Fortunately, we are a little wiser now. Much research has been carried out on clinicians whose work brings them into daily contact with those who have suffered trauma.

Compassion fatigue is characterised by physical and emotional exhaustion and a decrease in the ability to empathise. It is a form of secondary Post Traumatic Stress Disorder (PTSD), with the stress occurring as a result of helping, or wanting to help, those who are in need. It is often referred to as ‘the cost of caring’ for others who are in physical or emotional pain.

While it is not uncommon to hear compassion fatigue referred to as burnout, the conditions are not the same. Compassion fatigue is more treatable than burnout and I believe it is the early warning sign of a dysregulated Autonomic Nervous System (ANS), telling us it is in danger of developing burnout. Burnout signifies adrenal fatigue and, eventually, adrenal failure.

Some years ago I took early retirement from medicine as a practising GP and Gestalt Psychotherapist and set about exploring alternative healing methods — other ways to heal people mentally and emotionally. I created a modality, QEC, that works with the subconscious mind to heal past traumas and change limiting beliefs permanently.

QEC has always taught that the emphasis of clinical practice needs to be on self-care and addressing one’s own needs first.

Compassion Fatigue Research

Research found in ‘Helping till it hurts?’ by Kyle D Killian [1] shows that clinicians in the helping professions who are regularly exposed to traumatic compassion fatigue in their work, do best when they have access to social support and the protective function of supervision to process the secondary trauma of their own work. It indicated that a lack of awareness of stress led to more serious burnout and that education and advice on self-care was crucial.

Stress factors identified in this study – from most common down:

1. High caseload demands and/or ‘workaholism’
2. Personal history of trauma
3. Lack of regular access to supervision
4. Lack of control in the working environment
5. Lack of a supportive social network, social isolation
6. Worldview e.g. overabundance of optimism, or cynicism. Those with a spiritual belief system did best
7. Ability to recognise and meet one’s own needs – having self-awareness

Compassion Fatigue in Practitioners

How can we best prevent compassion fatigue and burnout?

The emphasis of clinical practice needs to be on self-care and addressing one’s own needs first. At this time, in particular, it seems that an abundance of people accessing therapeutic help are traumatised.

Many are severely traumatised, and some are even suicidal. It behooves us therefore to be most vigilant, at this time, with our own mental health, so that we are able to be fully present with challenging clients. We need to know the signs and symptoms of overwhelm in ourselves to become aware and to engage in timely prevention of burnout.

Signs and Symptoms of Compassion Fatigue leading to Burnout:

• Chronic exhaustion (emotional, physical, or both)
• Reduced feelings of sympathy or empathy
• Dreading working for or taking care of another, and feeling guilty as a result
• Feelings of irritability, anger, or anxiety
• Depersonalisation – i.e. ANS freeze – feeling disconnected and numb
• Hypersensitivity or complete insensitivity to emotional material
• Problems in personal relationships
• Poor work-life balance
• Physical symptoms such as:
• Headaches
• Trouble sleeping
• Weight loss or weight gain
• Impaired decision-making ability

Compassion Fatigue: Overwork

Some of us may be overworking, some even proudly consider ourselves ‘workaholics’. This is usually related to an inability to set healthy boundaries, maybe stemming from past, usually childhood, trauma. We must therefore look at our boundaries, both external and internal if we are suffering from compassion fatigue.

External boundaries:

Questions you could ask yourself:

“Do I have …”

• Good time management e.g. do I take time off between sessions?
• Regulating caseload – do I know when ‘too much’ really is too much?
• Am I able to say NO?
• Do I believe that my needs come first?
• Am I able to maintain a balance between work and rest?
• Do I feel guilty if I take time out from work?
• Do I allow myself to have regular social connections and support?
• Do I attend regular supervision and am I willing to be vulnerable and process my challenges?
• Do I have sufficient control over your work environment?
• Am I doing more than one job?

“If all you are using is emotional empathy, eventually you will run out of this emotion when empathising day after day, hour after hour. It is like an electric pump running without water, eventually, it burns out. You need to bring much wider and different energy to your connection – love and compassion from the heart.” – Matthieu Riccard, Buddhist monk

Internal Boundaries

What is my internal experience when I’m faced with immense suffering in my client?

The challenge here is to remain empathetic, and supportive of others without becoming overly involved in taking on another’s pain. Setting emotional boundaries helps you maintain a connection while still remembering and honouring the fact that you are a separate person, with your own needs.

Resilience

Bouncing back is always an indicator of internal resilience. We now know that resilience is a factor in how healthy and balanced our ANS is. It is vital then if you feel overwhelmed, that you immediately seek help and therapeutically return to optimal neurological balance.

This is something I teach my QEC practitioners; to attend sessions with a fellow practitioner to return to an optimal neurological balance rather than push on in a state of overwhelm.

Remember that your ANS has become overwhelmed for a reason – meaning that it’s likely that you’ve been triggered by your own unhealed trauma. The only way you can remain with a balanced ANS is to work on your trauma, release it, returning your ANS to optimal balance once more. Once more you will be able to have compassion for yourself and your clients.

Remember: seeking therapeutic help is the best strategy we have!

Footnote:

1. Traumatology Vol 14. No 2 June 2008. Ref. Self-Care in Physicians Working with Trauma Survivors

Additional resources:

Why do we work with the subconscious mind?

