Treatment Ideas For 'overwhelm' & 'avoidance'

[Maxi]

So I tried an exposure this week and it went horribly! I couldn't even get close to the situation I wished to expose myself to because I was so overwhelmed I just gave up (a recurring cycle in my life). I really don't know what to do with myself anymore :(

I spoke about feeling overwhelmed in my last post and someone recommended some DBT work and so I found some resources online and tried to put them into practise, but I was so distressed that avoidance seemed to be my only option. Exposing myself to my triggers is the only way I'm going to get my life back, but I've been standing in the same place for years trying different things and making improvements, but improvements which are so minor they are barely worth mentioning. I don't want to go down the medication route because I feel that I need to be able to make the behavioural shift myself in order to feel confident about my ability to handle triggering situations, but I'm running out of ideas here guys, I really don't know where to go. I've been trying to think outside the proverbial box, but I'm stuck.

And my T wants to start exploring early trauma stuff, well, I initiated the conversation and now I regret it. I don't know if this is the right time for all of that, I don't know if they'll ever be a right time. Even though I do see a clear link between my emotions of the past and my current emotions, I'm not sure how exploring that could help me.

I'm not being clear. My problem is my T can't help me unless I help myself (and to be honest I wouldn't want them to come in with a magic wand and fix my life, I'd like to have some agency over it), but I have run out of ideas to help myself. I'm very very easily overwhelmed by minor things and terrified, as in physically terrified of even the prospect of experiencing unpleasant emotions, even boredom. Both my OCD and PTSD seem so interconnected that it seems I can't go even a day without exhausting all my energy trying to keep myself well and semi-functional. I refuse to believe that this will be the rest of my life, I refuse. There must be something I can do to help myself, there just must be. How do I deal with my emotions? (I try to eat clean, meditate almost daily, do a little exercise, but I could do more, take a few herbal remedies, I've tried hypnosis, CBT, Acceptance Commitment Therapy, self-help DBT and EMDR, Mindfulness Based Stress Reduction and Neurollinguistic Programing).

Please. Any guidance, any suggestions for next steps. I'm beginning to become a little depressed. Where do I go from here? :(

 

[Seagreen]

So I tried an exposure this week and it went horribly! I couldn't even get close to the situation I wished to expose myself to because I was so overwhelmed I just gave up (a recurring cycle in my life). I really don't know what to do with myself anymore :(

This is a recurring cycle in my life too. I manage it in two ways. The first, is to completely throw the towel in on all commitments and go to bed. When I am calm I write down whatever it is I need to do and then break it down into little steps. Each step has to be manageable and I literally cross off each task after completion. Having a visual reminder of my achievements is a great motivator too. The second, (and this is hard sometimes) is to ask for help with the task at hand.

I would like to find a more efficient way to cope but I hope that will happen in time as I work on myself. I think there are other things that need to come into place before this can happen. All the best to you.

 

[Friday]

For me... The first step in exposure therapy is thinking about it. I have to be able to think about it without spiking before I walk my happy ass into the situation.

And that's my rule of thumb for every stage along the way. If thinking about it causes me to break out in a sweat? I keep thinking about it. Until it doesn't. Clearly, taking breaks. Hours, days. Until I can think about it without spiking my adrenaline. Okay. Now I'm bound and determined! Stand up. Break into a sweat/ start shaking/ whatever. Awesome! Have now made it to stage 2. Time to do that for however many days and weeks it decides to last for.

Some things I might have 5 million stages to go through. Some only a handful. The whole point being getting to the uncomfortable place, hanging out there for a time, and backing away. Over, and over, and over.

Part of exp. therapy... At least for me... Is learning to trust myself. Knowing that I can hang out in zing! zap! pain! land for a minute or three, but I'll always back away before tipping my SUDs scale too high. It's flirting along the edges, not divi into the deep end. Until I can not only keep pushing my own boundaries, but trust myself enough to hang out for an hour or three instead of a minute or three.

 

[Justmehere]

Working through triggers and childhood trauma can help. It will make symptoms worse for awhile. That's a normal part of the process. When it happens, try not to see it as a sign that the process is failing or not working - but a sign that you are on the right path. It stinks and it is miserable, and it is very important to pace yourself through this time. I have been working through childhood trauma lately, and I keep wanting to stop because I keep going through a big spike in symptoms. Instead, I'm learning to go slower.

