Mental Health, PTSD

Post-traumatic stress disorder (PTSD): How to Heal Your Trauma?

Traumatic events are everywhere.

It is estimated that 70% of adults in the United States have experienced a traumatic event at least once in their lives and up to 20 percent of these people go on to develop post-traumatic stress disorder, or PTSD.

While some trauma victims will say they came out stronger, others remain stuck in a cycle of negative emotion.

This makes recovery from trauma a major health issue.

Today, you’re going to learn how you can recover from your PTSD and live a fulfilling life.

Ready? Let’s begin!

What Is Post-traumatic stress disorder PTSD?

Post-traumatic stress disorder, or PTSD, happens when the trauma victim gets stuck in a cycle of a negative state of fear, shame, anger, and hiding.

People suffer from PTSD because of a variety of reasons, including, Childhood Sexual Abuse, rape, military and wartime experiences, domestic abuse, natural disasters, motor vehicle accidents, and exposure to violent situations such as being held at gunpoint and school, church, or workplace shootings.

If you have untreated PTSD, you may feel like the world isn’t the safe place you used to think it is. Your life becomes overcast with anxiety, anger or resentment over everything.

A lot of your energy is expended to avoid the horrors in your head.

Fortunately, modern psychology treatments are highly effective to help trauma victim, but they need to first come out of hiding and seek help.

PTSD Symptoms and Triggers

1. PTSD Symptoms

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There are at least four classes of PTSD symptoms that help the victim avoid or escape the pain caused by trauma:

1. Reliving the event.

This is called a flashback. The memories of the traumatic event can return at any time and the victim can feel the same fear as when the event took place.

The flashback can be triggered by a sound or a sight such as hearing a loud noise, seeing a car accident, or even seeing the news.

2. Avoiding situations that remind the victim of the event.

To avoid the pain, victims try to avoid situations or people that trigger memories of the traumatic event. They might even avoid thinking or talking about it.

That includes avoiding watching TV news or certain movies or places associated with the traumatic event, or even getting help so as not to talk about or think about the event.

They might also distract themselves with work or being busy.

3. Feeling numb.

Victims might forget parts of traumatic event or stay away from interactions and activities to avoid any triggers.

4. Feeling keyed up:

Because of their sensitivity to danger, people with PTSD are constantly on-guard and alert for danger.

This makes them prone to get easily startled. They might find it difficult to concentrate and have trouble sleeping.

5. Other possible symptoms:

  • Health problems with no easily identified causes;
  • Feelings of shame and hopelessness;
  • Difficulty to control emotions and behavior;
  • Communication and relationship problems with family, friends, co-workers or even strangers;
  • Impulsive or destructive behavior, such as substance abuse;
  • A change in beliefs and/or personality traits.

The distress and impairment caused by PTSD can affect every area of a person’s life – marriage, family life, social life, student or professional life.

These symptoms show up at a variety of rates and usually occur within a month following the trauma.

For some these symptoms may not appear until several months or years. This is especially true for those who think they are strong and self-sufficient or who see these symptoms as a sign of weakness, such as the military.

In any case, ignoring the symptoms for too long can cause a setback to one’s life especially when they’re ignored through self-destructive behavior such as substance abuse or relationships avoidance.

This is why it’s best to be “hypervigilant” about the course of PTSD when one has been through trauma.

2. PTSD Symptom Triggers

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Your triggers are anything that activates a PTSD symptom. These could be external or internal.

Usually triggers are directly associated with your traumatic event. For example, if you were in a sever car accident, you might experience intrusive memories of the accident brought on by being on the highway where the accident took place, or simply by being in a car going at a high speed, or hearing loud noises, etc.

Because of the unpleasant memories these triggers bring, people usually try to avoid them. While this might bring relief in the short term, in the long term, as this avoidance continues, things that aren’t directly connected with the traumatic event, become triggers as well.

For example, simply being in a car, even if it’s not moving, or seeing a picture of a highway, can bring PTSD symptoms.

PTSD symptoms can be brought on by internal triggers.

For example, if your heart was racing during your traumatic event, any time you feel your heart racing might being up thought or feelings associated with your trauma.

