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Therapy Spotlight: Critical Coping Skills for Trauma, PTSD, & C-PTSD

Updated: Nov 28, 2022

A Quick and Effective Toolkit for Regulating Your Nervous System When You've Been Triggered

By its very definition, trauma is overwhelming. It's overwhelming when the trauma occurs, but it's also overwhelming when we get triggered. Why is that?

When we talk about remembering a trauma, we're not so much "remembering" as we are "re-experiencing". Because these traumatic events are so incredibly painful and dangerous, our brain adapts to make sure that we 1) never forget and 2) are ready to act quickly if we ever run into this same danger again. That's why it feels like our emotions can go from 0 to 60 when we're triggered. Our brain has interpreted something in our environment as dangerously familiar and kicked us into survival mode.

This is adaptive: it's meant to help us survive! So why doesn't it feel that way? In the case of Post Traumatic Stress Disorder (PTSD) or Complex-Post Traumatic Stress Disorder (C-PTSD) the brain has over-compensated in an attempt to ensure our safety. Our internal "danger radar" system has become so sensitive that it gets set off by things that are not actually all that dangerous.

Think about it like a car alarm going off in a grocery store parking lot. Car alarms are built to tell us "Hey! Someone's breaking into your car right now"! And yet, we all know that car alarms go off for all sorts of other reasons, like when our phone presses into the keys in our pocket or when someone bumps our car with their shopping cart. The same thing happens to our brain after experiencing significant or repeated trauma.

That danger radar system is incredibly useful if we're still in a dangerous environment. However, when we finally make it to safety that danger radar system becomes incredibly annoying, incredibly painful, and incredibly exhausting. The thing meant to keep us safe is now causing the problems! That's why it's called "Post" traumatic stress. The problems often don't manifest until we're out of the trauma.

So how do we dial down the sensitivity of this danger radar system?

Below are some quick tips and skills that are useful in muting or dialing down the volume on our danger radar system. These tools are meant to be a resource that accompanies trauma therapy. You can use them independently, but we highly recommend bringing them to your therapist and getting some practice in session for maximum efficacy.

Tip #1 - STOP & TIPP

Let's start with a set of skills that are called "distress tolerance" skills. These are our crisis survival skills, meant to be used when we can't immediately solve a problem. Distress tolerance skills are a way to safely survive emotionally overwhelming situations without engaging in behavior we're trying to heal from: self-harm, suicide, substance use, risky sex, etc. Think of these skills as the "epipen" of coping skills: they will quickly stop the difficult emotion from escalating, but we still need further medical attention (aka other coping skills) after we use them.

Let's start with our STOP skill. STOP stands for Stop (so important, it's in there twice), Take a step back, Observe, and Proceed Mindfully.

Stop: our emotions affect our behavior, but our behavior reciprocally affects our emotions. When we're feeling a big emotion or are triggered into trauma, odds are that what we're physically doing with our body or something in our environment has triggered us. With Stop, we're literally coming to a grinding hault: don't move, don't speak, press pause, freeze frame.

Take a step back: If the cause for our sudden surge in emotion is in our environment, we need a change of scenery. When we "take a step back" we are literally stepping away from the thing, person, or place that set us off. Step outside, change rooms, put your phone down.

Observe: triggering happens when the "past" bleeds over into the "present". Our brain has recognized something as potentially dangerous around us and we've been pulled into "re-experiencing" trauma. With our Observe skill, we're reorienting our brain and body to our immediate environment because it's safer than it feels. Pay attention to what you can see, hear, taste, smell, and touch. Notice your internal body sensation: the heartbeat, the breath, muscle tension, etc. If you get lost in thinking, come back into your body over and over again.

Proceed Mindfully: we can't stand still forever. Hopefully the "thinking" part of your brain is beginning to take the wheel back from the "feeling" part of your brain. Ask yourself: "What do I need to do in order to make myself feel better? What other skills do I need to use?"

Next is our TIPP skill. TIPP is all about changing body chemistry to positively impact our emotional state. TIPP stands for Temperature, Intense Exercise, Paced Breathing, and Paired Muscle Relaxation.

