PTSD and Me

PTSD Recovery Advice | A Doctor's Experience

Author: Clare.tower

  • Step 5: Mindfulness

    Step 5: Mindfullness

    Learn to be aware of both your body and your feelings

    For me, properly understanding what mindfulness, and being able to use this skill regularly and competently was a real game changer. It took a long while for me to really understand what this was (not helped by a psychologist who I don’t think understood this properly either!). For ages, I thought it was ‘being in the moment’, concentrating on what you are doing just now, noticing your surrounding, colouring books or meditation. Whilst these can all be mindfulness practices, they are not the essence of mindfulness itself. 

    Mindfulness is the practice of learning to adopt the role of the observer when it comes to thoughts and feelings. It means noticing thoughts and feelings are there, and observing them from a distance, rather than being scooped up and absorbed into the emotion of that thought or feeling. It is hard to do properly and consistently, but with practice it gets easier. It has been described as imagining yourself on a train platform and thoughts and feelings being the train passing through the station.

    With mindfulness, you would watch the train pass through rather than stepping on it. Without mindfulness, you would feel compelled to get on the train and be in the middle of that turmoil and distress that the thought or feeling (and sometimes, if not often, that is physical) and you would be whisked along with it. Others have described it as watching clouds being blown across the sky.

    Mastering this is hard work.

    For me, I read lots of books (Ruby Wax for example) without properly truly grasping the meaning of this. The penny properly dropped when I read Janina Fisher’s book (more about this below), in which she uses a parts approach to managing PTSD.  This is based on the internal family systems approach of Richard Schwartz.

    The parts approach really encourages acknowledgement and then the mindfulness approach of standing back and just noticing.

    I think mindfulness is difficult to get your head around, and its only when you master it properly that you see the benefits. This takes regular daily practice – and its can feel like its boring and hard work and for ages it might not bring any benefits.

    But its really worth persevering.

    It is my experience that you cannot start EMDR without really good skills in mindfulness. If you have an EMDR practitioner who does not teach this first, you probably need a different EMDR therapist, in my view any way.

  • Step 4: Learn Nervous System Regulation

    Step : Learn Nervous System Regulation

    One of the fundamental problems to overcome in PTSD is dysregulation in your nervous system.

    This causes the physical feelings- the tense jaw, the numbness, the dry mouth, the palpitations and tight chest and so on. The way to manage this is through body techniques – known as a ‘body up’ approach. Getting an understanding of Polyvagal theory can really help with your understanding here.

    There are lots of different ways of doing this, and everyone has a version that works for them. They are all ways of reassuring that the body that you are safe, here and now in the present. What works for one person won’t necessarily work for another.

    Things that worked for me were grounding in the present, so paying attention to my surroundings, touch, feeling feet on the ground and so on. Some people find breathing techniques helpful here.  

    The idea is to use these techniques when you experience the physical nervous system dysregulation. This will help you widen your window of tolerance – more about this below in the EMDR section.

     

  • Step 3: Be Open Minded

    Step 3: Be Open Minded

    Be open to using more than one technique to get better – even ones that you don’t initially resonate with.

    When I found myself entering the mental health world, I had to pretty quickly learn to be open to trying things that I would previously have thought were ‘wu wu’.

    I am a surgical doctor so my approach was always focussed, straight forward and no- nonsense. The surgical approach is very ‘see a problem and treat it’, and it goes away generally. I had to shift this way of thinking and learn about things that seemed pretty weird and way out initially. Despite feeling quite resistant to some approaches, I had to learn to be more open and be more flexible.

    I had to learn that for many psychological approaches, things go slowly, gently, and are explorative. Outcomes are less predictable and one of the most important things is to be able the trust the therapist you are working with. It is important to say when things aren’t working as sometimes they don’t. I found myself doing yoga (which worked), mindfulness (more about this below – this is a vital part of recovery), meditation (this didn’t work and probably made things worse so caution here), all of which I would never have imagined myself trying before I had PTSD.

    One of the most ‘weird’ approaches I tried which was really helpful is something called the ‘parts’ approach, or internal family systems. This was a real game changer, even though to begin with, when I read about it I felt really really unsure about it. So, the message here is to learn, try things that others have recommended but be ready to say its not working and move on.

    One further bit of advice is that sometimes, coming back to a technique at a future point is helpful. Sometimes a technique comes at the wrong time, but at another point further down the line, after things have shifted, it can then work really well. 

  • Step 2: Get Educated

    Step 2: Learn about how PTSD alters your brain

    I will try to keep this section as easy as possible to understand as I do not want to get too technical. This may anger some pure-ists but it is best to keep things simple and understandable. However, it is really really important to get your head round what PTSD is, and how it alters how your brain works (the neurobiology is the medical or science word for this). For me, understanding this was the first step on the long road to recovery because it meant I stopped blaming myself.

    I spent 20 months working with a consultant psychologist, who I thought was helping me, who did not understand the basics of PTSD. She predominantly used standard cognitive behavioural therapy (CBT) techniques which were making me worse, and I could not understand why. As a result, I blamed myself even more, and the spiral continued downwards.

    Standard CBT is ineffective for PTSD because CBT needs a rational brain. PTSD involves an irrational part of the brain and you simply cannot reason with it. 

    I like to think of PTSD the same as I think of other physical disorders. Even though it is considered a mental health disorder, it is associated with changes that you can see on imaging investigations (scans of the brain), so I think it should be considered a physical disorder in the same way.

