Healing the Wounds of Memory – Examining Trauma Treatments

Trauma, by nature, is highly subjective and multifaceted, and it is estimated that around 70% of individuals will experience a traumatic event in their lives (World Health Organization, 2024). The Diagnostic and Statistical Manual of Mental Disorders defines trauma as “exposure to actual or threatened death, serious injury, or sexual violence” (American Psychiatric Association, 2013), which many clinicians argue is overly restrictive and fails to capture complexity of different forms of trauma (Martin et al., 2021). While defining trauma remains debated, clinicians agree that the effects of trauma are widespread. Initial responses such as dissociation and hyperarousal are evolutionarily wired to be protective in the moment of the trauma. It is when they become chronic or triggered by non-dangerous cues, that trauma’s effects are maladaptive, leaving the individual stuck in survival mode even when safety has been restored (van der Kolk, 2015). One such maladaptive response that is commonly associated with trauma is Post Traumatic Stress Disorder (PTSD).

PTSD is a profoundly complex disorder that may develop after experiencing or witnessing traumatic events and is often marked by debilitating symptoms like intrusive flashbacks, heightened emotional distress, and impaired cognitive and daily functioning (Egan, 2025). PTSD is estimated to affect approximately 4% of the global population, and many more individuals endure subclinical, distressing trauma-responses (World Health Organization, 2024). Not every trauma leads to PTSD, yet traumatic experiences can still profoundly affect one’s sense of safety, identity, and functioning. Increasingly, trauma is recognised as a transdiagnostic process that underlies a wide range of psychological difficulties. Comorbidity is the rule rather than the exception; up to 80% of individuals with trauma report at least one other disorder, with depression, anxiety, eating disorders, or substance use being particularly common (World Health Organization, 2024). This overlap makes trauma treatment complex and highlights the need for a nuanced, multi-layered therapeutic approach.

Considering trauma’s widespread effects, it is essential that treatment targets trauma and the, often intrusive and highly emotionally loaded, memories attached to it. Failing to address traumatic memories, for instance by merely focusing on current symptoms, may maintain other symptoms, heighten relapse risk, and hinder long-term recovery. However, introducing traumatic material prematurely may re-traumatise clients and exacerbate symptoms, as they are not well regulated and lack adequate coping tools (Van der Kolk, 2015). Individuals affected by trauma often re-experience intense memories both physically and emotionally, as though they were occurring in the present moment. This re-experiencing is central to why clinicians must tread carefully when addressing trauma. Clients often develop coping mechanisms such as dissociation, denial, or substance use to manage the unbearable weight of these memories. At its core, it is essential that therapy provides a safe space where the body can relearn that it is safe (van der Kolk, 2015). 

Specifically, avoiding re-traumatisation involves creating this safe space, building a strong therapeutic alliance, maintaining structure and routine, pacing therapy so clients remain within their therapeutic window—the optimal level of arousal where the client is present and alert without becoming overwhelmed or shutting down (Mohamadpour et al., 2019). This focus on the body’s reactions aligns with Bessel van der Kolk’s novel,  The Body Keeps the Score, which posits that trauma is not the memory or event itself, but rather what the event does to one’s nervous system and body. He, and other clinicians, argue that treatment must help individuals integrate their trauma in order to bring long-lasting positive effects. In talk therapy, therapists who overlook traumatic events or remain on a rational surface-level risk neglecting the emotional and physiological imprints that sustain distress (Van der Kolk, 2015).

Trauma treatment generally consists of three phases: Stabilisation, Processing, and Integration/Reconnection (de Boer et al., 2021). Specific techniques and interventions are subject to factors like the client’s needs, the clinician’s expertise/approach, and the nature of the trauma (van Vliet et al., 2018). The stabilisation phase involves establishing trust through providing psychoeducation and developing emotion regulation strategies; essentially building a safe foundation needed to process the trauma memories. In the processing phase, therapy focuses on reactivating and reprocessing traumatic memories to reduce their emotional charge. This includes developing emotional literacy, trigger awareness, and integrating adaptive regulation strategies (de Boer et al., 2021). Evidence-based interventions such as Eye Movement Desensitisation and Reprocessing (EMDR) or trauma-focused CBT are often employed to help reprocess distressing memories (Perlini et al., 2020). During reprocessing, clients may become dysregulated or dissociated when recalling particular events, where emotions become too overwhelming, and it is important for the therapist to notice and address this by bringing the client back to the “here and now”; for instance, through grounding, distraction, and breathwork (van der Kolk, 2015). Finally, the integration phase rounds off the treatment by reflecting on therapeutic gains, building relapse prevention plans, and fostering a “post-trauma self”, an identity reconstructed around safety, agency, and coherence rather than fear and fragmentation (Wang et al., 2018).

Given trauma’s complexity, a variety of therapeutic modalities can be effective. In the Netherlands, Cognitive Behavioural Therapy (CBT) is the standard of care due to its structured, short-term, and insurance-compatible nature (van Emmerik & Prins, 2022). While CBT is effective in addressing maladaptive beliefs and reducing avoidance, it is often criticised for being overly surface-level. For instance, van der Kolk argues that CBT alone fails to allow the individual to integrate the trauma properly, highlighting the need for additional tools that target non-verbal, somatic memory traces (van der Kolk, 2015). Techniques like EMDR can be valuable accompanying tools in CBT treatment to process traumatic memories (see Sandra’s article; Perlini et al., 2020). Imagery rescripting is another promising intervention, where the client reactivates memories and rewrites their outcomes to adjust the emotional and cognitive effects it has (Hagenaars & Arntz, 2012). 

Other therapeutic modalities exist and are used in treating trauma. For instance, psychodynamic and psychoanalytic therapy focus on exploring unconscious processes and relational patterns that maintain trauma responses (Hemsley, 2010). Additionally, Internal Family Systems therapy, which helps clients work with internal “parts” to uncover and heal past memories, is also gaining recognition for its depth and integrative approach (Hodgdon et al., 2022). Given trauma’s physical dimension, somatic and body-based therapies (e.g. sensorimotor psychotherapy, somatic experiencing) have shown strong potential in restoring bodily awareness and regulation following trauma (see Jules’ article; Kearney & Lanius, 2022). Complementary practices like meditation and yoga can also help clients feel more grounded and attuned to bodily sensations and emotions (Taylor et al., 2020). It is essential to approach trauma with care and intention, personalising the treatment’s pace, progress, specific interventions, and focus on the individual’s needs and background. Many therapeutic modalities can be viewed as tools in a shared therapeutic toolbox, each holding value depending on the client’s history and readiness for change (van der Kolk, 2015). The methods outlined in this article are a mere few of the methods that have shown clinical success. 

Ultimately, trauma treatment is not about erasing the past but about reclaiming the body and mind from its grasp. Healing the wounds of loaded memories means helping individuals learn that the danger has passed, that their bodies can relax, and that their stories can be told without reliving them. Integration, in this sense, is not forgetting what happened, but learning to carry those memories without being carried by them.