Hello everyone! We're back for Week 3, Session 2.

If this is the first time you’re reading this, a warm welcome to you! 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! 

The goals for this session are:

• Learn about C-PTSD
• Identify signs and symptoms of C-PTSD
• Reassure everyone that diagnoses do not define us

As always, we’re going to start with a grounding exercise. If you can, please join in. 

**Today’s grounding exercise will be…
**Think about your Safe Place. Practice it one more time. Imagine your Safe Place was being projected on a screen in front of you. Can you see it? Now imagine it is a touchscreen and with your fingers make the image of your Safe Place smaller, now bigger again, now slide it to the right or left…now close it like you would close a window in your computer or a tab on your phone. This technique can be helpful when suffering from difficult intrusive images. Imagine you can manipulate the image in this way and it might help you feel more in control of your intrusive memories. 

Fun question: What’s your favourite fact about the place you were born (or grew up)?

As we discussed in Week 2 when we explored ACEs, there are situations where trauma does not present itself as an isolated, one-time-only incident. We are talking about situations of continuous and repetitive exposure to trauma, such as violence, neglect or abuse.  

This kind of scenario is more complex; with time, exposure to a traumatic environment can affect the way we see ourselves, and it can affect our identity and personality. So today, we will be learning about what we call Complex Post Traumatic Stress Disorder (or C-PTSD), which encompasses what we were just describing: situations where people have repeatedly experienced trauma, either at an early age or during adulthood, or situations in which you have experienced multiple traumas with more than a single episode.

The diagnostic concept of Complex PTSD came about after we already had PTSD as a recognised disorder, because specialists started to see that PTSD didn't quite capture the reality of many people. A lot of our earlier understanding of PTSD as a disorder came from studying soldiers and people in conflict regions; these are very traumatic experiences, to be sure, but the relationship between the traumatic event and the present didn’t always manifest as directly. Clinicians realised that the picture for someone that had suffered an isolated traumatic event was not the same one that someone that had experienced prolonged, repeated trauma would have. 

These people, who’d experienced captivity or abuse, would be mostly suffering in silence. Or, if their pain manifested, it wasn’t well understood. In many cases, it meant that they would be medicated or treated for the various different symptoms that would manifest at the different stages of their lives - such as headaches, sleeping difficulties, anxiety or depression symptoms, and more - in isolation from each other.  This, of course, did not work. You probably already figured why: because the underlying trauma was not identified or addressed. 

Survivors of abuse can many times fall under this umbrella, and it's very common that they develop changes in their personality and sense of identity. And these are not captured on the original diagnostic criteria of PTSD! That is why professionals started to push to have a new formulation of a post-traumatic stress disorder that would include the complex experiences of people that suffered prolonged trauma exposure, and the impact on people’s personality that these traumatic experiences can have. As we have discussed before, trauma responses are not black or white. They are so complex and varied that they fit better under the idea of a spectrum of responses, and this new diagnostic concept attempted to throw some light over all the tones of the trauma grayscale. 

C-PTSD symptoms are similar to the ones we looked at when discussing PTSD but they might also include:

• feelings of shame or guilt
• difficulty controlling emotions
• periods of losing attention and concentration, also called dissociation
• physical symptoms, such as headaches, dizziness, chest pains and stomach aches
• cutting oneself off from friends and family
• relationship difficulties
• destructive or risky behaviour, such as self-harm, alcohol misuse or drug abuse
• suicidal thoughts

People that experienced C-PTSD are likely to have been under some kind of authoritarian control over a prolonged period of time - as in months or years. Some examples of situations like this are when people are taken hostage, Holocaust survivors, prisioners of war, childhood abuse survivors, sexual and domestic abuse survivors, amongst many others. 

One of the most characteristic features of C-PTSD, as we were recently discussing, is the changes one feels in our sense of self. Our self-perception can become compromised, making us feel like we are completely different to others and nobody can understand us, feeling very helpless and paralysed, with strong feelings of shame, guilt and self-blame. 

