Copyright © 2021 by Happyable, Inc.

Cover design by Terri Sirma

Cover photographs: © popovartem.com/Shutterstock; ©

Kitsana1980/Shutterstock

Cover copyright © 2021 by Hachette Book Group, Inc.

Hachette Book Group supports the right to free expression and the value of

copyright. The purpose of copyright is to encourage writers and artists to

produce the creative works that enrich our culture.

The scanning, uploading, and distribution of this book without permission is

a theft of the author’s intellectual property. If you would like permission to

use material from the book (other than for review purposes), please contact

[email protected]. Thank you for your support of the author’s

rights.

Hachette Go, an imprint of Hachette Books

Hachette Book Group

1290 Avenue of the Americas

New York, NY 10104

HachetteGo.com

Facebook.com/HachetteGo

Instagram.com/HachetteGo

First Edition: September 2021

Hachette Books is a division of Hachette Book Group, Inc.

The Hachette Go and Hachette Books name and logos are trademarks of

Hachette Book Group, Inc.

The publisher is not responsible for websites (or their content) that are not

owned by the publisher.

Library of Congress Cataloging-in-Publication Data

Names: Morton, Kati, author.

Title: Traumatized: identify, understand, and cope with PTSD and

emotional stress / Kati Morton, LMFT.

Description: First edition. | New York: Hachette Go, [2021] | Includes

bibliographical references.

Identifiers: LCCN 2021008018 | ISBN 9780306924354 (hardcover) | ISBN

9780306924347 (ebook)

Subjects: LCSH: Post-traumatic stress disorder. | Stress (Psychology) |

Social media—Psychological aspects.

Classification: LCC RC552.P67 M684 2021 | DDC 616.85/21—dc23

LC record available at https://lccn.loc.gov/2021008018

ISBNs: 9780306924354 (hardcover), 9780306924347 (ebook)

E3-20210803-JV-NF-ORI
 CONTENTS

Cover

Title Page

Copyright

Dedication

Author’s Note

Introduction

1 Our Shared Trauma: How Social Media Affects Our Mental Health

2 Have I Been Traumatized? PTSD & What You Need to Know

3 What Can Cause PTSD?

4 What Is Dissociation & Why Does It Happen?

5 What Is Repeated Trauma? C-PTSD & How It’s Different

6 Are We Sure It’s C-PTSD?

7 What Are the 4 Attachment Styles? Why Trauma Is Rooted in

Childhood

8 Can Trauma Be Passed Down? Transgenerational Trauma and Its

Lasting Effects

9 Why Do We Feel So Scared? The Science of Trauma Memories

10 How Can We Recover? The Benefits of Neuroplasticity

11 The Foundation of Healing: Finding the Right Treatment

12 Triggers: How to Identify What Causes Our Trauma

13 Breaking the Cycle: Avoiding Future Trauma & Triggers

14 Resilience: Building It & Keeping It

15 Building Support: How to Have Healthy Relationships

Epilogue

Discover More

Notes

Praise for Kati Morton

To my patients and viewers who were brave enough to

share their stories and teach me what it’s really like to

be traumatized. And to anyone who has ever felt like

they were being too sensitive or alone with their pain.

This book is for you.

Explore book giveaways, sneak peeks, deals, and
more.

Tap here to learn more.

 AUTHOR’S NOTE

The people and patients I have discussed in this book have charitably given

their permission. Many of the stories I share are very personal and come

from those I know in my private life, as well as from my own life

experience. To protect the privacy of those mentioned, all names and

identifying details have been changed. The stories shared in this book are

done to help further illustrate how mental health can affect us. This book is

meant to empower you to get the help you need and deserve. It is not a

replacement for actual mental health treatment. If you are struggling with

mental health issues, I urge you to seek professional help as soon as

possible.
 INTRODUCTION

I have many goals for this book. Most important, I want it to help you

more clearly understand what it means to be traumatized. I have been

creating content online for over nine years and not a day goes by that

someone doesn’t message me asking if what they experienced is considered

trauma or not. Most of us don’t know the nuances and diagnostic criteria

that help mental health professionals decide whether what someone is going

through is a post-traumatic response. That information shouldn’t be

something we only have access to if we can afford to see someone. Trauma

should be discussed openly, honestly, and done so often that if someone in

our life goes through a terrifying situation, they feel empowered and

supported enough to talk about and heal from it. My goal of getting mental

health information out to those who need it has been the driving force

behind my YouTube channel, my podcast, and now this book; if we don’t

have an understanding of trauma and how it’s defined, how can we work to

overcome it? We can’t get help with something we don’t know we have.

Having a name to put to what we feel can be validating and gives us a

place to start when it comes to getting help. Information is empowering and

gives us the language to frame our requests for support. This helps us figure

out what type of mental health professional we are seeking and what to ask

for when we make that first appointment. It can also help to know what the

different trauma symptoms are, and how they can feel, so that we can more

easily express what’s going on to those who can help us. This can ensure we

get useful tools and skills right away, and shorten the amount of time we

spend in pain or feeling misunderstood. By walking you through all of this

information, I hope you feel better prepared to ask for the help you need,

want, and deserve.

I want you to know that I don’t consider myself a trauma specialist. My

career up until this point has focused on helping those with eating disorders
and self-injury urges. I did most of my postgraduate work in an eating

disorder treatment center and continued that work when opening my private

practice. However, an interesting thing happened: As I helped my patients

overcome their self-destructive urges, I began to realize that most of the

reasons behind their desire to numb out or disappear grew out of their past

trauma. Trauma was the common thread connecting these mental illnesses,

and it was the root of the issues I was seeing each day. Without

understanding it and how to treat it, I couldn’t be an effective therapist, and I

couldn’t help my patients when they needed it most. It’s because of this

realization that I began to research trauma, and talk in depth about it with

my online community, which inevitably drove me to write this book: so that

anyone dealing with trauma or seeking more knowledge could find the

answers and resources needed to help them on their path to recovery.

I hope that by offering therapeutic tools and techniques, as well as which

styles of therapy are most effective, I am arming you with all you need to

process what happened, begin healing, and be able to move past it to live the

life you deserve. I also want the stories from my community to validate all

you have been feeling and remind you that you are not alone in what you are

going through. By shedding light on what trauma is and how it can feel, and

by offering resources to help repair the damage, I hope more people feel

seen, heard, and empowered to take their life back.

Surviving trauma is unimaginably difficult, and that can make it hard for

us to see any good in the world. My goal is that this book is your much-

needed reminder of the kindness still out there: that we can come together to

validate one another’s pain, connect through the heavy times, and share in

healing knowledge and helpful resources. Today, we are more connected

than ever before; let’s use that to our advantage by sharing compassion,

knowledge, and support.

 CHAPTER 1

OUR SHARED TRAUMA

HOW SOCIAL MEDIA AFFECTS OUR
MENTAL HEALTH

The past few years have been rough. We have encountered a worldwide

pandemic, witnessed multiple refugee crises, and America has been at war

for as long as most of us can remember. No matter what time of day we tune

into news outlets, we are flooded with frightening stories. We hear about

various ecological disasters, sickness, riots, school shootings, and sexual

assaults; the details and images can be hard to take in and often impossible

to forget.

This bombardment of information doesn’t only happen through

traditional news outlets. Every day we see people sharing their thoughts and

experiences through YouTube, Facebook, Instagram, Twitter, and more.

Sometimes this content can be helpful and exciting—connecting us with

other cultures around the world and allowing us to easily keep in contact

with the people we love. However, there is a harmful side effect to all of this

connection. Whether it’s videos of school shootings as they take place or

interviews with women speaking out about their experiences with sexual

assault, traumatic information is everywhere we look. It can feel impossible

to be online and not be inundated with terrifying information and feel

helpless to stop it.

Whether we realize it or not, this flood of negative information takes its

toll on our mental health. We can begin to see the world as a scary and

unsafe place, wonder whether we can trust our neighbors, and possibly
decide to not go out as much. Just the other day, I was walking to my local

coffee shop when I heard a loud bang. I immediately considered my options:

Should I run into this furniture store and hide there? Maybe I should dive

into the alleyway? These thoughts were automatic, and all centered around

my immediate belief that someone was shooting a gun in my neighborhood.

I have never been to war or been anywhere near a terrorist attack, yet at that

moment I believed I was in grave danger. This is the price we pay for being

so connected and having access to upsetting images and information twenty-

four hours a day, seven days a week.

Not to mention that because of COVID-19, we were told to stay home

and stay safe; encouraged and often required to wear masks and stay at least

six feet away from one another. I will personally admit that it did make me

fear other people to some degree. I would worry about who has touched

what, and whether I have sanitized things properly; I check and double-

check my cleaning process because if I don’t, I or someone I love could get

sick, and without a treatment or vaccine available, it can feel like a matter of

life and death. The constant stress of this pandemic, when all news outlets

only cover the death tolls and the effect on our economy, has made it almost

impossible to come out of this without some trauma response. In many ways

I have felt like I can’t look away, even if I try; the panic and upset are

everywhere.

ARE THERE BENEFITS TO USING SOCIAL MEDIA?

I don’t want you to think that social media is all bad, because there are many

benefits to being connected. We can find other people who are just like us,

reminding us that we are not alone, and that how we feel or what we think

isn’t weird or bad. Connecting can be freeing, validating, and it can improve

our mental health. Many in my online community share how finding others

with similar issues has been helpful, each sharing what has worked for them

and supporting one another during the tough times. Instead of feeling like an

outsider, we now have the tools to ensure we always find our peer group,

even if they live on the other side of the world. It’s powerful and life-

changing.

We can also be inspired by other people in the world, seeing all that they
are working on, the goals they set, and how they achieve it. This can help

motivate those of us who are stepping out on our own without any road map

or anyone nearby to help guide us. This connectivity can also encourage us

to make a change outside of ourselves and in turn help others who may be

going through a difficult time. We can help raise money for the fires in

Australia or for a parent whose child is chronically ill by simply adding a

Donate button to our posts. We can bring awareness to issues outside of our

backyard by speaking up about it online, learning from one another as we

share in experience and expertise. Being online can be helpful, supportive,

and a medium for positive change, but we have to choose to use it that way.

The way we use social media is instrumental to our overall well-being. If

we use it to connect and support, then we will feel those things in return.

But if we use it to tear others down and spread hate and hurt, then we can

start to think that that’s all the world has to offer us. Being more mindful of

what we do and who we follow online is key to ensuring social media has a

positive effect on us. Everyone agrees that if you eat food devoid of any

nutritional value, you won’t feel as good as you would if you ate a

nutritionally rich meal. The same goes for what you allow your eyes and

mind to digest. Notice how you feel after reading or watching content online.

Do you feel better or worse afterward? Are you jealous? Hate filled?

Inspired or excited? Whatever you feel, pay attention to it. If you find

yourself worse off emotionally after being online, it’s time to reconsider

what you are doing and who you are following.

I know all this talk about social media and mindfulness can seem silly or

unimportant, but I assure you, it is neither of those things. Just as with any

new technological tool, we have to figure out how to use it in a way that is

helpful, not hurtful; and part of this should be taking breaks from it

altogether. I know you may have just audibly gasped or wondered why you

picked up this book in the first place, but remember all things must be done

in moderation. We have to listen to ourselves and make decisions that help

us grow and change. If our social media practice is stressing us out, keeping

us up, or feeding us negative thoughts about ourselves and our world, it

needs to be adjusted.

HOW CAN WE IMPROVE OUR RELATIONSHIP

 WITH SOCIAL MEDIA?
The first step in adjusting our social media habits is to consider why we use

it. Is it to unwind from a long day? Maybe it’s to know what’s going on with

our friends and family? Or possibly we use it as a way to see what’s

happening in our world? Our reason could even change day-to-day or

depending on how we feel. Take some time to think about why you use it,

and then see whether that lines up with what you are getting out of it. If not,

this may be a good time to plan a break from it or unfollow and mute

accounts as needed. After a week or so of doing that, check back in with

yourself to see whether things are more aligned and if you are feeling better.

If it’s really difficult to put down your devices and take a real break,

don’t worry, you’re not alone. In July 2019, the Pew Research Center polled

American adults and found that more than 80 percent of them are online

every day, with 28 percent of those polled stating that they are online
1
“almost constantly.” I am even guilty of this. As someone whose business

is primarily online, utilizing social media to reach more people, I would be

hard-pressed to find a day when I wasn’t online at least once, if not for most

of the day. Trust me, I know what it’s like and how hard it can be to not

constantly check social media for fear that we will miss out on something.

Newer research shows that the overuse of social media can lead to

symptoms similar to substance-related addiction, some of which are marked

changes in behavior, difficulty in relationships, and an inability to control

2
use of social media. Therefore, it may be increasingly difficult to break the

habit of constantly checking our phone if we are in that 28 percent, but that

doesn’t mean we can’t learn how to take breaks. Our breaks may look more

like taking one night off every week or even just one hour away from our

phones and other devices. The important thing is that we try to get off social

media regularly so we can check in on ourselves and our mental health.

If we aren’t able to change the way we interact with social media or at

least work to manage the effects, we will continue to spread the trauma and

upset we encounter while online. The sharing or spreading of trauma isn’t a

new concept; in fact, psychologists first noticed this in 1966, when most of

their patients at the psychiatric clinic were children and grandchildren of

3
Holocaust survivors. They were shocked and couldn’t figure out why such a

large number of these people were seeking psychological support. They

were dumbfounded because those seeking help didn’t witness the trauma

firsthand, they weren’t the ones who were harmed during the Holocaust, so

why did they seek out help? The truth is that these individuals had felt the

effects of the Holocaust through their parents. It was passed down to them

generation after generation, a phenomenon we call transgenerational trauma.

Even though I did not grow up in a Jewish home and I do not have any

Holocaust survivors in my family, I do remember the effect the Great

Depression had on my great-grandmother and my family. Whenever we

would go out to dinner, she would stuff salt and pepper shakers as well as

any leftover bread and butter into her purse before leaving. If I didn’t want to

take my leftovers home, she would have them boxed and shove those into

her purse too. As a child I was embarrassed, and would always ask her what

she was doing, sometimes pleading with her to stop. She never would, and

instead would respond by saying, “Kati, they’ve got plenty here and you

never know when you will need it, so it’s best to save it now.” My mom

would try to explain to me why she did that and what she meant, but it

wasn’t until I was older and learned about the Great Depression that I

understood her anxiety about not having enough to feed herself or her

family.

Even if we take the word trauma out of this equation, think of how we

pass down good behavior to our children. We demonstrate saying “please”

and “thank you,” and we instruct them to do it themselves when appropriate.

Right? We teach using words and behaviors and repeat them until our

children do it on their own. What happens if we refuse to let our children

walk to the neighbor’s house because “someone could hurt them” and jump

every time we hear a loud noise? After a short while, our children can begin

to feel unsafe walking on their own and startle every time they hear a car

backfire.

That’s not to say that we can’t protect our children or show fear when

scary things are happening; of course, we can do that! But what we need to

be aware of is whether we are acting upon old unprocessed stories. I know

that probably doesn’t make sense, so let me explain what an old unprocessed

story is. When we are traumatized or even really scared, our brain can’t

always make sense of the experience. It doesn’t know how to put it into a

full story and file it away into our memory. What happened can be too much

for us to think about, process, and understand. So, these traumatizing

memories never get dealt with; instead, they can remain scattered in our

brain because we are never able to make sense of what occurred. All we

know are bits and pieces of the event and what we learned from that.

This can lead to us believing certain things that simply aren’t true. For

example, let’s say we were assaulted and robbed at gunpoint when we were

twenty-two years old. What a terrifying thing to go through! How can we

make sense of something that should never happen to a person? How can we

even begin to process the fear we felt at that time? Without therapy, we may

not be able to, and this can lead us to believe that it’s never safe to walk

down that specific street, or walk outside by ourselves, or possibly we could

feel it’s never safe to go outside again. Even though those responses can

seem extreme, if we think about it, it does in some ways make sense. We

were hurt on a particular street, by ourselves, and we were outside. If we

don’t take the time to piece together all that happened that day and

understand that we can’t always stop bad people from doing bad things, we

can live our life from the perspective that if we just avoid the things we did

that day, we won’t be in danger ever again.

We can take this one step further and say that living through the lens of a

traumatic memory would be akin to refusing to walk around anymore

because one time we tripped and broke our leg. Sure, if we aren’t walking

around, it’s not likely that we would trip or break our leg again, but we are

also preventing ourselves from walking on the beach, traveling, or enjoying

our life. We can even lead our children to believe that walking around in our

world isn’t safe and that they shouldn’t do it either. The long-term effects of

not understanding and processing our trauma aren’t something we should

take lightly. The confusion we may feel as the person experiencing the

traumatic events, images, or videos is nothing in comparison to the upset

our children could go through as a result.

One of the main reasons transgenerational trauma can be so hard to

understand, let alone process through, is that the people it’s passed down to

didn’t experience the trauma themselves. They don’t have a story to process

through with their therapist or a choppy memory to try to make sense of. All

they have is a feeling, something they sensed from their caretakers that they

can’t put words to. It could have been the anxiety they felt when their mom

gripped their hand tighter as they walked through town or the way their

father’s voice deepened as he spoke about certain times in his life. If the
people we trust most express to us that something’s wrong, we believe it

without question or explanation.

Those of us with transgenerational trauma probably don’t even know we

have it. A lot of what we do as a result of this can seem normal or make

logical sense to us. We learn so much from our parents and caretakers and

often take their preferences or oddities at face value. I even buy certain

brands of food at the grocery store because those are the ones that my

grandma and mom always purchase. Have I tried the other brands, and

decided these are superior? Nope. I just believe that they know best, and

honestly, never questioned it. I only offer that example to demonstrate just

how easily we follow what others in our family have done. We trust them,

look up to them, and possibly want to be just like them. Not to mention that

their way may be the only way we know, and if that’s the case, how can we

question something when we don’t know of another option? We can’t.

Trauma isn’t just passed down; it can be passed across to our friends and

others around us. This could be through images or stories we share online,

or even through trying to help others. I frequently hear from first responders

about how difficult and traumatizing their job is, and how they struggle to

cope with it all. Even if we aren’t the one who is hurt, seeing people who are

hurting can be just as difficult to process. Do you ever watch the news or

read an article about some horrific accident and have to look away or stop

reading? Yeah, me too. It can be too much to handle sometimes and has

even caused me to feel sick. That’s because we are empathic people. We

care about others and how they are doing. If someone is hurt or upset, we

can feel somewhat responsible for what’s going on and want to do

everything we can to make it better.

That is yet another reason we need to be careful about what we see and

say online. If we spend all day watching and reading content about people

being unsafe, hurt, and horrible to one another, it’s going to be hard for us to

think about the world positively. I think we can all agree that the bad things

are easier to believe and remember, but did you know that there’s a reason

for that? As adaptive creatures, we have to be constantly looking for any

threat to our life. It’s what keeps us safe and alive, and why our brain pays

close attention to any warning or hazard. It wants to be sure that the scary

thing isn’t going to do us any harm. We observe and think through things

until we are sure we can let them go. Which can feel like forever sometimes;
trust me, I ruminate on negative things too.

Positive situations or thoughts, on the other hand, are not threatening,

and for that reason, they are easy to ignore or forget. They can even be hard

to pass down to our children or along to our friends because they aren’t top

of mind. That’s why we need to constantly take stock of what we are

allowing our brain to feast on, and sometimes force it to focus on the

positive things.

The emotional ties we have to our families and friends can make this

shared trauma difficult to stop. Sharing in experiences and beliefs is part of

what connects us and gives us purpose and identity. If we don’t feel

connected to our family and friends, we can start to struggle with such

thoughts as “Who am I?” “Where do I belong?” or “What do I believe?”

Having others who think and act like us gives us a safe foundation from

which we can grow and enter into relationships of our own. So, how do we

keep the connection without spreading the trauma? It is a bit tricky, but with

the right tools, we can handle it.

HOW DO WE STOP SPREADING THE TRAUMA?

In addition to identifying why we use social media and ensuring it lines up

with what we get out of it, we also need to learn our limits—meaning that

we can’t live with rose-colored glasses on, or curate this idyllic environment

and just forget what’s going on in the world. Ignorance is bliss, but it can

also lead to us being out of touch and putting ourselves in dangerous

situations. Our goal shouldn’t be to shut out anything upsetting or negative,

but instead to work toward a more balanced view of the world. We can try to

take in the good with the bad and manage how it’s affecting us.

To strike this balance, we will need to first recognize our triggers. I know

the word trigger has been overused and misunderstood in recent years, but

triggers are real and can send us into a dark spiral if we aren’t careful. That’s

why we must start to notice when something in our life triggers a trauma

response. This could mean we find ourselves wanting to cry when we

normally wouldn’t or are extra jumpy when dealing with a certain person or

situation. Being triggered means that something happening to us now has

reminded us of something bad that happened before. This could be someone

raising their voice to us at work, and it brings us back to when we were

children and our mom would yell emotionally abusive things to us and our

siblings. Or the smell of burning rubber reminding us of a terrible car

accident we were involved in years ago.

Triggers can be any number of things depending on what we have been

through, but they are usually connected to situations we haven’t had the time

to process through in therapy. It can involve any of our five senses and often

feels like it comes out of nowhere. Since we can’t control what we don’t

understand, I encourage you to think back to the last time you felt a little out

of control or spaced out during a stressful time. Chances are, you were

triggered in those moments, and the more you can recall about that day or

week leading up to that feeling, the better you will be at identifying the thing

or group of things that caused your trauma response.

Once we know what our triggers are, we can work to process through

them as well as better manage our response in the moment. We can do these

on our own, but it is easier and more productive if they’re done with the

help of a mental health professional—preferably, find one who specializes in

trauma and understands how to best help us. They will help us figure out

what is upsetting us, assist us in coming up with language to describe what

happened, and talk us through the situation until it is no longer emotionally

charged for us; that is, we will talk through the story or situation until it is

no longer upsetting. Sure, it can still be described as sad or bad, but that

doesn’t change how we feel in the moment or ruin our entire day. This can

take time, but it is honestly the best way to manage any past trauma and

ensure we don’t pass it on to our family or friends.

Next, we will have to find ways to take real breaks from being online.

This doesn’t mean we trade in our devices for our television, but that we

aren’t digesting any media from anywhere. As I mentioned earlier, I know

this can be hard, and like any behavioral change, it will take time and

practice. It may be best if we first plan to take some time off from our media

when we are out to dinner or doing something else. That way we are

distracted from the potential thoughts or urges that can come along with our

first few social media breaks. It’s completely normal to worry that we are

missing out on things but, trust me, taking one night off isn’t going to do any

harm. There isn’t any news feed, meme, or tweet that cannot wait a few

hours. If something was an emergency that directly related to us, someone

would call or text us.

I am going to be honest here: I am really bad at doing this. As I said,

most of my work is online, and I struggle to not check my phone every few

minutes; it’s shameful really. But I was accidentally forced to quit cold

turkey when I went camping with my family over the Memorial Day

weekend. The cell service was so bad that I wasn’t able to reload any of my

social media apps or check my email. I couldn’t do anything online for four

whole days; it was my nightmare. But I had a choice to make: I could be

upset, insist on going home, and ruin the trip for everyone, or I could suck it

up and enjoy myself.

Of course, I sucked it up, but I was surprised at how quickly I forgot

about my phone, social media posts, and keeping up with everything. I felt

present, connected, and had a great time. Sure, I had the occasional thought

to take a picture of this or that, but overall, I didn’t even think about social

media or what I was missing. I was busy doing my own thing, enjoying the

lake, and relaxing with family, and I had the most recharging weekend of my

adult life. Sadly, it took that experience to show me just how necessary these

breaks are; just trust me when I tell you that it may be hard at first, but

worth it.

Next, I want to talk about filtering our feeds. This is something that I do

easily and often with reckless abandon, because it truly helps and is easy to

do. But this shouldn’t be done before we understand our triggers. Otherwise,

we won’t know which accounts to keep following and which ones to mute or

unfollow. Here’s how it works, once you have identified your triggers: If you

find someone or some topic upsetting and difficult to stop thinking about,

simply mute that person or type of content. As social media progresses, they

continue to give us more tools to curate our feeds, so make sure you are

utilizing these tools. I offer up the mute option because if the upsetting

person is someone you know well, muting doesn’t tell them you aren’t

following them anymore. You just don’t see their feed, and you can always

refollow or unmute things when you are feeling better, but you don’t have to.

Remember how I talked about paying attention to what we digest online?

Make sure your feed is filled with things that are helpful and fulfilling for

you.

Which rolls into my next tip, which is to check in with ourselves before

and after using social media. If we are already feeling low or upset, now
may not be the time to hop into our regular news feed; perhaps we could go

for a walk or talk with a friend instead. It can be tempting to zone out and

ignore what we are feeling but, trust me, that won’t end up making us feel

better. It can make us feel much worse. Just as our brain seeks out a threat

and therefore can hold onto negative things, if we are already in a bad mind-

set, we will most likely look for the hateful and hurtful things online

because they validate how we already feel. Checking in with ourselves

before engaging online allows us to decide whether we want to do it or not,

whether we think it will be good for us. That way, we don’t end up feeling

worse and instead can make a more informed decision.

On the other hand, checking in with ourselves afterward can tell us how

well we cleaned up our feed. When you are finished spending an hour or two

online, how do you feel? Inspired? Informed and empowered? Or do you

feel inferior, upset, and triggered? If you aren’t getting what you need from

your interactions online, you may want to go back to the previous step or

take a break. Too often in life, we do things on autopilot without considering

whether it’s beneficial to us, and afterward, we are left wondering why we

feel so bad. Taking a step back and considering what we are doing and how

it’s affecting us can change our mood and our outlook on life.

Since the news and other people’s stories can cause us to feel helpless

and hopeless, it’s important to consider what we can and cannot control. I

know this can be hard to do in the moment when something is upsetting and

we feel the urge to help out or stop something from happening, but we don’t

always have that power. That’s why it’s helpful to take stock of what we can

do, so we don’t waste any time or energy fighting for things out of our

control. Not to be the bearer of bad news, but in life, we can control only

ourselves. I know we like to think that if we just do something a certain way

or say the right thing, we can get people to do what we want. Wrong. Sure,

we can get people to see things our way or persuade them to join us, but

they are the ones that ultimately have control over their thoughts and

behaviors. The sooner we let go of the illusion that we can make other

people do things, the better.

When faced with something horrific and upsetting, consider what you

can do. Can you donate money? Time? How about getting some like-minded

people together to help petition for change? Setting up local meetings to

share knowledge and raise money? There are so many things we can do to
help out, and that’s why we mustn’t get caught up in trying to make other

people do things too. Shouting at someone on Twitter isn’t going to make

them see things your way; only they can decide to change their mind, and in

turn, change their behavior. Remember this tip when you find yourself

saying things like, “I could get over this if only they would…” If we allow

ourselves to think like that, we will be waiting on them forever. We can

move past and process situations on our own, and no one has to change for

that to happen.

We are bombarded daily with upsetting stories and images, and while

most of these are correct and true, we must start checking the sources and

facts. This isn’t to say that everything posted on social media is made up,

but it can often be skewed or biased in some way. At the risk of sounding

completely stupid, I want to share a story about how I was fooled by a

YouTube video last year, and how a simple fact-check could have saved me

from myself. As I am sure you know, much of the news we get through our

local outlets doesn’t always cover world news, and therefore, I am often

searching through YouTube to find out what else is happening in our world.

After watching a video talking about a natural disaster happening in

Southeast Asia, another video started playing. It looked like BBC News was

reporting live about Russia invading Estonia. I was shocked, scared, and

worried about the viewers I know who live in that area. I immediately put a

clip on my social media, asking whether anyone knew anything about this

and simultaneously did some research on it as well as checked to see who

had posted the video. It turns out it was a fake, a joke of a video that

someone created to show just how easily people would believe it.

I could have been angry at the person who had created the video, but I

was mad at myself. I should have gotten my laptop out, looked up the title of

the video, and checked to see who had created it. I should have done all of

those things before sharing it online. I hate to think that my misstep could

have upset or traumatized others, especially when a quick source check

would have prevented it. I hope my mistake reminds you to check where

your news is coming from before sharing or believing it to be true.

The last thing I want to talk about is that if you are trying some of the

tips and you are still feeling overwhelmed, easily upset, or just as if you have

unprocessed trauma, it is best to get into therapy. I know the idea of therapy

can sound scary and we often think we have to be ill before talking to
someone but, trust me, the sooner we get help, the better. We all have

mental health that needs to be cared for, and our mental health is no

different from our physical health. We wouldn’t wait until we could barely

get out of bed before we go see our doctor for a checkup, so why wait to see

a therapist? A therapist can help you figure out what is causing your trauma

symptoms and give you therapeutic tools to better manage them. Just make

sure you find one you connect with, who makes you feel heard and

understood.

Technology has changed how we interact with our world, but that doesn’t

mean we can’t find ways to ensure this new way of communicating is

healthy and helpful. Instead of mindlessly scrolling, taking in information,

and not considering the effects it can have, I hope we can all be more

mindful and engage with purpose. As with any change we try to make in

life, it will take time and practice, and there will still be days where we want

to dive into a news article even though we know it could upset us. If you are

still wondering whether your social media use is healthy or unhealthy, here

is a quick questionnaire:

• Do you spend more than five hours a day online? Or check your phone

constantly?

• Do you find yourself getting into heated arguments online? Or wanting

to leave hate-filled comments or responses?

• After being online, do you feel worse? Or more negative about life and

the world around you?

• Do you have a hard time taking a break from checking or interacting

on social media?

• Do you find yourself being jealous or upset by those you follow, but

struggle to unfollow them?

If you answered yes to more than one of those questions, it may be

beneficial to reassess your social media use, take another look at the tips I

offered, and make some changes. Social media should be something we use

to connect with others, learn from differing perspectives, and be reminded

that we are not alone. Making some changes to how we use social media can
benefit not only our mental health, but those around us too. I hope that if we

are all more aware, and doing our best to use social media for good, we can

stop the gratuitous spread of trauma and instead work to heal ourselves.
 CHAPTER 2

HAVE I BEEN TRAUMATIZED?

PTSD & WHAT YOU NEED TO KNOW

When we hear the words post-traumatic stress disorder (PTSD), it’s

common to automatically think of our veterans and those who have been

affected by war in one way or another. PTSD used to be known as “shell

shock,” and later as “combat stress reaction,” both of which were terms used

by the Veterans Administration to describe the symptoms experienced by

1
over eighty thousand World War I soldiers. Since the diagnostic criteria for

PTSD didn’t exist yet, soldiers came up with these terms to describe why

they or their fellow troops couldn’t function in their combat roles anymore

even though they were physically able. Many struggled to sleep due to

intense nightmares. Others would freeze in combat, putting themselves and

those around them in danger. These symptoms were affecting so many

troops that it was hindering the British Army’s ability to fight in the war,

and so they hired psychologist Charles S. Myers to study the issue in hopes
2
of finding a way to treat or manage it.

Myers began to study soldiers who reported having shell shock and

found that they seemed to view themselves and their situation very

differently from those around them. Many were fatigued, struggled to keep

their balance, had tremors, and reported headaches. Alongside another

psychologist, William McDougal, Myers hypothesized that these symptoms

were arising due to the suppression of the trauma of war. They believed that

by talking about the trauma and helping it be integrated into the patient’s
3
conscious mind, the shell shock symptoms would subside. Although the
war was terrible and traumatizing to many, it was the beginning of trauma

research and why we have the information and understanding that we do

today.

While Myers and McDougal believed they had a treatment option for

those suffering soldiers, the real struggle was in testing it and making it

quick enough to be integrated into the army bases. After testing these new

methods on a few soldiers, they found that their hypothesis was correct, and

integrative therapy techniques did alleviate the shell shock symptoms. The

next hurdle was the volume of need and trying to find a way to apply these

therapeutic techniques at scale. The closer they were to the action, the faster

they could get the soldiers into treatment and back out in the field, and so

they urged the armed forces to create special units close to their bases where

they could quickly treat any troops experiencing the symptoms of shell

shock. They believed that with swift therapeutic interventions, they could

prevent the symptoms from getting worse, and get the soldiers back to their

posts quickly. The armed forces must have thought his methodology was
4
successful as they still use this treatment plan in war zones today.

While those who have been in combat still suffer from the symptoms of

PTSD, it’s not something that only soldiers can struggle with. In Dr. Bessel

van der Kolk’s wonderful book The Body Keeps the Score, the author

explains that one does not have to be a combat soldier, or visit a refugee

camp in Syria or the Congo, to encounter trauma. He cites research by the

Centers for Disease Control and Prevention showing that one in five

Americans is sexually molested as a child; one in four is beaten by a parent

to the point of a mark being left on their body; and one in three couples

engages in physical violence. A quarter of us grew up with alcoholic

5
relatives, and one out of eight witnessed their mother being beaten or hit.

While those statistics may sound shocking or impossible, believe me

when I tell you that they are real. I hear about it every day and work

tirelessly alongside those who have been traumatized as they make their way

toward healing. I know it’s hard to take in and understand, as it’s human

nature to not want to hear about trauma or upset. Listening to how someone

was harmed as a child can be difficult, and imagining a person who would

do such harm can threaten our belief in our fellow man. Unfortunately,

trauma is all around us, happening each day, and that’s why we must
understand what it is and how it can feel.

HOW IS PTSD DIAGNOSED?

The first thing to know about PTSD is that we can suffer from the symptoms

even if the event didn’t happen directly to us. The Diagnostic and Statistical

Manual of Mental Disorders, 5th edition (DSM-5), states:

Exposure to actual or threatened death, serious injury, or sexual

violence in one (or more) of the following ways:

1. Directly experiencing the traumatic event(s).

2. Witnessing, in person, the event(s) as it occurred to others.

3. Learning that the traumatic event(s) occurred to a close family

member or close friend. In cases of actual or threatened death of a

family member or friend, the event(s) must have been violent or

accidental.

4. Experiencing repeated or extreme exposure to aversive details

of the traumatic event(s) (e.g., first responders collecting human

remains; police officers repeatedly exposed to details of child

6
abuse).

Therefore, even if a threatening event happens to someone we are close

to, we, too, can be affected by it. The DSM does add a caveat to the fourth

criterion, stating that it “does not apply to exposure through electronic

media, television, movies, or pictures unless this exposure is work-related.”

While I understand where the manual’s writers were coming from when

they added that caveat, I have to adamantly disagree. When this new edition

of the DSM came out in 2013, social media, livestreaming, and even the

news wasn’t what it is today. Not to mention that the people who work on

such literature are most likely not engaging in social media, and may not

understand its development and reach. Instead, they focus their attention on

analyzed research papers and other published articles on the subject. In

short, our research will never catch up with the ever-changing media

landscape, and will always fall short of integrating it into the diagnosis and

treatment of mental illnesses. Which is why things like the DSM and other
manuals are helpful when learning about diagnoses, their prevalence, and

comorbidities, but are not the only information one needs to consider. I

believe that the best tool we have for understanding and treating mental

illnesses is our patients and their stories, and by listening to them and letting

them lead us through their experience, then and only then can we give them

proper treatment.

Since I do believe that diagnostic criteria are important to the basic

understanding of a diagnosis, let’s dig into the actual diagnosis of PTSD.

Once we or someone we love has seen or experienced a traumatizing event,

it must be followed by intrusive memories of the event, avoidance of

anything that reminds them of the event, a more negative outlook on their

life and the world around them, and changes to how they react and respond

to life. A diagnosis of PTSD can also be accompanied by dissociative

7
symptoms, but not in all cases.

I know that’s a lot of information and symptoms to understand, so let’s

break it down a bit. First, we have the intrusive symptoms, which are most

commonly called flashbacks. These can happen when we are awake and

triggered by something in our environment, such as a smell or sound. A

flashback isn’t always just a quick clip of a traumatizing time flashing in our

mind; it can cause us to feel as if we are back in the place where the event

occurred and that the trauma is happening to us or our loved one again. In

many ways, I feel that flashbacks continue the trauma experience and can

perpetuate our symptoms of PTSD almost as if we are caught in a loop of

trauma experience of cope or repress, and experience the trauma again.

These flashbacks can also happen while we sleep, taking the form of a

nightmare, again causing us to feel that we are back in that terrorizing

situation. Many of my patients and viewers have shared how the nightmares

make it impossible for them to sleep, and they wake up screaming or

covered in sweat. Since trauma memories are not always clear or linear,

flashbacks can also feel like flipping through a photo album where certain

situations are frozen in a still frame, and as we move through the flashback,

it flips from one photo to another.

Avoidance is the set of PTSD symptoms that logically make the most

sense. We avoid things that we don’t want to deal with, and if we expect to

continue our life post-trauma, then we are going to have to avoid all things
that trigger us. For a second, imagine that you were physically and

emotionally abused as a child, and therefore anyone raising their voice can

send you into a flashback. This can make it impossible for you to focus and

do your job, not to mention that you may have to go outside or home to calm

yourself down. Now, let’s say that you just started a new job, and as we learn

about protocols and procedures, you make a mistake, and your boss yells at

you. For some people, this would be upsetting, but they’d probably just feel

bad and promise to do better next time. But if you have a history of trauma

relating to yelling and loud voices, this could be so debilitating that it could

cause you to quit your new job immediately. You would want to avoid that

type of situation or behavior because it’s simply too distressing for you to

manage.

My biggest issue with avoidance is when we not only avoid certain

situations or people, but we take it to the next level by avoiding specific

thoughts, memories, feelings, or anything that we think is linked to our

trauma. We stuff it down deep into ourselves and try to forget that it’s there

at all. This makes sense when we are in a hurtful situation, as it allows us to

keep going, push through, and survive it. However, when we are free from

those circumstances, keeping it in will only make us feel worse. Which

leads us into the final two sections of symptoms.

First up is memory loss related to the traumatic situation—meaning that

we can’t recall much about a certain time in our lives or a specific

experience. I have heard from patients, viewers, and even close friends that

they have no memory of years of their upbringing because it was so

tumultuous. Many worry that maybe they are making it all up because they

only remember a few small bits of a situation, or that it wasn’t that bad

because what they remember was just moderately upsetting. Memory loss

due to stress or trauma, called dissociative amnesia, is the biggest struggle

when we are trying to heal. I mean, think about it: How can we heal from

something we can’t remember? How do we know we aren’t making up the

memories as they slowly come back? This is one of the most substantial

reasons that I recommend working with a mental health professional, and if

available, one who specializes in trauma. They can offer tips and tools and

ways to encourage our memory to come back while having us fact-check

things along the way.

Along with memory loss, stuffing down our feelings can also lead us to
think of people and our world as a negative and unsafe place. We can

struggle to connect with others, not want to engage in social activities, and

feel unable to have any positive thoughts. It’s also common to turn those

negative thoughts on ourselves, believing that the trauma was our fault and

we did something to cause it. These thought spirals can lead us to believe

that we will never be able to get better and are ruined for life. We don’t want

to see real pain or hear about how common child abuse is; we would prefer

to think of our communities and our country as a safe and kind place. So,

it’s no wonder we struggle to cope with trauma, wanting to shove it deep

down and pretend it didn’t happen, but when it pops back up to remind us

it’s there, begging to be dealt with, we can think that something is wrong

with us. We can believe that if we were stronger, we wouldn’t have to

process it; that we could just move on. We need to know that there isn’t

anything wrong with us: Our trauma just needs to be seen and heard from so

that it can be processed and filed away with our other memories. Stuffing

things down only hurts us and hinders our future; whereas, by

acknowledging our pain and trauma, we can let it go.

Possibly the most noticeable set of symptoms are those of overreaction.

These can include hypervigilance, irritability, struggling to concentrate,

8
engaging in reckless or self-destructive behavior, and being easily startled. I

have always hated the term overreaction because I think it’s been given a

bad rap over the years, often connected with someone being unstable or

irrational, but I don’t see it that way. Overreaction is something we do

because we don’t see another way of responding. We may not know how to

take a beat, breathe, and then figure out what to do. This doesn’t mean we

aren’t capable of learning how to respond versus react, and as a therapist, I

am always very curious and interested in an overreaction. It tells us

something else is going on that is taking away our ability to see things

clearly, and trauma is one of the things that can cause an overreaction.

The last potential criterion for PTSD is dissociation. In response to the

trauma, we can experience depersonalization and/or derealization, which are

forms of dissociation. Either form can occur when our brain simply cannot

stay present and process what’s happening, so it allows us to float away for a

bit to catch up with all we may be experiencing. Depersonalization is when

we feel detached from ourselves. Many of my viewers and patients say it’s
like being a ghost of ourselves, almost as if we’re floating above our body,

watching it go through all of our daily tasks and motions. Then there’s

derealization, where we feel detached from our surroundings, or as if we are

in a dream. This has been described to me as more distant or severe than

depersonalization because we are not just outside of ourself but outside of

our environment, and what’s around us can even be distorted in color or

shape. Since I haven’t experienced either of these, I can’t say which is worse

or better, just that they are a sign from our brain that what we are going

through is too much for it to process. It needs a break from reality so it can

get caught back up.

