Moving Safely Through PTSD Recovery
Tips to manage emotions in therapy.
Posted December 18, 2021 | Reviewed by Gary Drevitch
Post-traumatic stress disorder can develop in adults after surviving a variety of events such as childhood abuse, domestic violence, combat, natural disaster, and sexual assault. PTSD can happen to anyone. According to the National Center for PTSD, about six out of every 10 men and five out of every 10 women experience at least one type of trauma in their lifetime. During the last couple of years, much more attention has been given to this diagnosis and people are feeling less shame about asking for help to manage symptoms. Commonly reported symptoms of PTSD include flashbacks, nightmares, extreme anxiety, suicidal tendencies, distrust in others, and a disruption in daily functioning. It is a mental health condition that wreaks havoc on many people’s ability to have healthy relationships and good self-care.
PTSD can happen to anyone, no matter what kind of event they have lived through. I have met patients who have lost parents suddenly, have been victims of sexual assault, were abandoned as children, lost their childhood homes, or have repressed childhood abuse. I have met hundreds of men and women who come to therapy after burying memories and feelings from their trauma for years, even decades. The longer someone avoids the pain and grief, the more complicated and difficult it is to manage PTSD.
During the last couple of years, the term PTSD has been used frequently as people try to describe their reaction to Covid-19 and all the challenges that have come with uncertainty and restrictions. One of the silver linings of these dreadful times is that the diagnosis has less stigma and people are less afraid to ask for help.
One of the challenges of working through trauma is the enormity of feelings that come with facing it. Once people open a Pandora’s box about whatever happened to them, the flashbacks, nightmares, and shame re-surface. The triggers are all around us and people cannot plan or predict when something will set them off.
Facing the Trauma and the Impact
The other day I spoke with a middle-aged man who told me, “I feel guilty and question every single thing I do ever since I was a little boy.” He was verbally abused by his father. He told me that he is haunted by his father’s words, sometimes a hundred times a day, when he wants to assert a boundary or be vulnerable with his wife. I work with another woman who went to therapy for years before she opened up in treatment about surviving sexual abuse by her uncle. When she started talking about what happened to her, she told me, “I feel like my world turned upside down.” She struggles with intimacy and staying in her body. At one point, she avoided intimacy altogether because of the flashbacks and feelings of distrust.
Before I counseled other patients in recovery from PTSD, I was in intensive outpatient therapy to begin healing from childhood sexual abuse. One of the worst parts of speaking out was the shame and pain and not always knowing how to manage or place these feelings. There were many times when I felt suicidal and wanted to give up. I learned that finding ways to replace the shame and move into a place of self-compassion were essential to staying safe while working through trauma.
It's bad enough to have to live through horror or devastation and not have a way to process the experience. Worse is to need to relive or re-experience the feelings once someone breaks the silence about what happened to them. Through the years I have developed safety strategies and ways to manage the symptoms. Developing a host of coping strategies that are about self-compassion helps many patients stay sane. Here are some suggestions of how to stay safe and use self-care when PTSD feels unmanageable.
8 Tips to Staying Safe and Grounded During Trauma Recovery
- Make a vision board or write a list of reasons why you are addressing your trauma now. For example, “I am doing this because I want to be a parent someday,” or “I want to feel less afraid to set boundaries with my husband and my family.”
- Make a plan for safety immediately after your therapy session ends. Make plans with a friend or return to work. If you need time to process the session before moving on with the day, grab a notebook and write down some thoughts and feelings. Remind yourself that therapy is a process and that you do not have to deal with all of your feelings in one session or one day. Reassure yourself that you will not forget what you have talked about in therapy and that your memories will not disappear.
- If you are feeling worse after the session ends, make sure to tell your therapist. You may need to take some time at the end of a session to shift gears and focus on something lighter — for example, talking about a book you are reading or something you are looking forward to doing before your next session.
- Use your pets as support. Plan hikes or walks or adventures you can go on if you have a dog. Focus on the love you feel for your pets and how they need you to be safe so you can continue to love them.
- If you are being flooded with flashbacks, memories, or nightmares, think about taking a break from the work. Focus on events or issues that are on your mind in the present to try to get your mind to slow down the memories. Tell yourself it is okay to pause and get back to trauma work. Talk with your therapist about how you can honor the work you have already done. Focus on your progress: For example, maybe you set a boundary with a colleague or maybe you are feeling more grounded when triggers are present. It is important to acknowledge all parts of this crazy-making process. Trauma work does not have to always mean talking about something that happened to you.
- Limit your time on social media. Images of gun violence, sexual assault, Covid surges, and other upsetting events can lead to more feelings of fear and isolation. Take notice of who you follow on these accounts. Look for words of hope and inspiration.
- When you feel overwhelmed or alone, imagine people who love you taking some of these feelings and holding them for you. For example, picture your therapist or your best friend or partner telling you, "You got this,” or “You are worth the fight.” Sometimes knowing that others believe in us, even if they do not fully understand the journey, can make a big difference.
- Use self-compassion when you can. Talk to your younger self that felt abandoned, afraid, or abused. Tell that younger part of you that “it was not your fault” or “You are not the cause of bad things happening to others.” Write a letter to your younger self and share that in a session. Remind yourself that old feelings of inadequacy or hopelessness will not last forever. When you feel unsafe or self-destructive, do the opposite. For example, when you want to hurt yourself, take a bath, go for a hike, or sit by a warm fire. Remind yourself that urges to self-harm come and go. Voice the urge and notice that it will pass if you hold it and move on to something else.