Temperature: what happens to your body temperature when you get anxious, angry, or triggered? Usually it skyrockets. When we use our temperature skill, we use ice, cold water, or an ice pack across the face and hold our breath for 30 seconds. This activates something called the "dive" response (Google it). It also creates a tremendous amount of sensory input that is hard to ignore. If we're focusing on present-centered body sensation, we're beginning to ground ourselves back into the present and out of our trauma.

Intense Exercise: our goal here is not to lose weight, be healthier, or change the shape of our bodies. With this skill, we're engaging in short but intense exercise for 3-5 minutes. When we're triggered, there's often a huge surge of energy in our body which will continue to build until we discharge it. Intense movement sends the message to our body/brain that we're running or fighting for our lives. When we stop, our brain assumes that we must have made it to safety and begins to shift our body chemistry in a calmer direction. Set a timer and sprint, do jumping jacks, burpee's, or push ups.

Paced Breathing and Paired Muscle Relaxation: these go together! Paced breathing means we're slowing our breath down and evening it out. When we breathe in we're going flex a muscle group tightly, pause, and then relax that muscle as we breathe out. Often clients find it helpful to work from the toes up: curl the toes, flex the calfs, straighten the legs, make fists, raise the shoulders to the ears, and clench the jaw. Make sure your "out" breath is a few seconds longer than your "in" breath. This also sends a "slow down and relax" signal to our body.

Tip #2 - Body-Based Mindfulness

Mindfulness is the act of paying attention, on purpose, without judgement. I know that might sound like a weird idea. Why would we want to pay closer attention to crappy feelings when we've been triggered?

Well, one way of looking at what it means to be "triggered" is that you're already paying really really close attention. We call this "hyperarousal". When we utilize body-based mindfulness in response to triggering, we're not talking about paying more attention, we're talking about redirecting attention, on purpose, in a way that helps regulate our emotions.

When we've been triggered, we're lost in implicit memory. We might experience the same sights, sounds, tastes, emotions, and sensations that we experienced during the trauma itself. Our brain is stuck in the past. Our body, however, is always firmly fixed in the present moment as experienced through our sensory system. If we can effectively tune into our body and our senses, often we can ground ourselves in the present. So what does this look like?

Let's try it together. Notice how your body feels right now. Scanning from head to toe, make a mental note of any sensation you notice and then move on to the next body part. You might notice places of tension or tightness. Places of warmth or relaxation. Places of bracing or holding. Places that feel numb or empty. All of this is okay! Notice which of these sensations is most prominent and fix your attention there.

Ask yourself:

  • "Where does this sensation begin? Where does it end"?

  • "How big is this sensation? How strong"?

  • "If this sensation had a color, what color would it be"?

  • "If this sensation had a sound, what would it say"?

Get curious about the sensation you've chosen. Then, give it some room to breathe. We're not going to chase it away, try to change it, or pretend that it's not there. We're going to turn towards it, let it spread out, and soften it. There's plenty of room, give it as much room as it needs. Then notice what happens.

Often, emotions (and their associated body sensation) are like those Chinese Finger Trap toys we've all played with as kids (pictured above). The harder we pull away, the tighter we get stuck. When we turn toward, we often experience release. Something about allowing what's here to be here, shifts our relationship with it. Try it for yourself!

"In order to change, people need to become aware of their sensations and the way that their bodies interact with the world around them. Physical self-awareness is the first step in releasing the tyranny of the past" – Bessel van der Kolk, The Body Keeps The Score

Tip #3 - Bi-lateral Stimulation

Bi-lateral what?

Bi-lateral stimulation is the use of alternating right, left stimulation across the midline of the body. This stimulation could look like tapping on the knees, legs, or shoulders, tapping toes, using eye-movements, or auditory stimulation. This form of stimulation helps the brain integrate information across the two hemispheres and suppresses amygdala activity.

Translation? When we use these bi-lateral movements while in the midst of a trauma triggering, the part of our brain that is screaming "Danger! DANGER!!!!" becomes muffled, harder to hear, and begins to settle down. This kind of input is often utilized during trauma reprocessing therapies like EMDR for this very reason. To be clear, trauma processing should not be taking place without the guidance and support of a therapist. The goal of this tool is not reprocessing, but the calming of our nervous system.

