Triggering During the COVID-19 Outbreak: People with Complex PTSD

March 17, 2020

Governor of the State of California, Gavin Newsom issues a “stay in place” mandate until April 17, 2020, for all of California except for essential activities and services such as food take out and delivery, grocery store shopping, obtaining essential healthcare services, mail delivery, going to laundromats, etc. 

Week One

In my small corner of the world where I sit in my California psychotherapy office, still most of my clients have elected to come in for their regular therapy sessions. At initial check-in, some of my clients have been a bit rattled, but still doing alright. With dedication I have disinfected my sky blue pleather couch between sessions and offered Crabtree & Evelyn hand sanitizer before and after each meeting. I’m told my new ritual has had an effect of reassurance and caring.

Week Two Of The COVID-19 Mandate

My clients dealing with complex PTSD are mostly feeling pretty isolated and more triggered by the COVID-19 pandemic. Themes of isolation, helplessness, doom, lack of personal agency, and escalating anxiety are central. I look across my carved wood coffee table into red-faced countenances, forward-rounding shoulders, words of irritable disbelief about human nature, and eye sockets sometimes quickly tearing up at check-in.

Mitigating Triggers

With COVID-19 cases escalating, I see both obvious and subconsciously concealed similarity to threats and danger from past trauma; this all gets understandably triggered in a person’s complex PTSD. 

What can people who suffer from complex PTSD do to mitigate the sometimes sudden and intense triggering these days?   

I realize this blog may be bordering on therapeutic advice; however, I am simply trying to promote mental health and awareness in a time of crisis. People who may not have access to a therapist and who have histories of early, ongoing caregiver neglect, physical abuse, emotional abuse, and/or sexual victimization need to know it’s really understandable that they experience elevated triggering in these unprecedented times.

Nonetheless, here are my thoughts.

1. Calm down the nervous system first.

Common knowledge is that a heart rate below 94 beats per minute maximizes access to higher brain functionality in the cerebrum versus absorption into the emotional brain’s reasoning and strong influence. Diaphragmatic breathing or any sustained controlled breathing techniques will do a relatively quick reset for the nervous system to set itself at a lower idle. This opens up greater conscious brain capacity to adapt to the situation at hand.

2. Hold in mind and sustain the most adult perspective (that is connected to the grounded reality of present life).

Allow the five senses to perceive the moment’s reality: name things of a similar color in the room, register different sounds heard in the room, make saliva in the mouth, plant feet into the floor with arms hugging the torso (repeat several times), notice any scents or have pleasant soap to smell.

3. Thank what is inside the mind and body communicating a sense of threat and danger.

Express gratitude for the ongoing attention and care promoting survival that has persisted all these years. Be non-judgmental, friendly and curious about the messages offered in whatever form they appear--as much as possible.

4. Help what’s inside to know the difference between what’s past and what is now true in terms of the adult self’s:

ability to protect what happens to the body, where the body is now in point of fact, and how much the adult perspective can help bring what’s inside up to current knowledge with the times. Allow what’s inside to communicate their different reality perspective, fears, way of protecting the body, etc. Remember to be curious and friendly to the messages received from within. 

5. Be gentle with what’s inside please.

Through your adult perspective,  offer calm and certain reassurance that the body will be protected and cared for; after all, that’s the job of the adult self. What’s triggered inside has successfully accomplished the job of sounding the alarm. Now it can be time to rest inside new understandings.

Get Help If Needed

If you yourself are experiencing triggering due to COVID-19 fallout and are in imminent danger of harming yourself or others, please call 9-1-1. And if you have been struggling with complex PTSD, the mitigation of triggers suggested in this blog merely serve as a starting point to deal with the situation at hand. Please consider getting professional help to alleviate your symptoms and struggles related to complex PTSD.

The International Society for the Study of Trauma and Dissociation has as therapist referral link for you.

Be well, and please take all necessary precautions to keep your body as safe and protected as possible in these times of the COVID-19 spread amongst our global population. Your care and attention to this matter really makes a difference!

