The field of mental health still has a long way to go in our general understanding of trauma. Trauma-based disorders are one of the few conditions that require a life-changing event for a diagnosis to be made. And unfortunately, many of our diagnostic understanding of trauma is looking at it after the fact. Mental health professionals typically explore the symptoms and functioning of people who have already endured a traumatic experience. But very little is said for the people who are still actively enduring traumatic situations, some even in their daily lives.

As with most things in healthcare, our current models of diagnosing and treating trauma are mostly during the post-traumatic phase.

Post-traumatic stress disorder has been the landmark understanding of trauma for decades. We know now these symptoms are only one possible presentation of trauma. Complex PTSD provides a deeper understanding of what it can look like for someone to endure chronic exposures to distress and overwhelm and helps paint a broader picture of symptoms that individuals may face

But there is an overwhelming need for us to examine what it looks like for people who are currently surviving adversity- understanding how symptoms present when exposed to active threats and how to better prioritize prevention. As with most things in healthcare, our current models of diagnosing and treating trauma are mostly during the post-traumatic phase. Protecting people from post-traumatic symptoms is an important part of this work, and we can best do that if we intervene as soon as possible- and we can only intervene if someone is capable of seeing that they are living through active distress.

What Happens When You Are in Active Distress?

Stress is psychological and physiological. It impacts you in your body and your brain- and the process by which this happens is a universal, neurobiological experience for everyone. In essence

• You are exposed to a demand or a threat that you perceive to be challenging or overwhelming
• This stressor is then processed by your body as a “bad thing” and a dangerous thing
• Your body communicates to your brain via the vagus nerve that you are now in the presence of danger and must shift into self-preservation mode
• This then puts you into fight or flight, and you shift out of your thinking brain
• Reflexively and automatically, you become more aware of how bad the stressor feels and you become fixated on how you can get relief from the stress
• Your body starts to feel uncomfortable because your heart is racing, your muscles are tense, your stomach hurts, and you have too much adrenaline and/or cortisol in your bloodstream
• It becomes harder to focus, to feel comfortable, to feel motivated and your behaviors shift into self-protective behaviors to get away from the stressor. You may:
  • Fight: Become self-defensive or conflictual
  • Flight: Try to avoid or escape the stressor
  • Freeze: Become paralyzed or stuck
  • Fawn: People-please or drop your boundaries
  • Flop: Submit and give up
  • Fright: Panic and explode
• You stay stuck in these behaviors until it feels like you have adequately dealt with the stressor
• Your body produces adrenaline and cortisol and then you crash into a low period so you can recuperate

This neurobiological process works great when presented with acute threats such as a bear in the woods. These processes do not work as great, however, when you are trying to function at work or in a relationship and you are stuck in a state of distress.

The longer you are in distress, the more damage your stress chemicals do to your brain and body. The more frequently you are exposed to distress, the more your ability to tolerate erodes away. The more intense or threatening the distress, the more you develop complicated or harmful coping strategies. When you are flooded with stress due to active crisis, your capacity to function becomes highly dysregulated. This regulation must be intervened before it becomes ingrained in us as a post-traumatic symptom of distress.

What Does Active Distress Mean?

While life almost always guarantees adversity, not everyone is exposed to the same intensity or frequency of adversity. And even fewer people are exposed to what would be considered true threats to their survival. When you have active threats of harm facing you, you move through the world differently than your peers. When exposed to intense, frequent, or harmful threats, you spend more resources in self-preservation and survival mode and therefore have fewer resources to expend on other parts of your life.

Systemic distress can look different to different individuals. For example:

• Financial insecurity is distressing because it poses a threat to housing or food.
• Housing insecurity is distressing because it poses a threat to safety and protection.
• Food insecurity is distressing because it poses a threat to survival and nourishment.
• Community violence is distressing because it poses a threat to safety and connections.
• Harsh political climates are distressing because they pose a threat to policy-driven needs and access to resources.

Some groups of people are more greatly impacted by these threats than others.

On a smaller scale, many people are exposed to threats of safety within their own homes. They may be exposed to

• An abusive partner, parent, sibling, or family member.
• High conflict or high control groups.
• Neglect or abandonment.
• Loss or grief.
• Substance use or harmful mental health challenges.

When Does Distress Become Trauma?

When someone is exposed to frequent, intense, and unsupported experiences of distress, it can become “toxic”. Your body is designed to only handle so much turmoil before it makes you sick. Trauma is psychological and physiological injury due to repeated or intense exposures to unregulated stress. Quite literally, trauma is when your stress exposure is so strong and so unmediated that it alters the way you feel and function.

From a behavioral perspective: if you are exposed to so much stress that it is harming you, your behaviors are going to become hyper-fixated on getting relief from the distress. This might lead to the development of relief-seeking behaviors that often exist within self-harm: non-suicidal self-injury (NSSI), eating disorders, substance use, etc. People might also develop compulsive behaviors to get relief which can develop into obsessive-compulsive disorders. On a more surface level, someone may also spend so much time and energy on surviving (working too much, protecting themselves from harmful people, etc.) that they can’t do anything else.

From a neurobiological perspective: chronic and uninterrupted exposure to adrenaline and cortisol causes damage to your brain and body. Your amygdala grows, your hippocampus shrinks, and you have less activation in your PFC. This changes how you experience and process emotions, how you access memories, how you think, and how you make decisions. This changes your capacity to make good, healing choices.

When you are flooded with stress due to active crisis, your capacity to function becomes highly dysregulated. This regulation must be intervened before it becomes ingrained in us as a post-traumatic symptom of distress.

From a physiological perspective: adrenaline and cortisol are also degrading to your digestive systems, pulmonary systems, cardiac systems, and endocrinological systems. Stress chemicals degrade you from the inside out which is one explanation behind why trauma survivors have worse health outcomes. This changes how much you can rely on your body to move you through life.

From an evolutionary perspective: you are moldable so you can adapt to your environments. You adapt in spaces of hostility so you can ensure your survival, but those adaptations do not easily apply to worlds outside of your trauma. These changes can be hard to get away from, causing repeated patterns of pain even when trying to heal from past trauma.
In short- when distress is too much, too intense, or too frequent, you can develop symptoms of traumatic stress. And trauma is complicated because it compounds. When this compounding is complex and chronic, it can change the trajectory of development, play a hand in the worsening of mental health conditions, and change the way you perceive and interact with your world.

