It had been a perfect day, despite PTSD.
You were having fun. All of a sudden the fear, the flashbacks, the avoidance and the panic of PTSD returns. Why now?
This is the question often asked by patients in clinic. There is a simple answer: panic frequently re-appears in PTSD. When it does, it often reduces sufferers to jelly.
This often happens suddenly and without warning. It is all to do with PTSD triggers – things that resemble or remind the brain of the original traumatic incident.
Big triggers and small triggers can both cause a massive panic response
Most people are aware of the big things connected with a trauma. Some people consciously make a list of things that were connected with the traumatic incident – these lists become their conscious trauma triggers. They believe that they can then anticipate the ‘hot spots’ and take action to manage the uncomfortable scenarios. However, this doesn’t often work. The problem is, it’s the unconscious and unknown triggers that knock us off balance and onto our knees.
For example, Gill* is a successful career woman. She was raped six months ago, on her way home from a nightclub. Gill is very aware of certain triggers: she is scared of being alone in town at night, particularly in a certain part of town. She also jumps at the sight of a certain make of car, and freezes if she hears any door slam.
Gill recalled that recently she was hosting a presentation at her gallery in Geneva. All was well. There were many high-profile clients attending. Naturally, she wanted to make a great impression. Instead, she suddenly found her mind racing, her heart pounding, and a pressing desire to sprint right out of the room.
At that moment, she felt that her very survival depended on escaping. She lurched to the ladies room, where involuntary shaking gave way to floods of tears. The presentation now seemed a threat. She was unable to regain her composure. Instead, she called a friend to collect her and left by the back entrance.
Hidden PTSD triggers
It was the following week, during treatment, that she suddenly recalled that she had registered a strong smell of a particular masculine fragrance at the gallery presentation. She remembered that her attacker had smelt the same. She hadn’t been aware of that hidden piece of the jigsaw previously.
Suddenly it made sense: it had been an unconscious trigger, that had remained below consciousness until the evening of the presentation. Now she is aware of a new trigger, she is able to use techniques learnt in therapy to tolerate her acute sense of fear. She is able to use learnt strategies to reduce that trigger’s effect on her.
PTSD set-backs are temporary
The point is that, for as many triggers we are aware of, there are also just as many that remain out of range. These are like rocks under the water. It is so important to recognise this fact.
It is tough to accept that, even where fantastic progress is made during treatment, there are likely to be temporary set-backs. But these set backs are exactly that: temporary ones. This is the nature of PTSD.
*Client’s name and occupatiation has been changed due to client confidentiality.
Written by Dr Chrissie Tizzard, Chartered Consultant Psychologist, BSc, MSc, PsychD, C.Psychol, C.Sci, AFBPS. Find out about EMDR treatment for PTSD at Christine Tizzard Psychology here.