The year was 2013, and the American Psychiatric Association was putting their final touches on their latest edition of the Diagnostic and Statistical Manual of Mental Disorders; their ponderous compendium of classifications and criteria that has become the standard reference book for mental health practitioners throughout the United States. It’s a very influential book. Each edition sends expanding ripples of consequences throughout the field for years and years. Decades and centuries, arguably. Consider for a moment the effect it had when homosexuality, for one example, was de-pathologized in a previous edition.

In anticipation of this event, there was a major push on to convince the APA to recognize complex PTSD, in some name (DESNOS, dissociative subtype), as a separate diagnosis. If you scan the literature, there is a dramatic increase, a huge swell, in the number of research articles supporting cPTSD right around 2013, as researchers across the world made their case for its inclusion.

Sadly it did not make the cut. The criteria for PTSD in the new DSM-V were amended to reflect some incontrovertible findings, but the APA in its wisdom ruled that cPTSD, as a thing, was not sufficiently distinct to merit its own separate entry.

And yet the diagnosis thrives. In the absence of formal classification (in the United States), it has grown in the public’s awareness and entered the common lexicon, and is in frequent use amongst researchers and clinicians. The reason for this is that cPTSD exists, and it is a useful distinction to make, especially clinically. Saying that someone suffers from cPTSD, if it is understood what that means, immediately provides a wealth of information that might otherwise take a great deal of time to ascertain in a treatment setting. Furthermore, and crucially, knowing that cPTSD is present guides treatment choices, because cPTSD needs to be treated differently than uncomplicated PTSD. I can’t say this enough. I wish I could write it in the sky: cPTSD needs to be treated differently than uncomplicated PTSD.

PART II

Unique Features

The most frequently recommended treatments for cPTSD are Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR). Look on any website talking about cPTSD, click on their “resources” tab, and there they are: CBT and EMDR.

The problem is that these two don’t work very well with cPTSD. They are based on the exposure model, which was developed before anyone had ever thought of cPTSD. In the exposure model, treatment consists of exposing the patient to the traumatic incident over and over, usually in the form of reciting a trauma script or prompts from the therapist to imagine this or that aspect of the trauma. The feelings this inspires (fear, terror, helplessness) are then processed until they subside.

CPTSD, however, presents with two unique features that confound the exposure model. The first of these is that whereas in uncomplicated PTSD, the trauma represents an atypical event (i.e. someone is going about their lives when something terrible and abnormal occurs), in cPTSD the trauma is formative, in that it is a circumstance or condition under which the person learns and grows (i.e. being raised in an abusive home). In that situation, trauma is adapted to, built upon, and incorporated into the self. In cPTSD, trauma pervades the personality. This makes it much harder to confront through exposure, because the problem isn’t that someone is now triggered by discreet stimuli like dark alleys or specific memories. The problem is that someone is engaging with the entire world, and relating to themselves, from a holistically traumatized standpoint. Addressing that requires a more comprehensive engagement with the person than repeating painful recollections.

The second unique feature of cPTSD that messes with the exposure model is what I call the suppressive/dissociative reaction. I call it that because it isn’t just dissociation. Dissociation is a largely involuntary reaction that can range from simple “spacing out” to severe and exotic phenomena such as depersonalization (when someone feels as if they are outside of their body). Dissociation certainly happens in cPTSD. However, in my experience people with cPTSD suppress as much or more than they dissociate. Suppression is a mostly deliberate, conscious effort to stifle feelings, and operate as if they aren’t there. People with cPTSD suppress all the time, which makes sense: if your trauma was prolonged, you were going to have to pretend that everything was fine a lot. Because both of these processes are present in cPTSD, and serve the same function (managing intolerable emotions), I combine them into a single term: the suppressive/dissociative reaction. The suppressive/dissociative reaction impedes exposure-based therapies by rendering emotions inaccessible. If all someone does when you expose them to a trauma script is shut down or dissociate, the emotions you’re hoping to process won’t show up, and the therapy won’t work.

Last part of this section: why, if they don’t work very well, are CBT and EMDR recommended for cPTSD so much? Well, I have a few theories. One, they were being used to treat PTSD, so when cPTSD came along people naturally thought “Sounds similar, these oughta work on that, too.” Two, insurance companies love CBT and EMDR because they can be manualized, so they get advertised quite a bit. Three, most websites talking about cPTSD are getting the word out, not doing research, so they copy/paste their recommendations from each other. Website content that is auto-filled by AI will also list CBT and EMDR. Four, they do kinda work – most studies done with CBT or EMDR on cPTSD show some symptom reduction; just not as much as they have on PTSD. And five, it might reflect the ongoing push to medicalize psychology.

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 post do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Brian Henley

Brian Henley is a licensed clinical psychologist based in Los Angeles. He specializes in the treatment of traumatic stress. You can find out more about his practice at his website, https://treatingcomplexptsd.com/, or read more about his theory and methods in his recent article, Psychodynamic Techniques Elicit Emotional Engagement in Complex Post-Traumatic Stress Disorder, available here: https://www.tandfonline.com/doi/full/10.1080/02668734.2023.2231059.

I was honestly terrified of losing control of myself and didn’t totally understand how it worked but after digging around I learned two important things: 1) it was like taking a fast forward on therapy and 2) it was transformative. So, I closed my eyes and applied.  According to their website, the program is for a diagnosis of PTSD, depression, substance use disorder, anxiety, disordered eating, and/or disordered sleeping that hasn’t shifted as well as you had hoped with medication, therapy, and other approaches.  Also, as one of the very few legal programs around, it’s not cheap.