Sometimes in the case of C-PTSD, this is because we have learned to internalise a sense of blame for our mistreatment. That is, in a basically inescapable situation such as an abusive home or a prisoner-of-war camp, to accept that there is nothing we can do about our abuse and mistreatment is to live a doomed life. But we are creatures wired to survive, and we cannot accept that we are doomed to suffer. So, we may internalise the idea that we are to blame for our mistreatment, because our own behaviour is something we can control. Of course, it is not our fault that we are in that situation, but internalising the feeling that we are to blame is a kind of protective mechanism against the despair of an inescapable situation. But of course, this sense of shame and blame can affect our sense of self.  It can be very confusing to feel like suddenly we are disconnected from who we feel we are, and not being able to recognise ourselves in the way we act or feel once we are outside the inescapable situation. This is very normal in traumatic situations like this, but we encourage you to consult a professional if any of this is resonating with you. There are lots of things that can help you feel better and reconnect with your sense of self along with what we are learning here, including therapy, which we will get to next week.

And remember, as we have been learning from the beginning of this course, trauma is heterogeneous which means it can present differently for different people and different communities, and it can gain complexity with time and prolonged exposure. We are sharing here the trauma diagnoses with you so you can have a better understanding of trauma; we want to give you information to hopefully allow you to make meaning out of what's happened to you and be able to reach out for professional support if you need it, but we would not recommend self-diagnosing. 

Preserving your self-care in cases of  PTSD and/or CPTSD

These terms can be of use in recognising the suffering that we have gone through and getting some tools to work these symptoms, but in no way does that diagnosis define us! We are a wonderful mix of many things and experiences, not just one medical term. Being a survivor of trauma or abuse has many layers and dimensions, none of these layers are the same for 2 people, and your existence is what you make of it, nobody else. 

We will be looking more deeply at coping mechanisms later on in the course, but today we want to leave you with some tips that can help if you are suffering from trauma reactions on a regular basis.

Learn about how traumatic reactions feel for you: try to identify your triggers. Is there a special sound, smell, place that brings back intrusive memories or flashbacks? Once you know this, try to put things in place to help you stay grounded by anticipating some things that can come up for you. Let's see an example: 

Julio has been suffering from intense trauma reactions following a house fire. He knows his triggers are: anything that smells like smoke, and when people all of a sudden bring up the subject of his house fire in conversation and in public. Julio’s self-care action plan is: 

1. Julio now carries a little bag of lavender leaves in his pocket to be able to contrast the smell of smoke if he needs to and feel reconnected with the present. 

2. He has communicated to his friends that he prefers it if they don’t bring up the subject of his house fire in public with no notice. 

Julio was able to anticipate his needs and act upon them to reduce the impact triggers can have. The context in which triggers might come up is not always predictable, but having some tools to quickly adapt to difficult situations can help us feel more in control. And practice is always helpful. 

Another technique that some trauma survivors have found useful is to keep a journal or thought diary. Journalling can help you understand and integrate parts of your experience, and then serve as a reminder for when you’re working through similar emotions at a later point. You can be creative with it! You can include songs, some art work, anything that connects to your experience and how you are feeling. This can be especially helpful if you tend to dissociate, or disconnect from yourself and the world around you, to be able to connect with the different parts of yourself and your environment. What is in your thought diary is personal and up to you, but having a journal to-hand and readily available, whether to write in or to read, may alleviate some of the stress of not knowing what to do when a panic trigger sets in.

The homework for this week is… well in fact, now we have got excited about having a journal or thought diary...so let’s each start one! This can really help with your recovery. So, for homework, start keeping a journal. Even when you don’t feel inspired to write anything, try to write 1 sentence or even 1 word a day.  

The key to journaling is practice and routine -- there’s no ‘right way’ to journal, but keeping it up as consistently as we can can help make it easier for us to turn to journaling when things become more stressful. For example, some people find it helpful to write down negative persistent thoughts, as a way of externalising them and realising that they might not be helpful or true, while others find it helpful to write down the positive things, in order to remember and use them more easily. It’s up to you! 

Remember, this is an investment in your own journey to recovery. Give yourself the best chance to build resilience. You can do this.