PTSD Guide. Lise Leblanc

with trauma, such as fear. Although not always conscious or intentional, there is good reason for this protective shield. It’s what allows us to function during times of crisis. When we experience thoughts and sensations that make us anxious or uncomfortable, we will try to withdraw by whatever means available. If these avoidance behaviours cause a lessening of anxiety, we are being rewarded through a process known as negative reinforcement (the removal of something we don’t like). Over time, these “rewards” cause us to become more and more avoidant of anything that causes anxiety, fear, or other difficult emotions. At first, avoidance behaviours can provide temporary relief, but they also cause long-term problems by increasing fears, worsening symptom severity, and interfering with healing, as well as creating new problems such as addiction, debt, or relationship problems. It is instinctual to try to escape from pain or to fight against it, but trying to avoid your dark thoughts and painful emotions actually makes them worse. Trying to ignore and push it all down causes it to grow. Now, this doesn’t mean we should discard all of our avoidance behaviours, but we should at least start alternating between avoiding and slowly allowing ourselves to face what it is we need to deal with.

       PRACTICAL EXERCISE — IDENTIFY AND VALIDATE

      Think about some of the ways you avoid the thoughts, emotions, situations, and reminders of your trauma. Make a list of everything you uncover and then validate your reasons for using avoidance to cope with what you’re going through. No matter how many problems these avoidance behaviours may be causing now, there was a time when they allowed you to temporarily escape pain, gain pleasure, or simply get through a painful moment. Acknowledge that you had good reasons for avoiding, but also recognize that alcohol, isolation, or whatever other strategies you are using are only prolonging and worsening your agony. Since you already know fighting your thoughts and emotions doesn’t work, try to slowly start acknowledging them. This will give you more psychological flexibility and allow you to stay connected to the present moment, despite unpleasant thoughts or emotions. So, the next time you notice a distressing thought or emotion, set a timer for three minutes and objectively observe it, the same way you would watch a movie on television. Try to remain objective, nonjudgmental, and unattached to your thoughts and emotions and see if you can let them pass through you without getting attached, fighting, fuelling, or avoiding them. Don’t try to figure out why they are there, where they came from, or how to get rid of them. Just let them be.

       REFLECTIVE QUESTIONS

      • What avoidance behaviours do you use to get through challenging moments? Make a list.

      • How are these avoidance behaviour strategies working for you in those moments? How are they working long-term?

      • What are you afraid might happen if you slowly start facing your trauma instead of avoiding it?

       NEGATIVE ALTERATIONS IN COGNITION AND MOOD

      The mental and emotional effects of PTSD can seem endless, like a bottomless pit. You may feel completely defeated and find yourself questioning whether life is still worth living, even though there are people in your life that you love dearly. You may start to lose hope and think you are cursed to a life of not being able to work or contribute to your relationships or to society. You may ask yourself things like:

      • Am I always going to be like this?

      • Will I always have to take medication?

      • Am I ever going to be successful again?

      • Will I ever feel happy or be at peace?

      • Will I be able to live a productive life or have fulfilling relationships?

      • What is the purpose of life? Why am I here?

      PTSD alters your worldview in negative, distrusting, and pessimistic ways. It can also negatively affect your views and beliefs about yourself. You may go from blaming others to blaming yourself for the trauma or for other things. You may feel mostly distressing moods — irritability, anger, fear, sadness, guilt — and have difficulty accessing positive emotional states. You may feel unlovable, insecure, unworthy, and unsafe, and this may come out in disturbing ways. The ways trauma can affect us emotionally can include:

      • Anger, irritability, cynicism, rage, control

      • Sadness, depression, isolation, loneliness, hopelessness, and despair

      • Anxiety, fear, and doubt

      • Guilt, shame, worthlessness

      • Dissociation, detachment, derealization, shock, numbness, indifference

      Example Statements (emotional):

      • I feel overwhelmed by every little thing. Something really small can feel like the end of the world to me.

      • I wake up in the middle of the night with panic attacks and can’t get back in bed for hours.

      • I feel nothing; it’s like I’m just a zombie going through the motions.

      • I’m always acting like an asshole and getting mad for every little thing.

      • I cry and cry. I just break down, my body just shakes, and I can’t pull myself together.

      • I’m afraid of everything, things that never even used to cross my mind.

      • I’m irritable and angry, lashing out at my kids for no real reason. Sometimes I scream at them or even hit them. I feel ashamed and know I need help.

      • I can’t get out of bed, I have no motivation, I feel down. Just getting through the day is exhausting.

      • I’m always on edge, worried about what’s coming next. I always have the feeling that something bad is about to happen.

      Trauma can affect our cognitive abilities in several ways, including:

      • Diminished ability to think or concentrate/low attention span

      • Difficulty processing and organizing information

      • Forgetting/memory issues

      • Difficulty making decisions or making rash decisions

      • Thoughts of death and/or suicide

      • Ruminating and dwelling on things (related or unrelated to trauma)

      • Inability to suppress unwanted thoughts and memories

      • Inability to remember certain aspects of the trauma

      Example Statements (cognitive):

      • I can only remember about thirty seconds of the crisis, but that thirty seconds is imprinted on my brain and plays repeatedly like a jumbled slideshow of graphic, violent images.

      • I’m in a brain fog. I can’t concentrate long enough to watch a movie or read a book.

      • Things that used to be easy for me are impossible now because I forget everything and have zero attention span.

      • I’m forgetting the simplest things and making stupid mistakes.

      • Sometimes I get lost. Literally. I can be driving, and suddenly I don’t know where I am or where I’m going.

      • I’m hard to live with because I’m always thinking the worst about people and expecting worst-case scenarios.

      • There are times when I can’t make any decisions; it’s like I’m paralyzed. Other times I’m impulsive and spend money I don’t have, even though I used to be very decisive and rational about my finances.

      • People might say I’m paranoid, but the world is a dangerous place; they just don’t know it yet because nothing really bad has happened to them.

      • Sometimes it’s like my brain just shuts down, and I can’t think straight. I can be in the middle of a conversation, and I stop mid-sentence and don’t know what I was talking about.

      You may not relate to all of these examples, and your personal experiences