I recently sat down with Guy Macpherson, host of The Trauma Therapist Project podcast, for an in-depth discussion on treating trauma:

• A look at the traditional way we treat mental health and trauma – what is and isn’t working
• How working with the subconscious actually works: an explanation of the QEC process – technique, results, length of process – from start to finish
• How and why QEC was created – my 40-year career in medicine as a GP, Gestalt Psychotherapist, TRE trainer and trauma specialist

Watch the interview here.

Prefer to listen? You can do so here.

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Dr Melanie Salmon

Medical doctor, Gestalt psychotherapist, TRE trainer, trauma specialist and teacher, I have committed my life to the exploration and practice of healing.

During my 40 years in medicine, I became increasingly frustrated with the limited ability for pharmaceutical drugs to treat the cause of health issues including psycho-emotional conditions in my patients. To me, it became clear that these problems were related to a dysfunctional nervous system caused by unresolved and unhealed trauma. This understanding led me to leave medicine to seek out a better way.

In 2008 I found it. Combining the best from many modalities including Gestalt psychotherapy, neuroscience, and epigenetics – drawing inspiration from both the traditional and modern – I created Quantum Energy Coaching (QEC), revolutionising the way we approach healing. A simple, yet profoundly effective method that works with the subconscious mind, QEC is a clinically usable tool that heals the effects of past trauma and changes limiting beliefs rapidly and safely.

Following early success, QEC soon established a global following, inspiring me to offer training in the methodology and to build a team of practitioners who today, use it to heal thousands all around the world from the most traumatised to those simply wanting to live their fullest lives.

My debut autobiography, There Has to Be Another Way, is available to buy at all good online retailers.

qecliving.com/

The definition: Complex PTSD happens in response to chronic and repetitive neglect, emotional, physical, and/or sexual abuse, usually occurs in childhood, and is typically deeply interpersonal within the child’s caregiving network. The child has no way to escape, or survive without the parent(s) or caregiver(s), and endures a cruel and imprisoned world of abuse and neglect with no empathetic witness to help or validate the child’s feelings or what’s happening. Often siblings are recruited as proxies to the abuser(s) adding to the vast interpersonal web of perpetrators. The child alone in this situation can endure predatory behaviors such as: scapegoating, gaslighting, stalking and bullying, humiliation, neglect, physical and sexual abuse, withholding of love and attention, making love and affection conditional, and total invalidation of the abuse, and needs of the child. The child has no safe space or family member to retreat to which increases the view of the world that the abuse will never end. Because the brain is still developing and the child is just beginning to learn about the world around them and who they are as an individual in that world, as well as developing first relationships – severe and repetitive trauma interrupts the entire course of their psychological, and neurological development.

When you’re born in a burning house, you think the whole world is on fire. But it’s not.

_Richard Kadrey

The child who endures this type of trauma begins to cope by going into survival mode and developing deep-seated survival strategies such as giving up and losing their sense of self to try and find a way to appease the abuser(s) and mitigate the trauma, becoming highly adrenalized, hypervigilant, hypersensitive, and hyper-intune to the harasser(s), the environment, and the telltale signs of looming abuse. The child’s brain begins to develop entrenched neural pathways that create survival mechanisms that become the first responders to recurring traumatic events, and the brain is left to fracture and compartmentalize to save and secure the parts that need safety and protection, as well as create parts that mirror the abuser(s). The child’s mind only knows survival under these circumstances. Logic, understanding, reasoning with the perpetrator(s), or speaking to another adult about what is happening is not an avenue for a baby or young child. There is no concept for anger, hatred, being abused, or neglected from a child’s perspective nor the ability to describe what is happening – the only understanding is confusion and the downward spiral to self-hatred, unworthiness, feeling unloved, unloveable, disconnected, separate, unwanted, and constantly under threat. This is the primary reason why abusers choose children because they are easy targets and there are generally no witnesses, or the mechanisms in place to fight back, understand or escape. As the child grows the brain is set up for survival and begins to meet life from this debilitating place of untrustworthy broken relationships, lies, betrayal, lack and scarcity, shame, low self-worth, and a menagerie of inner self-critics on steroids.

Self-hatred is only ever a seed planted from the outside in.

_Hannah Gadsby

The adult survivor therefore must contend with a brain that is still functioning through the lens of survival, and continuing to meet life and all of its challenges and burdens with the limited scope of survival strategies, avoidance, and fear of connection to others, overwhelmed by a nervous system caught in fight-flight mode, and trying to make sense of a patchwork of years of trauma. The healing journey for complex trauma is not an easy one. Finding the right trauma-informed therapist or mentor can help, and having trustworthy friends or loved ones to reach out to that can hold the space for you and love you through difficult times is also essential, and as you heal and integrate you can begin to do this work led by your heart, awareness, compassion, and love for yourself.

As I wept

In the arms of darkness,

I heard the voice of my grandmother say,

Nothing stays the same, darling,

Not even pain.

Life is a path of change.

Of ecstasy and ache.

So, no matter what the storm claims,

Let love light the way.