Does Everyone Realize They Are Developing Trauma?

When your world is so overwhelming and chaotic that the distress could be damaging, it also interrupts your ability to assess what’s going on. Your situation might be so familiar or so normal you don’t even know it could be harmful. It could be so overwhelming and consuming you don’t have the space to realize what’s happening. It can be so shameful or hard to look at that you ignore or deny it.

It is often difficult for people who are in active distress to act in ways that are healing enough to protect themselves from trauma. The way that we talk about trauma is so focused on how to identify it once you have survived. The gap in identifying how to know when you’re actively living it is so important for survivors to get help as soon as possible, to better prevent the establishment of long-term, chronic symptomatology. It also helps inform providers on how to best address symptoms of distress.

Your Turn: Do you have signs or symptoms of active distress? What does this look like to you? How have you found healing? Share in the comments below.

Boundary setting is a keystone to a healthy relationship- do you struggle to set boundaries or follow boundaries set by others?

Maybe you act clingy towards your partner. Maybe you spend too much time alone. You might constantly seek validation and approval, or you might tend to remain aloof and not dependent on anyone — even your partner.

These behaviors all stem from people’s individual attachment style. Identifying your own attachment style may help you figure out (and solve) your problems with setting boundaries.

What Is Attachment?

Attachment is how you securely connect with others, and the degree to which you feel safe in your relationships. You can think of it as how you interact and connect with the people around you, especially those you love.

Attachment is the level of closeness you feel with others: it’s how you show love, care, and affection. But it is also how you interpret or understand others’ affection towards you. The degree to which you feel comfortable in vulnerability is strongly determined by attachment.

Have you ever felt fear or anxiety over your partner leaving you, or how your friends and family truly feel about you? Have you ever struggled to balance time with yourself versus with others? Are you unsure of how to determine how close to get to others? These are likely influenced by your attachment style.

What are attachment styles?

Attachment styles are the pattern of behavior or traits you develop when dealing with people — especially those with whom you have a strong emotional connection.

Basically, your attachment style is what shapes and influences your behaviors when it comes to relationships. That includes setting and following boundaries.

Although we call them styles, they’re actually more like “attachment states” simply because you can’t change them according to your whim — like how you can with your fashion style. Unless you dig deep, identify, and actively work on your attachment style, it will remain how it is, likely for the rest of your life.

The Attachment Theory

The concept of attachment styles was first developed by psychiatrist John Bowlby back in the 1950s when he came up with what we now call the attachment theory.

Everyone forms their attachment styles early on — during their first five years as a child, in fact. Which attachment style you develop depends on your primary or earliest caregivers. This means your parents, your aunts or uncles, your grandparents, or other guardians.

Your earliest relationships set the stage for the relationships you later have in life. It impacts what you view as safe, what you think is possible, how you connect with others, how you trust others, and much more.

Whether you feel safe, loved, and fully secure in your adult relationships depends on whether you were able to feel the same way as a child.

Identifying Your Attachment Style

There are two main attachment styles based on the attachment theory: secure and insecure. However, the second one can be further divided into three types: anxious, avoidant, and disorganized. This gives us four separate attachment styles.

Out of these four, the secure attachment style is the healthiest and most stable.

The remaining three insecure attachment types are often rooted in poor relationships, some form of insecurity, or even childhood trauma. In turn, these usually result in negative patterns of behavior when you get into relationships as an adult.

Secure Attachment

A secure attachment style is born from a safe, visibly loving, and of course, secure relationship with your earliest caregivers.

You don’t need to grow up in a perfect environment to form a secure attachment. What’s important is you can trust your parents or guardians to tend to your needs — both physical and emotional.

Which attachment style you develop depends on your primary or earliest caregivers.

As a child, you didn’t have any anxieties or worries that you’ll be left to fend for yourself. You felt secure in your relationships with your parents or caregivers, and knew they truly loved you, supported you, and would come back for you even if they left.

Additionally, you were given both freedom and safe, firm limits.

What does having a secure attachment style look like as a grown adult?

• You maintain a sense of independence.
• You learn to appreciate your own self-worth.
• You have a positive view of yourself or have self-esteem and self-confidence.
• You have high closeness desires while still feeling comfortable alone.
• You can maintain a healthy balance of “me time” and “connected time” with your partner.
• You are not afraid of intimacy.
• You have low avoidance or feel comfortable being with others.
• You can reliably self-reflect and manage your emotions.
• You can trust others and give your trust in return.
• You feel confident in starting new relationships even after one ends.
• You feel comfortable depending on others and being relied on by your partner.

A great way to figure out if you have a secure attachment style is to think back on whether or not you fear or get anxious about being on your own.

Anxious-insecure Attachment

Also known as anxious-ambivalent or anxious-preoccupied, this is the likely attachment state of those who need a lot of reassurance to feel safe in their relationships. Like the name implies, you have high anxiety about being abandoned.

Anxious attachment is formed when the support, love, and care your parents or guardians provided were inconsistent. When you don’t know when your needs will be met, you feel as if you need to strongly hold on to, cling to, or make a scene to be noticed by your primary caregiver.

This also results in you constantly craving for emotional intimacy and validation. As adults, this can turn into acting “needy” or clingy. As a child, this worked, as it forced the adults to attend to your needs. In adult relationships, however, it can lead to ruptures in the relationship.

Other ways anxious attachment can look like for adults in relationships are:

• You can become too fixated with your partner.
• You feel anxious when your partner is away.
• You want to be close with others but at the same time are reluctant to fully do so.
• You constantly worry about what your others really think about you.
• You try to read between the lines too much.
• You often seek approval or support from your partner.
• You can become too demanding or controlling towards your partner.
• You feel less positive about yourself or have lower self-esteem.
• You have a tendency to overreact, especially to what you may consider threats to your relationship.
• You may struggle to maintain other close relationships, outside of your partner.
• You feel as if you won’t survive without your relationship and fear you’ll end up alone forever.

The ambivalent side of the anxious attachment style comes into play when you’re unable to fully trust or rely on the intimacy and love you receive. This is why relationships with anxious attachment people can still feel cold and distant, despite the clinginess.