Let's take a look at two popular methods of bilateral stimulation: the butterfly hug and binaural beats.

The butterfly hug simply involves crossing the arms over the midline of the body and resting the hands over or around the collarbones of the opposite arm. Then, tap firmly but gently with one hand, then the other, back and forth for 2-5 minutes or until the body begins to settle. This can be done with eyes open or closed, though. most people seem to find closed eyes more calming. Take a look at our therapist Dakota demonstrating this technique below:

Binaural beats are a form of bi-lateral stimulation utilizing auditory input. These songs are calming in nature and usually without any lyrics or words. The auditory emphasis changes from left ear to right ear. You'll need a pair of headphones for this one! There are several playlists of this kind of music on free streaming services such as Youtube or Spotify. You can find an example of one of these playlists here:

Tip #4 - The Container & Safe/Calm Place Exercises

The Container Exercise

The Container exercise utilizes imagery to help us compartmentalize traumatic memory into a mental "space" that we create. This way, the trauma and all of its associations can stay "locked" away until we're ready to begin addressing it in therapy. The purpose of this tool is not to help us avoid trauma forever. We can't avoid it forever! The purpose is the help us avoid getting triggered long enough to get support from our therapist. While it can be very productive to think about and work through trauma in therapy, it is often incredibly destructive and counterproductive to think about trauma at your child's baseball game. Context is key!

Here's how we do it:

1. Build the Container

I’d like you to imagine a container that would be strong, secure, and large enough to hold anything troubling or disturbing. It should be well constructed, with a way of closing completely and locking if desired. It can look like whatever you want: a vault, a coffee can, a treasure box, a shoe box. Don't force it, notice what image comes naturally to mind."

"If you have an image, just notice it....check to make sure it is large enough...strong enough...and has a way of closing securely...what comes to mind?”

“Just continue noticing it....Notice how it closes and opens. Notice what it might need to be an effective container...add whatever is needed to make it more effective.”

2. Fill the container “Now visualize ‘every disturbing thing’ passing into the container, and then seal the container... You do not have to know what every disturbing thing is...You do not have to look at the ‘disturbing things’ going into the container, it is enough to know they are going in.”

“What percent of every disturbing thing went in the container?”

If it is not 100%, ask: “What quality would you need to complete the containment?” Or ask: "Who could help you get the remaining percent into the container?"

Keep filling the container until it’s as close to 100% as possible.

3. Close the container. “Now, with everything inside, go ahead and close the container and put it away for later use. The container has a special valve that allows you to take out a single issue and work on it with your therapist without releasing the contents of the container. The container has a notice posted on it that states, ‘To be opened only when it serves my healing.’”

More of an auditory learner? You can find great audio instructions here:

Safe/Calm Place Exercise

The safe/calm place exercise is something most clients seem to respond to relatively strongly. This exercise also utilizes visualization, but the goal of this exercise is to help us regulate our emotions when we've been thrown into a state of distress by a trauma trigger.

The exercise asks us to imagine a place (or person, or experience) that has a strong positive association with it: relaxation, safety, reassurance, love, etc. This place can be anywhere we'd like. It can be somewhere real (e.g. grandma's house), somewhere totally made up (e.g. Hogwarts School of Witchcraft and Wizardry), or somewhere in between (a favorite beach you visited on vacation, but with better weather and no other tourists). We can pair this exercise with bi-lateral stimulation (see Tip #3) for maximum effect. Notice what effect this exercise has on your body. That sense of safety and relaxation should begin within and start to grow.

Here's how we do it:

Step 1: Image.

Identify an image of a safe or calm place that you can easily evoke and has a personal feeling of calm and safety associated with. You can ask, “Do I have a place real or imagined that feels calm or safe? What place comes to mind?”

Step 2: Develop the emotions and sensations.

Focus on the image, As you think of that calm place what do you see? Really notice the sights, the colors, the quality of the light. What can you smell? Perhaps it's fresh bread grandma used to bake, or the fresh clean smell of nature. What can you hear? Perhaps the crash of the waves, a favorite song on the radio, or a breeze through the trees. What can you feel? Maybe you're lying down, standing, or walking around. Maybe the temperature is just right with a light breeze on the face.

Notice what emotions you are feeling and identify the location of the pleasant physical sensations. Where do you feel it in your body?

