keywords
PTSD, trauma, mental health, prevention, coping strategies, research, psychological interventions, resilience, emotional support, healing
summary
In this conversation, Jess explores the complexities of trauma and PTSD, discussing the limitations of current research on prevention and treatment. She emphasizes the importance of understanding the difference between trauma and PTSD, and shares protective factors and practical strategies for managing trauma. The discussion highlights the need for emotional support, resilience, and the potential for personal growth through adversity.
- Research indicates that CBT is more effective than supportive counseling for PTSD.
- The prevention of PTSD is under-researched and often inadequately explored.
- Trauma is a temporary experience, while PTSD is a long-term condition.
- Avoidance behaviors can increase the likelihood of developing PTSD.
- Continuous support from loved ones is crucial for recovery.
- Identifying as a survivor can empower individuals post-trauma.
- Positive emotions and humor can aid in coping with trauma.
- Finding meaning in trauma can facilitate healing and connection.
- Managing feelings and acknowledging pain is essential for preventing PTSD.
transcript
One of the last times that we caught up on any personal matters, as I was reporting on my wildfire adventure, I stated something along the lines of, but hey, let's be real. Am I sort of the best person for this to happen to? All the trauma knowledge we've gathered together over the years, at least I know how to deal with it... to minimize the risk of PTSD taken hold.
And look, to some extent, is this true? Yeah, I think so.
And also to some extent, is this some goddamn trauma brightsiding? Also, yeah, probably.
So while I had working internet that I didn't know was on a countdown to implosion, I decided it would be a really easy, impactful follow-up measure to simply research ways to prevent PTSD during and following trauma in the academic literature and then see how well I truly did.
I thought, I'll just find a nice little review that lists out all the research that's been done and for shits and giggles. In case trauma begins impacting more and more of us as the calendar ticks away, then cool, we'll have these notes for a rainy day. It'll be quick, I said. It'll be effective. It'll be highly utilitarian for a crowd that is used to hearing about the many complexities and nuances of trying to stay sane through relational trauma. And then we can close the book on all of this.
... I thought.
Here's what I found in doing that dive into existing research. We'll start with the bad news and work our way upwards.
This article is called Interventions to Prevent Post Traumatic Stress Disorder, a Systematic Review.
They say:
Preventing PTSD among adults exposed to various traumatic events is increasingly relevant for a wide range of healthcare providers. Evidence for best practices for treating trauma-exposed individuals is very limited, but results reported here of either low or moderate strength suggest three tentative conclusions.
1) For people with acute stress disorder, CBT is more effective than supportive counseling in reducing PTSD symptom severity. 2) collaborative care provides a greater decrease in PTSD symptom severity after injury than usual care. And 3) Generally, debriefing is not effective in reducing either PTSD incidence or the severity of PTSD or depressive symptoms.
Only a subset of studies conducted clinical evaluations to determine PTSD diagnosis, leaving open the question of whether reducing symptom severity protects victims from developing PTSD. For all other interventions and outcomes of interest? Evidence was either entirely lacking or insufficient to draw conclusions.
Applicability of findings:
Healthcare professionals should view these findings cautiously, given the limited number of studies that met criteria for this review and the numerous deficiencies in reviewed studies.
Although studies covered diverse populations with respect to trauma type and subjects age, few or no studies dealt with victims of terrorism, sexual assault, natural disaster, or combat. Trials of pharmacologic interventions were scanned. Studies varied widely in the time between trauma exposure and trial entry and used disparate eligibility criteria for PTSD symptomatology at study entry.
Data were insufficient to draw conclusions about whether the response to intervention differs in people with versus without coexisting depression. These factors severely limit the applicability of these findings to specific subgroups such as racial or ethnic minorities, refugees, first responders, and individuals with coexisting psychiatric conditions or past history of other traumatic events.
Variabilities in the types of trauma and the context in which they occur, as well as differences among individuals exposed to traumatic events, will likely prohibit a one-size-fits-all model for preventative intervention. Individuals respond differently to stress and identifying persons at risk for PTSD, predicting who will develop PTSD, and successfully conducting early interventions in the aftermath of a traumatic event remain enormous challenges for the future.
Limitations.
Three major limitations characterize evidence about psychological and pharmacologic interventions.
First, published studies on the efficacy, comparative effectiveness, and harms of many interventions of interest simply were not found. Without efficacy evidence, assessing comparative effectiveness becomes impossible in most cases.
Second, the existing literature has many methodological shortcomings. Of the 56 studies potentially meeting eligibility criteria, 37 exhibited high risk of bias for various reasons. This precluded considering them for the main analyses.