This can often result in the end of relationships — turning your worries into a self-fulfilling prophecy.

Avoidant-insecure Attachment

Similar to people with an anxious-ambivalent attachment style, avoidant attachment also stems from feeling unsafe in relationships. If you have an avoidant attachment style, you still have high anxiety regarding being potentially abandoned.

However, instead of clinging to others, you feel wary of others, of forming connections, and especially of relying on other people. As a result, you do the complete opposite and simply avoid or push them away first.

Relationships with anxious attachment people can still feel cold and distant, despite the clinginess.

This is why it’s also called the dismissive attachment style. “They can’t leave me if I leave them first,” or even worse, “They can’t abandon me if I never let them in.”

Avoidant attachment usually forms if you were left to fend for yourself at a young age. You learn early on that it’s hard to trust and depend on others — and that it’s ultimately easier and safer to simply depend on yourself.

If you were reprimanded or even rejected by your primary caregivers for showing emotions, expressing your needs, or depending on them, then you likely be an avoidant type as an adult, too.

In adults, the some signs of having an avoidant or dismissive attachment style are:

• You avoid physical or emotional intimacy or both.
• You feel more comfortable alone.
• You believe you don’t need others to survive.
• You are dismissive of other people or of their concerns and feelings.
• You find it hard to trust others, even without any reason to distrust them.
• You don’t want to depend on others or have others to depend on you.
• You don’t feel comfortable sharing your thoughts and feelings.
• You often don’t feel desire for relationships.
• When in a relationship, you keep your partner at arm’s length.
• You prefer more casual relationships than long-term ones.
• The romantic relationships you form feel shallow or lacking deep emotion.

Although this attachment type doesn’t seek the approval of others, that doesn’t necessarily mean they have high self-esteem or a positive view of themselves. In fact, many are the opposite. Instead of having high self-esteem, you might simply not care about what others think.

Disorganized Attachment

Disorganized attachment — also called fearful-avoidant attachment — is usually formed when kids grow up in unpredictable, highly chaotic, or even risky environments. It can often stem from some sort of childhood trauma or abuse.

As a result, you also didn’t learn how to trust and rely on others, or even yourself. You want to love and be loved. However, you also don’t know how to show and accept love offered to you in a safe or healthy way.

Not only do you have a high anxiety about being abandoned, you also have conflicting wants; you have high avoidance but also have high enmeshment. You might want to be left alone or you may insert yourself into others’ life with ease. You might really struggle with boundary setting.

This attachment style can manifest as the following:

• You’re fearful of being left behind yet tend to start conflicts.
• You find yourself emotionally shutting down and pushing your partner away.
• You tend to not take responsibility for your actions.
• You often blame yourself when fights happen.
• You have a highly negative view of both yourself and your future.
• You can become overly involved in your partner’s life.
• You find it hard to depend on others.
• You struggle with independence due to a lack of skills or self-esteem.
• You struggle with regulating your emotions and can be volatile.
• You find it hard to communicate, or you have unhealthy communication behaviors.
• You can be insensitive or unnecessarily hard on your partner.
• You’re prone to dangerous or risky behaviors when under extreme stress, such as violence, self-harm, or substance abuse.

Avoidant attachment usually forms if you were left to fend for yourself at a young age.

Do Certain Attachment Styles Gravitate Towards Each Other?

Any attachment style can be paired with each other, and since these are usually unspoken patterns in relationships, you might not even be aware of your partner’s attachment style.

Having a secure relationship does not mean it will be perfect or last forever, but there will usually be healthier management if it does end. Additionally, two insecure attachment styles together doesn’t always mean the relationship will be unhealthy or end badly — though there might be a higher risk for rupture.

Though attachment styles may have certain distinguishing traits, each person is still different. Their growth and overall journey and life will still shape their attachment style — or even shift it as they grow older and wiser.

Still, there is a lot of information we can infer from two different attachment styles getting together.

• Secure and secure: This is the winning combination, generally leading to healthy relationships and positive, healthy changes individually.
• Secure and any insecure attachment: The secure attachment can potentially help heal their partner and serve as a positive impact. At the same time, they might not tolerate crossed boundaries and unhealthy relationship signs and simply step away.
• Anxious and anxious: This is generally only good at first as both heavily prioritize the other. The downside is the lack of independence from both makes it an unsustainable dynamic.
• Anxious and avoidant: The anxious attachment often gets the short end of the stick. They tend to prioritize their partner and seek reassurance, which is great for the avoidant. However, as the avoidant attachment fails to give reassurance and instead pulls back, this raises the other’s anxiety and risk for unhealthy behavior.
• Anxious and disorganized: This is usually a chaotic pair. The relationship tends to be an endless loop filled with insecurity and stress for the anxious attachment while their disorganized partner goes back and forth between wanting and not wanting intimacy.
• Avoidant and avoidant: This is most likely to end early, as both feel at ease walking away.
• Avoidant and disorganized: While the disorganized attachment can match their partner’s avoidant behavior, they are also prone to pushing for a closer relationship, which can potentially cause chaos.

How Can You Tell if Your Attachment Style Is Insecure or Impacted?

One of the easiest ways to tell if your attachment style is insecure is to think back to how you think and act towards your partner or loved one.

Do you thrive only when you’re in a relationship and not when you’re single? Do you heavily depend on your partner? Do you constantly seek approval of others?

Do you feel extremely anxious about being left alone? Do you find being on your own uncomfortable? Do you find the need to insert yourself thoroughly in all aspects of your partner’s life — just to reassure yourself of their love and trust them?

How about worrying about what others really think about you? Do you stress about oversharing your real thoughts and feelings, thinking you’d be judged for them?

If your answer to these questions are “no” then you most likely have a secure attachment. If you answered yes to a couple (or even just one) of these questions, then your attachment style has most likely been impacted by your life experiences.

How Do Different Attachment Styles Impact How You Express and Receive Love?

Different attachment styles can dictate how comfortable you are with expressing love and receiving love, affection, and trust.

Secure attachments basically don’t have any problem with giving and receiving love. They do both in healthy, positive ways — making it easier for their partner to also feel secure, heard, and seen.

