Self help for PTSD symptoms and Birth Trauma

So far in this series of articles, we have seen how a traumatic birth event can lead to the development of post-natal PTSD symptoms, how our body responds during times of threat and the mental and behavioural responses that keep post-natal PTSD symptoms going.

This article is all about helping you to develop self-help techniques for dealing with symptoms of Post-Natal PTSD related to birth trauma.  Here we will cover the skills needed to de-activate some of the troubling symptoms of PTSD, so that you can begin to get your life back after the birth trauma event.

Man feeling freedom on an open sea
Click on the buttons below to access other post-natal PTSD sections

These interventions will usually be covered in any treatment for Cognitive Behavioural therapy for PTSD or EMDR for PTSD.  I also want to be clear that these techniques are just one aspect of Trauma Focused CBT and EMDR and it is always advisable that you access treatment from a suitably qualified CBT or EMDR therapist when experiencing PTSD symptoms.

I’ve included links to my own audio recordings of each of these interventions so that you can download them and practice them at your leisure.

Diaphgragmatic Breathing

Learning how to manage our breathing when feeling anxious is an effective way of preventing ourselves from becoming overwhelmed and feeling out of control.

It all comes down to controlling the balance of oxygen and carbon dioxide within the body.  As we have seen previously, during a threatening situation, i.e., a traumatic birth event, the fight or flight response will kick in, meaning that the body will automatically speed up our breathing rate.  Our breathe will also become more shallow, coming from the chest, rather than from the chest and belly.

It does this to increase the amount of oxygen throughout the body and brain, for use in our fighting the threat or escaping from it.  This is great for when we need it, for when the threat is actually there, present in front of us.

However, as we saw in the section on “what keeps PTSD going”, in PTSD, the fight or flight response is being activated in response to the unprocessed memory of the trauma event, and to things in our environment which remind us of the trauma event, meaning that fight or flight is being activated when the real threat is not actually present.

So, by training ourselves to deliberately modify how we breathe, we are able to modify and control the degree to which the fight or flight response becomes active, giving us greater ability to tolerate memories of the traumatic birth event and related triggers in our environment.

There is generally always a balance between levels of Oxygen and Carbon Dioxide in our bodies.  When we become anxious the body takes in extra oxygen to provide fuel to our muscles and brain.  Oxygen has an arousal type effect on our bodies, whereas carbon dioxide has the opposite effect in that it defuses the physiological arousal state and makes us feel more relaxed.

Here is the Diaphragmatic breathing exercise:

  • Put one hand up on your chest and one hand down on the top of the belly, or diaphragm.
  • Now, breathing normally, just look down and notice how you are breathing at the moment.  Most people notice that they can see the hand on the chest moving up and down to a slightly more noticeable way than the hand on the belly.  Now, we’re going to practice seeing if it’s possible to breathe with just the belly/diaphragm area.
  • Take a normal breath and then gently breathe out.
  • When the air has passed from the body count to 4 and then slowly take another breath.
  • Repeat this process for another 10 to 15 times.  Try to ensure that the air is passing all the way down into the abdomen area.  You will know this is the case if the hand on your chest is staying relatively still, whilst your belly is raising more significantly.
  • After you have practised this, take a moment to see how you feel.  Notice any feelings of relaxation that you now have, and compare them to how your felt before.
  • Try to repeat this exercise at least 2 x daily.
  • In addition to experiencing the rewards of the actual practice time, you will have trained yourself to breathe this way when you are going about the rest of your day.

Progressive Muscle relaxation

Man in bicep tensing pose

Progressive muscle relaxation (PMR), which is also sometimes called Deep Muscle relaxation, is a useful technique to enable us to notice and ease from any muscular tension that we feel while on edge or anxious.

This technique works through all of the muscle groups in the body, progressively inviting us to tense them for a short period and then relax them for slightly longer.  This process of tensing and relaxing our muscles can be a really effective way of teaching us how to notice and deal with muscular tension on a day to day basis.

