This month I have decided to write about cPTSD (complex Post Traumatic Stress Disorder) which differs from PTSD in subtle ways. In broad terms, PTSD may result from a life-threatening experience or witnessing trauma resulting in death or life threatening in some way. It is generally a one-time event or of short duration – like a vehicle accident, plane crash, or natural disaster. War can fall into either category depending on duration and/or if there is a repeated threat to life.
War veterans (starting with WWI) have been the catalyst for studying and recognizing what was originally labelled shell shock. Soldiers were expected to recover from battle wounds and return to service unless permanently injured (e.g. loss of limb). Shell shock was not a visible, treatable wound; and therefore, soldiers were often shamed for what is now understood to be disabling PTSD.
Complex PTSD refers to repeated exposure to life-threatening situations over a period of time such as domestic violence (witnessing or experiencing partner abuse, child abuse/neglect), childhood trauma that impacts development (witnessing abuse or tragic event, loss of parent, bullying), or war crimes (genocide, Holocaust, prisoners of war, torture) to name a few. Both forms of PTSD deal with intrusive thoughts, flashbacks, nightmares/terrors, insomnia, cognitive impairments, depression, anxiety, self-isolation, and the like.
One webinar I watched differentiated between the variations of PTSD in terms of safety. In PTSD, there was a sense of safety that was destroyed and needs to be re-established. It’s disorienting because what was taken for granted as foundational to living is no longer reliable. For cPTSD, a sense of safety was never established and needs to be built from scratch – the foundation needs to be created, not rebuilt.
As one’s sense of safety was never properly developed, there is no starting point for re-establishing safety and security, and is often a foreign concept to grasp. The sense-of-self is constantly threatened and often negative or shame-based. Emotional flashbacks are also common and interfere with assessment of perceived or actual danger. In PTSD, the amygdala (danger detector of the brain) had a very real sense of danger that it can’t shake off and gets overlapped with the present. In cPTSD, the amygdala is always “on” – hyper-vigilant and highly sensitive without apparent reason – the triggering event is harder to ascertain and danger is perceived in harmless situations (no actual threat to life, but the amygdala is sending warnings as if there is reason to be ready to fight, flee, or freeze). In essence, we have significant trust issues because we never know when danger will strike.
In both cases, the amygdala needs to be reset to accurately assess for danger requiring fight, flight, or freeze responses. In an oversimplified nutshell, traumatic memories are improperly stored and need to be filed away appropriately to restore or establish stable functioning. Baseline functioning can be interrupted or impaired by triggers: sights, sounds, smells, words, images, etc. that elicit emotional and/or cognitive memories that feel like what is remembered is happening in real time. Our ability to differentiate past from present is impaired. Our recovery mantra becomes remembering, not reliving.
The reason I’ve chosen to write about cPTSD this month is that I had a ‘new’ symptom that took a couple days to figure out. Mid-month, I was experiencing excruciating pain in my lower back and left hip. One morning I could barely walk, and stairs were akin to climbing Mt Everest. I kept reviewing recent activity and couldn’t think of anything that would have pulled a muscle or strained a joint. By the second day and after no relief could be found via the usual treatments (baths, heat, ice, pain medications), I started journalling – revisiting prompts in Your Body Speaks Your Mind by Deb Shapiro.
The lightbulb moment occurred when I reread the connection between my particular area of physical pain and PTSD. So, I worked backwards looking for the trigger – the sensation that twigged my amygdala to sense danger where there was none and prompted my body to remember an unprocessed memory. Using the prompts in the book, I was able to identify the trigger: preparing for company for Sunday lunch – the cooking and cleaning – none of which was an imposition. And the visit was lovely and long overdue with members of my tribe – like-minded people who are trustworthy and true friends. Kinfolk in the figurative sense; or to use a phrase of Anne Shirley of Green Gables fame: kindred spirits.
