Grounding

One of the more detrimental symptoms of PTSD, I think, is the flashback. The survivor literally lives in the past: as if the trauma was happening around him or her. It can be excruciating and even dangerous. The survivor leaves the present world and enters the world of the trauma: sights, sounds, smells.

The brain can't distinguish between the past world of the trauma and the present world, but the survivor can pull through the flashback through grounding. Grounding takes some self-discipline, and if the survivor's loved one(s) are around, they can help. Grounding is like meditation: it's pretty easy to do, but it takes practice to develop effective techniques.

I found a great site that has a handy PDF file for PTSD grounding techniques by Lisa Najavits. There's a bunch of grounding techniques that engage all the human senses, but it's important to note in the first sentence, "Grounding is a set of simple strategies to detach from emotional pain".

I think we tend to think of detachment as a bad thing, especially if we're talking about it as a form of dissociation (another set of PTSD symptoms). In this case, grounding is a way to distract or bring back the survivor from the past back into the present. Again, it takes some time to develop, but here are three things that are super simple to do:

1. Try starting with some simple deep breathing from the diaphragm. Hold your breath and silently count to 10 slowly.
2. Look at things around the room that you are in, name them, and describe them. Play the "5-4-3-2-1" game described on this site. The whole idea behind grounding is to engage the present environment around the survivor. This technique has helped my wife and I get through flashbacks. I'll ask, "Do you hear the fountain outside?" or "Do you see the cat under the chair?" or "Can you hear my voice?" It helps with keeping the survivor in the present.
3. If you can, have your survivor run cool or warm water over their hands. This is designed simply to get the present senses engaged.

There are hosts of other techniques and suggestions mentioned in the two links above, so your options are virtually limitless. It's important for your survivor to find techniques that work for them. Remember, It does no good to invalidate the flashback. Instead, it's better not to resist it. Help your survivor get through it by gently (keyword here) asking your survivor about grounding techniques. Always keep safety at the forefront, especially during flashbacks. Grounding is a great way to perpetuate safety.

NAMIWalks 2015: May 17

Folks, I have an announcement to make.

This coming Sunday, May 17, I'll be walking to help de-stigmatize mental illness in Portland. Please, please, please support this extremely worthy cause by donating to NAMI.

Thank you for your support.

PTSD and What It Means for a Relationship

Many of you know this, but my wife has PTSD and ADHD. I don't have either. However, because I love someone that does have PTSD, I encounter it on a near-daily basis. Over the last few years, I have learned several things, and over the last couple of years, I have learned a lot about this loaded disorder. What I want for this post is to relay some of the things that I have learned as I reflect on the relationship I have with my wife. Now, let me say this right up front: I am not a medical professional, nor am I a marriage therapist or counselor of any kind. None of the things in this post (or this blog for that matter) should be taken as medical or relationship advice. Also, I want to say that survivors with PTSD do not all have the same circumstances. I will do my best to generalize, but it is difficult when no two people have the same experiences.

My wife and I were together for several years before she received a diagnosis of PTSD, so the last few years have been a quest for knowledge and understanding on both our parts.

1. PTSD means that conflict will happen and vary in intensity.
2. It is imperative to create an environment of safety and to make sure your partner has control when he or she is in flashback mode. Not only that, make sure your partner knows that he or she is in control when their symptoms are high.
3. At times, PTSD means deep, intimate discussions about PTSD. Other times, it means greater distance.
4. PTSD triggers are [sometimes] unpredictable. A way of thinking about this is "connecting the dots". For example, say you hear a loud motor whiz by as you're driving down the highway. For a PTSD survivor, a loud motor can be a trigger that connects to all sorts of other triggers and effects: A loud motor connects to a car accident that connects to medical bills that connects to avoidance of opening mail that connects to not answering phone calls...
5. Some days are easier to manage than others—but symptom level management is something a survivor will deal with on a daily basis.
6. Healthy coping methods should be in place at all times. This varies from person to person, so it's important to keep active discussions about them.
7. At times, the partner's role is more active. Other times, the partner's role is more passive.
8. Never, never, never, ever invalidate a partner's trigger or PTSD.
9. Both of you: Get extra support and vent frustrations.
10. Above all, communication and safety are two keys to deep intimacy.