The founder of the program, Shannon Dames, is a professor of nursing at VIU and is absolutely dedicated to ensuring the safety of participants. Ketamine is a strong drug and does have possible interactions, just like any medication. In the application process, you need a doctor’s approval of participation as well as a recent blood pressure reading. There is a bevy of nurses and doctors that work in the program and assist with all ketamine sessions.

I was put into a small group of eight women with one of the ladies participating from North Carolina. (She came to Vancouver Island for the ketamine sessions). Every week, we were in a large session and then split into our small groups where we learned how to give and receive unconditional positive regard. It was a strange, uncomfortable thing at first—to listen and not offer advice or opinion—to simply listen, accept and show that you heard. Most with trauma did not have this as children (necessary for secure attachment) so it was very powerful to finally have it. These weekly sessions created an environment of trust and acceptance which was the foundation of our ketamine sessions, a few weeks later.

For the first sit, my intention was to release fear. I was just so damn tired of being afraid. Unfortunately, the mother of all repressed memories decided to visit during the session, and I relived a terrifying moment that I was never sure had happened. The team leaped into action and helped me through it. After that session, I slept for two straight days. I felt like I had been hit by a truck and then it backed up and hit me again. I spent a week working through the memory with my cousin, my therapist, and the Roots to Thrive team.  At the end of the week, I woke up and realized I wasn’t afraid. I simply woke up. The fear had someone gone. It seems that the fear of not knowing whether this had happened was much more frightening than the reality. Finally, I was at peace.

For the second sit, my intention was to feel joy. Yahoooo, did I feel joy! Wow, that really showed me why hallucinogenics were so popular in the 60s—they may have had the right idea. I saw my two favourite people in heaven, my dad and my grandmother and I was dancing, flying, and running through meadows. If you are thinking, The Sound of Music, yup, exactly.  This picture is the photo I told them to take as I came out of the meds. I wanted them to get a picture of me with my eyes showing joy because, in all my pictures from the past, my eyes never smiled.  The crazy hair was how much I was moving around and partying.

For the third sit, my intention was to find my purpose. During my time in medicine, three words were repeated over and over: voice, community, and belonging. I was in the midst of a career and personal crisis at the time, and it completely changed my direction. I am now in school for Addictions and Mental Health Counselling as well as a certificate in Trauma. Also, I’ve started writing again…my voice.

So, bottom line, do hallucinogenics work? For me, without a doubt, that would be a resounding yes. Do I recommend them to everyone in the CPTSD community? Yes…but. The “but” is that it’s not necessarily just the drugs that are important. Ketamine should be done within a therapeutic setting and community to get a true therapeutic result. Just taking it at a party is not at all the same thing (and is super dangerous). The preparation and debriefing are as important as the actual medicine. Also, medically, it isn’t for everyone so be very sure you speak with your doctors.  Roots to Thrive is a model for this type of program so if you’re not sure about the one you’re considering, I highly encourage you to compare it to this one. The staff is amazing and if you have questions, definitely reach out to them.

If you’ve done hallucinogenics or considering them, I’d love to hear about it!

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 post do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Belinda Pyle

Belinda lives on beautiful Vancouver Island where she fills her need for nature with hiking, horses, ocean, and any furry critters she can find. She is completing her post-grad certificate in Addictions and Mental Health Counselling and looks forward to helping others as she has been helped. As a third-generation survivor of trauma, she comes from a long line of crazy but strong women who have somehow succeeded in making lives that don’t completely suck.

I am not going to lie; I was really skeptical at first. The thought that staring at a pointer would resolve decades of trauma stored in my brain seemed too good to be true. Nevertheless, I adore and wholeheartedly trust my therapist, so I reluctantly agreed to try it.

Our first session was called an intensive, which means 3-hours of therapy in back-to-back sessions. I’m not sure why I thought that was a good idea, but again, I trusted her, so I did. We did three different targets, which will take too long to handle in a single blog, so I will break this into two parts (one target I am not willing to share at this time).

The target I want to share with you today is related to a near-drowning accident that I experienced when I was ~ 4 years old. The gist of the story is that I left the patio at my aunt’s house to feed the ducks (they had a house on the lagoon), and I fell in the water. I don’t remember falling in the water, and for years, I didn’t remember much about it, but the story was repeated every time family got together. After a while, I started having flashes of memories pop up, but they weren’t connected.

I remember being in the water and trying to keep my head above water, but, of course, I couldn’t swim. I remember some teenagers jumping off the pier a couple of houses down from where I was, and I also remember calling out for help. I remember the green-brown water over my head, seeing the light above the water, and thinking I was going to die.

Obviously, I didn’t die, or I wouldn’t be writing this. The story goes that the teenage neighbor girl saw me fall in the water and rescued me. She brought me soaking wet to my aunt’s front door and rang the doorbell. I don’t remember any of that, but I’m pretty sure I was in shock at that point. I am sure I must’ve given my poor aunt a heart attack. Can you imagine her having to tell my mother that I drowned in the lagoon? Thankfully, God spared me.

Amazingly, this incident never caused me to be afraid of water or not want to swim, or even go onto the dock again. As the memories started to surface (pun intended), I became aware of some strange behavior I was exhibiting in the workplace, and I had no idea why I was doing those things.

When I first read The Body Keeps the Score by Bessel van der Kolk, I balked at the part where he talked about how, according to Freud, trauma victims had the compulsion to repeat portions of their trauma as an “unconscious attempt to get control over a painful situation and that they eventually could lead to mastery and resolution.” (Kolk MD, Bessel van der. The Body Keeps the Score (p. 32). Penguin Publishing Group. Kindle Edition.) In my mind, why would anyone want to repeat something traumatic repeatedly?

But that is precisely what I saw…in myself.

