Irene recently came to therapy because her anxiety had been revving up, resulting in sleepless nights, difficulty concentrating, and isolating. “I can’t tolerate all of the meanness in the world,” she said. For years, she had been markedly distressed by the political climate, and the recent war in Ukraine has made that worse.
Further probing revealed that Irene (not her real name) had survived a personal war. Growing up, she had been emotionally abused by her mother. “She called me stupid and told me how worthless I was,” Irene disclosed. As she confessed her secret, an out-of-place smile appeared on her face, but not before a fleeting expression showed her true emotion. Her wrinkled-up nose and protruded lower lip—the facial expression emotion researchers refer to as the “gape face”—betrayed her unconscious disgust toward her mother.
As trauma psychotherapists, we know that helping patients process painful emotions is crucial for recovery. However, research shows that disgust is often overlooked in therapy, to the detriment of the patient. Disgust is important to understand for trauma treatment, especially in the face of current events like the pandemic, political unrest, the rise in hate crimes against people of color, and war.
Named by neuroscientists as one of humans’ first evolving emotions, disgust is a natural response to poisonous stimuli like rotten foods, infectious diseases, and unsafe environments. In this way, disgust helps us ward off illness and danger. However, what many people don’t realize is that this emotion also arises when we’re violated, oppressed, and abused—all forms of trauma that can lead to anxiety, depression, and PTSD.
For trauma survivors, disgust exerts a force to be experienced (named, felt, listened to, and released). But when people come in for therapy, they don’t disclose their disgust by name. They can’t, because it’s buried by defenses to block it from conscious awareness. All that the survivors feel are symptoms like anxiety, depression, and low self-confidence.
Had Irene’s father or another close family member validated her anxiety by acknowledging her mother was wrong and had behaved in abusive ways, Irene may have felt seen. But victim blaming and “minimizing” can cause survivors like Irene to criticize and shame themselves, leading them to internalize disgust. Unlike discarding spoiled food, disgust-induced trauma cannot be escaped, and the unspeakable sense of disgust often shows up in the body. Like Irene, many patients exhibit the “gape face.” Others disclose distressing compulsions like repeated hand-washing or showering. Still others just show up with anxiety and depression.
In some cases, patients will project their disgust toward others onto their therapists with statements like “You’re probably so grossed out by what I’m saying,” or “I don’t want to say anything else, because I don’t want to traumatize you.” These words are clues that they perceive disgust coming from their therapist, rather than within themselves. Behaviors like these are emotional armor, which works to protect us from overwhelming emotions.
To help patients like Irene, we use a trauma therapy called accelerated experiential dynamic psychotherapy (known as AEDP). Developed in 2000 by psychologist Diana Fosha, this newer model of psychotherapy combines affective neuroscience, trauma theory, attachment theory, and rapid transformation theories. This type of emotion-focused therapy gets to the root problem, using the catalytic power of “core emotions” like disgust, sadness, anger, and joy to turbocharge brain change, also known as neuroplasticity. This stands in stark contrast with medicating symptoms of mood disorders or using behavioral tools to change thinking and behaviors.
Working with painful emotions can feel like being asked to touch a burning flame, which is why the first step in trauma therapy is to help patients feel safe and remind them that they’re in control. For instance, we say, “If there is something I ask that doesn’t feel right, will you let me know?”
To maintain safety, AEDP therapists watch for when anxiety is rising outside the patient’s “window of tolerance.” We track the patient’s physical movements, because as author and trauma psychotherapist Babette Rothschild says, “the body remembers.”
For instance, when patients like Irene sigh or wring their hands, we know anxiety is rising—and we need to bring it back down before continuing with any disgust processing. We might ask: “Can you tune in to that big sigh? What is it telling us? Can you notice your hands? If they could speak, what would they say?”
Trauma therapists listen with our eyes as well as our ears to seize glimmers of emotions and notice the defenses that patients are unaware of. When delivered with compassion and curiosity and without judgment, this type of emotional attunement fosters deep trust and confidence.
When patients like Irene share a painful memory, they may unknowingly laugh or talk very quickly. This is understandable; defenses like laughter helped us survive. Ultimately, though, processing the underlying core emotions can help people relinquish maladaptive—albeit protective—coping mechanisms.
