PTSD has a lot of emotions associated with it, not all of which are fear. I mean fear can be a really prominent emotion but there's also things like irritability and anger and guilt and shame. They may blame themselves for the trauma even when the trauma was clearly outside of their control, but they might say maybe I just didn't do enough to stop it from happening or maybe I didn't fight hard enough and therefore I'm to blame. A traumatic event is an event that happens to an individual that overwhelms their ability to cope.
Their emotions are enormous, complicated, varied. Rage is also there. Sadness is there. Loss is there. These are all very strong, primitive, primal emotions. I think that's what you're trying to access, is the most primal emotion associated with life and death. The most salient characteristic about shame, the thing that shame drives more than anything else is silence.
So when people feel ashamed of something, they don't tell about it. They don't talk about it. They don't mention that it ever occurred. They would really like it if you could cut that out of their memory. The best way to combat that is to end the silence. Talking about the thing that caused you such shame can be a really healing experience, although incredibly painful. Guilt and shame are the direct results of how the person's thinking about what happened to them.
How it's tying into their world view and their assumptions about what's going on. Well, if somebody believes in the fallacy of fairness and something bad happened to them, well then they deserved it. And that's where you see the guilt. Anger is a very common reaction to trauma as well. We're animals, you know, one of our responses is to be defensive in the face of aggression.
What I don't like to see is when someone gets stuck in the anger and that can happen with PTSD that they just get stuck in it and then anger can feel like a round room and they just go round and round and there's kind of no way out of it. When a client with PTSD is feeling emotionally upset, they often scramble for ways to try to feel better in the moment. A part of what we're trying to do in CBT is undermine that process. We're trying to get them to understand that you don't need to make your bad feelings go away.
You can in fact tolerate and make room for those feelings and recognize that nothing terrible happens to you. I think emotions are incredibly important to psychotherapy. We learn best when we have a bit of emotional arousal. Doing a very dry cerebral therapy is not going to be as potent as a therapy that infuses and embellishes emotion at times. People wanting to work in the field of trauma and PTSD have to be able and willing to sit with that emotion, listen to it, visualize it themselves, visualize the trauma themselves, and at the same time remain in the present with the patient, helping them navigate the story or the narrative of what it is that's happened to them.
But there's a lot of emotion in trauma and PTSD, and you really must be able to sit with that emotion, or else you're not going to be able to help.