Triggers : Removal Or Management?

[anthony]

If the core is too much to handle right now, then you need to be working at everything else, surrounding it... which builds you up to tolerate the spike to process the main offending trauma/s. There are always elements to work on... always. When you can't start at the worst, you start at the least, and work your way up.

 

[sedna]

I dont know if this helps, everybody is different, but I was pushed to disclose more than I could handle by a very well meaning but inexperienced therapist. It sent me backwards for a long time. I developed a drinking issue over it and my ability to function at base survival level was gone. If I could go back to the beginning of that I would have asked him to help me find ways to build my self esteem before we got to the serious stuff. It was like Pandoras box and I almost didnt survive it.

 

[Sandstone]

I'm not sure it is my self esteem that is the problem, it seems to be something that I'm not aware of until it hits me. I suppose it must be dissociation - I seem fine, calm and logical until we start to tackle the actual trauma, then either I react in the extreme afterwards - believe it is called decompensating - or I run in a state of incoherent panic from the session. T's tell me the second is a better response, but it feels shameful to me and still leaves me very distressed afterwards.

f the core is too much to handle right now, then you need to be working at everything else, surrounding it.

Can you give me an example? To pick from, I've got long term CSA, grooming by an actor, an odd assault, a later single family assault, rape by two strangers and ex-T adds in the stillbirth and the long fear of my husband's suicide when he was ill. Around those are what she called the formulation, to my beliefs about myself " I have no right to exist" " Don't make a fuss" " It's all my fault". Apart from the obvious physical triggers , I've got being trapped or pinned down, being disbelieved, being prevented from hiding when I perceive physical danger, fences, fear of talking to people I know - strangers are fine, and a whole bunch of stuff around burning, scalding and knives.

 

[BlueOrange]

That is disheartening. It seems to leave me trapped in a no mans land of being too unstable to do the processing, but unable to remove the causes of that instability, because I need to have processed the trauma in order to do it.

I like the way they talk about it in the Structural Dissociation book. (aka "The Haunted Self") The first stage in therapy according to them is to stabilize the patient enough that they can deal with day to day survival, and the challenges that are forced on them every day. Only when you've completed that first stage do you move on to stages two and three (processing the trauma). During stages two and three, you'll typically find that you need to return to 'stage one' type stuff.

It is important to do the processing. But it's essential to do the processing in a safe environment; getting a safe environment may well require us to do some work that is explicitly aimed at 'coping with triggers', as opposed to 'addressing the trauma.

My experience is based around coping with triggers before addressing the trauma. Reading this thread, I can see that Anthony's experience was different, and he was able to go straight for the trauma. I wasn't able to do that, and yet I seem to have worked out OK.

One thing that you do find is that the plateaus get frustrating. I did a bunch of stage 1 work, and I stopped getting improvements, and I got frustrated. It's easy to perceive the stage 1 work as pointless, because it's very different to stage 2. However, Van Der Hart and Nijenhuis say that it's a prerequisite, and I agree with them.

 

[Sandstone]

I wonder if it my T's who have perceived Stage 1 as pointless, or more accurately as minimal, because I look to them as if it is OK. T5 talked a lot about me having a tight Window of Tolerance and the need to widen it, but in fact we didn't do much about that. I think when things are challenging for me, " Don't make a fuss" " It's all my fault" kick in so I don't show anything until either I'm safely alone or until " I have no right to exist" becomes so powerful I act on it.

A few months ago, my husband wanted to drive a particular track, taking us past the scene of the rape. Obviously I couldn't tell him not to. (He didn't know this was where it happened.) I focussed on telling myself I wouldn't see the actual site behind the flood bank, and then as usual absorbed myself in architectural detail till it was over. Then went home and quietly had a very bad week. But I couldn't make a fuss by telling anyone because it was my fault for this. My point is, no-one knew before, during or after. I didn't look any different, and because I wasn't in touch with any of it at the time, I don't think it extended the Window of Tolerance.

 

[BlueOrange]

A few months ago, my husband wanted to drive a particular track, taking us past the scene of the rape. Obviously I couldn't tell him not to.

