Addressing the Return of Trauma Symptoms

Colleagues, clients, and I are talking about the return of trauma symptoms in people who have achieved remission from post-traumatic stress disorder (PTSD). It’s possible that pandemic conditions have strained brain resources that kept people in remission. Beyond pandemic languishing, to describe this current push-pull of stressors, Amy Cuddy, Ph.D., and other thinkers are using the term pandemic flux syndrome. Counselors and clients, together, are working on how to return to remission from trauma symptoms during these unprecedented times.

Let’s review what we know about trauma, trauma symptoms, and how to reduce them.

(A comprehensive explanation of trauma and its treatment are beyond the scope of this post. Information from the National Institute for Mental Health and National Center for PTSD may be helpful.)

At essence, the cause of trauma symptoms is the brain being alarmed too high, for too long, for it to recover its stable functioning.

Post-traumatic alarm is caused by:

  1. novel experiences of danger, threat, and shock,
  2. residual physiological and psychological effects from having experienced the original trauma(s),
  3. involuntary trauma symptoms,
  4. lack of comfort and help with thinking, and
  5. ways of thinking that perpetuate alarm.

At essence, to reduce trauma symptoms, a person has to “un-alarm” their brain for long enough for the brain to recover stable functioning.

In the list of the causes of alarm, although #1 is part of the human condition, and #2 is permanent, #3, symptoms, can dissipate if a person can help themselves with #4 and #5 as their own cognitive therapist.

Unfortunately, this process doesn’t:

  • make “un-happen” what happened.
  • result in instantaneous relief from an act of determination or will.
  • remove feelings, including those judged as “negative.”
  • disarm normal human brain functioning. Remembering – both consciously and involuntarily – and feeling activated will continue to happen.

Beginning with #4, after offering kindness and comfort to oneself, one heads directly for #5, ways of thinking.

Here are some initial questions to ask oneself:

1. Although I may not want this to be true and I may be somewhat numbed to it, what is going on in my life that logically and understandably might be alarming me? This could be one thing or a list of things. Although stressors related to the pandemic may be on my list, let me go deeper. What else might be alarming me?

2. Thinking “This shouldn’t be this way,” can alarm the brain. About what, even in the smallest way, am I thinking, “This shouldn’t be like this” or “This shouldn’t have happened”?

3. Thinking “This is too much for me,” can alarm the brain. Am I thinking, perhaps about some things at some times, “This is too much for me”? About what?

4. Thinking “I should be or do _____” or “I shouldn’t be or do ______” can alarm the brain. About what am I thinking “I should” or “I shouldn’t” about myself or my efforts? About what am I thinking “They should” or “They shouldn’t” about others and their actions?

5. Feeling upset or outraged at others can alarm the brain. Sometimes outrage at injustice is merited. Sometimes, I can rage at others or despair over myself or others as an outpouring of an inner sense of powerlessness, helplessness, and lack of control. Am I in danger and need to extricate myself? If I am not in danger, about what am I feeling a lack of power and control?

6. The brain knows “tough love” is an alarming oxymoron. Am I using “tough love” on myself? About what am I criticizing and judging myself? By what criteria am I measuring and evaluating myself and coming up short? Are these criteria realistic and helpful, aligned with my values and priorities, or are they cruel rules?

7. What facts and realities about myself, others, the human condition, and the way the world works am I avoiding? What do I need to approach, see as it is, acknowledge and/or accept, address with my cognitive skills, and, thus, help “un-alarm” my brain and ease my distress?

Of the 100 billion humans estimated to have ever lived, we can’t know what portion of them experienced trauma, or developed trauma symptoms. Over half of U.S. women and 60% of U.S. men have experienced at least one traumatic event in their lives. In my estimation, those who attempt to reverse the very brain changes that result in trauma symptoms are no less than heroic.

. . . . .

The content of this post is informed by cognitive behavior therapy (CBT), dialectical behavior therapy (DBT), cognitive processing therapy (CPT), acceptance and commitment therapy (ACT), positive psychology, and other therapeutic modalities.

Image: iStock

This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Becoming One’s Own Cognitive Therapist

A fundamental premise of cognitive theory-based counseling protocols is that, once people learn cognitive skills, they can take over as their own cognitive therapists.

What does this mean exactly?

A cognitive therapist uses the research-backed elements of cognitive theory to help a person acquire cognitive skills.