_Tanya Markul

From the deepest part of myself, I can say that I have found enormous healing through the challenges and overwhelming chaos of CPTSD, what it made me face, and how I had to meet myself every single day, and accept every single moment. This healing did not happen overnight, nor was it easy, gentle or kind. There were a lot of tears and tissues on this path to healing, with plenty more to come – I’m sure. I sought so many avenues of healing and found bits of help, wisdom, and hope along the way that helped me keep going but the elusiveness, scope, and magnitude of complex trauma are monstrous. After having tried just about everything possible to heal but still falling short I surrendered to my usual frustration, and that was when I finally realized that the only time I felt my mind clearing and feeling ok to be in my body was when I was in the moment, and open to a practice of self-care and self-love. The only way forward for me was to learn how to love myself even when I did not know what that looked like or felt like. I had dismissed my own needs and wants as part of my survival so I had to begin to understand and learn what my needs were, what I wanted, and what self-love was so I could begin to build my own safe and unique path back to loving my lost and frightened self.

For those anchored with complex PTSD trying to find remedy and healing can be a caustic and soul-aching journey. It is hard to find the words or the fortitude to explain this complicated and layered condition but the simple truth is when one hurts we all hurt, and when one suffers we all suffer. Finding a way to create a safe space, bring self-care, healing, compassion, community, connection, and courage, and bring more self-love to our aching hearts and traumatized soul is the only way forward. This is the reason I began the essential and loving work of HeartBalm, in hopes of sharing my story, my understanding, my love, and bringing balm to all hearts and souls who find their way here.

It is a gift of long-term survival that one becomes highly functional in the midst of a body and nervous system that is continually hijacked. It takes so much courage, mindfulness, acceptance, and loving yourself completely – warts and all to continue on, to keep trying, breathing, and living. If you are reading this and have endured amid trauma, abuse and neglect I bow to your bravery and courage, and willingness to be here. I see you and I honor your grace and wisdom for continuing, and joining me on this warrior’s journey to meet the self exactly where you are – here – now.

It was when I stopped searching for home within others and lifted the foundations of home within myself I found there were no roots more intimate than those between a mind and body that have decided to be whole.

_Rupi Kaur

Whether you have been on a healing journey, know deeply about the depths of your wounds, or are just beginning to prioritize your healing know that you are deeply loved and begin to step into the wisdom of your own divinity and grace. Let this lead you to open a heart path back to yourself. This commitment is for no one else but you sweet one. The way to peace, self-love, and safety is with the vast and infinite source of love within you. When you begin to witness all aspects of who you are in a safe space of awareness, with self-love, self-compassion, and acceptance you begin to heal. When you prioritize a heart-centered way of living and creating space in your day, in your moments that allow you to pause and be with what is arising then you begin to heal even more. Naturally, over time these spaces begin to expand and become more of who you are and bring peace and fullness to your daily life. Living with complex PTSD can happen, and can become healing of contrast and magnificence that has no equal, and can show you what a precious life this is, and how complete you make this world by simply breathing and being a part of it.

Meditations for each blog are also available at heartbalm.substack.com. Please subscribe or contact me with questions or comments. 

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

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Sunny Lynn, OMC

Sunny Lynn, OMC is a spiritual counselor, writer, poet, photographer, meditator, and nature lover on a mission of transmuting complex trauma through self-love, healing, and bringing balm to hearts everywhere. She has a blog and podcast – HeartBalm at heartbalm.substack.com that speaks on the topic of self-care and self-love, mindfulness and healing while living with CPTSD.

www.heartbalmhealing.com

As a people, we were not created to bear such global trauma and civil unrest. It touches the very core of our fears, we long for safety within our families and communities. As a CPTSD patient, my world is rocked, my brain is full and I am out of tears. Watching the world fall apart is scary and many of us need help navigating some of these uncertain and scary waters. Besides fear, a prominent emotion is that of empathy for those who have suffered and who are suffering. Empathy alone can serve as fray in the fabric of our beings, and empathy overload can and will take us to places we don’t want to go, and the road back is difficult.

In his book, “Get Your Life Back”, John Eldredge suggests a few ways we can give our brains a rest. He cites that the amount of information we consume on any given day would crash a computer. His wisdom in this book is good for everyone but it is particularly good for the trauma tribe. I found this book and some of these principles helpful as I make my way back to a calm nervous system absent of the ills of an activated one. Paying attention to those things that activate our trauma respects the hard work of healing. A few of Eldredge’s principles can transition our emotional brain into our safe present with relative ease.

Eldredge’s principles are reinforced by one statement in the book.

“We were not created to bear the burdens of the whole world but of our village”—John Eldredge

Here are a few key points from Eldredge’s book, in deference to brevity, it is impossible to provide them all here.

• Practice the one-minute pause. Eldredge and his team created “The One Minute Pause” to get us to do just that: pause. Available also on a web browser, this encourages us to stop– twice a day, breathe, meditate and ground ourselves to our present safety.
• Practice Benevolent Detachment. This is the ability to let go of that which does not belong to you, or that which you simply cannot control. This stops empathy over-load and protects our own mental health. We can still care about the sufferings of the world yet understand our own limitations. Protect yourself from vicarious trauma, because your brain cannot delineate your own trauma from that of the world.
• Practice Beauty Hunting. When we focus on beauty, we engage our emotional brains in beautiful things, literally switching your consciousness to your present safety and not your activated trauma.
• Put your phone down. It has been said that the computers we hold in our hands are more powerful than NASA computers. The ease of information is dangerous and we must practice some detachment from the barrage of information.

