The Mind Is In The Body: Everything I wish I’d known about PTSD healing earlier

or, my public cliff notes on trauma literature

31 min readApr 25, 2020

Trigger warning: mentions most trauma related topics, but not in a visceral way

Disclaimer: I am not a psychologist, therapist, biologist, or someone vaguely professionally licensed or trained in any way to give advice on these topics. I’m just a meticulous nerd working on my own cPTSD (complex PTSD), and my favorite coping mechanisms happen to include reading, collating, and creating resources.

Thanks to a great spike in people voicing their experiences online more this past decade, society as a whole is now more receptive to the idea that certain types of terrifying experiences and situations are likely to traumatize most people, or to traumatize more severely.

However.

If you feel like you may have symptoms of PTSD but you dismiss their validity because you haven’t experienced some kind of clearly “qualifying”, archetypal traumatic event, or can’t pinpoint what caused your distress, or often think “well, others had it worse” — please don’t dismiss yourself so easily. PTSD is a very wide spectrum, and can be caused more by the brain’s inability to process an overwhelming event than by the event itself.

It can develop as a result of one-time, scary events that might not traumatize other people, or less obvious recurring incidents that you felt helpless to, such as a relationship where you aren’t sure if you would call it “abuse” but in which your boundaries were routinely violated somehow. It can also develop as a result of passive treatment such as chronic emotional neglect in childhood, or simply by the wrong thing happening at exactly the wrong time. In addition, actively traumatic situations are often not obvious until you extricate yourself from them.

No matter how actively or objectively “bad” the original event might have been to an outside observer: PTSD is still a real, dysregulatory physiological phenomenon that occurs in the body, and it can stay with you decades after the originating event if left unaddressed. Remember that the PT is for Post-Traumatic: PTSD is not the event itself, but the symptoms you have afterward.

But, you can do something about it.

You may or may not have PTSD — who knows. I’m not your therapist or anyone’s except for my own. But naming holds power, and if you have names to begin considering, you can explore and find out what applies to you or not. Maybe you’ll find something here that resonates with your experience.

Here’s an overview of all the helpful resources, frameworks, and lenses I wish I had been aware of earlier in life. Feel free to skim it and see if anything jumps out at you.

Quick ref

I also made a website, PTSD Resources, where you can quickly look up the resources linked in this article by your Current Emotional Problem.

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Empowering terminology
It’s not your fault
PTSD is a physical reality (and what we can do about it)
Getting to know your inner pain
Attachment & attunement
General resources
(If all this info is too much for you right now, jump to bite-sized resources)
Coda

Referral disclosureThis blog is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means to earn fees by linking to Amazon.com and affiliated sites.Where possible, the books I reference have links to the original distributors. However, if you were planning to get the ebook or otherwise buy it through Amazon anyway, I’ve included my referral links.Also note that lots of these books may be available through your local library!

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Quick validation for gaslighting victims

If you reread this article and notice some of the phrasing has changed or paragraphs have moved around, it’s not just a figment of your imagination — I am continuously making updates as I dig up new resources, my understanding of these concepts improves, or I think of more clear ways to frame things. ❤

What if the traumatic situation is ongoing?

Most of this literature deals with addressing just the PTSD itself — the wary brain continuing to perpetuate internalized pain after you are no longer in danger — rather than dealing with an actively traumatizing or dangerous situation. For purposes of this article, I’ll just be focusing on unwanted PTSD responses to non-dangerous stimuli and associations, rather than PTSD responses to actual abuse or immediate danger.

Unfortunately, it can be difficult for domestic abuse survivors to discern the difference between being hijacked by harmless stimuli, versus being actively gaslighted by someone with narcissistic tendencies who wants to convince you that nothing is wrong and the fear is all in your head. If you suspect the latter and you only seem to get triggered around a specific person, research how to tell if you’re being gaslighted.

Let’s also acknowledge that our definition of a genuinely “dangerous” situation will differ based on context, and we can’t speak for what might be dangerous for other people. For example, the threat of losing a job may be literally life-threatening to someone with a chronic medical condition in the U.S. who works paycheck to paycheck, versus merely an ego-bruising temporary setback to a healthy citizen with a lot of savings.

If an actively traumatic situation is currently going on, it’s probably more pressing to first exit the traumatic situation, take stock of what you would need to do so, start gathering resources to build a safer life, or establish/strengthen connections with people who will be able to help you safely exit the situation (whether mentally or physically).

If for whatever reason it is not possible to exit or safer to stay for now, that’s a valid thing, but find allies and hold onto hope.

