Healing From Trauma Means Dealing With Disgust

Irene recently came to therapy because her anxiety had been revving up, resulting in sleepless nights, difficulty concentrating, and feelings of isolation. “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.

Further probing revealed that Irene 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 betrayed her unconscious disgust toward her mother.

Named by neuroscientists as one of humankind’s 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.

The first step in accelerated experiential dynamic psychotherapy (AEDP), the emotion-centered trauma therapy I practice, is to help patients feel safe and remind them that they’re in control. For instance, we say, “If I ask something 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.” For example, when Irene sighed or started rubbing her hands together, it was a sign her anxiety was rising. The next step is to lower anxiety before continuing with any disgust processing. “Can you tune into that big sigh? What is it telling us?” I might ask. “Can you notice your hands? If they could speak, what would they say?”

Then, the patient is invited to slow down and notice the emotions that are rising to the surface. “As you slowly scan your body below the neck, what else do you notice?”

Patients may point to their stomachs, aware they’re nauseous or feel like throwing up. Such clues can help people identify and name the disgust driving their physical symptoms. Once the patient names a feeling like nausea, I ask, “Is there an emotion word that goes with that feeling?”

With prompting, patients can often uncover the emotion, arriving at an “aha” moment. “It is disgust!” they might say.

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” 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, I 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 we use in AEDP therapy 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 into the feeling of disgust and notice what is happening now?”

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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 seeing footage of innocent people killed in the Ukraine war.

As a result of this work, Irene’s symptoms abated. She still experienced emotions like we all do because emotions are an innate part of being human, but now she could make healthy use of disgust. She decided to limit her 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, increased self-confidence, and an ongoing curiosity about her emotional world.