Life, Therapy

Finally talking about my trauma in detail

I experienced a traumatic event four years and nine months ago. I decided to do DBT PE (Dialectical Behavior Therapy with Prolonged Exposure) to treat my PTSD eight months ago. And today, I finally talked about the trauma in detail in therapy.

I’ve been building up to this for so long. I’ve gone over the traumatic event in my head so many times in varying levels of flashback-y-ness but always fairly anxious states. This has been a part of my life for so long.

But I had never said it out loud to another human being. I had never said it in order from start to finish. (well, the finish of one part, at least)

This feels like a watershed moment. Something small but fundamental has shifted inside of me, a change that will grow more pronounced as I continue this treatment.

I am still going about my same daily activities and interacting with the same people, but I feel a little different, as if I’m experiencing everything with freer eyes. It feels a little like what getting baptized felt like, or what traveling to another continent for the first time felt like. I knew logically what to expect, but now I’m experiencing it emotionally.

Of course, it was also really hard, and this is also only the beginning. But I finally said it!!!

Therapy

Using a safety behavior is like cheating on a test

I had an interesting dream last night that made me realize some things.

In the dream, my little sister was caught cheating on a test. Before taking the test, she had to fill out a form with her name, education level, employment, etc. (remember this was a dream, so it was a little weird). She made up a person, Avery Perkins, MD–an older, more educated woman–in order to seem smarter and get a better grade.

She took the test under this persona and got a B+. She had been hoping for an A+, but it was still better than the B- she got last time.

Now, her teacher had looked up this Dr. Avery Perkins my sister claimed to be and found that no doctor existed with that name. She knew that my sister had made up a fake person.

The teacher (who reminded me of my therapist) came over to my sister and told her that Dr. Avery Perkins doesn’t exist. She told my sister she was cheating. She looked at my sister with a serious, sad expression, and asked, “Do you understand why we don’t want you doing this?”

My sister said no, and the teacher continued, “If you cheat on a test or impersonate someone else and get a good grade, you assume that the good grade came because you cheated. You think that in order to get a good grade, you must pretend you are someone else. Getting a good grade when you cheat positively reinforces cheating. So you cheat more.

“The problem with this is that you never learn what happens when you don’t cheat. You don’t learn that you would have gotten the same grade if you had written your own name on the test. You don’t learn that you can take a test and be successful without anyone’s help. You don’t learn that you can do it.

“Cheating is a safety behavior. You use it as a crutch to get through the test. You rely on it. What are you avoiding? What are you afraid of?”

My sister said she didn’t know.

The teacher offered, “Are you afraid of failing? Are you afraid of disappointing your parents? Are you afraid of not being as good as you thought you were?”

My sister again said she didn’t know.

The teacher said, in a manner much like my therapist, “Well, I don’t have all day. I have other students to take care of. I want you to think about this and what cheating is doing for you.

“You’ll only learn that you can do it without cheating when you try it and see what happens. Maybe some things you thought would happen aren’t very likely to happen, or, when other things do happen, they’re not as bad as you thought.”

And she walked away and left me with my sister.

I like this dream because, as good dreams do, my subconscious uses metaphors to explain things to my consciousness. If I only try to face scary situations as Dr. Avery Perkins, using my safety behaviors, how will I ever know that I can face them?

My therapist has been talking to me a lot about exposure to the things I am afraid of and avoid. I’ve been noticing what my safety behaviors are when I do things that scare me.

A safety behavior is something that distances you from something you think would be too scary to face without it. Safety behaviors include avoiding something entirely (e.g. not going to a party out of fear of judgement), escaping from it when you’re confronted with it (e.g. leaving a party early), and avoiding in subtler ways (e.g. attending the party but not talking to anyone because you’re on your phone all the time).

I have a lot of safety behaviors. I carry around survival gear with me. I use google maps even when I know where I’m going. When I’m in the car, I physically brace myself for impact. I announce, “bump,” out loud before we drive over a bump. (I was in a bad car accident.) These are just a few. More obvious behaviors are that I never learned to drive on the highway, and I avoid going on trips with my family (I try to say no or get out of them).

I’ve been trying out mini exposures recently. I wiped up some blood (which was a big deal for me!), but I noticed that when I did it, I was sure to have lots of napkin in between me and the blood, and I washed my hands right away. So, to continue the exposure, next time I would try to do it without those safety behaviors.