The word 'obviously' is always a clue that things might not actually be obvious.

You seem to understand that your husband wasn't at fault, your decision not to disrupt his plans shows that you care about his feelings. You don't display the same sensitivity towards your own feelings.

If he cares about your feelings (that he married you is hopefully a clue), then I don't think he would want to remind you of the rape. I suspect that if he had known that seeing that place would upset you, he would have considered changing plans.

But I couldn't make a fuss by telling anyone because it was my fault for this.

I agree that it wasn't his fault. That doesn't make it your fault. I think that sufferers, in general, are not good at allocating blame - we tend to find one thing, and put all the blame there. It tends to be that we blame a part of ourselves, and dissociate from it. (In my opinion, that's how PTSD and other forms of trauma-induced dissociation work.)

There are people who obnoxiously refuse to be triggered, who say "You can't do that! It triggers me!" and they act like the world owes them something because they have feelings. A lot of the time here, we talk about that particular breed of asshole, and try to discourage sufferers from being assholes. But the opposite extreme isn't good either, and I think you may have pushed yourself a bit too hard when trying to be considerate this time around.

I didn't look any different, and because I wasn't in touch with any of it at the time, I don't think it extended the Window of Tolerance.

I agree. The Window of Tolerance expands when you experience a stress (including the stress of a trigger), but you end up feeling (and being) safe. It doesn't sound like you felt safe. Although, as I type that, I feel doubtful - perhaps a week of feeling sick is a better outcome than previous outcomes for a similar stress? Hard to tell. It definitely sounds unsatisfying.

And, perhaps processing the memory of 'that time my husband took me near the place where the rape happened' is going to be good practice. It seems like a memory that would be less stressful than other things you might remember.

I really like 'Window of Tolerance' as a concept, thanks for introducing me to it. I think that the thing that stages 1, 2 and 3 of the structural dissociation process have in common is that they all involve widening that window. First you widen it enough so that you can endure the things you can't avoid in order to survive, and then you start widening it to the things that happened in the past.

One thing that can be very difficult to tolerate is that sometimes, we're not feeling strong or safe enough to do the really hard work of dealing with the really hard stuff. If that's something that doesn't fit into your current window of tolerance, then it could be good practice for getting a wider window :)

 

[EveHarrington]

Both------diffused some, others I'm working on, some are being thrown in the "trigger trash can" as I'll never experience them again unless I was held down against my will and had them forced upon me------which will never happen as they are random and nobody could even use them against me as I've told nobody what they are, and they are benign things to 99.999999% of people.

 

[katz]

Interested to know if people have found it possible to actual stop a trigger being a trigger completely...

I have found that when I get a feeling that some thing has triggered a memory in me, then I just look around me and find out what it is. Smell, texture, sound, ect. (Sometimes even a color)
I usually don't know what the memory is, but being able to put the "trigger" in it's right full place--the past. Then I find that I don't have that same association/trigger anymore.

Even the weather conditions around me can trigger some very painful memories. And still do. I have to remind myself why they bother me. Then I talk myself back to the present, and remember that it was in the past and can't hurt me anymore.

I have also tried "following" a trigger. I notice it, especially if it is a strong one. Then I look around and see if I'm in a safe place...and follow it. I have figured out some of my strongest triggers this way. Then I write them down so I don't forget them, if they show their ugly faces again.

I like to go back in my journal and reread what I have wrote. I usually find things that I forgot and had wrote down. I find that by rereading my own notes in my own handwriting, it re-convinces me that I'm not lying to myself and creating these horrible memories.

I have a very hard time convinceing myself that I'm not ... crazy. Probably always will.

 

[anthony]

It is important to do the processing. But it's essential to do the processing in a safe environment; getting a safe environment may well require us to do some work that is explicitly aimed at 'coping with triggers', as opposed to 'addressing the trauma.

Bingo.

