$$$$ = very expensive $$$ = expensive $$ = moderately expensive $ = minimally expensive
Talk Therapy with a Certified Counselor or Therapist
$$$, Professional Needed
Talk therapy works. It takes a lot of time and patience, and things may seem to get worse before they get better. However, with the right therapist relationship, you can be empowered to see the world differently and find the courage to face and conquer your worst intrusive memories.
Be picky about your therapist. Ask for recommendations from others you trust, research potential therapists before you call them, and look for any special needs you have, like a therapist of a certain gender, race, or religious perspective. If you feel demeaned, disrespected, or discounted by your therapist, move on to a different one. You are important. Part of your healing is your ability to articulate and state your needs, specifically. Practice this when shopping for a therapist. Don't settle.
EMDR (Eye Movement Desensitization and Reprocessing)
$$$, Professional Needed
EMDR involves no medicine. Only a trained practitioner is needed. You'll want to have a trusting relationship with your EMDR therapist before conducting any sessions, as they can be very intense and personal.
I've found EMDR to completely restructure my thinking around the memories we process. EMDR can be used to process specific traumatic memories and integrate them into your consciousness, and it can also be used to address a recurring phobia or addiction.
EMDR is a life-changer. It's hard work & requires dedication, but it's worth it.
$$$$, Professional Needed
For many survivors, it's almost impossible to talk about horrific memories without medication.
There are thousands of drugs that might help: SSRIs (for depression), anti-anxiety meds, meds to reduce "night terrors," the list goes on and on.
It's illegal to use these meds without a prescription from a psychiatrist. And not every psychiatrist has your best interests at heart. Because of the mental nature of the symptoms they treat, an immoral psychiatrist can keep you on meds you don't need for years and collect your copay.
Be picky about your psychiatrist. You're worth it. Look for recommendations. If you have a therapist or doctor you already trust with your traumatic experiences, you should ask them for names of psychiatrists they trust.
Like most all PTSD treatment, finding the right meds or combination of meds at the right dosage can take months. You'll need to be patient. That's why it's key that you trust your psychiatrist.
If your Primary Care Physician or a specialist doctor tries to prescribe you meds to address PTSD, please, PLEASE: Ask them for the name of a local psychiatrist they trust instead, and get the prescription directly from a psychiatrist. Other doctors are not all trained in the nuances & required titration of administering SSRIs, contraindications for mental health meds, and off-brand uses. Trust only a psychiatrist for mental health prescriptions.
Mindfulness & Yoga
$$, Professional Strongly Encouraged
If you've read our description of the previous categories of treatment, you might be sick and tired of me telling you that you'll have to be patient. That's understandable.
When I was at my worst, it was hard for me to survive another day, much less wait months for treatments to be effective. The LAST thing I wanted to do was wait. I would've thought about punching you if you told me to "be patient." That's why I'm not telling you in person.
Most of the work of re-wiring your brain from PTSD involves training your mind to focus on the present moment. If you can simply concentrate on what's happening right here, right now, in your body, around your body and in your mind, your nervous system automatically calms. Just observe. How can you quiet your loud, frantic thoughts? Breathe.
Mindfulness is the nonjudgmental observation of yourself in the present moment. The practice is to gently pull your mind back from memories of the past or concerns about the future and focus on an "anchor," such as the bottom of your feet as they contact the surface on which they rest. Slow down your breath, and notice every sensation it causes, from inhaling at the nose, through the throat to the lungs, to the tummy. Then notice every detail of your exhale. Observe each of your five senses in that moment: what are you hearing, smelling, feeling? Don't judge it; simply note it.
If you can find the stillness to accomplish this task, you will find relief from PTSD. You can start with one minute, like I did, and slowly increase the duration of your practices. After almost 2 1/2 years of mediation, I can usually accomplish this for about 30 minutes. Practice every day, even if for two minutes. This will create and deepen healthy neuropathways in your brain.
