Dissociating during trauma makes PTSD worse by increasing negative narratives about the self? Connecting recovery with rejecting these narratives


It is somewhat common for individuals to experiences a period of dissociation and/or perception of being frozen and unable to move during a traumatic experience. Dissociation is a catch-all word to describe experiences where a person is somehow disconnected from a portion of their senses making what is happening feel somehow unreal. Experiences can include emotional numbness, feeling events are not real, not feeling in one’s own body, or not remembering what just happened.

In the April issue of the Journal of Trauma Stress researchers discuss possible connections between experiencing dissociation during a trauma and increased negative beliefs about the self. Dissociation during a trauma is called “peri-traumatic dissociation.” It is already understood that peri-traumatic dissociation is a strong predictor of subsequent PTSD diagnosis. 

This short study suggests that those who have dissociative experiences during trauma may be more likely to think negatively about themselves, both about their trauma experiences (e.g., I should have been able to stop it) and their present feelings about themselves (e.g., I’m unreliable). The researchers suggest that therapists ask clients about both forms of negative views of self if the client describes dissociative like symptoms during the trauma experience. 

It would have been helpful if the researchers connected their work with that of shame experiences. We continue to try to understand why some people find some experiences more traumatizing and thus have greater difficulty finding recovery. It seems that shame is distinctly tied to chronic trauma and being stuck in negative self-talk narratives. It may be that those who struggle the most with negative self-talk (I should have been able to stop my abuser) experience the most shame. But I have yet to see anyone try to parse that out. 

In my experience, negative attributions about the self are just about the hardest things for us to change. We may have developed these well-formed beliefs from failure experiences or we may have had them formed for us by our families. But whatever the cause, they are so very hard to let go. In fact, when others show kindness to our perceived uglyness, we tend to pull back, refusing to allow these parts to be acceptable.

What is it about letting go of our shame and accepting ourselves as normal, as valuable?  How would you articulate the problem?
*Thompson-Hollands, J., Jun, J.J. & Sloan, D.M. (2017). The Association Between Peritraumatic Dissociation and PTSD Symptoms: The Mediating Role of Negative Beliefs About the Self. JTS, 30, 190-194.  

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Podcast on Anxiety


Recently, I was interviewed for a podcast on the topic of anxiety by Walt Mueller and the good folks at the Center for Parent/Youth Understandings. You can listen here: https://cpyu.org/resource/episode-39-anxiety-with-dr-phil-monroe/

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Is it trauma or is it intensity/identity loss?


The current definition of PTSD requires an exposure to an intensely distressing event or events (either witnessed or told about in great detail) resulting in a pattern of intrusive re-experiencing, attempts to avoid such experiences and an ongoing negative cognitive/mood pattern. Such a diagnosis might be made after domestic and sexual violence, accidents, natural disasters, war, betrayal traumas, and even after hearing repeated stories of traumatic experiences to others (called secondary trauma).

Someone experiencing PTSD after life-threatening events might feel disconnected from family/friends, find it difficult to sleep, experience repeated nightmares, have difficulty not thinking about events during and after the traumatic experience, choose unhealthy coping patterns like alcohol abuse, or place themselves in situations where they re-enact parts of their trauma story.

But not everyone who has intrusive thoughts about a challenging situation, feels disconnected from their community (and previous self), drinks too much, or impulsively jumps back into danger have PTSD. Some of these same behaviors and experiences also show up in those who have left dangerous and all-consuming experiences and now do not know how to re-engage in regular life.

Consider these words of Dr. Steven Hatch, who spent time in Ebola clinics in Liberia at the height of the 2014 pandemic crisis in West Africa. He describes his experience after returning to his job at the University of Massachusetts.

To match the outside weather, my mood willingly turned dark. I withdrew from people, wandered about in a daze, and avoided public gatherings. When I did venture out, I carried myself in a completely different manner than I had before in my life.


