When I started therapy about 2 years ago, I started experiencing the full extent of my complex PTSD. The way my doctor describes it is that everything is locked tight in a growing ball of knotted string (emotional isolation and regulation as defence mechanism). What we are doing in therapy is slowly unraveling this ball of knotted string, forcing me to take a closer look at it, and finally being able to react.
Anyway, I’ve experienced many different reactions or manifestations of my PTSD in the past two years. Honestly, I didn’t know what to do in the beginning but now I’ve gotten better at managing it.
So, how do I manage them so I could still be a productive member of society? Here you go:
How I handle: HYPERVIGILANCE
I’ve always been very conscious about my personal space but during episodes of hypervigilance, multiply that by about 100 times. To give you an idea: I once had an anxiety attack in Starbucks because it felt like the girl in line behind me was standing too close. She wasn’t.
Whenever I feel like I’m beginning to be hypervigilant, I do these:
- Avoid going to strange places where I don’t know anyone
- Go to a quiet restaurant, park, or cafe with someone I trust
- Stay at home but call a friend to maintain human contact. Being at the safety of your own home helps a lot but can also be too comfortable that you may just decide to never go out. Speaking to someone allows you to start slowly stepping out of the instinctive protective shell you’ve created
- Be mindful about “acceptable” personal space. For example, I’m okay with arms length distance so I measure closeness based on that, reminding myself that I’m fine when people are arms length or stepping back if they are nearer than that
- If I feel it suddenly coming on, for example I was feeling alright in the morning but I went someplace and I felt that some person is standing so uncomfortably close to me, I just step away. Go somewhere else if that’s possible. Basically, remove myself from a situation that may lead to full-blown panic
How I handle: ANXIETY ATTACKS
The bad thing about an anxiety attack is that you almost never know that it’s coming. Like, you’re out at dinner with friends and then suddenly you start talking about something that you connect with a trigger and then suddenly you can’t breathe. Or, worse, there’s no clear connection to anything at all. You simply start panicking.
Whenever I find myself in the beginnings (or in the middle though that can be much harder) of an anxiety attack, I do these:
- Straighten up and take deep breaths. Some say put your head between your knees but that doesn’t work for me because it just contracts my chest and I need to be able to breathe deeply
- If I can, take myself out of whatever circumstance I found myself in. Step out of the room to somewhere quiet, or take a sort walk in a nearby outdoor area. As long as it’s not crowded but not really isolated. Isolation during an anxiety attack is dangerous
- Focus on a non-moving, non-human object as I try to get my breath under control. Hyperventilating, losing oxygen, and then blacking out is also an option to stop the attack but that’s not healthy. So, I do my best not to hyperventilate
- Ignore well-meaning, open ended questions and just focus on small decisions like whether I should sit or stand. The main focus is getting my breath under control and my heartbeat at a normal rate
Pro tip: if someone around you is having an anxiety attack, avoid questions like “Are you okay?” (clearly not) or “What do you need?” because they don’t help. At all. Instead, ask practical questions that let them focus on one or two things at a time (do you want to sit or stand? Do you want water or not?) or even make those decisions for them by leading them somewhere quiet. This lets them focus on logical things but doesn’t require them to grasp at answers they may not be able to give you.
Also, don’t tell them to “just breathe” because that’s just annoying. What you can do, if you have a personal or at least friendly relationship with them, is to put a hand on their shoulder and tell them to breathe with you. This is actually what one of my friends did to me. I was having trouble getting my breathing under control and am beginning to see white spots due to lack of oxygen. So he took my hand, placed it on his chest, told me to breathe with him, and started breathing deeply.
That worked because it gave me something to focus on (my hand on his chest) and something to match my own breathing with (the movement of his chest). It took about 5 minutes before I felt I can breathe normally on my own.
How I handle: DEPRESSIVE EPISODES
There are so many facets to a depressive episode. Most of the time, I can feel it coming and head it off. But there are moments when I wake up one day and I just can’t move. That’s another thing about depressive episodes: you almost never know what you’re gonna get. Sometimes you just find your thoughts churning with horrible things, sometimes there’s just….nothing.
So, I’m breaking them down into four categories:
(A caveat: my depression isn’t clinical. If you have clinical depression, you most likely need the aid of medicines to help you regulate the chemicals in your brain. While I sometimes need them, I don’t need regular maintenance ones.)
