Welcome to the Mind Campus Online Trauma Resourcing Course

Session 4

Welcome to your fourth OTR session. We’re really glad you’re here and using this resource in your trauma recovery. We would like to encourage you to work through all the sessions, even if you find resistance to some of the assignments. Resistance is one of the effects of trauma and can defeat us in our recovery.

We suggest that you complete a session each week for six weeks. If you can, set aside a two-hour window on the same day each week to do this work. We know that schedules change and life happens. The important thing is not to rush this process and not to stop either! This is your time, your space and your recovery.

So far in OTR your work has primarily focused on your experiences day-to-day. Through the learning and tasks you have completed you have developed some of the fundamental skills for PTSD recovery. This session looks deeply at a skill you have briefly been introduced to, ‘Challenging Questions’. You will be learning how to use this in relation to your index trauma.

This session will cover:

• Reviewing Task 3.4
• Blame, responsibility, and the unforeseeable
• Challanging questions
• ABC Worksheet Daily Task

Reviewing Task 3.4

It is often said that you get from therapy what you put in. This OTR course can be challenging and its effectiveness is dependant on you doing the tasks. You are taking responsibility for your own PTSD recovery, it is an empowering process. You are going to start this session by reviewing your progress with the assignments so far.

Blame, responsibility, and the unforeseeable

Putting traumatic events into their proper context is integral to cognitive processing. The goal is to recognise where your beliefs, thoughts and stuck points do not reflect the facts of the event.  This process can seem counter-intuitive or confusing at first, you may feel frustrated. In Session 3 you were introduced to an example of this counter-intuition:

This stage of OTR is so important that it is worth an in-depth examination of why this is counter-intuitive.  The first belief would be a great thing to truthfully believe, however, for the participant this was not yet the case. She had covered up her true thought (“I think I’m stupid for walking down the alley”) with a secondary thought. For the purposes of OTR it isn’t necessary to understand or examine why this happened, just to recognise that it has happened and the thoughts that were hidden. Indicators of secondary thoughts that you can look for in your worksheets and thinking are:

• Mismatches between A, B, and C (I couldn’t have done anything, so why do I feel stupid?)
• More than one, or a very strong feeling attached to a belief
• Thoughts expressed as feelings
• Feelings expressed as beliefs

When the participant in the example above had an opportunity to talk about her ABC sheet she spoke about how the exercise had deepened her understanding of her response to the situation. “I still feel angry and sometimes frightened, but it feels like these are more or less the right feelings at the right times now. They used to be constant, I worried whenever I was outside. I don’t think I’m stupid anymore, I feel sad that I did for a long time. Now that I have a better understanding of my thought process when I am triggered by an alley or someone walking behind me I don’t immediately go into my trauma response. It’s funny because I used to tell myself “I couldn’t have done anything” but I didn’t believe it. On one level I knew that it was true but I had to find out what was stopping me from believing it. I believed that it was my fault for walking down the alley. I blamed myself for someone else’s actions. Now my anger is directed towards the person who robbed and assaulted me, not myself. It’s similar for my fear, it used to be this massive thing because I guess that one part of me thought I had to be responsible for it happening. Now,  I do choose to be aware of the area I’m in, I don’t place the pressure I used too on myself to predict everything that could possibly happen.”

In most societies, there are distinctions among intention for an act, responsibility, and an accident or the unforeseeable. Legal consequences based on these distinctions can help in clarifying these constructs. For example, if someone was driving very slowly and carefully through a neighbourhood, and a child suddenly bolted out from between parked cars chasing a ball and was hit by the car, this would be considered an accident. Although the driver might be quite traumatized by the event, he or she would not be prosecuted and punished by the law if the police determined that the event was an unavoidable accident. However, if the driver was going too fast, was drunk, and killed the child, he or she might well be prosecuted for vehicular homicide or manslaughter.

In this case, the punishment would be somewhat mitigated by the fact that the driver did not intend to kill the child; he or she had responsibility for the crash but did not have the intention to kill. If someone, in a fit of anger, swerved and hit someone, this driver might be charged with second-degree murder. Or, finally, if someone waited to run over and kill a person with premeditation, this driver might be charged with first-degree murder. In the latter two cases, the behaviour was fueled by intentionality, either in the heat of passion or with premeditation, and blame/fault/guilt would be assigned. Most criminal justice systems make these distinctions, and the related punishments increase accordingly. If a victim of a crime says, “It is my fault for not stopping the crime,” this is an inappropriate use of the term “fault.” The victim did not intend the outcome and probably did not foresee it.