A prominent California pastor encourages this about cell phones and I have found it helpful in my own journey of protecting my peace and healing.

• Divert Daily—this is the practice of putting our phones away for one hour a day. Eldredge’s research demonstrated the average person picks up their phones eighty times a day!
• Withdraw Weekly—this is the practice of putting your phone away for one full day a week. The exception is those things phones were actually meant to do, but this is a practice that has helped me immensely.
• Abandon Annually—this is the practice of putting your phone away for an entire week. This is the hardest one of them all. I have successfully done this for two years and I was a little sad with reentry. I simply had no idea what immense amounts of screen time were doing to my nervous system.

As a trauma tribe, it is so important to protect your peace and healing during these times of unrest. Perhaps utilizing some of these practices will calm your nervous system down, and you can continue to live the life you deserve because YOU MATTER!

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Amy Watson

I am a Florida girl who loves a simple life, Jesus, family, friends, football and the beach (usually in that order). I am a native of Jacksonville, Florida, but have spent most of my adult life on Florida’s west coast.

While being introduced for a speaking opportunity a few years ago, the pastor asked me “who are you?”. The words that followed shocked even me: “I am the precious daughter of the most high God”. There were many years when I would not have answered that question as I did that day.

After you have dug deep inside yourself and gathered the courage to contact a therapist in your near with the request for help, you receive an automatic email with the message that is beyond any expectation, deplorable! Your email is categorized as ‘spam’!

Receiving such an email literally happened to me last year after contacting a German website that claims to be there for those who are dealing with the manipulations, lies, and delusions of a narcissist on a daily basis.  Why did I receive this robotic reply? Perhaps my email signature has caused this. Perhaps it is an electronic error and they don’t know that their system is sending out these kinds of automatic replies. Perhaps the content of my email was too objective, written too much in a clinical form, which made them think that I am nothing more than an ‘attention seeker’.  (with an attention seeker I mean someone who has to take the center stage in each situation. Someone who is demanding that all eyes have to be on him or her. And if not, they put up a dramatic show to bring the attention back to them)

Either way, receiving an email containing the message that your story is not to be found credible is far from what you want to read and, can create an incredibly deep dent in one’s self-confidence.  These kinds of robotic reactions, intended or not, do have the power of creating another psychological blow, a new invisible injury people can add to the ones they already have gathered over time.  It shows that some, who are practicing in the field of modern psychology, have yet to take the journey through the mind of those who have a strong sense of ‘self’ and are able to use ‘reflective thinking’.

Now, it is very easy to criticize people and only pinpoint in a negative direction saying, “You are doing it wrong!” But let’s be honest, it is often very difficult recognizing the difference between someone who is voicing his/her thoughts and emotions spawned from a real trauma experienced and, the fantasies (perhaps gathered from watching too many movies or, heard from others speaking about their experiences) of someone who is only seeking the attention for the wrong purposes.

What has even a higher level of difficulty is, detecting the moment a master manipulator (e.g. a narcissist) is providing you the right material for you to believe their delusional mind and become their prop. These, and many more, ‘ingredients’ are inside that person but you don’t necessarily see it right upfront. These individuals can cover up their true intentions for quite some time when they engage with people. But, sooner or later, you will find out that those characteristics have been there for the duration. And so you are over there thinking why didn’t I see it?

So, how can we determine the foggy line between what is ‘real’ and what is downright a mirrored behavior? Straightforward, those who are truly dealing with the nasty effects of  PTSD and/or CPTSD will speak with you about possibilities while recalling the event(s) and use reflective thinking. Those who are wearing the ‘victim badge’ will speak to you with what they believe are facts while blaming and criticizing others for everything that has gone wrong in their life.

What is real and what is not 

Personally, I think that the secret is recognizing the difference between those who are living in an altered reality and those who are truly dealing with and trying to overcome, the effects of PTSD and CPTSD lies in their body language.

Unfortunately, many therapists have, over time, developed this narrowness that is setting the scene for them not looking to reality. Most therapists are looking for or triggered by, the behaviors they are most familiar with and fit their pre-opinion on how one should behave according to the outdated literature. This makes a therapist an easy target to become a prop for anyone who is only seeking an opportunity to collect data and perfecting their ‘victim badge’.

So, how to make a distinction between what is real and what is not? The ‘reality’ in this matter lies with those who don’t prefer any attention to what looks like them being pet as a puppy. 9 out of 10 times this makes them feel uncomfortable and not taken seriously. Also, even when their voice might tremble from time to time, these people, when given the time, (not to be confused with an awkward silence) are capable of voicing their thoughts and emotions about what they have experienced or, are still experiencing. They analyze why and how their own mind is processing the information stored (self-reflection).  They want to make sense of the situation or situations but get slightly confused due to the fact that their thoughts are swirling in circles. Like with the Ouroboros, there is no end and there is no beginning. And so, it feels like the situation is unsolvable or, on the edge of escalating (PRE-Traumatic-Stress).

