Among the many things that can make coping with PTSD so difficult is that sufferers can’t know when they may get triggered. So while family, friends, and their therapist are saying “You need to get out of the house and back into the world,” PTSD patients are often thinking “Yeah, and I’ll run into a trigger and have a total meltdown in the middle of ____ (you fill in the gap: McDonald’s, my kid’s school auditorium, Wal-Mart, the movie theater, the mall…).”
Some triggers we can anticipate and prepare for; it’s the ones that come out of the blue that throw us for a loop. Shopping at Best Buy and stumbling into 30 television screens showing a triggering scene from a movie is hard to anticipate. Seeing someone who looks exactly like the person who attacked you (but isn’t) is hard to anticipate. Hearing what sounds like gunfire but is actually a car backfiring in the grocery store parking lot is hard to anticipate. Depending on the person with PTSD and their history of responses, a “meltdown” could include anything from freezing on the spot to fear of getting into a verbal fight to actually throwing a punch.
So how to find the balance between avoiding the world and avoiding meltdowns? Well, one way is to have a healthy list of coping skills available to you so if you do get triggered you can respond in a way that won’t keep you from going out again. The good news is, if you keep interacting with the world and using your coping skills you’ll find that, over time, you’re less easily triggered and, if you are triggered, it's become more automatic to respond in a healthy, healing way. Here are some tried and true, portable, and relatively easy to use coping skills to help when you get triggered:
1. BREATHE!
Take slow, deep breaths, pulling oxygen deep into your lungs, hold it for a second and then slowly exhale. Repeat. Repeat again. Notice how you are starting to calm. When we are stressed, as we are when triggered, our breathing tends to become rapid and shallow and our bodies start to prepare for a fight, flight, or freeze reaction. When we breathe deeply we put the brakes on that response and begin to calm. When we calm we can better perceive that we are responding to a trigger rather than to actual danger.
2. Use a grounding item
Find, carry with you, and hold or use as needed a grounding item. This is an actual item that you can use to help remind you to be present in the current moment and that you are not back in the trauma situation. When we get triggered sometimes it can transport us away from the present and to what happened during the trauma(s). It makes sense that a trigger can take your mind from the present to the past; a grounding object brings your mind back to the present so you can make good decisions in this moment. Grounding objects need to appeal to at least one of your senses—the smooth coolness of holding a stone or a marble in your hand, or the minty taste of a peppermint in your mouth, or the calming smell of lavender oil in a small vial kept in your pocket are all examples. There’s no right or wrong on this one—it just needs to work for you as a calming, grounding item that helps you in the moment to make good choices.
3. Get mindful
Notice what is actually happening to you in this moment. If you already practice mindfulness this will be an easier transition to begin to make. If you aren’t familiar with what mindfulness is and would like to learn, please listen to my podcast here. Very briefly, mindfulness is the practice of staying in the moment. The advantage of staying in the moment is that it allows us to stay focused on what is happening now, not what happened during our trauma. Seeing someone who reminds you of the person who hurt you can transport your mind back to the trauma and signal danger. Choosing mindfulness will remind you that this is not the same person and you are in a completely different situation in the here and now. I often refer to this transition into mindfulness as “taking a step outside of yourself to see what you’re doing.” When we’re in a panicky, triggered moment, we are in the midst of a storm; all we see around us is the wind, and trees blowing, and chaos. When we step out of the storm and watch it from a bit of distance we are better able to figure out what we need to do to slow or stop the storm in us and return to calm. That ability to watch ourselves doing whatever it is we’re doing is part of mindfulness. Usually at this point clients will say “But there is no way that I can do that when I’m triggered! I won’t even think about it!” And initially that may be true. Mindfulness is a skill that we develop over time. So initially you may think after the triggering event, “I should have used mindfulness. If I had, I would have realized faster what was going on inside of me and been able to slow it down or stop it.” And then soon you’ll realize during the triggering event, “Hey, wait a minute. I see what this is—I’m being triggered by that (person, sign, noise, smell, taste). Ok, what can I do to calm myself?” And then there will come a day when you experience the trigger and you’ll say, “I just got triggered. I’m going to choose not to respond any more than I already have.” You may even see the trigger coming—“That guy is wearing the same shirt as the person who hurt me; I’m not going to let myself get triggered by that. It’s not worth it.”
4. Use positive self-talk to get yourself through the situation.
You will likely use mindfulness with this without necessarily realizing that’s what you’re doing! The idea is to remind yourself that you are not in the trauma situation, that you are safe, that there is no danger here in this moment, that you are strong and resourceful, and that you can survive this trigger. It may be helpful to come up with your own mantra that you repeat to yourself in such moments. This might be “I am safe” or “I can handle this.”
5. Walk away.
If it really feels overwhelming, take a few minutes to walk away from the situation so you can catch your breath and slow your body down. Don’t be concerned if the timing is off (e.g., you’re in the midst of your kid’s school play)—just excuse yourself, get some air and space, splash some cold water on your face if you can, and remember to breathe.
6. Use distraction to get your mind off the trigger and back to the present.
Find something in your surroundings that you can use to take your focus off of the trigger. The grounding techniques discussed above can be considered a type of distraction. Other possibilities might include engaging in conversation with someone you’re with, counting or doing math problems in your head, going to a favorite calming image in your mind, or looking for a specific color to focus on in your current surroundings.
Keep in mind that not all of these tools will work for everyone—most likely you’ll find that you have your favorite go-to techniques that work the best for you. And, by all means, combine some of these techniques if you can! Do deep breathing while reciting your mantra; take some good deep breaths and then focus on your grounding object; use positive self-talk to remind yourself how your grounding object works (“I’m holding my favorite stone in my hand and feeling its smooth edges to remind myself that I’m here in the present and I’m safe.”) By practicing these techniques at the time of the trigger you’ll begin to loosen the hold that PTSD triggers can have on our lives.
If you’d like to discuss these tools further or learn more about PTSD treatments, please call me, Dr. Jana Drew, at 512-960-5265 or contact me here.