If you have survived a traumatic experience, it’s natural that you are feeling worried about how to proceed. You may have many concerns running through your mind: How long will I feel this way? Am I supposed to seek treatment? Is it normal for me to feel like this? Whether it’s an unsettling birth experience, a difficult pregnancy, a sexual assault, or any other traumatic event, we are left feeling vulnerable and distressed. This post is for anyone concerned about experiencing posttraumatic stress disorder (PTSD). I hope the following information will provide you some clarity and empower you to seek the support that best meets your needs.
What is PTSD?
PTSD is a mental health diagnosis that occurs after an individual has survived or witnessed a traumatic event. What qualifies as a traumatic event differs for every individual. Whatever the circumstance, the individual experiences a significant threat to their physical, emotional or psychological safety, or the safety of a loved one. The situation is so distressing , that the person feels unable to cope.
In working with prenatal and postpartum parents, I see a lot of caregivers who have experienced trauma in the following circumstances:
- Prenatal Loss: e.g. stillbirths, miscarriages, unsuccessful IVF treatment
- Unplanned pregnancies and abortions
- Domestic violence, affairs, or marital separation
- Pregnancy complications: e.g. infections, preeclampsia
- Early labor or NICU visits
- Unexpected health complications: e.g. positive screening for trisomy 21 or 18, car accidents
Not every traumatic experience leads to PTSD. There are many components that can influence your healing. Having resiliency factors (e.g. coping strategies, support from loved ones) can greatly improve how you process and move forward from this experience. Having a relatively safe life and limited trauma prior to this event can help us trust that the world is a safe place once again.
Depending on whether the traumatic event was a one time incident (e.g. mugging) versus a repeated event (e.g. ongoing civil war) can impact your healing. When it’s a one time event, our system is better able to see the situation as an anomaly. When there are repeated infractions, we struggle to see the world as a safe and predictable place, and there is increased risk for PTSD.
During a traumatic event:
During a traumatic situation, our survival system kicks in automatically. We are outside of our window of tolerance because this event was unexpected, and our nervous system is experiencing a threat to our well-being. Without conscious effort, our traumatized mind shifts to a state of flight, fight or freeze. We try and escape the situation as quickly as possible, or we try and attack and fight our way forward. If neither option works, we fall into a state of shock or freeze response. When safety is returned, most of us can calm down. However, for traumatized individuals, it’s like their mind is still hooked in that place of danger, and they continue to respond in a flight, fight or freeze manner.
Symptoms of Trauma
A traumatized individual will show symptoms such as:
- Hypervigilance: a need to assess for constant threat. This involves a high degree of alertness for anything related to the disturbing event.
- Reliving the traumatic event: e.g. through flashbacks, memories, dreams or intrusive thoughts
- Avoiding reminders of the disturbing event: this can involve avoiding even the most basic connection. For example, a mother with birth trauma may avoid going to hospitals or visiting medical professionals. She may refuse to talk about her birth experience or listen to others’ birth stories. In the hardest of scenarios, she may avoid any interactions with her newborn.
- Increase in negative thoughts and feelings: e.g. numbness, guilt, shame, anxiety, irritability, hopelessness. The traumatized person often feels the world is unsafe or unfair. He or she may be cautious about trusting others.
- Hyperarousal: Feeling on edge, jittery, difficulty relaxing
- Dissociation or impaired memory recall: In some cases, the individual may forget parts of the trauma, or have blocked out this entire event.
Usually, we experience these symptoms right after a traumatic event; however, some individuals have a delayed onset.
When is it “normal” and when is it PTSD?
The majority of us have survived a traumatic situation. In the beginning, we feel jittery, hyperalert, and avoidant. This is normal. There are parts of our system that are scared of a similar event happening again. In order to ensure safety, these parts will assess for danger and remain hypervigilant of repeat offences. During this time, you will likely experience a lot of distress. However, trauma symptoms tend to dissipate on their own within a month without any major influence. Short-term therapies, medication, and support from loved ones are effective tools that can help with this transition.