With ‘non-reality’ I mean, those people who are master manipulators (with narcissism for instance). They manipulate people’s minds in order to have control over their victim’s behavior which is in many cases no illusion at all. Their fantasies are truly creating victims. These people, living in their altered reality, are seeking attention for their fake narratives and they don’t care who or what they have to trample on to gain this.

There is a whole category of those who are only seeking attention but, in a nutshell, they are making things up to suit their narratives like copying the well-known and familiar behaviors accompanied with PTSD and CPTSD. Most will, on their own accord, propose to the therapist to prescribe the medication(s) only to show the packages, with a smile, to anyone who is willing to listen with empathy. This empathy is, unfortunately, supporting their narrative and thus are, in their mind, justified in criticizing and belittling anyone who has question marks about why they are so proud of having a small pharmacy. “I know that you don’t care about me, you never did! Luckily others do!”

A different approach requires experience

Experience (noun)

1. practical contact with and observation of facts or events.
2. an event or occurrence which leaves an impression on someone.

Let me stir up your emotions and perhaps kill your weekend for a brief moment…even though you, as a therapist, might have, say, two decades of practice experiences working with people who are dealing with the after-effects of a traumatic event, your knowledge, with all due respect, will only scrape the surface when your client is a 1^st responder.

Now, don’t get me wrong, you should not throw your training and knowledge in the trashcan right away. Your years of experience are working perfectly for many. What I am saying is, at the moment a 1^st responder is sitting across you it is very easy to look out for obvious behaviours like the low lows, the high highs, and the eerie silences.  But have you ever looked for the ‘invisible’ stressors that is triggering their ‘out-of-the-ordinary’ behavior?

Let me give you an example of these invisible stressors that might sound a bit of a strange comparison. Imagine a dog, any dog…it is a loyal and playful animal that is sleeping on the sofa while you watch a movie, read a book, or work behind your laptop. Then, suddenly, it jumps up, its ears are standing up straight and its eyes are focused on the door. The dog is sniffing a tricky situation, perhaps a dangerous one. Within a few seconds, its behavior has changed dramatically. Its gaze is rigid and sharp and the playfulness has transformed into an almost intense calmness. When observing this behavior, many will recognize it as an aggressive warning…one wrong move and the dog might attack.

This is similar to 1^st responders in general. I mean, at the moment a police officer, for instance, finds him/herself in a situation in which he/she needs to focus on his/her surrounding, similar alertness can be observed.

By means of the therapist not having enough experience(s) with the invisible stressors triggering this alertness with a 1^st responder (including their mindset), he/she will meet with the difficulty of understanding them suddenly focusing this visible. The therapist might experience this as a form of aggression or, distancing (creating borders) that, according to outdated literature, should be broken in order for the client’s mind to start healing from the traumatic event(s).

Thinking that this is aggression or distancing, which is not the case, the therapist will change his/her behavior what, in most cases, will, unlike many civilians, push the police officer (in this example) away simply because he/she is trained to read and respond to the changes in both human body language and the intonations in one’s voice.

Did you see the stressor that has triggered the police officer to convert his/her behavior from being willing to talk to observing a potentially suspicious situation? It was the subtle change in the therapist’s body language, intonation…even the eyes can be a trigger.

So, how to work with 1^st responders and, avoid these kinds of situations as much as you can? As I mentioned in my previous articles, I was a cop myself therefore, from my personal point of view, I think that a therapist who is working with 1^st responders, should not be afraid of explaining why his/her behavior has changed that suddenly. Be honest about what is going on. Not only will it reduce the alertness, but it will also build a stronger relationship between the therapist and the 1^st responders.

How do you reach them?

It is very easy to generalize the human mind and thus the thoughts and behaviours spawn from a traumatic event. But working with e.g. police officers, paramedics, firefighters, military personnel, recognizing and understanding their body language is not sufficient.

Many therapists don’t include the fact that 1^st responders are, in many cases, psychologists themselves due to the fact they are not only dealing with blood-thirsty perpetrators but also with victims. This way of thinking, and thus the accompanied behaviour, is, and I don’t mean this in disdain, seen less with civilians. Meaning, 1^st responders have a strong sense of ‘self’ which makes them view/experience many situations from a clinical/professional point of view and are therefore less likely to crawl into a corner, publicly.

For example, recently I spoke with a young German soldier (21) who, from my perspective, showed an ‘out-of-place’ behavior early in the evening. By this I mean, he showed an odd way of avoidance when political topics were discussed. This drew my attention and so, I observed this young soldier and listen to what he was not saying. It quickly became clear to me that he had, during the last months, made a connection between political powers and the impending war in Ukraine.

During our conversation later that evening he said and I quote, “I don’t know if my colleagues are feeling the same but if they do, they are hiding it very well. I don’t show it to my girlfriend but, I am terrified. I might be, in a couple of weeks, at the front-line and die in a war that’s not even mine! I am fucking 21 man! I wish there was someone who could take away this fear.”  Suddenly the movie “Good morning Vietnam” came to mind.

Although it might sound all very logical because no one wants to die let alone under horrifying conditions as such, a ‘confession’ as such – it takes a lot of courage to drop your guard, even for a few minutes –  has no other direction to travel than straight through the heart.  Still, there is this one thing many forget is happening with this 21-year-old soldier, perhaps even dismissing its reality because nothing had happened yet.  God forbid that it will but, when the moment arrives this war is the fact, he, like many of his colleagues, will go into combat traumatized.

