Self-Compassion Heals PTSD
Learn how the top PTSD therapies focus on accepting yourself.
Posted March 4, 2019
I find it fascinating that accepting and loving yourself can heal things like flashbacks, panic attacks and feeling on edge all the time. The science of it seems so strange. But it’s true. These miseries are some of the symptoms of post-traumatic stress disorder (PTSD), and they get better as we learn to understand and accept ourselves, and sometimes the world around us.
The fancy-sounding therapies that treat trauma and PTSD don’t seem on the surface to be about self-love, but that’s often what they are. Technical terms like cognitive behavioral therapy (CBT) and prolonged exposure make these treatments sound complicated. Sometimes they can seem to be, especially at the beginning. But when it comes down to it, all of the proven therapies that heal PTSD and related conditions peak in the same place. The proven trauma therapies all lead us to new insights that might sound something like, “I did the best I could at the time,” “I would never hurt anyone on purpose,” “Most people don’t mean to hurt me,” and “We all are inherently worthy of love.” I've watched this moment over and over again with my clients, and it's why I believe so strongly in these evidence-based therapies.
Another curious thing is that we don’t usually come to these insights because a therapist directly teaches them. The last thing many people with PTSD are able to hear is, “It wasn’t your fault,” (sorry Good Will Hunting). In fact, PTSD counselors are usually taught not to say this, because it runs the risk of the client then needing to defend more strongly the belief that whatever happened really was his or her fault.
Instead, skilled trauma therapists help clients go back to the memory of the trauma (in various ways, depending on the therapy) so they can come to new meanings on their own. Getting stuck in our heads at or just before this place is what causes PTSD symptoms. We’re afraid of the shameful thoughts and feelings, so we avoid them, and then they aren’t able to make sense of what happened and heal.
Put in other words, rather than slogging through the scariest stuff, we get stuck in the mud and can’t go anywhere. Then, because that's not a normal way for the human brain to function, we develop nasty symptoms like nightmares, hypervigilance, and fears of uncertain situations like crowds. Because after all, if we’re to blame for bad things that happened to us, we probably don’t feel very confident to function in the world in general. Our brain then reminds us of that constantly with anxiety.
In most cases, effective PTSD therapies (I’ll talk more about the most evidence-based ones below), people finally realize the trauma wasn’t their fault after all, or at least that they’re not fully to blame. In four types of the most effective trauma therapies, there are turning points when clients realize they aren’t to blame, they didn’t deserve what happened, they are actually safe most of the time in the world, and they are worthy of safety and love.
We all deal with life circumstances that make our actions and decisions pretty blurry. Sometimes we are at the mercy of others who are taking violent actions towards us, and rather than deal with the horrific reality that people can hurt us (although most people won’t or don’t mean to), we take the blame on ourselves, giving us the sense of control that we need to keep functioning. Therapy helps us accept that we're not to blame, and neither are most people in the world.
If we are initially stuck because we hurt someone else, we will realize through therapy that we also don’t go around trying to hurt people on purpose (and if we did, we probably wouldn’t then get PTSD about it).
To look closer at my theory, I'll examine it through four of the top PTSD therapies:
In Prolonged Exposure (PE) therapy, the client tells the story of the trauma over and over each week, and listens to it between sessions. A good portion of the session is spent processing the thoughts and feelings about what happened. This also happens between sessions. A special emphasis is put on any areas where the client is avoiding thinking about what happened, or where he/she blames him or herself. Most clients have moments of insight once they realize they aren’t at fault, or that most of the world isn’t to blame. At this point, external symptoms start to get better.
In Cognitive Processing Therapy (CPT), (a type of CBT therapy) the client makes a list of “stuck points” that relate to the trauma. Most of these are thoughts about himself/herself, and relate to shame. Sometimes the thoughts are relating to the world in general (like nowhere is safe to go at night). The client then practices challenging these beliefs and creating a new set of more balanced, accepting thoughts. This therapy directly targets replacing blame with compassion, typically self-compassion. I enjoy this therapy at times, because it directly teaches clients how to be accepting of themselves.
In Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for kids and teens, the therapy focuses on education and a trauma narrative, where the child creates some type of story representing what happened. As children develop these stories, the therapist helps them identify areas where they blame themselves or don’t trust others. The therapist then helps the child challenge these self-harming thoughts as the narrative progresses.
In Eye Movement Desensitization and Reprocessing Therapy (EMDR), the client makes a list of traumas that are not yet processed. They then recall the traumas, while activating both sides of the brain, and then replace the self-defeating belief with a “positive cognition,” as described by the EMDR International Association. In many cases, we could replace “positive cognition” with self-compassion.
If you’re dealing with PTSD or related symptoms, you can start with looking for a qualified therapist, and take gentle steps towards self-acceptance. The most recent PT magazine has a great article on how to stop beating yourself up. This applies to those who’ve experienced trauma. I also like my colleague's blog, Nurturing Self Compassion.
Just by reading this blog post, you’re already on your way to healing, so you can at least thank yourself for that.