The trigger puzzled me as it wasn’t the people or the visit – it was the preparations. My body/brain was remembering what it was like to cook & clean for and serve guests when I was a teenager. It was never by choice but required for survival. Always verbal, sometimes physical, abuse was part of the preparations for and execution of having guests over. And while often complimented on my abilities and service by guests, it landed skewed due to the circumstances. Pleasing people became necessary for survival (attempt to appease abusers) and for an externalized sense of self (what others thought of me over what I thought of myself). Remember that shame-based sense of self? External validation helps to appease its constant demands for ‘better.’ It becomes a vicious cycle.
My triggered body was informing me of unfinished business: I needed to complete the trauma loop to reprogram my amygdala. So, I set to work to do just that. I never again have to cook or clean or serve to gain anyone’s approval or appeasement. I cook and clean for my own purposes: genuine love & concern for myself and others, nourishment, hygiene, etc. I never have to be reminded of those former conditions to keep myself safe. I am free to cook and clean as I like – not for survival or for a sense of self via external validation.
I have been working hard on my healing journey to establish a sense of safety and security at my core. I know certain things about myself to be true regardless of external approval or lack thereof. I also have replaced the negative sense-of-self with a healthier, balanced one: recognizing my light and shadow sides – what I am capable of, both good and bad. But my core remains pure, untainted. It is my choice how I express myself and my values from that core – which always remains intact even when assaulted by tragedy or disapproval. Something I never knew until I did the hard work of trauma recovery – putting emotional and cognitive memories where they belong and filling the space left behind with accurate information.
To re-iterate, regardless of what my brain or body deals with, my core is safe. I had to get acquainted with it (my core) in order to establish that innermost sense of safety and security – a missed development stage involving basic attachment needs. Unlike PTSD, there isn’t a single memory or set of memories to contend with and file away appropriately. I am “constantly” facing triggers that I need to process and put in their place. It is a near daily experience on some level to reprogram my amygdala that it is remembering, not reliving. However, the return on investment is incalculable!
And so, I encourage my readers to consider how they have handled tragedy in their lives. What have you done to keep a healthy, balanced sense of self? How do you maintain a sense of safety and security deep within yourself regardless of what your brain or body experiences? Feel free to submit a comment or question or send an email.
This month’s blog entry is going to be a little different as it isn’t based upon discovering a theme in my journal entries for the past month. It is actually based upon conversations. I have talked about anxiety a lot this month. And I have never developed a handout exclusively about anxiety. So, I decided this blog entry would be an excellent springboard for both objectives: blog and handout.
Along with depression, I have struggled with anxiety my entire life. However, it was given a name a little further along the healing journey – and even further when it was added to my alphabet soup of diagnoses (GAD – Generalized Anxiety Disorder) and ‘treated’ in some form. Anxiety is somewhat challenging to address as it is many different things to different people; and it serves different purposes in the grand scheme of psychology. It can be both a symptom and a disorder in its own right. It can be a learned behaviour and part of faulty brain circuitry.
For the most part, I have seen anxiety as falling under the umbrella of trapped trauma response – namely the freeze response of flight, fright, or freeze – a way for our brains to ‘play dead’ – spinning our wheels instead of actually dealing with the threat. When we complete the trauma loop (see July 2024), we can help our bodies shake off the perceived threat and rejoin the land of the living, our tribe or community. But often our brains and bodies get stuck in hyper-vigilance – the facet of anxiety of being on high alert, always on the lookout for danger.
Or we overthink situations – what we said or did, what someone else said or did – looking for the missed cue or message that will get us in trouble or show us in a bad light. This is also a factor in OCD (Obsessive-Compulsive Disorder) – we get stuck in spiralling thoughts or think we must get something right in order to prevent something bad from happening. In a nutshell, anxiety in any form is a way our brains and bodies are communicating that something isn’t quite right – whether the unfinished business of trapped trauma, learned behaviour from being raised by anxious parents/guardians/systems, or survival mechanisms gone awry.
