Diversity Practice Approach

Buddhist Approach to PTSD

November 2009

By Glenda Ruder currently working to obtain her master's degree in Clinical Social Work at
Highland's University in Albuquerque, NM. This paper was written in response to a Diversity
Practice Approach assignment in a course entitled Advanced Multicultural Practice.

I have chosen to look at the theoretic approach of Buddhism; which is considered not

only a religion but a philosophical approach as well. Throughout the paper I will be exploring

how the Buddhist approach views mental illness particularly with the population of people

affected by Post Traumatic Stress Disorder.

Buddhism is a religion that was started by Siddhartha Gautama approximately 26

centuries ago in nowadays Nepal and northeastern India (O’Brien, 2009). Siddhartha Gautama

was born a prince and was married at the age of 16. At this time he began to grow restless of the

palace life and soon traveled outside of the palace walls. Every trip outside palace walls he

recognized human suffering; such as: sickness, old age and death (A View on Buddhism, 2009).

On his fourth trip, he saw a wandering monk who had given up everything he owned to seek an

end to suffering. "I shall be like him." Siddhartha thought (Instilling Goodness School). From

here Siddhartha studied with many different teachers. He mastered the art of meditation (the art

of no-thingness), and meditative absorption (focusing on“the state of neither perception nor non-

perception”) (A View on Buddhism, 2009). After mastering these two techniques he still did not

feel that he was any closer to finding an end to suffering. Continuing on; Siddhartha came to a

place called Bodhgaya in Northern India; while sitting under a Bodhi-tree he decided not to get

up until he discovered the truth. A short time later, he became a fully enlightened Buddha (A
View on Buddhism, 2009). Siddhartha Gautama came to be known as “the Buddha” meaning

the “awakened one” after experiencing a profound realization of the nature of life, death and

existence (O’Brien, 2009). After this realization Buddha began sharing his teachings. The

Buddha once summarized his entire teachings in one sentence: “I teach about suffering and the

way to end it” (A View on Buddhism, 2009). His teachings were called the dharma, which he

and his followers set out to spread throughout India.

During his enlightenment; Buddha came to three truths in which his teachings were based

off of. The first truth is that nothing is lost in the universe. This is a theory of all things being

inter- connected; everything has purpose. A dead leaf turns into soil (Instilling Goodness

School). The second universal truth of the Buddha is that everything is continuously changing.

Life is like a river flowing on and on, ever-changing. It is smooth and gentle in some places, but

later on snags and rocks crop up out of nowhere (Instilling Goodness School). Unexpected

things continually happen and you cannot predict what will happen in life. The third universal

truth explained by the Buddha is that there are continuous changes due to the law of cause and

effect. This is the same law of cause and effect found in every modern science textbook

(Instilling Goodness School). The idea of Karma is derived from this universal truth. Energy

and things that you put into the universe are the origins for what comes to you in life.

The Buddhist perspective perceives the mentally ill as those who become disconnected to

their environment and the world around them. In order to heal mentally ill through the Buddhist

perspective the issue needs to be looked at as a societal issue rather than an individual one.

Emotional suffering and mental distress may be a universal experience, but the ways they

manifest are unique from place to place (Duerr, 2009). A socially engaged Buddhist perspective
will lead us to inquire about our obligation to treat not only the person but also the environment

that has contributed to the conditions that create suffering (Duerr, 2009). Healing mentally ill

within the Buddhist perspective focuses on attention to the mind, body, and environment as

opposed to medicinal based interventions. Thich Nhat Hanh writes in The Path of Compassion

(1995):

Restoring mental health does not mean simply adjusting individuals to

the modern world of rapid economic growth. The world is ill, and ada-
ting to an ill environment cannot bring real mental health….Psychiatric
treatment requires environmental change and psychiatrists must partic-
ipate in efforts to change the environment, but that is only half the task.
The other half is help individuals be themselves, not by helping them
adapt to an ill environment, but by providing them the strength to change
it. To tranquilize them is not the Way. The explosion of bombs, the burn-
ing of napalm, the violent death of our neighbors and relatives, the pres-
sure of time, noise, and pollution, the lonely crowds-these have all been
created by the disruptive course of our economic growth. They are all
sources of mental illness, and they must be ended.

