When a person is confronted with a life and death situation, the body responds with a fight, flight, or freeze response. Other responses can include fawning, or complete total shutdown of the body. These behavioral responses to stressors, life altering events, or trauma in forms of abuse or loss correlate with inner workings of the sympathetic nervous system which activates the body to respond. While in the acute phase of reaction to threats, this evolutionary reaction system is good and beneficial but when trauma becomes stuck and unresolved resulting in constant hyperarousal or hypoarousal manifested in PTSD, then it can become pathological and require intense therapy to resolve the unresolved trauma. This article will review the inner workings of trauma response within the brain and why unresolved trauma becomes an issue for some individuals.
The limbic system plays a key role in the brain in accessing threats and dealing with trauma, Please also review AIHCP’s Trauma Informed Care Program
Please also review AIHCP’s Healthcare Certifications, especially in Trauma Informed Care, Grief Counseling and Crisis Intervention
The Brain and Threat Reaction
All reactions within the body are due to stressors. When something is perceived as a threat, the body responds. This fear circuitry promotes safety and survival (Evans, 2014, p. 20). The old part of the brain is the emotional part and possesses the feelings while the newer more evolved part of the brain processes the feelings from an intellectual perspective. Both these processes interact in stress response over riding each other. The primary reactions to stress include the autonomic nervous system which activates the sympathetic for fight or flight, the hypothalamic-pituitary-adrenal axis which releases hormones and cortisol for stress response and the limbic system of the brain which processes threats and emotions during a threat.
Evans notes that the fear response to threats is a crucial part of human survival and the process in which human beings react to fear in the brain is essential (2014, p. 21). Unfortunately, some events are not processed properly in the moment due to extreme emotional imprinting and this leads to unresolved issues.
In any fear, terror, or stress moment, the brain analyzes the threat. Within seconds, the sympathetic nervous system is activated to the perceived threat. The body releases norepinephrine and epinephrine , also known as noradrenaline and adrenaline into the body. The hypothalamus and pituitary gland also then releases cortisol into the body. This increases blood flow and heart rate, tightens muscles and prepares the body for fight or flight. In turn the amygdala processes these emotions and stores them. While the amygdala is operating, the prefrontal cortex or thinking part of the brain is less active. Once the threat is distinguished, the body is supposed to return to a base line state. Evans refers to this process as fear extinction (2014, p., 21). Individuals who continue to experience heightened fear responses when the threat is no longer an issue exist in a state of dysfunction with unresolved trauma since the brain cannot tell the difference between the memory and current non-threatening state.
Key to stress response are three key parts of the brain. This includes the hippocampus, the amygdala and the prefrontal cortex which make up the limbic system. These three interplay with each other and are key to fear extinction, emotional regulation and cognitive reasoning (Evans, 2014, p. 22). They also play a key role in storing memories from short term to long term storage and differentiating between past and present threats. The hippocampus deals with memory and context. It plays a key role in processing and storing memories and when the hippocampus is in dysfunction this can negatively effect trauma resolution. The amygdala during the stress response also becomes activated. The amydala is the alarm system of the brain. Those with PTSD are said to have a hyperactive amygdala due to unresolved trauma which prevents fear extinction (Evans, 2014, p.24). The pre-frontal cortex which manages cognitive thought, emotional regulation and decision making. It can also become impaired during trauma. When not working, it can lead to subjective fears and lack of emotional regulation and loss of rationale. Under normal circumstances, fear is extinguished and the body returns to a normal state via the hippocampus processing the context of here and then, the prefrontal cortex processing the event, and the amygdala activation decreasing. In cases when trauma is unresolved, the hippocampus is unable to process the here and now, while the amygdala remains hyperactivated, preventing the prefrontal cortex from processing the event. This hinders the ability of the hippocampus to store the memory properly in the past and the hyperactivation of the amygdala inhibits the prefrontal cortex from problem solving (Evans, 2014, p. 31-32).
Unresolved Trauma and PTSD
Individuals exposed to extreme cases of pain, loss, abuse, war, or inhumane treatment have the potential for PTSD. Post Traumatic Stress Disorder or PTSD is one of the most common forms of unresolved trauma disorders that individuals face. Once considered only a war time disorder, it now can effect any trauma survivor of abuse, rape, or natural disaster. Yet it is important to note that the same horrific event may be processed by some and not others. Most can process the traumatic event within 3 months, while others may experience prolonged trauma (Evans, 2014, p. 29). Numerous subjective variables about the person’s genetics, brain structure, past trauma, resilient traits and social support all play roles why some persons process trauma without dysfunction and others do. It is not a sign of weakness but merely an inability for a particular case and reason that the brain is unable to properly process the situation. As seen above, this sometimes has much to do with the amygdala and the inability to extinguish the fear.
While many only correlate PTSD with veterans it can also affect survivors of abuse or other traumatic experiences
Due to these issues, hyperarousal or hypoarousal can occur in those with PTSD. This leads to re-experiencing symptoms, avoidance, as well as hyperarousal which can lead to hypervigilance (Evans, 2014.. p. 29). Those with PTSD are unable to regulate emotions when hyperarousal or hypoarousal occur. To learn more about hyperarousal or hypoarousal and emotional regulation, please click here. Whether hypoarousal and its symptoms of numbing, withdraw and dissociation, or hyperarousal and its symptoms of anxiety and hypervigilance, the brain is unable to differentiate the past trauma with current triggers. This can cause flashbacks where the person loses contact with time, or location. Only until the person learns grounding techniques and ways to regulate emotion can he/she find a window of tolerance to experience the event, process it, recreate new neuropathways associated with the memory, and store it long term without unresolved trauma symptoms.
Many counselors utilize exposure therapies such as EMDR, or cognitive therapies such as CBT to help clients and victims revisit and reframe the event in a healthy fashion and learn to process it as well as manage and regulate emotions that can be triggered due to the event.