Step 3: Bi-Lateral Stimulation.

As you hold the image of your safe/calm place in your head, concentrate on where you feel the pleasant sensations in your body and allow yourself to enjoy them. Now concentrate on those sensations and begin to add bi-lateral stimulation through tapping the shoulders or knees as demonstrated in Tip #3.

If you're more of an auditory learner, check out a great rendition of this tool here:

Tip #5 - Co-Regulation (Pillow Toss)

I can't emphasize this enough: we are social creatures! One of the biggest reasons that therapy works is because it happens in the context of a relationship with another person. So, let's use this to our advantage.

"Emotion regulation" is a fancy, psycho-babble term for managing difficult emotions by lowering their intensity. When we're in trauma, the part of our brain that helps us regulate is severely inhibited. Co-regulation is another psycho-babble term that means "managing difficult emotions TOGETHER". When we co-regulate, we "borrow" another person's brain to help our brain put out the fire.

Usually when we're triggered those around us are not. This is why it's so critical to have some semblance of a support system and why we can't solve our problems (at least our trauma-related problems) all by ourselves.

The first key to this skill is to ask for help when you're not actively triggered. You've got to plan ahead! Ask someone you trust who won't judge you or trigger you further. Ask this person to be on standby the next time that you're triggered. This person might be a parent, a sibling, a friend, a romantic partner, a teacher, or really anyone you trust.

The second key to this skill is to come up with a game plan ahead of time. This plan should be simple, easy to remember, and centered around movement and your sensory system. The plan might be something like going for a walk together, using a sensory support like ice or a favorite fidget, or (my personal favorite) the pillow toss.

The pillow toss is exactly what it sounds like: you and your support person are going to toss a pillow (or something soft and available, like a small ball, water bottle, or tissue box) back-and-forth for 3-5 minutes or until the body begins to feel calm and safe. This exercise is done with minimal speaking. Concentrate on tossing the pillow! You can vary how you're throwing: using both hands, one hand, left hand only, right hand only, switching hands with every toss, etc.

Sounds a little simplistic, doesn't it? Try it out before you dismiss it. This seemingly simple technique is based in neuroscience. It forces our brain to get a little more in sync with our partners (that co-regulation thing we've been talking about) because we have to be tuned in to where they're throwing the pillow, when they're throwing the pillow, how fast, how hard, etc. This technique also gets us out of our head and into our sensory system by utilizing vision, touch, and proprioception.

When we're triggered, the "complex thinking" part of our brain goes offline or is severely inhibited. We can't use fancy "thought-based" coping skills when we're outside of our window of tolerance and inside our trauma. Coping has to be simple and body/sensory based. Once these tools have helped us regulate out of "crisis mode", the other parts of our brain begin to come back online. Then and only then can we continue to cope with more sophisticated tools.

The Take Home Message: Find a Therapist, Keep It Simple, Have a Plan

Trauma by it's very nature is overwhelming and disorganizing. These tools are a great starting place, but we want you to remember a few very important things. First, these tools are not a substitute for therapy. Trauma processing therapy is one of the only things that are really going to resolve or reduce trauma symptoms in the long-term. These tools are meant to act as a stabilizing agent until you and your therapist can get to the trauma processing phase of therapy.

Second, keep it simple! As we've mentioned, trauma affects the whole brain and body. Complex coping or trying to "think" your way out of being triggered is just really unlikely to work. These tools are a starting place, but there are a lot of other great body-based tools that can help people through overwhelming emotions. Talk to your therapist about other resources!

Lastly, have a plan and practice-practice-practice. Reading an article can be helpful (we hope you find this one helpful) but it's not enough. If you haven't spent a significant amount of time and energy repetitively practicing these tools when you're calm or only a little stressed, it's very unlikely that you'll remember a single one of them when you're actually triggered.

Time for a clumsy sports metaphor: You don't just show up for your first day on a team and play a real game. You practice every day, running drills for possible scenarios you might run into on the field. Let's approach coping the same way! If we put in the time, energy, and repetition ahead of time, it's much more likely that these skills will come up quickly, with less effort, and will work more effectively come game day.

So what are you waiting for? Get up and let's practice!


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