else often resets my mental state completely.

5. Practice Mindfulness (But Make It ADHD-Friendly)

Traditional meditation can be torture for ADHD brains. But mindfulness—the practice of present-moment awareness—is incredibly valuable for managing persistent thoughts. The key is finding approaches that work for how our brains actually function:

  • Walking meditation: Paying attention to each step, the sensation of your feet, the rhythm of movement
  • Sensory grounding: Naming five things you can see, four you can hear, three you can touch, two you can smell, one you can taste
  • Brief body scans: Spending just 2-3 minutes noticing sensations in your body, especially where you hold tension

These practices train your brain to notice when it’s wandering and gently redirect—exactly the skill needed to catch perseveration before it takes hold entirely.

6. Leverage Cognitive Behavioral Therapy

CBT is remarkably effective for identifying and changing the thought patterns that trap us. A good therapist can help you:

  • Recognize your specific cognitive distortions
  • Challenge all-or-nothing thinking
  • Develop more balanced perspectives
  • Create practical strategies for interrupting unhelpful patterns

As both a therapist and someone with ADHD, I can tell you that CBT isn’t about positive thinking or pretending problems don’t exist. It’s about seeing your thoughts more clearly and choosing which ones to invest in.

7. Break Down the Overwhelm

When analysis paralysis strikes—when you’re so stuck in planning and perfecting that you can’t start—break the task into tiny steps. Not “organize the garage” but “spend 10 minutes sorting items in one corner.” Not “develop new treatment approach” but “read one article and take three notes.”

Small steps bypass the brain’s overwhelm response and build momentum.

8. Strengthen Your Foundation

None of these strategies work as well if your ADHD brain isn’t getting what it needs:

  • Sleep: Non-negotiable for executive function
  • Exercise: Literally changes brain chemistry in ADHD-helpful ways
  • Nutrition: Blood sugar crashes amplify every ADHD challenge
  • Medication: If appropriate for you, it can dramatically improve cognitive flexibility

Think of these as maintaining the operating system. Everything else is just apps.

The Strength Hidden in Perseveration

Here’s what I want you to understand: The same brain that gets stuck on plans and struggles to let go is also capable of extraordinary persistence, deep focus, and the ability to hold complex problems in mind until they’re solved.

My “perseveration” has made me excellent at following through on long-term therapeutic goals with clients. When I commit to helping someone, I don’t let go. I keep the threads of their story woven together across sessions. I notice patterns others might miss because I’m still holding onto details from months ago.

That tunnel vision that frustrates my wife during home projects? It’s also what allows me to hyperfocus on research, to read dozens of articles on a topic until I truly understand it, to persist through difficult therapeutic moments when a more straightforward path would be to give up.

The challenge isn’t to eliminate perseveration—it’s to develop enough awareness and flexibility to choose when to harness it and when to release it.

Working with Others: The Ongoing Practice

I’m still working on this. I still slip into robotic mode. I still sometimes unintentionally bulldoze over others’ input. But I’m catching it more often now. And when I do see it, I’ve learned to say:

“Hold on—I just realized I went back to my original plan without considering what you said. Can we pause and really talk through your idea?”

That vulnerability, that admission of my brain’s tendency to lock on and tune out, has actually strengthened my relationships. People appreciate being seen and heard. They appreciate knowing that when I override their input, it’s not because I don’t value them—it’s because my brain sometimes operates on old code before I can update it.

Your Turn

If you recognize yourself in this article, know that you’re not broken. Your brain isn’t defective. It’s wired differently, with both unique challenges and remarkable strengths.

The goal isn’t to become someone else. It’s to understand yourself well enough to work with your brain instead of against it. To catch the moments when perseveration serves you and the moments when it limits you. To build in the pauses, the check-ins, the awareness that transforms a rigid challenge into an adaptive strength.

Start small. Pick one strategy from this article. Try it for a week. Notice what changes. Build from there.

And remember: The same persistence that makes it hard to let go of a plan is the persistence that will help you build new patterns. Your ADHD brain is capable of remarkable change—you just have to stick with it long enough to see it through.

Kevin Brough, MFT, specializes in working with adults with ADHD, drawing from both professional training and personal experience. He focuses on helping clients transform ADHD challenges into strengths, building awareness and strategies that work with—not against—the unique brain of individuals with ADHD.

Kevin Brough – Ascend Counseling and Wellness – 435.688.1111 – kevin@ascendcw.com

If you found this article helpful and would like to explore how to turn your ADHD challenges into strengths, I’d be happy to work with you. Understanding ADHD from the inside out is one of my specialties—because I live it too.

October 3, 2025

Reclamation Before Transformation

Reclaiming Your Self: Building the Foundation for Optimal Mental and Emotional Health

By Kevin Brough MFT

When trauma touches our lives, it often feels as though we’ve lost something essential—a core part of who we truly are. We may find ourselves responding to life in ways that feel foreign, disconnected from the person we once knew ourselves to be. The journey toward healing isn’t about becoming someone new; it’s about reclaiming the Self that has always been there, waiting patiently beneath the protective layers we’ve developed to survive.

As a therapist working with individuals navigating the aftermath of trauma, I’ve witnessed time and again the transformative power of understanding what mental and emotional health truly requires. This article explores a comprehensive framework for building that foundation—one that integrates practical daily structures (the 5 C’s of mental health) with a deeper understanding of your inherent, undamaged core Self (the 8 C’s and 5 P’s from Internal Family Systems therapy).

Understanding the Foundation: Two Frameworks, One Goal

Before we dive deeper, let me clarify something that might initially seem confusing: we’ll be discussing two different sets of “C’s” in this article. Think of them as complementary rather than competing. The first set—Connection, Compassion, Coping, Community, and Care—represents the external structures and daily practices that support mental health (Dialectical Behavior Therapy [DBT] Community, 2024). These are the actionable steps you can take today to build resilience and stability.

The second set comes from Internal Family Systems (IFS) therapy and describes the qualities of your core Self—the undamaged, wise, compassionate center that exists within you regardless of what you’ve experienced (Schwartz, 2021). These include eight C-qualities (Curiosity, Compassion, Calm, Clarity, Courage, Confidence, Creativity, and Connectedness) and five P-qualities (Presence, Perspective, Patience, Persistence, and Playfulness). Rather than tasks to complete, these represent inherent capacities you already possess that trauma may have temporarily obscured.

Together, these frameworks offer both a roadmap for daily action and a vision of the Self you’re reclaiming.

The Trauma Paradox: When Protection Becomes Prison

Trauma fundamentally alters how we relate to ourselves and the world. When we experience overwhelming events, our psyche develops protective strategies—what IFS calls “parts”—that help us survive (Schwartz & Sweezy, 2020). These parts may manifest as hypervigilance, emotional numbing, people-pleasing, perfectionism, or countless other patterns. While these responses served us when we needed them, they can eventually separate us from our core Self, creating a sense of living life at arm’s length from our own experience.

The beautiful paradox of healing is this: the Self you’re seeking to reclaim has never actually left. It’s been present all along, waiting for the conditions that allow it to emerge. By building external structures that create safety and stability (the first 5 C’s) while simultaneously recognizing and nurturing your inherent Self-qualities (the IFS C’s and P’s), you create the conditions for profound transformation.

The Daily Foundation: The 5 C’s of Mental Health Practice

Let’s begin with the practical framework that creates structure in your daily life. These five components work synergistically to build a foundation strong enough to support the deeper work of Self-reclamation.

Connection: Building Bridges to Others and Yourself

Connection forms the cornerstone of mental health, yet trauma often teaches us that relationships are dangerous or unpredictable. The first step in reclaiming your Self involves intentionally building and nurturing relationships that reflect your worth and humanity.

Daily practices for strengthening connection:

  • Schedule regular, meaningful contact with at least one trusted person—even a brief text or phone call counts
  • Practice vulnerable communication by sharing one authentic feeling or need each day
  • Join a support group, therapy group, or community organization where shared experience creates natural bonds
  • Notice and gently challenge the protective parts that tell you to isolate

When we connect authentically with others, we create mirrors that reflect back our inherent worthiness. These relationships become laboratories where we can practice expressing our true Self in increasingly safe contexts.

Compassion: The Antidote to Self-Criticism

Trauma survivors often develop harsh inner critics that replay messages of worthlessness, shame, or inadequacy. Compassion—particularly self-compassion—directly counters these internalized wounds by offering what researcher Kristin Neff calls “the three elements of self-compassion: self-kindness, common humanity, and mindfulness” (Neff, 2003, p. 224).

Cultivating daily compassion:

  • When you notice self-critical thoughts, pause and ask: “Would I speak this way to someone I love?”
  • Develop a compassionate self-talk practice, perhaps placing a hand over your heart and speaking kindly to yourself
  • Recognize that your struggles connect you to humanity rather than separate you from it
  • Extend compassion outward to others, noticing how this practice naturally circles back to yourself

Compassion creates the internal environment where your core Self can safely emerge. When you stop attacking yourself for having been hurt, you create space for healing.

Coping: Tools for the Journey

Healthy coping strategies are the practical skills that help you navigate difficult emotions without being overwhelmed by them. Unlike the survival mechanisms that trauma installed, conscious coping practices work with your nervous system rather than against it.

Building your coping toolkit:

  • Develop a personalized set of grounding techniques (deep breathing, progressive muscle relaxation, 5-4-3-2-1 sensory awareness)
  • Create a “coping menu” with options for different emotional states—what helps when you’re anxious may differ from what helps when you’re numb
  • Practice distress tolerance skills that help you ride emotional waves without destructive action
  • Engage in regular activities that regulate your nervous system (exercise, creative expression, time in nature)

Effective coping isn’t about making difficult feelings disappear; it’s about developing the capacity to be with your experience while maintaining connection to your Self. Over time, you’ll notice that the C-qualities of your core Self (particularly Calm and Courage) become more accessible when you have reliable coping practices in place.

Community: Finding Your Tribe

Trauma often occurs in isolation and heals in community. Being part of something larger than yourself provides perspective, purpose, and the reminder that you’re not alone in your struggles. Community engagement combats the shame that thrives in secrecy and creates opportunities for meaningful contribution.

Engaging with community:

  • Identify communities that align with your values or interests, whether local or online
  • Start small—attend one event, join one online group, volunteer for a few hours
  • Look for communities specifically designed for healing, such as trauma support groups or 12-step programs
  • Remember that contributing to community is as healing as receiving support from it

In healthy community, you have the opportunity to discover and express aspects of your Self that may have been dormant. You might rediscover the Creativity, Playfulness, or Connectedness that trauma temporarily buried.

Care: Stewarding Your Whole Being

Care represents the commitment to actively tend to your mental, emotional, and physical health. It’s the practice of treating yourself as someone worth investing in—a radical act for those whose trauma taught them otherwise.

