Q: Dear Frank, One of our support pals reports that she has constant intrusive thoughts of danger and tragedy and she wants to know how to deal with them. They occur daily and seem to be a normal part of her life and as she says (a rotten part of life).
A: Dear reader, There is an important difference between “thoughts of danger and tragedy” and memories of actual events. Both are part of PTSD. I’m going to assume that this support pal has PTSD as a result of one or more major traumatic events. (There are people who have not experienced major trauma, but, through no fault of their own, over-react to stimuli with debilitating anxiety. They panic easily, they worry constantly, and they focus on threats and losses. These people often need counseling and medication to adjust their body’s alarm system, and control their overactive adrenal glands. They have conditions known as GAD -generalized anxiety disorder or Panic Disorder or both.)
When PTSD includes intense intrusive recollections or flashbacks, the brain’s memory system is altered. “Hot” memories come spontaneously, intruding on normal life, causing a sense that the event is happening now and is not just a bad scene from the past. Therapists work with these intrusive memories, coaching a PTSD client on ways to start and stop the flashback. I use “The Counting Method” for just this purpose, and the GFW website explains it.
Usually, flashbacks and severe “hot” memories diminish with time. But our support pal may need help from a trained trauma therapist, using a technique to confront and control traumatic memories.
When PTSD includes anxiety in general (it almost always does) one is expected to have intrusive thoughts of danger. This could be because the feeling of danger is there and the thoughts follow the feeling, or it could be because one lives in a family or an environment that is filled with real reasons for fear. A professional trauma worker knows that security comes first: you make sure that steps are taken to minimize danger. Then coaching is used to improve survival skills. But often, a self-defeating pattern of pessimism, low esteem, and inadequate coping with reality (including poor choices about trustworthy friends) must be discussed and changed.
The pen-pals deal with this situation in a supportive, constructive email environment. Once in a while, professional assistance is needed, too. And if the therapist is not quite up to the task, the task becomes searching for a new therapist. I won’t discuss medication here, but meds may be part of the remedy. Once the anxiety pathways are calmed, it may be possible to reduce or eliminate medication, and face life’s ups and downs with improved confidence.