Regrettably, I have limited my therapeutic approach to anxiety through the lens of trapped trauma – if we complete the trauma loop, the anxiety should abate. It came to my attention this month, that the recovery from anxiety is much more nuanced than that; and I had to dig into my arsenal of personal coping strategies to assist some people. Above all, anxiety is about retraining the brain to recognize and/or manage perceived threats – the brain is in overdrive, and we need to help it downshift – to override the autopilot system. And often this is necessary before we can consider how the anxiety came to be in the first place.
There are a number of ways to downshift our anxious brains depending on the situation at hand. A few coping strategies (versus default mechanisms) will be explored briefly (in no particular order): the 3Rs; slowing the spiral to get to the centre of the cyclone; worry assessment formula; developing a fourth option to the default fight, flight, or freeze when danger is detected; deep breathing.
One of the first ‘tricks’ I learned in managing my anxiety was slowing down the spiralling thoughts and sensations to get to the underlying core belief fuelling the storm. At the centre of my cyclone or bottom of my spiralling thoughts was the belief that “I can’t do this.” The first time I used this trick, I had to ask my professor why he thought I could do the task at hand so that I could counter the flawed belief with “I can do this because…” Or as my counselling supervisor used to say to me: “You can do this – you are doing this” when I had doubts about my effectiveness as a counselling therapist. That belief that I was already doing what terrified me helped immensely.
A client recently shared with me a podcast clip that identified the antidote to anxiety was the statement: “I am capable” which totally fits with this ‘trick.’ The reason we are anxious is because we think we do not have what it takes to deal with the perceived threat (such as a challenging assignment or an intimidating boss or difficult co-worker or getting back into dating). When we switch up the inner dialogue to recognize we are capable to face our fear, it loses some of its fury.
Another approach is to identify the perceived threat: determining what the worst-case scenario is and developing a game plan of how to manage it. This is the worry assessment formula: 1) what is the worst-case scenario; 2) how likely is it to happen; 3) even if it has only a 1% chance of happening, what would I do? I used this formula without knowing about anxiety or coping strategies back when I was living in the Yukon and there was a case of West Nile Virus reported in southern AB (a long way from the Yukon!). While chances were low that I would contact West Nile Virus, if I did, there were two options: I would either die (and I believe in an afterlife, so was that really so terrible?), or I would be taken to hospital, receive treatment, and recover. This helped reduce my anxiety knowing I was capable of handling whatever came my way.
Sometimes, our thoughts spiral so out of control that we can’t think straight. In these moments, we may need to start with deep breathing in order to engage our parasympathetic nervous system (as our sympathetic nervous system is the one in overdrive when we are anxious). This type of breathing is called a few different things such as belly breathing, diaphragmatic breathing, or singer’s breath; but the principle is to inhale through the nose, hold it a moment, then exhale through the mouth. The idea is to breathe deeply past our lungs into our bellies (technically the diaphragm). My personal practise is to take three of these slow, deep breaths followed by checking in to our bodies to see if our parasympathetic nervous system has engaged (such as lower heart rate, regular breathing instead of hyperventilating, decreased shaking or trembling, lessened chest pain, etc.). If still agitated, take three more slow, deep breaths followed by another check-in. Repeat until body is in a normal, regulated state.
Once our brain is back online and functioning reasonably well, we can attempt coping strategies like the ones already mentioned or try practising the 3 Rs: Relabel, Revalue, Redirect. The full version is 4 steps (courtesy of Jeffery M. Schwartz in Brain Lock); but we tend to recall information in groups of three. So reducing it to only three things to remember sets ourselves up for success – and works just as well. When we catch our brains in an anxious mode, we can relabel the thought as intrusive (unwanted), revalue it as unhelpful, and redirect to a helpful or even neutral thought such as practising the mindfulness technique of taking note of your surroundings. If driving, take note of the objects in your car, the people with you, the scenery passing by. In any situation, you can take a moment to pay attention to your surroundings and identify what you see, hear, smell, touch, etc.