At work, I would always stand on the periphery in crowds and was compulsively “trying to get noticed.” I realized that I was trying to make sure I could be seen so that someone could save me.

I also heard myself repeatedly saying, “I’m drowning” at work, which led to being overwhelmed and unable to function. I would get upset when my boss or co-workers didn’t rescue me. It kept coming up in weird ways, so I thought, let’s deal with this target. Sure. Why not?

We started by talking about the sensation I was having in my body around, feeling like I was drowning in emails. Once that was activated in my body, my therapist held up this pointer and moved it horizontally across my visual field until I located the spot that was the most activated and fine-tuned it by moving the pointer vertically. (You absolutely can’t make this crap up. It really works.)

Once we found the spot, all I had to do was stare at this dumb pointer. It does feel dumb to stare at a pointer and think something amazing will happen, but that is exactly what happened. The feeling of helplessness rose to the surface, as well as the words, “I’m gonna die.” There was a resignation that I could NOT save myself. I didn’t know how to swim, and there was nothing I could do.

Then, I could hear the voice of the Spirit of God in my ear, reminding me He was with me, and all I needed to do was to call out to Him…so I did. He told me I was never designed to save myself; that was His job. He showed me that He was the one that sent that neighbor girl to rescue me. He never lost sight of me. He was waiting for me to stop struggling in my own strength to save myself before He sent help. That is exactly what they teach in lifeguard school.

That was super powerful, but my therapist told me to stick with it to see if anything else came up. I could hear this voice saying, “giving up is failure.” Again, I could hear the voice of the Lord speaking the words of truth to me. He said I didn’t give up; I called out to the One that could help me, and He did. He has all the resources I need at His disposal.

I have lived with this compulsion to try to save myself for five decades. I wouldn’t let people help me because I had to save myself.

I wouldn’t ask people to help me because that was admitting defeat. All this time, I’ve had the complete regimen of resources of the God of the universe at my disposal, and I refused to ask for help because I felt like I had to save myself.

I was absolutely amazed that the compulsion was gone. I mean gone, gone. I tried for a week to re-activate that spot again, and I couldn’t. Wow!! I cannot explain it, but I will tell you that I have already seen evidence of it being gone in how I’ve reached out to people for help and didn’t try to do things on my own. I can’t tell you how many times over the years my therapist would say to me that I don’t have to do this alone, but I still felt like I had to, but not anymore. I feel more open to asking for and receiving help from others. I don’t feel like I have to do it all alone.

It is so freeing to finally realize that the God of the Universe knows exactly where I am at all times. He never loses track of me. He is waiting for me to call out to Him, and He is ALWAYS there when I do. He has all the resources of the universe at His disposal. I was never meant to save myself; that is His job. He really does save…spiritually, physically, and emotionally.

What an amazing experience and that was just the second target of three. The depth that this got to in my brain was truly remarkable. I am encouraged to continue this journey and see how the Lord can use this modality in my healing journey.

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 post do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Cyndi Bennett

Believer. Leader. Learner. Advocate. Writer. Speaker. Coach. Mentor. Triathlete. Encourager. Survivor.
 
Most of all, I am a fellow traveler on the rocky road called, Trauma Recovery. My mission is to minimize the effects of trauma for survivors in the workplace.

My boss is a great lady who genuinely cares about and takes care of her people. On this trip, she really took care of us by renting a mini-van to drive us back and forth to the hotel, paying for dinners on her corporate card, and looking for opportunities for us to have fun (like stopping for Philly cheesesteaks on the way to the airport).

Pushing Back Against Bing Cared For 

Early in the trip, I found myself pushing back against being cared for, so I got a little curious about that. As a trauma survivor with severe attachment wounds, it is understandable that I sometimes have issues with authorities in my life. The catch here was that she was doing nothing wrong or bad…everything she was doing was with kindness and gentleness to care for us, but I was resisting that.

I started to ask myself what that was about. It was definitely a trauma response. I quickly realized this was related to the bind children experience when they naturally turn to their caregivers for comfort/support, and those caregivers are abusive like my dad was.

In Janina Fisher’s book, Healing the Fragmented Selves of Trauma Survivors, she says, “When attachment figures are abusive, the child’s only source of safety and protection becomes simultaneously the source of immediate danger, leaving the child caught between two conflicting sets of instincts. On the one hand, they are driven by the attachment instinct to seek proximity, comfort, and protection from attachment figures. On the other, they are driven by equally strong animal defense instincts to freeze, fight, flee, or submit or dissociate before they get too close to the frightening parent”(p. 24).

While that made sense to me, I recognized it as part of the living legacy of trauma under which I no longer had to operate. As trauma survivors, it is important for us to live in the “NOW” because that is where we have our POWER. As children, we did not have the ability or the power to protect and care for ourselves, but we do NOW.

Attachment in the Workplace

The residual effect of attachment wounds as children show up all the time in the workplace, but we may not recognize it. Have you ever observed a person at work who has to do everything for themselves and doesn’t want anyone mucking around in their sandbox? Have you ever seen someone or even experienced yourself being overwhelmed by being over capacity and swirling because they/you could not ask for help?

Sometimes this behavior is even rewarded both in childhood and adulthood, which makes it harder to recognize. Parents or teachers are often thrilled by a child who takes responsibility for their own care and is less of a drag on their already thin emotional resources. As managers/leaders, we are relieved when we have a self-sufficient employee who doesn’t require much care and feeding. They are low maintenance.

What we don’t see is that on the inside, these children and adults are functioning in full-on survival mode. They are doing only what is necessary for safety and survival. When we constantly operate out of survival mode, it starts to break down our health due to increased cortisol levels and the inability to relax. It is not sustainable and will eventually result in anxiety, fatigue, and depression.

