Trauma and Post Traumatic Stress Disorder (PTSD)

The aim of this leaflet is to help you to understand the mind’s reaction to trauma. The reactions can be upsetting in themselves and you can find yourself worrying about them. It is often very helpful to understand what is happening and that the reactions are ‘signs of coping’ or ways that your mind and body are trying to deal with the event.

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The nature of trauma

Traumatic events come in various forms but usually it involves an incident that was extremely threatening to self or to loved ones, and it usually involves feelings of fear, helplessness or horror. Often it involves feeling as though your survival or that of someone else was threatened.

People who have been exposed to such things are often haunted by memories of it. This reaction is very understandable given what was experienced. What happened to you would be markedly distressing to almost anyone. It’s really a normal reaction to an abnormal event.

These sorts of experiences are usually totally outside of our experience of life. Nothing has prepared us for it. When things happen that are so outside our experience then it really is natural to feel markedly distressed about it for a while. One could call it an ‘aftershock’. The mind and the feelings need some time to heal and this time varies according to each individual and what they experienced. Sometimes a recent event taps into a previous traumatic situation that happened a long time ago.

The 5 reactions to threat

There are 5 reactions to threat. We often hear more about our survival reactions of fight, flight and freeze. There are actually two more, ‘flop’ and ‘befriend’. When we are trapped and unable to run away, are perhaps overpowered or not capable of fighting, we can ‘flop’ (literally drop down, becoming limp). In other situations like this, we might perceive it is safer for our overall survival to try and ‘be-friend’ the threat or become compliant. This is particularly common in childhood or sexual assault situations. Where we were unable to fight or run, we can be left feeling guilt, embarrassment or shame, as if we failed ourselves in some way. The most important thing to remember is that we did what was necessary for our survival at that time. We often look back on events and reflect, saying to ourselves “I wish I had done this or that”, that is called hindsight bias and is a memory distortion. At the time you did that so you could survive the threat. You only knew the information presented at that time which is often very limited and in a chaotic, frightening situation difficult for your brain to interpret and understand. On reflection (often months or years later) with all the benefit of your frontal lobes which access your rational brain this may seem wrong. At the time it was not.

Being ‘on guard’ or vigilant

As a result of having things trigger off some of these emotional reactions, it is common to become generally “on-guard”. It is as if you are on the look out for something happening again, which makes sense after what you have been through. Think of it like a satellite dish on top of your head. Previously it was a lot lower and only picked up the signals in your immediate vicinity, at the moment though it is a lot higher and the radar is searching for things much further away. It can be overwhelming to the brain trying to process all this extra information.

After experiencing something dangerous it is natural to be on the ‘look out’ and to be extra cautious for a period of time for reasons of self- protection. Usually this eases off over time as the mind appreciates that there is a low likelihood of a repetition and that it is safe to lower the vigilance.

Being anxious or irritable

Naturally, being ‘on-guard’ can trigger anxiety or what is sometimes called the ‘fight or flight’ response. That is the system alarm or anxiety that is found in all mammals. The body gets automatically ‘worked up’ with tense muscles, sweaty palms, rapid heart beat etc. The body automatically feels like it is prepared to “run away to safety” or to “fight something off”. Adrenalin and cortisol are released. This is the wisdom of the body. If wasn’t for these reactions mankind would note have survived all these millions years … it is the survival instinct at work. Unfortunately these reactions of anxiety to reminders can be quite intense and unpleasant as anxiety always is. Also, being in this ‘fight/flight’ state you can be more irritable with more adrenalin pumping and of course sleep would be harder to achieve.

Feeling “switched-off” or “blank”

Another reaction that sometimes happens is a feeling of “switching off” or “going blank”, this again is a self-protection, a natural reaction of the body and mind. It just tries to “switch off” to make the distress go away or to try to build a wall up to keep out any more pain for the time being.

As you feel better you will be able to let the defences down bit by bit. However these reactions of “going blank” or feeling “cut-off” can be puzzling if they are not understood by the person experiencing them, but they are harmless and ease off as anxiety improves.

Memory gaps

Sometimes the memory for the incident is very poor and in little snippets. It can bother people that they cannot remember things perfectly. However this is again natural as these self-protection mechanisms have cut out some of the details. Often as anxiety improves and it becomes easier to think about what happened, the memory of it seems much more ‘joined up’.

