Dr. James Gordon is a Harvard-educated psychiatrist who uses self-care strategies and group support to help patients heal from psychological trauma. In this interview, he shares some of those strategies, which are also detailed in his book “The Transformation: Discovering Wholeness and Healing After Trauma.”
Gordon is also the founder and executive director of the nonprofit Center for Mind-Body Medicine (CMBM) in Washington, D.C., and is a clinical professor at Georgetown Medical School. During his presidency, President Bill Clinton appointed Gordon chairman of the National Advisory Council to the National Institutes of Health Office of Alternative Medicine.
Trauma Is a Virtually Inevitable Part of Life
According to Gordon, a recent U.S. survey found 60% of U.S. adults reported being significantly abused or neglected as children. Even if you had the good fortune to grow up in a loving and supportive family, you’re still likely going to experience some form of trauma at some point.
It could be a challenging separation or divorce, a child’s illness, chronic disease or the sudden death of a loved one. An astounding percentage of women also report having been raped or abused within a primary relationship.
“If we don’t experience trauma in our midlife, we certainly will if we live long enough to grow old,” Gordon says. “When we become frail and deal with the losses of people we love and with our own inevitable death, this understanding that trauma is a part of life is the wise teaching of religious and spiritual traditions.
All aboriginal people all over the planet understand this. I think in the modern Western world, we’ve come up with this idea that everything should be OK all the time.
We tend to believe there’s something really wrong if some misfortune comes to us or if we face a major challenge, and that makes it harder for us to deal with the challenges that inevitably come up.
The skills and tools I teach are ways of dealing with the trauma that comes to us and also ways of equipping ourselves to be more resilient when challenges inevitably do come.”
The Importance of Healing Childhood Trauma
In his book, Gordon addresses ACES, which is an acronym for “adverse childhood experiences.” He mentions that about a quarter of the adult population that is well-educated and financially secure report such experiences, and resolving the trauma from childhood is vital for health and well-being.
Typically, childhood trauma leaves far deeper scars than trauma inflicted later in life. Gordon explains:
“Childhood trauma, especially when it comes from those people whom we depend on — parents or other caregivers — is often much more severe, because these are the people to whom we look for comfort and care.
When they betray that trust, when they break that bond with us, we’re in a terrible bind because we have to keep on looking to them for care. We look to them for security.
At the same time, they may be betraying us on a daily basis … Even if it seems rather subtle, if you feel continuing disapproval … it goes very deep into the child, and the child has a sense that, ‘I’m not worthy. Maybe I should be treated badly. Maybe I’m not important after all.’ That stays with them through adult life.
One of the challenges and one of the issues that I address early on in ‘The Transformation’ is a need to become aware of these feelings that we carry around with us … Sometimes, for example, people will be mistrustful in their relationships as adults. They may wonder, ‘Well, why am I so mistrustful?’ They can come up with lots of reasons why.
But at a certain point, many people have a sense that, ‘There’s something going on. Maybe it’s not the people I’m meeting right now or the people I’m relating to right now. Maybe it has something to do with what happened back then.’
The trauma of childhood, first of all, needs to be realized. We need to understand that it actually happened. We need to come to accept it, and then we can begin to deal with it. It’s often … a more complicated process [than] dealing with a very major traumatic event that comes to us in our adult life.”
Healing the Trauma of War
Gordon founded CMBM in 1991. From the beginning, it was an educational organization. Initially, they trained clinicians in the U.S. on how to use techniques such as meditation, guided imagery, movement and self-expression through art and writing.
Shortly after the Peace Accords were signed in 1996, Gordon and Dr. Susan Lord, a family physician, traveled to Bosnia to see whether their work might be useful there. Heads of public health, the head of the Islamic University, the monsignor of the Catholic Church all welcomed them.
“We realized that the trauma had set in so deeply. The trauma had disturbed just about everyone’s physiology and their psychology.