    This is probably quite novel and a different approach, but I think it helps enormously and makes the whole situation much less confusing. PTSD is essentially a disorder of the amygdala. This is a tiny, almond shaped structure found deep in the middle of the brain (in fact we have two, one on each side). This is a primitive structure vital to survival, meaning that it is also a structure found in animals. It is useful to think of this structure as the brain’s smoke alarm. This means it goes off in response to any ‘smoke’ or trigger in the environment and generates a response in the body known as the ‘fright, fight, freeze’ survival response. I have to admit I hate using the word trigger as it is so over-used, especially in the media which means it has lost some of its meaning.

    For me, in this context the word trigger is used to mean some kind of sensory stimuli in the environment which the brain perceives as a threat to survival and as a result, sets off the survival response. It is obvious that this response is very necessary – if you see a tiger charging towards you then you need your brain to get you to run away as quickly as possible. This needs to happen super quick without any thinking as if you don’t you might find yourself tiger food! However, this highlights a key point about the amygdala that it is vital to understand. The amygdala is outside your conscious control. You cannot simply just think differently to stop it reacting. You can try, but, as I found, your physical symptoms will just escalate and it is exhausting psychologically. This is why standard CBT is of limited used in the treatment of PTSD. For me, CBT was really unhelpful – I was blaming myself when the approaches weren’t working and I just became more and more depressed. The awful situation just got worse!

    Scientists have imaged the brains of PTSD sufferers when they are ‘triggered’ – what is seen on MRI scan (a specialist kind of scan known as a functional MRI) is that the amygdala is over activated in response to what would be innocuous stimuli. At the same time, because the brain has gone into survival mode, the thinking part of the brain (mainly the frontal cortex) becomes down regulated or less active. This means it is very difficult, if not impossible to think straight, to take reasoned actions or conduct any rational executive function. When it is really bad, even the speech area of the brain, known as Brocas, becomes down regulated and speech can even become difficult. I experienced this quite a few times – it was really horrible, as I felt I had words I wanted to say but just couldn’t. It felt like it must feel for people having a stroke. 

    Gaining some understanding how PTSD affects the neural pathways in your brain can be really helpful. For me, it meant I stopped blaming myself and was able to understand the reasons for treatment. Because of the physical effects of PTSD, trauma specialists and scientists now understand that one of the first stages of treatment of PTSD has to be to help people to feel safe in their bodies. This is why body work of some description plays a really important part in recovery. Some people call this ‘a bottom up’ approach. For me this was a vital learning point. If you want to learn more about this, including some of the science – Professor Van der Kolk’s book, the Body Keeps the Score, is really good, although quite heavy going in parts. 

  • Step 1: Getting a Diagnosis

    Step 1: Getting a Diagnosis

    I know this sounds really obvious but this can be problematic. In the history of medical conditions, PTSD is a relatively new diagnosis and was only recognised in the 1980s.

    Complex PTSD is an even more recent diagnosis and was not added into the ‘official’ diagnostic medical lists until 2022. Further, the basic training for professionals, and that includes doctors, nurses, midwives, counsellors, psychologists and other mental health professionals, either does not include PTSD or if it does, is likely to be very limited and outdated.

    It is shocking that the basic training of health professionals omits such a significant and common disorder but that is where things are in the UK and it is best to be aware of this so that you can help any of your health care providers where possible and you can seek out specially trained ones if available. 

    The other problem is that although both PTSD and complex PTSD have a well defined list of criteria for diagnosis, these will only be picked up by a health care provider if they look or ask for them. Sometimes PTSD and complex PTSD get missed because health care providers do not understand that the response of the brain to trauma can underpin other conditions they are more familiar with, for example depression and anxiety.

    Also, the common and outdated misunderstanding that PTSD is only a condition of war veterans seems to persist so health care professionals are not alert to PTSD when they should be. My own PTSD got missed by a consultant Psychologist for many many months as she was overly focussed on low mood and free floating anxiety which prolonged my distress, delayed treatment and I am sure, made the condition worse. 

    A diagnosis of PTSD can be made by any health professional, and in the UK, the starting point is usually a general practitioner. The criteria for diagnosis are listed in the national NICE guidelines (Click here).

    Psychiatrists and psychologists also sometimes use scoring tools, the most common of which is the PCL-5. Copies of these can be found on line and they are fairly straightforward- just answer them fairly quickly and go with your instinct for each question. My advice is not to overthink it!

    For me, getting a diagnosis was initially a bit shocking and scary. However, as I got my head round it, it was enormously helpful as at least I knew what the problem was. I also found it helped other people understand what I was going to. It also, in a weird way, reduced some of the shame I was feeling.

    It also affected my employer as, for the most part, it is a diagnosis that people have mostly heard of, even if they do not know anything about it. The most important benefit of getting a diagnosis is that it creates the opportunity to move towards recovery.

    It is important, no matter how unwell the PTSD is making you, that you use this knowledge to start that recovery journey. Even if you are really struggling, as I was, there are small windows of opportunity within that distress to take those first steps yourself. You are going to need help to recover for sure but there  are steps you can take yourself.

    This is where I made my first mistake – and it is one I regret. At the time I got my diagnosis, I was trusting a therapist who was not trauma informed and I failed to seek out the right information, but more on this later. I delayed my recovery massively by doing this.