There is a TON of information out there about PTSD, or Post Traumatic Stress Disorder.  For simplicity, there are basically two types of PTSD.  Single Episode Onset PTSD happens when you are the victim of, or witness something so horrific or life threatening, that a single exposure is enough to cause debilitating symptoms.  Some people, like cops and soldiers may be exposed to these situations repeatedly, but it only takes one situation to cause the damage.  Gradual Onset Posttraumatic Stress Disorder, on the other hand, happens when someone is exposed to abuse or neglect, or horrific experiences over a long period of time, and they feel trapped, helpless and hopeless.  This type of PTSD is common among people in households where there is substance abuse and/or domestic violence.  Regardless of which type of PTSD it is, people with posttraumatic stress disorder (PTSD) describe a common set of symptoms.Symptoms include:

  • Re-experiences the event through flashbacks, nightmares or memories
  • Increased awareness of the environment (hypervigilence)
  • Avoidance of anything associated with the traumatic event.
  • A sense of numbing or depersonalization
  • Irritability and/or agitation

It is important to note that not everyone exposed to a trauma develops PTSD.  Some factors that make a person more vulnerable to developing PTSD include being the victim or being similar to the victim, a history of substance abuse or mental health issues, significant stress in the prior six months, lack of social support immediately after the trauma, and experiencing the trauma close to a place they felt safe, such as home or work.  Further, young children are at greater risk of developing PTSD if their parents are consumed with trying to cope with the trauma themselves.

When the traumatic experience continues for a long time, it may significantly impact how you see yourself in relation to the world.  This is sometimes referred to as gradual onset PTSD.  Experiences that can lead to Gradual Onset PTSD include:

  • Long-term domestic violence, physical abuse
  • Long-term child neglect or abuse
  • Human trafficking
  • Extended deployments in war zones

The first criteria for the diagnosis of Gradual Onset PTSD, is that you experienced a prolonged period in a situation in which you felt helpless or trapped.  In most cases, there is no single event or episode that can be identified as causing the PTSD, it is the sum of all of the awful events that stripped you of a sense of safety and personal control. But your feelings are real.

Symptoms include changes in:

  • Mood (e.g., persistent depression, explosive anger or inhibited anger)
  • Consciousness or awareness (e.g., forgetting traumatic events, reliving traumatic events or having episodes when you feel detached from your body)
  • Self-perception (e.g., a sense of helplessness, shame, guilt, stigma and a sense of being completely different than other human beings)
  • Relations with others (e.g., isolation, distrust or a repeated search for a rescuer)
  • Your sense of meaning in the world (e.g., a loss of sustaining faith or a sense of hopelessness and despair).

 

Survivors often avoid thinking and talking about trauma-related topics, because it can be overwhelming. Survivors (anywhere from 50 to 90 per cent) may engage in addictive behaviors as a way to avoid and numb feelings and thoughts related to the trauma, and may also engage in self-mutilation and other forms of self-harm.  If you are feeling suicidal or homicidal, that must be addressed first.  Go immediately to your local emergency room or call 911.   The best treatment results are achieved when you are stabilized and both PTSD and the other disorder(s) are treated at the same time rather than one after the other. This is especially true for PTSD and alcohol and other substance use.  Treating PTSD without treating any addictions or other mental health issues often makes those things get much worse.  Likewise, most addictions and mental health issues in people with PTSD are related to the trauma, and cannot be fully eliminated until the PTSD is.

Activity: Things to Do If you Have PTSD

Note:  This activity does really well in a group format too.

Learn about PTSD and how prevalent it is.  You are not alone.

  • I will learn about PTSD by:
    • If asking this in group, rephrase it to ask…”What do you know about PTSD…” and facilitate a guided discussion to make sure clients have correct info.
  • This is important to my recovery because:

Be good to yourself.  Working through a trauma is exhausting.  Now is not the time to offer to make Thanksgiving dinner for your whole family!

  • I can be good to myself by:
  • This is important to my recovery because:

Know your triggers—-Smells, sounds, places and people can all trigger a flashback.  Know what your triggers are so you can be prepared to avoid them when possible, and deal with them when necessary.

