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Monday, June 25, 2018

5 Common False Beliefs About Trauma

From sexual assault to combat action, I've seen numerous cases of trauma in my office.
 
Photo Source- Reset.me

Each patient's story is unique, visceral, and deeply saddening, but there are also common threads among them that emerge time and again regardless of who the patient is or what the trauma was. Often, these take the form of patients' false beliefs about the trauma they experienced, who they are in relation to it, and what they "should" be doing to recover. Until we identify them, such false beliefs limit my patients' progress in treatment—but once we recognize them, true recovery can begin.

I've listed below five of the most common false beliefs about trauma I've encountered. Do any of them remind you of the way you think about yourself? If so, maybe it's time to revisit those thoughts. They could be getting in the way of your healing.

1. "So many people have had it worse than I did. I shouldn't be complaining."

Many of my patients say this to me when we discuss their potentially traumatic memories. People who are empathic towards others, but critical of themselves, seem particularly vulnerable to this train of thought. Attuned to the suffering of those around them, they discount their own experiences as trivial in comparison and dismiss their own emotions relating to the trauma as melodramatic or immature.
If this sounds like you: Yes, there is always someone who has had it worse. And there is always someone who has had it better. But this is not a race to the bottom. Comparing your experiences to theirs may provide some perspective, but when it comes to healing, it doesn't help you or them. Your memories are best interpreted in the context of your life, your past, your personality--not someone else's. If a memory stirs powerful emotions, either positive or negative, it's okay to let yourself feel them without judgment or disdain. Emotions are our mind's way of telling us that something is worth remembering, and only by sorting through them can we figure out what that something is.

2. "My trauma defines me. It affects everything I think, feel, and do."
On the flip side, some individuals are consumed by their trauma. Having realized that the trauma shapes a significant portion of their reactions to the world, they extrapolate its effects to virtually every aspect of their lives. In doing so, they unwittingly turn a useful psychological tool--coming into awareness of one's trauma history--into a barrier to living a full life. They may become overly cautious, afraid of being triggered. They may misinterpret normal events and feelings through the lens of their trauma. Ironically, through these reactions, they end up living more in the past than in the present--which is exactly where they don't want to be.

If this sounds like you: While acknowledging the impact of your trauma is a good step towards recovery, overgeneralizing that impact can hurt you more than heal you. The very purpose of trauma treatment is to help you survive and thrive despite your painful past experiences, and in order to
do that, it's important to learn that your trauma does not define you, has not broken you, and cannot control you. It's understandable if you feel trapped within your traumatic memories and reactions--understandable, even, if your past has become a comfortable reason not to face your present. But you deserve more than that, and the sooner you can start living in the now, the sooner you can recover.

3. "I don't have PTSD, so what happened couldn't have been that bad."
As a diagnosis, PTSD has received so much scientific and public attention that it is sometimes incorrectly assumed that PTSD is the most common and natural response to a traumatic stressor. This can lead my patients to feel like their traumas are less serious, less painful, or otherwise less valid than those of others if they don't meet the specific criteria for a PTSD diagnosis.

If this sounds like you: In reality, PTSD is a relatively uncommon consequence of trauma. Most people who have a potentially traumatic experience actually recover without long-term psychological difficulties. Of those who continue to struggle, trauma more often results in depression than in PTSD. In addition, as I have studied and discussed elsewhere, peritaumatic distress—the constellation of symptoms felt immediately after a trauma—can result not just in depression and PTSD but also in anxiety, substance abuse, disordered eating, and even posttraumatic growth, among others. So if you're struggling with a history of trauma but don't have PTSD, know that what you're going through is still real, important, and painful. Each person's reaction to trauma is unique, and figuring out what yours is can help you heal.

4. "They told me this therapy would be effective for PTSD, but it didn't help me at all. There must be something wrong with me."
For my patients who have been diagnosed with PTSD, many of them have tried a number of well-researched PTSD therapies by the time they come to see me. Prolonged exposure (PE) and cognitive processing therapy (CPT) are the ones I hear most often about, especially from veterans who have received these treatments through the VA, but there are several others. These treatments are promoted as rapid and effective interventions for PTSD, so patients often go in with high hopes for recovery. And though many do benefit from these therapies, many also don't. But because they've been told over and over again that the therapies work, those for whom the therapies didn't work may come to feel like they're the ones who failed--when in reality, the therapies failed them.

If this sounds like you: Patients do not fail therapies. Therapies fail patients. Anyone who tells you otherwise may unknowingly be expressing an overconfident belief in the infallibility of science. On the one hand, the scientific method has enabled us to develop and rigorously test treatments for diseases, including PTSD. On the other hand, science in its current form can only poorly approximate the nuances of the human psyche. The truth is, as successful as the scientifically supported PTSD therapies can be, they've run into problems too: studies have found that up to half of patients drop out or don't respond to them. So if you've been disappointed by your experiences with PTSD therapy, know that you're not alone, that it's not your fault, and that science is still working on the answers.

5. "Getting over it is too hard. I'll be stuck like this forever."
Some of my patients have been struggling for years, perhaps even for decades, with the aftereffects of their traumatic experiences. Others have only recently been working through them but are already finding the process almost too much to bear. In the throes of this terrible and sometimes longstanding pain, they start to wonder if they'll ever recover.

If this sounds like you: Don't lose hope. Contrary to what today's rapid-

cycle medical culture may want you to believe, it takes a significant amount of time to heal from trauma. Even if medications, therapy, peer and family support, or other ways of coping have worked, it might be hard to feel whole again for a while. This doesn't mean you're not resilient or not trying hard enough. It means that integrating the trauma into your life narrative—and making meaning out of what you experienced—can't be rushed. It's okay to give yourself the time you need to heal.

I hope these points have helped to clarify some common misconceptions about trauma. Was there something I didn't cover that you'd like to share? Please let me know in the comments.


ABOUT AUTHOR
Mary C. Vance, MD, is a research fellow with the National Clinician Scholars Program at the University of Michigan and the VA Ann Arbor Healthcare System. She is also a Public Psychiatry Fellow of the American Psychiatric Association, where she sits on the Board of Trustees and the Council for Advocacy and Government Relations. She is a graduate of the adult psychiatry residency program at Massachusetts General Hospital and McLean Hospital.


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