Complex PTSD Sufferers, A Question About Exposure Therapy For You

[evergreen]

I want to talk to the sufferers here with Complex PTSD. I am one also.

Have you tried Exposure Therapy? What was it like for you?

Do you use a safe space for when you are triggered?



I believe in a period of avoiding triggers and a very slow method of Exposure Therapy. The problem with Complex PTSD is that there is no healthy person to reflect on that existed prior to trauma. It is virtually impossible to navigate triggered emotions if there is no emotional safe place to return to. What I have found to be helpful to me was to eliminate as many triggers from my life as possible for a period of time in order to establish what peace actually feels like. Of course, I didn't have the mentality that I was hiding out from the big bad world while I gave myself this peace either. I knew full well that I was looking for peace that I could remember for when I battled the Exposure Therapy.

My theory is that if we are traumatized as a very young child at the stages where we learn trust and independence, it is likely we did not gain the tools for these things. Therefore, we are left with nothing but the emotions and thought processes of this young child when we are triggered. Would we throw a screaming scared baby to the wolves so she can learn it will be ok? Of course not. So why is this expected of those with CPTSD?

I think it is impossible for suffers of PTSD to understand this. That is why I am specifically asking the CPTSD sufferers what their experiences have been. What do you think?

 

[dust]

Hi Evergreen,

my therapist doesn't really believe in DSM categories, and I have never asked. But my stuff started very early, I have amnesia and I dissociate regularly.

I think there are many things to say about your post. I had EMDR - I think that is an exposure therapy. It relieved me of many of my most painful and distressing symptoms. I am continuing with psychotherapy and continue to get triggered by the therapist nearly each time we meet. I think that the presence of the therapist in this scenario means that the 5, 7, 8 year old who is being 'exposed' to their own trauma, does so with the guidance of someone who is there to support and help them through - unlike the first time round, when there were probably no responsible adults. I think, for me, the idea of witness has also been important - the therapist as witness to the traumas and there is some resolution in that as a process. I can cry as a 5 year old and be treated with the empathy and kindness that should have been there when I was a child.

I sometimes have really deep existential crises about my identity and 'self'. I think I am getting to more of a sense of that self as I progress. My

Do any of these ramblings make sense?

dust

 

[Dylan]

Hi Evergreen,

Interesting post - thank you.

I agree that if the CPTSD sufferer is in crisis, the first order of business is to lower their threshold of crisis (perceived and actual external and internal safety, situational triggers minimized, etc). If this isn't done, it's taking someone in complete overwhelm and adding more - proving to their brains that being in survival mode IS the best way to operate. Pouring gasoline on a fire won't put out the fire - will, in fact, just fuel it.

After the crisis has been addressed, then exposure therapy with a LOT of support. In Judith Herman's incredible book on CPTSD (Trauma and Recovery: The Aftermath of Violence from Domestic Abuse to Political Terror), she at one point explains that getting a person out of that first stage, acute crisis, can take many months. It all depends on the individual.

When I was going through EMDR, I was in a pretty steady state, was seeing two therapists (one for EMDR and one for coping skills/talk therapy), was in a support group (ISA - incest survivors anonymous), and had the support of a mentor-like relationship with a very balanced and steady friend. My career was steady with no additional stressors. I had a LOT of unstructured time which I think was very important to my ability to keep processing without going over the edge. Even with all that, it was extremely rocky and difficult.

So, that said, I don't know that the approach should be different between PTSD and CPTSD: get the person safe and stable, then start the work.

I do think that there are issues unique to CPTSD, but the need to feel safe is as universal as it is primitive. Whether it takes more/longer for a CPTSD person to feel safe than it does a PTSD person, I don't know. I think that may be more individual. I say that despite the fact that my sense of safety in the world was shattered even before it was really formed, because I've read books like, "A Boy Called It" who may well have developed CPTSD, but didn't. I, on the other hand, had such extreme depersonalization that, at its worst, I wasn't sure if I was the couch I was sitting on or the cloud out my window; I had almost no existing sense of self left. At the end of the day, we're so very complex....it's just hard to say.


