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The ptsd cup explanation

Thread starter #1
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.

ptsd-cup.png


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.

Variability
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.

ptsd-cup-military.png


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.

Conclusion
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.
 
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A

Ashley Smith

#2
What if everyone just shuts down after too much stress and can’t handle anything? Like, their brain shuts off after being tortured. Is that the same as PTSD? These angry explosions with war buttons? Can you elaborate?
 
Thread starter #3
What if everyone just shuts down after too much stress and can’t handle anything? Like, their brain shuts off a...
Every person can have explosive anger. Nobody is above it. You should not confuse combat experienced and the explanation of a button, versus overflow with non-combat persons. Again, anyone can explode. That does not program them with a button. Military are literally programmed. It is a form of psychological manipulation to get the brain to do what it instinctively will fight again, such as running towards bullets, instead of away from them.

Non-combat persons do not have that training reinforced. You could apply that to someone who got PTSD whilst in the military, though not in combat, as PTSD may take what is there, then exacerbate it. PTSD does that well. There would still be a difference with recovery though, as the non-combat person would not have the engrained reliance that the training saved their life in combat.

All military are trained, but not all are trained in a way that a button is psychologically programmed into them. Not all military jobs are gun-ho, boots on ground, facing combat situations.

Specific situations need elaborate details, so that methods are only applied to the individual. Broad brush approach does not work, even for the cup. The cup is an individuals representation, and will be unique to them and their circumstance.
 
#4
Both PTSD and CPTSD are notoriously hard to overcome, and I am guessing that the majority of combatants come from working class families, who as a group typically carry higher levels of trauma and stress than their middle class counterparts.

I wonder if there is a way of making the cup bigger. Perhaps the mind already does this through disassociation, but I guess at some point the cup springs a leak and is unable to accommodate so much. Then the past trauma that has been sitting around not really causing much of a problem spills out and wrecks our lives.
 
#5
Interesting article. I find that illustration to be very helpful thank you.

In my mind, I see a correlation between the military training followed by exposure to combat and the experience of other forms of complex trauma. The initial trauma(s) trains a person to react in such & such a way in order to survive. When later trauma(s) is introduce you already have a coping mechanism in place to handle the situation (albeit, dysfunctionally).
 
Thread starter #7
Something I should elaborate on, which I have been asked before:

“Bad stress is just that — negative interactions that create negative emotion.”

Negative interactions are both internal and external. If you tell yourself self-defeating things (thoughts) then that is self-interaction. It is not different than actual interaction with an environment.
 
#8
I think this is a very good visual analogy. I’m non combat but old enough to have spent a year in the 60’s practiicing avoiding nuclear annihilation: folding my 4th grade body up, tucking myself under my desk, glad I wasn’t on a window row (they had to risk death longer by shutting the windows) We were all assured this would protect us from death under a white cloud. What a set up to carte blanche accept the attrocities that the next few decades brought, telivised and made many of us numb. It continues today as entertainment serves up violence, real and fictional. Exposure to terrorism or its threat is unavoidable yet we go on, accepting our leaders don’t do much about it. How much are we, from different generations, each with its own story of exposure situationns, actually programmed as those trained in military? To a degree aren’t we all told to run toward the bullets when we hear over and over not to let these almost daily acts of abhorrent violence stop us from going about our daily lives? Throw on top of that the campaigns telling us to be vigilant and report anything suspicious. In the face of the crazy making denials and reassurance that we collectively will triumph over evil, doesn’t that feel like conditioning? Doesn’t that push us all towards a military response? At least toward a measure of dissociation as a way of life? This feels like a baseline from which to begin functionality, to react to those personal events which bring us to this forum. Yes, there is help: therapy, medication, talking to each otther. I think 2016 might begin with a round of applause and a recognition we have survived so much, personally, nationally and globally, more than we realize. That peace, love, serenity starts deep within each of us and we are all making brave steps toward who we are, each off us, before the trauma we have each survived. We need each other and we will/are ok, no matter what. Someone used the word “dysfunctional” to describe an overflow and PTSD reaction. I hope we all stop labeling ourselves with those words. What if our reactions to stress are fully within the realm of NORMAL given our ABNORMAL unasked for traumas? What if we start there and move toward self acceptance via education, community and reassurance that we will, step by step with a little help from a friend, feel safe again? What if we begin by stating that our reactions are a normal and universal response but getting in the way of who we were, who we can become and who we might help. It took a very long time for me to know I am not who I was but each day, hour and minute is an opportunity for me to chose who I am, how I treat others, and the power of NO MORE. I may crumble before the day’s done but that will pass. Sometimes staying in bed is what I need, other times getting to the dentist is my next big battle.. but we’re all in it together and for that I’m very grateful for your company. I could not do this alone.
 

