PTSD Guide: How to Heal Emotional and Psychological Trauma?
Trauma is part of many people’s lives at some point.
Millions of people around the world are affected by PTSD.
Worldwide pandemics, terrorist attacks, natural disasters, wars, motor-vehicle accidents, bullying, workplace harassment, relationship and child abuse (mental, emotional, physical, and sexual), and other events anyone would consider traumatic and extremely stressful, might cause PTSD (Post-Traumatic Stress Disorder)
You might not even understand why you’re unable to “get over it”, and assume that you’re exaggerating or being “overly sensitive.”
The truth is, PTSD causes real, measurable changes to areas of the brain responsible for mediating stress, emotion, memory, and other cognitive and physiological functions.
But these changes aren’t permanent and you can recover from PTSD.
In this article you’re going to understand PTSD and how you can recover from it.
Ready? Let’s get started!
- What Is PTSD?
- Who Can Develop PTSD?
- Practical Exercise 1 — Name Your Trauma
- PTSD Symptoms
- Practical Exercise 2 — Identify Your Symptoms
- How to Support Your Healing?
- Practical Exercise 3 — Get More Support
- Normal Stress Response
- Practical Exercise 4 — Change Your Physiology
- Exercises For Regulating Intense Emotions
- Evidence-Based Psychotherapies
What Is PTSD?
In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), used by mental health professional, Post-Traumatic Stress Disorder (PTSD) is classified as a stress- and trauma-related disorder.
PTSD develops in response to a traumatic event that breaks down the stress management system and the nervous system – the central nervous system and the peripheral nervous system.
PTSD can create adverse long-term changes in emotion, thinking, and behavior as a direct result of exposure to trauma.
The symptoms of PTSD are persistent and can affect several, or all, areas of life — mentally, emotionally, physically, socially, and professionally.
Observable effects include:
- Exaggerated stress response
- Impaired ability to distinguish between safe and unsafe stimuli
- Difficulty regulating emotions (such as anxiety and anger)
- Periods of dissociation (the experience of feeling detached and dissociated from your surroundings or from oneself, as if you were an outside observer)
- Difficulty with concentration and memory
- Increased physical ailments (Actual physical pain, digestive issues, fatigue and loss of energy, heart palpitations, frequent illnesses/infections, headaches.)
Who Can Develop PTSD?
PTSD was first connected to war trauma, but soon it was discovered that it’s not just soldiers or veterans who can have PTSD.
Other professions who are much more likely to experience repeated exposure to trauma, are at high risk of developing PTSD such as firefighters, paramedics, police officers, doctors, nurses, and other health professionals.
But PTSD can also develop in anyone who is directly or indirectly exposed to major trauma.
A disease like COVID-19 with mass worldwide infection compounded by things like social isolation, uncertainty, fear of transmission, lack of treatment and resources, and immediate threat to life, would be considered a “sudden, catastrophic event,” that can cause PTSD, especially for healthcare professionals, and family members at a high risk of developing PTSD.
Practical Exercise 1 — Name Your Trauma
Reflect back on the traumatic experience(s) that triggered the development of PTSD.
If you are still unable to pinpoint the traumatic event, take the event that haunts you the most.
Take your journal and write everything you recall about this event. It’s fine if you can’t remember certain aspects of your trauma. Don’t fill in any of the blanks in your memory.
People who have told their traumatic story many times find themselves able to talk about it from a detached emotional state.
But if you haven’t faced your trauma before, you might experience discomfort and overwhelming emotions, so take it slow and work on mastering relaxation exercises before starting.
If it gets too overwhelming, take a break.
After the sock of a traumatic event wear off, most people return to a state of psychological and physiological balance and their nervous system starts to settle down until it returns to its normal prestress state.
However, people who develop PTSD remain in a state of psychological shock – their nervous system remains in a reactive survival state.
PTSD symptoms can vary from one person to another, but in order for these symptoms to meet the diagnostic criteria for PTSD:
- Symptoms must be present for at least one month.
- Symptoms aren’t caused by medication, substance use, or other illnesses.
- Symptoms must be severe enough to create impairment in the person’s ability to function in several areas of their lives.
- At least six months has passed since the trauma.
According to the DSM-5, PTSD symptoms fall into four symptom clusters:
1. Intrusion symptoms – such as unwanted and involuntary thoughts, flashbacks, memories, and nightmares causing emotional distress and/or physical reactivity.
2. Avoidance – which involves avoiding trauma-related thoughts, feelings, and external triggers (e.g., people, places, things, or situations that act as reminders of the trauma).
3. Negative alterations in cognition and mood – such as negative thoughts and assumptions about oneself, others, and the world in general, and persistent negative moods.
4. Arousal – manifesting in a state of hypervigilance (always being “on guard”) and heightened startle reaction (very jumpy).
In addition to these symptoms, an individual must also experience either a state of derealization (the experience of feeling detached and dissociated from your surroundings) or depersonalization (the experience of feeling detached and dissociated from oneself, as if you were an outside observer).
