We all come across things that trigger difficult memories, but for people with PTSD, these memories jumpstart a cascade of internal events that washes on panic, horror, or rage.
Then there are the triggered thoughts. Sometimes they’re clear and distressing (“it’s happening all over again” or “I deserve this”), at other times a jumbled mess of painful words and images that don’t materialize into something cohesive.
The feelings and thoughts leave the sufferer in a horrible place. Their world tips sideways and they feel like they’re slipping off the edge.
In PTSD, these memories are linked to traumatic events from the past, a castrophic moment in life that balloons out of control every time there’s a trigger.
So how does a person with PTSD navigate through these triggers? Here are some methods that can help with those difficult moments.
Immediate rescue: ground yourself.
“Grounding” is a technique that brings attention back to the present, allowing you to create space between the effect of the trigger and you. It’s a profoundly effective do-it-yourself intervention that everyone with PTSD should have in their toolbox.
Triggers carry us to the past, a roller-coaster trip of places we don’t want to go. They also make us worry about a doubtful future. Everything looks bleak. When this happens, when the past is so painful it’s intolerable and the future is so scary you’re not ready to go there, focus on the now.
Now is the present moment, a new moment in life, where you can stand and breathe in safety. Now is the way the ground feels beneath your feet, solid and ever-present. Now is the way the sun cascades through the trees, casting a flurry of light patterns across the forest floor, light and shadow dancing back and forth and reminding you that nature can be stunning. Now is the cat that climbs up on your lap, its fur soft, the vibration of its purr roaring softly, the honor it grants as it allows you a moment of friendship.
There are different ways to find the now. The above is an example of mindfulness. Other methods include muscle relaxation and meditation. Muscle relaxation involves focusing on your physical sensations to the exclusion of everything else, relaxing one part of your body at a time until you’re fully relaxed; this helps pull you away from the hurt. Where your body goes, your mind follows. Meditation is about focusing on the breath, inhaling and exhaling with the abdomen, comfortably, imagining all negative energy leaving the body with each exhale.
As you practice mindfulness, muscle-relaxation, or meditation, give yourself permission to put aside the effects of the trigger and focus on the moment. Troubling feelings, images, thoughts, and sensations will probably waver into consciousness; when this happens, relax, acknowledge them as if they were distant objects, then let them go and bring yourself back to the moment. You’ll find the upsetting emotion and cognitions lose their power over you.
Preventing: rewrite those thoughts.
A super way to deal with triggers is cognitive therapy (CT). In CT, also called cognitive behavioral therapy (CBT), you work to rewrite troublesome thoughts and experiences into something both uplifting and reality-based. That is, by changing your thinking patterns, you can change your emotional reactions to triggers.
For example, if a helicopter reminds you of combat, your first thought when hearing a helicopter might be that you’re in danger. But thoughts like, “I’m not safe,” or “that helicopter sound always brings on my PTSD” only make the symptoms worse. These are considered problem thoughts. The goal is to replace them with healthier, realistic, more helpful thoughts.
Restructuring the cognition in real-life CT involves multiple steps, but here’s simplified version:
(1) Identify the trigger and problem thought (which isn’t always easy)
(2) Review evidence for and against that thought
(3) Rewrite the thought using the new information (i.e. find new ways to think about things)
In the scenario of the helicopter, using CT a person might conclude: “This trigger is a false warning sign. There’s no danger here. I can come back to the present moment, remember I’m safe, and feel fine. The sound of a helicopter doesn’t have to cause my PTSD to act up.”
There are numerous helpful CT self-help books and online websites that teach the technique, but if you find yourself stuck in a circular thought system without seeing a way out, consider seeing a therapist.
Exposure therapy is about confronting the trigger until it doesn’t cause any problems. It’s best not to confront what’s bothering you without professional help, especially if the trigger is all-encompassing or dangerous.
One kind of exposure therapy is called “graduated exposure.” First, the individual learns various methods to deal with anxiety, especially grounding techniques (see above). Second, exposure is done slowly in a step-wise fashion, from least threatening to most. For example, if the trigger is a dangerous dog that attacked you, exposure therapy would be approached by doing the following:
(1) Think about dogs every day for 20 minutes x 7 days, then
(2) Look at photographs x 7 days, then
(3) Listen to tapes of dogs barking x 7 days, then
(4) See a dog in the distance x 7 days, then
(5) See a dog through a glass door x 7 days, then
(6) See the dangerous dog through a glass door x 7 days
The anxiety might worsen before it improves, but improvement is usually dramatic. There are circumstances where direct exposure is unrealistic or dangerous. In that case, therapists use imagery and symbolism.