Other internal triggers may include pain in a certain part of the body, muscle tension, feeling lonely, vulnerable, out of control, etc.

The healthiest way to deal with these triggers is to learn how to manage them instead of avoiding them.

3. Coping with Triggers

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Since it’s hard to avoid triggers and avoidance makes things worse in the long term, it’s important to learn coping strategies that help you limit the impact of a trigger on your PTSD symptoms.

The following strategies can help you manage your triggers.

1. Mindfulness

Mindfulness of your external environment is one of the best strategies to cope with triggers. It involves approaching the present moment nonjudgmentally, without evaluating the experience in any way.

In other words, you expand your awareness to everything happening around you and prevent your thoughts from focusing just on the trigger or symptoms.

Exercise: Mindfulness of Your External Environment

* Stop for a moment and scan your environment.

* Notice your surroundings and describe what you see, hear, smell, and feel on the surface of your body, such as a tree, the chirping of bird, the sun on your face, your clothes against your body, etc.

* Do your best to describe in details every object in your awareness.

* If you notice that your attention becomes focused on your PTSD trigger or symptoms, that’s okay. Acknowledge that your attention went back to the trigger or symptom and then gently bring your attention back to your external environment.

You can use this technique whenever a trigger catches your attention. “Stop, Take a breath, Observe what’s going on around you, and Proceed”

2. Grounding

Mindfulness is a form of grounding that keeps you in the present moment. But there are more specialized grounding exercises that connect you with the present moment quickly and completely, especially when a trigger brings about flashbacks or dissociation.

The following are some examples of grounding exercises, but you can come up with your own, the more options you have available, the better:

Exercise: Grounding

  • Smell something with a strong odor
  • Grab ahold of the armrest of your chair
  • Bite into a lemon
  • Take a cold shower or splash cold water on your face
  • Hold onto an ice cube
  • touch something rough
  • Breathe deeply
  • Visualize the face or the voice of someone you love

3. Distraction

Distraction aims to pull your attention away from a trigger. This is especially helpful for internal triggers such as intense thoughts, emotions, or bodily sensations.

The distraction activity or activities you’re going to choose need to be interesting or stimulating for you.

Keep in mind that distraction is designed to be temporary and a healthy activity. You don’t want to use distraction as a form of avoidance because this will only make the trigger stronger.

The following are some examples of distraction exercises, but you can come up with your own, the more options you have available, the better:

Exercise: Using Distraction to Manage Triggers

  • Do puzzles or crosswords
  • Play a game on your phone
  • Do some form of physical exercise
  • Talk to a friend about something unrelated to your trigger
  • Read an engaging book or magazine article
  • Do crafts
  • Look at picture of places you have been or would like to visit
  • Play with your pet
  • Drink a cup of soothing tea

The Problem With Avoidance

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People experience unending list of unpleasant events, such as hunger, thirst, cold, overheating, aches and pains, having an angry parent, being bored, experiencing teasing or rejection from peers, failing at attempted tasks, experiencing loss of any kind, etc.

Every action that results in reducing or eliminating any of these unpleasant experiences is quickly learned and maintained as a “go-to” response.

However, some unpleasant experiences are so strong, as in the case with PTSD, that avoidance is not an option.

Most of the time what PTSD victims do to cope with the mess in their heads and life is not working. Their avoidance behavior, although gives them momentarily relief, is in fact keeping them stuck.

In fact, avoiding or reducing the unpleasant feelings they experience after a trauma can take most, if not all, the victim’s energy and resources.

As a result, the trauma victim experiences reduced functioning, weariness, depression, and even suicide.

Avoidance, over time, can also spread to other areas of your life. For example, if you have been assaulted, naturally you’ll be afraid of the man who assaulted you, but over time, you might also begin to fear all men, or all men with similar characteristics. This is what we call generalization.

Intellectually you know that not all people are the same and that other situations are not dangerous. Nevertheless, you feel afraid. They have become connected to the danger you experienced during the traumatic event.

In other words, the more you avoid, the more you confirm the idea that whatever you’re afraid of is a danger and should be avoided.

