How is PTSD treated: Understanding Dissociation in Complex Trauma and PTSD
On a physiological level, trauma is high energy arousal of the nervous system that hasn’t had the possibility to discharge. It thereby interferes with the normal functioning of the nervous system and is most often accompanied by physical symptoms and mental/emotional disturbances.
The impact that leads to high energy arousal in the nervous system can either be incidental, like surgery or a car accident, or develop over time; for example, feelings of incompetence, lack of self-worth, etcetera.
Treating PTSD or Complex Trauma: Which Body-Mind Reactions are Present
The body is wired to self-regulate back to health. When we are overwhelmed by threat without having the possibility to regulate the high energy arousal of the nervous system through fight or flight, the body freezes the energy as an ultimate survival strategy. When there is no further interference, the body/nervous system will release this energy when space, time, and allowance for it are given and available.
What often happens, however, is that thought interferes with our self-regulating mechanisms thereby keeping trauma alive within the body and mind. When a value judgment is given to an incidence of high energy arousal we dissociate from embodiment and move into emotion. In turn, the emotion is coupled to the object, person, experience or circumstance thereby furthering the dissociation process.
How do Coupling Dynamics Affect Us?
To illustrate this with an example: Marie has to press on the brakes suddenly for a car stopping in front of her. When she checks in the mirror she sees the car behind her about to impact hers. She braces herself. As there is no time to regulate the energy arousal caused by the impact into fight or flight, her system freezes the high energy arousal of the nervous system. Apart from physical symptoms of the impact, she starts suffering anxiety attacks, sleeplessness and severely disturbed digestion.
As she is not aware of how to allow the body to release its surplus energy, she is overcome by feelings of helplessness, self-pity and a sense of loss of control which is accompanied by thoughts on the causal nature of the accident: “Why did this happen to me?” “What have I done wrong?” ” If only that other driver had been a bit more alert!”
In turn, these feelings stimulate her replaying of the event in her memory and dreams. Self-pity and helplessness isolate her from interacting with others and further reaffirms her state. As she is not able to regulate herself back to health and her condition persists, she is not able to commit herself to regular working hours and has started smoking again after not having smoked for more than ten years. The above example gives a clear view of the impact of trauma, coupling dynamics and dissociation processes. Furthering dissociation leads to more complexity and coping habits.
The Pathway of Dissociation in PTSD and Complex Trauma
The first dissociation happens when there is a negative value judgment given to the high energy arousal in the body. This happens at an unconscious level and can be instantaneous upon the event of the car accident. When that happens, the high energy arousal is coupled through a negative judgment value (“I don’t want to feel like this”,” I don’t like this”), to emotion such as feelings of helplessness, self-pity and loss of control (guilt, blame and self-reproach).
The second dissociation is when the event, in this case, becomes interpreted and colored by her emotional state. Thus her emotional state of self-pity (“why me?”), helplessness and blame (“If only the other driver had been more alert!”) is coupled to the event itself (recurrent replaying of the event in her memory and dreams infused with feelings of self-pity/guilt, helplessness/self-reproach and blame).
When working with trauma one must address these coupling dynamics in order to bring into awareness how trauma is kept in place.
Dissociation prevents one from self-regulating back to health. It is the work of the patient and therapist to explore dissociation so that the emotional residue and high energy arousal of the nervous system can be understood and released.