If you have an anxious-insecure attachment style, you find it hard to trust your partner and the security of your relationship. You tend to question and second-guess the love you give, as well as the love you receive. Many are also more reactive — rather than taking initiative, you take first then reciprocate.

For avoidant attachment types, there’s often a deep struggle with showing meaningful love. You tend to make shallow gestures instead. In many cases, avoidant partners may feel pressured to give more than they are comfortable.

With disorganized attachments, it’s basically both anxious and avoidant behaviors combined. You crave intimacy and seek love but often push others away or find it hard to express love in return.

If you experience a disorganized attachment style, you may feel insulted or threatened by your partner’s boundaries.

How Does Attachment Impact Our Ability To Set Boundaries?

From the examples of behaviors we gave for the four attachment styles, you can already start to see how each one sets and recognizes boundaries.

Secure Attachments and Boundaries

Secure attachments are generally the best at both setting and receiving boundaries.

In many cases, avoidant partners may feel pressured to give more than they are comfortable.

You know your limits, what feels comfortable for you, and most importantly, what you deserve. As such, you can set healthy boundaries accordingly.

You’re also able to communicate these boundaries well with your partner. If one of your boundaries is crossed, you’re confident and secure enough to walk away.

Moreover, because you know the value of boundaries and can set them accordingly, you are also able to receive and respect your partner’s boundaries.

All three insecure attachment types struggle with boundaries — but in very different ways.

Anxious Attachments and Boundaries

Anxious attachment finds it hard to set boundaries. When they do set boundaries, they struggle with following through on them. The fear of being abandoned plays a huge part in this.

Because of fear and anxiety, you’re more likely to let crossed boundaries slide. You’re also less likely to set conditions because of this fear. On the other hand, you’re also more likely to receive your partner’s boundaries well — also due to your fear and anxieties.

Avoidant Attachments and Boundaries

Meanwhile, avoidant attachment styles are actually good at setting boundaries — maybe a little too good.

If you’re an avoidant type, you’re more likely to set overly rigid or strict boundaries. Your desire to avoid dependence on others (and others’ dependence on you) can push you to make extreme boundaries designed to push your partner away.

When it comes to a partner’s boundaries, avoidants respect and recognize them well. Again, you may push this to the extreme and use it as an excuse to end a relationship. This can make it hard for your partner to set boundaries.

When you know the value of boundaries and can set them accordingly, you are also able to receive and respect your partner’s boundaries.

Disorganized Attachments and Boundaries

Disorganized styles are the ones who struggle most with setting boundaries. It’s usually because they don’t know what they want in the first place. It might also be easy to feel insulted or threatened by your partner’s boundaries.

Another thing that can make setting boundaries difficult for you if you’re a disorganized attachment is your difficulty in expressing yourself. Even if you know what you want, you struggle with communicating it with others.

Additionally, disorganized styles are less likely to steadily uphold boundaries — both your own and other people’s.

How Can You Improve Your Boundary Setting Skills?

There are several ways to improve your boundary setting skills. Knowing your attachment style and how it affects your abilities to set and receive boundaries goes a long way.

After all, recognizing the problem is always the first step to arriving at the correct solution. Knowing where you may be faltering will help you address it better.

Other tried and true ways to help you improve your boundary setting skills are:

• Improving your communication style
• Improving your beliefs about yourself and others
• Improving your understanding of other people’s needs
• Improving your understanding of your own needs
• Improving tolerance when faced with conflicts and loss of relationships

The exact way of how you can improve all these will depend on your attachment style, too!

Knowing your attachment style and how it affects your abilities to set and receive boundaries goes a long way.

Taking Steps To Repair Your Attachment Style

Perhaps repair might be too strong a word. After all, your attachment style isn’t “broken” — it may simply be unhealthy for your mental, emotional, and social well-being.

That being said, what can you do about it? Are there any ways to correct, improve, or change your attachment style? Yes, there are!

The following steps can greatly help you:

• Improve your fear of abandonment or judgment

• Find balance between isolation and enmeshment

• Improve desires for closeness

• Manage mental health or physical health challenges that are hurdles

• Enhance your overall relationships

• Find better support systems in life

• Grieve damaged and lost relationships in a healthy manner

• Improve emotional safety

• Heal from your past trauma, neglect, abuse, or betrayal

When you know your attachment style, you can start to work on it. You may be one of the insecure types today, but by addressing the issues you struggle with, you can eventually gain a secure attachment style some day.

Fear directs survival. A lot of fears are very rational: not only do they make sense, but they serve a critically important function of keeping us alive. For instance, if you’re afraid of heights, you will probably stay away from mountains and therefore reduce your risk of dying by falling off a cliff.

Fear is a natural and healthy reaction to danger. Some fear can be beneficial, but persistent fear can be debilitating- even life-threatening. We can learn to better manage our fear by understanding the flight/fight process of the nervous system, and how this process impacts the brain and body. Learning how to heal after a traumatic experience will help you take control over fear, so fear stops controlling you.

When humans are exposed to real threat to life- physical harm, childhood abuse or neglect, violence, sexual assault, or systematic oppression, your brain shifts in how it prioritizes fear. You become hyper-attuned to threats. When you don’t have adequate support after exposure to threat, this hyper-focus becomes semi-permanent. It’s an extended symptom to keep you on high alert to future threats.

When this experience happens often or with great intensity, more and more resources are directed towards your survival mechanisms. The number one job of the nervous system is to protect your survival by any means necessary. Unfortunately, complex trauma rewires us to be hyper-focused on staying safe. Your nervous system becomes so overloaded with messages of threat that it comes unreliable and unpredictable. You feel fear everywhere, while also losing your ability to tolerate the fear. You can become so scared you actually lose the capacity to keep yourself safe.

What is complex post-traumatic stress disorder (C-PTSD)?

This slow pressure of threat on the nervous system is the main crux of complex post-traumatic stress disorder (also known as C-PTSD). C-PTSD results from repeated and prolonged exposure to traumatic events. It’s characterized by a range of symptoms such as difficulty regulating emotions, flashbacks, intrusive thoughts, difficulty in relationships, and an altered sense of self. C-PTSD is distinct from PTSD in that it involves multiple traumatic events and a longer duration of exposure.