What do you think you need to do to overcome your fear?

You need to do the opposite of what you might feel like doing. That way, your brain will learn through experience that the particular situation is safe.

Healing From Trauma: How Is PTSD Treated?

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PTSD can have a significant negative impact on your life. Luckily, psychological treatments for PTSD have been developed, and the majority of people have reported recovery using these treatments.

There are two gold-standard psychological treatments for PTSD: “Prolonged exposure” and “cognitive processing therapy CPT”.

#1. Prolonged Exposure

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Prolonged exposure is done by having you come into contact with thoughts, situations, objects, and places associated with your traumatic event. The goal here is to help you process the emotions connected to the trauma.

The exposure can take two forms: “imaginal exposure”, or, “in vivo exposure”.

Imaginal exposure involves imagining the details of the traumatic events. This includes describing what you experience with your five senses as well as the thoughts you had and the emotions you felt at that time.

In vivo exposure involves coming into contact with the actual people, objects, places, or situations associated with the traumatic event.

For example, someone who had a car accident and has been traumatized might be asked to look at pictures of car accidents, listen to loud sounds, and eventually, once he gets more comfortable, drive on the highway.

This might seem like a scary treatment, but keep in mind that avoidance is what fuels PTSD symptoms.

By progressively confronting the things you fear, you build up your tolerance for fear and realize that you are not really in danger. The traumatic event is not recurring and the alarm your body is sounding is a false alarm. Over time, your body’s alarm system becomes less sensitive and less likely to be activated when you face reminders of a traumatic event.

1. In Vivo Exposure

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In vivo exposure is a real-life exposure, where you encounter real-life situations that you’ve been avoiding or that you’re afraid of.

This will help you realize that these situations are actually safe and help reduce your fear and anxiety.

Related: How to Treat Your Anxiety Using Cognitive Behavioral Therapy (CBT)?

List Activities you avoid or are afraid of

When you get used to avoiding activities or situations, it can become hard to notice them.

Be really honest with yourself. You can ask for suggestions and feedback from trusted friend, a loved one, support person, or therapist.

Think back to the time before your trauma. What types of activities you did back then that you have stopped doing?

As you list these activities, it’s important to connect them to goals that are important to you. Consider why it’s important to you to do these activities and how they can help you reach your goals.

For example, maybe you used to walk alone a few times a week because you wanted to lose weight or simply stay fit.

Schedule “In Vivo Exposure” Daily

After writing down your list of avoided activities, the next step is to schedule to deliberately practice these activities.

Exposure works best when it’s consistent and structured. This will help you turn exposure into a habit that will compete with your old habit of avoiding.

You’re more likely to do something if you have it in your schedule. This will ensure that you take action regardless of how motivated you feel.

It’s also recommended that you practice exposure daily, in order for you to pave a new path in your mind and resist taking the old one.

Start with the Items That You Can Best Handle

Start with easier items on your list, especially if you’re doing this on your own.

It’s easier for you to feel empowered and keep going when you choose situations that you can stay in for long enough for your brain to learn something new.

It’s important to take reasonable precautions. If you’re afraid to walk alone down your street at night, it would be naïve to place yourself in harm’s way. But make sure you’re not mistaking avoidance for safety behaviors.

2. Imaginal Exposure

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Imaginal exposure involves exposing yourself to situations in your imagination.

This is a good substitute for in vivo exposure, especially when it’s hard to get into the real-situations you’re afraid of, or when these situations are not particularly safe, like walking alone in the dark in a dangerous neighborhood.

One of the best forms of imaginal exposure for PTSD is “prolonged exposure”, which involves deliberately reexperiencing the traumatic event in your imagination in vivid details as if it’s happening right now.

This might be the last thing you want to do. You probably would prefer it if the memory were to disappear completely.

So why expose yourself to it this way? Well, simply because it works.

Many people have reported that their symptoms have improved considerably after prolonged exposure (Olatunji, Cisler, and Deacon 2010).

Prolonged exposure will also help you learn that, even the traumatic event may have been damaging, your memories of it aren’t dangerous and it can’t harm you. This will reduce your PTSD symptoms and help you move forward in your life.