In order to have a diagnosis of PTSD, you must experience continue to experience trauma symptoms a month after the traumatic event. These symptoms may last for months or years following, and they cause significant impairment in the person’s daily life and relationships. If you are concerned about experiencing, PTSD, you can take the Posttraumatic Stress Disorder Checklist (PCL-5) as a self-assessment. Any scores approaching 40 warrant a conversation with your family doctor or a mental health professional.
What can I do if I still feel traumatized after a month?
I encourage you to seek therapy as soon as you feel ready to process the traumatic event. While counselling is not meant to be triggering, it can be hard to revisit a difficult memory. If you feel too overwhelmed to even think about the traumatic incident, your system may benefit from extra support to manage this anxiety first. This may involve medication, or specific counselling strategies focusing on distress management.
There are many different counselling approaches that can be used to process traumatic events. Some well known options include: include cognitive processing therapy, sensorimotor psychotherapy and narrative therapies. The following three options are services that can be provided via Kasi Shan Therapy.
Eye movement Desensitization and Reprocessing (EMDR)
EMDR is a powerful approach that divides a traumatic experience into smaller, manageable chunks to slowly process each part of the incident. Typically, the work starts with either the first or worst part of the memory, depending on what feels manageable for you. In EMDR therapy, we use a process called bilateral stimulation to help process traumatic memories (learn more about how EMDR works vis this post). IN EMDR, with each passing of bilateral stimulations, the traumatized individual starts to feel some distance from the traumatic event. The event feels less personal, and there is a continued lowering of distress level. An individual quickly moves from negative beliefs and high distress to more positive beliefs about themselves, less fear when thinking of the memory, and calmness in the body.
EMDR does not require you to go into specifics of a traumatic event. Instead, clients can express barebone details aloud while still making sense of a unpredictable and nonsensical event. This can feel helpful for those who are not ready to speak about the traumatic event in detail as of yet. In fact, for those who do get stuck in the narrative of a traumatic event, your therapist will keep checking that you are properly processing a memory versus getting retriggered.
Cognitive therapies and prolonged exposure
When it comes to traumatic events, we form negative beliefs about ourselves and about the world. Cognitive therapies help us challenge these beliefs by assessing their validity. We look at whether our assumptions about the world, others, and ourselves are fair and consistent. The therapist and client works to start formulating more neutral or balanced thoughts.
In addition, many therapists will encourage clients to practice in some form of exposure therapy. With trauma, there is a lot of avoidance of the traumatic event. Prolonged exposure involves slowly approaching the activities or individuals that remind us of the traumatic event. This is done at a gradual pace in order to not overwhelm the system, and to help build confidence in our capacity to manage distress and test out problematic beliefs.
Internal Family Systems Therapy (IFS)
IFS recognizes that our system can become divided following a traumatic event. There are parts of us that carry the wound of a traumatic event. We often bury or push this part away from our awareness. These exiled parts typically carry a lot of shame, guilt, fear or overwhelm. Because they are so overwhelming, we have other protective parts that compensate. We have proactive parts that prevent us from triggering these wounds. We also have reactive parts that respond when we are triggered trying to manage the intensity of these exiled emotions.
For example, following a miscarriage, we may have an exiled part of us that believes we are responsible for the pregnancy not lasting. Because this is such a painful burden to carry, we may have proactive parts that do not let us get pregnant again, cancel IVF appointments, or push fights with our partner to prevent intimacy. If another miscarriage occurs, we may have reactive parts that become extremely angry at ourselves or our partners. This part may lash out through verbal attacks, or may cause physical harm onto our own bodies in order to deal with the pain.
In using IFS to treat trauma, we have to work with all parts of your system. Rather than diving straight into addressing the wound, we work with these protective layers first. We focus on building trust and safety with these protective parts. When they have relaxed, we then start to work with the core traumatic wound.
You may notice signs of healing within the first month, and not require additional support. However, if it’s been longer than a month and you continue to express traumatic symptoms, interventions can be helpful. Trauma and PTSD do not have to be a life sentence, and there are ways to help your recovery. If you or a loved one is struggling after a traumatic experience, reach out.