BEYOND THE DIAGNOSTIC CRITERIA FOR

TRAUMA—BIG Ts AND LITTLE Ts
I don’t want you to think that the diagnostic criteria are all that I consider

when diagnosing someone with PTSD. As I shared before, it’s my patient’s

stories and experiences, as well as my own, that help guide us in our journey

to healing. One thing I have learned through my time online and in practice

is that not all traumas start out as traumatic. What I mean by that is, on its

own, a certain experience could not be seen or felt as a trauma. Perhaps it

was simply an upsetting event that we were able to think about, feel out, and

be done with. However, when we start stacking these smaller yet troubling

events on top of one another, possibly back-to-back, without giving us the

time to think about them and process how we feel, they can grow into a

trauma.

We call these smaller upsetting situations “little Ts,” and the other, more

immediately traumatizing situations “big Ts.” This has been helpful in my

practice when trying to better understand my patient’s symptoms and

experiences. Too often I hear how there hasn’t been anything big that

happened, such as abuse or a car crash, and therefore there is no reason for

their PTSD symptoms. Not knowing why we feel the way we feel can not

only be painful and invalidating, but can also cause us to believe that there’s

something bigger wrong with us. To further explain what big Ts and little Ts

are, I reached out to my friend and colleague Dr. Alexa Altman, who is, in

fact, a trauma specialist and the person who introduced me to these terms.
 A big-T trauma is distinguished as an extraordinary and potentially

life-threatening event that leaves a person feeling powerless and out of

control. Some examples of big-T traumas are severe car accidents,

near drowning, exposure to war, natural disasters, physical assault,

etc. After a big-T trauma, a person will often report feeling terror,

rage, a fear of death, helplessness, a loss of faith in god, or a loss of

faith in humanity. A big-T trauma can be analogized to a tsunami.

When a tsunami wave pummels the shore, it engulfs everything in its

path, swallowing it whole and pulling it back out to sea. Like a

tsunami, a big-T trauma can obliterate a person’s psychological and

physical constitution destroying a sense of self, personal identity, and

purpose.

Whereas, little-T traumas are events that surpass a person’s

capacity to cope and can disrupt emotional, social, and cognitive

functioning. These events may not be life-threatening but are

extremely stressful and pose a threat to one’s sense of emotional well-

being. Some examples of small-T traumas are employment loss,

divorce, chronic illness, interpersonal conflict, and legal challenges.

Calling a very challenging event “little” can be dismissive or discount

the negative impact of these stressful life events. A little-T trauma can

be analogous to a large wave at the beach. When confronted by one

big wave, holding the breath, ducking under a wave, one can still

regain footing on the other calmer side of the swell. But, what

happens when these waves come in rapid succession? The ability to

catch one’s breath and regain a solid stance is diminished. The next

stressful event or wave will be experienced much harder than if a full

recovery was possible. The cumulative effect of small-T traumas can

be overlooked by an individual or even a clinician. Thus the

accumulation of small-T events can actually lead to a big T, leaving a

person unable to comprehend why a common stressful event can feel

so crippling.

Just this year, I had a close friend reach out to share how she was

struggling with dissociation and hypervigilance for the past two years but

couldn’t figure out why. She had a pretty normal and happy childhood; both
of her parents were still in her life and they all got along; she had had a few

long-term relationships throughout the years, but again, no abuse or trauma

there. I remember her lamenting to me after a long phone call about how she

wished she had just been in a car accident or something so it would all make

sense. I felt helpless to shed some light on what she was experiencing until I

learned about little Ts a few months later. So, I called her and asked whether

there had been any smaller yet still upsetting situations in the past two or

three years. After racking our brains, we came up with a whole slew of

smaller Ts: She had received a promotion at work three years ago and was

relocated; while it was exciting, it was also upsetting because she had to

move farther from her friends and family. The following summer, her

grandmother passed away, and not two months later, so did her grandmother

on the other side of the family. A few months after all of that, one of her

long-term relationships abruptly ended, and that’s when the symptoms

began. There we had it, a timeline filled with little Ts all building up until

she couldn’t process anymore, and that’s when the dissociation and

hypervigilance began.

While that wasn’t one of the happiest phone calls I have had, it was

exciting because we were able to unearth the reason behind it all and in a

way explain her symptoms. Of course, I recommended that she see a trauma

therapist as soon as possible, and she is still working on those little Ts, but I

am happy to report that her dissociation barely happens anymore! This is a

nice reminder that with proper support and treatment life can get better.

I am sure even the thought of little Ts has you searching your memory

for any inkling of trauma or upset, so here is a quick questionnaire to help

you decide whether you have been through a trauma or not.

• Have you had various stressful events occur within the last six months

or up to a year?

• Have you struggled to function in your daily life? Maybe unable to be

social or go about your day without getting emotional?

• Have you recently been through some major life change? Such as

moving, going through a divorce, or getting married?

• Have you had changes to your job situation? Like losing or getting a

new job? Or perhaps you have retired recently? Are you struggling
 financially?

• Are you struggling with any ongoing interpersonal conflict? Fights

with a spouse or family member? Ending of a long-term friendship?

• Do you or someone you love live with a chronic illness? Or have you

lost a loved one recently?

If you said yes to more than one of these questions, it’s possible that you

have been exposed to some little-T traumas, and seeing a mental health

professional to work through it could be beneficial. The sooner we get

support for all we go through in life, the better we will feel and the more

easily we will be able to manage the next upset.

KEY TAKEAWAYS
• Post-traumatic stress disorder (PTSD) isn’t something
that affects only soldiers or veterans.
• PTSD can be diagnosed if we or someone we love has
been in a terrorizing and traumatizing situation. We can
have flashbacks about this experience, avoid anything
that reminds us of it, and be constantly on guard to
prevent it from happening again.
• Memory loss is very common when we have been
through a traumatic experience.
• We can have dissociative symptoms on their own or as
part of our PTSD.
• Make sure your mental health professional rules out
other diagnoses before settling on a PTSD diagnosis.
• Mental health professionals should let their patients be
the real resource when putting together a plan for
treatment.
 CHAPTER 3

WHAT CAN CAUSE PTSD?

There are many various causes for PTSD and no way to list them all,

which is why I prefer instead to focus on the way we talk about PTSD and

define what trauma is. The most inclusive and understanding definition I can

come up with is that trauma is anything that happens to you or someone else

that is too much for your brain to process at the moment. The sheer

exposure to the situation pulls you out of a calm or relaxed state and pushes

you into either fight, flight, or freeze mode (otherwise known as your stress

response). I like to think of PTSD in that way because it takes into

consideration what each person can handle, validating everyone’s

experience and potential resulting symptoms.

That definition is also important when dealing with group trauma. It can

help someone understand why they were so traumatized by a situation when

their older sibling wasn’t. I hear about things like this all the time, how two

siblings went through the same situation, yet one is fine and the other is

grappling with symptoms of PTSD. This discrepancy could have to do with

their age, emotional maturity, or ability to cope on their own, and we are

seeing this play out right now in the wake of COVID-19. Some people are

taking the pandemic in stride, deep cleaning their house, making sourdough

bread, and planting a garden, whereas others are struggling to get out of bed,

shower, or take care of their basic needs. Everyone’s ability to cope is

different, and there shouldn’t be judgment surrounding that. We wouldn’t

judge someone for catching a cold when the rest of us happened to not get it,

so why would we treat mental illness any differently?

If you are not sure whether PTSD is what you or someone you love is
experiencing, it’s best to see a mental health professional so they can

properly assess what’s going on and ensure you get the right treatment. Also,

if you are still wondering whether you need to see a trauma specialist, here

is a quick questionnaire that should help:

• Do you think you have been exposed to a traumatic experience?

• Do you often feel that your emotions are out of control?

• Do you frequently have flashbacks or bad dreams related to the

traumatic event?

• Do you view others or the world around you as bad or unsafe?

• Do you find yourself numbing out from all you are feeling with drugs,

alcohol, gambling, or shopping?

If you answered yes to two or more of these questions, it’s worth finding

a mental health professional who specializes in trauma. That will ensure

that instead of being pulled off course by other symptoms, they will view all

of your symptoms as part of the bigger issue, the trauma, and possible

PTSD. In my years of experience, I cannot emphasize enough how

important it is that we get to the root of our issues in therapy. I know that

sounds obvious, but what I mean by that is we can’t get distracted by every

new symptom, spending our time trying to keep them all at bay. That would

be like going to the doctor because of a stomach upset, and instead of

running a test to see what’s causing it, they treat only our nausea and send

us on our way. After a day or two, we would find ourselves back in their

office still not feeling well. Sure we need to deal with those symptoms, but if

we can figure out what’s causing the pain and digestion issues and heal that,

the other problems will subside too. In therapy, we want to manage the

symptoms that are bothering us, but to stop them from continuing to come

back day after day, we need to focus on the root cause and process that

through. Otherwise, we’ve only treated the surface issues, and the real

problem has yet to be identified and dealt with.

ARE YOU SURE IT’S PTSD?

When working on a diagnosis with a patient, mental health professionals are

trained to complete what is called differential diagnosis, which is when we

rule out other possible diagnoses to ensure that PTSD is in fact what we are

dealing with. While I walk you through all of the signs and symptoms of

PTSD, I am sure you will see that depending on how it presents, it could

look like a lot of other mental illnesses. For example, if someone has a

negative outlook on life and reports issues with their sleep, it could be major

depressive disorder (MDD). To distinguish between these two diagnoses, we

would have to check to see whether they have any flashbacks, dissociation,
1
or hypervigilance, and if they do, then it’s most likely PTSD, not MDD.

Another group of disorders that could look and feel a lot like PTSD are

adjustment disorders. These require a stressor, just like PTSD; however,

when it comes to adjustment disorders, the stressor can be any intensity; it

doesn’t have to be threatening or traumatizing. If we were upset by our

spouse leaving us, and going through the divorce proceedings causes us to

become irate in public, and we avoid all things that remind us of them, we

could think we are struggling with PTSD. However, we are missing a lot of

the symptoms of PTSD, such as hypervigilance, flashbacks, and a negative

outlook on the world. Moreover, if our symptoms go away after six months

or so, it’s most likely an adjustment disorder.

You see, adjustment disorders occur when we are going through a period

of difficulty and change, such as a divorce, a move, change of job or school,

or anything that adds to the stress of our life. We can struggle to function,

and if we were able to look at the situation objectively, we would agree that

our reaction to the situation is out of proportion with what’s going on. Once

we feel more settled and adjusted, these symptoms go away. If we have been

exposed to something traumatizing, and do have such symptoms as

flashbacks or struggle to remember the details, it’s more likely that what we

are experiencing is PTSD.

Acute stress disorder is yet another diagnosis that shares some of the

same symptoms of PTSD and should be ruled out before moving forward

with treatment. The difference between these two diagnoses is pretty

simple: with acute stress disorder, the symptoms last anywhere from three
2
days to one month following the traumatic event. Any longer than that

indicates that it can’t be acute stress disorder and must be something else,
such as PTSD.

Because a potential symptom of PTSD is dissociation, it’s also important

to rule out dissociative disorders. The real way to ensure that what’s going

on is PTSD and not a dissociative disorder is to see whether the individual

has all or most of the symptoms of PTSD, not just dissociation. Those who

struggle with dissociation do not always have PTSD, so we need to check

whether they have flashbacks, exposure to a terrifying or traumatizing event,

and many other parts of the PTSD diagnosis. If not, and their main

symptom is dissociation, then we would want to explore those to see which

dissociative disorder fits best.

For a while, I thought that the COVID-19 pandemic was going to throw

most of us into acute stress disorder, PTSD, or possibly an adjustment

disorder. We were faced with a terrifying virus and illness that we don’t

know how to treat, not to mention that we have to adjust to being at home

more and not out in public places with friends and family. The transition has

been difficult and upsetting, causing people to struggle with increased

anxiety, have depressive thoughts, and even to develop a negative outlook on

their life and world. There have been numerous incidents of people getting

into physical altercations with police and security guards because of the new

laws and regulations around where they can go and what they can do. It’s

been incredibly hard.

However, as things continue to unfold, I have realized that each person

will react differently. Some may experience PTSD if they or someone they

care about was harmed by COVID-19 or any of the side effects it’s caused.

Others may struggle to adjust to the “new normal” and be upset for a few

months, whereas some may have some PTSD symptoms but those last for

only a few weeks. Again, everyone’s ability to cope is going to be different,

but everyone’s affected.

I recently read a post by someone I have been following online for years.

She was sharing how her husband had caught the coronavirus and due to

many complications, he had to be put into a medically induced coma. She

was devastated: they had just had a new baby, he was only forty-one, and he

was healthy with no preexisting medical conditions. How could this happen

to him? To her? I sat staring at my phone in tears, hurting for them and their

family, for the loss and trauma they were experiencing. I even had dreams

about it, waking up in the middle of the night upset as if it were happening
to me. Sure, you could say that I am just being sensitive and that I don’t

know this person outside the online community, but trust me when I tell you

that I was deeply upset by her story and situation. In part, I think this is

because I, too, am affected by the virus; it’s changed my life and my outlook

on the world. In a way, I think I can imagine what she must be going

through because I am going through a minuscule version of it, and I am

connected to her online. So again, when I read in the DSM that you cannot

have PTSD through electronic media, I have to disagree. We are linked, we

feel that we know one another, and in many ways, we can share in the

trauma. I also offer this example in hopes that it validates anything you have

been feeling during the pandemic. Too often we assume that how we think

and feel is unique or odd; however, it’s all normal and okay as long as we do

our best to offer compassion and understanding to one another as we

navigate this new world.

Finally, I want to address the small difference between how adults versus

children experience PTSD. In children six years old and younger, along with

experiencing the trauma themselves, they can also be traumatized by seeing

or hearing of their parent or caregiver being hurt. Since we rely so much on

those who care for us when we are young, it is devastating to have anything

happen to them. Although the DSM doesn’t have this criterion, I want to add

that in my professional experience, children tend to developmentally regress

when traumatized. This could cause them to start sucking their thumb again,

not be able to sleep alone, or even wet the bed after being potty trained. I

have always believed that this was because they were trying to go back to a

time when they felt safe and okay, or possibly because they feel that growing

up only means more danger is there, so they would rather not. Whatever the

reason, I personally always ask questions about this to ensure I am not

missing one of these important red flags.

WHY DIAGNOSIS ISN’T EVERYTHING

When I was getting my master’s degree back in 2008 I used to pore over the

DSM as if it was the Bible. I would read about different diagnoses, their

corresponding symptoms, and what I needed to rule out before making a

diagnosis. Even in my work on YouTube, I utilize the DSM for most videos,
citing it, reading from it, and helping it guide how I talk about certain

mental illnesses. Although it does help give some guidance and a place to

start when considering someone’s symptoms, it can also box me in and

cause me to overlook certain issues because it doesn’t fit with what the DSM

says.

The first time I realized that the DSM could be limiting was when I was

working with my first eating disorder patient. She had a slew of symptoms,

everything from panic attacks, depressive thoughts, and purging behaviors to

even some nonsuicidal self-injury. She came to me asking for help with her

eating disorder issues, but so many other things were going on and I was at a

loss as to where to start. So, I asked my supervisor for some help, pulling

out my handy-dandy DSM in the process and opening it up to the section

about borderline personality disorder (BPD). He pushed my book shut,

telling me not to rely so heavily on it, and to instead look at my patient:

What were her biggest complaints? What symptoms was I the most worried

about? Did I have any idea where all of these symptoms could be coming

from? He encouraged me to start there, ask her more questions, and let her

teach me about her experience, instead of trying to squeeze her issues into a

diagnostic box. It was eye-opening, and I am still thankful for his insight so

early on in my career. It helped me treat my patient as the unique person she

was and cater to her needs, instead of trying to rush to diagnose.

I would like to say that I learned my lesson after that one conversation,

but it was programmed into me to use that manual as a guide for treatment,

and so I found myself struggling with a similar situation about a year later. I

was working with a young man who came in for help with his anxiety. He

was successful in business, had done well in school, and even had a thriving

social life. On paper, his life looked great and without issue. After working

with me for a while, he confided that he had, on occasion, self-injured. If I

am being honest, I was surprised. He had everything working for him and

we had finally gotten his panic attacks under control. Why was he self-

injuring? The only diagnosis at the time that included self-injury was

borderline personality disorder, but he didn’t have any of the other

symptoms. I remember digging through my trusty DSM after that session,

trying to make sense of this remaining symptom, looking for something I

missed. Then, I remembered what my first supervisor said, don’t get caught

up in the criteria, let your patient teach you. And so I asked more questions,
sought to understand his experience, and learned that the self-injury was one

of the ways he dealt with all of his anxiety, and even though some of the

tools we had worked on were helpful, nothing helped as much as that. So,

after a particularly stressful day, he would still struggle to fight the urges to

harm himself. If I hadn’t taken the time to ask about it, I could have not only

misdiagnosed him but also started down a path of treatment that didn’t fit

his issues.

You see, the DSM never taught me that self-injury could be a coping skill

and doesn’t always have to be part of a BPD diagnosis. Instead, the DSM

labels each issue, pushing everyone into boxes, organizing each symptom as

part of a flow chart leading you to what it believes the diagnosis should be.

As much as I enjoy organization and flow charts, this was only making my

professional life harder, and while I still reference it when needed, I have

decided that my patients are the best manual, and I should lean into them as

much as possible.

Another issue I have with the DSM is how it seems to refuse to include

how situations and relationships can impact people. When reading through

the PTSD diagnosis, you will see a small portion entitled “Risk and

Prognostic Factors” that includes pre-traumatic factors, peritraumatic

factors, and post-traumatic factors. All in all this information doesn’t even

take up half a page. In that short space, it covers genetic predispositions,

environmental factors, and how someone’s temperament can affect their

mental health. I don’t know about you, but I feel that instead of spending all

our time talking about symptoms, we should be focused on the causes,

because it’s in those that we can find the cure. For starters, the

environmental factors should be woven throughout the diagnostic criteria

since it’s something in our environment that traumatizes us, and having

social support (another environmental factor) is paramount to our

development and recovery.

Going back to what I said about treating the root of the issue instead of

just the symptoms, I believe we focus too much on the symptoms and not

enough on the environment that’s causing them. If we all take a minute to

think about any mental health issue we’ve ever had—feeling anxious, being

overly stressed, or having depressive thoughts—we can always pinpoint at

least one thing in our environment that either caused or exacerbated it. I

hope that we move our schooling and continuing education away from the
DSM and symptoms and into a more holistic view, because nothing in our

life happens in a vacuum. All health professionals should be taught to

consider relational and environmental factors while tracking the reported

symptoms; in doing so, I believe we could all find more understanding and

healing instead of just diagnoses.

While I am not interested in getting involved in the politics of diagnosis,

and what we should or shouldn’t use, I do think it’s important to know that

the DSM and any other manual cannot possibly address all human

experience. Therefore, if you read through the symptoms we discussed and

felt that many issues were left out or part of your experience wasn’t

mentioned, that’s a failing on our system, not on you. Our system should

support referencing criteria while focusing the majority of our time and

energy on listening and learning from our patients. Our patients should be

our road map to treatment and healing.

KEY TAKEAWAYS
• Trauma can be defined as anything that happens to us
or someone else that is too much for our brain to
process at the moment.
• In addition to being exposed to a traumatizing event,
the likelihood of us being traumatized is linked to our
level of resistance, and can be affected by our age,
emotional maturity, or capacity to cope on our own.
• PTSD can look a lot like major depressive disorder
(MDD), various adjustment disorders, acute stress
disorder, and some dissociative disorders. That’s why
it’s vital that we are properly assessed by a mental
health professional.
• Children six years old and younger can be traumatized
by seeing or hearing of their parent or caregiver being
hurt, because they rely on them for much of their care
and support.
• Not all experiences and struggles will fit within the
diagnostic criteria, but that doesn’t mean we don’t
deserve help.
 CHAPTER 4

WHAT IS DISSOCIATION &

WHY DOES IT HAPPEN?

Experiencing a traumatic event can lead to dissociative amnesia,

which is when we cannot remember the details or possibly any portion of

what happened to us. This can be distressing and has led many of my

patients to believe that they are making up their symptoms of PTSD, but

dissociative amnesia isn’t the only form of dissociation out there. We can

feel spaced out, daydream, and even completely disconnect from our body,

and it’s believed that roughly half of all adults have experienced at least one
1
of these episodes. They are part of what’s called dissociative disorders and

the DSM places them next to the trauma and stress-related disorders to

reflect how closely connected, although separate, they are from one another.

When something overwhelming or traumatic occurs in our life, it can be

too much for our brain to sort through or make sense of. It can be so scary

or triggering that we can’t stay present and process what’s happening, so our

brain removes us from our conscious mind to enable us to escape the terror

and survive. In a way, our urge to disconnect keeps us safe, helps us forget

what happened, and allows us to keep going. It’s adaptive, and though it can

be helpful during a traumatizing event, it’s not easy to control and can

quickly become dysfunctional.

The definition of dissociation even in its simplest form,

 ‘a break in how your mind handles information,’ can
make one feel like there is something wrong with them:
we are broken. Somehow we are the ones that take on
the shame for this fundamental mechanism that allowed
some of us to survive. As a survivor I’ve been told by my
therapist, doctor, etc., ‘If you survived the abuse, you
will survive healing from it.’ Only they fail to realize that
I wasn’t even there mentally. I don’t remember a lot of
the details because I was dissociated. Most of the time I
wasn’t in my own body to experience the pain and
trauma. I did not understand that what was happening
would cause shame, hate, and disgust. I didn’t even
realize what was happening to me was even something
‘bad.’ It was like my body and my brain knew something
was wrong, but not me, not little me.

CAN DISSOCIATION BE DIAGNOSED?

The first dissociative disorder recognized by the DSM is dissociative identity

disorder (DID), which is characterized by a person having at least “two or

more distinct personality states, which may be described in some cultures as

2
an experience of possession.” These different personality states are often

called “alters” since they can represent alternate parts of our character. This

diagnosis used to be called multiple personality disorder because when an

individual with DID shifts from one personality state to another, they can

act like an entirely different person. This can be upsetting to both the person

with DID and to those around them.

Along with these distinct personality states, those with DID also suffer

from dissociative amnesia, not remembering what took place when they

were in that other state, as well as dissociative fugues, which are when we

don’t remember key components of who we are and aren’t able to recall how

we got somewhere. This can be scary and make it difficult for those with

DID to function in their daily life.

 In my experience, DID occurs because of intense trauma, where one part

of ourselves cannot handle what’s going on, and through continual

dissociation and repression, we create other personalities to help us cope.

This could mean that we have an alter that’s more aggressive or protective of

us, and possibly one that represents the part of us that feels like a hurt child.

Everyone’s alters are going to be different, depending on who they are and

what they have been through, but we must get some professional help if we

think this is something we struggle with. When I first looked into the

treatment options for those with DID, I believed that integrating all of the

personality states was the goal, and I released a video to that effect. My

audience quickly let me know that that was not what’s best for most people

with DID, and integration can in many ways be just as traumatizing as their

past experiences.

Dissociation makes me feel floaty and lightheaded. At

the very beginning, my heart feels like it’s going really
fast. I don’t remember anything and I’m not able to
focus on what’s around me. Almost like I have no sense
of what I’m doing, and I used to end up in places and
not remember how I got there. It sometimes led me to
do very risky things but not remembering I’d done them
until I’d become less dissociated.

If we fight to merge all of their alters, we are not only forcing them to

remember the past trauma, but also to remember all that they have done over

the years. Being in a dissociative state can cause us to act in strange, hurtful,

and dangerous ways; not remembering it is part of our self-preservation.

Although we should slowly work together to process all that happened, and

come to terms with what we do remember, that doesn’t mean our alters will

cease to exist. Without trying to completely eradicate them, we can instead

get all of these personality states to work with one another in harmony
instead of fighting with one another. I know this is hard to understand, but

it’s like these alters are our internal family, supporting us and helping us

survive some of our toughest times. Without them, we can worry we won’t

survive or even know who we are; therefore, instead of trying to kick them

all out, we have to get them to cooperate with one another, and therapy can

help us do that.

The next dissociative disorder listed in the DSM is dissociative amnesia,

and since we have already discussed this, I will keep this explanation short.

Dissociative amnesia occurs with a traumatic or stressful experience and it’s

not like normal forgetting where we may forget where we parked our car.

Those with dissociative amnesia won’t remember important details about

themselves or experiences they just had, even though that memory was

already stored. It’s as if it’s just out of the reach of their conscious mind.

The interesting thing with this type of amnesia is that it is always reversible

—meaning with the right help, they can remember it, whereas with other

types of amnesia, the memory was never saved, and therefore cannot be

recalled.

Finally, there is depersonalization/derealization disorder (DPDR) which,

based on my experience, is the most common of all the dissociative

disorders. Depersonalization is when we feel disconnected from ourselves.

We can have a distorted sense of time, be unable to connect with our

thoughts, feelings, or even our body. It can feel as though we are just

watching ourselves go through our day, unable to have direct contact with

what’s going on in our head, which can be incredibly uncomfortable and

scary. Many of my patients have said that when they are depersonalized,

they feel numb, checked out, and disconnected, and even if they want to

reengage, it’s as if they are moving through mud and can’t get there. I

believe this happens because being in our body and witnessing everything

that’s happening is too much to manage; our brain’s pulling us out allows us

to keep doing what we need to do to survive.

Dissociating made me feel safe because it allowed me

to escape from everything I was experiencing and then
 after the trauma had stopped it, protected me from
remembering the things that hurt me for so long. It’s
almost like my brain tapped out and said, ‘I need a
break.’ And dissociation was able to give me that.

Derealization, on the other hand, is when we feel disconnected from our

environment. This means that it could feel as if we are in a fog or that

everything in our world is out of focus and distorted. Many of my patients

have explained this as feeling that they are in a dream or an alternate reality

and everything around them doesn’t feel real. When we have DPDR, we can

experience disconnection from self or environment or both, yet even though

we can feel completely disconnected from ourselves and our world, we still

know where we are, who we are, and what we are doing.

I thought all people just didn’t have many memories,

like just a handful of 2- to 3-second clips and that was
all, even when you were living it at the time. I also
thought all people dissociated frequently, and everyone
felt trapped in time. I thought everyone just felt like
they were stuck at certain ages. Like my brain just
forgot to grow beyond 17. But most of the time I feel like
I am that fragile and hurting little girl, where everything
and everyone around me is so very big and scary.

Another type of dissociation I want to touch on is called maladaptive

daydreaming because, even though it’s not in the DSM, it is common and

important to understand. Maladaptive daydreaming is when our daydreams

take over and we find ourselves preferring to spend time in that alternate

reality instead of the one happening to us at the time. These are not normal
daydreams where we imagine a perfect life or space out for a few minutes

thinking about someone we have a crush on; maladaptive daydreams are

used as coping skills and a way to avoid what’s going on in the present. We

can find ourselves having them if our current life is trauma ridden or

overwhelming, or it could be our way to cope with any flashbacks or upsets

that happen to us. We may never have learned how to deal with things in

life, and so we created our escape to get us through.

Over the years, I have had patients tell me they will spend entire days

daydreaming, not wanting to come back to reality or engage with their real

life. That’s why it’s called “maladaptive”—meaning that it’s not providing

anything helpful to the person; instead, it’s creating an entirely new

problem. These daydreams can be very vivid, lifelike, and often have

storylines or plots going, almost as if you are part of your own television

show. Whereas we all can find ourselves drifting off to another place, or

dreaming of a better time, we know how and when to return to reality;

maladaptive daydreams get in the way of our ability to function. My patients

who struggle with this also have difficulty getting to sleep, completing their

work on time, and engaging in healthy relationships. Some have even been

caught talking to themselves or moving oddly while daydreaming in public.

Daydreaming in and of itself isn’t harmful; however, if we find ourselves

preferring the daydream over our real life, and spending hours engaging with

it each day, it’s time to reach out to a mental health professional who can

assist us. Since it’s often born out of trauma in our life, working to heal that

wound should make the need to live in a daydream go away for good.

WHAT IF THOSE DIAGNOSES DON’T FIT MY

ISSUE?
While those four dissociative disorders do help us to see the different ways it

can manifest, I believe dissociation to be more of a spectrum. Depending on

how triggered or overwhelmed we are, we will respond with different

dissociative symptoms; I have even experienced this myself. A few years

ago, I got into an argument with a good friend of mine, and if you know me,

you know that I hate conflict; even the idea that someone might be upset

with me can hijack my thoughts and ruin my day. Thinking back on this
fight, I can recall being upset at her and her yelling at me for not wanting to

go to a certain party, but all of the details are gone. Even as I sit here and try

to put what happened to words, I can’t. I know it happened to me, yet I can’t

remember what she said, or the events following it. I believe that’s because

her yelling pushed me into a short dissociative state. I couldn’t handle the

anger and upset, and so my brain let me step outside of the conversation for

a bit. While that argument ended up ruining our friendship, I am somewhat

thankful for my lack of memory during that time. It did allow me to get

through it, not react, and get home safely. But if this happened to me all the

time, I can see how it could be hurtful and scary, not to mention it could

cause me to feel even more out of control and disconnected. The fact that I

didn’t get to choose whether my dissociation happened was disconcerting,

and I do not want to feel like a passenger to my experience ever again, no

matter how uncomfortable it may be.

Last month I experienced one of the worst cases of this.

I was driving along the highway going to my house as I
live a bit outside of the city. I have zero memory of what
I was thinking about in this case, but all of a sudden I
could feel everything moving slow and I started to get
tunnel vision. I remember moving my head to the left as
I passed the turn I was supposed to take, but I was
unable to react to it. By the time my head came back to
the front, I could see I was drifting off the highway and
was now off the road in the dirt and grass, still driving
forward. I still couldn’t react. Then I saw I was headed
straight for a power pole and was finally able to move
the steering wheel, which caused me to go completely
off the road and down the side, ultimately landing my
vehicle in a shallow swamp. Once I had grabbed the
wheel to react and try not to hit the pole, I snapped
back into real time. I then spent the next 2 hours stuck
in a swamp, waiting for a tow truck, while random
 people drove by staring at me. It was beyond
embarrassing.

It all comes down to our ability to manage the things life throws at us; if

it’s more than we can handle, we can find ourselves disconnected from our

body or environment. That’s why dissociation can accompany many

situations, such as intense arguments, going through a divorce, or moving. It

can also be a part of various mental illnesses, such as social anxiety, panic

disorder, or PTSD. When our brain feels tapped and doesn’t have the skills

to deal with it all, it takes a break from reality and pulls us into a

dissociative state.

HOW DO WE GET BACK WHEN DISSOCIATED?

Dissociation can feel like it comes out of nowhere: one minute we are

present and able to focus, and all of a sudden we are caught up in a fog,

watching ourselves from afar. It can be scary, upsetting, and embarrassing at

times. The reason it can feel that it happens without warning is we haven’t

been able to figure out what triggers it. As we discussed, all five of our

senses can trigger symptoms of PTSD; from a familiar smell to the sound

and pitch of a voice. We can be going about our day, feeling fine, and then—

BAM—we hear something that we connect to our trauma, and our brain

pulls the ripcord, causing us to disconnect from everything.

Instead of feeling like an inactive participant in our dissociative

symptoms, we need to take back control where we can, starting with our

triggers. It’s important for many reasons to identify and understand what

upsets us, but when it comes to dissociation, we won’t be able to prevent it

from happening if we don’t first know what causes it. Although what we

remember of a dissociative episode may be a bit hazy or difficult to recall,

the time just before it occurred is usually pretty clear. Think back to your

last dissociative episode, and ask yourself the following questions to see

whether it gives you any information as to what triggered it:

 • Where were you? What were you doing?

• What did you feel, see, hear, taste, or smell?

• Who else was around you at the time?

• What is the last thing you remember?

• Have you dissociated in a similar situation before?

• Any idea how long it took for you to come back from the dissociation?

While that brief questionnaire isn’t exhaustive, it does get us thinking

about possible triggers and patterns. If there are specific areas or situations

where we frequently dissociate, we can try to avoid them until we have the

tools needed to prevent them from continuing to happen. It’s not a complete

fix, but it does give us a break from the disconnection and offer some much-

needed information about our emotional limits.

Once we have identified a few common triggers, we then need to build

up resources to help us better cope. Resources are just people, places, or

things that can help support us when we begin to feel maxed out or that our

brain is trying to pull us away. One of the most powerful resources is people

in our life who know us well and to whom we feel connected. Now, I know

that not everyone has someone in their life who knows about their trauma or

mental health issues, but if you do, that person should be the first on your

list of resources. Giving them a call when we are starting to feel

overwhelmed can pull us back to reality and soothe our system. Texting can

help, but phone calls or in-person meetings are best because there’s no lag in

responses, and hearing someone’s voice and looking them in the eye can be

much more powerful than a written message.

On that note, the next resource is our sight, and using our eyes to look at

things that feel safe, pretty, and connected can help us more quickly regulate

so that we don’t dissociate. This can happen by looking at a loved one in the

eyes, or even a pet. Any living being that we love and who feels safe can

help us calm down; our amygdala—our brain’s “fear center”—is always

looking for a threat, and if we show it that nothing dangerous is going on, it

may stop the stress response. We can also look at a waterfall or a flower, or

really anything that is nonthreatening, and do our best to take in all of its

details: What colors do we see? Is it textured or smooth? Hopefully, as we

give ourselves time to take in all the visual information, we will feel that
familiar pull of dissociation fade away.

One final visual example I want to share is one that I use in my office

constantly: counting colors. If I feel my patient slipping away—maybe I

have noticed their grip tighten, eye contact cease, and they stop talking

midsentence—I will ask them how many items in the room have the color

blue in them. Then, I move on to green, brown, or any other color I can

think of until I can see they are a bit more relaxed and present. Prompting

them to start noticing all that’s around them and keep track of the number of

items can be just enough to keep them from completely floating away from

our session.

We want all of our resources to be soothing and help us, and another way

we can accomplish that is through sucking and swallowing. Which I know

sounds a bit odd, but it’s why a crying baby is often calmed through being
3
fed, and why many children suck their thumbs. Our nervous system is

wired from birth to pacify and connect us when we do this, and as an adult,

we can mimic this experience by having hard candies on hand. The sucking

and swallowing required when we enjoy a LifeSaver can be a quick resource

to have with us at all times so that when we start to feel a bit overwhelmed

or upset, we can just pop one in our mouth and let the natural action calm

our nervous system down. Doing this can hold dissociation at bay and help

us not get overwhelmed by whatever trigger we encounter.

I also want to mention that because sucking and swallowing are calming

to us, those of us who have experienced trauma can also struggle with

overeating or even binge eating disorder. It can be one of the only ways we

are able to stay present and feel okay, but know other tools can help, and

working with a mental health professional to process through that trauma

will help us better manage our eating.

We can engage in resources that use our physical body, such as taking a

hot shower or doing some movement, such as yoga or stretching. Even

having a good friend or loved one rub our back or touch our arm to keep us

present can help. One of my friends who struggles with DPDR used to ask

me to sit next to her during large events so that I could rub her back or grab

her arm every few minutes so that she wouldn’t miss out on anything. This

safe physical touch allowed her to stay grounded and present at a time when

all her brain wanted to do was pull her away. If there is an action we can
take that helps us be more aware of our body and the sensations we feel

within it, let’s try to do it.

Just make sure that these activities don’t turn into a form of self-injury;

they should simply help us stay in our body and feel how we feel. Too often,

I have patients who will scald themselves in the shower or pinch themselves

on their arms so hard they leave bruises. These physical movements are not

intended to create pain or lead to use numbing out in other ways, so choose

some that can be safely implemented.

I recognize how hard this can be. Dissociation happens for a reason, and

it may have been our go-to escape our entire lives, so trying to do something

that prevents that can feel impossible at times. But just as we learned in the

last chapter, we can change our brain and get out of those unhealthy

behavioral ruts; it just takes a conscious effort to pull our thoughts and

behaviors away from what we used to do and into these new techniques. It’s

like learning to ride a bike: at first, we think about getting our feet on the

pedals, going fast enough that we don’t fall over, steering in the direction we

want to go, and trying to balance. It can be overwhelming, and we will most

likely fall a few times while we learn, but before we know it we will be

hopping on that bike and riding away easily. It’s the beginning that’s the

toughest when learning new things, so stick with it and know that, with

practice, it will get easier.

Dissociation did have its pros and cons. I learned to use

dissociation when it would benefit me. I used it when I
didn’t want to be present at doctor visits, the dentist’s
office, getting a tattoo, or even having my eyebrows
waxed. Unfortunately, because I was so accustomed to
using dissociation, I was unable to have a natural birth
for my son. I could not stay present long enough to get
through his birth and ended up having a C-section.
Dissociation took that life experience away from me. I
knew it was time to get this under control or it was
going to completely control me.
 WHAT IF I LIKE DISSOCIATING?
Many of my patients and viewers have asked why they need to stop

dissociating if it makes them feel better and it’s not hurting anyone, and

while I understand that it can feel good at times, it hinders a lot of the work

we try to do in therapy. Trauma therapy only works when we are present and

in what many call our “resilient zone”—meaning that we haven’t

dissociated, and we aren’t angry or in our fight-or-flight response; we are in

our body, aware of what is being said and what we are saying. I could even

go as far as saying we need to be in our resilient zone for any therapy to

work, but we especially know this to be true when processing any past

trauma. We previously talked about how trauma affects our brain and that

when our amygdala senses a threat, it shuts down our prefrontal cortex and

other parts involved in complex thought and decision-making. That allows

for us to get out of any potentially harmful situation and survive, so it makes

sense that we don’t need critical thinking when we just need to run away

from an ominous stranger in the alley. In the same way, if we are in a

dissociative state and we cannot connect to our body, our thoughts feel all

fuzzy, and we are completely zoned out, we aren’t going to be able to do any

therapeutic work. We can’t recall our trauma memories, talk about how that

made us feel, and come back next week to build from there. We may not

even remember the last session!

Letting go of this comfortable coping skill is hard and we may want to

let it take us away sometimes, but to stop our trauma memories from taking

any more from us, we are going to have to find a way to stay present and

work through it. I never said therapy was easy or that it wouldn’t force us

out of our comfort zone, but we need to trust that if we can push through the

discomfort and fight for a better future, we will get there.

KEY TAKEAWAYS
• When something traumatizing happens to us, our
brain can pull us out of our conscious mind so that we
don’t have to be present and experience the event.
This removal from our consciousness, called
dissociation, comes in many forms and levels of
severity.
• The three main dissociative disorders listed in the DSM
are dissociative identity disorder (DID), dissociative
amnesia, and depersonalization/derealization (DPDR).
• There is also maladaptive daydreaming, which isn’t in
the DSM but is also common. This is when we would
prefer to spend our time in our daydreams rather than
our real life.
• To combat dissociation, we first have to identify the
things that trigger it, and then build up some calming
resources to help us stay present. These can include
moving our body, sucking on hard candy, making eye
contact with a loved one, and many more simple
strategies.
• Staying present instead of checking out can be
difficult, especially if we have been doing it for years,
and that’s why we will have to put some conscious
effort into our resources and using them before letting
our dissociation take us away.
• It is common for people to enjoy dissociation, but if we
aren’t able to manage it and stay present, trauma
therapy—or any therapy—won’t help us.
 CHAPTER 5

WHAT IS REPEATED TRAUMA?

C-PTSD & HOW IT’S DIFFERENT

For most of my patients and viewers, their trauma doesn’t come from

one experience; instead, it’s spread over years or possibly a lifetime. While a

diagnosis of PTSD does help describe what it can feel like to be

traumatized, it falls short of explaining what being repeatedly hit with wave

after wave of fear, pain, and terror can do to a person. We call this type of

repeated trauma experience complex post-traumatic stress disorder (C-

PTSD). C-PTSD is not included in the DSM but it is in the eleventh edition

of the International Classification of Diseases (ICD-11). I only mention that

because it’s important to know that the symptoms have not been agreed

upon or laid out for diagnostic purposes, but it is on the ICD’s list for its

treatment to be coded and covered by insurance companies. In all honesty, it

doesn’t matter whether it’s in any diagnostic manual or on any list of

diseases and disorders; I know it exists because I have heard the stories and

have seen it with my own eyes.

Again, when thinking about trauma, I don’t want you to think only of our

veterans. While many of them come back from war with C-PTSD, we also

have first responders, abused children, people harmed by domestic violence,

those who are in poverty, health-care workers, and many more. If we take

the time to think about it, there are various ways we can be repeatedly

subjected to traumatizing situations, and if we don’t have the time or

resources to process the traumas as they come, we can slowly be engulfed by

them. Just as we discussed big and little Ts and how they can both lead to
symptoms of PTSD, those who are continually hit with wave after wave of

any traumatic situation never feel that they are on solid ground, or have a

firm grip on their environment, and therefore can struggle to manage all that

they feel. As a result, the symptoms of C-PTSD aren’t limited to those of

hypervigilance, struggling with flashbacks, and dissociation; it can go

deeper than that, eroding our sense of self and ability to regulate our

emotions. It’s also important to know that some of the symptoms we will

discuss are felt in PTSD, but not to the depth or severity that they are

experienced in C-PTSD.

HOW IS C-PTSD DIFFERENT FROM PTSD?

