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Thursday, 7 May 2015
Ways to deal with PTSD
Find ways to release.
Ways to deal with PTSD
“Always get your patients todothings.” —Milton Erickson
I recently read about some research that found that
or pushing a button increased tolerance to pain, but that
or hearing a recording of themselves or someone else
saying “Ow!” made no difference.
The researchers concluded that making some kind of vocal
may be an effective way of coping with pain, and they
described this as “distraction.”
However, I have a different interpretation of the results
of this study.
If pushing a button works as well as saying “Ow,” that
that a larger category of behavior than vocalization is
the key, namely taking some kind ofaction.
It may not matter what the action is, or whether it is
effective — only that the person is engaged
in some kind of activity in an attempt to cope with the
situation causing the pain.
This may result in “distraction,” but I think it is
different than simply attending to something
other than the pain. Many people who have been badly
injured in an accident feel little or no pain while actively attending to other
injured people or coping with the situation
— until they stop what they are doing.
Someone else responded to the article, describing the
effect as “releasing the feeling,”
but I think that is also misleading, implying that a
feeling is something tangible
that can be held onto or released, rather than an
The purpose of having pain or discomfort in response to
noxious events is to alert us
to take corrective action to protect the body. Saying
“Ow” is an action taken to alert others
and often to solicit their help; species that don’t help
each other don’t cry for help,
because it would do them no good. Once the action
commences, there is no need for the pain signal, and it makes sense to focus
attention on the action being taken.
I once knew someone who had been in the Peace Corps in
Walking on the beach, she got a nasty injury from a
fishbone in her foot.
The natives immediately got a mango and a knife, and told
her to stab the mango with the knife
to reduce the pain. I don’t think you have to use a knife
or a mango,
but taking some kind of action — particularly if it
mimics the mechanism of pain,
in this case stabbing in the same way that the fishbone
did — can make a difference.
Action and PTSD
Now let’s explore how this may be relevant to the
resolution of PTSD.
In a terrifying experience, there are 3 fundamental
categories of response,fight, flight,orfreeze.
The first two are actions, and whether or not they are
effective, they appear to protect against PTSD. However, freezing is theabsenceof action, and those who freeze are
most likely to suffer PTSD later.
For over nine years I was an emergency “first responder”
for our rural volunteer fire department, responding to accidents and medical
emergencies as well as fighting fires.
Quite often I would arrive on the scene to find someone
unmoving, staring into space,
not able to do anything in response to what had happened.
They surely had read about accidents and emergencies, but
they had never thought
it could happen to them, so they were totally unprepared,
The broader message is that being prepared todosomething in a terrifying situation is
important. Undoubtedly there are a few situations in which doing nothing is the
best — or the only — option.
But generally speaking, doing something — even if
it’s not the best thing —
at least has the possibility of coping with a difficult
situation. It will usually have a better chance
than doing nothing, and it will probably protect from
developing PTSD later.
When someone has PTSD, a “flashback” memory is usually
understood to be a terrifying one.
However a flashback can also be to a memory
with more positive emotions,
as described in Wikipedia:
“Aflashbulb memoryis a highly detailed, exceptionally
vivid ‘snapshot’ of the moment
and circumstances in which a piece of surprising and
(or emotionally arousing) news was heard.”
“Aflashback, or involuntary recurrent
memory, is a psychological phenomenon
in which an individual has a sudden, usually powerful,
re-experiencing of a past experience
or elements of a past experience. These experiences can
be happy, sad, exciting,
or any other emotion. The term is used particularly when
the memory is recalled involuntarily,
and/or when it is so intense that the
person ‘relives’ the experience,
unable to fully recognize it as memory and not something
that is happening in ‘real time.’ ”
Some time ago I started thinking about positive flashback
wondering what we might learn from them that we could
to the resolution of negative flashbacks. Let’s start
with a few examples.
Positive Flashback Memories
1. When I was in my mid-20’s, living in the San Francisco
Bay area, I did a lot of sailing on the bay
in a 14’ boat. One afternoon I was far out on the bay,
happily “planing” in which the boat skims across the surface of the water,
going much faster than usual. My toes were hooked under the lip
of the centerboard housing, and most of the rest of my
body “hiked out” to balance the boat,
as shown in the photo below.
And then my toes slipped, and I tumbled backward into the
Now, a half-century later, I still have a vivid snapshot
of the moment
when I was about 3 feet under the surface of the water,
looking up at an oval of sky framed by a transparent wall
of water all around it,
just before the water closed in over my body.
I am laughing uncontrollably at the shift from supreme
confidence and skill to utter chagrin.
2. One afternoon in fall, I walked out on our back deck
and saw a large black bear
about 20 feet up in the ash tree about 25 feet away from
Another 25 feet away was my wife, Connirae, who was
leaning down to check our tomato plants, obviously not aware of the bear. I
thought she ought to know about it, so I called out her name.
My voice frightened the bear, which slid quickly down the
trunk of the tree
and rushed away from me—and directly toward Connirae.
Connirae stood up and turned toward me to see what I was
calling about—and there was the bear, charging directly toward her, only a few
Before Connirae had time to recognize it was a bear, she
was looking into its eyes,
which were also looking right at her. It looked
and Connirae felt instant compassion for the poor
creature, rather than fear.
3. Walking up a narrow rocky trail from a delightful swim
in the clear creek at the bottom
of the canyon. I suddenly found myself about 3 feet to
the right of the trail
where I had been walking. Only then did I become aware of
the rattlesnake coiled right in the trail, which was now to my left. I was very
alert, but not afraid.