Third, selective availability of studies with positive results can seriously bias conclusions. Exploring publication bias for this review was quite restricted despite extensive efforts to find all relevant studies or unpublished data.
So I read that very quickly and not really for your comprehension because the point is it's not a quick, effective wrap-up of trauma care that assists in preventing post-traumatic stress disordering. In fact, they spit shit about the research that has been done and state that only a small percentage of it passes their standards. But don't worry.
They're not just spreading shade. Their opinion is not unique. To say it all a lot more concisely, here's another peer-reviewed article from a reputable journal.
Prevention of Post Traumatic Stress Disorder After Trauma, Current Evidence and Future Directions.
The general picture emerging from this review is that the prevention of PTSD, despite its critical importance, is under-researched and inappropriately explored. Treatment protocols have been implemented regardless of sample heterogeneities and individual vulnerabilities. Rudimentary theoretical assumptions have been hastily translated to haphazard case series and randomized clinical trials fell short of informing the overall effectiveness of PTSD in a real world.
This might be a typical situation in preliminary proof-of-concept research when treatment protocols must be rigidly implemented to ensure procedure reliability and there is no empirical foundation to stratify samples, let alone modify treatment approaches according to needs and progress.
In that sense, studies of the prevention of PTSD have successfully passed a first phase of searching in relative darkness.
Can we say bleak?
The research on preventing PTSD, apparently, according to these reviews, doesn't really exist. CBT is better than nothing, is what we can stick in our pockets. The research that has been done, apparently, is not considered viable or indicative of real-world efficacy or inclusive of differences between individuals, or their needs or vulnerabilities, per the reports of other psychologists who were also hoping to create comprehensive reviews of the material.
And doesn't that explain a whole lot about why PTSD doesn't seem to be fading away despite its prevalence and acceptance as a psychiatric disorder in the modern era?
P.S. Keep in mind that this was all from before science was being defunded.
Which is all to say from these two examples I just shared. I spent at least an afternoon, maybe two, seeking information that could not be found in peer-reviewed literature and the best, most practical, most easy to bite into information that was available was this little article that I'm going to share with you next, which is not peer reviewed as far as I can tell.
To wrap up this very concise look at trauma care for preventing future suffering, let's dig into what they say, because at least they do say something besides "cognitive behavioral therapy."
I will link this forthcoming article.
This is called How to Prevent Trauma from Becoming PTSD by Deborah Kissin, PhD, M.H.S.A.
They say:
The main difference between PTSD and the experience of trauma is important to note. A traumatic event is time-based, while PTSD is a longer-term condition where one continues to have flashbacks and re-experiencing the traumatic event. In addition, to meet criteria for PTSD, there must be a high level of ongoing distress and life impairment.
Okay, I just threw that in there to remind us all.... Trauma is not the same as PTSD. We can go through a T-word without developing life-interrupting mental and emotional disturbances. This
is the goal.
She continues, studies have shown a correlation with the development of PTSD and avoidance behaviors. In other words, the more one tries not to think about a traumatic event, resists revisiting a traumatic place, and avoids contact with any potential triggers of the traumatic event, the more likely one is to develop PTSD.
That was a useful couple of sentences, right? People who just keep moving after a trauma are people who are more likely to have psychological consequences later. Don't pull up your bootstraps to avoidantly stay busy and productive. Lay down and reflect. Or you'll be ground-leveled later despite your best intentions to be untouchable.
She says, studies have compared individuals who have experienced the same traumatic event, such as living through a weather-related disaster or terrorist attack. A review of the literature on resiliency and recovery following traumatic events identified the following as protective factors for developing PTSD.
Meaning, those who engaged in these behaviors did not endure longer term suffering:
Disclosing the trauma to loved ones.
Continuous contact with and support from important people in their lives.
Okay, we're going to stop there after those first two. Don't go through it alone. Don't aim for minimizing what you've gone through or withdrawing from close relationships.
Continuous contact and support?
I'll say a bit pretty unrealistic.
It also stanks of trauma bonding, parental transference and codependency to me. We do need ourselves, right? We need to have time alone in order to process, to build trust again within us, and to get back to kind of managing our feelings, as well.
But let's definitely say that having folks on call for support, for discussion without shaming, and for knowing that they can be relied upon when the brain gets too loud is all very important.
Next point.
Identifying as a survivor as opposed to a victim.
Indeed.
We don't want to paint ourselves into a helpless corner or a state of mind in which we consider ourselves weak and targeted by misfortune or abusers. This is where I find it helpful to acknowledge the strength that comes from traumas. It's not something that happens to you. It's something that you experience, that you steward yourself through.