1. Empowering terminology

Alexithymia — The inability to identify emotions in oneself or others.
This can be a general state for some people. But even if you’re usually fine at identifying emotions, it’s not uncommon to enter this state while feeling triggered or overwhelmed.
Interoception — Awareness of one’s internal physiological state.
Limbic system — A grouping of structures in the brain that deal with emotions, behavior, motivation, long-term memory, and olfaction.
Triune brain model — The idea that the brain is evolutionarily layered as a primitive “reptilian” survival brain, a limbic system for social attunement and emotions, and most recently, a neocortex for complex, abstract thoughts. While now recognized as a grossly inaccurate oversimplification, it is still widely accepted as a useful explanatory tool in pop psychology for the reasonably accurate generalization that the parts of the brain concerned with survival, fear, and attachment tend to overgeneralize and fire much faster and stronger than the rationalizing parts.
Emotional hijacking — The amygdala, which is associated with decision-making, emotional responses, and memory processing, sets off threat alerts a lot faster than our neocortex can make complex decisions. In other words, there’s a physiological explanation as to why new facts and rationalizations aren’t effective at preventing us from getting inappropriately triggered, scared, or angry, or from moving us forward once we’re triggered.
Learned helplessness — After sufficient repeated trauma where someone is rendered unable to escape or avert the trauma, they may give up entirely, even when the barriers previously preventing their escape are completely removed. This is common in abuse survivors with cPTSD.
Fight, flight, freeze, fawn — Many people now know about the fight-or-flight response, where we respond to perceived threats by getting angry or afraid. However, there is also a freeze response: when someone gives up, becomes numb, or dissociates because they have learned that resistance is futile. And a fawn response, when someone tries to appease the perceived threat by being pleasing or helpful.
Recognizing fight/flight/freeze | BetterHelp
The 4 Fs | Pete Walker

Empowering concepts

Transgenerational / ancestral trauma — Trauma is often cyclically re-inflicted on those one is closest to, especially to one’s children, often without people in the chain really understanding the traumatic origin. This is particularly commonplace if one’s recent ancestors were war refugees, slaves, or other severely brutalized groups. Trauma does not excuse abusing someone else, but it can be contextual and powerful to realize that a parent may have not have been able to provide care because they didn’t know how to deal with their own trauma. This can help shift the ingrained self-blame that we failed them as children, frame things more humanistically, and incentivize us to break the cycle so that we don’t pass it on to others.
Implicit flashback — People with PTSD may have explicit flashbacks where they feel as if they are literally reliving a past traumatic event. But they may also have implicit flashbacks, where they get triggered by an association and mistakenly believe that someone in the present is threatening them the same way a traumatic event once threatened them, even if the situation is actually safe. If not de-escalated, this can quickly lead to blaming and erosion of trust.
If this feels very relatable, read CPTSD: From Surviving To Thriving, Ch. 8.
Hypervigilance — A high-alert state of increased sensitivity to potentially dangerous stimuli, often associated with fight-flight/freeze responses. While useful in an active survival situation, this state may be triggered much more often (or even constantly) in innocuous situations in someone who has PTSD, causing higher baseline anxiety, fatigue, and distrust.

You might not realize you are in a trigger state if you have been there so long you have normalized it. For example, my blood pressure was 140/90 for my whole life until I physically exited my traumatic situation, at which point it immediately dropped to 90/50 and has stayed there ever since.My prescribed antidote to this scenario is to practice openness and talk about ~feelings~ with other people to broaden your perception of what's "normal".

2. It’s not your fault

Triggered states are overwhelmingly powerful, and it is not uncommon to feel ashamed or weak that we can’t overcome them through sheer force of willpower, or ashamed that we feel bad at all.

Am I triggered/hijacked?

You can learn how to de-trigger yourself, but it’s easy to forget to use those tools if you don’t learn to recognize that you are triggered in the first place — which is also surprisingly easy, because brains are great at making up fake rationalizations to explain your fear. “I am truly in immediate danger right now!” and so on.

You may be hijacked (experiencing an emotional flashback) if you:

Feel overwhelmed by fear, shame, or confusion
Feel small, fragile, helpless, terrified
Feel frozen, shut down, unable to make sense of things, dissociated, numb
Feel enraged, critical of others, judgmental, perceive ulterior motives
Feel worthless, self-loathing, self-disgust, self-hatred
Suddenly distrust your proven allies
Feel an evaporation of the self-esteem you have built up since the original trauma
Feel an overwhelming fear of catastrophe or in imminent danger that the world will end, in response to a minor/mundane/innocuous situation

[CPTSD: From Surviving To Thriving, Ch. 8]

Again: It’s. Not. Your. Fault.

To overcome triggers, we need to learn to overcome shame. Shame cuts us off from seeking help. Shame makes it hard to try. Shame is an obstacle to compassion.

It can help to learn that it’s not your fault this feels difficult. Triggered states are physiological. Regulation is physiological. Emotions are physiological. Terror, anger, and shame are not merely abstract thoughts in the brain: they are primal emotions that prepare the entire body to launch into an atavistic survival state. They completely change the way we think and rationalize, and make it easier to make snap judgments that we wouldn’t agree with normally. They have a physical cooldown period, so we can’t immediately snap back from them, and we can’t easily have a levelheaded conversation during them. [Emotional Intelligence, Goleman 1995]

This doesn’t mean that we’re helpless or unfixable. We can change these things, but it won’t just magically happen because we wished for it hard enough. To actualize change, we need to develop stronger self-awareness of these states and triggers, reestablish agency over our bodies, and find more pathways to feeling safe and secure. [The Body Keeps the Score, Ch. 13]

If you already have a general idea where your trauma-induced shame comes from, see CPTSD: From Surviving To Thriving, Ch. 9 for concrete exercises to help you shrink your Inner Critic and work through shame. If you’re not sure, ask a therapist for help figuring it out.

