Clarity’s signature twenty-day DBT complex trauma programme

Trauma treatment in Chiang Mai, Thailand

What is trauma?


TraumaThe word may make us think of exposure to death and injury during warfare, survivors of natural disasters, or victims of horrific accidents or even torture. However, the word trauma can also be used to describe the experience of being abused or neglected as a child by a parent or other caregiver.  It includes the experience of being bullied or abandoned, and it can even describe the impact of being betrayed as an adult by your partner or even your employer.

A more useful definition of trauma is any experiences or situations that are emotionally painful and distressing, and that overwhelm people’s ability to cope. Our own conclusion is that an event is traumatic if it is extremely upsetting and at least temporarily overwhelms the individual’s internal resources. We utilize this broader definition of Trauma, since people who experience major threats to psychological integrity can suffer as much as those traumatized by physical injury or life threat and can respond well to our Trauma Treatment Programme.

Trauma can occur within relationships with others and is referred to as Relational Trauma. While we provide treatment for those who have experienced trauma from combat or other life-threatening events, we are also focused on the traumas that result from being wounded in relationships. Trauma that is experienced during childhood can have a deep and enduring effect on many aspects of people’s adult lives. These types of Relational Traumas may affect us deeply and can negatively impact the way that we learn to relate to ourselves and to others. Relational Trauma can significantly contribute to addiction and ongoing destructive relational patterns.

What is post traumatic stress disorder (PTSD)?

Post-Traumatic Stress Disorder [PTSD] is a specific type of anxiety disorder that can result from experiencing trauma. The trauma can be an event that is life-threatening such as war, a car crash, a natural disaster, or an assault of some type. Or it can be an event that threatens the person’s sense of physical, sexual, or psychological wholeness such as sexual abuse, infidelity, physical abuse and includes childhood and adult relational trauma. Not everyone who experiences these types of traumas develops PTSD.

Symptoms of PTSD

  • When someone is experiencing PTSD, they will often find themselves reliving the event in some way through having flashbacks, intrusive memories, dreams, or random smells or sounds that they react to.
  • They attempt to avoid memories of the event through numbing themselves and have a feeling of being disinterested in life, often remembering only fragments of the event itself, whilst distancing themselves from others and generally shutting down. This can often look like depression but may actually be PTSD.
  • They may experience hyper-vigilance (a state of heightened alertness to threats) or become stuck in a high state of emotional arousal where it is difficult to sleep. A sufferer often feels anxious or like their internal engine is ‘revving’ all the time. This hyper-arousal often leads to irritability, angry outbursts, sleeping problems, difficulty concentrating and feeling like they must always be aware and on guard.
  • Whilst not all clients may meet formal clinical criteria for PTSD, elements of what are currently defined as the characteristics of PTSD are recognizable in a large number of people suffering addiction.           
  • PTSD that is undiagnosed and untreated can leave individuals more susceptible to addictions, mood disorders such as depression, and difficulties with their relationships.

What is EMDR?

EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences. EMDR is based on physiological as well as psychological principles. EMDR incorporates eye movements [and other forms of bilateral stimulation] into a range of standardized psychological procedures, in a structured and systemic manner, stimulating the neural pathways that help the brain to put information “in context”.

Dr Francine Shapiro, a clinical psychologist, originated EMDR Therapy after discovering the effects of eye movements on memory in 1987. In Shapiro’s model, psychopathology (mental and emotional disorders) are viewed as heavily related to memory. Unprocessed memories (such as traumatic ones which overwhelm the individual) can result in problems with cognition [thinking], emotion [feeling] and behaviour [acting]. The disruption of healthy information processing in the brain by traumatic events causes the memory of the event to be  held in a state specific form as stable episodic memory associated with high levels of autonomic arousal – which basically means that memory of the event remains the same as when it happened causing the person to experience very disturbing feelings over and over again.


How EMDR works

Eye movements (or other forms of bilateral stimulation) are used during one part of each session. After the clinician has determined which memory to target first, he or she asks the client to hold different aspects of that event or thought in mind and to use his or her eyes to track the therapist’s hand as it moves back and forth across the client’s field of vision.  As this happens, biological mechanisms involved in Rapid Eye Movement (as found in REM sleep state) cause internal associations with the memory to arise and the client begins to process the memory and related disturbing feelings.