PRE-Traumatic Stress Disorder (an anticipatory type of stress that mirrors post-traumatic stress disorder in its symptoms. In both cases, someone can experience flashbacks, nightmares, severe anxiety, and obsessively thinking about an event) this is not an official psychological disorder in the DSM-5 but, looking into the eyes of this young soldier while speaking these words, one can only disagree with this Manual of psychological Disorders.

Night terrors and PRE-TSD are scary but normal

Flashbacks, nightmares, anxieties, and/or not being able to remove the thoughts of a ‘pre’ or ‘post-traumatic’ event from your mind, is a normal process when the images have become your demons. Scary demons spawn from unusual moments.

Let’s place these very, very unpleasant images, thoughts, and emotions at the moment your mind is in a dream-state, under a magnifying glass. In other words, the fragile moment when you are asleep and your brain has the freedom to process everything in its own particular way. You ‘viewing’ any ‘pre’ or ‘post’ situation in your dreams, is logical and perfectly healthy. And even though some psychologists label these bizarre and surrealistic objects created by your mind as a form of Gestalt-processing, it simply speaks of you having a strong and stable mind. Your brain is doing its job in processing the information absorbed…even the scary data.

I think this is what we see happening with military personnel, police officers, medical staff, who have/had to deal with those situations most people do not have to experience this frequently. I think that a form of emotional distancing is speaking of a healthy mind simply trying to survive.  Unfortunately, there are people who have difficulties with processing it all…perhaps, and I saying this with caution, they have not learned how to express their emotions with words (spoken and/or written).  I think that at the moment one has learned this ability to use words instead of actions, to express him/herself, the image or situation viewed becomes more logical and thus easier to process.

This, in my opinion, are exactly what these dreams are, a  follow-up after witnessing a traumatic event. Your dreams are the remnants of what you have already processed on a consciousness level. It is just your mind smoothing up your memory by…um well, kicking out the last bit of nasty things. And yes, these moments are pretty intense.

For example, I once saw, in a dream, a bright flash and heard a loud bang. I woke up in a sweat. My heartbeat was sky-high because I was convinced I was shot. I literally checked myself for bullet holes and blood, that vivid it was to me.  Another time I woke up in full panic screaming “It’s not real, it’s not real!”. I cannot remember what the images were in my dream for me to wake up in this panicked state. But I do remember viewing my bedroom as if I was in a B&W movie from the 40ths.

Anyway, I fully understand how these terrifying dreams can have a particular grip on you. But, as soon as you find yourself analyzing and voicing your dreams with awareness, you have learned how to work with your subconsciousness and thus understand how to take the time to digest and break down the information absorbed.

And so, it is of huge importance for modern psychology not to stick to the well-known behaviors and lump people’s reactions onto one pile but to understand and recognize the differences between what is real and what is not. Because, when the non-reality is observed but, for whatever reason, is kept silent, it destroys the path for those who are truly fighting the demons spawn from (pre) trauma.

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Maria Anna van Driel

Maria is an Investigative Journalist & Reporter (member of the DVPJ-German Association of Journalists) covering non-fictional stories where modern science and myth meet, to find the scientific truth and proof concerning the origin of evolution in general. Maria is also a published writer and Theoretical Physicist having a Bachelor’s in Metaphysics and a MA in ancient Alchemy.

(Before I go further, I want to say: I don’t believe in the “pain Olympics.”  I don’t believe that anyone is suffering more/less in any way right now, or certainly not in any manner that is worthy of note or discernible.

As a complex PTSD sufferer AND a Board Certified Behavior Analyst (BCBA), I can say confidently that it IS entirely possible, within the broad range of the human condition, to suffer *the same level* of pain at the same time.  Read that again. I can confidently say that it is entirely possible we could *all* be experiencing the same level of grief simultaneously right now.  Why?  Because everything that is happening is relative to each of us, on an individualistic level.  And that is all that matters for many (too many) of us right now.  Please remember this point, as you read my writing.)

But, when you have complex PTSD (and of course, this is only my experience), everything around you suddenly *has the potential* to become a trigger. 

Here is an example. 

One of my favorite shows in the world is Schitt’s Creek.  (I also have a deep love for Seinfeld, and SC is THAT UP THERE- that’s serious business) I love it, for a large number of reasons (and many of them are sentimental, with my daughter).  I am a bit obsessed, one could say. 

But, there is a *portion* of a scene within that show that makes my heart rate spike every time I see it.  It catches my breath, and there’s a part of me that goes blank for a brief moment.  The whole “scene” lasts about… 10 seconds, maybe?  You can easily dig up a video of this (it’s in the episode where the singles event happens), but I would like to describe it myself, for those that haven’t seen it (totally watch it, though!).

Moira and Alexis (Mother/Daughter) are essentially just bickering.  It’s about fairly petty things in the scheme of things regarding an event they are putting on together (a local “Single’s Event”).  Pretty typical silly bickering type stuff- no big deal.  Then, there is this part where Alexis goes a teeny bit *too far* with Moira I, and Moira gets a tone in her voice that is very mocking, ridiculing. (Moira says: “I’ll tell you what I’m about to do… “ – when that line starts).