The Fourth Option ‘trick’ is usually most helpful when our anxiety is specifically trauma based rather than learned behaviour or a more general condition. The ‘tricks’ already mentioned can act as a ‘fourth option’ when we are trying to reprogram our amygdala to not overreact to perceived dangers based on past experience rather than the present moment. Sometimes our anxiety is actually an emotional flashback to previous trauma; and we need to take note that we are remembering and not reliving – grounding our self in the present moment by the mindful practice of paying attention by what we see, hear, taste, smell, etc. or to our current situation instead the traumatic one (such as no longer a vulnerable child, but an adult with choices).
A broader approach to anxiety is to understand it in terms of unmet attachment needs (see Nov 2023). As this blog is already pretty long, I will condense this last point by noting that when our early attachment needs are not sufficiently met, it hijacks our systems from developing a core sense of safety and security. In the absence of this solid core, the vacuum is filled with anxiety. We are always on high alert trying to ascertain how to keep ourselves safe and secure. In this way, it is a form of trapped trauma that can be addressed by identifying the unmet need(s) and figuring out how to meet that need retrospectively through inner child work and my version of narrative internal family systems (see Nov 2024).
Much of these tricks are what I use myself to manage my anxiety whether it is from trapped trauma, unmet attachment needs, my OCD, GAD, or cPTSD. Please let me know if any of these tricks are helpful for you. And please share any coping strategies that you have found helpful in managing your own anxiety. If you are one of the lucky few who doesn’t struggle with any form of anxiety, hopefully this blog sheds some light on what your friends, family members, peers, and others might be going through and feel free to encourage them to see how they are capable to meet the challenges and perceived threats that they face!
February has been an interesting month for me. I didn’t review the entire month’s journalling; but a theme surfaced none-the-less – that of shedding an old skin. Not sure how to unpack that, but we’ll see how this goes. I find it interesting that the beginning of the month marked the start of the Chinese Year of the Snake – a time of shedding the old, renewal & rebirth, energy shifts, deeper intuitive capacities, among other things (credit: Rewilding For Women). Spirit Daughter posted the year of the snake as “a time of rebirth, renewal, and transformation. The snake represents the death of all that doesn’t serve you so you can be reborn into a frequency that resonates with your soul.” While I didn’t know what this meant for me at the beginning of the month, it has become clearer as the month progressed.
Sparing you the details, I had two significant triggers this month in quick succession. I barely had the one sorted out before I was hit with another – albeit entirely different in nature. What makes this a challenge to unpack for you is that the person who triggered my trigger will likely be reading this – so I have to choose my words very carefully. As many of you know, I prefer the direct approach; but sometimes tact and diplomacy are called for – which means digging through old mental files of business communication and not just transcribing from my journal. 😊
Brief context: my bestest buddy, who is also my second cousin, attended the funeral of a mutual relative – technically a closer relation to me biologically, but not necessarily in familiarity. Hence, one of my cousins commented to this shared relative about my absence and, among her other various comments, noted that she was ‘concerned’ about me given what I had been writing in my blog. While this may seem innocuous to the casual observer, that ‘concern’ was the trigger word as it always comes with the implication that there is something not quite right with Barb. It’s hard to explain this given it is an emotional and body memory stored over decades of growing up in this extended family. To complicate matters, my subconscious was still processing this trigger two nights later in a very strange dream.
It is a family pattern to talk about others rather than directly to the member that is the subject of ‘concern.’ Sometimes word gets back to the member who is the subject of discussion, most times not. It is also possible to overhear conversations at gatherings. On occasion, these comments of ‘concern’ were made directly to me as a teenager – but with an indirect message. I definitely got the impression it was my responsibility to reassure the concerned family member rather than be the recipient of any actual assistance. The implied message was two-fold: there is something wrong with me; and I’d better not turn out “crazy” like my birth mother.