Validity is complicated

There are a lot of seemingly contradictory, but actually compatible validations / anti-judgments I’ve developed over the years that I find useful to simultaneously hold when processing things.

It’s not your fault a traumatic event happened. It’s not your fault you have PTSD symptoms. I cannot say this enough.
However, unfairness does not negate responsibility. It’s a completely unfair setback that we have PTSD symptoms, but it doesn’t mean we aren’t still generally accountable for our actions.
Only we can perform the inner work to heal ourselves.
However, we will need help. Probably a lot of it. It is okay to ask for help (so long as you’re willing to accept no for an answer), and doing so doesn’t make you weak. If anything, you become stronger by confronting it than ignoring it, and secure co-regulation is shown to make us significantly more resilient.
If you have never seen healthy behavior modeled by someone else, it’s really hard to figure out what it might look like. Growth is a slow, trial-and-error process.
Many of the most resilient and empathetic people I know come from trauma backgrounds. We can’t change the past, but we can change how we react to it.

I know just saying these or rationally believing them doesn’t make them feel real. It’s taken me many years to internalize them, and I still lapse in triggering situations. But it can be powerful to hear and say them.

There might not be fault at all

Sometimes there’s a clear place one might instinctively assign blame for trauma, such as if you had a very clear-cut abuser who chronically took advantage of you. Often, as in the case of an accident, understandable levels of emotional immaturity, complex systemic inequality, bad timing, or general unkindness from the universe, there might be no one to blame.

The punitive Western justice system might have us believe that everything is a matter of right or wrong, your fault or my fault, but pain isn’t any less real just because there’s no irredeemable Disney villain to point fingers at. Restorative justice & nurturance culture show us another path forward.

Blaming others doesn’t fix our problems. And not blaming others doesn’t mean we are dismissing our problems. Difficult things happen all the time without malice involved. All we can do is try to collectively make things healthier, safer, and more accountable as best we can. For more on these philosophies, check out The Big Book of Restorative Justice and Turn This World Inside Out (Nora Samaran)[AKPress].

3. PTSD is a physical reality (and what we can do about it)

Rational awareness of our thought-bodies is important, but doesn’t fully address our triggered emotions, which are rooted in survival-oriented brain structures that are hard to override using our rational brain. We might try to rationalize our fear, but that can often lead to misinterpretations about the current situation. In order to become calm and rational, we first need to focus on soothing and deactivating the survival response.

Trauma is non-integrated

Trauma is not integrated in the brain.

Normally, when non-traumatic scary things happen to people, we’ll get scared, process them, realize the world didn’t end, file them away in our life experience catalog, and go on with our lives.

Trauma memories are fragmented and isolated from the rest of our integrated memories — they were too overwhelming to be stored and processed properly. When we have flashbacks, we get so overwhelmed because our bodies believe that they are re-experiencing a trauma moment in the present, even if the original trauma happened decades ago. [The Body Keeps The Score, Ch. 4] Flashbacks may be explicit, where we relive the details of an originating trauma event, or implicit, where we only relive the survival emotions, but project them onto our current surroundings.

Some integrative methods such as EMDR focus on accessing and reintegrating these memories with the aid of bilateral brain stimulation. Once a memory is successfully integrated, the source no longer provokes a traumatic reaction, and is recognized as a normal bad memory without the same paralyzing power. This has been shown to resolve PTSD symptoms significantly more rapidly than conventional talk therapy. [The Body Keeps The Score, Ch. 15]

In a 2007 study, 6 months of EMDR treatment were shown to completely eliminate PTSD symptoms for 75% of adult-onset subjects and 25% of childhood-onset subjects.
[DOI: 10.4088/jcp.v68n0105]Reintegration can help subjects heal back to a preexisting healthy state, which is particularly effective on acute PTSD caused by a single event. Unfortunately, childhood-onset PTSD from caregiver abuse is more complex, since the traumatic source may be someone's entire life experience.With severe caregiver abuse, there may not be some preexisting healthy state to heal back to, so you will probably have to supplement with many approaches to build a new healthy self that didn't exist before.

De-triggering 101: Simple soothing

Mind-body integration in the case of PTSD can be a very gradual process. After all, you are unlearning your body’s old survival instincts. But once you recognize that you are being hijacked, you can soothe yourself out of it.

Here are some simple methods you can start using right away.

