Acting and responding VS reacting

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As we navigate through life, there may be situations or conflict presented that requires us to act and respond in order to maintain personal boundaries or sense of self. There is a subtle difference between reacting to a situation or conflict and responding to one and i feel that it is important to cover in terms of not only supporting a partner who has experienced trauma but for the survivor of trauma themselves as part of recovery.

In terms of survivors of trauma; survivors frequently REACT in times of; stress, facing (potential) triggers, conflict, criticism (feared or actual) and within relationships. Any situation or relationship stressor can cause a survivor of trauma to be impulsive and reactive due to the nature of trauma itself and related symptoms. Of course, there is a huge spectrum with regards to this; just as a diamond differs – each individual reaction to trauma will too.

TRUK diamond theory

In cases of Childhood developmental trauma; research shows the developmental period to be of great significance in terms of reactions to trauma in adult life. What occurs inside the developmental phase will essentially impact a survivor in to their adult life and mold their interactions and view of self accordingly.

In terms of reacting, a survivor of childhood trauma will in many ways exhibit learned behaviour in their personal relationships – that behaviour being what was unjustly done by supposed “caregivers”. Many adult survivors of trauma which occurred in childhood feel a perpetual sense of self guilt and hate, blaming their personality and attributes as being the cause of trauma in the past. This can significantly shape and alter how a survivor reacts within their personal life and lead to cause issues if not addressed.

Reacting in a way similar to past abuse is just as common as the other end of the spectrum – people pleasing and denial of own needs/desires and completely dependent upon the individual survivor; their personality, experience and level of support available. Just as it is possible to react, it is possible to learn how to respond instead.

In cases of adult interpersonal relationship trauma; impulsive reactions to potential conflict or triggers is also a common trend. Reactions may be caused by personal triggers and flashbacks to past toxic relationships. Even interaction with the best intent can trigger a survivor to react and rely on 4f responses.

An individual who reacts is someone who is always responding to external events around them. Responding to triggers, to external stimuli and to a skewed perception due to either maladaptive upbringing, abuse in childhood or Adult interpersonal relationship trauma.

Constantly responding disregards guidance from our core values. It allows all and any to impact us and yank on our chain and we end up reacting to a complete set of unnecessary stimuli. Used constantly, reacting becomes a waste of energy and inner resources as it rarely brings about positive change.

Reacting over that which you have no control has no use nor does it bring much; if any – positive change.

Conflict arises when individuals react rather than act.

Acting (responding) however is a more balanced and intentional act. It involves forethought, planning, ability to reason and control emotions; refraining from using them in an emotional (reactive) response.

Acting is not used in the form of the act being in some way fake, however one having the ability to have an internal dialogue and control over the chosen response.

To act usually incorporates a positive attitude.

During conflict; human behaviour is shown to react negatively to a response which is emotionally reactive. Whereas generally speaking, a positive balanced action tends to alleviate any aggravation caused – this is of course true in normal relationships which are free from abuse or toxic behaviour and stimuli.

Trauma survivors tend to react to events that are perceived to be outwith their control as a habitual response. Learning to handle conflict in a way that iss less reactive and more responsive negates the risk of negative consequences such as retraumatization and triggering.

Reacting can be reduced through positive reflection; awareness and at times perception alterations (if appropriate). It is important to note that reacting is something we do instinctively and is closely related to animal behaviour. For survivors of trauma; reacting can become a form of armour – used to protect and defend. The issue with this is that its not always balanced or appropriate to rely on the impulsiveness of reactions as it can actually serve to cause situations which reinforce negative messages such as shame, guilt and poor self worth.

More information can be found within our group; TRUK.

Helping a survivor of trauma through a flashback

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Our recent posts have focused on partners and friends of survivors in the sense of how to support a survivor through their trauma illness. A wealth of information can also be found on our Facebook group; TRUK. Having already covered an overview of trauma and the types of disorder it can cause, the importance of support (found here) and helpful advice in supporting survivors (found here); I felt it was also important to look more specifically at how to support during a flashback episode.

Understanding what a flashback is and what it causes can be extremely helpful with regards to being able to provide appropriate support. On gaining an understanding of triggers and flashbacks you will have a general view of how these MAY impact your friend or loved one however it is important to note that every reaction, interpretation and perception will differ and this information will only provide you with a first step. The next steps are completely reliant on you personally having a good level of awareness of the personal triggers and issues that may cause an acute onset of trauma symptoms. Anticipating these triggers is the best way to support a survivor of trauma; having that awareness not only makes the survivor feel heard but provides a sense of safety.

It can be helpful to ask your loved one (friend, colleague etc) if they are personally aware of their own triggers and if so; what they are. You don’t need to push to understand why or hear the details – of course if your partner looks to divulge this, then by all means provide a listening ear – this will give you a bigger understanding of individual triggers and issues in order to help you support.

If there is no awareness of many (or any) triggers, it can be important to begin to identify these. We have a lot of files on our group which help identify emotions, triggers and flashbacks. You cannot force your partner to work on identifying triggers, no one wants to be triggered in to such panic – survivors of trauma WILL get there when they CAN.

A flashback is a vivid and sometimes intense experience where an individual may relive some aspects of a traumatic event or feel as if it’s happening right now. Flashbacks don’t always involve a dissociative type state such as feeling as if you are watching videos of your trauma, flashbacks don’t always involve reliving your trauma beginning to end and can actually come in the form of feeling physiological sensations such as: pain or pressure, noticing sounds or smells associated to your trauma or experiencing the emotions that you felt during the trauma.

Flashbacks range from one-off smaller experiences that may go unnoticed to repeated places and situations triggering an emotional response. Some flashbacks can be worked through with a combination of therapy, analysis and safe coping mechanisms however, for some flashbacks you need to learn to ride the wave. When emotions come and go, it’s best not to fight them off; rather than to ride with them.

CPTSD triggers often go unrecognised, not like single type 1 traumas with a beginning middle and end that can be identified easily. With CPTSD, due to the nature of traumatic events – multiple traumatic events result in small social environmental cues that can be easily missed. With complex trauma; the effects of trauma are not clear-cut and neither are the flashbacks associated with it. Every person is different and will experience different types of flashbacks and every person may also respond differently to treatment methods – more info on emotional flashbacks can be found here.

The important thing is that flashbacks can be managed through reflecting on personal triggers and working on perception, grounding, removing unnecessary stress and appropriate support. They can appear out of control and frightening however, the only individual experiencing debilitating fear is the survivor of trauma.

During a flashback or trigger response, it can be helpful to vocalise this and give it meaning. Identify to your partner that what they are experiencing is a flashback (or they have been triggered by x, y or z) and that you are there for support.

Many survivors have never experienced the beauty of strong authentic support and this can catch them off guard. This may take practice to really overcome. The finer points of course being patience and non judgement, survivors usually belittle themselves for experiencing flashbacks so strongly and it’s important to normalise this. Let your partner know how they respond is normal.

It can also be helpful to remind your partner of their surroundings, this works as a sort of grounding at times bringing them back quicker than would normally. We have a great deal of grounding exercises over at TRUK. These can help in assistance and during progression however just putting a voice out there can be extremely therapeutic.

Encourage your partner to breathe slowly and deeply. Usually shallow breathing comes along side panic, fear and triggers/flashbacks. Regulation of breathing resores oxygen back to where its needed and allows the frontal lobe to return.

It is important to avoid sudden movement. Even if you think you have given your partner enough space, slowing down that movement will really help in Calming the emotional storm and survival activation. Our graphic should be helpful in reminding you of these subtle tips.

Remember it’s so important to always ask before you touch. Some survivors can handle unexpected touch and that’s fantastic, however many survivors can not. It is physically painful to be touched unexpectedly especially during a flashback or trigger. Giving your partner that sense of control can do wonders for recovery in general and not just in times of deep emotional distress.

Once again we have a huge resource available on TRUK covering the smaller points of support. This however will give a good solid starting point in which to open up communication lines and make your own plan.

Support is available to any one who needs it, please Contact us!

How complex (and developmental) trauma affects sleep

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Sleep continues to be a common issue found within survivors of trauma and can act as a catalyst for a host of additional symptoms which are associated with trauma. Traumatic experiences often lead a survivor to experience high levels of epinephrine and adrenaline which are released to continue the survival response and act as a protective factor. These neurochemicals remain present in the brain following past trauma and can serve to interrupt an individual’s normal sleep cycle causing difficulties with; insomnia, nightmares and daytime fatigue caused by poor sleep hygiene/quality.

Trauma responses such as flashbacks and troubling thoughts can make the act of falling asleep seem impossible at times. Not only interfering with sleep hygiene but the actual quality of sleep. In a sleep state, there is no control. An individual is victim to whatever images are produced by the brain and has no ability to alter this (there are cases of individuals practicing the act of dream modification however this post looks at the consensus population of which follow REM paths). To sleep ‘perchance to dream’ , survivors commonly fear the dreams that may come due to the uncontrollable aspect that flashes them back to the past.

Within waking life, a survivor of trauma may feel the need to maintain a high level of vigilance. Experiencing day to day life in a manner that protects and ensures safety. A survivor may engage in behaviors which are self protective, avoiding stimuli that are perceived potentially dangerous (or uncontrollable). As a survival response (each of the 4f responses), a survivor of trauma may live their life in ways that are predictable and calculated. This safe place is in stark contrast to the dream world; where dreams and at times; night terrors plague an individual with no ability to change or control that environment. Going to sleep therefore can transform into a negative association with the pattern of night terrors serving to exemplify that.

Darkness itself may present anxiety and agitation within many survivors of trauma. It can cause a survivor to be triggered, to experience reliving of the trauma (flashbacks) or result in the use of maladaptive coping and reliance in order to deal with the uncomfortable feelings that it brings. Fearing darkness leads to added stress and anxiety; especially as the hours pass and darkness nears. This fear can result in manifestations of SAD (seasonal affective disorder), depression, anxiety and produce phobias. At times when an individual is in such a heightened emotional state, it is possible to visually see things which may not be there. Individuals with anxiety over darkness commonly report associating shadows and objects negatively as well as see insects and objects which aren’t physically there. These visual manifestations are a way for the brain to remain vigilant during exhaustion and research has found exhaustion and poor sleep quality to be a huge factor in physiological health.