Due to a lack of accredited symptomatology, those with C-PTSD are often

misdiagnosed and not given proper treatment. Simply talking about how this

differs from PTSD doesn’t fully explain the experience, but this story from a

viewer can hopefully help us understand:

C-PTSD kind of feels like Jenga. Remembering difficult emotions or

memories is like picking out a block and waiting for things to fall

apart. Avoiding things so everything doesn’t collapse around you and

always being on high alert because “just in case something bad

happens” and in every relationship, you’re waiting for everything to

fall or be scary because that’s what you’re used to. It’s that constant

worry that things aren’t going to be right, so you have to check and

recheck things which make it impossible to make decisions. Being

hurt or expecting trauma is an everyday thing and there’s no escaping

how on edge you feel because of that. Sometimes you can come

across as moody or having unstable emotions but in reality, it’s just

because your brain is trying to juggle so many thoughts and emotions

relating to past experiences and trying to predict the outcome of

potential situations. And if the Jenga tower falls over, you know that

it’s your fault for trying to manage all of this.

I love that explanation and analogy—thinking of C-PTSD as a game of

Jenga. With all the worry and fear swirling through our mind constantly, it’s

no wonder that the first differentiating symptom between it and PTSD is

emotion regulation. As this viewer shared, “sometimes you can come across

as moody or having unstable emotions…” Juggling all that’s going on in our

mind and being on high alert constantly is exhausting and difficult. If you

think about it, being tired or overwhelmed can make us all more emotional

and it can feel impossible to address life’s ups and downs calmly and

responsibly. We can come across as explosive or too sensitive when what’s

going on is that we are drowning in memories, worries, and trying to make

sure we don’t get hurt again.

Our difficulty regulating our emotions can take its toll on our

relationships. On the one hand, we can lash out preemptively, thinking that

we are protecting ourselves from further pain and suffering. We can also be

short-tempered because we spend most of our day fighting off the thoughts,

memories, and worries. Therefore, when someone asks us to help them out

or gets upset about something we did, it can cause us to come unraveled. On

the other hand, many of my viewers share how they isolate themselves as a

way to deal with all they are going through, because it’s easier to manage

when there are fewer triggers. That way, we don’t get asked how we are

doing or why we aren’t very talkative; we can just focus our energy on

managing all of the thoughts and experiences that bombard us every day.

We discussed dissociative amnesia in the previous chapter, and why

trauma memories can be fractured and difficult to fully recall; that still

exists within C-PTSD; however, it’s much more intense. Many of my

patients and viewers struggle to remember any portion of their traumas,

some sharing how experiencing yet another upsetting event pushes any

memory they had out of reach entirely. I have seen this over and over again

in my practice, where a patient will show definite signs of C-PTSD, but

when asked about any upsetting situation or scary experience, they can’t

think of any. It’s as if our brain hides the hurtful memories from us so that

we can keep living our life unencumbered by them. What I find in my

practice is that the memories remain hidden or suppressed until we are in a

safer place where we can open up and talk about what happened. Once we

are safe, the signs, symptoms, and bits of memory will bubble up and, in

essence, urge us to process them.

 There’s also a strong feeling that there is something
wrong with you but you can’t figure out why. The feeling
like you are insane due to your overreactions to often
small things. In some ways, learning about them makes
you feel more unstable until you learn to handle those
triggers.

C-PTSD can also make it hard for us to trust people. If we have been

hurt repeatedly, possibly by multiple people, throughout our lifetime, it’s

going to be difficult for us to welcome anyone new into our life. Not to

mention that because we have had such terrible and harmful relationships in

the past, we can question our ability to vet people. This is where the effects

of C-PTSD take the largest toll, by eroding our trust in ourselves and our

abilities, and we can begin to think that something’s wrong with us. Often

wondering why we can’t just be okay, move on, and live a normal life. We

can even think that we did something to cause all of this.

Another differentiating component of C-PTSD is how we can have a

distorted perception of our abuser or whoever harmed us; this could be a

parent or other caretaker, a spouse, or even someone we considered a friend.

Especially if the trauma occurred when we were young, it can be hard for us

to understand how someone could say they love us while doing something

hurtful. This can lead to us forming bonds with our abuser, wanting the

attention they give us, and possibly even falling in love with them. I know

this is hard to understand, but when we are young, we are primed for

connection and attachment. If we are subjected to abuse during this time and

told that this is what love, family, or attention looks like, we believe it.

Psychologist Patrick Carnes calls this emotional connection a trauma bond,

and it is believed that they are formed out of intense fear, terror, and a need
1
to survive.

Even if we don’t bond with our abuser, we can try to make sense of it,

thinking that maybe they really didn’t mean to hurt us or perhaps we are the
ones that caused it to happen. I cannot tell you how many times I have heard

some version of “I didn’t fight back after a while, so I think it’s my fault that

it kept happening.” It can be hard for us to understand that if we can’t fight

back or get away from the situation, our only other option is to freeze until

the trauma is over. This frozen state not only makes us feel helpless and

scared, but it can also lead to a lot of shame and guilt. Just like that viewer

shared earlier, “If the Jenga tower falls over, you know that it’s your fault for

trying to manage all of this.” We take all the blame for the pain and hurt,

unsure of whether our abuser deserves it. They can tell us they love us and

that’s how they show it, or possibly blame it on something we did as if we

made them do it. If we repeatedly hear this for months or even years, it can

be hard to not believe it or possibly wonder what’s wrong with us.

Trust is completely eroded into nothingness. And there

are so many walls set up as a result of those traumatic
incidents that everything appears fake. You start to
question your reality and every interaction that you
have. And interacting with every person is basically a
new me, to the point where I have been having a huge
crisis of identity, trying to pin down who I am.

All of these experiences and resulting symptoms can rob us of our sense

of meaning in life. Which as a therapist is scary, because meaning and hope

are what help keep us motivated and alive. Whenever someone is losing

hope or feels helpless against their struggles, suicidal thoughts are not far

behind, and while I believe everyone can get better and life is worth living, I

also understand why suicide feels like an option. When I asked my audience

to share their stories, my inbox was flooded with messages like this one:

People around me are over my shit. They think I am just lazy or not

trying hard enough. They think that if I did more or just sucked it up
 and got on with things I would have a job and be out in the

community. But most times I think they don’t get just how bad it

really is or how hard I am fighting. But it’s hard with C-PTSD. And

nightmares suck. Every night I am pounded with multiple nightmares

of past traumas. Where I get trapped in these horrible scenarios,

sometimes all of them at once, where I am hurt over and over again

by these evil people and can’t find any safety. Often jolted awake

mid-scream and shaking, feeling so very small and fragile as I was

back then. And some days because of how hard I am fighting my

brain, the biggest achievement I can accomplish is getting out of bed.

Most days it takes me hours to be able to pull my head out of that

torture and convince myself that I am safe and grown. Some days it is

as late as 7 or 8 pm before I can pull my head out of it, which is

disheartening knowing that I have to do it all over again not long

after. And the number of times that I have gotten in trouble for being

rude or “trying to get attention” because some days I lose the ability

to speak for a few hours. Where I can type and I can write to

communicate, but I can’t physically speak. And it takes me a while to

regain my voice, but people around me just assume that I’m putting it

on for attention.

It’s stories like these that show just how important it is that we be

understanding and compassionate toward those with C-PTSD, and why it

can be so debilitating for those suffering. Being in traumatic situations over

and over throughout our lives can take its toll on our emotional health and

make it difficult for us to form healthy relationships. As we continue

through the COVID-19 global pandemic, this understanding is even more

vital since we will have essential workers emerge having been traumatized

day after day, without a chance to vent or process it all. The less we judge

and the more we listen, the better suited we will be to help them. As a

therapist, it’s a reminder to listen to my patients and let them teach me about

their experience, so that we can work together toward treatment and healing.

STRUGGLING TO DEAL
When we feel that we can’t seem to get our head above water, the traumas

keep coming, and we are barely able to catch our breath, it’s no wonder we

try to find a way out of the pain. Coping with trauma isn’t easy, and while

dissociation can offer some relief, it’s often not enough. That’s why our

brain gets creative when coming up with ways to numb the pain, or to help

us feel alive again. Throughout my years in practice and online, I have heard

them all; from overspending to drinking, doing drugs, harming ourselves,

and even using food and exercise to deal. Many of my patients whose

trauma experiences revolve around sex can find themselves using sexual acts

to cope, sharing how it made them feel they were taking their power back.

Here’s an example from a viewer about all of the ways she tried to cope:

My experiences with C-PTSD all started with being exposed to

childhood sexual abuse that lasted for a couple of years. At a young

age, I wasn’t prepared for a life that would consist of recurring sexual

trauma. Throughout my early teens, I struggled with anorexia and

hated my body, it never felt like my own, I was very introverted, I had

issues with trust and was emotionally withdrawn. This shifted during

my later teens into alcohol and substance abuse and becoming

sexually promiscuous without any emotions attached.

In many ways, we try to grab hold of anything that will give us a break

from our pain and suffering. These various coping skills can change over

time, depending on what we need or how we feel. One of the most common

unhealthy coping skills for C-PTSD is self-injury. And before you jump to

any conclusions, no this isn’t for attention or a suicide attempt. Self-injury is

often a way to physically show all of the emotional pain we are

experiencing. It can be done to numb out from all we feel, or even be a way

to create an event where we have to tend to our own wounds, in essence

physically caring for ourselves because we don’t know how to do so

emotionally. I have also had many patients tell me that it’s a way to let out

all they feel, as if the physical hurt releases the emotional pain.

Since self-injury doesn’t help us process all we have been through or get

more connected with ourselves and how we feel, its relief is short-lived. The

act of self-injuring can lead us to have a whole slew of other issues as a

result. For example, when we self-injure, it’s usually done in secret and there

are shame and embarrassment around the action. We can fear anyone

finding out because they might think we are crazy or not understand why we

do it. Too often, I hear of people being put into the psychiatric hospital

because a family member or even mental health professional didn’t

understand or know how to treat them. I don’t want to downplay the

potential for infection and other complications stemming from self-injurious

behavior, but once the injury has been properly cared for, it’s important to

understand the emotional side of it and what it means to the person who is

engaging in that behavior. That’s why my advice is to listen and seek to

understand someone’s experience before jumping to any conclusions. Doing

so can save all of us any additional pain and ensure that the proper support

and treatment are given.

Another type of coping skill I see concerning C-PTSD is eating

disorders. I know you are probably wondering what food and exercise have

to do with trauma, and in all honesty, they aren’t related at all. The reasons

we use eating disorder behaviors to cope are in some ways the same reasons

many use self-injury: We want to numb out and not think about the real pain

we are experiencing. Eating disorders allow us to focus on and control the

one thing we can, our body. Putting all of our focus and energy into what we

eat or don’t eat can be a welcome distraction from the flashbacks, waves of

emotions, and worry about the future. To explain this with more clarity,

here’s a story from another viewer:

Everything in my life felt out of control. I was having a hard year at

work, I couldn’t fix my mom’s issues no matter how hard I tried, I

couldn’t keep my family together as we were falling apart, but I could

control myself, and I could most definitely control my eating and my

exercise. I developed an eating disorder in college, but I have been in

recovery for several years, feeling healthier and so much more free

than I had during those years in college. However, when the family

stress and trauma came into my life, I found myself becoming more

food-obsessed. I started to track my food again, measure everything I

put into my body, and exercise daily, too much exercise for the

number of calories I was consuming… I believe that because of this,

 my eating disorder has returned because it makes me feel like I finally

have control over something in my life, and nobody can take it away

from me. Nobody can take away this power I have, and that gives me

a sense of security back in my life. The more I control the amount of

food that goes into my body, and the more I exercise, the more I feel

like the world isn’t spinning me around anymore. When I eat less, I

feel calm. When I run, I feel calm.

I do want to mention that not all eating disorders cause you to lose

weight, and they don’t happen only to women. If you were already

imagining a young girl who looks emaciated, I want you to think again. My

eating disorder patients have been every age imaginable, and at least half of

them struggle with binge eating, not restricting. An eating disorder occurs

when we use food as a way to cope with how we feel, and almost all of our

thoughts each day are food-focused. That’s it. Sure, we can get caught up in

the symptoms and which eating disorder diagnosis fits those symptoms, but

I don’t care about the diagnosis. What I care about is figuring out why the

eating disorder exists in the first place. What was going on in our life when

food became such a focus? When did we start overeating? Undereating? Or

overexercising? You would be surprised how many of my patients will tell

me they have no idea why they struggle so much with food, and that their

life is fairly normal and happy. But just a few sessions later, we have

uncovered how their father used to drink too much and hit their mom, or

that they were bullied for four years in school. It’s normal for us to stuff

down any traumas and upsets so we can keep going, but it will come out one

way or another; in many cases unprocessed trauma will erupt in eating

disorder behaviors.

There are various ways we can try to cope with a trauma-filled life, but

the last ones I am going to discuss here are alcohol and drugs. I feel that we

hear about this one the most: how people who have been through a

traumatizing situation drink or do drugs as a way to dumb out and forget

that it happened, and it makes sense. If we are inebriated, we truly cannot

think straight, focus, or process all we have been through. We can just zone

out and relax; that is, until the high or alcohol wears off and then we are

back where we didn’t want to be, with all of our thoughts and feelings
rushing back. We can get caught up in this cycle of numb out, sober up, and

do it all over again.

In the wake of COVID-19, the market research firm Nielsen reported

that alcohol sales were up 27 percent, and though many argue that it was

because people were not drinking out at restaurants and bars, I think there is
2
more to it. Many people live alone, are feeling stressed and worried, not to

mention Alcoholics Anonymous (AA) and Narcotics Anonymous (NA)

meetings aren’t taking place in person anymore. Needless to say, the spike in

sales is a bit alarming. Too often, we fight to find a way to ignore all we feel

instead of working to process it. As our world continues to be subjected to

traumatic experiences, we must take note of all the ways we try to numb out

instead of tap in and validate how we feel. I know it’s uncomfortable, and

we aren’t always ready for it, but if we keep ignoring it and covering it up, it

will only fester and cause us more pain.

KEY TAKEAWAYS
• Complex post-traumatic stress disorder (C-PTSD)
happens when we are traumatized repeatedly.
• The symptoms of C-PTSD that are not included in the
PTSD diagnostic criteria are difficulty regulating
emotion, issues in our relationships, struggle to recall
anything about the traumatic experiences, inability to
trust others or ourselves, distorted perceptions of our
abuser or perpetrator, and struggling to find meaning
in life.
• Due to the COVID-19 pandemic, it’s likely that most of
us will experience some form of trauma. Noting what
symptoms of trauma affect us and finding ways to talk
about all we are experiencing, whether with a therapist
or friend, can help us overcome this together.
• Numbing out from the pain of C-PTSD is common and
can be done through self-injurious actions, engaging in
eating disorder behaviors, or abusing drugs and
alcohol, to name a few.
 CHAPTER 6

ARE WE SURE IT’S C-PTSD?

Too often, C-PTSD is misdiagnosed and mistreated. Since we are not

taught about it in school and the DSM isn’t any help, most mental health

professionals have to learn about it through colleagues or by treating

patients with it, if they learn about it at all. This lack of information and

understanding has led many patients to be seen for a short time, feel

misunderstood, and then referred out, seeing three or four therapists a year

while trying to find someone who will help them process it all. This can be

disheartening, invalidating, and painful. I believe this all stems from a lack

of understanding and the fact that many of the symptoms of C-PTSD

overlap with those of borderline personality disorder (BPD).

BPD is a very misunderstood mental illness and is characterized by an

intense fear of abandonment, a pattern of unstable relationships, and

impulsive behaviors, often born out of trauma. As far as the DSM is

concerned, someone with BPD shows, “A pervasive pattern of instability of

interpersonal relationships, self-image, and affects, a marked impulsivity,

1
beginning by early adulthood and present in a variety of contexts.” Already

you can see how this could overlap with some of the symptoms of C-PTSD,

at least when it comes to difficulty in relationships. However, BPD is a much

more pervasive diagnosis; the criteria go on to cover nine other symptoms or

behaviors; to be diagnosed with BPD, we must have at least five of them.

The first criterion and one of the ways I differentiate BPD from C-PTSD
2
is “frantic efforts to avoid real or imagined abandonment.” When we have

BPD, we can believe deep down that we are unlovable and bad and therefore

are not deserving of love or affection. Instead of allowing someone to leave

us, which would be too painful for us to endure, we lash out and may try to

leave them first. This can be hard for others to deal with, they can think we

are hateful, easily upset, or overly emotional. The real reason we do this is

to protect ourselves; we can’t trust that someone will always be there for us,

or be trustworthy, so we strike first. Many of my patients have shared how

they often lash out to see how people react, in hopes that those individuals

will apologize and tell them how important they are, but too often, this

outburst ends up harming the relationship and, in turn, the person with

BPD.

Although this criterion can in some ways look like those of C-PTSD

because we can be emotional and our emotions can feel out of control at

times, the big difference is why we feel that way. Do our emotions feel out

of control because we are dealing with so many flashbacks, nightmares, and

trying to predict another trauma? Or is it because we are so sensitive to any

perceived loss or abandonment? Of course, to find this out many of us will

have to see a mental health professional, but once we think about it, I am

sure we can figure out which diagnosis fits us best.

Next up, we have “a pattern of unstable and intense interpersonal

relationships characterized by alternating between extremes of idealization

3
and devaluation.” This one could be a bit tricky because those of us with

C-PTSD can struggle in our relationships, making them unstable or intense;

however, the last portion about alternating between extremes is purely a

BPD thing. If we can go from loving someone to hating their guts within

minutes, it’s more likely BPD instead of C-PTSD. When it’s C-PTSD, our

relationships can become unstable because we are dealing with so much

pain and turmoil internally that we can struggle to trust, communicate, and

have patience with those around us. We don’t idealize someone one moment

only to think they are the worst person to ever walk this earth the next.

Moving along, the next criterion is hard to tease out and could be why so

many people with C-PTSD are misdiagnosed as having BPD. This symptom

is “identity disturbance: markedly and persistently unstable self-image or

4
sense of self.” When it comes to BPD, this expresses itself through shifting

goals, career plans, who we want as friends, and what our core values are.

Since many of those with BPD can believe something is wrong with them or

that they are bad in some way, they can quickly switch between being needy
and clingy to strong and assertive. This is done as a way to connect and get

support, but also protect them from the perceived threat or upset. This

happens in some ways with those who have C-PTSD, since they are

constantly on the lookout for another potential traumatic situation; however,

the big difference is when it’s C-PTSD, we are trying to figure out who we

are in this dangerous world. When it’s BPD, we are trying to get connection

and attachment by being whoever we think we need to be. It’s more like we

chameleon ourselves to start or continue a relationship.

The next criterion is impulsivity, and one main area of overlap between

BPD and C-PTSD. The DSM states that we must show “impulsivity in at
5
least two areas that are potentially self-damaging.” These are such things as

overspending, being hypersexual, or binge eating. The DSM does not include

self-injury in this section, but I believe it should be there since that kind of

behavior is impulsive and urge driven. With regard to C-PTSD, we can be

impulsive in some ways because our mind is focused on so many other

things, and binge eating does happen as a way to cope with the pain of the

trauma. It does present more as being reckless, which can be a form of self-

destructive behavior, and that’s why I would say that this is one portion of

the two diagnoses that are the same, but remember you have to have five of

these symptoms to be diagnosed with BPD, so they are still very different.

The fifth criterion is yet another reason many of us with C-PTSD are

diagnosed with BPD. These symptoms are “recurrent suicidal behavior,

6
gestures, or threats, or self-mutilating behavior.” Self-injurious behavior

can happen for various reasons; however, it’s only in the DSM under the

diagnosis of BPD. And just as a note, the DSM-5 did mention “non-suicidal

self-injury” as a Condition for Further Study but it hasn’t been included yet.

Therefore, if we go to see a therapist or other mental health professional and

let them know that sometimes we harm ourselves when we are feeling bad,

they could automatically diagnose us with BPD. Now, I would hope that

they would spend more time with us, ask questions, and look for other

symptoms of BPD, but I know that’s not always the case.

When it comes to the difference between C-PTSD and BPD concerning

this, there may not be any. I know that many of my BPD patients have used

suicide and self-injury as a way to test their relationships, to get some extra

support and care they were craving, or to try to end all of the pain they feel;
however, that’s not always the case. The way I distinguish between the two is

to ask questions about why they self-injured: Did it have anything to do with

a relationship? Possibly it was done to express an upset from an argument or

breakup? If that’s the case, then it’s most likely related to BPD; if it was

done to manage all of the anxiety, panic, or body memories, then it’s caused

by C-PTSD.
7
Next, we have “affective instability due to a marked reactivity in mood,”

and you can see again how this could look a lot like C-PTSD. After all,

when we have been traumatized over and over again, we can be easily

irritated, upset, and struggle to control our moods. However, when this is

related to C-PTSD, we will struggle with emotion regulation as we process

through all the trauma, and that could last months or even years. When this

symptom comes from BPD, these outbursts or reactivity only last for a few

hours and on the rarest occasion a few days.

8
Another symptom of BPD is “chronic feelings of emptiness.” In BPD,

this can be due to our struggles in relationships and constant worry that we

will be abandoned. Many even report being easily bored, which can lead

them into acting impulsively or lashing out. However, in C-PTSD, it’s more

common to have a negative outlook on life and struggle to look for reasons

that the traumas occurred, but again it’s not related to abandonment or our

relationships. The upset and detachment we feel is focused on the traumas

and trying to ensure we don’t get hurt again.

The second-to-last symptom is “inappropriate, intense anger or difficulty

9
controlling anger.” In BPD, I believe this comes from our belief that

something is wrong with us or we are just bad, and that’s why everyone will

leave us. While those thoughts and beliefs aren’t true, it can lead to angry

outbursts because we are just so full of shame and upset. Those with C-

PTSD can lash out and be easily angered, it’s not usually as severe as those

with BPD. The difference between BPD and C-PTSD regarding these

criteria can be hard to discern, and again, shows us why these two diagnoses

are so often mistaken for the other. That’s why all mental health

professionals must spend time with their patients; listen to them; ask

questions to figure out where the urge, upset, or other symptoms are coming

from; and then decide which diagnosis is best.

The final criterion can easily be linked to BPD and C-PTSD, and it is
“transient, stress-related paranoid ideation or severe dissociative
10
symptoms.” We have already discussed how dissociation is part of PTSD

as a whole, and a way for our brain to cope with all of the pain and trauma.

Those who have been traumatized can also be paranoid that it will happen

again, like this clip from an earlier example from one of my viewers:

It’s that constant worry that things aren’t going to be right so you have

to check and recheck things which make it impossible to make

decisions. Being hurt or expecting trauma is an everyday thing and

there’s no escaping how on edge you feel because of that.

The real difference in how these symptoms are expressed in BPD versus

C-PTSD is that those with BPD feel this way due to real or imagined

abandonment, and those with C-PTSD have these in response to trauma

triggers in their environment. Again, it can be hard to spot the difference,

but by having a conversation about when the symptoms began or digging

into what triggered the sensation, we should be able to figure out which

diagnosis explains it best.

As you can see, there are many overlapping or similar symptoms

between these two diagnoses, and that’s why many people get misdiagnosed

with BPD when it should be PTSD, and vice versa. It’s also important to

know that many people meet the criteria for both diagnoses. A recent study
11
found that 24 percent of those with PTSD also had BPD and 30 percent of
12
those with BPD also had PTSD. They used the PTSD diagnosis in these

studies because, as I shared earlier, C-PTSD isn’t in the DSM and doesn’t

have any clear diagnostic criteria.

Another diagnosis that is often misrepresented as C-PTSD is bipolar

disorder; however, the differences between these two are not as nuanced as

with the previous one. While there are two types of bipolar disorder and

many ways it can present, the important thing to know about bipolar

disorder is that it’s episodic. That means people with bipolar disorder of any

kind go through episodes of elevated energy and feeling really good about

themselves as well as experience periods of feeling really low and

depressed. C-PTSD is not episodic; unfortunately, we feel the symptoms of

it all the time. Therefore, the easiest way to discern between these two
diagnoses is to track the symptoms and see how long they last. I often work

on timelines of the symptoms with my patients to see how often they come

up, what triggers them, and how long they last. This helps us better prepare

for and manage the symptoms.

Overall, when diagnosing and treating someone with C-PTSD, it’s

important to rule out other diagnoses that could look and feel very similar,

to ensure we know what we are working on. Even though a diagnosis isn’t

everything, we do need to understand the symptoms that are bothering us so

that when we reach out for help, others know what to assist us with. To

check that you completely understand what C-PTSD is and is not, here is a

quick questionnaire:

• Have you been traumatized multiple times in your life?

• Have you repeatedly witnessed someone else experience a traumatic

event? One in which you feared for their safety?

• Do you worry more days than not about another trauma happening to

you or those you love?

• Are you constantly assessing your environment for any signs of a

perpetrator or unsafe situation?

• Do you struggle to manage all you feel, and think you overreact to

some of the smallest things?

• Have you ever used self-injury, sex, eating, or alcohol or drugs to deal

with how you feel?

• Do you find it almost impossible to trust people?

If you answered yes to the first or second question and to at least one

other question, you could be suffering from C-PTSD. The next helpful step

is to reach out to a mental health professional in your area or online who

knows how to treat PTSD and understands the nuances of C-PTSD. And

yes, it is perfectly okay to ask them about these disorders as relates to their

training before making an appointment with them. We want to make sure we

find the right person to help guide us on our path to recovery, because we

can and will get better.

 WHY DO I KEEP BEING TRAUMATIZED?
One of the most common questions I get about C-PTSD is “Why do I keep

getting hurt? Am I doing something to lure bad people into my life?” and I

understand their concern. If it seems that every relationship or situation we

get into leads to us being hurt, we can start to question ourselves and what

we are putting out there into the world. If we consider the symptoms of C-

PTSD, we can see some ways they could be working against us.

One of the first symptoms is that of the freeze state. If we were in a

traumatizing situation and fighting or fleeing weren’t options, we could go

into a state of freeze. Freezing can be a helpful stress response because it

can prevent us from potentially causing ourselves more harm; for instance, if

we fought back knowing an abuser is much stronger, we could end up with

broken bones or possibly be killed. Therefore, in many ways, our freeze

state can save us. However, when we are repeatedly in situations in which

we cannot fight or flee, and instead have to go into our freeze state, we can

slowly develop learned helplessness—meaning that because we have tried to

deal with everything that’s happened to us, yet no matter how hard we try
13
we don’t succeed, our automatic response can be to give up. This can hurt

us in future situations because even if we could get away or fight back, our

brain automatically goes into freeze, rendering us helpless and increasing

the likelihood that we are hurt again.

On the flip side, many of us who grew up in constant trauma or stress

can become so used to the environment it creates that we look for

relationships or situations that feel just like it. In the same way people joke

about dating someone just like your mother or father, many of us with

abusive parents can in essence do the same thing and find a person that is

just like our past abuser. Being in this continuous state of stress can also

lead us to overlook it in our regular life. We could be walking down a dark

alley late at night and not think anything of it because we are used to feeling

at risk or on edge, whereas someone without C-PTSD wouldn’t be

comfortable and would most likely run out of that situation or not put

themselves in it to begin with.

The final symptom of C-PTSD that can lead to us being hurt again is our

distorted perception of ourselves and our perpetrator. Being traumatized

multiple times can cause us to question ourselves and our ability to properly
assess other people. Furthermore, if we formed a trauma bond with our

abuser, we can feel even more confused and unsure of ourselves. This can

cause us to get into unhealthy relationships and be talked into doing risky

things. If we don’t think we can trust our intuition because it hasn’t served

us well in the past, we can look outward to others and hope that they will

make the right decisions for us. However, this can put us in more

traumatizing situations.

HOW CAN I STOP IT FROM HAPPENING AGAIN?

I don’t want to leave you thinking that if you have been traumatized more

than once, there isn’t anything you can do to stop it from continuing to

happen, because that is not the truth. There are many things we can do to

fight against those symptoms that can hurt us, and lean into the ones that

keep us safe. The first thing you can do is to find a mental health

professional who understands C-PTSD. I know that’s obvious, but it’s really

important to find someone you can trust, and since trust can be hard to offer

in our daily lives, a therapist is a great place to start. Then, you can use them

to vet other people, letting them know what was said, how you felt, and

together you can decide how to proceed.

Next, be a detective. Not as if you are trying to solve a crime; more of a

detective of yourself and your past situations. If you can, look back on the

last relationship you were in that was hurtful. Did you have any inkling that

it was going to be abusive? Were there any early signs that they weren’t a

good person? Maybe you have friends or family who can weigh in on these

situations; you could ask them whether they sensed anything before the

traumatizing event. I know memory can be hard here; that’s why I made

getting a therapist the first tip, but family and long-term friends can help out

where our memory isn’t as sharp. Being a detective also means keeping

track of our symptoms and feelings. This can be hard at first, but trust me,

with practice it gets easier. Making a list of the symptoms I discussed in this

chapter can help. Maybe write them down on one side of a piece of paper

and note things that you did that day that fell into each category. And if

feelings are hard to name, you can simply search online for a “feelings

chart” and tons of forms with lists of feeling words will pop up and you can
download or print them off.

My final tip is to take your time. Too often, we rush into relationships or

situations without giving ourselves time to get to know people, letting them

meet other people in our life, and having a chance to see them in various

environments. If we take our time, fight any urges to be impulsive, and

check in with those we know and trust, it’s less likely that we will find

ourselves in yet another hurtful situation. Also keep in mind that anyone

who doesn’t respect our time frame and wants to rush us into decisions isn’t

worth our time anyway.

C-PTSD can be difficult to deal with and we can feel like we keep getting

hit with wave after wave of trauma, but with proper understanding, support,

and hard work, it does get better. We can heal and go on to live a life free

from the symptoms and pain that have been holding us back all this time.

KEY TAKEAWAYS
• C-PTSD is often misdiagnosed as borderline
personality disorder (BPD) or bipolar disorder. That’s
why it’s important to see a mental health professional
who understands the differences.
• Those with C-PTSD can be more likely to be
traumatized again, for many reasons. First, we can feel
helpless to stop it from happening again. Second, we
can be so used to living in a traumatic or stressful
environment that we seek it out. Finally, our distorted
perception of ourselves and our perpetrators can make
it hard for us to know who’s good or bad.
• We can prevent trauma from happening again by
seeking the support of a trauma therapist, using our
past traumatic situations to help us better prepare and
protect ourselves, and taking our time getting to know
people first.
 CHAPTER 7

WHAT ARE THE 4

ATTACHMENT STYLES?
WHY TRAUMA IS ROOTED IN
CHILDHOOD

My first job working as a therapist was at a free clinic in North

Hollywood. We saw mostly court-mandated cases: some struggling with

addiction, many active gang members, and a lot of children affected by their

parents’ divorce. My first therapy patient was a ten-year-old girl named

Isabella. She was having a hard time at school, unable to keep up with her

homework, and getting into fights with her peers. Her teachers

recommended she see a therapist and a psychiatrist to assess whether she

needed to be placed in a special needs classroom for disruptive children.

Isabella was quiet at first, struggled to make eye contact, and only wanted to

color or play with the wooden dolls I had in my office. As a new therapist, I

was worried that I would never get through to her or get her to share with

me what was going on, but after seeing her every week for two months, she

started to open up. She began incorporating this plastic dinosaur toy from

another toy bin into her therapy play. She made the dinosaur hit one of her

wooden dolls over and over again, yelling at it, while she hid the other doll

behind her. I asked Isabella who the dinosaur was and she just shook her

head, brought back out the other wooden doll, and continued to play with

the two dolls again as if nothing had happened. I wasn’t sure why such a

simple question had shut her down, and I worried that I had done something
wrong or hurt our new therapeutic relationship. Whatever had happened, I

needed to find out more about it and do better next time, so I went to my

supervisor.

At this time, I was still an intern and therefore had weekly supervision

with a licensed therapist to help guide me when I felt lost and ensure I was

offering quality care. His advice was to wait until she brought out the

dinosaur again and ask some things about the other characters since she

didn’t feel safe enough to talk about the dinosaur. I took some notes based

on what he said and waited for our next appointment together. She kept

playing without the dinosaur for the next few weeks, but finally, it made

another appearance, and this time I had a new way to approach the subject. I

asked who the doll was that she hid behind her and asked her whether that

doll was safe and okay. She still shook her head, not able to talk about the

scenario she was demonstrating through play, so I asked whether she wanted

to color or draw instead. She loved that idea and helped me get out all the

crayons and paper. While we colored, I asked many questions about what

she was drawing, who her best friend at school was, and tried to get to know

her better. It’s important to let you know just how slow work with children

can be, especially those who have been traumatized. They don’t trust easily,

nor do they know how to tell you what’s going on. Maybe they don’t have

the words or have been told that if they do say something, they or someone

they love will be hurt. Isabella and I colored for another month or two

before I was able to find out that the doll she hid while the dinosaur hurt the

other doll was her, and that she had to hide to be kept safe. Yes! I was finally

getting somewhere!

Over the next few months, I came to learn that it was her mother who

was being hit by her boyfriend, and Isabella would hide in the closet in her

room when he came over or when he raised his voice. He had hit her a few

times in the past, and that’s why she had decided to hide in her closet. An

unfortunate part of my job is having to report situations like this to Child

Protective Services, the governmental agency that helps protect children. As

a therapist, I am a mandated reporter—meaning that I am legally bound to

report any child, elder, or dependent adult abuse that I hear about or see in

my practice. Even though I talked with the mother and let her know that I

had to report it, she never brought Isabella back to see me, and I often think

about her and hope that she is doing okay. I know I did what was right, but
when seeing children, it can be hard because they aren’t in complete control

of their life and who’s allowed in it. As someone who got into this line of

work to help people heal, I struggle with situations like this and often

wonder whether I could have handled it better. I was a brand-new therapist,

and while I did ask my supervisor to ensure what I was doing was correct,

should I have done something differently? Did I inadvertently cause Isabella

more harm than good? I may never know.

IS CHILDHOOD TRAUMA COMMON?

Unfortunately, Isabella’s story isn’t an anomaly. Before the age of sixteen,
1
two-thirds of children report experiencing at least one traumatic event.

Which means that most of us have faced at least one upsetting and terrifying

situation, and while we know that with proper support and care we can

process the trauma and be okay, the younger we are, the less likely it is that

we have any emotional understanding or ability to deal with it. These earlier

life traumas can shape who we are and who we decide to get into

relationships with. For many years, we didn’t know how to assess for these

early life traumas or what effect they could have on us as we get older. That

all changed in 1998 when the Centers for Disease Control and Prevention

(CDC) and Kaiser Permanente published their Adverse Childhood

Experiences (ACEs) Study based on seventeen thousand adult patients and

how their childhood trauma exposure affected their mental and physical
2
health later in life. This groundbreaking study proved that there was a

connection between ACEs and future health concerns—meaning that the

more traumatic childhood experiences we had, the more health concerns we

will have as we age.

They based their findings off of ten ACEs: emotional, physical, and

sexual abuse, physical or emotional neglect, domestic violence, parental

mental illness, substance dependence, incarceration, and parental separation

or divorce. These ten ACEs do not include things that come from our

environment, such as bullying, poverty, or racism, and because those

situations can have a detrimental effect on us, many clinicians have begun to

add them to their assessments as well. While the demographic information

of those included in the study are not the most diverse, it’s still important to
note that even with the participants being almost 75 percent white, about

half were sixty years of age or older, and 39 percent of them had completed

college, almost two-thirds of those studied reported at least one ACE. Also,
3
one in eight reported four or more ACEs.

When I first heard about this study, I immediately wanted to take it

myself to see whether I had any ACEs, and I would assume that you are no
4
different, so here is an adapted ACEs questionnaire:

• Before your eighteenth birthday, did a parent or other adult in the

household often or very often swear at you, insult you, put you down,

or humiliate you? Or act in a way that made you afraid that you might

be physically hurt?

• Before your eighteenth birthday, did a parent or other adult in the

household often or very often push, grab, slap, or throw something at

you? Or ever hit you so hard that you had marks or were injured?

• Before your eighteenth birthday, did an adult or person at least five

years older than you ever touch or fondle you or have you touch their

body in a sexual way? Or attempt or actually have oral, anal, or

vaginal intercourse with you?

• Before your eighteenth birthday, did you often or very often feel that

no one in your family loved you or thought you were important or

special? Or your family didn’t look out for each other, feel close to

each other, or support each other?

• Before your eighteenth birthday, did you often or very often feel that

you didn’t have enough to eat, had to wear dirty clothes, and had no

one to protect you? Or your parents were too drunk or high to take

care of you or take you to the doctor if you needed it?

• Before your eighteenth birthday, was a biological parent ever lost to

you through divorce, abandonment, or other reason?

• Before your eighteenth birthday, was your mother or stepmother often

or very often pushed, grabbed, slapped, or had something thrown at

her? Or sometimes, often, or very often kicked, bitten, hit with a fist,

or hit with something hard? Or ever repeatedly hit at least a few

 minutes or threatened with a gun or knife?

• Before your eighteenth birthday, did you live with anyone who was a

problem drinker or alcoholic or who used street drugs?

• Before your eighteenth birthday, was a household member depressed

or mentally ill or did a household member attempt suicide?

• Before your eighteenth birthday, did a household member go to

prison?

For every yes, give yourself one point; the total number is your ACE

score. What the CDC and Kaiser Permanente did in their study was take

these ACE scores and compare them with people’s physical health

outcomes, and they found that people with an ACE score of 4 or more were

four and a half times more likely to suffer from depression than someone

with an ACE score of 0, and twelve times more likely to struggle with

suicidality. They also found those with an ACE score of 4 or more were two

and a half times more likely to have hepatitis, chronic obstructive

5
pulmonary disease (COPD), and many other health concerns. Now, you

could look at this data and think that it’s obvious that those who were

traumatized when they were young would be more likely to drink, smoke,

and engage in risky behavior, but it’s much more than that. Even if we don’t

engage in any risky behavior, those of us with high ACE scores are still

more likely to develop health issues. You might be wondering why that is,

and the truth lies in our stress response. When we get scared or stressed, our

body sends the signal to our brain to release stress hormones, such as

adrenaline and cortisol, and we enter our fight/flight/freeze response. This

makes our heart pump faster, our airways open so we can breathe better, and

our pupils dilate so we can see more clearly. Our body readies itself for

action. This stress response helps keep us alive and helps us run away from

danger or fight back against an attacker. However, it’s not meant to be

engaged for long periods, and if our environment keeps us held in that stress

response day after day, it’s no longer lifesaving, it’s hurting and hindering

us.

In the ACEs Study, they call this type of stress “toxic stress” and it

affects our brain development. It can decrease the response from the reward

center in our brain (the nucleus accumbens), which is responsible for

sending a signal alerting our midbrain that we have been rewarded and tells

it to release more dopamine, making us feel amazing. When this part of our

brain isn’t as responsive, we can feel more depressed or struggle to find

enjoyment in our lives. This could also be what leads those of us with a high

ACE score to turn to drugs or alcohol to get that rewarded feeling or high.

Elevated ACE scores can also affect the amygdala, or what I like to call the

fire alarm in our brain. It’s responsible for initiating our fear response, and if

it’s activated too frequently, it can become enlarged and lead to symptoms of

hypervigilance. It can also lead to us being so used to feeling on edge or at

risk that we struggle to know what’s dangerous or not. The prefrontal cortex

is our brain’s control center and decision-maker and is vital for learning. I

like to think of our prefrontal cortex as the adult part of our brain. It can

take into consideration all of the information, manage our emotions about it,

and help us calmly make decisions. When we have a high ACE score, this

part of our brain is impaired, which can make us more impulsive, struggle to

plan, and have difficulty creating goals for ourselves.

As you navigate your answers to that ACE questionnaire, try not to

minimize what you have been through. It’s so common that we think, “Well,

that only happened when he had a bad day,” or “I know she didn’t mean it.”

Take into consideration just how you felt at the time as a child, and whether

you felt unsafe or worried that your parent or caregiver was going to lose

control and hurt you; count that as an ACE. Going back to what we

discussed in the second chapter, being traumatized has more to do with

whether we thought we or someone we love was in real danger and less to

do with what happened. The ACE questionnaire continually mentions

“often or very often” when asking us if something happened to us when we

were young, which leads me to believe that most of the ACEs are examples

of experiences that could cause us to have C-PTSD.

Having a high ACE score doesn’t mean that things can’t get better or that

we are doomed to have health issues for the rest of our lives. Dr. Stephen

Porges researched people being held in their stress response for long periods

and tried to find out what we could do to help calm ourselves down and feel
6
better. What he came up with was the polyvagal theory. In short, while

studying our vagus nerve, Dr. Porges identified a third type of nervous

system response (we used to think we only had two: activating or calming);
this third response that he identified was the social engagement system.

What he found was instead of our nervous system being either more

activated and less calm or calmer and less activated, it could do a little of

both. We could be activated through social interaction while also calming

our system down. It’s the safety we find in true connection with others that

helps us manage and more quickly calm the stress response. This means that

the best way to overcome the hypervigilance or stress we can feel from our

adverse childhood events is to have safe, nurturing relationships. Making

time for these connections is the true antidote to our stress response and any

upset we have experienced.