Sinking into Support

Even though I have done a lot of work in therapy, the habitual pattern of thinking that I have to take care of myself still creeps up at times, as it did on my trip; only now, I have the tools to be able to manage it.

I acknowledged that this was related to my attachment wounds and reminded myself that my boss was not my father. So, basically, I became more present with the current situation and put my past back in its place. Once I addressed that old thinking, I was able to sink into my manager’s care without feeling threatened by it.

Since this is a relatively new experience for me, I want to describe what it felt like for me. It felt like laying down in the middle of a bed that had a super duper mattress topper on it and then being covered up with blankets. It felt like being held and rocked as a child. I felt safe and cared for…and relaxed. It was like the 1,000-pound gorilla was no longer on my back. It was awesome. I was amazed by how good it felt.

That is how support is supposed to feel. It should hold you up. It should take the weight off of you. It should assist you and enable you to function at a higher level.

This is what I do as a coach, which is why I love what I do. I want my folks to feel the support that they might never have experienced in their lives before. I want to help them live in the present and achieve the career goals they have set for themselves. I want to enable them to function at a higher level in the workplace.

You don’t have to do this alone

If you are struggling with overcoming the living legacy of trauma in your work life, you are not alone, and you don’t have to manage it alone. We were never meant to carry this burden or walk the path to healing alone. The weight is too heavy, and the journey is too long.

What about you? Where are you in your healing journey? Are you still trying to go it alone? Are you curious about what it would be like to have support? Are you just plain tired of having to pull yourself up by your bootstraps over and over again…alone?

I’m here for you. You can find me at www.cyndibennettconsulting.com. Schedule your complimentary discovery call today.

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 post do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Cyndi Bennett

Believer. Leader. Learner. Advocate. Writer. Speaker. Coach. Mentor. Triathlete. Encourager. Survivor.
 
Most of all, I am a fellow traveler on the rocky road called, Trauma Recovery. My mission is to minimize the effects of trauma for survivors in the workplace.

“Breathe deeply.”

I close my eyes and belly breathe as my EMDR therapist scoots her chair closer. This is standard practice in our weekly sessions. Soon she’ll tell me to open my eyes, focus on a certain phrase or idea, and follow her finger left and right. Sometimes fast, sometimes slow. Crossing the brain hemispheres is supposed to help process and eventually heal trauma.

At first, my trauma wouldn’t budge from its hiding places. I don’t blame it. Covert narcissistic child abuse is no joke. From a young age, I was taught that emotions were dangerous and that I was to blame for some pretty scary stuff. That caused Complex PTSD, layers of trauma that constantly get re-traumatized. Basically, my fight or flight got permanently switched on so I’ve been in survival mode my whole life. It’s really challenging to undo.

The more I learn about INTERNAL FAMILY SYSTEMS, the more fascinated I become. My non-mental-health-professional understanding is:

In order to protect itself from melting down, my brain split into parts (trauma-splitting or fragmentation). I have 4yr old, 6 yr old, 12 yr old Jamies that hide separately, each with their own unprocessed trauma. These EXILES are deep-rooted and heavily protected.

When I first sought help I said “it feels like I have a Manager personality that allows me to do functional things, like grocery shopping while I’m having a panic attack.” It turns out I was right. The PROTECTORS are called MANAGERS and FIREFIGHTERS.

The MANAGERS help with functional things like sleeping, eating, interacting, and focusing on goals. They keep us in our heads to help us AVOID danger.

FIREFIGHTERS help when they think we ARE in danger. They send us signals through our bodies that distract us in order to help. They are also responsible for unhealthy behaviors like addiction.

6 months of weekly EMDR (Eye Movement Desensitization Reprocessing) sessions showed me just how strong and prepared my protector parts are. I get sudden pangs of hunger, exhaustion, muscle cramps, tinnitus— anything my body can think of to keep me from accessing the trauma itself. When things get really bad, I can lose my ability to read, like my brain unplugging things so they don’t blow a fuse.

Still, there’s progress. I’m more aware of how my parts work and am even able to loosen some muscles. I just haven’t BEFRIENDED them, which I’m told is the key to healing. When I get frustrated, I picture my friend giving his mother CPR at Christmas, unable to revive her. If EMDR helped him heal that, it can help me.

Through trial and error, my therapist realized that I respond best to storytelling and visuals. My answers have slowly moved from “I don’t know” to more detailed information. Today we’re doing an activity called COMMUNITY ROOM.

“Just breathe. Picture a room…”

Picturing a room is good. It gives me a concrete image to start from. Without this detail, I get lost in racing thoughts. Overwhelmed. This used to happen when I was in school. I just needed one thing to focus on to be successful, which was not how the school worked.

“Let me know when you see the room”

After a few minutes…I see it!

“Open your eyes and follow my finger.”

Left right left right…

“Take a deep breath. What do you notice?”

A deep starvation burns from my throat to my sternum. I always eat before my sessions, because this firefighter constantly shows up. It helps me distinguish what it actually is. The hunger shows up at home too, which makes me overeat, often never feeling full. Then I feel shame and it sends more hunger. Oy!

“Ask the hunger how old it is.”

This is new. Usually, she just reminds me it’s a firefighter. Hmmm…breathe deeply, focus internally…how old are you?

8 jumps right up. Ok, 8 and…16.

“Ok, ask 8 and 16 if we can have permission to move forward.”

I ask and suddenly memories from those ages clog my brain at once.

“It’s ok, put those in the container. Tell them we’ll get to them later.”

In our first sessions together I created an imagined container to put distracting thoughts. We use this a lot and I use it at home. Accepting and managing instead of denying. Denying is what makes things worse.

“Ok, do we have permission to move forward?”

