#mental health related trigger warnings to be specific so the game is clearly my type

[punkgang]

once i finish everhood i’m going to start another game my boyf recommended which is omori because i love suffering and getting emotionally gut punched

[hillnerd]

ptsd/c-ptsd,  therapy & writing

(This is written by someone with CPTSD - I am not a mental health expert, and am just writing from my own experience! )

So a lot of writers want to incorporate PTSD and C-PTSD into their fiction. Sometimes people get it super right- other times I’m left cringing. I wrote this to help writers know more about it, then it also ended up being something I sent to a friend with PTSD as it got into it so she’d know more what the therapy process is like. 

So! What’s it like to have PTSD? PTSD therapy vs regular therapy-How are they different? How are they the same? What does PTSD therapy consist of?

Trigger warning:

I will be describing therapy, talk of other disorders like anxiety and depression, and might use some 'you' talk - example 'once you've gone through this, then you start to feel better.' This will also skim over child abuse, suicidal ideation mentions and trauma in general- Read w/ caution if you are sensitive to this

general overview to PTSD and C-PTSD

I am diagnosed with PTSD, but it's actually C-PTSD*

C-PTSD or Complex Post Traumatic Stress Disorder differs from PTSD in that it's more for people who have had chronic environments of trauma/abuse for years - and is currently proposed to have a certain symptoms not listed under PTSD symptoms. 

Much of these symptoms have more to do with how one relates to other people, their self perception, and generally their learned behaviors in order to protect themselves long-term. PTSD is more about a specific event, of series of events that occurred in quick succession.

Despite the lack of official diagnosis, therapists treat people for CPTSD all the time- they just use a lot of the same tools they would for PTSD.

Not everyone who experiences trauma or battles develops PTSD, but there are factors that make you more inclined to develop it.

What is PTSD like?

There are many ways that people manifest PTSD/CPTSD symptoms.They are easy enough to google and be familiar with, but what's it ACTUALLY like for me.

a hair-trigger startle instinct I have had a few times where my husband is up at night, and I didn’t realize he was in the room- then I see the outline and start screaming- and can’t stop for like 2 minutes- then the crying settles in for 30 minutes. My traumas had nothing to do with strangers in the night. I just have a super intense startle instinct that sends my whole body into panic mode sometimes.

Hyper-vigilance- trying to control everything around you to keep you safe, and being super on edge keeping an eye out for how things will fall apart. Making sure things are locked, being extra wary of people, wanting to not have your back to people, perking up at every little noise etc.

issues sleeping- insomnia, light sleeping, & nightmares-   Sometimes reliving a memory, or just having intense dreams that leave you exhausted the next day you can barely function. This ties in with hyper-vigilance a lot- so falling asleep and staying asleep can be hard.

Depression and anxiety- pretty self explanatory- but it's common to experience these, and for pills to not necessarily be that helpful without the therapy. Sometimes anxious self destructive thoughts and memories start haunting you and making you freeze up or panic, feel like you’re going to die/be left alone by everyone etc. Sometimes emotional abuse from your past starts coming up and haunting you and you feel all your selfworth leaving your body leaving behind nothing but the want to sleep all day/cut yourself off from people - at times this can turn to suicidal ideation and other really dangerous behaviors and thoughts.

Sudden mood switches/panic responses usually a trigger for these switches is something associated with your trauma- but basically when something associated with our trauma suddenly comes up sometimes it causes us to start having feelings and emotions that feel out of whack for the situation at hand. 

Example: When I was a five I was beaten and locked on a sunny porch of a 2 story building with a sliding door.  Once my husband blocked me on the way to the door so I wouldn’t accidentally walk into some freshly painted furniture on the other side of the sliding door. I immediately panicked and angrily screamed at him to’ let me GO! fuck you!!! when he’s the gentlest man in the world and has never ever been anything but kind and wonderful with me. Then after the rage wore off I was like crying and so sorry.

I’m usually not an ‘angry reaction’ person- I’m usually a freeze/cry type- but yeah.Sometime people get panicked in crowded places, or if they feel someone is mad at them, or if they feel trapped, or if they feel like they’re being abandoned.

