Healing from Trauma (PTSD)

Experiencing sexual abuse can be traumatic. Trauma, in this context, is an adverse event such as exposure to actual or threatened death, serious injury or sexual violence.  One psychological consequence of such traumatic experience is the onset of a mental disorder known as post-traumatic stress disorder (PTSD). 

It is important to note that not everyone who undergoes trauma will develop (PTSD). The likelihood of developing PTSD is influenced by various factors such as genetic predisposition, psycho-social and environmental factors, etc. Nevertheless, a significant number of individuals go through debilitating effects of PTSD. According to RAINN, among women who are sexually assaulted, 94% of them experience PTSD symptoms in the two weeks following the attack, and 30% of them experience symptoms nine months later. 

Possible symptoms

For some people, PTSD symptoms get better over time and disappear with good psychosocial support and positive life events. But for some, the symptoms can be debilitating and pervasive. They require professional help to overcome difficulties. 

Given below are some of the symptoms of PTSD. (Note: these symptoms are not to be used for self-diagnosis. A diagnosis can only be made by a mental health professional after careful clinical evaluation). 

• Recurrent distressing memories, flashbacks of the traumatic event or dreams that are related to the traumatic event.
• Dissociative reactions such as flashbacks in which the individual feels or acts as if the traumatic event were recurring. 
• Intense psychological distress and physiological reactions when exposed to internal or external cues that symbolize or resemble an aspect of the traumatic event.
• Avoidance of or efforts to avoid distressing memories, thoughts, feelings, or external reminders (people, places, conversations, activities, objects, situations) about the traumatic event.
• Inability to remember an important aspect of the traumatic event.
• Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” ‘The world is completely dangerous”).
• Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame) and an inability to experience positive emotions.
• Markedly diminished interest or participation in significant activities.
• Feelings of detachment or estrangement from others.
• Irritable behaviour and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
• Reckless or self-destructive behaviour.
• Hypervigilance and exaggerated startle response.
• Problems with concentration, appetite, and sleep.
• Dissociative symptoms such as experiences of feeling detached from one’s mental process or body or experiences of unreality of surroundings. 

(Source: Diagnostic and Statistical Manual of Mental Disorders (DSM–5))

Road to recovery

Recovering from PTSD is often not a simple, straightforward process. What proves effective for one person may not necessarily be effective for another. The presentation of symptoms might itself vary to a great extend among individuals with PTSD. Hence, it is crucial to seek professional help for understanding the disorder and its management.  

Treatment options encompass pharmacotherapy, as well as intensive psychotherapies such as EMDR, CBT, ACT, and others. A positive prognosis is not solely dependent on the chosen treatment approach but is also significantly influenced by the support system available to an individual, the nature of responses they receive from those in their immediate environment among other strategies that fits with an individual’s unique need. 

Some evidence-based helpful tips for healing are:

1. Practising relaxation, mindfulness and grounding exercises: Hyperarousal is a very commonly seen symptom of PTSD. We can use our body to alter and regulate the arousal mechanisms through breathing, chanting, and moving. Practices such as Yoga, meditation, Taiichi, biofeedback, etc. help towards achieving this goal.  

Mindfulness is simply an awareness of the present, accepting what is happening without any judgement. Its practices include focusing on physical sensations in and around us. This process helps in relaxation and regulation of hyperarousal. 

Grounding exercises are techniques that helps one ground themselves to the present/reality, when they feel stuck in the past or worries of future. It works like an anchor. Some examples for grounding exercises are clenching fists for few seconds and opening, pressing one’s legs firmly on the ground, holding a comforting piece of cloth, etc. 

1. Talking about trauma: Talking about what happened when one is ready to do that is one of the first steps towards healing. This could be to a mental health professional or to a trusted confidant. It is very important that the listener provides a non-judgemental and safe environment for disclosure. If that is not the case, talking about the traumatic event could have counterintuitive effects. 

For some people, talking about trauma can be more triggering. In such cases, they should take professional help and should explore other options. There are psychotherapeutic practises such as eye movement desensitization and reprocessing (EMDR), where one is offered avenues for addressing trauma without necessarily verbalizing the experience. 

1. Writing about trauma: Writing, especially in the form of journaling, can be healing. Most people who follow this practice would agree that it gives them a sense of relief. Writing about emotionally disturbing and upsetting personal events has been linked with better psychological and physical outcomes according to research. 
2. Art, music & dance: Numerous studies highlight the efficacy of expressive therapies for trauma survivors. While more research is needed to comprehend the mechanisms behind the change, it is evident that many people find comfort and healing through music or some form of expressive art or movement-based activities. This type of intervention is highly effective with children. Given that children may not have fully developed logical reasoning or linguistics abilities, expressing and healing from trauma through language might be ineffective. They are found to be more expressive through drawings/art or play. 
3. Relationships: Human beings are social animals. Social engagement is not just a physical necessity but also, an emotional one. Loneliness is found to have serious mental health consequence. One significant aspect of trauma is that the person feels lonely in their experience. They feel they cannot talk about it to anyone or that no one can help them. Humans have always found great strength through the power of community. This is visible in the times of natural disasters, accidents, etc. Even with personal emotional trauma, connecting with loved ones or to a community and sharing their experiences help people in the path of recovery. 

References

1. Victims of sexual violence: Statistics. RAINN. (n.d.). https://www.rainn.org/statistics/victims-sexual-violence
2. Francis ME, Pennebaker JW. Putting Stress into Words: The Impact of Writing on Physiological, Absentee, and Self-Reported Emotional Well-Being Measures. American Journal of Health Promotion. 1992;6(4): Doi:10.4278/0890-1171-6.4.280
3. Bessel Van Der Kolk. The Body Keeps The Score: Mind, Brain and Body in the Transformation of Trauma. New York & London: Allen Lane, Penguin Books. 2014.
4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Article by: Parvati Raveendran
Clinical psychologist