EMDR involves attention to three time periods:  the past, present, and future.  Focus is given to past disturbing memories and related events, current situations that cause distress, and to developing the skills and attitudes needed for positive future actions.  With EMDR therapy, these items are addressed using an eight-phase treatment approach.

Identify possible targets for EMDR processing.  These include distressing memories and current situations that cause emotional distress.  Other targets may include related incidents in the past.  Initial EMDR processing may be directed to childhood events rather than to adult onset stressors. The length of treatment depends upon the number of traumas and the age of onset.  Generally, those with single event adult onset trauma can be successfully treated in less than five sessions.  Multiple trauma victims may require a longer treatment time.

During the second phase of treatment, the therapist ensures that the client has several different ways of handling emotional distress.  The therapist may teach the client a variety of imagery and stress reduction techniques the client can use during and between sessions. A goal of EMDR is to produce rapid and effective change while the client maintains equilibrium during and between sessions.

In phases three to six, a target is identified and processed using EMDR procedures.  These involve the client identifying three things:

  •  The vivid visual image related to the memory
  •  A negative belief about self
  • Related emotions and body sensations.

In addition, the client identifies a positive belief. The therapist helps the client rate the positive belief as well as the intensity of the negative emotions

In phase seven, closure, the therapist asks the client to keep a log during the week.  The log should document any related material that may arise.  It serves to remind the client of the self-calming activities that were mastered in phase two.

Phase eight consists of examining the progress made thus far.  The EMDR treatment processes all related historical events, current incidents that elicit distress, and future events that will require different responses.

The following organizations have recommended EMDR for the treatment of PTSD and Trauma and Stress Related Disorders:

  •  2004    American Psychiatric Association
  • 2004    US Departments of Veteran Affairs and Defense
  • 2005    UK National Institute of Clinical Excellence [NICE]
  • 2007    Australian National Health and Medical Research Council
  • 2012    Australian Psychological Society
  • 2013    World Health Organization [WHO]

In its recent recognition and recommendation of EMDR, The World Health Organization said:

“Trauma-focused CBT and EMDR Therapy are recommended for children, adolescents and adults with PTSD. Like CBT with a trauma focus, EMDR therapy aims to reduce subjective distress and strengthen adaptive cognitions related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve [a] detailed descriptions of the event [b] direct challenging of beliefs [c] extended exposure, or [d] homework.”

Co-treating addiction and trauma disorders at Clarity

“Over half of individuals seeking treatment for their addiction meet criteria for current PTSD [Post Traumatic Stress Disorder] and it is recognized that historically, those individuals with co-occurring PTSD and Addiction issues tend to have poorer outcomes compared with those without such co-morbidity.” [Berenz & Coffey, Current Psychiatry Reports Journal; 2012: 14]

In order to provide the best possible programme here at Clarity, we offer an integrated treatment model, co-treating addiction and trauma disorders including PTSD. The model incorporates Dialectical Behaviour Therapy, Mindfulness/Yoga, trauma focused Cognitive Behavioural Therapy [CBT], Trauma Release Exercise (TRE) and Eye Movement Desensitization and Reprocessing [EMDR].

The therapeutic programme is implemented by Trauma trained Psychotherapists and led by our Consultant Psychologist Lee Hawker. The high levels of care and support and the beautiful and peaceful setting at Clarity ensures that people seeking treatment for their trauma disorder find a safe place to recover and heal.

For optimal co-treatment of your Addiction and Trauma issues, we recommend a minimum of 60 days in treatment which includes sufficient EMDR sessions to result in significant clinical improvement in your symptoms.

As we have already discussed for an individual to be diagnosed with PTSD, he or she must:
  • Have experienced an event in which the life, physical safety, or physical integrity of the patient or another person was threatened or actually damaged
  • the patient must have experienced intense fear, helplessness, or horror in response;
  • continue to re-experience the traumatic event after it is over (e.g., flashbacks, nightmares, intrusive thoughts, and emotional and physiological distress in the face of reminders of the event);
  • seek to avoid reminders of the event (e.g., avoidance of thoughts, feelings, and conversations about the event;
  • avoidance of people, places, and activities that are associated with the event;
  • difficulty recalling aspects of, or the totality of the event;
  • diminished interest in formerly pleasurable activities;
  • feelings of detachment;
  • and a sense of a foreshortened future);
  • exhibit signs of persistent arousal (e.g., difficulty with sleep, increased irritability, concentration problems, scanning of environment for danger, and heightened startle responses).