Implementing comprehensive care:

  • Establish non-negotiable self-care routines (adequate sleep, nourishing food, movement, rest)
  • Seek professional support when needed, recognizing that therapy is a sign of wisdom, not weakness
  • Create boundaries that protect your energy and well-being
  • Regularly assess whether your daily choices align with your values and long-term flourishing

Care is where intention meets action. It’s the daily decision to honor your needs and prioritize your healing, even when parts of you protest or minimize your suffering.

The Core Self: Qualities You Already Possess

As you build these external structures through the daily 5 C’s, you simultaneously create conditions for your core Self to emerge more fully. Internal Family Systems therapy offers a profound truth: beneath your protective parts lies an undamaged Self characterized by specific qualities that don’t need to be learned or earned—they simply need to be accessed (Schwartz, 2021).

The 8 C-Qualities of Self

These qualities naturally arise when you’re Self-led rather than led by traumatized parts:

Curiosity replaces judgment, allowing you to approach your inner experience and outer world with openness. Instead of avoiding difficult emotions or experiences, you become genuinely interested in understanding them.

Compassion flows naturally from Self, offering warmth and kindness to all parts of your internal system and to others. This isn’t compassion you force yourself to feel—it emerges organically when you’re Self-led.

Calm provides the internal steadiness that allows you to face challenges without becoming overwhelmed. This isn’t the false calm of dissociation but rather a grounded, present equanimity.

Clarity cuts through the confusion that trauma creates, allowing you to see situations accurately and make decisions aligned with your truth. You recognize patterns without getting lost in them.

Courage enables you to face what you’ve avoided, to speak your truth, and to take risks in service of your healing and growth. This courage isn’t reckless—it’s grounded in Self-trust.

Confidence emerges as you recognize your inherent capacity to handle life’s challenges. This isn’t arrogance but rather a realistic acknowledgment of your resilience and capability.

Creativity allows fresh perspectives and novel solutions to emerge. You discover your ability to approach problems flexibly and express yourself authentically.

Connectedness reflects your natural capacity for healthy relationship—with yourself, others, and something larger than yourself. You recognize your place in the web of life.

The 5 P-Qualities of Self

These additional qualities further describe what emerges when you’re Self-led:

Presence means fully inhabiting the present moment rather than being pulled into past trauma or future anxiety. You’re here, now, available to your life as it unfolds.

Perspective allows you to hold the bigger picture without minimizing or catastrophizing. You can zoom out when needed, recognizing that difficult moments are part of a larger journey.

Patience replaces the urgency that trauma often instills. You trust the timing of your healing and development, understanding that growth can’t be rushed.

Persistence provides the endurance to continue showing up for yourself and your healing, even when progress feels slow or you encounter setbacks.

Playfulness reconnects you with joy, spontaneity, and lightness. It’s the antidote to the heaviness that trauma imposes, reminding you that life can include delight.

Integration: Reclaiming Your Self Through Daily Practice

The magic happens when these frameworks work together. As you engage the daily practices of Connection, Compassion, Coping, Community, and Care, you create the safety and stability that allows your core Self-qualities to emerge more consistently. Simultaneously, as you recognize and access your inherent C’s and P’s, you find yourself naturally drawn to practices that support mental health.

This isn’t a linear process. Some days, you’ll feel firmly rooted in Self, experiencing Calm, Clarity, and Compassion with ease. Other days, protective parts will take the lead, and you’ll need to rely more heavily on your external coping strategies. Both are part of the journey.

Your Commitment to Reclamation

Reclaiming your Self after trauma is both the simplest and most challenging work you’ll ever do. Simple because your Self is already there, complete and undamaged, requiring only the conditions to emerge. Challenging because creating those conditions means facing what you’ve survived and gradually releasing the protective patterns that once kept you safe but now keep you small.

I invite you to make this commitment to yourself:

I commit to building the daily structures (Connection, Compassion, Coping, Community, Care) that support my mental and emotional health. I commit to recognizing that beneath my trauma and protective strategies lies a core Self characterized by Curiosity, Compassion, Calm, Clarity, Courage, Confidence, Creativity, and Connectedness—along with Presence, Perspective, Patience, Persistence, and Playfulness. I commit to approaching my healing with patience and persistence, trusting that my true Self is not lost but merely waiting to be reclaimed. I commit to treating myself as someone worth investing in, worthy of the time and effort that healing requires.

Moving Forward: From Understanding to Ownership

Understanding these frameworks intellectually is valuable, but transformation requires moving from knowledge to embodied practice. Consider these steps as you begin:

  1. Start where you are. You don’t need to implement everything at once. Choose one element from the daily 5 C’s to focus on this week. Perhaps you commit to reaching out to one person (Connection) or establishing one self-care routine (Care).
  2. Practice Self-recognition. Several times each day, pause and notice which C- or P-quality is present. When you notice Curiosity arising, acknowledge it: “This is my Self showing up.” This simple recognition strengthens your relationship with your core Self.
  3. Work with your parts. When you notice resistance, criticism, or protection, recognize these as parts trying to help. Rather than fighting them, approach them with curiosity: “What are you afraid will happen if you let my Self lead right now?”
  4. Seek support. Consider working with a therapist trained in IFS or trauma-focused approaches who can guide you in accessing Self and healing the wounds that keep parts activated.
  5. Celebrate small victories. Each moment of Self-leadership, each practice of one of the 5 C’s, each recognition of your inherent qualities—these are victories worth acknowledging.

The Vision: Your Optimal Future

Close your eyes for a moment and envision your life when you’re consistently Self-led, when the daily 5 C’s form your foundation. What does your life look like when Calm, Clarity, and Connectedness characterize your days? How do you show up in relationships when Compassion and Courage lead? What becomes possible when you approach challenges with Creativity and Perspective?

This vision isn’t fantasy—it’s your birthright. It’s the life that becomes available when you reclaim your Self from the protective patterns trauma installed. The person you’re becoming isn’t someone new; it’s who you’ve always been beneath the armor.

Your optimal future isn’t somewhere distant you must strive to reach. It’s revealed gradually, moment by moment, as you practice the 5 C’s and recognize the Self-qualities that have always been yours. You’re not building yourself from scratch; you’re excavating the treasure that was temporarily buried.

The journey of reclaiming your Self is both profound and practical, mystical and mundane. It requires daily commitment to structures that support mental health while simultaneously recognizing that beneath your wounds lies a core that trauma never touched. In this paradox lies your freedom: you have work to do, and you’re already whole. Both are true.

Welcome home to your Self. The journey begins—or continues—right now, in this moment, with this next breath, with this next conscious choice to honor who you truly are.

Kevin Brough – Ascend Counseling and Wellness, St. George, Utah – kevin@ascendcw.com

References

Dialectical Behavior Therapy (DBT) Community. (2024). What are the 5 C’s of mental health? 24/7 DCT. https://247dct.org/what-are-the-5-cs-of-mental-health/

Neff, K. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85-101. https://doi.org/10.1080/15298860309032

Schwartz, R. C. (2021). No bad parts: Healing trauma and restoring wholeness with the Internal Family Systems model. Sounds True.

Schwartz, R. C., & Sweezy, M. (2020). Internal Family Systems therapy (2nd ed.). Guilford Press.

Kevin Brough is a therapist specializing in trauma recovery and treatment. He works with individuals seeking to reclaim their authentic selves and build sustainable foundations for mental and emotional health.

September 10, 2025

Congruency & Harmony

Finding Your Inner Harmony: How Parts Work Can Heal Trauma and Transform Your Life

Discovering the power of working with—rather than against—all aspects of yourself

Have you ever noticed that sometimes you feel like you’re at war with yourself? Maybe part of you desperately wants to pursue a dream, while another part holds you back with fear and doubt. Or perhaps you find yourself being incredibly loving and patient with others, yet harshly critical of yourself. You might even catch yourself saying things like “Part of me wants to…” or “I’m torn between…” without realizing you’re actually describing something profound about how your mind naturally works.

If this sounds familiar, you’re not alone—and you’re not broken. What you’re experiencing is the natural multiplicity of the human psyche, and understanding this can be the key to profound healing and personal transformation.

The Revolutionary Understanding: You Are Not One, But Many

For decades, psychology has been moving away from the idea that we each have one fixed personality toward recognizing that we all naturally contain multiple aspects or “parts” within ourselves (Schwartz, 2021). This isn’t a sign of mental illness—it’s how healthy minds naturally organize themselves to navigate the complexity of human life.

Think about it: You probably show up differently when you’re at work versus when you’re playing with children. You have a part that’s responsible and organized, another that’s playful and spontaneous, perhaps one that’s cautious and another that’s adventurous. These aren’t different personalities—they’re different facets of your complete self, each with its own wisdom and gifts.

“The goal isn’t to eliminate parts of ourselves, but to create internal harmony where all parts can coexist and contribute their unique strengths.” — Richard Schwartz, creator of Internal Family Systems

When Parts Work Against Each Other: The Roots of Inner Conflict

Problems arise when our parts become polarized against each other or when some parts take over to protect us from old wounds. This often happens as a result of trauma, difficult life experiences, or simply growing up in a world that taught us certain parts of ourselves were “unacceptable.”

For example, if you were hurt or rejected in childhood, you might have developed:

  • A protective part that keeps you isolated to avoid future rejection
  • A critical part that constantly points out your flaws to prevent mistakes
  • A people-pleasing part that sacrifices your needs to maintain a connection
  • A wounded part that still carries the original pain and fear

When these parts operate independently without communication, you end up feeling fragmented, conflicted, and exhausted from the internal battle (Van der Hart et al., 2006).

The Promise of Parts Work: Integration, Not Elimination

Here’s the revolutionary insight that forms the foundation of all parts-based healing approaches: Every part of you developed for good reasons, and every part has gifts to offer. The goal isn’t to eliminate “difficult” parts, but to understand what they’re trying to protect and help them find healthier ways to contribute.

Parts work—whether through Internal Family Systems (IFS), inner child healing, or other related approaches—offers a compassionate pathway to:

  • Understand rather than judge your internal conflicts
  • Heal old wounds that keep parts stuck in protective patterns
  • Integrate all aspects of yourself into a harmonious whole
  • Access your wise, centered Self that can lead with compassion

Your Wise, Unbroken Self: The Leader Within

One of the most hopeful discoveries of parts work is that beneath all the protective patterns and wounded parts lies what IFS calls your “Self”—your essential, wise, and compassionate core, which was never damaged by trauma or difficult experiences (Schwartz, 2021). This Self has the capacity to:

  • Hold space for all your parts with curiosity and compassion
  • Make decisions from wisdom rather than fear
  • Heal the wounds that keep parts stuck in old patterns
  • Lead your internal system with kindness and clarity

When you learn to access and strengthen this Self-leadership, everything changes. Instead of being caught in internal battles, you become the calm, loving presence that can help all your parts feel heard, valued, and safe.

