Post-traumatic stress disorder (PTSD): how to move on

"Why can't I move on?"

Imagine two individuals going through the same traumatic experience. For example, having been in the same hostage situation. Obviously both are shaken up by the events and for both the feelings of intense anxiety remain for many days (or even weeks) afterwards. But while person A eventually starts feeling better and is able to pick up his daily routine, person B gets stuck in negative thoughts and painful memories that seem to get worse over time.

Why is that? What makes person As trajectory different from person Bs? Is it because of a difference in the traumatic events they were exposed to? Previous trauma? Genetics? Or maybe a physical difference, such as different hormonal balances?

In contrast to what you might believe, the cause is most likely none of the above. Through the latest research on mental health, it has become clear that there's a completely different reason as to why severe anxiety grabs a hold on some, and not on others.

What you'll read in the remainder of this article is based on methods developed through recent scientific findings - and goes against many of the beliefs of the traditional school of psychology. Because for you to overcome your trauma it's not necessary to process them, or solve them in any deliberate way. In fact, in many cases this could even be hindering the recovery! This article echoes a completely new perspective on what causes and maintains anxiety - including PTSD.

(Spoiler alert: the reason why the pain after a traumatic episode begins to take up more space in your everyday life has a lot to do with the way you relate to your thoughts and symptoms after the event)

To explain this we can resort to a metaphor: When you accidentally cut yourself while making a sandwich, you are left with a bleeding wound. Likely you'll put on a bandaid, and simply go on with your day. And you trust your body to take care of the healing - even though you don't know exactly how your body does this. But also you know that by interfering (scratching and digging into the wound) it will only take longer to heal. It's clear that your body doesn't need your help or attention to take care of the healing.

Interestingly, new research shows that this metaphor is also applicable to psychological trauma. Turns out the human mind is pretty remarkable at dealing with the aftermath of mental wounds - if  you let it. The fascinating thing is that this is also exactly where person A seems to differ from person B. While person A leaves his mental wounds alone, person B spends quite a lot of time picking at his wounds by excessively going over the events in his mind, trying to figure out what happened and whether there was anything he could have done differently.

In general, the amount of engagement with your negative thoughts and symptoms is a pretty good indicator of your risk of developing an anxiety disorder. Earlier we wrote an article about this topic: Why are some people more prone to anxiety than others?

But let's have a look at what this means for the specific case of PTSD.

Destructive strategies

First of all, it's important to remember that after experiencing a traumatic event it's completely normal for you to have intrusive and unpleasant thoughts, images and memories. Bodily restlessness is also normal and expected in the first days and weeks after the event.

We all deal with unfortunate experiences in our own way. When you're in pain it seems only natural that you come up with strategies to reduce the pain. And if you're suffering from PTSD it's quite likely that you're already adopting strategies in an attempt to fix the trauma.

However, many common strategies that people use to deal with trauma are unhelpful and can even aggravate the problem. This is happens when the adopted strategy leads to a destructive self-reinforcing cycle, where your symptoms worsen over time instead of gradually diminishing.

The thoughts, feelings, and symptoms you experience after a trauma can be very painful. It makes complete sense that you want to do something to push them away or deal with the trauma to make the pain pass faster. Unfortunately, the more you try to dampen the discomfort, the more intrusive the memories and feelings of anxiety become. If you continue using a strategy that maintains or worsens the symptoms, you are likely to go on to develop post-traumatic stress disorder (PTSD).

One of the most common strategies that backfire, is trying to process the trauma by repetedly going over what happened in your mind. Instead of helping you process, this can ofte lead to increased feelings of depression, shame, hopelessness, and anxiety.

There are a number of inappropriate strategies that equate to digging into a mental wound. We'll start by discussing one of the most common strategies: processing.

1. "I need to process this"

What we see a lot, is that people believe they can reduce the pain and feel better if they "process" the trauma properly. Understandably so, as this is what you'll probably be told to do if you seek advice from friends, a doctor, or a therapist. But although exposure therapies such as EMDR and CBT for trauma do work, excessive thinking about the trauma is one of the worst things you can do to your mental health.

Newer research shows that thinking back to the trauma and going over what happened in the search of answers, is actually making you worse. We call this form of thinking rumination, and it usually consists of trying to work out questions such as:

• "What actually happened?
• "Why did it happen to me?"
• "Was it my fault?
• "Could I have done something different?"
• "What did I do?"  
• "Why am I feeling this way? Am I about to go crazy"?
• ‍Other times it can be questions related to the circumstances or people involved in the events, such as: "Can I remember the face of the person"?

In an attempt to find out what really happened or who is to blame for the incident, many people spend excessive amounts of time going over their memories trying to remember as much as possible. This rarely gives any good answers, and instead leads confusion and muddled memories (this is just how the mind works). It also gives increased attention to the unpleasant memories, which usually increases their frequency and strenght. So instead of helping to relieve the situation, of this exercise/strategy often sends you into a negative spiral that increases the amount of negative thoughts and feelings.

Similarly, many people begin to ponder why they get these intrusive thoughts to begin with. Whether there is something wrong with them, why they are not progressing, etc.

It becomes really easy to forget what thoughts and emotions really are: passing events in your mind that you don't necessarily have to do anything with. A thought is nothing more than just some brain activity, which doesn't have the ability to have any control over your present reality. And just like all other thoughts you've had in your life, this one will undoubtedly disappear by itself as well. If you just let it.

What you can do instead is reduce the time you spend thinking about what happened during the traumatic event. Drop attempts to fill gaps in your memory, cut out the evaluation of how you could have handled the event differently, and hold back on assessing whether you yourself were to blame. This only maintains the focus on the memory and unpleasant feelings such as fear, anger, sadness and shame, without you arriving at any good answers.