I walked around to get past the snake and continued up
In the first example, I was able to have an enjoyable
response because of my knowledge
and experience. I knew how to swim, and I also knew that
since I had released the rope
that held the sail, the boat would immediately head into
the wind and drift slowly,
so that I could easily swim to it, get in, and continue
Someone without this knowledge probably would have been
terrified of drowning,
but I had only the surprise of being unceremoniously
In the second example, Connirae saw a relevant aspect of
the rushing bear
that most people might not have noticed, so she had an
unusually resourceful response
in what would otherwise have been a very scary
By the time Connirae realized it was a bear, it had
dropped on its haunches, skidded to a stop,
and turned 90 degrees to run away from her. She was
thankful that the bear saw her
before she saw the bear, because “The bear became afraid
before I had a chance to.”
In the last example I must have unconsciously seen the
rattlesnake and taken appropriate action, long before my conscious mind caught
up with what was happening.
I had a lot of experience with rattlesnakes from my
childhood on a ranch in Arizona,
so I knew what to do, and no thinking or deciding was
In the first example, myknowledgeandexperienceprotected me from terror,
in the second, Connirae’s perceptionprotected her,
and in the third, myperceptionandactionprotected me.
It’s important to realize that in all three examples no
conscious thinking or decision process
was involved. Now let’s explore how this information can
be used with PTSD.
Resolving Negative Flashback
When someone has a terrifying flashback experience, they
are always back inside the experience, reliving it, re-experiencing the
feelings that they had in the original.
The first thing to do is teach them how to re-view the
same experience in a different way,
namely as an outside observer watching themselves go
(This process is probably very familiar to most readers
of this blog,
demonstrated in an 8-minutevideoon YouTube, made over 30 years ago.
This process is also demonstrated in a 14-minutevideowith an Iraq vet.)
After this process, the client has a neutral emotional
response to the flashback memory.
Although this process resolves the memory by eliminating
it doesn’t teach someone how to respond more
resourcefully to any future repetition
of the terrifying event. If something similar to the
flashback event were to happen in the future,
they would be just as unprepared as they were the first
Creating a More Positive
If we create an alternative movie in which we respond
and rehearse it in our imagination, that can prepare us
for any potential repetition
of a troublesome event. The primary purpose of this is to
program us with alternate ways
to cope with a similar event if it were to occur in the
We will also feel more secure about our capability in the
but that is a secondary benefit. The instruction for
creating a new scenario is fairly simple,
but certain criteria need to be met for it to be really
Selecting, Eliciting, and
Rehearsing a New Response
“I want you to recall the event that was terrifying.
Without directly changing
anything external to you,
how couldyourespond differently to lessen the
negative impact of that event, neutralize it,
or possibly even make it positive? This could include any
additional preparation, knowledge, understanding, perception, or action that iswithin your control.
The goal is to make you more resourceful and empowered in
responding to that kind of event
in case something like it ever happens to you again.
“Here are some examples of what I mean. You already know
that something like this
could happen to you, so that knowledge is already one
kind of preparation.
You also know that you survived that event, so that is
additional preparation for any repetition. Instead of tensing up just before
the crash, you could relax instead,
so that your body is more supple and less likely to be
You could raise your arm to ward off the assailant’s blow
to protect your head.
You could smile at the mugger and ask him for the time,
hoping that might puzzle and distract him. You could deliberately misunderstand
what someone else said.
You could perceive the signs that warn you of danger, or
refuse an invitation,
avoiding the event altogether.
“A thorough search of alternative actions will usually
turn up many, many possibilities,
and some of the most uncommon or bizarre ones may be the
in changing the impact of that situation. If your
creativity runs down,
ask others for help in generating additional
possibilities. After an extensive search,
you may still conclude that doing nothing was actually
the best option in that situation.
If so, make freezing into a choice, rather than a
default—something that you do,
rather than the absence of doing.
“When you have identified something that you coulddodifferently,
create a scenario of you doing that in the context, with
you inside the movie,
looking out from your own eyes as the event unfolds. As
you imagine doing something different,
it is fine if that changes the situation indirectly—for
instance someone else involved
may respond differently to what you did differently.
“If you were to imagine a scenario in which external
events are directly changed
(for instance, a rescuer enters the scene, or the
assailant does something different on his own, etc.) since those changes are
not under your control, they would be useless in any future repetition
of the event. Furthermore, changing external events
implies that you arenotable to influence
the situation yourself, theoppositeof empowerment.
“If you make a change that is within your control (such
as refusing an offer of a ride home)
that may change external events through changed
consequences (no rape/assault).
This is a legitimate and very useful change, especially
if is based on specific sensory warning cues that were available but that you
ignored in the original event.
“In his really excellent book, TheGift of Fear,
Gavin de Becker teaches assault victims
what cues to search for in the original event, in order
to protect themselves from a future repetition. After doing this with a woman
who was brutally raped, and barely escaped being murdered,
she said something like, ‘You know, it’s funny, but I
feel safer now than I did before the assault.’
“When you have created a new scenario that changes the
impact of an event, test it in your imagination to be sure that it has the
desired effect, and find out if you can improve it in any way. Then create at
least two additional alternative scenarios — the more the better — and test
them in your experience, to be sure they are effective in reducing the negative
impact of the event.”
Carefully rehearsing a variety of more positive
alternative scenarios in this way prepares you
to respond resourcefully with unconscious choices. When
done thoroughly, this prepares you
to respond to any repetition with a variety of actions
for coping with a difficult situation,
reduce its harmful impacts, and at the very least it
should protect you from a recurrence of PTSD.