The Complex PTSD Workbook by Arielly Schwartz, PhD, is a workbook designed to go along side it’s counterpart book, A Practical Guide to Complex PTSD: Compassionate Strategies to begin healing from childhood trauma. I unfortunately didn’t care for the original book, but the workbook is fantastic! I like that it gives the reader questions and has areas to write out your answers. I have put my favorite quotations from the book below:

Complex PTSD is a set of symptoms that are the result of pain and stress that often begin at a very early age- they could be all you’ve known. 

Complex PTSD is a normal response or adaptation to non-normal life conditions that may be in a person’s history. 

8 Contributing Factors to the development of C-PTSD

1. Intensity, duration, and timing: the longer the abuse or trauma continues and the greater its intensity, the greater the likelihood you will develop C-PTSD. Children are most susceptible to the impact of such stressors during critical growth periods, such as the first 3 years of life when the nervous system is extremely fragile and during adolescence when they are forming their identity. 
2. Genetics 
3. Environment
4. In Utero Influence-infants born to mothers who were pregnant during a traumatic event that could have resulted in a diagnosis of PTSD. Babies born during the time around 9/11 had lower birth weights and decreased levels of cortisols (stress chemicals). Such infants can then be harder to soothe, more prone to colic, and at increased risk for PTSD. 
5. Family Dynamics
6. Modeling
7. Presence of a learning disability or ADHD- there is a strong correlation between children with learning disabilities like ADHD. 
8. Lack of resilience factors 

It takes tremendous courage to confront childhood trauma. You may have grown up in an environment where your curiosity and enthusiasm were constantly devalued. Perhaps you were brought up in a family where your parents had unresolved traumas of their own, which impaired their ability to attend to your emotional needs. You learn to compensate by developing defenses around your most vulnerable parts. Every person’s experience is different and leaves different wounds. 

Healing childhood trauma involves a balance: attending to the wounds of the past while living in the present. 

You are not broken, in need of fixing. Rather, you are deeply hurt, in need of care. 

Traumatic experiences are frightening and overwhelming. Growing up afraid has ramifications on cognitive, emotional, and physical development that can persist into adulthood. 

How Complex PTSD affects the mind and body- 

• Cognitive distortions- inaccurate beliefs about oneself, others and the world
• Emotional distress- frequent feelings of being overwhelmed
• Disturbing somatic sensations
• Disorientation
• Hypervigilance- high sensitivity of watching others and tracking nuances and subtleties in body language and facial features to keep oneself safe
• Avoidance

Other symptoms of C-PTSD

Feelings of irritability

Emotional eating

Difficulty concentrating

Impulsivity or recklessness

You might feel emotionally overwhelmed. When you are “flooded“, you will have a hard time effectively thinking your way through any situation. 

Dissociation, like all other symptoms of C-PTSD, is a learned behavior that initially helped you cope with a threatening environment. A neglected or abused child will rely upon built in, biological protection mechanisms for survival to “tune out” threatening experiences. 

Young children are completely dependent upon caregivers for a sense of safety and connection in the world. When parent are frightening, abusive, or unavailable, children can feel confused about who is at fault. When children witness something bad, they feel bad. Inaccurate and judgmental thoughts such as the following ones perpetuate shame. Thoughts like “there must be something wrong with me”. “I’m so stupid.” “I can’t seem to do anything right”. “I’m an emotional wreck”. “I’m just lazy”. 

PTSD is associated with frequent bursts of cortisol and chronically low levels of available cortisols in the bloodstream. This is the physiological explanation of the classic alternation between feeling overwhelmed and shut down. It is as if you are driving with one foot on the gas and one on the brakes. 

In regard to the ACE Study- (which is a 10 question screener for PTSD)- experiencing any 1 of the categories places a child at risk, but having lived through 4 or more ACE factors appears to be a critical mass of stress. Adults who had been exposed to 4 ACE factors as children are 4x more likely to become depressed, 7x more likely to use substances, and 12x more likely to attempt suicide than adults with an ACE score of zero. These individuals are more likely to experience social, emotional, and cognitive impairments, and are at a greater risk for physical illness such as heart disease, cancer, chronic lung disease, and liver disease. 

As revealed by the ACE study, unresolved childhood trauma takes a significant toll on physical health. Stress and trauma-related diseases are associated with chronic dysregulation of the ANS, these include high blood pressure, blood sugar imbalances, immune system problems, and digestion disturbances. 

C-PTSD is relational trauma; in other words, it is harm caused by one person to another. 

 A core dilemma of C-PTSD is that your longing for connection conflicts with memories that tell you relationships aren’t safe. In a trusting relationship, you can expose your fears and learn that you will not be rejected or harmed. Although nobody likes conflict, there is an intrinsic  value in healthy conflict, for this process will actually help retrain your nervous system as you build trust in your capacity to successfully navigate through interpersonal challenges. 

Grounding refers to your ability to sense your body, feel your feet on the earth, and as a result, calm your nervous system. This concept sits at the heart of somatic psychotherapies. Grounding is a key resource for trauma and emotional overwhelm. Grounding refers to using your ability to sense your body and feel your feet on the earth in order to calm your nervous system. Grounding is a key resource for trauma and emotional overwhelm. 