Post Traumatic Stress Disorder (PTSD) is defined as severe recurrent emotional anxiety

reactions that originate from an intense and traumatic experience. A trauma occurs when there is

a combination of sensory and emotional overload that cannot be processed and integrated into

the psyche. A war scenario provides many intense visual, auditory and contextual stimuli that are

completely foreign to the average person, as does sexual abuse, rape or witnessing a car accident

(Strong, 2009). PTSD is a significant health risk for many that are afflicted by it in the United

States. Because the symptoms of anxiety and PTSD are a result of internal thoughts that bring

about physiological change, it is important to seek out the type of therapy that will foster an

improvement in health. Using Buddhist-styled therapy, one, can learn to approach and embrace

the challenges in life and manage the thoughts while understanding that challenges and suffering

are normal and that life’s circumstances will only improve (Cadena, 2008).
 Buddhist- centered therapy focuses to provide a comprehensive approach to mental

healthcare (Cadena, 2008). In the Buddhist religion members are encouraged to seek

encouragement from a Buddhist monk. In order to correlate this method into a therapeutic

approach; those effected by PTSD are asked to seek guidance and advice from their therapist

when they are feeling anxious. Through initiating communication with a guidance counselor,

the feelings of anxiety are often alleviated. The focus of the Buddhist-styled therapy is to not

only encourage through the principles of Buddhism but to encourage initiation of care by self-

motivation (Cadena, 2008). Another important aspect of Buddhist-styled therapy is beginning to

understand the world around you using the universal truths of Buddhism. The components of

this are: the understanding that nothing is lost in the universe, life in constantly changing, and

the belief of cause and effect. The understanding of how these truths relate to suffering will

allow them to understand how the environment is ever evolving. This can help provide hope and

encouragement (Cadena, 2008). The understanding of Buddhist theory can facilitate growth and

help someone work through the struggles of their experiences.

Buddhist Psychotherapy or Mindfulness Meditation Therapy can be defined as the direct

application of mindfulness to an emotional complex to facilitate transformation and resolution

(Strong, 2009). This is another form of a Buddhist approach; however, rather than focusing on

the understanding of Buddhist theory it focuses on inner awareness. Learning to be present

during situations even through times when traumatic images are triggered. Presence is one of the

most important components of sensitive listening as when we are listening to a friend who is

suffering. In this same way, learning to be fully present for our emotional suffering is highly

therapeutic and is perhaps one of the major contributions to the healing process (Strong, 2009).
Another aspect of this is focusing on our emotional suffering that prevents us from being fully

present at a given time. Meditation is a tool used to bring mindfulness and awareness to the

individuals personal suffering. The main purpose of Mindfulness Meditative Therapy is to

separate the flashback of images they experience with the emotions or anxiety that they feel

during these experiences. This allows the person to slowly break down these experiences which

enables them to slowly digest this information which will allow them to work through these

emotions. Someone afflicted by PTSD are flooded with traumatic memories. These memories

may be photographic or may include abstract elements of color, shape and movement in

something resembling a surrealistic collage. The emotional reactions that are formed from these

memories are referred to as the Structural Theory of Emotions.

An intense emotion is likely to be encoded in intense colors such as red

and orange and the imagery is likely to be large and close in the
person’s inner visual field, whereas neutral emotions are likely encoded
in neutral colors such as pale blue or white and appear small and far
away. It is by becoming aware of this internal structure of the imagery
that encodes the emotional energy of the trauma that we can explore the
possibility of changing the imagery and thus changing the emotional
intensity of a traumatic memory. This concept is developed to an art in
the therapeutic modality called Neuro-Linguistic Programming, or
NLP. Just as language is made of words that represent internal
experience, imagery represents the natural language of the mind – the
mind thinks in pictures and uses inner imagery to organize experience
and memory (Strong, 2009).

The Structural Theory of Emotions relates to this approach with the belief that if the

structure of the flashing images can be changed you may be able to heal the emotional reactions

to the images. However, for this to work effectively the imagery must arise experientially from

the emotional felt sense, rather than be created through deliberate visualization (Strong, 2009).

In order for this to be possible one must work through these images and emotions connected to

them on their own through their own inner experience. This healing cannot come from external

sources. There is no attempt to interpret what arises, only to experience fully and know
completely whatever arises (Strong, 2009). This process strives to break down the emotional

aspects of the experiences so eventually they will be able to work through their traumatic

experiences; rather than taking it in all at once and becoming overwhelmed by it.