  • The following situations could trigger a flashback. For each situation, identify how you can avoid or cope with it.
    • This needs to be handled delicately in a group…if you do this at all.  Avoid detailed discussions of traumas which could traumatize or retraumatize other group members.  What you are looking for here are things like “Seeking rape scenes during a television show,” or “watching docu-dramas about the military” (i.e. Blackhawk Down), or “sounds I hear at night when it is quiet.”  All of these are pretty general.  Another (often safer) approach is just to put up some common sort of generic triggers on the white board and have clients brainstorm ways to deal with them.
  • This is important to my recovery because:

Create a safe zone in your home where you can relax

  • My safe zone is:
  • It is safe because:

The body and mind are amazing.  Most reactions are designed to either protect you, just like the fight or flight reaction, or alert you that something you experienced doesn’t “fit” with how you have always understood things.  For example, when you touch something hot, you remember not to do that again. When you experience a threat, your mind wants to remind you not to do that again.   Likewise, if you believe that your neighborhood is a safe place, and you are a victim of a robbery, your mind needs some help fitting those two ideas together.  It will continue to remind you of the danger until you integrate that experience into your thought patterns and, when necessary, do something to help yourself feel better.  For example, you might start thinking “My neighborhood is safer than most, but no place is immune from crime.  I will add an alarm system to better protect my family.”

PTSD symptoms are “designed” to remind you that the world can be unsafe and it is important to protect yourself from people or situations that make you vulnerable or could hurt you.  Unfortunately, the parts of your brain that are trying to protect you are also some of the most primitive parts, so fears and anxieties may become generalized—For example, someone who is in a very bad traffic accident may experience significant symptoms when they are in the car.  They have nightmares about the accident.  They are always on edge when they are in the car.   They start to see every car trip as if it were the traumatic event.  The easiest way to protect yourself from being in a car wreck is to not get into a car, but that is not practical.

In the following activities you will start to understand how the symptoms you are experiencing are your body’s way of trying to protect you from being in that situation again, and create a plan to help you deal with flashbacks and night terrors.

 My PTSD

Identify the symptoms of PTSD you have and describe how you experience them, how each of these symptoms protect you from re-experiencing the trauma in real-life, and how can you more effectively deal with each symptom.
Re-experiencing the event through flashbacks, nightmares or memories

  • I experience this through:
  • It protects me by:
  • I can deal with it by:

Increased awareness of the environment (hypervigilance)

  • I experience this through:
  • It protects me by:
  • I can deal with it by:

Avoidance of anything associated with the traumatic event.

  • I experience this through:
  • It protects me by:
  • I can deal with it by:

A sense of numbing or depersonalization

  • I experience this through:
  • It protects me by:
  • I can deal with it by:

Mood changes (e.g., persistent sadness, suicidal thoughts, explosive anger )

  • I experience this through:
  • It protects me by:
  • I can deal with it by:

Changes in consciousness, awareness, depersonalization (e.g., forgetting traumatic events, numbing or having episodes in which one feels detached physical body)

  • I experience this through:
  • It protects me by:
  • I can deal with it by:

Self-perception changes (e.g., a sense of helplessness, shame, guilt, stigma and a sense of being completely different than other human beings)

  • I experience this through:
  • It protects me by:
  • I can deal with it by:

Problems in relations with others (e.g., distrust or a repeated search for a rescuer)

  • I experience this through:
  • It protects me by:
  • I can deal with it by:

Altered sense of meaning in the world (e.g., a loss of faith or sense of hopelessness).

  • I experience this through:
  • It protects me by:
  • I can deal with it by:

Remember that each symptom has a function.  To deal with that symptom, you need to find something else that does the same (or similar) thing.  For example, avoidance of reminders is your mind’s way of protecting you from the bad memories/flashbacks.  You cannot always avoid reminders though, so can you protect yourself in a more helpful way?  One of my patients developed PTSD after watching someone die in a traffic crash on the interstate.  It is not practical to avoid interstates forever.  In his case, if he had to get on an interstate and started to feel anxious, he would call his spouse.  They would talk and it would keep him in the present moment, preventing (or at least minimizing) flashbacks.  Over time he and many experiences of safely driving on the interstate, it got to the point that the interstate did not bother him anymore.   The key was to help him counteract the notion that the interstate is unbearably dangerous.  After a while he didn’t even think twice before he got on the interstate.

In the presentation, I review many of the underlying concepts for these activities so you know the direction you want your clients to go with their answers.

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