Triggers, flashbacks and intrusive thoughts

It is common that things can act as reminders of the traumatic incident and these reminders can trigger some of the feelings and even make you feel “as if” the event was actually happening again – this is called a “flashback”. The triggers could be anything associated with the incident, for example the sound of a car horn, the flash of something in the corner of our eye or a certain smell etc. Because of the distress that triggers, people would naturally try to avoid such triggers or try to control these reactions. Sometimes the trigger is inside your own stream of thoughts as your mind drifted onto a reminder of the incident. The same thing can happen in the flow of our thoughts in sleep and a disturbing sleep and a disturbing dream or nightmare could occur.

As we as situations triggering memories, thoughts about the incident can keep pushing themselves into the mind for no apparent reason. These are called intrusions because the thoughts keep on intruding into the mind when you don’t consciously want them to. With them comes the distress or survival reaction. It can be difficult to understand these intrusions because they are opposite of what you would like to be happening. The intention usually is to try to forget the incident rather than keep on thinking about it. Yet the thoughts come without any intention or choice. This can feel worrying or puzzling because there is a feeling of not controlling what happening in your own mind.

However it’s not as puzzling as one might think. Because the incident was so very out of the ordinary and because life has not equipped you with any previous experience to make sense of all this, the brain does want to try to “make sense” of it. So even though you would like to forget it because it’s upsetting, other parts of the brain would like to go over the incident to try to “figure it all out” and “get used to it”.

In fact this is how we get used to other powerful life events such as bereavement. For some months after a loss we keep thinking of that person even though it makes us upset. Eventually though we get used to it and the loss takes its place in your overall life story. Although the memories are upsetting, the wisdom of your body/mind is trying to bring the memories to you to get you used to what happened. In time that is what tends to happen, and the memories get less intense and less frequent.

Trying to “block it out”

It is natural to try to “forget” the event, but sometimes this backfires. We all have the experience of trying to not think a certain tune but the more we try to get it out of our heads the more it comes back. When it does come against your wishes it can seem all the more frustrating. Even if you successfully block out the thoughts during the waking hours, it is not unusual for the memories to come back in sleep in the form of nightmares. Generally speaking, it is more helpful, when you are ready and in controlled doses, to recollect it, to talk about it or to express the memories in some way. Unfortunately it is not helpful to try to use things like alcohol to block them out. It can be helpful sometimes to write recurrent images, thoughts or parts of the experience down on paper.

Trust

If what you suffered was the result of fault of someone else’s actions, then you might find that you struggle to trust people the same as before. This makes sense in short term as a natural safety measure. By distrusting more, it makes it feel safer as most of risk is taken away by being very cautious. In time though you will probably find yourself able to ease off a little and fine-tune how much you can trust and just what this bad experience has taught you in terms of how you might change your approach to people.

Avoidance

As you try to avoid thinking about what happened and try to avoid any triggers, you might also be avoiding in other ways eg avoiding people or driving or being alone. This in the short term is a natural way of controlling high levels of distress.

It does mean you have some control and over time you can control the pace at which you face some of it, and control the dose of how much distress you are prepared to face at each point.

Shut down emotions

Another experience that you might have is of feeling limited in your usual emotions. Except for anxiety and irritability, you might have noticed that you are not feeling a range of other feelings like interest, happiness, humour, closeness, sex drive. This is a natural process to prevent feelings can gradually come back to you as the distress levels fall.

Self- blame

Self-blame or guilt is quite common. In retrospect there is nearly always something else that could have happened, for example, “if only I hadn’t gone out of the house that day” even though going out is an ordinary thing to do and there is no way that the event could have been predicted. This is an attempt to try to keep a sense of being in total control of fate. It is a process of trying to think that we would have prevented it, so that we can believe we are in total control of our futures. However, it is a high price to pay to self-blame.

Summary

Overall then the feelings and reactions are actually survival and coping strategies. These are useful to you for how long you need them. At the right time when they are no longer needed, the body/mind is ready to begin to give them up. Therapy can also help with this. Most importantly you need to think about yourself and your situation in a kind way, considering how you might respond to a friend who had been through a similar event. Switching off your internal critical voice, and developing a kind, more understanding friend inside your head. Making time for yourself to do what you know helps you rather than punishing yourself with harsh criticism or unrealistic demands.

Rachel Wesley, Psychological Trauma Therapist

Email: wellness-consultancy@outlook.com