keywords
PTSD, peritraumatic stress, trauma reactions, emotional responses, cognitive overload, dissociation, mental defeat, community support, resilience, coping mechanisms
summary
This conversation delves into the concept of peritraumatic stress, exploring the emotional, cognitive, and physical reactions individuals experience during traumatic events. It highlights the importance of understanding these reactions to better prepare for and cope with trauma, emphasizing the social dimensions of trauma responses and the potential for resilience and positive action in the face of adversity.
- Peritraumatic stress refers to the stress experienced during a traumatic event.
- Recognizing signs of trauma can help protect mental health.
- Emotional reactions during trauma can include anger, fear, and confusion.
- Cognitive overload can lead to disorganized thoughts and feelings of being overwhelmed.
- Dissociation is a common response, leading to a distorted sense of reality.
- Participants often felt a loss of control and agency during traumatic events.
- Physical reactions can include immobility and psychosomatic symptoms.
- Positive reactions, such as taking action and providing support, can emerge during trauma.
- Social connections and community support play a crucial role in trauma responses.
- Understanding these reactions can foster resilience and coping strategies.
transcript
Hi fuckers. Today we are here to talk about PTSD. Aren't we always? Nope. Because this time we're discussing not post-traumatic, not pre-traumatic, but peritraumatic stress. As in
What happens when we are actively in trauma? Currently experiencing what is a PTE, potentially traumatizing event? And how can we support ourselves during, as well as immediately after, those happenings in order to minimize our post-traumatic stress symptoms and likelihood of psychic disorder? It's a series.
We're on part two. We're going to keep moving through it quickly. Come on in. Today in this quick and dirty rundown, we're going to discuss the common characteristics of a traumatic event on the human system and psychology. The lived experience.
That way, yeah, we can make sense of what we've already been through. And maybe more so, we know what to anticipate so we can prepare for those experiences. We can set up our plans for self-support, recognizing that we will probably have disruptive inner events making it difficult when shit hits the fan. And when reality isn't always reported as reality, we can also use these commonly reported personal experiences as indicators that maybe we are in a system stressful time, which might become a post-traumatic event.
We may be living through trauma that we're not fully recognizing.
Instead, if we can notice through our own systems that we are going through a potentially traumatic event, we can protect our minds from further damage.
So, not to say spoilers too soon in the episode, but we can also find hope in these reports as they relate to these issues of positive humanity, of connection, caring for others even in the depths of destruction. Co-munity above all.
So, let's talk about the experience of trauma. Peritraumatic reactions.
These are our stories.
Dun dun.
Just a heads up, which I normally do not do. The findings of this article are often pretty emotional and a little bit upsetting to hear, though I tried to cut out the worst parts. They might remind you of rough times in the past or get your brain spinning about the future. If you're not in a healing space right now, or you are at risk of overwhelm already, perhaps this isn't the episode for ya.
Now let's get into it.
The article we'll be spending time with today is called Feelings, Thoughts, and Behaviors During Disaster. It was published in Qualitative Health Research in 2020.
They say.
The field of trauma and post-traumatic stress disorder has highlighted the thoughts, feelings, and behaviors people experience during or immediately after exposure to traumatic events. These phenomena have been collectively named peritraumatic reactions. The reactions that have received the most attention are peritraumatic dissociation, both in its psychic and somatiform presentations, distress, tonic immobility, panic attacks, data-driven processing, and mental defeat. The current focus of the psychotraumatology literature on a small subset of negative peritraumatic reactions appears incomplete when compared with the more nuanced and complex picture provided by experiential accounts of disaster survivors.
Semi-structured interviews were conducted with 104 earthquake survivors. Participants reported experiencing various peritraumatic reactions. The survivors' accounts confirmed presence and overall phenomenological characteristics of commonly studied peritraumatic reactions. In addition, novel and understudied reactions were identified.
That's what we're here for.
We will be starting dark and duh, with what most of us probably expect them to find. And we'll be working our way towards the light, the surprising and hopeful results of the study. In we go.
EMOTIONS
A number of participants reported reacting to the events with anger, irritability, and frustration. Anger was often fueled by a perceived sense of injustice concerning the event. Participants often mentioned that what had happened was unfair, alluding to a tacit universal moral structure that had suddenly shattered.