Survivors of trauma often report as using sleep to cope with symptoms of trauma. Commonly taking frequent naps throughout the day as a response to the tiredness that comes along with vigilance, obsession and control. The efforts that are placed in controlling one’s environment can not be overlooked. As a coping mechanism; a survivor may meticulously plan, analyze and control their environment as a self protective measure. Although helpful, taking naps during the day can be maladaptive if done to remove oneself from an anxiety inducing situation or if taken too much. Too many naps will obviously directly interfere with an individual’s ability to fall asleep and stay asleep.

Nightmares often cause individuals to have difficulty falling asleep afterwards. A night terror commonly wakes an individual from REM sleep and such crude awakening leads to instant agitation and anxiety. Such feelings may come even before full consciousness is achieved and an individual can turn to 4f reliance at breakneck speed due to the nature of waking becoming uncontrollable and triggering. Not only that, but an individual waking from a night terror commonly has memories of said terror. For survivors of trauma who often process their individual trauma during sleep; this can lead to memories that have been blocked becoming evident and residing for a prolonged period of time. It can take many hours (if at all) for a survivor to calm down enough to return to sleep; however , the fear of continuing the memory or terror can directly affect one’s ability to sleep (even if desperate to).

Night terrors (or trauma memories manifesting within dreams) cause the brain to switch directly on to survival mode. This 4f response carries with it extra adrenaline and is fueled by vigilance and a deep desire for safety. No animal or species – human or not; would be able to sleep in a state of uncertainty. Not only can it take a great deal of time to come back down from this state, but commonly, survivors resort to maladaptive coping in the time between. A survivor of trauma in this state is completely driven to achieve a state of safety and the uncomfortable feelings which go hand in hand with feeling unsafe may cause an individual to reach for things which are not safe in the long term however produce quick, instant feelings of euphoria or ease. Research has reported individuals upon waking often leave their bed and go forth to cope with their insomnia in a maladaptive way including; drinking coffee/tea, watching TV, cleaning, writing, eating snacks or making a meal, gambling, online gaming, scrolling through their phone and using substances as a way of forcing a desired state (either sleep/alertness).

Using substances to numb or dull feelings can help in the short term, however long term it builds a reliance that requires more of said substance in order to achieve feelings close to past usage. In terms of substances, that is not always to say drugs are used. Substances include; alcohol, caffeine, food, sexual needs, prescriptions, painkillers and dissociative tasks (such as scrolling through Facebook at 4am). Although substances work in the short term, it can lead to an exacerbation of symptoms and neural changes within the brain.

Trauma alters the brain by changing neural pathways and volume. Sleep disturbances are listed by the DSM-IV as insomnia, frequent wakening or night terrors as one of many symptoms associated with PTSD and CPTSD. Each symptom however acts as a potential issue with regards to sleep. For example, issues with arousal with regards to anxiety and hypervigilance cause direct issues with an individual’s ability to fall asleep. A survivor with a heightened startle response may jump awake easily during the night at the smallest sound; this change in sleep can also serve to exacerbate other trauma related symptoms. An exhausted individual will undoubtedly be more irritable and agitated or have greater difficulty concentrating. Trauma symptoms lead a survivor to face difficulty in leading their day to day life and adding sleep issues and consequences on top of that can be debilitating.

Sleep problems can intensify daytime (C)PTSD symptoms, this can make it even more difficult to sleep at night. Survivor’s who feel anxious or fatigued during the day may ruminate more on their traumatic memories or experiences this further increases the risk of nightmares and other issues when sleep is attempted.

Coping

For those who are experiencing temporary sleep problems, there are a number of recommendations for dealing with insomnia, bad dreams, and daytime fatigue. Sleep experts recommend trying to reduce feelings of stress, especially before bedtime. Don’t watch the news right before going to bed. Avoid coffee in the afternoon and evening. Take a warm bath or soak in a hot tub before bedtime. If sleep problems persist, see your doctor, who can prescribe medications that will help you sleep but won’t make you groggy in the morning.

Tips

• Go to bed when you feel ready to sleep. Try not to force sleep, which can add to the pressure of wanting to get to sleep. Developing the harmful habit of lying in bed awake for long periods when you want to sleep is counter-productive.
• Engage in a relaxing, non-alerting activity at bedtime such as reading or listening to music. For some people, soaking in a warm bath or hot tub can be helpful. Avoid activities that are mentally or physically stimulating, including discussion about your violent experience, right before bedtime.
• Create an environment in which you can sleep well. It should be safe, quiet, cool and comfortable. While it often helps to sleep in a dark room, if keeping a night light on helps bring about a more safe feeling, then consider keeping the room dimly lit. It may also help to have a friend or family member stay in the room, or perhaps in a nearby room, while you are sleeping.Rest when you need to rest. It is common to feel exhausted after a violent trauma, so you may need more rest or to rest differently during this time. Relaxing and resting for brief times throughout the day and taking short naps (15-45 minutes) may help.
  Do not eat or drink too much before bedtime and recognize the negative role that alcohol can have on your sleep.
• Sleep in a location where you will feel most rested and safe. While the bedroom is optimal, it may not be possible to rest there soon after the trauma if you experienced violence in that room.
• Stress and anxiety management strategies can be helpful for managing (C)PTSD-related sleep problems. Some people find relief from meditation or yoga,guided imagery or positive mantras
  Medications, including anti-anxiety and sleeping medications, may help some people in the short term. However, when the underlying PTSD symptoms remain, sleep problems will likely return when you stop using medication.
• Therapy can help with both sleep issues and (C)PTSD. A compassionate trauma informed therapist will help you work through your trauma in a safe space, free of judgment, help you set goals, help you understand how trauma changes the brain and work with your GP to decide which (if any) medications are appropriate.

Further research

Although a study completed in Sweden showed that sleep deprivation actually aids a trauma survivor by that intrusive thought and flashbacks are reduced; no other research has furthered this.

Research carried out by the University of Oxford, the MRC Cognition and Brain Sciences Unit in Cambridge and the Karolinska Institute and published in the peer reviewed medical journal of sleep included 42 participants; 20 within the ‘sleep deprived’ group and 22 within the ‘sleep’ group. Participants resided in a sleep facility for 6 days, both groups were shown the same clip and informed that they could stop the recording at any time. They were not permitted the use of devices (phones, laptops etc) and were provided a sandwich and fruit every two hours – being allowed to shower and use the bathroom.

The study looked at participants’ perception of stress and intrusive thought through their diary entries throughout the study. Findings showed that both groups experienced similar levels of negative mood and feelings of detachment following watching the film, day one results showed the sleep deprived group obtained lower impact of event scale results than the group that had slept. Over the next six days, this trend continued.

The group which were deprived of sleep reported less intrusive memories than the participants who were allowed sleep and this led researchers to state; that sleep deprivation on one night, rather than sleeping, reduces emotional effect and intrusive memories.

This study had its limitations, it was criticized for various reasons; that being the entire fact that the experiment was staged within a laboratory could have confounded and altered results. The study was further criticized due to its short time frame, difference in individual sleep issues, participant size and generalized results.

In contrast to this, a study conducted at the University of Zurich has provided evidence that sleep within the first 24 hours post-trauma has a positive impact on distress and memories related to said traumatic event(s). This led researchers to believe that sleep has a medicinal effect in regards to processing trauma(s). Birgit Kleim stated that on the one hand; sleep can weaken emotions connected to existing memories; it also helps to put recollection into context and process them in a different way. Such research has helped recommend early treatment for trauma survivors in offering a non invasive alternative to current treatment (Kleim, 2016).

Sleep plays a hugely important role with regards to integrating emotional memories (Walker, 2008). In order for the brain to adequately process memory it must do so through offline memory consolidation where memories are labeled and encoded during unconsciousness. Sleep enhances previous encoded emotional pictures and consolidates it with relevant retained emotional stimuli. That is why sleep is so important, especially for a survivor of trauma. Not only does sleep help to build a clear picture of memory, but it reduces the degree of emotional arousal experienced with said memory. In short, sleep helps our traumatic memories become more accessible and less fearful (Pace-Schott et al, 2011).

Non-rapid eye-movement (NonREM) sleep has been associated with the strengthening of hippocampus dependent declarative memories (Stickgold, 2009), whereas REM sleep has been implicated in the modulation of emotional memories and arousal (van der Helm et al., 2011b, Walker and van der Helm, 2009) and the extinction of conditioned fear (Spoormaker et al., 2011, Spoormaker et al., 2010)

Some research suggests that sleep problems are more than just a symptom of PTSD. Instead, they may be a core component of the diagnosis. Research published in 1989 suggests that disturbances in rapid eye movement (REM) sleep are a PTSD hallmark that play a key role in other PTSD symptoms. Subsequent research has yielded mixed results. While some studies, including of animals, find a pattern of REM disturbances associated with PTSD, others do not.

A 2013 review of the literature argues that disturbances in sleep, especially REM sleep, may increase the risk of PTSD. Sleep issues may also worsen outcomes in people with PTSD. The study further argues that sleep issues can decrease the effectiveness of many PTSD treatments and that targeted treatments for sleep issues may speed recovery.

A study that compared people with insomnia who did not have PTSD to those with combat-related PTSD and insomnia found important differences in the two groups. Those included:

• More repetitive nightmares in people with PTSD.
• People with PTSD were more likely to say their nightmares made it difficult to go back to sleep.
• More anxiety during the day in people with PTSD.
• Increased day time fatigue with those with PTSD

As we can see, sleep is paramount for recovery from trauma. There are many helpful ideas to help with poor sleep however, in the instance of such tips being unhelpful – I would strongly suggest seeking help from a GP for short term relief to reactivate individual sleep patterns. Further support on sleep and trauma can be found within our Facebook group and accessed through our social links at the top of the page.

