Hello and welcome to Week 5,  Session 2. 

If this is the first time you’re reading this, welcome! We’re so happy to have you here. However if you’re just starting out please do head back to the first session. We build on material throughout the weeks, and we don’t want you to miss anything!’

You may want your thought diary for the homework, so take a moment to find it if you haven’t already. 

We will be covering how to cope with the symptoms of post-traumatic stress disorder and complex post-traumatic stress disorder, and the methods and tips for recovery. We will be describing healthy coping mechanisms for lessening the impact of triggers at home, explain why & how these methods work - and will also outline the professional services available to those diagnosed.

The goals for this session are:

• To explain the difference between the parasympathetic and sympathetic nervous system, how relaxation techniques can help shut down the effects of post-traumatic stress.
• Outline multiple at-home methods to both prevent and interrupt your triggers
• Discuss different professional services, so you can choose which might be best for you. 

We do want to emphasise that, while not everyone is living in a “safe” environment, this doesn’t mean these tools and tricks won’t work for you.
Even if your day-to-day life isn’t “safe”, your body is. These are still methods to give yourself the love you need - not to become stronger - but because you can experience the ways you already are. 

Let’s start with a grounding exercise…

Today we are going to do something physical to help ground us and also to hopefully decrease some tension that might be built up in your body.  It’s a simple one but can be pretty effective. Take your pointer finger (the finger next to the thumb) and put them at your temples. Put a bit of pressure on them and massage them while you breathe in deeply. You can even close your eyes. 

Fun question: Would you rather be able to fly or breathe underwater? Why?

Today, we’re teaching you new methods to cope: to build trust in our bodies so - we can leave the past behind, and move towards a future we choose.

The Nervous System 

First, a final bit of biology, about how our bodies and minds process the fear response. When our brain tells us that we’re in danger, it taps into one of two nervous systems. There’s our sympathetic nervous system, which is associated with that fight-or-flight response. It prepares the body to run. Remember those stick figures, about where you feel danger on our body? That’s our sympathetic nervous system. 

However, we also have a parasympathetic nervous system that restores our cells: which deals with sleep and digestion. Functionally, we’re meant to work in rhythm between the two to keep our systems balanced. Of course, when we think we’re in danger every day, we can’t always “turn on” this parasympathetic system - which is why so many of the symptoms associated with PTSD interrupt our ability to find peace. 

The problem is that even if we have insight into our experiences, insight alone - or knowing “why” what’s happening is happening - isn’t always enough to shut off those danger signals. The aim in healing our traumatic symptoms is to recognise what is an emotional or internal signal, learn how to attend to them - and get our more rational brain online - not because that rational brain is more important, but because it works in harmony with the body. We want to restore that balance between our brain and our body. 

The trick is that when we MAKE our bodies relax, only one of our nervous systems can be “on” at any one time. As we sit down and go through breathing exercises, this calm system starts up, and the sympathetic nervous system - which controls our stress responses - has to shut down. 

We’ve actually already found ways to regulate our nervous systems - and to bring the parasympathetic on: these are often called coping mechanisms. Eating, drinking, or the more dangerous self-harm are ways of returning to that state of “rest”. In this way, we’ve ALREADY been taking care of ourselves, we just haven’t known that was what we were trying to do, or always had the resources to make the healthiest choices. 

There are several ways to manage stress and symptoms at home - to switch from fight, flee, or freeze back to our parasympathetic nervous system - without professional assistance. As we move through the following, we can naturally turn off the danger signals linked to our traumatic symptoms - to think, sleep, and find peace. 

Effective, healthy coping strategies at home for lessening the impact of triggers include:

• Grounding exercises (as we’ve been doing!) 
• Stress management → meaning: when you know that something causes you stress and isn’t necessary to your healing, you don’t bring it into your life - as with boundaries (and our non-negotiable needs!). For example: setting times of day when you respond to email.
• Breathing exercises

The best bit about breathing exercises is they’ve been documented to decrease your reaction to stress long-term! That means that each time we practice deep breathing - even just doing our 5 breaths at the end of each of these videos - it gets easier and easier to settle anxiety and to get back to feeling well. 

There is another strategy for managing stress and triggers, called relaxation techniques, or the full body scan. During a full body scan, you pay attention to different parts of your body one at a time, while lying still, and really feel the sensations in each part of your body as it slowly relaxes. (Progressive muscle relaxation is another related technique).

These relaxation techniques have the opposite effect on the body as our fear response. There are many guided meditations and full body scans on YouTube, if you’re interested in having a look.