What we saw were people in chronic fight-or-flight — anxious, agitated, drinking to subdue their symptoms — people who were withdrawn and unable to connect with each other because not only had the fight-or-flight response persisted, but they had also shut down to protect themselves (the freeze response).”
As soon as the war in Kosovo started, Gordon and Lord knew they needed to go there and start working on trauma support. “This is a lesson for anyone who is watching or listening to us: The time is to start as soon as you realize the trauma is there,” he says. Together with The Center for Mind-Body Medicine faculty, they trained 600 people in Kosovo, including all 240 who staffed the newly established community mental health system.
“Our model became central to all of mental health in Kosovo,” Gordon says. “Kosovo is actually the first country in the world where mind-body medicine is a completely integrated part of the health care system …
Some of the people we trained were teachers in a rural high school. They began to teach our method of self-care to high school students. Eighty percent of these students had had their homes destroyed and 20% had lost one or both parents. They were very severely traumatized kids.
The high school teachers formed small groups and taught the kids these techniques of self-care, the same ones that I present in ‘The Transformation.’
Eighty-five percent of the kids who began those groups with post-traumatic stress disorder, (PTSD) — qualifying for that diagnosis — no longer had it after 11 weeks and those gains held at three months’ follow-up.
We published the research — the first randomized controlled trial of ANY intervention with war-traumatized children — in a major psychiatric journal. This is very important for many reasons. One is that the method works. The second is that you don’t need to be a psychiatrist or a psychologist to teach people these techniques … somebody who’s … learning them from [reading] ‘The Transformation’ can also get the same kind of benefits.”
Gordon was soon invited to come to Gaza by an Israeli and a Palestinian psychologist, both of whom were reporting the same thing: The trauma caused by the ongoing conflict was hurting the children, and they didn’t know what to do about it. Seventeen years later, CMBM is the only organization working on a large-scale with psychological trauma on both sides of that still very big and very painful divide.
Hopelessness to Healing 15 Years Later — An Example
During the 2014 war that killed some 2,000 people in Gaza, including 500 children, the CMBM team fanned out and began teaching in every part of the territory. Gordon tells the story of one 9-year-old girl named Azhaar Jendia:
“In the first of a series of our groups … we ask everybody to draw three pictures … yourself … yourself with your biggest problem, [and] yourself with your problem solved. Usually, the second drawing helps people to focus on what the biggest problem is … There are so many things that are distressing. The drawing helps to focus.
The third drawing is usually very hopeful, because it taps into our imagination to create a solution to the problem.
In Azhaar’s second drawing, the biggest problem, she drew herself as a tiny little stick figure in the corner of the page with her mouth turned down in sadness. Occupying the page was a scene of carnage and destruction. Her home was falling down.
Overhead, there were planes that were bombing her home. On the ground, next to her destroyed home, soaked in red blood was her dead father. Next to him were two uncles … [and] her aunt, who were also killed in the bombing …
It was very distressing to see the second drawing. But the solution she came up with in the third drawing was even more distressing. In the solution, she was lying next to her father in a coffin in the ground. When I asked her what was going on, she said, ‘I am with my father again. He is dead. There is no reason for me to be alive. I want the Israelis to kill me.’
Five months after the war, and other kids in the group had similar kinds of pictures. In nine sessions, once again led by a teacher, Azhaar learned the practice of self-awareness and self-care. She learned different kinds of meditation. She used mental imagery. She moved her body actively to free up the stress and the tension.
Azhaar did written dialogues with some of the symptoms she was having. She drew a genogram, a family tree. She imagined the sources of support from her family.
In the final, ninth group, she did some drawings again. This time, when she drew who she wanted to be, which is equivalent to the solution to her problem, she drew herself in a white coat with a stethoscope around her neck, the earpieces of the stethoscope in her ears and the resonator on the chest of a person lying on a table in front of her.