Conclusion
The purpose of this short article was more so to understand the parts of the brain associated with the stress response and how the brain normally operates to better understand why when it does not operate correctly, one experiences unresolved trauma and PTSD. An overactive amygdala and underactive prefrontal cortex play off each other and cause the inability for the body to continue the process of fear extinction. This causes an inability of the hippocampus and prefrontal cortex to properly process, understand and store the memory. While most resolve traumatic experiences within 3 months, some do not. There are many subjective variables as to why one person and not another may experience unresolved trauma. Trauma Informed Care specialists understand the neuroscience behind PTSD and help the client or victim find windows of tolerance and teach them emotional regulation and grounding techniques to heal from cope as well as heal from past trauma.
Please also review AIHCP’s many healthcare certification programs and see if they meet your academic and professional goals
Many times in counseling when discussing trauma, emotions can emerge tied to the unresolved trauma that can de-regulate a client/victim/survivor. Discussing issues of abuse, or loss, or traumatic memories whether current or in the past can cause individuals suffering from unresolved trauma to dissociate from the present, flashback to the past, or enter into states of emotional dysregulation. Licensed counselors who specialize in trauma care and crisis intervention have strong understandings to utilize techniques to help ground and contain negative emotions associated with trauma. Unlicensed mental health professionals in crisis response or even pastoral care may sometimes come across individuals who also need these same techniques due to acute crisis or trauma. It is hence important to understand how to help individuals suffering from PTSD, acute trauma, or unresolved trauma with the appropriate techniques to help victims or survivors find stabilization. This article will focus more on in session counseling and long term trauma care than immediate psychological first aid which is addressed in other blogs. Primarily, we will discuss the therapeutic relationship’s window of tolerance with a victim/survivor, how to expand this window, and review various techniques found in grounding and containment to help others find calm and peace.
Many clients/survivors/victims need aid in regulating emotion after trauma. Please review AIHCP’s healthcare certifications
Please also review AIHCP’s Trauma Informed Care Program, as well as its Crisis Intervention program and also all of AIHCP’s Healthcare Certifications.
Window of Tolerance
In counseling, individuals can experience emotional dysregulation due to unresolved past trauma. Simple triggers of retelling the story, to similar images in a room, or a familiar scent can reset a person and dissociate, flashback, or cause intense states of hyperarousal or hypoarousal. Compton explains that individuals can experience two types of dysregulation. In hyperarousal, the person becomes angry, anxious, hypervigilant, or impulsive (2024, p. 208). Compton points out that with hypoarousal the opposite occurs when the person experiences withdraw, numbness and lack of emotion even in some cases to a state of dissociation (2024. p. 209). In the fight or flight response, counselors will see anger and anxiety, but during the freeze response, counselors will see the shutdown. These are natural ways the body and brain responds to past trauma. The key is how easily can one’s system return to a state or emotional regulation when dealing with these triggers or reminders that cause emotions to emerge. Individuals in trauma can be stuck in a variety of phases, some may exist in a state where they feel no safety anywhere, others may exist in a state where safety may not be an issue but trust is totally lacking. It is the goal of the counselor through the therapeutic relationship to help victims again find phases of regained power, regained self esteem and eventually the phase where they can again reintegrate with society and form healthy relationships. It is within the Window of Tolerance of a person’s emotional state where this healing can occur.
The Window of Tolerance is term phrased by Ogden, Minton and Pain that refers to the optimal window of time between hyper and hypoarousal states in which a person can experience balance (Compton, 2024, p. 209). Within this period of time, therapeutic counseling can occur where the trauma can be discussed and better ways to cope can learned by the client. During this time as well, the reasoning part of the brain as opposed to the emotional part has more awareness to communicate, reason, learn and grow (Compton, 2024, p. 209). Counselors can help clients learn how to operate and heal within the window but also learn ways to expand this window in real world settings through a variety of skills. Counselors can help clients co-regulate their emotions within the window and expand it through supplying empathy, support, a safe and secure environment and also preventing re-trauma by limiting or eliminating potential triggers.
Counselors during this time through the therapeutic relationship can help with focusing on the needs of the client and being aware of discomfort or physical manifestations associated with mental discomfort. Compton points out that the term “interoception” best describes the ability of a counselor to have this type of awareness of what is happening inside someone based on what the body is displaying or doing in the moment (2024, p. 196). this is why watching for non-verbal cues is key in counseling during the selective attention skill of focusing. During this important window, counselors should engage their clients. By focusing, reflecting and providing context, counselors can help survivors understand their trauma better (2024, p. 197). In addition to engaging, counselors need to help clients process emotion and then help them reflect on it. The biggest part of processing is not only discussing it, understanding it, and reframing it but to also learn how to manage it.
Tracking and Identifying Emotional States
Within trauma counseling, it is important to utilize the window of tolerance but it is also equally important to track the client’s body and behavior for signs of either hyperarousal or hypoarousal. It is also important to track oneself, since sometimes the stories and events relayed can even shock a counselor and cause deregulation within. It is important to note that most individuals exist within a normal operating existence of balance when viewing safety and conditions. The securing of safe environments and the scanning by the brain to ensure safety within a environment is referred to as neuroception. A person in a calm and secure state is not activating the sympathetic nervous system but is existing in normal state where the cognitive functions of the brain are operating. When the sympathetic nervous system strikes it can close down cognitive functioning and increase emotional responses. Fight, flight or freeze, or even fawn can emerge as reactions to this. Interesting enough in cases of hypoarousal, the parasympathetic system, the calming aspect of our nervous system, can deactivate an individual due to the intensity of the trauma or recalling the trauma. When working with survivors or victims, merely recalling traumatic events can cause a hyper or hypoarousal response. This can affect healing and reduce the window time tolerance to discuss the trauma with the cognitive functions operating.