Practical Exercise 2 — Identify Your Symptoms
You might have been suppressing and avoiding your symptoms of PTSD like avoiding triggers and numbing your anxiety.
Become more mindful of these symptoms you’re experiencing and write them down in journal.
To identify your symptoms ask yourself which of the symptoms listed above can you relate to most? And of these symptoms, which are most distressing to you?
How to Support Your Healing?
Support and practicing healthy lifestyle habits can help you heal faster and enjoy a better quality of life, such as:
- Early treatment: the sooner you receive treatment, the better the outcome
- Availability of emotional support immediately after the trauma (a sense of belonging to a community, support groups, etc.)
- Avoiding alcohol
- Healthy habits (like good sleep, regular exercise, balanced diet, and other self-care activities)
Practical Exercise 3 — Get More Support
Identify available factors that can support your healing and help you feel normal and less alone.
Make a plan and start practicing these activities.
Find a support group in your community. Avoid support groups that focus on the details of trauma and instead find one that focuses on healing and recovery.
Normal Stress Response
The stress response, often referred to as the fight-flight-freeze response, is a state of arousal that puts the body in a peak state to increase our chances of survival when faced with potentially dangerous situations.
This state activates the adrenal glands to release stress hormones such as cortisol, adrenaline, and norepinephrine.
These hormones increase your heart rate, blood pressure, and your rate of breathing, and slow down nonurgent processes like digestion and metabolism to provide your survival systems with as much energy as possible to deal with whatever threat is present or perceived.
When working properly, the stress response is critical to our survival. It also makes us faster, more alert, and improves our performance in critical moments.
However, our stress response responds in much the same way to imaginary threats as it does to real ones – your body doesn’t know the difference.
Reexperiencing the traumatic event in your mind through memories, flashbacks, and nightmares can activate this stress response.
Practical Exercise 4 — Change Your Physiology
When the stress response is unnecessarily activated by a perceived danger, calm yourself down using the following techniques:
1. Mammalian Dive Reflex
The diving reflex is the body’s physiological response to submersion in cold water. It causes immediate decrease in heart rate and metabolism, which helps you calm down faster.
* Submerge your face in cool water (below 21 degrees Celsius or 70 degrees Fahrenheit) for thirty seconds.
* Making sure your forehead, temples, and ears are under water.
Consult your doctor before doing this exercise if you have a medical condition
2. Deep Breathing
Take gigantic deep breaths, followed by a short period of not breathing.
* After exhaling, simply stop breathing for as long as it feels comfortable.
* Repeat until you feel calmer
3. Other Techniques to Calm Yourself Down
* Do five minutes of intense physical activity, like push-ups, jumping jacks, etc. while at the same time saying out loud, “I am completely safe,” over and over again.
* Do a Sudoku puzzle or solve a few math problems to activate the rational part of your brain and to deactivate the emotional part.
Exercises For Regulating Intense Emotions
The purpose of the following exercises is to help you connect with and develop a deeper relationship with yourself—a relationship based on an awareness of your senses and physical being.
Try out one exercise at a time rather than attempting to do them all at once, and give yourself a couple of weeks before you decide how you feel about them.
#1. Breath Work Exercise
Breath work helps you manage stress of all levels and varieties and bring you back to the present moment.
1. Try doing this exercise lying down on the ground and notice how that provides a sensation of being grounded to the earth.
2. Place one hand on your stomach and the other on your heart.
3. Inhale deeply through your nose as you silently count to three.
4. Exhale through your mouth as you silently count to six.
5. Repeat this six more times, and then see if you can work up to a four-count inhale, followed by an eight-count exhale, and then five-count inhale, followed by a ten-count exhale.
Once you’re done, notice how you feel calmer and more present.
#2. Orienting Exercise
This exercise will help you practice using your five senses in order to more accurately sense whether or not you need to use your survival instincts of fight, flight, or freeze.
By creating awareness of your environment, you help yourself build a sense of safety and thus find yourself able to relax.
1. Begin by taking note of how you feel, both physically and emotionally.
2. Notice the entrances and exits and pay attention to what’s around, such as objects, colors, and shapes.
3. Now notice what it feels like to be supported by the chair or floor.
4. Connect with your other senses. Notice smells, sounds, the taste in your mouth.
Once you’re done notice how you feel both physically and emotionally. Did this exercise help you feel safer?
#3. Survival Energy Exercise
After the traumatic event, you might feel as though you weren’t in charge of or able to defend yourself from danger in the past.
The following exercise will help you access these feelings of helplessness, and help you release them and restore equilibrium.
The exercise is ideally performed with a trusted person. If that is not possible, you can perform the first part of this exercise on your own, pushing against a wall.