For me, yoga is mindfulness applied to a body. I find it easier to remain with my physical sensations when I'm moving slowly, or in certain positions that promote healing. If you have PTSD, I strongly suggest starting a Restorative Yoga practice. Find a local yoga studio that offers it, or join me at Swan River Yoga's online restorative classes. Restorative Yoga doesn't require yoga experience or even much flexibility. Rather, it's holding a few poses for several minutes each, meditating on body sensations all the while. For me, it works as a body/mind reset. If the sickness of PTSD is that our minds detach from our bodies and live in the past, then the medicine is to integrate our bodies with our minds and live in the present, which is the goal of yoga.
I have come to think of mindfulness and Restorative Yoga as the antidote to PTSD.
IMPORTANT NOTE: Mindfulness and yoga are the most powerful tools we have to recover from PTSD symptoms. However, sometimes paying attention to our bodies, or our thoughts, can actually scare us. Even trigger us. While you practice mindfulness, notice any physical or emotional discomfort; is it the fight/flight/freeze response? Measure it on a scale of 1-10, with 10 being get up and run out of the room, and maybe punch someone in the process. If you're at a 7 or above ANY TIME YOU MEDITATE, open your eyes and look at your physical surroundings. Tell yourself "It's right now. I feel __ under my feet. I'm at __ and I'm with __ who protects me. I'm safe." If those statements just aren't true at the moment, then give yourself permission to end the session. And then congratulate yourself for taking control & knowing your body.
$$$, Professional Needed
As I've said before, one of the most destructive symptoms of PTSD is dissociation, when your mind "divorces" your body. People with dissociative disorders may find it difficult to feel physical cues of hunger, or someone touching their foot, for example. In more extreme cases, they may not recognize themselves in a mirror, however briefly.
Massage slowly heals dissociation over time as you experience a firm, healing touch, and learn to track your perception of contact as the massage therapist works on different parts of your body. I've even developed the ability to concentrate on nothing else but the sensation I feel where the therapist's hands are. I'll often use an inner mantra something like this: "Ankle. Ankle. She's working on my left ankle." "Now she's working on my right foot. I can feel my feet."
Habitually clenched muscles are another common PTSD symptom. You may not even realize how tightly you hold your body in place until it's so painful it begins to cause headaches, jaw pain, back pain, joint issues, etc. The danger is over, but your body hasn't gotten the memo. Your body is still "bracing" for trauma. Massage delivers the message: "It's okay. You can relax now." straight to your muscles. Regular massage reinforces that message.
IMPORTANT NOTE: So often, the therapies than can heal us can also trigger us. Think carefully about whether your body is ready to be touched by a stranger. A lot of your readiness will have to do with your relationship with the massage therapist; if you already know & trust them, it's less likely your body will be triggered. The gender of the massage therapist could be a trigger. The space in which the massage is conducted (whether it's dark or bright, how it's decorated, whether there are windows), the kind of music being played, the massage therapist's voice, and any scented essential oils being diffused or used for massage could possibly trigger your body to have a "muscle memory" or flashback of abuse. Know this before you get a massage, and have a plan. Minimize the triggers you can predict. Often, you can have a brief conversation with the therapist before you undress & let him/her know about your triggers, and/or declare areas of your body off-limits for massage today. Be bold & make requests for light levels, music, aromas, etc. (Example: "That music is disturbing me. Can you please change it?") You need to feel safe or massage won't help you.
And remember, if you do get triggered, YOU'RE IN CONTROL. You can simply say out loud: "I'm having a flashback" or "I'm triggered," even if you don't understand exactly why. If you begin having severe (above 7 on a scale of 1-10) urges to fight or flee or freeze, that's your signal to take care of your body & ask to stop the massage. Certified massage therapists are aware of the flashback risks, and will not force you to continue with the massage.
Other considerations before planning a massage:
- Ask your body whether you're more comfortable with a male or female therapist.
- Before you go, consider which of your clothes you'd like to keep on & which you're okay taking off (you never have to be naked).