References

Bennion KB, Mickley Steinmetz KR, Kensinger EA, & Payne JD (in press).Sleep and cortisol interact to support memory consolidation. Cerebral Cortex.
Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005). A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162, 214-227. doi:10.1176/appi.ajp.162.2.214
Diekelmann, S., Wilhelm, I., & Born, J. (2009). The whats and whens of sleep-dependent memory consolidation. Sleep Medicine Review, 13(5); 309-21.
Ehlers, A., Clark, D.M., Hackman, A., McManus, F. & Fennell, M. (2005). Cognitive therapy for posttraumatic stress disorder: development and evaluation. Behaviour Research and Therapy, 43(4), 413-431. doi:10.1016/j.brat.2004.03.006
Foa, D. W. (1992). Treating PTSD: Cognitive-behavioral strategies. New York: Guilford.
Foa, E. B. & Kozak, M.J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20-35.
Gehrman, P., Seelig, A.D., Jacobson, I.G., Boyko, E.J., Hooper, T.I., Gackstetter, G.D., Ulmer, C.S., Smith, T.C. (2013). Predeployment Sleep Duration and Insomnia Symptoms as Risk Factors for New-Onset Mental Health Disorders Following Military Deployment. Sleep, 1;36(7):1009-1018.
Germain, A. (2013). Sleep disturbances as the hallmark of PTSD: Where are we now? American Journal of Psychiatry, 4(170), 372-382. doi: 10.1176/appi.ajp.2012.12040432
Gradus, J. L. (2007, January 31). Epidemiology of PTSD. Retrieved from https://www.ptsd.va.gov/professional/PTSD-overview/epidemiological-facts-ptsd.asp
Healthy sleep tips. (n.d.). Retrieved from https://sleepfoundation.org/sleep-tools-tips/healthy-sleep-tips
Harvey, A.G., Jones, C., & Schmidt, A.D. (2003), Sleep and posttraumatic stress disorder. Clinical Psychology Review, 23, 377-407
Inman, D. J., Silver, S. M., & Doghramji, K. (1990). Sleep disturbance in post-traumatic stress disorder: A comparison with non-PTSD insomnia. Journal of Traumatic Stress, 3(3), 429-437. doi: 10.1007/BF00974782
Kleim, B., Wilhelm, F.H., (2013). Sleep enhances exposure therapy. Psychological Medicine (advance online publication).
Koren D, Amon I, Lavie P, Klein E. Sleep complaints as early predictors of posttraumatic stress disorder: a 1-year prospective study of injured survivors of motor vehicle accidents. American Journal of Psychiatry 2002;159:855–7.
Krakow, B., Haynes, P.L., Warner, T.D., Santana, E., Melendrez, D.C., Johnston, L., Hollifield, M., Sisley, B., Koss, M. & Shafer, L. (2004). Nightmares, insomnia, and sleep-disordered breathing in fire evacuees seeking treatment for posttraumatic sleep disturbance. Journal of Traumatic Stress 17:257-268.
Martinez-Vargas, M., Estrada Rojo, F., Tabla-Ramon, E., Navarro-Argüelles, H., Ortiz-Lailzon, N., Hernández-Chávez, A., Solis, B., Martínez Tapia, R., Perez Arredondo, A., Morales-Gomez, J., Gonzalez-Rivera, R., Nava-Talavera, K., Navarro, L. (2012). Sleep deprivation has a neuroprotective role in a traumatic brain injury of the rat. Neuroscience Letters, 7, 529(2), 118-22.
Mellman, T.A., David, D., Kulick-Bell, R., Hebding, J. & Nolan, B. (1995). Sleep disturbance and its relationship to psychiatric morbidity after Hurricane Andrew. American Journal of Psychiatry, 152:1659–63.
Neylan, T.C., Mannar, C.R., Metzler, T.J., Weiss, D.S., Zatzick, D.F., Delucchi, K.L., et al. (1998). Sleep disturbances in the Vietnam generation: findings from a nationally representative sample of male Vietnam veterans. American Journal of Psychiatry, 155:929–33.
Nishida, M., Pearsall, J., Buckner, R. L. & Walker, M. P. (2009). REM sleep, prefrontal theta, and the consolidation of human emotional memory. Cerebral Cortex 19, 1158-66.
Ohayon MM, Shapiro CM. Sleep disturbances and psychiatric disorders associated with posttraumatic stress disorder in the general population. Comprehens Psychiatry 2000;41: 469
Pace-Schott, E. F., Milad, M. R., Orr, S. P., Rauch, S. L., Stickgold, R. & Pitman, R. K. (2009). Sleep promotes generalization of extinction of conditioned fear. Sleep 32, 19-26.
Pace-Schott, E. F., Shepherd, E., Spencer, R. M., Marcello, M., Tucker, M., Propper, R. E. & Stickgold, R. (2011). Napping promotes inter-session habituation to emotional stimuli. Neurobiol Learn Mem 95, 24-36.
Phillips, K. (2015, February 4). What are the types of sleep disorders? A full list of sleep disorders. Retrieved from http://www.alaskasleep.com/blog/types-of-sleep-disorders-list-of-sleep-disorders
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Sleep and PTSD. (2015, August 13). Retrieved from https://www.ptsd.va.gov/public/problems/sleep-and-ptsd.asp
Stickgold, R. (2009). How do I remember? Let me count the ways. Sleep Medicine Review 13, 3.
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van der Helm, E. & Walker, M. P. (2011). Sleep and emotional memory processing. Sleep Medicine Clinics 6, 31–43.
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Attachment disorders and trauma

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Attachment theory is an area of psychology that is ever evolving; as sociological and psychological advancements replace once early theories by Bowlby (1958), Ainsworth (1970), Lorenz (1935) and Harlow (1958). Bowlby’s theories proved popular (mostly in America) as it was viewed as a nonsensical self explanatory approach. Bowlby and later his student; Ainsworth, provided a positive and achievable theory for parents – if a mother is loving, affectionate and consistent; her child will be protected magically from anxiety and depression in later adult life. This theory was further explored and criticized due to its socioeconomic context and confirmation bias. Attachment can be defined as a deep emotional bond in which each individual seeks closeness and feels a sense of security when in the presence of the attachment figure (an overview of attachment and intimacy can be found here).

Recently, trauma theorists have proposed the notion that complex trauma and developmental trauma are forms of attachment disorder. Individuals who have experienced trauma either within the development phase or later in adult interpersonal relationships face difficulties in forming attachment and maintaining relationships due to the nature of trauma itself. There are obvious difficulties with the notion that trauma is a disorder in attachment, as attachment forms in the first three years of life; it drastically reduces the scope of effect. More research and analysis is needed in this particular field in order to quantify such theories.

Complex trauma (adult interpersonal relationship) and developmental trauma (from child abuse/neglect) do carry issues in attachment however, issues are not solely limited to attachment and relationships – individuals suffering the effects of trauma will also be effected in their reactions to others and the self as well as potentially using a host of maladaptive coping methods in order to function within society (such as; dissociation, disordered eating, control issues and issues with perception). To simplify trauma as far as to say it is solely a disorder of attachment is negating the experiences hundreds of thousands of survivors have had to endure throughout their lives.

Both complex and developmental trauma hold features of attachment difficulties alongside the manifestation and development of individual trauma symptoms. As each trauma differs; each response differs and thus to simply put CPTSD (and developmental trauma) in to the category of attachment disorder dulls its effects and takes away from the suffering of hundreds of thousands of individual survivors worldwide. That is not to say however that attachment issues do not form part of CPTSD, it also does not over take it. Most research which investigates attachment difficulties and disorders focuses on children still within the developmental phase, attachment disorders are said to be experienced by children and research also shows the potential for these childhood psychiatric illnesses to manifest and follow the individual through to adulthood.

Repeated positive experiences with a caregiver/parent helps infants develop a secure attachment and bond. When a parent or caregiver responds to a baby’s cries with feeding, changing, or comfort appropriately and consistently; the baby learns they can trust the adult to keep them safe and care for their needs.
Children who are securely attached tend to form better relationships with others and solve problems more readily. They are willing to try new things, take more risks and explore independently with fewer extreme responses to stress.

Most infants develop secure emotional attachments to their caregivers at an early age (from 0-3). They show healthy anxiety when their caregiver is absent, and they show relief when they’re reunited. Some infants, however, develop attachment disorders because their caregivers aren’t able to meet their needs or through having being placed in care (either through fostering, adoption or orphanages at an early age. These babies are unable to bond with their caregivers and they may struggle to develop any type of emotional attachment which can follow through to adulthood. Infants who experience negative or unpredictable responses from a caregiver may develop an insecure attachment style, they may see adults as unreliable and they may not trust them easily. Children who experience abuse or neglect during the developmental phase(s) may associate attachment with fear as their bond with their own parental figures centers around abusive behaviors. Those children with insecure attachments may avoid people, exaggerate distress, and show anger, fear, and anxiety; they may refuse to engage with others and so have difficulty in forming friendships throughout their school life; often leading to similar patterns in adulthood.

Attachment disorders are psychiatric illnesses which manifest in childhood causing issues with a child’s ability to form emotional attachments to others. This can present as early as a child’s first birthday(and further in to adulthood) and deeply effect a child’s ability to form relationships. Attachment issues in early infancy can lead to severe colic or feeding issues; a failure to gain weight, detached/unresponsive behavior, a difficulty being comforted, preoccupied and/or defiant behavior, hesitant in social interaction and unusual closeness being formed with strangers. Such manifestations do not need to all be present and can occur as a mixture of issues, main symptoms include a difficulty in social interaction; either being introverted or extroverted; inability to be comforted in expected ways (I.e; hugs, soothing tone etc) and signs of detachment and unresponsiveness within social or school settings which could lead to future psychiatric illness.

Issues in attachment arise due to problems or difficulties within a *child’s early relationships. Common factors leading to disorders of attachment include physical, emotional or sexual abuse in childhood, neglect, inadequate care, institutional care – foster home, adoption, care home or orphanage. The physical, emotional and social problems associated with attachment disorders may persist as the child grows older.

Children who have attachment issues can develop two possible types of disorders: Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) – recent research however puts forward the notion of FOUR different types of attachment disorder, the DSM-IV is yet to recognize any more than the two listed below.

