Trouble Staying Present with Posttraumatic Stress Disorder
If you're one of over 24 million people in the US who struggle with symptoms of posttraumatic stress disorder then you probably know exactly what it feels like to dissociate. When a situation, emotions or triggers cause you to feel overwhelmed, anxious, frozen or terrified the mind offers a typical (and really fantastic) coping mechanism: you go somewhere else in your head.
While dissociating can be a life-preserving response it can become a habit that severely inhibits PTSD recovery efforts. Part of healing means learning to become more present.
Explaining the Trouble of Staying Present
During your trauma your brain did what it's designed to do: protect you and keep you safe. It mobilized a fight/flight/freeze response, activated your biological and chemical systems to deflect energy from parts of your body that didn't need it (digestive, reproductive) and sent that energy to where you did need it (heart, limbs).
Your psyche got into the survival act, too. At a moment that was too intense you may have experienced yourself floating out of your body, seeing the situation from outside of yourself, or even blacking out. The psyche has a neat little mechanism to preserve your sanity, so it creates ways for you to handle a moment - even if that's by leaving the moment.
Part of the brain's job after trauma is to recalibrate. Some of what that means is that the brain looks for what lessons to learn and how they apply to future experiences. When it comes to dissociation, the brain learns, When a situation gets too intense check out!
The problem begins when that survival mechanism turns into an overgeneralized posttraumatic stress habit. In my own experience, for example, I dissociated often to escape feelings of pain, grief, sadness, anxiety and even the stress of social situations. Since PTSD becomes a lifestyle the coping mechanisms we put in place start to implement themselves in all parts of our lives, even when they aren't critically necessary.
Get Past the Trouble Of Staying Present
Trauma expert, Robert Scaer, has said, "Trauma is dissociation." That being the case, I believe healing is being present, which means you have to find new ways to do that. Some options include:
Sensory focus - Choosing one sense (sight, sound, smell, taste, touch) through which to interpret the world for a moment, an hour a day. Try this: Take yourself outside and be very still and just listen for 60 seconds. Or, bite into a tart lemon, taste the bitterness, feel your body's reaction.
Meditation - Developing a daily practice that trains your brain how to focus in the here and now. Try this: Quieting your mind can be tough. However, there's a simple trick to make it easier....
Breathwork - Science proves more and more how managing your breath brings enormous benefits in trauma and PTSD recovery. Try this: inhale 4 counts, hold 4 counts, exhale 6 counts, hold 2 counts. Do 10 cycles to start; work up to 20 minutes per day.
Physical movement (tai chi, dance, exercise) - Using your body to connect to the present moment sends a message to your mind. When you lose yourself in a physical activity your mind can become so engrossed in the task at hand that it increases its experience of the present moment. Try this: take a class in some physical activity you've either never tried or really love.
For more information about dissociation, why you're not present and how to develop a being present attitude listen to Dr. Cheryl Arutt explain the process of the brain during and after trauma, and offer tips for how you can begin to shift the balance of old habits versus new.
Rosenthal, M. (2012, October 31). Trouble Staying Present with Posttraumatic Stress Disorder, HealthyPlace. Retrieved on 2022, September 27 from https://www.healthyplace.com/blogs/traumaptsdblog/2012/10/do-you-have-trouble-staying-present
Author: Michele Rosenthal
Hi all from the UK. I've been struggling with this since I was around twenty years old. Now 42 I'm just getting a grip on what it is. I had anxiety (that may have come from childhood experiences) which then became obsessive thinking about various things that could perpetuate the anxiety. For me this started with constantly worrying I had contracted HIV (even though I was not promiscuous by most standards) and had many tests done to alleviate my worries. This would calm me down for a day or two then I would start worrying again (what if they made a mistake with the results etc) and the cycle would start up again. This went on for fifteen years or so, worries about health, whether I'd hurt someone's feelings etc etc..my life revolved around it. Very soon after it began I remember looking at nature, or listening to music, anything that used to give me pleasure and thinking, 'why doesn't this feel REAL anymore?', like there was a slight detachment between me and reality that I couldn't define. Many years later after the death of my Dad, my uncle (a Bhuddist monk!) suggested my mum should read a book by J Kabat Zinn called 'full Catastrophe Living' to help with her grief and health problems. I picked it up one day and suddenly things started to make sense. I had become detached from life by anxiety and left with NO joy. Even the births of my kids (the most important people in my life) didn't give me pleasure or happiness, only worry and fear. Being a musician (my career wish) became a torture, stage fright, unable to concentrate on practice etc , so I pretty much gave it up after devoting twenty years of my life to it! It felt like I'd missed a huge chunk of my life. Further reading about meditation, yoga etc gave me the knowledge about the path I needed to walk the rest of my life on, I'm still nowhere near it yet, but I'm optimistic! I find meditation difficult, the mind does anything to remain 'detatched' from the present moment. I would recommend anyone here to read all they can about meditation, yoga, tai Chi etc. The truth behind most religions, what they all point to, is to LIVE IN THE PRESENT! To 'sin' is to NOT be present, bad things come from lack of presence. Books that have been pivotal for me are Power of now (an obvious but powerful read, once you get in 'tune' with it) , Alan Watts' Wisdom of Insecurity, and J Kabat Zinn's various mindfulness works have been invaluable guides to making changes. I have to read these books over and over to remind myself but it's the only way I think. Good luck to you all!
