There is Hope in the Face of Complex Post-Traumatic Stress Disorder

In the month of November, we have concentrated on Post-Traumatic Stress Disorder, Complex Post-Traumatic Stress Disorder, and how they are formed, plus how they impact the lives of those who are diagnosed with them.

We’ve seen how both diagnoses differ, who is impacted, and what are some of the causes for their existence in people’s lives.

This article will concentrate on the progress that has been made in recent decades to treat both CPTSD and PTSD and how there is hope.

Hope-Filled Treatments for PTSD and CPTSD

In the past few decades, there have been movements toward helping people living with the impact of CPTSD on their lives. While some may seem remarkably familiar, others are new and have advanced both the understanding of treatment for such a complex disorder.

Psychotherapy

Also known as talk therapy, psychotherapy involves sitting with a therapist either alone or in a group to discuss the way they feel and examine the behaviors that come about by their reactions to those emotions.

One such form of psychotherapy is Cognitive Behavioral Therapy (CBT) where a therapist helps their clients to identify negative thought patterns and offer new tools to replace them with healthy positive thoughts.

Some therapy involves a form of CBT called dialectical behavioral therapy that will clients to better respond to stress and to build better and stronger relationships with others.

Eye Movement Desensitization and Reprocessing (EMDR)

Commonly used to treat both PTSD and CPTSD, EMDR is a process where therapists will ask their clients to briefly think about a traumatic moment while moving their eyes from side to side.

There are other techniques as well such as having someone tap on the hands instead of moving the eyes.

Over time, it is believed that EMDR helps to desensitize clients to the traumatic memories and their accompanying thoughts that hold them back from living normal and healthy lives.

EMDR is somewhat controversial, but the American Psychological Association conditionally recommends EMDR for the treatment of post-traumatic stress disorder.¹

Stellate Ganglion Block

In the early 2010s, military medical centers began offering a procedure used for decades to alleviate pain, stellate ganglion block (SGB). The procedure involves injecting a local anesthetic into the stellate ganglion, a region of nerve cells and nerves in the neck that helps regulate the body’s fight or flight response.

At first, the medical community was skeptical that the procedure would work, but soon studies were conducted that proved that SGB is a true breakthrough in PTSD treatment.²

Although, as reported, the stellate ganglion block has been approved for use in the treatment of PTSD, there are two reasons it has not been used to treat CPTSD.

One, the American Psychiatric Association does not as yet recognize complex-traumatic stress disorder as a separate illness from PTSD, and two, there have been no clinical trials to prove or disprove it would help.

The Hope of Trauma-Informed Care

CPTSD is recognized as needing long-term treatment because of the damages done to a person’s self-identity, deficits in self-regulation, and their inability to see there are hope and healing available to them. Fear and hopelessness can be a daily reality for most survivors living with CPTSD symptoms. Therapists choosing to collaborate with patients living with CPTSD symptoms must take the time to receive the education they need to provide trauma-informed care. Additionally, they will need to understand that with the resolution of one issue—there will come others popping up seemingly out of nowhere.

This is the nature of CPTSD.

The understanding of the day-to-day difficulty patients faces while living with complex post-traumatic stress disorder is a necessary part of trauma-informed care. Patience and unconditional warm regard are key if we are ever to help anyone have the hope they need to heal.

Trauma-informed care is an approach that sprang from the Substance Abuse and Mental Health Administration (SAMHSA), and its recognition of trauma is a significant role in the formation of women’s issues and gender-specific treatments in the 1990s. Over the next two decades, a lot was learned about diagnosing post-traumatic stress disorder and the diagnostic criteria and treatments for it.

The core ideas for trauma-informed care started to take shape and spread during the ACEs study mentioned in previous articles, as well as the launching of the Women, Co-Occurring Disorders and Violence Study in 1998 which was sponsored by SAMHSA.³ This study began the search for plans to help women who were victims of trauma and who also had co-occurring diagnoses of mental health disorders and substance abuse disorders.

The researchers recommended for “trauma-integrated services counseling” which has morphed into trauma-informed care today.

Trauma-Informed Care: The Basics

To save time and get to where we learn about the different forms of therapy used to treat CPSTD, I’m only briefly going to touch on the different goals of trauma-informed care. In future articles, we will discuss this subject in much more depth.

There are six basic aspects a trauma-informed therapist works towards; these include forming a therapeutic alliance, guiding you away from certain topics, helping you to understand where your behaviors and symptoms stem from, setting recovery as the goal for treatment, focusing on your strengths rather than your illness, and learning resiliency.

The first goal is covered extensively toward the bottom of this article, so we will discuss these aspects out of order.

Guiding You Away from Certain Topics. Your therapist will do their best to guide you away from topics charged with emotions.  At first glance, this step may seem counterproductive. Isn’t tackling the issues which drove you to therapy the most crucial part of your recovery? However, a therapist trained in trauma-informed care understands you must first learn to cope with the inevitable pain which will come up while working on your past before you may safely face it.

Helping You Understand Where Your Behaviors and Symptoms Stem From. Trauma-informed therapists know unhealthy coping mechanisms, like shutting down in sessions and dissociation, are coping mechanisms that stem from your adverse childhood experiences. Trauma-informed therapists help you to understand these are indeed coping strategies you have used and may still use, to deal with your overwhelming emotional pain.

Trauma-informed practitioners will also make a significant statement to you, that at first, you may not accept: “What happened to you so long ago was never and shall never be your fault. You were a victim. However, now that you have achieved adulthood you and only you are responsible for your life today.” Adult survivors of adverse childhood experiences have an exceedingly tough time believing they are not to blame for their trauma and abuse.

