How Abreaction Relates to Dissociation and Trauma

Upset man in therapy

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An abreaction is an emotional, unconscious reaction that you have in response to a stimulus that brings back a painful situation you have experienced before. It may be an event that you remember, or it may be something that suddenly pops into your consciousness when having the abreaction. 

Overview

As an example, consider someone who has been physically abused who responds to a raised hand by cringing even though the other person's intent was to brush away a stray thread.

Abreaction can also be used to describe the process a therapist uses to desensitize or help you to stop having these automatic reactions. Within the safety of a therapy session, you may be led to experience abreaction so that you can then learn to replace the illogical, gut-instinct reaction with one that is more suited to the situation.

History of Abreaction in Therapy

Abreaction, along with its counterpart catharsis, which refers to emotional release, was first discussed at length by Sigmund Freud and Josef Breuer in their early studies on psychoanalysis. They initially put a significant amount of emphasis on the importance of the abreaction and catharsis.

After more study, Freud and Breuer realized that simply expressing and/or reliving painful emotions is not all that is needed to achieve recovery, particularly for trauma survivors.

This emphasis on achieving catharsis through abreaction carried on through World Wars I and II through trauma therapists who used hypnosis and chemically-induced techniques to create abreactions. Some did realize the importance of helping trauma survivors do more than just deal with their emotions, however.

Abreaction and Dissociation

Trauma often causes people to dissociate from their emotions, memories, and/or identity. The amount of dissociation a person experiences can range from mild, similar to daydreaming, to severe, as in the case of people with multiple personalities. Freud's initial belief in promoting an abreaction in therapy was that through the release of the painful emotions, the traumatic experience would be dealt with.

The problem is, abreaction, in this case, the expressing of emotions, by itself does not cure anything. Many people can experience their emotions or relive the traumatic events over and over, but nothing is ultimately solved. Especially for sufferers of trauma, there is often still some amount of dissociation involved and some schools of thought believe the dissociation needs to be dealt with as well by making it part of your consciousness and identity.

We know today that dealing with traumatic stress such as post-traumatic stress disorder (PTSD) cannot rely just on treating the traumatic memories with abreaction or any other method. In fact, studies have shown that one of the best kinds of therapies for PTSD is cognitive-behavioral therapy (CBT), which has nothing to do with abreaction.

Cognitive-Behavioral Therapy

CBT works because it helps PTSD survivors reframe their thinking about their trauma. For instance, a rape survivor may feel illogical and unnecessary guilt for putting herself in what she perceives as a bad situation. With CBT, she would learn to change her thinking to realize that it doesn't matter what situation she was in, only rapists rape, and she could then learn to let go of the guilt. Changing faulty thinking and replacing it with more rational, factual thinking instead helps PTSD survivors cope better with the feelings of guilt, anger, distress, and fear they may have.

Uses for Abreaction

While abreaction has been largely disregarded for therapeutic use, some therapists may use it in some context, usually integrated within a larger treatment plan. When abreaction occurs, people may work with their therapist to deal with the feelings associated with past trauma. The value of an abreact is that it may present a realization, but that does not mean that the feelings surrounding the difficult experience have been resolved.

Once a past trauma has been brought to mind, memories may be carefully explored, but in a way where people have access to the support that they need to cope with the trauma. Learning to integrate these experiences and lean on helpful coping skills may minimize the dissociation that people may experience in response to trauma.

Abreaction is rarely used in isolation as a therapeutic tool. Simply eliciting a reaction to a stimulus does nothing to address the emotions and behaviors associated with the past trauma. As an integrative approach, abreaction may have some value when incorporated into a treatment plan that utilizes other treatments such as CBT.

Some research suggests that a technique known as abreactive ego state therapy may be effective for treating PTSD. This process involved the use of repeated hypnotically-induced abreactions of the trauma, followed by ego strengthening.

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