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Gift From Within - PTSD Questions & Answers with Frank Ochberg, M.D.
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|PTSD: Triggers and Body Sensations
Q: Dear Frank, I often hear from survivors who report sudden strange sensations that can be disturbing or very frightening. How do you handle those?
A: Dear Joyce, Just recently I received an email from Mrs. C_____ who had been doing relatively well after many years of physical abuse within her family. In fact, she was back in touch with an estranged adult child of hers. But then she realized that the child contacted her from the home of her ex-husband who was the source of much of her abuse. "Just that small thing caused terror. Like ants crawling all over me. Shower, Wash it off! ," she wrote to me.
I wrote back, "Understood! There are a lot of "triggers" - things that evoke strong sensations. I like the idea of
1. recognizing the trigger (your ex-husband's home)
2. identifying the sensation (like ants - creepy, crawly, disgusting)
3. visualizing a remedy (shower - wash it off)
4. taking action (you wrote to me; maybe you actually took a shower)
If it worked, good for you! If it didn't work, or didn't work completely, do try to keep at it. That's the right track (recognition of a trigger; naming the sensation; visualizing a remedy; taking action)"
There are some interesting aspects of this exchange with Mrs. C. First, she mentions "terror." But the terror is not a lethal threat. It is a sensation that includes elements of disgust, of helplessness, of being overwhelmed. PTSD often includes physical sensations and mental images that are difficult to put into words. It helps to express the feeling and to have the feeling recognized, received and validated by another person. Too often, that other person tries to help, but fails. They say something intended to be consoling. That response may trivialize the terror that the survivor experiences. On the other hand, a friend may increase the survivor's reaction by saying, "Oh, how awful!" I think of these people as "crisis augmenters." I chose to characterize Mrs. C's sensation as "creepy, crawly, disgusting." All I was doing was translating and paraphrasing "like ants crawling all over me." In a way, I did take the emotion down a notch by commenting on the ants and not on the "terror." Terror is a very strong word. But PTSD is a return to terror. It is not trivial.
I still do not know whether or not Mrs. C. took a shower to reduce her terrible sensation. But the fact that she mentioned "Shower. Wash it off." is a noteworthy finding.
Too often, a survivor has no effective antidote for the PTSD sensation. Mrs. C. came up with an image that is potentially therapeutic. Her terror was like ants crawling all over her and her remedy was a cleansing shower. Her remedy also was emailing me - putting the whole episode into words and sharing those words.
I chose not to explore further negative associations. Being triggered by a reminder of her ex-husband could have caused her to re-experience a particular beating, or the anticipation of his coming home drunk. No need to go there. She had a sensation in her skin. She mentioned (to herself and to me) a way of diminishing that sensation. I did not want to cause further PTSD pain.
Joyce, most survivors can relate to this. They will be triggered from time to time. The body remembers and reacts. A bodily sensation may feel "creepy" and may be accompanied by fear or horror or helplessness or all of that together. If you can visualize a source of remedy for the sensation, you need not recall the original trauma. You can remind yourself that you are safe and you are in the present, not the past. If you can take some self-soothing and self-affirming action, that helps, too.
A therapist or a friend can observe how the survivor coped. This is often more effective than telling a person how to cope.
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