Yes. The hunger instantly disappears. It still boggles my mind how all of this works. I’m talking to my younger parts and they’re answering?!

“Now, invite all of your parts to join you in the room.”

Between eye movements, I close my eyes, breathe deeply and invite my parts. They’re reluctant. I’m not surprised. We’ve previously been able to access my parts for just a few seconds. Then they suddenly turn to demons and attack me.

“Let them know they don’t have to do anything but show up.”

Instant relief rushes through my body. I hadn’t even realized how tense my shoulders were until she said that. They loosened immediately and parts started showing up! The really young ones first, 4, 6. Then some of the older, 11, 12, 13. Then a block.

9 or 10 doesn’t feel safe. I can feel their fear.

“Ask them what they need.”

A blanket and a chair to hide under.

“Give them a blanket and a chair.”

I imagine a blanket and a chair. The part scurries underneath

Whoa! 16 is angry, hostile. Like tiny little stabs in my brain.

“Ask 16 what they need.”

To get the FUCK out of here (16’s words). They’re furious. Stomping, arms crossed. Standoffish.

“What does she need in order to do that?”

A car. I imagine a car. She gets in and takes off. I don’t blame her. 16 was filled with traumatic experiences. It was the age I fully realized that my father was not a parent and that he meant me harm.

My parts fill the room now, sitting around a giant table drinking chocolate milk and water. Why? I’m not sure. They’re joyful, the way my theme park co-workers and I were when management brought cake. It’s a real “characters love cake” vibe.

I see myself sitting at a giant drawing table watching all of the parts enjoying themselves. From the tips of my fingers, across my shoulders and all the way down my other arm are soldiers standing guard, tall spears in their hands and helmets on their heads. That makes sense since those muscles are constantly tight.

We spend some time in the room exploring who’s in attendance. Processing a few emotions with eye movement and deep breaths, our hour is up.

“When you’re ready, open your eyes and return to the room.”

Done.

“Really great work today. For homework, I’d like you to draw the Community Room”

No problem. It’s so vivid in my head. Ta-dah!

After 6 months of weekly sessions, we finally accessed my parts AND they agreed to come together, which is the ultimate goal. We’ll use this room in future sessions to strengthen their bond and begin to heal the actual trauma. Looking forward to being a cohesive team instead of a body of fragmented parts. Let the befriending begin!

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.

Jamie Donmoyer

Creative storyteller and recovering scapegoat of a narcissistic parent, working through Complex PTSD one post at a time

The Struggles of Someone Affected by Complex Post-Traumatic Stress Disorder

Complex post-traumatic stress disorder forms during repeated traumatic events such as childhood sexual or other abuse. The symptoms of CPTSD are life-altering and, if left untreated, can significantly limit the person who experiences it.

The symptoms of CPTSD include those of post-traumatic stress disorder plus others such as follows:

• Feeling angry
• Feeling distrustful of others and the world
• Difficulty controlling emotions
• Feeling empty
• Feeling hopeless
• Feeling damaged or worthless
• Feeling different from other people
• Avoiding friendships and other relationships
• Finding, making, and maintaining relationships
• Experiencing dissociative symptoms
• Experiencing headaches, chest pain, dizziness, and tummy aches
• Having suicidal ideations or actions

There are several psychotherapeutic approaches to the treatment of CPTSD, including EMDR.

What is EMDR?

Eye movement desensitization and reprocessing is a form of psychotherapy enabling people to heal from the symptoms and emotional distress that accompanies complex trauma.

Many therapists believe that EMDR actually shortens the length of time a person is in therapy. What once took years of intensive psychotherapy may take months.

EMDR goes on the premise that the mind can heal from psychological trauma like the body recovers from physical trauma. For example, when the body gets a foreign object in it, the wound festers and causes pain. Once the object is removed, the person’s wound heals.

Those practicing EMDR have found that a similar sequence occurs with wounds to the psyche. If the person’s mind is blocked or imbalanced by trauma, the emotional wound festers and causes emotional pain. Left untreated, the wound will not heal but remain open and bleeding. However, the wound begins to heal once the block is removed through EMDR treatment.

During a session, the therapist uses EMDR to help those with CPTSD to activate their mind’s natural healing processes.

Research Backing EMDR

Many research studies (more than 30) have been conducted to see if EMDR is an effective treatment for both single and multiple traumas. Some studies have shown that 85%-90% of single trauma victims heal and are no longer diagnosed with PTSD after three 90-minute EMDR sessions.

Yet another study completed by HMO Kaiser Permanente found that 100% of single-trauma survivors and 77% of multiple trauma victims were no longer diagnosed with PTSD after six 50-minute sessions (Shapiro, 2014).

There has been so much research on using EMDR treatment that it is now recognized by the American Psychiatric Association and the World Health Organization as an effective treatment for trauma.

It is easy to see that EMDR is recognized around the world as an effective treatment for memories that cause people to experience low self-esteem, feelings of powerlessness, and many other mental health problems related to relational trauma.

Millions of people have received EMDR treatment successfully over the past thirty years; it has been available and used by over 100,000 clinicians worldwide.

The Stages of Eye Movement Desensitization and Reprocessing   

Research reports that EMDR effectively treats CPTSD because the therapist employs treatment goals, procedures, and adaptations for each phase of treatment (Huss et al., 2015). The stages of eye movement desensitization and reprocessing treatment are stabilization, trauma processing, and reconnection/development of self-identity (Korn, 2009).