- Try a few therapists out and stick with a massage therapist you feel comfortable with (try not to have a different massage therapist each time). This will allow you to get familiar with the massage room and your therapist's technique.
- Note that it is "expensive" compared to the quick-fixes we're used to. ($90/hour is a basic, low price) Look into insurance coverage. Hopefully you can begin to think of massage as a medical, preventative expense. Regular massages may save you thousands of dollars in NSAIDs, prescription pain medication, and doctor's bills over the long run.
You've probably heard that scent is the sense most closely tied to memory. Aromas are powerful means to change our emotional & mental states.
Experiment with (high quality, organic) essential oils. Start with singular scents (not blends), such as peppermint, lavender, or tea tree. Choose a time in your day or a habit for which you'd like to change your mindset to a more positive orientation. Choose an essential oil you'd like to "pair" with that time or habit, and keep the bottle easily accessible for that time.
Falling asleep used to be very difficult for me; I'd experience a charge of anxiety and fear as I laid in bed. I've paired peppermint essential oil to my bedtime ritual. I put a few drops on my hands and rub them together, then hold them about 2 or 3" away from my face and slowly breathe. I focus my attention on the scent of peppermint as it flows in and out of my body.
Over time, "pairing" an essential oil with a particular situation can create new neural pathways which lead your mind to more positive places and help your body to feel safe.
There are many ways to experience the benefits of essential oils. Before rubbing them directly on your skin, make sure they're medical- or food-grade. Some oils are extremely strong & may cause a burning sensation on skin, especially in more sensitive areas. A diffuser is another lovely way to inject positive scents into your daily routine. Some people sleep with diffusers near their beds, or use them for meditation. Stronger scents like peppermint work nicely in a diffuser. Sprinkling essential oils into a warm bath is also relaxing, but don't use too much peppermint or menthal! :)
Your Five Senses
Our senses are direct pathways to communicate with our bodies when our minds want to ignore our bodies. Just as you need physical and emotional boundaries in order to feel safe, you should be thoughtful about your boundaries around your 5 senses.
We've already talked about scent. (Check out the aromatherapy section.)
Music! Make yourself playlists that you love, full of songs you associate with calming, safe experiences. Use them ALL THE TIME. When you notice you're feeling down, listen to your curated music. You can even have separate playlists or Spotify channels for different situations or moods: exercise, mediation, nap, calming, encouraging... Try to focus all of your attention on the music when listening. If you're a person of faith, worship music can really shift perspective.
We take what we see for granted. Often, we disregard the power a negative image has on our pysche. For me, a huge part of creating sight boundaries is researching a movie or TV show before I watch it and limiting my social media consumption. One meme can piss me off for days. You may know the feeling. If I see severe violence toward women or children on TV, I can be thrown off for days. Think about guarding your sense of sight.
Another thing: did you know that some colors have been scientifically proven to promote peace and healing? Look into those & spread them around in your life.
Finally, I write my healing mantras (beliefs that I need my brain to embrace) on sticky notes & put them in strategic places in my life. (Makeup drawer, closet, car dashboard, etc.) It's all about knowing visual input has a huge impact and taking that into your control.
My favorite meditation "quick-fix" is to eat something pleasant and focus ALL of my mental energy on the sense of taste. You can do this before you take the bite (anticipation, mouth-watering), while enjoying the bite (try to describe the different flavors & sensations), and after you've swallowed the bite (remembering the taste). I'm telling you. That's some good therapy right there. Gets your brain in a totally different place.
I have separate entry about massage, which is the obvious therapy involving touch. But did you know that our brains release oxytocin when we perceive a positive touch from a trusted person? We even get a little hit of dopamine when we make eye contact with someone we trust. (Okay: eye contact isn't quite touch.)
You can alter your mental state by:
- holding a loved-one's hand and concentrating on the sensations. (warmth? moisture? acceptance?)
- exchanging back rubs with a friend
- focusing all of your attention on touching your clothes, or a pet, or a pleasant texture for you