But what about those people who have been subjected to repeated traumas? These individuals frequently describe a lifetime of experiences and time spent in invalidating and excessively stressful environments. At Clarity our highly qualified trauma team know that these individuals have histories of interpersonal victimization, multiple traumatic events, and/or traumatic exposure lasting for extended duration.

These individuals are more likely to be described as having been exposed to a more complex form of trauma. This form of traumatic experience is more common than many people would think. The common name for this prolonged exposure to stressful and significantly adverse life events is complex trauma. Psychiatrists and psychologists use the diagnostic term DESNOS which is an abbreviation of disorder of extreme stress not otherwise specified. This simply means a collection of traumatic events rather than one single defined event.

When you speak to one of Clarity’s psychologists at the assessment stage they will ask a series of questions to help define the level of traumatic experience you have been through. The reason for this is that awareness of the characteristic backgrounds of individuals who meet criteria for DESNOS will aid in effective case conceptualization and treatment planning.

Often individuals who present for treatment for complex trauma have histories of a large variety of traumatic events, spanning years and even decades. Such individuals may not have had discrete single traumatic experiences so much as ongoing, chronic exposure to untenable and seriously adverse environments. An example of a typical DESNOS history would be a woman who reports that she was never held as a child and was sexually abused throughout her childhood by her alcoholic father, who also physically assaulted her mother in her presence. Even when sober, her father frequently called her names and insulted her intelligence, attractiveness, and capabilities. As an adolescent, she may have witnessed the serious injury of several friends during a drunk-driving accident. As an adult, this woman may have been raped and had a series of emotionally and physically abusive partners. This type of history of chronic traumatization is not uncommon in many patients who go on to self-medicate with substances or alcohol or for whom anxiety and depression become a significant factor in their lives.

It has been noted in numerous studies that there is a high rate of “comorbidity” between PTSD and other disorders. In the National Comorbidity Study, Kessler and his colleagues found that approximately 84% of the patients they sampled had another disorder at some point in life. Individuals with PTSD were found to be eight times more likely to have had three or more additional disorders than individuals who were not diagnosed with PTSD. The disorders most consistently found to co-occur with PTSD are:

  • Major depression
  • Other anxiety disorders
  • Substance abuse
  • Personality problems

Impact of adverse childhood experiences and childhood trauma on dysfunctional behaviours

Experiences in early childhood can have a long-lasting and profound impact on peoples’ lives. However, this doesn’t mean that these experiences have to be defining.


With years of experience in addictions, trauma and co-dependency treatment, our highly trained psychologists manage the twenty-day Complex Trauma Programme at Clarity Thailand Our team at Clarity has introduced a new twenty-day Complex Trauma Programme to help patients to understand how their early childhood issues have potentially fueled various addictions, mental health issues, eating disorders, and relationship issues in their adult lives.


A recent study into the link between childhood trauma and adult psychosis in the UK found that approximately 60% of respondents reported that they had experienced childhood trauma (Reeder, et al, 2017). As such, Clarity believe it is so important that we help patients to explore what can often be ‘root-causes’ of adult dysfunctional behaviour, as part of our DBT trauma programme.


The goal of our twenty-day DBT Complex Trauma Programme is to help people to ‘break-free’ from their dysfunctional behaviours that have been deep-rooted from a young age.


Another study into the effects of childhood and stress on health across the lifespan, has shown that, at an appropriate level, stress can help children to develop the skills that they need to effectively cope and adapt throughout life. However, during these early stages of development, it is important that children receive support from their parents or caregivers so that they learn how to respond to stress in a healthy manner. Without this support, prolonged periods of stress during childhood can impact a person’s nervous and immune systems, and can lead to alcoholism, depression, eating disorders, heart disease, and other chronic diseases (Middlebrooks and Audage, 2008).