I understand that you do not want to be overly dependent on your therapist and have your own agency in your recovery. That's great! Maybe part of your recovery includes learning how to rely on your T's guidance a little more, so that you can learn it's ok to trust them a little more.

 

[Maxi]

Thanks for all of your responses guys :)

This is a recurring cycle in my life too. I manage it in two ways. The first, is to completely throw the towel in on all commitments and go to bed.

Hi Seagreen. I think if I were to stay in bed I'd just grow really depressed (it has happened before) and it would be much harder getting myself up next time. I did try to make the steps small and manageable, but it seems I overestimated my abilities yet again. I do create to do list, but they're more of a reminder of the things I haven't achieved rather than those I have. Would you mind me asking; who do you tend to ask for help? I don't know who else could help me.

For me... The first step in exposure therapy is thinking about it. I have to be able to think about it without spiking before I walk my happy ass into the situation.

FridayJones this is a really good idea. Just to clarify, do you take a few minutes out of each day to sit and think about going into the situation you fear? What sort of things do you focus on? Doing the tasks you'll be required to do, or the interactions you may have, or what you may be thinking? How do I structure it?

Working through triggers and childhood trauma can help. It will make symptoms worse for awhile. That's a normal part of the process.
I understand that you do not want to be overly dependent on your therapist and have your own agency in your recovery. That's great! Maybe part of your recovery includes learning how to rely on your T's guidance a little more, so that you can learn it's ok to trust them a little more.

Hi Justmehere. How long does working through childhood trauma take, because I need to get on to working on the trauma which brought me to see my T in the first place. And is there anything I can do to speed up the process? I trust my T, but she's not there outside of sessions, which tends to be the time when all of the emotions which were absent during therapy catch up with me. When you go through a spike in symptoms how do you keep yourself grounded? Are you able to hold down a job, go out with friends and do things which you enjoy? I need to learn how to be functional when I'm an overwhelmed mess inside.

Maxi

 

[Justmehere]

Hi Justmehere. How long does working through childhood trauma take,

This is going to be the most annoying but truthful response ever: It takes as long as it takes. There is no way to tell how long it will take for any one person. Your therapist might have an idea, but it really varies from person to person, from trauma to trauma, and by biology and life circumstances and all kinds of factors.

because I need to get on to working on the trauma which brought me to see my T in the first place.

Working on the childhood trauma may lead to a reduction of symptoms related to the later adult trauma. Most trauma therapists tend to work on the adult trauma first, then go back to the childhood trauma. It can be done either way, but the fact that you asked to deal with childhood trauma before adult trauma, and not your therapist, is a little reason for some hesitation about diving in too deep into the childhood trauma just yet. It might be good to talk to her about if that is the most effective path to go, or if you should work on the adult trauma first. It may not matter at all.

In the end, it sounds like what you really need is a reduction of symptoms. Working on any part of the adult or childhood trauma in a paced way, step by step, is the best and quickest way to work through it.

And is there anything I can do to speed up the process?

Yes and no.

Yes, you can speed up the process by becoming an expert on mindfulness, grounding, coping skills, and self care. The more you practice and become really good at those things, the quicker everything else will go. Not only will trauma work go more quickly, but PTSD symptoms and trauma work will not disrupt the rest of your life as much. By practicing these skills, I mean by doing them many times a day. Several times an hour if possible. (Mindfulness is something that can be done while doing just about anything else at the same time.) It is important to practice these kinds of skills even when not triggered or stressed. The idea is to build new pathways in your brain. Those pathways are easiest to begin to build when not triggered. Right now, your brain has the trigger = fight or flight pathway down cold. It needs to learn trigger = use coping skills, stay grounded, return to state of calm pathway. That path is easier to go if your brain already easily can use those skills. It become must easier to process trauma in a more effective way and to use the time best in therapy if you use your out of therapy time to work on helping your brain and body learn t hose various ways to cope and return to states of calm.

No, you can't speed up the process by jumping into the trauma work by jumping into it more quickly. In fact, you can actually make things take longer if you go too quickly. Some people need to be prodded to jump into the trauma work more, you come across as the other type, like me, who is very proactive, and risks going too far too fast. You are not doing anything wrong, at all. This is just a word of caution about doing trigger exposure work on your own.