WHY IS IT SO HARD TO CONNECT TO OTHERS?

We learned through the ACEs Study that having these adverse childhood

events can lead to more health concerns later in life. Our emotional

development starts in our first year of life when we attach to our primary

caregiver, and in the psychology world, we call this first connection our

attachment style.

The theory of attachment styles was first researched in the 1950s by

7
British psychologist John Bowlby. After working for many years at the

Child Guidance Clinic in London, he had become fixated on understanding

the distress and upset children experience when separated from their

primary caregiver. I use the term primary caregiver because not all children

are raised by a parent. In some families and cultures, it’s more common for

a grandparent or aunt to raise the children or even a nanny. Whoever we

count on to tend to our basic needs is considered our primary caregiver and

the person with whom we attach to. Bowlby defined attachment as a “lasting

psychological connectedness between human beings.” And he believed

attachment to be all or nothing—meaning that we either have a healthy

attachment or we don’t. However, this definition and all-or-nothing approach

didn’t explain children who would cling to a parent and then want nothing to

do with them. There was more to it than being attached or not, and that’s

where psychologist Mary Ainsworth came in.

In the 1970s, Ainsworth devised a standardized assessment for

attachment behaviors in children called the Strange Situation Classification

(SSC). In short, she observed children as they were put through eight

different scenarios where the child, its mother, and a stranger was

introduced, separated, and reunited. Each scenario lasted three minutes, and

she scored the children’s behavior based on four criteria: (1) Proximity and

contact seeking, (2) Contact maintaining, (3) Avoidance of proximity and

8
contact, and (4) Resistance to contact and comforting. After observing one

hundred children, Ainsworth identified three main attachment styles: secure,

9
insecure-avoidant, and insecure-ambivalent. This was the first study to

support and expand on John Bowlby’s theory of attachment, and in 1990

two researchers, Mary Main and Judith Solomon, used Ainsworth’s SSC to
10
discover a fourth attachment style that they called “disorganized.”

Throughout Mary Ainsworth’s studies, the majority of children were

securely attached to their primary caregiver. When a child has this type of

attachment, they will feel easily soothed and safe when with their primary

caregiver. If they are distressed, they will turn toward their caregiver, or seek

them out in some way. This attachment is formed when a child knows they

can count on their caregiver to be there for them when they cry, soothe

them, and care for them. They will use this secure attachment as a safe base

from which they can explore all that’s around them.

The next observed attachment style is insecure-avoidant. Children with

this style do not attach to their caregivers because they don’t feel they can

count on them. This usually means that their primary caregiver either hasn’t

been there for them when they needed it or has been rejecting or dismissive

of their needs altogether. This could be in response to a parent who was

emotionally or physically neglectful of their child, or if we go back to the

fourth question from the ACEs Study, “Before your eighteenth birthday, did

you often or very often feel that no one in your family loved you or thought

you were important or special? Or your family didn’t look out for each

other, feel close to each other, or support each other?” If any of that is

happening to us in our first few years of life, it is going to be hard for us to

feel safe to navigate the world. We can believe that something is wrong with

us, or that we are unworthy of love and attention. We may not know who to

trust or think that we can’t trust anyone. In Ainsworth’s study, when a child

is in distress and has this type of attachment, they will not seek contact with
their primary attachment figure. They won’t even show a preference between

their primary caregiver and a stranger. Again, this is because they aren’t sure

who will help them or what adult figure will offer support and security.

To further explain this type of attachment I want to share part of a story

from one of my viewers:

My whole childhood, as far back as I remember, had been being told

by my father that I was a mistake, a financial drain on them and that

he and my mother would be happier if I wasn’t there. My mother

would just stand there and say nothing—she would kind of treat me

like I wasn’t there, saying nothing negative or positive, just nothing. I

think that because of this I was a quiet and withdrawn child. I

remember crying a lot because I was so confused all the time. My

parents hated or ignored me for reasons I didn’t know. I had no idea

why the kids at school hated me so much, I always tried to be nice,

until after a while I just stopped talking. I never understood why no

adult would ever help me. My parents would have people come over

and play cards (I had to stay in my room) and I would always hear

about how having me was a mistake and if it wasn’t for me they

would have bought a nicer house, and that I cried about everything

for no reason…

The confusion caused by neglect and emotional abuse can make it hard

for us to enter into new relationships and we can question the validity of any

relationship we get into. Even if someone continuously tells us we are

important and that they love us, we can still worry that they will leave or

hurt us, which could be too much for us to take. I have had many patients

with this style of attachment, and the majority refuse to entertain the idea of

romantic relationships or any close friendships; the risk just felt too high.

The third style of attachment Ainsworth observed was insecure-

ambivalent. Children with this type of attachment tend to be clingy and

needy of their caregiver, but when the caregiver comes to their aid, they

reject them and are not easily soothed. This is usually in response to their

primary caregiver not being predictable in their support. Perhaps they are
comforting and soothing one minute only to be hurtful and abusive the next.

While the child will want to be soothed by their caregiver, they aren’t sure

whether the caregiver can give them what they need. That’s why even if

their parents come to comfort them, they don’t soothe easily; they are still

waiting to make sure they are safe.

I have always referred to this style as the anxious type because children

who are raised feeling like they are walking on eggshells, not sure whether

their parents will be comforting or hurtful, grow up to have symptoms of

anxiety. These can be caregivers with mental illnesses that cause mood

swings or struggle with substance abuse or even two caregivers who have

drastically different parenting styles. Again, you can tie some of these issues

back to the ACE questionnaire and see how devastating this can be to a

child. When we are growing up and developing, and we learn that

sometimes our caregiver is loving and comforting, but other times they

aren’t, we try to figure out why. Because we can’t know or understand the

real reason behind the hurtful behaviors, we assume it’s something we did.

Many of my patients with this style of attachment are overachievers and

perfectionists because they grew up believing that if they did everything just

right, they would get the love and attention they so desperately needed.

The final style of attachment is disorganized. Children with this type of

attachment will show a confusing mix of attachment behaviors and may

even appear to be confused or disoriented. They believe that this attachment

style is caused by inconsistency from their caregivers—meaning that a

parent may be soothing and helpful, but also fear-inducing and hurtful.

While you may be thinking that that sounds a lot like the insecure-

ambivalent style, a disorganized person doesn’t have any pattern to their

behavior. It’s not them clinging to their caregiver and then not being easily

soothed; instead, they may not want anything to do with their caregiver, or

other times cry until the caregiver comes and holds them and then are

soothed easily. In essence, they aren’t sure what they feel or whether they

can count on their caregiver. This is usually born out of abuse, where there

aren’t any other caregivers around, and the child associates them with love

and support and also fear and pain. Therefore, they oscillate between secure

responses and insecure-avoidant ones. I believe this wasn’t observed in

Mary Ainsworth’s SSC study because in the three minutes of observation,

she probably only saw one type of response from the children, and didn’t get

to see them move between the two attachment styles.

WHAT CAN UNHEALTHY ATTACHMENT LEAD TO?

You may be wondering what attachment styles have to do with trauma, but

the two are closely connected. Our first few years of life are key to

developing a strong sense of self, feeling confident in ourselves and our

abilities, and believing that we are safe to go out into the world. In essence,

our primary relationships help shape who we will become and what future

relationships we will have. It’s like a blueprint for connection and

communication. If we are hurt, neglected, or upset constantly as a child, we

may look for those same things in our life moving forward—meaning that

those of us who grew up with loving, predictable, and comforting parents

have a secure attachment and are more likely to get into other relationships

that offer those same things. On the other hand, if we had caregivers who

were unpredictable, abusive, or emotionally neglectful we can seek that out

too—which can put us in more potentially traumatizing situations as we

navigate life.

If we experienced trauma within our first few years of life, it can take

therapy and a lot of work to get us to believe that the world is a safe place

and that we have a right to be in it. It can be hard for us to think we are

loveable, important, or that people care, and that can cause us a lot of

shame. Shame isn’t something that’s talked about very often, and I believe

it’s because most people don’t know what it is, not to mention that it’s an

uncomfortable feeling to acknowledge. In short, shame isn’t just feeling

guilty or upset about a situation; shame runs deeper than that. When

someone is covered in shame, they truly believe that something is wrong

with them, or that they are defective in some way. Embarrassment could be

considered a mild form of shame, but embarrassment comes about due to a

specific situation, while shame encompasses our entire self and all that we

are. In cases where people are traumatized many times throughout their life,

especially if it started when they were children, it’s common to wonder

whether they are doing something to cause continued pain. To further

illustrate this, I want to share another viewer’s story:

The trauma that I endured as a child has forever changed how I look

at the world and would eventually give me the diagnosis of C-PTSD.

Although I view myself as a healthy adult now, it took me many years

of hard work, therapy, and EMDR to get here. During my healing

from trauma, I learned just how much C-PTSD shaped me. I became

aware of the hidden shame that caused a devastating self-hatred. I

believed that if I continued getting hurt, I must be the one causing it.

When working in therapy to heal from trauma, it’s the shame that’s the

most difficult to overcome. I’ve even had patients tell me that they deserve to

have hurtful or bad relationships, some even getting into abusive situations

and sharing how they believe it’s the best they can do. It’s heartbreaking and

at the root of why we can feel so stuck in our trauma. If we honestly believe

that something is wrong with us, and therefore we deserve to be treated

poorly, why would we all of a sudden think that it could get better? We

wouldn’t. However, because the pain or other symptoms of trauma are often

too much to carry alone, we reach out for help, and even though it is hard

work, we can heal.

I also want to share how and why attachment issues can make their way

into our therapy appointments because, too often, my patients feel even

more shame about their struggles with our therapeutic relationship. Just

know that our relationship with our therapist can often reflect our past

relationships, and we can treat our therapist just as we did the person from

our past. In a way, this is our brain trying to work through past trauma or

upset, or we may not know of another way to have a relationship. Either

way, it’s normal to oscillate between feeling connected to our therapist and

wanting to push them away so we don’t get hurt. It can be confusing to be in

a relationship with someone where they care about you, how you are doing,

and want to help you feel better. This consistency and clear communication

can feel foreign and scary, so give yourself time to get used to it and let your

therapist know about these feelings as they come up. Our therapists cannot

read our mind, so the more information we can give them, the better. That

way, they can help us figure out where these thoughts and urges are coming
from and help us heal.

HOW CAN I HEAL FROM CHILDHOOD TRAUMA?

When our trauma is rooted in childhood, reparenting (also called inner child

work) must be part of our therapeutic work, and no I don’t mean that we

have to have our friend or spouse act like our parent: that’s not how this

works. This therapeutic technique doesn’t involve our parents or caregivers

at all and is completed in therapy with the sole purpose of healing ourselves

from our past trauma. Reparenting is when we mentally take ourselves back

to the time when the traumas occurred and work to heal that part of

ourselves. For many years I have used letters to help start this process,

asking my patients to write a letter to their child self, and having their child

self write letters back. It can help us to feel heard and understood and give a

voice to ourselves at a time when we didn’t think we had one. The goal of

reparenting is to give ourselves the love and comfort we needed as a child so

that we can have a healthy and happy life now. In a way, we are rewriting

our blueprint for life and our relationships, since the one we were given was

unhealthy and traumatizing.

When doing this work, I often have my patients come up with some

loving parental phrases that they wish they heard. These could be things like

“you are important to me” or “I love you just as you are” or “I see you.”

Making a point of writing these things in the letter to our child self can help

us give ourselves what we needed back then. And I know this all kind of

sounds crazy and maybe a little woo-woo for you, but I promise, it works.

We cannot go out into the world hoping that someone else will fix what

happened to us in the past; what that does is force us to rely on other people

to heal us and give us what we need, and other people are out of our control.

If we try to use other people to help us heal, we will only be left feeling

more alone or hurt when they let us down or do something upsetting. They

are only human, they have their faults, and they cannot be responsible for

our healing. Therefore, the best and only person we can count on to heal us

is ourselves, and of course, a good therapist can help guide us along as we

work through it.

We can also reparent by doing the things we wished our parents had
done, such as take us to that amusement park or go on that trip. It could

even be simple things, such as cleaning a wound on our knee or taking care

of ourselves when we are sick. We can do these things without outside help

—sure, it would have been better if our caregivers had done it when we were

growing up, but it’s great that we have the tools to do it for ourselves now.

Try your best to focus on that and know that it will be strange and

uncomfortable at first, but it does get easier and more healing with time. If

you have a tough time coming up with things to do, your therapist can help

you think of some, while also giving you a chance to talk out the times you

were hurt, let down, or upset by the shortcomings of your caregivers. Just

know that with time and professional support, we can heal that hurt child

inside of ourselves.

Another way we can heal from any attachment issues we have is to be

more mindful of our emotions and discomfort in relationships. It’s very

common to not know how we feel in certain situations, but it’s much easier

to notice or remember a time when we felt uncomfortable. By paying

attention to these things, we will be better able to identify people or

situations that trigger our attachment issues. Maybe it’s the fear that

someone will leave or let us down, or perhaps it’s letting anyone get too

close; whatever it is, being able to identify it is more than half the battle.

Once we have a better idea of what’s triggering us, we can then work to

better regulate our emotions so that we don’t lash out or isolate. Following

are a few dialectical behavior therapy (DBT) techniques that I find helpful.

Checking the Facts

11
The first DBT technique is Checking the Facts. When we are acting out of

a past upset, we may overreact in the present and even feel embarrassed

about this reaction later. Checking the Facts forces us to slow our reaction

time down by noticing what emotion or event triggered the response. Then,

we check in to see whether we are making assumptions or interpreting

something without having all the information. Too often we don’t have any

evidence, other than our past experience, to support what we think is going

to happen. Taking the time to double-check our thought process and any

assumptions we may have made can prevent us from lashing out and hurting
ourselves or an important relationship. Finally, we note whether our initial

reaction was in line with what we assumed to be true, or what we have

evidence to support as truth. Overall, this ensures that we aren’t acting a

certain way because of something that happened to us at another time;

instead, we are slowing our reaction down, considering the facts, and

deciding how to respond.

Opposite Action
12
Another DBT technique that can help is Opposite Action. Whenever we

are triggered or upset, there are a bunch of emotions or urges that can come

along with it. We can feel angry and want to shout, punch, or run away. If

we are hurt, we may want to cry, stop talking, and isolate. These automatic

emotional responses aren’t always commensurate with what happened and

can be coming from past experience. Using Opposite Action allows us to see

we have a choice in how we respond and can help change our painful

emotions into more helpful ones. It can also help stop us from lashing out

and causing ourselves more pain and upset. An example of how to properly

use Opposite Action would be that if my best friend cancels on me last

minute, I might feel upset, sad, and as if I am not important enough. I could

want to dodge her calls or texts, not reschedule our get-together, and spend

the rest of my day crying. Opposite Action would mean that I would push

myself to engage in conversation with her, tell her that I am disappointed

and let her explain the late cancellation, and even reschedule. I know this is

difficult, but we always have a choice as to how we respond to life’s ups and

downs; we just have to create the space and time for those choices. Taking

back the control from our emotions is empowering and gives us a chance to

grow and thrive.

ABCs PLEASE
The final DBT skill focuses on ways that we can reduce our emotional

vulnerability—meaning that by using these techniques we are taking care of

our basic needs so we aren’t so easily thrown off by an upsetting situation.

13
This skill is called ABCs PLEASE, and it works like this:
A: Accumulate positive emotions. One of the easiest ways to

do this is to take some time each day to do things we enjoy doing or to focus

on things we are grateful for. This helps us gather some positive emotions so

we feel better and are better able to manage any upsets that come our way.

B: Build mastery. By doing things we enjoy and getting better at

them, we not only accumulate some positive emotions, but we start to feel

more confident and competent in life. These tasks could be things like

cooking, playing an instrument, doing some art, riding a bike, organizing

our space, etc. The more regularly we do these things, the better we will feel

and the easier it will be for us to weather any emotional discomfort.

C: Cope ahead. Having a plan in place for when we feel down or upset
is key, that way we are prepared for whatever life throws our way. We can

“cope ahead” by putting together a list of things we can do that make us feel

good, people we can call who are supportive and loving, or some things we

can do to distract ourselves if other things don’t help. Putting together this

plan will ensure that when we feel overwhelmed and want to lash out, we

have something else to do until we are more clearheaded and able to make a

thoughtful choice.

PL: Physical illness. When we are sick, we aren’t at our best;

therefore, we have to make sure we are taking care of ourselves. If we are

sick, we need to rest or possibly make an appointment to see a doctor. This

also means we have to take any medication as prescribed and take a few

moments every few days to check in on how we are feeling physically.

E: Eating regularly balanced meals. Waiting until we are

starving is not only bad for our body, it’s also bad for our ability to regulate

our emotions. The term hangry (a combination of the words hungry and

angry) exists for a reason, so make sure you are eating a variety of foods

every 3 to 4 hours to ensure you have energy throughout your day.

A: Avoid mood-altering drugs. It can feel good to numb out

from all we feel through nonprescribed drugs or alcohol, but remember that

those substances don’t make anything better. Mood-altering drugs can cause

us to be even more emotionally vulnerable then we were before. Consider

only drinking in moderation and avoiding all nonprescribed drugs.

S: Sleep! Not getting enough sleep can make us more irritable, easily

upset, and run by our emotions. Not to mention how hard it can be to focus

or concentrate when we are tired, which can make remembering our

emotion regulation skills even more difficult. Do your best to sleep and

wake around the same time each day and allow for at least 8 hours of sleep

each night.

E: Exercise! I know the word exercise can be triggering for many of us,
making us think of slogging away in a gym day after day, but that’s not what

I am talking about. Making time in our life for exercise means that we do

what we can each day. Some days, that may be stretching and then walking

for 15 minutes; other days, that may mean we take an hour-long yoga class.

My goal for my patients is to get them to a place where they can do some

form of exercise for 30 minutes, 3 to 4 times a week. Exercise releases

endorphins and other mood-boosting chemicals, which can make us feel

better, and better able to manage anything life throws at us.

Overall, we must take the time to care for our basic needs each day. I

know that sounds pretty simple, but on those days when we aren’t our best,

it can be hard to do. Sometimes, all we can accomplish is getting up to go to

the bathroom, and that’s why we have to check in with ourselves and use our

ABCs PLEASE skills before we allow our thoughts and choices to be driven

by emotion. When we have a past filled with ACEs and failed caregivers, it

can take time to learn how to recognize and manage all we may feel; it’s as

though we are building a new muscle we didn’t even know we had. Be

patient with yourself as you try out these new tools, and as always it’s a

process, not perfection.

 KEY TAKEAWAYS
• Childhood trauma is very common, occurring in two-
thirds of children aged 16 and younger.
• The CDC-Kaiser ACEs Study helps us better understand
childhood trauma and how to identify ACEs early on.
• The higher our ACE score, the more likely it is that we
will have health complications later in life.
• Safe, nurturing relationships are the key to overcoming
our ACEs.
• There are four styles of attachment: secure, insecure-
avoidant, insecure-ambivalent, and disorganized.
• We can overcome our ACEs and attachment issues
with the help of a trauma therapist and using
reparenting techniques. The DBT skills Check the Facts,
Opposite Action, and ABCs PLEASE also help us better
manage our emotions along the way.
• Healing from childhood trauma is hard but completely
possible.
 CHAPTER 8

CAN TRAUMA BE PASSED

DOWN?
TRANSGENERATIONAL TRAUMA AND
ITS LASTING EFFECTS

During the Cold War, which lasted for roughly forty-four years, the

Communist Party took over Czechoslovakia, and in 1948, it built three

parallel electrified fences along its border with Germany; this electric fence

was called the Iron Curtain. It was heavily patrolled by armed guards, and

close to five hundred people were killed attempting to escape. This fence

was taken down when the Cold War ended in 1991; however, the local red

deer still refuse to cross the area where it once stood. In 2015, Czech

biologist Marco Heurich and his colleagues published their findings from a

seven-year study where they followed three hundred red deer using a

tracking collar and found that even though the average life span of a red deer

is only fifteen years, they were still affected by a barrier that existed over

twenty-four years ago. The researchers believe it’s because the mother deer

take their fawns near the old border but never allow them to cross it,

therefore passing on the fear of the area and belief that it’s not safe to roam

into German territory. The researchers also followed deer on the German
1
side and came to the same conclusions.

Although these studies were conducted on red deer, not humans, it still

tells us that trauma can be passed down from generation to generation, and

possibly onto other people in our lives. In many ways, trauma can act like a
virus, moving from one person to another until all those around us feel some

of the effects. We call this type of trauma transmission transgenerational or

intergenerational trauma, and it was first noticed in the children of those

who survived the Holocaust. In 1966, psychologists in Canada reported that

the grandchildren of Holocaust survivors represented a majority of their

referrals, citing that they were three times more likely than others to seek
2
mental health support from their clinics.

WHO CAN BE AFFECTED BY

TRANSGENERATIONAL TRAUMA?
This type of trauma doesn’t only happen to those in the Jewish community,

however; we can find examples of transgenerational trauma everywhere we

look. A brief search online returns thousands of research studies conducted

in different parts of the world all with the goal of explaining why those who

haven’t been in or witnessed a traumatic situation themselves are still

experiencing PTSD symptoms. Some lived through the Holodomor

genocide in Ukraine, which claimed millions of innocent lives through

forced starvation, not to mention the Native American populations being

forced onto reservations back in 1851. These two examples happened on

other sides of the world from the Holocaust, and yet many Ukrainian and

Native Americans struggle with similar trauma-based coping strategies,

such as binge eating, substance abuse, distrust of the surrounding

3
communities, isolation, and hostility. It doesn’t matter where we live or

what trauma we were exposed to; we are all human, and the effects of terror

can last for generations.

We also see transgenerational trauma in the Black community stemming

from both slavery and racial inequality. I was just watching a video online

the other day where a Black father shared how he taught his children to

interact with the police. He asks his daughter to share what he taught her,

and she states her name and then with her hands up says, “I am eight years

old, I am unarmed, and I have nothing that would hurt you.” The fact that

we live in a society where this father has to teach his eight-year-old what to

say, should she encounter the police and they have a prejudice that could put

her in danger, is terribly sad. I do not doubt that this can affect the emotional
growth and development of a child. Imagine being taught and told from

birth that you are different and people will unfairly judge you because of it. I

believe all of these scenarios are traumas that we cannot help but be

personally affected by.

There is also transgenerational trauma within the immigrant community,

due to discrimination, not being able to immigrate together as families, and

possibly living in poverty until they can find better work. This can take

mothers or fathers away from their children at a young age as they make the

move to build a better life for themselves and their family, which we know

can affect a child’s attachment. Here is a story from a close friend of mine

sharing her experience with this:

I was left to be raised by my aunt and grandmother at a young age so

that my mom could make a better life for both of us by migrating to

the United States. When I migrated to be reunited with my mom as a

teenager, I found out that my mom was left by my grandmother to be

raised by an aunt and also to start working at the young age of 11.

Later on, as I grew up, I learned that my grandmother had also been

left as a very young child to be raised by an aunt because her mother

died when she was just five years old.

Looking back at this pattern, it makes so much sense why I

struggle with attachment and constantly worry people will leave me.

Sometimes even fearing to let people get close, worrying that I will

get too attached. For generations, my family has engaged in this

system of traumatic abandonment, and although I am still dealing

with the ramifications of it, it has also shaped who I am today, and is

a constant reminder that I can overcome any obstacle life throws at

me.

The list of who can be affected by transgenerational trauma has no end,

from those living in poverty to refugees, women, people in the LGBTQ+

community, and everyone in between. If someone in our family has been

traumatized, we could feel the effects in our own life, and that’s why we

must recognize PTSD symptoms early on and get professional help quickly.

While it can be tricky finding a therapist who understands trauma as well as

what it can be like for a person of color, refugee, or immigrant, they are out

there. Refining our search to include therapists who say they specialize in

trauma; or are certified in such trauma therapies as EMDR, schema therapy,

or somatic experiencing; as well as asking them upfront about their

background and experience can ensure we find someone who is a good fit.

In addition, I believe that being educated on these important issues should

be a requirement for licensure and added to all health-care-based

educational programs. When people are brave enough to reach out, I would

like to know that someone caring and competent is there to help.

WHY DOES TRANSGENERATIONAL TRAUMA

KEEP BEING PASSED DOWN?
We learn a lot about ourselves and the world around us from our parents or

caregivers, and if they are dealing with trauma and upset, how can they not

pass it off onto their children? We have already learned just how many

symptoms come along with PTSD, and how difficult it can be to manage

them. If we are trying to parent at the same time, it’s like trying to teach

someone to downhill ski while learning it yourself.

Transgenerational trauma continues to be passed down for two main

reasons; first, most of us don’t realize we are struggling with it because

we’ve never known another way; and second, healing from trauma is hard

work. Not knowing we were traumatized or that we could do things

differently is by far the most devastating to our children, because there’s no

attempt to do better. I see this every day in my practice: a parent comes in

angry or upset that their child is acting out, claiming that something is

wrong with the child and they need me to fix it. It takes all of my strength to

calmly explain to them that although a child may suffer from a mental

illness, it’s often exacerbated by what’s going on at school or in the home. I

have even had parents not come back after I gave them feedback on their

style of discipline, offering some other ways that could be better for their

child; this is part of the reason I began only seeing adults in my private

practice. Too often, the parents would stand in the way of any tools or tips

that could help their children. In essence, they tied my hands and then

wondered why their child wasn’t getting any better. It was exhausting and
heartbreaking.

When parents are not able to recognize that they do play a role in their

child’s physical and emotional development, it’s even more difficult for the

child to get the help that they need. This is what leads to generations of

shared trauma and patterns of unhealthy behavior. It could be the reason that

for three generations the women in one family all married alcoholics, or it

could be to blame for an entire family’s fear of flying. The sooner we accept

that through nature and nurture we affect our children, the sooner we can

start working toward a better future.

We all know that healing from any trauma is difficult, and we are also

aware that parenting is hard and trying at times. Putting those two things

together can make not passing down our upsets feel impossible.

Having an awareness of our mental health issues and any traumas we

have endured is a giant step in the right direction. I am constantly being

asked by parents how they can talk to their children about emotions, mental

illness, and any difficulties they are going through. This is a sign that we

have a lot of great parents out there who are just trying to do their best for

their children. Since I am sure that those parents aren’t alone, let’s dig into

some of the questions I see on a regular basis.

I feel like I look at transgenerational trauma differently

because I have a 7-year-old and she shows signs of
having been traumatized despite not having anything
traumatic happen to her. She is a normal happy little
girl, but she still jumps as I do at loud noises and she
gets very upset whenever we talk about my family
despite never meeting them and she hates being alone
at night, just like I did at her age.
I feel like part of the reason she displays these
behaviors is because I do/did and as far as I’m aware, so
did my mum. Most of what children learn is from their
parents. I didn’t learn love or compassion from my
parents so with her it’s us figuring it out. When trauma
 and abuse have been passed through generations, it
often feels like you are fighting a losing battle because
it’s going to happen no matter what you do. You and
your family have been in pain for so long that you don’t
know what to do. I guess the only thing you can count
on is that environment also has a big impact on a child
so breaking away from the cycle (like me and my
daughter did), it hopefully won’t be destined for her like
it was for me. I just need to make sure what happened
to me doesn’t change her worldview.

WHAT DO I SAY IF MY CHILD ASKS ME WHY I’M

SAD?
Too often, we try to hide our feelings and upsets from our children. Trust me

when I tell you that they already know all about it. They just don’t know

how to approach us or ask what’s going on. Whenever a child asks about our

emotional state, we must lean into it and let them know it’s okay to ask.

Start by looking them in the eye, thanking them for checking in on you, and

then explain what’s going on in a very simple manner. For example, let’s say

you just got some bad news at work and didn’t get the raise you wanted. It’s

completely fine to tell your child that you thought you were going to get an

award at work and make more money, but you just found out you didn’t and

that makes you feel sad. Children aren’t as judgmental as we are, so let’s use

that to our advantage. They just want to know what’s going on and whether

they had anything to do with us being upset. Setting the story straight in a

short and easy-to-understand way will prevent them from internalizing any

of our stuff.

WHAT IF I TAKE OUT MY ANGER ON MY KID?

Trust me, you are not alone in this, and this is a judgment-free zone.
Everyone does it from time to time. We have a bad day followed by a worse

evening, and we yell at our kids. We can have a lot of things going on: We

could be stressed about money, going through a divorce, or not feeling well.

No matter what the cause, we owe our child an apology. I know that sounds

strange, but yes, we can apologize to our children when we take out our

issues on them. Along with my answer to the first question, tell them what’s

going on that’s upset you, and that you are sorry you yelled at them. Be

honest about why you did it and ask them whether they understand and

accept your apology. This is not a time to offer a gift or treat, even though

we may want to make it up to them. The only way we can make it up to

them is by trying harder next time. We want any apology we offer to be met

with emotional support, conversation, and understanding, not just purchased

goods or presents.

CAN I SHARE TOO MUCH WITH MY KIDS?

Since we discussed how helpful it can be to talk with our children about

how we are feeling, and why we may have lashed out at them, I think it’s

also important that we discuss boundaries around these conversations. Our

children should only know about things that affect them and their

relationship with us—meaning that if we are emotional at home, we should

explain briefly why, but we do not need to get into all the details with them.

Our children are not our close friends and engaging in that sort of

relationship with them is extremely unhealthy. If we want to vent about all

that’s going on, we should reach out to a close friend or find a therapist in

our area. Talking to our children as if they are equals or adults can cause

them to act like one and in turn rob them of their right to continue acting

like a child. In the therapy world, we call this being a parentified child, and

that’s not something we want to pass down either. Overall, we want to talk

openly with our children about emotions, upsets, and our relationship with

them, so that they feel comfortable to do the same. We just want to be

careful that we don’t think of them as our emotional support and someone

we come to with all of our problems. That’s not a healthy parent-child

relationship.
 DOES MY FAMILY HAVE TRANSGENERATIONAL
TRAUMA?
If you are still wondering if you experienced transgenerational trauma or

not, here is a story that hopefully will shed some light:

I sat here thinking if any of my mental health issues could have been

passed down to me. I thought about how my mom used to say,

“Sometimes, I just want to drive off this bridge,” but it was said more

for means of getting what she wanted and to make me feel bad for

her. So, I thought no, I don’t think that has anything to do with my

stuff, so I wasn’t going to respond. Until BAM!!! I think I’ve

discovered something interesting that wasn’t recognized before. I am

certain my dad had PTSD and didn’t realize it. As a child, he battled

polio not once, but twice. He spent a good bit of time in the Shriners

Hospital. I asked him one day what that was like and he said it was

really hard to make friends and then watch them die. He said he had a

best friend who would go to the IV treatment room with him and they

would always sit next to each other. And then one day, they rolled

him in, but not his friend. That was how he found out [his friend]

didn’t make it. Fast-forward 50 or so years later, and my sister and I

were taking him in for his first chemotherapy appointment. My job

was to stay with him while they hooked him up and my sister’s job

was to do all of the paperwork. They had him in a room sitting in

those big chairs (like the ones when you give blood) and I was just

talking to him while we were waiting for them to come hook him up.

I looked over at him, and he was frozen. I said “Daddy” several times

and he didn’t move. Then I said “Paul” and he looked to both sides,

then to me, and started to cry. I was 23 years old and this was the

only time I ever saw him cry, followed by a complete nervous

breakdown. He kept begging me to take him home, and I helped get

him out of there. He ended up not having chemo that day. We had to

take him later that week to the hospital where they could give it to

him in a room by himself.

That night, when it was just me and him at home, I asked him,
 “What happened today? I’ve never seen you cry before or panic like

that.” He said, “When I saw all of those people lined up beside me

for chemo, I saw all of the kids in the Shriners Hospital all over again

and I felt like I was back there. I just can’t be there again. It took me

too long to erase those memories.”

My dad was never diagnosed with PTSD, but I think he had it.

I’m not saying that it was necessarily “passed” down to me, but his

trauma reaction is the same as the one I am dealing with now; hiding

it from everyone, FREEZE, and holding back tears until you can’t

anymore. So maybe? If that’s possible, it passed to me from my

father.

There are so many ways we can be traumatized in our life, from growing

up in poverty to losing a close friend when we were young. If you are still

curious whether trauma could have been passed down to you, here is a quick

questionnaire.

• Has a parent or close family member ever talked about a dark or

difficult time in their life?

• Are there certain topics that are off-limits to ever bring up? Or were

you told to stop asking about those things as a child?

• Has a parent or close family member shared any experiences of

trauma (e.g., going to war, dealing with illness, abuse, etc.)?

• Have you experienced some of the PTSD-like symptoms but don’t

have any memory of being in a traumatizing situation?

• Can you recall any behaviors by your parents or grandparents that in

retrospect could be a trauma coping skill (e.g., hoarding food,

alcoholism, not going out at night, etc.)?

• Were there certain rules or behaviors in your house that your friends

thought were odd or that you never saw in anyone else’s house?

If you answered yes to more than one of these questions, your family

may be experiencing transgenerational trauma. While it can be difficult to

break these cycles, with personal awareness and professional help, we can
overcome it.

DOES TRAUMA CHANGE OUR DNA?

We know that we can pass down our trauma responses onto our children and

they in turn can act like they have been traumatized as well, but does this

passing down of trauma change our DNA? Researchers have been trying to

answer this question for years, but they have already stumbled upon some

interesting findings. In a 2013 study led by Brian Dias at the Emory

University School of Medicine, they found that a fear of a certain smell

could be passed down to our children and even our grandchildren. They

conducted this study on mice, and after conditioning a group of male mice

to fear the smell of cherry blossoms by giving them an electric shock when

the scent was released, they bred them with a group of female mice. What

they found was that the children and grandchildren of these male mice were

jumpier and showed signs of fear when the scent was released. They

compared these mice to those whose fathers weren’t conditioned to fear the

smell, and there was a stark contrast. They also tried adding a neutral scent

and all the mice acted normally—meaning that it was only the cherry

blossom smell that put them on edge, which could only have come from
4
their father or grandfather’s experience.

While they still believe we need more robust data to prove that fear of a

specific scent can be passed down from one generation to the next,

researchers do agree that trauma does not change our DNA. However, it

does change the way our DNA is read or interpreted, otherwise known as

our epigenetics. Epigenetics are markers on top of our DNA that tell us how

our DNA should be read, and they are highly influenced by our environment

—meaning that if we have been physically abused for years, our epigenetics

will want the parts of our DNA responsible for our fight/flight/freeze

response to be clearly read, and possibly overdevelop certain areas that

could help keep us safe. These epigenetic markers are passed down to our

children and they can cause us to have symptoms of PTSD even if we have
5
never been exposed to trauma. For years, researchers argued whether it was

nature or nurture, but now we know that our environment shapes how our

genes are interpreted.

 Knowing that trauma can change our epigenetic markers can be

validating and helpful, but it can also be upsetting. If our epigenetics are

altered, can they be altered back? Further research does show that just as

hurtful things in our environment can change the way our DNA is

interpreted, nurturing and helpful things can too. They have found that

nurturing relationships can change our epigenetic markers for the better—

meaning that having a loving and nurturing person in our life can undo some
6
of the damage the trauma has caused. As a therapist, this is what I love to

learn about, because we can’t go back in time and undo the trauma or work

to forget all of the pain we endured, but we can increase the number of

nurturing relationships we have and the amount of time we spend in them.

These connections will not only calm our nervous system down, but also

help realign our epigenetic markers so that it’s not only reading the parts of

our DNA assigned to our stress response, for example, but also those parts

responsible for deep connection and overall health.

CAN WE PASS TRAUMA TO PEOPLE OTHER THAN

OUR CHILDREN?
Unfortunately, trauma isn’t just shared with our relatives, but also to those

around us. We can pick up behaviors, reactions, and beliefs from those we

are in close relationships with, and therefore be affected by one another’s

trauma. We know that our environment can change our epigenetic markers,

so it’s no wonder we can pass our trauma on to our friends, roommates, and

colleagues as well. I believe this shared trauma is exacerbated by social

media because it allows us to be closely connected to more people,

increasing the likelihood of us encountering a trauma response. It can also

make it more likely that we see something terrifying or upsetting as well.

In May 2020, a video was released showing a police officer in

Minneapolis taking George Floyd into custody and kneeling on his neck for

almost nine minutes until he was killed. People all over the world had access

to that video and everyone I know has watched it at least once. It is horrific,

intensely upsetting, and difficult to put words to. I believe anyone who

watched that video shared in that trauma, and although the full effects of it

have yet to be discussed, we have seen an outcry from the masses for police
reform and justice for the victim.

All of this connection can bring us together, help us learn from one

another, and work together toward common goals, but it can also spread

trauma like wildfire through our world. Now more than ever, we are a global

society; we travel around the world with ease and communicate with people

anywhere with the touch of a button. All of this connectivity has both

helped and hindered us toward the end of 2019 with the emergence of

COVID-19. From the first known cases in November 2019 to March 2020,

the entire world went into a government-forced lockdown, shutting down

any nonessential businesses, closing borders, and enacting stay-at-home

orders. I still remember being so confused, scared, and unsure of what was

happening. We had had outbreaks in the past with the bird flu and Ebola,

but businesses had never been forced to close and we hadn’t been forced into

staying home.

Wearing a mask, while necessary, makes it hard for us to see one

another’s face, smile at strangers, and connect with those around us. Not to

mention the potential effects this could have on our children as they are told

to stay home and go to school online, or go into school but to stay away

from their classmates and wear a mask. It’s devastating, but letting our

children know why this is happening and that it won’t last forever, along

with encouraging them to have virtual hangouts with their friends, can help

them get some of the connection they are missing. I have seen groups of

parents getting tested for COVID-19, and once they receive the negative

result, they form school groups or pods so that their children can engage

socially and have some sort of normal school scenario. This pandemic has

hit us hard, but we can adapt, lean on one another for support, and work to

salvage some sense of normalcy during this trying time.

Social media allowed us to see what COVID-19 was doing to other parts

of the world, first responders showing full hospitals, and people sharing

videos of them and their loved ones waiting in long lines for treatment. The

images, videos, and stories broke my heart and made it difficult for me to

even get online for weeks at a time. The news stations had graphics with live

tallies showing the number of cases and deaths thus far, and every story

covered a new city being hit hard by this novel virus. I messaged my friends

in Milan, Italy, to check in on them, only to hear that both of their parents

had caught the virus. They were devastated and told me it felt as though they
were living in a nightmare. They implored my husband and me to take it

seriously, stay home, and wear our masks, because at this time they were

about a month ahead of the US (based on when the first cases were

recorded)—they felt that they could see into our future and they didn’t want

us to make the same mistakes. Luckily, both of their parents survived the

virus and made full recoveries, but the impact of all that happened still

lingers.

That was just the beginning: New York City (NYC) was one of the
7
hardest-hit cities with over twenty-two thousand deaths. It was eerie seeing

the streets of NYC empty, and health-care workers showing red marks and

bruises on their faces from wearing their personal protective equipment

(PPE) as tightly as they could to ensure they were kept safe. To say we were

overwhelmed during this time doesn’t do it justice; I still remember

watching the news as it showed large refrigerated trucks sitting outside of

hospitals to help them manage all the bodies of those who had lost their

lives to the virus. There were also companies in Brazil working to create

cardboard hospital beds that also turn into coffins to help hospitals better
8
manage the large number of deaths they were seeing every day. The

information online and on the news was unutterable. I felt so overcome with

grief and sadness, and I wasn’t even directly impacted. I cannot imagine the

trauma felt by the people whose job it was to fill those refrigerated trucks, or

treat those who were ill, not to mention all the people who still had to go

into work during all of the chaos.

I have friends and family who were essential workers in grocery stores,

prisons, and pharmacies. I felt compelled to call them every few days and

check up on them, fearing that they would catch the virus and I wouldn’t

have gotten a chance to speak with them. The fear that we all felt for

ourselves, our loved ones, and all who were affected was palpable and

undeniable. We have never shared in trauma the way we have during the

COVID-19 pandemic, and while it has been a complete tragedy, and many

have lost their lives, it has also connected us, helped us to see that we are in

this together, and brought out the best in people. One of my close friends

has been checking on her elderly neighbors and going to the grocery store

for them each week so they don’t have to risk being infected, and many

individuals have signed up for the vaccine trials, offering up their health to
help others. In times like this, it can feel as though the good news is hard to

find, but if we take the time to look for it, we will see that it’s everywhere.

WHAT CAN WE DO TO SHAKE THIS TRAUMA

EXPERIENCE?
We could talk about the COVID-19 pandemic for ages, there is so much still

to process and learn, but what’s important is figuring out how to deal with it.

The reason this pandemic has been so harmful and upsetting isn’t just

because it’s a virus, it’s because we all felt threatened and therefore were

pushed into our stress response. Our stress response is something that is

only meant to be activated for a short period: we see a threat, we get ready

to fight it or run from it, and we take action. For example, if we lived in a

cave and heard a bear rustling the bushes outside, we would hear it, get

scared, and run away. A few moments later, we would have reached a safe

place, our stress response would no longer be necessary, and we would

relax. However, when the threat we are all sensing is an invisible virus that

we can catch from people and things, and we don’t even know that much

about it except that people are getting sick and dying, our body readies itself

for fight, flight, or freeze. But there isn’t any action we can take that will

make the threat go away or be less scary. We have to sit in it, feeling the

stress and energy course through our nervous system without a release.

