Dodging the bullet: when is avoidance right?

[Applecore]

PTSD can involved obsession about the traumatic experiences, addictive thinking patterns and intrusive thoughts. Isn't it sometimes better to avoid triggers, avoid the addiction to thinking, avoiding the vulnerable-narcissistic point of view that 'it's all about me' while disregarding the experiences of others? How do we know when avoidance is right and avoidance is wrong?

 

[arfie]

i believe avoidance is a valid therapy tool, but balance in all things. with my own psycho snot knots, i look for the line between avoidance and denial in the frequency with which i avoid on any given topic and the intensity with which i push the thoughts away. if i am fiercely pushing them away with absolute determination (always, ever, never, etc.) i am in denial. if i can gently and compassionately lay the thoughts to rest while i am living my current day, i have successfully used avoidance as a therapy tool.

but that is me and every case is unique.

steadying support while you find the distinctions which work for you.

 

[EveHarrington]

I think that if you are being bombarded and cannot handle everything, it’s ok to do some avoidance of certain things so that you have the time and energy to work on fixing other issues. If you are avoiding everything, then this could be a problem as you become more and more withdrawn from life.

 

[Survivor3]

In my opinion, avoidance is right when your f*cking petrified and terrified get the f*ck out of there,... when you don't feel safe enough to explain how your feeling. I mean anxiety attacks can subside in maybe 10-15 minutes sometimes but panic attacks and sheer fear can last hours. It's good to push the boundaries a bit because it helps you socially but sometimes you just f*cking know that you need to just leave and be on your own in a safe place to ride it out.

 

[KayW]

How do we know when avoidance is right and avoidance is wrong?

I think most symptoms have a time that they help us get through trauma. But then there's a time when the symptom itself is hurting or is so damaging to an area of life that you want to heal that symptom.

 

[Sideways]

Isn't it sometimes better to avoid triggers, avoid the addiction to thinking, avoiding the vulnerable-narcissistic point of view that 'it's all about me' while disregarding the experiences of others?

Do these need to be lumped in together?

For example - avoiding triggers, could be rebalanced to choosing our exposure to known triggers, so that we can recover from them, rather than flood ourselves and suffer a setback. Trauma therapists are often very helpful in deciding where that balance is, and giving us coping skills to make sure it goes well.

I’m not sure what you mean by the ‘addiction to thinking’. My brain does what it does, and when I sleep it still does its own thing. It’s not an addiction, or something I could really avoid in any real sense. I personally found mindfulness incredibly helpful with learning how to direct what my brain did with its waking hours, which was incredibly helpful to manage a lot of cognitive-based distress. Very different to what’s going on with my triggers, and reminders of my abuse, requiring very different management.

The last one? I’m not gonna buy into. It’s part and parcel of mental illness to be focused on our own suffering. That’s different from narcissism, it’s suffering. And I don’t avoid it, I work on recovering from the mental illness causing it.

 

[Tinyflame]

I think @Sideways post is spot on.

I have felt the same as you @Applecore , and recently I question why I should acknowledge anything for myself about this at all? Idk if I'm making too big a deal of anything (any deal at all?), or minimizing all of it, which was how I always survived and functioned. Even large negative choices I made or would have for myself had very little emotional feelings attached about them, such as SI. But there is a point I suppose where even if it's denied if it's causing problems or distortion or grief there is only denial and it's consequences or trying to work on it or through it.

I also suppose because it's intensely private only you can know how much or in what ways it's impacting you, no matter what others realize or not, or what shows. I think most of us have had to keep to ourself or hide stuff much of the time.

I was also thinking how threats that aren't as personal, or what have you, don't seem to be a big deal. I remembered today being chased by a guy one time after work years ago, and another time for some unknown reason a guy in an SUV trying to run me over repeatedly when I left my house for work (have no idea who, unless it was a guy I had gone out with??). But neither of those experiences caused me avoidance or 1/1ooth of the fear after the fact than ones with personal triggers and uncertainty. I don't even allow myself to call them 'traumas', just happenings. But I hid under the bed more than once and also once in the dryer when the doorbell rang (I mean years before, and later). Weird, eh?