The simple explanation was that I had post-traumatic stress disorder, and a few people, including some whose job it is to make such diagnoses, thought this to be true. (p. 239, Inferno)

He goes on to dispute his experience fighting Ebola as trauma. While difficult, he did not think it rose to the level of trauma experienced in war or even other more overwhelming Ebola clinics.

I could, however, recall the event [death of a toddler] in my mind without being emotionally overwhelmed, but also just as importantly I was able to still experience emotions about it, feeling appropriately somber. I just didn’t feel traumatized. (p 240)

So, what was his problem?

What I did share with many other volunteers was a sense that I didn’t belong in the States, for the work in West Africa was far from over. I desperately wanted to return, and almost within days of coming home I was trying to figure out how I could get back to an ETU [crisis Ebola center]. What I missed was the profound sense of purpose that such work had provided, and I slowly realized why people talked of “missing the war,” a phrase that always seemed discordant to my ears. You miss being in the midst of senseless butchery? Great. But I belatedly realized it was that purposefulness, the sense that you were doing something that was deeply and truly meaningful, that drove people back to such unstable situations. (p. 240-41)

There you have it. The seeming loss of crystal clarity or purpose in life can be very painful. When you are in an intense helping situation as Dr. Hatch was, every movement leads towards life or death. At the end of a day, you can count who lived and who died. No ambiguity. In addition, you are doing it with a team of people all committed to the same thing. You share the same vision, goal, and daily experience. You do not have to explain anything. And in these intense situations, you can have the kinds of intimacy not often experienced even in your immediate family. Also subtract mundane activities (grocery shopping, cleaning, taking care of children, etc.) that may not need to be done.

This is a recipe for distress upon return.

Return to regular life where you are expected to do these seemingly inconsequential activities AND where you have no one around to save AND no one who was present with your toughest experience…and you have a recipe for trouble. You may find it difficult to find joy in light of intrusive thoughts of recent emotionally intense experiences. You may long for a return to that sense of purpose and value. Because others do not understand and aren’t part of your “tribe” you may withdraw or find other ways to numb the pain.

Loss of identity and intensity may mimic trauma symptoms. They may be significant to need treatment. Military ending tours of duty, missionaries returning from field, humanitarians returning from doing crisis work, church planters leaving high stakes urban church plants, and trauma healing trainers returning from intense experiences may be at risk.

What can be done to prevent this distress?

  1. Probably nothing will take care of the problem. One could not go do intense work. Or one could become a crisis junkie. Neither are good options.
  2. But developing re-acclimation plans can help. Yes, training done before entering the intense experience will set the stage for healthy returns but post-tour of duty re-entry work is more important. The Army has develop protocols for re-entry by beginning the process even before leaving the “theatre.” Creating space for coming off the “high” giving time to process and following-up in the early days back can help. Involving family in the re-entry planning and building activities that can elevate family intimacy upon return will help immensely.
  3. Encouraging time and space to lament and process in group settings. This is where a therapist can help. Group process helps to put words to experiences and acknowledges impact on identity. This can also help re-connect with meaningful activities and experiences at home. One has to re-learn that meaning is not solely connected to intensity.

I have some very small personal experience with this. I’ve had intense experiences in international settings. When I have returned, I have sometimes found it hard to be at home when my head was still overseas. Being able to share with Kim and others helped. Practicing lament helped. Learning to be mindful of the present also helped me remember what has meaning and value in everyday life.

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Historic child abuse prevention course


Godly Response to Abuse in the Christian Environment and my seminary, Biblical Seminary, have teamed up to offer a 3 credit course for seminarians on the topic of child sexual abuse prevention and response. This course will run on our Hatfield campus on Monday nights during the month of June. To my knowledge, a course like this has not been offered before. I highly encourage you to send your pastors or church leaders for some continuing education.

Press release and details here: Curriculum Press Release or go to the BTS site to see it here.