The second phase of Mindfulness Meditation Therapy is focused on establishing

Mindfulness Based Relationship. This happens when one presents non-reactivity and allows the

imagery into their present awareness rather than disassociation. There are different techniques

in order to come to this result. One technique includes watching the imagery as if projected on a

screen is one technique (Strong, 2009). Once a client begins to experience a state of a

Mindfulness Based Relationship they will be able to recognize the specific content of the various

images they may be visually experiencing. This will bring about the prevention of disassociation

or anxiety when experiencing these images.

The Mindfulness Based Relationship is an essential part of the

transformation process for many reasons, the primary reason being that
it allows the compacted emotional complex to unfold into more
manageable parts. At another level, the MBR allows the client to
fundamentally change the way that he relates to his inner emotional
experience and he begins to break free from seeing himself as a victim
of the emotional trauma. This in itself is an essential requirement for
change (Strong, 2009).

Mindfulness Meditation Theory helps the client work through the effects of their traumatic

experience by exposing them to their fear. They do this in repeatedly and various ways in order

to prevent the client from being over whelmed. This exposure desensitization effect is regarded

by most schools of psychotherapy as an essential part of overcoming PTSD and Mindfulness

Meditation Therapy provides a very subtle and effective way of doing this (Strong, 2009).

The Buddhist theory approach would require the client to be open minded and willing to

look inside themselves to work through the trauma that they have experienced. If a client would
have to be self-motivated for this approach if they were not the clinician would not be able to

engage them. The clinician would give them the tools they would need throughout the process;

however, as in any approach you need a willing client.

A clinician would assess the clients’ progress when they had mastered each step. In the

first approach I discussed the client would be ready to move on when they had recognized and

understood the three universal truths in Buddhism. When they were able to recognize that they

weren’t necessarily victims, according to this theory, however things that happen in life are not

on a personal level rather on a universal one. With Mindfulness Meditation Theory the client

would be able to move on when they possess the ability to sit with the recurrent images and are

present with them. Goal setting within both approaches would be working towards the next steps

in the theory; to master each one. You would end services with the client after they were able to

process the trauma that they experienced and they no longer had anxiety or emotional reaction to

it. You would evaluate this through observation and subjective recollections of how the client

was feeling when they were experiencing the flash backs.

I think that in order to use this approach in practice you would really have to believe in

the theory behind it. Before using this approach you would have to identify what your own

beliefs are regarding it. Many clinicians use pieces of different theories in practice; however, I

think that this is a theory you would have to use fully in order to see results.

The main basis of this theory is for each individual to be self-motivated. In order to help

someone with PTSD process their trauma you would have to remain objective. In every theory

this is important, however, because this theory is so focused on the idea that ‘things happen for a

reason’ it is really important to be aware of counter transference and your own past experiences
not effecting the work that you are doing with these clients. Mostly focusing the energy on their

experiences, understanding of the 3 Buddhist truths and how they fit together in order for them to

be able to work through their experience; and find greater meaning for these experiences in order

to move past them. You would need to keep the client focused and facilitate their understanding

of the basis of these approaches.

Bibliography

Cadena, Christine. (August 27, 2008). Returning War Veterans Benefit from Buddhism- Styled

Therapy. Associated Content: Health and Wellness. Retrieved on October 31, 2009.

http://www.associatedcontent.com/article/988142/returning

_war_veterans_benefit_from.html?cat=72

Duerr, Maria. (May 19 2009). Impossible Choices- Buddhism and Mental Illness. Medical
Ethics. Retrieved on October 31, 2009. http://www.scribd.com/doc/15621451/
Impossible-ChoicesBuddhism-and_mental-Illness

O’Brien, Barbara (2009). What is Buddhism? An Introduction to Buddhism. Retreived on

October 31, 2009. http://buddhism.about.com/od/basicbuddhistteachings/a/
basicshub.htm.

Strong, Peter. (August 26, 2009). Mindfulness Psychotherapy for Post-Traumatic Stress
Disorder (PTSD) in Boulder, Colorado. Retrieved on October 31, 2009.
 http://articlebase.com/stress-management-articles/mindfulness-psychotherapy-for-
posttraumatic-stress-disorder-ptsd-in-boulder-colorado-1161636.html

Other Websites:

A View on Buddhism. (August 24 2007). Retrieved on October 31, 2009.

http://www.viewonbuddhism.org/buddha.html

Instilling Goodness School. Following the Buddha’s Footsteps. Retreived on October 31, 2009.

http://online.sfsu.edu/~rone/Buddhism/Footsteps.htm