# Trauma Therapies, Healing, and Survival - URL: https://alisanburak.com/en/travma-terapileri-iyilestirim-ve-sagkalim - Language: en - Last updated: 2026-08-29 - Page title: Trauma Therapies, Healing, and Survival | Assoc. Prof. Dr. Alişan Burak Yaşar > Why does posttraumatic stress disorder develop, and how do EMDR and CBT work? On the nature of trauma and the healing mechanisms of therapy. This page was translated automatically from Turkish. [Read the original](https://alisanburak.com/travma-terapileri-iyilestirim-ve-sagkalim) [← Back to blog](https://alisanburak.com/en/blog) # Trauma Therapies, Healing, and Survival December 12, 2018Articles in Bilim ve Ütopya [Görsel: Trauma Therapies, Healing, and Survival] In DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) [1], the principal manual that names and classifies psychiatric disorders, the most prominent trauma-related disorder is “Posttraumatic Stress Disorder.” For this diagnosis to be made, a person must first experience an event or situation that can be described as “traumatic.” Critical accounts argue that the definition of trauma in DSM-5 is overly reductive, and that certain aspects of this approach (such as the note that exposure to a traumatic event through television does not satisfy this criterion) stem from pressure by insurance companies to restrict treatment coverage. Nevertheless, this manual and its definitions remain among the most widely used guidelines for establishing specific criteria through a shared international language and planning treatment accordingly. We diagnose our patients with reference to this manual. Under this definition, the first criterion for describing an event as traumatic is that the person directly experiences the event or situation, witnesses it, or learns that it has happened to someone close to them. The second criterion is that the event involves exposure to actual or threatened death, serious injury, or sexual violence. If these conditions are present and the person develops emotional numbing alongside the other core symptoms of posttraumatic stress disorder—persistent intrusive thoughts, re-experiencing, and escape and avoidance—we can say that they have developed posttraumatic stress disorder. Common symptoms of posttraumatic stress disorder include insomnia, nightmares, frequent distressing recollections of the event, a persistent fear that the event will happen again and consequently feeling on edge, an exaggerated startle response, irritability, difficulty planning for the future, alienation (the feeling that others do not understand me or what I have experienced), and distress in situations that recall the event and avoidance of those situations [1]. Approximately 5–12% of people exposed to a traumatic event develop posttraumatic stress disorder [2]. We can therefore consider that the remaining approximately 90% have a “normal” recovery mechanism for coping with trauma. With developments over the past 30–40 years, the scientific literature has demonstrated that psychotherapies are effective in treating disorders associated with psychological trauma [3]. The World Health Organization recommends Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) as first-line treatments for posttraumatic stress disorder [4]. Setting aside childhood trauma and human-inflicted trauma with an “interpersonal component,” which may take longer to treat, these approaches can improve symptoms in the majority of patients within 7–12 sessions [5]. EMDR therapy, like cognitive behavioral therapy (CBT), is a psychotherapy approach used for psychological trauma. Like all psychiatric and psychological treatments, this therapy is a very recent discovery and development; since Shapiro’s discovery in the 1990s, it has developed rapidly and productively [6]. Looking ahead, these treatments, although scientifically proven to be effective, can be viewed as exciting and promising approaches that are still, so to speak, in their adolescence. Considering the past half-century, if these psychotherapies continue to develop and improve at the same pace, the future looks very bright in terms of alleviating psychological suffering. At this point, another area for reflection emerges. As physicians and psychotherapists, our primary duty is to alleviate suffering and promote mental and physical well-being. Now, as a thought experiment, let us consider for a moment the other sides of alleviating suffering. To take an example from other medical conditions, patients with the blood disorder called sickle cell anemia experience anemia. Yet malaria, a disease caused by an infectious organism, does not produce symptoms as severe in people with sickle cell anemia as in others and follows a milder course [7]. In other words, one disease may protect people from another painful disease or offer partial protection against its effects. Approaching this issue through the scientific disciplines that examine survival and the continuation of our species, or