Tracking emotions and signs is hence an important skill for a counselor in any session but even more so when helping individuals in intense grief, loss, crisis or intense trauma. In states of hyperarousal a person will display various physical and also behavioral symptoms. In essence the person cannot calm down. Clients in hyperarousal can display anxiety, irritability, panic or rage. They may have racing thoughts, or an inability to concentrate and may display signs of hypervigilance during the session. Physically they have increased heartrate, muscle tension, clenched jaw, closed fists, display sweating or have a racing heart rate. Behaviorally, they can display an overall restlessness which may be affecting their sleep and impulse control. They may fidget and move and express emotions easily during the session. This can lead outside the counseling room to regular life in feelings of being on edge, easily irritated, over-thinking social interactions, and feeling uneasy in social settings (Mindset Explained, 2025).
When tracking, a counselor also needs to track possible signs of hypoarousal. Hypoarousal can be induced by either the sympathetic or parasympathetic. It is usually tied to parasympathetic functions that relax the body but in these cases it shuts the body down as a self defense mechanism to the trauma or even thought of the past event. A person experiencing hypoarousal will display detachment, numbness and seem withdrawn and lacking motivation. Cognitively, they may be slow to speak and appear confused and lacking details about events. Physically they will seem lethargic and have a slower heart rate, display fatigue, or over relaxed muscle state. During a session, they may zone out or seem distracted. Behaviorally this can lead to intense isolation outside the counseling room. Many may have a hard time getting out of bed, or detach from loved ones, feel powerless and lose interest in things they like to do (Mindset Explained, 2025).
In both cases, counselors need to be aware of these signs but also know when to utilize activation strategies for hypoarousal or settling techniques for hyperarousal. In these cases, settling or activating becomes the choice a counselor needs to make. In states of hypoarousal activities that help the person activate the nervous system include helping the client begin to move, via stretching, or walking around can be a first good start. Other ways to activate include grounding techniques that are tied to touch and sense, such a the feeling of a cold object or ice cube, or the splash of water on the face. Other forms of breathwork, as well as cognitive activation through counting or labeling things in the room can also aid the client. Sometimes music can be helpful, or even the scent of a candle (Mindset Explained, 2025).
With hyperarousal, the concern is to settle, not activate. Hence, breathing exercises, ground techniques such as holding something, or touching something, as well as sensory and cognitive ways to help the person remain in the present. Progressive muscle relation techniques as well as guided meditation and visualization can help a person induce the parasympathetic system as well. We will discuss more types of ground and containment strategies later in this article. What is optimal is a stable state of being. Stable and emotionally regulated states allow the window of tolerance to be utilized in therapeutic sessions. Healthy states permit better focus, cognitive functions, stronger relationships, better sleep and better energy levels to cope with stressors and potential triggers (Mindset Explained, 2025).
One thing to consider and be aware of is that while helping others, counselors can also enter into various states of hyperarousal or hypoarousal. The term reciprocal defense mobilization is the mirroring of emotional states. While ideally the counselor is the co-regulator in a session providing energy, trust and security to the person, sometimes horrible stories or emotional breakdowns can affect the counselor. In fact, past trauma of the counselor can also be triggered in counseling. This type of vicarious trauma can have acute affects on the session but also long term affects and burnout for the counselor. If a counselor is affected via hyper or hypoarousal, the ability to listen, exercise empathy, or help the person heal can be at risk. Hence counselors may sometimes need to activate or settle themselves. It is harder though for a counselor to express these feelings or exhibit certain strategies while counseling and because of this counselors need to be able to subtly activate or settle themselves. In cases of hypoarousal, a counselor may notice one’s own signs of shutting down and look to activate by clenching one’s fist or hand or shifting or tapping one’s foot. A counselor can also discuss both parties standing up and stretching as a ploy to not only help the client but oneself. A break or a pause can be helpful for both client and counselor in these cases. During hyperarousal, a counselor can label, or count, or focus on one’s own breathing.
One should consider basic strategies to manage both hyperarousal and hypoarousal in daily life. In regards to hypo, utilize frequent exercise if possible, alone, if public gyms are unsettling. Utilize breathing and mindfulness, and create and stick to routines that give a sense of accomplishment and work on connecting with others, especially those who are closest. Even if a short phone call or text! For hyperarousal, one will utilize more grounding techniques in daily life which will be discussed below and also employ relaxation and meditation, as well as with creating a calmer environment with music, or scented candles (Echowave, 2025).
Grounding and Containment
A person during counseling who becomes hyperarousal needs various help to manage his or her emotions within the session. These skills and techniques can help not only help them regulate and expand the window of tolerance in session but also be applied later to out of session in the world experiences. The two most common types of skills taught in counseling for individuals with unresolved trauma and PTSD are grounding and containment.
Grounding a way to help survivors stay in the present moment when hyperarousal or hypoarousal overtake them in life or in a counseling session. Please review AIHCP’s healthcare certifications as well as its Trauma Informed Care Program
Grounding techniques can be sensory, cognitive or somatic in nature. In sensory grounding, the counselor utilizes the five senses to help a survivor find placement in the present. In regards to the sense of touch, it can be as a simple as feeling the feet on the ground or the soft touch of the couch on the finger tips. A counselor should help the survivor with calming words describing the sensation one feels as the fingers sway across the texture of the couch, or the firm feel of the foot against the hard floor. In some extreme cases, ice in a person’s hand can be used to help a person find the present. In all cases, the sense of touch should be used especially carefully when counselor or client come into contract via a tap on the shoulder or a hug because these things could possibly be a trigger to the prior abuse (Compton, 2024, p. 214). With sight, the counselor can direct the client to note anything in the room they see and what color it may be or details one may not have noticed before. The scent of smell can help calm through oils, incense or candles that can help a person find calm but again be aware of your client’s history and scents that could trigger him or her. With taste, sometimes, one can focus on a piece of candy available and the taste of it, or imagine a particular dessert. The counselor gently inputs into the mind these scenes to help the client find regulation (Compton, 2024, p. 212). From a cognitive approach, a counselor can have a client count from a higher number down to zero to exert awareness of the now or have the client name things within the room to help the person find connection to the present. From a somatic approach, breathing exercises can be employed to help grounding. In fact, breathing exercises are sometimes the first utilized to help a person calm. Deep breathing initiate the parasympathetic nervous system which reverses the affects of the fight or flight response. The deep inhale and exhaling can lower the heart rate and help a person find calmness. Usually the breathing is done with some type of visualization. One common theme is balloon breathing where the client is told to imagine a balloon inside oneself and as one inhales to imagine the balloon inflating and while exhaling to imagine the balloon deflating (Compton, 2024. p. 212). The breathing should be coming from the abdomen and not the chest since chest breathing is usually associated with anxiety. To ensure proper breathing, one can tell the client to put his or her hand on ones chest and stomach and see which part of the body is moving more. One can also utilize touching the shoulders to see if the shoulders are rising which is indicator of chest breathing.
