PTSD and Partners of PTSD
4 HELPFUL STEPS, WHEN YOUR PARTNER HAS PTSD
Those who are in relationship with a person that becomes symptomatic from Post Traumatic Stress Disorder (PTSD), are often times confounded and confused in regards to how they can help the person suffering and not make matters worse with their attempts to help. The partners of those with PTSD can gain knowledge about how to navigate certain symptoms of PTSD, and so when they occur, both parties are not left feeling helpless, terrified, and/or in despair. Dealing effectively with PTSD symptoms can feel counter intuitive, and yet when practiced, tools for recovery can alleviate some unexpected feelings of being lost and/or isolated.
The following four steps will provide couples with some options, in order to gain a sense of predictability, increased stability, and a navigational system. Although PTSD is much more complicated than this article addresses, this four-step approach can help to lessen the distress for couples.
Key elements partners can practice during times of distress include: reminding yourselves that both you and your partner are not reacting by choice, i.e. the reaction is not volitional; by identifying the triggers that caused the reactivity; by deciding on key words that may be used as sound bites during triggered episodes; and then lastly by constructing a plan of action, a plan to navigate, in order to maintain stability.
Often times when the person with PTSD is triggered, the triggers that caused the dysregualtion, i.e. hypervigilence, dissociation, panic, terror, altered shift in cognition or mood, seemingly unwarranted anger, avoidance, and/or fight, flight, or freeze response, can be identified if there is a discussion regarding all of the possible triggers that occurred. This discussion needs to take place during a time when the triggered response is not activated. Triggers can range from smells, visual stimuli, auditory stimuli, time of day, certain dates, movements of others, movements of objects, light, touch, sound especially, vocal prosody, and many other possible forms of input and or experiences that serve as reminders or memories of the trauma.
Applying The Four Steps To Regulation and Stability
1. THE REACTION IS NOT VOLITIONAL. YOUR REACTION, AS THE PARTNER, TO THE REACTION IS NOT VOLITIONAL.
When triggering events occur, it disrupts secure attachment as well as stable regulation for most parties involved. It helps to know that nobody is doing this on purpose, the reactions are not by choice, not volitional, when one is triggered into survival mode unexpectedly.
I have constructed the following interactive pattern as an example of how parties can become blind sighted by a PTSD trigger, and how one can apply solutions. During these episodes follow the following process. Identify the event, the trigger, the subsequent reaction, and then key words and action tools that serve to help with regulation. This reaction is psychobiologically based and caused by a trigger.
Example of Triggering Episode: Two people are planning to attend their daughter’s wedding. Both parties are in an excited state, as this wedding has been planned for two years. The couple arrives at the place where the wedding will take place and there is a loud cracking furnace noise intermittently banging away in the structure. The partner with PTSD dissociates and it seems like caring about the daughter’s wedding has gone out of the door. Now, instead of getting into an argument, they have already established that when there are loud sounds of metal clanking established a key word is utilized. The triggered party says, “Noise Overload”. Because they already agreed on specific actions that may be taken during PTSD triggers, they decided that they would both go somewhere separately and have a cool beverage with ice, for about ten minutes, with the intention of the partner with PTSD coming back into a more regulated state. Because they have established, that during the times when they may not have hours to spend reregulating, they agreed on whatever was possible and/or reasonable.
The interaction above is an example of affiliative behavior, which has been recognized as a healing factor for those with PTSD. Interaction with one another during these times, with a goal of regulation is an affiliative agreement. (1) Instead of the couple alienating themselves from one another, they plan to work together on regulating one another.
The sympathetic and parasympathetic nervous system, operate, along with a multitude of biological functions, to provide necessary responses to basic biological needs, and play a large part in one’s ability to gain necessary energy during times of stress, as well as reduce energy levels for times of relaxation and restoration. With PTSD, the two systems have sometimes become altered and when the traumatic event has passed, the nervous system may operate as though the trauma is still occurring. When you have this knowledge, that during triggering times, you and your partner are conductors of an orchestra that has gone awry, it helps not to feel as though you are simply thrown into a state that is filled with confusion and terror. (2) Ultimately, the goal together, as a couple is to create a regulating system, in concert, to provide one another with an affective (emotional) intention, and state (bodily function) adjustment, in order to supply and provide optimum functioning collectively and individually.