We can already guess that that anger is a secondary emotion to sadness, which is one way that we might also be experiencing
FEAR
Fear was also experienced widely. Fear was at times associated with participants holding catastrophic beliefs. These ranged from thinking that everyone they knew was dying or was going to die, that the earth was going to split under their feet and swallow them, or that the apocalypse was taking place.
OVRWHELM AND COGNITIVE OVERLOAD
The overwhelming intensity of thoughts, feelings, and sensory stimuli experienced during the traumatic event led some participants to enter a state of cognitive overload, a reaction consisting of moderate to severe disruption in how they processed information around them. This often led participants to feel confused during certain moments of the earthquakes.
Participants described this reaction as feeling dazed or stunned and not as being able to fully take in, process, or understand what was happening. External and internal stimuli were described as being too intense, too fast-moving for cognitive capacities to keep up and assimilate them. The detachment from cognitive resources was described metaphorically by participants as being out of one's mind, feeling absent like a zombie, struck by lightning or drunk, and acting, quote, without cognition. Cognitive capacities were conceptualized by participants as being a finite container that was overflowing with powerful internal and external stimuli, leading to confusion.
Participants often compared their minds and brains with computers or mobile phones that were struggling to process the information received. They variably described their brain and minds as going into overload, haywire, or standby, as having to be reset or shut down, or as not connecting and stalling.
Participants reported that thoughts appeared disorganized, racing and disconnected from one another. Thoughts were described as possessing a materiality and a mass that caused them to crowd, pile up, cram, and condense in one's mind. In addition, thoughts acquired a stickiness that made them clump together and made it difficult for participants to distinguish one thought from the other.
Interestingly, some participants reported an overabundance of thoughts during cognitive overload. Others also described an opposite state of thought vacuum and cognitive void, where they reported experiencing no thoughts.
In the first moments, I couldn't divide different thoughts from one another. I couldn't think rationally of only one thing at a time. In the moment, they were all clumped together and I couldn't manage to divide them. Male, 20 years old.
As with emotional distress, the initial phase of cognitive overload was, in some participants, followed by the ability to gather one's cognitive resources and enter a more reactive and focused state. Others reported fluctuating between moments of cognitive overload and moments of rationality. Conversely, a minority reported exiting the state of confusion only days following the event.
So we can say a lot of things are happening in the brain. It's lit up, firing off so many thoughts that they can become a hindrance. Those with the same tone are more closely and heftily linked through those neural networks. And therefore, they clump together with emotionality, potentially as trance-like cognitive states in which the individual can't think outside of this bundled bunch of thoughts because that section of cells is so activated and stubbornly wired together. Remembering, of course, that by section of cells, we actually mean those highways can be traversing large spans of the brain.
But again, the way that they are wired together makes them turn on all at once. Or the mind is so overwhelmed that it can't think at all. Perhaps the situation is so novel that there are no neural network connections to jump in on. The brain is stuck in shock and awe mode, removed from all sense of mundane reality, all familiarity, or associated learned responses.
So therefore, it becomes crippled, vacant, and potentially the mental space flip-flops between those two conditions. All or nothing is happening until perhaps days after the events pass.
Many of us probably can attest. remember, you're not going nuts or losing your capacity permanently in a traumatic event. If you're experiencing this cognitive overload in racing or empty thought patterns, consider what it suggests about circumstance rather than the self.
This is all biological, psychological, normal, it does not mean that you are failing or weak or incapable. Next point,
PERITRAUMATIC DISSOCIATION or disassociation during the trauma.
Participants reported experiencing a variety of peritraumatic dissociative reactions. These reactions clustered around three key phenomena.
Distortion in one's sense of reality, derealization, distortions in one's sense of self, depersonalization, and emotional numbness. The most commonly reported dissociative reaction was experiencing distortions in one's sense of reality, 51 % of the sample.
The disaster experience was permeated by a profound perception of unreality. Some of the most common adjectives participants used to describe what they experienced were surreal, absurd, impossible, and unbelievable to indicate the disintegration of their perception of reality. The most widespread perception concerning derealization described by participants was, of course,
the feeling of being in a dream. Participants also described feeling part of a movie, a fiction, a parallel reality, another dimension, or a video game. Together with a disintegration in the sense of reality, a smaller number of participants also reported disintegration in their usual sense of self and personhood. They reported not feeling like themselves, or feeling outside of themselves. One participant described the sensation as being so acute that he started thinking he had disappeared or become invisible, a ghost, and touched himself to check he still existed.
