In Part One, we considered how trauma creates a “values vacuum” in which victims become stuck in a never-ending cycle of avoiding unpleasant symptoms while believing and/or trusting in nothing once-valued (PTSD). Traumatic experience also drastically changes one’s life narrative. The purpose and meaning of the life traumatized are shaken to the core. Understanding how our life narratives develop can help in changing them back to something similar to the pre-trauma narrative.
Internal Dialogue in PTSD: The Role of Narrative in Recovery
Each of us spends most of our waking hours engaged in an “internal dialogue” where we describe, evaluate, and re-imagine the events happening around us. To a cognitive-behavioral psychologist, internal dialogue is caused by past social experiences, and it is changeable.
The incessant internal dialogue going on inside is the raw material of the life story or narrative we each are creating. After a trauma, that narrative naturally becomes negative, even tragic. But the good news is that the trauma-tinged internal dialogue can be modified by changing the patterns and content of interactions with others.
Verbal behavior, including self-talk, is strengthened or weakened by how those listening to it respond to it. When what we say (or write) is met with positive reactions from others, similar thoughts are strengthened. But when the verbal behavior is met with bland or even negative reactions from those in our social community, such content tends to be weakened. This process of ‘shaping’ what we say and what we think has been going on constantly since birth.
The content of internal dialogue changes depending on with whom one is interacting (or what one is reading/watching). However, once set, internal dialogue can and does get stuck if the social groups with whom one interacts become stagnant where only one type of content (e.g., negative/hopeless) is encouraged over other types. Since many exposed to trauma greatly reduce the number and range of people with whom they interact, input to change internal dialogue is even further reduced.
Social communities encourage asking others for advice, input and even help. Also encouraged, even demanded, is the labeling of the causes of the events that happened as well as attributions of who caused them. Most of us spend significant time engaged in this internal dialogue musing about who did what and why it was done, influenced greatly by what those around us are saying on similar issues. The influence of others on what we think is even more potent when it is paired with significant affirmations from those people and/or relief from uncomfortable emotional states or situations (negative reinforcement). Most internal dialogue is shaped gradually over time and accumulated social interactions. But the destruction of trauma acts instantly.
The narrative of a life can be going along great, maybe even according to one’s life plan, and then WHAM! —a trauma happens, and the narrative changes. Before trauma, a glimpse of the internal dialogue might be summarized as “Everything is okay/I’m in charge/I like my life/ I have hope/this is fun, if not hard.” After trauma, however, it becomes “The hurt is unbearable/I can see no end to it/I can’t do anything to stop this pain/others don’t understand/nothing matters anyway/my life is awful/I’m awful/HELP/leave me alone.”
When this narrative changes, the avoidance symptoms of PTSD take over, and the life gets stuck! But the internal dialogue does not stop. Constant negative self-talk, often on “automatic pilot,” goes on indefinitely. Social relations suffer (and stop), health suffers, job/family/marriage and other practical matters get dysfunctional. The narrative that accumulates turns into a pain-filled and hopeless modern tragedy. Mix in alcohol, drug abuse or poor life decisions, and the spiral swirls wildly.
Two Particularly Pernicious Patterns—Values Vacuum and Loss of Self-Efficacy
The trauma event often shatters long-held central beliefs and values. The victim loses sight of what is important in life. A lack of values clarity can cause a lack of passion and enthusiasm for progress or renewal. The grieving parent loses the motivation to show love to others. An abuse victim dares not place trust in others, however well-meaning. A veteran finds it impossible to take orders or tolerate the petty details of life. Crime victims never allow themselves to assume safety. A rape victim can’t let intimacy happen because it only means more pain.
A second outcome of a life thus interrupted by trauma is a horrible case of the “I can’ts.” Psychologists identify Self-efficacy as the belief a person has that he/she can actually perform a specific behavior. For example, successful cooks have the belief they can prepare a tasty meal, whereas someone who has never done any cooking has very little belief (self-efficacy) in the ability to cook. An experienced driver might have a strong belief that she can drive in heavy traffic, but the new driver is not so certain.
Self-efficacy beliefs result from four types of life experiences: 1-actually accomplishing tasks, 2-vicarious experiences of watching another accomplish a task, 3-verbal encouragement from others about learning and doing a new task, 4-the experience of physical sensations/feedback when a task is successfully attempted and completed.
