Therapy for Trauma, PTSD, Anxiety and Depression
Complex trauma or PTSD is a psychological stress injury that results from ongoing or repeated trauma over which the victim has little or no control. A situation where it is perceived that there is no real hope of escape. The victim feels trapped and powerless. Examples can include childhood neglect or abuse, adult relationships where there has been sustained sexual or physical violence, living in a violent neighbourhood where there is a constant fear of coming to harm. Alternatively, complex trauma can result from an isolated incident or freak accident that results in a combination of fear for one’s own life, but also leads significant loss. For instance, in the Grenfell Tower fire disaster survivors faced horrific challenges and consequences. Some lost their complete livelihoods and multiple loved ones, alongside suffering significant psychological trauma from being trapped in a burning building with little hope of survival.
PTSD is considered a normal response to an extremely stressful situation. It can prevent us from being able to think and feel at the same time. It can limit our ability to function as integrated human beings. We become stuck in ‘survival’ mode, ready for fight or flight. Traumatic experiences are often speechless and immobilized. The part of the brain which is responsible for speech shuts down during a traumatic experience and the thinking brain is kicked ‘off-line’. We don’t have time to ‘think’ about what we are going to do in a life or death situation, we rely on automatic survival responses. Which is why often when we recall a traumatic event, there are lapses in our memory. We may suffer from flashbacks or triggers that don’t make sense, or seem out of context. Our brain doesn’t have all of the information it needs to fully process the trauma. And so the traumatic experience may be held in places in the body where it does not know that the trauma is over. This can result in triggers which evoke emotions and visceral feelings that make us feel like the trauma is happening all over again.
Post-traumatic stress disorder symptoms will vary from person to person. They tend to fall in three categories of intense, emotional and physical reactions.
This is the most common symptom of post-traumatic stress disorder. It can be extremely distressing for anyone who goes through it.
Many people who have PTSD will experience the following symptoms connected to the actual events of the trauma:
Being reminded of the event that caused the trauma can trigger feelings of fear and anxiety. As a result of this, PTSD sufferers are more likely to avoid reminders. These include places, people or situations. Avoiding the topic of the traumatic event in conversation is also very common.
Sufferers will try to counteract the painful memories and feelings by feeling nothing at all. This emotional numbing typically has a negative effect on communication with others. Individuals with post-traumatic stress disorder are also likely to:
Other common symptoms:
It is not uncommon for sufferers of PTSD to be overwhelmed with powerful and conflicting emotions. ‘Acceptance’ is the first step in resolving any unwanted emotional state, therefore it can be helpful to understand the positive function in seemingly negative and harmful emotions.
This may involve an effort to prevent injury or maintain boundaries. Anger is a common response to been threatened, hurt, scared or towards the person who caused it. It escalates to rage when our assertions of ‘don’t’ or ‘stop’ are not respected.
Fear alerts us to danger and is stimulated by something in the environment, whereas anxiety alerts to danger but is stimulated within the self.
Fear is the driving force in many psychological disorders such as phobias, panics disorders and OCD.
In PTSD fear persists long after the threat has gone, and its protective function can become handicapped if everything is seen as dangerous and become unable to differentiate between what is truly dangerous and what is not.
Trauma victims with PTSD may repeatedly fall prey to dangerous situations because the internal alarm systems are so overloaded they become disabled.
This emotion not released or expressed in the same way as other emotions (i.e. sadness and grief is expressed through crying, anger may be expressed though shouting or stomping around) and as such it can be difficult to find a discharge outlet.
BUT….shame seems to dissipate under non-judgemental and accepting contact from another human, talking therapies can often help with this.
People often fear grief as a regression into trauma because feeling of sadness may be increased. However, it is usually a sign of progression and trauma survivors may feel more solid and less fearful. Grief usually occurs when an aspect of trauma has been resolved and the internal experience changes i.e. from a feeling being experienced in the present, to an acknowledgement that it is now an element of the past, i.e. I was really scared, I felt bad, I felt so ashamed.
When an event first happens, it is received by a part of your brain (amygdala) that is responsible for emotions, survival instinct and deciding what memories are stored where. This part of your mind also alerts you to danger and stimulates the flight or fight response.
