Symptoms of PTSD: Avoidance (Part 3)

All quotes below are from the following Open Access sources and are solely intended for the education of the reader:

1. Norrholm, S. D., & Jovanovic, T. (2010). Tailoring therapeutic strategies for treating posttraumatic stress disorder symptom clusters. Neuropsychiatric Disease and Treatment, 6, 517–532.
2. Brousse, G., Arnaud, B., Roger, J. D., Geneste, J., Bourguet, D., Zaplana, F., … Jehel, L. 2011. Management of Traumatic Events: Influence of Emotion-Centered Coping Strategies on the Occurrence of Dissociation and Post-Traumatic Stress Disorder. Neuropsychiatric Disease and Treatment, 7, 127–133.

As described by Friedman [2006], exposure to a traumatic event … can produce a robust emotional response…, and this association can lead to PTSD avoidance symptoms…. (1)

Emotion-centered coping is an attempt to manage the emotional responses induced by the situation…. Numerous strategies belong to this category, including substance abuse, physical activity, expression of emotions, feeling of responsibility, minimization of the event, alteration, denial or avoidance of reality, hoping for a miracle, and use of the imagination. Among all these emotional behaviors, avoidance of the event seems to particularly influence evolution to PTSD, suggesting that emotion-centered strategies (avoidance, flight, denial, or self-accusation) may lead to more negative outcomes after a traumatic event…. (2)

One of the earliest theories proposed to explain avoidance behavior is Mowrer's 2-factor theory [Mowrer, 1960; Levis, 1981], which posits that escape of a fear-conditioned stimulus negatively reinforces avoidance behavior, thereby maintaining fear responses. Applied to PTSD, this theory suggests that avoidance of reminders of the trauma can maintain the disorder by preventing extinction of the original fear associations. (1)

One problem with avoidance is that it keeps you stuck. I think a lot of us construct walls of sorts to keep out the things we'd rather not see, hear, or think about. Certainly avoidance does have its place in preserving our safety and well-being, but when avoidance becomes crippling it is not healthy. And, evidently, scientific inquiry has led us to the conclusion that avoidance of (perceived) fearful things only strengthens the fear association in our brains. I don't know that there is a way to shut off the fear. But I do know that avoidance is only one way to handle it. Several other options exist. I know I have not explored those options enough. I am slowly getting there.

If you struggle with avoidance as well, please be assured that there are other methods of coping. Help is out there. We need to peek over the wall long enough to spot it.

Symptoms of PTSD: Avoidance (Part 2)

I have been reading the second edition of Coping With Trauma: Hope Through Understanding by Jon G. Allen, PhD, sporadically for the past 2 years. He discusses the topic avoidance a lot in this book. Before you even make it to the double-digit page numbers, he has pretty well defined the role of avoidance in PTSD. He describes it as a primary symptom, saying that anyone who has experienced trauma will likely avoid any reminders of the event. Even thinking about the trauma can trigger overwhelmingly unpleasant emotions. And although avoidance is a natural coping strategy, it can ultimately keep you stuck. To move forward, it is vital to think about the trauma rather than to avoid it.

One recent afternoon, probably as I was trying to avoid other trains of thought, I was thinking, Well, yes, it's true that I avoid things I shouldn't. But there are things that I should avoid. What are those things? I delved into the book of Proverbs and found some very sound advice from King Solomon.

• Avoid sin.
• Prov 4:14–15—Enter not into the path of the wicked, and go not in the way of evil men. Avoid it, pass not by it, turn from it, and pass away.
• Prov 22:3—A prudent man foreseeth the evil, and hideth himself: but the simple pass on, and are punished.
• Avoid certain types of people, especially in certain situations.
• Prov 14:7—Go from the presence of a foolish man, when thou perceivest not in him the lips of knowledge.
• Prov 20:19—He that goeth about as a talebearer revealeth secrets: therefore meddle not with him that flattereth with his lips.
• Prov 22:24–25—Make no friendship with an angry man; and with a furious man thou shalt not go: Lest thou learn his ways, and get a snare for thy soul.
• Prov 23:20–21—Be not among winebibbers; among riotous eaters of flesh: For the drunkard and the glutton shall come to poverty: and drowsiness shall clothe a man with rags.

Note that Solomon's advice is for our own good: to keep us from foolishness, to keep our secrets safe, to keep our souls, and to keep us from poverty.

Several of Solomon's ancestors fled people and situations when avoidance was the best action to take.

• Solomon's father David fled from King Saul in 1 Sam 19:10–12:

  And Saul sought to smite David event to the wall with the javelin; but he slipped away out of Saul's presence, and he smote the javelin into the wall: and David fled, and escaped that night. Saul also sent messengers unto David's house, to watch him, and to slay him in the morning: and Michal David's wife told him, saying, If thou savest not thy life tonight, tomorrow thou shalt be slain. So Michal let David down through a window: and he went, and fled, and escaped.

• Joseph fled his master Potiphar's wife in Gen 39:7–12:

  And it came to pass after these things, that his master's wife cast her eyes upon Joseph; and she said, Lie with me. But he refused, and said unto his master's wife, Behold, my master wotteth not what is with me in the house, and he hath committed all that he hath to my hand; There is none greater in this house than I; neither hath he kept back any thing from me but thee, because thou art his wife: how then can I do this great wickedness, and sin against God? And it came to pass, as she spake to Joseph day by day, that he hearkened not unto her, to lie by her, or to be with her. And it came to pass about this time, that Joseph went into the house to do his business; and there was none of the men of the house there within. And she caught him by his garment, saying, Lie with me: and he left his garment in her hand, and fled, and got him out.

