Post-traumatic stress and post-traumatic growth
In this post I offer you three evidence-based approaches to address the effect of traumas large and small, including post-traumatic stress disorder (PTSD).
Our lives, as we support a child with an eating disorder, is peppered with distressing or fearful events — some affect us for a day, and some can bring us to tears, or invade our sleep, even when all is well again. It’s not uncommon for parents to report PTSD.
Our children too accumulate traumas: there’s the eating, the delusional states, the treatment centres, the suicidality, the sense of being utterly alone and misunderstood, and the terrible fights with parents and siblings.
Some traumas stick and lead to post-traumatic stress. Others make us grow and lead to post-traumatic growth.
How can we transform the things that deeply shocked our word into wisdom, gratitude, expansion? Or, less ambitiously, how can we stop being reacting disproportionately to the slightest trigger?
Go for evidence-based methods first
The last thing you want, if you’re suffering from PTSD, is to make it worse. So personally I would go for approaches that have been researched and approved by your official health organisations. In the UK, we have the NICE guidelines, and they recommend just two methods:
- trauma-focused cognitive behavioural therapy (TF-CBT) and
- eye movement desensitisation and reprocessing (EMDR).
I’m going to flag up one more because I have heard it’s nearly about to get approval in the US and in the UK, and that’s emotional freedom technique (EFT).
Trauma-focused cognitive behavioural therapy (TF-CBT)
It’s not ordinary CBT, so make sure you see someone specially trained in the ‘trauma’ bit. I worry that any form of CBT is a talking therapy, that it tries to address the rational and that it requires will-power, effort and vigilance. Whereas if trauma was accessible to the rational brain you would have dealt with it by now. But if trauma-focused CBT is in the NICE guidelines, it will be because it’s achieved a mix of working well enough and being not too costly or difficult to implement.
Eye Movement Desensitisation and Reprocessing (EMDR)
EMDR, when you look at it or do it, seems completely daft, I warn you. Yet it is recommended by professional bodies worldwide, including the World Health Organisation. Here in Scotland, the authorities trained a large number of educational psychologists in EMDR following the Dunblane school massacre, and the approach has become mainstream for a whole range of problems — not just PTSD.
We don’t know how it actually works. The idea is that somehow your brain ‘reprocesses’ negative beliefs as your eyes follow the left-right movement of a pointer, or your shoulders are tapped alternatively.
Use a well-qualified EMDR therapist who has the humility to stick to the well-researched protocol. Their skill is to target the emotions around unhelpful beliefs about yourself — these could be beliefs around your safety, responsibility, choice, or self-esteem.
There is talking, yes, but there’s no need for detail, which is an advantage when people have distressing memories or shame. And nothing happens before a sense of ‘a safe place’ is established. EMDR should not be a distressing experience.
It can work in a very small number of sessions, because once the trauma around one key event is reprocessed, all the other related sources of misery fall away too. Checking for any residual fear-based reaction is part of the approach.
I had one EMDR session around an event where I had thought my life was in danger. Not PTSD, but still, if I chose to think of the event, my body went into mild fear reactions and I ruminated about my helplessness. Since the session, I can bring the event to mind and the only reaction I note is a sense of empowerment.
Emotional Freedom Technique (EFT, or ‘tapping’)
Emotional Freedom Technique (EFT) is not in the NICE guidelines and I don’t think it is in any equivalent standard internationally. I include it here because I’m told it’s nearly there. This paper, reviewing its effectiveness for PTSD and other problems, using — among others — randomised controlled trials, is quite impressive:
Feinstein, D. (2012). Acupoint stimulation in treating psychological disorders: Evidence of efficacy. Review of General Psychology, 16, 364-380
I’m afraid that ‘tapping’ looks at least as ridiculous as EMDR. This time it’s not your eyes going left and right, it’s you tapping on various points of your body. You can look pretty daft doing it, though it is possible to tap discreetly on finger locations during a distressing event.
I’ve been very impressed with EFT. I don’t have PTSD, but I like how it takes the sting out of the countless small-ish traumas associated with supporting my daughter, especially second time round as suffered a relapse. I think it brings real resilience when you’re on the kind of long-haul required with an eating disorder in the house.
For example, something that brought me to tears as soon as I brought it to mind, may stop registering on the emotional scale. Or I will still feel very sad about it (because hey, some things really are sad), but I don’t get weakened, scared, depressed about it. It means that the next time something similar happens, I’m starting from a clean slate, emotionally.
One thing EFT does incredibly well is how gently it addresses difficult memories. It will not let you dive in. Instead, you explore around the edge, working on any anticipatory fear. It’s only when you register no emotion at the abstract thought of working on a memory, that you get to address the memory itself.
Like EMDR, EFT requires very few sessions, is not heavily talk-based, and does not require you to use will-power or rational self-control. And just like in EMDR, it is honest: the therapist checks that a memory or stimulus really has stopped causing an over-reaction. I find EFT dovetails nicely with mindfulness, because every few minutes you are checking in with thoughts and feelings in order to see if another round of ‘tapping’ is required.
If you go for EFT, make sure you get someone who is well qualified. EFT resources are freely available on the internet and as a result there are a lot of self-taught therapists. They may do great for everyday stuff, but I wouldn’t go to them with PTSD. If you’re looking for a recommendation, the person who’s been fantastic for me is Odet Beauvoisin, who does Skype.
When nothing has worked so far
We are in the middle ages when it comes to mental health. If you have tried these therapies and are still suffering, please don’t blame yourself — blame the approach or the competence of your particular therapist. Self-compassion and kind connections are your allies all along this journey.