PTSD PROTOCOL

Over the past few years, I've come to recognize that many of my patients have been misdiagnosed- especially as bipolar, but sometimes labeled with schizophrenia, personality disorders- when actually they are suffering from a severely traumatic childhood, making it difficult to sustain an adult functioning personality on a reliable basis.

As I've worked with patients, and looked at my own situation- as I've unraveled the mysteries of this kind of PTSD-  I've come up with a protocol that works pretty well.  Perhaps it can help you.

PTSD consists of intrusions of memories into your everyday life, in a manner that is disruptive.  The disruption can last for a few seconds, or for weeks.  They can make concentration and task completion difficult. 

Sometimes they are so frequent and prolonged that they take over everyday life, making it difficult to build a life or sustain a life activity, such as school, jobs, family.  You may not be aware of what is happening, and think you are “in a bad mood”, or “spacing out”, or “just messed up”.

I call these memory intrusions "PTSD episodes".  One patient describes it as falling off a cliff.  Another as falling into a memory hole.  There is a sense of being taken over, spaced, and emotionally distraught.   Nightmares often continue the episodes, disrupting sleep.

The memories are of childhood, and you tend to regress emotionally to the age at which the memory took place, whether 14, or 6, or 1.  Sometimes the trauma took place before you could talk, and so your reaction is non-verbal.   This can manifest as a childish display of emotions- tantrums, rages, curling into a ball.  It also can manifest as harmful acting out- self-medicating with alcohol or drugs, hurting yourself, hurting others.  It can show up as illnesses of various sorts- irritable bowel, asthma.

Before you can start working on the memories, you have to be able to manage the PTSD episodes so that they are less disruptive, and you can carry on everyday life.  Working on them in depth prematurely can lead to weeks of inner disorganization, and inability to function.

So the first piece of advice is to use a mantra-  "I'm xx years old".  This keeps you in current reality, serves as a lifeline to your adult personality.

Second, is to learn to recognize the onset of an episode.  If you can catch it early, it can be aborted by using the cooling breath- rolling your tongue and breathing through it like a straw.  If you can’t do it (it’s a genetic thing) you can purse your lips instead.  This yogic breathing technique can stop panic attacks, rages, and PTSD episodes. 

I also give people a beta blocker called propranolol, to use as needed.  It cuts off the adrenaline rush.   Beta blockers can trigger asthma, so anyone with that tendency can’t use them.   Otherwise, they are benign and non-addictive.

Third, start keeping a PTSD journal.  This consists of making a brief note about each episode, covering 4 items:

1) what triggered it;

2) how long did it last;

3) content- just the headline- age at time of memory and a few words- try to stay out of the memory itself when making the journal entry;

4) exit- how did you get the episode to end- could be a nap, a walk, talking to someone, watching TV, working.

The diary serves several purposes. 

1) It objectifies the episodes, the first step toward gaining control of them.

2) It gives you a sense of the pattern- the frequency, the time of day, whatever information you can get.

3) It gives you a way to monitor the variations as healing takes place.

4) It gives you clues on how to manage the episodes, so they are less disruptive.

If you bring the diary to therapy sessions, we can look at the entries together, and I can help you understand the childhood trauma and correct the emotional reactions which are still obstructing your adult life.