Slow, deep breathing activates the parasympathetic nervous system and helps calm down our threat response. (The Trauma Center teaches kids this through the brilliant medium of bubble wands.)
Safe touch — a physical, sensory resource you find grounding to touch when you are triggered. Hugs or hand holding can be extremely helpful. You can also give yourself a hug. But if human touch feels unsafe when you are triggered, you might want a pet, a plush, a weighted blanket, a necklace, a palm stone, a fidget object, a tree, etc. Safe touch can help you remember that your body is in the present.
Other calming ambient sensory experiences. I find it extremely helpful to open a window or stand on my fire escape when triggered, because the sunlight and wind remind me that my body exists. Soothing music can also be helpful.
Say, “I am safe here.” Remind yourself that you are safe in the present, and the traumatic event is not happening again. Remind yourself of ways in which your allies and resources have supported you and been trustworthy in the past.
Identify familiar patterns instead of drowning in them. If you feel like this has all happened before, identify what past scenario this reminds you of. If you are feeling deeply judgmental of yourself or others, recognize the presence of an Inner Critic or Outer Critic. If you are feeling deeply abandoned, recognize whether you are being reminded of a past abandonment. Recognizing patterns helps loosen their hold over us and separate “aaa everything is truly terrible and the world is ending” from “I feel angry/shamed/afraid because I am hijacked right now”.

For many more useful steps, see Pete Walker’s 13 steps to managing emotional flashbacks.

Emotional regulation through mindfulness

It’s not uncommon for people who have been traumatized (especially gaslighted) to have blockages in their emotional self-awareness and self-regulation. But we can’t address our emotional issues unless we know what emotions we’re feeling and why, so developing a stronger sense of awareness is really helpful.

As Western medicine is starting to realize and investigate, meditation and mindfulness are not merely abstract hippie beliefs. Self-awareness and self-regulation are muscles (well, specialized regions in the brain) that we can quantifiably strengthen through mindfulness [The Body Keeps The Score, Ch. 6].

Countless monks and other spiritual teachers have devoted their life’s work to developing gentle ramps for us to get better at mindfulness long before therapists existed or the term “PTSD” was coined, so there are loads of resources out there! I particularly find the mindfulness writings of Thich Nhat Hanh (a Buddhist monk, community leader, war survivor, and extremely compassionate writer) to often be a gentler way of addressing inner hurts and relaxing out of my overanalytical brain than the more direct therapy approach.

I’ve written a shorter article about self-regulation through mindfulness here, with some overlap:

Mindfulness for Skeptical Nerds

a.k.a. a letter to my past self

medium.com

Introductory mindfulness resources

Intro to mindfulness practice by Thich Nhat Hanh
There Is No Right Way To Meditate (Yumi Sakugawa) [sample][via S&S]
Approachable and goofy cartoons visualizing many different ways to find ways of meditating that work for you.
A Handful of Quiet: Happiness in Four Pebbles (Thich Nhat Hanh) [via Parallax Press]
Designed for children, but could also be useful for those very new to mindfulness or looking for a hands-on approach with less philosophy. Offers simple and useful spatializations for processing emotions, like putting your anger into a pebble in your pocket.
Insight Timer — a customizable meditation timer app with soothing sounds, plus a large library of guided meditations
Plum Village app — guided meditation app for Thich Nhat Hanh’s mindfulness teachings. Calming body scans, general awareness, and gratitude practice.

I’ve also linked deeper mindfulness resources for dealing with one’s inner pain below, in the section on comforting the inner child.

Somatic awareness

If your body is a scary and confusing place to be sometimes, you might particularly benefit from somatically-informed therapy approaches. [The Body Keeps The Score, Ch. 13, 16]

Somatic experiencing, sensorimotor psychotherapy, and the Hakomi method are related approaches that combine traditional therapy with utilizing or gently developing the client’s awareness of how a traumatic experience (or experiences in general) may be held in the body, and facilitating their ability to re-establish agency over their bodies and regulatory mechanisms while triggered.

These approaches can be useful for dismantling learned helplessness, improving interoception, learning to separate physical sensations from trauma emotions, and learning how to get out of dissociative states, especially in people with physical trauma origins.

EFT/tapping involves tapping on your own body while focusing on particular feelings you are having. I don’t subscribe to the mechanistic claim that it rebalances your chi. However, enough people seem to swear by it, and I also find that it feels helpful. It’s also easy to do on your own, incorporates mindfulness and physical stimuli to help your body stay in the present, and involves bilateral stimulation.

Building general somatic awareness

Flow arts, yoga therapy, or other expressive/movement arts can help you learn to inhabit your body and build general agency over your bodily sensations and awareness.
On environment-based mindfulness for people with severe body-based PTSD | Clementine Morrigan
Nature therapy, gardening, or generally doing something calming with your hands and sensations

Nervous system regulation

Polyvagal theory describes our autonomic nervous system’s role in fight-flight-freeze responses, and how to identify and manage different states. If you find yourself getting stuck in a triggered state such as primal anger/fear/terror and you have a lot of trouble deactivating, you might find this useful. Haven’t personally delved much into this area yet, a friend recently recommended it to me.