While grounding helps a survivor find the present and remain engaged, containment skills can help clients learn to control uneasy emotions. The tool of containment helps clients break away from traumatic memories and feelings (Compton, 2024, p. 215). Containment tools include visualization and various expressive arts. Most of these tools are also utilized with breathing techniques and can be used in session as well as in the real world. When working with clients expressive arts are similar to play therapy with children. They can help a person find calm when discussing difficult issues. Compton references vertical regulation as way for the survivor to draw lines of different colors up and down a page while deep breathing. Other expressive arts include dance and music to help with hypoarousal to push energy into the person. Liturgical or spiritual music can be utilized if it provides the necessary calm, or secular music that the client enjoys (2024, p. 211). Creative writing is another expressive art used to contain emotion. In expressive writing, one can write a note to oneself, or a parent, or God, or anyone the client freely wishes to write too. The message can be a positive one that employs safety and security (2024, p. 212). Visualization and breathing remain one of the most used containment practices in sessions. With guided breathing and the visual scripts from the counselor, the client can visualize safe and secure places when facing trauma memories or uncontrolled emotions. One classic visualization technique is imagining the a container in which the client can put all the unwanted emotions into and cover with a lid. The counselor guides the client to understand that any intrusive thoughts at any time can be stored in this container, box, or chest when needed (Compton, 2024, p.216). The key is to discover a safe, secure and calm place. Many times counselors will lead a guided visualization of a place the client finds peaceful. Whether a cabin in the mountains, or a spot on the beach, the counselor can take the client back to that place or peaceful place in time. During which the client will close his or her eyes, breath deeply and follow the voice of the counselor describing the calm associated with these places and times. Butterfly hugs are also a tool that can be utilized during visualization in which the client is taught to hug oneself and allow their hands to tap their back in assurance and calmness (Compton, 2024, p. 217).
In all of these exercises, if the person is spiritual or religious, spiritual aspects and words can be utilized on a case by case basis to help the person find calm. For some, spirituality may be beneficial but for others who were exposed to spiritual abuse, it may not be warranted. If spirituality is accepted and desired, sometimes clients can breathe in with a statement about God and breathe out with a statement of safety, such as “God is good” and “I am safe”. In other cases, scriptural references that the client enjoys can be utilized from whatever sacred book he or she adheres to (Compton, 2024, p. 218).
In all cases, help the client be in control. The purpose it to help the client learn to regulate and being in control is key, especially when the survivor is not in session. In such cases, when introducing breathing techniques or new tools, instead of dictating, or saying “do this”, utilize phrases such as “would this be helpful to do this?”. This reduces distress and gives autonomy to the survivor who in many cases, if abused, was told what to do numerous times.
Conclusion
Please also review AIHCP’s Healthcare Certifications as well as AIHCP’s Trauma Informed Care Certification
Many situations in counseling trauma victims/survivors require helping them to learn to regulate emotions. These skills are important both in session and out in the real world. In session, it helps extend the window of tolerance which then can be applied to real world situations. Skills in grounding and containment help clients with hyper/hypoarousal and maintain control and learn to deal with the symptoms of trauma in a positive fashion. These tools in counseling also allow for the discussion, reflection and processing of the unresolved trauma. It is important to remember that when treating trauma, it is a marathon not a sprint. These skills take time to implement and the body and mind need time to heal.
Please also review AIHCP’s Trauma Informed Care Program, as well as its many healthcare certifications in crisis intervention, grief counseling, stress management and Christian spiritual counseling. All programs are open to qualified healthcare and mental health professionals seeking four year certifications to utilize within the scope of their practice. The healthcare programs are online and independent study and have mentorship as needed.
Resource
Compton, L & Patterson, T (2024). “Skills for Safeguarding: A Guide to Preventing Abuse and Fostering Healing
“Hypo-Arousal and Hyper-Arousal: Nervous System Dysregulation”. (2025). Mindset Explained. Access here
“Feeling Hypo or Hyper Aroused How to Spot the Subtle Signs”. (2025). Echowave. Access here
Dissociation is a serious condition resulting from PTSD. When triggers of past trauma arise, the mind tries to shut the body down through dissociation. Sometimes it is through a flashback, or a disconnect from reality. These situations while in public or driving can cause injury to the person. So it is important to understand what triggers it and how to ground oneself when dissociation occurs.
Please also review AIHCP’s numerous mental health certifications which include grief counseling, crisis intervention, spiritual and Christian spiritual counseling, stress management and anger management programs. The programs are online and independent study and open to qualified professionals seeking a four year certification.
The first time that Post-Traumatic Stress Disorder (PTSD) reached the public eye, it was known as the concept of “shell shock” – debilitating nightmares, hyper-reactivity and increased dangerous behaviors in veterans who had experienced traumas of combat during World War I. It is still very much a common diagnosis amongst the veteran community, with an incidence of almost 13%(PTSD and veterans: Breaking down the statistics 2021).