There are also professional treatments for PTSD. One of these is Trauma-focused cognitive behavioural therapy (CBT). Cognitive behavioural therapy is where you talk through your experience with a professional who helps you make links between your thoughts, feelings, and behaviours. CBT targets current symptoms and problems, and you work as a team with your therapist to identify unhelpful patterns in your thoughts and feelings related to your trauma, as well as how these thoughts and feelings might be related to negative beliefs about yourself, and unwanted behaviours such as unhelpful coping mechanisms. The goal of therapy is to help you gain a greater sense of control in your thoughts and behaviors and feel new hope for the future. 

For some of you, there may be a worry that a therapist might ask you to do activities or remember things that are too painful. We’d like to remind anyone considering therapy that your therapist is meant to be an ally and not someone pushing you towards anything unsafe - or exposing you to things you aren’t ready for. There is a difference between the discomfort we feel when we challenge ourselves (which comes from a place of growth) and harm. We do not have to hurt ourselves to get well. In seeking out a treatment provider, remember that you are the client. You get to decide when you find a therapist who works best to address your needs.
Another psychological therapy that has been used for  “Exposure Therapy”, you can request it be done in a fear hierarchy. Exposure therapy is where you expose yourself to things that make you frightened or start the stress response, like “triggers”, and if it’s done in a fear hierarchy you will slowly work yourself through levels of exposure as you feel comfortable, and guided by the therapist. It isn’t diving into the deep end, you’re not doing it alone.

Related to exposure therapy, there is Eye movement desensitisation and reprocessing (EMDR). Essentially, EMDR involves thinking about your trauma, and at the same time, the therapist helps stimulate both parts of your brain by making you tap your knees or follow an object with your eyes. These rapid eye movements are intended to create a similar effect to the way your brain processes memories and experiences while you’re sleeping. It is believed that helps with reintegrating the sensory aspects of the memory -- sound, sight, smell, touch -- and the reprocessing of a traumatic memory, without the brain’s attention and sensory mechanisms becoming too overwhelmed, and ultimately giving the survivor agency over the traumatic memory. This method usually involves less discussion over the traumatic event so it can work well for people that find it very difficult to talk about their feelings. 

For C-PTSD there are also specific psychological frameworks that some survivors have found useful, such as reparenting. Reparenting is a technique that some therapists use with people who grew up with dysfunctional or abusive parents who did not meet the needs of their child for love, respect, and protection. Reparenting is the process during which the therapist initially assumes the role of the ‘parent’, as it were, in affirming the child’s needs that were not originally met, and eventually hands over this over to the survivor to ‘self-parent’ their inner child. It’s a process of recognising how the inner child of a survivor may still be hurt, and allowing them the space to meet their own needs.

So there we have some psychological therapies which many survivors have found useful: CBT, exposure therapy, EMDR, and reparenting. 

Another kind of treatment some survivors have found useful for PTSD is Medication. Although there are no medications that have been specifically designed to treat PTSD, there are a variety of well-established medications used to treat other conditions such as depression and anxiety that can be helpful in managing PTSD symptoms - if that is something you’d like to discuss with a doctor. 

Before we close, let’s discuss just a few more complementary tips for PTSD that are important to uphold, which can lessen the panic that comes with flashbacks, prevent triggers, or get into that state of relaxation. 

• Yin yoga or trauma-sensitive yoga, which focuses on more gentle movements and less hands-on adjustment.
• Acupuncture for muscle relaxation and stress: it has been research-backed and approved by the US Department of Veterans Affairs as an effective complementary treatment.
• Journalling

General tips:

• Get enough sleep - 8 hours of sleep per night - because sleep is the time of the day that our cells heal, our memories settle, and we relax
• Muscle relaxation: unclench your jaw, take the tongue on the roof of the mouth, relax your shoulders, and breathe
• And, most importantly, don't isolate yourself. Seek out a community! You are learning these tools for yourself, but you don’t have to do it all alone. Find friends and family in whom you can confide, ideally people who don't panic or try to "fix” what you tell them. You can also speak to your therapist about PTSD support groups to share your thoughts with others who understand what you are going through: to share tips, validate your experiences, and remind you that you are never in this alone.

The homework for this week is… to develop a ‘staying well’ plan.

As the name implies, a safety plan is something we prepare in advance to keep ourselves safe when confronted with our triggers.
While your grounding techniques and stress management tools will always be there to regulate your nervous system and calm you down when needed, it can be stressful to try new things when we don’t know what might set us off, or else decide which method we’ll use when we’re reliving our trauma.

But, if we decide what to do in advance, there’s no reason for us to feel scared, overwhelmed, or cut off from living. We know exactly what we need to feel safe before it happens. 

This week, write out your favourite grounding exercise or toolkit methods on index cards, a piece of paper, or on your phone. Then, when you are experiencing distress, take out your cards and go through each step. That way you don’t have to remember each method by heart until you’ve gotten enough practice.