Which is a powerful and strong thing to do, which leaves you with infinitely more knowledge and wherewithal and even self-esteem than before the traumatic event if you acknowledge it that way. Acknowledge what happened, yes, but also acknowledge all the ways you were there for you and potentially others.
And then when you're later creating your trauma narrative, make sure you give yourself credit for those points. Also, try to paint it as another round of trial that you've successfully navigated on a long journey. Don't make it like the ultimate story of your lifetime. I promise it isn't unless you frame it.
And make it so.
[I also want to throw in there... you know, I think there's been kind of a drastic misunderstanding of the title of this whole project. Traumatize motherfuckers. It was always meant to be a nod to the strength and go-git-em-ship, the grit and determination and adaptability that rounds of trauma can bring to a personality.
So not traumatize motherfuckers, poor us, but traumatize motherfuckers. Watch out, because we've seen too much to be complacent, surface level bound, weak ass sufferers. Yeah. If it helps, think of yourself as such, a real motherfucker, not an abusive one strongmaning the world, but a person who knows what's real, what matters, and what can be disregarded as they act in line with themselves, your own beliefs and trauma clarified values. Just a reminder.]
Next point.
Holding the belief that you can manage your feelings and cope.
... is another PTSD protective factor. This one goes hand in hand with that prior point. See yourself as a survivor with the skills to keep your feet on the ground, your head in the game, and to take care of yourself. You were able to do it in the event, at least enough to make it out. And in this community, you have a lifetime of feelings and copings that have defined your breathing experience.
So why wouldn't you believe that you could manage your emotions and find non addictive ways of getting through the day this time too with all of this extra know how that you've picked up.
One thing I do want to mention is the phrase that they use, "manage your feelings." It's not a great one. For me, that means shut down your feelings, which is the exact opposite of preventing trauma or recovering from PTSD. So I think we need different verbiage.
What we really want to be able to accomplish to prevent PTSD is shuffling your feelings and knowing that you can do it. Like being able to acknowledge what is there and then deciding if it's the wisest time to have those feelings. If you have what you need, time, space, and energy for the feelings that are the loudest, the most intrusive.
If not, that feeling can be noted and then felt with later. Then you must return to it as you've promised yourself. Have it, take the message away from it, and shuffle the emotional deck again to let it go. Being aware that that is within your capacity is very relieving and helps with the onset of PTSD.
The truth is, you can have big feelings and be okay too. You will most likely need to prioritize doing that inner work over the outer work that normally constitutes life. And that's a challenge. If you attempt to jump over the emotions to keep sprinting though, just remember that you will be tripped up later for much longer with much harder recovery work to be done.
Great. Next points and the final ones on this list. I'm giving all three in rapid succession because I think they are related.
First, use of positive emotion and laughter.
Next, finding positive meaning in the trauma.
And lastly, helping others in their healing process.
Okay, first things first, I've been waiting to talk about this for almost a year. You know what one of the highest maturity self-defense mechanisms is?
Humor, being able to hold the complexities of life dualistically at once. Yes, this horrible thing happened. And also isn't at least some part of it ridiculous. Hey, here's where your brain was logically going, assuming everything was chill. And here's the curveball that served as the punchline, some drama. I mean,
That is how jokes work, right? With misdirections. And traumas are kind of a lot of misdirections. Anyways, comedians are some of the most traumatized individuals you will ever hear from. And they are in their profession because they use humor to transform those events into stage performances can include next point,
Finding positive meaning in the trauma and maybe helping others in the healing process.
We don't need to be toxically positive about dog shit events. Okay. It doesn't behoove us. Refer to that first point. However, we do need to construct a narrative around the event that doesn't paint us as a victim because that creates long-term cognitive challenges and issues with the self.
So if we can find some positive takeaway, then we can at least say, there was a reason that this happened and sow it into our lifetime story. It can mean something and that thing isn't, I'm fucking doomed. Rather, now, I see how strong I am, etc.
And in doing so, in finding a purpose or a positive meaning in the trauma, we might help others to reframe their own T-word the same way.
Or we can take our very, very difficult and shitty challenges, empathize that others are going through similar sufferings, and put our boots on the ground, acting purposely as the social disclosure and support strongholds that other people are probably reaching for.
We can help others go through the same challenges that we already have or still are. We can use our wounds for healing. Our pains can have purpose. If we take the time to reflect, to find the lessons in them, and then spread those wisdoms with those who are still in it.