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Photo by Amin Moshrefi on Unsplash

What’s at the Heart of Trauma Resolution

When is it trauma?

So many of us have brushed aside the notion of being traumatized because our self-image, our self-talk, our reliable defensive stance in life don’t allow us to reflect inside. “It was my fault. I shouldn’t have been dressed that way. Maybe then they wouldn’t have followed me outta that bar and beaten me up…” is what I heard one new client referred by the Victim Witness Assistance Program tell me when speaking about their most recent hate crime.

My client didn’t consider themself a victim, and they were proud of that. I respected their personal experience of the beating, and I knew their take on it was protective for them. My understanding of their beating (which I didn’t share with them at intake) was that they had likely dissociated from the vulnerable feelings and sensations that were a part of the beating in that dark parking lot. While this client presented a more obvious story of trauma that therapy could, and would resolve, other traumas are less obvious…yet just as devastating to the mind-body psyche.

Interestingly, conscious awareness at the time of traumatic experience is not a prerequisite for people to [subconsciously] register experience as traumatic. At clinical intake, the psychotherapist may hear, “My childhood? Mine was just great. Wonderful parents! Funny thing though…I don’t remember anything specific about it now that you ask.” Only many sessions later may the therapist begin to discover the client’s abusive/neglectful childhood if there is one. This kind of dissociative process happens automatically as a built-in survival mechanism attendant to the human condition. Why? -----because we are built to cordon off that which we cannot metabolize consciously. And kids are especially susceptible to dissociating when life gets to be too taxing for their burgeoning personal psychology in the midst of abuse and/or repeated experiences of emotional neglect.

My client who had been beaten up did not begin to consciously register their trauma until they sensed it was safe enough with me to explore this possibility within a paced, therapeutically shared internal journey. Resolution of trauma came quite slowly. After careful clinical interviewing, it became apparent to me that this client had Dissociative Identity Disorder (DID), and we worked through a serious history of early trauma extending up to the present at age 21 years. Their trauma healing process took a handful of years altogether in therapy with me.

When does the trauma response cease to be triggered? 

Skilled therapeutic intervention is key to resolving trauma, and fortunately there is not just one method or modality to accomplish resolution of traumatic experiences! At the heart of mental/emotional trauma resolution is therapeutic memory reconsolidation as articulated by Bruce Ecker’s (2018) methodology literature review. Healed trauma cannot be re-triggered. It’s permanently gone. Erasure of memory’s traumatic aspects connected to the declarative (aka, factual) and episodic recall is complete. This is fantastic news!

At present, there are ten different therapy modalities that have the backing of published scientific research explaining therapeutic memory reconsolidation. Check the list out here.  These distinct therapies provide a framework for established best practices in the field of trauma psychology. The International Society for the Study of Trauma and Dissociation (ISST-D) has treatment guidelines for adults which can be found here, and for child treatment of trauma, the guidelines can be viewed here. Working within these guidelines leaves ample room for applying the various treatment modalities alluded to above. FYI, please look them up!

To be frank with you, in my early years of treating Complex PTSD and DID, I hardly knew how to recognize what the heart of the matter was with these clients! I definitely contributed to the well-known statistic of DID clients being in therapy for an average of seven years before being given an accurate diagnosis of DID.  Fortunately, I found ISST-D via one of my mentors, and my confidence in working with traumatized clients has blossomed over the years. I now utilize the treatment modality of EMDR as a framework with nearly all of my clients, and it requires a specialized, advanced application with traumatized persons. If you are a client needing trauma-informed care, or if you are a psychotherapist treating trauma, aren’t we so fortunate as seekers and deliverers of therapy at the current time when trauma truly can be healed! Please share this blog with anyone you know who may benefit.

Ecker, B. (2018). Clinical translation of memory reconsolidation research: Therapeutic methodology for transformational change by erasing implicit emotional learnings driving symptom production. International Journal of Neuropsychotherapy, 6(1), 1–92. doi: 10.12744/ijnpt.2018.0001-0092