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(p. 25) Session 2: Common Reactions to Trauma and Craving Awareness 

(p. 25) Session 2: Common Reactions to Trauma and Craving Awareness
(p. 25) Session 2: Common Reactions to Trauma and Craving Awareness

Sudie E. Back

, Edna B. Foa

, Therese K. Killeen

, Katherine L. Mills

, Maree Teesson

, Bonnie Dansky Cotton

, Kathleen M. Carroll

, and Kathleen T. Brady

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  • To review your PTSD symptoms and any substance use since the last session

  • To review the homework from last session

  • To learn about common reactions to trauma

  • To learn about cravings

  • To plan the next homework assignment

Since Your Last Session

Your therapist will review the questionnaires you filled out before the session to see how your mood, PTSD symptoms, and substance use have been during the last week. You may spend a few minutes discussing these with your therapist at the beginning of the session.

Homework Review

Your therapist will ask you about the homework, and whether or not you found the assignments helpful, or if you encountered any problems completing them.

(p. 26) Common Reactions to Trauma

Everyone responds differently to traumatic events. However, there are some common experiences that people report. Remember that many of the reactions following a traumatic event are normal. In fact, most people who directly experience a traumatic event have symptoms in the immediate aftermath. Many people then feel much better within the first 1 to 3 months after the event, but others recover more slowly. Some people do not recover and instead they continue to experience debilitating symptoms as a result of the traumatic experience. Here is a list of the most common problems people experience after a trauma:

  1. 1. Anxiety and fear. Anxiety is a common and natural response to a dangerous situation. For many people it lasts long after the trauma ended. This happens when views of the world and a sense of safety have changed. You may become anxious when you remember the trauma. Triggers or cues that can cause anxiety may include certain places, times of day, certain smells or noises, or any situation that reminds you of the trauma. As you begin to pay more attention to the times when you feel anxious, you will be able to identify what triggers or sets off your anxiety.

  2. 2. Re-experiencing the trauma. People often “re-experience” the traumatic event. For example, you may have unwanted thoughts of the trauma and find yourself unable to get rid of them. Some people have flashbacks, or very vivid images of the event, which can feel as if the trauma is occurring again. Nightmares are also common. These symptoms occur because a traumatic experience is so shocking and so different from everyday experiences that you can’t fit it into what you know about the world. So in order to understand what happened, your mind keeps bringing the memory back, as if to better understand it, makes sense of it, and fit it in with your experiences.

  3. 3. Increased vigilance is also a common response to trauma. This includes feeling “on guard,” jumpy, jittery, shaky, nervous, on edge, being easily startled, and having trouble concentrating or sleeping. Continuous vigilance can lead to impatience and irritability, especially if you’re not getting enough sleep. This reaction is due to the freeze (e.g., deer in the headlights), fight or flee response in your body, and it is the way we protect ourselves against danger. Animals also have the freeze, fight or flee response when faced with danger. When we protect ourselves from real danger by freezing, fighting or fleeing, we need a lot more energy than (p. 27) usual, so our bodies pump out extra adrenaline to help us get the extra energy we need to survive.

    People who have experienced a traumatic event may see the world as filled with danger, so their bodies are on constant alert, always ready to respond immediately to any attack. The problem is that increased vigilance is useful in truly dangerous situations, such as if you are in a war zone. But increased vigilance becomes harmful when it continues for a long time, even in safe situations. People will sometimes use alcohol or drugs as a way to try and relax their body and not feel so on edge. Alcohol and drugs are commonly used among people with PTSD as a way to try and enhance sleep (e.g., to get to sleep, to not remember nightmares).

  4. 4. Avoidance is a common way of trying to manage PTSD symptoms. The most common is avoiding situations that remind you of the trauma, such as the place where it happened. Often situations that are less directly related to the trauma are also avoided, such as going out in the evening if the trauma occurred at night, going to crowded areas such as the grocery store, shopping mall or movie theatre.

    Another common avoidance tactic is to try to push away painful thoughts and feelings. This can lead to feelings of numbness or emptiness, where you find it difficult to feel any emotions, even positive ones. Sometimes the painful thoughts or feelings may be so intense that your mind just blocks them out altogether, and you may not remember parts of the trauma. Sometimes, people turn to alcohol or drugs as a way of trying to avoid, escape or block out the memories, feelings, and thoughts associated with the trauma.

  5. 5. Many people who have experienced a trauma often feel angry. They may feel angry for a variety of reasons (e.g., the unfairness of the terrible situation they experienced, because of how other people reacted when they told them what happened, or because they believe they could have prevented it from occurring). If you are not used to feeling anger, this may seem scary and out-of-control as well. It may be especially confusing to feel angry at those who are closest to you. People sometimes turn to substances to try and reduce these feelings of anger.

  6. 6. Trauma often leads to feelings of guilt and shame. Many people blame themselves for things they did or didn’t do to survive. For example, some assault survivors believe that they should have fought off an assailant, and blame themselves for the attack. Others who may have survived an event (p. 28) in which others perished feel that they should have been the one to die, or that they should have been able to somehow prevent the other person from dying. You may feel ashamed because of the ways you acted during the trauma; doing things that you would not have otherwise done. Other times, people may blame you for the trauma.

    Feeling guilty about the trauma means that you are taking responsibility for what occurred. While this may make you feel somewhat more in control, it is usually one-sided, inaccurate and can lead to feelings of hopelessness and depression.