The good news is that we can get that energy out and calm our nervous

system down so that we feel better. The first tip and best way to do that is

through true social connection. This is why COVID-19 hit us all so hard:

We were threatened, stressed out, and then told to isolate to save lives.

Doing the one thing we were told to do only made us feel worse, and that’s

why video calls became so popular and many people refused to follow the

stay-at-home orders. We needed that connection to know that someone else

understood us, and to be reminded that we are valued and important. Social

connection has even been proven effective through Dr. Stephen Porges’s

polyvagal theory: instead of our nervous system being either more activated

and less calm or calmer and less activated, it could do a little of both. We

could be activated through social interaction while also calming our system
9
down. It’s the safety we find in true connection with others that helps us
manage and more quickly calm the stress response.

Another way to manage the stress or trauma we are experiencing is to

take action where we can. Since our stress response readies our body for

action, we have to move and do what we can to release it. We could start by

cleaning the house or going for a walk, or what has helped me is dancing in

my living room, which surprised me at first. Why did I feel so much better

after dancing around for an hour to some music? Why did I feel worse on

days when I didn’t make time to dance? And then I remembered Dr. Peter

Levine and somatic experiencing.

Dr. Levine studied animals in the wild and was interested in

understanding why they could constantly be in traumatizing circumstances

yet show no symptoms of trauma. What he found was that, after being in a

threatening situation, animals either run or fight, then when they have gotten

to a safer place, they do a full-body shake. They innately release all of their

built-up energy so that they can relax. He believed that it was in our freeze

state, when we aren’t able to run or fight back, that trauma is born. This

freeze experience can cause us to feel helpless, and immobilizes us, thus

trapping the energy buildup in our body, leading to such symptoms of PTSD
10
as hypervigilance, feeling on edge, dissociation, and flashbacks. Making

time to move our body can help regulate our nervous system and prevent any

long-term symptoms of trauma—meaning that we can literally shake off

some of the symptoms of trauma!

Also, it’s best to limit the amount of media we digest each day. If we are

only watching the number of cases and deaths go up, hearing interviews

with people who have lost their jobs or someone they love, it’s going to

overwhelm us at one point or another. Not to mention that during times of

stress and trauma, people are more irritable and easily angered, making

social media a very toxic place to be. In the wake of COVID-19, I have seen

more false facts, hate-filled comments, and passive-aggressive posts than

ever before. I know we don’t want to be ignorant of all that’s happening in

our world, but we don’t have to engage with things 24/7 either, so find a

balance that works for you. I decided to limit my news consumption to about

thirty minutes each morning, and I only engage in social media when

sharing my content or something positive I found. This allows me to stay

informed yet not become overwhelmed with information, and it has

drastically improved my mood.

Another way that we can manage the stress and trauma we feel is to

consciously relax the muscles engaged during our stress response. These are

the muscles in your face, neck, and shoulders. Keeping them tense will only

perpetuate our body’s trauma response and can even lead to muscle pain and

headaches. Periodically throughout my day, I try to roll my shoulders down

and back, do a few neck rolls in each direction, and relax my jaw. It sounds

simple, but it works! When the pandemic first hit the US, I knew I was

worried and stressed, but I didn’t recognize that that was why my neck was

killing me and I was constantly fighting tension headaches. Taking a few

minutes each day to tense and then relax all of these muscles can help us

notice when we are holding our emotional stress in our body and

consciously let it go.

My final tip is to see a mental health professional. Having someone to

vent to about all that we feel can not only lighten our emotional load, it can

help us feel heard and valid in our thoughts and experience. This could also

be the connection we are desperately needing right now, and the simple act

of sharing space with another person could be calming in and of itself. We

are all sharing in the trauma of the pandemic and talking about our

experience with our therapist can deepen the therapeutic relationship and

help us see them as people too. I cannot tell you the number of patients that

have shared how comforting it is to know that I am struggling with this as

well. In a way, the fact that I am upset, grieving, and stressed out validates

their own experience and permits them to feel it too.

A few months into the COVID-19 pandemic, I released a video sharing

how grief-stricken and upset I was with all that was going on in the world,

and the reaction from my community was that of support and

understanding. They, too, were sad, stressed out, and struggling to cope at

home. I was nervous to release such a video because I don’t usually share

too much about myself or my struggles; I try to keep it educational and

informative, but that didn’t seem to work in this situation. No matter how

many ways I tried to intellectualize, rationalize, and explain why I felt the

way I felt, it didn’t make me feel any better and it didn’t lead to any helpful

insights I could share with my community. I decided to just share my

thoughts, unscripted and unedited, and it resonated more than I could have

imagined. Hearing that I was sharing in their experience allowed them to

accept how they were feeling, and instead of pretending that I knew better or

had all the answers, I was now free to be in it with them. Sharing in trauma

isn’t pleasant, no one wants to be traumatized, but it sure is nice to not have

to weather it alone.

I want you all to know that there is so much we can do to prevent the

spread of trauma, from connecting with others to doing our work in therapy,

to even just being more mindful of how we behave around our loved ones.

Knowing that we can spread it is half the battle, and while chances are that

we all will have at least one traumatic experience in our lifetime, that

doesn’t mean we have to let it change us or those around us. We can

overcome it, we can get better, and we can heal. I think Dr. Peter Levine says

it best: “Trauma is a fact of life; however, it doesn’t have to be a life

sentence.”

KEY TAKEAWAYS
• Transgenerational trauma is trauma that is passed
down from generation to generation—meaning that a
child can express symptoms of PTSD without having
been involved in any traumatic situation.
• Transgenerational trauma continues to be passed
down for two main reasons: first, most of us don’t
realize we are struggling with it because we’ve never
known another way; and second, healing from trauma
is hard work.
• It’s okay to talk to our children about how we are
feeling, apologizing for times we got angry, and
explaining why we are upset. However, we shouldn’t
expect any emotional support from our children;
instead, we should seek out the help of a therapist or
even a close friend.
• Trauma doesn’t change our DNA, but it does change
the epigenetic markers on our DNA. Epigenetic markers
 tell our brain and body how to read the DNA.
• Trauma can also be passed around to other people in
our lives, not just those we are related to. Social media
assists in this spread because it can give us more
access to traumatizing situations.
• There are five ways we can manage our trauma
response and stop the spread:

1. Social connection. Making time to connect with loved

ones can remind us we are not alone and help calm
us down.
2. Move our body! Shaking out the stress and fear helps
regulate our system as well.
3. Limit our exposure to the media. Not getting on
social media or watching the news as often can help
us curb our stress response.
4. The muscles in our face, neck, and shoulders are
involved in our stress response. Taking a minute to
relax those muscles can help us feel better.
5. Seeing a mental health professional. Having a safe
space to vent and share all we may be feeling can
not only give us the connection we may be craving
but also validate our experience and get some
helpful tips and tools along the way.
 CHAPTER 9

WHY DO WE FEEL SO
SCARED?
THE SCIENCE OF TRAUMA MEMORIES

Have you ever been going about your day when you smell something

familiar and it stops you in your tracks? Instantly, you are reminded of

another time, situation, or person; possibly you are taken back for a moment

to that time. It’s as if that scent was somehow connected to a memory, and

being around that smell pulls that memory back to the surface. Just the other

day, my husband and I picked up some blueberries from the grocery store

and when we got them home and I popped one in my mouth, I was

immediately taken back to my childhood summers. When I was growing up,

my cousin Amanda and I would go to her grandparents’ and swim in their

pool until our hair turned green, one of the side effects of being blond and

loving to swim. Outside of the fence surrounding the pool were blueberry

bushes, and we would run from the pool to the bushes grabbing blueberries

and quickly popping them into our mouth before going back to jump in the

pool. The taste of a fresh blueberry immediately takes me back to that time,

and if I close my eyes I can still smell the chlorine on my skin and hear the

bees buzzing us as we looked for ripe berries to pick. That was over twenty-

five years ago, yet through taste and smell, I can tap into that memory and

feel as if I am a kid again enjoying the warm summer sun.

Memories are interesting things. We count on them to help remind us

where our car is parked, and also to recall that amazing vacation we took,
but we rarely give much thought to them. We can take the creation and

storage of memories for granted since it happens automatically. We go about

our lives, and when asked about a certain time or situation, we can recall

full details of an event or possibly just tidbits; either way, we can tap into

our memory bank when needed. But how are memories formed? Why are

some times and events easier to recall than others? Why do we sometimes

have huge gaps in our memory? Are trauma memories different from regular

ones? There is so much to learn, but we’ll start with how they are created.

Actually, let’s try to make a memory together right now. I want you to think

of these three terms: palm tree, flip-flop, and water bottle. Try to put these

three terms into a story, and maybe even spray your favorite scent into the

air or onto this book. Smell that scent, think of those terms, and I will check

in later to see whether you can remember them.

HOW ARE MEMORIES CREATED?

The hippocampus is the part of the temporal lobe in our brain that’s

responsible for memory creation as well as for storing long-term memory.

Researchers have also looked at the brains of people who had Alzheimer’s

disease and discovered a profound loss of cells in the hippocampus, while

1
other areas remained intact —thus proving that our hippocampus is the area

of the brain responsible for memory function and retention.

How the hippocampus stores our memories, or whether they are kept

there, is up for debate, but we do know that memories themselves come

from patterns of neuronal activity that can be ignited through our

environment—meaning that when I taste that fresh blueberry, the set of

neurons associated with that memory are activated and connect to mentally

take me back to that time I enjoyed them poolside as a child. These neurons

are like a group of old friends getting back together to help us recall that

information. As we grow and develop, our hippocampus creates more of

these neurons through a process called neurogenesis, and each day they join

together to form new memories. That’s why when we smell or taste

something, for example, we can be pulled back into a memory. The smell or

taste triggered those neurons associated with that memory to get back

together and play it back for us. But if we don’t access those neurons very
often, they can forget about one another or what to do when triggered, and

our brain will eventually clean out the ones not being used, to make space
2
for the newer or stronger memories.

One of my favorite representations of memory creation and storage is

shown in the Disney Pixar movie Inside Out. As the viewer, you get to see

inside the mind of a young girl named Riley and watch as her emotions

control what she thinks and does. They manage her memory recall and even

send her newly formed memories from that day to long-term memory when

she goes to sleep. I love this film because the way her emotions—which are

depicted as characters—show memory creation and management is

surprisingly accurate. Each memory is represented as a perfectly formed

marble, and they share how Riley’s core memories power the different

pillars of her personality. They also accurately show how memories can

change after they have been formed, because our perspective has shifted or

we have been through a different experience. Since our memories are

formed through connections in neurons, we can add to an older memory

when we come into contact with new information—meaning we just added

some newer neurons to an older neuron bundle.

Something I have noticed over my years of creating video content online

is that I am not able to tell the same story twice. That doesn’t mean that I

can’t get the same points across, or remember the key components to it, but

it won’t ever be exactly the same. Every time I share a memory or

explanation about something, it’s unique, and the precise wording can’t be

re-created. How we tell a story about our life can be impacted by how we

feel that day, how well rested we are, or what point we are trying to make.

Every time we reach into our memory bank to tell a story, that memory

returns with a few changes. In Inside Out, Riley’s emotions pull up one of

her old happy memories, but the character Sadness touches the memory

while it’s playing and alters it. Another character, Joy, attempts to change it

back but can’t, and tells Sadness to not touch any more memories until they

can figure out how to fix what she did.

The truth is, we can’t change them back. We now have new information

and have applied that to what we knew, and in a way, it’s helpful, adaptive,

and allows us to be educated and grow. It’s also important to know that

memories cannot be changed unless they are brought into our conscious
mind; it’s only in the retrieval and reliving of them that we can change them.

So, it’s easy to conclude that if we haven’t recalled something until now,

there is no way we could have made it up, or altered it, which will be
3
important to remember as we discuss trauma memories.

HOW ARE MEMORIES STORED?

One important component of memory creation and storage is sleep. In

Inside Out, Riley’s emotions wait until she goes into REM (rapid eye

movement) sleep before hitting the button to move all her newly created

memories to be filed away in her long-term memory bank. What occurs

during our REM sleep is that our hippocampus repeatedly reactivates the

newly encoded materials—meaning that it takes newly formed memories

and triggers the neurons over and over so that we can form a strong memory

that can be easily recalled at a later time. This process, called memory

consolidation, is imperative for learning and memory formation. That’s why

sleep researchers, such as Dr. Matthew Walker, talk endlessly about the

importance of sleep: though each of us will have different needs, we all

require at least seven and a half hours of sleep a night to ensure our brain

and body function well the following day. If we don’t get enough sleep, it

can cause a buildup of newly formed memories without strong connections

to clog up our hippocampus and make it harder for us to learn new things or
4
recall things we learned before.

Dr. Walker said something interesting when he was on Joe Rogan’s

podcast. He stated that when we are sleeping in a hotel or away from home,

we don’t get the same quality of sleep because only half of our brain can

sleep, leaving the other half to stay up and be on guard. It’s a sort of

protective mechanism within our system to ensure that when we are in a

5
new location, we are kept safe. If we apply this to trauma, knowing that

those who struggle with C-PTSD may have never felt safe, or gotten a full

night’s sleep, always feeling on edge or threatened, it’s no wonder many

struggle with their memories of that time. Their hippocampus never had the

chance to consolidate what happened to form an easily retrievable memory.

 ARE TRAUMA MEMORIES DIFFERENT?
If our memories are like the marbles shown in Inside Out, then a trauma

memory would be a shattered marble, dropped on the floor of our

hippocampus; it wasn’t fully formed and it couldn’t be consolidated and sent

off to long-term memory. The splinters are everywhere, and when we least

expect it, we can step on one and be pulled back into a fraction of that

trauma memory. I have heard from many of my patients that these trauma

memories can be difficult to untangle, and the longer we go without

processing them, the more confusing they become. Many talk about them as

being like hazy dreams that don’t make any sense, or like an image that’s so

out of focus that they can’t tell what it is.

Another reason that trauma memories can be so confusing is that the

sheer act of remembering them triggers our stress response, activating our

amygdala. When our amygdala is activated, it overrides our prefrontal

cortex, which is the control center in our brain. Its job is to help us plan, put

feelings into words, consider the options we have available, and make the

decision that’s best for us. In many ways, our prefrontal cortex is responsible

for our personality, and what makes us who we are. If it’s offline, we can’t

think clearly—we can only think of how to get out of this threatening

situation, and we use our emotional response to aid us in our escape. I

believe this is why, for many of us, trauma memories are just too stressful or

emotional to recall, and why we can’t see it clearly or remember the details;

all we can do is remember the feeling.

That’s why it’s no surprise to find out that the amygdala is connected to

the hippocampus—meaning that our emotion and threat response is linked

to the part of the brain responsible for memory. Which makes sense,

because our memories of events do have emotions attached to them. As I

recall those summers at the pool with my cousin, I feel joyful, relaxed, and

maybe a little sad that we don’t have summers like that anymore. So much

of our memories are tied up in our emotions, and if one is too upsetting or

emotionally driven, it can trigger our stress response, stimulating our

amygdala.
 As I have attempted to talk through these memories
with my therapist, all I can remember is how I felt. I
have flashes of feeling scared, trapped, and helpless.
But I can’t come up with any of the details about what
happened, just what it felt like, and sometimes I can’t
even come up with that. It’s like once I start to
remember bits of what happened to me I dissociate, and
come to in my car on my way home from my therapy
session. And that’s terrifying too!

If the amygdala is activated, and other areas are turned off, it could be

igniting our emotions about a situation without any context, and why we

only remember how we felt, not what happened to us. Psychiatrists and

neuroscientists believe that because the role of the amygdala is to recognize

a threat and ready us to deal with it, it’s constantly using our senses to check

out our environment. This can help prevent us from getting into threatening

situations, and allow us to more quickly recognize something dangerous, but

it can also lead to us associating benign items with the harmful event. For

example, if I were sexually abused by a neighbor, and this abuse occurred

after they gave me a snack of crackers and peanut butter, I might connect

that snack, or even just the smell of those items, with the abuse. If I find

myself at a friend’s house years later, and they use that same brand of peanut

butter, I can be triggered by the smell or taste of it. Even if I don’t remember

what happened to me, my brain knows that when I smell or taste things like
6
that, I am hurt, and it readies me for action.

These sensory connections can continue to grow and spread as we have

other traumatizing situations or remember other bits of what’s happened to

us—making it even more difficult for us to know what occurred and manage

all of the triggers we encounter every day. It’s as if the cards are stacked

against us when we are traumatized. We can’t sleep well because of the

nightmares or just not being safe in our own home, therefore our brain

cannot fully process or consolidate the memory. This means that we can’t

fully remember what happened, other than the emotions we felt or just
flashes of the experience. Finally, our amygdala continues to add more and

more triggers to the list to try to keep us safe, but instead, it can make

almost any object or person a reminder of the terrifying event. In many

cases, this can leave us feeling frozen with fear for much of our life,

struggling to have relationships and function in daily activities.

DID I MAKE IT UP?

When every bit you know about an upsetting event seems to flash in and out

of focus, not make sense, and change all the time, it can be hard to know

whether we are making it all up. Too often, I hear from my viewers and

patients that they worry they created the trauma to help explain why they

have been struggling. The truth is, terrifying instances are much easier for

our brain to recall, and we can retain a fairly accurate memory of the

upsetting event for years. This is due to adrenaline being released in our

system, which has been found to create a more permanent and precise
7
memory of an event. Also, we already know that memories cannot be

altered without their being remembered, so it’s very unlikely that we made

up a traumatic instance.

My memories feel like they have gone through many

‘sieves,’ ones with big holes and ones with tiny holes, to
the point where I don’t even know what really
happened, what has been told to me, or what I could
have made up.

This may seem off base, but I love the show Law & Order, and every

time the characters go out to ask the neighbors or other people on the street

whether they saw anything odd or heard anything strange that day, for the

most part, these individuals don’t recall hearing or seeing anything. That’s
because, if they hadn’t encountered something scary or unsettling, no

adrenaline would have pumped through their system to help form an

accurate and long-lasting memory. If we experience only things that seem

normal and regular, we don’t remember them as well. For example, we may

all clearly remember where we were on 9/11, but it’s not as likely that we

will remember what we were doing the day or week before.

Although adrenaline can help us form more clear and lasting memories,

it helps us only up to a certain point. If we, as Bessel van der Kolk states in

his book The Body Keeps the Score, “are confronted with horror—

especially the horror of ‘inescapable shock’—this system becomes

8
overwhelmed and breaks down.” This is what leads to these fragments of

memory and bits of emotional and sensory reminders without any story to

make sense of them. In a way, we know what happened, while at the same

time, we don’t.

Since trauma memories can have many environmental triggers, we will

constantly be pulled back into pieces of the memory and experience bits of

it over and over until we process it. I have always thought that this

occurrence, while extremely uncomfortable, is a good sign. Our brain

doesn’t often allow us to recall any trauma memory while we are still in a

dangerous situation. It hides the memory away so that we can live through

the traumatic situation and be okay. It’s like it sweeps the splinters of that

shattered marble under the rug until we are safe and then pulls the rug away

to remind us of what’s there when we have made it to safety. Therefore,

flashbacks and bits of memory returning to the surface mean that we are

doing okay, and now is the time to process all that happened.

Memories of my childhood trauma used to be kind of a

huge, blurry, yet familiar memory, kind of like when you
wake up and half recall a dream. While I was being
treated for trauma at the VA, individual memories would
come into focus. As soon as they came into focus, there
would be a relief of finally resolving that blurry memory,
like when you have a word on the tip of your tongue and
 then realize what the word is.

Trauma memories aren’t like other memories. We are not in control of

when we recall them, and they don’t fade away as normal memories do

either. We can go about our lives for years thinking nothing has happened,

only to run into an environmental trigger and suddenly realize that

something terrible occurred.

Normal or nontraumatizing memories aren’t like that; there’s never a

period when we aren’t able to remember what it was like to graduate from

college, or what happened on our wedding day. Normal memories aren’t

completely forgotten only to resurface later; that’s only something trauma

memories do. If someone was to ask you about one of the happiest days of

your life, you would probably think for a bit, get a smile on your face, and

recall a beginning, middle, and end to your story. You could easily come up

with the story of that day, and it would make sense. Trauma memories, on

the other hand, are disorganized, unclear, and don’t follow any timeline. We

can mix up what happened to us when we were seven with another event

that occurred when we were twelve. All of those splinters are mixed

together, and since we didn’t get an opportunity to piece them together and

file it away, we can’t easily remember what happened when.

CAN WE TRUST TRAUMA MEMORIES?

Because trauma memories are disorganized, fleeting, and difficult to recall,

many victims of trauma worry that they are making up their memories.

Going our whole life without thinking we were hurt, only to come into

contact with something and have a terrifying memory come flooding back is

odd. We can think there’s no way it’s true, we must be going crazy! Not to

mention that we may not get the entire memory back at once; we may only

get a feeling or a flash of ourselves in a hurtful position, and it’s tough to

make sense of that.

A few years ago, I had a patient who had come to me for help with his

depressive symptoms. It had caused him to gain weight and lose his
girlfriend of two years, and he was currently struggling to keep up with

college classes. It was due to the urging of his parents that he reached out for

my help. For months, we worked together to combat negative and

motivation-stealing thoughts, and slowly things began to improve. About six

months into our work together, his family took a trip back East to visit some

extended family they hadn’t seen in years. My patient was a bit nervous; he

hadn’t seen these members of his family since he was a child, and he also

hadn’t missed his weekly session with me since we began. We went over the

tools that had worked for him so far, prepared him for the trip, and planned

for a phone session. I remember thinking that this trip was going to be good

for him because he would get to test out some of his new skills in a safe

space with a family that cared about him. I thought it would help him build

some much-needed self-confidence, and I was excited to hear how it was

going in our phone session.

A few days into his trip, I received a panicked voicemail asking me to

please call him back immediately; he was not doing well and needed help. I

was shocked, and when I returned his call, he frantically told me about how

they all went out for dinner the other night, and when he gave his uncle a

hug, he suddenly remembered something. He couldn’t piece it together at

first, but he said he knew something bad had happened to him at the hands

of his uncle. He said the smell of his cologne brought up these memories of

being in his swimsuit in a damp basement and being scared. He saw flashes

of himself naked in this light yellow bathroom, being washed by someone.

He told me he felt sick to his stomach and spent the entire dinner “totally

spaced out,” not sure what was going on. Unfortunately, coming into contact

with his abuser after all these years uncovered a deeply hidden trauma

memory, and because of the intense shock of this revelation, he dissociated.

I kept in daily contact with him while he was on vacation, and told him to

stay away from his uncle as much as possible. It was a rough week, but he

made it back and we started working to help him heal from this past trauma.

While some people may balk at the idea of repressed memories

(otherwise known as dissociative amnesia), wondering how someone could

forget something so terrible, remember that this is part of the diagnostic

criteria for PTSD: “inability to remember an important aspect of the

traumatic event(s) (typically due to dissociative amnesia and not to other

 9
factors such as head injury, alcohol, or drug(s).” There has been a research

battle going on for years about whether repressed memories are real, but if

I’m honest, I don’t care about being right or following the research as much

as I care about helping my patients and viewers feel heard and understood.

One of the biggest arguments against the existence of repressed

memories is that there isn’t any evidence to support that the repression

occurs without conscious effort—meaning that these trauma memories don’t

10
just hide away on their own; we choose to conceal them ourselves. I don’t

know about you, but I don’t think that proves anything. How the forgetting

began isn’t as important as whether people fully forget what occurred, and

we have plenty of research to support that it does.

These memories are so hard to recall because I don’t

really want to remember; it’s like my brain holds its
hands up and goes, ‘No that’s too much, I can’t handle
that.’ So, it’s buried deep until you feel safe enough to
process whatever it is. I also think recall is hard because
of shame. For me, I feel ashamed that I ever let bad
things happen in the first place, remembering them
would be a difficult experience. I also worry I’ve made
experiences up, because I can’t fully recall it due to how
painful it is, or I feel like I let it happen because things
like that don’t happen to people.

One important study about repressed memories that van der Kolk

references is “Recall of Childhood Trauma: A Prospective Study of

Women’s Memories of Child Sexual Abuse,” conducted by Dr. Linda Meyer

Williams in the early 1970s and published in 1994. Williams completed sit-

down interviews with 206 girls immediately following their admission into

the hospital for sexual abuse, and all of the victims spoke about the abuse

they had just endured. Then, seventeen years later, she reinterviewed 136 of
the original 206 girls and found that 12 percent of them said they were never

abused in their lifetime, 38 percent did not remember the abuse she had

recorded years earlier, and 68 percent of them reported new incidents of

childhood sexual abuse not already in their files.

As I have talked through memories, I realized that my

brain has tried to completely detach myself from what
happened, which has led to me questioning myself and
whether these events really happened. Whenever I talk
or write about these memories, it feels like I am talking
about someone else. It’s like my mind can’t come to
terms with the fact that this happened to me and is
something very real that I need to work through.

Williams also looked into the reliability of the girls’ memories and found

that the younger the victims were when the abuse occurred, the more likely

they were to forget it at some point in their lives. In fact, 16 percent of those

who did recall their abuse said that they had forgotten about it at some point

in the last seventeen years but then remembered it again later on. Also, the

victims who remembered the abuse when reinterviewed by Williams were

able to recall much of what they told her all those years ago. Some of the

minor details had changed, but the core facts and story of the trauma stayed

the same. This proves that even if we do forget about our trauma for a

period, we can still accurately recall the events, and therefore we can trust

our trauma memories.

I know that some memories are too difficult to manage at the time;

therefore, we return to them when we can finally process them through. I

also believe that just because our brain doesn’t repress the memories

without us consciously making them, that doesn’t make the memories

themselves any less real or true. In many ways, our brain and body are

adaptive, and we hide things away until we feel safe to pull them back out
again; it’s something we feel we must do to survive. When we are still being

traumatized, or are unsafe, we are not going to have the energy or

motivation that’s required to process an upset like that. All of our drive must

support our survival and escape from the terrorizing situation.

WHAT IF OUR MEMORIES AREN’T COMPLETE?

For most of my patients, the trauma memories don’t just come flooding back

with all the details and particulars we have been looking for. Instead, they

trickle in slowly, revealing more and more information as we seek it out.

This process can be difficult, slow, and confusing at times, because not all of

the memories that come back are actual trauma memories. Remember what

we talked about previously? That our amygdala can associate trauma and

upset with all sorts of different objects, making our ability to recall the core

instance all the more difficult? It can cause our recollection of an event to be

tied up with a ton of triggers and flashes of fear that shouldn’t be linked to

the terrorizing event itself. We can struggle to know what happened when,

and what triggers are real. One way to make sense of all this splintered

information is to create a trauma timeline, which is exactly what it sounds

like—a drawn or written-out chronological account of what has happened in

our life. We want to identify the main upsetting events and place them on

the timeline with as much accuracy as we can. One important thing to

remember when organizing our memories is to not get too caught up in

whether something is a trauma. Big-T and little-T traumas all have a place

on this timeline, as well as times when we felt calm or happy.

Keeping a timeline as a living document allows us to fill it in as more

memories come flooding back. It can help us see all we have been through

and validate why we may be having a tough time, as well as help us

recognize patterns of behavior in our families. Many of my patients have

said that seeing it all written out stops it from getting more confusing or

their feeling that they have to keep it all straight in their head. Breaking

down our lifetime into five-year increments is a good place to start, and fill

in each chunk with whatever comes to mind when you think of that period.

These could be things like our parent’s divorce, moving, changing schools,

abuse, addiction in our home, first sexual experience, fighting with a friend,
and so on.

Doing the work of putting together a trauma timeline helps us place our

upsetting memories into narrative form, which can be healing too. It’s often

the lack of verbal or storied memory that keeps us from processing what

happened and filing it away in our long-term memory and can cause us to

continue struggling with flashbacks and other symptoms of PTSD.

Therefore, putting words to what happened, keeping it in a cohesive

timeline, and being validated along the way can help us make some sense of

what happened. For many years, most mental health professionals, myself

included, believed that talking through trauma would help our patients heal

and move on. However, upon further research and experience, we know that

though talk therapy does help some people heal, most of us with PTSD will

need additional forms of treatment to achieve full remission of our

symptoms.

Talking through what happened in a cohesive story is a good place to

start on our path to recovery, but for many of us, even this first step feels

impossible. What if we still have periods where we don’t remember

anything? How can we check to make sure we are putting the pieces together

properly? How can we fact-check this? One of the most helpful tools in this

portion of trauma work is to find a fact-checker. A fact-checker is someone

in your life that you feel comfortable talking to, who would know whether

something you remember is true. They can fill in any blanks you may still

have and offer up other tidbits of information to help you make sense of the

rest of your timeline or story.

It can be hard to find someone like this, but the first place to look is to a

sibling, preferably an older one. If we don’t have a sibling, or we don’t get

along with the ones we do have, we can look to a cousin, aunt, or even a

babysitter—anyone who would have been around during that time who

could help us piece things together. Now, I know this can be scary; we are

opening up to someone regarding things that we still aren’t sure about, and

they could tell us what we remember didn’t happen. They could

retraumatize us or cause us to feel we are back at square one. That’s why we

don’t reach out to other people until we have worked on the timeline and

story for a while, when we have some specific questions for them. We don’t

ask our fact-checkers whether something happened, we tell them what we

remember, and ask direct questions, such as, “Hey, remember when we used
to camp by the lake every summer? I remember this one year when we had

fireworks, and one shot right at me—was it our uncle who set those off, or

someone else?” We let them know what we remember and ask them for one

or two clarifying things. This keeps it on topic and prevents them from

potentially adding details that aren’t helpful to us and our healing.

When I remember a memory now it feels as if it

happened to someone else. I can recall what has
happened but not the emotions with it, or the opposite
way around. Sometimes it still makes me believe that
it’s all in my head until I talk to someone older that has
remembered what happened to reassure my thoughts.

Taking the time to untangle our memories and piece together what

happened to us can be difficult, overwhelming, and at times unbearable. For

those reasons, we must give ourselves the time and space needed to do the

work. So often, I hear how much people wish they could speed things up,

heal more quickly, and just get over it already. The secret to consolidating

and healing from these trauma memories is in the letting go of the result and

allowing ourselves to go at the pace we can. Too often, in recovery, we want

to push harder, move faster, and force our brain into submission, but that can

end up doing more harm than good. Instead of expecting our process to

follow a certain schedule, we should try to accept where we are at, let go of

the things we cannot change, and allow ourselves the time needed to heal.

Some things in life cannot be rushed, and trauma work is one of those, so be

compassionate with yourself as you move through it, and trust me, it does

get better.

KEY TAKEAWAYS
• Memories are created in our hippocampus, which
connects groups of neurons to one another. They are
saved in this long-term memory bank during our REM
sleep cycle.
• The sheer act of retrieving an older memory changes it
slightly because we have new experiences and
perspectives to add to it.
• Trauma memories are different because they aren’t
complete and therefore cannot be logged away into our
long-term memory. By trying to remember them, we
trigger our amygdala, which can make putting our
feelings to words even more difficult and prevent us
from making sense of what happened.
• Our amygdala continues to add an increasing number
of triggers to the list to try to keep us safe, but instead,
it can make almost any object or person a reminder of
the terrifying event. This can make trauma memories
confusing and hard to understand.
• Trauma memories are not like regular memories,
because we don’t control when they are recalled, nor
do they fade away as normal memories do.
• Repressed memories are real; however, we do
consciously push them down. Once we retrieve them,
they are found to be accurate and trustworthy.
• If there are gaps in our memory due to trauma, using a
trauma timeline, putting our experiences into a
narrative, and finding fact-checkers from that time can
help us figure out what happened.
• Trauma memories take time to put together, so be
patient with ourselves and our process, because it does
get better.
 CHAPTER 10

HOW CAN WE RECOVER?

THE BENEFITS OF NEUROPLASTICITY

We have all heard the adage that you can’t teach an old dog new tricks.

We tend to use this phrase when we encounter someone who is stubborn in

their ways or isn’t open to any feedback about the way they handle things.

We often let older people off the hook with this proverb, believing that it’s

better to just let them be the way they are, and not bother them with any

expectation of change. However, the truth is that everyone, no matter their

age, learns new things every day through a process called neuroplasticity.

The term neuroplasticity was introduced in 1906 by Italian psychiatrist

Ernesto Lugaro, and it explains why we can adapt, learn, and grow
1
throughout our lives —meaning that no matter how old we get, we can be

taught new tricks!

Neuroplasticity allows for our nervous system to be shaped or molded; in

other words, with enough energy and repetition, we can change our brain.

This is where the field of psychology thrives; this career is founded in the

belief that people can change, heal, and grow, and it’s up to us mental health

professionals to guide them on their way. We discussed in the last chapter

how our brain creates new neurons every day, and it’s with those neurons

that it builds new memories; we also learned that it gets rid of the unused

information to make room for all of these new skills and experiences. It’s in

this daily churn that we learn new things and make room for change.
 HOW CAN I LEARN NEW TRICKS?
When I was a kid, I used to bite my nails, and even though I hated that I did

it, I couldn’t stop. My mom thought it was a bad habit that would lead to my

getting sick more often because my fingers were constantly in my mouth,

and so she tried to help. She bought this bad-tasting nail polish, offered me

rewards for not biting my nails, yet nothing seemed to work until I told my

friend Helen about it. She swore that she would get me to stop, and began

batting my hand away any time I tried to bite my nails. She would even

shout at me to stop when I was out of arm’s reach. At first, it was funny, and

I would sometimes still bite my nails (often to be stubborn or show her that

I couldn’t be stopped), but her consistent hitting and shouting made me

more aware of when I was biting my nails, and after a while, the behavior

ceased. Every time I would raise my hand to my mouth, I could hear her

screaming for me to stop, or feel an arm reaching out to swat my hand away.

This consistent punishment, while playful, slowly decreased my urge to bite

my nails, and I haven’t done it since.

I know that talking about how I stopped biting my nails when we are

discussing trauma can seem like an oversight or insensitive, but I think it’s

important we understand how we learn in basic situations before applying it

to bigger issues like traumatic events. Let’s start by getting into the three

types of behavioral learning: classical conditioning, operant conditioning,

and observational learning.

Classical conditioning had the most influence on this area of psychology,

and to share one of my favorite psychology jokes of all time, does the name

Pavlov ring a bell? If you don’t get that joke now, don’t worry, it will all

make sense soon. Classical conditioning is when we pair a neutral stimulus

with a naturally occurring response. This type of conditioning was

accidentally discovered in a famous study conducted by Russian

physiologist Ivan Pavlov in the 1890s. Pavlov originally believed that dogs

would salivate when food was placed in front of them, which makes sense.

If they see and smell the food, of course, they would salivate; it’s how our

digestive system begins its process. However, what he found was that the

dogs would begin salivating when they would hear the footsteps of his

assistants who were getting the food ready. They had learned that the sound

of their footsteps meant food was coming, and their body readied itself for
it. Upon seeing this behavior, he wanted to test this discovery and

hypothesis: that you could pair a neutral stimulus with a naturally occurring

response.

Pavlov reconstructed his study to include a bell being rung before the

food was given to the dogs. He wanted to see whether he could pair this

neutral stimulus (the sound of a bell) to the dogs’ natural response when

they saw food (salivation). Each time the assistants fed the dogs, they would

ring the bell first, and then place their food in front of the animals. Slowly,

the dogs began to associate the sound of the bell with being fed, and then by

just ringing the bell, Pavlov could cause the dogs to salivate. This was the

first proof that classical conditioning worked, and Pavlov devoted the rest of
2
his career to studying it. Now, do you understand my joke? It’s just so

dorky and funny, and feel free to use it at your next party.

What this style of learning means for us is that, if we have a trigger or

stimulus in our life that is causing us pain or upset, we can in fact pair that

stimulus with something more positive and, in essence, snuff out the

negative connection. A current example of this would be the fact that social

gatherings have resulted in an increase in COVID-19 cases and deaths.

Therefore, we can begin to associate getting together with others with

sickness and death, and feel the urge to isolate completely. However, once

we have a vaccine and treatment, we can slowly expose ourselves to others

in a safe and healthy way, and will be able to see that fewer people get sick,

and more are able to recover. By slowly exposing ourselves to the scary

thing (gathering) without getting the terrifying result, we can change our

previous association. This is not only exciting to know, but it also offers

hope for a better future for those of us who have felt imprisoned by our past

experiences.

The next type of behavioral learning is the one we hear about and use the

most, and it’s called operant conditioning. Operant conditioning is what I

described with my friend Helen and my desire to stop biting my nails;

through her consistent punishment when I tried to bite my nails, I was able

to decrease that behavior. The most famous study related to operant

conditioning was conducted by B. F. Skinner in the 1930s and used what he

called the “Skinner box” to demonstrate how reinforcement and punishment

can shape behavior. Skinner would place hungry rats into this box that had a
lever on the side of it. When the rats began running around the box, they

would inadvertently hit the lever and a food pellet would come out. It didn’t

take very long for the rats to learn that when they were hungry, they just hit

that lever and food would come out. The food was known as a positive

reinforcement since it reinforced the behavior that the rats’ hitting the lever

yielded food and made it more likely that they would hit that lever over and

over again.

Another way to strengthen certain behavior is by removing an adverse

stimulus, otherwise known as negative reinforcement. In the Skinner box,

this form of reinforcement was demonstrated by electrifying the floor of the

box, making the rats uncomfortable and causing them to run quickly around

the box. They would accidentally bump into the lever, causing the electricity

to stop, and their discomfort would go away. It didn’t take long before they

learned that the lever would stop the shock, and when the rats were placed

back into the Skinner box, they would quickly make their way over to the

lever and hit it. They had learned through negative reinforcement to hit that
3
lever and to do it quickly.

When I was in college we had this computer game called “Sniffy the

Virtual Rat” that allowed us to conduct studies just like B. F. Skinner, but

without harming any rats, and it was interesting to see how such a simple

positive or negative reinforcement could change their behavior. I also

enjoyed the fact that through technological advancements, we could get

away from having to use real animals in our studies, because I don’t know

whether I could have completed my homework using a real rat, especially as

we got into the punishment portion of the study.

While positive and negative reinforcements seemed to shape the

behavior of the rats, Skinner also tried punishment as a means of weakening

or removing the reinforced behavior—meaning that when the rat would get

into the box and begin hitting the lever, it would get a small electrical shock.

This was done to see how quickly this punishment could extinguish the

already learned behavior (to hit the lever), and though this did work, and the

rats quickly stopped hitting the lever, it also made them fear the lever. Some

became aggressive, and it didn’t guide them toward any desired behavior,

only away from the undesired one. Overall, what this tells us is that if we

want to change our behavior or the behavior of our children, it’s best if we
use positive or negative reinforcement. Having a reward added or a negative

situation removed allows us to shape our behavior into something more

positive and helpful while avoiding any unfavorable side effects.

The final type of behavioral learning is observational learning, which is

when we master something by watching someone else do it and imitating

their behavior. This happens a lot in children, and we have that funny saying

“Monkey see, monkey do,” which represents the art of mimicking or

imitating. If we watch someone do something enough times, we can usually

figure out how to do it ourselves.

When I was growing up, we had a lot of animals—multiple dogs, cats,

and guinea pigs—and they would all watch us open up the doors in the

house or the ones in their cages every day. Since our yard was not fully

fenced, we would put our dogs into the kennel before leaving for an outing,

and one summer I remember walking out to lock them in, and when I got

back inside my mom asked why I hadn’t put the dogs away yet. I was

stumped, because I had just put them in the kennel. She went out and placed

them in herself and we left for the afternoon, and when we returned, the

dogs were back out in the yard. We figured they had gotten out somehow,

but couldn’t figure it out because it looked as if their kennel door was still

closed. We put them back in the kennel and then looked through the window

in the house to see our golden retriever Bailey carefully balance on his back

legs while lifting the latch, opening the door, and then shutting it behind

him. We were shocked and amazed, and immediately got a different latch

that didn’t just hook over the pole on their kennel, and they never got out

again.

I would like to say this was the only case of our animals learning from

observing us, but our cats also figured out how to open the pantry door so

that they could get into their food, and our guinea pigs found a way to let

themselves out of their cage. Observational learning is probably our most

innate form of learning and part of why studying in school with others is so

beneficial. This is also why many parents try their best to model good

behavior for their children; they are watching us and picking up on our

actions and language. One of my favorite observational learning stories

comes from my babysitting days in college. I used to babysit for this couple

who had just had twins, and the mom would have me pop by for a few hours

so that she could get things done around the house, visit friends, or go run
errands. One day, it was my duty to get the twins to their Gymboree class,

and so I strapped them into their car seats, packed up their snacks, and we

hopped onto the freeway. If you don’t live in a city like Los Angeles, know

that you rarely just hop on the freeway; it’s more of a battle, and traffic

seems to happen no matter what day or time you are traveling. This day was

no different, and as we came to a stop on the on-ramp, one of the twins let

out a big sigh and said, “Well, shit, traffic again,” as she threw her arms at

her side and dropped her head. I burst out laughing but quickly pulled

myself together so that I didn’t reinforce her behavior. When I got back to

the house, I let her mom know what had happened, and she admitted that

she wasn’t the best at watching what she said when the twins were in the car,

and we both had a good laugh about it.