It’s not recommended to do prolonged exposure alone. It’s best done with a therapist who can help you remain safe and support you while guiding you through the exercise.

#2. Cognitive Processing Therapy (CPT)

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Cognitive processing therapy CPT focuses on how you interpret your traumatic event, as well as on the beliefs you develop about yourself and the world after your traumatic event.

In fact, after a traumatic event, negative beliefs can be developed about yourself and the world. These beliefs or “stuck points” cause a large array of unpleasant emotions, like hopelessness, self-blame, helplessness, and avoidance behavior. They interfere with your recovery and keep you stuck.

CPT tackles these stuck points by identifying your patterns of unhealthy thinking and assisting you in looking at your experience from a more accurate and compassionate perspective.

Doing this helps alleviate your PTSD symptoms and lead to less avoidance and other unhealthy behavior.

In CPT, you are asked to write about your traumatic event and then read it to your therapist while identifying stuck points that needs to be addressed.

Cognitive Processing Therapy (CPT) includes 12 sessions of structured treatment that aim to help the victim cope with the post-traumatic stress symptoms and regain control in his or her life.

Descriptors of the 12 Sessions of Cognitive Processing Therapy (CPT) (Resick, et al., 2008)

1. Introduction and Education

2. Meaning of the Event (impact statement)

3. Identification of Thoughts and Feelings (ABC)

4. Remembering Traumatic Events (accounts)

5. Remembering Traumatic Events

6. Challenging Questions

7. Patterns of Problematic Thinking

8. Challenging Beliefs Worksheet (CBW) & Safety Issues

9. Trust Issues

10. Power/Control Issues

11. Esteem Issues

12. Intimacy Issues and the Meaning of the Event

The CPT gives you effective coping skills that include management of stress, pain, and discomfort, as well as better emotional regulation, social communication, and clearer thinking.

These skills need to be learned and applied in life circumstances.

#3. Skills for Regulating Intense Emotions

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People with PTSD struggle with a number of intense emotions that can be difficult to regulate, like anxiety, guilt, sadness, and anger. These emotions can get very overwhelming and become hard to manage.

Fortunately, there are a number of skills that can help you regulate your emotions.

1. Experiencing Emotions

The first step to regulate emotions is to allow yourself to experience them.

But wouldn’t getting in touch with your emotions make them even more intense and overwhelming?

The answer is no.

It’s when you avoid your emotions that they become more overwhelming as one study show (Hayes, Strosahl, and Wilson 2011).

Mindfully Observe Your Emotions

Allowing yourself to experience your emotions will allow them to run their course and pass making them last for a shorter amount of time than trying to suppress them or ignore them.

* Notice the urge to avoid your emotions and gently turn your attention toward them.

* Notice the thoughts and bodily sensations that accompany your emotions. Bring your attention to how these emotions feels in your body and describe all of the various physical sensations you’re experiencing.

* Remain objective when describing your emotions or physical sensations. Don’t label them as “good” or “bad”.

* Remind yourself that as uncomfortable and intense your emotions maybe, they won’t hurt you and that they’ll dissipate soon.

* Finally, as your emotions begin to dissipate, notice how your body feels, what thoughts are you having right now, and how quickly the intensity of your emotions decreases.

Mindfully observing your emotions is one helpful technique for allowing yourself to experience your emotions, but there are other strategies that can also help you get in touch with your emotions.

The following are some of them.

Write About Your Emotions – Journal about how you’re feeling, what bodily sensations you’re experiencing, and what thoughts you’re having in the moment.

Talk About Your Feelings With Others – In order to describe your feelings to someone else, you’ll need to allow yourself to experience these emotions to some extent.

2. Identifying Your Emotions

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By identifying your emotions you gain emotional clarity. This makes your emotions more manageable and you’ll be more capable to figure out how to make yourself feel better.

The things that will make you feel better depend a lot on exactly what emotions you’re feeling at the time. If you’re sad, talking to a friend, or slowing down and relaxing a little can help you feel better. If you’re angry, going for a long run can help you release the energy.

