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Tama Lane, Psy.D.: Why PTSD Flares Up During the Holidays--And What You Can Do About It

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By Tama Lane, Psy.D.

Posttraumatic Stress Disorder (PTSD) is a debilitating disorder with an estimated lifetime prevalence between 1% to 9% in the general population. With PTSD, the psychological and emotional wounds and repercussions of the actual traumatic event can last for many years, and if unresolved, can become more devastating than the original traumatic event. The insidious effect of PTSD can negatively impact interpersonal relationships, mood, self-concept, the ability to perform in work or school settings, and overall quality of life. Due to the stress, anxiety, and specific emotions that the holidays can spark, the holidays often present numerous setbacks and obstacles for PTSD sufferers. They might not understand their own reactions, igniting feelings of powerlessness and loss of control, not only for themselves, but also for family and friends who feel helpless during PTSD activation episodes.

Seek treatment.
The sequela of trauma, if left unprocessed and untreated, can impact every layer of functioning. For the traumatized individual, entering into trauma-focused psychotherapy may evoke fear and uncertainty. However, a mental health professional that specializes in the treatment of PTSD and trauma can provide support, assist with learning adaptive coping strategies to manage symptoms, and explore the numerous ways in which trauma has impacted your life.

If you or someone you know is unable to begin treatment immediately, here are tips to help manage the symptoms and situations associated with PTSD:

Minimize triggers.
Triggers, either internal or external, are correlated with a past traumatic experience. It is as though the survivor's mind has captured and frozen every sensory aspect of the traumatic event. The activation can be unsettling, confusing, terrifying, and physically and mentally paralyzing. PTSD suffers can begin to identify and actively track their triggers with the goal of reducing the occurrence or impact of those triggers. For instance, monitor the date and time of the trigger, the exact stimulus that caused the trigger and senses involved, the type of situation you are in, physical response, and emotional response.

Be mindful of crowds.
Holiday crowds can be filled with triggers that serve as land mines to the traumatized person. Particularly in unfamiliar surroundings, people with PTSD may become hypervigilant to signals of danger and threats, and may even trigger flashbacks. In this situation, shopping during off peak hours or shopping online can significantly reduce feelings of anxiety, panic, impending danger and doom, or feeling trapped and unable to escape when surrounded by large crowds.

Control intrusive thoughts.
Loss of control and a sense of powerlessness are often heightened during the holidays. The holiday itself becomes a trigger that opens the person to memories of life before trauma, loss, stress, anger, and trauma-specific memories. One of the most disturbing events of PTSD is intrusive reexperiencing. Learn to control and reconstruct the memory and change the modalities (visual, auditory, somatic sensations) of the image in as many ways as possible. For example, when disturbing memories arise: (1) decrease the size of image to 10%; (2) if the traumatic event occurred at night, change the scene to a sunny day; (3) if walking alone, place an object of safety within the image. This can be a place or person. These strategies can restore a sense of control over uncontrollable intrusions and change the emotional quality connected to the image.

Be sensitive to your negative emotions.
Holiday cheer may not be filled with mirth and merriment. Downward spiraling mood can occur as holidays or even trauma anniversaries approach, leaving the individual unable to experience positive emotions. Those people with PTSD might experience a pendulum of emotions or feel emotionally numb in situations where emotional responses are expected. Techniques such as self-monitoring (for example, keeping a mood diary) allow the examination of causes and change of symptoms throughout the day or week. Rather than avoid symptoms, self-monitoring allows you to understand what scenarios trigger negative moods and coping strategies that are most effective in certain situations.

Put your coping strategies in place.
During the aftermath of a traumatic event, defense mechanisms, such as denial, suppression, and dissociation, can often act like a reliable BFF, protective when needed, and helping us cope with painful internal and external states. They also allow us to avoid uncontrollable situations in a maladaptive manner. Not only is it imperative to learn healthy coping strategies, but also to understand the language of the body. For example, when external cues are associated with a real or perceived threat and the PTSD sufferer is unable to correct the situation by walking away, the stress response is activated. Rather than screaming the words, "Hey, get me out of here now!," he or she may experience increased heart palpitations, sweating, or nausea. Instead of ignoring these danger signals, coping strategies might include deep breathing exercises to relax the diaphragm and slow the heart rate, expressive writing or journaling, or progressive muscle relaxation techniques to reduce anxiety. Developing healthy coping strategies will also prevent the development of unhealthy coping strategies such as alcohol and substance use.

Don't don the invisibility cloak.
Particularly in the presence of others, survivors of trauma often emotionally shield themselves from others and, sometimes, themselves. I often have patients report not wanting to be viewed as different, judged, misunderstood, or cause distress in family or friends. Wearing the "invisibility cloak" aids in masking feelings of shame, pain, guilt, powerlessness, helplessness, confusion, anger, or self-loathing. It is not uncommon for those with PTSD to avoid holiday gatherings and social settings. These settings might provoke fear, stress, and danger. For example, if triggered he or she might lose control, the cloak drops, leaving the PTSD sufferer feeling exposed, vulnerable, helpless; thereby exacerbating PTSD symptoms. As the holidays approach, create new holiday rituals that will allow you to gain a sense of control and safety. For example, plan a smaller meaningful celebration such as a tree trimming or one-to-one coffee holiday get together instead of a big family dinner.

The experience of trauma and PTSD symptoms that may follow are often overwhelming and distressing. It is difficult to see past them, but awareness and treatment is important to restoring hope and helping PTSD sufferers regain their lives.

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Tama Lane, Psy.D., is the founder and Director of New York Psychotherapy and Neuropsychology Group, where she provides psychological services for individuals presenting with a range of psychopathology, including trauma and learning disorders. To learn more about Dr. Lane, visit her at redroom.com.

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