What Parts Work Looks Like: A Journey of Self-Compassion

Parts work isn’t about analyzing yourself into pieces—it’s about developing a loving relationship with every aspect of who you are. In therapy, this might involve:

Getting to Know Your Parts

  • Identifying the different aspects of yourself and the roles they play
  • Understanding what each part is trying to protect or achieve
  • Recognizing when parts are activated by current situations

Healing Old Wounds

  • Helping wounded parts share their stories and pain
  • Providing the care and understanding they needed but didn’t receive
  • Releasing the burdens of shame, fear, and trauma they’ve been carrying

Negotiating New Relationships

  • Helping protective parts trust your Self to handle challenges
  • Finding healthy ways for all parts to express their gifts
  • Creating internal collaboration instead of conflict

Living from Self-Leadership

  • Making decisions from your wise, centered Self
  • Responding to life’s challenges with all your parts’ resources
  • Maintaining internal harmony even during stress

The Profound Healing Possible

When people engage in parts work, they often experience transformations that feel almost miraculous:

  • Inner peace replaces constant self-criticism and conflict
  • Authentic relationships become possible when you’re not hiding parts of yourself
  • Creative expression flows when previously suppressed parts are welcomed
  • Emotional resilience develops as you learn to care for yourself with compassion
  • Life purpose becomes clearer when all your parts can contribute their wisdom

Research has shown that parts-based approaches like IFS are effective for treating trauma, depression, anxiety, eating disorders, and relationship difficulties (Hodgdon et al., 2022; Shadick et al., 2013). But beyond symptom relief, people report feeling more whole, authentic, and alive than ever before.

Signs That Parts Work Might Be Right for You

Consider parts work if you:

  • Feel like you’re “at war with yourself” or constantly conflicted
  • Notice harsh self-criticism or perfectionism
  • Experience anxiety, depression, or trauma symptoms
  • Feel disconnected from your authentic self
  • Have relationship patterns you want to change
  • Want to heal from childhood wounds or difficult experiences
  • Feel like some parts of your personality are “stuck” or immature
  • Long to feel more integrated and whole

Beginning Your Journey: First Steps Toward Inner Harmony

If parts work resonates with you, here are some ways to begin:

Start with Self-Compassion

  • Notice when you’re being self-critical and try speaking to yourself with kindness
  • Practice asking, “What is this part of me trying to protect or achieve?”
  • Treat your internal conflicts with curiosity rather than judgment

Pay Attention to Your Inner Voices

  • Notice the different “voices” or perspectives inside you
  • Instead of fighting difficult emotions, try asking what they need
  • Practice thanking your parts for trying to help, even when their methods are outdated

Seek Professional Support

  • Look for therapists trained in parts-based approaches like IFS, inner child work, or other trauma-informed therapy
  • Consider that healing happens in a collaborative relationship—having a compassionate witness can accelerate your journey
  • Remember that seeking help is a sign of strength, not weakness

A New Way of Being Human

Parts work offers something our culture desperately needs: a way of being human that honors complexity, embraces all emotions, and treats every aspect of ourselves with dignity and respect. Instead of trying to be “perfect” or eliminating parts of yourself you don’t like, you can learn to be a loving leader of your own internal community.

Imagine what it would feel like to:

  • Wake up without that critical voice immediately pointing out everything wrong
  • Make decisions from wisdom and self-love rather than fear
  • Feel confident in who you are, knowing all your parts are valued
  • Approach challenges with the full resources of your integrated self
  • Live authentically without hiding or rejecting parts of yourself

This isn’t fantasy—it’s the natural state of a healthy, integrated human being. And it’s available to you.

Your Invitation to Wholeness

Your journey toward inner harmony begins with a simple but profound shift: instead of fighting against the parts of yourself you don’t like, what if you got curious about what they’re trying to tell you? What if the very aspects of yourself you’ve been trying to change hold keys to your healing and wholeness?

Every part of you—even the ones that seem problematic—developed to help you survive and navigate life’s challenges. They deserve your compassion, not your criticism. And when you learn to lead them with love, they become your greatest allies in creating the life you truly want.

You don’t have to carry the burden of internal conflict alone. Professional support through parts-based therapy can provide the safe, compassionate space you need to heal old wounds, integrate all aspects of yourself, and step into the wholeness that is your birthright.

Your parts have been waiting for someone to listen to them with kindness and understanding. That someone is you—the wise, compassionate Self that has always been there, ready to lead with love.

Kevin Brough – Ascend Counseling and Wellness, St. George, Utah – 435.688.1111 – kevin@ascendcw.com

If you’re interested in exploring parts work therapy, look for licensed mental health professionals trained in Internal Family Systems (IFS), inner child work, or trauma-informed parts-based approaches. The journey toward inner harmony is one of the most valuable investments you can make in yourself and your relationships.

References

Hodgdon, H. B., Anderson, F., Southwell, E., Hrubec, W., Schwartz, R., & Tompkins, M. A. (2022). Internal Family Systems therapy for posttraumatic stress disorder among female survivors of childhood sexual abuse: A pilot effectiveness study. Journal of Evidence-Based Social Work, 19(2), 108-125.

Schwartz, R. C. (2021). No bad parts: Healing trauma and restoring wholeness with the Internal Family Systems model. Sounds True.

Shadick, N. A., Sowell, N. F., Frits, M. L., Hoffman, S. M., Hartz, S. A., Booth, F. D., Sweezy, M., Rogers, M. P., Duhamel, J. P., & Weinblatt, M. E. (2013). A randomized controlled trial of an Internal Family Systems-based psychotherapeutic intervention on outcomes in rheumatoid arthritis: A proof-of-concept study. Journal of Rheumatology, 40(11), 1831-1841.

Van der Hart, O., Nijenhuis, E. R. S., & Steele, K. (2006). The haunted self: Structural dissociation and the treatment of chronic traumatization. W. W. Norton & Company.

September 9, 2025

Navigating Grief

Navigating Grief: Finding Hope in Our Darkest Hours

When Life Becomes Unbearable: Understanding Loss, Addiction, and Mental Health

Grief is perhaps the most universal human experience, yet it remains one of the most isolating. When we lose someone to addiction, mental illness, or suicide, the pain carries additional layers of complexity—questions that seem to have no answers, guilt that feels unbearable, and a profound sense of helplessness that can shake our faith in everything we once believed.

The truth is that bad things do happen to good people. As Hyrum Smith powerfully stated in his funeral address, “Pain is inevitable. Misery is an option.” This distinction becomes crucial when we find ourselves confronting losses that challenge our understanding of justice, mercy, and the very nature of existence itself.

The Landscape of Grief: Elisabeth Kübler-Ross and the Stages of Loss

Dr. Elisabeth Kübler-Ross revolutionized our understanding of grief through her identification of five stages: denial, anger, bargaining, depression, and acceptance. However, when dealing with addiction and mental health-related deaths, these stages often become more complex and cyclical.

Denial in these circumstances might involve refusing to acknowledge the severity of a loved one’s struggles, or later, an inability to accept that they’re truly gone. We might find ourselves saying, “If only I had seen the signs,” or “This can’t be real.”

Anger can be particularly intense and multifaceted. We might feel angry at our loved one for their choices, at ourselves for not doing more, at God for allowing suffering, or at a medical system that seemed inadequate. This anger is natural and necessary—it’s part of the process of trying to make sense of the incomprehensible.

Bargaining often involves endless “what if” scenarios. What if we had intervened sooner? What if treatment had been different? What if we had said something else in that last conversation? These thoughts can become consuming, but they’re part of our mind’s attempt to regain control over an uncontrollable situation.

Depression in these losses often carries additional weight. Beyond missing our loved one, we might grapple with feelings of failure, stigma from society, and questions about whether we could have prevented their death. The depression stage might involve confronting our own mortality and the fragility of mental health.

Acceptance doesn’t mean we’re “okay” with what happened. Instead, it means we’ve found a way to carry the loss while still engaging with life. For those who’ve lost someone to addiction or suicide, acceptance often includes coming to terms with the reality that some battles are beyond our control.

The Question That Haunts: Why Do Bad Things Happen to Good People?

Rabbi Harold Kushner, in his profound work “When Bad Things Happen to Good People,” challenges the traditional notion that suffering is always deserved or meaningful. Sometimes, Kushner argues, bad things happen simply because we live in a world where randomness and human freedom exist alongside divine love.

C.S. Lewis, writing from his own profound grief in “A Grief Observed,” noted that “The pain now is part of the happiness then. That’s the deal.” Lewis understood that love inherently carries the risk of loss, and that our capacity for joy is inseparable from our vulnerability to sorrow.

Truman G. Madsen, in “Eternal Man,” explores the concept that suffering serves multiple purposes in human development. Some suffering, he suggests, is redemptive—it teaches us empathy, deepens our capacity for love, and connects us more fully to the human experience. However, not all suffering falls into this category. Some pain exists simply because we live in a world where mental illness, addiction, and human frailty are real.

The Particular Pain of Addiction and Mental Health Losses

When we lose someone to addiction or mental health struggles, we’re often confronting what Hyrum Smith (Franklin Covey) called “a mistake”—but a mistake made by someone whose capacity for clear thinking had been compromised by illness. This understanding can be both comforting and complicated.

Mental illness and addiction are diseases that affect the brain’s ability to process reality, make decisions, and hope for the future. The person we loved was fighting a battle against their own neurochemistry, often while society stigmatized their struggle. Understanding this doesn’t eliminate our pain, but it can help us separate the illness from the person we loved.

Dr. Michael Hentrich’s work in psychiatry emphasizes that mental health conditions are medical conditions, not moral failings. When someone dies from diabetes complications, we don’t question their character or their eternal destiny. The same compassionate understanding should apply to those who die from mental health conditions, including addiction.

The Mercy Perspective: Insights from Hyrum Smith

Hyrum Smith’s courageous address at his friend Lowell’s funeral challenges many traditional assumptions about suicide and divine judgment. Speaking from his own experience with serious mistakes and the process of repentance, Smith offered several profound insights:

He posed five crucial questions, three of which he felt qualified to answer. When asking “What is Lowell thinking now?” Smith suggested that, based on his own experience with serious error, his friend was likely experiencing regret, pain, and anguish. But this led to his more critical questions:

“Will the Lord allow Lowell to repent?” Smith’s answer was an emphatic yes, calling the belief that suicide is an unpardonable sin “just flat not true.”

“Will the Lord forgive him?” Again, yes. Smith testified that Lowell would receive all the blessings he rightfully deserved from his remarkable life.

