Understanding and Overcoming

In our last column, we began exploring the four ‘clusters’ of PTSD symptoms: intrusive thoughts and memories, avoidance, alterations in mood and cognition, and hyperarousal or hypervigilance. Having discussed intrusive thoughts, this month we’ll delve into the complex sphere of avoidance.

Intuitively, it makes sense for someone with PTSD to avoid anything that might trigger a distressing re-experience of trauma. It’s akin to avoiding an open flame after getting burned - a straightforward, protective response. In essence, avoidance can be seen as a ‘safety behavior,’ an adaptive strategy developed to shield oneself from perceived danger.

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However, the traumatized brain can be deceptive. Initially, sensible avoidance behaviors can escalate and rigidify, taking over more and more of daily life. Last month, I described a veteran who had been robbed in a grocery parking lot. His justifiable fear of the robbery location morphed into a broader avoidance of all parking lots. He started taking taxis to work, at considerable expense, to avoid parking in his office parking garage, and even refrained from social events that required night-time parking. His wife became increasingly concerned when he began avoiding social outings. He became more morose with feelings of intense shame, fearing his friends and co-workers might find out about his trauma. His world began to shrink as he succumbed to avoidance.

Furthermore, he developed recurrent nightmares about dying, which awakened him in a panic. To fend off these nightmares, he started avoiding sleep, subsequently resorting to heavy drinking to induce a dulled, dreamless slumber. As you can see from this case, unchecked avoidance can infiltrate multiple aspects of life, affecting mobility, daily tasks, social interaction, family and sleep.

The subtlety of the traumatized brain lies in its ability to justify avoidance. Every successful instance of avoidance is interpreted as evidence that the strategy is working. The ‘safety division’ of our brain is reassured when disaster is averted, and so the avoidance repertoire expands, further shrinking the PTSD sufferer’s world. This process can inadvertently cultivate feelings of loss, shame, and secrecy, paving the way for depression.

In illuminating the intricate workings of PTSD, my intention is not to paint a bleak picture. Rather, by fostering a comprehensive understanding of these symptoms, we can better tackle them. Over the next few months, as we explore the remaining symptom clusters, we will also delve into effective methods that help individuals reclaim control, rekindle confidence, and rediscover joy on their path to recovery.

Cuyler is chief clinical officer of Freespira, an FDA-cleared non-medication treatment that helps people with panic and PTSD manage their symptoms by learning how to regulate their breathing. - www.freespira.com mobiusmobility.com info@mobiusmobility.com www.freespira.com/veterans