PTSD Avoidance: Is It Grounding Your Recovery To A Halt?
I have a client (we'll call him A.) who said to me yesterday, about an action he needs to take to move forward, "I just don't want to do it. It's too painful, so I avoid it."
While avoidance is typical in PTSD recovery here's the problem: Nothing in recovery happens unless you make it happen. So what will happen if you continue to avoid? Nothing.
What to do when PTSD avoidance grounds your progress to a halt?
PTSD: Avoidance: Getting Back on Track
As you already know, avoidance is one of the three main categories of PTSD symptoms (along with re-experiencing and arousal) that define the diagnostic criteria of PTSD. When you've been through something horribly traumatic it makes absolute sense that you wouldn't want to revisit it in any way shape or form. Fear around the subject begins to drive your behavior: fear of the memory, fear of your feelings, fear of what will happen if you face the memory and your feelings.
The list of fears that drive avoidance coping strategies go on and on -- and are very legitimate. In survival mode, you will do anything to preserve your ability to function, even by doing so with dysfunctional behavior.
A. has been stuck in the same place in his recovery for several months and he's annoyed about it. He comes into our sessions snarly, snarky and disagreeable to both himself and me.
What I've learned about trauma and PTSD recovery is that when one direction yields a road block you can make progress by simply turning in another direction. There is no "how-to" or "should" magic when it comes to healing. The most important thing to trust is how you feel. If you feel you can approach a specific part of the healing work, then you're ready for it and will often find some aspect of success if you approach it.
Likewise, when one path of work places an enormous obstacle it can be a sign that you're not ready for that element yet, in which case moving on to something else and bookmarking where you want to come back to can often be exactly how to achieve a breakthrough in your process.
A. will not do any of this. Instead, he insists each week on bringing up the subject he wants to avoid, only to continue avoiding it. When I gently suggest we turn in another direction he refuses. Due to this resistance, A. has been stuck in the same place in recovery for several months.
The problem is that the work A. is avoiding is a double-edged sword: He wants to retrieve a part of his life before the trauma. In order to do so, he has to face the harm someone else inflicted upon him. A. is simultaneously driven by what he wants (to go back to a time before anything bad happened) and to avoid the bad thing that happened. You can see how it's easy to get so stuck.
In order to move through this place, I suggested A. renegotiate his approach to the painful topic. There's no rule that says something painful has to be faced all at once. You can, in fact, break it down into many small pieces and face each of the smaller, more manageable parts one at a time so that you can reach a comfort level with the individual elements before attempting to tackle the whole.
In your own recovery, listen to your internal reactions. Let them guide you in the work you do. Trust the feedback your internal self gives and find ways to take the information and apply it to your recovery in ways that ease the process rather than make it twice as challenging.
Rosenthal, M. (2013, April 3). PTSD Avoidance: Is It Grounding Your Recovery To A Halt?, HealthyPlace. Retrieved on 2020, April 6 from https://www.healthyplace.com/blogs/traumaptsdblog/2013/04/ptsd-avoidance-is-it-grounding-your-recovery-to-a-halt
Author: Michele Rosenthal
And even though you know the fears are irrational and wasn't present before the PTSD intruded, you still fear it and have an anxious response to the thoughts and different things in the environment.
I have a question, why is it that PTSD can emerge years after the last trauma? And how come after being diagnosed and working through different things you begin to fear different things that never was an issue prior to the PTSD surfacing. I have come a long way in recovery but just find both of those things still causing me grief on a day to day basis.
@Jesse -- You've just named two (of the many!) PTSD ironies. Sometimes the mind can absorb, suppress and block the impact of a trauma -- until something else tips the balance and then PTSD emerges. I like to think of it as if we are pitchers of water and we can fill up just so much to the brim before one final addition of even one small drop causes an overflow. Late-onset PTSD can happen decades after an event and can emerge when the coping mechanism becomes dislodged.
I had to smile at your comment about working through things just for some new fear to present -- that was exactly my experience! It seemed like every time I made progress some new issue popped up to take the place of the old one. I'm working with a client right now on exactly that same process. I think 1) fears are layered and working through one makes room for another to reveal itself, and 2) feeling better and making progress brings with it a) new fears -- feeling better can be scary, b) manufactured fears because we're so entrenched in the fear habit that without the old fear we need something new in its place in order for things to feel familiar.
As my mom always told me, "Keep on keeping on!" The more aware you are (and you do sound very aware) the more you will find ways to ameliorate the things that drive you crazy and continue to make progress moving ahead.