C-PTSD is most often diagnosed among people who have been victims of prolonged, repetitive trauma. It’s most commonly found in those who have experienced childhood abuse or neglect; domestic violence; and sexual assault.

Coping with C-PTSD

The impact of trauma on the brain, emotions, and behavior. 

Trauma can have a profound effect on the brain, emotions, and behavior. Traumatic events can cause changes in brain chemistry and structure, leading to changes in behavior and emotional reactions. These changes can range from difficulty concentrating and problems with memory to feeling detached from reality, increased anxiety and depression, and changes in personality.

Some people may also have difficulty regulating emotions, become more aggressive or impulsive, or have difficulty establishing close relationships. Trauma can also lead to an increased risk of physical health problems, substance abuse, and self-harming behaviors. Coping with C-PTSD poses its own set of challenges, and can be further complicated if an individual doesn’t have a support network or trusted individuals to lean on.

The following are some common ways that trauma can affect one’s ability to function:

• • Memory problems – forgetting things more than usual, difficulty paying attention, or completing tasks.

  • Anxiety or panic attacks – feeling like your emotions or bodily sensations are out of your control.

  • Depression – feeling hopefulness, sad or not enjoying activities you normally enjoy.

  • Hypervigilance – feeling on edge or fearful in your day to day life, despite lack of actual threat.

  • Heightened startle response – exaggerated response to unexpected stimuli, especially sounds, that can feel intense and long-lasting (i.e.jumping at the sound of an ambulance siren, feeling physical sensations like heart palpitations, sweaty palms, or anxiety that takes awhile to dissipate).

  • Intrusive thoughts – Image-based memory is also tied to fear, along with belief systems. Your brain will prioritize these, earmarked as “urgent” increasing the frequency in which you experience negative thoughts and intrusive memories.

  • Depersonalization/Derealization – feeling disconnected from your thoughts, feelings, and physical sensations, or surroundings. You may experience yourself as an outside observer of your own life or experience a sense of unreality or dreamlike state, as if you’re living in a fog. 

How does fear impact the nervous system?

What are the 10 fear responses?

1. Fight- I can beat the bear
2. Flight- I can escape the bear
3. Freeze- I can hide from the bear
4. Flounder- I attempt self defense but struggle
5. Fawn- I can please the bear
6. Friend- I can become the bear
7. Fright- I can scare the bear
8. Flop- I can submit to the bear
9. Faint- I can detach from the bear
10. Face- I can control my response to the bear

How fear hijacks the nervous system’s threat response.

When faced with fear, your responses change based on your perceived ability to beat the threat, your ability to escape the threat, or your ability to evade harm. When you see the bear, a subconscious judgment is made and then a response is activated. This response is then either strengthened or changed based on your actual experiences.

Fear is a normal reaction to trauma, and is your body’s way of protecting itself from danger – real or perceived.

The more your system learns it has no power over the threat, the more it shifts down into helplessness. Chronic activation of fear, especially fear that led to actual harm or danger, can disrupt the way your nervous system regulates. Living with C-PTSD, you might stop feeling fearful at all, you might experience numbness or dissociation, or you might experience intense depressive episodes. For other people, you may be able to maintain elevated responses, where you find yourself activated constantly. Most people bounce between these two states.

People who have experienced trauma may see bears everywhere, literally. This is because the amygdala- or the fear center of the brain– has adapted to see bears even when there aren’t any. Studies show that people coping with C-PTSD have amygdalas which are unable to recognize the difference between a threat in the past and a current threat. This means that if you’re reminded of a past experience, it’s as if you’re experiencing the traumatic event for the first time. This phenomenon is designed to keep you in a state of self-defense even when there is nothing to defend against. Our brain is trying to keep us safe, but it’s actually hurting us.

With complex trauma disorders, the amygdala has become hyperactive. You might experience a trigger or emotional flashback by something completely unrelated to your trauma. This is because the amygdala also hijacks most emotional processing- meaning fear gets woven into almost all of your experiences- even post-trauma experience. Emotions, thoughts, beliefs, and memories can all become tainted by fear. This is made more complicated due to the under-active prefrontal cortex.

So while your amygdala is overreacting to nonexistent threats, your prefrontal cortex (the rational, decision-making area of the brain) isn’t assessing threats as well as it should be. Having an underactive prefrontal cortex can mean slow learning of new information (which may help how you respond to fear), logical thinking, and having a harder time controlling your fear response.

assessing threat and coping with c-ptsd

Learn how to distinguish ‘real threat’ from ‘perceived threat.’

How to improve coping with C-PTSD and managing fear

Fear is a normal reaction to trauma, it’s your body’s way of protecting itself from danger (or perceived danger). It can be managed consciously and by taking steps to reduce stress and anxiety.

You do this through repeated practice of regulating our reactions to stress, seeing it like a form of physical therapy for your nervous system. We can’t stop the train from leaving the station- our nervous system is reflexive and autopilot shifts on easily. Coping with C-PTSD means that we can catch the train quicker, slow it down quicker, and rope it back into the station more effectively.

Here are things you can do that will help you feel safer when you’re feeling fearful, including:

• • Practice mindful breathing: Take slow, deep breaths, focusing on your breath and trying to relax your body.

  • Practice progressive muscle relaxation: Slowly tense and relax each muscle group in your body, starting with your feet and working up to your head.

  • Engage in activities or grounding exercises that you find calming or enjoyable: Try yoga, meditation, or even just going for a walk in nature.

  • If possible, remove yourself or take a break from whatever situation makes you feel anxious until your nervous system calms down.

  • Take care of  your basic needs and your health make sure you are: eating well, getting enough sleep and exercise, engaging in activities you enjoy (like drawing, socializing, or playing music)

  • Challenge your negative thought patterns: Identify the negative thoughts that come up when you feel fear and challenge them with positive, more realistic thoughts.

  • Talk to friends and family: Sharing your experiences with someone can be a great way to reduce fear reactions and build a support system.

  • Seek professional help: If your fear reactions are persistent and affecting your quality of life, it might be beneficial to speak to a trauma-informed therapist who specializes in working with people who’ve experienced trauma.

learn the signs of your fear responses to retrain your nervous system

When you can reduce the fear reactions you experience when NO threat is present, you’re retraining your nervous system to become more accurate and less reactive. This triggers a slow but important domino effect where your thoughts are less connected to fear, your emotions are less connected to fear, and your behaviors are less driven by fear.