Quick intro: Complex PTSD and the Polyvagal Theory | Polyvagal Podcast

Accessing the Healing Power of the Vagus Nerve (Stanley Rosenberg)
Self-help exercises for improving self-regulation of your autonomic nervous system. The author comes from a craniosacral perspective.

The Polyvagal Theory in Therapy (Deb Dana)
A clinician perspective, written more for therapists looking to incorporate this approach with clients. Includes worksheets and exercises.

4. Getting to know your inner pain

You won’t know the depth of your distrust, until something happens to illuminate it. When you work with this issue, it may become clear that you’ve never felt safe anywhere. […] So, a big part of the method is creating a missing experience. It can be powerful. Someone who has never felt safe is going to have a powerful experience when they finally do.
— History of the Hakomi method

Feeling bad about feeling bad

It is very common and understandable to feel bad about having PTSD symptoms. After all, they take away our sense of agency and are holding us back from being who we want to be. It feels like a betrayal when you lose control of your own body.

While this may be a fair assessment, it doesn’t actually help us heal. Shame and self-loathing are powerful emotions that only make us feel worse.

But blind positivity doesn’t work either. It doesn’t acknowledge the pain we have gone through or the specific healing we need to tackle our issues. Generically positive statements can feel foreign, invalidating, and even sometimes scary for people who have internalized the opposite of that, or been exploited.

Many integrative therapeutic approaches specifically involve identifying the sources of our pain and locating our inner wants and needs. By processing and validating these specific wants and needs which are trying to express themselves through pain, we can find positive feelings which tune into our specific needs. This can help us feel viscerally safe so that our trauma parts stop hijacking us, instead of simply making ourselves feel worse and getting more and more hijacked.

IFS (Internal Family Systems) model

This therapy approach focuses on identifying the conflicting parts of ourselves and disidentifying their fears from our true wants.

An Inner Critic that says “you’re bad and it’s hopeless to try” might find a reframe as an expression of learned helplessness fearing “I will make a mistake and then something terrible will happen”. An Outer Critic that suddenly starts finding fault with your loved ones and saying “you can’t trust them” may be afraid because a trusted person treated you very badly in the past. And so on.

Although these conflicting pieces of ourselves may be frustratingly self-destructive in the way they perpetuate old hurts upon us, it’s important to recognize how these instinctual behaviors were once adaptations that helped improve our chances of survival. Even if they’re unhelpful now, they exist because they used to help us in a genuinely terrifying situation.

Useful IFS-based self-compassion tips, via lizlistens

If a childhood caregiver habitually abused or neglected you, but you still relied on them for food and shelter, then it was an extremely reasonable childhood adaptation not to trust people you feel close to. After all, the person you relied on for survival was not trustworthy. But unless you are still in an abusive situation, it’s probably hurting rather than helping you in the present day.

By identifying the sources and adaptive nature of these behaviors, and thinking of them as different pieces of us with different needs, we can better figure out what we need in the present day. If the distrusting piece is trying to protect us, then we can write down our ground truths during a calm moment. But if we keep letting its distrust send us into a panic frenzy, we’ll just keep damaging our relationships with people we are actually safe with.

Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation (Janina Fisher)
A deep resource on processing and healing our fragmented trauma parts. Focuses on understanding traumatic responses, managing dissociation, and finding safety for all of one’s trauma parts.
The Body Keeps The Score, Ch. 17: Putting The Pieces Together.

Comforting the inner child

The premise of IFS seems very analogous to mindful self-compassion, or the concept of comforting the inner child.

Lots of people with learned helplessness have trouble giving compassion directly to themselves due to ingrained self-blame, because they have been conditioned to believe they are not worthy of that compassion. But it can be much easier to comfort a separate, imagined child who went through the same experiences. This is your inner child.

Would you ever tell a hurt, crying child that they’re not worthy to receive comfort? Probably not. So why do it to yourself?

A Gift To Myself (Charles Whitfield)
An inner child healing workbook.
No Mud No Lotus (Thich Nhat Hanh) [via Parallax Press]
A general primer on how to live mindfully in the present, as well as how to gently connect with and reassure your inner pain without feeling overwhelmed by it.
Fear: Essential Wisdom For Getting Through The Storm (Thich Nhat Hanh)
A more focused read on transforming the garbage of your fear, anger, and anxiety into compost to feed the flower of compassion.

Rescripting the inner experience

PBSP (Pesso Boyden System Psychomotor therapy) is detailed in The Body Keeps The Score, Ch. 18: Creating Structures.

It’s hard to find much information about this online, but from my understanding, it focuses on rescripting inner experiences and core beliefs in an interactive spatial setting, through having volunteers stand in for traumatic and ideal versions of core figures, and having a therapeutic witness acknowledge and validate the rescripted, healthy core beliefs. (It seems similar to a common method for breaking recurring nightmares, which allows you to find catharsis by scripting and rehearsing a new, non-scary ending to the nightmare.)

I haven’t yet been able to find an available therapist trained in this. It seems more niche, and is best utilized with a group of volunteers. I’ve done a solo DIY version on myself, and that alone was extremely helpful, although I’d still like to try the full experience.