This is why it’s important to label your emotions.

Oftentimes, you might not be aware of or in touch with your feelings until you find yourself wanting to cry or scream.

Considering the three different components of emotions will help you identify your emotions:

(1) Cognitive – the thoughts that go through your mind. Thoughts that might accompany anger could be “This is unfair!” or, “What a jerk!”

(2) Physical – the way your body responds. Physical sensations that might accompany anger could be a racing heart, tense muscles, tight jaw, etc.

(3) Behavioral – the things you do or have urges to do. The behavioral component of anger may include urges to punch something or someone, scream, throw things, etc.

Once you know exactly what you’re feeling, it becomes easier to figure out the best way to cope with these emotions.

3. Identifying the Information Provided by Emotions

Your emotions are functional and serve a purpose. They provide important information about yourself and your environment. This is why figuring out why you’re having an emotion and the information it’s providing can be very helpful.

(1) Fear – signals danger or threat.

(2) Anger – tells you that you’ve been violated in some way or that your need or want is being blocked.

(3) Sadness – signals loss

(4) Guilt – tells you that you’ve done something that isn’t aligned with your values.

Identifying the information provided by your emotions will help you respond more effectively and help them pass more quickly.

4. Distraction Skills

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After identifying your emotions, it’s important to distract yourself and resist the urge to act on these emotions in unhealthy and unhelpful ways. All you need to is find something else to capture your attention.

Keep in mind that these distractions are meant to help you manage your emotions. Use these distraction skills in moderation and don’t overuse them or turn them into avoidance.

Find an activity that will capture your attention. The following are some examples:

  • Exercise,
  • Take a walk in nature,
  • Do some work,
  • Hang out with a good friend,
  • Prepare a meal,
  • Etc.

5. Specific Skills for Managing Anger

Anger, like other emotions, is a basic human emotion that serves an important purpose. Anger can give you the motivation to address problems and change things, and the strength to stand up for yourself and others.

However anger can become overwhelming and difficult to manage.

The following techniques will help you manage intense anger:

Leave the Situation

This technique is simple, yet powerful. Oftentimes, all you need is time and space to figure out how best to respond to any situation and give your anger a chance to subside.

Stop and Take a Step Back

There are times when you can’t simple leave the situation or when leaving the situation has its downsides, like being in a car with someone, in an important meeting, etc.

When you can’t physically leave the situation, simply stop and take a step back from the situation. Pause before you act or respond. Give yourself a moment to relax and figure out what to do next.

6. Skills for Managing Shame

Even though the vast majority of emotions people experience are functional, shame, on the other hand, is far less helpful.

Shame stems from negative evaluations and judgments of you as a person. Unlike guild that stems from negative evaluations of certain things you said or did, shame is felt when you judge yourself as a whole. It not only brings self-loathing and low self-esteem, but it can also get in the way of healing and moving on. It keeps you stuck.

The following is a strategy to help you manage shame:

Opposite Action

Opposite actions involves doing the opposite of the action urges that come with an emotion. This keeps the emotions from intensifying and helps it pass more quickly.

* Identify the action urges that go along with shame (hide, avoid, shut down or self-punish).

* If you feel like hiding, do the opposite. Approach other people. Tell a trusted friend or your therapist about your traumatic experience.

If you can’t think of a supportive friend who’s going to listen, try 7cups of tea it is an online service with thousands of volunteer listeners stepping up to lend a friendly ear.

* If you feel like punishing yourself, do the opposite. Treat yourself with compassion and kindness. Do something nice for yourself even if you don’t feel loving toward yourself or deserving in the moment. Focus on your strength and positive characteristics.

#4. Reestablishing Purpose and Meaning for One’s Life

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Reestablishing purpose and meaning for the PTSD victim’s life in an important prerequisite to recovery.

In fact, after trauma the purpose for one’s life is disrupted. PTSD robs people of many goals and beliefs they used to have in their lives and a void is formed. This void needs to be addressed, as Aristotle said, “Nature abhors a vacuum.”

