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Healing Past Relational Trauma with Wholehearted Presence

May 8, 2014

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The Meadows

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Dr. Jon Caldwell

The swirling busyness and restless energy settled and a profound stillness permeated the room, enveloping the group like a soft feather blanket. Sitting in silence and sensing the body was unfamiliar territory for most of the two-dozen workshop participants. After all, for many of them, the body had long been associated with shame, self-judgment, discomfort, and trauma. Yet, there they were, courageously bringing compassionate awareness to their embodied experience, one moment at a time. Opening to the life that had been refused, again and again, until that moment.¹

REAC²H Workshop

This is a description of the first day of the first REAC²H workshop, which was conducted with a group of female survivors of childhood maltreatment. REAC²H is an acronym that stands for Restoring Embodied Awareness, Compassionate Connection and Hope. It is an innovative approach to healing past relational trauma by cultivating present-moment awareness and self-compassion. The workshop was designed by Dr. Jon G. Caldwell, DO, Ph.D. after years of research and clinical work in the fields of traumatology, attachment theory, affective neuroscience, and contemplative practices.

The REAC²H workshop was specifically designed to help individuals who have experienced “relational trauma”, which encompasses various kinds of emotional, physical, and sexual abuse that occur in the context of close relationships. Relational trauma has meaningful effects on the attachment system – an innate, biological system that facilitates interpersonal connection to adaptively shape human development. Thus, relational trauma and the resulting disturbances in attachment can have profound effects on a person’s developmental trajectory across the lifespan.

As discussed in the previous article in this series, when attachment partners are inconsistent, enmeshing, hypercritical, abusive, uncaring, or neglectful people must adapt if they are to maintain personal and interpersonal integrity. Meaning, in unsafe or insecure attachment relationships, people are generally walking a precarious line of trying to get their basic relational needs met while also remaining safe. This balancing act is accomplished by unconsciously developing patterns of thinking, feeling, and relating that, over time, can crystallize into attachment orientations or styles.

Anxious vs. Avoidant Attachment

There are two main attachment dimensions: anxious and avoidant. People with an anxious attachment style usually harbor tremendous fear of abandonment and tend to have strong desires for closeness. They are hypersensitive to perceived relationship threats and react with intense negative emotion, dramatic displays of affection, and desperate attempts to cling to relationships, even at great cost to themselves. People with an anxious attachment style are prone to self-doubt, rumination (i.e., repeating loops of negative thinking), and they have trouble managing intense emotions.

On the other hand, people with an avoidant attachment style generally have deeply embedded distrust of others and fears of intimacy and interdependence. Unable to rely on others, they try to keep their relational needs to themselves. People with an avoidant attachment style are also sensitive to relationship threats, but they usually respond by shutting down desires for closeness, hiding their vulnerabilities, and suppressing thoughts and emotions that might invite connection. They are not antisocial or asocial, they simply hold back from meaningful connection for the sake of self-protection.

My clinical experience and preliminary research indicated that both insecure attachment dimensions, anxious and avoidant, were related to lower levels of resiliency and diminished capacity for mindfulness. This led me to an important question: Could the cultivation of mindfulness and self-compassion help people who were mistreated as children to develop healthier attachment-related patterns of thinking and emoting?

To answer this empirical question, I conducted an experiment involving a treatment group that received the REAC²H workshop and a control group that received no intervention. Both groups were assessed before the treatment group received the workshop, one week after the workshop, and again six weeks after the workshop. Thus, because the only significant difference between the two groups was that the treatment group received the workshop and the control group didn’t, we were able to compare the two groups and attribute any differences in pre-and post-assessments to the REAC²H workshop.

The results of this unique study were recently published in the journal Mindfulness. We found that women in both groups who had experienced higher levels of childhood maltreatment were more likely to have anxious and avoidant attachment styles in adulthood. Interestingly, among the various types of childhood abuse and neglect (i.e., emotional, physical, sexual), emotional neglect was the strongest predictor of adult attachment insecurity – more so than physical or sexual abuse. Also, similar to my previous research, anxious attachment was related to rumination and negative affect while attachment avoidance was related to emotion suppression and emotional ambiguity.

Comparing the two groups over time, we found that people who received the REAC²H workshop showed significant reductions in rumination, negative emotion, emotional suppression, and emotional ambiguity. Also, compared to the control group, the treatment group showed greater capacity for emotion regulation and mindfulness. In fact, for those who received the REAC²H workshop, improvements in rumination and emotional clarity contributed most to the gains in mindfulness.

To test whether these changes were specific to thoughts and feelings associated with the attachment system we invited study participants to write about a stressful or traumatic experience from their childhood involving caregivers. Participants in both groups wrote about the same experience prior to, and six weeks after, the treatment group received the workshop. Using advanced text analysis software, we were able to detect changes in language usage across time. We found that, compared to their counterparts, women in the treatment group used fewer past-tense words and more present-tense words after the mindfulness-based workshop. They also used more words that showed insight and cognitive processing of the stressful or traumatic childhood experience.