Still on earthly plane
- Go to the gym. My lazy ass has to admit that a good workout really helps. It’s scientific, but I don’t want to get into those now
- Eat out somewhere with an energetic vibe either by myself (which I sometimes prefer) or with other people I know. I most certainly have two to three places as my go-to that I know for sure I would have a good experience
- Play with my dog. Honestly, there’s nothing like the pure love of a happy dog
- Plan a trip. This really helps a lot because it focusses my mind on something that excites me
Slowly retreating from public view
- Get food delivered or cook. The first one ensures that I at least have minimal interaction with another human without subjecting myself to the social aspect of going out and eating amongst other people. The second one, if I can manage it, give me something to focus on without using too much brain power
- Watch Die Hard. I do not know why, but there’s just something about this movie that kinda perks me up
- Listen to Andrew McMahon, The Mowgli’s, and Yes Sir Boss. Why? They have happy tunes, and their music is generally upbeat and positive. Whenever I am in a depressive episode but I have to work, they’re usually playing in the background
- Yoga or meditation. It’s difficult to clear your head, but the effort it takes to do that is helpful in diverting thoughts
- Make a gratitude list. This can get really hard, because sometimes I can’t even think about something I like let alone feel grateful for, but I force myself to think of the things I’d normally feel grateful for so I can start believing that all is well
Never want to leave the bed
- Eat a small piece of chocolate. On days I can’t even manage to get up, I force myself to eat a small piece of chocolate. That’s why my fridge is stocked with it
- Drink lots of water. If I’m not eating, at least I won’t be dehydrated
- Read. My go-to is Damned by Chuck Palahniuk. It’s funny and deliciously devious.
Generally, I do my best to keep my brain engaged so as not to descend to the last type of depressive episode, which I call:
This is just…nothing. Seriously. So I sleep because most of the time, I don’t have a choice in this. It’s like waking up at 7am and telling myself I have to at least try to get up, and then I close my eyes and suddenly it’s noon and I haven’t done anything at all.
I look at it as the body knowing how to fix itself and oftentimes, sleep is the answer. But I do my best not to go over 4 hours during the day and force myself to wake up and do something else (usually “something else” means sitting up)
This is why I always keep a water bottle by my bed. Because, again, if I’m not eating, at least I drink water.
Of all the manifestations, a depressive episode is the most debilitating. I’ve only experience Hell’s Vagina three times before, but the first lasted three days and the second lasted five.
All I can do is catch up after.
How I handle: EMOTIONAL ISOLATION AND REGULATION
Ah, my go-to manifestation. This is the reason my PTSD went unnoticed for years. I usually prefer being on my own that it wasn’t too obvious when I began to emotionally isolate myself. It started with avoiding making deeper connections with new people despite their efforts to get to know me, and had begun to progress to shutting myself out of people I actually care about.
In fact, the trigger that made me think that something is wrong with me was when I flat-out panicked when a friend told me that I’m like a sister.
How fucked up is that right?
So, anyway, here’s what I do all the time now to make sure I don’t fall back into old habits:
- Reciprocate when new acquaintances make an effort to get to know me
- Remain in regular communication with friends. Both online and in person
- Join activities and try to get to know people whenever I travel just to practice my oft-neglected social skills
- Try to get to know new people for more than work purposes
- Start opening up more to more people
- Also, this blog. To serve as practice for speaking my mind and talking about all these things. Soon, maybe I’ll have the courage to talk about all these without hiding behind the safety of my keyboard
- Remind myself that I’m intelligent and that I can trust my own judgement on people’s intentions. About 80 per cent of my issues stem from anger at myself for failing to protect myself before (another story for another day) and I need to constantly remind myself that I can do better now
But we all have to remember that we react differently. These work from me, it may not work for anyone else. The important things is that we take care of ourselves – eat healthily, exercise regularly, and be mindful about our triggers – because self care is really our greatest tool.
I come from a country that has a stigma against mental disorders and seeking help for it. I don’t feel comfortable talking to my family about it and it’s frustrating that I had to go through all these on my own (save for a few friends and now my sister) but I found that infinitely better than backsliding because I am not emotionally and mentally prepared to deal with how they will react if they knew.
I have to admit it’s tiring, frustrating, and difficult and there are days when even just managing these is too much. But I do my best to take it one step, one decision, one breath at a time.
If there is an overall “how I manage” tip I could give it is just thinking ONE.
And with each one, hopefully I find myself on my way to feeling better.