-Dylan

 

[zoe]

Personally, I think life is exposure therapy for someone with PTSD or CPTSD ,and that no one should go through it alone.

I have no "before" to work from. I only have what I see and what I believe life should be like. It is extremely difficult. As far as the " exposure therapy" I think you are referring to...I agree that one must go at there own speed and have much support. There is a difference between being thrown to the wolves and slowing pushing forward.

It sounds like Dylan was wise and lined up a lot of support - even then it was hard. I have some support, but I don't think there is ever enough. I guess we just do the best we can.

Take care of yourself,

Zoe

 

[sigh]

I think you have to establish a safe place first--whether it is real (home, a room, in bed under the covers) or figurative (one of my peoples in my head maybe with a stuffie). My new therapists office will hopefully be a place of safety... It's dicey because for me, places like my home, my mother's home, my brother's home, and all the people in my life are not safe people. I'm trying to do the exposure diary here for a couple of reasons. One, I don't know you guys IRL, I don't expect you'll hunt me down. Two, I don't know your judgment so if I don't like something I can take it or leave it. Sometimes someone here says something that's very true that I just don't want to know about--but it's there.

Exposure therapy in vivo? I am not going to see my father again. I am not going to have a confrontation with him so I can be beaten down while trying to stand up.

 

[Dylan]

I found this on Wikipedia and thought it summed it up rather well:

"A differentiation between the diagnostic category of C-PTSD and that of post traumatic stress disorder (PTSD) has been suggested. C-PTSD better describes the pervasive negative impact of chronic repetitive trauma than does PTSD alone.


PTSD descriptions fail to capture some of the core characteristics of C-PTSD. These elements include captivity, psychological fragmentation, the loss of a sense of safety, trust, and self-worth, as well as the tendency to be revictimized, and, most importantly, the loss of a coherent sense of self. It is this loss of a coherent sense of self, and the ensuing symptom profile, that most pointedly differentiates C-PTSD from PTSD.


C-PTSD is characterized by pervasive insecure attachment."

And under treatment:

Treatment for adults

Herman believes recovery from C-PTSD occurs in three stages. These are: establishing safety, remembrance and mourning for what was lost, and reconnecting with community and more broadly, society. Herman believes recovery can only occur within a healing relationship and only if the survivor is empowered by that relationship.
Complex trauma means complex reactions and this leads to complex treatments. Hence treatment for C-PTSD requires a multi-modal approach. It has been suggested that treatment for C-PTSD should differ from treatment for PTSD by focusing on problems that cause more functional impairment than the PTSD symptoms. These problems include emotional dysregulation, dissociation, and interpersonal problems. Six suggested core components of complex trauma treatment include:

1. Safety
2. Self-regulation
3. Self-reflective information processing
4. Traumatic experiences integration
5. Relational engagement
6. Positive affect enhancement

Multiple treatments have been suggested for C-PTSD. Among these treatments are experiential and emotionally focused therapy, internal family system therapy, sensorimotor psychotherapy, cognitive behavioral therapy, eye movement desensitizations and reprocessing, family systems therapy and group therapy"
http://en.wikipedia.org/wiki/Complex_post-traumatic_stress_disorder#cite_note-41

 

[sigh]

Herman Is Good While Wikipedia...

Let's just say I won't be looking for my license plate on it.

I think those things may be true. I have CPTSD. But I also feel that if a child whose ego is not formed undergoes trauma, it may effect them in a kind of CPTSD way. So I believe it is a spectrum.

But I do feel that others with CPTSD understand what that prisoner like feeling is more than someone whose undergone a traumatic event.

s.
Ah. Whatever.