I said, ‘What’s going on here?’ She said, ‘I am a heart doctor. This is my patient on my examining table. Since the war in 2014 here in Gaza, so many people have hurt their hearts. I am taking care of them.’
There were five other figures standing next to the examining table. I said, ‘And who are these, Azhaar?’ She said, ‘Oh, those are my other patients. They’re waiting for me. There are many people who need my help.’
This is a very dramatic story of a little girl. Five months after the war, the only solution to her problem, to the destruction, to the loss, was to die, to be killed.
Coming through this group, learning how to regulate her body, regulate the fight-or-flight response with quiet meditation, how to break up fixed patterns and tension with movement, how to use imaginative techniques to come up with solutions to problems, she herself discovered a way to move forward with her life …
This is what is possible, even for people who have been severely traumatized — not only to recover from the trauma and to build resilience, but to discover possibilities they have never even dreamed of before they were traumatized.”
The Fight-Or-Flight Response
While there are certainly other techniques for healing trauma, Gordon believes his approaches are foundational, as they help rebalance your body and nervous system. This alone can be transformative.
The basic idea is that when trauma occurs, whether the injury is to your body, mind or spirit, two basic processes are activated. The first is the fight-or-flight response, which when activated increases your heart rate and blood pressure. Blood is shunted from digestion into tensing muscles, heart and lungs. Stress hormones are produced to help you fight or run.
While crucial in acute situations of danger, the fight-or-flight response is meant to be turned on and back off quickly. As soon as you’re out of immediate danger, you’re supposed to return back to balance, feeling safe and at ease. Problems arise when we go into fight-or-flight and stay there long after a traumatic event is over.
“Sometimes it’s because the trauma is ongoing. That’s what happens to kids who are in abusive or neglectful situations. But sometimes, we’ve experienced a traumatic event and we’re stuck in that fight-or-flight. It’s like our foot is on the accelerator and we can’t take it off.
So, we become anxious and agitated. We have trouble sleeping, trouble concentrating. We’re impatient with other people, impatient with ourselves. Also, we’re stuck in that past. We replay the images, the images of someone abusing us, someone assaulting us or a boss treating us badly or what happened to us when we were deployed …”
The Freeze Response
The second process activated by trauma is the freeze response. Fight-or-flight is part of the sympathetic nervous system, which is one-half of the autonomic nervous system. The other half of the autonomic nervous system is the parasympathetic nervous system.
“In general, we’re trying to mobilize the parasympathetic nervous system to balance out fight-or-flight,” Gordon explains. “But sometimes, if the situation is so overwhelming and so inescapable, we go into what is called the freeze response, which is mediated and governed by the oldest part of the parasympathetic nervous system, deep in the mid-brain.
We just shut down; we collapse. We put out large amounts of endorphins to protect us against the pain that’s there. We distance ourselves because the trauma is so overwhelming and inescapable. We can’t do anything else except shut down our bodies and close off our minds.
This happens, for example, to children who were abused by their parents, because the abuse is terrible and they can’t get away from it. It happens to people who were assaulted by others who are much more powerful than they are. It happens when we’re raped. It happens in a warzone when we can’t get away and we can’t fight. We’re just overpowered by the situation.“
When these two responses — fight-or-flight and freeze — continue, they are the essence of post-traumatic stress. “One way to look at it is that post-traumatic stress keeps us chained to the past, to the traumatic events, which we keep on replaying in our body and mind,” Gordon explains. “We’re worried it will happen again.”
The essence of healing psychological trauma is to return back into the present moment because, when traumatized, you’re chained to what happened in the past. You worry it will happen again. If you can relax and come into the present, then the trauma starts to dissipate.
Creating a Foundation for Healing
The first technique taught in Gordon’s program is slow, deep, “Soft Belly” breathing for eight to 10 minutes. Simply breathe in through your nose and out through your mouth, keeping your belly soft and relaxed. Closing your eyes will help eliminate external stimulation. As you do this, pay attention to your breath and allow your muscles to relax.
