Triggering During the COVID-19 Outbreak: People with Complex PTSD
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?
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!
Photo by Amin Moshrefi on Unsplash
Instinct, Defense, and the Development of Complex Trauma
Pierre Janet (1859-1947) once wrote, “Traumas produce their disintegrating effects in proportion to their intensity, duration and repetition.” (1909) He was the first in a long line of clinician theorists who have attempted to explain what happens to the human condition as a result of enduring repeated, ongoing neglect and all manner of abuse.
Not All PTSD Is Created Equal
Pierre Janet (1859-1947) once wrote, “Traumas produce their disintegrating effects in proportion to their intensity, duration and repetition.” (1909) He was the first in a long line of clinician theorists who have attempted to explain what happens to the human condition as a result of enduring repeated, ongoing neglect and all manner of abuse. And though contemporary understandings have made PTSD a commonly recognized acronym, a majority of mental health professionals grapple with efficiently treating the complexity that PTSD often involves. Why? The simple answer is that not all PTSD is created equal. Here’s an illustration: Surviving the fallout from a fiery car crash (having previously enjoyed a trauma-free upbringing) is quite different from surviving the latest trauma of a fiery car crash given the backdrop of an abusive, neglectful and chaotic upbringing.
The roots of psychological disintegration that Pierre Janet so elegantly outlined for us come from an instinctual, desperate attempt to survive perceived threat. Humans (at any age) will do whatever is necessary to survive when escape from perceived threat is impossible. Infants cry instinctually in an attempt to get attention, so their physical survival is maximized. And when aggressors are much larger, the primacy of the fight instinct is abandoned for fleeing as the best way to cope. And when fleeing is not an option, what’s left is to submit and comply with the powerful other’s demands; submittal with analgesia (the body goes limp and internal endorphins are released) is the last survival strategy by instinct. These automatic survival processes are designed by nature to segregate traumatic experiences, especially severe and chronic ones. This process helps the survivor to most efficiently focus on daily life despite their trail of traumatic experiences.
The success of survival from chronic, perceived threat comes at the price of a disintegrated psyche via traumatic learning.
Traumatic learning is very difficult to undo because it holds strong survival value. Here’s an example: A child learns to wall off the realization that the parent who molests her late nights is the same parent smiling and making small talk at the breakfast table the next morning. This child cannot escape the molestations and must carry on a “normal” relationship with that parent. This girl who submits to and experiences the molestations may be remotely aware (or even unaware) of the one who makes small talk with her molester-parent at the breakfast table. This is but one possible effect of traumatic learning processes that are born out of an instinctually defensive purpose to survive.
How Do We Begin To Help Our Clients?
So where do we start as clinicians with treating such complex trauma? We start with gentle kindness, with friendly curiosity. We hold space for our clients’ confusion, their knowing and not knowing about what their past experience holds. And when the time is right, we reaffirm whatever the client had to do in order to survive was alright. That’s where we begin, and that’s where we stay as long as is necessary.
When we, as clinicians, understand these instinctually defensive roots of traumatic response, we can help our traumatized clients begin to stabilize their daily living and to build customized skill sets that address what is needed to eventually confront the realization of their traumas. Out of this process, our clients will eventually make sense of their trauma in terms of who they intend to become—not only as survivors, but also as thrivers.
Click the button below to learn more about how the treatment of PTSD can be achieved through EMDR Therapy.
Photo by Camila Quintero Franco on Unsplash