The result is that you’re in better control of your physical symptoms, you improve your self-care, and begin to feel more present in life. When we aren’t motored by worry, we have space for more emotions and can experience true safety.

Here are some things you can do when you’re not in a fearful state to begin to retrain the nervous system:

• • What were the real threats, or your “bears?” How did you respond to stay safe? Why was this most likely the safest way to react to the bear?
  • Identify any coping mechanisms or strategies that may no longer be serving you.
  • What is a non-threat that triggers fear? Can you notice and manage symptoms that come up? Why does this feel so much like a bear?

Healing from C-PTSD is possible

The journey toward healing and recovery from Complex Post-Traumatic Stress Disorder (C-PTSD) is a process. There is no one size fits all approach, and it can be particularly challenging when you’re working on your own. You need to be patient with yourself, but also know that it’s okay if you need help from others along the way.

Coping with Complex-PTSD and learning how to heal is ideal in the presence of a trained trauma therapist. A trauma-informed therapist can help give you the necessary tools to practice soothing yourself out of fear, and help you distinguish between real and perceived threats. If you’re ready to take control of your own safety and stop living in fear, reach out to begin the process of healing with trauma therapy today.

Your Turn: What were your bears? How did you respond to stay safe? How have you let go of fear-based behaviors that are no longer serving you?

Receiving Higher Levels of Care (HLOC) is a necessary step for many people in their healing journey, but it can often be difficult transitioning back into everyday life. The transition from residential placement, inpatient care, or an intensive outpatient program (IOP) back to outpatient treatment can feel scary and intimidating. Your treatment program likely provided a reliable structure and added support to your routine. Some people often find it helpful to have a supportive network ready to help them or their loved ones navigate this transition.

Group therapy is a great option if you’ve just completed an IOP or inpatient treatment and are looking for extra support and accountability. Groups can help you build supportive relationships and share experiences with others who can relate to your experience. Group therapy also offers a safe space for individuals to learn new skills and challenge any negative thought patterns or destructive behaviors.

A support group that fits your specific needs is likely a great resource in your aftercare plan post treatment. However, unlike member-run support groups, group therapists have the necessary qualifications, training, and clinical knowledge to provide guidance, targeted support, and accountability to help you along your emotional wellness journey.

How can group therapy help someone leaving an intensive outpatient program (IOP) or inpatient treatment program?

Group therapy acts as a structured yet open forum to discuss personal experiences and challenges. Many group members find that over time, what they practice and experience within the group has a direct impact on their thoughts, feelings and behaviors outside the group, in their day-to-day lives.

With the guidance of a trained professional in a group setting, you may expect to:
 

1. Share and receive support and feedback among other group members
2. Developing skills to better handle stress and enhance communication
3. Learn and practice new effective coping strategies and techniques
4. Identify and better understand triggers of distress
5. Experience increased empathy and insight into personal and collective issues
6. Work towards your own personal growth 
7. Explore unhelpful thoughts, feelings and behaviors
8. Create meaningful connections with others
9. Develop healthier relationships with yourself and others

we offer virtual group therapy options for dbt and trauma

Dialectical Behavior Skills (DBT) Group, Trauma Skills Group, and a Trauma Processing Group.

Groups meet online once a week with one or two therapists and between 6-15 members who are seeking care for similar challenges. You’ll be guided through exercises and interventions, and engage in active group discussions. The overall flow of the session and group therapy activities carried out will be largely dependent on the style and the goals of the group.

Dialectical Behavior Skills (DBT) Group –Tuesdays 5pm-6:30pm 

Our DBT skills group is an open group (meaning group members can come and go at any time) of 3-15 members. You’ll learn new techniques to better manage stress, cope with negative feelings, and improve your relationships. You can expect to deepen your emotional understanding of yourself, while improving how you communicate and relate to others. You’ll learn about and build four major skills of DBT:

• • Interpersonal Effectiveness– improve relationships, communication, and conflict management

     

  • Mindfulness– learn to be present and more engaged in life while accepting yourself without judgment

     

  • Emotion Regulation– recognize and express feelings in healthier ways while feeling greater control over your emotions

     

  • Distress Tolerance– manage crisis and extreme experiences of stress through the use of coping skills

     

Mindfulness is the practice of learning
to be present and more engaged in life, while accepting yourself without judgment.

Trauma Skills Group – Wednesdays 5pm-6:30pm

If you’ve experienced trauma, we recommend starting with our trauma skills group to improve how you cope with unpleasant trauma symptoms. This is a closed group, which means it has the same members for the full 10 weeks.

You’ll learn effective coping skills to manage traumatic stress and gain knowledge about trauma’s impact on your thoughts, feelings, behaviors and relationships. In this group you can expect to feel heard and seen while healing through support from others who have also experienced trauma.

Trauma Processing Group – Saturdays 9:30am-11am

Once you gain the foundational skills, we encourage you to join our trauma processing group to begin your journey towards healing. This is an open group which consists of 3-10 members.

You’ll learn how to build trust, feel less shame, and work through difficult emotions as you share your story with the guidance of a trained professional. You can expect to deepen your self-awareness, gain new perspectives, and foster a sense of connection and community with others in a safe space.

Group therapy has been shown to be effective in treating a wide range of mental health concerns including:

Anger issues – Group therapy can provide a safe space to discuss and effectively manage anger.

Social anxiety – Group therapy can help participants build confidence, support each other in difficult social scenarios and decrease fear of judging.

Grief and loss – Group therapy can provide a sense of community and understanding, help people better understand the bereavement process and support those struggling to cope with the loss of a loved one.

Trauma and Post-Traumatic Stress Disorder (PTSD) – Group therapy can help people process and cope with traumatic life experiences, increase assertiveness, and learn strategies for regulated emotional responses.

Depression – Group therapy provides a supportive environment for individuals to gain insight into their negative thought patterns, discuss their feelings and learn problem-solving strategies to cope with depression.