The final question—”Will you?”—places the responsibility for mercy and healing squarely on those left behind.

The Stockdale Paradox: Facing Brutal Facts with Faith

Smith shared the powerful story of Admiral Stockdale and his discovery of three types of people in crisis: pessimists, optimists, and realists. The pessimists saw only the brutal facts and gave up. The optimists ignored the brutal facts and lived in denial. Only the realists—who saw the brutal facts but maintained faith that they could be dealt with—survived.

This framework provides a powerful model for grief. The brutal facts of our loss are real and must be acknowledged. We lost someone precious. They suffered. We couldn’t save them. However, the realist also maintains faith that these brutal facts can be endured, processed, and eventually integrated into a life that still holds meaning and purpose.

The Gift of Forgiveness

One of Smith’s most profound insights concerned the nature of forgiveness. Through spiritual revelation, he learned that “forgiveness doesn’t mean forgetting. Forgiveness means remembering—but it doesn’t matter anymore.”

This distinction is crucial for those grieving addiction and mental health losses. We may never forget the circumstances of our loved one’s death, the struggle that preceded it, or our own feelings of helplessness. But we can reach a point where remembering doesn’t carry the same crushing weight—where we can hold the memory without being destroyed by it.

Forgiving our loved one doesn’t mean condoning their final choice. It means releasing them from our anger and ourselves from the burden of perpetual judgment. As Smith noted, quoting scripture, “I, the Lord, will forgive whom I choose to forgive, but of you, you’re required to forgive all men.”

C.S. Lewis and the Reality of Love and Loss

C.S. Lewis, writing through his own devastating grief after losing his wife Joy, offers perhaps the most honest exploration of grief in Christian literature. In “A Grief Observed,” Lewis wrote, “No one ever told me that grief felt so like fear.” He described the physical and emotional reality of loss with unflinching honesty.

Lewis challenged the notion that faith should make grief easier or shorter. Instead, he argued that love necessarily includes the risk of devastating loss. “The pain now is part of the happiness then,” he wrote. The depth of our grief often reflects the depth of our love.

Most importantly, Lewis demonstrated that faith and doubt can coexist in grief. His questions about God’s goodness and presence weren’t signs of weak faith—they were signs of a faith mature enough to wrestle with mystery and contradiction.

Moving Forward: The Wagons Are Ready

Smith concluded his funeral address with a powerful metaphor from pioneer history. When pioneers died on the trail, families would stop to bury their dead and grieve. But eventually, the wagons would be ready to move on because staying meant death for everyone.

This metaphor speaks to the necessity of continuing to live while carrying our grief. The wagons represent life itself—responsibilities, relationships, opportunities for service and joy. They’re waiting for us to finish our necessary work of grieving so we can rejoin the journey.

This doesn’t mean rushing through grief or pretending to be “over it.” It means finding ways to carry our love and loss with us as we continue living. It means believing that our loved one would want us to experience joy again, form new relationships, and find meaning in our continued existence.

Practical Steps for the Journey

Acknowledge the complexity: Grief from addiction and mental health losses often involves guilt, anger, relief, and confusion alongside sadness. All of these feelings are valid and normal.

Seek professional support: Therapists who specialize in grief, particularly complicated grief, can provide tools and perspectives that friends and family may not be able to offer.

Connect with others who understand: Support groups for survivors of suicide or families affected by addiction can provide the understanding that comes only from shared experience.

Practice self-compassion: You didn’t cause your loved one’s illness or death. You couldn’t cure it or prevent it. You are not responsible for their final choices.

Honor their memory fully: Remember the whole person, not just their struggle or their death. Their illness was part of their story, but it wasn’t their entire story.

Consider their perspective: If they could speak to you now, would they want you to be consumed by guilt and sorrow? Or would they want you to find peace, joy, and meaning in your continuing life?

The Eternal Perspective

From an eternal standpoint, the questions that torment us now may seem less significant. Truman Madsen’s “Eternal Man” suggests that our current perspective, shaped by time and mortality, inevitably limits our understanding of justice, mercy, and purpose.

The God described in Smith’s funeral address—the God who “knows the weakness of man and how to succor them who are tempted”—is not a God of harsh judgment for those who struggle with illness. This is a God who sent Jesus precisely because He knew we would need an advocate, someone who understands our weaknesses and provides a way for all mistakes to be repaired.

Finding Hope in the Journey

The journey through grief, particularly grief complicated by addiction and mental health issues, is not linear. There will be good days and terrible days. There will be moments of peace and moments of overwhelming sadness. This is the nature of love continuing beyond physical presence.

But there is hope. Hope that our loved ones are at peace. Hope that their struggles are ended. Hope that love transcends death. Hope that we can learn to carry our grief in ways that honor both their memory and our own continued existence.

As Hyrum Smith testified, “God lives. Jesus is the Christ. He loves everybody in this room. He’ll take care of [our loved ones]. He’ll take care of us, too.”

This is the ultimate comfort for those walking through the valley of grief. We are not alone in our sorrow. We are not forgotten in our pain. And we are not without hope for healing, reunion, and peace.

The wagons are indeed ready when we are. The journey continues, and love travels with us—changed but not diminished, tested but not broken, and ultimately victorious over death itself.

Love & Light, Kevin Brough

Kevin Brough – Ascend Counseling and Wellness, St. George, Utah – 435.688.1111 – kevin@ascendcw.com

August 28, 2025

Profound Change Work

Change Work: Moving Beyond Surface Behaviors to Deep Transformation

By Kevin Brough, MFT

Introduction

In my years of practice, I’ve come to understand a fundamental truth about human change: You can’t change what you’re not aware of. This simple yet profound statement encapsulates the essence of meaningful therapeutic work and personal transformation. Too often, we focus on behavioral modifications—what I call first-order changes—without addressing the deeper cognitive and emotional systems that drive these behaviors. True, sustainable change requires a systems-based approach that recognizes the interconnected nature of our thoughts, emotions, and actions.

The field of cognitive-behavioral therapy has evolved significantly from its early focus on symptom reduction to a more comprehensive understanding of human change processes. Systems-based CBT recognizes that lasting behavioral change is only possible when we address the underlying cognitive and emotional patterns that maintain problematic behaviors (Mahoney, 1991). This approach acknowledges that human beings are complex systems where changes at one level inevitably impact other levels of functioning.

First-Order vs. Second-Order Change: Understanding the Hierarchy of Transformation

The distinction between first-order and second-order change is crucial for understanding why many therapeutic interventions fail to produce lasting results. First-order changes are surface-level behavioral modifications, such as stopping a habit, following a new routine, or implementing coping strategies. While these changes may provide immediate relief or improvement, they often lack the depth necessary for long-term sustainability.

Second-order change, in contrast, involves fundamental shifts in our cognitive schemas, emotional regulation patterns, and core belief systems (Watzlawick et al., 1974). These more profound changes create the foundation upon which sustainable behavioral modifications can be built. When we address the emotional and cognitive roots of behavior, we create systemic change that naturally supports new ways of being.

Consider, for example, a client struggling with chronic anxiety who learns relaxation techniques. This first-order change may provide temporary relief, but without addressing the underlying cognitive patterns of catastrophic thinking and the emotional dysregulation that fuels the anxiety, the symptoms are likely to return. However, when we help the client develop awareness of their thought patterns, process underlying emotional wounds, and restructure their core beliefs about safety and control, we create second-order change that naturally reduces anxiety at its source.

The Foundation of Change: Awareness, Consciousness, and Mindfulness

The journey toward meaningful change begins with awareness. As I often tell my clients, transformation is impossible without first developing a clear understanding of what needs to be transformed. This awareness operates on multiple levels: cognitive awareness of our thought patterns, emotional awareness of our feeling states, and somatic awareness of our bodily responses to stress and triggers.

Prochaska and DiClemente’s Stages of Change model offers a practical framework for understanding how awareness evolves into action (Prochaska & DiClemente, 1983). The model identifies six stages that individuals progress through when making lasting changes:

Precontemplation

At this stage, individuals are often unaware that a problem exists or that change is necessary. They may be in denial about the impact of their behaviors on themselves and others. The therapeutic work here focuses on raising awareness and helping clients begin to see patterns they previously couldn’t recognize.

Contemplation

Awareness begins to emerge, and individuals start to recognize that change may be beneficial. However, they remain ambivalent, weighing the costs and benefits of change. This stage is characterized by increased self-reflection and exploration of the problem.

Preparation

The decision to change has been made, and individuals begin to take small steps toward transformation. They may start gathering information, seeking support, or making preliminary changes to their environment.

Action

This stage involves implementing specific strategies and behaviors to create change. It requires significant commitment and energy as individuals work to establish new patterns while resisting the pull of old habits.

Maintenance

The focus shifts to sustaining the changes that have been made and preventing relapse. This stage requires ongoing vigilance and the continued use of coping strategies.

Termination

The new behaviors become so integrated that the individual no longer feels tempted to return to old patterns. The change has become an integral part of their identity, rather than something they must actively maintain.

This model illustrates how awareness naturally progresses to ownership and action. Each stage requires specific interventions and support to facilitate movement to the next level of change.

Extending Awareness to Relational Systems

Just as individual change requires awareness of internal patterns, relationship transformation—whether in couples or families—demands an expanded awareness that encompasses the interactive patterns and systemic dynamics between individuals. In my work with couples and families, I’ve observed that sustainable relationship change cannot occur through individual efforts alone; it requires each person to develop awareness of how their individual patterns intersect with and influence the relational system as a whole. This includes recognizing communication patterns, power dynamics, emotional triangles, and the unspoken rules that govern family interactions. For instance, a couple may each work individually on their anger management and communication skills, but without awareness of their cyclical pattern of pursuit and withdrawal, or how their family-of-origin experiences create complementary dysfunctions, their individual changes may actually make more tension in the relationship. True relational transformation occurs when partners or family members can simultaneously hold awareness of their own internal processes while also observing and taking responsibility for their contribution to systemic patterns. This dual awareness—of self and system—allows for coordinated change efforts where individual growth supports rather than threatens the relationship, creating space for authentic intimacy and healthier family functioning.

Developing Emotional Intelligence Through Awareness

Emotional intelligence—the ability to recognize, understand, and regulate our emotions while empathizing with others—is a crucial component of second-order change (Goleman, 1995). Many of the behavioral patterns we seek to change are driven by emotional reactions that occur below the threshold of consciousness. By developing emotional awareness and regulation skills, we gain access to the emotional drivers of our behavior.

The process of developing emotional intelligence begins with what I call “emotional mapping”—learning to identify and name our emotional experiences with precision. Many clients come to therapy with limited emotional vocabulary, describing complex feeling states with simple terms like “stressed” or “upset.” Through mindfulness practices and focused attention, we can cultivate the ability to recognize subtle emotional states and their corresponding cognitive and somatic markers.

