The Psych Prof

Finding Balance: Navigating Emotional Healing in Complex Post-Traumatic Stress Disorder

C-PTSD, or Complex Post-Traumatic Stress Disorder, is a psychological condition that can develop in individuals who have been exposed to repeated or prolonged traumatic events, particularly in situations where there is an imbalance of power or the trauma is inflicted by someone close, such as in cases of ongoing abuse, neglect, or captivity.

Similar to the more familiar PTSD (Post-Traumatic Stress Disorder) C-PTSD can been thought of as an extension of PTSD. The main difference between PTSD and C-PTSD lies in the duration and nature of the traumatic experiences. PTSD typically arises from a single traumatic event, such as a car accident, sexual assault, witnessing violence, or death or destruction. It involves experiencing or witnessing a traumatic event that causes intense fear, helplessness, or horror. The symptoms of PTSD may include intrusive thoughts, flashbacks, nightmares, avoidance of reminders of the trauma, and heightened arousal.

On the other hand, C-PTSD develops as a result of repeated or prolonged exposure to traumatic events, particularly in situations where there is an ongoing imbalance of power or the trauma is inflicted by someone close, such as in cases of chronic abuse, domestic violence, or childhood neglect. C-PTSD holds the symptoms of PTSD with a cumulative effect leading to a more complex set of additional symptoms related to the impact of prolonged trauma on an individual’s sense of self and their ability to regulate emotions and form relationships.

C-PTSD often involves symptoms related to emotional dysregulation, such as difficulties in managing emotions, mood swings, or a sense of emotional numbness. It may also include symptoms of dissociation, altered beliefs about oneself and the world, and challenges in forming and maintaining healthy relationships.

While both PTSD and C-PTSD share similarities in terms of symptoms and treatment approaches, C-PTSD reflects the broader impact of chronic and prolonged trauma on an individual’s psychological well-being and daily functioning.

The symptoms of C-PTSD can be grouped into four main clusters:

1. Re-Experiencing the Trauma: Similar to PTSD, individuals with C-PTSD may have intrusive thoughts, nightmares, or flashbacks related to the traumatic events they experienced. These memories can be distressing and vivid, causing the individual to feel as if they are reliving the trauma.
2. Emotional Dysregulation: C-PTSD often leads to difficulties in regulating and managing emotions. This can manifest as intense anger, irritability, or a sense of emotional numbness and detachment. Individuals may experience mood swings, have difficulty trusting others, or struggle with low self-esteem and feelings of shame or guilt.
3. Avoidance and Dissociation: Individuals with C-PTSD may engage in avoidance behaviors to protect themselves from triggering situations or reminders of the trauma. This can involve avoiding certain people, places, or activities associated with the trauma. Dissociation, a state of detachment from one’s surroundings or emotions, is also common in C-PTSD and can serve as a coping mechanism during overwhelming situations.
4. Altered Beliefs and Relationships: C-PTSD can profoundly impact an individual’s beliefs about themselves, others, and the world. They may develop negative self-perceptions, feelings of helplessness or hopelessness, and a diminished sense of safety. Additionally, C-PTSD often affects relationships, leading to difficulties in establishing and maintaining healthy connections with others. Trust issues, fear of intimacy, or a tendency to repeat patterns of abusive or unhealthy relationships may emerge.

C-PTSD as well as PTSD can disrupt an individual’s window of tolerance leading to difficulties in regulating emotions, managing stress, and maintaining a sense of safety. The window of tolerance can be thought of as a zone between hyperarousal (overactivation) and hypoarousal (underactivation) states. Let’s explore these states:

1. Hyperarousal: Hyperarousal refers to a state of heightened physiological and emotional activation. When individuals with C-PTSD are triggered or experience stressors, their nervous system can become overwhelmed, leading to intense emotional reactions such as anger, panic, anxiety, or hypervigilance. This can manifest as a fight-or-flight response, with the individual feeling a sense of urgency or an intense need to escape the situation.
2. Hypoarousal: Hypoarousal, also known as dissociation or freeze response, is a state of decreased physiological and emotional arousal. It can occur as a protective mechanism when the individual perceives threat or experiences overwhelming stress. In this state, individuals may feel emotionally numb, disconnected, spacey, or detached from their surroundings. It can be challenging to engage in everyday activities or make decisions while in a hypoaroused state.

The concept of the “window of tolerance” is frequently used in the context of trauma, including C-PTSD, to describe the optimal range of emotional and physiological arousal within which an individual can effectively cope with stressors and engage in adaptive behaviors. It was first introduced by Dr. Dan Siegel, a psychiatrist and neuroscientist.

The goal of working within the window of tolerance is to help individuals expand their capacity to tolerate and regulate their emotional experiences, without becoming overwhelmed or dissociated. Therapy and self-care strategies aim to support individuals in widening their window of tolerance by developing skills for emotional regulation and distress tolerance.

