This year a study found that we have around 6,000 thoughts each day. That’s a whole lot of self-talk. Most of us enter into a conversation with ourselves from the moment we acquire language. And this conversation holds the power to shape our beliefs and moods. But the truth is most of us are driving so fast down our inner highways that we barely notice the scenery. Our thoughts become as unexamined as the air we breathe.
Unexamined thoughts can have dire consequences, from reinforcing racism, sexism, classism, homophobia, transphobia, and ableism, to leaving us feeling enraged or hopeless about our own lives. But for those of us with PTSD, inattention to what we’re thinking can have an immediate impact on our well-being.
This is because most of the time, we only notice our thoughts when they cause distress—flashbacks, intrusive memories, hateful or violent or rage-driven thoughts—at which point we get locked into a vicious cycle. In order to keep speeding down our mental highway, we nudge away these thoughts and feelings. But the more we push them away, the more likely they are to return stronger than ever. Psychologists call this “the rebound effect” (Tull, Gratz, & Chapman, 2016). Meanwhile, this constant effort to keep our car on the road, ticking off the miles on the odometer, drains us further.
It’s kind of like we’re driving through a haunted house ride. Scary shit pops out and cackles at us in the most unexpected moments. We swerve in order to keep moving, but as time goes on, the shit gets scarier and we get successively more fatigued, our swerves less and less effective. Ultimately, this tug-of-war between our consciousness and our inner world can “leave [us] with less energy to deal with other symptoms of PTSD or life in general” (Tull, Gratz, & Chapman, 2016, p. 43). Eventually, that car will break down, and the scary shit on our heels, stronger than ever, will catch up with us.
But there is a way out of this nightmare.
In my previous posts, I’ve outlined the steps before I even began to approach my thoughts. My most overwhelming symptoms fell into this category (negative changes in cognition and mood), so I needed to be ready before I tackled them.
- Learn as much as possible about PTSD.
- For me, this meant reviewing everything under the “Learn” tab in PTSD Coach as well as the first chapter of The Cognitive Behavioral Coping Skills Workbook for PTSD (Tull, Gratz, & Chapman, 2016). Because I could only read a little at a time, this step took me a week.
- Track my symptoms as well as behaviors or stimuli that seem to correlate with increases or decreases in distress.
- I did this for a week, which was hard enough, before pairing it with Step 3.
- Be aware that increased awareness of mental health symptoms can temporarily increase their frequency or severity.
- Build a toolkit that can reduce distress immediately after encountering a trigger.
- I spent a month trying different tools every day, like exercise, deep breathing, and meditation. I recorded my distress levels before and after using each tool. I also tracked symptoms daily. This made it easy to personalize my toolkit based on what worked for me.
Finally, I was ready to turn my attention to what I was thinking.
Thoughts are treacherous little beasts. A writing teacher once described them as “nothing more than vapor,” yet they can have the devastating impact of a bomb, leaving behind nuclear fallout and a scorched landscape. If you’re afraid of your own thoughts, I don’t blame you one bit. So am I.
In PTSD, thought-related symptoms include (Tull, Gratz, & Chapman, 2016):
- Persistent and extreme negative beliefs or expectations about yourself, others, and the world
- Persistent and inaccurate thoughts about the cause or consequences of a traumatic event
- Persistent negative emotions (shame, fear, rage)
- Feeling detached or estranged from others
- Persistent inability to experience positive emotions
These can range from I deserve everything that happened to me to No one can be trusted and If I only I was ___, I could have stopped the trauma from happening. These are nasty little buggers that worm their way into the wood. They’re capable of infecting entire forests, felling acres of your interior world. And until you train yourself to spot them, they’ll keep on going, devastating everything in their path.
Anyone familiar with Cognitive Behavior Therapy knows what comes next: a worksheet.
I got a handy-dandy handout, and each time I experienced some degree of noticeable distress, my job was to record:
- What happened immediately beforehand
- Example: A project supervisor promised one task, then piled on loads more work.
- My immediate thought
- Example: “What a jerk! They think they can just take advantage of me without any consequences.”
- How I felt emotionally and physically
- Example: outraged, disrespected
- shaking hands, rapid pulse
- How I responded
- Example: I did the rest of the project while composing an angry email in my head (which I knew I would never send), resulting in a lower quality of work as well as more intense fatigue because I was so distracted by my rage.
There it is, folks. I’m not proud of it. But I now have pages and pages proving that, yeah, I hide it well, but I’m kind of a live wire. Yikes.
I did that for about a week. Humbling is a nice word for it. Uncomfortable is closer. Downright alarming is most accurate. Rage thrums through me nearly all the time, and it takes only the smallest perceived slight to make it bloom into my outward life.