The goal is to understand that there are many ways in which we can

change and grow, and I believe this can easily be applied to therapy and

healing from past trauma. For example, observational learning can happen

in therapy, as a therapist demonstrates healthy communication,

understanding, and even how to disagree without aggression. We can also

incorporate some positive reinforcement in therapy or even do it ourselves in

our own life. I have even done this with my book-writing process. Each

week, I have some small goals I hope to accomplish, whether that’s how

much research I hope to complete or a certain number of pages I want to

finish. If I reach those goals, then I reward myself at the end of the week. It

keeps me motivated and makes it easier for me to jump back into writing in

the following weeks and months. In therapy, I can apply this in the same

way, working with a patient to come up with some small goals, such as

trying to expose themselves to a triggering item and using their new tools to

calm themselves back down. If they do this successfully once this week,

they will have a reward already planned, such as getting a coffee, taking a

week off from therapy homework, or buying themselves something.

HOW DO I CHANGE MY BEHAVIOR?

When it comes to behavioral change in trauma work, we must go beyond the

learning models and dig into our thoughts because, like it or not, thoughts

are the drivers of our actions, and of how we can make real, lasting change
in our brain and life. One of the best styles of therapy for this is cognitive

behavioral therapy (CBT), since it works under the belief that our thoughts

lead to our feelings, which, in turn, lead to our behaviors. This creates a sort

of cycle as we go through life—while we are engaging in certain behaviors,

they can work to only intensify our original thoughts, and there we are back

at the beginning of that cycle again.

Since I know this can be hard to visualize, let me share a personal

example. For years, I have struggled with overapologizing, even saying sorry

for saying “Sorry” too much; I know, it was bad. But this issue all stemmed

from my thoughts about my existence. I would often have thoughts like “I

am not good enough” or “I am just not getting the hang of this fast enough, I

am letting people down,” and because of those thoughts, I would feel sad,

lesser than, and that I just wanted to disappear. All of those thoughts and

feelings would lead me to overapologize. I would assume that my boss

didn’t think I was catching on quickly enough and so I’d apologize for how

long it took me to complete a task, or I would worry that I was in someone’s

way in the grocery store and say sorry as I moved my cart to another part of

the aisle. As I engaged in these behaviors, I was only solidifying my

thoughts and feelings that I was less than and not good enough. It had been

pointed out to me throughout my life: once my softball coach told me that I

would have to run the bases every time I said sorry to him when it wasn’t

warranted, and I ran almost the entire practice. But it wasn’t until my

husband, Sean, started to kindly point it out that I brought it up in therapy

and decided I needed to change.

Just like any change we want to make, it took time and a lot of work. My

therapist had me start noticing what my thoughts were in situations where I

felt the urge to apologize; in CBT, this is called keeping a thought record.

She had me write down some of these thoughts, and surprisingly, a lot of

them were just different versions of the same thoughts. I was having these

repetitive negative thoughts about myself all day every day. Which kind of

sucked to realize, but was also validating in that I had proof that my urge to

constantly apologize was coming from somewhere. She had me continue to

keep track of my thoughts while also journaling about how I felt and what I

did each day.

Next, my therapist discussed cognitive distortions with me, which is just

a fancy phrase for thoughts or beliefs we have that are not founded in any
truth. There are ten main cognitive distortions: all-or-nothing thinking,

overgeneralizations, discounting positive things that happen, filtering,

jumping to conclusions, emotional reasoning, magnification, labeling,

4
“should” statements, and self-blame. My biggest distortion was “should”

statements. I believed that I should be better, faster, smarter, or whatever,

and therefore I needed to apologize constantly to make up for the fact that I

could never meet my unattainable goals or standards. In a way, I was setting

myself up for failure.

WHAT DO MY THOUGHTS HAVE TO DO WITH IT?

Before we move on to the next step in my CBT work, I want to explain each

of the cognitive distortions or faulty thoughts because we all have them, and

we must understand them so we are able to more quickly identify them in

our life. First up is all-or-nothing thinking, or what I like to call the diet

mentality: I am either on a diet, eating perfectly, or I am not on a diet, so I

might as well eat everything in sight. We could also call this distortion

black-or-white thinking, because it doesn’t leave room for any slipups,

mistakes, or possibility of it getting better. It only sees things as one way or

another, all or nothing.

Next, we have overgeneralizations, and this happens when we take one

experience and apply that result to everything else in our lives. We can

assume, because we had one bad relationship where someone hurt us, that

all relationships we could be in will end the same way. Generalizing like this

doesn’t leave any room for change and loves such words as “always” and

“never.”

Moving on, discounting positive things that happen is a very common

cognitive distortion in my patients with anxiety or depression. We can have

a pretty wonderful day, everything is going our way, people are kind, and we

accomplish what we need to; however, when we get home, we get into an

argument with our daughter, and then we think our entire day, hell, our

entire life, is shit. We can overlook any of the good things that have taken

place and instead focus on the one bad thing. This doesn’t allow us to see

the full picture or manage life’s ups and downs.

Filtering is the combination of overgeneralizing and negating the

positive. This happens when we only focus on one bad part of an

experience, magnify all of the details, and obsess over it so that we can’t see

any of the positive things about it or ourselves. It filters out all of the other

information or facts so that we only see what we want to see.

There is also the cognitive distortion of jumping to conclusions, which I

think we all do from time to time. We can do this by assuming we can read

someone’s mind, that we know they are upset, angry, or hate us. Because of

this thought distortion, we can act in ways that support those thoughts and

harm our relationships. We can also do this by thinking we can see into the

future and act a certain way because we “know what’s going to happen.”

Again, this doesn’t allow for life to unfold or thoughts to be challenged,

because we are taking action that only solidifies the false thoughts.

Another cognitive distortion that I see constantly in my office and online

is emotional reasoning, where we judge ourselves or our environment based

on how we feel. For example, if we are having a bad day and feeling stressed

out, we can believe that that one person on the Zoom call not muting their

mic while they do things around the house is doing that just to annoy us.

When we are in this distortion, we are living in our emotional mind, not our

wise mind, and therefore aren’t able to see things clearly. This can make us

irrational, easily upset, and act in ways that only make us feel worse.

Another distortion is magnification, and this is when we magnify one

part of something, ignoring the other equally important components. We

could also call this catastrophizing, when we blow things out of proportion.

The next cognitive distortion I want to discuss is labeling, which is when

we take one example or experience and judge ourselves or someone else by

that, believing that that example is representative of who we are as a person,

not just one thing that we did. Let’s say we were rude to someone because

we hadn’t slept well and they were asking a lot of questions; we may tell

ourselves we are a rude person, that that’s just who we are, instead of

thinking that we acted rudely that one time.

One cognitive distortion that I struggle with is “should” statements,

where we “should” all over ourselves until we feel terrible about who we are

and what we can accomplish. “Should” statements set unattainable high

standards and can lead to us feeling that we can’t ever measure up.

Finally, there is self-blame. This is when we take responsibility or blame

for something we didn’t have full control over. I see this frequently in my
patients who have been abused or assaulted; they believe that they did

something to cause it or that they could have prevented it from happening.

Self-blame can erode our sense of self and lead to feelings of shame.

HOW CAN I STOP LIVING IN THESE COGNITIVE

DISTORTIONS?
Once I was able to identify the cognitive distortion that was causing me to

constantly apologize, the next step was to restructure it—meaning that I

would have to recognize when I was “shoulding” all over myself and force

my brain to think about it in a new way. This is, in my experience, the

toughest part of CBT work, because we have usually been engaging with

this distortion for so long that we don’t even notice when we are in it. For

me, I always framed my “should” statements as motivational or aspirational,

but my therapist helped me to see how often they were sabotaging me. Once

I recognized just how hurtful that way of thinking was for me and my life, I

was motivated to work to stop it.

One of the ways we can restructure our cognitive distortions is to

challenge them with facts or other perspectives. For me, this meant that

when I thought something like “I should be doing more with my life,” I

would force myself to stop and come up with some things that I have already

done. For example, I have completed undergrad and graduate school, I have

a wonderful and fulfilling job, and I have gotten to travel all over the world.

Challenging those false but automatic thoughts helped me see that they

weren’t true and were only holding me back. If we struggle with a different

cognitive distortion, such as all-or-nothing thinking, this would mean that

we would have to look for possible middle ground or gray areas. Instead of

thinking, “I messed up today, so I might as well just give up completely,” we

can be softer and look for the things that we did do well, or tell ourselves

that tomorrow is a new day and we can start over. The urge to engage with

those comfortable false thoughts will still be there, but once we know what

our repeat thoughts are, we can recognize and challenge them quickly.

Another way to stop these cognitive distortions from running and ruining

our lives is to be curious about them and see how they play out. Now, I don’t

mean that we should engage with these faulty thoughts and see how much
damage they can do, but it can be helpful to see where the thought ends.

What I mean by that is, if my thought is “I am going to blow this interview

because I should have prepared more,” I could let my imagination run

through this scenario with the understanding that I won’t get the job I am

interviewing for, and in the end help me to see that while it’s not pleasant or

my desired outcome, it’s also not life-ending. Letting our brain play out an

entire thought or worry can help us to see that it’s not worth worrying about

and make it easier for us to challenge it or let it go.

While many various CBT techniques are beneficial, the last one that I am

going to address is exposure. Once we have recognized our faulty ways of

thinking and are fighting to change them, we must practice taking this new

action. While it is helpful to role-play in therapy or even visualize ourselves

acting in a new, healthier way, we should try it out in our regular life.

Continuing to use my example, my exposure had to be completed in busy

public places, at work, and home. It started with my not apologizing when

someone needed to get past me in a crowded public space, such as the

grocery store, yoga studio, or airport. If someone needed to get by, I had to

just move (if possible) and say nothing, which sounds simple but was

incredibly difficult. Next, if a project took me up until the deadline, I was

just supposed to turn it in and not apologize for taking so long. In short, I

was supposed to note whether I had done something that made someone

else’s life more difficult, and if not, I wasn’t allowed to apologize. Oh my

god, this was so hard.

I also had to try to go for an entire day without apologizing to my

husband, Sean (unless I could prove to myself that it was worth apologizing

for). This was, by far, the hardest exposure, and I found myself feeling more

anxious and unsure than ever before. I would sit in silence trying to consider

whether I should apologize for not knowing that the garbage was full and

taking it out, or for bumping into him in our very small hallway. I know

these thoughts sound crazy, but when you’ve been saying you’re sorry for

pretty much everything you have ever done or not done, it can be hard to

know what warrants an apology and what doesn’t. Over time and with a lot

of practice, and checking in with my therapist, I was able to understand that

when something I did was upsetting to someone else, it deserved an

apology; everything else did not. Sounds simple, but this new way of

thinking and behaving took me months to work out, and although I still
struggle with this when I am stressed out or upset, it doesn’t run my life as it

used to.

The interesting thing I learned throughout this process is that I was

putting all of this energy into something that did not serve any purpose. My

apologizing all the time and feeling that I should have been doing something

else didn’t help anything, and it didn’t improve my life or relationships; it

only made me feel bad and less than everyone else. Once I got out of this

harmful thought cycle, I was able to see everyday experiences with more

clarity, be more thoughtful with my actions, and my life and relationships

improved. I realized that a few of my friendships only fed into this

unhealthy way of living, and once I wasn’t so down on myself or overly

apologetic, those relationships didn’t work anymore. It was shocking at first,

but after deciding to not associate with them anymore, I feel freer and

lighter, not to mention it’s now easier for me to continue making healthy

choices for myself.

WHY IS IT SO HARD TO CHANGE?

While doing some of those CBT techniques can sound pretty simple, in the

moment it can be difficult to not engage with the thought, agree with it, and

act a certain way as a result. That’s why it’s important to be kind and

compassionate with yourself as you work to make the change. Know that

recovery or growth is never a straight line, but more like a winding path

with ups and downs along the way. The reason it can be so hard to make

these changes is that our brain loves habits, patterns, and consistency, and it

will want to go back to what it knows. I have described this in the past as

our brain being a balloon filled with sand. Every action we take as a result

of how we feel causes a marble to roll across the balloon, creating a small

rut to form in the sand, and as we continue to take those actions, that rut

will only get deeper. Therefore, when we want to change what has now

become our automatic response (the rut we have created), we are going to

have to try hard to keep that marble from falling back into that well-worn

path.

If we are trying to stop ourselves from getting into yet another abusive

relationship, or we want to be out in public without worrying someone is

going to hurt us, we are going to have to utilize some of these tools to

recognize what cognitive distortions we struggle with most and fight to

challenge them. I know it’s hard. It’s as if we are building a new muscle we

never even knew existed, so we can get tired quickly, become frustrated, and

want to give up. But stick with it; with each rep, you get stronger and will

feel more confident to do it again the next time, and before you know it, a

new healthier habit will have formed.

Since we have been talking about learning and how we can change and

grow, now is a great time to test your memory. Remember how I told you to

spray your favorite scent onto this book and put those three terms into a

story so that you can later recall it? What were those three terms? Test your

memory, and then take a look back at here to see whether you were right!

HOW DOES THIS RELATE TO TRAUMA?

The reason neuroplasticity and learning are important when it comes to

understanding trauma is that they prove we can heal and grow. Too often,

when we have been traumatized and are struggling to manage all of the

symptoms of PTSD or C-PTSD, we can lose sight of the shore and feel as if

we will forever be lost at sea. I hope that this is a reminder of all the

research and experience supporting the fact that we can learn new things,

and change the way we think, feel, and act. We also have to remember that

we cannot change other people or go back in time and prevent the painful

experience from occurring; we can only focus on ourselves and the choices

we have moving forward. If we don’t like how things are going, how we feel,

or the relationships we are in, then we have to change something, and it has

to start with us.

KEY TAKEAWAYS
• Neuroplasticity is the ability of our brain to adapt and
change as we learn things and have new experiences.
• There are three types of behavioral learning: classical
conditioning, operant conditioning, and observational
 learning.
• Classical conditioning is when we pair a neutral
stimulus with a naturally occurring response, as Pavlov
did with his studies of dogs.
• Operant conditioning is when we use positive or
negative reinforcements to increase or decrease a
behavior. We can also use punishments as a way of
extinguishing a certain behavior, as Skinner did with
rats and his “Skinner box.”
• Observational learning is when we learn how to do
something by watching someone else do it first, as my
dogs did when they learned how to let themselves out
of their kennel.
• To change our behavior, we have to change our
thoughts because they become our feelings, which in
turn become our actions. Cognitive behavioral therapy
(CBT) works using this principle.
• There are ten cognitive distortions: all-or-nothing
thinking, overgeneralizations, discounting positive
things that happen, filtering, jumping to conclusions,
emotional reasoning, magnification, labeling, “should”
statements, and self-blame.
• To change our behavior, we have to track our
thoughts, recognize the cognitive distortions that affect
us most, and restructure or challenge the distortion.
We can also let our imagination play out the thought
and expose ourselves to situations that would normally
trigger unhealthy behaviors, and try doing the healthier
ones.
• By utilizing our ability to learn, change, and grow, we
can overcome our past traumas and heal.
 CHAPTER 11

THE FOUNDATION OF
HEALING
FINDING THE RIGHT TREATMENT

No matter how hard we try, we cannot forget what happened, and we

can’t go back in time and make it so that the traumatic situation never

occurred. Therefore, the only way to deal with a traumatic experience is to

find the right mental health professional and begin working through it.

While the style of therapy we enter into is essential, it’s more important that

we find a therapist we like and have a good rapport with. Doing trauma

work can be difficult and triggering, which is why it’s necessary that we feel

safe with them and in their office. It may take us a few sessions with

different therapists before we find a good fit, so don’t give up or get

discouraged; it’s part of the process. Just like dating, on the way to finding

someone we enjoy, we usually have to weather a few bad ones first, so stick

with it and know that, in time, you will find one that works for you.

One of the ways to know whether you are seeing the right therapist is

that you feel they hear you and are on your side. You shouldn’t have to keep

reminding them of the details about a certain event or the name of an

important person in your life; they should take notes and remember. They

should also push you to try harder, do a little more than you think you can,

and support you along the way. In many ways, a good therapist is like the

training wheels on a bike: we may not always need them as we cruise

through certain situations, but when things get rough or tricky, they are
there to keep us upright and safe. In trauma therapy, faster isn’t necessarily

better; it can end up causing more pain and upset, and that’s why they

should challenge us to work through the traumatic events, but not at a pace

that’s so quick it could be retraumatizing.

Along with finding the right fit in a therapist, we also need to figure out

what type of therapy they offer. Not all therapists are trained to do trauma

work, and even though their websites may say they do, it’s always good to

ask them on the phone about it and to specify what types they are trained in.

Remember, this is your treatment, time, and money; don’t be afraid to make

sure they can help you. We wouldn’t make an appointment for a heart

disorder without first knowing that the doctor is a cardiologist, so why treat

our mental health any differently?

WHAT ARE THE TYPES OF TRAUMA THERAPY?

Know that the trauma therapies mentioned are in no way an exhaustive list,

nor am I able to include all of the research and data that proves their

efficacy. What I hope to illustrate is that there are many options available,

and if one isn’t working for you, or if you don’t have access to some of them,

you can still overcome your symptoms of PTSD and heal.

The most common form of trauma therapy is what is known as talk

therapy. This means that the therapist will help you put words to what

happened, and piece together your experience into a cohesive story. Since

most of us have never shared what happened with another person, or even

said it out loud before, this process can be daunting and overwhelming at

times. However, as we get support and validation for all we have been

through, it can also be transformative and healing. It can help us remember

what occurred and get us talking about it for possibly the first time, but talk

therapy alone isn’t always enough. Many of my patients still experience

flashbacks or body memories, and feel haunted by what happened. I believe

this is because trauma memories are stored differently, and if we can’t calm

our stress response, we aren’t going to be able to piece together what

happened any better than we did when it first took place. This is why there

are many other forms of trauma therapy out there—if one doesn’t work, we

can add another or switch over completely.

 Another trauma therapy option is eye movement desensitization and

reprocessing (EMDR), which was developed by Francine Shapiro in 1988

after she realized that her eyes’ tracking people walking past her in the park

decreased her response to some upsetting thoughts. She believed that these

side-to-side eye movements could potentially help us better manage our

negative experiences, or at least lessen the severity of our response to them.

Shapiro tried to mimic her eyes’ following people walking past by having

her patients follow her finger from left to right, and she tested her new

treatment and hypothesis on trauma victims. Much to everyone’s surprise,

she found it to be as effective as exposure therapy and selective serotonin

1
reuptake inhibitors (SSRIs), which was encouraging for many reasons, but

especially for people who aren’t open to trying medication as part of their

treatment.

EMDR is based on the understanding that when something traumatizing

happens to us, it overwhelms our system, making it impossible for us to

process what took place and neatly file it away into our long-term memory.

EMDR gives us another chance to do that at our own pace and allows us to

go back to that horrifying experience without being retraumatized by it.

When we return to those upsetting images or memories, the EMDR

therapist will have you follow their finger with your eyes from side to side,

or they may tap you on your left and right shoulders or knees, or even have

you hold buzzers that mimic the tapping. I have even been told that some

therapists have headphones you can wear that make a beeping noise in your

left and right ear separately. All of this tapping and eye movement are used

to create bilateral stimulation, which means that we are stimulating both

sides of our brain and body and therefore are improving the communication

between our brain’s hemispheres as well as enhancing our memory.

This style of therapy has been life-changing for many of my patients,

some sharing that they didn’t even have to talk through all of their trauma

memories in EMDR for it to feel less painful. Being able to mentally return

to that situation with their new therapeutic resources allowed them to go

back to the terrifying experience while still knowing they weren’t physically

there. They could see what happened from another, more adult perspective,

or feel empowered enough to change the way they viewed the outcome. One

of my patients told me she could see herself being abused but knew she was
an adult now and wasn’t going to have to go back there ever again. It allowed

her to recognize that the abuse wasn’t her fault, and gave her permission to

feel angry and sad about what happened. In our previous talk therapy

sessions, going back to that time was impossible because she would become

so overwhelmed with emotion and feel as if it was happening to her all over

again. I referred her to an EMDR therapist and it happened to be just what

she needed to finally heal.

In many ways, EMDR sounds like magic, but it’s in our ability to return

to the memory, feel what happened while knowing we are safe and okay,

that it works. Since I can’t be inside people’s brains while they do it, I can’t

fully explain why it’s effective, but I have seen it transform people, and even

though it may sound strange that eye movements could help us heal from

trauma, trust me when I tell you it can.

The next style of therapy that can be utilized in trauma work is trauma-

focused cognitive behavioral therapy (TF-CBT). This style of therapy was

created to specifically help children and adolescents overcome their

traumatic experiences, and therefore the parents and caregivers of the child

play an active role in the treatment as well. Created by doctors Anthony

Mannarino, Judith Cohen, and Esther Deblinger, TF-CBT uses cognitive-

behavioral principles and exposure techniques to help alleviate any

symptoms of PTSD. The goals with the child or adolescent are to help them

understand that how they feel is a normal reaction to trauma, and assist

them in building up some ways to self-soothe, relax, and talk themselves

down from a trigger or upset. They are also taught to notice when they have

fallen into one of the cognitive distortions we discussed in a previous

chapter, things like all-or-nothing thinking or catastrophizing. Then, the

therapist will slowly expose the child to something triggering and help them

to see that that particular object, situation, or smell doesn’t have to be scary
2
or traumatizing—they can use their new skills and be okay.

This is where the work with the parents (or caregivers) comes in, as they

are supposed to listen to their child as they talk about the trauma and

support them so they feel safe and cared for. The adults can only be a part of

the therapy if they are not the ones who terrorized their child, and it has

been found that having the parents on board for their child’s care speeds up

their healing process. I would assume this is because the parents can ensure
therapy homework is being done, and by their being in session, it can help

their child feel more secure to talk about what happened. In some cases, the

therapist will even see the parents without the child, to teach them how to

model appropriate behavior, when to remind their child to use their

relaxation skills, and how to talk about the trauma with their child if they

bring it up. I like this style of therapy because it’s designed for children and

it includes their parents in the process whenever possible. Too often,

children don’t get the help that they need when they are young and are

instead forced to manage their symptoms of PTSD alone, without any skills

or understanding of what’s going on. Having this type of therapy available

gives me hope that more children are being helped and can heal from any

trauma they have sustained.

Another type of therapy that can work for anyone who has experienced a

trauma in their lives is exposure therapy. This type of therapy is part of

cognitive-behavioral therapy (CBT), but I wanted to separate it from CBT to

explain why it can be so helpful in healing from trauma. When we are

traumatized, we can associate certain smells, sounds, and tastes with that

terrifying time, and we work to avoid anything that reminds us of it. This

makes sense because if we avoid scary things, then we won’t get upset or

retraumatized. However, this can make it difficult for us to live our lives and

we can feel that we are constantly looking over our shoulder for another

person or thing that could hurt us. That’s where exposure therapy comes in:

It pushes us to encounter these fear-inducing things, work to calm our

nervous system down, and prove that it wasn’t that scary after all. In a way,

we are creating evidence that our amygdala has attached things to our

trauma memory that don’t belong there, and we are weeding them out one

by one.

Just know that exposure therapy doesn’t mean you are going to be forced

into a scary situation on day one. The first and most important component

of exposure therapy is to build up our relaxation skills. We do this first so

that when we do expose ourselves to the scary thing, we have some tools to

use to help us feel better. Next, we put together a hierarchy of fears, starting

with something that is only slightly upsetting, moving up to doing the one

thing that is almost too terrifying to consider. When doing the exposures, we

will always start at the bottom and work our way up. It’s completely fine to

skip some of them because they don’t seem as scary anymore, or to have to
go back and do one over. It’s all about going at our own pace and slowly

working our way up the list until we get to the top. We can be exposed to

these scary things in our imagination, in therapy, or by going to do it

ourselves. Whenever I have done this with patients, I usually start by having

them imagine they are doing the scary thing, then have them try it in my

office (if possible), and finally doing it out in the world by themselves. I find

that building up like that lessens the likelihood that they will be

retraumatized or get overwhelmed.

The reason I like exposure therapy is that it gives us our life back—the

trauma has taken enough already; we don’t want it to take away our ability

to live our lives and do what we want. It also has an amazing long-term

success rate, showing that after four years 90 percent of those treated still
3
had a significant reduction in their fear and impairment.

Another form of therapy that can be beneficial when treating PTSD is

somatic experiencing, which was developed by psychologist and trauma

specialist Dr. Peter Levine after he noticed that animals in the wild managed

the almost daily trauma of their environment by shaking out their body after

they had made their way to safety, as a way to regulate their nervous system.

This instinctive action expressed all of the energy built up from their fight-

or-flight response, and that’s why they didn’t show any symptoms of PTSD.

This led Dr. Levine to believe that PTSD and its accompanying

symptoms are not caused by the trauma itself, but by our nervous system

being overloaded by constant perceived life threats. It’s because we have all

of this energy stuck inside our nervous system that we feel dysregulated, on

edge, and exhausted all the time. Therefore, somatic experiencing takes

what is called a body first approach: the therapist slowly has you recognize

where you feel the trauma in your body and then offers some ways you can

move to release it. This style of therapy doesn’t focus on recovering

memories or putting words to all that’s happened; it’s more about finding a

way to sit with the sensations we have in our body as a result of the trauma,

and releasing it. This could be through trembling, doing a full-body shake,

or even by taking a trauma-informed yoga class.

I know this sounds a bit odd or silly, but trust me when I tell you I have

seen it work. So often, my patients will tell me that they have talked through

all of their trauma memories, tried EMDR, and are still having flashbacks or
body memories of what happened. Then, they try out a trauma-informed

yoga class, and although they are uncomfortable at first, they report feeling

less on edge or hypervigilant. I have always believed that if a type of therapy

works for one person, then it’s worth considering. So before you dismiss this

as too new-age for you, consider how you experience your trauma symptoms

and whether some therapeutic body movement could be healing.

The final type of therapy I want to address is schema therapy, which was

created by Dr. Jeffery Young in the 1980s after he recognized that CBT

didn’t work as well with his more chronic patients, specifically those who

reported unmet emotional needs in childhood. Schema therapy pulls

therapeutic techniques from various therapies in hopes of helping people

who haven’t found much success in therapy thus far. It is based on the belief

that when our emotional needs are not met in childhood, we develop these

maladaptive schemas to help us survive, but as we get older these schemas

get in the way of us using healthy behaviors to get these needs met. These

schemas are unhelpful and unhealthy beliefs we have about ourselves and

our world, stemming from childhood and continuing into adulthood.

Eighteen different schemas have been identified, but to make it easier to

discuss, they have been grouped into five categories. The first category is

disconnection and rejection, and this includes such schemas as

abandonment and instability, mistrust and abuse, and emotional deprivation.

This category of schemas is what can make it difficult for us to develop

healthy relationships. If we don’t think we can trust anyone, or believe that

something is inherently wrong with us so it’s best if we are left alone, that

doesn’t set us up for connection. The next set of schemas are impaired

autonomy and performance, which can include feelings of incompetence,

enmeshment, fear of harm, and failure. These unhealthy schemas can erode

our confidence and make us question our ability to function in the world.

The next group is impaired limits, which includes entitlement and

superiority as well as lack of self-control or discipline. These schemas can

make us competitive, lack empathy for others, and struggle to meet our own

goals; even though we can put on a brave face and pretend we are better or

more successful than others, we don’t honestly believe that to be true. The

fourth category is other-directedness, which leads us to put others’ needs

before ours, ignoring what we think and feel, and doing anything to get the

approval of the people around us. This can make it hard to have healthy
boundaries, do any form of self-care, or have healthy and balanced

relationships. The final group of schemas is known as overvigilance and

inhibition, which is when we focus on the negative aspects of life, struggle

to express or communicate how we feel, and are hypercritical. This section

can make self-reflection or understanding inaccessible, hold us and those

around us to impossible standards, and cause us to have grudges for any

wrongdoing. These schemas can be incredibly rigid and end up costing us

4
all pleasure or excitement in life.

Identifying the schemas that are alive and well in our life is at the heart

of schema therapy. Once we have recognized the ones that affect us the

most, we try to see what thoughts and behaviors we have that are reinforcing

them. This can be difficult since we have most likely been acting out of

these schemas for most of our life, so we need to be patient with ourselves

as we force ourselves to think and act differently. Next, we try to figure out

where these schemas came from and find other more healthy ways to get our

emotional needs met. Throughout this style of therapy, the therapist will try

to bring our attention to our schemas as they come up in the therapy session.

They will also try to help us see why that way of thinking and acting isn’t as

helpful as it may feel, and work with us to come up with a new way of

interpreting a situation. It may be uncomfortable and slow going at first, but

if we can replace these unhealthy beliefs with more balanced thoughts and

actions, we will begin to see that the world isn’t as scary or hurtful as we

once thought. Schema therapy helps us recognize when we are doing

something because of what happened to us when we were a child, and

challenges us to consider the facts we have now.

I also want to mention group therapy and how beneficial it can be for

anyone recovering from a traumatic experience. When we have been hurt by

someone, it can be difficult for us to open up to others, and we can even start

to believe that what we think and feel is wrong or that we did something to

cause the past upset. Hearing from other people who have been through a

traumatic situation can help validate our experience, normalize what we

have done to try to cope, and get us the social connection we need. Listening

to our group member’s stories and struggles allows us to offer compassion

and understanding, and it can help us see our situation with more clarity and

care. There are many benefits to group therapy, but when it comes to trauma
work, I cannot recommend it enough, in fact, I believe it should be a

required addition to all trauma work.

There are many forms of trauma therapy, and again I just want you to

know that if you find one that works for you, stick with it. While therapy

itself is never easy, it’s always worth it.

WHAT IF THERAPY ISN’T HELPING?

For many people, therapy alone isn’t enough. It can feel as though, no

matter how many things we try, we can’t break free from our symptoms, and

that’s why there are alternative options. These other treatments do not

involve therapy, and although they are completely outside my scope of

practice, I felt it necessary to make you aware of them, since it wasn’t until

this past year that I knew they were an option. The first treatment option is

stellate ganglion block (SGB), which is when we get an anesthetic injection

to block the growth of the stellate ganglion, a nerve group in our neck that’s

part of our sympathetic nervous system (responsible for our fight-or-flight

response). It is believed that when we are severely traumatized, our

sympathetic nervous system is repeatedly activated, causing it to grow extra

sprouts of nerves, leading to higher levels of norepinephrine, which in turn

activates our amygdala. This is what keeps us held in our PTSD response for

long periods, and why no matter what we do, we still feel on edge. By

blocking these nerves, we can alleviate the symptoms of PTSD in as little as

thirty minutes and the effects can last for years. Researchers believe that this

treatment resets our nervous system back to the way it was before we were

traumatized. The only thing to consider with SGB is whether we are still

involved in a terrorizing situation, and if possible, to wait until we are safe

to do the procedure. The SGB procedure has been performed since 1925

and is considered a low-risk pain option with success rates averaging 85 to

5
90 percent. It began as a treatment to help improve blood flow and manage

pain in the neck, head, chest, or arms; however, in 2008, an article was

published about its effectiveness in treating PTSD. My only frustration is

that this treatment hasn’t been more widely tested or known, even though

it’s been around for almost a hundred years.

Another treatment option for PTSD is vagus nerve stimulation (VNS),

whereby a stimulation device is surgically inserted under the skin in our

chest that allows an electric impulse to be directed toward our left vagus

nerve. Our vagus nerve, also known as the tenth cranial nerve, connects our

brain to our peripheral autonomic nervous system (PANS), which is

responsible for regulating involuntary bodily functions, such as our heart

rate, blood flow, and breathing. During times of trauma or upset, the vagus

nerve signals our brain to speed up its storage of memories necessary for

survival, and fights against our stress response. In essence, our vagus nerve

counteracts our body’s fight-or-flight response and helps calm us down so

6
that we can remember key information and survive. Therefore, stimulating

our vagus nerve by using VNS can help us calm our system down when we

are drowning in our PTSD symptoms.

The final alternative treatment I want to discuss is transcranial magnetic

stimulation (TMS), which uses a small electromagnetic coil to stimulate

certain areas of the brain, activating the cells in that region and causing

them to release neurotransmitters. This small coil does not have to be

surgically inserted—it is fixed into a helmet that the patient wears during

their treatment—and the magnetic pulses are controlled by a computer

program. The patient is awake during the treatment, and although electric

pulses are being sent into our brain, it’s not painful or felt by most patients.

The early TMS studies focused on the prefrontal cortex because of its role

in our mood regulation and found that one-hour TMS treatments five days a
7
week for four to six weeks did improve patients’ mood. While it is great

news that this nonsurgical procedure can help improve our mood and treat

such mental illnesses as depression, anxiety, PTSD, and obsessive-

compulsive disorder (OCD), it is very time-consuming and therefore not

easily accessible. However, it is another potential option for those of us

suffering from the symptoms of PTSD.

Another portion of trauma treatment that I want to address is

psychotropic medications, such as antidepressants, antipsychotic

medications, benzodiazepines, and others. Although the medications

themselves do not fully treat PTSD or any mental illness, they do help with

some of the symptoms. I am always telling my patients and viewers to think

of medication as a life raft: when we are drowning in the symptoms, it can

help us get our head above water so that we can take part in therapy. For
example, let’s say we aren’t able to stay present in therapy because we

become too overwhelmed and dissociate during each session. Since we

know that trauma therapy doesn’t work if we are dissociated, medication

may help calm our nervous system down so that we can participate and stay

grounded in our sessions. I don’t believe medication alone can treat PTSD,

but it can be part of our overall treatment plan. I am not a doctor; if you are

considering medication, you should see a psychiatrist so that you can be

assessed and they can decide whether and which medication could work for

you. I just think it’s important that we know about all possible treatment

options so that we can make the decision that’s best for us and our healing

process.

HOW MUCH TREATMENT DO I NEED?

When it comes to trauma treatment, everyone’s needs are going to be

different. Some of us will feel good seeing our therapist for one hour a

week, whereas others will need to be in an inpatient facility where there is

24-hour support. To help you better gauge whether the level of treatment

you’re receiving is enough, here is a quick questionnaire:

• Are you able to do all you need to do in your life outside therapy?

Able to function at work or at school? In your relationships? Take care

of your basic needs?

• When not in session, are you able to manage your PTSD symptoms?

• Do you feel that you can accomplish what you need in your weekly

session time?

• Does therapy feel difficult but not impossible?

• Even if it’s slow going, do you feel like you are making progress?

If you were able to answer yes to those questions, then the level of

treatment you are getting is right for you. Overall, we want to feel challenged

in therapy, but not pushed so far that we can’t function in our life—meaning

we don’t want to be so upset by our work in a session that we can’t manage

the aftermath. Finding that right level of care takes some trial and error, but
overall we should feel supported yet pushed along as we heal from all that

happened to us.

We all want to get better and overcome our symptoms of PTSD, but

unfortunately, trauma treatment is difficult and it takes time. So often, I hear

from my viewers how they wish they were moving more quickly through

their EMDR sessions or that they just want to get to the point where they

feel normal again, and I get it. Having flashbacks, experiencing body

memories, and feeling constantly on edge isn’t something anyone wants to

live with, but healing from trauma is one of the times in life when pushing

harder and faster won’t help us. If we move through it too fast, we can be

retraumatized, which can push us deeper into our symptoms of PTSD, and

that’s why we need moderation and compassion as we slowly make our way.

If you are ever feeling lost or like you want to give up, just ask your therapist

to run you through some of the progress you have made in your time

together; that can help you see how far you have come and all that you have

worked through. That’s one of the reasons I recommend journaling to most

of my patients; having that record of how we were feeling and what we were

working on can help us see just how much better things are now, and that

can keep us motivated in those dark times when all we want to do is give up.

There will be times when we want to give up, or when we don’t think it’s

getting better, but, trust me, every time we fight against the trauma

symptoms, we get a little bit stronger and freer.

Trauma is a fact of life. It does not, however, have to be

a life sentence.
—Peter A. Levine, PhD

KEY TAKEAWAYS
• Finding the right therapist is key to doing trauma
 therapy work. We should feel safe with them, that they
listen and are on our side, and that they push us to do
more than we think we can.
• There are also many kinds of trauma therapy, and
finding the right one for you is important as well. Some
popular therapy styles are talk therapy, eye movement
desensitization and reprocessing (EMDR), trauma-
focused cognitive behavioral therapy (TF-CBT),
exposure therapy, somatic experiencing, and schema
therapy.
• There are also some alternative treatments if therapy
doesn’t work for us. These include stellate ganglion
block (SGB), vagus nerve stimulation (VNS), and
transcranial magnetic stimulation (TMS). Medication
can also assist in symptom management.
• Finding the right level of treatment can be tricky, but
we should feel challenged yet supported as we work
through our trauma experiences.
• Trauma work takes time and effort, so be patient with
yourself as you work through it at your own pace.
Going too fast can cause us to be retraumatized, which
can only worsen our symptoms.
 CHAPTER 12

TRIGGERS
HOW TO IDENTIFY WHAT CAUSES OUR
TRAUMA

The word triggered has gained more popularity in the past few years,

and as with most things, when shared through the telephone game of social

media, it loses its real meaning. It has become a joke to many who casually

use the term to describe being upset or attacked by something someone said

or did. To be triggered isn’t a joke or a situation that’s merely

uncomfortable; it’s something in our environment that reminds us of a

traumatic event and causes us to have an intense emotional response. This

could be a certain smell or sound that we come into contact with and

suddenly we are six years old, in that dark room, and being hurt all over

again. Many of my patients express how debilitating triggers can be because

they can lead to panic attacks, dissociation, or push us into our

fight/flight/freeze response. Triggers are things that most people with PTSD

avoid at all costs. Although such avoidance can lessen the likelihood of our

being retraumatized by our environment, it can also limit what we do in life.

Not knowing what is going to trigger past traumas can make it difficult to

decide what to avoid or plan for. This can also make it hard to have

relationships, go to work, and live a fulfilling life without feeling constantly

on edge. The reason it can be so tough to figure out what’s going to upset us

is that our nervous system is constantly assessing our environment for any

threat, and if we have been traumatized, it is going to connect anything that

reminds it of that time to the trauma itself—meaning that even if we were

harmed by one man when we were four years old, we can attach everything

about that day to the trauma. If we had a snack before the abuse, those food

items are now off-limits; or if there was a song playing in the background,

we may not be able to listen to anything by that artist without feeling

overwhelmed. There is no limit to the number of things that can be

triggering to a traumatized person.

A trigger is something that calls forth a visceral and

overwhelming reaction to a stimulus or stimuli that also
overwhelms my senses and ability to cope. In other
words, I melt.

These external triggers are often associated with our five senses—what

we smelled, touched, saw, heard, or tasted during the terrorizing situation—

but they can also be connected to certain dates, times, or places. Some of

my patients who had domestic violence in their homes can hear strangers

arguing on the street and be thrown into a flashback from their childhood,

whereas others struggle around certain trauma anniversaries. Our

environment is filled with tons of triggers, which is why PTSD can become

so debilitating. If we can’t go to our friend’s barbecue because they are

going to have fireworks and loud noises are triggering, or if we aren’t able to

go to the mall on the weekends because crowds remind us of our trauma, we

can slowly become isolated.

ARE ALL TRIGGERS THINGS IN OUR

ENVIRONMENT?
Not all triggers are external or things that we encounter in our environment;

for many people, the triggers are internal, such as feeling lonely, out of

control, or vulnerable. Just as in the story on the next page, it wasn’t the
obvious things that triggered her; instead, it was seeing her friend lovingly

interact with her children that prompted the upsetting emotional response.

We could assume that that was an external trigger because she was watching

her friend interact with her children, but I would argue that it’s the thoughts

and feelings that came up as a result of those interactions that upset her—

possibly wishing she had had that type of relationship with her mother or

father, or that someone in her life treated her with love and compassion.

Whatever it was, it was her thoughts and emotions that ended up triggering

her, instead of the overt actions. Internal triggers can be even harder to track

down because we don’t always know how we feel, especially if we are

suffering from PTSD. Being disconnected from how we feel could have

been one of the ways we pushed through and survived, because our

emotions probably felt overwhelming and not safe to feel for so long.

Sometimes I will prepare myself for situations and

certain triggers, and the things I thought would trigger
me were fine, but things I had never even thought about
before will trigger me instead. For example, when I am
going on a long weekend to visit my friends with small
children, I have a plan in place for things that might
trigger memories of childhood sexual abuse, like diaper
changes, playing dress-up or doctor. But then seeing my
friend snuggle her kids, or discipline them with such
encouragement and love will trigger me more. Certain
very overt things are easier for me to plan for and
handle than others. A particular movie was always put
in when I was a kid while I waited for my ‘turn’ for
‘special games.’ That trigger makes sense to me; it is
easy to process and nonconsequential to avoid. Friends
being kind to me or their children is harder to
understand and much more difficult to not feel ashamed
about and I also cannot avoid it if I want friendships.
 In my experience, most triggers are both internal and external, but

because the external components are easier to identify and avoid, they are

the parts we try to deal with first. It’s in the avoidance that these triggers

gain more power over us; that’s why one of the treatment options I

mentioned was exposure therapy. We expose ourselves to something that

usually pulls us back into that traumatic memory, but instead of letting it do

that, we stay calm and use our therapeutic tools that help prove to our

nervous system that that place or thing isn’t a threat anymore. It’s as though

we are giving our brain the chance to double-check whether its belief about

that thing is true or false, and by continuing to do this, we build up more

evidence that it’s not as scary as we thought, which in turn opens us up to

more experiences in life without our feeling on edge or disconnected.