(In an earlier article we also wrote about how revisiting unpleasant thoughts strengthens the neural pathways in your brain, leading to those thoughts become more persistent, and taking up increasingly more space in your head)

But thoughts and feelings are just thoughts and feelings. They can't harm you, and if you leave them be they will pass in their own time (more about that later).

2. "Next time I'll be prepared"‍

Traumatic events often trigger thoughts of danger. Could it happen again? Am I still at risk? Many would respond to such thoughts by imagining future scenarios, and (mentally) preparing themselves for how they would handle similar events if they were to happen again. You start to worry. 

And similar to brooding, worrying does not lead to a solution or a feeling of security, but instead often ends up stealing a lot of time and energy. While at the same time prolonging and intensifying the unpleasant feelings of still being in danger. This is an example of an unhelpful worrying cycle that gets worse over time.

(Also for some a paradox emerges, as excessive efforts cause high levels of fatigue and stress, which in turn triggers a stronger feeling of insecurity, which in turn triggers the need for even more preparation)

What you could try to do instead is to recognize when you are entering into a worry cycle, and try to pause it as early as possible, instead of falling into the rabbit hole. Choose to reduce your engagement with the thought, let it be, and continue with your day as if the thought never occurred. That way you can cut down the time you spend on imaging what might happen and preparing for all eventualities.

3. "Next time I'll see it coming"

Having been through a traumatic experience urges you to avoid this happening again. Closely monitoring your environment for any sign of danger seems like a logical strategy to ensure that you're not exposed to similar incidents in the future.

It varies what you might be looking out for. For example a person exposed to an assault outdoors in the evening may begin to look for and follow shadows around them when walking on the street. While a person involved in a serious car crash with a moose might be hyper-alert to the possibility of crossing wildlife.

Similar to the previous point where we discussed preparations, this monitoring for danger in your surroundings results in worries that keeps your attention locked onto potential threats. By focussing on it in such a manner we are behaving as if the threat is about to happen at any moment. Your body (and to some extent your brain) doesn't always know the difference between imminent danger and your perceived dangers.

Although this strategy is very understandable, it has the unfortunate consequence of sending a false signal that you are still in danger. This in turn creates a negative cycle that gets increasingly stronger.

(And paradoxically, this strategy could even be counter-productive as you steer away your focus from other areas. As with the example of being hyper-alert to crossing wildlife, by excessively focusing on what's happening on the sides of the road you might miss what's happening in front of you.)

4. "I will just avoid the situation"

‍To deal with the worries that something similar will happen again, many people start the process of avoidance. This may include avoiding certain people, surroundings or other things associated with the traumatic experience. A person who was assaulted at a party will, for example, avoid going to parties again, while a person exposed to a car accident might avoid being inside a car.

You start to narrow your life. And this provides fertile ground for even more rumination and anxious worrying.

Also you might be avoiding things trying to prevent yourself from being triggered by thoughts and feelings linked to the traumatic event. The strategy quickly backfires, leading to fear of both your own thoughts and to an increasing number of activities. Avoidance increases anxiety, and prevents you from discovering that there are other (more effective) ways of dealing with negative thoughts and feelings when triggered. An example could be doing nothing at all. Trying this will give you a chance to discover that the symptoms self-regulate.

What helps is to remind yourself that it's perfectly normal to be triggered by thoughts, images and memories after a traumatic experience. In fact, this is not a sign that there is anything wrong with you, but a natural result of what you have been through. Let it come when it wants to. Thoughts can't hurt you and they will certainly pass again.

5. "I shouldn't have these thoughts"‍

Many try to push the unpleasant thoughts and images away. It is understandable that you want to get rid of unpleasant thoughts, but thought suppression costs a lot of mental energy, and is rarely a successful strategy. This is because we simply cannot choose which thoughts we get, or when we get them. We can only choose what we do with them when they appear.

Another disadvantage of trying to control (or suppress) your thoughts is that you can easily become disappointed with yourself. When you realize that the images do not disappear, or that they return, many tend to believe they have lost control over their own mind.

To deal with the unpleasant and unwanted thoughts and feelings, some begin to use drugs such as alcohol or tranquilizers to try to calm down. This may work in the short term, but can quickly create fertile ground for other problems such as addiction, somatic injuries, etc. Similar to avoidance, you also risk missing out on important experiences of more effective ways of dealing with your thoughts.

Hold back on avoidance, drugs, suppression, or other strategies aimed at suppressing or controlling your thoughts and feelings. Instead, practice letting thoughts and feelings come, and letting them be. Then they will quickly be perceived as less important, and they will have the opportunity to fade.Thoughts and feelings regulate themselves if we choose to let them be. They are incredibly fleeting when we do not engage with them. While most people believe that this is not a choice - it actually is! You can actually choose to not do anything with your negative thoughts. And this is something that you can (gently) try practicing already today.

Key take-aways

And there you have it! Our tips to help you recover from PTSD. The message we want to get across is that the idea of trauma needing to be processed is heavily outdated - and in fact may even be contributing to the problem. And this is good news for many, because what this means is that you don't need to process, solve or revisit a trauma for it to disappear.

A key take-away of this article is that the human brain is incredibly good at regulating and repairing itself. Much more than we tend to give it credit for. And referring back to the metaphor of cutting your finger: we trust our body to take care of healing from physical traumas, and we know that meddling with this process will likely make things worse. And having the same approach to our psychological traumas is found to be a much more effective way towards recovery from PTSD.

PTSD has much in common with other general forms of anxiety. If you think this article was helpful you may also be interested in reading our previous post 7 Tips against worrying that actually work!