internal communication

An In-Depth Conversation with Elizabeth Vermilyea

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   If you've worked in the field of trauma and dissociation for any amount of time, the name Elizabeth Vermilyea will likely be very familiar to you. For survivors new to their healing, you may not know her by name, but you've most certainly been using her tools and symptom management skills! In part due to her own humility and unassuming disposition, it's quite possible to be unaware of the impact of Elizabeth's work, despite having benefitted from it for years and years. If learning the detailed process of containment, modulation, healing pool/healing light imagery, or the more welcoming takes on internal communication, sounds familiar to you -- you have her to thank for that!

   Elizabeth's workbook, "Growing Beyond Survival: A Self-Help Toolkit for Managing Traumatic Stress" truly revolutionized the way that trauma survivors could not only learn about their conditions, but explore a variety of tools to alleviate their suffering at the same time. An unintimidating and easy to understand look at complex trauma, it allowed survivors to really work at their own pace. Clinicians were also given a new language with which to explain coping skills to their clients, and most importantly, a chance to work on them together.  Elizabeth's message of educating with compassion and warmth, and always including survivors in the process, has remained steadfast throughout the years and is a lasting legacy on the community. Through her continued work in the field, she keeps the momentum of trauma education and care headed in the right direction -- always focused but empathic.

    It is our absolute honor and privilege to bring to you an in-depth interview with someone we admire and value so deeply. You'll get a chance to learn more about Elizabeth's personal journey, her experience weeding through the at-times tepid and contentious world of trauma, and also explore the past, present and future of trauma care! We sincerely hope you enjoy!


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Let’s start with some background for those who are being introduced to you for the first time.

・Where are you from/currently residing? Where did you attend school and what did you earn your degree in?
How long have you been practicing and in what capacity do you currently work with trauma survivors?

     I was born in Raleigh, NC, and I currently live in Napa, CA. I don’t like to focus on schools and degrees because I don’t think they tell us anything about who someone is. Suffice it to say, I’ve spent a great deal of time on my education, but I really learned the most from the people I’ve worked with over the years both as clients and colleagues. Currently I do not treat survivors, but I do train and consult with professionals and survivors alike. My consultation with survivors focuses on managing traumatic stress symptoms.

 

・What made you interested in pursuing trauma disorders? Did you always know you wanted to focus here, or was it something that found you?

     I like to say that I tripped and fell into this work, and then fell in love with it. I had intended to become an experimental psychologist. My first job out of college was at the Masters & Johnson Sexual Trauma program at River Oaks in Louisiana, and I got that job after sending out resumes everywhere I could. They were the ones who called back! It didn’t take long for me to realize that I wanted to make a career in the trauma field.

 

・When did you come to understand the full impact of complex childhood trauma vs. trauma as an adult? What was your introduction to dissociative disorders like?

     My work at River Oaks was my introduction to all of this. I remember going home one night in tears after having heard some horrific stories of abuse at the hands of a man’s parents. I found my mom and said, “Thank you for not abusing your power over me.” I realized how much that relationship means, how it can be twisted, how it can torment a child. Most of the clients in that program were diagnosed with a dissociative disorder, so I learned a great deal there. The program took a relational approach to the work, and I appreciated that. It wasn’t so hierarchical or tied to the strict medical model.

 

You began your work in this field over 25 years ago — a time where dissociative disorders were even more heavily stigmatized, disbelieved and could even be used to question the integrity of the very clinicians who supported their existence.

・What would you say the climate was like when you were first starting out? Did you face any particular challenges — clinically, interpersonally or even within yourself? 

     I started this work at the beginnings of what would become known as the recovered memory debate era, but I didn’t encounter much of that controversy until I moved to Baltimore and began working at Sheppard Pratt in their Trauma Disorders Program. Across town was Johns Hopkins and Paul McHugh who staunchly denied that recovered memories could be valid and that dissociation was real. The climate among those of us at Sheppard Pratt was one of dedication to the cause and to believing people. When I was starting out, the challenges I faced were related to understanding that horrible things are done to people, but that doesn’t mean the world is horrible. Holding those truths together is an important part of the work for all of us. More challenges came later when I began to chafe against the medical model and hierarchy in the treatment arena, and especially the “once a patient always a patient” mentality.

 

・When did you decide you wanted to write a book? And not just an informational or educational book but specifically a workbook for survivors?

     For several years I ran a PTSD Symptom Management group at Sheppard Pratt. I used to create worksheets because there weren’t any around that met the needs of the clients and my needs as a helper. Over time, I had a rather large portfolio of these worksheets. My colleagues and the clients started telling me I should write a book. So I began.

 

・Were there any unique obstacles to getting it published? Did you ever have any reluctance or hesitation, particularly given the atmosphere back then?