PTSD and Hypervigilance: Maintain Safety

PTSD has three categories of symptoms: hyperarousal, reexperiencing, and numbing. All three categories can exist at the same time, or they can be experienced in stages.

For this blog entry, I'll focus on one part of the hyperarousal category: hypervigilance. This is the feeling of intense alert to perceived danger. It's important to note that the danger doesn't have to be there; it can just be perceived. However, to the survivor, it is there. The survivor may feel a threat when in fact there is none. Therefore, it is important for the partner not to dismiss the survivor's sense of danger, but rather, validate it and concentrate on maintaining a safe environment.

I know I stress safety a lot in these posts. Remember, PTSD always comes from a set of circumstances outside the survivor's control, and they are always put in a position of danger—that is, not safe. When helping your survivor, safety is always of the utmost concern. It is the single greatest thing you can do as the partner to help your survivor get through whatever set of symptoms are plaguing your survivor.

Is It ADHD or PTSD?

I feel as of late that I have spent a lot of time researching PTSD and blogging about it, but I haven't given enough time to ADHD. My wife has both.

Sometimes, the lines of these two acronyms are so blurred that it can be extremely difficult to tell which is which. Is a lack of motivation because your partner is in flashback mode, relapse mode, or depression, or is it that they don't know where to start, or that they feel overwhelmed by the day's tasks?

It can be especially difficult if the trauma brings about hypersensitivity that runs over into daily routines.

The result is looking at a Venn diagram with a very blurry middle. As you might expect, this is a largely loaded subject. There are overlaps of co-morbidities and symptoms. Both PTSD and ADHD require constructive coping techniques. Both require lots of attention and self-awareness.

Let's talk about some constructive ways to keep grounded and maintain self-awareness. This list is by no means inclusive, but it should provide some ways to help manage symptoms.


Make an interest box or closet to combat idleness and possible dark moods
Any time you or your partner comes across something that the survivor feels would be interesting but don't want to get into it at the present moment, put it into an interest box. This could be anything from magazines, CDs, arts or crafts projects, what have you. The idea is that this box will provide stimulation and creativity when things seem to be at a lull. 

Practice constructive coping techniques [exercise, meditation, art]The interest box is a constructive coping technique itself, but it's also the gateway to other constructive coping techniques. When your survivor is bored, bring out something to do from the interest box. Make some suggestions. Go jogging with your partner to get the blood flowing. Meditate wherever it feels comfortable. Meditation is a great activity that stimulates and focuses the brain.

Break bigger problems down into smaller ones
The idea of a big project can seem overwhelming to anyone (I know it does to me). But, if I think of the big project in terms of many little projects, things seem smaller. If I pace myself, or come up with a schedule equally spreading the work load (or as equal as possible), things get even easier.

What constructive coping techniques do you keep in your arsenal?

The Role of Dissociation

One thing (of many) that fascinates me about PTSD is the role of dissociation: that is, the distancing of oneself during or when reliving a traumatic experience. Think of dissociation as someone experiencing a trauma, but watching it happen from another's point of view.

What is the role of dissociation? Simply to cope with the trauma as it is occurring. When someone experiences trauma that is so psychologically uncomfortable or traumatizing, a natural defense mechanism is to avoid it completely.

This can be helpful in the short-term, but as Professor Richard Bryant from the University of New South Wales points out, it has some serious psychological consequences, but it prevents the trauma from being processed, and it could lead to PTSD. However, it doesn't always mean that PTSD will develop.

When we as people experience any type of hyper-arousing or stressful circumstance, we experience dissociation to a degree. We have temporary lapses in memory, we can't remember certain details, we stifle emotions related to the event, and the like.

In PTSD, this is a uniquely manifesting degree of symptoms, because while it initially may strive to help by distancing the survivor from the trauma, it comes back in ways like flashbacks, blind rages, the sense of being out of body, detachment, or other similar symptoms. What might start by appearing to be an escape of sorts can easily turn into a tonic for a type of amnesia or repression. It doesn't take a lot to come to the conclusion that this is a destructive coping pattern, not just for the survivor, but for the survivor's closest circles.

My wife has experienced this several times on several occasions brought on by several stimuli and environments. There are a few common results of a highly dissociative episode (especially in the form of blind rages):

1. The survivor remembers little to nothing of what happened during the episode. The survivor might remember feelings, fragments of thoughts or conversations, or other elements of the episode. We usually can't talk about everything that was said because she says, "I don't remember."

