In this post, I will concentrate on 3 main factors that can hinder one’s recovery from PTSD/complex PTSD. These are as follows:
- Unprocessed memories that are highly emotionally charged and easily triggered.
- Unhelpful thinking about, and interpretations of, trauma memories.
- Cognitive and behavioral responses, including avoidance and safety strategies, have become maladaptive (Ehlers).
Let’s look at each of these in turn:
- Unprocessed memories that are highly emotionally charged and easily triggered:
Memories that remain unprocessed can be intrusive, vivid, and disturbing. They can also take the form of flashbacks that cause the individual that s/he is reliving the trauma in the here and now. It is thought that traumatic memories are processed differently from normal memories and are fragmentary, sensory, involuntary, unchanging, and vivid and give the person experiencing them a distressing sense that the trauma is happening again in the present. To learn more about how unprocessed, traumatic memories differ from processed memories in relation to how they are respectively stored in memory see my article about the linen cupboard metaphor. One type of therapy that can help us process traumatic memories is EMDR therapy.
- Unhelpful thinking about, and interpretations of, trauma memories:
PTSD can cause cognitive distortions or thinking errors. For instance, many trauma survivors feel a deep sense of irrational guilt (e.g. an abused child may falsely believe the abuse was his/her fault). Also, trauma can play such havoc with a person’s mind that s/he may believe s/he is going irreparably insane and will never recover. Thirdly, as alluded to above, memories of trauma can be so intense and vivid that they perpetuate a sense of being in danger months or years, or even decades after the event (in the absence of effective therapy such as CBT).
- Cognitive and behavioral responses, including avoidance and safety strategies, that have become maladaptive.
People with BPD who are plagued by intense fear and anxiety in a variety of situations may perpetually avoid such situations so as to avoid exacerbating their symptoms. Unfortunately, when this coping mechanism is used excessively and to the exclusion of other, more healthy, coping mechanisms, it can become highly maladaptive, maintain the person’s anxiety, create further psychological problems, and/or exacerbate existing ones. For example, continual avoidance behavior can increase self-focus and rumination on one’s problems because avoidance strategies reduce the amount of external stimulation the individual experiences. Also, if an individual predicts certain situations will be psychologically intolerable so perpetually avoids such situations, this will prevent him/her from having the opportunity to test and prove his/her prediction wrong. A final example of how an avoidance strategy can compound one’s mental health problems is that it deprives the individual of experiencing potentially positively reinforcing activities and so perpetuates his/her feelings of depression. People who suffer from maladaptive avoidance behaviors can be helped with therapies including trauma-informed CBT incorporating supported exposure to the fear-inducing situations and Acceptance and Commitment Therapy (ACT).