The irony is that I was born “crazy” like my mother in that we have shared mental health diagnoses (at least one with a genetic component). The difference is that there are two decades between our diagnoses (some of which have been inaccurate – for both of us) and hence treatment options. Of no credit to my family (extended or immediate), I did receive self-directed help via various channels since my mid-twenties – and accurate diagnoses have trickled into my lived experience as symptoms impacted daily functioning at various times and places. Fast forward to the dream.
The plotline of the dream was absurd, but the message was clear enough: I was a “hot mess” – a danger to myself and others. That phrase wasn’t in circulation during my formative years; and I may not fit the classic description of a person who is disheveled and confused (barring the photo of me on the ferry crossing between Labrador and Newfoundland in 2009 😊). However, it correlates with the message I received more than once well into my third decade: you have potential if only you could get your shit together. Sometimes those exact words, other times more diplomatic wording. A backhanded compliment, if you will. My thought was always: why don’t you/who is going to help me get my shit together? Obviously not the person giving that advice (including professors). Don’t you think if I had any idea how to get my shit together, I would? Who wants to struggle through life with what I referred to as my ‘broken brain’?
Last month, I wrote about my new discovery of being on the neurodivergent spectrum. But I felt different long before neurotypicals were a thing simply because I knew I didn’t see nor function in the world like my peers. I knew my brain operated differently due to depression and anxiety (except I didn’t have those words in my vocabulary). I could keep up, even excel, with my peers academically. It was how they interacted with each other and felt about their lives, etc., that had me baffled. None of them seemed to struggle with a low-mood disorder complicated by major depressive episodes (again, not words in my vocabulary at the time). I was simply different – an observation reinforced by these expressions of concern from extended family and others in my parents’ friend circle.
I was always being ‘watched’ – waiting for Barb to lose her shit like her birth mother. Therefore, it is somewhat ironic that people advised me to get my shit together in order to succeed. I didn’t even know where or what my shit was to either lose it or get it together! So, when I heard about my cousin’s ‘concern’ because of what she was reading in my blogs, it triggered a flood of hurt and self-doubt. It also reminded me of feeling unheard and unseen growing up. When I unpacked the dream of two-nights later, I realized I need to shed the identity of being a ‘hot mess.’
My ‘year of the snake’ is shedding the self-perception of being a hot mess, of needing to “get her shit together,” of proving herself worthy or ‘not crazy,’ of being less-than or defective, of being plagued with self-doubt and second-guessing, of being the black sheep of the family. It also means shedding the way I was raised, my parents’ worldview, and their guiding principles. Doesn’t mean I don’t have any, just that they are ones I have chosen myself; and they differ from my upbringing – which automatically makes them suspect to those who express ‘concern’ for me. In my estimation, they are less concerned for me per se and more for the beliefs I espouse and how it reflects upon my extended family. I understand that no one likes to hear their ideals may not be accurate or reflective of my lived experience. I am choosing to shed that which deeply damaged me. It is no longer mine to carry. Granted it makes certain people uncomfortable. That is their discomfort to deal with and not my responsibility to alleviate – even though that was my family role for decades (since a young child).
Even since writing this yesterday, I have discovered more layers to shed. It is a complicated process. But as I am opening myself up to other ways of seeing the world and being in it, I am getting stronger in my sense of self. That idea of having to lose something to gain something. I don’t know what the snake experiences in the process of shedding an old skin and growing a new one. I imagine it can’t be comfortable. However, there is also likely a sense of relief when the process is complete; and the snake can get on with its life – until it’s time to do it all again.
So while I have some reservations about posting this blog, my question for you is what comes to mind when you think of shedding old ways of being and thinking that no longer serve your highest good? Feel free to leave comments or email if you have anything you’d like to share or questions about this posting.