However, in more recent years, PTSD has been a more commonly diagnosed mental health disorder that can affect anyone who was exposed to any form of abuse, trauma, or life-threatening situation.
As a result of PTSD becoming more of a common occurrence among the population, it has also become more important for those who are experiencing symptoms to seek out treatment. There are a wide variety of options available, including the tried and true, research-verified effective Cognitive Behavioral Therapy, or CBT.
CBT focuses on the relationship among thoughts, feelings and behaviors, targets current problems and symptoms, and then focuses on changing patterns of behavior that lead to difficulty functioning.
What is Post-Traumatic Stress Disorder (PTSD)?
Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can develop after a person has experienced or witnessed a traumatic event, such as a combat event, a natural disaster, a car accident, or a violent crime.
Symptoms of PTSD include re-experiencing the traumatic event through flashbacks or nightmares, avoidance of reminders of the event, and increased feelings of anxiety and depression.
Most people who go through traumatic events may have temporary difficulties with adjusting and coping, but with good self-care practices and time, they usually are able to overcome it. If symptoms worsen, linger and interfere with day-to-day functioning, they might be experiencing PTSD.
Getting effective treatment after PTSD symptoms develop can be critical to reducing symptoms and improving overall function.
What is Cognitive Behavioral Therapy (CBT)?
Cognitive Behavioral Therapy focuses on the relationship between thoughts, feelings and behaviors. It targets individuals’ current concerns and issues with day-to-day-functioning and the symptoms they are experiencing, and then provides ways to help challenge negative patterns of thought and behavior, in order to help improve quality of life.
How does Cognitive Behavioral Therapy Help PTSD Symptoms?
Several theories that revolve around trauma help explain why CBT is an effective treatment to reduce symptoms of PTSD.
Emotional Processing Theory suggests those who have experienced a traumatic event can develop associations with reminders of the event. Challenging these associations, especially the ones that lead to unhealthy functioning, is the core of emotional processing.
Social Cognitive Theory suggests that those who have defined their existing beliefs about themselves, others, and the world, based on the trauma they experienced, often struggle with unhelpful interpretations of their experiences of their environment.
Cognitive Behavioral Therapy has been scientifically proven through many studies, to alleviate symptoms of PTSD. Typically, CBT treatment includes two main components: exposure therapy and cognitive restructuring.
Exposure Therapy
Exposure Therapy aims to reduce the emotional distress associated with reminders of the triggering event. Exposure Therapy operates similarly to how it sounds. It involves gradually exposing the individual to reminders of the traumatic event in a controlled and safe environment.
If you go through Exposure Therapy you may be asked to recall the traumatic event in therapy, visit places, or engage in activities that are associated with the traumatic event. Over time, the hope is that you will be able to identify your triggers and use coping mechanisms to downplay the symptoms you experience (Yetman, Exposure therapy: Types, how it’s done, and more 2021).
Cognitive Restructuring or Prolonged Exposure (PE) Therapy
The second aspect of CBT is Cognitive Restructuring or Prolonged Exposure Therapy (PE). PE is a type of CBT treatment that involves identifying and changing negative thought patterns associated with the traumatic event (Prolonged exposure (PE).
Cognitive restructuring may include challenging and refuting negative beliefs about oneself, the world, and others developed due to the traumatic event.
For example, a person with PTSD may believe that the world is dangerous and that they are helpless to protect themselves, which can lead to anxiety and fear.
Through Cognitive restructuring, a therapist may help the person to challenge and refute this belief and replace it with a more balanced and realistic perspective.
CBT is a scientifically proven effective treatment for PTSD
CBT is effective in treating PTSD in several studies. CBT was found to be effective in reducing symptoms of PTSD in adults in over 12-15 sessions either in a group setting or one-on-one.
CBT has also been effective in treating PTSD in specific populations, including veterans and individuals who have experienced a traumatic event in childhood. The VA and the American Psychological Association recommend using CBT for PTSD survivors. CBT not only targets PTSD but also targets other symptoms of PTSD such as depression and anxiety.
Multiple studies through the years have championed CBT for PTSD treatment. (Cognitive behavioral therapy (CBT) for treatment of PTSD).
What are the Benefits of CBT?
Besides the fact that Cognitive Behavioral Therapy is a scientifically proven effective treatment for individuals suffering from post-traumatic stress disorder, there’s also a wide variety of benefits over other forms of therapy. Here’s a few of them:
1. It gives people hope about their condition.
Oftentimes, due to the nature of mental health disorders, sometimes it can cause those who have been diagnosed to have a pessimistic outlook about their future wellbeing. It can be difficult to think about a time where their illness won’t impact their life.
CBT challenges this mindset–and offers hope for the future.
It does this by using its own methods to challenge thoughts and ideas like this. Provides a way to seek out alternative possibilities. That life could be very different, and in a more positive way.
2. It develops self-esteem.
It’s not a surprise to note that with many mental health conditions, also comes with a lower sense of self-worth and self-esteem.
This feeds into the cycle of negative thinking, which influences behaviors, and vice versa.
CBT can help disrupt these negative thoughts and patterns, and as a result, help develop more confidence in a person’s own abilities and strengths.
Understanding how thoughts work, and how they are under the control of those who are thinking them, changes things on a fundamental level. Including the way people see themselves.
3. It can help with relaxation.
Because CBT directly helps with managing thoughts and emotions, this comes with it the ability to control how a person responds to their symptoms.
As a result, it helps regulate responses to triggers and reduce symptoms by utilizing a variety of relaxation techniques.
4. It develops more rational thought processes.
Perhaps the most important benefit of CBT, is that it helps people regain control of their thoughts and emotions.
Over time, the process of questioning and challenging our thought processes, and replacing them with healthier ones, can transform people entirely.
