Living beyond trauma (Part 2): What is PTSD and how does psychological therapy help?

Recently I shared a blog inspired by the story of Gill Hicks who is a survivor of the London suicide bombings in July 2005, exploring her experiences and what this teaches us about trauma. The world in that moment changed irrevocably for Gill and the others who were on those carriages that day… many things that were safe suddenly became threatening and dangerous.

For example, the sound of ambulance sirens, and loud unexpected noises would be some of the memories stored in the brain. The feelings and the horror of that day are likely to be triggered at unexpected moments when thoughts or similar sounds occur in the present environment. Among other symptoms, nightmares and flashbacks are a common experience for many following a traumatic event, disturbing sleep and resulting in intense anxiety.

In this blog I share more about the key symptoms and behaviour changes associated with Post Traumatic Stress Disorder and consider how a psychologist may assist people who are struggling.

What defines trauma?

Life sadly never allows us to feel comfortable all the time, despite us often desperately trying to achieve this. The reality is that at times in our lives we may encounter situations out of our control that are traumatic that threaten our life, our safety or the safety of others, whether it be physically, emotionally or both. It is normal for us to experience powerful emotional responses to such experiences. The nature of this trauma may vary including a threat to life, actual or serious injury or sexual assault and has the potential to impact others emotionally if experienced directly or by hearing about it or witnessing it. Military combat, terrorism, car accidents, natural disasters, sexual assault are some examples of traumatic events that test our usual coping mechanisms.

Feelings of fear, terror, sadness, anger, anxiety, vulnerability, powerlessness and grief are common after a traumatic event and constitute a very natural response to danger.

When feelings and memories either fade or continue to get in the way of living life

Over time, with support from family and friends, we often start to make sense of what’s happened, making meaning of the event. These intense feelings may gradually fade and we may start to recover and get back into our life, having felt challenged on a daily basis in the early stages after the event. However, sometimes witnessing a distressing event can lead to severe feelings of fear and anguish that stay with you for a long time, affecting your ability to sleep, work, reactivity, engagement in daily activities and our relationships.

Furthermore, if you are one of those people who has experienced multiple traumatic events, these feelings may be more intense and harder to shift given the repeated threats to your sense of safety. When this happens, it is possible that you may have developed the symptoms of Post Traumatic Stress Disorder and may benefit from some help to understand and manage these symptoms.

Are you suffering in silence or reaching out?

The psychological impact of trauma is not seen by many, it is more often a silent suffering, making it hard for survivors to really get across what it feels like to live with Post Traumatic Stress Disorder. This experience is incredibly distressing for people, often having a significant impact on relationships as unusual reactions occur sometimes and partners or friends struggle to understand what is changing.

Do you dislike feeling helpless and feel more comfortable when you are in control?

For many people who have been traumatized or trapped, similar situations or any situation where they feel powerless or out of control are likely to produce intense anxiety and other emotions as their brain takes them back to that moment and their body mirrors a similar response. For those people who have been traumatized and experienced feelings of helplessness, something as simple as standing in a supermarket cue or being in the middle of a row in the cinema or on taking a plane flight are examples of triggers for people who may find control important as a means of establishing safety.

Do you avoid situations that trigger or talking about the event?

Experiencing thoughts of the traumatic experience or discussing details of what happened are sometimes enough to set the body into the same physical and emotional response. What this means is that that many people do their best to stop thinking about their experiences or discussing it in the hope that it will stay in that box with the lid on tight never to open.

Unfortunately the impact of trauma on how the brain functions doesn’t usually allow this strategy to work forever. Many people may function at a reasonably high level for years before circumstances force the lid off that box and they come to therapy as their coping mechanisms finally break down.

How do you know if you have PTSD?

PTSD has four groups of symptoms outlined below.

1. Re-experiencing the trauma

Symptoms may include:
* distressing and ‘intrusive’ thoughts and memories
* nightmares
* flashbacks of the trauma
* severe reactions to things that remind you of the traumatic event
* reliving the event which then leads to symptoms such as a racing heartbeat, difficulty breathing, nausea etc

2. Avoiding reminders of the event that may trigger intense feelings, memories and physical sensations

Reminders may include:
* people
* places
* objects
* conversations

3. Negative changes in thoughts and mood after the trauma

Symptoms may include:
* not being able to remember part of the traumatic event
* heightened sense of danger
* blaming yourself or others for the event or its aftermath
* feeling very down or numb
* feeling strong guilt, horror or anger
* being unable to enjoy things you used to find pleasurable
* feeling detached or ‘cut off’ from people, dissociated,

4. Feeling ‘on edge’ and overly aroused
Symptoms may include:

* irritability
* violent /angry outbursts
* reckless behaviour
* getting startled easily, feeling ‘jumpy’
* overly alert to danger (hypervigilance)
* finding it hard to sleep
* finding it hard to concentrate.

