Accomplishing the types of everyday tasks that many people take for granted can present an overwhelming challenge for trauma survivors. Seemingly simple activities like going to the grocery store, driving to an appointment, or attending an event in support of family may seem impossible in the aftermath of trauma.
When functioning properly, the fight, flight, freeze response allows us to detect and respond to threats. However, traumatic experience can damage this response and cause survivors to react to safe situations as if they are dangerous. It’s important to remember that the fight, flight, freeze response can be lifesaving when triggered by a potentially harmful situation. However, when someone experiences this response in an unneeded situation, it’s an acutely uncomfortable – both physically and emotionally – false alarm. Over time, we can begin to anticipate the situations that trigger these false alarms and develop strong urges to avoid them or intense anxiety when we have no choice but to endure them. Intellectual recognition that a situation is unlikely to be harmful means little in the face of such an intense physiological response. Eventually, simple, yet critical tasks can feel excruciating.
Loved ones may interpret withdrawal or avoidance of shared activities as a lack of interest or support. It’s not unusual for trauma survivors to respond with anger or refusal when pushed to engage in a triggering activity. This is a difficult situation for family and friends who may feel torn between offering encouragement and fear that they are placing unreasonable pressure. Over time, they may feel deprived of companionship, give up on making requests, and even develop resentment. Avoidance can bring a powerful short-term reprieve from fear responses but over the long run it can lead to loneliness, disconnection and a loss of the valued activities that make life worth living.
So, what to do? A good first step for individuals who have noticed changes after trauma is to evaluate ways that their participation in activities, large and small, have changed. Sometimes these changes can be so slow or subtle that we convince ourselves that they are unimportant. Indeed, interests and activities may have changed for any number of reasons, but I encourage survivors to really consider the cost of the things they have given up. Seemingly unimportant tasks may contribute to larger goals or values. For instance, watching movies at home because one becomes anxious in a crowded theater may seem like an irrelevant change in routine. However, if maintaining relationships and spending time with family or friends is valued, routinely opting out of activities with loved ones may have a profound impact on the relationship. This does not mean that healing must mean a return to a life that looks exactly the same as it did before the trauma, but true healing does require a life that has meaning and purpose.
When we examine our values and related goals, they rarely come down to one simple behavior. Rather, values represent the things that are important to us over time. In order to maintain valued action, we need to continually reevaluate our goals in the service of those values. Moving in a valued direction, such as achieving financial stability, requires many goals and associated behavior in support of those goals. A large goal, like paying off a debt, requires many steps and repeated action over time. Avoidance after trauma can initiate a pattern of behavior that is not in service of our long-term goals and values. If being financially responsible is a value and we find ourselves not opening the mail or calling out of work, avoidance may be contributing to movement in a less valued direction. Honest evaluation of your values, goals, and current behavior can help identify areas where you most value change.
Facing one’s fears in the service of change is uncomfortable. But progress requires a willingness to tolerate discomfort. When we do this in safe situations that we have learned to fear, change becomes possible. That said, it’s important to consider the intensity of anxiety when challenging fear. If an individual practices exposures that trigger little or no anxiety, they will not benefit from the learning potential in tackling more challenging situations. On the other hand, if they start with challenges that trigger extreme distress, they are increasing the probability of being flooded with intensely uncomfortable feelings that will make persisting extremely difficult. It is recommended that when trying to increase participation in valued activities, the individual selects activities that elicit a moderate level of discomfort, stay in the situation for long enough to foster new learning, and to engage in repeated practice with small increases in difficulty over time.
Relationships with loved ones can be improved simply by sharing that you are struggling. While it may seem obvious to you that your avoidance is not a reflection on how you feel about your loved ones, it may not be so clear to your family and friends. Education about PTSD, triggers, and avoidance can help those who want to be supportive. Tell those around you how you respond in certain situations and give them ideas about how to support you. Remember to offer patience and understanding for the people in your life who are struggling to know how to be there for you. The long-term impact of trauma is challenging for anyone to understand so it’s likely to require many conversations and a process of trial and error. I do know that loved ones can serve as great motivation to heal and gently push you outside your comfort zone.
Trauma-related anxiety can contribute to significant losses in the areas that make life most meaningful. A loss of joy or comfort in daily activity is common in the aftermath of trauma. With a willingness to take on challenges it is possible to get back to enjoying the things that are important.