• Joseph's father Jacob fled his own father-in-law in Gen 31:3–7, 20–21:

  And the Lord said unto Jacob, Return unto the land of thy fathers, and to thy kindred; and I will be with thee. And Jacob sent and called Rachel and Leah to the field unto his flock, And said unto them, I see your father's countenance, that it is not toward me as before; but the God of my father hath been with me. And ye know that with all my power I have served your father. And your father hath deceived me, and changed my wages ten times; but God suffered him not to hurt me.… And Jacob stole away unawares to Laban the Syrian, in that he told him not that he fled. So he fled with all that he had; and he rose up and passed over the river, and set his face toward the mount of Gilead.

In a first therapy session with a healthcare professional, one of the first questions asked to someone who has been abused is, “Are you in a safe living situation?” To heal and cope, you need to be in a situation conducive to healing and coping (speaking from personal and unfortunate experience). If someone is threatening your life, forcing or coercing you into a sexual relationship, or otherwise taking advantage of you, you have the support of this lowly blogger, hundreds of healthcare professionals, and the Almighty God to leave that situation.

Yes, avoidant behavior is a major symptom of PTSD, but it often has to be the first step on the road to recovery.

More on avoidance (the bad kind) soon …

Scripture quoted from the King James Version of the Bible. The KJV is public domain in the United States. See version information here: https://www.biblegateway.com/versions/King-James-Version-KJV-Bible/#vinfo.

Symtoms of PTSD: Avoidance (Part 1)

Google the initialism “PTSD” and you will quickly find that the symptoms of this disorder are most commonly grouped into three categories: 1) re-experiencing, 2) avoidance, and 3) hyperarousal.

The second category has been on my mind a lot recently. Avoidance can be an effective coping strategy, but when taken to the extreme it is debilitating. Here is an analogy my therapist made today:

Let's say that someone eats something that has a raw egg in it and gets food poisoning. Because of that experience, this person decides that in order to keep himself safe he is never going to eat food again. End result: he dies.

This man did what he could to keep himself safe. His logic was flawed, obviously, because he overgeneralized. Food itself was not the problem. It was the improper preparation (or misuse) of the food. All he needed to do was avoid the improperly prepared food, not food altogether!

I have done the same thing with the word and concept “love.” I avoid saying and thinking that word; I can barely bring myself to type it in quote marks. I avoid people or discussions that use that word frequently. I avoid reading about God's only begotten son who embodies that word in its purest form because I overgeneralize. I am the food-poisoned man … except that I'm not a man and I don't have a problem with food.

More on this topic soon….

A Brief Conversation About Prayer

After church services this evening, I was shooting the breeze with the teenage boy who habitually sits in the pew right behind where I habitually sit. We stumbled upon the topic of prayer. All of a sudden a spark of clarity illuminated the cobwebby confines of my mind. Each member of the Godhead plays a key role in prayer!

We pray to God the Father …

Matt 6:6—[W]hen thou prayest, enter into thy closet, and when thou hast shut thy door, pray to thy Father….

Matt 6:8–9—[F]or your Father knoweth what things ye have need of, before ye ask him. After this manner therefore pray ye: Our Father which art in heaven….

in the name of Jesus the Son …

John 16:23–24—And in that day ye shall ask me nothing. Verily, verily, I say unto you, Whatsoever ye shall ask the Father in my name, he will give it you. Hitherto have ye asked nothing in my name: ask, and you will receive….

John 16:26–27—At that day ye shall ask in my name: and I say not unto you, that I will pray the Father for you: For the Father himself loveth you, because ye have loved me, and have believed that I came out from God.

with the help of the Holy Spirit.

Rom 8:26–27—Likewise the Spirit also helpeth our infirmities: for we know not what we should pray for as we ought: but the Spirit itself maketh intercession for us with groanings which cannot be uttered. And he that searcheth the hearts knoweth what is the mind of the Spirit, because he maketh intercession for the saints according to the will of God.

Eph 6:18—Praying always with all prayer and supplication in the Spirit….

We talked about God, Jesus, and the Spirit in relation to prayer perhaps for no more than 30 seconds. Then we both smiled.

Scripture quoted from the King James Version of the Bible. The KJV is public domain in the United States. See version information here: https://www.biblegateway.com/versions/King-James-Version-KJV-Bible/#vinfo.

Fear and PTSD

Fear forcing past into present
Or present into past?
Heart, lungs, beating and breathing fast
Post-shame, post-guilt, post-pain:
What comes after? More of the same.

Fear changing stone into soldier,
Or soldier into stone?
Body, mind, haggard and hollow bone
Traumatized, tantalized
By what's before, behind the eyes.

Fear pushing child into adult
Or adult into child?
Limbs, legs, trembling and tangling wild
Stress out, stress in, stressed still
And always now; against the will.

Fear forcing life into chaos
Or chaos into life?
Head, heart, disarmed and disrobed strife,
Disordered, and diseased,
Burning with fear in a frozen freeze.

To the extent possible under law, J has waived all copyright and related or neighboring rights to this work. This work is published from: United States.