When looking at events you could not predict or did not intend the resulting outcome, you should come to realise that you have somehow provided the occasion for your traumatic events, but that you were not the cause of these events. In other words, you need to understand that you happened to be in the wrong place at the wrong time, and that this may have had a major effect on yourself, but that the event says nothing about you as a person.

In this section, so far, you have learned about unforeseeable events and those that people can appropriately see their own level of responsibility for. As you have seen there is a third category, ‘Fault or Blamewortiness’. You may be wondering how OTR can help when you’re feeling guilty for harm that you intended to cause. To start to understand this you will follow the same process that you have already learned, checking that the ABC make sense. In cases of blameworthiness, there are some key things to look for in your ABC sheets:

• Is the ABC accurate?
• Are you blaming another person or situatuion because it is easier than accepting your own feeling of guilt?
• Do you see yourself as totally defined by the harm you caused? (I am nothing but an evil monster)

There are some cases in which OTR participants used poor judgment, had some level of responsibility, committed some intentional act, or did not act when they could have. PTSD can result, even when someone actually intended harm at the time of the traumatic event. Prisons are full of people with PTSD from a lifetime of victimization who then committed criminal acts. Sometimes in gang territory, the rule is “Join the gang and commit crimes and kill, or be killed.” Or military personnel may commit acts or not prevent something from happening that they later regret when they come home and have time to reflect on their actions or inactions. It is important to remember and convey to such clients that if they had no consciences, they would not have guilt or shame over these acts, and therefore would not be haunted by their traumatic events.

If you are here for treatment for PTSD and have committed some act against another person (or did not act when you could have) then it is a good sign that you do have a conscience. If you indeed are the cause of intended harm against someone else, guilt is the appropriate response, and you should not try to take that away. You  may have to accept what you did and consider whether any type of restitution is possible, for the victim(s) or for the community in general.

• Could you volunteer at a shelter for homeless people or
  otherwise give back to the community in some way?
• Would it be possible to make a financial restitution?

Typically, in these cases of PTSD, we are talking about events that occurred in the past for which you feel guilt and remorse. You may have sentenced yourself more harshly than a jury would. If this is the case, then the task is to “right-size” the Stuck Points (e.g., “I am nothing but an evil monster”), and put the event into the context in which it occurred and then into the larger context of your life. The following may help you realise the context of your actions:

• When did you start to act this way?
• When did you stop acting this way?
• If a similar situation occurred now, how would you act?
• When did you learn to act this way?
• How did this affect the decision you made to act?
• Who are you now?
• How would it feel to replace “I am evil” with “I am a good person who did the wrong thing”?

Challanging Stuck Points

In this section, you are going to identify a stuck point and learn how to challenge the way you think about it. Through the course, you have been creating a list of stuck points, given that you have learned a lot since beginning OTR some may no longer be relevant. In task 4.3 you will choose one stuck point to focus on. When you come to choose a stuck point, look for one that you can now see is problematic from what you learned in the section above.  Below is the list of questions you will answer and some guidance for each.

Belief: Put a Stuck Point here. You can use your Stuck Point Log to find one.
The belief should not be a feeling or behavior, and should not be too vague. Use “If–then” statements if possible.

1. What is the evidence for and against this Stuck Point?
Evidence consists of the type of facts that will hold up in court. We are not challenging that the event happened. We are looking for evidence that supports and does not support the Stuck Point you have given above.

For: Do not use another Stuck Point! Make sure you are identifying facts.

Against: Only one exception is needed to make a belief not a fact. A fact is 100% and absolute. If you can identify one exception to your Stuck Point, then it is not a fact, and therefore would not hold up in court.

2. Is your Stuck Point a habit or based on facts?
Have you been telling yourself this belief for so long that it feels like a fact? It’s like advertising: After a while, you start to believe it. Is this belief something that you have been in the habit of telling yourself for a long time?