This awareness then extends to understanding emotional triggers and patterns. Clients learn to recognize the early warning signs of emotional dysregulation and develop strategies for intervention before reactive patterns take over. This represents a shift from being controlled by emotions to creating a collaborative relationship with our emotional life.

Transformational Skills: The Tools for Change

Once awareness has been established, the next phase involves developing what I term “transformational skills”—the specific abilities needed to create and maintain change. These skills can be broadly categorized into several domains:

Cognitive Restructuring Skills

The ability to identify distorted thought patterns, challenge unhelpful beliefs, and develop more balanced and realistic cognitive frameworks. This includes skills such as thought monitoring, cognitive reframing, and the development of adaptive self-talk (Beck, 1976).

Emotional Regulation Skills

Techniques for managing intense emotions, including distress tolerance, emotion surfing, and developing self-soothing strategies. These skills help individuals remain functional during emotional storms and prevent impulsive reactions (Linehan, 1993).

Interpersonal Skills

The capacity to communicate effectively, set boundaries, and navigate relationships in ways that support rather than undermine change efforts. Many behavioral patterns are maintained by dysfunctional relationship dynamics that must be addressed for lasting change to occur.

Mindfulness and Present-Moment Awareness

The cultivation of non-judgmental awareness of present-moment experience, including thoughts, emotions, sensations, and environmental factors. This skill forms the foundation for all other transformational abilities (Kabat-Zinn, 1994).

Behavioral Activation and Goal-Setting

The ability to identify values-based goals and take consistent action toward their achievement, even in the presence of obstacles or setbacks.

Like any skill set, transformational skills improve with practice and application. Initially, clients may find these skills awkward or challenging to implement. However, with consistent use, they become more natural and automatic, eventually requiring less conscious effort to maintain.

The Neurobiological Foundation of Change

Understanding the brain science behind change can be empowering for both therapists and clients. Neuroplasticity—the brain’s ability to reorganize and form new neural connections throughout life—provides the biological foundation for all psychological change (Doidge, 2007). When we engage in new ways of thinking, feeling, and behaving, we literally rewire our brains.

Chronic stress and trauma can create rigid neural pathways that maintain problematic patterns of thinking and behaving. The amygdala, which is responsible for threat detection, can become hyperactive, while the prefrontal cortex, which is responsible for executive functioning and emotional regulation, may become less active. This neurobiological state makes change more difficult but not impossible.

Therapeutic interventions that promote mindfulness, emotional regulation, and cognitive flexibility help strengthen prefrontal cortex functioning while calming amygdala reactivity. Through repeated practice of new skills and behaviors, we create new neural pathways that support healthier patterns of functioning. Over time, these new pathways can become the brain’s preferred routes, making positive changes feel more natural and automatic.

The process of neuroplasticity also explains why change takes time and why consistent practice is essential. Each time we choose a new response over an old pattern, we strengthen the neural pathways associated with the new behavior while weakening those associated with the old pattern. This is why I often tell clients that change is not a destination but a practice—a daily commitment to choosing new responses over familiar ones.

Trauma-Informed Change Work

No discussion of change work would be complete without addressing trauma’s impact on our capacity for transformation. Trauma, whether acute or developmental, creates disruptions in our nervous system that can significantly impact our ability to engage in change processes (van der Kolk, 2014).

Traumatic experiences often overwhelm our natural coping resources, leading to the development of survival strategies that may have been adaptive in dangerous situations but become problematic in current contexts. Many of the behaviors clients want to change—addiction, relationship difficulties, emotional dysregulation—can be understood as trauma responses that have outlived their usefulness.

Trauma-informed change work recognizes that healing must address both the psychological and physiological impacts of traumatic experiences. This often requires a combination of top-down approaches (cognitive interventions that help make sense of experiences) and bottom-up approaches (body-based interventions that help regulate the nervous system).

Top-Down Processing for Change

Top-down approaches work through the neocortex to influence lower brain regions. These interventions include:

  • Cognitive restructuring to address trauma-related beliefs about safety, trust, and self-worth
  • Narrative therapy techniques that help clients develop coherent stories about their experiences
  • Psychoeducation about trauma’s impact on the brain and nervous system
  • Mindfulness practices that strengthen prefrontal cortex functioning

Bottom-Up Processing for Change

Bottom-up approaches work directly with the body and nervous system to promote regulation and healing:

  • Somatic experiencing techniques that help discharge trapped trauma energy
  • Breathwork and other nervous-system regulation practices
  • Movement and dance therapies that help restore natural rhythms
  • EMDR and other therapies that work directly with traumatic memories stored in the body

The most effective trauma-informed change work integrates both approaches, recognizing that healing occurs through multiple pathways and that different clients may respond better to various interventions.

Mastering Awareness: The First Phase of Transformation

The development of awareness is not a one-time achievement but an ongoing practice that deepens over time. I conceptualize this as the first significant phase of personal transformation—learning to observe ourselves with clarity, compassion, and accuracy.

This phase involves several key developments:

Meta-Cognitive Awareness

Learning to observe our thoughts without being controlled by them. This includes recognizing thought patterns, understanding the difference between thoughts and facts, and developing the ability to step back from our mental content.

Emotional Awareness

Developing the capacity to recognize, name, and track our emotional experiences throughout the day. This includes understanding emotional triggers, recognizing the physical sensations associated with various emotions, and learning to tolerate difficult emotional states without resorting to immediate action.

Somatic Awareness

Tuning into the wisdom of the body and recognizing how stress, trauma, and emotional states manifest in physical sensations. This includes learning to use the body as an early warning system for emotional dysregulation.

Relational Awareness

Understanding our patterns in relationships, including how we contribute to relationship dynamics and how our past experiences influence our current interactions.

Values Awareness

Clarifying what matters most to us and understanding when our actions align with or contradict our most deeply held values.

Mastering Transformation: The Second Phase

Once a solid foundation of awareness has been established, the focus shifts to mastering transformation—the skillful application of change strategies in real-world situations. This second phase is characterized by several key developments:

Flexible Response Repertoire

Rather than being limited to automatic reactions, individuals develop multiple options for responding to challenging situations. They can choose responses based on effectiveness rather than habit.

Emotional Regulation Mastery

The ability to remain centered and responsive even in highly charged emotional situations. This includes skills such as self-soothing, distress tolerance, and maintaining perspective during challenging times.

Interpersonal Effectiveness

The capacity to maintain relationships while also maintaining personal boundaries and values. This includes skills for communication, conflict resolution, and collaborative problem-solving.

Resilience and Recovery

The ability to bounce back from setbacks and maintain forward momentum even when progress is not linear. This includes skills for self-compassion, meaning-making, and adaptive coping.

Practical Applications and Interventions

The theoretical framework outlined above translates into specific therapeutic interventions and practices:

Mindfulness-Based Interventions

Regular mindfulness practice helps develop the awareness necessary for change while also strengthening the neural pathways associated with emotional regulation and cognitive flexibility.

Cognitive-Behavioral Techniques

Traditional CBT interventions remain valuable for helping clients identify and modify problematic thought patterns; however, they are most effective when integrated into a broader, systems-based approach.

Somatic Interventions

Body-based interventions help clients develop awareness of how emotions and stress manifest physically while also providing tools for nervous system regulation.

Interpersonal Skills Training

Many behavioral patterns are maintained by dysfunctional relationship dynamics. Teaching clients effective communication and boundary-setting skills often facilitates broader change.

Values Clarification Work

Helping clients identify their core values and align their actions with these values provides motivation and direction for change efforts.

Conclusion

Change work, at its essence, is about helping individuals move from unconscious reactivity to conscious responsivity. This transformation requires more than surface-level behavioral modifications—it demands fundamental shifts in how we think, feel, and relate to ourselves and others.

The journey begins with awareness. As I’ve emphasized throughout my practice, you cannot change what you are not aware of. This awareness must be cultivated patiently and compassionately, recognizing that many of our patterns developed as adaptive responses to earlier life circumstances.

Once awareness is established, the focus shifts to developing transformational skills—the specific abilities needed to create and maintain change. These skills, like any others, improve with practice and become more natural over time.

The integration of top-down and bottom-up approaches ensures that change work addresses both the cognitive and somatic dimensions of human experience. By working with both the mind and body, we create the conditions for profound, lasting transformation.

Perhaps most importantly, this approach recognizes that change is not a destination but a way of life. The skills we develop in therapy become lifelong tools for continued growth and adaptation. As we master awareness and transformation, we build the capacity to navigate life’s challenges with greater skill, resilience, and authenticity.

The work is not easy, but it is profoundly worthwhile. Each moment of increased awareness, each skillful response to a challenging situation, and each choice to act from values rather than habit contribute to the larger project of becoming who we are meant to be. In this way, change work becomes not just about solving problems but about discovering and expressing our fullest potential.

Love & Light

Kevin Brough – Ascend Counseling and Wellness, St. George, Utah – 435.688.1111 – kevin@ascendcw.com

References

Beck, A. T. (1976). Cognitive therapy and the emotional disorders. International Universities Press.

Doidge, N. (2007). The brain that changes itself: Stories of personal triumph from the frontiers of brain science. Viking.

Goleman, D. (1995). Emotional intelligence: Why it matters more than IQ. Bantam Books.

Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. Hyperion.

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.

Mahoney, M. J. (1991). Human change processes: The scientific foundations of psychotherapy. Basic Books.

Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390-395.

van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

Watzlawick, P., Weakland, J. H., & Fisch, R. (1974). Change: Principles of problem formation and problem resolution. Norton.

August 11, 2025

Somatic Therapy & Healing from Trauma

Somatic Therapy & Healing from Trauma: Understanding the Body’s Memory

An evidence-based exploration of how trauma lives in the body and how somatic approaches facilitate healing

Introduction

The famous words of psychiatrist Bessel van der Kolk, “The body keeps the score,” have become foundational to our understanding of trauma recovery. Recent research suggests that cellular memory is responsible for our physical and emotional responses to specific events and stimuli, regardless of whether we are in actual physical danger or completely safe (BodyBio, 2024). This emerging understanding of how trauma becomes embodied at the cellular level has profound implications for both trauma survivors and the healthcare providers who work with them.

Somatic therapy represents a paradigm shift from traditional talk therapy approaches by recognizing that trauma is not merely a psychological phenomenon but a whole-body experience that requires whole-body healing. Virtually every behavioral pattern exhibited during routine activities of daily living results from learned data that is stored, or encoded, as cellular memory (Academy for Traumatic Stress Studies, 2025). This article explores the neurobiological foundations of trauma, the role of cellular memory in trauma storage, and how somatic therapy approaches offer pathways to healing that honor the body’s innate wisdom.