2. The survivor has feelings of guilt or remorse afterwards (when the survivor comes back to the present).

3. Depending on the responses during the conversation, the episode can last from several seconds to several hours. Flashbacks or blind rages can usually bring heated conversations, and it's important to recognize when they are happening and stay grounded (see my other blog post on developing a safety checklist to help you and your survivor cope before, during and after a flashback).

It is crucially important to help your survivor by maintaining an atmosphere of safety. The degree of safety depends on your relationship, but safety begets trust, and trust begets intimacy. True intimacy is what keeps a couple together. Your survivor is on a rough road, no doubt, but there's no fooling yourself into thinking that you're on a separate path. Maintain an atmosphere of safety, and you'll go a long way to helping your survivor manage their symptoms and trauma in a constructive and safe way.

Safety Checklist: Before, During, and After Flashbacks

Your partner has PTSD, you might or might not. This is a world that is most likely foreign to you, filled with chaos that seemingly comes out of nowhere and brings about a host of reminders of problems that might have happened long before you two met. Whatever happens during a flashback or a trigger, it is important to seek understanding. The first thing that you can do to start to understand is to validate the other person. Even if the person is remembering something that happened differently than what you remember, validate it. To them, it is true.

Ask about it. Even when symptoms are highest, talking about what's going on might prove more helpful than detrimental. Our natural human instinct is avoidance (and I'm often guilty of this). If the time is right, it might help to sit down and discuss the degree of symptoms and offer support. Be careful here, as this is getting into dicey territory. It only takes a few phrases that can make the difference between a thoughtful and open conversation and the catalyst to a blind rage or intensified flashback. Ground your partner by saying things that are happening around you—the state of the weather, a pet running across the room, children talking, or even asking if your partner can hear you. When a survivor is having a flashback, they have no awareness of their surroundings. It's like they're there, but not really there [a future post on the role of dissociation is coming soon]. A few things that have helped with my wife and me has been calling out a term of affection for my wife, asking if she is going into flashback mode, or asking if she can see or hear things that are going on. Every situation is different, so you'll need to play each situation by ear: It is as important to talk about it as it is to give the other person the space they need. Sometimes talking about things afterwards makes for a better conversation. Always maintain that your partner has control.

PTSD comes out of trauma that is out of the person's control, so make sure that during elevated times of symptoms, triggers, and flashbacks that you communicate that the other person is in control. During these times, safety is the utmost priority and should not be compromised—period. If your partner tells you to stay away, back off. If your partner is belligerent, calmly validate the things they are saying, and calmly reassure that you are there for them. Do NOT under any circumstances threaten the safety of the survivor; it will only escalate the survivor's symptoms. When your partner is in flashback mode, it can seem like a minefield, but stay the course and watch what you say and do. It will pass eventually. If the flashback hasn't lifted for a few hours, it might be time to call a mental health crisis line or 911. If the survivor threatens the safety of themselves or you, it's always important to call 911.

Living with someone that has PTSD presents a new set of challenges to a relationship, so it's extra-important that communication be as strong as possible. My wife and I remind each other often, "Don't forget your Vitamin C [C meaning communication]." It helps us immensely, especially when her symptoms are high.

A concise checklist summarizing what was said above follows:

Before flashbacks begin:
1. Ask your partner if they are still in the present. Ask if they can hear things, see things, smell things that are going on. Help them by grounding them in what's going on around you.
2. Prepare a "grounding box"—together. Include things that will help your partner remain in the present as much as possible. Remember, the survivor is in control, and they know themselves best.
3. Be sensitive to their requests. If they need some space, give them space. If they need some alone time, give it to them, but check in every once in a while to make sure they're okay. Never threaten them or disrespect what they ask for when it comes to space or time apart, but don't abandon the situation, either.

During flashbacks:
1. DO NOT try to take control. You're now in the supporting role. Your job is to bring your partner back. Talk about what you see, ask what they're hearing, seeing, or feeling.
2. If they become physically belligerent, back off.
3. If things get too prolonged or unsafe, call 911 or a mental health crisis line.

After flashbacks:
1. If the mood permits, talk about what happened. Ask again if your partner is in the present.
2. Discuss possible prevention measures you both could have taken.
3. If you don't have a conflict management system in place, discuss it (I'll write about one in a future post).