Therapists often use the window of tolerance as a framework to help clients understand their physiological and emotional responses to stress and trauma. It provides a way to conceptualize how individuals may oscillate between hyperarousal (overactivation) and hypoarousal (underactivation) states when faced with triggering situations or traumatic memories.

By working within the window of tolerance, therapists aim to support clients in expanding their capacity to tolerate and regulate their emotional experiences, without becoming overwhelmed or dissociated. This can involve various therapeutic techniques, such as grounding exercises, breathing techniques, mindfulness practices, somatic awareness, and the development of emotion regulation skills.

The window of tolerance is not only a conceptual framework for therapists but also a practical tool that individuals can use to better understand their own emotional states and develop strategies for self-regulation. It helps individuals recognize when they are within their optimal range of functioning, identify when they are being pushed beyond their capacity to cope, and engage in self-care or seek support to return to a regulated state.

Here are some suggestions to help expand the window of tolerance:

1. Trauma-focused therapy: Approaches like Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), or Sensorimotor Psychotherapy specifically address the impact of trauma on the window of tolerance. These therapies aim to help individuals process and integrate traumatic experiences, develop coping skills, and regulate their emotions more effectively.
2. Grounding techniques: Engaging the senses and focusing on the present moment can help anchor individuals who are experiencing hyperarousal or dissociation. This can include deep breathing exercises, mindfulness practices, or sensory-based activities such as touching or smelling objects.
3. Emotional regulation strategies: Learning to identify and regulate emotions is essential for managing the intensity of emotional triggers. This can involve techniques like deep breathing, progressive muscle relaxation, journaling, or engaging in creative outlets.
4. Self-care and stress reduction: Engaging in activities that promote relaxation and self-care can help individuals maintain their equilibrium and reduce the risk of being pushed beyond their window of tolerance. This can include activities like exercise, spending time in nature, practicing hobbies, or seeking social support.

Managing symptoms related to C-PTSD typically involves a multifaceted approach. Medication, such as antidepressants or anti-anxiety medications may also be suggested to manage specific symptoms like depression or anxiety.

Expanding the window of tolerance is a gradual and individualized process. Working with a trained therapist who specializes in trauma can provide guidance, support, and evidence-based techniques to help individuals navigate their emotional triggers and enhance their overall well-being. It’s highly recommended to seek professional help from a mental health provider experienced in trauma and C-PTSD to receive appropriate diagnosis, treatment, and support tailored to individual needs.

Other supportive interventions such as self-care practices and building a strong support network are also crucial for individuals with C-PTSD.

*It’s important to note that the diagnosis of C-PTSD is not yet recognized in all diagnostic manuals but is included in the ICD-11 (International Classification of Diseases, 11th Revision) by the World Health Organization.

For more reading about C-PTSD and The Window of Tolerance:

“The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma” by Bessel van der Kolk, M.D.

• This book explores the impact of trauma on the body and mind, including C-PTSD. It delves into the concept of the window of tolerance and offers insights into healing from trauma.

“Complex PTSD: From Surviving to Thriving” by Pete Walker

• Pete Walker, a licensed therapist, shares his expertise on C-PTSD and provides practical guidance for individuals on the journey to recovery. The book covers the window of tolerance, grounding techniques, emotional regulation, and other essential aspects of healing.

“Trauma and the Body: A Sensorimotor Approach to Psychotherapy” by Pat Ogden, Kekuni Minton, and Clare Pain

• This book explores the interconnection between trauma, the body, and the window of tolerance. It presents the Sensorimotor Psychotherapy approach, which focuses on body-based interventions for healing trauma and expanding the window of tolerance.

“Coping with Trauma-Related Dissociation: Skills Training for Patients and Therapists” by Suzette Boon, Kathy Steele, and Onno van der Hart

• This comprehensive resource offers insights into understanding and treating dissociation in individuals with complex trauma, including C-PTSD. It addresses the window of tolerance and provides practical skills training for both therapists and individuals dealing with dissociative symptoms.

“Waking the Tiger: Healing Trauma” by Peter A. Levine

• Peter Levine explores the impact of trauma on the nervous system and provides insights into resolving trauma and restoring resilience. While not specifically focused on C-PTSD, it offers valuable perspectives on trauma recovery and the window of tolerance

If you’d like to book an online, one on one, or group therapy session for symptoms manifesting from trauma and live in Canada, you can book an appointment here.

For those interested in booking a 1, 2, or 3-hour workshop covering a variety of mental health topics you can write to me here for more information.

Those who would like more information and/or to secure a spot at The Healing Journey Retreat in Mexico can sign up for more information here.

Follow me on Facebook, LinkedIn, Instagram, Youtube