“Cognitive theories are characterized by their focus on the idea that how and what people think leads to the arousal of emotions and that certain thoughts and beliefs lead to disturbed emotions and behaviors and others lead to healthy emotions and adaptive behavior.”
DiGiuseppe, et al., 2016

A person with cognitive skills, in the context of self-kindness, becomes aware of having felt, thought, spoken, or acted automatically, regains consciousness, deliberately frees themselves from getting boxed in by beliefs about what one should or shouldn’t be and do in favor of making principle-based decisions, sees reality as it is, and makes helpful, criteria-based choices about what to say or do next – or not say or not do.

Boxed in by beliefs

“Take back your consciousness.”

At essence, a person with cognitive skills can become aware of when they need to say to themselves, “Take back your consciousness.”

People who seek counseling often realize that ways of feeling, thinking, speaking, acting, studying, working, and/or relating are interfering with their own intentions for themselves, and with their ability to relate effectively with themselves, partners, children, family members, instructors, co-workers, and/or community members.

Very often, these ways are unconscious and automatic, born of temperament, brain traits (such as sensory sensitivity or attention variations), childhood or later trauma, family of origin challenges, and learnings from families, communities, education, culture, nationhood, and the media.

A conscious self-embrace

Use of a set of research-informed counseling protocols – categorized as applied “cognitive theory” – can help people use awareness of their thoughts and feelings to identify these automatic ways, begin to see facts and realities as they are – however unwished-for they might be – assess probabilities, derive strategies, and make conscious choices based on their needs, wants, strengths, preferences, values, and priorities.

My work with clients is primarily informed by these cognitive theory-based counseling protocols: cognitive behavior therapy (CBT), dialectical behavior therapy (DBT), and cognitive processing therapy (CPT).

“Cognitive” can be considered a cold term, but cognitive-based counseling is anything but. The entirety of one’s feelings, thoughts, and experiences are courageously and deliberately honored and addressed. People map out what occurs, what’s in their hearts and on their minds, then use all that data to decide what would be the most realistic, helpful action to take. This meticulous examining is nothing short of heroic. Kindness, mercy, and bravery reign.

“Getting cognitive” also does not mean becoming robotic. One’s full humanity is seen, known, and appreciated. Reality is approached, not avoided. Reality is complex and dynamic; reality delivers unexpected shocks and sucker punches. Cognitive skills can’t undo what’s done, or make people “un-feel,” “un-think,” or “un-experience.” What they do is give people the power to help themselves through experience of all kinds, including hardships.

Self-kindness becomes direct rather than indirect. Rather than “giving oneself a break,” granting an indulgence, or engaging in a distraction, people can pause, use their attention, become deeply aware of what would be truly kind, and do that. With practice, self-kindness can feel moving, ecstatic, powerful, and peaceful, all at the same time.

Why become one’s own cognitive therapist and gain cognitive skills?

Even if only partial consciousness exists through ever-present stressors at home or work, immediately after shock or loss, after brutality or injury, or through congenital brain traits, accompanied by one’s consciousness, one can co-travel kindly and effectively with one’s experiences: inner and outer; past, present, future; kind or cruel; expected or unanticipated; desired or undesired.

In particular, a person can take back consciousness:

  • from despair;
  • from naturally and understandably feeling powerless, helpless, hopeless, victimized, overwhelmed, and in chaos by the facts of one’s existence: past traumas, past losses, the pandemic, memories, nightmares, symptoms, nearly automatic substance use, emotional and physical pain, and current incidents and situations;
  • from replaying a past event in hopes of figuring out what might have made it go differently;
  • from alarming and re-alarming one’s brain from replaying a past event;
  • from taking troubling experiences in short-term/working memory into deeper, long-term memory through repetition (a “flashcard effect”);
  • from attempting to anticipate, plan for, and script future events;
  • after having developed an intense inner state to regain cognitive functioning;
  • from learned actions intended to relieve intense inner states, such as use, overuse, or ill-use of substances – food, caffeine, nicotine, alcohol, marijuana, prescribed and non-prescribed drugs – eating unintended foods and eating more than intended; purging; words and actions born of impulse, anger, and rage; many others.
  • after involuntary occurrence of intrusive memories, thoughts, and nightmares;
  • from attention going “there” instead of “here,” i.e. where it was intended to go and stay;
  • from symptoms and traits of disorders such as trauma and stress disorders, obsessive-compulsive disorder, attention deficit disorder, mood disorders, personality disorders, autism spectrum, and others.

Why take back one’s consciousness?

Outcomes. Simply put, people want to feel better and to do better. Based on decades of research, cognitive therapies help many people feel better and do better, much of the time, better than other therapies, and better than doing nothing.