CBT is a great way to treat PTSD
In conclusion, CBT is a widely recognized and effective treatment for PTSD. This type of therapy is based on the idea that our thoughts, feelings, and behaviors are interconnected and that we can change our emotional response to a traumatic event by changing our thoughts and behaviors.
Through exposure therapy and cognitive restructuring, CBT can help individuals reduce symptoms of PTSD, such as re-experiencing the traumatic event, avoiding reminders of the event, and decreasing feelings of anxiety and depression.
Author Bio:
Claire Szewczyk is a Digital Content Coordinator for Hill & Ponton, PA in Florida. She was a former US Airforce civilian employee, who worked at Hill Air Force Base, in Layton, UT as a flight testing administrator. She has also spent several years working with the Department of Veterans Affairs audiology programs in Salt Lake City, UT and Pocatello, ID. She enjoys working with the Veteran population and keeping them up to date with information they need the most.
Please also review AIHCP’s Anger Management Specialist Certification and see if it meets your academic and professional goals. The program is online and independent study and open to qualified professionals seeking a four year certification in Anger Management Counseling.
Trauma if it is not faced consciously will re-emerge in the subconscious. Nightmares can bring back past trauma in an attempt to understand and face the eluded issue. Due to disassociated mental material, trauma is trapped in the brain and not stored as a long term memory properly. Due to this, the trauma memory becomes a rogue thought within the brain. It haunts the individual through PTSD. Grief Counseling can help.
Only till the trauma is resolved, faced and understood, can one begin to heal from the event. Nightmares surrounding the trauma manifest as a way to face it but in an incomplete way. The nightmares at first are more vivid and true to the event but overtime can become more symbolic. The only way to overcome the nightmares is to face the trauma when awake. Counselors can also help individuals who are facing nightmares with strategies to minimize the nightmare and prepare the mind for a more peaceful sleep. Ultimately though, one has to be put in the work when awake to eventually overcome the haunting past traumatic event.
Please also review AIHCP’s Stress Management, Crisis Intervention and Grief Counseling Certifications. The programs all deal with trauma in some aspects. They are all online and independent study and open to qualified professionals seeking a four year certification.
PTSD is unprocessed trauma due to a horrific event. Learning to finally face that trauma and move forward is an important step. Learning to process and again learn to trust and have productive relationships are important. Please also review AIHCP’s Stress Management Program and see if it meets your academic and professional goals.
Sexuality and intimacy are crucial aspects of human life. It allows two to bond and share the deepest feelings with a wholesome sexual experience. An experience that is pure and filled with love as opposed as corrupt and full of hate. During trauma, individuals can lose intimacy and a healthy understanding of love and sex. This can create obstacles to fully reacclimating into society because one is not able to form a new bond or attachment with another human being. The act of intimacy and the act of sex in themselves can also become triggers and reminders of past abuse and push the person away from these normal and healthy bonds. Please also review AIHCP’s Grief Counseling Program
One who has experienced trauma must eventually face intimacy, trust and friendship and if desired, a more deeper friendship in the contract of a sexual relationship. Unfortunately, trauma makes this difficult and can prevent the person from an important fountain of healing that can bring the person closer to becoming one again. In this article, we will look at a few issues of intimacy and sexuality that someone who has faced trauma will deal with and how that someone can learn to trust and love again. Please also review AIHCP’s Grief Counseling Courses
In intimacy, one opens oneself to another. This can mean many things to a survivor of sexual trauma or betrayal. One feels the loss of a control. In isolation, one feels one has the power to control what occurs and the fear of opening oneself, puts oneself partly at the power of another. It is exactly this power that a trauma survivor fears. In addition, trauma survivors fear abandonment. If one opens up, then one risks the chance of being hurt and betrayed again. Hence many experience abandonment issues. Intimacy also opens up the chance of rejection. Trauma survivors fear the thought of being rejected for who they are and may very well reject someone before they can be rejected.
It is important with intimacy to accept fears. This is the hardest part, but only until one dismisses the fears, can one again learn to have a trusting relationship. The fear may be in the other person, or in one’s own tendencies but one cannot have the healing powers of intimacy without trust and letting fears go. One also needs to reject ideas and notions that can block intimacy with others. Many who have been traumatized universally label everyone. All men/women are bad is a common over generalization. The perpetrator was not good but not all people are bad. This central concept can take time to finally become a reality again. Other false narratives include assuming no one has every experienced what one has experienced, or that one cannot ever burden another with one’s issues. In addition, others feel unloved and if anyone ever knew what occurred, then that person would no longer be lovable. Flaws are seen as more prominent and as a sign of weakness, when in reality everyone has flaws.
It can be difficult after trauma to again show intimacy and open oneself up. Please also review AIHCP’s Grief Counseling Program
Learning how to discuss the past and discuss the future are critical communication skills. Individuals who fear intimacy need to be better able to express to another and share how to handle issues and conflicts. Without releasing the fear, false notions and opening up communication, then a person suffering from trauma will not be able to open again and find the value and healing within a friendship or a deeper relationship.
One of the biggest blocks to a deeper relationship is again seeing sexuality as wholesome and natural. Sex in its very nature promotes union, trust, and love but the trauma has distorted the true value of intimacy and sexuality. Following an assault, sex itself can become a trigger to a PSTD response. A certain touch can remind one of the trauma and turn something of love into something of abuse. The person has a hard time viewing sex as holy and the person as sacred. The rape or assault has stripped sexuality and intimacy of its dignity and the person has difficult times again experiencing these feelings and senses in a positive way.
Sex can also be seen as a way to control others, or it may be a device to fix what went wrong before. Unhealthy expressions and sexual behavior can result in different directions from fear of sex to promiscuity later in life. It is hence important to remove these past negative images. One image that is especially unhealthy is seeing all sexual behavior and correlating it with a sense of disgust. It is important to learn skills to neutralize this feeling of disgust and help re-evaluate these past negative experiences with positive experiences.