I also told a couple friends that I was in a bad car accident, something I definitely avoid talking about. My safety behavior in that situation was that I laughed through the whole thing. I couldn’t keep a straight face, even though I was talking about something serious. I wasn’t fully experiencing the emotions that talking about it brought up. I was also very jumpy and tried to end the conversation as soon as I started it. I’m not sure how much control I have over the laughter, but maybe next time I’ll be more serious.

I’ve also been doing exposures to vulnerability with my parents. I try to share something vulnerable that I would normally avoid, like how I’m really doing. My biggest safety behavior there is avoiding eye contact at all costs. I also avoid eye contact when I’m telling my therapist something I’m uncomfortable with, and she has to remind me, “I’m over here, look over here at me,” and “If you don’t see my face, you won’t know that I’m not judging you or thinking you’re weird.”

My dream made me realize more deeply what I already knew logically, that I have to try the things I’m scared of without my safety behaviors, just as I am and no one else, in order to learn that they are safe and I can do it on my own.

Therapy

Exposure Therapy!

Today I made the decision to do exposure therapy for my PTSD!

Prolonged Exposure (PE) is offered as an optional part of the DBT treatment program I’m doing (so it’s DBT-PE if you want to be technical). My prior-to-DBT therapist and my DBT therapist have both been talking to me about doing exposure or processing through my trauma in some way for a while. I’ve been very hesitant to try it because it sounds so scary to expose myself to the things I fear most.

There’s a part of me that really wants to do the exposure therapy so that I can finally get over the trauma and leave it behind me. This part of me, my wise mind, knows it will be good to process it through. It knows that the symptoms are taking a toll on my life.

There’s another part of me, my emotion mind, that has an intense gut reaction of “NO!” to the idea of exposure. Exposure sounds terrifying. It sounds dangerous.

IMG_7051
Wise mind — a DBT concept

My wise mind argues back that a memory isn’t dangerous. I will not be put in any objectively dangerous situations as part of the exposure. And my reluctance to do the exposure is another form of avoidance, part of what exposure is trying to solve (so meta!).

Still, my emotion mind is strong. I have a lot of fear.

My DBT therapist had me do a pros and cons of continuing to avoid the trauma versus doing the exposure for it. Even after doing the pros and cons and seeing how much of my life I could get back by doing this, I wasn’t sure.

After showing my completed pros and cons chart, discussing it, and getting some more info about DBT-PE, I left therapy feeling kind of sad and hopeless. A lot of hope had been riding on this treatment program and especially the PTSD treatment (the prolonged exposure). I was really hoping this would “cure” me, if not fully, then at least a good amount. I started feeling more depressed than I had been before. I didn’t want to do anything. I saw no future for myself.

I kept thinking about it, and a few hours later, I sat down and wrote my decision below my pros and cons list.

Decision: Do exposure stuff.

Because…

  • I’m sick of this!
  • It’s been too long
  • I could feel better
  • It’s worked for other people
  • I could be more of myself
  • If I don’t, I’ll probably keep being like this, and that makes me sad.
  • I can use skills, so it won’t be THAT that bad.
  • My therapist can help me. I won’t be doing this alone.
  • Wise mind me wants to do this!
  • I am doing this because it is safe to do, and I want to feel better, not because I’m being forced into it by anyone. This is my decision.
  • Memories aren’t actually dangerous!
  • I can always decide not to do something later. I am in control of the exposures and the pace, and I can always say no.

Exposure therapy sounds like the obvious choice when I write it out like this. But I’m writing this from wise mind. It was really hard to think about this and to even consider exposure when I was in emotion mind. And I kept getting drawn into emotion mind every time I tried to think about this.

I don’t know exactly what made me switch into wise mind and finally be able to consider this rationally. Maybe the organized pros and cons list helped. Maybe all the handouts and diagrams and evidence helped make it more empirical. Maybe I needed enough time to think about it. Maybe seeing how sad I felt when I thought about deciding to not do it showed me how essential this treatment is for me right now.

This was a really hard decision, but I feel so much more hopeful now that I’ve made it.

(More info on DBT-PE: https://dbtpe.org/treatment-overview/)

What do you think of choosing to avoid something vs. expose yourself to it?