The Neurobiological Landscape of Trauma

The Amygdala as Neural Router

Understanding trauma requires appreciating the brain’s alarm system, centered around the amygdala. LeDoux has proposed that in emotional processing, sensory information may access the amygdala via two different routes, called the low road and the high road (Journal of Neuropsychiatry, 2019).

The low road is a direct route to the amygdala from the thalamus, bypassing the cortex, that might promptly elicit fear defense responses without conscious recognition of the threat. By the high road, as soon as the sensory information projects to the thalamus, it is sent to the sensory cortex, insula, and PFC for a more complete analysis (conscious awareness of the conditioned stimulus), then this information is sent to the amygdala (Journal of Neuropsychiatry, 2019).

This dual-pathway system explains why trauma survivors often experience triggered responses before they can consciously process what’s happening. The amygdala essentially functions as a neural router, rapidly linking sensory data with emotional content and determining whether information should be processed through fast, survival-oriented circuits or slower, more deliberate conscious pathways.

Memory Encoding During Trauma

During traumatic events, bursts of adrenaline activate the amygdala, leading isolated sensory fragments to be vividly recalled. Specific sensory details such as visual images, smells, sounds, or felt experiences can be strongly imprinted and recalled (Dr. Arielle Schwartz, 2024).

This explains why trauma memories often lack coherent narrative structure. High arousal emotional and somatic experience disrupts the functioning of the hippocampus, which impairs our ability to recall all of the details or maintain a sense of sequential timing of events. We might have only fragments of sensory information (Dr. Arielle Schwartz, 2024).

The implications of this fragmented encoding are profound. Unlike typical memories that can be recalled and discussed coherently, traumatic memories exist as disconnected sensory fragments, body sensations, and emotional states that can be triggered without conscious awareness or understanding.

Cellular Memory: Where Trauma Lives in the Body

The Science of Embodied Trauma

Recent advances in neuroscience have revealed that trauma’s impact extends far beyond psychological symptoms. As it turns out, every one of our cells, not just neurons, has a kind of cellular memory that remembers and holds onto trauma from years prior, even from infancy when we have no conscious memory of what happened to us (BodyBio, 2024).

During the shock and stress of an event that is perceived as a physical or emotional threat, a special complex of hormonal messenger molecules are released by the limbic-hypothalamic-pituitary-adrenal system. These substances encode all the external and internal sensory impressions of the perceived threat as cellular memory (Academy for Traumatic Stress Studies, 2025).

This cellular encoding creates what researchers refer to as “traumatically encoded cellular memory patterns,” which can influence behavior, physical health, and emotional responses long after the original trauma occurred. When a person is not capable or willing or simply doesn’t have the time and resources to process their experience, it is stored in the cells in its raw form. If it is a distressing experience, it is stored as a ‘trauma’ (Vitality Unleashed Psychology, 2024).

The Molecular Basis of Trauma Storage

At the molecular level, trauma appears to affect multiple biological systems simultaneously. One of the most critical molecular findings in PTSD research is that patients exhibit abnormally high GR sensitivity. Central to this finding is the immunophilin Fkpb5 (FK506 binding protein 5), which has become one of the most studied genes in PTSD research (PMC, 2017).

These molecular changes help explain why trauma symptoms can persist even when conscious memory of events may be limited or absent. Emotional memories of traumatic life events are stored in the brain, with anger, grief, worry, stress, and fear often associated with them. Research has now shown that emotional memories, both positive and negative, leave strong impressions on our brains and therefore affect our behaviour (Camino Recovery Spain, 2023).

Physical Trauma and Emotional Integration

The Convergence of Physical and Emotional Pain

When trauma involves both physical injury and emotional distress, the integration of these experiences creates complex neurobiological patterns. A robust body of research demonstrates that prolonged or repeated exposure to stress and trauma can have serious negative consequences for physical and mental health, particularly when stress is experienced early in development (PMC, 2019).

The nervous system doesn’t distinguish between physical and emotional threats in its fundamental alarm responses. Compromised maternal care, including neglect, inconsistency, and lack of sensitivity, is a significant contributor to ELS (early life stress), resulting in increased numbers and function of excitatory synapses upon stress-sensitive neurons in the hypothalamus, a critical structure in coordinating the autonomic response to stress as part of the HPA (Taylor & Francis, 2022).

This helps explain why survivors of physical trauma often experience ongoing emotional and physical symptoms that seem disproportionate to their current circumstances. The body’s alarm system, having been overwhelmed by the combination of physical threat and emotional distress, remains hypervigilant and reactive.

Somatic Processing of Combined Trauma

From a phylogenetically and ontogenetically informed perspective, trauma-related symptomology is conceptualized as grounded in brainstem-level somatic sensory processing dysfunction and its cascading influences on physiological arousal modulation, affect regulation, and higher-order capacities (Frontiers in Neuroscience, 2022).

This understanding suggests that healing from combined physical and emotional trauma requires interventions that address the foundational sensory processing systems. Somatic approaches are particularly well-suited for this integration because they work with the body’s natural capacity for self-regulation and healing.

Somatic Therapy: Working with the Body’s Wisdom

Theoretical Foundations

Somatic therapy emerged from the recognition that traditional talk therapy alone may not be sufficient to address trauma that is stored in the body. Pioneer Peter Levine observed that animals in the wild naturally recover from traumatic experiences through physical discharge and developed Somatic Experiencing based on this observation.

The core principles of somatic therapy include:

Bottom-Up Processing: Rather than starting with cognitive understanding, somatic approaches begin with body sensations and allow awareness to emerge organically.

Window of Tolerance: Developed by Dan Siegel, this concept describes the optimal zone of arousal where healing can occur without overwhelming the nervous system.

Pendulation: The natural movement between states of activation and calm that builds resilience and expands capacity for regulation.

Resource Building: Identifying and strengthening internal and external resources that support nervous system regulation.

The Integration of Polyvagal Theory

Stephen Porges’ Polyvagal Theory provides crucial neurobiological understanding for somatic work. The theory describes three neural circuits:

  1. Social Engagement System (Ventral Vagal Complex): Supports calm, social connection, and optimal functioning
  2. Sympathetic Nervous System: Manages fight-or-flight responses
  3. Dorsal Vagal Complex: Handles immobilization responses, including freeze and collapse

Understanding these systems enables somatic therapists to track client states and intervene effectively. As the body changes, threat detection systems in the primitive brain can be activated. This part of the brain responds strongly to touch, safety, and presence. If a change in the body can be supported, cellular memory can be modified without needing to remember or even understand the traumatic event (Vitality Unleashed Psychology, 2024).

Evidence Base for Somatic Approaches

Research Findings

Multiple studies have demonstrated the effectiveness of somatic trauma therapies:

Somatic Experiencing: A 2017 randomized controlled trial by Brom et al. found that SE was as effective as CBT for PTSD treatment, with particular advantages in reducing physical symptoms and improving quality of life.

Sensorimotor Psychotherapy: Research by Langmuir et al. (2012) showed significant improvements in PTSD symptoms, with powerful effects on intrusive symptoms and emotional numbing.

Body-Based Interventions: A meta-analysis by van der Kolk et al. (2014) found that body-based interventions showed significant promise for trauma treatment, particularly for symptoms that don’t respond well to traditional talk therapy alone.

Neurobiological Validation

Brain imaging studies have shown changes in areas affected by trauma following somatic interventions. Using a combination of advanced genetic tools, 3D electron microscopy, and artificial intelligence, Scripps Research scientists reconstructed a wiring diagram of neurons involved in learning. They identified structural changes to these neurons and their connections at the cellular and subcellular levels (NIH, 2025).

This emerging research on neural plasticity supports the premise of somatic therapy, which suggests that the nervous system can reorganize and heal when provided with appropriate interventions.

Clinical Applications and Techniques

Core Somatic Interventions

Sensation Tracking: Teaching clients to notice and describe body sensations without judgment creates the foundation for somatic awareness.

Grounding Techniques: Helping clients connect with the present moment through physical contact with the earth or floor supports nervous system regulation.

Boundary Work: Exploring physical and energetic boundaries helps clients develop a stronger sense of self and safety.

Movement and Discharge: Encouraging natural movements and impulses supports the completion of interrupted defensive responses.

Integration with Other Modalities

Somatic therapy integrates well with other evidence-based approaches:

EMDR: Eye Movement Desensitization and Reprocessing naturally incorporates bilateral stimulation that supports somatic integration.

Cognitive Processing Therapy: CPT can be enhanced by including body awareness and sensation tracking.

Mindfulness-Based Interventions: These approaches naturally complement somatic work by developing present-moment awareness.

Special Considerations for Different Populations

Cultural Responsiveness

Modern somatic trauma work increasingly recognizes the impact of systemic oppression and collective trauma. This work revealed that experiences, ranging from individual to structural, are embodied, with their effects on the physical body as well as on emotions and cognition (PMC, 2024).

Practitioners must consider:

  • How different cultures relate to the body and healing
  • The impact of systemic oppression on nervous system functioning
  • Accessibility and inclusivity in somatic interventions

Special Populations

Children and Adolescents: Dramatic brain/body transformations occurring during adolescence may provide a highly responsive substrate to external stimuli and lead to trauma-related vulnerability conditions (ScienceDirect, 2023). Somatic approaches for young people must be developmentally appropriate and trauma-informed.

Complex Trauma Survivors: Those with histories of repeated or prolonged trauma may require specialized approaches that build safety and stabilization before processing trauma material.

Advanced Integration: The Alexander Technique and Energy-Based Approaches

Movement Education and Somatic Healing

The Alexander Technique offers valuable integration with somatic trauma work by addressing habitual movement patterns that may perpetuate trauma responses. This method teaches awareness of how we use our bodies and provides tools for conscious choice in movement and posture.

The integration of Alexander principles with somatic trauma work offers several advantages:

  • Pattern Stabilization: Helping clients maintain nervous system changes achieved in therapy
  • Conscious Choice: Teaching the ability to pause before falling into old trauma patterns
  • Functional Integration: Translating healing into improved daily functioning

Energy-Based Integration

Approaches drawn from Reiki, Quantum Touch, and other energy-based modalities can complement somatic trauma work when integrated thoughtfully:

Body Awareness Enhancement: Energy-based hand positions can increase proprioceptive awareness. Nervous System Regulation: Specific breathing patterns combined with gentle touch support parasympathetic activation. Integration Support: Energy-based practices can help anchor and integrate the gains from somatic therapy.

Future Directions and Implications

Emerging Research Areas

Epigenetics: Research on how trauma affects gene expression and how somatic interventions might influence epigenetic changes shows promise for understanding intergenerational trauma transmission and healing.