For the record, it seems like the other treatment methods described in section 4 also involve rescripting your inner experience, but perhaps in a more somatic and less vocalized way.

The Abandonment Onion

Those who were chronically emotionally neglected during a formative period in their lives may have a traumatic fear of abandonment, and a variety of learned responses they used to cope with it.

CPTSD: From Surviving To Thriving (Walker), Ch. 12 frames the internal response to abandonment issues as a series of learned defensive layers that wrap around each other like an onion, with each layer trying to protect us from the layer beneath.

Abandonment depression. The worst, innermost layer.
The traumatic and overwhelming fear of abandonment. The lingering pain that we were not nurtured when we needed help the most. Children learn to cope with neglect by any means necessary, including suppressing their desire for healthy connection so they can obtain whatever is available, be it conditional or exploitative.
Fear/shame pain
This layer tries to dissociate from abandonment depression by trying to prevent us from deeply connecting. If we don’t connect, we don’t have to worry about being abandoned by others, because we have already preemptively abandoned ourselves.
The Critic
This layer tries to dissociate from emotional pain. It may direct inward or outward. By projecting our fear and shame — making extreme statements like “I’m inherently bad”, “I don’t deserve love”, “they can’t be trusted”, “people will always leave me”, the Critic distracts us with easy concrete targets for fear and shame.
Outermost layer: the 4Fs — Fight, Flight, Freeze, or Fawn.
Distracts us from our suppressed, legitimate desire for authentic connection by giving in to or dissociating from the Critic. These are the coping mechanisms we may have developed to obtain scraps of safety when dealing with past emotional neglect.
Fight: bullying, controlling, or blaming others
Flight: perfectionism, panicking, hypervigilance
Freeze: isolating and suppressing desire for connection
Fawn: people-pleasing and suppressing our needs and boundaries

While anyone (particularly from problematic relationships) may exhibit tendencies like the Critic to some extent and benefit from this framework, survivors of chronic childhood neglect/abuse have concretized these responses to a very extreme degree, and often have difficulty telling apart the Critic from real evidence to the contrary, unless they’ve actively worked on it.

The good news is that since these are learned responses, they can also be unlearned!

If this felt relatable to you, you’ll find help processing abandonment pain and establishing healthy responses in Walker’s CPTSD book. This reparation work is often called reparenting.

5. Attachment & attunement

Attachment dysregulation frequently co-occurs with PTSD from relationship/family issues, and is incredibly useful for traumatized people to understand in interpersonal relationships. However, one does not need to have experienced any sort of trauma to have some attachment dysregulation. Attachment is a wide, fluid spectrum.

Attachment theory (one of the most widely accepted theories in psychology) describes various behavioral styles of responding to emotional intimacy — something which is deeply coded into us by formative emotional experiences, often with our childhood caregivers (or lack thereof).

It posits that we all share a common goal of wanting safety from an intimate bond when stressed. However, if our core attachment figures had a long history of being improperly attuned to our needs, or if we have experienced an impactful loss, we may express this desire for safety in wildly different and often counterproductive ways, which may come off as unpredictable to others and even to ourselves.

For example, we may feel unsafe without constant reassurance (anxiously attached), or may feel unsafe with intimacy (avoidant), or simultaneously seek out and fear closeness (fearful-avoidant / disorganized), sometimes with self-destructive effects that undermine the very safety we seek. Again, these patterns likely developed to help us better navigate a difficult situation in the past, but perhaps they don’t help any more.

We may also be drawn to behaviors that match with past core attachment figures, even if they are not the best for us, because our limbic systems recognize those behaviors as familiar.

Note that attachment styles are neither fixed nor absolute. They are just very useful points on a spectrum, and people can respond to different situations very differently. For example, many people who are insecurely attached in romantic relationships may be relatively securely attached in platonic relationships (although the opposite can also be true). People may simultaneously exhibit a mix of different patterns based on multiple contexts (e.g. internalizing different core beliefs from different parents), though the labels are still generally helpful for figuring out one’s underlying needs.

While attachment styles formed in childhood have extremely strong sticking power, it is definitely possible to switch or gradually change styles in adulthood, especially through relationships or traumatic events.

Favorite resources

The Body Keeps The Score, Ch. 7

A General Theory of Love (Thomas Lewis, Fari Amini)
Great and empathetic overview of mammalian attachment, social attunement, emotional intimacy, and healthy interdependence. This is a fairly general read, and probably useful to anyone interested in self-regulation and emotional intelligence.

Adult Children of Emotionally Immature Parents (Lindsay C. Gibson)
Fantastic read on better understanding your childhood experiences and responses, understanding confusing mixed signals from one’s caregivers, and learning to set healthy, self-respecting boundaries.

This book doesn’t assume a particular degree of objective badness, only that you would like to work on dysregulation of some kind. So it seems like it’d probably be useful for addressing a very wide range of parental relationship dysfunction, from lovably frustrating to toxic.