The understanding of mundane reality is so different from what is transpiring that the brain doesn't know how to process it or place the individual within it, especially not as themselves. Also, of course, we can say that the mind protectively leaves the building during traumas, creating the illusion of more space between the events and the observer, or the observer's body.
They're defensive measures as much as they're issues of cognitive processing capacity.
If you or others are calling things unbelievable, absurd, or saying this can't actually be real, consider if the mind is experiencing a trauma and do what you can achieve to put yourself back in your body, on your timeline. We've talked about methods to do this 10,000 times
Check out any episode on the self for tips. Also, check out that recent episode on nervous system balancing tips. If the neuroceptive capacities are overwhelmed, if the autonomic state is stuck in any given on position, then the downstream feeling, processing, and narrating capabilities which create our sense of self and reality are going to be affected as well.
Bringing us to our next finding.
MENTAL DEFEAT AND LOSS OF CONTROL
Helplessness was a prevalent, 60 % of the sample, paratraumatic response. The earthquake was often conceptualized as an entity that exceeded any human attempt to react to it. Indeed, while individuals reported losing their own sense of agency,
They simultaneously projected a sense of all-powerful agency onto the earthquake itself.
This perceived loss of human agency was at times associated with a feeling of defeat, discouragement, resignation, as some participants reported losing all hope, feeling destroyed as a person, or psychologically annihilated. Some participants reported losing interest in whether they were going to live or die and surrendering to the event.
This feeling of defeat was also associated with a perception of exhaustion as emotional, physical, and cognitive resources had been depleted.
helplessness and the perceived loss of human agency also contributed to shifts in the perception of self and personhood during the earthquakes. Some participants reported feeling like a pawn or a vegetable at the mercy of nature. This sense of objectification was at times exacerbated to the point of participants perceiving themselves as being nothing or no one.
The threat can be experienced as being too large to deal with because the thoughts about the threat are too large to deal with, too whelming. And the self in comparison is estimated as too small to make an impact As they said, the traumatic event became personified being described as a monster.
Once we're thinking in this manner, giving outside events big personalities, motivations, intentions, as well as evil, immoral, or demonic labels that can drudge up even more fear. Well, I think we can all see how that's creating a story that is doing our brains, our nervous systems, and ultimately ourselves, a disservice.
There are all the details in front of us that we actively need to respond to in material reality.
And then there are the extraneous thoughts piggybacking off the real observations that cause us to question our capacity to respond to the risks, to care, support, or advocate for our well-being.
Taken together, it can become a fog of mental and emotional activities that overloads a system and causes stagnation as well as disassociation.
Bringing us to...
IMMOBILITY AND SOMATIC REACTIONS
Participants also experienced a diverse range of psychosomatic reactions. The most commonly reported psychosomatic reaction was physical immobility. Participants generally describe the sensation of having their entire body or specific body parts blocked, heavy, stiff, rigid, paralyzed, or immobilized. They describe feeling as if their body was not responding to intentional commands. Two participants describe themselves as a mummy and as a doll, respectively, inanimate objects unable to move autonomously.
Participants also reported psychosomatic reactions related to fear responses such as fainting, shaking, losing one's appetite and thirst. In addition, a minority of participants, a variety of psychosomatic reactions linked to immobility were reported such as not feeling pain, not being able to scream or shout and feeling cold.
Alright, so as we know, fear is immobilizing when the threat is estimated as overpowering.
Another presentation of this might be falling asleep inappropriately. Stress goes up, the body can go down. This can be a defense mechanism and a symptom of full system overload, resulting in powering off. In stark contrast to TAKING ACTION
The good news is we're through the worst of it. We've described all of the most horrific scenarios as far as paratraumatic reactions and their likelihood to create downstream PTSD. Now for some positive reactions.
TAKING ACTION
Participants reported experiencing a considerable number of agency-driven reactions indicating orientation toward action, focus, and attempts at managing one's emotions while in distress. Some participants reported quickly gaining full understanding of what was happening. Others described progressively initiating a process of making sense of the event and putting things into focus in the subsequent hours and days.
The process of gaining awareness of what was happening was generally followed by a shift to actions oriented toward a goal. These actions were both directed toward the external environment, for example, providing support to others and toward oneself, such as regulating one's reactions.
Participants reported switching to an operational mode by unblocking or activating one's self and springing into action. Some participants described this shift from confusion to action as that of resetting a frozen computer or phone. It was only a moment of confusion.