To do progressive muscle relaxation, first find a place to relax were you won’t be disturbed for about 10 minutes.  You might want to lie down for the exercise or, if this is not possible, then sitting down will do fine.

Firstly, we’re going to start the exercise by tensing the muscle groups in the toes.

To do this just tense the muscles around the joints of the toes by curling up the toes (it’s possible to do this with shoes both off or on).

Tense these muscles as much as you can for around 10 seconds, and then just ease off, relaxing the muscles and noticing the difference between tension and relaxation.  Really pay attention to those relaxed feelings.  Notice this relaxed state for around 30 seconds before you move onto the next muscle group.

Work your way up the body tensing for 10 seconds and then relaxing for 30.  Progress through the body as follows:

  • Front of the legs – Stretch your legs outwards pointing your toes away from you.
  • Back of the legs – Stretch out both legs and point your toes up towards the sky.
  • Buttocks – Just tense them as tightly as you can.
  • Stomach – Tense together the stomach muscles.
  • Chest – Tighten chest muscles by putting both arms behind you and pushing out chest.
  • Hands – Make fists with your hands as tightly as you can.
  • Upper arms – Tighten up the bicep muscles.
  • Shoulders – Lift up both shoulders up to your head and hold.
  • Face – Crunch up the forehead and eyebrows.

It may feel a little uncomfortable as you first start to practice this routine, but stick with it – over time you will another skillset to enable you to cope with the physical tension that comes with anxiety.

Sensory grounding technique

This next technique is what we call a “Grounding Technique”.

What we mean by this is that it enables us to ground ourselves, placing us in the present moment in touch with the ground in the here and now.

As we have discussed before on the site, Flashbacks and intrusive memories of a trauma event can have the effect of us feeling as though we are back at the time of the trauma event, reliving it in the present.

Regular practice with using grounding techniques can help us to disrupt the flashback memory and give us the resource to cope.

I sometimes also teach this particular exercise to people who are struggling with worry and rumination because it enables us to detach from whatever is going on “in our heads” and refocus upon the present moment and whatever can be experienced with our senses.

So this is how this grounding technique works.  We are going to train ourselves to use our senses to bring ourselves into the present moment.  I am at first going to ask you to begin to notice five things that you can see.  At this point, I’d like you to look around the room and simply tell me 5 things that you can see around you.  There’s no right or wrong answer with this, just notice what you notice.

Next I’ll ask you to tell me 5 things that you can hear.  Again, there is no right or wrong with this, I don’t expect you to hear any sounds in particular, just notice what there is.  This could be the sound of a ticking clock, a car driving past outside or the sound of a heating system.  Whatever you hear isn’t important, just allow yourself to use your senses to notice what is there in the here and now.

Thirdly, try to notice 5 things that you can feel.  It’s important here to find things that are external to you – for instance, you might be able to feel the chair that you’re sitting on, a breeze on the back of your neck or the feel of the floor.  Your brain is filtering out this stuff all of the time, so by just taking a bit of time to notice these sensations, you will be grounding yourself.  Please try not to focus on Internal sensations – “I feel my heart pounding”, “I feel angry” – just notice the things that are available to your senses from around you.

Once you have done this – 5 things that you can see, 5 things that you can hear and 5 things that you can feel – move onto 4 things that you can see, 4 things that you can hear and 4 things that you can feel.  Repeat this with 3 things, 2 things and 1 thing.

When you have finished, take a minute to see how you feel after having completed the exercise – do you feel calmer, or less fearful?  Are there things around you that you hadn’t noticed before?  Are you able to move on with the rest of your day?

Practice doing this grounding exercise a couple of times each day so that you can get the hang of it when you’re out and about.

Safe place

The safe Place exercise is an exercise in using imagination to bring about a change in emotion.

Have you ever noticed what happens in your body when you are worried about something, even when the worry is about something in the future?  You will probably notice that your muscles become tense, your heart rate will increase or you might get a little restless.

Think about this – you are thinking about a future concern and yet your body is feeling anxious now.

Now consider the opposite.  What happens when you think about a pleasurable event that you have experienced or are looking forward to – for instance a family holiday or a celebration?