Results of the REAC²H Workshop

The following examples illustrate language-based changes in mindfulness across time for participants in the treatment group. Again, the first paragraph was written during the week prior to the REAC²H workshop while the second paragraph was written six weeks after the workshop. This first set of narratives was written by a woman with an avoidant attachment style:

Pre-Intervention:My father was an alcoholic and would yell at night and this bothered me and upset the whole family. His yelling was addressed to my Mother and her family. I was upset that he did not have a regular job like my friends’ fathers and was absent many times as he would stay out at the ranch while we were at my grandfather’s home after my grandmother died.

Post-Intervention:As time passes and I reflect on the experience, I find I view it differently. This may be viewing it from a more mature and healthier attitude and as one who is in recovery. My father was a very sick alcoholic and now I see that my mother played an important role in the disease. My mother was not present during these times and often left my brothers and me alone with him while he was drinking. She was the one who yelled at us while he was the one who yelled at and about her. I can understand and accept that this results in some very disruptive thinking about the situation.

Consistent with an avoidant attachment style, this individual initially wrote about her traumatic experience in a somewhat distant, unemotional manner. After briefly noting that her father’s drinking and yelling bothered her, she quickly moved to emotionally safer topics: his unemployment and their living situation. However, following the REAC²H workshop, her use of language was more present-moment focused and it showed greater insight and understanding. The cultivation of mindfulness and loving-kindness enabled her to reflect on her difficult attachment experiences with more compassion for her father and for herself.

This next set of narratives was written by a woman with an anxious attachment style.

Pre-Intervention: “I said something back to my mother and she slapped me. I don’t remember what we were arguing about. I just remember her being so angry. I remember being shocked that she slapped me. I was confused and scared. When I think about it I can feel the sting in my cheek. I couldn’t believe my mom has hit me like that. I didn’t deserve to be hit. You DON’T hit people you love. It taught me that disagreeing with mom and voicing it was NOT OK. I was scared of my mom. Today I fear doing the same thing to my children. I don’t want my kids to feel unloved, scared, hurt, and let down. I don’t want to relive that day and I am scared that I will.”

Post-Intervention: “When I was in middle school and my mom was picking me up from spending time with my best friend’s house. We were sitting in the car in front of the house. We were arguing, and my mom slapped me for talking back to her. I can still feel the pain in my cheek when I remember it. That feeling is like a memory. The pain will always be there, but just a faint shadow of the day. My mom hit me because she didn’t have boundaries. It’s a sad memory, but no longer holds the level of pain.”

Consistent with an anxious attachment style, this individual’s first account is full of strong negative emotion and she seems to get lost in the pain of the story. Her use of language indicates that she readily makes contact with her fears and vulnerabilities and tends to ruminate on them. After the REAC²H workshop, she was able to write about her stressful attachment experience without getting overwhelmed by the emotions associated with it. Applying mindful awareness, she was able to adopt an observing stance where she could be a witness to her own attachment experiences with greater equanimity and serenity.

These narratives illustrate how mindfulness and self-compassion can help people to develop a new relationship with the stories from their past. The combination of these two contemplative practices is important because mindfulness fosters non-judgmental clear-seeing or insight of our experience in the present moment and self-compassion enables us to hold that experience with loving-kindness. Tara Brach talks about mindfulness and self-compassion being like two wings of a bird and I believe that both are needed on the journey to healing attachment-related wounds.

A Mindful Approach

As people learn to embody a wholehearted observing stance toward their own experience, they become better able to offer the wounded parts of themselves the unconditional regard and loving presence that may have been missing in their past attachment relationships. This mindful approach facilitates a sort of re-parenting process, as a more functional part of the self mindfully emerges and compassionately accepts and integrates all parts of the self. This integration naturally facilitates emotion regulation and self-regulation. With practice, people can develop a “felt sense” of attachment security as they learn to relate to themselves with greater care and compassion.

In the research literature, this integrated and regulated state of mind regarding attachment has been called “earned security”. Even people who have experienced very challenging attachment relationships, like the women who participated in the REAC²H research project, are able to make peace with their past by wholeheartedly embracing their experience in the present moment. Research also indicates that people who are on the path to earned security have more loving relationships with their children and romantic partners. It all starts right here, at this moment, in this body-mind, with the simple inquiry: “Can I accept with love and compassion the life that is here”.

About the Author

Dr. Jon G. Caldwell, DO, Ph.D., is a board-certified psychiatrist and clinical researcher specializing in the treatment of psychological trauma and addiction. He is a lead psychiatrist at The Meadows and an Assistant Clinical Professor at the University of Arizona. His approach to healing has been heavily influenced by his graduate work at the University of California, Davis in human development and by contemplative teachings and practices like mindfulness and loving-kindness. He has published a number of articles on childhood maltreatment, attachment theory, emotion regulation, and mindfulness ( Dr. Caldwell is a noted international speaker and trainer on these and other topics. He resides in Arizona with his gurus—his wife and two children.