     Getting the book published was an incredibly serendipitous series of events. I was meeting with Esther Giller, the President and CEO of Sidran Institute, a publication company specializing in traumatic stress education and advocacy. Let me see if I can remember it the right way. She was looking for someone to come on board as a trainer for a Federal Grant project she was involved in. At the same time, she was looking for someone to produce a self-help symptom management book for a project being underwritten by the States of Maine and New York who were embarking on a massive training effort in their public mental health systems. This is a long story, but a good one.
     Survivors in the State of Maine had sued the state saying not only was the mental health treatment they received not helpful, but worse, it was hurtful. So the State handed down a consent decree that all state mental health personnel be trained in what is now called Trauma-Informed Care. This was the beginning! Esther had located professionals to create the material for training personnel (the good folks at TSI CAAP – Karen Saakvitne, Laurie Ann Pearlman, Beth Tabor-Lev, and Sarah Gamble – who wrote the Risking Connection Curriculum), and they also wanted material for the clients. That’s where I came in. I left Sheppard Pratt to take the training job at Sidran, and Sidran published the book, which was then distributed to survivors in the Maine and New York public health systems for free. I’m really proud of that.

 

Your workbook, whether you know it or not, truly revolutionized trauma care on the patient level. Worksheets were printed out on trauma units, weekly inpatient groups were held to teach your skills, your techniques and scripts became the go-to standard for coping with specific symptoms, and survivors in countries across the globe use your tools by name (sometimes not even knowing where they came from or having read your book)!

・Did you ever anticipate that your work would have such a profound impact or global reach, let alone become the foundational launchpad for which survivors worldwide would begin their trauma healing? 

     I am humbled beyond words by what you’re saying. I can tell you when I did the second edition I felt really good that there was still an interest in the book and that it was still useful thirteen years after the original publication. It’s mind boggling to think it has the impact you describe. I guess I have to take your word for it! I really felt I had arrived on the day a friend told me her book had been stolen! I replaced it for her, but for someone to steal it… it must be valuable!

 

・What has it meant to you seeing your work, and not just your book but your advocacy and education in all forms, fill such a massive void in the trauma community?

How does it feel knowing most has stood the test of time?

     Like most people dedicated to this work, I feel good about being able to educate, support, help, advocate, and hopefully change for the better the process of healing for trauma survivors. I know that every professional I am able to help will spread that exponentially outward, and that’s why I do it. I think it has stood the test of time because the material I focus on is universal and not subject to treatment trends. I want to offer something that can help everyone every time.

 

・What would you say is the biggest change you’ve noticed in the field of trauma since beginning your studies (ex. education, the approach to care, general attitudes toward trauma/dissociative disorders, etc)?

     The biggest change I’ve seen is the mainstreaming of trauma-informed care. There used to be a handful of treatment centers providing good treatment, and now, thanks to the Adverse Childhood Experiences (A.C.E.) study, there’s a deeper understanding of trauma as a public health issue. Even Oprah has got on board recently! I’ll be working with the Oregon Commission for the Blind next month because they want to better serve traumatized persons in their vocational rehabilitation programs. That’s huge! If you Google “Trauma Certificate Programs” you can find them all over the country. That’s amazing!

 

・What areas do you feel still need significant improvement? Is there anything you feel is almost missing entirely? What changes would you like to see be made in those areas?

     We need to improve the awareness, understanding, and addressing of the intersections of trauma with addiction and the criminal justice system. These intersections are at the heart of recidivism in both arenas. We have to keep showing agencies and organizations what’s in it for them and how trauma-informed practice can support and enhance their existing work. Essentially, we have to sell it.

 

・Do you have any colleagues or mentors that you really look up to or admire?

     Oh gosh, too many to name. I can tell you one person who had tremendous influence on me professionally. Her name was Andrea Karfgin, and she was a psychologist. She died several years ago, but she lives on in me. She taught me how to think about this work, how to understand really important dynamics in the work, and she guided me through tough lessons as a professional. I hesitate to mention other names for fear I’d forget someone. I worked with a number of survivors who were brave and trusting enough to let me into their inner worlds and allow me to walk with them into the wider world with more confidence, faith in themselves, and stronger boundaries toward life beyond survival. I’ve had many colleagues who were instrumental in shaping my professional development. I’ve had the privilege to work with some of the most respected people in the field and to have worked with the amazingly skillful lesser-known warriors for survivors. What I love is that I keep meeting people in the field who continue to inspire me and who keep me on track. I am so grateful that I get to do this work.

 

・What keeps you going after sitting face-to-face with some of the darkest, heaviest tragedies this world has had to know? What keeps you focused, rejuvenated or inspired?

