Therapy for Trauma, PTSD, Anxiety and Depression
If you have ever endured a significant trauma, you may be suffering from nightmares, flashbacks and panic attacks, as your mind and body struggle tirelessly to process the memory. In an ideal world, once the traumatic event has ended we return back to a normal state. But for many people, this doesn’t happen. This article takes a look at how the brain responds to trauma, and why it may feel as if at times it is still happening, even if it was several years ago.
Most of what happens in the brain during a traumatic or life-threatening event is an unconscious, automatic survival response. It happens instinctively and without conscious consent.
Blood flow to the front ‘thinking’ brain is reduced to avoid any ‘paralysis of analysis’. Unconscious, instinctive responses are key to survival. These come from the emotional back brain.
Chemicals (noradrenaline and cortisol) are released to help the back survival brain focus and react quickly. These chemicals prepare us for mobilisation – Fight or Flight. When neither of these is an option the freeze response may result.
Note: The feeling of helplessness during ‘freeze’ results in unresolved stress responses remaining in the body long after the incident has passed. This is discussed in more detail below.
The body ‘remembers’ feelings that relate to traumatic incidents. It creates ‘somatic markers’ linking feelings to events (which may be the trigger for flashbacks in the future). The result of this is that you may feel as though at times the trauma is still happening, even if it was several years ago.
Triggers are there to help us, to warn us about what was dangerous in the past. The more traumatic experiences we have had, the more sensitive the amygdala (the brain’s emotional alarm system) becomes to assuming the worst. It becomes hypervigilant, like a faulty smoke alarm that can’t tell the difference between burning toast and a burning house.
During times of trauma, our back brain takes over, as discussed above. When we are triggered the same thing happens, the front brain switches off so we can’t think, and the survival brain switches on so all we want to do is act.
Avoidance is a short-term solution to managing triggers. Avoidance re-enforces fear. However, everyday life contains triggers, and these can become so frequent, unpredictable, and unbearable that a life of avoidance becomes inevitable. Avoidance is life-limiting. It impacts our ability to reach our full potential and to stay connected with healthy ways of living.
To change how we feel and react to stimulus that acts as a trigger we have to ‘do something different’. We have to change the way our brain works. Every time we react to a trigger, and then beat ourselves up for it afterwards, we are training our brain that triggers are something to be feared. And so, the cycle continues. We avoid the trigger, and the brain never learns that the trigger isn’t dangerous at all. It doesn’t learn that the trigger is just an association with the past, and not a reality of the current situation or environment.
Acknowledge what is happening, what you are thinking and feeling. Triggers are not nice or pleasant, but they are a faint echo of the original trauma. You survived the real trauma, so you can survive the trigger.
Find a way to switch the thinking brain online. When we are triggered, the survival brain isn’t really needed, it’s a false alarm and we have to find a way to manage that. The thinking brain is responsible for logical and rational thinking. Switching the thinking brain online will help us to notice that the trigger is an association with the past, but nothing more.
Sensory awareness exercise
A suggested technique for 5,4,3,2,1
This simple 5,4,3,2,1 exercise helps to focus your attention on the senses and bring you back to the ‘here’ and ‘now’. In turn, this helps you to realise the ‘reality’ of the current situation and that you are not in danger. Sensory awareness exercises reduce emotional intensity because they require a high degree of focus on each sense individually. This distracts from what our ‘imagination’ is telling us , and helps us to acknowledge what’s really going on in our immediate environment
Look for 5 things you can see – the object furthest away from you, the object nearest to you, the object you are most drawn to, the object you can’t quite work out – be creative, don’t go for the obvious, the idea is to get your senses working hard to enable a fully functioning thinking brain.
Find 4 things you can touch – Notice the texture, is it a calming and soothing feel or irritating and uncomfortable. Pets are a great object here – if you have a dog / cat notice how different the ear fur is to the back fur, the tummy hair compared to the leg hair. Plants and other objects of nature are also great examples as they often have lots of different textures.
Listen for 3 sounds – we are hearing ‘noise’ constantly, but unless we are having a conversation, we rarely stop to consider what we can hear, or differentiate between sounds. Notice what you can hear, from the very subtle to the really obvious.
Identify 2 things you can smell – again smell is an intricate sense, but we often don’t take the time to identify the various scents that make up our environment. You might seek out smells you really like, such as a favourite perfume or food.
And finally, reward yourself with something you can taste – whether that be your favourite drink, a boiled sweet you can take your time with or indulging in a sweet or savoury snack of your choice. Eating and drinking is not associated with the survival response. It tells your body that all is well, there is no danger and normal activity can resume.
You can change the order of the above to suit your environment, to make the exercise more challenging or easier. Make a note of this exercise somewhere easily accessible so that you can refer to it as soon as you have those visceral feelings that ‘something is not right’. Catch the sensations before they escalate.
After the exercise, notice how you feel, any reduction to traumatic symptoms is positive. Practise the exercise at times when you are not triggered, so that you become familiar with the process, and it is easier to implement when really needed.
The facts-based information centre - Do low level mental activities such as puzzles and quizzes. Employment and volunteering in roles that aren’t too complex and don’t have relational conflict or risks can be stabilising factors for the front left thinking brain engagement.
Relationships – human attachments switch on the front right thinking brain. This could be bonds with a partner or close friend, or the effects of an established therapeutic relationship. Seek out companionship and conversation with those you have a positive connections with.
Noticing – the front middle brain is associated with self-awareness, thoughts, emotions and sensations. It is the part of the brain that allows self-reflection – How am I feeling? What is going on for me right now?
Trauma survivors often struggle to ‘stand back and observe’ what is happening in the moment and may become quickly overwhelmed by automatic body responses. Put your experience into words, without judging or beating yourself up.
A part of the brain that shuts down during trauma is the speech centre (Broca’s area). Voicing your experience (or writing it down) switches this part of the brain back online. It allows you to rationalise that this is ‘just a feeling, thought or emotion’ it will pass and is not something that defines you. Feelings and sensations are temporary states – they come and go.
By developing grounding activities and repeating them consistently we develop new ways of thinking. It allows the brain to establish new, healthy pattern matches with our current environment and differentiate between past trauma and the ‘here and now’.
Gradually the hypervigilance will dissipate, and our over sensitive ‘emotional alarm system’ will slowly but surely start to regulate itself.
When we are no longer ‘stimulated’ by our triggers, we can work on helping our brain to recode the way the memory is stored – so it goes into a part of brain where memories fade and feel less recent. You will never forget the event happened, but recollection will be voluntary and wont pack the same punch.
To explore more about how you can be supported to overcome traumatic memory and PTSD please don’t hesitate to get in touch by email: calmthechaoscounselling@gmail.com or telephone: 07392 766305. I aim to respond to all enquiries within 24 hours.
