The Pain Paradox:  East Meets West in a new paradigm for processing and moving beyond complex trauma

As our field matures, and currently-promoted therapies are tested in the real world, the limitations of some approaches to PTSD and complex trauma are becoming clear. Fortunately, researchers and clinical practitioners are discovering the power of new affect regulation interventions, interpersonal therapies, and empirically-based mindfulness and compassion models that, in combination with newer approaches to therapeutic exposure, are generating a “third wave” of effective approaches to trauma.

As importantly, clinicians are increasingly discovering the limits of medical model approaches to trauma-related difficulties, and are moving beyond the need to “fix” or “cure” problems that are not diseases or disabilities in the first place. As it turns out, acceptance, growth, and wisdom - all achievable by the trauma survivor - are natural complements to symptom reduction techniques, and often bring the client to new levels of awareness and appreciation.

This workshop presents the Pain Paradox, an East-West theory of trauma-related suffering that suggests that the “solution” to unwanted states is not to avoid, suppress, or intellectualize, but rather to carefully engage, accept, process, and even use painful material in the context of a compassionate therapeutic environment.

Building on his most recent books with valued co-authors (Principles of Trauma Therapy, 2nd edition, DSM-5 Update (2014) and Mindfulness-oriented interventions for trauma: Integrating contemplative practices (2015)], this two day presentations offers new approaches, insights, and perspectives described in John Briere’s book-in-progress, The Pain Paradox: Embracing the unwanted in the search for well-being.

This workshop includes the following topics, taken from The Pain Paradox

•           The pain paradox and the suppression effect

•           Engaging compassion as it counters harsh self-perceptions and reprocesses early relational schema;

•           The second arrow: Reducing identification with posttraumatic thoughts and feelings;

•           Mindfulness as a freedom technology;

•           Metacognitive and existential awareness as clinical goals

•           Urge-surfing, trigger management, and mindfulness-based breath techniques for self-regulation;

•           Titrated memory processing and the new science of reconsolidation;

•           RAIN: An algorithm for decreasing countertransference;

•           Processing socially-transmitted schema about personal unacceptability and imperfection, and

•           New work on engaging anger, hatred, and revenge;

 Learning Objectives

Attendees will be able to:

•           Describe the clinical implications of the pain paradox

•           Define metacognitive awareness

•           Describe “urge surfing” and “trigger management” as they relate to changed identification with

             internal states and processes

•           Describe the basic neurobiology of activated attachment schema

•           Implement a model of client-therapist interaction that is nonauthoritarian and yet empirically-based


Detailed Program Outline

Day 1

  1. Brief overview of complex trauma

              a) Complex trauma characteristics

              b) Effects

                 i)    Posttraumatic stress

                ii)    Altered self-capacities

               iii)    Heightened use of avoidance strategies

           c) Substance abuse, dissociation, tension-reduction behaviors, suicidality

              iv)      Existential impacts

          2) Modern Western approaches to trauma effects

              a) CBT and exposure-based models, including EMDR

              b) Affect regulation approaches

              c) Relational psychotherapy

          3) Problems with Western models

              a) Incomplete efficacy

              b) Misidentification of problems

                  i) Disorders versus dimensionality

                 ii) Overlooking existential problems and issues

                iii) “Fixing” and “adjustment” as narrow interventional bracket

            c) Inadequate attention to growth

            d) Insufficient attention to developments in therapeutic mindfulness

         4) Eastern or more existential approaches to trauma

            a) Focus more on suffering than pain

               i)What is the difference?

           b) Mindfulness

           c) Attention to engaging and allowing distress

           d) Intentional fostering of compassion in both therapist and client

           e) Growth, wisdom, and happiness as primary goals

         5) The Pain Paradox

          a) Why avoidance often doesn't work

            i) The suppression effect

           ii) Buddha’s second arrow

          b) Why seeking pleasure doesn’t help

            i) Dopamine fade

           ii) False goods

        6) The four species of pain and the results of suppressing each

          a) Physical pain

          b) Cognitive/emotional pain due to events

          c) Culturally-related pain

             i) The dangers of seamless perfection and its pursuit

            ii) Akhilandeshvari: She who has never been not broken

          d) Existential pain

 Day 2

          7. The Perception Problem

          a) Snakes versus ropes

            i) Conditioning by previous experience

           ii) Activation of schematic versus true perception

          iii) Source attribution errors and confirmation bias

         b) Metacognitive awareness

            i) Beyond thoughts and feelings

           ii) Addressing source attribution errors

        8) Inviting your memories and pain to tea

           a) Processing conditioned emotions from maltreatment

             i) The theory of intrinsic, evolutionary-based processing

            ii) Flashbacks, nightmares, rumination, re-doing and reconsolidation

         b) Explicit processing

            i) Exposure

               1) Classic vs. titrated vs. mindful

           ii) Activation

          iii)  Disparity/safety/contradiction of beliefs

           iv) Extinction/Counterconditioning/Accommodation

            v) Reconsolidation

        9) Mindfulness

           i) Definition

          ii) Western versions

         iii) The power of acceptance

         iv) Mindfulness as a freedom technology

          v) On “jobbing it out”

         vi) Mindful processing

     10) Affect regulation training

         a) Mindfulness-based breath techniques

         b) Meditation

           i) Indications

         ii) Contraindications

        iii) Hierarchy of intensity

            1) Mindful - absorption - Metta and yoga

         c) Urge- and -emotion surfing

         d) Trigger management

           i) The Trigger Grid

         e) RAINing

           i) Recognition

          ii) Acceptance/Allowing

         iii) Investigation

          iv) Non-identification

      11) Relational work

         a) Activation of attachment schema and cultural traumas in the context of compassion

         b) Neurobiology of compassionate treatment

         c) Detoxifying relationships

           i) Non-authority

          ii) Self-reliance and empowerment in the context of relational acceptance

         iii) Allowing others: Learning in to relationship

       12) Special issues

          a) Bad guys and evil

            i) Bozos and busses

           ii) Dependent arising

          iii) Buying into payback and retribution

          b) Recovery versus growth

              a) Growth and wisdom, versus getting back to where you were before

              b) Psychotherapy

                i) When fixing is helpful

               ii) When fixing isn’t

              iii) Synthesis