     In the beginning I wrote a lot of songs to process what I was seeing, feeling, and understanding. I would play music for the clients in the evenings, sometimes songs about them and their struggles and strengths. That helped a lot. I keep a guitar in my office in case any of my staff need to sing the blues. Laughter is important and has always been a way for me to rejuvenate. We have to be able to laugh in the midst of awareness of such pain. I’m fortunate that people put up with my goofy humor. What helps most though is that with every workshop I do, I encounter people who believe, who want to help, and who are eager to learn how to be more effective in the work. It gives me such hope!

 

・·Do you have any advice to new, or even veteran, clinicians who are seeking to work with trauma patients?

     Do your own work. Get a good clinical supervisor. Make friends with countertransference. It will help you through so many confusing moments, and being able to notice it, understand it and use it to strengthen the relationship will be helpful and a huge protection when facing ethical dilemmas. Cultivate a good support system. Pay attention to and address signs of vicarious trauma, compassion fatigue and secondary traumatic stress. TAKE VACATIONS!

 

・What is the biggest thing you’ve learned from your patients, or other survivors, over the years? What have they taught you that books could not?

     I’ve learned that I can never give up on a person, never write them off, because people are more resilient that we imagine, and we never know when the moment of hope will come - the moment of immersive transformation that gives someone a reason and the will to continue. I’ve learned to trust people’s judgment about themselves. I’ve learned to be kinder. 

 

・If there was one thing you wish the world could understand about trauma survivors, or the clinicians that help them, what would it be?

   There is no “them.” There is only us.


 

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     Thank you, Elizabeth for your sincerity, your thoughtfulness, and your humble dedication to survivors everywhere.

    You can find more information about Elizabeth here on her website. You can also order the "Growing Beyond Survival" workbook here (or here). [Note: While the blue cover edition is still available on Amazon, the Second Edition (green cover) is the most up-to-date and has the most current perspective on trauma, so we of course recommend that one. The first is also no longer in print, but Amazon has held onto some copies.]  We cannot recommend this workbook highly enough. It has been the first recommendation on our Resource page, since the day it was made, for a reason!
 

 

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MORE POSTS YOU MAY FIND HELPFUL:

    Grounding 101: 101 Grounding Techniques
    Flashbacks 101: 4 Tools to Cope with Flashbacks
    Nighttime 101 and Nighttime 201Sleep Strategies for Complex PTSD
    Imagery 101Healing Pool and Healing Light
    DID MythsDispelling Common Misconceptions about Dissociative Identity Disorder
    Did You Know?: 8 Things We Should All Know about C-PTSD and DID
    Trauma and Attachment: 3-Part Series on Attachment Theory with Jade Miller

 

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4 Tools to Cope with Flashbacks

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    There is no delicate way to put it: flashbacks are just awful. Whether you've just started experiencing these upsetting and intrusive symptoms, or you've been fighting them for years, we know how challenging and exhaustive they can be!  Thankfully, a wide variety of tools and skills exist to help you break free -- each one highly customizable to your specific needs. That said, some of the very best options out there can take some time, and a lot of practice, before you've shaped them into that go-to symptom management tool you can pull on any time. Skills like imagery, containment, split-screen, and a few modulation tools are all incredibly valuable, but they can be quite advanced, and sometimes even turn survivors away from them altogether if introduced too soon. For those new in their healing, options that are very straightforward and uncomplicated can be their greatest lifeline. For those with a full workshop of tools, we know how possible it is for giant waves of new or stubborn trauma material to put even your best skills out of reach. So, items that are extremely easy to recall in a time of panic or crisis, as well as very rudimentary to enact, may be the only efficient skills at your disposal. We hope to be able to offer survivors in all stages of recovery that perfect flashback kit.

    Before we get too far, let's first define what a flashback is! Whether you're a trauma survivor yourself, or a loved one/supporter of one who is are trying to learn more, you may be surprised to learn there are different types of flashbacks:

 

 

 

    So, what can you do?

     We recognize that half the battle when you're struggling is being able to just remember that these tools even exist and are available to you. When you're terrified, feeling very young, or you aren't oriented to the present, it can be really hard to even recognize that you're symptomatic. Try to be compassionate with yourself (or your friend, family member or client) about this. Years upon years, sometimes decades, were spent responding to distress/trauma in the same exact way; it is very hard to retrain the brain to respond differently when you're only presented an opportunity to try every so often. Also, flashbacks stem from a completely different section of our daily-functioning brain. It takes very hard work to override that circuitry, and none of us think very logically or critically when flooded with fear and adrenaline. But, with practice, and by utilizing these skills as early in your symptoms as you can, you'll find they become more habitual and automatic — taking less conscious effort and acting more like muscle memory.

     Let's get to it!