 

[Friday]

Sadly, avoidance (Criterion C) doesn’t make intrusive symptoms (Criterion B) go away. They’re both symptoms. That exist perfectly happily together in the same constellation.

Being symptoms? That means


1. We’re NOT talking about normal avoidance, or making smart choices, or even problematic avoidance (like procrastinating, deflecting, etc.). We’re taking full blown pathological avoidance. By definition.

Not normal. Not smart choices. Not problematic. But pathological.

2. Avoidance (as a symptom) doesn’t actually let you avoid intrusive thoughts, rumination, nightmares, flashbacks, or anxiety/panic attacks. Or it wouldn’t be a symptom set, but a treatment modality.

***

As far as how to determine what avoidance is a symptom, what’s a problem, what’s a smart choice, and what’s flat out normal?

Working on the cognitive distortions that are lumping it all together into all one thing? (All or nothing thinking, labeling & mislabeling, feeling that it should be this or that, IE emotional reasoning & should statements) …help. A ton. And are annoying as hell. But still help.

Primary cognitive distortions (negative thinking styles)

Cognitive distortion forms the backbone of PTSD. Whether you know it or not, all moods and behavioral patterns originate from your cognitions-- your thoughts. The first thing that happens is a thought, and then a mood or behavior occurs. When you allow an area of your life to become dominated...

www.myptsd.com

The 10 primary cognitive distortions are:

1. All or nothing thinking -- You see things in black and white categories. If your performance falls short of perfect, you see yourself as a total failure.
2. Over-generalization -- You see a single negative event as a never-ending pattern of defeat.
3. Mental filter -- You pick out a single negative detail and dwell on it so exclusively that your vision of all reality becomes darkened, like the drop of ink that colors the entire beaker of water.
4. Disqualifying the positive -- You reject positive experiences by insisting they "don't count" for some reason or other. In this way you can maintain a negative belief that is contradicted by your everyday experiences.
5. Jumping to conclusions -- You make a negative interpretation even though there are no definite facts that convincingly support your conclusion. (Involves mind-reading and fortune-telling.)
6. Magnification and minimization -- You exaggerate the importance of things, or you inappropriately shrink things until they appear tiny.
7. Emotional reasoning -- You assume that your emotions necessarily reflect the way things really are, as in "I feel it, therefore it must be true."
8. Should statements -- You try to motivate yourself with "should" and "should not," as if you have to be whipped and punished before you could be expected to do anything.
9. Labeling and mislabeling -- This is an extreme form of overgeneralization. Instead of describing your error, you attach a negative label to yourself.
10. Personalization -- You see yourself as the cause of some negative external event which, in fact, you were not primarily responsible for.

Criterion C (Avoidance) & Criterion B (Intrusion Symptoms)

C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidence by one or both of the following:

1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:

1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: Spontaneous and intrusive memories may not necessarily appear distressing and may be expressed as play reenactment.
2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note:It may not be possible to ascertain that the frightening content is related to the traumatic event.
3. Dissociative reactions (e.g., flashbacks) in which the child feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Such trauma-specific reenactment may occur in play.
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
5. Marked physiological reactions to reminders of the traumatic event(s).

 

[Applecore]

Do these need to be lumped in together?

For example - avoiding triggers, could be rebalanced to choosing our exposure to known triggers, so that we can recover from them, rather than flood ourselves and suffer a setback. Trauma therapists are often very helpful in deciding where that balance is, and giving us coping skills to make sure it goes well.

I’m not sure what you mean by the ‘addiction to thinking’. My brain does what it does, and when I sleep it still does its own thing. It’s not an addiction, or something I could really avoid in any real sense. I personally found mindfulness incredibly helpful with learning how to direct what my brain did with its waking hours, which was incredibly helpful to manage a lot of cognitive-based distress. Very different to what’s going on with my triggers, and reminders of my abuse, requiring very different management.

The last one? I’m not gonna buy into. It’s part and parcel of mental illness to be focused on our own suffering. That’s different from narcissism, it’s suffering. And I don’t avoid it, I work on recovering from the mental illness causing it.