Once one has one’s consciousness back, what does one do with it?

Co-travel. Co-travel with what is happening. Keep the self and one’s identity separate from one’s inner and/or outer experience. Operate from within one’s consciousness. State, for example, “I feel fear” rather than “I am afraid.”

Consider precise, person-centered language. Note the differences between “I am a person in remission from addiction” and “I am an addict.” Compare “I am a person who, at times, experiences anxiety” to “My anxiety is bothering me.”

How does one take back one’s consciousness?

Consider this sequence:

  1. Become aware of having a sense that something is a bit “off” and say to oneself, “Take back your consciousness.”
  2. Access the portion of one’s consciousness in which resides a) one’s inner wisdom and true self, b) awareness of this knowledge: one’s needs, wants, strengths, preferences, values, and priorities, and c) one’s cognitive skills.
  3. Engage self-kindness and banish belief-based self-judgment and self-criticism.
  4. Become aware of what one is feeling.
  5. Sort feelings into primary* and secondary** feelings.
  6. Kindly and humanely help oneself with primary feelings.
  7. Use secondary feelings as data about one’s thoughts. Ask, “What thought caused that feeling?”
  8. Identify thoughts as beliefs or facts.
  9. Shift one’s attention to thoughts about facts and reality.
  10. Comfort oneself if realities are painful or fervently wished otherwise.
  11. Using the criteria of one’s self-knowledge, values, and priorities for direction, imagine options, assess probabilities, then choose.
  12. Derive implementation strategies.
  13. Appreciate, acknowledge, and accept: “This is the best I can I think of with what I know at this time and with the resources I have.”
  14. Based on the above criteria, say or do – or don’t say and don’t do.
  15. Take back one’s consciousness again and again if any one of these occurs: second-guessing, self-criticism, self-judgment, repetitive thoughts (“noodling,” ruminating, listing), replaying past troubles, or anticipating future dire consequences.

Always, always practice self-kindness.

We are human, humans have extents and limits, reality is complex, and we each have such a short time on the planet to work things out. Kindness is merited.

. . . . .

*Primary feelings are natural feelings that go along with being human and happen automatically without thought: mad, sad, glad, afraid, surprised, disgusted, alarmed (includes fight-flight-freeze response).

**Secondary feelings happen as a result of thoughts – often thoughts that are opinions, beliefs, or rules – that cause feelings of shame, guilt, humiliation, self-blame, mistaken other-blame, regret, rage, dread, panic, despair, nostalgia, jealousy, righteousness, vengeance, and “ideations,” i.e. intrusive thoughts or fantasies of harm to self or others. Secondary feelings that result from thoughts cause suffering through 1) escalating natural feelings, 2) causing painful feelings, 3) creating a sense of “no escape,” which can result in feelings of rage, helplessness, and hopelessness, 4) increased reactivity vs. conscious choice, and 5) creating troubled interactions with others.

Photo images: iStock

This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

About Grief

What’s to be done about grief?

Untitled by Trish Shelor White

It’s real.

It’s painful. The end in mind would be to feel less pain. Turning away is instinct. Forcing it to change is instinct. However, grief handled really, as it is, eases. What optimizes the easing of grief?

This is what I’ve become aware of about grief, from personal experience and training:

  • Neither stalling nor hustling help. Neither distracting nor avoiding help. Tough love hurts.
  • Turning towards the reality of grief, as it is, begins with self-kindness and compassion.
  • Grief without judgment, without beliefs, and without rules eases. “I should be feeling/thinking/doing ____,” and “I shouldn’t be feeling/thinking/doing _____,” exacerbate grief.
  • Seeing grief as it is offers up this question: “Can I help myself do something about this? Or is this something to help myself accept? Help do? Help accept?”
  • In the context of grief, acceptance can be having the bravery and compassion to rearrange one’s heart to make space for a new fact about being human, however unwelcome.
  • Replaying scenes to see if they truly happened the way they did or to see if different clues can be found to change the ending or its meaning works like flashcards to deepen painful memories, escalating grief. Becoming aware of replaying scenes is the time to say, “I have given that due time. I accept that it was the way it was.”
  • Being with people who aren’t grief-savvy exacerbates grief. The unconscious subtext under well-intentioned intoning of rules about grieving, e.g. “Time heals all wounds,” “You should travel,” or “_____ helps,” is usually judgment and criticism: “You should be over this by now. Why aren’t you farther along in ‘the grief process’? Follow my rules and you’ll get through it faster.” The deeper subtext can be that the person feels frightened and lonely without the person in grief.
  • Grief has to be felt and life has to be lived. Both are true at the same time. Opting out of either exacerbates grief. Grief is felt and relationships are tended. Both are true.
  • Guilt, a feeling born from the thought, “I should be/have been/do/have done more or something else,” often accompanies grief. Standard feeling and thinking skills can help:

“What am I feeling? Which of my feelings are natural human emotions and which are caused by thoughts? Which of my thoughts are facts and which are beliefs? Okay, let me challenge the beliefs and ease those thought-created feelings. And now let me help myself with whatever feelings are left and follow the facts!”