I am not looking to get into the exact details of why a mother mocking her daughter, even in jest, would be a triggering 10 seconds and cause my heart rate to spike.  But, I am looking to point out the following: everything has the *potential* to become a trigger when you have complex PTSD due to the specific intricacies and detail that usually accompanies long-term, traumatic events. 

But why does this matter?

The eventual effects of long-term, repeated trauma will soon be important to recognize as we are *all* going through a collective traumatic experience, particularly healthcare workers. I fear complex trauma will become a subject that we will all need to become more familiar with within the coming years.

To be clear, this doesn’t even mean that it will result in a huge uptick in C-PTSD diagnoses’ (though that is certainly possible). Rather, what is more horrifying, is that this collective trauma will have physiological and emotional consequences for even those that are “okay” enough never to receive any formal diagnosis.  This vast knowledge and research of the long-term effects of trauma will soon be relevant for all of us (again, particularly health care workers/front line workers that have witnessed atrocities and months of death), like it or not.

I write this as an introduction for myself, as, ultimately, a C-PTSD sufferer that has spent the past 9-10 months (being forced to…) identify my own triggers.  This has been while on medical leave from work, which occurred when my own struggles resulted in physical ailments (manifestations) of trauma in my daily life. 

So, I  have spent far too much time deconstructing my own triggers within a personal and academic framework, so I also write this as a professional.  I aim to use my education and professional experience, in conjunction with my personal background, to inform how the science of behaviorism can be used responsibly to pull apart one’s own triggers (once identified), as this will, unfortunately, become a problem for many of us. 

—–

(Like gravity or the laws of physics, the science of behaviorism (and thus, how we interact and perceive the world around us) isn’t science that can be refuted.  Not easily, anyway.  However, I would like to speak to the neurodiverse community and say: I recognize that many chapters of the history of behaviorism (and the field of applied behavior analysis as a whole) do have a sordid history that should be acknowledged.  I have many thoughts on this subject, but I ultimately very likely agree with your assessment. It’s why I want to help educate about the *science* of behaviorism so it can be thoroughly picked apart and humanely reconstructed within fields.  (I.e., such as the deconstruction of triggers and “unpairing” them from ourselves physiologically, etc.).  I hear you and want to learn from you if you’re willing (in addition to my own education efforts). 

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Elizabeth Connis

The constant exposure to death and destruction takes an enormous toll on the mental health of first responders. Yet, many of them will not acknowledge their pain. If a first responder has a history of child abuse, the effects on their mental health by responding to calls for help can lead to many complications, including death by suicide.

This article will examine complex post-traumatic stress disorder (CPTSD) in first responders and how their vital work harms these brave souls.

The Mental Health of First Responders

The public has ignored for far too long the mental health of those who care for and rescue them. We have overlooked the fact that they are people first, people who can become depressed and stressed like anyone else.

First responders have an image in public, and among each other that they are tough, rugged, and ready for any emergency. But, what if that paramedic, fireman, or nurse is also a survivor of childhood trauma and lives with the effects of complex post-traumatic stress disorder?

The sturdy and unbreakable façade that many of those who are on the front lines of defending our lives leave them open for ridicule should they need to admit and seek help. They need to seek advice for stress, depression, or any of the myriad other mental health problems they may face.

A Refreshment About CPTSD

Complex post-traumatic stress disorder is a mental health condition caused by childhood maltreatment perpetrated by the people children should be able to trust the most. CPTSD is a life-altering and life-long disorder that affects adults and produces a variety of dysfunctions, including the following:

• Flashbacks to childhood traumatic events
• Avoidance behaviors
• Hyperarousal (hyperawareness)
• Difficulty controlling or expressing emotion
• Negative self-image
• Trouble forming and keeping relationships
• Depersonalization
• Derealization
• Losing one’s core beliefs, values, religious faith, and hope in other people

To be clear, people, including first responders who live with CPTSD, may exhibit a few or all of the above symptoms. However, keep in mind that some of the adaptive living styles learned by first responders while surviving as children are crucial for making a great ER doctor, fireman, or paramedic.

Complex Post-Traumatic Stress Disorder and First Responders

Being a fireman or a police officer is tough. They risk their lives and changing their family’s lives every time they go to work and face tremendous stress on the job. A paramedic or nurse never knows when a patient will present with severe trauma, rape, or today, victims of COVID 19. In essence, they are always waiting for the next shoe to fall.

For many, who have survived an abusive past and have CPTSD; as a result, these emergencies can force them to relive what they endured as children through flashbacks and emotional turmoil. They will be present, aware, and damn good at their job when a crisis arises. Later, after the emergency has subsided, they find themselves weeping uncontrollably, or pushing their turmoil deep down where they believe it will be hidden from everyone.

However, turmoil like those first responders who live with complex post-traumatic stress disorder endure is not ever forgotten. Their body and mind remember and because it equates with what they suffered as a child will come back to haunt them.

COVID 19, CPTSD, and First Responders

Most of us are aware that the hard-working people on the front lines, doctors, nurses, nurses aides, and other personnel, to name a few. These folks are working extended hours to care for the sick and dying from the COVID 19 pandemic. How horrible it must be for them to fight so hard to save someone only to have their lungs and other organs fail, and their patients die.