The therapist achieves these stages by employing eight different phases of treatment:

• Phase 1: History-taking
• Phase 2: Preparing the client
• Phase 3: Assessing the target memory
• Phases 4-7: Processing the memory to an adaptive resolution
• Phase 8: Evaluating treatment results
• (Shapiro, 2017)

Phase 1: History-taking. The therapist gets a complete history of their client and conducts an appropriate assessment so they can work together to identify targets for treatment, including targeting memories, triggers, and any future goals the client may have.

Phase 2. Preparing the client. The therapist explains the treatment and introduces the survivor to the procedures, practicing the eye movement component. The therapist helps their client to practice affect management, leading them through the safe/calm place exercise.

Phase 3: Assessing the target memory. This phase of EMDR treatment activates the memory that is being targeted by identifying and assessing each of the memory components: image, cognition, affect, and body sensations.

Phases 4-7: Processing the memory to an adaptive solution. In this phase, the client focuses on a memory while engaging in eye movements led by the therapist. The survivor reports if new thoughts have emerged. The therapist uses standardized procedures to determine the focus of each set of eye movement treatments. If necessary, the process is continued in more sessions until the client reports that the memory is no longer distressing.

Phase 8: Evaluating treatment results. If the targeted memory was not fully resolved in the session, instructions, and techniques to remain safe and to provide containment until the next session are discussed. Each session ends and begins with a reevaluation of how effective EMDR is for the survivor, what memories may have emerged since the last session, and what works for the client.

Processing a specific memory can be completed in one to three sessions. EMDR does not expose the person receiving treatment to distressing memories or detailed descriptions of the traumatic event.

Ending Our Time Together

Eye movement desensitization and reprocessing have been used successfully for over thirty years to successfully treat those who have experienced both single and multiple traumatic events.

This form of psychotherapy is safe and effective when done by an adequately trained mental health professional. The client sits with their therapist and is led through an eye movement exercise while thinking about the traumatic event chosen for work at the beginning of the session. Afterward, the effectiveness of the process is evaluated to see if the therapist can do anything different in the next session.

Sometimes, EMDR is used in conjunction with regular psychotherapy to enhance the ability of the survivor to process the memories and bodily sensations they may have felt during the session.

One provider who offers EMDR is Annie Wright. In future posts, we shall examine Annie Wright and her important work treating clients who have survived multiple traumas and formed complex post-traumatic stress disorder.

“She could never go back and make some of the details pretty. All she could do was move forward and make the whole beautiful.” Terri St. Cloud

References

Hase, M., Balmaceda, U. M., Hase, A., Lehnung, M., Tumani, V., Huchzermeier, C., & Hofmann, A. (2015). Eye movement desensitization and reprocessing (EMDR) therapy in the treatment of depression: a matched pairs study in an inpatient setting. Brain and Behavior, 5(6), e00342.

Korn, D. L. (2009). EMDR and the treatment of complex PTSD: A review. Journal of EMDR Practice and Research, 3(4), 264-278.

Shapiro, F. (2014). The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences. The Permanente Journal, 18(1), 71.

Shapiro, F. (2017). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures. Guilford Publications.

Are you a therapist who treats CPTSD? Please consider dropping us a line to add you to our growing list of providers. You would get aid in finding clients and helping someone find the peace they deserve. Go to the contact us page and send a note; our staff will respond quickly.

Shortly, CPTSD Foundation will have compiled a list of providers treating complex post-traumatic stress disorder. When it becomes available, we will put it on our website www.CPTSDFoundation.org.

Visit us and sign up for our weekly newsletter to help inform you about treatment options and much more for complex post-traumatic stress disorder.

The Healing Book Club

As of May 7th, 2022, the current book will be – “A Practical Guide to Complex PTSD: Compassionate Strategies to Begin Healing from Childhood Trauma.”

by Dr. Arielle Schwartz.

Here is an Excerpt –

Repetitive trauma during childhood can impact your emotional development, creating a ripple effect that carries into adulthood. Complex post-traumatic stress disorder (C-PTSD) is a physical and psychological response to these repeated traumatic events. A Practical Guide to Complex PTSD contains research-based strategies, tools, and support for individuals working to heal from their childhood trauma. You don’t have to be a prisoner of your past.

Learn the skills necessary to improve your physical and mental health with practical strategies taken from the most effective therapeutic methods, including cognitive-behavioral therapy (CBT), dialectical behavioral therapy (DBT), eye movement desensitization, and reprocessing (EMDR), and somatic psychology. When appropriately addressed, the wounds of your past no longer need to interfere with your ability to live a meaningful and satisfying life.

This book includes the following:

• Understand C-PTSD—Get an in-depth explanation of complex PTSD, including its symptoms, its treatment through various therapies, and more.
• Address the symptoms—Discover evidence-based strategies for healing the symptoms of complex PTSD, like avoidance, depression, emotional dysregulation, and hopelessness.
• Real stories—Relate to others’ experiences with complex PTSD with multiple real-life examples in each chapter.

Start letting go of the pain from your past—A Practical Guide to Complex PTSD can help show you how.

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

• Daily Calls
• The Healing Book Club
• Support Groups
• Our Blog
• The Trauma-Informed Newsletter
• Daily Encouragement Texts

All our services are reasonably priced, and some are even free. So, sign-up to gain more insight into how complex post-traumatic stress disorder is altering your life and how you can overcome it; we will be glad to help you. If you cannot afford to pay, go to www.cptsdfoundation.org/scholarship to apply for aid. We only wish to serve you.

Mindfulness, Prayer, and Meditation Circle

Meditation can be an integral part of healing from trauma. Our 9-week self-study video course helps you integrate this fantastic grounding, centering, and focus method. Join the Mindfulness, Prayer, and Meditation Circle today!

