Cognitive Therapy for Trauma Recovery: Possible Versus Likely

People recovering from trauma, especially those living with conditions like Post-Traumatic Stress Disorder, Complex PTSD, or Dissociative Identity Disorder (DID), often experience a mismatch between what the conscious mind knows and what the body feels or understands. You may know, for example, that no one in the room with you is actively trying to hurt you right now, yet feel as if you’re in imminent danger. “Bottom-up” therapy approaches, like Eye Movement Desensitization and Reprocessing (EMDR), are designed to bring together what the conscious mind already knows with whatever discomfort is being experienced more deeply. I use a lot of these “bottom-up” approaches in my work with people, but I use “top-down” approaches too.

Cognitive Behavioral Therapy (CBT), Cognitive Processing Therapy (CPT), Dialectical Behavior Therapy (DBT), and the like are considered top-down because the work starts with the conscious mind and uses that as a pathway to shift unconscious material. The prefrontal cortex is actively engaged, the part of the brain that I often refer to as the “new brain” or “thinking mind.” We’re talking here about the “left brain,” responsible for logical, analytical, verbal thought. I haven’t yet witnessed someone heal from trauma using an exclusively top-down approach. Keep in mind that relationship – what happens between two people – is bottom-up. So can someone heal from trauma using CBT or CPT with the right therapist? I imagine so, because healing is happening through the relationship in addition to the cognitive modality.

Even while the crux of distress for many trauma survivors may not lie in distortions of the conscious mind, that doesn’t mean we can’t all benefit from work that strengthens and expands the thinking brain. I’m certified in Cognitive Processing Therapy, but it’s way too structured for me to use the way it’s designed. I just don’t work that way. As with many therapeutic modalities, I pull from CPT what seems mostly useful at any given time. One of my favorite things to pull is the distinction between possible versus likely.

Distinguishing between possible and likely tends to be helpful when we’re only focusing on unpleasant possibilities. Let’s say, for example, you’re about to present a proposal and you’re worried it won’t go well. Is it possible? Sure. Is it likely? You can do some thinking to figure that out. How prepared are you? How thorough is your proposal? You may determine that your proposal is at least as likely to go well as not, but you’re still worried. Here’s where you want to actively, consciously bring in the pleasant possibilities. You may even want to write them down to reinforce them. The proposal may or may not go well. There’s no good reason to believe it won’t. It’s possible that people will hate it, but it’s a sound proposal, so that’s not likely. It’s possible people will love it. Have you considered that? You’re excited about it. You’re presenting this proposal because you like it, or because it was requested of you. If I ask you to do something and you do it, isn’t it more likely that I’ll be pleased versus displeased?

Let’s consider another example. You’re afraid of driving. You’ve witnessed or experienced a driving accident and you’re concerned it will happen again. Possible? Absolutely. Driving accidents happen all the time. Likely? Not unless there’s some identifiable reason that makes it so. In fact, statistically, you’re more likely to get where you’re going without incident than to encounter an accident along the way. Notice this. Do the math. Imagine the pleasant possibilities: you enjoy a favorite song on the radio while you drive. You make great time and are happy to arrive at your destination.

While many of us experience single incidents that change our lives in profound ways, it’s much more the mundane, day to day experiences that impact our quality of life. I can focus on what I fear will happen, or I can focus on what I want to happen. I would never suggest that you lie to yourself, dismiss your emotions, or ignore unpleasant possibilities. What I do suggest is that you allow at least as much space for the pleasant possibilities as you do for the unpleasant. Actively working with our conscious minds to identify and shift any potential cognitive distortions is one way to accomplish this.

The next time you find yourself struggling, maybe notice what you’re telling yourself about a given situation. Notice if you’re concerned about something that’s possible, but not likely. If something unpleasant is, in fact, likely to happen, you may be able to build up your resources or change your plans. If the unpleasant outcome is possible but not likely, allow yourself to imagine all the pleasant possibilities. Hold those pleasant possibilities together with the concern. Get into the habit of checking your beliefs and shifting what you tell yourself. You may be amazed by just how powerful this can be.