Collective and Community Trauma: Developing somatic approaches that can address trauma affecting entire communities represents a critical frontier.

Technology Integration: Virtual reality, biofeedback devices, and smartphone applications are now supporting somatic trauma work in innovative ways.

Clinical Integration

The future of trauma treatment lies in integrating somatic approaches with traditional healthcare. Over 70% of individuals experience a traumatic event at least once in their lifetime, with approximately 10% developing posttraumatic stress disorder (PTSD) as a result (NCBI Bookshelf, 2024).

This prevalence underscores the importance of trauma-informed care across all healthcare settings, with somatic approaches offering valuable tools for assessment and intervention.

Implications for Practitioners

Training and Competency

Effective somatic trauma work requires specialized training that includes:

  • Personal Somatic Work: Practitioners must engage in their own healing to develop the sensitivity required for this work
  • Supervised Practice: Extensive supervision is essential for developing subtle somatic intervention skills
  • Ongoing Education: The field continues to evolve, requiring commitment to lifelong learning

Ethical Considerations

Working with trauma stored in the body requires careful attention to:

  • Informed Consent: Clients must understand the nature of somatic interventions
  • Boundary Awareness: Touch and body-based interventions require clear boundaries and consent processes
  • Cultural Sensitivity: Approaches must be adapted to respect diverse cultural perspectives on the body and healing

Practical Recommendations

For Healthcare Providers

  1. Develop Body Awareness: Cultivate your own somatic awareness to better attune to client’s nervous system states
  2. Learn Basic Nervous System Education: Understanding polyvagal theory and window of tolerance concepts enhances all clinical work
  3. Incorporate Simple Somatic Tools: Basic grounding and breathing techniques can be valuable additions to any therapeutic approach
  4. Seek Training: Consider formal training in somatic approaches to enhance your clinical skillset
  5. Build Referral Networks: Develop relationships with qualified somatic practitioners for appropriate referrals

For Trauma Survivors

  1. Explore Body Awareness: Begin noticing body sensations without trying to change them
  2. Practice Grounding: Simple techniques like feeling your feet on the floor can support nervous system regulation
  3. Seek Qualified Practitioners: Look for therapists trained in somatic approaches when traditional talk therapy isn’t sufficient
  4. Be Patient with the Process: Somatic healing often occurs slowly and requires patience with the body’s natural rhythms
  5. Build Resources: Identify activities, people, and places that help you feel calm and regulated

Conclusion

The emerging understanding of cellular memory and the neurobiological basis of trauma storage represents a significant advancement in our approach to healing and recovery. The first step is becoming aware of the experience, identifying it, and understanding that it is not the memory of the trauma itself that hurts you. It is the perception of the trauma you remember that’s hurting you (Vitality Unleashed Psychology, 2024).

Somatic therapy offers hope for those who have not found relief through traditional approaches alone by honoring the body’s role in both storing and healing trauma. As our understanding of the intricate connections between mind, body, and healing continues to evolve, somatic approaches will likely become increasingly central to comprehensive trauma treatment.

The integration of somatic therapy with other evidence-based approaches, including movement education and energy-based practices, opens new possibilities for healing that address trauma at all levels – from cellular memory to conscious awareness. For both practitioners and survivors, this represents an invitation to trust in the body’s innate wisdom and capacity for healing.

The body truly does keep the score, but it also holds the keys to recovery. Through patient, informed, and skillful somatic work, we can help the nervous system complete interrupted responses, discharge stored trauma, and return to its natural capacity for regulation, connection, and resilience.

As we continue to understand trauma’s impact on the whole person – body, mind, and spirit – somatic approaches offer a pathway back to embodied presence, safety, and wholeness. The future of trauma treatment lies not in choosing between mind and body, but in recognizing their fundamental integration and working with both in the service of healing.

Kevin Brough – Ascend Counseling and Wellness, St. George, Utah – 435.688.1111 – kevin@ascendcw.com

References

Academy for Traumatic Stress Studies. (2025). Decoding traumatic memory patterns at the cellular level. Retrieved from https://www.aaets.org/traumatic-stress-library/decoding-traumatic-memory-patterns-at-the-cellular-level

BodyBio. (2024, March 28). The cellular health + trauma connection. Retrieved from https://bodybio.com/blogs/blog/cellular-health-trauma-connection

Bourassa, K. J., & Sbarra, D. A. (2024). Trauma, adversity, and biological aging: Behavioral mechanisms relevant to treatment and theory. Translational Psychiatry, 14, 285. https://doi.org/10.1038/s41398-024-03004-9

Brom, D., Stokar, Y., Lawi, C., Nuriel‐Porat, V., Ziv, Y., Lerner, K., & Ross, G. (2017). Somatic experiencing for posttraumatic stress disorder: A systematic review and meta‐analysis. Trauma, Violence, & Abuse, 18(3), 272-283.

Camino Recovery Spain. (2023, August 4). How trauma manifests on a cellular level. Retrieved from https://www.caminorecovery.com/blog/how-trauma-manifests-on-a-cellular-level/

Colich, N. L., Rosen, M. L., Williams, E. S., & McLaughlin, K. A. (2020). Biological aging in childhood and adolescence following experiences of threat and deprivation: A systematic review and meta-analysis. Psychological Bulletin, 146(9), 721–764. https://doi.org/10.1037/bul0000270

Dolcos, F., LaBar, K. S., & Cabeza, R. (2005). Remembering one year later: Role of the amygdala and the medial temporal lobe memory system in retrieving emotional memories. Proceedings of the National Academy of Sciences, 102(7), 2626-2631.

Dr. Arielle Schwartz. (2024, December 30). The neurobiology of traumatic memory. Retrieved from https://drarielleschwartz.com/neurobiology-traumatic-memory-dr-arielle-schwartz/

Frontiers in Neuroscience. (2022, October 14). The brain-body disconnect: A somatic sensory basis for trauma-related disorders. Retrieved from https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2022.1015749/full

Girgenti, M. J., Hare, B. D., Ghosal, S., & Duman, R. S. (2017). Molecular and cellular effects of traumatic stress: Implications for PTSD. Current Psychiatry Reports, 19(11), 85. https://doi.org/10.1007/s11920-017-0841-3

Journal of Neuropsychiatry. (2019, June 20). Neurobiological evidences, functional and emotional aspects associated with the amygdala. Retrieved from https://www.jneuropsychiatry.org/peer-review/neurobiological-evidences-functional-and-emotional-aspects-associated-with-the-amygdala-from-what-is-it-to-whats-to-be-done-13029.html

Langmuir, J. I., Kirsh, S. G., & Classen, C. C. (2012). A pilot study of body-oriented group psychotherapy: Adapting sensorimotor psychotherapy for the group treatment of trauma. Psychological Trauma: Theory, Research, Practice, and Policy, 4(2), 214-220.

National Institutes of Health. (2025, June 12). Study illuminates the structural features of memory formation at cellular and subcellular levels. Retrieved from https://www.nih.gov/news-events/news-releases/study-illuminates-structural-features-memory-formation-cellular-subcellular-levels

NCBI Bookshelf. (2024, August 16). Trauma-informed therapy. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK604200/

PMC. (2017, September 9). Molecular and cellular effects of traumatic stress: Implications for PTSD. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5907804/

PMC. (2019). Neurobiological development in the context of childhood trauma. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC6428430/

PMC. (2024). Toward integration of trauma, resilience, and equity theory and practice: A narrative review and call for consilience. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC10940235/

Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W. W. Norton & Company.

ScienceDirect. (2023, January 4). The body keeps the score: The neurobiological profile of traumatized adolescents. Retrieved from https://www.sciencedirect.com/science/article/pii/S0149763423000027

Siegel, D. J. (1999). The developing mind: How relationships and the brain interact to shape who we are. Guilford Press.

Taylor & Francis. (2022). The neurobiology of childhood trauma, from early physical pain onwards: As relevant as ever in today’s fractured world. Retrieved from https://www.tandfonline.com/doi/full/10.1080/20008066.2022.2131969

van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

van der Kolk, B. A., Stone, L., West, J., Rhodes, A., Emerson, D., Suvak, M., & Spinazzola, J. (2014). Yoga as an adjunctive treatment for posttraumatic stress disorder: A randomized controlled trial. Journal of Clinical Psychiatry, 75(6), e559-e565.

Vitality Unleashed Psychology. (2024, June 23). Cellular memory of trauma. Retrieved from https://www.vitalityunleashed.com.au/cellular-memory-of-trauma/

August 6, 2025

Building Resilience Against Alzheimer’s

Building Resilience Against Alzheimer’s and all forms of dementia: A Therapist’s Guide to Evidence-Based Prevention and Support

By Kevin Brough, MA, MFT

As a Marriage and Family Therapist who has witnessed the devastating impact of Alzheimer’s disease on many families, I’ve become deeply invested in understanding what current research tells us about prevention and early intervention. Having lost my father to this disease and recently my brother to early-onset Alzheimer’s at just 68, I’ve experienced firsthand both the clinical and personal sides of this journey. In searching for answers for myself, my siblings, my family, and my clients and their families, I have been & am deeply invested in finding and implementing any strategies and solutions that make a difference. This article synthesizes evidence-based research on cognitive, behavioral, and lifestyle interventions that may help reduce Alzheimer’s risk and support overall brain health.

Important Disclaimer: The medical, nutritional, and supplementation information presented here is based on published research findings and is not intended as medical advice. I am sharing this information in my capacity as a mental health professional interested in prevention and wellness, not as a medical practitioner. Please consult with your physician, neurologist, or other qualified healthcare providers before making any changes to your medical regimen, diet, or supplement routine. This article is for educational purposes only and should not replace professional medical consultation.

The Intersection of Mental Health and Neurological Wellness

From a therapeutic perspective, Alzheimer’s prevention represents a unique intersection of mental health, behavioral change, and medical wellness. Research increasingly shows that many of the same interventions we use in therapy to promote psychological resilience—stress management, social connection, purposeful living, and cognitive flexibility—also appear to protect against cognitive decline (Livingston et al., 2020).

The concept of “cognitive reserve,” first described by Stern (2002), suggests that individuals who engage in mentally stimulating activities throughout their lives may be better able to maintain cognitive function despite brain pathology. This aligns perfectly with therapeutic principles of growth, adaptability, and resilience that we foster in our clinical work.

Cognitive and Behavioral Interventions: The Therapeutic Foundation

Cognitive Stimulation and Lifelong Learning

As therapists, we understand that the brain’s neuroplasticity continues throughout life. Research by Park et al. (2014) demonstrated that engaging in cognitively demanding activities—learning new skills, languages, or technologies—can improve cognitive function in older adults. In my own recovery from Repetitive Concussive Disorder, I’ve found that returning to language learning (brushing up on Portuguese and Spanish) has been particularly beneficial for rebuilding neural pathways affected by my communication difficulties.

