SUDC Bereavement Series Topic 5

Almost exactly two years ago my life literally changed overnight when I discovered my beautiful, healthy, thriving two-year-old son, Jackson, unresponsive in his crib just days after his second birthday. Although my role in this excruciating loss has been as a mother first and psychologist second, I experienced the déjà vu of learning first-hand how to facilitate my own recovery. As a clinical psychologist specializing in the treatment of posttraumatic stress disorder (PTSD), I learned to apply what I know, in my heart and in my brain, to surviving my own personal tragedy. Most importantly, when I initially found myself experiencing “PTSD-like” symptoms, such as intrusive memories from “that morning” and strong urges to avoid painful reminders of Jackson’s life and death, I reminded myself of a powerful fact: most people who experience trauma do not go on to develop PTSD.  

What’s the difference between posttrauma reactions and PTSD?  

Posttrauma reactions are normal and expected after traumatic events and include a variety of common symptoms, such as intrusive memories, nightmares, intense negative emotions, avoidance of trauma reminders, sleep difficulties and irritability to name a few. Although these reactions sound a lot like PTSD symptoms, they are not considered “disordered” at first. This is because most trauma survivors will initially experience some of these reactions and find that the intensity of these reactions naturally and gradually diminishes over time. This is not to say that the goal is to “get over” the trauma or “get rid of” one’s grief, but rather to highlight that natural recovery processes do tend to eventually and automatically kick in.   

 This doesn’t mean we will no longer miss our children, cry or experience fear or sadness; it just means most of us will be able to regain functioning in important life domains. The recovery is often gradual and hardly ever linear, but most trauma survivors will find that they are eventually able to continue parenting, working, and taking care of other important relationships and responsibilities. The same way that our skin eventually regenerates over a wound after physical injury, it’s important to remember that we are similarly evolutionarily wired to recover, or learn to live with, emotional losses and traumatic events. Time may not heal all wounds, but time often does help heal.   

However, some trauma survivors will continue to struggle with persistent post-trauma reactions and may eventually develop PTSD. For these individuals, posttrauma symptoms tend to stick around, or possibly even worsen, over time. I like to think of PTSD as a rubber band that has lost its elasticity and has trouble “bouncing back.” Although it’s impossible to bounce back to our old lives, it is possible to find a new path forward and eventually participate in life again. However, living with PTSD can make this very difficult. Individuals with PTSD may feel stressed or afraid in objectively non-dangerous situations (e.g., visiting a playground), may desperately avoid reminders of their trauma, may feel haunted by memories despite trying to push them away and are likely debilitated in some way by their symptoms (e.g., keeping up with responsibilities at work, school, home etc.). Typically, people who do not experience a reduction in PTSD symptoms during the first three to six months are less likely to recover from PTSD on their own without professional help. Individuals are also at higher risk of developing PTSD if they engage in excessive avoidance (e.g., avoiding thinking or talking about the trauma or “self-medicating” with substances), hold extreme negative beliefs about themselves or the world (e.g., “I am a terrible parent”; “The world is completely dangerous”) and lack positive social support. These risk factors are generally thought to make natural recovery a lot more challenging, thereby increasing the likelihood of developing PTSD.   

 What if you or someone you know has debilitating PTSD?  

The good news is that contrary to what many people think, PTSD is a very treatable mental health disorder. Treatment guidelines by the American Psychological Association strongly recommend trauma-focused cognitive-behavioral therapies such as prolonged exposure (PE), and cognitive processing therapy (CPT), because these are the treatments with the strongest evidence base. These treatments focus on the interplay between thoughts, feelings, and behaviors in helping survivors to recover after traumatic events. Although these therapies can feel scary at first, it is important to remember that these treatments are not re-traumatizing; in fact, they can help survivors face their trauma, regain control over their lives and overcome debilitating PTSD symptoms. 

Prolonged exposure (PE) specifically helps trauma survivors to gradually approach trauma-related memories, feelings, and situations they have been avoiding, allowing them to process the trauma and regain functioning in their lives. Cognitive processing therapy (CPT) specifically helps trauma survivors explore “stuck points” (e.g., “it was my fault”) and change upsetting trauma-related thoughts and beliefs that keep them “stuck” in their PTSD. For children and adolescents 3-18 years old, the gold standard treatment is trauma focused cognitive behavioral therapy (TF-CBT) which involves psychoeducation for the whole family and focuses on teaching emotion regulation and cognitive coping skills, as well as processing the trauma memory and learning to approach safe trauma reminders.   

Although the research evidence is strongest for the treatments described above, Eye Movement Desensitization and Reprocessing (EMDR) is another psychotherapy for PTSD that incorporates elements of exposure (described above) with eye movements or other forms of rhythmic, left-right stimulation. There is not strong evidence for the necessity of the eye movement component, but the treatment has been shown to be effective. Medications, particularly antidepressants like SSRIs (selective serotonin reuptake inhibitors), are also effective in reducing PTSD symptoms.  

Bottom line?  

There is nothing wrong or pathological with common posttrauma reactions after the sudden and unexpected loss of a child. SUDC is an unbelievably painful tragedy that can shatter our hearts and destabilize our lives. Grieving, missing our children and suddenly feeling unsteady in a world that no longer feels like it makes sense are all completely normal experiences. Harnessing the power of natural recovery involves seeking out support from friends and family, taking care of our physical and emotional health needs and gently nudging ourselves to continue participating in life, even and especially when we feel the urge to shut it all away.  

PTSD as a mental health disorder comes into play when you find yourself months (or even years) past the trauma and still feeling haunted and debilitated by the trauma of your loss. Maybe you are struggling to function at home or at work, or maybe you are experiencing a significant narrowing of your life due to overwhelming fear and other negative emotions like sadness, anger, guilt or shame. There is an important balance between normalizing common reactions after this kind of devastating loss and not jumping too quickly into believing you need psychiatric treatment – while also not waiting too long to ask for help if you’re struggling.  

It’s worth noting that sometimes people struggle with disorders other than PTSD after traumatic events, such as depression and complicated grief. If you think you or a loved one might have PTSD or another mental health disorder, seek a professional assessment from a trained clinician. Grief counseling may also be a helpful option, even in the absence of a mental health disorder. You can also visit the following websites for more resources.  

PTSD: Posttraumatic Stress Disorder (National Institute of Mental Health) 
Prolonged Exposure: What is Prolonged Exposure? 
Cognitive Processing Therapy: What is Cognitive Processing Therapy? 
Trauma Focused CBT: What is Trauma-Focused Cognitive Behavioral Therapy? 
Find a clinician: ISTSS Clinician Directory 

By Natalia Garcia, Ph.D. (Jackson’s mama)