Then and Now' Technique

Vulnerability and Safety Contrast.

This cognitive technique seeks to break the generalization of danger that the trauma establishes in the mind of the survivor.

It consists of making an explicit comparison between the circumstances of the "Then" (the moment of the trauma) and those of the "Now" (current life). The patient is asked to identify specific differences.

For example: "Then, I was a dependent child with no physical resources; Now, I am an adult with autonomy and physical strength".

"Then, I was isolated with the aggressor; Now, I have a support network and can ask for help".

By evidencing that the vulnerability variables have changed, the perception of current threat is reduced and the constant alert is deactivated.

Identification of Identity and Perspective Shifts

Trauma changes people, and this exercise explores that transformation in two ways: negative changes (fear, distrust) and potentially positive changes or post-traumatic growth.

The patient is invited to reflect on how his or her view of life has changed.

He may find that, although he has lost a certain innocence or carefree attitude ("I am now more cautious"), he has also gained reflective depth or a greater appreciation of his emotional ties ("I now value my family more").

Recognizing that the traumatic experience may also have forged resilience or a new hierarchy of values helps to integrate the event into the biography in a less destructive way.

Addressing Derived Cognitive Distortions

In analyzing the "Now," cognitive distortions that maintain suffering often emerge, such as overgeneralization ("All men are dangerous" following an assault) or polarized thinking ("I will never be safe again"). The technique involves challenging these absolutist conclusions born of trauma.

The availability heuristic is used to show that, although the patient feels that danger is imminent because the memory is fresh, the actual statistical probability of recurrence may be low.

Work is done to make thinking more flexible: from "The world is bad" to "Something bad happened in the world, but there are also spaces of safety".

Summary

This technique contrasts the circumstances of the trauma with the safety of current life. By evidencing concrete differences in resources and autonomy between the two stages, the chronic alertness is deactivated.

Profound changes in identity and life perspective are analyzed. Recognizing post-traumatic growth or acquired resilience facilitates the integration of the event into personal history in a constructive way.

Absolutist cognitive distortions born of grief, such as the generalization of danger, are addressed. Thinking is made more flexible to accept that, although something terrible happened, there are safe spaces in the present reality.