 A new Trauma-Informed Yoga program is now available! Check out our information page about this highly requested new program! #yoga #traumainformed #cptsd #mentalhealth #recovery #wellness https://cptsdfoundation.org/traumainformedyoga/

 Do you have goals you need help reaching, or help define what goals suit you? Have you considered working with a #traumainformed coach? Learn about a new opportunity and a Free Discovery Call!

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

Credit: Karla Ruiz

What is Betrayal Trauma?

• How do you begin to heal when you discover that your partner has been unfaithful?
• How do you learn to trust again when a family member has betrayed you?
• How do you move forward when your boss abused their position of power and sexually harassed you?

In the wake of a betrayal, many people feel their world has been shattered. Some are left wondering whether they even have a future at all. Betrayal and the ensuing sense of despondence can leave victims with chronic distrust problems and crippling self-doubt. Being betrayed by a trusted person can have a long-lasting impact on physical and mental well-being and compromises the ability to form lasting relationships with others.

In her article ‘Understanding Complex Trauma, Complex Reactions, and Treatment Approaches’  Dr. Christine Courtois highlights the interconnectedness of betrayal trauma and Complex Post-Traumatic Stress Disorder (CPTSD), stating that “complex trauma generally refers to traumatic stressors that are interpersonal, that is, they are premeditated, planned, and caused by other humans, such as violating and/or exploitation of another person” (Courtois, 2019). Betrayal causes immense emotional pain and has far-reaching physical and psychological consequences, which are not easily overcome in a day, a week, a month, or even a year. Some people never get over the impact of betrayal. Healing from betrayal requires intense reflection and work on personal growth to rebuild a sense of worthiness, self-confidence, and belonging. Learning to trust others is one of the most difficult hurdles to overcome. Recovery from betrayal is isolating and painfully difficult and often leads to a transformation of the self.

Types of Betrayal

The most common types of betrayal include the disclosing of confidential information, disloyalty, infidelity, and dishonesty. At the least, betrayal causes shock, loss, anger, and grief; at worst, it can cause anxiety disorders and PTSD (Rachman, 2010).

Examples of betrayal:

• Discovering that your husband/wife/partner had a physical, emotional or online affair.
• Finding out that your husband/wife/partner has engaged in addictive behaviour, e.g. drug-taking, gambling, porn.
• Experiencing sexual, physical and emotional abuse at the hands of a family member or by a key relationship.
• Discovering that your friend told someone a secret that you entrusted them with.
• Finding out that your co-worker used your work as their own to elevate their status.
• When your family justifies your partner’s abusive behaviour.
• When a boss abuses their position of power and takes advantage of you.
• Failure to offer or provide support and assistance during times of physical or emotional need.

Types of Betrayal Trauma

• Institutional
• Parental
• Partner
• Interpersonal, e.g. friends.

Additionally, any of these types of betrayal trauma may be accompanied by ‘betrayal blindness’,  an unawareness or forgetting of the act of betrayal. (Freyd, 1999).  This adaptive response may be associated with betrayals not traditionally recognised as trauma, such as adultery, inequities in the workplace and society, etc. Victims may unwittingly manifest symptoms of betrayal blindness to preserve the relationships and social systems upon which they depend. (Freyd, 2021). 

Symptoms of Betrayal Trauma 

• Chronic mistrust
• Commitment issues
• Flashbacks
• Nightmares
• Hopelessness
• Dissociation
• OCD
• Emotional dysregulation
• Confusion & self-doubt
• Panic, anxiety & depression
• Irritability and rage
• Fear
• Toxic shame and guilt
• Low self-esteem
• Loss of confidence & self-worth
• Extreme exhaustion
• Withdrawal from social interactions
• Difficulty maintaining relationships

Childhood trauma and the associated betrayal can elicit symptoms that continue through adulthood and often prevent the formation of deep, intimate relationships due to past experiences. The severity of betrayal trauma is complex because it concerns not only the experience of the act of abuse but also the experience of being betrayed by a trusted person or someone the victim relies on for support and survival. Symptoms of betrayal trauma do not meet the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) diagnostic criteria for PTSD. However, symptoms of betrayal trauma are closely related to those of CPTSD which occurs as a result of abuse and ongoing trauma. (Diagnostic and statistical manual of mental disorders: DSM-5-TR 2022)

Feelings and effects of betrayal such as degradation, rejection, and humiliation can be catastrophic and life-changing. Betrayal on any level causes immense emotional pain and can be incredibly isolating, but with professional help, therapy, and support, many trauma victims go on to live fulfilling lives. Trauma-informed therapy, such as that offered by the C-PTSD Foundation, helps individuals move forward in their personal and professional lives with ongoing support that promotes healing and recovery. Some individuals with extensive trauma histories may remain in therapy for years; however, recovery is possible with a trauma-informed approach and lots of determination and support.

References

• Courtois, C. A. (2019). Understanding Complex Trauma, Complex Reactions, and Treatment Approaches. Understanding complex trauma, complex reactions, and treatment approaches – Gift From Within. Retrieved from
• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: Dsm-5-Tr. 
• Freyd, J. J. (1999, June). Blind to Betrayal: New Perspectives on Memory for Trauma. Retrieved from https://dynamic.uoregon.edu/jjf/articles/freyd99.pdf
• Freyd, J. J. (2021). What is a Betrayal Trauma? What is Betrayal Trauma Theory? Definition of Betrayal Trauma Theory. Retrieved from https://dynamic.uoregon.edu/jjf/defineBT.html
• Rachman, S. (2010). Betrayal: A psychological analysis. Behaviour Research and Therapy, 48(4), 304–311. https://doi.org/10.1016/j.brat.2009.12.002

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.