Hold Me Tight (Sue Johnson)
Empathetic framework & exercises for repairing unhealthy patterns in committed relationships with an anxious-avoidant dynamic, by finding ways to gently build self-awareness of patterns, and bridge both partners’ seemingly conflicting needs for feeling safe.

This is the first book I’ve ever read that actually talks about what kinds of needs/reactions might be going on when an avoidant person becomes opaque and withdraws, and how to create a mutually safe space during that.
The relationships in the case studies are very cis-het-mono, but I think the framework itself seems reasonably generalizable to other contexts with a bit of mental filtering.
Note that this framework requires a lot of vulnerability, and assumes that you are working on a merely dysfunctional relationship where both people are willing to do work, and not a toxic/abusive relationship. If you think you might be in the latter situation, figure that out before proceeding.

Resources I did not find quite as helpful, and whyAttached: The New Science of Adult Attachment (Amir Levine, Rachel Heller)
A general intro to attachment styles in the context of romantic relationships. Largely a list of identifying behaviors; useful but I prefer the resources above to start. I also thought it demonized avoidant-leaning people in a way that didn’t seem conducive to building understanding with them. Might be useful if your relationship experiences have been more toxic or inflexible.Wired for Love (Stan Tatkin)
Very similar premise to Hold Me Tight, but I didn’t personally find it quite as actionable, empathetic, or memorable. Also felt like it encouraged self-judgment in a way that had potential to be regressive for people who have particular difficulty recognizing & holding their own boundaries due to a history of gaslighting or abuse.(By this, I don't mean to suggest that we should avoid evaluating our actions. Hold Me Tight asks the reader for vulnerability and acceptance of wrongdoing, but I think in a way that also upheld their wants/values.)

6. General resources

Top picks

If you have limited room in your reading queue, start with one of these.

The Body Keeps The Score (Bessel van der Kolk)[via Penguin].
Foundational overview of PTSD research, the neurobiology of trauma, and how mind-body integrative therapy can help dislodge stuck trauma more than talk therapy alone.

Big focus on cPTSD from childhood abuse since that’s the most stubborn and complicated common trauma to deal with. But it covers a lot of ground, and should be generally useful if you carry any kind of trauma, or simply want to better understand a traumatized person in your life.

A bit theory-heavy. Better read as a whole than in pieces. May be particularly useful if you don’t understand why your trauma is so difficult to work through and you tend to feel validated by scientific studies.

Complex PTSD: From Surviving To Thriving (Pete Walker)
Extraordinarily actionable handbook for people with cPTSD from relational abuse or neglect. Extremely applied, with “toolboxes” of steps to go through when you are being hijacked. Structured so you can pick and choose the chapters that are relevant to you.

Includes a whole wonderful chapter of affirmation for people who berate themselves for feeling bad or who don’t seek out help because they believe that their trauma is insignificant compared to others’ trauma.

Written specifically for survivors of parental abuse or neglect, particularly those who were subjected to chronic emotional neglect, chronic contempt, or disproportionate punishment growing up. However, seems like it would be also be very useful for dealing with the impact of non-parental formative relationships that were abusive/neglectful, or anyone who wishes to reduce the impact of emotional hijacking on their life. For a short sample, see the author’s 13 steps to managing flashbacks.

Other generally useful resources

“NVC” — Nonviolent Communication (Marshall B. Rosenberg)
A communication framework rooted in deep listening and compassion to others and ourselves that has completely expanded my emotional self-awareness. Simple, memorable method to observe a situation, distinguish the objective externals from the subjective internals before we speak rashly, and move forward in mutual understanding.

Particularly useful if you have trouble with boundaries (yours or others’), or if you find your emotions confusing and wish to increase your emotional clarity.

Some of my friends have a preference for Crucial Conversations (CC) over NVC. They are very similar in premise but stylistically different. CC seems a bit more oriented toward anger management tips, while NVC seems more oriented toward people-pleasers. The case studies also lean slightly more workplace-oriented in CC. If you’re not sure which one calls to you more and you have the time, it’s worth reading both.

(To complete this trifecta, I found Difficult Conversations very similar in premise to NVC, but more long-winded and not as personally actionable or straightforward to implement.)

“The Opposite of Rape Culture is Nurturance Culture” (Nora Samaran)
The essay that kicked off Turn This World Inside Out, a really lovely collection of essays on encouraging care and accountability in a way that repairs and humanizes everyone (rather than shaming, as callout culture does).

Emotional Intelligence (Daniel Goleman, 1995)
Thorough overview on the somatic nature of emotions, and evidence/reasoning that emotional intelligence is often much more critical for happiness, and even for very societally conventional metrics of success, than conventional intelligence is.

This book went into great depth about emotional dysregulation, but didn’t offer many solutions. However, it was useful for helping me better grasp the physiological nature of emotions, and validating all this time I’ve been investing into emotional regulation that I could instead be spending on more normatively “useful” things.