It’s important to get help

If these symptoms sound familiar and your life is being affected significantly then seeking help from a practitioner experienced in working with trauma would be a step towards a more meaningful life.

As a psychologist, being a witness to my clients’ stories and an important support is an incredible privilege. Again and again, I have learned that one of the most powerful gifts to give someone learning to live with the impact of trauma is to be truly heard and to model the skill to sit with and manage discomfort that we teach in sessions, with an attitude of deep compassion, empathy and respect. I do my best to help people understand and make sense of their experiences, find hope in the midst of despair and intense anxiety and over time help improve their quality of life again.

For many I am the first and only person they have communicated with about this impact and the relationship is fundamental in establishing a safe space to share feelings of such intensity and memories they have done everything to block out and stay away from.

The issue of trust

For those who have experienced early childhood trauma, trusting others may have always been hard as they may have learned that their caregiver let them down, never validated feelings or responded to distress consistently, nor gave them a sense of security. The therapeutic relationship provides a space to build trust and learn that it is possible to be vulnerable and to rely on someone for support, providing the opportunity to learn how to do this in other relationships and also how to self soothe. This provides the opportunity to open up and learn that it is safe to do so given shutting down emotionally and disconnecting and dissociating from emotion or physical pain has often been a survival pattern for a very long time.

How do you cope?

When my clients first come to therapy, some of them have had multiple traumas and over the years they have developed their own coping mechanisms to assist them in coping with all of this. Some of these have been very adaptive and functional early in life or soon after the trauma to survive and some more problematic if used consistently over many years.

Creativity, dissociation, writing, blocking of thoughts and memories, distraction, avoidance of situations that may trigger, isolating from others, avoiding relationships and intimacy, working long hours, drug and alcohol use and comfort eating are all common ways of coping I hear about.

Some of these mechanisms seek to express feelings when words are not enough, others seek to block it all out in the hope it will all go away. In my experience the control mechanisms that aim to block feelings, thoughts and memories eventually breakdown and at some point the mind says it is now time to deal with it when the emotions are hard to contain. This is when I find most people come to therapy, when nothing seems to be working anymore to contain the distress or impact on their life.

Our job as psychologists is to be able to assess how these coping mechanisms are functioning in your life and to find new ones that will allow for this trauma to be processed more effectively.

How may a psychologist help get your life back following trauma?

* Provide you with a safe space to explore the impact of the trauma
* Educate you on the symptoms of trauma and help you understand why your brain has responded in certain ways both at the time of the trauma and in other situations
* Learn strategies to manage intrusive thoughts and intense feelings of distress such as sadness, anxiety, hopelessness, anger
* Process the impact of the trauma on beliefs about sense of safety, self and the future and help facilitate a shift in beliefs that may be getting in the way of living a richer more meaningful life
* Building a plan for keeping safe emotionally and physically
* Repeated exposure to memories of the event with support from the psychologist to shift level of fear to events and help modify beliefs
* Becoming aware how the body may be affected by trauma and working at a somatic level to shift effects of trauma that present physically
* Develop a greater sense of safety within the therapeutic relationship that allows for trust to develop and for other relationships to improve or to break avoidance of closeness, intimacy and seeking support within other relationships
* Building core mindfulness skills to anchor to the present when triggered by memories and to manage all the intense feelings that may come and go with trauma
* Addressing nightmares and sleep disturbance through re-scripting nightmares to dreams that modify the parts of the content that is most disturbing
* Breaking down shame and guilt that often comes from trauma through speaking about events and processing things differently
* Processing grief regarding aspects of self that were compromised and finding ways of rebuilding a life beyond trauma that is meaningful.
* Working out how to identify values and set goals about increasing actions towards your values, while accepting that some situations may trigger at times.
* Dealing with other issues that often occur concurrently such as depression and relationship/family/friend/work issues.
* Finding meaning in the event(s) and some learning out of the experience that helps facilitate post traumatic growth

If you or a friend is suffering from Post Traumatic Stress Disorder symptoms and needs help, many of the psychologists at Attuned Psychology are experienced in dealing with trauma and will work with you to develop tools to manage trauma and live a more meaningful life again.

Alexandra Frost