Can you explain to me why it helps with post-traumatic stress to revisit the upsetting event or scene?
Can you imagine a cowboy getting over a fear of horses by talking about it in an office?
When we’re in the midst of the horror of a traumatic event, our bodies are thrown into a high state of overdrive. This fight-or-flight response instantly puts the body into just the right mode for survival – battle-or-bolt. We need this arousal reaction – it’s very handy for self-preservation, not to mention the survival of the species. But, it has some disadvantages.
For one, it is easy to get too trigger-sensitive. That is, the merest hint of danger may ignite you. Say, a combat vet hearing a sudden noise, or a rape victim approached by a gentle man just a little too close and quickly. Both of these otherwise calm and poised individuals are instantly pitched into the same dreaded state.
A second disadvantage is that this fight-or-flight just shrieks. It’s terribly uncomfortable and we’ll do almost anything to avoid it. It’s supposed to be uncomfortable by the way. Is there any smoke alarm which gives a comforting little melody? The discomfort puts us on high alert, and trains us to avoid dangerous situations where we might experience the punishing sensation.
Finally, just as we link the “shriek” of the full-throttle fear response to the presence of danger, we also link danger to the response. Pavlov’s dogs hear a bell, therefore, they assume, it’s chow-time. It’s as if we say “I feel like there’s a grave danger, therefore, there must be a grave danger.” The sense of impending doom causes panic, which increases the sense of doom, and through the roof we go.
Now, you can read many books about post-traumatic stress disorder. You can talk with friends and therapists at length and you can perform rituals complete with incense. Actually these things are important – the support of friends and family, a sense of belonging, comforting rituals, a consistent structure to the day, a sense of purpose and meaning in your work and so on. Elements like this in your day-to-day life may prevent a traumatic event from shaping into post-traumatic stress disorder, or may soften PTSD and hasten its resolution. But the instant, patterned reactivity of PTST is in the gut, so to speak, and might remain untouched. In this case, you have to have the bodily experience, in a perfectly safe situation, to “unlearn” the reaction.
Think of the cowboy who’s been thrown from his horse. He can stay away from horses and feel just fine. He walks up to a horse though, and panic wells up. If he’s sensible like I am (or, uh…try to be), he’ll walk away from the horse and instantly feel better. But what just happened? The lesson is “close = danger, and distance = safety”. This has just confirmed to him that the horse is indeed hell-bent on killing him. He feels good for the time being, but has strengthened his PTSD.
Let’s go to the rape victim. She might stay away from a two-mile perimeter of the crime scene, she might avoid unknown men and will avoid imagining the awful event. Then she sees a therapist, who in this case is a little like the dentist in that he or she has to create discomfort to be effective. After plenty of preparation, and when the victim – wait – she was a victim. Now we’ll call her a client. When the client can pronounce with confidence that the office is in fact perfectly safe, she might be instructed to tell the story of the rape. In the present-tense, with detail. In all likelihood it will bring on that old terror. Almost like she’s there. “I feel like there’s grave danger, therefore… hey!” This time she sees that she is alive, safe and intact. She has started to learn, experientially, that she can afford to disconnect this particular alarm.
I’ll leave out other details of the process but if she repeats something like this often enough, very soon she’ll find that the retelling sparks less and less of a reaction. Keep going, and it will become downright manageable. She’ll be instructed to go out at night to safe places with safe people, and so on, to “desensitize” outside the therapy office in the same way.
The trauma happened in the past. Revisiting is not re-experiencing; it just feels like it. But feelings cannot harm you. Saddle up.