through philosophical inquiry seeking to make sense of our existence, may offer us a different perspective alongside this example. Is it always good to alleviate the suffering that “psychological trauma” causes an individual? Might the suffering associated with psychological trauma also have benefits for survival in people today? Even if it does, could there be situations in which we should not alleviate the suffering of psychological trauma, or particular periods during which we should work to heal it? If there are circumstances in which we should wait a little before alleviating the suffering of psychological trauma, how can we define them? At what particular times? In what particular situations? For which people? What might the benefits and harms of postponement be? What would its individual and societal effects be? And by what criteria should we determine what constitutes a benefit? Here, it may be helpful to return briefly to the nature of psychological trauma. The component of memory we call explicit memory allows all of us to leap across time and recall events and emotions that, although experienced in the past, somehow continue to live in our minds. Yet recalling an individual memory, however important it may be, is not like finding a photograph in an album. Recalling memories is a creative process. It is thought that the brain stores only the core memory. During recall, this core memory is processed and reconstructed. In this process, things are added, removed, distorted, and elaborated. In trauma, however, something further happens: psychological trauma itself directly disrupts the processing of the traumatic event as information. Psychological trauma disrupts the usual nature of information in memory. It distorts the stored memory, entangling it with unrealistic feelings of worthlessness and guilt and with negative beliefs. Yet even under normal circumstances, there is a bias in how information is stored in our memory. Our memory is not entirely objective [8]. When people’s beliefs about self-worth, controllability, and optimism are examined, there is a positive bias that goes beyond reality [11]. In other words, even in ordinary circumstances, there is a bias toward positive thinking. In posttraumatic stress disorder, the traumatic memory becomes timeless, and the scene of the trauma persistently replays in the mind for many years. This continual recollection, detached from time and place, causes psychological suffering. Returning to our subject, if we also keep in mind the view that these symptoms served a purpose in evolutionary terms for humans living on the savannas and for other mammals, helping them survive, might symptoms associated with the psychological suffering of trauma also provide some benefit for modern humans [9]? Setting aside human-inflicted trauma associated with malevolence may make this easier to consider, because as long as “evil” and “injustice” inflicted by one human being on another exist, the political dimension of psychological trauma will remain undeniable. Furthermore, the effects of natural disasters on people, rather than human-inflicted trauma, may provide a more comfortable space in which to think about this issue. From this perspective, could treating trauma symptoms make a difference to the likelihood of survival? For example, consider Istanbul, where an earthquake is expected in the very near future and which witnessed an earthquake in 1999—that is, in the recent past. There are still people in the community experiencing “untreated” trauma symptoms following the 1999 earthquake, with a serious impact on their quality of life. When we examine these individuals’ lives closely, being unable to go into multistory buildings (avoidance) and feeling as though they are reliving the earthquake at the slightest sudden sound (re-experiencing) are among the difficulties they report most often. As a result, these people struggle to socialize, work, and travel. As mental health professionals, we expect an improvement in their quality of life when we treat these symptoms. To summarize in simplified terms, before treatment, people experiencing psychological trauma report complaints such as “the anxiety of thinking an earthquake could happen at any moment, the distress of being constantly on alert, the fear that every sound from outside signals an earthquake and therefore startling at every sound, and the return of earthquake memories and negative emotions when the sky looks bright.” After treatment, these are replaced by more reasonable thoughts such as “this building is a safe place; if everyone else can enter it comfortably, so can I,” and they can go about their lives as freely as others. As I mentioned earlier, people tend toward positive thinking that goes somewhat beyond reality [11]. In other words, this extra optimism is part of our nature. It helps us adapt better to life and society. On the other hand, returning to earthquakes, despite the improvement in these