Self-efficacy is important because if one has little of it in a particular category of behavior, that person will make very few, if any, attempts to perform that action. Trauma victims who are stuck are convinced they can do nothing about the unpleasantry of their lives. They can’t be honest about the trauma and their shame. They can’t let other people know how completely messed up they feel. They can’t take on new challenges added to the load of daily survival. They can’t, they can’t, they can’t. And sadly, they don’t.
Cognitive behavior therapy typically tries to help the victim understand what has happened to create being stuck in the relentless cycle of avoidance, believing in nothing once valued and thinking nothing can be done to change things. Such an educational rationale then provides the framework on which new skills and behaviors are gradually tried and eventually perfected.
Engineering Post-traumatic Growth—What Must Be Done to Become Unstuck
The good news is that there is much that can be done to change the dynamics described above. In fact, the difference between trauma victims who eventually come to have post-trauma growth and those who go on to get stuck in PTSD may be the arrangement of a social community in which self-efficacy is “manufactured” by arranging the four life experiences mentioned above.
Engineering can be defined as the process of combining smaller parts to construct a larger and useful entity. For the trauma victim, the narrative of “I can’t” must change to “I can.” Behavioral science suggests a technology of behavioral engineering through social interaction. Trauma victims who survive and learn to thrive make social interaction changes by taking small steps toward being more real and “authentic” with themselves and others. They begin to make gradual progress toward improved coping by learning new stress management skills. And they redefine what is important in their lives and find passion and meaning in pursuing those values. All of these outcomes happen by changed social interaction patterns, sometimes in therapeutic situations and sometimes in self-help groups or other groups occurring naturally in a person’s life, like family or a work environment.
While it might at first seem difficult if not impossible to find or become a part of such a healing community, changes are more possible than ever in the age of social media. Many opportunities exist in which trauma victims can reach out to others and begin the step by step process of rehabilitation. The necessary conditions for trauma recovery include finding a leader, becoming more authentic about the trauma, learning better coping skills, finding group support and finding meaningful life pursuits that generate passion.
Cognitive and behavioral therapies, preferably in group contexts, are available to create the new social communities that will help one re-write the narrative of damaged lives. Many published or online sources exist that show how to create these essential changes. An excellent place to start is this website: cptforptsd.com. Another helpful webpage details the narratives of trauma survivors who achieved post-traumatic growth by clarifying values and finding life pursuits about which they became passionate. There are even no cost programs in which victims can get treatment in person! (University of Central Florida RESTORES Program and The Star Strong Consortium
And when recovery from trauma happens, a glimpse of the repeating loop of internal dialogue might become: “That hurt was the most difficult experience in my life/But I have managed to survive/If I can survive that, I can do anything/Thank goodness for my real friends/I’ve learned what is truly important in life/I’m pumped about passing on what I’ve learned.”
We hope you begin to investigate this approach to trauma recovery through rearranging social interaction in healthy and progressive ways. Our new book, Trauma Recovery: Sessions with Dr. Matt is one way to visualize such a journey in that it describes in detail the narratives of seven trauma victims whose interactions with a therapist and each other achieved the needed changes to recover from trauma. While the book is on sale at Amazon and other booksellers, both Matt and Beth are committed to making a copy of the book available to anyone who is not able to afford its purchase. We can be contacted through our website, drmattbook.com.
About the Author
Dr. Jaremko has taught clinical psychology at the University level for almost 20 years. This academic activity has been balanced by the operation of an independent practice of clinical psychology for over 25 years. He estimates having taught over 2000 students through the years and delivered over 35000 hours of psychological services to around 10,000 clients. He has over 30 publications and nearly a hundred presentations at professional meetings on stress and trauma. In addition, chemical dependency and dual diagnosis has been a point of focus in his clinical practice. He, along with Beth Felhbaum-a trauma survivor, have written Trauma Recovery: Sessions with Dr. Matt: Narratives of Hope and resilience for Victims with PTSD which is available for pre-order and will be launched in December, 2018.
We hope you begin to investigate this approach to trauma recovery through rearranging social interaction in healthy and progressive ways. Our new book, Trauma Recovery: Sessions with Dr. Matt is one way to visualize such a journey in that it describes in detail the narratives of seven trauma victims whose interactions with a therapist and each other achieved the needed changes to recover from trauma. While the book is on sale at Amazon and other booksellers, both Matt and Beth are committed to making a copy of the book available to anyone who is not able to afford its purchase. We can be contacted through our website, drmattbook.com. Please visit the Matt E. Jaremko author page on Facebook for more trauma recovery information.