Tracy Guy

Tracy Guy is a published author and a proud guest writer for the C-PTSD Foundation. Professionally, Tracy has experience in mental health and muti-trauma nursing and is now a full-time registered counsellor working with people struggling with complex trauma, anxiety, and grief. Her passion for writing, unwavering instinct to help others, and professional and lived experience drives Tracy to support and advocate for those suffering from debilitating traumatic experiences and C-PTSD. Tracy hopes to raise understanding and awareness of C-PTSD, more specifically, the association of C-PTSD with abusive relationships.

A few years ago, I was invited to attend a new support group for people diagnosed with complex trauma. I was (unsurprisingly) anxious about going, but hopeful it could help me. When I got there, I expected that nervousness to calm down, but instead, it got much worse. It took every bit of strength in me not to run out of the room. When it was over, I went home and hid under my blankets for three hours.

Eventually, I decided to give the group one more try. I experienced the same terror, and to top it off, I spent the majority of the hour crying uncontrollably. It was such a dysregulating experience that in the days that followed, I deteriorated into a new depressive episode. It was devastating and left me feeling broken and like a walking open wound. Needless to say, I did not return.

A few months later, when I was able to think more clearly, I tried to figure out what had happened. I eventually realized, in my opinion, that nothing had been done to ensure I (or anyone else) felt safe at the outset of the group. From what I recall, we were not given information on what to expect in advance. I remember I was unsure if the leader intended to disclose my story without my permission, and likewise I don’t remember there being a conversation on if it was appropriate for folks to share details that could be triggering. It was akin to being thrown into the deep end with the expectation you’d just learn to swim.

No wonder group had felt so awful, and now I know why. It’s my perspective this group did not utilize a bottom-up approach, and so my nervous system was on such high alert that being there was nearly unbearable. I don’t think the leader was bad at their job, I just think they didn’t consider or weren’t trained in the style I needed.

So, what is the difference between “top-down” and “bottom-up” therapy, and why does it matter?  The first thing you need to know is the words “top” and “bottom” are references to particular sections of the brain and what they are responsible for. It’s also important to know that until recently, most therapy has followed a top-down approach, and as you may have guessed from my story above, this doesn’t always have the desired results.

It’s believed the top section of the brain is concerned with thinking, speaking, and present-day emotional awareness. Top-down therapy typically means working through things cognitively. This involves stuff like thought patterns, communication, decision-making, and problem-solving.

The bottom section of the brain is thought to include the areas responsible for memories, impulses, and survival responses. Therefore, bottom-up therapy works on understanding sensations, education on the nervous system, grounding, mindfulness, and body awareness.

The new school of thought theorizes bottom-up approaches are especially helpful for folks who have experienced trauma, particularly long-standing, developmental or complex trauma. The suggestion is top-down methods often don’t work well for folks with this type of history because it presupposes what needs adjusting is the person’s way of thinking. This does not take into consideration the automatic nature of the nervous system, or in other words, a body that is hardwired to perceive danger where there is none.

In regards to trauma, bottom-up takes into account that the first thing that typically occurs is the body reacting, and then, later on, the mind thinking. To paraphrase Peter Levine: You cannot properly process thoughts if your insides are telling you that you are standing in front of a tiger.

In my case, I could not effectively join the above group until my nervous system felt safe there. Unfortunately, since this did not happen, I could not tolerate it.

So, if therapy or popular “self-help” methods have caused you to feel like your hair is on fire and you need to run screaming from the building, there is a good chance your nervous system has kicked in. If this (or something like it) is a regular occurrence, it’s possible you may benefit from bottom-up methods. I certainly have!

I’ve been with my current therapist for a long time, and she uses a bottom-up approach. This doesn’t mean I don’t ever have discomfort or anxiety in therapy, but what it does mean is it isn’t ignored and we attempt to regulate it.

Recently when COVID-19 restrictions were starting to lift, we went back to in-person sessions after a year of virtual. When I was finally sitting in front of her, I right away felt activated. I trust this therapist a lot, and so I quickly told her how I was feeling. She was understanding and reassured me it made sense because my nervous system hadn’t been in the same space with her for almost a year and it was probably being a bit cautious. This was helpful in taking any of the blame off me. We then did some grounding exercises until I felt more settled, after which we were able to move on. This clearly sounds much better than what took place in the previous story.

If you want to seek out a therapist that does things bottom-up, look for the following training: Somatic experiencing, emotion-focused therapy, eye movement desensitization and reprocessing therapy (EMDR), sensorimotor therapy, art therapy, polyvagal theory, compassionate inquiry, and trauma-informed yoga. There are probably many others, and it’s always a good idea to have a conversation with a provider about how they practice and what theories they follow. You can also look into self-help that uses these methods.

It’s prudent to remember both top-down and bottom-up are valid methods, and in reality, most therapists likely use some type of a blend of the two. Additionally, while folks who have experienced trauma may need to start at the “bottom,” the goal would likely be to work one’s way to the “top” eventually. There are also therapists who attempt to work with one foot in each realm, and this may be helpful, too.

If you have tried therapy in the past and it seemed to do more harm than good, you may feel discouraged or like you are somehow “broken.” I can certainly relate to those feelings. I’ve had the good fortune to have the support that fits my needs and this has been incredibly healing. I’m here to encourage you, that in a similar way, it very well may be a bottom-up approach is what works for you. You are worth it!

 If you’d like to follow along with my journey, you can find me on Instagram as @mentalhealthyxe.

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.

Heidi Fischer

Heidi Fischer is a mental health advocate who lives in Saskatoon, Canada. Heidi enjoys writing about her personal experience with C-PTSD, Depression, and Anxiety. Heidi is the creator of a popular mental health Instagram called @mentalhealthyxe and can also be found on her website mentalhealthyxe.com. 

www.mentalhealthyxe.com/