Not being present, is this also thinking about the past, triggers cause anxiety, and i realize this and have learned to discover what triggers me, but doing that, sometimes it takes me an hour, also explaing people what triggers me, might cause me not to be present. Is this diassociating too ? Sometimes you have to think about what kind of feeling you feel and where it comes from. How to distinguish between all these symptoms and how knowing to respond rightly then ? Like trigger people amd for me wrong people....those are very similar things, but yet very different. I,find this a hard issue the moment.
@Elaine -- Yes, not being present means being disconnected from the moment you're in and this often happens when we let ourselves drift back into the past, or when a trigger occurs and we shift into fight/flight mode. This is a very tough issue but with mindfulness (bringing your attention to the thoughts and feelings and sensory input of the moment) you can begin to develop both an opportunity to give yourself a process for becoming more present and also an awareness of how to prepare a response to triggers that allows you to flow more easily through them.
I have problems staying in the present but mine is also due to having multiple personality disorder along with PTSD and Borderline Personality disorder.
what if i can't stay in the present and i don't have ptsd?
Best thing to do would be to 1) have a full medical check up and express your symptom(s) to your primary care physician, 2) if you have zero medical issues connect with a therapist/counselor/psychologist to figure out what's causing you to leave the present moment.
thank you so much for this. the value of the "i can handle this!" feeling in allowing one to stay present is a lesson that just seems to get truer. (i wish i didn't have to keep learning it.)
to the other commenter... it's disorienting to feel like you'd "not know how to live anymore", eh? for what it's worth i think it must be the case that both a) it's worth it, this new way, and b) you're still you. your life is still your life. the change isn't too much.
@Rachel -- You're so right: it's a lesson that gets continually truer while we do have to keep learning it! Think about this: technically it takes the brain 30 CONSECUTIVE days to imprint and utilize a new pattern. So.... if you were to give yourself the opportunity to learn/reinforce that lesson every day for 30 days you can really help your brain solidify it.
The ultimate equation? Feel the fear and do it anyway + I can handle this = success!
I too have a hard time distinguishing between whether or not I am in some PTSD trance or actually meditating. It happens while I'm doing something I can do without being mindful of it (sort of like driving a stick-shift), and I go somewhere into my thoughts. Sometimes I am sure that my mind went somewhere related to the traumas. I am usually snapped out of it by a loud noise or someone asking me a question. I know that working out really helps. I've also experienced a lot of relief with massage and reflexology. Reflexologists can do this thing called "grounding" that has worked very well for bringing me very present. I think physical touch, like a hug, or roughhousing with your kids is also very effective.
@LadyGirl -- I used to do that, too! Just drift off and then you're surprised to come back. I think one way we can look at it this: meditation isn't a state one gets 'snapped' out of. It is a choice to deeply focus inside, and then a choice to return our focus to the outside world. Dissociation, which is the appropriate term for the PTSD trance you describe, is less mindfully voluntary and more related to a habitual response to anxiety. How does all that sound as a way to distinguish one from the other?
I've had so many problems in my life (Bipolar Disorder, Eating Disorder) that my ever present and constant day dreaming seemed unimportant. My mind has become so well conditioned at just checking out that I check out most of my day. I'm not diagnosed with PTSD, but I did have childhood trauma. I learned about mindfulness from DBT, which seems to fall along similar lines of what you're talking about. I still find it hard to undo something that I do all the time. I don't think I'd know how to live anymore.
You're so right that undoing what's become a lifestyle habit is a challenge! I think the trick is learning to live in a new way, and also, with an 'I can handle this!' feeling that allows us to stay present. Usually, we check out due to fear, anxiety and overwhelm. Developing more proactive coping techniques can allow us to let go of things like dissociation because we're replaced them with a technique that's even better!