Memories are usually passed from here to your ‘hippocampus’ which converts short term memory to long term memory and encodes our memories with relevant information relating to date, time, location and context. However, if the amygdala is ‘activated’ due to high levels of stress the hippocampus shuts down and the natural process of memory conversion is blocked. This means that traumatic memories may be stored without full context, and this explains why the recollection of traumatic memory is often sketchy, blurred and indistinct. We may not even be sure if the memory is real or not. Memories with incomplete contextual information can also cause triggers that do not relate to a key part of what happened.
Triggers are there to help us, to warn us about what was dangerous in the past. Triggers are vital pieces of information relating to past experiences. The amygdala is the ‘emotional alarm system’ of the brain. It scans incoming data from our environment for threat or danger. This happens outside of conscious thought. If the amygdala senses threat it initiates the body’s flight or flight system. The amygdala is a basic bit of kit, which functions at speed. It acts as a ‘smoke alarm’ and responds to what it perceives to be danger. The more traumatic experiences we have, the more sensitive the amygdala is to assuming the worst – it becomes hypervigilant, like a faulty car alarm that goes off every time the wind blows.
When we are triggered a simple but powerful process happens, the front brain switches off so we can’t think, and the back brain switches on so all we want to do it act. The back brain is responsible for automatic responses and survival. It happens outside of conscious thought and within the blink of an eye. Being triggered by an automatic body-brain response can make us feel helpless.
Helplessness is that feeling of being overwhelmed and powerless to stop what is happening to us. If we have experienced repeated trauma and intense helplessness our brains grow and develop in response to this experience. So without a sense of choice, we develop a learned sense of ‘helplessness’ which can become the ‘default’ state when we are triggered into, or reminded of the original trauma.
If triggers and flashbacks are related to a specific traumatic incident the Rewind Technique may be helpful in enabling your brain to recode the way you store the memory. During REWIND we recall the memory in a state of disassociation and relaxation, which then doesn't alert your emergency warning system. Your memory can be accurately activated in a part of your brain where memories fade and feel less recent (this is what happens with your happy and neutral memories).
Many people with trauma have been treated using approaches which drag them back through the experience again; a highly unpleasant thing to have to do. This doesn't happen with the Rewind Technique when treating traumatic memory and PTSD. In fact, I don't even need to know the details of what happened to you.
During the Rewind Technique, you access the trauma whilst in a safe, relaxed state. I will guide you through a sequence of observing the trauma in a forward 'film' and then in rewind. We will do this several times in a single session. I will talk you through the process and ensure you always stay relaxed. This allows the brain to reprocess and store the traumatic memory as an ordinary, albeit unpleasant, and non-threatening memory rather than one that continually activates a terror response. People often say that after, they are surprised that they don't feel 'bothered' by the trauma anymore. The event is not forgotten, but when recalled, it doesn't pack the same punch. So, it won't be accompanied by those old feelings of anxiety, fear or panic.
Sometimes triggers and flashbacks relate to a history of complex traumas. Avoidance is one way to manage triggers, but it has a huge cost attached to it because it’s difficult to control our environment and the people in it. So, avoidance is a short-term solution at best, but it is no way to live in the long term. To change how we feel and react to triggers we have to do something different. We have to change the way our brain works. Triggers are horrible, they can take us back to where it all started and we feel like the trauma is happening all over again. Afterwards we may beat ourselves up for reacting to the trigger. And so, all the time our brain is learning that triggers are really, really awful. They are something to be afraid of. And so, the cycle continues. The good news is we can change our stance on triggers and notice its ‘just’ a trigger.
“It’s not nice or pleasant, but I can survive it. After all I have been triggered many times.”
Triggers are a faint echo of the original trauma, you survived the real thing so you have done the difficult bit. During trauma-focused therapy I will first and foremost help you to re-establish a sense of safety and learn how to regulate your emotions around triggers. I will help you to learn to think differently about triggers and to soothe yourself when you are triggered. You will learn to talk them down, not talk them up. The brain needs to notice that the trigger is an association, but that is all it is. The trigger is not an indication that the trauma is happening, or about to happen, all over again. We will look at ways to switch the front thinking brain online, this will help you to think rationally and logically, instead of being reactive and fearful. Ultimately, you will be empowered with the understanding, tools and resources you need to live a life that is free of avoidance and maladaptive coping mechanisms. A life where you start to reconnect with healthy ways of living and can realise your future potential.
