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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: Coping During The Holidays.

Q: Dear Frank, as Thanksgiving approaches, do you have any thoughts for Gift From Within?

A: Dear Joyce, I usually worry about holidays, along with many therapists. This is, ironically, a difficult time of year for our clients and patients. Holidays are family occasions when survivors of trauma and tragedy tend to count their losses rather than their blessings. Who can feel thankful when the family is a source of abuse, neglect, or failure to comprehend? Who can feel thankful when there is an empty chair at the table--a seat once filled by a mother, son or lover? This is also the season of shorter days, longer nights, and depression triggered by a fact of biology: Seasonal Affective Disorder, SAD, makes PTSD harder to handle. Artificial light can help.

But I want to write about a different kind of light: the light of "gratitude." This month's Harvard Mental Health Letter features an excellent article, "In Praise of Gratitude" (

The authors note how gratitude "helps people refocus on what they have instead of what they lack. And, although it may feel contrived at first, this mental state grows stronger with use and practice." Specific steps for improving one's feeling of gratitude are offered, including prayer, meditation, keeping a gratitude journal, writing thank you notes--even writing mental notes that are never sent, but are thought through at a regular time, daily or weekly. I'm doing it right now as I write, feeling grateful for every one of you who cares about another human being. I need to remind myself that there are thousands of people who take the time to help others, sometimes by just being there.

I'm a so called expert in the Stockholm Syndrome. That syndrome includes an odd feeling of affection for a person who captures you, threatens you, but doesn't kill you. He (or she) lets you live. This sensation of being allowed to live is hard to describe. I've heard it countless times from hostages who were eventually freed. My conclusion is that the survivor experienced a fundamental feeling of gratitude. This feeling lies at the root of all positive feelings to others--feelings of love, of attachment, of worthiness. As infants, we experience the comfort of a mother's touch, of warmth, of food, of familiarity. Even more importantly, we experience the relief of hunger, pain, isolation and the terror of abandonment. This relief triggers love. But we are too young to understand love. That comes later. Searching for a word that approximates an infant's feeling of relief and at the same time approximates a hostage survivor's affection for a killer who doesn't kill, I came up with "gratitude."

I now realize that gratitude is the feeling we hope to kindle and rekindle and sustain through the ritual of Thanksgiving. And as trite as it sounds, we can
do it by simply focussing our minds, by redirecting our thoughts from what we lost to what we have.

Elsewhere in the GFW website, I describe "colors of positive emotion." I intend to write more about those colors and how to evoke the feelings they represent. Briefly, there are six basic positive emotions in my scheme: energetic joy; sensual pleasure; love; the sensation of spiritual connection and awe; blissful serenity; and self-worth, including a reasonable feeling of pride. The colors I assign to these six feelings are, in order, yellow, orange, red, purple, blue and green.
The Color Wheel: Positive and Negative Emotions.

In this webcast, Dr. Frank Ochberg discusses a therapeutic tool called The Color Wheel, and how he uses colors to correspond with positive and negative emotions. Dr. Ochberg talks about assigning colors to emotions.

length: 11:46
Gratitude is not easy to assign within this spectrum, but I'd like to place in purple, where we feel good about our place among those we value, where we sense, in some way that eludes words, that we are cherished and connected. Religious people feel the love of god and love for god. Non-religious people use other words and ideas, but experience something positive as they overcome fear and alienation and regret, and summon-up a general sense of connection.

Purple stands for feeling a part of something larger than oneself, and for the sensation of gratitude that comes with that belief. Too often, we forget to feel. We can practice, through repetition and ritual and imagination, to elevate our positive emotions, particularly that part of the spectrum that I arbitrarily place in the purple zone. We have our own, personal, idiosyncratic ways of thinking ourselves into better emotional states. This is the right time of year to use a form of cognitive behavioral therapy: CBT. Focus on ways to express thanks - specific thanks to specific people. Then let those thanks travel further, beyond those you know to those you never met, but hold in high regard. Finally, take it way, way further, if you can. Thank humanity and the universe and, if it is right for you, thank god. But I'm not advocating a belief. I'm advocating the opposite of PTSD: learning how to feel positive feelings despite suffering. The feeling of gratitude is the root of other positive feelings. Giving thanks creates gratitude.

Here are the references listed in the Harvard article on gratitude. You do not need to read them all, but let's be thankful for those who study gratitude, and remind us of its application to our lives.

Emmons RA, et al. "Counting Blessings Versus Burdens: An Experimental Investigation of Gratitude and Subjective Well-Being in Daily Life," Journal of Personality and Social Psychology (Feb. 2003): Vol. 84, No. 2, pp. 377–89.

Grant AM, et al. "A Little Thanks Goes a Long Way: Explaining Why Gratitude Expressions Motivate Prosocial Behavior," Journal of Personality and Social Psychology (June 2010): Vol. 98, No. 6, pp. 946–55.

Lambert NM, et al. "Expressing Gratitude to a Partner Leads to More Relationship Maintenance Behavior,"Emotion (Feb. 2011): Vol. 11, No. 1, pp. 52–60.

Sansone RA, et al. "Gratitude and Well Being: The Benefits of Appreciation," Psychiatry (Nov. 2010): Vol. 7, No. 11, pp. 18–22.

Seligman MEP, et al. "Empirical Validation of Interventions," American Psychologist (July–Aug. 2005): Vol. 60, No. 1, pp. 410–21.

For more references, please see

Recovery: Coping During The Holidays.

Q: Dear Frank, Holidays are very hard for families with recent losses, and birthdays can serve as reminders as well. What do you suggest for coping? In addition at holiday time, a lot of GFW members feel alienated from their families. And for those who decide to visit, what can you do to make it less painful?

A: Dear Joyce, Here is what I wrote a few years ago and still makes sense today.

Holidays are notoriously difficult for those among us who are acutely aware of loss. Days are short. Gaiety is for others. Ceremony reminds us of what we are missing, rather than what we have. Survivors of cruelty and catastrophe are particularly affected by the commercialization of compassion.

So how can we cope and how can we care? For those with PTSD and related conditions, we can limit our dose of exposure to difficult and dreaded stimuli. A previously abusive parent may be just such a stimulus. Small doses, buffered by supportive friends and relatives, may be tolerable. Complete avoidance may be a reasonable gift to ourselves.

We can bolster our resistance with reminders of our independence, maturity and network of kindred spirits. It's a good time for using the GFW email pen-pal service. We can overcome our understandable reluctance to exercise, eat sensibly and drink moderately -in other words, practice good health habits before making New Year's resolutions. And we can seek opportunities to help others. Nothing works as well as altruism at this time of year. If we are caregivers, relatives, friends of those with PTSD, we can be realistic. We can't change terrible reality. But we can acknowledge it. We can't give soul-saving advice. But we can simply be there. Being there, touching (if wanted), listening, sharing silence, and backing off when space is needed -these are sensible acts of real compassion. Easy to say, difficult to do.

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