Resilience is not a trait that you either have or do not have. It is a set of strategies that can be learned and practiced by anyone. Strategies include: 

• Cultivating a growth mindset, in which you believe you can grow through both positive and negative life events. 
• Staying connected to your community rather than isolating yourself
• Successfully working through difficult emotions
• Believing that you have the capacity to shape the course of your life now
• Supporting your physical health through movement and exercise
• Expressing yourself through journaling and creativity 

The 3 primary aspects of resilience:

• Connection
• Choice & Control- childhood trauma can strip you of your sense of choice and control. You did not get a say in what happened to you then. Resilience is associated with an understanding that, with effort, you can influence the course of your life now. 
• Growth Orientation- resilient people often believe that growth and wisdom can be gained from both positive and negative life experiences. They recognize that life offers ongoing opportunities for new learning. 

Many with a trauma history share a deep empathy for humanity and develop a desire to help others or stand up against social injustices. 

The vagus nerve plays a central role in ANS regulation because it connects your brain to your digestive system, heart, lungs, throat, and facial muscles. Dr. Stephen Porges introduced polyvagal theory, which proposes your nervous system reflects a developmental progression with 3 evolutionary stages. 

To heal from C-PTSD, you need to feel safe and stable in your life now. 

A core dilemma of C-PTSD is that your longing for a relationship is in direct opposition to memories that tell you relationships aren’t safe. 

Emotional Hijacking refers to the ways strong emotions such as fear or anger can overpower your thoughts and behaviors. There is a key structure within the limbic system of the brain called the amygdala, which functions like a smoke detector- it is wired to determine if you are in danger. If the answer is yes, your amygdala can temporarily inhibit your neocortex, the upper brain center responsible for rational and reflective thought. Emotional hijacking initiates the instinctual fight-or-flight response. 

The Window of Tolerance is a concept developed by clinical psychiatrist Dr. Daniel Siegel. It refers to an optimal zone of nervous system arousal where you are able to respond effectively to your emotions. When you are outside of your window of tolerance, you will go into survival modes. Feeling anxious, overwhelmed, or panicked is a sign that you are hyper or over-aroused, whereas feeling shut down, numb, or disconnected is a sign that you are hypo or under aroused. It is common with C-PTSD to alternate between the two extremes or to feel stuck in one or the other. 

Persistent childhood trauma is characterized by a state called learned helplessness. This term was initially introduced to describe how animals that were repeatedly exposed to an unavoidable shock would make no attempt to escape, even when given an opportunity to exit. Psychologist and researcher from the University of Pennsylvania Dr. Martin Seligman later extended an understanding of learned helplessness to people who feel and behave in a helpless manner when they have no control over a threatening situation. He suggested that learned helplessness was the base of a pessimistic attitude. He identified the 3 P’s of pessimism: Personalizing, Pervasiveness, and Permanence. In other words, it’s like saying “It’s my fault, I mess everything up, and I will always be this way”. 

Dr. Seligman suggests adopting a positive set of thoughts he calls “learned optimism”. This process is achieved by consciously challenging negative self-talk and replacing inaccurate thoughts with positive beliefs. 

Shame is often hidden underneath perfectionism. As a child, you may have internalized the belief that you had to act perfect because your parents couldn’t handle your authentic feelings. Or perhaps you believed acting “good” would stop the bad things from happening. In either situation, you may have had to hide your true feelings to avoid rocking the boat. Perfectionism is maintained by critical self-talk that attempts to push down painful feelings. 

The question we should be asking is not “Why did this happen to me? What did I do to deserve this? That is really an unanswerable, pointless question. A better question would be, “Now that this has happened to me, what am I going to do about it?”

Forgiveness is an act of letting go of your own negative feelings, whether or not the other person deserves it. Forgiveness is not a forced process. It is a choice. Forgiveness asks you to reflect deeply on harmful actions, your and those of others. You start by forgiving yourself for the ways that you have caused harm. As you reflect on others’ harmful actions, you might find that people hurt others because they were once hurt, were afraid, or were in pain. You also begin to recognize that another person’s harmful actions are not a reflection of your own worth. 

Resources in Review:

• Replace negative self-statements with positive beliefs
• Visualize a safe or peaceful place
• Consciously breathe with a 4 count inhale and a 4 count exhale
• Seek, identify, and visit a healing space in your home
• Ground yourself by feeling your feet on the earth and releasing your weight into gravity
• Give yourself positive messages about your emotions
• Replace “I am sad” with “I feel sad”
• Avoid saying “should” to yourself
• Talk back to shame or your inner critic as if you were standing up to a bully
• Reassert healthy boundaries by saying no or asking for what you need
• Engage in healthy communication for conflict resolution
• Allow yourself to be vulnerable 
• Reach out for connection by making a phone call or getting together with a friend
• Allow space for grief
• Journal about difficult life events
• Write a forgiveness letter to yourself or another person
• Journal about gratitude (3 good things)
• Go for a savoring walk
• Focus on positive sensations in your body and allow them to grow
• Engage in a creative activity 
• Practice mindfulness through meditation, yoga, qigong, or tai chi

To get a copy of this book for yourself to enjoy, click below:

 

 

 

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