There is a one page document I wrote years ago, which covers these points exactly: https://www.myptsd.com/threads/ptsd-therapy-one-page-as-simple-as-it-gets.16010/

You can't skip anything. Stability as best you can prior to trauma therapy is the foundation to successful trauma therapy. Many therapists have this theoretical understanding from texts and classes, that they can treat trauma in the default 12 sessions of therapy. 1 - info, getting the scoop, 2 and 3 - apply fundamental relaxation and such 4 - 10 treat the issue and surrounding symptoms, 11 and 12 is winding down, any missed stuff, then off you go and apparently you're all good now.

Absolute, total, bullshit!

They can treat minor things in 12 sessions, and I say minor such as a car accident, maybe being in a robbery where nobody is killed or shot, so forth. Minor events. You will not treat rape, child abuse, combat trauma, and so forth severity traumatic events, in 12 sessions. More likely 12 months to 3 years of hard working therapy with a lot of self help (homework) in-between sessions.

Many child abuse treatments require the first one to two years learning stability skills. Progressively pushing symptoms up in small doses so you can learn to manage yourself and get back under control to self-regulate. Then you go at trauma.

If you have someone on hand near 24/7, then you could do it in a short burst few months, in total.

 

[BlueOrange]

Stability as best you can prior to trauma therapy is the foundation to successful trauma therapy.

I'm delighted that you agree, because when I wrote that reply, I was feeling nervous. You had said this:

Tackling triggers is usually something done in the later stages of healing, i.e. after trauma therapy. You can't have unresolved trauma consistently provoking you during the exposure process, where you have enough to work on as it is.

And it seemed to me that you were skipping past the 'stabilization' phase, and getting straight into 'processing the stuff'.

Now that I've re-read this thread, I think I have the context that enables me to understand what happened.

Let me test again to see if we agree, using the Structural Dissociation thing as my structure.

1) Stabilize. During this phase, we only address triggers to the extent that they interfere with our ability to achieve basic functioning. We don't try to defuse them at this stage, we just manage the impact that they have on our stability.

2) Address the phobia of the facts of the experience. (Prolonged Exposure using the diary method that is promoted by myptsd.com has helped many people do this.) At this point, we can start to understand our triggers in a far more meaningful way.

3) Address the phobia of the feelings of the experience. (Prolonged Exposure via the diary could be helpful here, but I find that sitting at the keyboard makes me get very intellectual, less 'in touch with my feelings'. Your Mileage May Vary.) This is the point where triggers can potentially 'stop being there at all'.


How's that?

 

[Amy J]

Interested to know if people have found it possible to actual stop a trigger being a trigger completely...

I actually had this sane question about 2yrs ago, I knew i had to stop stone of them or I may die (suicide).

For me, and no I ain't preaching, rahe it or leave it, 3 things helped me. My own will to not die and getting fed up of having flashbacks all the time and punching ppl in the face, my relationship with Jesus Christ, and accupuncture.

Honestly accupuncture grass been a life saver, I may do more if I need to for ptsd, but there is an amazing treatment which does 5 points on the ears, usually on both ears and sometimes will hook up a low current electric diode to each needle.

It's not unpleasant, but it feels funky for sure.

What i found when we did this, over about 6 treatments it peeled back many layers of my trauma, sometimes i had horrible flashbacks or dean's while eating with the needles, and for a few days after treatment it will dredge up a lot of things, BUT once that was done, a trigger or two would get better and over those 6 treatments some of them flat out went away.

Is it for everyone? I don't know, but it wouldn't hurt to try the 5 point accupuncture, my accupuncturist suggested it because they use it on soldiers in the battlefeild when they start developing ptsd from combat now, and i thought, 'if it works for soldiers, it works for me!' I am glad that I did more than one treatment, and if you try it, i would probably recommend doing 3 before saying it dies nothing. AND journaling about any dreams or flashbacks you have during treatment or while asleep or waking over the next few days following the treatment and make a note if you start seeing situations you would normally have been triggered in that you are not now. :-)

~Amy

 

[Sandstone]

Many child abuse treatments require the first one to two years learning stability skills. Progressively pushing symptoms up in small doses so you can learn to manage yourself and get back under control to self-regulate

So how do you do this by yourself? It took four years to push the NHS to a years TF-CBT.That has ended, without going anywhere much. I've been waiting this time for 5 months and nothing has happened, I need to get on with it by myself.