Reactive Attachment Disorder (RAD)

Children with RAD are less likely to interact with other people because of negative experiences with adults in their early years (This could be due to abuse, neglect or trauma). They have difficulty calming down when stressed and do not look for comfort from their caregivers when they are upset, they may in fact shy away from comforting techniques or become reactive in defense. These children may seem to have little to no emotions when interacting with others, and can be confused with having learning disabilities such as ADHD, Autism or Aspergers. Children who have RAD may appear unhappy, irritable, sad, or scared while having normal activities with their caretaker or parent and this may carry through to insecurity over adult figures in general and manifesting in to issues with all social interaction. The diagnosis of RAD is made if symptoms become chronic.

Disinhibited Social Engagement Disorder (DSED)

Children with DSED do not appear fearful when meeting someone for the first time. They may be overly friendly, walk up to strangers to talk or even hug them. Younger children may allow strangers to pick them up, feed them, or give them toys to play with. When these children are put in a stranger situation, they do not check with their parents or caregivers, and will often go with someone they do not know. Again DSED can be confused with other disorders and disabilities and should never be diagnosed without the support of a trained child psychologist.

Signs that a child may have an attachment disorder include:

Intense bursts of anger
Extreme clinginess
Poor impulse control
Failure to smile
Oppositional behaviors
Lack of affection for caregivers
Lack of fear of strangers
Lack of eye contact
Bullying or hurting others
Withdrawn or listless moods
Self-destructive behaviors
Watching others play but refusing to join in

Treatment

Children who exhibit signs of RAD or DSED need a comprehensive psychiatric assessment and individualized treatment plan. Treatment involves both the child and the family. Therapists focus on understanding and strengthening the relationship between a child and his or her primary care givers. Without treatment, these conditions can affect a child’s social and emotional development. Treatments such as “rebirthing” strategies are potentially dangerous and should be avoided. Reactive Attachment Disorder and Disinhibited Social Engagement Disorder are serious clinical conditions. However, close and ongoing collaboration between the child’s family and the treatment team will increase the likelihood of a successful outcome.

Researchers agree there is a link between attachment disorders and significant neglect or deprivation, repeated changes in primary caretakers, or being reared in institutional settings. Some other possible risk factors for attachment disorders include: caregivers with poor parenting skills, anger issues and/or psychiatric conditions. Attachment issues may also form due to parental neglect, exposure to drugs or alcohol or due to being placed within foster care, institutionalized or having experienced multiple traumatic events (including being removed from caregiver).

Most children who form attachment disorders have experienced serious neglect, have experienced trauma or have had frequent changes in caregivers. Children who have been in foster care or children who have been institutionalized have been found to be at the greatest risk of developing an attachment disorder as well as those children who have endured a traumatic event(s), spent time in an orphanage or have been removed for a period of time from their primary caregiver.
There is no formal diagnosis for attachment disorder in adults however; you can certainly experience issues relating to attachment in adulthood. For some, these may be lingering symptoms of RAD or DSED that went undiagnosed in their childhood.

Although presently there are two formal attachment disorders, research has opened the possibility of other attachment related disorders which is not currently recognized within the DSM-IV. As attachment styles can be broken in to either secure or insecure we find some additional difficulties which coincide with insecure attachment evolving from developmental trauma. Within examples of developmental trauma there is a common trend which is said to result in further difficulty – that being the response of caregivers to ones innate needs as an infant. Survivors of trauma who faced caregivers who responded inconsistently or abusively (neglectful etc) to their needs commonly develop insecure attachment as a result. This can carry through to adulthood where it becomes increasingly difficult to form intimate bonds with others due to past experience and trust issues. There are several subtypes of insecure attachment styles in adults;

Anxious-preoccupied attachment

Individuals with an anxious-preoccupied attachment style may have a tendency to idolize romantic partners, spending a considerable amount of time thinking and prioritizing said relationships – even over self needs. Commonly, individuals with AP attachment difficulties have an increased need to feel wanted and may experience jealousy or irrational fears. There is a deep need for reassurance; if this need is not met however, individuals may begin to doubt how others feel about them; commonly interprating anger and disdain from relationships/partners. Those with AP attachment fear abandonment and such fears can actually serve to drive sensitivity surrounding relationships leading to misinterpretation and the break down of future relationships/friendships.

Dismissive-avoidant attachment

Individuals with a Dismissive-avoidant (DA) style of attachment may prefer to be on their own, isolated within their own world. DA attachment difficulties include issues with feeling dependent on others and a worry that forming close bonds may make their life less independent. Individuals with DA attachment issues commonly believe that relationships are troublesome and dangerous and so may behave in ways to prevent a loss of perceived independence. These behaviors can make it difficult for others to support you or feel close to you.In addition to this, if someone does put in extra effort, individuals may react by closing off completely.
Individuals who face issues with DA attachment do not necessarily have little care for others rather than undertake said behavior as a self protection mechanism which ensures individual self sufficiency.

Fearful-avoidant attachment

Individuals with fearful avoidant (FA) attachment styles may have a deep desire to build relationships however fear being abandoned or hurt by said relationship and so push feelings and emotions aside in order to try and avoid feeling them (blocking). This results in short bursts of intense and overwhelming emotion as a negative pattern begins to form in relation to others. It is common for individuals with a FA style of attachment to have conflicting feelings about intimacy and relationships; fearing self inadequacy leads to poor relationships.

Further research

Leading attachment theorists have recognized the limitations of the DSM-IV and so proposed broader diagnostic criteria in terms of attachment issues. There is as yet no official consensus on these criteria. Boris and Zeanah (1999) have offered an approach to attachment disorders that considers cases where children have had no opportunity to form an attachment, those where there is a distorted relationship, and those where an existing attachment has been abruptly disrupted. This would significantly extend the definition beyond the DSM-IV definitions (those definitions are limited to situations where the child has no attachment or no attachment to a specified attachment figure).

Boris and Zeanah use the term “disorder of attachment” to indicate a situation where the child has no primary caregiver and may be indiscriminately sociable and approach all adults. Alternatively however, a child may be emotionally withdrawn and fail to seek comfort from anyone. Boris and Zeanah also describe a condition in which they term; “secure base distortion”. Where the child has a preferred familiar caregiver, but the relationship is such that the child cannot use the adult for safety (I.e; in cases of developmental trauma or neglect) while gradually exploring the environment. Such children may endanger themselves, may cling to the adult, may be excessively compliant, or may show role reversals in which they care for or punish the adult. The third type of disorder proposed is termed; “disrupted attachment”. This type of problem, which is not covered under other approaches to disordered attachment, results from an abrupt separation or loss of a familiar caregiver to whom attachment has developed. The young child’s reaction to such a loss is parallel to the grief reaction of an older person, with progressive changes from protest (crying and searching) to despair, sadness, and withdrawal from communication or play, and finally detachment from the original relationship and recovery of social and play activities.
Most recently, Daniel Schechter and Erica Willheim have shown a relationship between maternal violence-related PTSD and secure base distortion which is characterized by child recklessness, separation anxiety, hypervigilance, and role-reversal

Emotional armouring

Psychological armouring

A common hurdle to recovery: emotional (or psychological) armouring has the potential to not only negatively impact an individuals future relationships and inner psyche; but produce a plethora of related physiological symptoms within the body.

Armouring refers to a maladaptive coping method whereby a survivor of trauma holds back or represses natural emotions or expressions in order to conform to expected societal norms. Over time, armouring results in an altered character which manifests as a coping mechanism in defense from pain experienced due to not expressing ones inner desires. The conflict between our basic needs/desires or feelings becomes heightened with unnatural attitudes and conditioning placed upon us.

Armouring is a common tool used by survivors of early developmental trauma and adult interpersonal relationship trauma and many survivors may use this without the realisation of the fact. When armouring manifests in to a survivors inner character, it causes a range of effects with regards to one’s personality, physiological systems and desires (Personal dreams, goals, wants, needs etc).

Emotional body armouring forms in response to chronic trauma; the fracture of a relationship or the disintegration of one’s values. For adult survivors of Childhood abuse or neglect (and cases of adult interpersonal relationship trauma); armouring can become deeply enmeshed within one’s developed characteristics. This is to state that neural pathways may have been forged in a way that would not have been. It is not to say that such pathways cannot be altered.

Adult survivors of Childhood developmental trauma may have been punished during times of self expression. The potential is that self expression which is not deemed appropriate or acceptable by an abuser may be termed so because it creates feelings of deep insecurity and lack of control within the abuser(s). When this fear is met with a lack of perceived control, it causes a heightened reactive response. That is in no way to say that an abusers actions are deemed acceptable or normal, as an adult they are just as responsible as others (including ourselves) to react appropriately and without abuse. Each time a survivor may have attempted to express their needs or desires, this cycle is most likely to have been repeated and so the child (or adult) becomes conditioned in to learning not to express, not to feel and not to show weakness.

We know the mind and body are connected; dis-EASE of the mind leads to DIS-EASE of the body systems. Repressed feeling that commonly accompanies emotional armouring is seen to be stored within body systems and thus seen to manifest as tightness, tension or illness.

Armouring is an accumulative process and as time passes; the addition of further dis-Ease plagues the survivor in the form of chronic pain, fybromialgia, hip/joint issues, jaw issues, shoulder and muscle spasms.

The psoas is the largest hip mover of the body. It is the muscle that moves our legs to run (fight/flight) and to draw our knees up to go into the fetal position (freeze). For people with C-PTSD or PTSD the psoas becomes shorter and tight because it’s never allowed to relaxed due to the sympathetic nervous system being always in fight/flight/freeze. Which leads to lower back pain, hip pain, and inner and outer thigh pain, knees, pain in the glutes, and possibly even difficulty breathing because the diaphragm is impacted by the psoas muscles.

Learning to relax the SNS (sympathetic nervous system) will help to relax the psoas muscle. Learning to relax the psoas muscle may also contribute to relaxing the SNS.

Breathe work, visualization techniques, along with somatic yoga practices will help release, relax, strengthen, and lengthening the psoas muscles will help alleviate back, glutes, hips, legs, and knees and improve the breath. Learning to relax the body and move from the sympathetic nervous system to the parasympathetic nervous system. The parasympathetic nervous system is responsible for our bodies ability to rest and digest. More information regarding recovery of the psoas can be found within our group.