3. In what ways is your Stuck Point not including all of the information?
Is it possible that your Stuck Point is unrealistic or not completely accurate or not completely true? Does your belief reflect all the facts of the situation? Remember the context of the trauma.

4. Does your Stuck Point include all-or-none terms?
Does your Stuck Point reflect all-or-none, black-and-white categories? Are things all good or all bad? Are you missing the gray areas in between? Example: If your performance falls short of perfect, you see yourself as a failure.

5. Does the Stuck Point include words or phrases that are extreme or exaggerated (such as “always,” “forever,” “never,” “need,” “should,” “must,” “can’t,” and “every time”)?
These words or phrases may be hidden. Example: “Men can’t be trusted” is actually “All men can’t be trusted.”

6. In what way is your Stuck Point focused on just one piece of the story?
This question is about deciding that one piece of information from the event caused the event to happen. Then, you use this one aspect to create your Stuck Point. Example: “If I had been stronger, then this wouldn’t have happened.” Now think about drawing a pie chart and showing one small slice of that pie as the one aspect you are focusing on. You are probably assigning 100% of the “blame” or “cause” to this “slice” and discounting all the remaining factors (other slices) in the rest of the pie. Other slices might include that you were outnumbered, the perpetrator had a weapon, you were taken by surprise, there were no other options at the time, or similar factors. Why are these other factors/slices not considered here as contributory? Are you discounting them and only focusing on the one factor/slice?

7. Where did this Stuck Point come from? Is this a dependable source of information on this Stuck Point?
Think about the time period when the event happened. Who were you at the time (a scared 20-year old in combat, a child victimized by an adult, etc.)? Your Stuck Point may be based on a thought that you developed when you were scared or very young. You have retained that Stuck Point all these years, based on how you thought at the time. Or think about the enemy/perpetrator/other sources: Are these people reliable? Can they be trusted to make judgments about the event (or you)? Your Stuck Point might be a statement told to you by a perpetrator. Is a perpetrator to be trusted (reliable) to make this statement? Would we expect that a perpetrator is truthful? Consider your source.

8. How is your Stuck Point confusing something that is possible with something that is likely?
This question is best for a Stuck Point that is focused on the present or the future. It asks you, “What is the likelihood or percentage/chance that the Stuck Point will happen again?” An example of a present or future-oriented Stuck Point would be “If I trust others, then I’ll get hurt.” It may actually be a low probability, but you are living your life as if it is a certainty. Yes, it could happen, but are you living as if it will happen? Of course, in a dangerous environment, you may have to consider everything as a high probability, because the consequences (death or injury) are great. But are you taking into consideration that you don’t need to hold this same degree of probability in all environments? In other words, are you applying the Stuck Point as if it has a high probability (a certainty) of happening again in all situations now? For example, think about driving. We all know that many people die every year in car accidents, yet we still drive. We do this because although we are aware that we could die in a car accident, we don’t live as if it will happen.

9. In what ways is your Stuck Point based on feelings rather than facts?
This question represents the idea that if you feel something is true, then it must be. For example, think about hypervigilance: Because you feel uncomfortable or under threat in a crowd, you assume (or develop the belief) that it is dangerous. This becomes “I don’t like crowds,” which translates into the Stuck Point “I am never safe in a crowd,” or “If I am in a crowd, then I will be harmed.” Another example is that if you feel guilty, then you assume you must be at fault.

10. In what ways is this Stuck Point focused on unrelated parts of the story?
This question is about focusing the cause or blame on something that had nothing to do with the event’s happening. For example, “I wore a red dress; therefore, I was assaulted.” This is different from question 6 because it is about something that was irrelevant, whereas in question 6 the factor may have contributed to the event but is not wholly to blame. However, even in question 6, the piece may be incorrect rather than factual.

Review of Session 4

Well done for completing OTR Session 4! 

Today you have:

• Reviewed your completed ABC Worksheets.
• Filled out your Stuck Point Log.
• Learned about blame, responsibility and the unforeseeable.
• Been introduced to the Challenging Stuck Points Worksheet.

Between now and your next session do your best to complete one Challenging Stuck Points Worksheet every day.

You have done a lot of work today so take a break and ground yourself now.