Eating disorders – Group therapy can help individuals develop healthy attitudes and behaviors towards food and eating, increase understanding of their triggers and the causes of their disordered eating, and learn comprehensive methods of coping with their symptoms.

Substance abuse – Group therapy can aid individuals to identify patterns leading to substance abuse, recognize and control destructive triggers, develop social and recreational activities to replace substance usage and form strong, healthy relationships with peers.

Behavioral addictions – Group therapy for behavioral addictions such as gambling can provide structure and support to help individuals stay accountable and develop healthier relationships with themselves and others.

Stress management – Group therapy can encourage clients to discuss stressors and come up with effective strategies for responding to stress.

Low self-esteem – Group therapy can help individuals recognize and reframe unhelpful thinking patterns, develop assertiveness skills and receive positive feedback from their peers.

Family conflict – Group therapy can help families identify the causes of conflict, work through their disputes in a more constructive manner, build better communication methods and form stronger relationships.

Major life transitions – Group therapy can support individuals in adapting to new changes, allowing them to feel less isolated and more prepared for growth.

Chronic pain and illness – Group therapy can provide much needed support, understanding, and normalization for people suffering from chronic pain and illnesses. It can help create a sense of solidarity by allowing individuals to connect with others who genuinely understand the everyday struggles that come with managing chronic pain and illnesses.

Emotion regulation – Group therapy can help individuals identify and communicate their feelings in more constructive ways, improve how they cope with and respond to difficult feelings.

Discover the benefits of group therapy

Graduating from IOP or inpatient treatment can be exciting and scary at the same time. You’ve experienced a certain routine, structure, and support likely for several intensive weeks. Group therapy can be especially helpful if you’ve recently completed treatment and are looking for the next step in your mental health journey.

You’ll be able to build on your progress and continue to practice how to cope more effectively, build meaningful relationships with other group members, share your experience in a safe, supportive environment, hear stories of healing and transformation, and ultimately heal and gain insight into yourself. Reach out today to schedule a complimentary consultation to see if group therapy is the right fit for you.

Your Turn: What helped you add extra structure and support into your routine after leaving a higher level of care? If you’ve participated in group therapy before, what benefits did you experience? Share in the comments below.

Flashbacks are a common symptom of trauma disorders. Trauma is an experience of unmanageable stress following exposure to a threat or actual harm. Trauma can be responsible for lasting symptoms that rob you of a fulfilling life. A flashback is an intense recollection of a traumatic experience.

Emotional flashbacks don’t always give us time to prepare for them, and they can be jarring and upsetting when they happen. You might feel an extreme rush of emotions that feel out of your control. They occur when our system is triggered, and they can be difficult and challenging to understand.

Overtime, you might be uncomfortable with your feelings. You might even become afraid of your feelings.

While emotional flashbacks have the potential to be debilitating for many, it is possible to heal from this overwhelming symptom of trauma. By exploring different feelings and learning to experience emotion without fear, you can regain control of your body and your life. 

What are emotional flashbacks?

An emotional flashback is when it feels like you are reliving a traumatic experience, even when you’re not. These might feel like extremely intense emotions, physical sensations, or body activation for self-defense. This gives you a sense that you are actively reliving it and your body may feel the same level of terror, sadness, anger, hopelessness, etc.

These emotional experiences can feel very extreme and can be very difficult to endure. They can cause major changes in a person’s capacity to function – both in terms of day-to-day experiences as well as longer term goals.

What’s the difference between a flashback and an emotional flashback?

A flashback is when you experience a memory so intensely, it feels like you are reliving the traumatic experience. When your memory is horrifying to think about, the flashback is equally horrifying to endure.

Each person might experience flashback differently, but some common patterns include:

• • Vivid memories in the form of daydreams, intrusive thoughts, nightmares, and hallucinations. It may feel like you’re seeing the traumatic experience happen, whether you see it in your head (like a daydream) or immersed in your environment (like a hallucination).
  • Dissociation in the form of detachment from reality, a loss of time, disconnection from the environment, or splitting
  • Terror in the form of panic attack, intense emotions, or total shut down

Emotional flashbacks are not what you see or hear in your memory- they are how you feel in your body during that memory. Emotional flashbacks are as diverse as the people experiencing them, but some common patterns include:

• • Extreme experience of emotions that feel out of control or confusing. Common emotions in flashbacks are fear, sadness, anger, or shame.
  • Activation of fight, flight, freeze, etc. where the body reacts as if facing actual threat of harm in real time.
  • Physical sensation memory such as pressure, pain, pleasure, or other body reactions.

It’s typical for flashbacks and emotional flashbacks to occur at the same time. With the flashback, you might see yourself standing outside in the cold. With an emotional flashback, you might start to shiver and tense up and become panicked about freezing.

Why do emotional flashbacks happen?

Your brain and body remember experiences to help you survive.

Your brain and body remember things to help you survive. When you are exposed to something scary or dangerous, your brain prioritizes that information, as it is deemed extra-important. The goal of this is to help you stay safe the next time you encounter something dangerous. This information is stored in your nervous system, which is a fast-acting messenger system.

One important type of information stored following a trauma is sensory information, or bits of memory connected to your five senses. Your brain might hold on to things you smelled, things you saw, things you heard, things you tasted, and things you felt. This includes emotions you might have been feeling before, during, or after the trauma. When a feeling is connected to a trauma trigger, you might experience an emotional flashback.

When we get a sense of fear or anxiety, our nervous system sends messages all throughout our body to get us ready for self-defense. This is called your fight/flight/freeze response. The nervous system might make your heart race, or make your breathing shallow, or cause your muscles to get tight. When you have a history of trauma, however, you feel scared more often, and your self-defense is more intense. This means your emotions might also feel more intense. Your body’s attempt at keeping you safe may actually add to your distress.

Where is emotional trauma stored?

Pretend you’re walking in the woods and you see a bear. That bear is a real threat to your safety, and it is best if you can get into self-defense mode as quickly as possible. Your muscles will need to tense, your heart rate will need to increase, and your breathing will need to change. Your digestion system will temporarily turn off, your thinking brain will temporarily turn off, and all of your resources will be directed at staying safe from the bear.

Because of how quick this process needs to be, information about safety is stored in your body. Muscle memory is when your body can react without having to think about it. Overtime, muscle memory becomes a reflex, and happens outside of your control.