Focusing awareness to the body sensations associated may help when practicing feeling and reducing armouring behaviors. Recovery from armouring requires body and breathe work as well as relaxation and cognitive skills/therapy or support.

More information about the intricacies of armouring can be found on our group.

Using feeling to recover from past trauma

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Grieving ingests our most painful experiences and feelings. This can cause the downward spiral, Flashbacks, suicidal ideation and active suicidality. It is imperative to have insight as to whether this recovery type is appropriate at the present moment. If one struggles with any of the four methods of grieving (anger, feeling, crying, verbal ventilation) prior work must be explored or adequately supported from a trauma informed therapist.

Through recovery, a survivor must appropriately grieve and reparent the self; leading to nurturing self thought and insight (an overview of recovery through grieving can be found here).

When we look at recovery through grieving as a whole, we see anger and crying to be the primary first stages of the journey. Both anger and crying as methods of recovery are essential in reducing inner critic attacks and increasing self compassion. Working through both anger (found here) and crying (found here) can give a survivor of trauma varying safe coping mechanisms in which to further their recovery journey. Progression of this journey leads an individual to working through verbal ventilation (found here) as a primary fundamental step prior to using feeling as a way to release one’s body from repressed memories and emotions.

Feeling emotions can be feared by both survivors of developmental trauma and adult interpersonal relationship trauma due to any previous experiences (or attempts) to express oneself having been met by further punishment or abuse. It can take a great deal of time for a survivor of trauma to begin to accept that both feeling and expression are natural instinctual forms of experience which need not be approached or dealt with by fear (and fear related behaviours).

Feeling is normal; just as angering and sadness are. Experience in full leads to the destruction of pain and associated body sensations. Through using the first three methods of grieving (anger, sadness and verbal ventilation); feeling can become accessible once more.

It is important to note the difference between feeling and emoting (reacting). Walker (2013) explains the 4 processes of grieving in his book; “CPTSD; From surviving to thriving” – this resource is freely available on our group and can be purchased online. It is an informative resource for survivors of Childhood developmental trauma who are on their recovery journey. Emoting is the reactive response one exhibits during grieving from past trauma. This takes in to account reactions of angering, sadness (crying) and verbally ventilating. Feeling however is the process of sitting with the feelings that accompany past trauma. Feeling involves the surrender of control and allowing experience of inner emotions devoid of reaction or falling back to maladaptive coping, dissociation or flashbacks.

In order to use feeling, not reaction; a survivor must shift focus from active thought to one’s body effects/sensations; being one with the body as emotions rise in order to begin to process them in a different way.

This is a step up from reacting by angering, crying and venting. Feeling in order to grieve involves passive acceptance in this final stage of the grieving process. Grieving through feeling requires an ability to place direct attention to emotionally/mentally painful states and surrender to the self without resistance. An individual must relax in to the pain of past trauma in order to absorb the energy and sensations left behind.

We know the mind and body are connected. Research shows that repressed emotions are stored within the body and produce physiological bodily symptoms in the form of chronic pain, tension and disease. These symptoms can be a symptom of emotional armouring, a common coping mechanism used by survivors of both childhood developmental trauma and adult interpersonal relationship trauma. Over time, armouring becomes accumulative and brings with it a plethora of physical manifestations.

Adult survivors of Childhood developmental trauma and adult interpersonal relationship trauma who may have been punished for self expression face increased rates of chronic disease, muscle tension, pain and spasms all said to be due to emotional armouring over what could potentially have been a lifetime of trauma(s). Feeling as a grieving method can aid a survivor in reducing the tensions and illness caused by trauma’s outside of our control.

Emotional armouring is the repression of natural expression in order to conform to expectations of family, friends or partners. This can result in an altered character; constructed to protect from the pain of not expressing by forming defenses. As our basic needs are compromised, bodily expressions ensue due to the conflict of inner desire and unnatural outer expectation conditioning attitudes placed upon us.

Emotional body armouring forms in a response to chronic trauma or the fracture of relationships/values. Recovery from trauma through feeling involves body/breath relaxation alongside cognitive work/therapy. Armouring results in symptoms such as obsessive jaw clenching, withholding of breathe/shallow breathing and tension in upper back/shoulders. More information regarding armouring and its effects can be found here.

Focusing awareness to the body sensation which accompanies emotions helps in practicing feeling. Paying attention to body sensations increases awareness of feeling and aid in the processing of emotions. Early work may include reaction responses to feelings however as work progresses; practice of being present without resistance brings optimal recovery through grieving.

Recovery is not linear. Feeling will at times bring repressed memories or emotions back to the forefront. Such new emotions and memories require to be grieved in full through all grieving methods and so recovery through grieving can be seen as a winding and unpredictable path. This journey although easy feared, is essential in order to fully accept past trauma.

Research shows that remembering events in full is not necessarily required in order to recover from past trauma. The importance is in merging both cognitive processes with body sensations and patiently and compassionately allowing oneself to grieve the injustices of the past.

With practice, feelings become less intense and more manageable. The journey of time and patience continues as an individual grieves past trauma through fully being present within ones feelings. Approaching one’s recovery in such a way is one of the most compassionate acts possible. It becomes the final gift that one can present when moving forward with life. Practice brings a sense of safety in knowing and comfort in the knowledge of one’s ability to sit with uncomfortable feelings for longer than once possible.

There are various ways in which a survivor can learn to grieve their past trauma. Using each of the four methods of grieving as an appropriate and balanced approach can transform one’s recovery journey and allow a survivor to become comfortable with the emotional distress which often accompanies trauma.

Using feeling in passive acceptance is described by Walker (2013) as being the penultimate step to recovery from trauma through grieving. His work can be found both within our Facebook group and online as he remains one of the most influential theorists within the field of trauma. Importance is placed on working through each method slowly and consistently and if required; with the help of group support or a trauma informed therapist.

Using verbal ventilation for recovery from trauma

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Verbal ventilation is a term which has been taken from literature by Pete Walker – “complex PTSD from surviving to thriving“, 2013. Walker describes each of the four methods used in grieving from trauma as a recovery tool in great detail. I intend to further provide an overview of verbal ventilation for grieving trauma (both developmental and interpersonal abuse) and provide some strategies for achieving such recovery tactic.

Verbal ventilation concerns the writing or speaking of one’s trauma and emotions in order to fully release/reflect on the repressed painful feelings associated with such event(s). Primarily; speaking holds the greatest yield in terms of recovering from trauma – writing ones feelings and experiences can be an optimal way to begin to embark upon fully ventilating through speech.

By attaching meaning to words; an individual can begin to release pain associated with past trauma. When reflecting through written word, it switches one’s left brain to become functional allowing reduced right brain symptoms (hyper vigilance, racing thought, flashbacks, emotional avoidance/flashbacks, dissociation etc) and an ability to reflect appropriately on the event(s) concerned.

Determined practice of this method can result in a survivor of trauma having a newfound ability to begin to speak their pain and hear the emotional response in their own voice. This allows for further reflection and acceptance but should be worked towards. It is not an easy method to perfect, speaking ones pain can be difficult for many survivors of trauma as they have faced abusive behavioural conditioning in response to voicing their basic human rights. For survivors of Childhood developmental trauma who have in many cases developed in such a way that speaking without self judgement becomes incredibly difficult; using writing first in order to practice a form of verbal ventilation can be helpful when working towards having the self confidence and compassion required to voice that pain.

Adult interpersonal relationship trauma often results in similar conditioning with a survivor or victim being punished for speaking out, having an opinion and judged accordingly. Both examples are what differs PTSD from complex trauma and developmental trauma as both include deep brain changes (in volume/pathways) and complex interpersonal difficulties. However both survivors of developmental trauma and adult interpersonal relationship trauma can effectively work towards finding their voice through writing to reflect. An individual can use journaling, interview style question/answers and art and creative means in order to begin processing the pain associated with the past – and slowly working towards having an ability to verbally ventilate without judgement and fear.

As one begins to hear the words, meaning becomes attached in a new way; different from the written word previously used. When we speak about our past; the words become tinged in emotion and memory and can identify repressed feeling attached ultimately removing shame and guilt from a survivor with self blame and inner critic attacks.

Speaking in an uncensored manner without fear of judgement while simultaneously focusing on feelings or body sensations provides release of the emotion of the past. For some individuals beginning their journey or using verbal ventilation for the first time; emotional identification may not come so easily. As each trauma differs; each response differs – what one recovering individual is able to attain does not equate to the other. Trauma is a multidimensional illness which differs for each and every survivor. Those survivors who can not easily identify their emotions may benefit from working on emotional labeling and processing (either alone or alongside a trauma informed therapist).

Verbal ventilation provides the same release as anger (found here) the or crying (found here) but also helps to expose the critic driven attacks which become commonplace for a survivor. When a survivor is able to increasingly verbalise and communicate their needs they take a step closer to peace. These needs that were once unmet (and unjustly so) can be attained through appropriate verbal ventilation and recovery through grieving methods. Used in succession with anger and crying; verbal ventilation serves to propel an individual with regards to recovery.

Using verbal ventilation for recovery from trauma requires courage. When hearing those words that flow from a newly freed place within; they are individually tinted and descriptive, carrying alongside anger, guilt, fear, sadness and shame. That can turn in to a dark place where the survivor may lack emotional regulation to fight off the critic attacks that can blend sneakily in to what one believes to be verbally ventilating.

Using ventilation alongside crying and anger can propel recovery through grieving and help a trauma survivor to become free from previous emotional constraints. Regular practice of this method not only increases intimacy but actually helps to remediate the brain changes which are caused by CPTSD and developmental trauma (brain changes info can be found here)

During an emotional flashback, the right side of the brain (emotion) becomes overstimulated and hyperactive while the left side of the brain function reduces considerably leading to an inability to process the emotional reaction required at that time. Verbally ventilating brings the left brain back to function. With an acquired ability to think and feel simultaneously; words translate to feelings which can be processed and resolved. There is an increase in ones ability to interpretate and communicate not only with the self but with others.