In doing so, again, we are creating positive meaning from our trauma as it becomes a catalyst to becoming more connected, to adding a layer of community healing to our environment, and as we increase our authority in ourselves. Hitting multiple points on the list of PTSD prevention behaviors and some that they didn't list here.
That way, our lives become positively aligned with what we have been through, transmuting difficult events into points of healing for all, rather than, again, trying to just ignore what has happened, and in doing so, passing that still alive pain around to a crowd.
It all starts with acknowledgement of what you've survived and allowing yourself to notice how powerful the resulting insights are. First for you, then for the other animals who might be in similar situations. You might even do it with a laugh or two to make it more healing for everybody.
This also might be the whole point of this project. Traumatized motherfuckers.
So...
I encourage you again to be one if that little mental shortcut helps you to bring the right energy into your recovery goals.
And y'all, that was the list.
You got it? Yeah, probably not. Here are those points again without my interruptions.
Disclosing the trauma to loved ones.
Continuous contact with and support from important people in your life.
Identifying as a survivor rather than a victim.
Holding the belief that you can manage your feelings and cope.
Use of positive emotion and laughter.
Finding positive meaning in the trauma
Helping others in their healing process.
These are all things that we can do to help ourselves. These are all useful pointers...ish. Let's be honest, many of these points are, again, not very accessible or clear to many of us. They're a bit abstract and ideal to be highly applicable when your brain is struggling to perform even basic tasks.
So, will there be a follow-up episode or several getting more granular and well-defined in the ways we can help ourselves than this list was? There will be. And here's a little touch of that now from the same article.
Deborah continues,
One exercise you can practice is to set a timer for five minutes each day. In these five minutes, you are to open up to any thoughts, sensations, or feelings that are associated with the trauma. I describe this to my patients as setting office hours where all thoughts, feelings, sensations, and images are welcome. For the rest of the day,
When painful internal experiences arise, you can acknowledge the thoughts, feelings, or images and gently remind them that they can come back during office hours. But at the current moment, there are other tasks you need to be available for.
Okay, now here's me speaking.
First of all, I think she's saying, tell your exiled parts that you'll hear them later on. So, can wrap IFS into that if you really want. Secondly, she recommends five minutes so that you don't get overwhelmed by going balls to the wall. I'm going to suggest a modified setup in case this sounds like not what you need.
Set a timer for 30 seconds and start there experiencing all your thoughts and feelings and sensations. That is enough to begin with. Five minutes is like asking for a lifetime of trauma recollection right at the beginning. You do not need to be that deeply immersed.
Instead, start low and keep working with yourself, noticing when your nervous system is becoming dysregulated past the point of breathing deeply to soothe it. And consider that that is your limit for the day. Maybe that's your limit for the week. Then set a new goalpost for being with your feelings for the next week. From 30 seconds, extend the timer to 60 seconds, then eventually 120.
You get the point. Work up to that suggested five minutes.
And I also would recommend making a ritual of it by providing as much comfort and self-support during that time, also before and after it, as possible. You aren't going in there for five minutes torturing yourself, experiencing the trauma. You want to create an environment for the experience that reminds you that you are okay, you are in control, you are in the present moment, and that this trauma processing isn't a punishment or a prison.
Then, when you're going about your day and thoughts or feelings begin intruding, it's a much more welcoming and pleasing pivot to tell yourself or your exiled parts... Not right now. We'll do this work later. When we not only have a timer set, but we also will have our favorite blanket, couch, ⁓ smells, foods, sounds, follow-up activities like taking a hot shower, etc.
Make a therapy date out of your office hours, so that you aren't going through your day white-knuckling your brain and avoiding the processing part later. You'll start to form a more peaceful and copacetic relationship with your trauma thoughts and your self-management tactics and work through that psychic corrupting material while you're at it.
Anyways, there's one practical suggestion that you can begin with right now.
Is it good enough to prevent PTSD? No, probably not. So we will talk about more things you might want to learn and try out very soon.
To wrap for today, we'll end with a Debra's final sort of fucking fluffy
But it is a trauma response to write them off for that reason alone.
She tells us.
No one can prevent the pain and suffering tied to the human experience. It is inescapable. We will all experience losses of immense proportions. Jesus, Deborah, okay. What we can prevent, however, is suffering on top of pain. I sometimes describe this to my patients as stubbing your toe and then being so frustrated that you stubbed your toe that you then punch yourself in the face.
You can allow yourself to just have pain and not suffering on top of pain by opening yourself up to the thoughts, feelings, and sensations associated with loss and trauma. Now, this does not mean to flood yourself or artificially bring up memories and triggers randomly throughout your day. Instead, when these distressing thoughts and feelings do arise, welcome them.