In rebuilding oneself for intimacy and sexual relations, the traumatized need to overcome many hurdles of trust and intimacy but certain steps can help to start the healing process. Disgust and association with trauma can be overcame with patience and time and understanding from one’s new partner.
It is hence important to again see certain parts of the body as holy and good. They cannot be seen or associated as evil in themselves. The action must be separated from the part of the body itself. Second, one needs to learn neutralize disgust. Ideas that the body is an object to be used must be dismissed and replaced with ideals that the body is a temple and a gift. This not only deals with the other person, but also how one views oneself. One can further separate the feeling of disgust with sex itself and shame. The shame with trauma needs to be separated from the act itself. By learning to separate negative feelings and events from the body and act itself, one can better open up to others. One can then create a new narrative where the event with a different person is not hateful or abusive but instead filled with love and respect.
Unfortunately, while rebuilding each other, partners should be conscious of others past. Certain boundaries may initially needed and a slow crawl until mutual comfort is met. Flashbacks can occur and it is important to recreate intimacy and the sexual experience together to form new wholesome memories. This requires patience, counseling as well as awareness.
Healthy sexuality is the ultimate key. While intimacy does not necessarily involve sexuality, nor the necessity of entering into a sexual relationship, one must still restore a sense of the sacred to the sexual act. Sex is not about control, secretive, shameful, wrong, abusive, dis-connective, controlling, superficial, or selfish but instead is a spiritual, emotional and physical act that binds. It builds self esteem and gives proper pleasures associated with that. It is celebrated and gives deeper meaning to life. It does not abuse, but promotes a feeling of unity and safety. It honors and loves and builds two instead of breaking down another. Finally, it does not reject, but it also accepts the imperfect and celebrates the two.
For some, sex is more than naturally just beautiful but also sacred from a religious view. Sex in this regard binds two as one before God and calls forward a vocation that goes beyond the symbolic act of sex, but carries itself in all matters of life itself. Spiritually, the destruction of sex to anything less is not of God and is a misuse of this divine gift to not only bring forth new life but also unify two into one.
Restoring intimacy with a victim of abuse can take time and patience but it can again reveal the goodness of intimacy and love
One can restore intimacy, and if desired, a healthy sexuality after assault, but naturally, the traumatized must learn to reprogram one’s mind to not only not fear but to open up and let go past narratives that prevent the leap of love and faith. The traumatized must also learn differentiate the corruption of the perpetrator from the holiness and goodness of the action itself and how it can be experienced with a good person.
It is a most disgusting sin to harm another through sex because it injures the person not only physically but also emotionally. It affects one’s ability to feel intimacy again and feel trust. It is more than a theft of virginity or physical freedom, but is a theft of self, but fortunately, through healing, counseling and prayer, one can again heal.
In any type of trauma, there is anger. Anger can continue to feed the trauma and keep it alive longer. Anger can also weaken the individual overtime through depression, fatigue and anxiety. Keeping strong emotional anger is unhealthy and it is important to learn how to properly release anger. This does not mean one does not have a right to be angry over the offense and trauma, but i does mean one must escape the anger before it becomes toxic.
Anger keeps trauma highly charged and weakens the self. It leads to sarcasm and bitterness in life, as well as resentment and possibly revenge. Revenge leads to further destruction and a cycle of violence and continued trauma. Furthermore, anger that prevents forgiveness stunts social growth. It prevents trust, increases hatred and forces oneself to close off to others. Hence it is important more so for one’s health to resolve anger and forgive than for the lack of worthiness of the offender to receive it.
Unresolved anger can lead to health issues. It is far better to release anger for oneself. Please also review AIHCP’s Anger Management Certification
Many feel forgiveness is impossible. Perhaps they view the offense as unforgivable. Rape, molestation and murder are sometimes very hard things to forgive. These things represent the worst within human society. Other things may be easier to forgive, but regardless of the degree, if one associates an action as unforgivable, then it becomes an anchor around one’s neck. Others feel they must protect themselves and must remain bitter and remain closed. Those who were physically abused, may feel their anger empowers them and protects them from ever being hurt again by never letting someone get close to them. Others feel they may betray themselves or their loved one, if they forgive the perpetrator. These are all blocks to resolving unhealthy anger and moving forward in life.
Anger is an emotion that may very well be important to the event. It is in fact a true emotion in trauma. It is OK to be angry. It is OK to feel the anger, but eventually, the anger can become toxic. It is important to start to experience the anger and understand it, but in a way that allows one to remain in touch with its importance but not its ill effects. It needs to be analyzed free from the toxic charge of initial rage, so one can understand its rationale and comprehend where it is aimed.
In doing so, many times, things need to be said, when those things cannot be said, then it is important to be able to find other ways to release. This is especially true when justice is not given to a particular case that prevents closure. Justice is an excellent way to help heal unresolved anger but in so many cases, justice at least in this world is not given. It is hence critical to be able to resolve anger sometimes without justice.
Some therapists suggest Gestalt Chairs, when one plays the role of both oneself and perpetrator. This allows the necessary discussion as one plays both roles. Being able to vocally express anger, confrontation and forgiveness is key. Furthermore, those with a belief of the afterlife, can find some closure knowing nothing goes unpunished before God. Ultimately, facing anger, the situation and forgiving, frees oneself from the perpetrator.
Forgiveness, however, does not mean minimizing the event, or condoning it, or forgetting it, or trusting the same person again. It does not dismiss the event, but it frees oneself from the emotional tie of the perpetrator. Even if one does not ask, it can free oneself. Forgiveness does not mean the individual still must pay a debt in this life or the next but it does allow one to move forward.
It is important in some cases to ask for forgiveness, but in other cases, this may not be an option, but the key is to decide to finally heal. Being able to resolve anger and give forgiveness may have to be done in constructive ways to release. Gestalt chairs or belief in God may be the best ways to forgive and understand. One needs to try to forgive the best way they can for their own healing. Sometimes, this can be accomplished through rituals such as confession, or other forms of expression.