What happens now?  You might notice feelings of excitement in your gut or a slight smile might creep onto your face, with a subtle emotion of happiness.

Have you ever considered why or how we can feel emotions (anxiety, sadness, happiness) just by thinking about something, even when the thing we are thinking about is in the past or the future?

This happens becasue the parts of our brain that are most involved in dealing with our emotional states, the Amygdala and the Hippocampus, can become active in response to us thinking about something, as well as us experiencing it directly.  These parts of the brain are not very good at being able to tell what is happening on the outside world, and what is happening in our minds.  As such, many people can experience mental health related distress due to the brain focusing upon the inner world.

But we can use this to our advantage.

We can train our brain to use the imaginal world to create feelings of calm, safety and relaxation.  We can tease the hippocampus and amygdala to generate these positive feelings, whenever we choose to do so, and as such give ourselves another coping strategy resource to deal with anxiety as it arises.  Imagery is fantastically powerful in its ability to ease our mood.

Here’s how to do the Safe Place exercise:

  • Find a place where you won’t be disturbed for a while, maybe just around 10 minutes.  Get yourself comfortable.
  • Close your eyes.  Bring your attention to the sensation of the breath.  Notice the in breath, as it comes in through the mouth or nostrils, and just allow your attention to gently follow it all the way down to the belly or lungs and then watch it go out again out again.  Do this for a minute or so.
  • Next, allow your mind to drift to a place that you associate with warm feelings of happiness or safety.  If you struggle at first, just ask yourself the question, “if I could feel safe, where would I need to be?”  and watch what comes up.
  • You might think of a holiday you have been on, a place you go to now to unwind, or it could be a place you’ve fantasised about going to – a desert island or in the middle of a deserted forest.  Whatever you associate most with positive feelings of safety, peace and calm is what to go with.
  • When you have identified the safe place, just notice all of the different things that you can see – it could be the sky, the ocean, the trees.  Just notice these and notice how this makes you feel in your body.  Notice where you feel it.
  • Now, notice what sounds you can feel in this safe place.  Can you hear the sea, the birds in the sky or the trees rustling in the wind?  Just take a minute to really notice these sounds in your imagined safe place.  Again, notice how this makes you feel.
  • Now notice if there are any smells that go with this safe place.  Can you smell the salty air of the sea or the mossy earth beneath your feet?  Can you smell the food from the barbeque or the tequila in your glass?
  • And next we’re going to notice what kinds of tastes are associated with this safe place.  Just notice any tastes that you can – the taste of the salt on the air from the sea or from the ice cream that you’re enjoying if the beach is your safe place.  Notice how this makes you feel in your body and where you feel it.
  • Lastly, just notice if there are any feelings that go with this safe place.  If you have happy or relaxed feelings, then just notice where exactly they are in your body.  Notice what they feel like – are they warm or cool, large or small?
  • Just sit with all of these aspects of the safe place for a few minutes.  The sights and the sounds, the smells and the tastes.  Noticing all of these things together, keep noticing what you feel in your body.

If you find this technique helpful then why not try setting aside a little time each day to practice the technique, knowing that you can have these same relaxed, safe happy feelings whenever you feel you need them.

Conclusion

We have covered 4 simple self-help strategies for PTSD and Post-Natal Trauma – Diaphragmatic Breathing, Progressive Muscle Relaxation, Sensory Grounding Technique and the Safe place guided imagery.  If you find any of the above techniques helpful then practice them whenever you get the chance until you can use them automatically, as an additional resource to help you with symptoms when they arise.

George Maxwell CBT Therapist

George Maxwell is an Accredited Cognitive Behavioural Therapist and director of Access CBT UK.

He specialises in the treatment of Male post-natal depression but also has extensive skills in working with PTSD, Anxiety disorders, OCD and Panic. If you would like to arrange individual therapy with him (either face to face or via Skype), or would like to receive information and updates relating to New Dad Depression then feel free to contact him at enquiries@accesscbt.co.uk or follow on twitter @newdad_depressn