For example, Childhood Sexual Abuse (CSA) survivors spend their first years of life learning trust, only to find that it was no more authentic than a politician’s promise. This can lead to the elimination of a sense of security in their world.

In such case a “values vacuum” take place after experiencing trauma.

Values are the things that people think important. Without them, passion about life is reduced.

Reestablishing meaning and purpose for one’s life helps PTSD sufferers to find something to believe in beyond the everyday struggle to avoid pain.

1. Post-Traumatic Growth: Ways to Fill the Vacuum

Tedeschi and Calhoun (1996) propose five ways in which victims experience improvement post-trauma:

(1) relating to others;

(2) new possibilities;

(3) personal strength;

(4) spiritual change; and

(5) appreciation of life.

When passion and commitment to goals guide life, the trauma sufferer becomes capable of coping with the “here and now” struggles. By engaging in approach behavior and moving toward something considered meaningful, the trauma victim finds growth and recovery after trauma.

2. Passions Engineered

Passions and meaning can be created.

By interacting with others whom we admire and engaging on novel things that get us thinking and acting with the concerns of others in mind, we find passions and meaning.

To clarify your values start by reading a list of common values.  Examples of values include authenticity, charity, wealth, love, popularity and fame, education, etc.

Below is a list of values you can inspire from:

Accuracy
Achievement
Adaptability
Adventure
Affection
Alertness
Ambition
Assertiveness
Authenticity
Balance
Beauty
Boldness
Broad-mindedness
Calmness
Capability
Career
Caring
Clear
thinking
Compassion
Competence
Confidence
Conscientiousness
Consideration
Contentment
Contribution
Cooperation
Courage
Creativity
Customer-service
Dependability
Determination
Diligence
Discipline
Dynamism
Education
Effectiveness
Encouragement
Energy
Enjoyment
Enterprise
Enthusiasm
Excellence
Faith
Fitness
Flexibility
Focus
Forgiveness
Freedom
Friendship
Fulfillment
Generosity
Gentleness
Good attitude
Good humor
Growth
Happiness
Hard work
Health
Helpfulness
Honesty
Hope
Humility
Imagination
Impartiality
Independence
Innovation
Integrity
Joviality
Joy
Kindness
Knowledge
Leadership
Learning
Love
Loyalty
Maturity
Method
Meticulousness
Modesty
Naturalness
Nurturing
Optimism
Organization
Originality
Patience
Peace
Perseverance
Persistence
Personal fulfillment
Personal mastery
Playfulness
Pleasantness
Politeness
Possessiveness
Practicality
Precision
Professionalism
Progress
Prosperity
Punctuality
Purposefulness
Quality
Quickness
Resourcefulness
Respect
Responsibility
Satisfaction
Security
Self-actualization
Self-control
Sensibility
Simplicity
Sincerity
Skill
Sociability Specialness
Status
Strength
Success
Sympathy
Tact
Talent
Teamwork
Thankfulness
Thoroughness
Tolerance
Tranquility
Trustworthiness
Truthfulness
Understanding
Uniqueness
Value
Versatility
Victory
Vigor
Warmth
Willpower
Wisdom
Wit
Youthfulness
Zeal

Choose the ones that stand out the most for you and explore how you can strengthen the ones most important to you and look for people who are considered a “leader” in that activity. This person doesn’t have to know that you’re following him or her. You simply emulate the leader’s example.

Creating and strengthening your new values requires practicing new habits. Once you start building a new history, you start pulling yourself out of past trauma. This might take time, but when done, it can be a better way to live life than spending all of your energy and resources trying to avoid pain day after day.

Recovery from PTSD is possible, but it’s very helpful to have a destination in mind when you begin healing. Your values are what determine that destination.

Your turn…
We love hearing from you. Please share your thoughts with us in the comments below.

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Resources

Portions of this article were adapted from the book Trauma Recovery ‑ Sessions With Dr. Matt, © 2018 by Beth Fehlbaum and M. Jaremko. All rights reserved.

Portions of this article were adapted from the book The Cognitive Behavioral Coping Skills Workbook for PTSD, © 2017 by Matthew T Tull. All rights reserved.

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