I used to dive in really deep into trauma work on my own. I ended up triggering myself so badly I had to do a partial hospitalization program to get on track and be functional again. That program was based out of Harvard and was designed for people with PTSD. The very first they told everyone in the program was that pacing is KEY for recovering from PTSD. If people with PTSD jump in too quick into trauma work, it actually causes re-traumatization, and it takes longer to get a reduction of PTSD symptoms.

Learning to pace is part of the recovery process in and of itself. PTSD tells us that everything has to happen, and now, and in a hurry, or else all of life will fall apart. Learning to be able to "contain" the work and the symptoms is a way to reduce the symptoms and undo some of what PTSD does.

Not pacing will end up reinforcing the PTSD symptoms too much and you will always be trying to dig yourself out of an ever sinking hole.

@FridayJones is spot on about how effective it can be to just imagine the trigger. In fact, there is a whole therapeutic process in trauma focused CBT about imagining triggers as a way to do exposure to work with them. It's not much different from what FridayJones describes. It is call "imaginal exposure" or "imaginal desensitization." There are some good step-by-step instructions online. The key is to go slow, and to not get to the point of total overwhelm, but enough so that there is some trigger, and to do it again and again. I have done it where I had to describe a traumatic event on a voice recording, and then had to play it to myself once a day every day. It was a little brutal, but it helped. At first, I could only play part of the tape. Then I would play a little more of it and a little more. I also did an imaginal desensitization around just a trigger, rather than the actual trauma. This was much safer to do on my own, and just as effective for symptom reduction around that trigger.

When you go through a spike in symptoms how do you keep yourself grounded?

Google "grounding techniques." You can find a lot of info online. Some of these techniques are "obvious" things, but keep doing them even if they seem to simple or they don't seem to work right now. Over time, they will work better and better.

One of the not-so-obvious grounding techniques that I learned in the PTSD intensive program is holding ice, or a frozen water bottle. Sometimes, for many PTSD suffers, this will stop a panic attack in it's tracks. It especially works if I can hold something warm too. The idea behind why it works is that it kind of shocks the nervous system back into the here and present. PTSD symptoms are about the body/brain fearing/re-living that past trauma, and doing so as if it is happening now. The more we connect to this present moment, the more the PTSD symptoms can go down (as long as the present moment is relatively safe.) This is also why mindfulness techniques work too. Mindfulness is all about connecting to the here and now and being present. Google all you can about mindfulness. It all will seem overly simple, and yet in the middle of a spike of symptoms, it will be hard to do, at first, and yet even trying can help counterbalance your nervous system. This is also why practicing mindfulness and grounding when not triggered is important. It will get so much easier when triggered. I have a book called 100 ways to be mindful, and I try new ones every day. I even have an reminder on my phone to go off every 2 hours to remind me to take a moment and be mindful in the activity I am doing already.

Are you able to hold down a job, go out with friends and do things which you enjoy? I need to learn how to be functional when I'm an overwhelmed mess inside.

It varies from person to person what they are able to do. Doing things we enjoy and staying connected to social supports are a key part of recovery. It's not like, oh I can go process trauma and get better from PTSD *or* I can spend time with friends.

Spending time with friends and working to what degree you are able to do so is actually a part of the process of enduring and recovering from trauma. Keep doing what you can, and if you find that you can't do as much, bring it up with your therapist and you both can figure out if the pacing is right or if the increase in symptoms is ok.

Trauma work will make symptoms get worse, but through pacing and becoming an expert at the skills I mentioned, you will be able to endure those spikes and they will calm back down a lot more quickly.

I'm glad you trust your therapist. Studies have been done that show that the strength of the therapeutic alliance is the single biggest factor in therapy working - more than even the type of therapy. Go figure...

You are taking a lot of great steps. Remember to pace yourself, and keep up the good work!

 

[Maxi]

@Justmehere Thank you for your response, it's a lot to take in. I had a very intense session with my T today where she emphasised mindfulness several times, so I'm really going to up my meditation and try and build more mindfulness into my days :) Also, I think you're right about pacing. I am quite proactive and so I too wanted to speed things up a bit, although after todays session I think I'm a little keener on taking things slowly. Also, I Googled and YouTubed imaginal exposure and found some helpful links and so I'm going to try that technique out. I think I'm going to have a busy week of trial and error ahead. Thank you for all of the advice and hope your week is treating you well and therapy isn't too taxing for you at the moment :) X