PTSD: Are you or a family member stuggling with PTSD symptoms? Want help? This is part 2 of a three-part series by guest author Greg Gifford and considers flashbacks and other problems. Part 1 covered understanding PTSD basics. This article appeared first here on the Biblical Counseling Coalition website and is used with permission.
Dealing Wisely with Difficult Circumstances and Memories
In the beginning of your ministry to a family member struggling with symptoms of PTSD, it will be imperative to avoid circumstances that prompt flashbacks. You will want to identify what circumstances trigger PTSD symptoms and seek to contain exposure to them as best as possible. It would be inconsiderate to constantly expose a person to circumstances that conjure up symptoms of PTSD. Yet, it would be equally terrible to never expose them to the circumstances that plague their memories.
Moreover, certain circumstances cannot or should not be avoided. For instance, one individual suffered with painful memories of a childhood that was extremely abusive—both physically and sexually. (See Stuart Scott and Heath Lambert, eds., Counseling the Hard Cases: True Stories Illustrating the Sufficiency of God’s Resources in Scripture, 39.) Her flashbacks were typically triggered when she would enter the kitchen or take a shower, which are both places that she had to visit. Therefore, the counselor could not tell her to avoid these places, but rather to observe the patterns of her flashbacks and how they relate to these places.
Types of PTSD Triggers
Do these places or circumstances conjure up the painful memory and what about the circumstances does this? Is it a smell, the lights, the noise level, or the people? What associates this place with the place that their painful memory occurred? Once you have connected this dot, then you can wisely approach a plan of thinking and doing, principles of being a truth-thinker, and other related efforts that orient your loved one back to reality.
For the circumstances that you can avoid (e.g., the market, the home, the woods, etc.) seek to wisely abstain from visiting these locations at first. You will want to counsel and disciple your loved one in preparation for visiting such places or types of circumstances. Secular psychology would term this exposure therapy, but it is nothing more than wisely and lovingly introducing the circumstances that stimulate the painful memories of a person’s past. Your goal is to teach them how to approach these circumstances, and then to live out that instruction in the midst of their difficult environment.
Yet the aim is not behavior modification. Behavior modification says, “Avoid those type of circumstances and all is well.” However, true and authentic heart change orients itself towards God’s purposes in the middle of those environments. For example, to avoid a place with a large crowd may be wise initially, but through the power of the Holy Spirit, a person can learn to trust God and believe He will not leave them even in large groups.
There is an enormous importance in being wisely reintroduced to environments that stimulate those painful feelings so a person can grow in those regards. To avoid the circumstance completely is only wise in a few instances and behavior modification in most instances.
Dealing Wisely with Known Stimuli
Likewise, recognize the stimuli in a person’s life. If you know that a person struggles in a loud environment (as most with PTSD symptoms will do) then seek to keep the noise down. This is a manifestation of the golden rule (Luke 6:31) and Philippians 2:2-5; consider their interests as more important or simply how you would want to be treated. Be careful not to slam the door or play a certain song. Ensure that you do not yell in the house or touch them in a certain way. The idea is that you know these stimuli so as not to tempt or incite painful memories unnecessarily.
Here are some questions that could be helpful in identifying these stimuli:
- When do episodes tend to flare up? Is there a certain time of the day? Is there a certain event? Is there a certain context? Were you inside or outside? Was it close to a mealtime?
- What was happening? What were you doing? What were they doing and were others doing around them (i.e., the kids running around the living room)?
- Where were you? Were you at home? On a car ride? In a shop? Eating out?
- How was the person acting before? Were they tired, irritable, or brooding? Were they in deep thought or manic? What was the person acting like before the symptoms started again?
These types of questions can easily be logged so you can look for themes within your loved one. And in a very real sense, you may observe what they do not. They may not see that when they are hungry they are more susceptible to flashbacks. They may not notice that when they are in deep thought with much free time, they have more flashbacks. These areas will be very important as you seek to understand your loved one and help them grow in their walk with Christ.
A warning is necessary here: even though a person may have a certain stimuli now does not mean they are sanctioned for ungodliness and unrighteous responses. Be gentle and gracious here by not exacerbating them, but also calling them to grow in this area. If your spouse really struggles to be calm and control their anger when the kids are yelling in the house, there is a two-fold obligation.
The first is to address the kids and call them to be kind, considerate, and die to their own desires to be loud and rambunctious. Next, there is an obligation to call your spouse to grow in this area. Even though the kids are screaming like wild banshees, your spouse has an obligation to honor God in that moment. (This may also be a great opportunity for the family member to show their loved one the biblical teaching that a person’s circumstances does not determine their heart attitude but only reveals their heart attitude.)
Join the Conversation
What additional suggestions do you have for wise help that avoids the extremes of enabling a person struggling with PTSD symptoms or of abandoning/ignoring/pretending that the person’s symptoms are not real or do not require understanding, compassion, and assistance?