Soothing Triggers & Flashbacks: Complex Trauma, PTSD & C-PTSD

This is a conversation I had with a therapist in my early twenties. This therapist, while good-intentioned, applied a very common intervention for those who experienced singular traumatic events. 

However, in my case, I had experienced chronic abuse that occurred over a decade of my childhood by my primary caregiver. The abuse started as early as I could remember and therefore, the abuse colored my developmental milestones. For those who experienced chronic trauma, like myself, exploring one’s identity becomes more complex, and de-threading abusive messaging from self-worth, relational roles, and boundaries becomes more important than a compare and contrast with who we were before and after a traumatic event. But someone who isn’t a trained complex PTSD therapist may not be aware of such nuances. 
 

Post-traumatic stress is completely normal. 

As we adjust to life after exposure to a life threatening event, either by directly experiencing it, witnessing it, having a loved one experience it, or hearing it over and over again; our bodies and minds try to do their best to protect us from experiencing that ever again. Therefore, it’s normal to look for signs of danger so that we can escape the danger before it happens.

But if these symptoms continue to persist for longer than one month, then clinicians begin to consider a Post-traumatic Stress Disorder (PTSD) diagnosis. Clinically speaking, PTSD is a diagnosis that is applied to a cluster of symptoms that typically relate to a single traumatic event. Symptoms include:

• Intrusive thoughts, memories, or sensations related to the trauma
• Avoidance of reminders
• Negative changes in thoughts, beliefs, memory, and/or mood
• Changes in how the body reacts to one’s environment (e.g., feeling tense, on edge, difficulty concentrating). 
   

These symptoms may further impact our daily functioning, relationships, and ability to manage our responsibilities.
More well-known examples of events that lead to PTSD include being in military combat, surviving a natural disaster, and experiencing physical assault. Other less known examples include exposure to emotional abuse, psychological abuse, childhood trauma, sexual violence, and interpersonal violence. 

What is the difference between PTSD and C-PTSD?

While PTSD offers language to understand the feeling of reliving the traumatic event, persistently feeling unsafe or in danger, and avoiding reminders of the traumatic event; the PTSD diagnosis doesn’t necessarily do a great job of capturing the ways that complex trauma may impact how a person functions emotionally, relationally, and individually with the self. 

Renowned trauma expert, Dr. Judith Herman coined the term complex PTSD, which typically follows sustained or repeated exposure to trauma in which it was nearly impossible or impossible to escape. In addition to the symptoms of PTSD, C-PTSD also captures difficulty calming oneself down (i.e., emotion regulation), negative beliefs of oneself (e.g., worthlessness, shame or guilt associated with the trauma), and difficulty developing and sustaining close emotional bonds with others. 

These symptoms can make it really hard for the survivor to function on a day to day basis. The simplest of tasks no longer seem so simple, as symptoms can occur without warning and disrupt how we manage daily responsibilities. During symptom flare-ups, all of a sudden, things like making meals, showering, or even picking up the phone can feel like monumental tasks. Regular day to day tasks can end up being over-stimulating or triggering which can make going to classes, work, the grocery store, or even being in one’s home that much more difficult. 

What are C-PTSD triggers or activations?

PTSD and complex PTSD triggers can be seen as anything that may remind a person of the traumatic event(s) that leads to heightened dysregulation. PTSD and complex PTSD triggers can elicit strong emotional responses that can be incredibly overwhelming for the survivor. Depending on the nature of the traumatic event that was experienced, triggers may present differently in every survivor. 

WHAT ARE FLASHBACKS?

PTSD or complex PTSD flashbacks are moments of re-experiencing the trauma as if it’s happening right now. Flashbacks can occur in the form of images, physical sensations, thoughts, or emotions. These C-PTSD attacks can make us feel out of control and back in a time when we felt helplessness and terror.
For those with complex PTSD, it’s common to experience emotional flashbacks. When we notice going into a shame spiral after being triggered, that’s a clue that we might be experiencing an emotional flashback. 