For people with trauma, your muscle memory causes your body to feel like it did during your trauma. The reaction in your body can make you feel like you’re actively reliving it, even if you logically know you’re safe.

What triggers emotional flashbacks?

Our brain has a very large task of maintaining survival. If someone has been exposed to an experience where this survival was threatened, your brain is going to do everything it can to protect you from that experience moving forward. Unfortunately, the mechanisms for survival require your brain to remind you of possible threats, even if it is distressing. For people with trauma, your feelings become intertwined with these messages of threat.

You will always encounter emotions in some form. Feelings act as messages that tell you about your environment. 

You will always encounter emotions in some form. Feelings act as messages that tell you about your environment. Sadness tells you that you are in pain. Happiness tells you that you are doing something you like. Anger tells you there has been an injustice. Feelings are all around you all the time. While some feelings may be uncomfortable, feelings in general are a normal part of the human experience.

Unfortunately, emotional flashbacks are triggered when you experience a feeling. If you were sad during your trauma, feeling sad could trigger an emotional flashback. This might mean anytime you are sad, you also feel incredibly afraid. What makes emotional flashbacks complicated, is they can be triggered by very neutral, or even positive, experiences. Something as safe as a sad movie could put you into a state of fight or flight.

What does an actual emotional flashback feel like?

We feel our memories all the time. Think about how you’re feeling while envisioning these scenarios to deepen your understanding of how your mind and body revisit experiences.

•  Imagine for a moment that you are riding in a car on an interstate, and you roll the window down. Can you feel the sensation of air on your skin?
•  Imagine you’re about to jump into a cold pool of water. Maybe you felt your body tense and you held your breath.
•  Imagine the last time you experienced something funny. Did your face smile or get a twitch in your belly?

Emotional flashbacks are more insidious. Traumatic memories often include experiences of harm, neglect, and danger. Imagine instead, that the emotions and physical sensations you recall are associated with a memory of extreme terror, hopelessness, or overwhelm. 

When thinking about your traumatic experiences, you might get a sensation of heat or heaviness in your chest. You might be hit with a sudden experience of terror, discomfort, or an extreme sensation that feels out of control. Your body might instantly become unsafe or unstable.

Why do I experience emotional flashbacks?

Emotional flashbacks are often a symptom of trauma. Trauma is a broad experience, and many people have trauma even if they don’t realize it. Flashbacks of any kind usually come from your own lived experience, but not always.

Firsthand flashbacks are when the memory is your own. You might be the target of the threat, or you were observing someone else being the target of the threat.

Secondhand flashbacks, or vicarious trauma, are when the memory was created after hearing about someone else’s story. You might hear about trauma from a family member in vivid detail, causing an intense emotional reaction.

You might have emotional flashbacks even if you can’t remember your trauma. If you are having emotional flashbacks, you could benefit from talking with a trained therapist to explore a possible history of trauma.

How can I cope with emotional flashbacks?

Emotional flashbacks are triggered by feelings, and feelings are impossible to hide from. You might find yourself trying to numb certain emotions or avoid certain emotions. Emotional flashbacks can increase the risk of dissociation as you attempt to escape your body. This might increase isolation as an attempt to reduce triggers in your life.

Over time, you may rely on harmful or unhealthy coping behaviors that impact your mental health. Someone might overuse  substances, develop eating disorders, or engage in self-harm. These are all attempts that may provide relief in the short-term to control how you feel and to reduce the emotional reaction in your body.

By learning that emotional flashbacks are a form of muscle memory for your body to keep you safe, you can develop a better understanding for how to manage them.

By learning that emotional flashbacks are a form of muscle memory for your body to keep you safe, you can develop a better understanding for how to manage them. Working with a trauma therapist can help you learn new ways to respond to feelings and practice being safe in your body. Trauma therapy can safely expose you to certain feelings to help you get used to the experience and make it less scary. You might practice “feeling sad” in therapy and then get support through skills and compassion.

Over time, this makes the feeling more tolerable and for some- even enjoyable! We can’t imagine feeling better until we actually experience feeling better. While feelings of sadness might cause a lot of pain now, you could one day enjoy a sad song or watching a sad movie. Maybe happiness has been tarnished by a difficult experience, but in the future you might find yourself feeling joy and appreciation. When we learn to understand our feelings, our feelings become safer to feel.

Strategies for coping with unwanted flashbacks

Emotional flashbacks can sometimes feel impossible to tolerate, but with practice and support, you can learn to sit in your emotions more comfortably. According to Pete Walker, a specialist in complex trauma, there are steps that can be taken to improve your ability to experience your feelings.

1. Work with a qualified professional to learn about your emotions, recognize triggers that set-off your flashbacks, and to safely reconnect with your body.
2. Participate in targeted trauma therapy to establish peace in your present life, to nurture your wounded parts, and practice safely recalling your traumatic experiences.
3. Learn and implement tools to improve safety, to challenge critical thoughts, and to improve supportive connections with others.
4. Remember that all emotions can be safe, your flashbacks will pass with time, and be patient with yourself as the most stable recovery is a process that takes time.

With support, healing is possible

Through healing, you’ll be able to release yourself from the paralysis of fear and avoidance. 

Emotional flashbacks can be overwhelming and often unbearable. Through healing, you’ll be able to release yourself from the paralysis of fear and avoidance. You’ll be able to trust yourself more and be less overwhelmed by the possibility of reliving past pain and traumatic experiences with intolerable emotion.

Learning how to manage your flashbacks and heal from some of your experiences can give you the freedom to move forward in a new way – a way that allows you to live how you desire and deserve. The goal is to no longer avoid unwanted feelings and to live life more present and open. 

Although healing from trauma can feel like a daunting journey, it’s possible with the right support. As a trauma therapist, I have experience helping clients just like you learn how to successfully cope with unwanted emotions and emotional flashbacks so that they can feel better.

My wish for you is that you’ve found this helpful in your journey to also begin healing from trauma. If any of this resonates with you or you’d like to learn more about how to manage emotional flashbacks, please get in touch with me today.

Your Turn: How have you managed emotional flashbacks? What’s helped you along the way? Share your thoughts in the comments below.