Sometimes I’ll get super manic and impatient/snappish if there’s not a plan on what we’re doing at a crowded place (really it’s because I want an escape plan/safe place I know we can always go to- and feel vulnerable when it’s a lot of people standing around without a plan and feel like I’ll get lost/abducted)

intrusive negative thoughts 

It’ll be the darkest weirdest repeating thoughts that you associate with emotional upset.  In ptsd treatment there is a lot of going through the events and rethinking your conclusions you’ve taken away from them. It’s simplified a lot in shows to a simple ‘it’s not your fault’- which, yeah, that’s the crux of it- but the actual work of it is super intense, exhausting, and so much more in depth.  

unhealthy coping mechanisms so a lot of people with ptsd will find ways to cope to help them fill an emotional void, or to cover up feelings etc. There are tons of ways people do this. Some will do extreme things like drugs, risky behaviors, drinking a lot etc Example: They experience a ‘violent retraumatizing’ moment like a pet getting killed in front of them- then later to cope have casual sex and drink too much in order to numb their emotions and not think about them.

A lot of ‘avoidance’ and ‘overdependence’ can be a part of ptsd. Like you might avoid certain things like the plague, or constrastingly might start using people or things or substances or food like an emotional crutch/security blanket instead of coping in a healthier way or learning to be independent.

Self protective steps you take might be super over the top, or self-destructive and borderline suicidal. 

Sometimes trying to repress all your emotions and not express them is something you do to protect yourself. 

This can be all over the map really- there are hundreds of examples!

triggering moments of your ‘Stuck points’

Stuck points are thoughts that keep us from recovering. Stuck points are concise statements that reflect a thought – not a feeling, behavior, or event. 

Example of stuck points:  'If I let other people get close to me, I'll get hurt again', 'I am useless.' 'I'm broken', 'I can't trust anyone in authority', 'People will reject me if they get to know me/see me at my worst’ ‘I’m a monster.’ ‘I’m worthless’ 

These can come up and you won’t even realize it at first. You’ll have something super innocuous happen and all of a sudden you’re on the verge of a breakdown, angry and/or panicking for seemingly no reason. 

These intense emotions will hit you and don’t feel like there’s any thoughts connected to them- there ARE thoughts behind it of course, but it takes a bit of deconstructing to figure it out though and realize ‘ooooh, there’s the thought train that was bubbling under the surface! I didn’t realize because thinking through my emotional processes was something I wasn’t allowed to do during my trauma- so now I don’t know how to instinctively do that even a little.’

Examples in fiction 

Harry Potter in Order of the Phoenix where he is yelling at the drop of a hat when he feels abandoned/rejected by everyone. His reactions are so CLEARLY PTSD related to me.  Actually, I think he has CPTSD and it just got to a tipping point due to the traumas he experienced in the graveyard.

Hunger Games Books  Probably the best portrayal of PTSD, of books I’ve read, is Hunger Games. The movies glazed over it a bit- but the books? Oh man, they nail it so hard.

HP and Hunger Games both have protagonists who are great portrayals of ptsd. The anger, the disassociation, the depression, the nightmares, the inability to identify with humans at times, the self protective steps that are unhealthy, the coping mechanism of avoidance etc.

Disassociating

People describe this in tons of different ways, but personally I think of it like body/brain numbness. All of a sudden it’s like a blankness comes over you, almost like that hazy way of daydreaming, only instead of daydreams it’s nothing but a buzzing blankness with maybe like slight almost invisible undercurrent of panic. It’s like the body is paralyzed, and you can’t act or think or do anything but stare or numbly move a bit- it almost feels like your soul just left your body for a bit and you’ve been consumed by a white room of emptiness. Not a black void- it’s not being lost in darkness- it’s like being lost in the light, if that makes sense? Like think of a blank why void like in The Matrix where the whiteness goes on forever. 

Flashbacks

In tv shows they often show it like it's a hallucination or something. Flashbacks are typically shown as a person basically becoming delirious and having visual and audio hallucinations, then perhaps even becoming violent to those around them because they literally see something different than what is real.

