Tuesday, March 10, 2015

How PTSD Is Perpetuated by Avoidance

Traumatic events, large and small, affect many of us at some time.  Many people recover in a short period of time, but sometimes we are affected with conditions such as post-traumatic stress disorder (PTSD).  We all naturally have resilience that helps us to not only survive but to thrive and grow after bad things happen.  Yet, when something happens that does not make sense given our past experiences, it can be difficult to think about and integrate into our understanding of our lives.

Avoidance is a common reaction after experiencing trauma.  Of course we don’t want to think about a distressing event or feel upsetting emotions.  These emotions can be painful, and it makes sense to not want to experience pain.  However, the process of attempting to avoid traumatic reminders can cause anxiety symptoms that get in the way of living the lives we want.

Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder is a mental health condition created by exposure to a highly distressing event.  This exposure can be a direct experience of the traumatic event, or it can come from witnessing something terrible happen to another person.  It can also come from learning that something has happened to a family member, close friend, or loved one.

PTSD can be triggered by a specific event, such as combat or sexual assault, or by ongoing exposure such as that experienced by police officers and other first responders.  The symptoms of PTSD are clustered in categories of re-experiencing, avoidance, negative thought and mood changes, and increased arousal (hypervigilance).  I focus here on avoidance because of its role in perpetuating the cycle of PTSD symptoms.

How avoidance creates PTSD

Avoidance refers to a set of PTSD symptoms that have to do with efforts to prevent contact with thoughts, feelings, people, places, and activities that are associated with the traumatic event.  It also includes emotional numbing and the loss of interest in activities that the person used to enjoy.

Emotional numbing can be especially difficult.  People sometimes describe feeling “like a robot” or “on auto-pilot,” with feelings pushed out of awareness.  This is sometimes called “emotional anesthesia.”

In the short term, emotional avoidance may seem to work.  It gives us temporary relief.  Unfortunately, however, avoided emotions do not go away.  They are still there in our subconscious, fighting to get out.  And they grow stronger.  Unfortunately, attempts to avoid may also go stronger, leading to unhealthy coping attempts such as drug and alcohol use.

Avoidance also makes it difficult to come forward and seek help.

How do we learn to avoid?

Sometimes we receive messages from home, such as “Don’t dwell on it” or “Just let it go.”  You may have been taught that emotions are bad or destructive, or that thinking about something only makes it worse.  You may be worried that if you feel intense emotions, they will destroy or overwhelm you.  The truth is, emotions only last for a second -- until we re-trigger them with a thought or behavior.  If we let the emotion pass by like a wave in the ocean, it will pass through us and leave us open to experiencing a different emotion.

Is all avoidance bad?

There’s a fine line between distraction and avoidance. Distraction is often an effective coping strategy that helps people rebuild their lives and continue doing things they need to do after a traumatic event.  Distraction is an active coping process, which happens through adding positive events to your life -- doing things that bring about positive emotional experiencing.

Avoidance takes a lot of effort, especially when strong emotions are involved.  Rather than adding positive emotional experiences, you are focused on pushing away negative ones.  This is the type of avoidance that gets in the way.

Emotions exist for a reason!

Emotions do a lot for us.  They motivate us and help us get organized to act when we need to do something.  Through facial expressions, tone, and body language, we share important information with people around us about how we’re doing and what we need.  This helps us to get our needs met.  Emotions also help us know when something is wrong -- they function as a signal or alarm.  This intuition is important, even though it is not the same as factual information.  While we cannot treat our emotions as facts, we can use our emotions to know when to check the facts.

How can you accept difficult feelings and stop avoiding?

The most important thing is to reduce attempts to escape and avoid.

One skill that is helpful comes from Dialectical Behavior Therapy and is called Opposite Action.  This is a skill for changing emotions that you want to change.  In this case, the emotion is likely to be fear.  When fear is justified by the situation, of course, you will want to follow that feeling.  When the fear is not justified by the present situation, however, the way to diminish the feeling of fear is to approach rather than avoid.

Eventually we get used to things that are bothersome but not actually dangerous. This is the key to overcoming PTSD, and it does take time.  If you find that avoidance and other PTSD symptoms are getting in the way of living the life you want, it would be a good idea to get in touch with a therapist.  There are treatments that work -- people can and do get better.

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