The vast complexity of each person’s brain and body, each person’s history, each person’s temperament, all suggest each person’s experience of grief, moment-to-moment, is individual and may fluctuate. Awareness, though, can help people decide moment-to-moment what is real and what can help.

Image: Untitled by Trish Shelor White

The content of this post is informed by the work of David Kessler and therapies derived from cognitive theory.

This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

If You Are Having Trouble Regulating Your Emotions, Try This

Become aware of having an intense inner state.

Activate self-kindness and self-efficacy. Think, “I am going to help myself with this.”

Adjust the intensity of one's inner state

Name the primary feeling(s). Activate executive functioning structures and functions in your brain.

Primary feelings are natural feelings that go along with being human and happen automatically without thought: mad, sad, glad, afraid, surprised, disgusted, alarmed (includes fight-flight-freeze response).

Name the secondary feeling(s).

Secondary feelings happen as a result of thoughts – often thoughts that are opinions, beliefs, or rules – that cause feelings of shame, guilt, humiliation, self-blame, mistaken other-blame, regret, rage, panic, dread, despair, nostalgia, jealousy, righteousness, vengeance, and “ideations,” i.e. intrusive thoughts or fantasies of harm to self or others.

Ask yourself, “What thoughts caused these secondary feelings?”

Ask yourself, “What happened that activated this feelings-thoughts pairing?”

Ask yourself, “What are the facts about this trifecta of events, feelings, and thoughts?”

Think, “Given this data, what are my options to supportively and realistically help myself with this?”

Options come from:

The content of this post is intended to serve as text to copy and paste into a document to tape to the refrigerator or into the notes feature on a phone for easy reference. Plain language is used with a minimum of clinical terms. Clinical terms are linked to further explanations.

Image: iStock

The content of this post is informed by Cognitive Behavior Therapy (CBT), Dialectical Behavior Therapy (DBT), Cognitive Processing Therapy (CPT), Acceptance and Commitment Therapy (ACT), Positive Psychology, and other work. it was synthesized and compiled by Anne Giles, M.A., M.S., L.P.C.

This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

Doing the Numbers on the Human Condition

Conceptually, to do easy calculations, let’s give each person 100 years on the planet. Although this is pure speculation, I estimate in their lifetimes humans handle 1,000 random, varied, meaningless hardships and make 1,000 mistakes.

Doing the numbers on the human conditionLet’s also assume that each person has some level of consciousness, defined for our purposes as awareness of the existence of the self and of other selves. Let’s also assume that reality is complex and dynamic. Let’s acknowledge that, currently, beyond the realm of calculating and estimating probabilities, the human brain does not have the power to change the past or know the future.

Now, to quote Kai Rysdal, let’s do the numbers.

“Despite the tendency to celebrate individual genius, humans’ true intellectual might is collective.”
– Morning briefing, The Economist, 10/23/21, reporting on When and Why Did Human Brains Decrease in Size? A New Change-Point Analysis and Insights From Brain Evolution in Ants, Frontiers in Ecology and Evolution, 10/22/21

What conclusions do I draw from seeing these numbers?

1) Even though I am 1 of 8 billion on the planet, and 1 of 100 billion who have ever lived, my consciousness is acutely aware that I have one, precious life.

2) Knowing the vastness of the human experience doesn’t minimize my experience. What happens to me happens to my universe.

3) My genetic makeup might just as easily have been dropped by the stork into another family’s chimney, at another place, in another time. This might mean:

  • Familial and geographic assignment are random.
  • Loyalty to family or to a nation is a choice, not an objective imperative.
  • Familial and cultural beliefs I have been taught might not be objective truth. (Gasp!)
  • What happened to me in my family of origin might not have happened to me if I have had been randomly assigned to another family.

A common, usually well-intentioned statement made to people who have experienced loss or hardship is, “It could have been worse.” Given the vastness of the human experience, it also could have been better.

Image: iStock

Updated 10/23/21

This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.