Unfortunately, many people that Clarity treat have already lived through and seen some of these impacts first-hand, and so at Clarity our role is to help them to live a more positive and fulfilling life by helping them to identify, deal with, and resolve these childhood traumas.

Underpinning Clarity’s signature twenty-day DBT complex trauma programme

The twenty-day Complex Trauma Programme, which is unique to Clarity Thailand, is based on Pia Melody’s Post Induction Therapy (PIT), a method that is widely used in the USA. The PIT approach utilizes an eclectic mix of therapy and treatment models. Clarity’s signature 20-day trauma programme designed by our Consultant Psychologist Lee Hawker goes beyond what other treatment programmes offer by bringing together elements of:
  • Psychoanalysis
  • Psychodynamic Therapy
  • Gestalt Therapy (Gestalt helps people to focus on their immediate thoughts, feelings and behaviours and to better understand the way they relate to others
  • Family systems therapy
  • Transactional analysis therapy
  • Rational emotive therapy
  • Trauma Release Exercise
  • Eye Movement Desensitization and Reprocessing Therapy

By using educational and experiential processes, we Clarity are able to help patients to identify and address their childhood trauma and family-of-origin issues. Once we have identified these issues, Clarity’s psychologists work with patients to explore ways to deal with the emotions that accompany their past traumatic events and deliver effective emotional regulation and distress tolerance training as part of their DBT programme to resolve the resulting grief and distress.

The programme model also examines the five core symptoms of co-dependent patterns:
  • Self-esteem
  • Boundaries
  • Reality
  • Intimacy
  • Moderation/containment

Toxic shame

At Clarity we know that family and social norms experienced in childhood that are deemed as being ‘less than nurturing’, can lead to feelings of shame. Children carry this shame with them, from their initial core-relationship with their parents or carers, to other subsequent relationships with themselves and with others. The shame effectively acts as a ‘relationship pollutant’ and is extremely toxic.

In Clarity’s Signature Twenty-Day DBT Complex Trauma Programme, our highly trained psychologists act as an advocate to help patients to acknowledge their reality and start to release some of their repressed shame. This is done through our re-parenting process, which includes teaching effective boundaries, self-esteem and moderation.

Preventing relapse

Clarity’s Signature Twenty-Day DBT Complex Trauma Programme can have a significant effect on reducing depression, and crucially, helps to prevent relapse.

We require patients to complete the full twenty treatment days for the Signature DBT Complex Trauma Programme Complex Trauma Programme. Where a co-occurring substance use issue exists treatment must be delivered to address this issue first. This is to help prevent relapse and promote long-term change.

The aim is for patients to complete the DBT Complex Trauma Programme with an understanding of the unhealthy coping behaviours (such as addiction) and damage that they have inherited from their childhood trauma and to learn how to create healthy relationships with others and to have a better understanding of themselves.

Who is Clarity’s Signature Twenty-Day DBT Complex Trauma Programme aimed at?

Clarity’s Signature Twenty-Day DBT Complex Trauma Programme is designed to help anyone who has experienced developmental or complex trauma and who may also be affected with addiction, co-dependency or attachment disorder. Treatment is not limited to patients affected by addiction.

How does Clarity’s signature twenty-day DBT complex trauma programme work?

Clarity’s Signature Twenty-Day DBT Complex Trauma Programme includes:

Psychologist only treatment delivery

At Clarity we understand the ethical responsibility and accountability for the delivery of your care is paramount. For that reason, Clarity’s Signature Twenty-Day DBT Complex Trauma Programme is only ever delivered by a Consultant Psychologist with specialisms in forensic and clinical psychology. At Clarity we know how vulnerable and precious mental health is. For this reason, your Signature Twenty-Day DBT Complex Trauma Programme will only be delivered highly skilled accredited professionals.

Clarity’s Signature Twenty-Day DBT Complex Trauma Programme includes free aftercare groups which are offered to graduates on a weekly basis, for 90 days post treatment.

If you or someone you care for have been affected by developmental trauma, attachment disorder and addiction then call now to speak to one of our health care professionals.


Why choose Clarity

Clarity offers an incredible healing experience for our clients and their families that is second to none. Our team is comprised of individuals with years of experience who are all here for one reason. To help you realise, achieve, and maintain permanent long term recovery.