The repeated pattern of using verbal ventilation for recovery allows the formation of new neural pathways which allows the left brain and right brain to finally balance and work together ultimately leading to an ability to reflect and recover.
Such results have been seen throughout research and theorists can now see these brain changes being present on an MRI following successful verbal ventilation and reflection.

The actual practice of verbal ventilation allows alignment of both the right an left hemisphere. Whenever the right side becomes activated (I.e flashbacks); the left side can provide steps to reduce and manage the reaction.

Proficiency of verbal ventilation leads to an ability to think and feel and ultimately creates appropriate healthy responses to inner feelings. Survivors practicing verbal ventilation have shown to begin to show their selves compassion and respect the – a core trait required in ones ability to appropriately label and react to emotions.

This type of grieving method is only effective when the critic (both inner and outer) has no control over the survivor. Using anger and sadness as a first step in recovering has been proven successful in reducing critic driven attacks. Work should be completed here prior to verbal ventilation so in order to reduce the risk of oversharing or to reduce the potential from a shift from healthy ventilation to critic driven attacks (which can easily blend in to attempts to ventilate).

Verbal ventilation easily turns in to self attacking, criticism, triggering or intensifies flashbacks. For these reasons; practice in verbal ventilation should be approached slowly and if possible with support (from a recovered spouse, friend or therapist). It is common for survivors of trauma to be unaware of this shift from ventilation to critic attacks. This may be due to the nature of trauma itself and how an individual may have been forced to develop over the course of their life and trauma.

Practiced alone, verbal ventilation can be helpful. There is no other person available to hear or judge the emotive words and memories held by a survivor and can be a great starting point in recovering from trauma through grieving. It is important to note that verbal ventilation should only be completed alone if the survivor is fully aware of critic attacks.

Support can be beneficial in helping a survivor to recognise and neutralise critic driven attacks, through repeated practice; this healthy response becomes formed in those new neural pathways and thus becomes second nature in which to practice.

Verbal ventilation heals trauma and abandonment by improving our connection to others. Sharing what is important to us through ventilation forges new healthy connections with others. Completed within a safe environment and relationship; humans have an instinctual desire for verbal-emotional intimacy. Doing so creates connection and friendship increasing one’s positive experience and fueling desire to repeat successfully.

Sharing itself can be triggering for a trauma survivor. A survivor of developmental trauma may have spent their entire childhood being taught that it is not beneficial to share or open up. In fact, many cases of both interpersonal abuse and childhood trauma impacts an individual’s ability to voice opinion never mind inner most feelings. In cases of trauma with no clear beginning, middle or end; difficulties arise with perception and interpersonal relationships. This can be the hardest hurdle to recovery however can be efficiently counteracted through group or individual support (or more preffered; from a trauma informed therapist).

Trauma survivors who have successfully terminated relationships with abusers often re enter toxic relationships and can over share as a coping mechanism to past trauma. This type of verbal ventilation is not effective in recovering from trauma through grieving. Oversharing causes vulnerability and actually harms relationships by not only providing others with fearful information but by causing others to question life and their own self in the process. When an individual over shares; they reduce the strength of their personal boundaries. Boundaries which are set in order to protect.once those boundaries become blurred; it becomes more likely that the individual in question will face further trauma from interpersonal relationships.

Verbal ventilation increases intimacy through bringing comfort and restoring connection between oneself and others. Sharing appropriately produces a bond through mutual sympathy and a desire to connect. This can aid a survivor in being more emotionally intimate with their partner or within common relationships.

Grieving through verbal ventilation also reduces the abandonment fears and depression associated with past trauma. Through cognitive work and practice of verbal ventilation techniques a survivor can not only build neural pathways but form new connections and experience further positive outcomes as a result.

Tips for ventilation

Start by writing – if you have never experienced verbal ventilation it can be beneficial to build a fundamental base through first writing ones experiences. Writing for ventilation includes journaling, writing poetry, creating song lyrics, writing personal memoirs and using an interview style structure in order to aid processing and reflection.
When writing it can be helpful to write without worry of spelling, punctuation or structure. Ventilation through writing concerns an individual writing everything and anything that comes to mind – no matter how insignificant it feels at the time. Worrying about one’s punctuation or structure is incredibly counterproductive and causes the left side brain to take over from feeling.

Music as a tool – a mediator step between writing and speaking emotions would be to use music to express how you feel. When reflecting on past abuse; assigning a particular music type to it can really aid a survivor in beginning to become used to hearing the sounds of emotions as a protective step prior to verbally ventilating.
Different genres may touch you in different ways. Try all genres of music until you find one that feels right. Whether that be classical, rock, dance, pop, piano, rain sounds or meditation – assigning meaning to music can be a productive tool especially during flashbacks.

Practice – using any of the four grieving tools as a recovery tool is not a quick process. Accept that such practices of recovery can take a while to adopt. Over time it can be helpful to reflect on the progress that you have made over your time grieving.
Reflection – write down or journal emotions and feelings for the day, it may be helpful to follow a script or pre written interview when reflecting. Journaling is an effective way to set small; attainable goals whilst tracking them as well as providing opportunities for self reflection, offloading of thoughts and allowing an alternative response to be explored. Journaling or reflecting can also be useful for a survivor of trauma when attempting to replace negative self talk and behaviour.

Replace negative with positive (the key is balance) – it can be common for a trauma survivor to become enmeshed with one’s negative inner critic.
The inner critic can manifest to one’s own personality and become enmeshed in ones identity making it difficult to separate. As life continues, the critic begins to take the driving seat in ones own reactions and perception. Fighting the critic reduces such attacks by substitution of thought (replacing negative self talk with positive) and thought correlation (when i revert to; “shut up!” I will instead ask for a break etc). Such reflection leads to an increased sense of personal likeability and desire for interpersonal boundaries.

Feel, accept, reflect – feel the emotion and label it, whatever it be it is important for recovery to fully accept that its ok to be feeling in this way. It can be helpful to remember our key phrase; “I feel – – – and because I choose to feel this way.” and repeat that until emotions return. Focusing on one’s breath can be beneficial in aiding the body to physically return to normal in the sense of its biological processes.

Work with support

Support gives a survivor a second set of eyes and opinion, in many cases support can be helpful in allowing a survivor of trauma to face difficulties with conflict (either self or relationship). Support from a trauma informed therapist can be important to work through the various issues which survivors of trauma face in their day to say life, providing validation and building confidence and ultimately helping build a strong foundation for which to recover. Many survivors may not feel comfortable using a therapist for support or may not be in the place to do so. Support can come in all forms, our group supports survivors by providing knowledge and information about our own trauma in order to help others feel less alone, online friendship can be beneficial for a survivor beginning their recovery journey as it removes the uncontrolled aspects of making and maintaining “real world” friendships.

Focus on the little things

Focusing on the small positives on one’s life can also aid a survivor in managing to balance anger appropriately. Reflecting on the reason behind the anger as well as balancing with reasons they are still OK in this moment can really cement a survivors recovery especially during difficult times.
This can be achieved by replacing negative self talk with more positive affirmations and balancing the in-the-moment anger that a survivor of trauma experiences. Practicing gratitude can be helpful in building these skills.

Build a positive circle

In this age of technology and at a time of lockdown restrictions and recommendations, a circle can be a small number of online relationships and friendship. There is no neccesity in meeting face to face, the goal primarily is to form a positive trusting circle with similar individuals of whom you can open up and reflect with. Reflecting in a group can propel recovery as the brain reacts to the opinions of one’s “pack” more intensely than individual thought.

Work on staying in the present

It is common for a survivor of trauma to over analyse the past in an effort to try to understand it. This is an important aspect of recovery however focusing on just one aspect leads to an imbalance and uneven recovery. Working on staying in the present not only helps an individual from basing present day decisions on past experience but gives a sense of freedom from past abuse. As the singular event(s) is over (and in some cases ongoing); the only fuel that can be given to it is that of a survivors own mind.

Although it is imperative to process the symptoms of trauma and at times the event that occured; it must not be forgotten to balance this with healthy expression in all forms. A balanced approach stops a misdirected recovery and helps a survivor of trauma to begin to live again.

Using crying to recover from past traumatic experiences

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The opposite to anger (recovery through anger can be found Here), crying and grief/sadness usually follows angry expression and has a close relationship in terms of recovering from trauma through grieving.

Recovering from trauma through crying

In recovering from trauma, survivors face a phase of grieving in order to propel and resolve overwhelming feelings associated with past trauma. Recovery through grieving allows an individual to work through the loss associated with experiencing trauma. Grieving effectively aids trauma recovery and helps a survivor of trauma with the death-like feeling of being lost/trapped within trauma flashbacks and memories (am overview of recovering from trauma through grieving can be found here)

Crying as a recovery tool brings relief in the same sense as anger and both work alongside the other in achieving total release of repressed emotion. Both anger and crying free a survivor from the abandonment which trauma caused.

Although both crying and anger are the main tools in recovering from trauma through grieving, an unbalanced approach is not only difficult for others to react to but can lead to negative outcomes with regards to maladaptive coping and interpersonal relationship issues. Having this in mind; the utilisation of both anger and sadness (grief or crying) can actually be socially deviant. In terms of socioeconomic culture and gender perceptions – using anger and sadness fully (in their full spectrum of feeling) can be viewed by others negatively.

Many cultural differences can impact the ability to use grieving methods throughout recovery. It does not however negate the importance of both methods being required in order to grieve effectively and fully. The British culture is renowned for its stereotypes just as any other country is. Typically, British culture is viewed as individuals who have a stiff upper lip. This refers to the concept that the British are quite reserved; keeping their emotions and feelings to themselves. With regards to the authenticity of this stereotype I am not going to debate, however generally speaking as a culture; we tend to not express ourselves as fully as we perhaps should and this will have implications when recovering through grieving.

Gender stereotypes also play a part in an unbalanced grieving response and of course age, life experience and socioeconomic status. As far as gender perceptions are concerned; males commonly show an imbalance with favouring anger as a grieving response as opposed to females who tend to use grief and crying in an attempt to fully express oneself and ultimately recover from using such grieving methods. As helpful as one method can be, an imbalance of one or the other can lead to reactionary behaviour and further repressed emotion. If possible; a survivor of trauma should attempt to balance both anger and grief when recovering. Of course only one emotion can be felt at any one time and that is completely natural. Each phase should be fully experienced on their own and in conjunction in order to fully express emotions which may have previously been unresolved. There is a cut off where coping solely with anger or grief turns maladaptive, a balanced approach has shown to be more effective in terms of recovery.