Again, this is my experience- but flashbacks have never worked like that for me. I more disassociate, and then all the emotions of that memory hit me, and in my brain I’m able to see bits and pieces of what happened back then, or even the whole thing- it’s like a SUPER intense memory/daydream/nightmare just settles in there for a bit- and you feel all the full emotions of it for a bit- can suddenly feel the sensations of it too at times-but at NO point am I actively moving about in a real room around people getting them confused with the past and lashing out at the hallucinations.

 I’m just sitting there, or crying there- and if someone in the room with me were to talk to me they might have to get my attention because I'm deep in that daydream/flashback- but I’d hear them and see them once I realize I’m spacing out. The most outburst I’d have would be to not want anyone to touch me- or get super startled from someone touching me then pushing them away from me. That’s very different than the crazy shit they show on TV and movies sometimes.

BAD EXAMPLE: One particular one that still makes me mad is when that had Owen from Grey’s Anatomy sees a fan- then get ‘triggered into a ptsd episode’ where he is unblinkingly choking out Cristina as she begs him to stop for a long time. Like…. It’s one thing for someone to be startled and have their instinct be to strike out- that’s a very different thing from what they portrayed. If they wanted to show him as ptsd dangerous- which is worrisome to me as people with mental health are stigmatized enough- but if they wanted to- it would have made much more sense for her to startle him somehow and for him to just blindly strike out before he realizes it. With combat training, he could very well have instincts that aren’t safe when he’s over sensitized and startled.

What are the main treatments for PTSD?

Cognitive Processing Therapy  (CPT)

CPT is the main treatment for PTSD. It is highly structured, and the majority of it is writing and worksheets. There is a LOT of writing and talking out about your trauma, writing and talking about how you process it, and analyzing it.

Beyond the traumatic memories, there is also noticing the behaviors you have that are related to your trauma and how they come out in every day scenarios. This leads to:

Cognitive Behavioral Therapy (CBT)

This is not about processing past events, but about processing current behaviors/reactions and trying to slowly change those behaviors over time so that they are healthier reactions/coping mechanism in place.

Exposure therapy- Reliving memories

For PTSD some people do a lot of reliving the trauma memories by describing them in detail, every tiny detail they can think of- and basically reliving them, but then trying to reroute the emotional response to them. 

Some people are SO repressed that this is a very difficult thing for them to access- both remembering the memory, but also knowing what their emotions were/are. These memories of trauma aren't always easy to remember/re-feel/access and that can be frustrating.

I personally am REALLY GOOD at reliving memories- in fact I'm so good that we have been avoiding it for a bit because i go straight into flashback mode way too easy (more on flashbacks and how they work later)

There are ways of doing this that are more than just revising the memory through talk therapy, that I haven't done and would require research on your part:

virtual reality to revisit the place

watching videos or listening to recordings of the event and talking it through

exposure therapy that's more about getting used to sounds/smells/words that are triggering

The main point though is to process the emotions tied to that event and not make your brain default to that flight/fight/freeze mode when triggering things happen.

IMPORTANT TOOLS FOR THERAPY

If a person hasn't had much therapy, CPT/CBT has a lot of learning for that person, and a LOT of trying to identify emotions and really feel them, so one can process them.

Grounding techniques/exercises-

techniques used to sooth/calm a person when activated- there are like thousands of these guys out there- I think everyone is a bit familiar with them- like breathing exercises in yoga? Basically it's a way of regrouping and centering yourself- 'grounding' you in reality, instead of letting your brain go off on a tangent/emotional rollercoaster.

It's basically any way you can snap your thinking out of your anxious thoughts and concentrate on something until your re-calibrate and are calmer.

Personally the breathing techniques make me freak out- so I don't use those. :P Ones I find helpful are ones like 'Name every color you can see.' or 'go through the alphabet and letter by letter name an animal that starts with that letter.' and 'hold an ice cube in your hand and concentrate fully on every sensation you're feeling.'example  example

-CBT and CPT WORKSHEETS

god, SO many worksheets.