Therapeutic Applications:

  • Encourage clients to engage in novel learning experiences
  • Support exploration of creative pursuits like music, art, or writing
  • Facilitate discussion about lifelong interests that can be rekindled or deepened
  • Help clients reframe learning challenges as growth opportunities rather than failures

Social Connection and Community Engagement

Longitudinal studies consistently show that social isolation increases dementia risk, while strong social networks appear protective (Livingston et al., 2020). From a systemic therapy perspective, this reinforces our understanding that healing and health occur within relationships and community contexts.

Therapeutic Interventions:

  • Group therapy formats for older adults
  • Family therapy to strengthen intergenerational connections
  • Community-based interventions and support groups
  • Volunteer work and meaningful social roles
  • Processing grief and loss to prevent social withdrawal

Stress Management and Emotional Regulation

Chronic stress and elevated cortisol levels have been linked to hippocampal atrophy and increased Alzheimer’s risk (Sotiropoulos et al., 2011). As mental health professionals, we have numerous evidence-based tools for stress reduction that may also support brain health.

Evidence-Based Stress Interventions:

  • Mindfulness-Based Stress Reduction (MBSR): Research by Luders et al. (2013) shows that meditation practice is associated with increased gray matter density in areas involved in learning and memory
  • Dialectical Behavior Therapy (DBT): The mindfulness and distress tolerance skills from DBT are particularly valuable for managing the emotional intensity that can accompany cognitive health concerns. Research by Perroud et al. (2013) demonstrates that DBT mindfulness practices can reduce inflammation markers, which are implicated in causing neurodegeneration
  • Somatic Therapy Approaches: Body-based interventions help regulate the nervous system and reduce chronic stress activation. Techniques such as Somatic Experiencing and body awareness practices can help individuals recognize and interrupt stress patterns before they become chronic (van der Kolk, 2014)
  • Cognitive Behavioral Therapy (CBT): Helps identify and modify stress-inducing thought patterns
  • Acceptance and Commitment Therapy (ACT): Promotes psychological flexibility and values-based living
  • Breathwork & Progressive Muscle Relaxation: Reduces physiological stress markers

Emotional Regulation and Distress Tolerance

The ability to manage intense emotions without becoming overwhelmed is crucial for both mental health and cognitive preservation. Chronic emotional dysregulation can lead to sustained stress hormone elevation, which research links to hippocampal damage and increased dementia risk (McEwen, 2017).

DBT Skills for Cognitive Health:

  • Distress Tolerance: Learning to tolerate uncertainty about cognitive changes without engaging in harmful behaviors or rumination
  • Emotion Regulation: Identifying and managing emotions related to health anxiety, grief, and fear
  • Mindfulness: Present-moment awareness that reduces anxiety about future cognitive decline
  • Interpersonal Effectiveness: Maintaining relationships and seeking support during health challenges

Somatic Interventions for Nervous System Regulation: Research increasingly shows that trauma and chronic stress are stored in the body, affecting both mental and neurological health (Porges, 2011). Somatic approaches help individuals:

  • Recognize early warning signs of stress activation in the body
  • Develop tools for nervous system regulation and co-regulation
  • Process trauma that may contribute to chronic inflammation
  • Build resilience through body-based resources and grounding techniques

Therapeutic Applications:

  • Body scanning and awareness exercises
  • Breathwork and nervous system regulation
  • Movement therapy and expressive arts
  • Touch and boundary work (when appropriate)
  • Titrated exposure to difficult emotions through somatic awareness

Meaning-Making and Purpose

Viktor Frankl’s logotherapy emphasized that meaning and purpose are fundamental to psychological well-being. Recent research by Kim et al. (2013) found that individuals with a higher purpose in life had a reduced risk of Alzheimer’s disease. This suggests that therapeutic work around life purpose and meaning-making may have neurological benefits beyond psychological ones.

Therapeutic Approaches:

  • Life review and reminiscence therapy
  • Values clarification exercises
  • Legacy work and generativity
  • Exploration of post-career identity and purpose

Lifestyle Factors: The Evidence Base

Physical Exercise and Movement

Research consistently identifies aerobic exercise as one of the most powerful interventions for brain health. Erickson et al. (2011) found that aerobic exercise increased hippocampal volume and improved memory function in older adults. The therapeutic implications are significant—exercise functions as both a biological and psychological intervention.

Evidence-Based Exercise Recommendations:

  • 150 minutes of moderate-intensity aerobic activity weekly (World Health Organization, 2020)
  • Resistance training 2-3 times per week
  • Balance and coordination exercises (tai chi, yoga)
  • Activities that combine physical and cognitive demands (dancing, sports)

Sleep Optimization

Sleep disturbances are both a risk factor for and an early symptom of Alzheimer’s disease. Research by Mander et al. (2017) shows that sleep disruption accelerates tau protein accumulation in the brain. From a therapeutic standpoint, sleep hygiene becomes a crucial intervention.

Sleep Intervention Strategies:

  • Cognitive Behavioral Therapy for Insomnia (CBT-I)
  • Sleep hygiene education
  • Relaxation techniques and bedtime routines
  • Addressing underlying anxiety or depression affecting sleep

Nutritional Considerations

The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet has shown promise in reducing Alzheimer’s risk (Morris et al., 2015). While nutritional counseling falls outside most therapists’ scope of practice, we can support clients in making behavioral changes around eating habits.

Research-Supported Nutritional Elements:

  • Mediterranean diet patterns emphasizing fish, vegetables, and whole grains
  • Anti-inflammatory foods, including berries, leafy greens, and nuts
  • Limited processed foods and refined sugars
  • Adequate hydration and moderate alcohol consumption

Supplementation Research Findings: Research has examined various supplements for brain health, though results are mixed, and individuals should consult healthcare providers.

  • Omega-3 fatty acids (EPA/DHA) for inflammation reduction (Yurko-Mauro et al., 2010)
  • Vitamin D for neurological function (Annweiler et al., 2013)
  • B-complex vitamins for homocysteine reduction (Smith et al., 2010)
  • Antioxidants like curcumin and resveratrol (Hamaguchi et al., 2010)

Supporting Families: The Systemic Approach

Caregiver Support and Family Dynamics

When working with families affected by Alzheimer’s risk or diagnosis, a systemic approach recognizes that brain health occurs within family and social systems. Research by Brodaty & Donkin (2009) emphasizes the importance of family-centered interventions.

Family-Centered Interventions:

  • Psychoeducation about Alzheimer’s risk and prevention
  • Communication skills training for difficult conversations
  • Caregiver stress management and respite planning
  • Family meeting facilitation for care planning
  • Grief counseling for anticipatory loss

Intergenerational Considerations

Families with Alzheimer’s history face unique challenges around genetic risk, family planning decisions, and intergenerational trauma. Therapeutic work may involve helping families navigate these complex emotional territories while maintaining hope and agency.

Early Intervention and Monitoring

Cognitive Assessment and Monitoring

While formal neuropsychological testing requires specialized training, therapists can be alert to cognitive changes that warrant referral. Research by Petersen et al. (2018) emphasizes the importance of early detection and intervention in mild cognitive impairment.

Clinical Observations:

  • Changes in executive functioning or decision-making
  • Increased difficulty with complex tasks
  • Language or communication changes
  • Personality or mood alterations
  • Social withdrawal or behavioral changes

Building Cognitive Reserve Through Therapy

Therapeutic work itself may contribute to cognitive reserve building. Engaging in psychotherapy requires complex cognitive processes—memory, executive function, emotional regulation, and social cognition—that may strengthen neural networks.

Therapy as Cognitive Exercise:

  • Narrative therapy and storytelling
  • Problem-solving and decision-making processes
  • Emotional processing and integration through both cognitive and somatic approaches
  • Insight development and self-reflection
  • Relationship skill building
  • DBT Skills Practice: The cognitive demands of learning and applying DBT skills—mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness—provide excellent cognitive exercise while building practical life skills
  • Somatic Integration: Body-based processing that integrates cognitive insights with felt sense awareness, promoting whole-brain engagement

Addressing the Emotional Impact

Managing Anxiety About Cognitive Decline

For individuals with a family history of Alzheimer’s, anxiety about cognitive changes can become overwhelming and paradoxically impair cognitive function. Therapeutic intervention focuses on finding the balance between appropriate precaution and excessive worry.

Therapeutic Strategies:

  • DBT Distress Tolerance Skills: “TIPP” (Temperature, Intense exercise, Paced breathing, Progressive muscle relaxation) for managing acute anxiety about cognitive changes
  • Somatic Grounding Techniques: Body-based interventions to interrupt anxiety spirals and return to present-moment awareness
  • Uncertainty tolerance building
  • Realistic risk assessment and education
  • Control vs. influence discrimination
  • Mindfulness and present-moment awareness

Body-Based Anxiety Management: Somatic therapy recognizes that anxiety about cognitive health often manifests physically before becoming conscious thoughts. Teaching clients to recognize physical sensations of anxiety—tension, shallow breathing, racing heart—allows for earlier intervention and prevents escalation into panic or rumination.

Processing Grief and Loss

Families dealing with Alzheimer’s experience multiple losses—the gradual loss of the person they knew, changes in relationships, and fears about their own futures. This anticipatory grief requires skilled therapeutic support.

Grief-Informed Interventions:

  • Ambiguous loss framework (Boss, 2000)
  • Continuing bonds theory
  • Ritual and ceremony for marking transitions
  • Family storytelling and legacy preservation
  • Support for disenfranchised grief

Prevention as Empowerment

Perhaps most importantly, focusing on evidence-based prevention strategies can restore a sense of agency and hope to individuals and families who may feel helpless in the face of genetic risk. While we cannot control our genetic inheritance, research suggests we may be able to influence when, how, or if these genes are expressed through our lifestyle choices.

Conclusion

The emerging research on Alzheimer’s prevention offers hope and concrete actions for individuals and families concerned about cognitive decline. As mental health professionals, we are uniquely positioned to support the psychological and behavioral aspects of brain health while working collaboratively with medical providers on the biological components.

The interventions that support cognitive health—stress management, social connection, purposeful living, and psychological resilience—align perfectly with our therapeutic goals. By integrating this knowledge into our practice, we can offer our clients not just symptom relief, but potentially life-changing prevention strategies.

The journey of brain health is ultimately about living fully and intentionally, maintaining connections, and continuing to grow throughout our lives. These are the same goals we pursue in all our therapeutic work—making this integration both natural and essential.

For information or to work therapeutically with the Author:

Contact Ascend Counseling & Wellness 435-688-1111 or email kevin@ascendcw.com

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