To do so, we draw attention to patients’ nonverbal communication by gently pointing out the discrepancy between laughter and the upsetting memory. Then we invite them to slow down and notice the emotions that are rising to the surface. “As you slowly scan your body below the neck, what do you notice?” we ask.
Patients may point to their stomachs, aware that they’re nauseous or feel like throwing up. Such clues can help patients identify and name the disgust that’s driving their physical symptoms. Once the patient names a feeling like nausea, we ask, “Is there an emotion word that goes with that feeling?”
If the patient struggles to name the emotion, we thread together the clues they’ve provided by referencing how their bodies do the talking. We might say, “When you spoke about your mother, your nose wrinkled up like you were smelling something bad. It was a look of disgust on your face.” With prompting, patients can often uncover the emotion, arriving at an “aha” moment. “It is disgust!” they might say.
Not even all therapists receive a formal education in how emotions work in the mind and body, much less your average patient—so it’s unsurprising many patients believe that feeling sad, angry, or disgusted means they’re weak in some way or hurting the person responsible for their trauma, whom they may also love. However, the process of naming and describing emotions and sensations, which scientists call “affect labeling,” calms the nervous system, research has found. In one study, participants were shown various photos of people expressing negative emotions, and researchers used brain imaging to examine the impact of participants naming these emotions. The result? Labeling helped temper immediate emotional reactivity. Emotions researchers have also found that putting words to feelings fosters long-term benefits. For instance, people who completed 16 sessions of AEDP therapy had fewer symptoms—such as depression—and more positive emotions—such as self-compassion—and these effects held steady 12 months after treatment ended.
As trauma therapists, we recognize Irene’s downcast head as emerging shame, and we normalize simultaneously experiencing many emotions that may be opposite in nature, like disgust and love. Each emotion needs to be listened to, honored, and processed separately. We tell our patients: “Feelings just are! They do not mean you’re a bad person. It’s so natural to feel disgust in response to the traumas you’ve been through.” Often, we ask, “Do you think you can move aside self-judgment so we can honor these important emotions?” When patients like Irene nod “Yes,” we know it’s a green light to continue with emotion processing.
When possible, we help patients connect the feelings in their bodies to the object of disgust. We invite them to be open to any associations coming from the body, such as images, memories, and impulses.
When Irene said she felt nauseous, she was encouraged to breathe deeply, name the emotion, and stay with the sensations to notice the impulse—the adaptive action tendency that the emotion evokes. In this moment, Irene was able to connect her feeling of disgust with the abuse she suffered from her mother, and she recognized the impulse to push her mom away.
To help clients further process this emotion, we might ask, “If disgust could take shape and do what it wants to your mother in a fantasy (not a dress rehearsal for reality), what would it do?” This question sets in motion a “fantasy portrayal”—a technique that helps patients release core emotions like disgust by accessing the impulse and enacting the emotion’s “adaptive action.”
In this case, Irene saw herself shoving her mother hard and telling her how hurt she was by her insults and threats.
Supportively, we invite the client to imagine (in their fantasy) how the hurtful person responds to their words. With a wince, Irene said her mother looked shocked.
As her facial expression changed, Irene was asked to notice what shifted. “Can you check back in to the feeling of disgust and notice what is happening now?”
Irene shared that her nausea had disappeared. She also spoke of the sadness she noticed for her mother, as well as for herself. “Mourning for the self,” a form of grief over what was lost because of the traumas inflicted, is a key part of trauma healing.
Having felt and processed disgust from past abuses, Irene could more easily name and recognize this emotion. For example, she went on to be able to recognize that it was disgust she felt when she saw footage of innocent people killed in the Ukraine war.
As a result, her symptoms abated. She still experienced the emotions, but now she could make healthy use of disgust. She decided to limit exposure to violent news images, channel her disgust about racism into anti-racist work, and set firmer limits for how she would be treated by family members. With newfound awareness of disgust, Irene’s anxiety was replaced with greater vitality, an increase in self-confidence, and an ongoing curiosity about her emotional world.