COPING WITH C-PTSD TRIGGERS AND FLASHBACKS 

There are a number of ways to cope with PTSD or complex PTSD triggers and flashbacks. Ideas that I often provide clients are based on what symptoms tend to present for them. 
For hyperarousal symptoms (e.g., panic, hot, sweaty, fight or flight), I like to suggest the following:

TIPP: A collection of coping strategies that can help when one is in a heightened state of dysregulation from Dialectical Behavioral Therapy (DBT). 

• T: Temperature change (e.g., splashing cold water on the face)
• I: Intensive exercise (e.g., jumping jacks, burpees, push ups, running)
• P: Paced breathing (e.g., 4-7-8, box breathing)
• P: Progressive muscle tense and release exercise
   

For hypoarousal symptoms (e.g., numbing, dissociating), I like to recommend strategies like: 

• Gentle movements of the extremities
• Rubbing hands together to generate heat
• Consuming something warm
• Taste something sweet or sour
• Observe visually stimulating art / nature

For both, I believe that seeking a sense of safety is of utmost importance. You can do this through grounding exercises in a safe place. Examples of grounding can be pushing your feet into the ground, leaning against the wall, touching a tree, identifying 5 things you can see, 4 things you can feel, 3 things you can hear, 2 things you can smell, and 1 thing you can taste. 

We can also help to calm our bodies after being triggered by doing vagus nerve stimulation exercises such as humming, singing, laughter, deep breathing, or scalp massage.

Methods I personally like to use when triggered center on getting back into my body by doing things like: 

• Physically shaking a part of my body
• Getting out of the room I’m in
• Saying a mantra or word to bring me back
• Tracking my breath

Engaging in strategies to come back into the present reality helps remind your brain, body, and nervous system that you are not under immediate threat.  
 

Treatment methods for C-PTSD to consider.

When looking for treatment for C-PTSD, it can be easy to get overwhelmed. From talk therapy to somatic therapy to equine—which one do you choose?
Some common treatments for PTSD include Eye-Movement Desensitization Reprocessing (EMDR), Cognitive Processing Therapy (CPT), and Prolonged Exposure (PE), to name a few. 

For complex PTSD, treatments like Internal Family Systems (IFS) or somatic therapy may help to treat more of the nuances of complex trauma. That doesn’t mean that treatment like EMDR won’t work for complex trauma. It all boils down to how your therapist understands the nature of the trauma you’ve experienced and how treatment modalities may be tailored to best fit your needs. Regardless of which modality you choose for therapy, remember to go at your own pace and to trust your intuition around the quality and efficacy of your care.

MY COMPLEX TRAUMA RECOVERY

As a complex trauma survivor myself, I have found living with complex PTSD to be a collection of practices for living, grounding, soothing, retreat, and re-engaging. I have learned how to give myself the same kind of spaciousness I give others in relationships. That is, give myself space to be messy, afraid, confused, curious, and happy. The space to identify my needs and allow them to be met. It’s a process of getting to know myself and the world again, while learning how to dismantle the lens of danger that has been placed on my perception of the world. 

Ultimately, my C-PTSD recovery has been a multifaceted process of learning how to live from a place of consent and harnessing the ability to choose how I engage in the world, rather than being controlled by the reactions to threat my body, mind, and nervous system has been trained to do in an attempt to protect me. 

 

Healing from C-PTSD is a process.

While healing from complex trauma can feel overwhelming at times, it is a process that can yield incredible moments of self-discovery, reparenting, and empowerment. Along the way, we can learn a collection of strategies to cultivate a sense of safety. For those of you considering trauma therapy, it may help to visit a website like the C-PTSD Foundation or Psychology Today. There, you can search for a complex / PTSD specialist near you. For other resources that can help in your healing, check out Incest AWARE or RAINN. No matter what path of healing you take, remember to take it easy, lean into areas of nourishment, and go at the pace of your nervous system.