“This is technically a concentrative meditation,” Gordon says. “You are focusing on the breath, on the words ‘soft’ as you breathe in, and ‘belly’ as your breathe out, and on the feeling of your belly softening, relaxing. It is the antidote to the fight-or-flight response. It activates the vagus nerve, which slows heartrate, lowers blood pressure, helps us relax the big muscles, improves our digestion.
It quiets centers in the brain, like the amygdala in the emotional brain, that are responsible for fear and anger, and stimulates centers in the frontal part of our cerebral cortex that make us more self-aware, more thoughtful, more capable of decision-making, more able to be compassionate to other people and to ourselves.
This is the place to begin. This becomes a foundation for learning all the other techniques, because if we’re in this relaxed moment-to-moment awareness, then it’s much easier to use the techniques that mobilize our imagination.
It also becomes easier to use the active, physical techniques that can break up the frozen tension that’s in our bodies. It’s important to know that, when we’re dealing with psychological trauma, we need to work with our bodies, as well as our minds and our imagination.”
Other Self-Healing Techniques
“Shaking and Dancing” is one of these active techniques. It is technically an “expressive meditation,” designed to loosen our trauma-tensed bodies and relax and open our preoccupied minds. Here’s how you do it: Stand with your feet shoulder-width apart, your knees bent, and start shaking from your feet up through your knees and hips to your shoulders, chest and head.
Continue for five to seven minutes. “Shaking begins to break up the fixed patterns that have come into our bodies when we’ve been traumatized,” Gordon explains. The physical shaking also loosens the repeating thoughts that intrude in your mind, and opens you up to emotions that have been suppressed and repressed.
“Sometimes it’s sadness. Sometimes it’s anger. Sometimes it’s fear. Sometimes it’s laughter,” Gordon says. “We do that for five or six minutes. And then stop and stand and relax and be aware, be mindful of the breath and the body.”
After that, Gordon suggests putting on energizing music that you find uplifting, something that raises your spirits. Then allow your body to move to the music in whatever way it wants.
“‘Shaking and Dancing’ breaks up patterns that come from both fight-or-flight and freezing. It allows emotions to come up. It gives us a little time for mindfulness to become aware of what came up in our body as we did the shaking. And then it gives us a chance to express ourselves in dance, to feel some freedom,” Gordon says.
These three are basic — the Soft Belly breathing, the drawings and the Shaking and Dancing. Once you’re in a state of increased equilibrium — balancing out the fight-or-flight response and bringing yourself out of the freeze response, you can use all the other techniques I teach.
These include guided imagery, written dialogues, biofeedback and autogenic training (phrases that mobilize the parasympathetic nervous system and help us rest and digest), and many others — walking, meditation, mindful eating, being in nature and with animals, laughter, gratitude, and forgiveness.
The Trauma Healing Diet
When we’re psychologically traumatized, our GI tract, from the mouth to the anus, suffers just as much as our brain. Every aspect of digestion is significantly disrupted. We need to restore functioning. Techniques like Soft Belly, which quiet the fight-or-flight response and allow your digestion to operate more efficiently, are part of the healing process.
“There are also many dietary changes we can make that can make a major difference in how we feel and how quickly and well we recover from trauma … If we eat a basic healthy diet and eliminate food additives and preservatives, that, in itself, is going to help your gut to heal,” Gordon says.
“I also suggest people eliminate gluten-containing foods and stay away from milk products until their gut is restored. Trauma often opens spaces between the cells that line the small intestine and these grain and milk proteins can then enter the bloodstream and cause inflammation everywhere in our body, including our brain.
We need to supplement with probiotics. I would also add … a multivitamin, multi-mineral supplement. There’s an interesting study done in New Zealand after the earthquake there, a very good randomized controlled trial, showing that people who took a high-dose multivitamin and multi-mineral [supplement] had far fewer symptoms of psychological trauma than those who did not.”