Incomplete release comes from an unbalanced grieving response. That is in terms of emotions being stored in the body and resulting in reactionary responses to both the outside world (outer critic) and self (inner critic).

Having the ability to cry without judgement actually serves to stimulate relaxation and self growth. For a survivor of trauma; ones grief and sadness may have been met by disdain or an increase in abusive events and or punishments. This can result in many survivors of trauma having great issue in terms of dealing with grief and the emotional issues that arise from said response. Crying however balances the parasympathetic nervous system; which Walker (2013) states helps to balance hyperarousal commonly experienced during flashbacks and associated trauma symptoms.

When a baby is born; it first expresses fear/anger and loss of safety as it initially screams. This is more often than not followed quickly by sadness and grief over the loss of the womb – its safe place. The newborn is quickly consoled by direct skin contact from its parental figures – more importantly; the mother. That bond that formed over 9 months is finally met in environment and the familiar smells and breathing of the mother provides an alternative nurturing comfort which was once provided in utero.

Humans are built to connect, to feel safe and to express freely. Over the developmental period however this free expression becomes stifled. Although it becomes more difficult to express in terms of sociocultural difficulties, it is still one of the most important aspects of recovering from trauma through grieving.

Using crying aids a survivor who also deals with negative self critic attacks. Crying stops the inner critic by releasing fear before it turns to a trauma response (I.e a flashback). Crying as a grieving tool actually dissipates fear, shame, guilt, self abandonment and increases a survivors ability to process anger (which in turn aids grieving).

Recovery from trauma through crying allows a survivor to grieve and provides a cathartic release which leads to fully mourning the losses associated with past trauma and abuse. This may take the form(s) of grieving over lost relationships, a lack of nurture or sense of self. When a survivor is able to feel the natural sorrow of the horrors of their past; it leads to experience and connection with not only the self but with others.

It is important that a survivor who is using grieving as a recovery tool has an ability to accept crying and sorrow whilst simultaneously riding the wave of emotion in its entirety. Fully experiencing sorrow leads to an increase in self compassion as the survivor forgives oneself for the myriad of trauma events that occurred at the hands of another.

Repeated practice of fully expressing emotions allows said practice to become habitual and this becomes the cornerstone in recovery. The increased self esteem and reduction in flashbacks and trigger reactions leads to a reduction in personal abandonment fears. As crying increases self compassion; a survivor begins to see a positive correlation with regards to maintaining healthier relationships.

With the newfound ability to be present and available begins to aid a survivor in developing new friendships which are healthier than previous experience. The release of repressed grief increases self allegiance and strengthens confidence and self esteem while providing a solid foundation in which to lay boundaries. These new additions to one’s recovery toolbox serves an individual in their personal relationships with others and the self.

In reference to a survivor who faces incomplete expression; tension may build within the body and the mind. This can range from self hate (controlling behaviour), outer critic attacks, 4f response reliance or maladaptive coping. This blocked anger or sadness usually results from repressed crying or feeling resulting in decreased lower limb activity, avoidance, headaches, dry mouth, fatigue, chest pain, chronic pain, stomach pain, nausea, behavioural overreaction, self harming behaviour and substance abuse/reliance or addiction.

Denied feelings result in limited beliefs, a lack of appropriate risk taking and poor connection. It can be helpful to use the phrase; “I feel – – – the because I choose to feel this way.” when dealing with emotional reactions that feel overwhelming.

In order to completely grieve, an individual must gain some form of closure. As is the case with anger; a survivor who is not able to fully process either sadness or anger should not continue trying to recover from past trauma through grieving. Support should be sought from a trauma informed therapist in order to complete the fundamental background work required prior to continuing their recovery journey.

Other helpful ways in which to grieve through sadness include;

Reflection – write down or journal emotions and feelings for the day, it may be helpful to follow a script or pre written interview when reflecting. Journaling is an effective way to set small; attainable goals whilst tracking them as well as providing opportunities for self reflection, offloading of thoughts and allowing an alternative response to be explored. Journaling or reflecting can also be useful for a survivor of trauma when attempting to replace negative self talk and behaviour.

Replace negative with positive (the key is balance) – it can be common for a trauma survivor to become enmeshed with one’s negative inner critic.
The inner critic can manifest to one’s own personality and become enmeshed in ones identity making it difficult to separate. As life continues, the critic begins to take the driving seat in ones own reactions and perception. Fighting the critic reduces such attacks by substitution of thought (replacing negative self talk with positive) and thought correlation (when i revert to; “shut up!” I will instead ask for a break etc). Such reflection leads to an increased sense of personal likeability and desire for interpersonal boundaries.

Motion releases emotion – simply getting up and moving your body can switch uncomfortable feelings to a more tolerable level. This can be helpful when fully expressing grief in order to ride the wave but also provide relief. As trauma and unresolved emotions are stored in our body; it is as equally important to work on releasing repressed trauma from the body through muscle release or meditation. Participation in trauma release exercise can really aid a survivor in letting go of the pent up emotions which become stored within our body. More info and examples of TRE can be found in our Facebook group.

Feel, accept, reflect – feel the emotion and label it, whatever it be it is important for recovery to fully accept that its ok to be feeling in this way. It can be helpful to remember our key phrase; “I feel – – – and because I choose to feel this way.” and repeat that until emotions return. Focusing on one’s breath can be beneficial in aiding the body to physically return to normal in the sense of its biological processes.

Heightened emotional states produce biological reactions similar to those experienced in a flashback. Breathing and taking mindful breaths can return one’s heart rate, blood pressure, cortisol and adrenaline to lower levels. Focusing on any abdominal sensations can be helpful when dealing with grief as it is stored within the GI system as well as mind.

Using both anger and grief in order to recover from past trauma can be liberating and freeing; however it is not a quick fix. Using appropriate grieving methods in which to recover can take years in order to fully process however does provide a survivor of trauma with that release necessary for both the body and mind to recover.

Using anger to grieve past trauma.

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In recovering from trauma, survivors face a phase of grieving in order to propel and resolve overwhelming feelings associated with past trauma. Recovery through grieving allows an individual to work through the loss associated with experiencing trauma. Grieving effectively aids trauma recovery and helps a survivor of trauma with the death-like feeling of being lost/trapped within trauma flashbacks and memories. An overview of recovery through grieving can be found here

Using anger as a grieving method

In order to recover from trauma; it can be helpful to grieve the loss of self through the four responses of grieving; anger, sadness, verbal ventilation and feeling.

Using anger as a grieving tool can serve to benefit a survivor of trauma by replacing critic driven attacks of the self with an increased self compassion and the revival of past protective instincts.

In order to vent the injustice of past trauma and injustice, a survivor must embrace the disdain of previous events and their outcomes. Trauma brings a sense of loss; the loss of one’s sense of self, compassion and perceived safety. As social animals, humans crave a sense of belonging. Grieving the loss of one’s sense of self is imperative to recovery from trauma.

Anger is a natural emotion, a warning sign that self protection is necessary as ones boundaries are tested or crossed. As a base emotion for a plethora of underlying injustices – anger is grown by the need to protect; humans are born to express emotions freely; this Instinct can become dulled through social circumstance and experience; making the notion and act of anger difficult to attain.

Anger must be processed in the mind and body; unresolved emotions such as anger can cause a range of issues for an individual. Repressed anger presents as; sarcasm, self sabotage, abandonment fears, muscle tension in the jaw, upper back and stomach; fatigue, a compromised immune system, nail biting/picking/chewing, substance reliance/dependence, addiction, control issues, difficulties saying “no”, passive aggressive communication styles and at times ultimate denial. An individual with repressed anger may be in such a state of denial they believe they are inherently happy however display physiological or psychological reactions which indicate an anger response.

It is important to note that for those survivors who cannot express anger (or any of the grieving methods) work on with a trauma informed therapist should be completed prior to recovering through grieving. In such instances, emotional labeling and becoming aware of one’s emotional waves is a great fundamental basis for prior grieving work.

Whether anger is managed alone or with support, working through such feelings alone can be incredibly beneficial in building a sense of armour in order to protect oneself from inner critic attacks.

Anger is a deep emotional response that can be productive or destructive; to oneself and others and especially if not used appropriately. If anger is processed in maladaptive ways; it can lead to the manifestation of unsafe coping and further issues with mental health. There is no need to rage directly at the abuser, especially if a survivor is still within the dynamics of abuse. It is important to remember that only some growth can be obtained whilst residing within similar toxic conditions as these circumstances will inadvertently cause triggers, Flashbacks and reliance upon one’s survival mechanisms (leading the survivor unable to fully reflect or gain appropriate perception of their environment or reactions).

Using anger to grieve past trauma rescues a survivor from feelings of inadequacy and powerlessness they once were forced to experience. Through self defence and protection, anger releases a survivor from the chains of past abuse and expectations.

When a survivor is able to vent the injustices of the past; complain of past loss (both loss of self and loss of perceived safety/nurturing relationships) and rage about previous intimidation tactics used against them – they open themselves to a new world of forgiveness and compassion. Not forgiveness of the abuser as that is not necessarily required in order to grieve, but forgiveness of the self and the reparenting (and nurturing) of one’s inner child.

It is perfectly acceptable and is encouraged that a survivor rages the neglect, humiliation, lack of safety, betrayal, protection and lack of guidance they faced or endured. To be able to accept that what happened was only the fault of those who chose to do unthinkable acts and not the fault of ourselves is to open our horizon to freedom and inner peace. When we have spent the majority of our new lives berating or criticising ourselves not only does the inner critic take on its own identity, we become used to speaking and treating ourselves in the exact same way the abuser did. We are angry at the fact the situation occurred in the first place more than the intricate acts of abuse we independently experienced.

