PTSD, self regulation and finding safety
Before and after PTSD
The response to a traumatic situation is a vital and protective response and is not a conscious one.
Imagine two different typical everyday scenarios of pre trauma and post trauma. Prior to a traumatic situation, going out of the house to experience life involved witnessing an array of different sights such as the presence of the rose bush in the front garden, the normal red letterbox across the road and the different array of colourful front doors and windows on neighbours houses; all simple experiences and maybe fairly comforting for some. However after a trauma, in the case of post traumatic stress disorder (PTSD) these everyday sights, can all become potential triggers. Here is a typical example, on a deep unconscious level, the red letterbox, may be determined as a threat, our brain detects the potential dangers of red and the association made from the past trauma in the unconscious memory of the blood that was also present and deeply felt as a sign of danger in the initial trauma situation. Because this memory, with all its feelings, is so instantaneous and not conscious, its so complex for us to rationalise; the fight and flight response is then activated in an everyday normal experience of seeing the colour blood red in the letter box. At the other end of the scale someone experiencing PTSD may feel completely numb, dead emotionally inside. The once pleasing rose bush and interesting array of doors and windows, the familiar red letterbox, all can leave someone feeling empty, disconnected and isolated. Both responses are common responses to trauma. At one end of the spectrum we have an over arousal, hyperarousal and at the other we have under arousal or hypoarousal.
Flight or freeze
Sometimes it can help to understand what’s happening within us when dealing with trauma.
Hyperarousal is activated by the sympathetic nervous system and causes what is commonly known as the fight and flight response, where an individual may feel initially agitation, restlessness, irritation, or maybe a feeling of the need to escape. This feeling can sometimes escalate further to feelings of being out of control, where anger can not be controlled or an overwhelming sense of panic forces someone to literally runaway.
At the other end of the scale is hypoarousal which is activated by the parasympathetic nervous system. This response is often referred to as the freeze response. This can often been initially felt as a disconnection to the world around, almost a sense of pulling away or detaching from the body, a dissociation to the immediate situation but after time this can become a sense of deadness emotionally inside, leading to feelings of depression.
In a traumatic situation the brains amygdala instantaneously detects any potential threat. Because it’s called upon under extreme conditions and potentially life threatening, it’s demand is instantaneous and therefore it’s crude and is unable to analyse any given situation thoroughly. If the amygdala does detect danger the fight or flight, or freeze response is immediately triggered. The hippocampus, in the brain, on the other hand is more logical and in response to the amygdala it will then rationalise what the amygdala receives. If the hippocampus determines that the amygdala had correctly identified a threatening situation it will allow for the continued fight or flight or freeze response. If the hippocampus determines that the situation is actually safe then it disengages these responses.
Under normal situations, where the fight and flight or freeze responses are triggered, the amygdala and hippocampus work together in a healthy functional way. However In the case of PTSD, when someone has been exposed to prolonged periods of stress, the brains function, with the amygdala and hippocampus, can start to disfunction causing prolonged hyperarousal or hypoarousal. This leads to ongoing feelings of either alertness to any potential threatening situation, leaving someone in a constant state of stress where they startle easily, feel irritable and are left with a permanent state of anxiety and fear or, at the other end of the spectrum, a sense of numbness and depression. Often people suffering from PTSD can fluctuate between hyperarousal and hypoarousal. In this state everyday life can be a roller coaster of feelings which range from feeling unconsciously reactivated to the fight or flight response and feelings of being in permanent place of danger or feeling completely removed and disconnected with the hear and now, often with a dull sense of feeling empty and emotionally dead inside.
Finding safety is a key part to recovery from trauma. Finding a safe place to do this is vital, usually with the support of trusted person such as a counsellor. Working through the issues of trauma cannot be explored further until the person has first found their level of safety which they can call upon before exploring their feelings around the trauma further. Part of this process means coming to understand what is happening to the body, all their feelings, when they experience life and potentially triggering situations. As this understanding of their body and emotional responses becomes more conscious its very possible for someone to find ways to self regulate, to manage their responses over time.
Daniel Siegel's concept of ‘window of tolerance’ is such an easy, accessible, helpful tool to call upon in relation to the responses to PTSD and managing the feelings around triggers. The ‘window of tolerance’ facilitates someone in the process of getting in touch with these feelings and identify, to themselves, what it feels like for them when they feel safe and what situations create that feeling of safety. For example it might be that a smell, a song, a calm memory of a place or person that brings someone back into that feeling of a place of safety, know as the ‘window of tolerance’. Taking this concept further someone, overtime, can also start to identify when they move out of the their window of tolerance into either hyperarousal or hypoarousal. By identifying the initial feelings of moving out of the optimum area of tolerance, into the more stressful responses, it’s possible to sort of ‘nip it in the bud’ and call upon actions that help to bring the person back into their ‘window of tolerance’.
Given time and a safe space
Overtime working with the ‘window of tolerance’ can expand tolerance levels so that someone’s feelings of safety becomes much larger. Going back to the example of stepping out into the neighbourhood, with the red letterbox that had once caused a full blown flight response, if the person now experiencing this, is more able to become aware of their bodily responses and corresponding feelings, as they move closer to the red letterbox they can potentially have more control. With this awareness they can call upon self regulating tools that they know work for them. It might be a word, a way of breathing, a helpful thought but the person knows they have it at hand.
Often the first step is exploring the window of tolerance with a counsellor as an individual works through the trauma in the safe environment of the counselling room, this can then progress onto the real life outside world. This is self regulation, a powerful tool. For survivors of trauma, feeling they can take charge of their lives is very empowering and is a big step on the road to recovery.
Christine Sanderson, working with trauma, pp 152-153
Judith Herman, trauma and recovery, pp35- 36
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