Post-traumatic stress disorder: Which strategies help VS hinder recovery?

The thoughts, feelings, and symptoms you experience after a trauma are very painful. It makes sense that you want to push them away or deal with the trauma to make the pain pass faster. But the more you try to limit the discomfort, the more intrusive the memories and feelings of anxiety tend to become.

One of the most common strategies that backfires, is trying to process the trauma by repeatedly going over what happened in your mind. Instead of helping you process, this often leads to increased feelings of depression, shame, hopelessness, and anxiety.

There are a number of unhelpful strategies that equate to digging into a mental wound.

1. 'I need to process this'

What we see a lot, is that people believe they can reduce the pain and feel better if they 'process' the trauma properly. Understandably so, as this is what you'd probably be told to do if you sought advice from friends, a doctor, or a therapist. But although exposure therapies such as EMDR and CBT for trauma do work, excessive thinking about the trauma is one of the worst things you can do for your mental health.

Newer research shows that thinking back to the trauma and replaying what happened is actually making you worse. We call this form of thinking rumination, and it usually consists of trying to work out questions such as:

• 'What actually happened?
• 'Why did it happen to me?'
• 'Was it my fault?
• 'Could I have done something different?'
• 'Why am I feeling this way? Am I going to go crazy'?
• ‍Other times it can be questions related to the circumstances or people involved in the events, such as: 'Can I remember the face of the person'?

In an attempt to find out what happened or who is to blame, many people spend excessive amounts of time going over their memories. This rarely results in helpful answers, and instead leads to confusion and muddled memories.

Similarly, many people wonder why they get these intrusive thoughts to begin with, and whether there is something wrong with them that's stopping them from progressing.

It's easy to forget what thoughts and emotions really are: passing events in your mind that you don't necessarily have to engage with. A thought is nothing more than just some brain activity, which doesn't have any control over your present reality. And just like all other thoughts you've had in your life, this one will undoubtedly disappear by itself as well, if you let it.

What you can do instead is reduce the time you spend thinking about what happened during the traumatic event. Stop attempting to fill gaps in your memory, cut out the evaluation of how you could have handled the event differently or if you're to blame. This only maintains the focus on the memory and unpleasant feelings such as fear, anger, sadness and shame.

In part one of this PTSD series, we wrote about how revisiting unpleasant thoughts strengthens the neural pathways in your brain, leading to those thoughts becoming more persistent, and taking up increasingly more space in your head.

2. 'Next time I'll be prepared'‍

Many people experience trigger thoughts, like: Could it happen again? Am I still at risk? They continue to worry and mentally prepare for how they would handle similar events if they were to happen again.

And similar to brooding, worrying does not lead to a solution or a feeling of security, but instead prolongs and intensifies the unpleasant feelings of danger. This is an unhelpful worrying cycle that often gets worse over time.

(Also, for some, a paradox emerges, as excessive efforts cause high levels of fatigue and stress, which in turn can cause stronger feelings of insecurity, which in turn triggers the need for even more preparation.)

What you could try to do instead is to recognize when you are entering into a worry cycle, and try to interrupt it as early as possible. Choose to reduce your engagement with the thought, let it be, and continue with your day as if the thought never occurred.

3. 'Next time I'll see it coming'

Going through a traumatic experience urges you to avoid it from ever happening again, and closely monitoring your environment for any sign of danger seems like a logical strategy to avoid danger.

A person exposed to an assault outdoors in the evening may begin to look for and follow shadows around them when walking on the street. A person involved in a serious car crash with a moose might be hyper-alert to the possibility of crossing wildlife.

But this constant monitoring for danger in your surroundings keeps your attention locked onto potential threats. And your body and brain doesn't always know the difference between imminent danger and your perceived dangers.

Although this strategy is totally understandable, it unfortunately sends false signals that you are still in danger, creating a negative cycle that gets increasingly stronger.

4. 'I'll just avoid the situation'

‍To deal with the worries that something similar might happen again, many people start the process of avoidance. They may avoid certain people, surroundings or other things associated with the traumatic experience. A person who was assaulted at a party might avoid going to parties again, while a person who was in a car accident might avoid driving.

You start to narrow your life. And this provides fertile ground for even more rumination and anxious worrying.

You may be avoiding things to prevent yourself from being triggered by thoughts and feelings linked to the traumatic event. But this avoidance can lead to fear of both your own thoughts and to an increasing number of activities.

Instead, when you're triggered you could try doing nothing at all with those thoughts and trust that it will self-regulate. It helps to remind yourself that it's perfectly normal to be triggered by thoughts, images and memories after a traumatic event. This isn't a sign that there's anything wrong with you. The thoughts and feelings will always pass if you let them.

5. 'I shouldn't have these thoughts'‍

Many try to push the unpleasant thoughts and images away. Of course it makes sense that you want to get rid of upsetting thoughts, but thought suppression costs a lot of mental energy, and we simply cannot choose which thoughts we get, or when we get them. We can only choose what we do with them when they appear.

When we fail to get rid of these thoughts, many tend to believe they have lost control over their own mind. To deal with the unwanted thoughts, some turn to drugs such as alcohol or tranquilizers, which can quickly create fertile ground for other problems such as addiction, somatic injuries, etc.

Practice letting thoughts and feelings come, and letting them be. Then they will quickly be perceived as less important, and they will have the opportunity to fade. Thoughts and feelings regulate themselves if we choose to let them be.

While most people believe that this is not a choice - it actually is! You can choose to not do anything with your negative thoughts.