Setting Recovery as a Goal for Treatment. Although co-occurring problems may exist, it is vital for your trauma-informed therapist to help you understand they will get better as you work through what happened in your past. The other symptoms or disorders, such as depression and anxiety, are not the overarching concerns, but rather effects from working on your recovery from complex post-traumatic stress disorder.

Focusing on Your Strengths Rather Than Your Illness. Many skills can be learned to cope with childhood trauma, and a trauma-informed therapist will collaborate with you to use them. Your therapist may ask your questions to help you think and keep focused on the future such as, “What are some of your accomplishments which make you feel proud?”  By using positive language, your therapist will help you recognize you are capable of coping well even with tough experiences.

Learning Resiliency. Resiliency’s best described as the ability to overcome challenges of all types—including tragedy and personal crises—and bounce back stronger than before. Most of us who have survived childhood trauma is already very resilient. However, we often overreact or do not respond appropriately when faced with problems in our adult lives. Your trauma-informed therapist can help you understand some fundamental concepts such as how life is not fair, or how life is not easy. Once you have these lessons under your belt, events such as life changes, struggles, and death take on a new perspective, as they are just parts of life that all humans share.

The Importance of Establishing the Therapeutic Alliance

For we who were victimized in childhood and did not have a chance to establish a safe base with someone we trust, beginning to see a therapist feels very risky. The bond which forms between our therapists and us forms a connection where they can engage with us and help us to recognize our old behaviors and learn new ones.

This relationship is called the therapeutic alliance, and it isn’t one-sided or static. This relationship with your trauma-informed practitioner will be reciprocal—in fact, it is worth noting, a hallmark sign of all healthy relationships is reciprocity. This is not to say all relationships which have reciprocity are safe and healthy relationships, however, any relationship lacking reciprocity is worth looking at closely and determining whether or not it is safe or healthy.

It is also worth noting, therapists are humans too and can become emotionally attached to their clients. To help themselves, therapists must practice excellent self-care, such as setting healthy boundaries and taking ample time off from work for vacations. Therapists, like all humans, have flaws, but they can find ways to use those flaws to help us understand our recovery journey and to connect with us.

As the relationship between you and your therapist goes on, it will change and not remain static.

At first, you may feel uncomfortable and unable to share your feelings. However, after a bond forms and you begin to trust, you will relax into the relationship. You will then become open and honest about not just how you are feeling but you’ll also feel safer telling your therapist about any dangerous behaviors or thoughts you might be having.

This is when therapy and recovery can begin.

Establishing Safety

It is safe to say that a tremendous therapeutic bond is absolutely vital to anyone living with symptoms of complex post-traumatic stress disorder, especially if we are to ever face and accept the indescribable pain of what happened in childhood.

Once you feel comfortable with your therapist, it will be easier to begin the demanding work of facing what happened to you head-on, and ways you can heal.

Some of the safety issues which need to be tackled before the healing work begins are:

• Impulsive Behaviors
• Self-Destructive Thoughts and Behaviors
• Dangerous Relationships
• Addictions
• Suicidal Thoughts and Behaviors

It is clear, all the above safety concerns can be highly re-traumatizing, and suicidal ideation/behaviors can lead to death. To mitigate these threats to life, a trauma-informed therapist must seek to replace the need for these behaviors. This happens through agreeing on a safety plan. This is always done with you.

A safety plan may include you learning how to contact your therapist if you are having problems between sessions. However, your therapist may have rules about the ways you may contact them, such as at the office only or via email.

Your therapist may also ask you to sign an agreement with them stating you will not try to die by suicide. Instead, you promise you will reach out to someone you have listed on your safety plan or agreement.

Some therapists may ask you to attend Wellness Recovery Action Plan (WRAP) classes so you can make a detailed plan of what you will do in case you find yourself in trouble and having thoughts of self-harm or suicide.

As can be seen, there is enormous hope involved in the utilization of trauma-informed care for both the recognition and treatment of both CPTSD and it’s brother PTSD.

Never, Ever Give Up

Although the struggles brought to the lives of those living with the effects of PTSD and CPTSD on their lives may seem hopeless, I hope this article has proven otherwise.

There are some distinct challenges to both disorders, but they are not insurmountable, in fact with each year new and better treatments are being found to alleviate the painfulness that is PTSD and CPTSD.

While there are millions of people living with these disorders and sometimes with both, the bottom line is to never, ever give up.

We here at the CPTSD Foundation care deeply for you and wish you only health and happiness. Please, remember, there is always hope and a cure for many mental health disorders including PTSD, and CPTSD may just around the corner.

References:

1. Courtois, C.A., Sonis, J., Brown, L.S., et. al. (2017). Clinical Practice Guideline for the treatment of PTSD. Guideline development panel for the treatment of posttraumatic stress disorder in adults. Adopted as APA policy on February 24, 2017.
2. Lipov, E. G., Joshi, J. R., Sanders, S., & Slavin, K. V. (2009). A unifying theory linking the prolonged efficacy of the stellate ganglion block for the treatment of chronic regional pain syndrome (CRPS), hot flashes, and posttraumatic stress disorder (PTSD). Medical hypotheses, 72(6), 657-661.
3. McHugo, G. J., Kammerer, N., Jackson, E. W., Markoff, L. S., Gatz, M., Larson, M. J., … & Hennigan, K. (2005). Women, co-occurring disorders, and violence study: Evaluation design and study population. Journal of Substance Abuse Treatment, 28(2), 91-107.