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Complex Trauma: Going Deeper, By Diane Langberg


As part of our staff meeting today we watched this video by Diane Langberg. It reviews the 3 stages of typical trauma recovery process plus focuses on the impact of the work on the counselor. Self-care is a common conversation these days. However, a few lines stuck out to me:

Unless we take care of ourselves, we will not be able to bear witness…. Vicarious trauma is not something done to us but a consequence of having empathy…. Evil and suffering also provide an opportunity to expose the weak places in [the counselor]…. Seek out the antidotes to the poison that you sit with…[these antidotes] are not just good coping mechanisms but part and parcel to living the life obedient to God.

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Reading the bible through the lens of trauma?


What if you read the bible through the lens of trauma? Some are quite obvious–catastrophes are all throughout the bible. But are these stories of trauma in the bible merely keeping a record of it or attempts to deal with the trauma, to put the world back proper perspective after chaos?

Consider this 2015 video by Rev. Dr. Robert Schreiter entitled: Trauma in The Biblical Record. He gives some background about this newer way to read the bible through this lens and then ends with 3 examples. I’ve just ordered this book on the subject, but those wanting to jump ahead may wish to know about it as well.

 

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Diane Langberg: Living with ongoing trauma


A few years ago, Dr. Diane Langberg gave a talk about ongoing trauma experiences, when there is no “post” in the posttraumatic stress disorder. When there is no after trauma yet (e.g., ongoing domestic violence, living in a war zone, etc.), what kinds of help and hope might a survivor hold on to? Is there anything that can be done?

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What does resilience look like in the face of traumatic experiences?


Does a resilient individual appear as if stress and trauma has not lasting impact? Does it mean we bounce back as if it never happened? Are there better ways to think about resilience in real life?

In 2014 I gave a presentation reviewing the topic of resilience (definition, examples, threats to, and helps) at our annual Trauma Healing Community of Practice hosted by the American Bible Society.

Sometimes we consider only resilience as an individual trait. I spend a bit of time talking about community resilience. Video is 25 minutes and associated slides (not embedded in the video) can be found here: 2014 COP Resilience.

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Diane Langberg on Shame


A few years ago, Dr. Diane Langberg presented on the topic of shame at the 2014 Community of Practice hosted by the American Bible Society. She describes the toxicity of shame as a distinct part of trauma, especially betrayal trauma. You will learn about the cognitive phase of shame, kinds of shame experienced and how the response to shame takes one of 4 common forms (i.e., withdraw, avoid, attack self, attack others).

Make sure you watch to the end as she shares some insights to how God understands and responds to our problem of shame. See how Jesus enters in to our shame.

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Why we need a theology of trauma


[Previously published April 2015 at http://www.biblical.edu. The faculty blog no longer exists there thus re-posting here]

We live in a world shaped by violence and trauma. This week that I write 147 Christian Kenyan university students were killed because of their faith. Such horrific forms of violence shock us. But they shouldn’t given that in our own country violence and trauma are everyday occurrences. While some of our local brothers and sisters face actual death, all of our communities are shaped by soul-crushing abuse and family violence. Take the most conservative numbers we have—1:6 males and 1:4 females have experienced sexual assault before age 18—and realize that a large portion of your friends and acquaintances have traumatic experiences.

In a congregation of 100, 20 of your fellow church members are walking around with invisible wounds of sexual violence on their bodies and souls. And that number says nothing about those walking around with other invisible wounds, such as caused by domestic violence, racial prejudice, sexism, bullying and the like. Were we to include these forms of interpersonal violence the number would likely reach 70!

As my friend Boz Tchividjian asks, what would the sermons and conversations look like if 20 of our mythical congregation of 100 had just lost a house in a fire or a child to premature death? Wouldn’t we be working to build a better understanding of God’s activity in the midst of brokenness rather than passing over pain as a mere hiccup of normal life?

Yet, we continue to imagine trauma as some sort of abnormal state.