  7. 7. Grief and depression are also common reactions to trauma. This can include feeling down, sad, or hopeless. You may cry more often. You may lose interest in people and activities that you used to enjoy. You may stay home and isolate yourself from friends and family. Because the trauma has changed so much of how you see the world and yourself, it makes sense to feel sad and to grieve for what you lost because of the traumatic experience.

    You may also feel that plans you had for the future don’t seem to matter anymore, or that life isn’t worth living. These feelings can lead to thoughts of wishing you were dead, or doing something to try to hurt or kill yourself. If you have these feelings or thoughts, it is very important that you talk to your therapist. Do not keep these feelings or thoughts to yourself. Your therapist is trained in how to handle these thoughts and experiences and will help you get through this. You are not alone. Let your therapist help you through this.

  8. 8. Self-image often becomes more negative after a trauma. You may tell yourself, “If I hadn’t been so weak, this wouldn’t have happened to me.” Many people see themselves as more negative overall after the trauma (“I am a bad person and deserved this”).

    It is also very common to see others more negatively (“People are so stupid”), and to feel that you cannot trust anyone. If you used to think about the world as a safe place, the trauma may suddenly make you think that the world is very dangerous. If you had previous bad experiences, the trauma may convince you that the world is indeed dangerous and others are not to be trusted. These negative thoughts often make people feel that they have been changed completely by the trauma. Relationships with others can become tense, and intimacy becomes more difficult as your trust decreases.

  9. (p. 29) 9. Sexual relationships may also suffer after a traumatic experience. Many people find it difficult to feel intimate or have sexual relationships. This is especially true for those who have been sexually assaulted, since in addition to the lack of trust, sex itself can be a reminder of the traumatic experience. People will sometimes use alcohol or drugs as a way to cope with intimacy, both physical and emotional.

  10. 10. As mentioned earlier, many people increase their use of alcohol or drugs after experiencing a trauma. Often, they do this in an attempt to “self-medicate” or avoid painful memories, thoughts, or feelings related to the trauma. People with PTSD may have trouble sleeping or may have nightmares, and use alcohol or drugs to try to improve sleep or to not remember their dreams. It’s important to know that there are treatments, such as this one, that can help you recover from the trauma and experience long-term relief without the use of alcohol or drugs.

Many of these reactions to trauma are connected to one another. For example, a flashback may make you feel out of control, and will therefore produce anxiety and fear, which may then result in your using alcohol or drugs to try to sleep at night. Many people think that their reactions to the trauma mean that they are “going crazy” or “losing it.” These thoughts can make them even more anxious. As you become aware of the changes you have gone through since the trauma, and as you process these experiences during treatment, the symptoms will become less distressing and you will regain control of your life.

Craving Awareness

Cravings can be defined as a strong desire or urge to use alcohol or drugs. It is important to know that cravings are a normal part of recovery. It is also important to know that cravings are time-limited and do not last forever. They are like ocean waves. They get stronger only to a point, and then they fade away. In fact, research shows that most cravings last less than 15 minutes.

As you learn new ways of coping with cravings, you will find that cravings occur less often and are less intense when they do happen. Each time you do something other than use alcohol or drugs in response to a craving, the craving will lose its power and you will regain yours.

(p. 30) Triggers

The first step in learning to manage your cravings is to identify what brings them on for you. Some triggers for cravings are hard to recognize, especially at first. Quite often, this whole process happens so quickly you may not even realize what has happened—it’s almost like you’ve gone into automatic pilot and it can seem like you just want to use for no reason. By slowing down your thinking and becoming more aware of your triggers, you put yourself in a much better position to be able to manage them. You gain control over your cravings, instead of them controlling you. The best way to deal with triggers for substance use is to stay away from them whenever possible.

Common triggers for substance use include:

  • People, places, and things (for example, being around alcohol or drugs, seeing other people use alcohol or drugs, bars, former using friends, certain neighborhoods, cash, advertisements for alcohol).

  • Emotions (for example, anger, depression, loneliness, boredom, feeling stressed out).

  • Thoughts (for example, “I could have just one and no one would ever know,” “Using would help me feel better,” or “The only way I can sleep is to drink”).

  • Physical symptoms (such as feeling restless, muscle tension, fatigue, physical pain, withdrawal symptoms).

In your next session, you and your therapist will focus on specific techniques that you can use to cope with triggers and manage cravings or urges to use. Some quick tips include:

  • Stay away from triggers.

  • If you do come into contact with a trigger, leave the situation immediately and call a supportive friend or your therapist.

  • Use the breathing relaxation exercise that you learned in the last session to “ride out” the craving.

  • Remember that cravings are usually over within 15 minutes. Distract yourself during this time by getting involved in a positive, healthy activity (e.g., go to the gym, go for a walk, watch a movie, read a good book, go to an AA or an NA meeting).

(p. 31) Homework Checklist for session 2

  • Listen to the audio recording of this session at least once.

  • Practice breathing retraining three times each day.

  • Refer to “10 Common Reactions to Trauma” (Form 8 at the end of this Workbook).

  • Complete the “Daily Record of Cravings” (Form 9 at the end of this Workbook).

  • Read “Facts About Cravings” (Form 10 at the end of this Workbook).

  • Optional: Guidelines for Better Sleep (Form 11 at the end of this Workbook).

(p. 32)