Bite-sized resources

You may have noticed that I am a very heavy reader. If reading an enormous pile of textual trauma tomes doesn’t quite align with your preferences or current capacity, here are some excellent PTSD & attachment educators who serve up helpful information in more bite-size and/or visual formats.

Monique Koven: The Healing Trauma & CPTSD Podcast

Toni Talks — somatic trauma therapist. Tips for getting started with therapy, and basic de-triggering/reframing exercises.

Andrea Glik — somatic trauma therapist, some LGBTQ/poly content. Relatable prompts and suggestions for replacing self-destructive thought patterns with a growth mindset, and a focus on nervous system regulation. Blogs, podcast interviews, and workshops on her website.

Clementine Morrigan — trauma healing writer, CSA/incest survivor, extremely LGBTQ/poly affirming. Focuses on nervous system regulation, sexual abuse healing, and tips for people with severe somatic dysregulation. Recommended resource list.

Silvy Khoucasian — attachment-focused coach. Offers useful and in-depth (but still bite-sized) prompts & tools for people with boundary issues or childhood trauma. Also has a podcast, Love With Integrity.

Liz Listens — attachment-focused therapist. Offers engaging visual paraphrases of attachment/healing frameworks (including many of the above). Helpful, concrete, and validating tips on breaking out of unhealthy patterns and being a kind person.

Getting therapy

Useful validations from tonitalkstherapy that you don’t need to have experienced some “qualifying” degree of badness in your life to receive or benefit from therapy. [1][2]

PsychologyToday has a detailed search engine that lets you find therapists by particular parameters (insurance accepted, location, specialties, treatment modalities), and provides price ranges upfront. Many therapists on it seem to have ramped up their teletherapy options during shelter-in-place. You contact therapists individually through it to set up consults.

BetterHelp is an online therapy platform that supports weekly live sessions and unlimited messaging for a monthly fee. ($160–280/month, coming out to $40–70/week. Offers up to ~40% financial aid if you’re low-income. Also, my referral link gives us both a free week.) You fill out a questionnaire and then they will match you with a counselor within a day or two. So even if you don’t plan to subscribe to them long-term, they are a great way to quickly or inexpensively try therapy.

Open Path Collective is a nonprofit network that offers low-cost therapy services to uninsured or underinsured people. ($59 for membership, then $30–60/session.)

Quick guide on choosing therapy modalities by Andrea Glik.

7. Coda

In this massive overload of research and information, it can be easy (at least for me) to forget that the central tenets and driving motivations of all this effort are simply: to build healthy self-compassion and feelings of safety that allow us to feel at home in our bodies, and to feel safe and connected in interpersonal relationships.

If you can already do that easily, perhaps this all seems unnecessary because you don’t need much help. For people undergoing particularly difficult times, people who have deep internalized blocks, people who were chronically unsafe during their formative years, or people who have no idea where on earth to start, it can be really difficult to navigate without falling back into old patterns. I, at least, find it useful to explore and consider many different approaches and lenses that have worked well for other people.

It might also be exhausting to spend too much time delving into and working on PTSD. Maybe you need to timebox it and tackle it in very small doses. That’s okay too. It’s important to know your limits.

Gratitude

Big thanks to Rae for originally recommending The Body Keeps The Score, Aug and Balt for helping expand my emotional self-awareness and frequently spotting me as I fumbled the unwieldy twin barbells of self-compassion and emotional baggage, and the countable but large set of other cherished people who have helped me feel valued, stay afloat, and co-regulate in bad and good times.

Obligatory science disclaimer & counterpoints

A bunch of somatically based PTSD theories and therapies are considered "alternative" due to "low volumes" of "rigorous" studies. Although I am usually skeptical of such, I find the "alternative" label very acceptable in this particular context for a variety of reasons.1. It is not possible to efficaciously double-blind a study where the person administrating the therapy needs to emotionally engage with the subject's deepest personal fears. And most of these therapies require building a trusting rapport with someone who is not particularly trusting, so any studies will be relatively slow, long-term, and high-investment.On the other hand, even though most pharmacological treatments (for a notable exception that augments normal therapy, see MAPS research into MDMA therapy for treating PTSD) are proven not to be particularly effective for most PTSD scenarios, it's easy to set up rigorous drug-only studies with large sample sizes, since pills are fast and easy to administer and double-blind.2. The therapies outlined in The Body Keeps The Score have been scientifically studied, with control groups. The neurobiological bases for these theories have been scientifically investigated, with MRIs. The limited funding and complex nature of the subject makes it difficult to crank out lots of studies or large sample sizes, but the studies and sample sizes seem pretty reasonable given all these constraints.3. Although trauma and PTSD are now fairly common knowledge in modern lexicons, the field of PTSD therapy is extremely young. "PTSD" did not even exist as a DSM diagnosis until 1980.4. PTSD sucks. I'll try anything that has a vague chance of helping just to see what sticks a bit. Here verily I do disclose my bias.5. If a method was shown effective enough to be considered highly promising by someone who has dedicated several decades of their life to trauma research since before the term "PTSD" was even coined, it's damn well more than good enough for me to spend time learning about.