I man the PODS helpline on a Tuesday evening from 6 to 8 pm and take other calls by appointment throughout the week. On average I take about 12 calls from people with a dissociative disorder every month, and most of them last between 30 minutes and an hour. On top of that I respond to around 30 helpline emails every month – these aren’t just requests for information, or enquiries about training days, or orders for resources, but emails asking significant questions, looking for significant answers. And when I stand back from it all and have supervision, one of the things that continues to strike me is slightly obvious, very simple, but hugely important: almost every single person behind every single call and email has a significant level of anxiety and/or distress in their life.
I think it’s fair to say that most trauma survivors live with intolerable levels of anxiety on a day-
In many ways I think that ‘recovery’ from dissociative disorders, rather than being specifically about resolving traumatic memories and ‘integrating’ dissociative parts of the personality, can be quantified in much simpler terms. I would suggest that recovery can be measured by how frequent ‘crises’ are, and how quickly the survivor or client can return to normal life after them. Is that ‘bounce-
As well as running PODS, I’m in the latter states of my training to become a counsellor and I am currently in the middle of my placement with the mental health charity, Mind. So in the course of an ordinary week I come across a whole range of people, not just those that we might consider to be at the ‘extreme end’ of the spectrum with a dissociative disorder or a significant trauma history, but people without a mental health diagnosis but who are nonetheless regularly experiencing states of unbearable anxiety. So what does anxiety look like in the people I talk to, counsel, email and live with?
Some symptoms of anxiety are as follows:
- chronic and excessive worrying
- feeling keyed-
up or on edge
- being easily fatigued
- difficulty concentrating or mind going blank
- muscle tension
- sleep disturbance
- feelings of distress
- inability to relax or wind down
- panicky thoughts and sensations
- fast heartbeat
- racing thoughts
- digestive disturbances
That’s just a selection – bullet-
And it’s what we do to cope with anxiety that often leads to problems. How do you calm down if you’re in a state of constant restlessness and you’re exhausted but you can’t sleep, you feel panicky and on edge and you don’t even know why? Many people quite understandably turn to ‘alternative’ or even illicit methods to counteract this anxiety. For example there are what are essentially cognitive strategies, which if severe and chronic enough can end up being diagnosed as OCD (obsessive compulsive disorder) – the need to wash your hands constantly because there’s an overpowering anxiety and focus of attention on dirt or germs. Or the need to do things in sets of four, because it doesn’t feel ‘complete’ if you don’t, and sets of four reduce the tension and distress inside temporarily, while doing something three times or five times seems to heighten it. There are practical attempts to dull anxiety, such as through drinking alcohol, eating certain foods, smoking, drug-
When anxiety levels rise, often they are fuelled by factors in our environment – it very rarely happens for no reason. Crises are precipitated by outside stressors, such as involvement with the police (perhaps to report historic childhood abuse), an absent therapist (and it’s him or her that we use to manage our feelings, amongst other things), mounting life pressures such as relationship conflicts or job hassles or the boiler breaking or benefits being reduced. We all exist as part of a system, and when anxiety levels hike, it’s often important to try and identify what it is that is causing that – what is causing it outside of ourselves, because it’s too easy to blame ourselves for not being able to cope and for worrying, when in fact anyone would be stressed out if they had our particular soup of life circumstances to deal with. Sometimes the best remedy for anxiety is to deal with the thing that’s causing the stress – the difficult relationship, being in contact with abusive family members, a job that pays badly in return for crazy working conditions. Too often these circumstances can’t actually be changed, at least not immediately, but it’s important to try to identify if they can, because trauma leads to powerlessness, and sometimes there are things that can be changed that feel as if they can’t. Feeling stuck and trapped and powerless is a surefire way to spike anxiety.
A very real phenomenon that I have come across in dozens of people is the way that anxiety is often fuelled by the person’s sense of their own inability to manage feelings generally. It’s a sort of vicious cycle: “I’m stressed because I know I get stressed easily.” People with secure attachments and good resilience feel generally confident in facing down life’s challenges – they have confidence in themselves, so they deal with situations with less anxiety and concern. This frees them up to deal with the actual challenges themselves. But the opposite is true of people who have had a rough time growing up. If you feel that you’re not going to be able to cope, that in itself is anxiety-
What is really important to realise, though, is that struggling to cope and remain calm in difficult circumstances is not because you’re ‘bad’. It’s not because in some way you are ‘defective’ and ‘worthless’ and ‘pathetic’. It’s a natural result of not having lived in a secure, stable, predictable world when you were growing up. Your edginess now, your hypervigilance to things going wrong and your suspicion that you’re going to be ripped off, is your brain’s adaptive attempt to be one step ahead of the game in a hostile world – it’s trying to anticipate things going wrong to give you increased time to respond to a potential threat. Your hyper-
This is why the preferred treatment pathway for trauma-
Of course I don’t just work with people who experience high levels of anxiety, but I live with someone too! As we have written and talked about in many previous contexts, several years ago and almost literally overnight Carolyn went from being a highly competent ‘professional’ to having what we then termed a ‘breakdown’. She was beset for months on end with unbearable levels of anxiety and distress. It was through all of that that memories of her abuse began to flood back and the dissociative nature of her personality became clear, and she’s been on a journey of recovery ever since, which is ongoing. But a major thing which has helped Carolyn ‘cope’ better, which has enabled her to return to full-
In talking about this subject with her, Carolyn identified three bundles of groupings of thoughts which she would experience (and still does) during periods of high anxiety. These are:
- catastrophic thoughts
- and paranoid thoughts.