1. Have your trusted person brace themselves against a wall as you push against their hands for 10 to 60 seconds.
2. Once you’re done, close your eyes and notice how you feel physically and emotionally.
3. Repeat pushing and noticing your feelings in two or three more times.
4. For the second part of this exercise, trade places and let the other person push you against the wall.
5. Notice your sensations and feelings.
#4. Resourcing Exercise
The goal here is build a list of internal and external resources you have at your disposal, such as people, place, activities, or things that make you feel safe.
An example of an internal resource could be your ability to connect with people, or maintain a good attitude when time things get tough, etc.
1. To create this list, start paying attention to moments when you feel strong and safe, or think back to a time in your life when you felt this way.
2. Keep this list at your disposal by writing it on your phone or in a journal and continue adding to it.
Creating this list helps you go directly to these resources every time you need them.
#5. Self-Soothing Exercise
The goal of this exercise is to help you calm the nervous system and create boundaries and safety in the body.
Physical and emotional boundaries go hand and hand. They help us protect ourselves and define what is acceptable.
Set a timer for three or five minutes and notice how you feel at the end of that time period.
1. Put on some soothing music and allow yourself to connect with the sound.
2. Wrap your arms around yourself and hold your body. Notice what it feels like.
3. Place one hand on your heart and the other hand on your stomach.
4. Close your eyes and feel your breath rise and fall as you breathe deeply.
5. Release all judgment and simply sit with the sensations.
#6. Free-Flow Dance Exercise
This exercise will help you sense your body in time and space and change the stories you may be telling yourself about your body after experiencing inflexibility and rigidity in response to trauma.
1. Give yourself the space and permission to experience spontaneous body movements.
2. Put on whatever music that will inspire you to move with freedom.
3. For three minutes, experience free-flowing movement. Observe how you feel both emotionally and physically.
4. Eventually, work your way up to five and then ten minutes.
Practicing these exercises is like building a muscle.
At first, the changes might be subtle. But over time, you will build muscle memory and discover strength that you never thought you had before.
There is no one-size-fits-all approach to treating PTSD.
There are a variety of treatment options available that include medication and/or psychotherapy, mainly Cognitive Behaviour Therapy (CBT) and Eye Movement Desensitization Reprocessing (EMDR).
1. Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is a treatment developed by Francine Shapiro in the 1980s that helps the client bring forth a traumatic memory, as well as the bodily sensations and thoughts associated with this memory.
To help him do this, the therapist simultaneously moves their finger slowly from side to side in front of the client’s face while they track the therapist’s finger movements with their eyes as they recall and talk about disturbing aspects of their trauma.
This bilateral stimulation (tracking finger from side to side) helps reactivate the amygdala to its original trauma state (recalling traumatic details to process them) while reducing activity in the prefrontal cortex (keeping it distracted with the task of tracking finger movements so I won’t block the disturbing thoughts and emotions that are being recalled).
The processing of traumatic thoughts and emotions is the key to healing from trauma.
Throughout the session, the therapist asks the client to rate their level of distress and the process is repeated until the physiological and emotional reactions of the client subside.
The therapist will also assist the client in replacing any negative thoughts surrounding the trauma with more realistic ones that will support the client’s healing.
2. Cognitive Behaviour Therapy (CBT)
Cognitive Behaviour Therapy is the most widely recommended treatment for PTSD.
CBT is a very structured approach that the therapist uses to raise the client’s awareness of the thoughts, emotions, and behaviors underlying their current problems.
The therapist will help the client challenge cognitive distortions and alter any unproductive, harmful, or automatic thought patterns.
CTB emphasizes homework and practicing the exercises provided.
There are different forms of CBT.
Cognitive Processing Therapy CPT and Prolonged Exposure Therapy are the two forms of CBT most often used in the treatment of PTSD.
Cognitive Processing Therapy
In cognitive processing therapy the therapist will ask the client to write about their traumatic experiences in detail and then read it out loud.
He then helps the client identify and monitor their thoughts and emotions and help them evaluate the validity of their thinking, in an effort to disrupt the automatic thought patterns that are causing distressing emotional states and problematic behaviors.
Prolonged Exposure Therapy
The idea here is that the “avoidance” of trauma (and trauma triggers) is causing the problem to persist.
This is why, the client is asked, with the support of the therapist, to slowly and systematically confront the disturbing thoughts, emotions, and situations they’ve been avoiding.
They will be asked to access a traumatic memory during each session, whether verbally, in writing, or by imagining it in as much detail as possible, starting with less distressing thoughts and memories.
The client learns through “exposure” that they can handle their distressing thoughts and emotions without becoming overwhelmed.
Once the person becomes comfortable enough facing his distressing thoughts, they will be asked to expose themselves to these distressing things in more real settings, including the setting where the traumatic experience occurred.
It is important to understand that exposure therapy is a slow process that helps you safely start reinterpreting the painful thoughts and emotions associated with your trauma.
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- Portions of this article were adapted from the book Moving Beyond Trauma, © 2020 by Ilene Smith. All rights reserved.
- Portions of this article were adapted from the book PTSD Guide, © 2020 by Lise Leblanc. All rights reserved.