Andrew L. Martin, PsyD
This is the second article in a series on post-traumatic stress disorder, or PTSD. In this article we explore how post-traumatic stress symptoms might develop after a traumatic event.
PTSD symptoms develop when there is a mismatch between two things – 1) the way our mind sees the world; and 2) something that happens to us. For example, our mind may see the world as a place where we can prevent all negative things from happening to us. But then something happens that is out of our control – like an automobile collision we couldn’t avoid, or a physical assault or illness we couldn’t prevent. Suddenly, there is a mismatch, or conflict, in our thoughts – a conflict between the way our mind sees the world, and the traumatic event that happened.
Our minds deal with that conflict in different ways. Sometimes, in an attempt to keep things simple, our mind switches from one belief to its exact opposite – for example, “the world is totally safe,” becomes, “the world is totally dangerous.” This way of thinking leads to symptoms of anxiety, restlessness, and fear and avoidance.
Or, maybe our mind tries to change the memory of the traumatic event. It tries to change the way it views the event, so it matches the way it views the world. In other words, we begin to experience thoughts that the traumatic event was our fault, for example, “I should have prevented it,” “I shouldn’t have drove that day,” or, “I shouldn’t have worn that dress.” This lets our mind keep the view that the world is safe, and that nothing negative can happen to us without our having some control over it. Now, we just need to figure out what we did wrong to cause the traumatic event, then we can prevent such future events. But that never happens because the event wasn’t our fault. The event happened to us. Changing the memory of the event leads to symptoms of guilt, shame, and frustration toward ourselves.
Whether our mind changes its view of the world too much, or it changes its memory of the event, life becomes more difficult. We might begin crying even though the day has not been stressful, or we may not want to get out of bed in the morning or drive in traffic, or we might start doubting our ability to make decisions. We may avoid anything that might remind us of the traumatic event. And when we are reminded of the event, we feel intense distress, or panicked. Without realizing it, we start avoiding things that might remind us of the event, so that we can avoid the distress and panic. But as long as we avoid thinking about the event, or we struggle with distress and panic, we don’t have a chance to feel our natural feelings, like anger, sadness, or grief, and we wind up carrying around a lot of emotional pain.
The ideal way to resolve the conflict – and this is what psychotherapy does – is to change the way our mind sees the world just enough to incorporate what happened to us. The new way of thinking might sound like this – “Negative things can happen to me without my having control over them. Thankfully, those situations are very rare, so I don’t need to see the world as totally dangerous. And it’s not my fault that the event happened. It’s just something that happened TO me.” Seeing the world more realistically is often accompanied by feelings of sadness, but then a feeling of peace, and strength. Seeing the event more realistically allows natural emotions to finally emerge and rapidly dissipate.
It is normal for our minds to overestimate both our sense of safety, and our ability to control negative events. And if something small happens, like stubbing our toe, and our mind over-blames us, it doesn’t matter much. But if something really big happens, like an assault or death, then over-blaming ourselves can lead to significant anxiety and distress. We can change our thinking. It takes some practice and skill-building, but we can become aware of our automatic or unconscious thoughts, challenge them, and replace them. With the change in thoughts comes a change in feelings, and reduced PTSD symptoms.
In the next article, we will explore how psychotherapy addresses and fixes the causes of PTSD symptoms.
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Ref: Resick, P. A., Monson, C. M., & Chard, K. M. (2016). Cognitive processing therapy for PTSD: A comprehensive manual. Guilford Publications.