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Section 10
Intrusions and PTSD

Question 10 | Test | Table of Contents

Protective denial guards your client from its opposite- intru­sions. Intrusions take the form of...
• Flashbacks. • Recurring memories of the trauma. • Overwhelming feelings of Terror, Extreme Anxiety, Helplessness, or Rage. • Confusions. • Unwanted and frightening dreams. • Unexpected and painful bodily sensations.

Intrusions As Flashbacks
Flashbacks are sudden, vivid images of the trauma that seem to come from nowhere. Flashbacks make it seem like the event is happening now. That is, during a flashback, there is no distinction between the trauma being remembered and the present. Flashbacks even include the attendant physical reactions, such as sweating, increased heart rate, and hair standing on end.

Remind your client that flashbacks are a normal reaction to what has happened to them, but flashbacks are also frightening because there is a fear they might, in a sense, become caught in them. Encourage them to remember that flashbacks pass. If your client is having flashbacks, it may be helpful to know that they do end, just as the traumatic event ended. Your client will not stay in the flashbacks for long. If flashbacks persist over time, advise him or her to seek help from a trauma counselor. There are techniques available to help control flashbacks. Take advantage of professional help.

Memories of the trauma are different from flashbacks. Sometimes memories are not accompanied by feelings. They are isolated from the feelings, not unlike watching a silent slide show. However, like flashbacks, intrusive memories can be ac­companied by all of the unpleasant feelings of the event. But the client is are aware that it is a memory. Because your client is involuntarily recalling the event, it is an intrusion. The involuntary nature of the memory makes it unpleasant at best.

Actress Kelly McGillis commented during our interview about the way a memory can just over­whelm someone: "I haven’t thought about [the rape] in a while. It was a whole lifetime ago. ft’s funny though, 1 will tell you something that’s very strange. I’m doing this play years later, and [the main character] threatens my character and one night, in the mid­dle of the performance, it struck some kind of visceral memory where I just started crying; I couldn’t stop. For the first time in my life I re­alized that any traumatic experience we go through is somehow kept and stored, and for some reason that one time or one word triggers a whole chain of emotional responses not felt for years. Right when it happened, I knew what was happening. It was like being on an out-of-control train. You can’t stop it."

Intrusions As Overwhelming Feelings
Intrusions can be experienced as • Terror. • Extreme anxiety. • Helplessness. • Rage. • Intense sadness and grief.

These and other feelings may accompany a memory of the event, or they may be experienced, but remain isolated from the memory. In this circumstance, it may seem they come out of no­where. With some scrutiny, your client will probably discover that something triggered them. That something will always be connected to the trauma. It may be something obvious or something remote, but it will always be linked. For example, if your client was assaulted by someone, the feelings might be triggered by seeing someone who looked similar to the person who hurt you.

Knowing the feelings are linked makes them more man­ageable. In recognizing the link, your client can let him or herself know that the intrusion was triggered by something tied to the past and had nothing to do with the present. This way he or she can begin to differentiate past from present, which begins to make the present safe.

Intrusions As Confusions
Intrusions can be experienced as confusions.
• Sometimes intrusions confuse your client because they sud­denly feel they are in the moment when it happened.
• Sometimes they confuse your client because they create strong feelings and they don’t know why.

Intrusions as confusions are disorienting. Your client may suddenly feel s/he does not know where s/he is and that s/he does not know what period of time s/he is in. This can be alarming because it makes your client feel as if s/he is not in charge of him or herself.

Once again, confusions are to be expected and are not unusual. It is one of the ways your client’s unconscious is attempt­ing to deal with what happened.

Intrusions As Dreams
Intrusions can be unwanted and frightening dreams. Just as flashbacks, memories, overwhelming feelings, and confusions can occur during waking hours, they can also occur in dreams.

Shawnee had terrifying nightmares where she was chased by "guys with guns" They were nightmares that intruded violently into her sleep, as the two men had intruded violently into her life.

Dream images often are just as vivid and repetitive as day­time flashbacks and memories, and they usually include intense feelings. If these types of dreams are occurring, your client may also be experiencing: • An inability to fall asleep. • Sleep deprivation. • Fear of sleeping. • Night terrors. • Night sweats.

If they persist and are too disruptive, your client may need to get help to deal with their effects, via counseling or medication.

Shawnee realized she had to do something about the nightmares that were leaving her drained and exhausted She went for help and they soon ended.

The Upside Of Intrusions
It may be hard to believe there is an upside to intrusions, but there is. As with most aspects of how our psyche operates, there is more than one side to the story. Intrusions are attempts to confront the trauma. Our minds cannot forget what has not been remembered. In order to really resolve something and make it part of our life experience, it needs to become part of our life story.

Explain to your client that traumatic experience, until it becomes a part of us, has the potential to be reexperienced in its original form— that is, as a trauma. However, when it becomes a part of your client, it is a puzzle piece that fits into and together with the rest of your client. Each time there is an intrusion, there is an opportunity to deal with the trauma and make it a piece of the puzzle that is part of your client. The intrusion can become an opportunity for your client to think about the trauma in order to understand it and its meaning; to put it into perspective; and to further resolve it.

The goal in this process is to no longer have the trauma be a puzzle piece that is floating off by itself, out of your control. Each intrusion is a chance to capture that piece and make it yours.

- Hybels-Steer PhD, Mariann; Aftermath: Survive and Overcome Trauma; Simon & Schuster: New York; 1995. (Edited)

Personal Reflection Exercise #8
The preceding section contained information about intrusions in PTSD.  Write three case study examples regarding how you might use the content of this section in your practice.

Update
The association between childhood maltreatment and
suicidal intrusions: A cross-sectional study

- van Bentum, J. S., Sijbrandij, M., Saueressig, F., & Huibers, M. J. H. (2022). The association between childhood maltreatment and suicidal intrusions: A cross-sectional study. Journal of traumatic stress, 35(4), 1273–1281. https://doi.org/10.1002/jts.22821

Peer-Reviewed Journal Article References:
Contractor, A. A., Weiss, N. H., Dolan, M., & Mota, N. (2020). Examination of the structural relations between posttraumatic stress disorder symptoms and reckless/self-destructive behaviors. International Journal of Stress Management, 27(1), 35–44. 

DeCou, C. R., Mahoney, C. T., Kaplan, S. P., & Lynch, S. M. (2019). Coping self-efficacy and trauma-related shame mediate the association between negative social reactions to sexual assault and PTSD symptoms. Psychological Trauma: Theory, Research, Practice, and Policy, 11(1), 51–54.

Khayyat-Abuaita, U., Paivio, S., Pascual-Leone, A., & Harrington, S. (2019). Emotional processing of trauma narratives is a predictor of outcome in emotion-focused therapy for complex trauma. Psychotherapy, 56(4), 526–536. 

QUESTION 10
What does Hybels-Steer consider to be an upside of intrusions? Record the letter of the correct answer the Test.