Ruard Ganzevoort[1] tells us that, “When one looks at issues like these, we must conclude that our western societies are to no less degree defined by violence and trauma, even if everyday life is in many ways much more comfortable” (p. 13). Thus, Ganzevoort continues, we must “take trauma and violence not as the strange exceptions to an otherwise ‘nice’ world” (ibid, emphasis mine). He concludes that while we have a strong theology for sinners, we have a less articulated theology for victims.

What if we were to read the Bible in such a way to build a theology of trauma for victims? What would it look like? I would suggest that Diane Langberg’s maxim sets the stage quite nicely: the cross is where trauma and God meet. Jesus cries out due to the pain of abandonment by the Father. Since we do have a high priest who understands our trauma (Hebrews 4:15), we can read the entire canon from the frame of trauma—from the trauma of the first sin and death to the trauma of the cross to the trauma just prior to the coming new heavens and earth.

Key Themes in a Theology of Trauma

Reading the Bible through the lens of trauma highlights a few key themes beyond the foundation of a God who Himself knows trauma firsthand in the unjust torture and death of Jesus:

Anguish is the norm and leads most frequently to questions

When more than 40% of the Psalms are laments (and that doesn’t count the primary themes of the prophets!) we must recognize that anguish is most appropriate forms of communication to God and with each other. But we are not alone in the feelings of anguish. God expresses it as well. Notice God expresses his anguish over the idolatry of Israel (Eze 6:9) and Jesus expresses his when lamenting over Israel (Luke 13:34) and cries out in questions when abandoned by the Father (by quoting—fulfilling—Psalm 22).

Despised and rejected, a man of sorrows, acquainted with grief.

Peace happens…in context of chaos

Psalm 23 comes to the lips of many during times of trouble as it expresses peace and rest during times of intense trouble. Shadows of death yet comfort; enemies around yet feasts. Peace happens but rarely outside of chaos and distress. Consider Jeremiah 29:11, frequently quoted to those going through hardship to remind them that God has a plan. He does have one, but recall that the plan was to live in exile among those who see the Israelites as foreigners and second-class citizens!

The kingdom of God in the present does not promise protection of bodies

Try reading Psalm 121 aloud among those who have survived genocide or been raped repeatedly by soldiers. “The Lord will keep you from all harm.” Really? You lost 70 family members? You cannot maintain your bladder continence due to traumatic injury to your bladder? Where was your protection? Our theology of God’s care must take into consideration that He does not eliminate disaster on those he loves. Recall again the trauma wrought on those God chose to be his remnant. They were the ones ripped from families and enslaved by the Babylonians.

God and his people are in the business of trauma prevention, justice, and mercy responses

The kingdom of God is not for those who have pure beliefs. The kingdom of God is for the poor in Spirit, the persecuted, those who provide mercy and those who hunger for justice (Matthew 5). True or pure religion is practiced by those who care for the most vulnerable among us (James 1:27). Jesus himself is the fulfillment of healing as he claims Isaiah 61 as fulfilled in his personhood and mission (Luke 4:18-21). We his people are the hands and feet to carry out that binding up and release from oppression.

Recovery and renewal during and after trauma likely will not eliminate the consequences of violence until the final return of Jesus Christ

Despite our call to heal the broken and free those enslaved, we are given no promise that the consequences of violence are fully removed until the final judgment. Rarely do we expect lost limbs to grow back or traumatic brain injuries to be erased upon recovery from an accident. Yet sometimes we assume that traumatic reactions such as startle responses, flashbacks, or overwhelming panic should evaporate if the person has recovered. A robust theology of trauma recognizes we have no promise of recovery in this life. What we do have is theology of presence. God is with us and will strengthen us guiding us to serve him and participate in his mission to glory.

There is much more to say about a theology of trauma for victims. We can discuss things like theodicy, forgiveness, restorative justice, and reconciliation. But for now, let us be patient with those who are hurting as they represent the norm and not the exception. And may we build a missional theology of trauma, not only for victims, but also for all.

[1] Ganzeboort, R. Ruard (2008). Teaching that Matters: A Course on Trauma and Theology. Journal of Adult Theological Education, 5:1, 8-19.

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