Her ‘catastrophic’ thoughts all revolved around the premise that everything was going to go wrong. Rather than it being just one unpleasant email she had received, or just the washing machine that needed fixing, in this kind of state of mind, it was as if everything was about to explode. If the washing machine had stopped working, then how did we know that the oven wasn’t about to pack in too? If one person had gossiped something unpleasant about us via Facebook, how did we know that all our friends wouldn’t suddenly turn against us? Who was to say that the noise that the car was making wasn’t terminal, and shouldn’t we just get rid of it now before we found out that it was a worthless deathtrap-
It has always been tricky for me to fully empathise with Carolyn when she has been in this state of mind, to realise that the overwhelming blackness feels so incredibly real to her – because to me, outside the situation, and outside her state of mind, this supposed catastrophe looks awfully like a temporary blip … and I want to say so! But I have learned, and perhaps am still learning, that agreeing with her emotions whilst verytactfully offering an alternative to her catastrophic appraisal of truth, is the best way forwards. Saying, “Don’t be so stupid!” in a frustrated-
Many trauma survivors will likewise be familiar with the ‘self-
And sometimes as a combination of the catastrophic and the self-
So it’s been helpful for Carolyn to realise that her brain is over-
There are a variety of measures in therapeutic and healthcare settings that are used to tackle anxiety, some more effective than others, but it’s a good idea to take a broad-
- Cognitive Behaviour Therapy (CBT) – especially useful for tackling some of the distorted thinking (eg catastrophising) that can lead to and increase anxiety, as well as result from it
- medication (although beware of side effects and the addictive nature of certain drugs eg benzodiazepines)
- mindfulness, including MBSR (Mindfulness-
Based Stress Reduction)
- relaxation techniques
- tackling insomnia (the vicious cycle of sleep deprivation leading to reduced coping capacity, which increases anxiety, which increases insomnia) – apart from medication, there are a variety of ways to improve sleep including exercise, diet, ‘sleep hygiene’ (routines and environment etc), exposure to daylight and so on
- soothing strategies (ie finding ways to reduce anxiety and distress once it starts to build eg by going to a ‘safe place’, either literal or imagined, or anticipating upcoming stressful events and planning to manage them as well as possible)
- increased social support (eg a better network of friends, supportive family, counselling/therapy, and engaging in social groups or activities)
- ‘boxing’, ie putting anxiety or the things causing it into a metaphorical ‘box’ and then allowing a ‘controlled explosion’ or exploration at a more supported and appropriate time, eg during a therapy session
care (includes diet, exercise, self- talk, positive and pleasurable experiences)
- dealing with underlying causes of anxiety in therapy
- learning to manage the physiological (bodily) symptoms of anxiety, eg breathing exercises, stretching, ‘tracking’ internal sensations as part of Sensorimotor Psychotherapy).
There are many more ways that I could mention and in much more depth, but the point that I am trying to make is that anxiety is not something that just has to be put up with. It’s something that can be dealt with on a number of levels in a number of ways, rather than being impossible to tackle. And that’s very much what I believe about recovery: that trauma is primarily about loss of control and ‘self-
And it can be a revelation to people to realise that they can learn to start to take control of their thoughts, their feelings and even their bodies. For many trauma survivors, all their life things have just happened to them, outside their control, and especially where their bodies are concerned. So not only is getting in control of anxiety helpful in and of itself, but it can be a really positive stepping stone towards changing your view of yourself: that you’re not a helpless victim of whatever thoughts or feelings or bodily sensations come your way, but that you can manage them, and control them, and even start to change them. That is one of the many reasons why mindfulness can be so helpful in the recovery from trauma and dissociative disorders – because it teaches skills that directly impact your control of your mind, emotions and body.
So ‘affect regulation’, learning to manage your feelings, is not just a casualty resulting from early life traumatisation, but it can be a barometer for measuring recovery – for how well you’re starting to get back in control, after a lifetime of powerlessness and victimhood. And in many ways that is a balancing act of two factors. Firstly, the process of recovery involves learning to manage anxiety and feelings in general, which is a bit like mopping up overflowing bathwater that is flooding the bathroom floor. It’s a case of responding to the emergency-
In conclusion, there is hope. High anxiety is something that plagues almost all trauma survivors, and learning to manage it is an essential skill. It is the first and possibly most essential part of the three phases of treatment: safety and stabilisation. Anxiety left unsoothed can quickly escalate to a crisis. But anxiety understood and responded to, with skills such as mindfulness and relaxation, and then processed at a deep level by understanding what led to it in the first place (the dissociated trauma) does dissipate over time. And life becomes more bearable, without that sense of doom or dread, without the frantic, skin-
Don’t worry, be happy … It’s a promise, not a command!
© PODS 2013