 

[BlankCanvas]

I have been going through exposure therapy for about a year now. I've taken a lot of breaks along the way to work on other day-to-day coping skills. I started using my bedroom as a safe space when triggered, but I've noticed that it's causing a lot of difficulties now that I'm doing a bit better and have started to consider things like traveling, staying over with friends, etc. I think the key to getting passed this is to make my 'safe place' somewhere that is in my mind, not a physical space. I've worked on visualization techniques to develop this peaceful/calm place in my mind, but it really only works if you practice consistently (something I have a problem with).

Insightful thread, I rarely think about the differences between C-PTSD/PTSD. Good read, thanks guys and girls.

 

[kers]

So, that said, I don't know that the approach should be different between PTSD and CPTSD: get the person safe and stable, then start the work.

In my experience, to a large extent, getting safe and stable is the work. Just being in therapy provides me with endless triggers to work on! But I think that while there's no 'pre-trauma' me to reflect on, I can build a version of that today. At least for me, I feel like therapy provides a re-do on the trust building and safety I missed out on as a kid.

I think the key to getting passed this is to make my 'safe place' somewhere that is in my mind, not a physical space.

This is such a good point. I was so annoyed when my therapist had me visualize an imaginary place (which is safer than any real place, since it's only in your own head), but I really return to it when I need to calm myself now.

 

[dust]

Personally, I think life is exposure therapy for someone with PTSD or CPTSD ,and that no one should go through it alone.

This really rang true with me - I see my whole life as a form of exposure therapy... getting to work, going out, touching other people, reading the news, engaging with politics, being in a relationship... things that other people take for granted are triggers for us. I started this fight with lots of zeal. I have more energy now, but sometimes I feel less inclined to constantly face the things I feel naturally inclined to avoid. EXHAUSTING!

dust

 

[sigh]

I was just at this Mexican Dive Restaurant. I was talking to the guy in spanish about what kind of drinks he had. And then my boyfriend (whom I normally think of as a safe guy) came up behind me and said "eehhh. She can't speak spanish. Don't listen to her."

#1 I can.
And #2 hearing the "dont listen to her" crap just threw me on my butt. I know he was joking, but I get really defensive and down when I hear comments like that.

I am sooooooo sensitive I cannot blow it off.

So safe for me is internal. And it's a place not a person. And an animal, not someone who speaks. I can't risk abandonment. I can't suffer through antagonism.

In so far as making my t's place safe. Well, it's the little things. What she has. That she always offers me water (I'm always thirsty). That she's got morning glorys outside and a sunflower by her door. Somehow *things* settle me more than people.

Exposure therapy is not having a panic attack so bad I think I'm going to die. It's breathing when all I want to do is hold my breath. It's not turning and running when all I want is to run away.

Re: the safe people thread.. I consider my "big brother" safe because I can go a month without talking to him and he'll always be there. His motives are clean.

I might say I'm too wounded to tell what someone's motives are... but that's bullshit. I've gone through so much since I initially lost it that I would be doing a disservice to myself if I didn't give myself some credit.

sigh

 

[SquirrelCommander]

The problem with Complex PTSD is that there is no healthy person to reflect on that existed prior to trauma. It is virtually impossible to navigate triggered emotions if there is no emotional safe place to return to.

Yes, exactly. If one is raised in a CONTEXT of persistent trauma combined with a concerted effort by all family member to invalidate one's feelings and gaslight in general, what can one return to? Nothing really helps as much as recognizing the incredible kindness available in the present, and seeing what people are like outside of my family's sick system.

One of the things that hurts most about coming to terms with the severity of the abuse and neglect is not having anyone within whom to compare experience(s). My siblings are just as bad if not worse than my parents and stepmom, so there's nowhere to go.

In my case, what is most powerful is being PRESENT and becoming attuned to the kindness around me. That warms my heart a little and helps me to come out of my frozen state and FEEL. I know I'm in a bad space when I feel shut down, and that's pretty much anytime I go anywhere near family. For me it's basically been all about appreciating friends and reminding myself that there's a whole beautiful world out there.