Sammy

MyPTSD Pro
#9
I have to say that while I was not in the military, I was trained as a child and through many years of marriage. I was trained as an infant that I did not matter and to be safe, I had to be invisible. I was trained to to be compliant, not argue, accept that I did not matter. Then there was the teacher in high school. I learn again that everything was my fault. I was trained to hold it all in. Never talk. Then the marriage – again, I did not matter. Be compliant. Agree. My opinions didn’t matter. Cap the anger. Never let it show. Hide the pain and frustration. Until I couldn’t do it any more and then the consequence was divorce. I was thrown aside because I stopped being compliant because my own survival depended on it. I was as trained as anyone I have ever known. Hold it in. Don’t share. Don’t complain. Just survive. It isn’t just military that are trained. I didn’t choose to be trained. It just was.
 
Thread starter #10
Hi Sammy, whilst I agree with you in relation to complex traumatic circumstances, that you’re trained a certain way… so is every child by parents, guardians and those around us who influence us, positively and negatively.

Military training is done in adulthood, and it is done to train specific PTSD symptoms into every soldier. That is the difference and why military training is isolated in the PTSD cup. We’re talking about PTSD here, and its symptoms.

I’m not sure there are too many cases where a child is literally trained, reinforced, assessed, and then put into action for specific PTSD symptoms. A child typically endures PTSD symptoms based on the trauma suffered, not trained with them to use in the world.

I hope that explains the difference from this articles view.
 
#11
Thank you for saying this. I’m new here and just reading thru the responses. I had this same experiences. Added to that my brother and husband were explosive and threatened my life, I was constantly in fight or flight. I was conditioned over time and now despite being out of the situation I’m carrying around these battle scars. Daily life became a battlefield. It’s all been retained in my head and body and I feel more of the negative affects the longer I’m away it seems – I can easily become overwhelmed, irritable and liable to lash out. Abuse, extreme forms of neglect and betrayal, all can cause PTSD. Many of us learn to cap our feelings in order to survive.
 
A

Annika1

#12
This is my opinion based on my experience. Raised by a military family fraught with an ongoing daily battle of sexual incest and severe trafficking that was often similar to a war being waged upon a small child. The survival tactics, for me, are very similar to your description of the lid and button. To be a survivor is the utmost understatement. However, I would agree in a normal day to day lifestyle I may experience the third cup example routinely, which is my baseline for stress. The fourth cup example exists for me today with the added stressors placed upon me by multiple abusers and perpetrators re entering my life. I have a lid and a button. It allows me to monitor my emotions despite the ongoing daily threat to my safety. Because I advocate for myself and have no outside support (police failure to protect, kidnapping, organized criminals with government clearances, etc.), it is critical to my survival to maintain the lid and when safe allow the explosion as a release. It helps me return my baseline to the third cup example. I long for the days when I could coexist within cup two with the occasional cup three exampled here. I agree, it is the daily routines that keep me stabilized over the past two years of events that have raged a war over me once again. Never could I have imagined how badly re-traumatization could be until the resurgence of and the continued exposure to criminal behavior. I am grateful for this site and appreciate your writings. The input from everyone is so very helpful.
 
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