One second, then I saw the stones on the ground and I thought, shit, it's the earthquake. It was as if I had reset my brain and I went along with the mechanical memory. I mean, I had identified priorities one, two, and three, and until I had completed all of those priorities, I didn't stop. Female, 25 years old.
As much as we're prone to overwhelm during these chaotic times, there's also the potential for the threat to cut through outside noise and offer clarity about what needs to happen. Somehow setting priorities and taking action can become automatic reactions, as if the mind has an intelligence of its own pre-programmed into it.
They say,
the most commonly reported external action was that of providing both practical and emotional support to other people in need, 64 % of the sample. Practical support ranged from offering food and water, giving people clothes and bed covers, to providing first aid and rescuing people from under the debris. At times, participants reported putting their own safety at risk to help others.
People often reported that what pushed them to provide practical support to members of their community, as well as to strangers, was the need to feel useful and take agency in relation to the situation, together with an identification with the suffering of others during the event.
I put myself in the background in order to help others. I instinctively annihilated my ego. I considered the life of another person just as important as my own. Male, 28 years old.
Participants also reported providing emotional support to others. This included calming and comforting them as well as being strong for people around them. The act of providing emotional support was often associated with an attempt to put one's own emotions on hold to concentrate on the suffering of others. Participants reported engaging in various kinds of emotional labor to regulate, postpone, and control their emotions.
The function of this emotional labor was often that of projecting and constructing an exterior impression of calm for others, sometimes actively lying to oneself due to internal turmoil.
Participants conceptualized other survivors as open containers within which one could inject calmness, rationality, and tranquility. Emotions were described as communicable entities. Participants reported having been able to maintain a state of calmness and detachment by freezing and turning off their feelings.
This emotional blunting was at times identified as a defense mechanism to handle particularly distressing scenes.
This indicates that on some instinctive level, we know how to sort through emotions. We can postpone our own feelings that we deem not useful and return to them later. Even more so... We can do it in order to take action to provide the emotional support that others need, recognizing that emotions are communicable entities. Seeing people as being open vessels that supportive feelings can be injected or poured into.
They say,
at the cognitive level, participants also described a particular state of enhanced focus on action. This was a state characterized by heightened levels of concentration and problem solving, enhanced awareness and perceived rationality, mental lucidity and clarity, concrete thinking, and narrowing of attention to a specific aim.
The actions that participants were engaged in appeared to function as mental black holes, totally absorbing the cognitive capacities of the individual. Participants described this state of hyperfocus as similar to being in a state of trance, as we often describe with trauma.
My head was completely empty. I was only focused on acting. It's not that while I was lifting the debris, I was thinking about things. I didn't think about anything. It was similar as when I go running and I focus on the run itself, on my breathing. Male, 31 years old.
Even after near total devastation, we have our instincts to lean on, telling us what to do, what to focus on, what matters, and nothing else. That might be without enormous thought or planning, which can feel unusual for us as commonly being over-thinkers. So often we villainize our reactions.
In this case, rapid action for survival, was appropriate and it was applied. It made sense and it was highly functional and it assisted the person and the people around them because action was taken without delay. we don't want to hate or fear our nervous systems.
We want to notice when they're appropriately responding. We do have welcome, highly functional, survival promoting trauma reactions programmed within our very nerve endings.
And those can include EMOTIONAL RESPONSES
Again.
We're revisiting our first point, this time to find the gold in the fear and anger turd nuggets that we previously discussed.
They say.
EMOTIONAL RESPONSES
The majority of participants mentioned fear as the predominant emotion experienced during the earthquake. However, fear for the safety of others was reported by more participants, 78 % of the total, than fear for one's own safety, 70 % of the sample. Fear was conceptualized by participants as a social emotion often held in relation to significant others, especially family members, not physically present at the scene.
Look, I might be a cynical dickbag who anticipates nonsense from most, but as far as unexpected occurrences in life-threatening times go, that finding ranks pretty highly, as does this.
POSITIVE AFFECT
A number of more positive emotions were also reported by participants. Hope was the most common positive emotion reported 29 % of the sample. The earthquake events were conceptualized as spaces of intrinsic uncertainty and ambiguity. And while some participants filled this lack of information with catastrophic prospects and anxiety, others filled them with hope. Participants often reported hoping that people close to them had survived the earthquake, while some reported hoping that they were in a dream.