Here are some helpful links

https://positivepsychologyprogram.com/cbt-cognitive-behavioral-therapy-techniques-worksheets/  --- This page covers cognitive distortions really well, and has some helpful resources and worksheets.

https://trailstowellness.org/resources   This page has a lot of great worksheets for trauma.

https://www.psychologytools.com/professional/problems/post-traumatic-stress-disorder-ptsd/- unfortunately you cannot access the documents here without paying- BUT you can read what the docs are, and how they will be used in a therapy setting- so can use that as a launch point for what sort of worksheets/phrases to google.

I specifically worked from  Cognitive Processing Therapy for PTSD: A Comprehensive Manual a lot.

What is the structure of PTSD therapy?

First session

The first thing I had to do was fill out a questionnaire (PTSD test , cptsd questionnaire) to make sure she thought the treatment was appropriate. We talked about this a bit, what symptoms I had, talked over examples of it. I'm comfortable with therapy so this wasn't so bad for me, but I can see this being very difficult for people who aren't as comfortable in this setting and would need to be walked through it more and have more questions as they might not have a lot of self-awareness. We discussed goals, what could be achieved, and generally what it would be like. We went over the first worksheet and I was given homework of figuring out what my stuck points are.

Sessions after that

Each session we begin with typical therapy for a bit 'how was the last week? Were there any events I should know about?' Then we go over the worksheet I filled out, and analyze it, talk about examples, or apply it to trauma memories.

What is trauma therapy LIKE?

I always try to have the next day or so as free as possible after therapy, because afterwards I am wiped out, exhausted, and sometimes super triggered and crying afterwards.

The analogy I like to use is cleaning out a closet you keep hoarding stuff in:

Your house is your life, your brain is a closet, and PTSD/trauma is a messy hoarders type hidden away in the closet. When the door to this closet is closed you can almost pretend there isn't a mess there at all. Y ou close the door by being in denial, not thinking about your trauma, not acknowledging or processing it. You just keep stuffing the trauma into the closet.

But the longer you let the closet stay like that, the worse the situation gets. Soon that closet door keeps busting open and all sorts of crap falls out when you don't want it to. Freakouts, hypervigilance, meltdowns etc. The crap in the closet starts to multiply.

Ever seen Hoarders or Marie Kondo? You know how people are crying over t-shirts and crap and the house looks WORSE for a while? That's trauma therapy.

In therapy you have to open the closet door, take out ALL the crap you've been hoarding in the closet, process it, organize it, and then put things in order again. Every single box of trauma needs to be looked at then put away- The goal is to  throw out the intense intrusive emotions tied to the junk. You have to keep your memories- but you don't have to keep holding on to the behaviors they've formed, the turbulent emotions, and the intensity of it all. During therapy at first it's fine. Kondo is walking you through it and it's all just fine and dandy- then you are faced with this HOARD of CRAP you have to work through- and it's SO overwhelming. My anxiety and depression got way worse for a while. Like, I was on EDGE and having nightmares and it was horrible. But then once you've processed the memories, and start actively applying what you've learned and start using grounding techniques more and more- things do get easier.

I am not fixed. I am not cured. I will have to continue to work through stuff- It's that whole 'healing is a not a straight line' thing. Like, there are times I regress and I hate it. :P But it's gotten a lot better.

IF YOU GUYS HAVE ANY QUESTIONS ABOUT THIS I’M HAPPY TO HELP.

I figure this can be an ok resource for people who don’t know much about ptsd except what it says on like webmd (which isn’t that accessible to me) and want to write about it (or want to just know more about it)

( *C-PTSD has not been considered an official different disorder from PTSD for all that long. In fact, one technically can't be medically diagnosed with CPTSD in america yet. PTSD is diagnosable and has been considered an official disorder for decades, but C-PTSD has not been named a disorder of its own yet in the official guidebook of psychological disorders in the US (DSM). I think they might have JUST recognized it in the UK guidebook (ICD). I know it was proposed for the 11th addition.)