Thank you. I like your idea of not lumping things together. Choosing which triggers to have exposure to. I'd be curious to know what sort of coping skills a therapist might give us. Because I've had relatively little experience of therapy, a few starter sessions while trying out two or three therapists. So maybe 10 in total and it didn't involve being given skills.

'Addiction to thinking' I can explain. It's a phrase I came up with to explain my problem, which was extreme rumination and extreme intrusive thoughts. I would literally be zoning out while say walking in the park with my girlfriend, my mind completely taken over not exactly by the flashbacks but by cognitive analysis of flashbacks. Like the proverbial soldier who turned left instead of right, she lost her leg on a mine and ever since she obsessively, addictively asks herself over again why she didn't turn right. Eventually that analysis kicks in involuntarily, there is no answer and just a compulsive rush of debilitating thinking: much like an addiction.

I had the same, but with my life experiences of course. The way I improved myself was to think about it like an addiction, and I was able to draw down the doses of my post-traumatic analysing of why everything got so f*cked up in my life. As an experiment I treated it like an addiction, and forced myself to refocus on the park, the leaves, the sunshine, the birds, my girlfriend's hand in mine. It really helped. After some years of this, I have been able to go back and look at why everything got so f*cked up without it taking over my brain. Metaphorically, like having a nice glass of wine instead of an entire bottle. It's what worked for me.

I take your point about narcissism. For me, and likely not for everyone, it was simply a way of helping me get over my problem, to look inside myself for narcissistic traits that I believe we all have to a lesser or greater degree. "I was severely emotionally abused as a child, I have CPTSD, I am not in a wheelchair and the sun is shining," became one of many helpful prayers. I told myself that despite having been through such horrors that I was driven to suicidal ideation, I can perceive that I am not the centre of the universe, which is not all about me; things could be much worse, and in many ways I have it better than many others despite having it much worse in many other ways too. That's not denying my hardships, that's getting some perspective on them. There was so much to be grateful for in life. And the little things in life are so wonderful: like a leaf in the sun that makes you smile, and a joke that makes you laugh.

Not saying that approach is the only way to do it. It's what worked for me. Thank you again.

 

[Weemie]

I have to balance the avoidance of PTSD with the actual therapeutic treatment for OCD, when both are very much at odds with one another. How to do NET and ERP at the same time? I'm working on it, OK? It's been fun! ERP I actually think has good value as a PTSD tool, especially the cognitive replacement pieces, because it aims to reduce your subjective distress by changing the content of intrusive thoughts, rather than removing your capacity to have intrusions (which as far as I know is only truly addressed by medication).

One of my old intrusions used to be "I'm a pedophile and a child killer and a monster and if people knew they'd execute you and you should be executed while everybody points and laughs at you like in Medieval times," lmao like and you can probably guess, it just gets worse from there. So part of using ERP in conjunction with FORNET (which is all-but impossible in name to actually combine but boy howdy, do I try) is not by saying "nooooo, ur not a monster!" because I just don't believe that, at my core.

It's like when my old therapist used to make me "tap your wrist and say 'I love myself.'" and I'd be there like "this is bullshit." You can't say stuff that you don't actually believe is true. But instead I will say the facts of the situation out loud (which I know, due to FORNET, so that part of it does synergize well) and be like "I was eight years old and blah blah blah, the facts of the crimes." And one of those things is infinitely easier to hear ("you were eight years old and adults indoctrinated you into committing violence" as opposed to "you are a baby killer and you should be executed for war crimes.")

And because of that, my distress when I start spiraling out gets reduced. Unfortunately the intrusions can tend to increase the more I do FORNET, because that therapy has a very large cognitive load - you are meant to be thinking about, analyzing, picking through your traumas, constructing them, placing them in a timeline, and going through the neuropsychological basis for violence and aggression. So, the more you think about your trauma, the more intrusive thoughts you'll have about it. So that's where they do not mesh well at all.

As both disorders have intrusions I believe ERP is best suited to address that component, but one has to be careful to be applying it within the realm of therapeutic benefit and not going "my therapist said it was fine for me to ghost my family!!"