The inner critic can manifest to one’s own personality and become enmeshed in ones identity making it difficult to separate. As life continues, the critic begins to take the driving seat in ones own reactions and perception. Fighting the critic reduces such attacks by substitution of thought (replacing negative self talk with positive) and thought correlation (when i revert to; “shut up!” I will instead ask for a break etc). Such reflection leads to an increased sense of personal likeability and desire for interpersonal boundaries.

Anger is a great tool in using to defend against critic centered attacks. The “shut up” one may revert to telling oneself can be counteracted by thought substitution and correlation which eventually becomes habitual. Stopping self hate and blame by redirecting the anger a survivor may feel towards the self with anger to the event can help to aid one’s self compass and realign ones inner needs and desires.

Anger as a grieving method also teaches a survivor to assertively respond to the self and others. It revives previous lost instincts of self protection and defence as ones inner boundaries increase; a survivor gains confidence in furthering their recovery by taking more risk and building positive experiences.

Emotional avoidance is a common maladaptive way of coping with anger. It is natural for a survivor to fear anger, in many instances anger was used as a precedent to abuse faced and so in a survivors adult life this emotional response becomes tangled with negative past experiences as well as poor self reflection and compassion making ultimately a fearful response.

Being accepting of anger as a natural emotion is crucial in using it effectively to recover from past trauma. The biological reactions that anger brings can also be used to one’s advantage; the adrenaline and cortisol can be used to get tasks done, to process emotion and to strengthen boundaries.

Anger can be productive and empower or it can take on a destructive form and turn to envy, hate, disdain, bitterness and distrust. Each destressing facet that anger may bring only arrives through maladaptive use and coping. Anger as an emotional response has a natural curve and will dull, having safety in this fact is imperative; knowing that the anger you feel is temporary and as a protective measure can be beneficial in using it safely.

This technique of recovery is not a short process. Anger naturally presents itself across recovery. The key is in using it when it does arrive to be productive to one’s trauma recovery; by using anger to positively recover one’s inner psyche over years of background work.

The reconstruction of anger towards abuser(s) limits the potential for a survivor to reenter a new toxic relationship. As is common for many survivors of trauma; toxic relationships can cause compounding of trauma experienced and a plethora of issues with retraumatization. Allowing oneself to feel the anger that is natural will open new parameters to reflection which will allow a survivor to see warning signs clearly and employ a reactionary style to preserve their inner self.

Using anger effectively increases personal boundaries and gives it strength as well as increasing self confidence and compassion. All three absolutely essential in furthering ones recovery journey, it is not without the other that one can fully accept oneself and release the blame and guilt that has been unresolved.

It is important for a survivor to take time in assessing healthier ways to express anger and use it safely. Some ways that anger can be expressed in a healthier manner are covered below

Work with support

Support gives a survivor a second set of eyes and opinion, in many cases support can be helpful in allowing a survivor of trauma to face difficulties with conflict (either self or relationship). Support from a trauma informed therapist can be important to work through the various issues which survivors of trauma face in their day to say life, providing validation and building confidence and ultimately helping build a strong foundation for which to recover. Many survivors may not feel comfortable using a therapist for support or may not be in the place to do so. Support can come in all forms, our group supports survivors by providing knowledge and information about our own trauma in order to help others feel less alone, online friendship can be beneficial for a survivor beginning their recovery journey as it removes the uncontrolled aspects of making and maintaining “real world” friendships.

Muscle release

As trauma and unresolved emotions are stored in our body; it is as equally important to work on releasing repressed trauma from the body through muscle release or meditation. Participation in trauma release exercise can really aid a survivor in letting go of the pent up emotions which become stored within our body. More info and examples of TRE can be found in our Facebook group.

Focus on the little things

Focusing on the small positives on one’s life can also aid a survivor in managing to balance anger appropriately. Reflecting on the reason behind the anger as well as balancing with reasons they are still OK in this moment can really cement a survivors recovery especially during difficult times.
This can be achieved by replacing negative self talk with more positive affirmations and balancing the in-the-moment anger that a survivor of trauma experiences. Practicing gratitude can be helpful in building these skills.

Build a positive circle

In this age of technology and at a time of lockdown restrictions and recommendations, a circle can be a small number of online relationships and friendship. There is no neccesity in meeting face to face, the goal primarily is to form a positive trusting circle with similar individuals of whom you can open up and reflect with. Reflecting in a group can propel recovery as the brain reacts to the opinions of one’s “pack” more intensely than individual thought.

Work on staying in the present

It is common for a survivor of trauma to over analyse the past in an effort to try to understand it. This is an important aspect of recovery however focusing on just one aspect leads to an imbalance and uneven recovery. Working on staying in the present not only helps an individual from basing present day decisions on past experience but gives a sense of freedom from past abuse. As the singular event(s) is over (and in some cases ongoing); the only fuel that can be given to it is that of a survivors own mind.

Although it is imperative to process the symptoms of trauma and at times the event that occured; it must not be forgotten to balance this with healthy expression in all forms. A balanced approach stops a misdirected recovery and helps a survivor of trauma to begin to live again. Anger, although commonly feared is a useful emotion to express with regards to grieving trauma.

Recovery through grieving

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In recovering from trauma, survivors face a phase of grieving in order to propel and resolve overwhelming feelings associated with past trauma. Recovery through grieving allows an individual to work through the loss associated with experiencing trauma. Grieving effectively aids trauma recovery and helps a survivor of trauma with the death-like feeling of being lost/trapped within trauma flashbacks and memories.

Some methods of grieving are inaccessible to trauma survivors dependant on where they are in their own recovery and personal experience they have faced. For example, a trauma survivor may not be able to show anger or have the ability to cry, ventilate verbally or express feelings. Work should therefore explore this prior to grieving as a recovery intervention.

Grieving ingests our most painful experiences and feelings. This can cause the downward spiral, Flashbacks, suicidal ideation and active suicidality. It is imperative to have insight as to whether this recovery type is appropriate at the present moment. If one struggles with any of the four methods of grieving (anger, feeling, crying, verbal ventilation) prior work must be explored or adequately supported from a trauma informed therapist.

Through recovery, a survivor must appropriately grieve and reparent the self; leading to nurturing self thought and insight.

Insight is crucial; it helps a survivor respond to their past experiences with kindness and self acceptance. As a survivor works through the common losses that trauma will bring; insight leads to the need to process unresolved grief.

Trauma causes loss within an individuals psyche. Recovery through grieving works through the loss associated from trauma such as; a loss of Childhood, of relationships, a loss of trust in others and personal ability to protect or express feelings; the loss of safety or the loss of the perception of safety, a loss in an individual’s sense of self (self compassion or self esteem), a loss in the sense of belonging and the heartbreak of (potentially numerous) failed attempts to win approval or affection. Each of these losses that has been caused by past trauma leads an individual to grieve the original act and consequences of such.

It is only through grieving, building the inner critic and processing unresolved grief that an individual can heighten their recovery. Where first insight is required in order to understand the loss personally experienced it becomes a catalyst in recovering through grieving and finding peace within the self.

As a survivor of trauma begins to grieve and evolve; it is common to uncover unresolved grief from the absence of nurturing experience. It is within this insight that a survivor can begin to understand how unmet needs in childhood or within interpersonal relationships may lead an individual to have to reparent one’s psyche in a nurturing way in order to feel peace.

Survivors who are not able to appropriately grieve their past trauma (due to inability to express) may benefit from additional support from a trauma informed practitioner. It can be helpful to look within the body as a way to balance the difficulties that trauma symptoms may bring. Until such times, recovery through grieving should not be attempted.

Mourning the awful realities that we have experienced creates a self empowerment which ultimately acts as a catalyst in our own self care and compassion. However on this journey of recovery through grieving; many instances can bring about an acute onset of trauma symptoms which have to be addressed patiently and in a nurturing way as our mind begins to provide us opportunity to successfully self parent in a way we perhaps have not experienced before.

With sufficient grieving and support, a survivor can grieve oneself out of shame, guilt and fear. Sufficient grieving bringa the knowledge that one was innocent at the time of abuse. It is this insight which sticks and remains a constant as the recovery journey begins to progress. As self compassion and acceptance builds; the survivor is said to become ready and able to face the challenges that complex trauma can bring.

The increase of self compassion allows an individual to parent themselves (be there for) no matter what they may be experiencing internally (inner critic) or externally (outward reaction).

The inner critic is explained by Pete Walker in his book; “CPTSD; from surviving to thriving”, 2013. Walker explains that it is the inner critic that can become the greatest difficulty to recover from and cause the most issue with regards to recovery through grieving. The toxic inner critic attacks can leave a survivor of trauma feeling punished before grieving can fully be explored leading to an exacerbation of symptoms instead of relief. When tears automatically trigger toxic shame (“I’m so pathetic!”) or inner critic attacks; it is imperative to cease recovery through grieving and seek support in order to validate and pick through such attacks.

In such cases where an individual struggles with one of the 4 types of grieving, prior inner critic work should be explored before grieving can begin.

With reference to the critic, it is driven by fear. This can cause an acute onset of trauma symptoms including; flashbacks, critic attacks and intrusive thought. Fear is a core emotional experience (Walker, 2013). In such instances, emotional tools can be helpful in metabolising and managing fear responses. It is through the four grieving responses that fear is released from the psyche, by crying, angering, verbally ventilating and allowing oneself to fully feel and ride the wave of emotions. Unfortunately, each of these 4 responses to grieving can become internalised and magnified and thus start to create personal difficulties with recovery. Recovery is enhanced when a survivor can use each response to grieving in a rational and balanced way, in a way which shrinks the inner critic and allows for the highest optimal progression throughout recovery.

As we look more in depth at each response to recovering through grieving; we can identify which area or response we may find difficulty in. Our insight will aid us in creating a stronger and more nurtured individual psyche as we begin to self parent in the way by which we require in order to grow within.

As we continue to work within the body in releasing the past trauma, we make space for this new form of recovery to ensue. As time progresses our journey becomes more bountiful as we begin adding to our psyche in ways to help our inner child grow and feel safe again. We replace the fear and loss of our sense of self by our new constructed psyche as we continue on the road to recovery; we find things easier to integrate and interpret within our daily lives.