people’s trauma symptoms, we know that many of the buildings that others enter “comfortably” in Istanbul pose an earthquake risk[10]. Yet there is a fact worth noting: suffering constantly over the possibility of an earthquake that may not occur for another 50 years, living a lifetime filled with symptoms of posttraumatic stress disorder, and carrying the burden of trauma throughout life will also prevent a person from pursuing various human aspirations, such as loving and being loved, realizing their ideals, thinking freely, and being productive through work. For this reason, the benefit of relieving individuals of this suffering and of their optimistic outlook toward the future is beyond question. Their suffering will probably diminish within 7–12 sessions to a level at which it no longer affects their lives. The effects of posttraumatic stress disorder in the evolutionary development of humankind can be discussed in another article. There are many well-reasoned views on why these symptoms arise and what biological purpose they serve. However, considering that the pace of human cultural evolution has far outstripped biological evolution, we can identify another issue that may contribute to our discussion. Our very young psychotherapy approaches will one day reach an even more advanced stage. To exaggerate a little and use our imagination, let us imagine that one day we can achieve in five minutes the “psychotherapy” effect we currently achieve in 7–12 sessions of 90 minutes each. Pushing the boundaries a little further, let us suppose that we could offer these therapies—which are already more effective than medication for certain patients—in the form of a pill, and that we could add this active ingredient to all drinking water through the municipal water supply. This treatment for reducing psychological suffering would be a tremendous service. But if such a possibility became a reality, how might we answer the following question: would it have any harmful or negative consequences for humanity? As we turn this question over in our minds, let us conclude our discussion with the following. Events that cause psychological trauma are very common in society. Research shows that one in two people encounter such events at least once in their lives. Indeed, depression and posttraumatic stress disorder have been identified as the two most common disorders following psychological trauma. Moreover, although DSM-5 does not define events outside the circumstances I mentioned at the beginning as trauma, we know that a directly experienced traumatic event is not necessary for trauma symptoms; the perception of trauma is sufficient. Even an event that seems very minor can trigger the most severe trauma symptoms for that person. So, what do you think: should this imaginary medication that alleviates psychological suffering in a single dose be added to the water supply of the future? ## References 1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub. 2. Aker, T. and P.P. Önen, Travma Sonrası Stres Bozukluğu. Turkiye Klinikleri Journal of Internal Medical Sciences, 2006. 2(12): p. 52-63. 3. Seidler, G.H. and F.E. Wagner, Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: a meta-analytic study. Psychological medicine, 2006. 36(11): p. 1515-1522. 4. Organization, W.H., WHO releases guidance on mental health care after trauma. Saudi Medical Journal, 2013. 34(9): p. 975. 5. Yurtsever, A., et al., An Eye Movement Desensitization and Reprocessing Group Intervention for Syrian Refugees With Post-traumatic Stress Symptoms: Results of a Randomized Controlled Trial. 2018. 6. Shapiro, F., Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures. 2001: Guilford Press. 7. Allison, A.C., Protection afforded by sickle-cell trait against subtertian malarial infection. British medical journal, 1954. 1(4857): p. 290. 8. Kandel, E.R., In search of memory: The emergence of a new science of mind. 2007: WW Norton & Company. 9. Silove, D. "Is posttraumatic stress disorder an overlearned survival response? An evolutionary-learning hypothesis." Psychiatry 61.2 (1998): 181-190. 10. Solak, H.İ. et al. Kentsel dönüşümde riskli alan önceliklerinin belirlenmesi için bulanık 11. mantık tabanlı sistem tasarımı. 2017. 12. Cummins, R.A. and H. Nistico, Maintaining life satisfaction: The role of positive cognitive bias. Journal of Happiness studies, 2002. 3(1): p. 37-69. --- *This article was first published on December 12, 2018, on the web portal of the journal Bilim ve Ütopya. Since the portal is no longer online, I am republishing the text here.* [Next → Psychological Trauma and Its Evolutionary Nature](https://alisanburak.com/en/ruhsal-travmanin-evrimsel-dogasi) --- Kaynak / Source: https://alisanburak.com/en/travma-terapileri-iyilestirim-ve-sagkalim İletişim / Contact: Bağdat Caddesi, Veli Güneysu Apt. No:453 K:4 D:9, Suadiye / Kadıköy, İstanbul · +90 532 642 95 25 · info@alisanburak.com · https://alisanburak.com/bagdat-caddesi-psikoterapi-iletisim