Kamis, 31 Januari 2013

Common Feelings From Trauma That Fuel PTSD Symptoms

When a traumatic event occurs, it shakes us to the core, often creating unanswered questions. In a futile attempt to gain answers to these questions, unique feelings arise as a means of making sense of the senseless event that occurred, leaving a mixed bag of feelings in its wake.

Simple truth, human beings want answers, crave control and aren't comfortable with the unknown. At its very root, traumas are events that are ultimately out of our control and cause us to feel powerless. This powerlessness can be overwhelming, so as a way to gain a false sense of control, it's in our very nature to create stories about the traumatic event and the pieces that don't make sense. We have a tendency to fill in the gaps of the traumatic experience that went against our moral code and way of being in the world. These usually inaccurate, fabricated answers to the gaps create intense feelings all in an attempt to answer the philosophical question of "why did this terrible event happen?" The seemingly benign question of why has the strength and tenacity to keep the symptoms of PTSD alive and well.

When we ask why to a phenomenon that we will never be able to truly have the answers for, we make up our own stories. These stories catalyze unhealthy beliefs and manufactured emotions that can override the natural feelings, making the healing process from the traumatic experience that much harder. Traumas can create two distinct emotional categories: natural and manufactured. Natural feelings are the emotions that most individuals would feel in that same situation. Whereas manufactured feelings are those that we create to help us make sense of the traumatic event even though they don't belong. Common natural feelings could be fear and sadness while common manufactured ones could be blame, shame and guilt.

Let's take a closer look. While deployed to Afghanistan, an individual, let's call him Charlie, was ordered by his Platoon Sergeant to drive the third truck whereas he usually was in the first vehicle. He questioned this decision as much as he could, creating a case that he knew the route, knew the potential dangers and hotspots. His command's decision remained. While on convoy, right before his eyes as if in slow motion, the first truck hit an IED. The explosion shook the entire convoy, however the only injuries were to those in the first truck, killing two and injuring three. One of the KIA was the driver who happened to be an expectant father, leaving theatre in three weeks to go home to see his wife and be there for the delivery, as well as Charlie's best friend.

Using this example, the natural feelings associated with this traumatic event could be sadness, fear and anger. This is where it then begins to get tricky. If asked what would the natural emotions be, most people would quickly answer saying guilt and blame as well as sadness and anger. Guilt and blame would be manufactured emotions in this case. It would be natural for Charlie to feel sorrow, grief, sadness, fear and anger over the loss of his friend. However, the guilt and blame that could easily be associated would be manufactured because Charlie did nothing wrong. The death of his friend was not his fault; there was no ill intent or malice. The only time guilt, blame or shame are natural is if the individual did something wrong and holds some responsibility. For example, if someone was at your house for a dinner party and stole your grandmother's heirloom necklace, guilt, shame or blame would be natural.

As Charlie is left reeling with the natural emotions of his loss, dependent upon how he processes them and how he handles the traumatic experience is paramount in stopping him from creating beliefs and man-made feelings. At this time, if he allows himself to ask why or any derivative of this question, he is walking a slippery slope towards making up stories and manufacturing feelings that could cause and/or increase the symptoms of PTSD.

Assuming Charlie is emotionally intelligent, gets into treatment quickly, is resilient, does not have complex trauma and has a strong support system, there is a good chance he will process the natural feelings organically while going through the cycle of grief and be able to see the experience as horrific but not take ownership of it.

Unfortunately, creating manufactured emotions happens all too easy. If Charlie is unable to work through the natural feelings and ends us asking himself, "why did this happen?" and starts replaying the experience over and over again in his head to make sense of it, there is a high likelihood that manufactured emotions will evolve.

How this might look in real life is that Charlie then spends each night the rest of his deployment sitting in his CHU thinking of his friend and what went wrong. The deep sorrow and grief then turn to guilt and shame as he begins to tell himself, "It should have been me." "It would have been better if it were me, I don't have kids." "I robbed his family." "I am failure." "I should have fought my NCO harder on driving the first truck." "If I was in the first truck I would have spotted the IED." And the list of toxic beliefs goes on, all as a way of trying to make sense of the traumatic event. Logically, not being in Charlie's situation, we can all see that none of his thoughts are accurate.

Manufactured emotions can also take the form of anger and fear. Charlie's fear and anger in the beginning made sense and were natural, but over time they evolved into manufactured feelings. How these evolve using the same example is that Charlie can then begin to feel powerless and fearful due to the constant threats while downrange and to make sense of this, he then projects hatred, anger and fear onto the world and specific populations at large. These may sound something like: "Muslims cannot be trusted." "The world is unsafe." "If I don't have my gun on me, I am in danger." "If I am hypervigilant, then I will be prepared and can stay safe." These even go on and remain while the solider is stateside, which is large in part as to what keeps the manufactured feelings alive.

Entertaining manufactured emotions is dangerous because they end up developing unhealthy beliefs about our self, the world and others. These maladaptive beliefs are called stuck points and they keep us stuck in our unhealthy thinking and being in the world, often magnifying the PTSD symptoms by acting like kerosene to a fire. Stuck points can be all consuming.

Stuck points are created by the manufactured emotions that arose from the traumatic experience and the stories created to make sense of it. Often when a trauma happens it goes against our way of being in the world. Most of us have been raised to believe that good things happen to good people and bad things happen to bad people, bad things don't really happen at all or they wouldn't happen to me. So if a trauma occurs, it can challenge our moral and philosophical compass, often causing us to either change our beliefs about our self, the world or both. "If something bad happened, it must be because I am bad and something is wrong with me," or "The world is now bad and can't be trusted like I thought it could."

In other words, based on the manufactured feelings these little pesky beliefs called stuck points are nurtured. Everything that Charlie was telling himself were stuck points. From his story, there are 10 stuck points that can be identified above. The good news is that there is evidence-based treatment that can help to unravel the stuck points, extinguish the manufactured emotions and process the natural feelings. It is called Cognitive Processing Therapy, a treatment specific towards PTSD that directly challenges the stuck points and manufactured emotions. If interested, look for a clinician certified in this treatment modality, it can truly help.

Even though this was only one example to illustrate how manufactured emotions are catalyzed, the same concept applies to any traumatic event. There are many common feelings associated with trauma and it's important to be able to identify the natural from the manufactured. Doing this can change the course of PTSD and its symptoms.

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