In can sometimes be difficult to give forgiveness. Please also review AIHCP’s Anger Management Certification
Trauma is difficult to overcome. Some trauma is more severe and some cases of anger are harder to overcome. It is not an issue of denying the evil that occurred but it is an issue of healing and finding peace for oneself. Holding on to anger does not punish the perpetrator but it punishes the self and allows the perpetrator to continue to hurt the victim. It is hence important to learn ways to live and forgive before one’s life is totally destroyed.
Please also review AIHCP’s Crisis Intervention Program, Grief Counseling Program, Stress Management Program and Anger Management Certification. The programs are online and independent study and open to qualified professionals seeking a four year certification in the above disciplines
Source
“The Post Traumatic Stress Disorder Sourcebook” by Glenn R. Schiraldi, PhD
Dreams are the subconscious mind actively sorting out things while the conscious mind sleeps. Dreams cover a wide variety of issues that the person deals with on a daily basis and helps resolve those issues. From a religious standpoint, some contend dreams can also be of a supernatural origin, but even within this theology, these would be rare circumstances. Science and psychology see dreams only as an internal response to external events while one sleeps.
Nightmares can have many symbolic monsters to interpret. Please also review AIHCP’s Stress Management Training
How one dreams and the symbols within those dreams can be confusing. Some dreams are less important in processing, while other dreams can become more persistent in regards to unresolved issues. The more trauma and intense, the more intense the pushback within the dream. In this intensity, sometimes dreams can take a darker path and become nightmares. Those who experience PTSD usually also experience intense nightmares regarding the event and at more common rate that the regular population. The more recent the event, the more detailed, while the more processed the trauma, the more symbolic the dream may become.
Unprocessed and walled off trauma that is dissociated manifests in dreams. Sometimes, these dreams will create a different outcome or they will push a certain theme. Various symbols in the dream can haunt a person. Monsters, shadows, danger, being chased, being punished, re-threatened, trapped, abused or other physical injuries can occur in these types of intense nightmares. Most nightmares occur in the rapid eye movement of sleep which is later in the night. They are created through the anxiety and fear associated with the trauma.
Until trauma is faced, these dreams will continue to haunt someone. It is hence very important to try to understand what the mind is trying to tell someone regarding the trauma. Counselors suggest confiding to others about one’s dreams. Relate the setting, what happened, how one felt and the various symbols within the dream. It is important to ask how one felt, if one felt helpless or felt fear or shame to better understand what the mind is trying to communicate. Analyze the dream and attempt to see what one’s mind is trying to sort out. Does it relate to the past trauma? Does it relate to how one acted? Does it relate to how one feels about the event? Various symbols within dreams usually have deeper meanings. The monsters themselves have meaning if one looks to analyze the dream.
For example, monsters or being chased or attacked, usually indicates one is running away from something in life itself or is afraid to face something. This is why it is common in PTSD. Individuals are terrified to face or confront the “monster”. It is important to understand who the monster is before oneself in the dream
Injuries, or wounds in a dream indicate a feeling of weakness or powerlessness in one’s life. This again is common for victims who feel they have lost all power in their lives due to the attacker.
Falling is closely associated with those who feel they have no control in their lives. They do not feel like they are in command within their personal or work life.
Being trapped is another common symbol that expresses the need to escape from a bad situation.
Whatever the type of dream and its symbol, it is important to access what it means to you
Some counselors suggest in addition to confiding to another about the dream to imagine the dream at its most intense moment and relate, “It is just a dream”. Understand that it has no power over oneself. It is good to remind oneself before bed in this regard.
Those suffering PTSD experience more nightmares. Please also review AIHCP’s Stress Management Program and see if it meets your academic and professional goals
Also consider confronting the monsters in one’s dream. While awake, ask what do these monsters want? You can also confront the dream by creating an alter ending. Write or draw and discuss the new ending and see if it has any result. Dreams change as one better copes. Coping and facing trauma will indirectly affect one’s subconscious mind and help one process dissociated material that may be haunting one while one sleeps.
Before sleep, also practice deeper breathing and meditation, as well as Progressive Deep Muscle Relaxation strategies.
Dreams are what dominate one’s mind during sleep. When one is experiencing PTSD, the trauma will find a way to be expressed and sometimes dreams are the only outlet until one chooses to cope and deal with the issue itself. Learning to cope with PTSD, especially through dream management is critical to overcoming PTSD and helping the subconscious mind properly store the memory.
If you would like to learn more about Stress Management Training, then please review AIHCP’s Stress Management Consulting Program and see if it matches your academic and professional goals. The program is online and independent study and open to qualified professionals seeking a four year certification in Stress Management.
PTSD has numerous triggers. Hyperarousal is the brains reactions to those triggers. Individuals respond to scent, sounds, memories, visuals or even touch that tap into the dissociated mental material of trauma. This can send the person into a flash back or even into a violent rage. It is very dangerous for them as well as for others. It is important to identify triggers and learn how to cope with hyperarousal and manage it. Once the trauma is properly processed, these issues become less of an issue and eventually healing begins.
Individuals suffering from PTSD exhibit hyperarousal. Please also review AIHCP’s Stress Management Consulting Program
The article, “What Is Hyperarousal in PTSD?” by Christopher Bergland takes a closer look at hyperarousal within PTSD. He states,
“Hyperarousal keeps the body and mind constantly “on guard,” which makes it hard to go about daily life. Chronically heightened states of arousal are perpetuated by the fight-or-flight branch of the autonomic nervous system. This article discusses the causes, symptoms, and treatment for hyperarousal that occurs with PTSD.”
Please also review AIHCP’s Stress Management Consulting Program and see if it meets your academic and professional goals. The program is online and independent study and open to qualified professionals seeking a four year certification in Stress Management Consulting.
Written by Claire Szewczyk
Exposure Therapy 
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