Internal triggers, on the other hand, aren’t as easy to avoid or expose

ourselves to, because we have to figure out what they are first. If we aren’t

aware of how we are feeling or what it was that upset us about that situation,

it can be difficult to deal with or stay away from. Journaling can help,

because if we start taking note of the times when we feel overwhelmed or

upset, then we can begin to see patterns. Maybe we are always in a situation

where someone puts us down, or perhaps being alone for too long causes us

to spiral into a dark hole; whatever it is, having it in writing can help us

more clearly see the causes. Getting into therapy is the next best step, so that

we can talk about these patterns or common situations that elicit our PTSD

response. Having a therapist help us tease out what it is about those

situations or people that always upset us can help us identify our internal

triggers and better manage them.

DO TRIGGERS ALWAYS CAUSE FLASHBACKS?

Triggers are like everything else in psychology: complicated and everyone is

going to experience them differently. Not to mention that being triggered

isn’t always so cut-and-dried: most of us don’t only get pulled back into a

trauma memory; instead, whatever PTSD symptom we suffer from is

followed by the urge to use an unhealthy coping skill, such as under- or

overeating, using drugs or alcohol, or engaging in self-injurious behavior.

This can make it even more difficult to identify what it was that set us off,

especially since a lot of treatment focuses on managing those unhealthy

coping skills, not what triggered them. We can spend years trying to get a

handle on our drug or alcohol use, but if we aren’t able to understand where

the urges to use come from, we can be helpless against them.

I had a patient many years ago who, when triggered, would go on

shopping sprees, and it took us a while to figure out that it was after she

smelled a certain cologne that she started to feel scared and vulnerable. She

would feel overwhelmed for a few days and then go on a shopping spree

because it seemed to be the only thing that could calm her down. For

months, we talked about these shopping sprees, trying to figure out why she

engaged in such financially harmful behavior, and it wasn’t until a man

wearing that cologne got into the elevator with her on her way to my office

that we were able to connect the two. Having that understanding allowed us

to put together some tools and techniques to help her calm down without

spending hundreds or thousands of dollars on things she didn’t need.

HOW DO I KNOW WHETHER I HAVE BEEN

TRIGGERED?
We know how easy it is to second-guess ourselves and whether we have

been traumatized. From struggling with repressed memories to the feelings

of shame that usually accompany any trauma experience, there are so many

things working against us. Unfortunately, identifying our triggers can be

wrapped up in our ability to recall our past traumas, since they pull from

things our brain has connected to the original terrifying experience.

However, there are other ways to know whether we have been triggered, and

we don’t have to fully recall our trauma to be aware of them. First, it’s

helpful to notice our emotional response to situations in our life and

compare our responses to those around us. Let’s say we have a terrible boss

at work, and she is rude, always publicly calling people out for making

mistakes. While everyone in the office hates her and talks badly about her

behind her back, they get over it quickly and are only mildly upset. We, on

the other hand, may struggle to move past it, feel on edge the rest of the day,
and want to file a complaint or quit. If everyone else seems to be only

marginally affected by this interaction, there may be more to it for us. It’s

possible that our boss reminds us of our mother and how she used to yell at

us or put us down in front of our friends. Our overreaction is one of the

indicators that we may have been triggered.

Another sign is if we have any dissociative symptoms, such as losing

track of time or feeling spaced out, unable to snap out of it and pull

ourselves back to the present. Although you may think that this is an

obvious sign, I find that many of my patients don’t even realize they are

doing it until I ask them about it. Some of the questions I always ask

include: Have you ever driven home and not remembered how you got there?

Or felt like you came to while you were doing something? Do you enjoy

daydreaming so much you find it difficult to stop when you need to? Often,

we don’t recognize how checked out we have been unless someone asks us

about it, or something else happens while we are dissociated, forcing us

back to reality. This urge to check out during our day can be a sign that we

have been triggered by something in our environment.

Since avoidance is the easiest way to fend off any possible upsets,

noticing whether there are a lot of things we steer clear of is a good indicator

of a potential trigger. Especially if other people in our life don’t have the

same worries or level of discomfort that we do. We all have things we enjoy

and don’t enjoy doing, and if someone pushed us, we would probably go

along with it and be fine, but what I mean are situations that we will not

participate in, no matter what. We could even get into arguments with others

about it, lying and making up excuses so that we don’t have to go. If

everyone around us seems to think it’s something safe and okay to do, we

may be reacting to a trigger from our past.

Since triggers don’t only cause us to experience one of the symptoms of

PTSD, it’s also important to take into consideration the other urges that

could coincide with us being triggered. Just like my patient who shopped as

a way to cope with smelling cologne, we have to consider other things that

we do to manage all we feel. The most common is using drugs or alcohol to

numb out from the intense emotional experience, and while it’s often

socially acceptable to have a drink after work, we may wish we could start

drinking earlier or want to drink more than our colleagues. We could also

feel this intense urge to exercise or under- or overeat as a response to being

triggered. Since our society praises those who exercise regularly, this can go

unnoticed for many years until we get injured or we have such a drastic

change in our weight that it becomes easily noticeable. I am not saying that

having the urge to work out regularly is bad or a sign of being triggered; we

just need to distinguish between doing something good for our body versus

feeling compelled to do something even if we are sick or injured. My

patients who utilize exercise as a way to manage their upsets will go for a

run on a sprained ankle or try to work out when they have the flu. These

urges are not things we can ignore, and if somehow we are not allowed to do

the exercise we need to, we can completely lose our cool. There are many

other examples of these types of impulses that can come along with being

triggered, such as self-injurious behavior, gambling, porn, or using sex to

numb out from the pain or upset. If you find yourself feeling compelled to

do something that could later negatively affect you, you may have been

triggered.

Finally, along the lines of us having a more intense emotional response

than those around us, we could feel overcome with emotion without

knowing where it came from. In the first example, I talked about having a

mean boss and how that could be triggering because it reminds us of an

abusive parent, but sometimes we don’t know what initiated the anger or

upset we feel. Many of my patients report that their intense emotions seem

to come out of nowhere and lead them to act out in ways that are detrimental

to their life. We could be going about our day and suddenly feel intensely

scared and unable to interact with those around us, or we could be overcome

with anger and act aggressively toward others. When we aren’t aware of our

trauma or haven’t had the chance to work through it yet, we can be triggered

and have an emotional response to that trigger without being conscious of it.

Our inability to track down where these feelings and behaviors came from

could be another indicator that we have run into a trigger.

I know it may still be hard to assess whether we have been triggered

before, so I have condensed the signs we discussed into this quick

questionnaire.

• Do you sometimes have a more intense emotional response than those

around you?
 • Have you ever lost track of time or have lapses in your memory? Or

do you enjoy daydreaming so much it’s hard to stop sometimes?

• Do you avoid certain people, places, or things that others don’t have

issues with?

• Do you suddenly feel the urge to shop, eat, gamble, self-injure,

exercise, or use drugs or alcohol? Does that compulsion feel like it

comes out of nowhere?

• Do you often feel overcome with emotion and not know why?

If you answered yes to any of those questions, you may have been

triggered by something in your environment. Although we may not know

much about our trauma or what the trigger was, it is helpful to know

whether it’s happening to us and to be able to put a name to what we’ve

been feeling. Even though having this information doesn’t fully explain

what’s going on, hopefully it lets us know that how we feel is okay and there

is a reason behind it.

IS BEING TRIGGERED BAD?

The reason triggers are something we want to avoid is that it’s

retraumatizing to feel thrown back into a terrorizing event. Most of us are

not able to distinguish between the actual trauma and a flashback because

they can feel the same. This repeated trauma experience can wear away at

our self-confidence and our ability to read situations or people. We can start

to think that we only cause ourselves more pain because, everywhere we

turn, we are hurt again. Since we don’t think we can trust ourselves, we can

let others make decisions for us, or can be easily pressured into doing

something we don’t want to do. This can mean we end up engaging in risky

behavior that can lead to us being traumatized yet again. In a way, we get

caught up in this cycle of traumatized, triggered, traumatized again.

That’s why we do all we can to avoid triggers, and if that’s not possible,

we may use unhealthy coping skills to manage the upset that comes along

with it. This has caused many to offer trigger warnings before movies and

TV shows, news videos, or posts online, and while I agree that we should
warn people before we share something that could be upsetting, I don’t think

this is always helpful. If these warnings only cause us to remove ourselves

from the situation and continue avoiding the thing we fear, we won’t get

better. The more we avoid these triggering things, the stronger the

association will be between these situations and feelings of fear and trauma.

It could even cause our brain to connect more things to our trauma, and

slowly but surely our world will get very small. That’s why I believe trigger

warnings only work if we use them to help us gather our tools and

therapeutic techniques, and expose ourselves to the situation anyway. I know

we won’t be able to do that in all circumstances, but we are going to have to

challenge ourselves to push against the triggers so that we don’t let our past

trauma predict our future.

WHY IS IT IMPORTANT TO KNOW WHAT MY

TRIGGERS ARE?
To improve our future, we are going to have to use our triggers to our

advantage—meaning that we need to be curious about them, work to

identify the things that set us off, and figure out where the fear stems from.

They not only tell us what harmed us when we were younger, but also what

parts of that we haven’t been able to process yet. Triggers bring forth the

things we tried to hide away or stuff deep within ourselves, and though they

are not comfortable, they are valuable. Since we know they are not rooted in

the present, but in the past, our triggers hold the key to our healing. There is

this old principle called Chesterton’s Fence that comes from G. K.

Chesterton’s 1929 book The Thing: Why I Am a Catholic, in which the

author puts forth a pretty simple concept: We should not change something

until we first understand what its purpose is. In the book, Chesterton

referenced a fence that one man may not see any use for, and therefore he

wants to tear it down, but when asked what the purpose of the fence was, he

admits that he doesn’t know. That man is told to go away and think about

why the fence is there, and only once he knows its purpose, can he tear it

down.

I believe this principle applies to our triggers and many of our unhealthy

coping skills. We can’t try to remove them from our life without first
understanding what purpose they serve. They exist for a reason, and if we

don’t acknowledge that reason, these triggers and urges will just keep

popping up. I had one patient many years ago who claimed that her eating

disorder urges just went away when she moved out of the house and entered

college. Sure, most of her stressors came from her having to live with her

past abuser, but we had only just begun talking about that, and she was still

feeling triggered almost every day. She swore moving out was the answer to

her problems, and although I pleaded with her, she stopped seeing me.

About six months later, she called me, very upset, stating that her eating

issues had returned and she wasn’t sure what she had done wrong. In our

sessions together, I learned that she was doing well until she had her first set

of finals at college. The stress of having to prepare became too much and

she found herself wanting to binge and purge again. I explained that it

wasn’t anything she had done wrong, but because we hadn’t had the time to

talk about all her childhood trauma, and better understand what triggered

her almost daily, she wasn’t prepared for any of life’s upsets. In a way, she

never understood the purpose behind her eating disorder, and why those

urges coincided with times she felt scared and powerless. We hadn’t had

enough time to get her to see the link between her eating habits and past

abuse. Instead, when faced with the stress and pressure of college finals, she

used the only coping skill she knew: bingeing and purging.

Know that I wish we could just magically feel better, and moving away

from an abusive parent or spouse would just remove any of the scars or

triggers from our life, but unfortunately, that’s not how our brain works. For

us to move past our trauma and heal, we are going to have to work through

it, take some time to understand why something is triggering to us, and

challenge some of those unhealthy urges. When it comes to trauma work,

we can’t go over it, we can’t go around it, we’ve gotta go through it.

KEY TAKEAWAYS
• A trigger is something in our environment that reminds
us of a traumatic event and causes us to have an
intense emotional response.
• There are external and internal triggers. External ones
are often associated with our five senses, and the
internal ones are connected to our thoughts or feelings
about something. Most triggers are both external and
internal.
• Ways to know if you have been triggered:

• Your emotional response is more intense than those

around you.
• You experience dissociative symptoms, such as
losing track of time.
• You find yourself avoiding things other people don’t.
• You have the intense urge to use drugs, alcohol, self-
injure, shop, under- or overeat, gamble, or use sex to
numb out.
• You feel emotional and don’t know why.

• Being triggered can be retraumatizing, which is why

we must learn what causes them, force ourselves to
understand where they come from, and get some
techniques for better managing them. Avoiding
everything that’s triggering will only limit what we can
do in our life.
• We cannot just ignore or remove our triggers or
unhealthy coping skills without first understanding
what purpose they serve. They exist for a reason, and
until we figure out what that is, they will keep coming
back.
 CHAPTER 13

BREAKING THE CYCLE

AVOIDING FUTURE TRAUMA &
TRIGGERS

Ignoring our triggers doesn’t make them go away or help us feel any

better; in fact, avoiding them shrinks our world and increases the likelihood

of us being traumatized again. That’s why we have to find some ways to

manage our reaction until we can get them to go away for good. The tools

and techniques that help get us through any upset are called coping skills.

Coping skills, by definition, enhance our ability to adapt to our environment

—meaning that they ready us for anything life can toss our way. Building

these skills will be vital, as they allow us to expose ourselves to some

triggering things and not be overcome with PTSD symptoms. In short, our

coping skills will help us get our life back to what it was before we were

traumatized.

As we discussed, exposure therapy is best for dealing with triggers,

though it’s uncomfortable and probably the last thing any of us want to do.

This style of therapy involves building up coping skills to deal with the

anxiety and upset that triggers bring, and then slowly exposing ourselves to

the triggering thing. It can be difficult, and we can still get upset or feel

anxious, but for us to move on, heal, and live a full life, we have to challenge

our trauma beliefs. Our brain has connected all of these things to our

trauma, and it will continue to add more if we don’t challenge it. That’s why

building up these skills, and walking toward our triggers, is key to healing

and moving on, not to mention that exposure therapy is highly successful
 1
and rarely has to be repeated.

WHAT IF I DON’T KNOW WHEN I AM BEING

TRIGGERED?
The first step is to learn some mindfulness skills so that we can tell when we

are upset versus calm. I know that can sound silly, and you may think it’s

easy to tell, and if so, you can skip on to the next section. However, many of

us struggle to recognize when we are triggered or upset, and therefore it can

be hard to know when we need to use these coping skills and for how long.

My favorite mindfulness technique is what I call 4x4 breathing, when we

breathe in for four seconds, hold it in for four seconds, and breathe out for

four seconds, and we do this four times. It’s pretty simple, we can do it

anywhere, and it can help calm our nervous system down. For this breathing

technique to be a mindfulness skill, we have to focus on where we feel the

breath: think about how it feels on the edge of your nose, how it fills up your

belly, chest, or shoulders, and the release you get from breathing out. Pulling

our attention to what’s happening inside our body can help us better

recognize when we feel tense, or are not breathing deeply, and do something

to cope with it quickly.

The next mindfulness technique I frequently use is to start identifying

our emotions. Too often, we don’t even recognize what it is we are thinking

or feeling, which can cause us to be in pain for longer than we have to. I love

feeling charts for this, and you can easily search for them online; they are

just lists of emotion words, and you can print them out and start circling two

or three each day. Some of my patients can easily recognize what emotions

they are experiencing without the charts, but I find that seeing the feeling

words written out already can help us decide what it is we feel and possibly

even unearth an emotion we were trying to stuff down. I have my patients

try to do this every day, working up to identifying five every time they do it.

It may sound difficult at first, but with time and practice, it does get easier.

While there are many other mindfulness techniques out there, those are

the ones I work on first before moving on to coping skills. Having the ability

to tap into how we feel and recognize when our body is tense and

dysregulated will help us know when to use our coping skills and even help
us pick out which one we should use in the moment.

Next, we need to come up with some coping skills that help us feel

soothed and okay. Everyone’s are going to be different, so don’t think that

just because someone said they love breathing exercises that you have to

agree; pick some tools that help calm you when you are feeling

overwhelmed. I like to break these coping skills into two buckets: those that

help us process what we are feeling, and ones that help distract us from the

painful thoughts or experiences. The reason I do this is that there are going

to be times when we can’t focus enough to process all we are feeling, but we

still need to deal with the flashbacks or other PTSD symptoms. There will

also be times when we need to pinpoint what it is we are feeling and

consider why that’s so triggering. Each of these instances will call for

specific types of coping skills; therefore, to handle anything life throws at

us, we need to have tools for both instances.

WHAT IF I CAN’T PROCESS ALL I AM FEELING?

Let’s start with the distraction-based coping skills, since these are the ones

we can most easily engage in when we first start to deal with our past

trauma. When we are triggered, we may not have the ability to process

anything in the moment; we just need a break from the terrible feeling, and

that’s where these coping skills come in. One of the easiest ways to distract

our mind is to move our body; we can do this by stretching, going for a

walk, or even joining a workout class. Exercise releases endorphins,

chemicals that lessen our ability to feel pain and make us feel good, which is
2
just an added benefit while getting our mind off what’s upsetting us. Also,

remember that movement is a cornerstone of somatic experiencing therapy

and what Dr. Levine has based his life’s work on, so getting out and

exercising has many benefits when it comes to our trauma treatment.

I try to limit the amount of time I think about it outside

of my therapy sessions with distractions. I use music,
reading, movies, pretty much anything but silence to
 keep my mind from thinking about it. Time also helps.

I regularly recommend going for a walk to my patients and viewers, not

only because of the benefits we just discussed, but it also gets us away from

any trigger or unhealthy coping skill. If we tend to abuse alcohol or drugs,

engage in self-injurious behavior, or overshop online, getting out of the

house limits our access to the items we use in our harmful behavior. This

can allow us to breathe, consider our options, and make a better decision.

Another helpful distraction technique is doing a craft, such as coloring,

painting, or doodling. As we get older, we tend to stop doing crafts, but it

can help to have some on hand for when we are triggered or have a bad day.

Pulling our focus off of the upsetting event and onto staying in the lines or

drawing mountains with snowy peaks can help us ride the wave of emotion

without getting pulled under.

One of the coping skills we saw in full effect when COVID-19 first hit

was cleaning or organizing our house. This is not only a great way to keep

our hands and mind busy, but it can also give us a sense of accomplishment

and make us feel more comfortable in our space. As I said at the beginning,

not every skill is going to work for you, so pick and choose whatever you

like, kind of like a coping skill buffet.

Now I could go on and on with ideas for distractions, such as bowling

bubbles and imagining our issues are the bubbles and we watch them burst

and disappear, but you get the idea. A distraction coping skill helps us focus

on something else for the time being until we feel calm enough to process

why we felt that way or expose ourselves to the scary thing once again.

Before we move into the process type of coping skills, I want to add one

thing that I believe belongs on both the distraction and process lists, and that

is supportive people. The reason I think they straddle both styles is because

we can choose to share what we are going through or not, but either way,

they are helpful and soothing to our system. We can even have people we

only reach out to because they love to talk about themselves, and that can be

a nice and much-needed distraction. We can also have people we are close

to who will know we are upset from the moment they hear our voice and
want to know what’s going on and how to help. Both types of people are

helpful and should be on our list of possible ways to cope. We know how

important connection is to our nervous system and that it’s the true antidote

to our stress response, so working on this list will be a vital part of our

trauma recovery. We can also benefit from being around animals, whether

we foster, adopt, or even volunteer at a local shelter. They can give us a

reason to get up and out each day, and remind us that we are not alone. It

can also help to know that someone is depending on us for their survival,

and that can give us purpose and motivation when it may otherwise be hard

to come by.

HOW TO TURN A TRIGGER INTO A THERAPEUTIC

RESOURCE
Distracting ourselves from how we feel will only get us so far because it

doesn’t help us understand or process what we are going through; it just

gives us something else to focus on for a while until the intense feelings or

flashbacks pass. Once those emotions have passed and we are feeling

calmer, we are going to have to utilize some process-based coping skills.

These are the tools we will use to make sense of what has happened to us,

help us better understand why we are feeling this way, and gain a new

perspective and insight on the issue. They are a bit more intensive and will

require us to slow our thinking down so that we can consider a different

emotional response.

My most utilized process-based coping skill is impulse logs. These are

things we fill out whenever we feel the urge to abuse alcohol or drugs,

engage in self-injurious behavior, or really do anything that could harm us

and those around us. They help us recognize how we are feeling, what we

can do instead, and increase our tolerance for intense emotion. The reason I

use impulse logs so often is that they help create time and space for us to

make positive decisions, rather than be driven by our emotional impulses.

These logs are lifesaving and could be the difference between our staying

sober and falling off the wagon or even the reason we don’t self-injure when

upset. I could attempt to explain what an impulse log is, but it’s easier to

share one with you so that you can create your own and use them as needed.
The one that I use most was created by S.A.F.E. ALTERNATIVES, which

is an organization that offers treatment for those suffering from self-

3
injurious behaviors, as well as training for clinicians. While its focus is on

treating self-injury, I believe this impulse log can be used to manage any

unhealthy impulse we may have. I have added an example to help you better

understand the nine different columns.

Impulsive/self- What
destructive Day and Where are What’s the feelings are
thoughts time you? situation? you having?

Ex.I am broken Tuesday at At home My friend asked Judged, sad,

and cannot be 10pm me why I am mad,
fixed. I should just not better yet, shameful,
drink until I can’t and why I still disgusted,
think about it. go to therapy and anxious
twice a week

What are you

trying to
Result of doing communicate
the impulsive with this What action did What was the
thing? behavior? you take? outcome?

Breaking my That I am doing I called my The feelings

sobriety, I would the best I can and I sponsor and passed and I am
have to tell my need more texted with my glad I didn’t
sponsor, I’d feel understanding and therapist. drink. I am even
embarrassed, and support. kind of proud of
like I threw away my myself.
progress.

I know doing these logs can seem tedious and frustrating at times, but

stick with it. As we do more and more of these, we can start to see patterns

in our thoughts and behaviors. Maybe we tend to be triggered when we are

around certain people, or are more vulnerable to things during a specific

time of year. As I mentioned previously, all of that information is helpful

when we are trying to manage our triggers, because the more we know

about what triggers us the better we can prepare for it.

Another less structured way to begin processing is to journal, and no,

journaling doesn’t have to be like keeping a diary, and we don’t have to

write about everything that happened each day. Journaling is just a way to

keep track of how we feel, to note what’s going on that could be upsetting

us, and to push us to think of some things we are looking forward to. The

goal of journaling is to get some of what we are worrying about out of our

head and onto paper, so that we can put words to what’s going on and gain a

new perspective on it. This can also help when we are feeling stuck in

therapy or that we aren’t making enough progress; by journaling regularly,

we can look back a few months and see how much we have changed and

grown.

If even the idea of journaling is overwhelming and makes you want to

give up, just try writing out your answers to these three questions every day

for one week and see whether it helps: What’s one thing you are grateful

for? One thing you are working on? And finally, what is one thing you are

looking forward to? We can also write letters to those who hurt us and then

rip them up or safely burn them, without sending them. This can be another

way to express what we are going through without feeling that we are

writing in a diary or have to document everything that happens each day.

One thing I will recommend you do if you choose to write letters to those

who harmed you is to also write a letter to someone you love and care for.

Taking the time to shift our mind away from the pain and onto how much

someone means to us helps prevent us from thinking all people are terrible

and out to get us. It can be a much-needed reminder that people do care, we

are loved, and there is support available to us.

The final process-focused coping skill I want to talk about is creating a

feeling word collage. I know crafting seems like something only children do,

but trust me when I tell you that this can help people of all ages recognize

the emotions they are having when all they want to do is shut down

completely. The way feeling word collages work is you start with one

emotion you want to work on: write it out in big letters in the middle of a

piece of paper. Feel free to use block letters or even color in the word with a

shade that you feel fits that emotion. Next, begin to add other words that
connect with that feeling until you have filled up the rest of the paper. In

case that wasn’t very clear, let’s say we are working on the feeling of anger; I

would write ANGER in big letters in the middle of my sheet of paper and

then add other words around it, such as mad, tense, impulsive, or scared.

Doing this for emotions that are difficult to understand or process can help

us see how we experience the feeling and possibly what caused it. It can

help us untangle all the swirling thoughts and emotions so we can more

clearly see our process. Also know that it is very common to struggle with

emotions that are seen as positive, just as much as with the more negative

ones; what’s important is that we select the feeling words that are

uncomfortable to us.

WHAT IF COPING SKILLS DON’T HELP ME?

Too often, distraction- and processing-based coping skills don’t help my

patients when they are struggling with trauma triggers, and that’s why we

also utilize grounding techniques and safe spaces. We discussed grounding

techniques a few chapters back when we were learning about dissociation,

but they can also assist us when we are trying to stave off a flashback or

other PTSD response. These can include counting the number of things in

the room that are blue or green, as well as eating “hot” candy or smelling

something with a strong scent. Using our five senses to bring us back into

our body, instead of letting the trigger take us back to the trauma, can save

us from being upset all over again.

Consider how you can use your five senses to keep you present and make

sure you always have some tools on hand so you are prepared for any

potential trigger. For example, if smells can be triggering, maybe we keep a

bottle of peppermint essential oil with us to sniff quickly before the other

scent pulls us into a flashback. Or perhaps we keep cinnamon candies in our

backpack or purse, so that we can pop one in if we start to feel overwhelmed

or spaced out. Try out a few different tools and techniques, and when one

works, make sure you have access to it at all times.

If we aren’t able to use our senses to keep us present and calm us down,

we can also use our imagination and go to a safe space. Safe spaces are

places we can go in our imagination that help us feel protected and okay.
This could be the home of someone who always defended us, the apartment

we lived in before the trauma, or a space we have created in our mind that

helps us feel peaceful. Whenever I feel overwhelmed or stressed out, I

imagine myself floating in the ocean off the coast of Costa Rica, my ears

below the surface of the water, quieting any outside noise, and the sun hot

on the bits of my skin exposed to the sun as I feel the waves rock me from

side to side. That was one of the most relaxing and peaceful times of my

life, and taking myself there in my mind stops any thoughts, feelings, or

impulses from ruining my day. Take some time to remember or create some

of your own; just make sure these places feel safe and secure so that when

you go there, you know you are okay.

HOW DO I TALK TO PEOPLE ABOUT MY

TRIGGERS?
Whenever we are struggling, we must share what’s going on with those in

our lives. We don’t have to tell everyone we know about our trauma and

what we are doing to manage it; however, we do need to find a way to

communicate with those closest to us. They need to know what we are

working on, how it can affect them, and what they can do to help. That way,

if we are having a bad day, they don’t jump to conclusions and assume it’s

something they did or didn’t do; instead they can check in or realize it’s

because of what we are personally working on.

Before we share anything about our trauma experience and treatment

with those around us, consider what it is we are comfortable with their

knowing and try to break it down into a maximum of three to five points.

This can help us stay on track, not dump everything at once, and ensure that

we share what we need them to know. For example, one bullet point could

be:

• I have some stuff that happened to me in my past and I am working

through it, but it’s causing me to be on edge and more easily upset. I

wanted to tell you so you know that it has nothing to do with you.
 We will also want to let them know of any indicators that we are being

triggered or having a flashback, and whether there is something they can do

to help. This can give us another layer of support so that if we aren’t able to

help ourselves, someone else can be there to comfort us and get us through.

Additionally, it’s helpful to figure out what we need from them, and add that

after the three to five bullet points. We could ask for support and check-ins,

see whether they can help us pay for therapy or other appointments, or

maybe give us a ride to and from our consultations. It is going to differ

depending on how and where we engage with them. If we work together, we

may want them to sit next to us in meetings, or bring us a hot drink before

we have a presentation; and if we live together, we may need them to give us

space or help us get to our appointments. Consider how they could assist

you best, and make sure you ask for the help. I know it’s difficult to ask

others to do things for us, but if the roles were reversed, I know that we

would want to know how to help them. Allow them to support you when

you need it most.

Finally, we need to make time for this conversation, and do it when we

aren’t already maxed out or in a rush. We want everyone involved in the

conversation to be present and able to hear what we have to say. Don’t try to

talk about sensitive issues during a holiday meal or an argument. Wait until

things are less intense to let them know what’s going on, and also remember

that we don’t have to say everything about the issue in one conversation.

This is the first of many discussions, so if you don’t get it all out, don’t feel

pressure to fit it in; you can always bring this topic up at another time. We

have to give our loved ones time to digest what we are telling them, and

hopefully, they will come back to us with questions as well as the type of

support we asked for.

As we work to better manage our triggers, and expose ourselves to things

we thought were scary only to realize they aren’t that bad, we will slowly

learn to trust ourselves again. We can start to feel more confident in our

decision-making skills, and in our ability to ride out the ups and downs of

life. This newfound trust in ourselves can make us less likely to be

traumatized again, whether it’s from triggers in our environment or new

experiences. As we feel stronger, we will be able to more quickly recognize

detrimental behavior, develop healthy relationships, and finally feel in

control of our life and future. Doing this work is difficult and exhausting at
times, but our trauma has already taken so much from us, I think it’s time

we took back what is ours.

KEY TAKEAWAYS
• Ignoring our triggers will only make them stronger.
Using exposure therapy to help us realize that what we
thought was scary wasn’t that bad is how we heal and
move past our trauma.
• To engage in exposure therapy, we have to have
coping skills to help us calm our nervous system down
while we are exposed to the trigger.
• For us to know whether we have been triggered, we
have to be able to tap into our body and how it feels.
Using 4x4 breathing can help us calm down, and allows
us to identify some of the emotions we feel each day.
• One style of coping skill is distraction, such as going
for a walk or exercising, coloring or other arts and
crafts, as well as cleaning and organizing.
• Once our nervous system is calmer, we can engage in
the process-based coping skills, such as journaling and
using our impulse logs. This can help us acknowledge
and gain perspective on all we are feeling.
• If distracting and processing coping skills don’t work,
we can always use grounding techniques, such as
smelling a strong scent or going to a safe space in our
imagination. We can also revisit a pleasant memory.
• We have to talk to our loved ones about our trauma,
triggers, and what we are working on. This allows them
to support us and can help them understand why we
may be having a tough time or are acting out.
 CHAPTER 14

RESILIENCE
BUILDING IT & KEEPING IT

Resilience is defined as our ability to cope with emotional distress

and know that we will be okay. Another way to describe it would be our

capacity to bounce back after something bad happens to us, and when

healing from a traumatic experience, resilience is what keeps us going.

Resilient people can reach out for support when they need it, meet the

demands of work or school, and know when they need to take a break.

Resilience isn’t something you can achieve once and use for a lifetime; it is

something we constantly have to work on, and depending on our current

state we may have more or less of it.

Many years ago, I took a continuing education course focused on

working with teens in a school setting. I had hoped to learn how to help

them regulate their emotions and communicate with them in the best ways,

in order to ensure that if I decided to work in the school system, I could be

effective at my job. Although I did learn a lot during that session, what I

walked away with was what the course instructor called the poker chip

analogy: that when we wake up in the morning, we all have a certain

number of poker chips in our bag. We could have ten, or maybe five

depending on how well we slept and whether we are sick or we are dealing

with some emotional pain. When we are getting ready for our day, let’s say

we receive a text from a colleague telling us they won’t be there for our

presentation together; well, that stress is going to cost us two poker chips.

We go to make our coffee and realize we are out of beans—toss one more
poker chip in the pile. Then, we get on the freeway to head to work and

there’s a traffic jam—that’s going to cost us yet another poker chip. For

many of us, by the time we get anywhere, we could be out of poker chips,

which means that when we encounter another stressful or upsetting

situation, we can’t just toss out another chip and move on; instead we can

lash out, lose our cool, and feel completely out of control. The poker chips

that we had are our built-up resilience, and the more of it we have, the better

we will be able to get through life without acting in ways that only leave us

feeling worse. We want to build up extra so that on those particularly

difficult days, we can dig deep into our bag and pull out the chips we need.

ARE SOME PEOPLE BORN WITH MORE POKER

CHIPS THAN OTHERS?
On the one hand, I believe we are all born with a certain amount of

resilience; for example, some of us are more resourceful, outgoing, or

intuitive, any of which can give us more ways to cope with something

terrible instead of being wiped out by it. On the other hand, many people are

shy, struggle to make new friends, and prefer to numb out from all they feel.

This discrepancy would explain why one sibling can come out of an abusive

home struggling with addiction and self-hatred, while another can focus on

school, build a support system, and move on successfully. It’s also important

to mention that our parents are often the first examples of resilience, and if

they modeled the use of positive coping skills and resources, then we will

have a leg up on those whose parents didn’t. Also, some of us may have

better access to resources like group activities or supportive family or

friends, which will make building up our resilience easier as well. Now, that

doesn’t mean that only some of us will be able to recover, it just means that

we may have to work a bit harder to build up our resilience, which is why

it’s important to show yourself a little compassion as you get started.

HOW DO I BUILD MY RESILIENCE?

Building resilience starts with our ability to take care of ourselves; we can’t
deal with something hurtful or stressful if we didn’t get enough sleep the

night before. Not to mention, the word hangry exists in our vernacular for a

reason: when we haven’t eaten in a while, we can be more irritable and

impatient as opposed to how we act when we have a full stomach. That’s

why one of my favorite dialectical behavior therapy (DBT) tools is HALT. It

stands for “hungry, angry, lonely, tired.” We are supposed to “halt” and

check in on those things before making a decision or engaging with

1
someone. This can tell us whether we are in a position to think things

through with a clear mind or if we are filled with impulsive and emotional

thoughts.

By ensuring we eat regularly, process our anger, connect with loved ones,

and get enough sleep, we are lowering our vulnerability to our environment

and emotions. This also increases our ability to cope with all we feel and

still make positive, helpful decisions, which is, you guessed it, what

resilience looks like. This simple acronym HALT can help us slow down

our reactions and ensure that when we engage with others we are doing so

thoughtfully and with care, instead of acting impetuously.

It’s also important that we recognize when we need to take a break from

something. This could be a difficult project at work, a relationship we are in,

or even when we need to rest and do nothing. Although this seems like

something we should all realize, it can be hard to know when we have had

enough, and if I’m being honest, I struggle with this one the most. It’s hard

for me to notice when I am overworking myself, feeling burned out, or

putting too much energy into something and need to stop. Therefore, I often

find myself feeling completely drained. I think we struggle to recognize

when enough is enough because we don’t check in on ourselves regularly.

Instead, we compare ourselves to other people who are doing better than us

and ignore the signs that we may be physically or emotionally worn out.

Being mindful of how we feel, and noting the evidence that we are tired or

overworked, is important and a huge component in building up our

resilience.

Going back to something we discussed in previous chapters, connection

helps calm our stress response and therefore is vital to our resilience as well.

Although casual relationships have their benefits, deeper understanding

offers more support and the necessary reminder that we are not alone in our
struggles. Feeling that other people care about us is life-affirming and gives

us someone to reach out to when we need help. Recovery from our past

trauma is hard and we are going to need other people outside of ourselves to

lean on when we can’t stand on our own. Having this true connection also

allows us to offer support when someone needs it, which can give us a sense

of purpose and meaning. Which, you guessed it, helps us build even more

resilience.

When I was traumatized, my relationships were my

stability. Trauma can steal away many facets of your
sense of self and I found myself terrified I wasn’t going
to be me ever again. It’s like you’re swimming in the
depths of the pool and someone guides you to the top
and reminds you to breathe some fresh air. That fresh
air is what keeps you going.

Finding social support is often the most difficult task for my patients

because if we have suffered from PTSD symptoms for a long time, we could

have isolated ourselves so that we don’t get triggered or retraumatized. Many

have told me how they stopped replying to texts, not calling people back or

going to parties, and now don’t feel that they have anyone they can count on.

If you find yourself in a similar situation, don’t fret; there are some simple

ways to get you reconnected and feeling better. First, if you had a healthy

relationship with someone before, it’s okay to reach back out. Sure, it’s been

a while, but all you have to do is acknowledge that you stopped responding

and hanging out, and let them know why. Then, check in: Ask how they are

and whether you can get together in the next couple of weeks. I know the

thought of reaching out can be hard, but what have you got to lose? If they

don’t reply or aren’t interested in getting reconnected, you are right back

where you are now, so send that text! Do it now! Start building up that social

support one message at a time.

 If you didn’t have any healthy past relationships, it may take more effort,

but asking your therapist whether they know about or offer group therapy

sessions is a great place to start. Also, finding groups online can give us

some extra support, as well as many of the peer support sites, such as

TalkLife, 7 Cups, and Crisis Text Line. If those options don’t render any

results, you can join a gym or workout studio, a church, or even take group

music lessons. Finding an activity we enjoy and doing it with other people

makes it easy to strike up a conversation, get to know people slowly, and

decide whether we want to pursue that relationship. To meet new people and

build up our support system, we are going to have to say yes to some new

social activities. I know it can be uncomfortable, but through discomfort

comes growth and resilience.

One of the traits that all resilient people have is a belief in their ability to

change and grow. We just have to know that we can change and grow, and

believe in that. The shift in our thinking is subtle but important because

when grappling with PTSD, we can struggle with shame, guilt, and

embarrassment, making confidence hard to come by. Therefore, it can be

easier to agree that we do have choices and that there are things we can do to

help us adjust and manage our life. Making that shift can cause us to feel

more empowered and motivated, which—you guessed it—builds more

resilience.

Although making that small shift in our thinking can sound easy, it’s

often difficult and can require us to pay attention to the thoughts and beliefs

that consistently run in our mind, and work to make them more positive.

This doesn’t mean we have to only think positive things, but instead of

allowing our brain to get caught in a shame spiral, we can reframe the

thoughts. Reframing is when we consider and then create a new way of

looking at something. We can do this with our thoughts and beliefs, and an

easy way to find out whether we need to reframe them is to answer these

four questions:

• Did we use absolutes, such as always, never, nobody, or everybody?

• Are we engaging in blaming language?

• Are we shouldering all responsibility for a situation that involved

multiple people?
 • Do we think we can read people’s mind or see the future?

If we said yes to any of those questions, we are going to want to reframe

our thoughts—meaning that we will need to consider an alternate

perspective. For example, is it possible that we don’t always upset people?

Or maybe we aren’t the only ones to blame for a bad experience? Are we

open to the idea that we don’t know all the facts, and therefore cannot be

sure something is going to turn out badly? When we are using absolutes and

other unhelpful thought traps, they don’t leave us open to the belief that we

can make better choices and that things could turn out okay. If we find it

difficult to consider the possibility of a better future, notice whether we are

falling into one of those traps, and fight back by reframing the thought. This

can help us see opportunities for growth and have a more balanced outlook

on our life.

Another way I help my patients reframe their struggles or automatic

thoughts is through natural curiosity. Before we jump to judge ourselves for

a decision we made or an issue we are having, could we be curious about it?

Maybe we could try to learn more about the situation or strive to understand

our response. Wanting to know more about ourselves and the reasons behind

our actions can keep judgment at bay and give us helpful information about

ourselves and our past. If we feel uncomfortable when our friend tells us

how grateful they are for us, can we attach that reaction to something from

our past? Maybe we can try to search our memory for a time when someone

complimented us, only to harm us afterward? Or perhaps whenever we are

told we are helpful and kind, we worry that we can’t live up to it and our

self-doubt and shame get in the way. Being curious about the reasons we

think and act as we do allows us to learn about our experience without

punishment or penalty, and the more we know, the better able we will be to

change and grow.

If we are still finding it difficult to believe that we can adapt and develop,

journaling can be another helpful tool. Keeping track of what we are

struggling with, working on, and looking forward to can help us get

everything out of our head and onto paper (or our computer). This prevents

us from ruminating on past events or focusing only on the negative things,

but it’s also helpful when building up our resilience. After we have been
journaling for a bit, we can look back on our frame of mind from a week or

even a year ago and see how much we have changed. It can prove to us that

emotions and upsets pass, as well as show us just how far we have come on

our path to recovery. When we are having a bad day or struggling with the

symptoms of PTSD, it can feel as though it will never get better, but having

proof that it already has can keep us motivated and believing in our abilities.

WHAT IF I AM TOO DAMAGED?

Too often, I hear from my patients and viewers that they don’t believe they

can get better, that they are broken, or too far gone. While this experience

can feel incredibly real at the moment, know that it’s not true; it’s just

shame lying to us and stealing our belief in our ability to change. Shame

likes to hold us captive, push us down, and make us think something is

innately wrong with us. This is why we have to fight back, push against the

shame, and overcome the fear it feeds on, and the first step in doing that is

using bridge statements.

Bridge statements are phrases we use to move our negative thoughts into

a more positive place. These aren’t outright positive statements, but they do

help build a bridge toward a more positive place, and they apply here as well

because shame isn’t something we can just ignore or push past easily. We

are going to have to slowly shift our beliefs about ourselves one thought at a

time—meaning that we will need to start tracking those automatic thoughts

and actions. Before you jump to conclusions, know that you don’t have to

keep track of every thought you have each day. Just start paying attention to

what you say to yourself about how you relate to others, how well you can

do things in life, and how you feel about yourself and your abilities. Keep

track of these because it’s likely that you are having the same five to ten

thoughts relating to you and your worth over and over again. These

repetitive thoughts are holding you in your shame and trauma experience,

and recognizing them is the first step in getting them to go away.