Confronting: use a journal
For some people, exposure therapy comes in the guise of journaling, and journaling can be very effective for PTSD. First, make sure you’re well-versed in grounding techniques, as confronting the past can bring up a lot of emotion. Next, buy yourself a notebook and pen. The final step, start writing. Give yourself twenty minutes/day, if you can.
Write about the trauma, and write repeatedly. Scream, cry, do what you must do, but bring out the details, your deepest feelings and thoughts, and get them on paper. Try to be as descriptive as possible. As you find yourself progressing though the experience, consider the following questions:
- What happened, and how did it make you feel, physically and emotionally?
- How does the experience affect your life now?
- What do you wish you could change about the experience?
- What did you learn from the experience, good and bad?
Finally, look for evidence of post-traumatic growth in your life. This can be challenging, but consider the following questions to help you find that “cloud with a silver lining.”
- How have you healed since the traumatic event?
- What good things has PTSD taught you, if anything?
- Are there ways you’re using your experience to help others?
- How are you a survivor instead of a victim?
- What strength got you through? (Remember your ability to survive is a strength).
Even if you can’t find that cloud with a silver lining, just processing the experience on paper helps you conquer it. Write about the same aspect of the trauma every day until you feel like you’ve reached the other side: healing.
With time, the trauma not only loosens its hold on you, but you usually find peace. However, if you find that journaling makes things worse, no matter how much effort you put into it, it’s best to process the trauma with a professional.
Avoiding: work the trigger out of your life.
Sometimes, no matter how many times a person confronts the trigger, their reaction doesn’t get better. In that case, one option is to reduce or avoid exposure altogether.
This could include avoiding the news, cutting a particular person out of your life, staying away from a restaurant or park that sets you off, or “refusing to engage” a certain thought when it comes up. If a movie brings on a bad memory, turn it off or leave the room. If it’s a certain subject of conversation that bothers you, pull the discussion in a different direction; if this doesn’t work, say, “Sorry, let’s talk about something else.” If the person refuses to change the subject, get up and leave.
Some people make radical decisions to avoid triggers. They move out into the country where it’s simple: they don’t have to deal with people. If this is what you need, do it.
Preparing: dealing with unavoidable triggers.
Some triggers are unavoidable. When you know it’s up ahead, your best bet is to plan for it in advance. Keep exposure brief and to the point. Plan what you’re going to say and not say. Decide what you can do to stay calm. Organize your exit strategy before you even get there. Consider using imagery exercises to desensitize yourself to an upcoming situation. Carry your kids’ photos in your wallet to remind yourself of who you are during those tough moments. For example, for those nights your parents insist on watching their favorite horror movie, the kind that gives you nightmares, bring along headphones to listen to music. Another example, plan a well-timed phone call to help you escape from a family reunion you couldn’t avoid.
Unexpected triggers are more challenging, like a song at a club or the scent of a man’s cologne as he walks by. In this case, use grounding techniques or distraction to maintain function and stay in control. If there’s a certain place where specific unexpected triggers tend to crop up, keep that in mind. Sometimes just knowing that this trigger might happen makes it easier to deal with.
It isn’t easy. Coming to terms with PTSD triggers is a process that takes time. Grounding techniques only become effective with practice. PTSD and its associated cognitions and triggers make for a complex framework, and it takes abundant CBT and exposure therapy to gain control. Avoiding triggers isn’t always possible. Coping skills have to be practiced and then some.
But, as a psychiatrist, I’ve seen people heal tremendously using these techniques. The biggest suggestion, then, is to have hope and never give up.
For more information about PTSD, check out trauma-related disorders and PTSD: dealing with nightmares. If you have PTSD and your symptoms or triggers are all-encompassing and debilitating, please seek professional help. There are many treatments available, including eye movement desensitization and reprocessing (EMDR), exposure therapy, CBT, cognitive reprocessing therapy, and medications.
“Sometimes the smallest step in the right direction ends up being the biggest step of your life. Tip toe if you must, but take that step.” –Naeem Callaway