2. IDENTIFY THE TRIGGERS
If the person with the PTSD symptom becomes triggered and needs to regulate, their partner may feel immediately abandoned and blind sighted. This most naturally would make most people feel angry or sad. Create a firm understanding of the reactions all parties experience during triggering episodes, the partner included. What are your reactions to the reactions?
While identifying triggers, the challenge is to identify the triggers beforehand or retrospectively, because when one is triggered into a fight, flight, or freeze state, the reflective function of the brain is limited, because the necessary survival response has taken over. Amygdala activation occurs during PTSD symptom provocation. (3) Consequently, after the person with PTSD has been triggered, their trigger can subsequently activate a survival mechanism in those around them.
3. UTILIZE KEY WORDS
Once the triggers have been identified, when the person with PTSD has been triggered , have a firm plan in place, whereby you utilize key words that you can say to one another as an acknowledgement that an alarm has gone off, which means dysregulation has occurred.
Decide together what key words each party can use, comfortably, to signal one another that you are feeling off. Communicate whenever there may be the onset of a trigger. Say words such as, NOISE, ODOR, TIME, or some key word identification. Establish a short cut sound bite to communicate AND IDENTIFY the trigger.
4. APPLY NAVAGATIONAL REGULATING ACTION TOOLS FOR ALL PARTIES INVOLVED
Apply navigational regulating action tools for all parties involved, starting with the baseline understanding that when someone is triggered, they will need more time than most to calm back down, or what is considered the process of reaching a restored regulated state. During that time, utilize a list you have created with one another, of regulating activities and actions, and give one other an agreed upon amount of time to separate physically or remain together while you practice your tools.
Agree on a calming or centering interaction, i.e. deep breathing, humming, meditating, or possibly drinking a cool drink or applying cool water to your neck, feet, and wrists, deep breathing, humming, meditating, taking a swim, taking showers, listen to music with ear buds, draw, write, paint, sit with your backs to one another breathing deeply which will activate a parasympathetic response. Learn about what brings you and your partner towards an increased regulated state. This experience, if you decide to separate for demarcated periods of time, is not the same as isolation as a reaction to flight response, but a restorative time, followed up by an agreed upon check-in update time. The reevaluation is constructed in order to observe whether sufficient regulation has been accomplished in order to function sufficiently.
Regulating tools are critical. Not everyone is calmed down by physical separation, but if you remain within close proximity, decide what action you will take together for restorative purposes. Always assign a time frame for the need to regulate, otherwise all of the parties involved will remain in a stressful state. If you are unready upon return, have an agreed upon additional time frame, and decide whether or not the tool you applied was working.
There is a clear psychobiological response to stress when someone has PTSD. If the stressor is above certain intensity or lasts for a longer period of time the sympathetic response to the stressor becomes more intense, and then restoring the emotions and body back to a more normal state becomes more difficult. Without ways to help reduce the chronic stress and head back to normal functions, the pattern in and of itself can cause stress. So, having a way to restore functioning together is critical, and although it may take multiple trials to notice stress reduction, over time, knowing there is an action in place is helpful.
When both parties are in agreement that they both want to modulate arousal and engage in taking effective action (5) it helps both parties to learn how to better master their environment, as well as the quality of their lives and relationship.
Because during times of triggers, secure attachment can become threatened, therefore navigating towards keeping the stability and safety is key. When both parties are involved in navigating optimum affect regulation helplessness is reduced. Not only will working together as a couple bring you closer to one another but also there is great importance regarding the effects affect regulation has on optimum neurobiological development (6) and overall health.
In conclusion, the four steps that I have suggested have been designed as a result of over three decades of clinical experience working with families, couples, groups, and individuals as they navigate PTSD, offering professional education and training, and in- depth research. I have offered a four-step model for partners, or anyone that has a relationship with someone who has PTSD, that wants to overcome helplessness and gain empowerment during times of distress.