A number of participants also reported transient feelings of joy and happiness in certain moments. These emotions were often reported as being circumscribed in time and mixed with a diverse range of other feelings and thoughts, which often changed rapidly. In the midst of terror, fear, and anxiety, some participants were still able to identify moments of lightness.
I remember when we saw all of our family members or people that up to that day before you had never talked with and you would hug each other. There was this feeling of brotherhood, people that maybe before you didn't even like, but seeing them there, it was such a joy. Female, 23 years
Ricocheting off of fear, we can hope that things turn out okay. That things can be rebuilt, that change is ultimately a positive, even though it's painful, And that can also be accessed. Positive affect such as appreciation for what remains, for even seeing people that you may have previously had tumultuous relationship with, also matters sample size significantly.
Let's wrap it up with their
DISCUSSION.
Our findings provide empirical support for the identification of peritraumatic dissociation, distress, immobility, and mental defeat in the quantitative literature. While some work has explored peritraumatic reactions qualitatively, it has been generally done so tangentially or in small samples. This is the first study to explore immobility and mental defeat during an earthquake.
This shows that these two peritraumatic constructs, mostly conceptualized in relation to interpersonal violence, might be relevant to other traumas as well. The accounts provide insight into an understudied peritraumatic reaction, that of cognitive overload, a state of disruption in information processing characterized by a perceived sense of confusion. A lack of integration of sensory perceptual stimuli into higher cognition, and disorganized, overwhelming, racing thoughts.
Our results also highlighted the presence of a range of more adaptive and positive peritraumatic reactions, such as hyperfocus on action and positive emotions such as joy, hope, and relief. These reactions have received virtually no attention in the peritraumatic literature, and its focus on more negative and dysfunctional reactions has meant that more normative aspects of trauma responses have been neglected.
Survivors did not experience distress, dissociation, and helplessness passively, but were able to respond and endeavor to manage these reactions through various coping mechanisms, such as emotional regulation and cognitive focus on goal-oriented actions. This could provide some explanation for the widespread psychological resilience that is shown by survivors.
As these more neutral and adaptive reactions and their consequent appraisal post-trauma could play a protective role against post-trauma psychopathology. Another core finding from the data cutting across most reactions was the inherently social dimension of the peritraumatic experience, in that most participants reported noticing the reactions of others, fearing for others, and supporting others. While the findings are limited by possible social desirability biases, they are in line with findings from social psychology highlighting the cooperative, social, and non-selfish nature of most reactions during mass emergencies.
All of this might begin to tie together some loose ends as we consider that final point in our last talk, that helping others is a mind-protecting behavior
Against all assumptions, it appears that we're not as selfish and me-oriented during terrorific times as one might think, as the literature has led us to believe.
And actually, perhaps.... It's the moments before the feces is flapping in the fan that we are cognitively unclear about what matters. Even with all of that potential cognitive overwhelm, we begin taking actions with clarity once we're reminded of what is important.
Fuckers for today, that's it.
The purpose of this little episode was just to help prepare, think, and feel about traumatic reactions. To be able to identify when trauma is tickling your nervous system. And to start turning gears before then about what you can do in extreme times, for everyone's mutual benefit.
During those times, we might notice things like mental capacity failures and fluctuations, strong feelings of helplessness or hopelessness, anger or fear, sense of unfairness and disempowerment, stagnation or extreme outward action and also intense concern for the experiences and safeties of others.
And hopefully we've learned enough about these signs within our systems to trust what we're perceiving,
So that we aren't waiting for an obvious earthquake to hit before we begin providing the pre-peri- and post-traumatic care that we need to survive, to self-soothe, to protect our brains...
And to serve our species.
I hope you catch my meaning in all of this.
Next time we gather here, we'll touch on two additional research articles that can assist us in understanding what and what not to do to protect ourselves from PTSD following the T.
Then we're going to dive into what I can say, from my weeks of peri and post-traumatic care, with a straightforward, accessible, you can do them right now, list of activities and actions that I've been engaging with, things that might help your system the way they've seemingly so far supported mine.
Sharing and preparing is caring.
Hail yourself.
Hail your motherfucking survival responses.
The good news being, apparently, there are statistically significant sample common reactions under peritraumatic conditions which already might give you a little bump of hope.... and even a sense of co-munity.
Until we come back here to foster some more,
Cheers y'all.