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Gift From Within - Questions & Answers with Frank Ochberg on PTSD

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Questions & Answers
Joyce Boaz & Dr. Frank Ochberg

Read "Survivor Psalm" by Frank Ochberg

Recovery: Triggers.

Q: Dear Frank:

I received this question from a GFW support pal member.

I am a trauma survivor and would like to know what is the difference between a person being triggered from a horrible past event and a person with PTSD being triggered? I really thought about how two people can experience a horrible event together and one person gets PTSD and the other does not. So at a later date if both people are triggered how would the person with PTSD differ? I often hear people say that we all have crap in our pasts and why is it any different for somebody with PTSD. I would be very interested to hear your thoughts on this.

A: Dear Joyce:

The short answer is that the person with PTSD has a much higher risk of being "triggered" into any or all of the PTSD symptoms, while the other person would be reminded. as we all are, of bad times. Being reminded of times of tragedy or danger evokes "autobiographical memory." That is normal memory, whether pleasant or unpleasant. PTSD involves flashbacks, "re-experiencing" and a host of other psychiatric elements. The webcasts I have made on the SAM and the VAM explain this in more detail. See my webcast called Trauma Memories at

Recovery: Triggers.

Q: Dear Ms. Joyce: Thank you for being a guest clinician. This question is not unusual and I believe a lot of survivors have this problem. I was asked, "What do you do when you have a friend who triggers your PTSD stuff? I have a friend whose behavior is basically reminding me of my mother in a huge way. I am getting angry with her for valid reasons, but I think the intensity of my rage at her is exaggerated and I'm over reacting. How do you separate the present from the past when emotionally they feel the same?"

A: Joyce, Thanks for asking me to be a guest clinician. This sounds like a tough situation. If the friend knows about her trauma I might say something like, "when you do _______ I feel upset because it reminds me of my Mom. Right now I don't know how to cope with it except to ask you to stop doing ____." If the friend doesn't know about the trauma it's a big decision in itself deciding whether to tell her. If the friend doesn't know and you don't opt to tell her, I might take a 3x5 card and write yourself a nurturing reminder/note. Right before you're going to visit with this friend take a look at the card, or during the visit excuse yourself, get some air and read the card. The card can say something like "I am safe and I am can end this interaction with my friend when ever I want to."

Separating the present from the past starts with the awareness that you conveyed in your question. It's important for us to first be aware of when this is happening and, as you said, it usually is when we find ourselves feeling an intensity of emotion disproportionate to the event at hand. With this awareness, we can learn to interrupt our cognitive, emotional and/or physiological reaction to the event. This is quite a process and can be done with the help of Cognitive-Behavioral Therapy or EMDR, etc. We can also use various cues (such as the 3x5 card) to indicate to ourselves that we've been triggered and to remind us of what to do. The visual cues are helpful because, once triggered, our minds are unable to think very clearly; we're in the fight, flight or freeze mode. Anything that will calm us (deep breathing, repeating affirmations, rubbing lotion on our hands and smelling the comforting scent) will contribute to redirecting our bodies' response to the trigger. Babbette Rothschild and Dusty Miller have written about breaking these patterns in "The Body Remembers" Rothschild) and in "Women Who Hurt Themselves" (Miller).

Answered by Patty Joyce, LCSW

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Page created on 9 Febrruary 2010
Last updated by on 27 September 2010