So now that I could see this, I needed to take it to the next level. It’s all well and good to notice I’m angry much of the time, but that’s not enough to change it.
So I did my CBT homework. And that included beginning to label those thoughts.
Cognitive Behavior Therapy can help all of us recognize that a lot of what we think is bullshit. Plain and simple. It’s nonsense.
And unless I was okay with my delusions controlling my life, I needed to be aware of that nonsense and dismantle it.
This is not a do-this-for-a-week-and-you’re-good type of plan. It takes most people anywhere from three weeks to three months to build a new habit. Which is what CBT is all about: new thought habits. For some of us, it can take up to six months.
So after I had spent a week logging my thoughts and the emotional reactions, they fostered, it was time for me to start identifying the specific problems with those thoughts. I still tracked my experiences, thoughts, and emotional reactions. But then I applied a label to my thoughts.
To do this, the first thing I had to learn was a list of “Thinking Traps,” which are basically logical fallacies:
- either-or thinking
- Either I have to back down or she does. Someone has to lose here.
- Because that friend was insensitive during our last conversation, they must always be insensitive. They’re an awful, horrible person.
- Here’s someone walking down the road in the middle of the night. They’re probably going to slit my throat and leave me for dead.
- She said that because she wants to hurt me.
- mind reading/jumping to conclusions
- My friend isn’t responding to my texts. She must be pissed off with me.
- downplaying the positive/focusing on the negative
- I didn’t get anything done today. (Despite having blogged, submitted a short story, taught classes, and finished chores.)
- I shouldn’t have to do all this work. It should be easier than this. I should be moving through this faster.
There are more, but these are my usual suspects. And as you can probably see, there’s plenty of overlap. We can label thoughts in any way that rings true for us. The point is just to notice that our thoughts are often skewed. If what we think were a college essay, all of us would get an F.
Once I learned that my inner voice was maybe not so lucid as I once believed, the final step became much easier: thought challenging. And this is where I’ve spent the last three months.
Thought challenging can take a dozen forms, but it always involves wrestling with the thought directly. One strategy is to mentally gather evidence for and against the thought. Another is to point out that it’s just an interpretation; thoughts rarely reflect what we know. Much more often, they are about what we assume. There are many other tools, but my favorite is to just provide an alternative explanation along with a strategy (or an acknowledgement that this is not something I can personally solve).
Sure, my friend could be pissed off, but she also could be busy. I’ll check in with her in a couple more days, and then if she still doesn’t get back to me, I’ll give her some space. I can’t force people to engage if they’re not willing.
The miracle of CBT, for me, has been that I’ve been able to go back to emails or messages or online posts from people that I read as angry, hostile, and accusatory—and suddenly I see they’re nothing of the sort.
And this changes not only my experience of life but the way I react.
PTSD had cast a lens over my entire world, and through that lens, everything appeared darker, more menacing, and more malicious than it actually was.
This is not to say that people are never menacing or malicious. Of course they are. But the thing is, most of the people I’ve known who function that way are far back in the past where I left them. I walked away. I left them behind. And because of that, when most people in my life now do something hurtful, it’s usually out of obliviousness or self-absorption. Very few people think about me as intensely as my abusers did. In fact, I’m pretty sure no one in my life now thinks about me with the obsessiveness and calculation of my abusers. No one.
I honestly don’t know how people heal from PTSD, anxiety, depression, or any other mental disorder if they are still in contact with abusers who caused the disorder. I just don’t know. I recognize that’s maybe more my own lack of imagination, but I have been free of all my abusers for nearly 10 years now. And I’m only just beginning my healing journey. Speaking only for myself, I couldn’t have stepped foot on this path if I hadn’t left them behind.
I’ve been through CBT training before with a professional for my insomnia. And it made a huge difference. I’ve done it for my chronic migraines as well when I started feeling suicidal about acquiring a disability. And CBT saved my life. Doing it now for PTSD has been groundbreaking for me. My entire life, I have viewed people with fear and suspicion. Being able to let go of that, even the tiniest bit, has been astonishing. I hadn’t known how trapped I was behind that veil of fear. I had never realized how much it suffocated my personality, my expression, my confidence.
And all it took was a simple four-step habit: notice the thought – notice the emotion – label the thought – challenge the thought.
So much of our perception is subjective. And so much of our perception is based on personal history. Next week, I’ll get into how I started to understand the ways my history has shaped those perceptions. But for this week, let’s just sit together in the peace of knowing that our thoughts are just thoughts. They are what we make of them.
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*I am not a therapist or treatment provider and am only recounting my personal experience of PTSD and its treatment. This blog is not intended to be a substitute for professional advice, diagnosis, or treatment. Always seek the advice of a physician, licensed therapist, or other qualified health provider with any questions you may have regarding PTSD or any other mental health disorder.