As she works hard and stays committed to the process of resolving her trauma, she feels very proud of herself and receives validating feedback from her therapist, who acknowledges her hard work and progress. She then notices that with the change of seasons, some of the symptoms she tried so hard to minimize or eliminate altogether come creeping back. She notices, as the time of year associated with her trauma approaches, her symptoms worsen still.
She becomes very frustrated. She fears she will experience the same degree of trauma she did immediately after the traumatic event. She wants to just give up. “What’s the point?” she asks herself and her therapist. “I have worked so hard and here I am, going right back to the trauma!”
This case example illustrates a very common occurrence in trauma work. Trauma symptoms may resurface or worsen at certain times of year—it is almost as if the change in seasons is a catalyst that causes a person to feel as though they are regressing. It is easy at these times to dismiss the progress that has been made in therapy and focus, instead, on the reemerging symptoms. Rather than consider this a regression in therapy, I prefer to think of it as an expected occurrence in trauma work that should be normalized and discussed.
Several factors can be at play here. First, as the time of year when the traumatic event occurred comes around again, a very powerful reminder of the trauma often occurs. The brain is triggered and begins remembering. The body also remembers and symptoms reemerge.
Another consideration is that holidays can also trigger trauma memories and symptoms, especially if loss has occurred. The loss of a loved one is one of the most common and difficult traumatic events humans can experience. Even if the loss did not occur around the holidays, holiday times often serve as reminders of loved ones who are deeply missed.
Furthermore, according to the American Psychiatric Association, 80% of people who meet criteria for a diagnosis of posttraumatic stress disorder (PTSD) also meet criteria for other mental health diagnoses. In my experience, one does not have to have an actual diagnosis of PTSD to become more susceptible to other troubling mental health symptoms after a traumatic event. Just experiencing a traumatic event can make someone more likely to experience symptoms related to anxiety, depression, and other challenges.
Certain times of the year can make symptoms worse. For example, with colder weather and less daylight during the winter months, a trauma survivor who also experiences symptoms associated with seasonal affective disorder (SAD) may encounter a worsening of both SAD and trauma symptoms. Similarly, someone prone to anxiety may find symptoms flare up during the holidays, when more cars are out on the road, malls and stores are more crowded, and financial and social pressures are mounting.
Unfortunately, many people are ashamed to talk about reoccurring or worsening symptoms, and this can cause symptoms to escalate even more, impacting well-being and functioning.
Unfortunately, many people are ashamed to talk about reoccurring or worsening symptoms, and this can cause symptoms to escalate even more, impacting well-being and functioning. Beliefs may surface that all the time and hard work one has given in moving forward from a traumatic experience has been wasted. Feelings of frustration and an urge to give up on therapy are very common during these times, as illustrated in the case example.
In addition, a fear of disappointing one’s therapist may come up, preventing some people from openly discussing new or reoccurring symptoms. Making progress in therapy is validating and rewarding, as the case example demonstrated. Returning to therapy when symptoms reoccur can bring up feelings of shame or guilt, causing one to feel as though they will somehow disappoint the therapist or that the reoccurring symptoms will suggest to the therapist they are not working hard enough.
I find this point in trauma work is sometimes the most critical, when clients have a wonderful opportunity to make the most progress toward resolving their trauma for good. This is the time to talk to your therapist to let them know exactly what you are experiencing and how it is making you feel. A good trauma therapist will validate and normalize what you are going through and help you to confront the fear of reoccurring symptoms so that when other triggers come up, it is not so daunting to confront them. This is an opportunity to practice skills with your therapist that will reinforce that you are strong and capable of handling whatever may come up.
Going back to our case example: The therapist validated and normalized what the woman was feeling and experiencing. She reassured the woman that what she felt was very common in trauma work and presented it as an opportunity. The woman stuck with therapy, continuing to talk about her urges to give up on therapy and her feelings of disappointment as they came up. She continued working hard and trusting the therapeutic process.
She was able to overcome her reemerging symptoms. The time of year that served as a trigger passed, and she found that when she thought of that time of year rolling around again, she was not as distressed as she expected. She felt better and more confident as she moved forward. Eventually, she did not need to see her therapist anymore, although she always knew she could return if she felt the need. And when the next trigger appeared, she handled it beautifully, which just reinforced her strength and the belief that she could continue to move forward.
Reference:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
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