Nearly a decade ago (2006) I wrote The PTSD Cup Explanation, a simple view of how PTSD causes symptoms in day-to-day life. This article is an update to that original piece.
Regardless of the type of trauma endured, the PTSD Cup does not change, deviate or apply differently to your circumstance. The PTSD Cup is a basic representation of your capacity for tolerating stressors. As your cup fills, symptoms get worse. When your cup overflows, you may break down crying, become psychotic or manic, attempt to kill yourself, and many other possible outcomes.
The differences unique to each individual lay within their environment (exposure to daily life), their ability to manage stressors, and finally, the actions that occur upon overflow.
One example of this uniqueness is seen in a high functioning PTSD sufferer. They have the same cup as any PTSD sufferer; however, they may differ in their ability to manage work stressors. Their work may make them feel positive, good about themselves. Another area of their life may suffer, say… relationships. They feel good about their work, but a partner or friendship may cause stress they can’t reconcile.
The above image contains one cup, through three stages. There is a fourth stage to the PTSD cup, applicable only to combat veterans. I will discuss that briefly at the end.
Each block within a cup is variable. Simply put, each block will move up or down with some predictability, based on your daily activities, how you feel, what you’re thinking, and so forth.
Cup One (Left Cup)
Many people think good things don’t cause stress. Well, they do! The difference is the net effect. When you get out of bed, have a shower, brush your teeth, comb your hair, drink your morning coffee, and so forth, you feel good after performing these daily tasks. This is called “good stress,” and creates positive emotion.
These menial, often disregarded, tasks help reduce your bad stress. Positive and joyous interactions and feelings continuously counter negative stressors.
Cup Two (Middle Cup)
Here we’ve introduced bad stress. Bad stress is just that — negative interactions that create negative emotion.
This cup represents everyone without PTSD. You can see how much room there is in that cup. Lots! People without PTSD have the capacity to deal with daily stressors. They balance their day with good stressors, and rarely overflow their cup.
When you go to sleep, sleep reduces negative stressors from your cup so you start the next day fresh. When a person ruminates overnight, they may awake with bad stress in their cup. An example is a teenager giving a presentation. They awake tired, grumpy and partially stressed, thinking they aren’t prepared, or their presentation lacks something. When they deliver their presentation without incident, and obtain positive feedback, this creates positive emotion and removes the negative stress. That night, they will sleep better and remove all their remaining bad stress.
Think broadly when applying this to yourself.
Cup Three (Right Cup)
Now we introduce PTSD. The problem is that we still have the same good and bad stressors, but without the same overall capacity as a non-PTSD sufferer.
Who thought good stress could make you overflow? With PTSD, it can do just that – not to mention what bad stressors can do.
Think about it like this — the reason you don’t want to get out of bed, have a shower, do anything at all, is that your cup is full. Your brain tells you to stay in bed, otherwise you overflow. Place your own situation here; the model does not change.
The Obvious Question
It’s easy to talk about a problem, ignoring its solution — but this solution isn’t rocket science.
Trauma is the problem. Trauma is full of bad stressors. Work through trauma and you reduce bad stressors. Make life changes where you’re negatively stressed. Reduce your traumatic effect, you reduce your PTSD symptoms.
Depending on your level of trauma, this may take months, a year, or many years.
The Fourth Cup (Military Training)
The cup I didn’t show is specific to those who have deployed within an operational zone where military training kept them alive. Add an additional block to the cup, call it “training.” Now you have good and bad stress, PTSD, and training.
The above cup has little capacity already, so how does training fit? Well, it’s squeezed and compresses all blocks. Part of the military training block is a lid with button. This lid and button is effective within a military environment, the cup is full, compresses, an order is given, the soldier explodes against the enemy.
Notice how overflow has been removed from the below image? Combat veterans have a lid and button. Everything builds-up, compresses, then explodes — instead of overflowing.
This is useful in active service, but not very effective in regular society. The military used to control the button, for the most part; post-service, PTSD is in control. The cup can only take so much pressure before the button fails. With a constantly full and compressed cup, all it takes is for the toilet roll to be around the wrong way — the veteran explodes at someone (spouse or child), or something (wall or door), and only then will the pressure be released.
This is behavioral conditioning that helped the veteran remain alive. When differentiating between a combat zone and civilian life — the brain knows the difference, but still functions on instinct, in the ways that have been proven effective in order to stay alive.
The most obvious question is, why do combat veterans have this extra block and not all military?
When military are trained, they’re trained to have some PTSD symptoms, especially Army, Marines, or Special Forces-type training. Hyper-vigilance, startle response, alertness — these are all symptoms of PTSD. When leaving the military and without combat, this training quickly subsides and the person reverts to civilian behavior.
Once a soldier enters a combat zone the brain accepts that this training saved their life, or their buddy’s life. This makes training a priority for survival. The training becomes instinctual, regardless of whether they are in a combat zone, or not. This block is one of the most difficult to lessen, and typically only diminishes from a combination of time, and decreasing the traumatic effect.
The PTSD cup is a simple representation that defines your internal stress. We all react differently when our cup overflows. Some may cry, some may dissociate, some may become angry. A soldier may explode with horrific rage and violence. To control the effect is to minimize the cup’s content, where possible.
I might wish we could remove the PTSD block — that would be ideal. Unfortunately, there is no cure. So, work with what is within your reach. What immediate stressors can you reduce or remove with the least amount of change? What did you used to do that made you happy? Remember, good stress counters bad stress, so do things that make you happy to create capacity within your cup.
Remember that this is, more often than not, a long-term process. Managing your internal stressor cup takes time, education, and skills learned for future improvement.