Imagine, though, that you are a survivor of trauma yourself and have never begun treatment to reverse the damages done when you were a child. The pressure and anxiety leveled upon your person every day in the combat zone of COVID 19 would take a massive toll on your mental and physical health.

According to the Substance Abuse and Mental Health Services Administration (SAMSHA), it is estimated that 30% of first responders develop mental health conditions. These include depression and post-traumatic stress disorder. The general population figure is 20%. Add the proclivity for developing PTSD on top of an already existing condition of CPTSD, and you have a recipe for disaster.

The Danger of Death by Suicide to First Responders

Those on the front lines of the COVID 19 crisis are awash with different emotions and physical discomforts such as anger, hypervigilance, and chronic exhaustion. Even during “normal” days, the stress takes a toll on not only the first responder’s personal health but that of those around them, leading to divorces and illness.

It is no wonder that the death toll of those who first respond to our physical and legal needs are dying in record numbers by suicide. Often those who protect and help us find themselves addicted to alcohol, depressed, and avoiding finding mental health treatment because of the tremendous stigma involved in doing so.

In one paper, it was written that studies have found that in 2017 alone, at least 103 firefighters or EMS workers across the United States died by suicide. They also reported that more police officers die by suicide than in the line of duty every year (Heyman et al. 2018).

Ways First Responders Can Help Themselves

All is not lost as there are plenty of ways that first responders can be effective in improving their lives by good self-care. According to The National Center for PTSD, below are only a few of these methods quoted from their site.

First responders working shift work should:

• Practice self-monitoring and pacing
• Regularly check-in with colleagues, family, and friends
• Working with partnerships or teams
• Practice relaxation techniques and stress management breaks
• Periodically check in with a peer for consultation and their supervisor
• Make sure to time-outs for primary bodily care and refreshment
• Keeping anxieties conscribed to actual threats
• Do their best to maintain helpful self-talk
• Focusing their efforts on what is within their power
• Accept situations they cannot change
• Foster a spirit of endurance, patience, tolerance, and hope

While doing all of the above first responders should avoid the following:

• Working too long by themselves without checking in with colleagues
• Working “round the clock” with few breaks
• Feeling that they are not doing enough
• Excessive intake of sweets and caffeine
• Engaging in self-talk and attitudinal obstacles to self-care

Only by practicing good self-care first responders, especially those who live with CPTSD, hope to conquer the mental crisis caused by COVID 19.

Ways the Public Can Help

The public need not stand by and allow our brave nurses, doctors, firemen, police officers, and other first responders to take their own lives.  There are many ways we can help.

Provide Support. Allow first responders to talk about what they have seen in their work within the confines of the HIPPA law. Offer these brave men and women follow-up treatment and support from mental health professionals and the public alike to shore up their depleted supply of encouragement.

Shout out their worth. Many communities have begun ringing bells, honking horns, and otherwise acknowledging the bravery and courage of first responders during the COVID 19 pandemic. The public must keep telling our brave men and women on the front lines of caring for our health and welfare how valuable they are to us and how much we appreciate and love them. A kind word may be the catalyst to help a police officer not die by suicide or assist a nurse in having a better attitude at home saving her marriage.

In Closing

First responders are a vital part of our society and play a fantastic role in keeping us safe and healing us when we are sick. There is no reason we the public cannot reach out to nurses, doctors, policemen, aids, firemen, and all the other people involved in our care. They are all that stands between us and death by COVID 19.

They need us, and we need them.

It is time to stand up and recognize the pain that those first responders who lived through childhood trauma their struggles and their courage.

“You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, ‘I lived through this horror. I can take the next thing that comes along.’” ~ Eleanor Roosevelt

“One isn’t necessarily born with courage, but one is born with potential. Without courage, we cannot practice any other virtue with consistency. We can’t be kind, true, merciful, generous, or honest.” ~ Maya Angelou

If you or a loved one are living in the despair and isolation that comes with complex post-traumatic stress disorder, please, come to us for help. The CPTSD Foundation offers a wide range of services including:

Daily Calls

The Healing Book Club

Mindfulness, Prayer, and Meditation Circle

Support Groups

Our Blog

The Trauma-Informed Newsletter

Daily Encouragement Texts

All our services are reasonably priced, and some are even free. So, to gain more insight into how complex post-traumatic stress disorder is altering your life and how you can overcome it, sign-up, we will be glad to help you.

References

Giourou, E., Skokou, M., Andrew, S. P., Alexopoulou, K., Gourzis, P., & Jelastopulu, E. (2018). Complex post-traumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma?. World journal of psychiatry, 8(1), 12.

Heyman, M., Dill, J., & Douglas, R. (2018). The Ruderman white paper on mental health and suicide of first responders. Ruderman Family Foundation.

Shirley Davis

My name is Shirley Davis and I am a freelance writer with over 40-years- experience writing short stories and poetry. Living as I do among the corn and bean fields of Illinois (USA), working from home using the Internet has become the best way to communicate with the world. My interests are wide and varied. I love any kind of science and read several research papers per week to satisfy my curiosity. I have earned an Associate Degree in Psychology and enjoy writing books on the subjects that most interest me.

www.learnaboutdid.com