I know the concept of welcoming pain is a tricky one to grasp. After all, who wants to be welcoming pain? But pain is there for a reason. The pain we feel when touching a hot stove is there to teach us that fire is dangerous to the skin. The pain we experience after living through a trauma is there to guide us in the future and to see what lessons there are to learn.
that may protect us from future loss.
End scene.
Not the greatest wording, but okay. So let's take all of that and let's store it away just in case. What did we learn today in this intro episode to caring for ourselves to prevent PTSD onset after traumatic times?
Well, we learned that the research literature has somehow really missed the mark on uncovering this information, despite what one might believe has been a period of prevalent PTSD studies, considering how much we've all been yapping about it on the internet. Are you shocked? Because I am a bit shaken by this finding. And I'm not a person who really believes that science is on the ball much of the time.
What can we say though?
Well, we learned that for people with acute stress disorder, CBT is more effective than supportive counseling. Collaborative care produces a greater decrease in PTSD symptom severity after injury than usual care. In other words, it helps if your health care providers and supports speak to each other about your progress. And generally, debriefing is not effective in reducing PTSD incidence or severity of symptoms. In other words, telling people what has happened to them after a chaotic time does not make that distress leave their system.
We were also told only a subset of studies conducted clinical evaluations to determine PTSD diagnosis, leaving open the question of whether reducing symptom severity actually protects victims from developing PTSD. So as we have often said on this show, which people have not appreciated all the time, we need to treat the trauma at the root, not at the level of symptoms. This is why something like an antidepressant or disassociating into a comfortable state as a coping mechanism simply doesn't protect against PTSD development.
We also learned variability in the types of trauma and the context in which they occur, as well as differences among individuals exposed to those traumatic events, will likely prohibit a one-size-fits-all model for preventative intervention. So be careful if you are seeking help and finding that your providers aren't really listening to you or tailoring the treatment to your needs or preferences.
You will have to listen to your own brain and body and be the authority in guiding your own recovery to at least some extent. But some of the things that we can broadly apply to help ourselves are disclosing the trauma to loved ones, continuous contact with and support from important people in your life. I still have my hangups around that one.
Identifying as a survivor, not a victim.
Knowing that you can shuffle your feelings and cope. Use of positive emotion and laughter.
Finding positive meaning or purpose in the trauma.
And helping others in their healing process.
All of this helps to integrate the trauma with our life experience and provide a more positive meaning. It can become connective and healing rather than being lonely and perpetually painful for no reason.
And of course, we can also say very firmly that emotional and embodied experiencing are crucial. The more we shove away the experience, the more it takes hold in the hidden places inside of us and spreads, eventually reaching the surface. Therefore, we can use things like timers to increase our windows of tolerance for recognition of these feelings, memories, and sensations.
I recommend starting low, 30 seconds on the clock, and increasing stepwise from there. Using that time to comfortably be with yourself, providing guidance before and after, and being the parent that you need and have always needed to you.
Be the buffer between you and the world, especially if that world is increasingly wonky.
And with that, we wrap for today.
I'll see you next time as we really pick up the pace, get a lot more detailed, dive into the research, and talk about what common reactions we can expect from ourselves during times of trauma, as well as immediately following.
Why? So we know what we're likely to go through in discombobulating times. so that we can develop plans and remember to apply them, to apply care, even when we lose our wits a bit. We can scrimmage so you're not bowled over.
And also, so we can identify when we are in a traumatic event based on our own reactions and therefore knowing when we require extra care. Because frankly, with all the trauma many of us have accumulated and forcibly ignored, it can be hard to know what is a potentially traumatic event versus what's a regular Wednesday.
And it helps to recognize that in our close associates too, to be able to see the symptoms to know a trauma is taking place for them. That way, we aren't assessing them as "lost their goddamn minds," when in fact they're experiencing a potentially PTSD invoking event.
From there, after we get through all of the research literature that I did find, I want to talk about the specific behaviors that I used in a natural disaster, which was also during a highly CPTSD inflammatory time, relational trauma abound. Actions which seem to have mitigated many of the symptoms of PTSD so far.
[Noting that, of course, only time will tell if those actions have fully fended off the disorder or not. I promise to keep you updated. So fuckers, welcome to our next series. It's a month of May Day episodes, continuing our effort of detailing how we can care for us at times when the world is really testing. Our nervous symptoms.]
Hail yourself, hail your self-helping.
May it lead to mutual healing, turning wounds into wisdoms, and maybe finding just a drop of funny in all of the fuckery to prevent PTSD.
Cheers y'all and I'll talk to you soon.