Once we have narrowed it down to these repeat offenders, let’s try to

make them less shame filled. For example, instead of thinking that we are

too broken to get help, could we think that while we are broken, someone

may be able to assist us? It may not work, but we could feel a bit better or at
least have someone who will listen to us. I know that doesn’t seem like a big

shift, but that’s okay; that’s the point of bridge statements, to help us move

slightly closer to a more positive outlook. Each time we have those

automatic and shame-filled thoughts, let’s try to shift them into the

“maybe,” “possibly,” or “I am open to” type of thoughts. Not taking our

shame thoughts at face value allows us to show ourselves some compassion

and consider another perspective.

This type of work is hard, and it can be exhausting at times, but just

being more aware is a huge step in the right direction. Too often, we are

asleep at the wheel, letting our thoughts flutter in, accepting them as facts,

and acting in harmful ways as a result. Being more conscious of what we

allow ourselves to think and believe helps us weed out any false facts and

unhealthy thought traps, leaving space for logical thoughts and choices. It

can also prevent us from quickly jumping into a shame spiral or numbing

out completely, such as when someone offers some constructive criticism

about something we did and we immediately feel a pit in our stomach and

consider all the ways we messed up in our life, or when we lash out in a rage

when someone offers us another perspective. These are all signs that we are

not acknowledging our feelings of shame and challenging them, and the

more aware we become, the less power it will have over us.

It can also help to separate who we are from what we do. Just because I

am a therapist doesn’t mean that that’s all there is to know about me; I am a

complex person with many hobbies, beliefs, and ideas, and you are too.

Taking a handful of experiences and choices we have made and believing

that that is representative of all we can be isn’t right. We go through phases

in life, we grow and change, and the choices I made when I was younger are

not the same ones I would make today, and that’s okay. Notice when shame

tries to focus on only a few of those past choices and push you to believe

that they are indicative of who you are as a whole. When we feel that urge,

recognize it for what it is, a lie, and choose to focus on some of the good

things we have done. If we aren’t able to come up with any good things, it

can also help to focus on the things we did that weren’t good or bad, but just

okay. At the very least this can help us have a more balanced outlook on our

lives and our decision-making skills instead of being pulled into an all-or-

nothing, shame-filled thought process.

As we work through this, just remember that we are all allowed to be less
than perfect. We don’t always act appropriately or make the best decisions,

but that doesn’t make us bad people; that makes us human. It can even help

to write this reminder on sticky notes and put them all over your house so

that you don’t forget, because if we let that message allude us, shame will

jump right back in and get cozy, and that’s not what we want. We want to

accept that mistakes happen, and we aren’t perfect, but we can learn and

grow for a better tomorrow.

WHY DO I NEED RESILIENCE?

When we start trying to build our resilience, it can feel like an

insurmountable task, and we can try to find shortcuts or easier ways to cope,

but we need to stay the course. Resilience is vital to our growth and healing

because it prevents us from being traumatized again by minimizing the

potential for us to be pushed into our stress response. As our resilient zone

gets larger, it moves in on the areas that used to be utilized for our

fight/flight/freeze response, which gives us more opportunities to ride out

the waves of life without being overwhelmed by them. Think of life as a

wavy line running along a sheet of paper, and as stressful things occur, it

moves closer to the top or bottom of the sheet. The middle section of this

piece of paper is our resilient zone, and the top is fight and flight, while the

bottom is our freeze state. Doing this work slowly grows that middle section

—meaning that we can ride out more intense ups and downs more easily,

use our skills, and stay present. This will help us be less vulnerable to

triggers, and even allow us to do more trauma work in therapy.

Think of this resilient zone as our poker chip bag, and as we build it up,

that bag expands to house all of the skills and techniques needed to weather

the storm. We want to take any opportunity to add to that bag, which means

that even if we are only able to add one more poker chip to our bag this

week, that’s amazing progress and gives us the ability to manage one more

upset than we could before. Paying attention to these incremental gains will

help keep us motivated, more positive, and end up adding more poker chips

to our bag than we originally thought possible. Before we know it, we will

be able to handle any trigger or difficulty while remaining calm and

clearheaded.
 KEY TAKEAWAYS
• Resilience—our ability to cope with emotional distress
and know that we will be okay—is important in trauma
recovery.
• Some people have more resilience than others
because of their personality, ability to reach out for
support, or their parents’ modeling resilient behavior.
• We can build resilience in the following ways:

• Taking care of our basic needs and checking in to

make sure we aren’t hungry, angry, lonely, or tired
(HALT).
• Knowing when we need to take a break.
• Growing our social support system.
• Focusing on our ability to change and grow.
• Reframing any negative or unhelpful thoughts.
• By being curious about our progress and decisions
instead of judging them.
• Journaling can also help us keep track of our
progress.

• Shame is the belief that something is innately wrong

with us, and it can try to impede our recovery.
• We can fight back against shame by doing these few
things:

• Use bridge statements to argue against the shame

thoughts.
• Separate who we are from what we do.
• Remember that no one is perfect and making
mistakes is part of being human.
• We need to build up our resilience so that we are less
and less likely to be pushed into our fight/flight/freeze
response while working to process our past traumatic
experiences.
 CHAPTER 15

BUILDING SUPPORT
HOW TO HAVE HEALTHY
RELATIONSHIPS

Support is necessary when working to overcome any traumatic

experience. Unfortunately, trauma doesn’t only affect those who are

personally harmed by it; the ripple effect of trauma can be felt by those

closest to us as well. Our past terror can cause us to lash out, be too

attached, or not connected enough. The slew of issues that trauma can throw

into our relationships with ourselves and others is endless. Therefore, we

must understand our trauma’s impact on our loved ones and everyone

around us.

One way past trauma can affect our relationships is that it can lead us to

become enmeshed with those we care about. We may not have healthy

boundaries between us and the other person, and we can struggle to know

who we are outside of the relationship. This can cause us to rely on others to

make decisions for us, struggle to see that we have value on our own, and

believe that we won’t make it without someone else there at all times. This

can make it hard for us to build up our self-esteem, and to be able to tap into

how we are feeling. Relying completely on someone else can feel good at

first, especially if we are exhausted by our PTSD and other life struggles,

but enmeshed relationships are never good in the long run. They don’t allow

space for us to have our own experiences untainted by someone else, and

they certainly don’t help us rebuild our faith in ourselves and our ability to

change and grow.

 Trauma can also cause us to lash out at those around us in a rage because

of all the pain we already feel inside. It’s almost as if we just can’t cope with

the intensity of what we feel, and we snap at those we love or even get into

fights when what we want is support. This tends to happen to those we are

closest to because they are around us the most and checking in frequently. If

we are caught off guard or on a bad day we can act out of our trauma

experience, and yell, scream, blame, and shame. However, sometimes we do

this to unsuspecting strangers, such as someone who cut us off on the

highway, or a customer service representative on the phone. If we don’t

know how to healthily express the anger and upset we feel, it can erupt out

of us at any time.

We can also use our relationships with others to initiate another

traumatizing event. This can be through engaging in an abusive relationship

just like the one we were in before, or by using the person to act out our

terrorizing experiences as a way of taking the power back or being in

control of it.

We can use our relationships to continue the pain or to create a new

situation in which we are terrorized again, and I know that may sound odd; I

mean, why would we want to harm ourselves again? However, there are

many reasons we could do this; for example, we may not know what a

healthy relationship looks like because no one in our life has shown us how

to have one. We could think that the pain we feel is normal and a part of

every relationship, or believe that we deserve to be in bad, hurtful

relationships due to the shame caused by our trauma.

My past trauma hasn’t gotten in the way of any long-

term relationships, but I did go through a period of time
where I used sex with men as a form of punishment for
myself and a way to cope with the trauma.
 And unfortunately, due to our upbringing, we didn’t
know what love looked like, or what healthy attachment
was. I never had a parent I could go to, and neither did
she. We became each other’s everything. And with the
shame involved, this was quite the recipe for disaster.
And soon became a super abusive relationship. There
were a lot of fistfights, and a lot of arguing, a lot of
controlling each other, a lot of manipulation. It was
pretty messy.

If our trauma occurred when we were young or happened as a result of a

dysfunctional family (e.g., domestic violence or another form of abuse), we

can grow up having skewed perceptions and beliefs about relationships. This

can cause us to get into yet another abusive relationship because it’s what

feels comfortable and what has been modeled for us growing up. I know

people often wonder why someone would stay in an abusive relationship,

but if it’s all that they know, and it’s the way love and connection were

shown to them as a child, it’s natural that they would be drawn to it. They

may find comfort in the abuse and the unpredictable behavior, because as

we know, change can be uncomfortable and extremely difficult. On the flip

side, being raised in an abusive home can lead to us being extremely

cautious, jumping to conclusions when someone acts in a way that reminds

us of our past. This can lead to us seeing other’s actions in an unfavorable

light, always assuming the worst. This overprotective state can cause us to

act in emotionally abusive ways, making it difficult to have healthy and

happy relationships, and possibly lead to being called toxic and hurtful.

Not to mention that being in a traumatic situation can also wear away at

the relationship we have with ourselves. The shame, embarrassment, and

guilt we can feel as a result of living through a traumatic experience can

cause us to push everyone away to feel safe and ensure we don’t upset

anyone else. Since the world around us doesn’t feel safe, we can shut it all
out, giving ourselves complete control over our self-limited environment. I

have had many patients take jobs where they can work from home, and

disconnect from everyone else as a way of protecting themselves from

another upset, sharing that they prefer to let their relationships go rather than

work on them, because they can’t stomach being to blame for anything else.

While this makes sense when it comes to safety, it doesn’t help us move past

our trauma; it only broadens its reach, making everything dangerous. One of

my patients told me that she built up these walls to keep herself safe, only to

realize she had created her own prison. I thought that was a powerful visual

to describe what this protective measure can do to us over time.

If we don’t push everyone away and build up walls, we can believe we

have to hide parts of ourselves from our friends and family so that they will

accept us, sometimes even overcompensating by putting on a happy face and

pretending everything is okay. I constantly hear how exhausting it can be to

wear this happy mask all day at work, or that the pressure to be the “fun

one” can be difficult when we were just triggered. Not being able to be

ourselves or to let ourselves have down days can leave us feeling that no one

knows who we are or what we are really going through, and that can be

lonely and isolating too.

I personally haven’t been in any relationship during

recovery, although I think it would help sometimes. It’s
tough being my own ‘check in on her person.’ It would
be nice to simply have someone else around to say,
‘Whoa, you are looking overwhelmed! Are you okay?
Time to distract!’ Or to simply help reground…

Even now that I’ve been diagnosed with PTSD, I haven’t

told my husband, or anyone really, because I feel the
 need to protect the people I love from having to deal
with that, even though I know them being able to
support me is what I need. I feel like I have to tackle it
on my own and because of that have been slowly
pushing people away, which has only been hurting my
relationships with others, when in reality I’m trying to
protect them for some reason.

There are many ways that trauma can negatively affect our relationships,

but I think that’s enough of the doom and gloom. It’s time to discuss the

ways that we can get our relationships back on track, because with the right

tools and techniques, they can improve and become the support we need on

our path to recovery.

WAYS TO IMPROVE OUR RELATIONSHIPS

Whether our relationships have been hindered by one or by all of the issues

that can come along with a history of trauma, don’t fret; with some simple

strategies and skills, we can get them to a healthy and helpful place. Doing

this work is important because we need social support when healing from

traumatic experiences, and even though we like to think we can go at it

alone and just push through, having real loving support is vital to our

recovery.

The first tip for improving our relationships is clear communication; and

don’t worry, everyone struggles at clearly communicating to others what’s

going on, how they are feeling, or what they need from other people.

However, we can learn how to best do it and practice those skills until we

feel more comfortable; trust me when I tell you that putting effort into doing

this will improve all of your relationships, especially the one you have with

yourself, so stick with it.

Before we get into sharing with others, we first have to figure out what it

is we are feeling, thinking, and needing from them. I know we discussed this

a bit before, but it’s also important to mention it here, because we can’t
communicate about something we know nothing about. So, we need to get

to know ourselves a bit: pay attention to our thoughts, beliefs, and what

assistance could be helpful, and write that stuff down.

Once we have that information, we can decide what we need to share

with our friends and family. My advice here is to keep it simple, focus on

the issues that you know are affecting your relationship, and lean into the

things you usually brush over—meaning that instead of acting as if things

are okay, or bottling up how you feel only to explode later, let’s talk about

those patterns. Let them know that you have been traumatized, you are

working on it in therapy, and you have become aware of the ways you may

have taken it out on them. List some of the situations and things you did that

you wish you didn’t, and ask for forgiveness. Also, make sure you give space

to their experience too; this isn’t all about you and your struggles, it’s about

the relationship you have together. You need to make space for their upsets,

too, and giving time for these types of real conversations will help you both

heal and grow closer together. Not to mention that it can prevent you from

bottling everything up, lying about how you are doing, or feeling pressure to

put on a happy face when you aren’t doing well. Being vulnerable in our

relationships is the only way to feel truly supported and cared for; if we

don’t open up, those in our life won’t know how to help. We need to give

others a chance to listen and learn, and do our best to offer them the same in

return.

It was also difficult to learn to let people care about me

and help me. Having supportive friends gives me people
I can go to when I struggle and they can call me out
when I am doing harm to myself. They understand
trauma more now, so we can support each other on that
level.

Clear communication will also need to include conversations about our

triggers and working to let others know what they are and when we have

been upset by them. So often in relationships, we don’t let someone know

we are overwhelmed, but because this can cause us to lash out, freeze, or

even have a panic attack, we need to let them know why it’s happening and

that it’s not their fault. If we don’t take the time to explain what’s going on

or let them learn along with us, they could think they’re to blame, and get

defensive or want to leave. We don’t want a lack of vulnerability and

understanding to cause more issues, and to prevent that from happening, we

just have to try our best to let them know.

Another helpful tool in relationship building is healthy boundaries. We

cannot make every conversation about us or always feel that we are giving to

others without getting anything back. Healthy relationships operate with

give and take. I know this can be difficult to calculate, and that’s because we

shouldn’t be keeping a laundry list of all we have done versus what others

have contributed. Instead, we should be taking the time to check in on

ourselves and how we feel in certain relationships. Do we feel that the other

person knows what’s going on in our life? Do we know how they are doing

and have listened to them share as well? After spending time with them, do

we feel rejuvenated and good about things? Or not? All of these questions

are important to check in on, and if something feels off, go back to the first

tip and talk about it. Then, we can take some action to right the relationship

so that it’s healthy and beneficial to both parties. Even if the relationship is

toxic, doing this exercise can help us more quickly recognize when things

are off and feel more empowered to speak up about it.

When we have survived a traumatic experience, we can struggle to

connect with ourselves and who we are, which can cause us to easily get

sucked into relationships with people who will tell us what to think, do, and

believe. This enmeshment can leave us without a sense of self, and while it

may be comfortable for a while, we aren’t able to process and move past our

trauma in this state. Figuring out who we are, what we like, and what we

don’t like can take time and, just like recovery, it will be hard, but I cannot

think of anything that will be more worth it. We need to do our best to

consider what we want to do each day, what food sounds good, and who we

want to spend our time with. Journaling is a great way to think through our

options, consider situations where we wanted to speak up but didn’t, and

write out some ways we could be more assertive in the future. This
introspection can allow us to sort through what is ours and what is someone

else’s, which can stop us from taking on someone else’s pain and from

blaming other people for how we feel. Setting up and maintaining

boundaries can seem impossible at first, but just like any change, once we

get over that initial disruption, we get comfortable in the new way of doing

things, and before we know it, going back to an enmeshed situation will be

difficult and unbearable.

Since trauma can cause us to think the world isn’t safe and people aren’t

always good, intimacy of any kind can be tough to come by. It can be scary

to let people in and allow them to get to know our true selves, which is why

we often keep people at arm’s length. However, to get the support we need,

we are going to have to let people in, let them see us without our mask on,

and share our real self. I know this isn’t easy, but if we don’t allow it, we

will always feel alone and that no one understands what we are going

through—because they don’t. We cannot expect people to read our mind and

know how to respond; we have to let them know what we are thinking and

feeling and allow them to be there for us. Not everyone in our life deserves

to know our most intimate details, but finding one person who cares for us,

who we can trust, can be invaluable.

Learning to separate myself from my mother and see

that it wasn’t my fault helped a ton with my relationship
to myself. Seeing I have value as a person.

WHAT ABOUT SEXUAL INTIMACY?

Intimacy in relationships can be emotional and physical, and for those of us

who have had sexual-based trauma, physical intimacy can feel impossible.

Allowing someone to get that close, possibly doing similar things that our

abuser did, can be triggering and unpleasant. This is why communication is

imperative if we want to be able to engage in a healthy sexual relationship. I

know talking about any past traumatic experience is uncomfortable, and

talking about how it relates to our sex life, well, that could be excruciating,

but it’s the only way we can move past what happened and have healthy

sexual experiences. Having a partner who will listen and work with us is

going to be the most important part of this work.

The growth of our sexual relationships will take time, and they will need

to be patient as we figure out our triggers, utilize grounding techniques so

we don’t constantly dissociate, and slowly prove to our brain and body that

sex can be a loving and enjoyable act. While it’s great to have a partner who

is going to be there through this work, it’s also important that we choose to

do this because it’s what we want, not just what our partner wants. I only say

this because I have had too many patients and viewers tell me that they

wanted to work on their sexual intimacy because they were afraid their

partner was going to leave if they didn’t. I know this is hard to hear, but if

someone is going to leave us because we aren’t able to have a healthy sex

life yet, let them go. This is going to be a painful process—starting and

stopping sexual acts, struggling to feel safe, often dissociating—and we need

someone there with us who wants to support us as we find our way.

Anything less than that will only make this arduous process even more

grueling.

I have been so thankful for my boyfriend who has been

so supportive of me and my recovery. He’s played a
really important role and continues to by reminding me
that I am safe now and I am enough. His support means
the world to me. That being said it’s also difficult
focusing on trauma work and romantic relationships at
once. Intimacy is a challenge for both of us in different
ways that we continue to work on together.

By talking about what happened in therapy and with our partner, we can
heal from our past sexual trauma and go on to have a healthy, happy sex life.

One of my favorite tools to use to help move this along comes from The

Courage to Heal Workbook and it has survivors put together safe sex

guidelines, splitting up intimate acts into three categories: safe, possibly

1
safe, and unsafe. This can help guide us and our partner as we try other

sexual acts together, starting with safe ones and moving on to possibly safe

ones. This also gives us an entire section of things that aren’t safe to share

with our partner, so that they don’t accidentally do something upsetting. I

know a lot of this sounds slow and tedious, but to prove to ourselves that sex

doesn’t have to be about shame, control, or pain, we are going to have to

take our time.

Another way to improve our sexual intimacy is to talk about it. I don’t

mean to talk about the trauma and our healing, but talk about sex with each

other. We should feel open to share our fantasies, things we would like to try

in the bedroom, or something our partner did that we liked. Sometimes we

have to be more intentional about connecting with each other, and trying to

start and engage in these conversations can not only allow us to learn more

about our partner and what they like, but it also helps us to tap into our own

sexual desires. I know this can be tough at first, but we should keep trying,

maybe even journal about it a bit first so that we can find the right words for

what we are thinking and feeling. And by continuing to go at our pace,

talking about it along the way, and working with our sexual partner, we will

be able to have a healthy and enjoyable sex life again.

HOW DO I FIND GOOD PEOPLE?

The most common issue my patients and viewers have with relationships is

knowing who to have them with. As we discussed throughout this book,

when we have been traumatized, it can be hard to know who to trust, and if

we haven’t had good experiences with people, we could have taken steps to

isolate completely. However, having supportive loving relationships during

our trauma recovery is incredibly important, and that’s why I am going to

share some of the ways we can figure out who we should build a

relationship with.

The first step is to consider the traits that we enjoy in people. If that’s too
difficult, we can simply consider what characteristics our abusers or other

toxic relationships had and write down the opposite. These can be things

like being caring, supportive, trustworthy, calm, or even challenging. Once

we have our list of possible qualities to look for, I would encourage you to

bring it into your next therapy session and talk about it with your therapist.

Whenever we are embarking on something that challenges an old way of

thinking and acting, we want to check in with someone else to ensure we are

doing it safely. If our therapist agrees that those traits are healthy and worthy

of our time and energy, then we can reference this list as we meet new

people, letting it be our new relationships guide.

The second step is to take our time getting to know people before we let

them into our lives completely. This could mean that we only hang out with

our coworkers in group settings so we are safe and have a chance to see how

they interact with other people, or that we schedule weekly coffee dates to

ensure it’s during the day, and can be over once our coffee is gone. Any type

of relationship will take time to build, and a healthy person isn’t going to

rush us into intimacy or dump a lot of personal information onto us right

away. It’s okay to not be available to hang out all the time, or taking a few

hours to respond to a text. We want to build healthy boundaries from the

beginning, and giving ourselves space to consider how our last get-together

went is part of that. If we feel rushed or as if it’s not okay to take our time,

that’s a red flag that this person doesn’t respect us or our boundaries, and we

should probably stop seeing them. Giving ourselves time to slowly get to

know someone will leave space for these red flags to make themselves

known. If we get too close too quickly, it can be even harder to end the

relationship, so give ourselves time to slowly ease into it.

Finally, remember that we can end a relationship at any time. I know that

sounds obvious, but too often we feel stuck in these toxic or abusive

situations when all we have to do is stop responding to their calls and texts

and end the relationship. I know surviving a traumatic experience can leave

us feeling like something is wrong with us and we deserve bad things, but

trust me when I tell you that we all deserve happy and healthy relationships.

Since I know we can all talk ourselves in and out of relationships, and we

often don’t know what’s healthy or not, here is a short and by no means an

exhaustive list of reasons it’s acceptable to end a relationship:

 • They have hurt you emotionally, physically, or sexually, or have

neglected you.

• They put you down, trash-talking you and those you love.

• They don’t like you having other friends or spending time with your

family.

• Spending time with them is exhausting and you dread it.

• They tell you what to do, how to spend your money, or who you can

see.

• They are so easily upset; you find yourself walking on eggshells

around them.

• They don’t respect your boundaries and will ignore any assertion you

make (e.g., you say you are not comfortable going somewhere and

they expect you to go anyway).

• They only talk about themselves and never ask you how you are doing.

• They share your private information with other people without your

permission.

• You don’t want to be in a relationship with them anymore.

The only caveat to that short list is that if we are in a relationship with

someone who is challenging us to speak up more and do our therapy

homework, and they don’t let us pretend everything is okay when it’s not,

well, that’s not a reason to end it. We all need people in our life who know

when we are lying and are there to support yet push us along in the right

direction. I know it’s uncomfortable, but all change feels that way, so check

in with your therapist about it, and remember that relationships take some

effort and a lot of vulnerability, but finding good people who know us well

and can support us along the way is invaluable.

Relational connection is key to feeling safe enough to

remove the mask. It’s key to feeling supported when
you can’t get your words out. It’s key to reframing your
thinking.
 It’s key to finding hope when all seems lost.

KEY TAKEAWAYS
• Surviving a traumatic experience not only affects us
but those around us.
• Our PTSD symptoms can damage our relationships.
Some of the most common ways are lashing out in
anger, isolating, struggling with boundaries and
becoming enmeshed, using our relationships to
continue the pain, skewing our perception of others,
and allowing shame to ruin our faith in ourselves.
• We can fix our relationships through clear
communication and healthy boundaries.
• Trauma can also make intimacy difficult, but by
communicating with our partner, and being patient as
we work through it, intimacy can get better.
• Creating a safe sex guideline of what is safe, possibly
safe, and unsafe can prevent us from being
retraumatized.
• To find people worth having in our lives we have to
figure out what traits we desire in others, take our time
getting to know them, and know that we can end a
relationship at any time.
• Relationships are a key part of our recovery from
trauma and will make the journey less painful and
lonely.
 EPILOGUE

I wish we lived in a world where bad things didn’t happen and people

were not traumatized by others, but unfortunately, that’s not the case. Abuse,

assault, school shootings, and much more are happening in our world each

day, and surviving these traumatic experiences is no small feat. I want you

to know that I see you, hear you, and know that this path to recovery can

feel impossible at times. That’s why I decided to write this book: to remind

anyone out there who has been through a horrific experience that they are

not alone and that with the right help, it can get better.

There is no judgment here, no expectations of when you should feel

better or that you have to get into this difficult work right now. You are in

control of your recovery and get to go at your own pace. I hope that you use

this book in a way that suits you and your recovery process, and that it can

be a reminder of the resources available when you are ready. Trauma already

takes so much from us, but through the stories and therapeutic tools I hope

you feel empowered to take back what is yours; placing boundaries where

they need to be and putting yourself first.

Remember that you deserve to be free from PTSD symptoms and any

feelings of shame. You are important, valued, and worthy of love. Keep

putting one foot in front of the other, pushing back against the lies you were

told in the past. You can live a life free from the concern of what happened

and instead have focus and excitement for what tomorrow can bring. Trust

me, I have seen it happen over and over again, and it can happen for you too.
 Discover Your Next Great Read

Get sneak peeks, book recommendations, and news about

your favorite authors.

Tap here to learn more.

NOTES
 CHAPTER 1: OUR SHARED TRAUMA: HOW
SOCIAL MEDIA AFFECTS OUR MENTAL HEALTH
1. Pew Research Center, “About Three-in-Ten U.S. Adults Say They Are

‘Almost Constantly’ Online,” July 2019,

https://www.pewresearch.org/fact-tank/2019/07/25/americans-going-

online-almost-constantly/.

2. D. J. Kuss and M. D. Griffiths, “Social Networking Sites and

Addiction: Ten Lessons Learned,” International Journal of

Environmental Research and Public Health 14, no. 3 (2017): 311,

https://doi.org/10.3390/ijerph14030311.

3. P. Fossion et al., “Family Approach with Grandchildren of Holocaust

Survivors,” American Journal of Psychotherapy 57, no. 4 (2003): 519–

527.
CHAPTER 2: HAVE I BEEN TRAUMATIZED? PTSD
& WHAT YOU NEED TO KNOW
1. G. C. Bunn, A. D. Lovie, and G. D. Richards, eds., Psychology in

Britain: Historical Essays and Personal Reflections (Leicester, UK:

BPS Books, 2001).

2. Edgar Jones, “Shell Shocked,” American Psychological Association 43,

no. 6 (June 2012), https://www.apa.org/monitor/2012/06/shell-

shocked.

3. Jones, “Shell Shocked.”

4. Jones, “Shell Shocked.”

5. Bessel van der Kolk, The Body Keeps the Score: Brain, Mind, and

Body in the Healing of Trauma (New York: Viking, 2014).

6. American Psychiatric Association, Diagnostic and Statistical Manual

of Mental Disorders, 5th ed. (Washington, DC: American Psychiatric

Association Publishing, 2013).

7. Diagnostic and Statistical Manual of Mental Disorders.

8. Diagnostic and Statistical Manual of Mental Disorders.

 CHAPTER 3: WHAT CAN CAUSE PTSD?
1. American Psychiatric Association, Diagnostic and Statistical Manual

of Mental Disorders, 5th ed. (Washington, DC: American Psychiatric

Association Publishing, 2013).

2. Diagnostic and Statistical Manual of Mental Disorders.

 CHAPTER 4: WHAT IS DISSOCIATION & WHY
DOES IT HAPPEN?
1. American Psychiatric Association, Diagnostic and Statistical Manual

of Mental Disorders, 5th ed. (Washington, DC: American Psychiatric

Association Publishing, 2013).

2. Diagnostic and Statistical Manual of Mental Disorders, 292.

3. S. Sexton and R. Natale, “Risks and Benefits of Pacifiers,” American

Family Physician 79, no. 8 (2009): 681–685.

CHAPTER 5: WHAT IS REPEATED TRAUMA? C-
PTSD & HOW IT’S DIFFERENT
1. Patrick J. Carnes and Bonnie Phillips, The Betrayal Bond: Breaking

Free of Exploitative Relationships, rev. ed. (Boca Raton, FL: HCI,

2019).

2. Nielsen, “Rebalancing the ‘COVID-19 Effect’ on Alcohol Sales,” 2020,

https://www.nielsen.com/us/en/insights/article/2020/rebalancing-the-

covid-19-effect-on-alcohol-sales/.
 CHAPTER 6: ARE WE SURE IT’S C-PTSD?
1. American Psychiatric Association, Diagnostic and Statistical Manual

of Mental Disorders, 5th ed. (Washington, DC: American Psychiatric

Association Publishing, 2013).

2. Diagnostic and Statistical Manual of Mental Disorders.

3. Diagnostic and Statistical Manual of Mental Disorders.

4. Diagnostic and Statistical Manual of Mental Disorders.

5. Diagnostic and Statistical Manual of Mental Disorders.

6. Diagnostic and Statistical Manual of Mental Disorders.

7. Diagnostic and Statistical Manual of Mental Disorders.

8. Diagnostic and Statistical Manual of Mental Disorders.

9. Diagnostic and Statistical Manual of Mental Disorders.

10. Diagnostic and Statistical Manual of Mental Disorders.

11. M. S. Harned, “The Combined Treatment of PTSD with Borderline

Personality Disorder,” Current Treatment Options in Psychiatry 1

(2014): 335–344, https://doi.org/10.1007/s40501-014-0025-2.

12. Marylène Cloitre et al., “Distinguishing PTSD, Complex PTSD, and

Borderline Personality Disorder: A Latent Class Analysis,” European

Journal of Psychotraumatology 5, no. 1 (2014): 25097,

https://doi.org/10.3402/ ejpt.v5.25097.

13. Gordon H. Bower, ed., The Psychology of Learning and Motivation:

Advances in Research and Theory (Academic Press, 1981), 30.

 CHAPTER 7: WHAT ARE THE 4 ATTACHMENT
STYLES? WHY TRAUMA IS ROOTED IN
CHILDHOOD
1. Substance Abuse and Mental Health Services Administration,

“Understanding Child Trauma,” April 29, 2020,

https://www.samhsa.gov/child-trauma/understanding-child-trauma.

2. V. J. Felitti et al., “Relationship of Childhood Abuse and Household

Dysfunction to Many of the Leading Causes of Death in Adults: The

Adverse Childhood Experiences (ACE) Study,” American Journal of

Preventive Medicine 14, no. 4 (1998): 245–258,

https://doi.org/10.1016/S0749-3797(98)00017-8.

3. Felitti et al., “Relationship of Childhood Abuse and Household

Dysfunction.”

4. Joining Forces for Children, “What Are ACEs?” 2020,

http://www.joiningforcesforchildren.org/what-are-aces/.

5. Nadine Burke Harris, “How Childhood Trauma Affects Health Across

a Lifetime,” TED Talks, September 2014,

https://www.ted.com/talks/nadine_burke_harris_how_childhood_trau

ma_affects_health_across_a_lifetime?language=en#t-362018.

6. S. W. Porges, “The Polyvagal Theory: New Insights into Adaptive

Reactions of the Autonomic Nervous System,” Cleveland Clinic

Journal of Medicine 76, suppl. 2 (2009): S86–S90,

https://doi.org/10.3949/ccjm.76.s2.17.

7. John Bowlby, Attachment and Loss (New York: Basic Books, 1969).

8. S. A. McLeod, “Mary Ainsworth,” Simply Psychology, August 5, 2018,

https://www.simplypsychology.org/mary-ainsworth.html.

9. M. D. S. Ainsworth et al., Patterns of Attachment: A Psychological

Study of the Strange Situation (Hillsdale, NJ: Erlbaum, 1978).

10. M. Main and J. Solomon, “Procedures for Identifying Infants as

Disorganized/Disoriented During the Ainsworth Strange Situation,” in

Attachment in the Preschool Years: Theory, Research, and

Intervention, ed. M. T. Greenberg, D. Cicchetti, and E. M. Cummings

(Chicago: University of Chicago Press, 1990), 121–160.

11. Marsha Linehan, DBT Skills Training Handouts and Worksheets (New

York: Guilford Press, 2015).

12. Linehan, DBT Skills Training Handouts and Worksheets.

13. Linehan, DBT Skills Training Handouts and Worksheets.

CHAPTER 8: CAN TRAUMA BE PASSED DOWN?
TRANSGENERATIONAL TRAUMA AND ITS
LASTING EFFECTS
1. M. Heurich et al., “Country, Cover or Protection: What Shapes the

Distribution of Red Deer and Roe Deer in the Bohemian Forest

Ecosystem?” PLoS ONE 10, no. 3 (2015): e0120960,

https://doi.org/10.1371/journal.pone.0120960.

2. P. Fossion et al., “Family Approach with Grandchildren of Holocaust

Survivors,” American Journal of Psychotherapy 57, no. 4 (2003): 519–

527.

3. B. Bezo and S. Maggi, “Intergenerational Perceptions of Mass

Trauma’s Impact on Physical Health and Well-Being,” Psychological

Trauma: Theory, Research, Practice, and Policy 10, no. 1 (January

2018).

4. B. Dias and K. Ressler, “Parental Olfactory Experience Influences

Behavior and Neural Structure in Subsequent Generations,” Nature

Neuroscience 17 (2014): 89–96, https://doi.org/10.1038/nn.3594.

5. N. A. Youssef et al., “The Effects of Trauma, with or without PTSD, on

the Transgenerational DNA Methylation Alterations in Human

Offsprings,” Brain Sciences 8, no. 5 (2018): 83,

https://doi.org/10.3390/brainsci8050083.

6. F. A. Champagne, “Epigenetic Mechanisms and the Transgenerational

Effects of Maternal Care,” Frontiers in Neuroendocrinology 29, no. 3

(2008): 386–397, https://doi.org/10.1016/j.yfrne.2008.03.003.

7. Centers for Disease Control and Prevention, “Corona Disease 2019

(COVID-19): Cases in the U.S. June 24th, 2020,”

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-

us.html.

8. J. P. Daniels, “Colombian Designers Prepare Cardboard Hospital Beds

That Double as Coffins,” Guardian, May 27, 2020,

https://www.theguardian.com/world/2020/may/27/colombia-

coronavirus-cardboard-hospital-beds-coffins.

9. S. W. Porges, “The Polyvagal Theory: New Insights into Adaptive

 Reactions of the Autonomic Nervous System,” Cleveland Clinic

Journal of Medicine 76, suppl. 2 (2009): S86–S90,

https://doi.org/10.3949/ccjm.76.s2.17.

10. P. A. Levine, In an Unspoken Voice: How The Body Releases Trauma

and Restores Goodness (Berkeley, CA: North Atlantic Books, 2010).

CHAPTER 9: WHY DO WE FEEL SO SCARED? THE
SCIENCE OF TRAUMA MEMORIES
1. Michael Yassa, “Hippocampus,” Encyclopædia Britannica, November

28, 2018, https://www.britannica.com/science/hippocampus.

2. University of Queensland Brain Institute, “How Are Memories

Formed?” July 23, 2018, https://qbi.uq.edu.au/brain-

basics/memory/how-are-memories-formed.

3. Bessel van der Kolk, The Body Keeps the Score: Brain, Mind, and

Body in the Healing of Trauma (New York: Viking, 2014), 178.

4. Matthew P. Walker, “The Role of Slow Wave Sleep in Memory

Processing,” Journal of Clinical Sleep Medicine 5, no. 2 suppl. (2009):

S20–S26.

5. Matthew Walker, “The Joe Rogan Experience. Joe Rogan Experience

#1109—Matthew Walker,” April 25, 2018, https://youtube.com/watch?

v=/pwaWilO_Pig.

6. E. Joseph LeDoux, “Coming to Terms with Fear,” Proceedings of the

National Academy of Sciences 111, no. 8 (February 2014): 2871–2878,

https://doi.org/10.1073/pnas.1400335111.

7. L. Cahill and J. L. McGaugh, “Mechanisms of Emotional Arousal and

Lasting Declarative Memory,” Trends in Neurosciences 21, no. 7

(1998): 294–299.

8. van der Kolk, The Body Keeps the Score, 178.

9. American Psychiatric Association, Diagnostic and Statistical Manual

of Mental Disorders, 5th ed. (Washington, DC: American Psychiatric

Association Publishing, 2013), 271.

10. Ashley Pettus, “Repressed Memory,” Harvard Magazine, January–

February 2008, https://www.harvardmagazine.com/2008/01/repressed-

memory.html.
 CHAPTER 10: HOW CAN WE RECOVER? THE
BENEFITS OF NEUROPLASTICITY
1. G. Berlucchi, “The Origin of the Term Plasticity in the Neurosciences:

Ernesto Lugaro and Chemical Synaptic Transmission,” Journal of the

History of the Neurosciences 11, no. 3 (2002): 305–309,

https://doi.org/10.1076/jhin.11.3.305.10396.

2. Saul McLeod, “Pavlov’s Dogs,” Simply Psychology, 2018,

https://www.simplypsychology.org/pavlov.html.

3. Saul McLeod, “Skinner—Operant Conditioning,” Simply Psychology,

2018, https://www.simplypsychology.org/operant-conditioning.html.

4. David D. Burns, The Feeling Good Handbook (New York: Plume,

1999).
CHAPTER 11: THE FOUNDATION OF HEALING:
FINDING THE RIGHT TREATMENT
1. M. L. Van Etten and S. Taylor, “Comparative Efficacy of Treatments for

Post-Traumatic Stress Disorder: A Meta-Analysis,” Clinical

Psychology & Psychotherapy 5, no. 3 (1998).

2. “Trauma-Focused Cognitive Behavioral Therapy for Children Affected

by Sexual Abuse or Trauma,” Child Welfare Information Gateway,

2012, 6, https://www.childwelfare.gov/pubPDFs/trauma.pdf.

3. J. Kaplan and D. Tolin, “Exposure Therapy for Anxiety Disorders,”

Psychiatric Times, September 6, 2011,

https://www.psychiatrictimes.com/view/exposure-therapy-anxiety-

disorders.

4. Cognitive Behavior Therapy Center, “Schemas in Schema Therapy,”

2020, http://cognitivebehaviortherapycenter.com/schema-therapy-

california/schemas-in-schema-therapy/.

5. Eugene Lipov, “Using Stellate Ganglion Block (SGB) to Treat Post-

Traumatic Stress Disorder,” February 8, 2019,

https://www.anxiety.org/stellate-ganglion-block-sgb-for-ptsd-research-

update.

6. Christa McIntyre, “Is There a Role for Vagus Nerve Stimulation in the

Treatment of Posttraumatic Stress Disorder?” Bioelectronic in

Medicine 1, no. 2 (May 25, 2018), https://doi.org/10.2217/bem-2018-

0002.

7. Butler Hospital, “How Does TMS Work?” 2020,

http://www.butler.org/programs/outpatient/how-does-tms-

work.cfm#:~:text=TMS%20uses%20a%20small%20electromagnetic,re

sonance%20imaging%20(MRI)%20machine.
CHAPTER 13: BREAKING THE CYCLE: AVOIDING
FUTURE TRAUMA & TRIGGERS
1. B. Sissons, “Exposure Therapy: What It Is and What to Expect,”

Medical News Today, May 5, 2020,

https://www.medicalnewstoday.com/articles/exposure-therapy.

2. V. J. Harber and J. R. Sutton, “Endorphins and Exercise,” Sports

Medicine 1 (1984): 154–171, https://doi.org/10.2165/00007256-

198401020-00004.

3. Adapted from “How to Use the Impulse Control Log” by S.A.F.E.

Alternatives (2007–2020), https://selfinjury.com/resources/how-to-use-

the-impulse-control-log/.
 CHAPTER 14: RESILIENCE: BUILDING IT &
KEEPING IT
1. Marsha Linehan, DBT Skills Training Handouts and Worksheets (New

York: Guilford Press, 2015).

 CHAPTER 15 : BUILDING SUPPORT: HOW TO
HAVE HEALTHY RELATIONSHIPS
1. Laura Davis, The Courage to Heal Workbook: For Women and Men

Survivors of Child Sexual Abuse (New York: Harper, 1990).

 PRAISE FOR KATI MORTON

“A humane, compassionate, and extremely helpful guide to the complex

world of mental health care. Knowing what’s wrong and when to seek help

can be life-changing, and Morton’s book is packed with tools and tips for

navigating life with mental health challenges.”

—John Green, #1 New York Times bestselling author of Turtles All the

Way Down and The Fault in Our Stars

“An exemplary guide for anyone wondering if they or someone close to

them may benefit from mental health therapy.”

—Library Journal

“An intuitive handbook that empowers readers to tend to their own mental

health… Chapters provide practical tools for handling anxiety, depression,

and other mental health difficulties, while also offering powerful insights.”

—Publishers Weekly

“[Morton] answers the questions many of us have but don’t necessarily feel

comfortable asking. This is information everyone can benefit from.”

—Bustle

“Compassionate and hopeful.”

—Energy Times

“An undeniably essential read.”

—Cultured Vultures