 

 

Grounding

     Your absolute number one, first line of defense for any posttraumatic symptom is to be grounded -- or at least substantially more grounded than you are in that moment. None of your other skills will be effective if you aren't grounded first. (You can learn more about what it means to be grounded, as well as have an entire list of 101 Grounding Techniques at your fingertips, right here on our website!) We do know it can sometimes feel impossible to practice grounding before you've put a memory away, especially if that memory is what's fueling your dissociation and making you ungrounded. But, if you're heavily dissociated, and stuck in the past, you're only putting the memory away in the past - not in the here and now. It will continue to find you in this timeline. As you start the grounding process, you'll find that some of the intensity of the trauma material backs down, freeing you up to use other skills that you may have more completely (i.e. containment or modulation); this takes things down another notch, allowing you to get even more grounded, and so on. A positive loop.

    What are some of the best, most-easily accessible grounding tools?:

  • Open your eyes. Uncover your ears. Make as many senses available as you can!

  • Look around. Try to label 5 things you can see, 5 things of a single color, 5 things of one shape.

  • Listen. What do you hear? Is it close or far? Loud or soft? Pleasant or grating?

  • Open up, feet on the floor. If you're curled into a ball, or have your feet tucked up on the chair, try to put them on the floor and press your feet firmly into the ground. Become rooted to the space you’re in (no longer lifted or untethered to anything, just like your currently dissociative mind), but especially free yourself of those childlike, fear-based positions that continue to alert to your brain that you’re in danger. We know they feel self-soothing, but they’re doing the exact opposite to your mind,

  • De-trance. If you are rocking, tapping, swaying a limb, clicking, or engaging in any other rhythmic, trancing motion, try to start slowing it to a pause or make sure it’s no longer a pattern.

  • Sit upright. If you are slouching deep in your seat or laying down on your bed, try to sit up. Lying prone can be very disorienting and triggering for many.

  • Orient. Remind yourself of the date, your age, where you are, and that you're safe now.

  • Movement. If you feel frozen and unable to move, start by just trying to wiggle your toes or finger tips. Slowly work up the body, little by little, until you regain movement.

  • Smell. Inhale strong fragrances (they don't have to be pleasant!). Coffee, candles, lemon, lotions, the kitty litter, it doesn’t matter! Just awaken yourself to what’s before you.

  • Taste. Chew gum, eat mints, or suck on sours. Eat a meal or snack. Drink a very cold or warm beverage.

  • Touch. Run your fingers over unique textures within reach. Your clothes, the furniture, a zipper, a pet, a grounding stone or fidget item.

   There are many, many other grounding tools, as well as a more detailed explanation as to why and how they are helpful, in our aforementioned article, so we'll move on to our next step!

 

 

Self-Talk

     Our inner monologue is far more important and powerful than we tend to give it credit. Self-talk during a flashback can be part of your grounding or be used to keep you calm and steady while you employ other techniques.  It can be hard to access your grounding skills (or other tools) if you’re in a panic and can't remember what's even happening to you or who you are. Self-talk can be a vital skill that allows everything else to fall into line.

   You can say things to yourself like:

  • "This is a flashback. It is just a flashback; it is not real. This is not happening right now."

  • "I am safe now. No one is presently harming me. There is no external threat to my safety right now."

  • "I am an adult now. My name is ______. I am ____ years old. It is 20__."

  • "This will not last forever. I have the power to make this symptom go away."

  • "I am competent. I am able. I have done this before."

  • "It's important that I get grounded. Dissociating can feel safer, but I've learned it puts me and others at risk. I can do this."

  • "I can ask for help. I am worthy, even if that's hard to believe right now."

  • "This is temporary. I can feel it getting easier already. I will be okay."

  • “I am in control. I get to decide when and how this leaves. I have the power now.”

   Find a mantra or phrase that feels right to you, something you know you'll remember when it's time. Talk yourself through the process. It is healthy, helps keep you planted in reality, and reminds you of the power you have now that you didn’t before.

 

Separating Past from Present

     Separating past from present can work on many levels as a combination of self-talk, grounding and reality-testing. It's also a tool outsiders or loved ones can help you with, too! No longer all up to you! During a flashback, it's very easy to be disoriented from the current time or place. You could feel like you're all the way back in the 80's, believe you're a small child, or just in a completely different environment than you truly are. Taking the time to label - in your mind, out loud or in writing - all the things that are different now from the past you're reliving, can help your mind tease apart the complete lack of safety you feel from the security of your present environment.

   Some examples:

  • "It is 20__, not [date/timeframe of the flashback]"

  • *look at body* "These are adult hands and feet. I am taller now." Observe other physical changes like tattoos, body modifications, health changes, wrinkles or grey hairs.

  • "There were no smartphones back then. TVs didn't look like this. I didn't have a laptop or desktop computer like this." Notice other anachronisms and things that couldn’t have existed at the time of the memory.

  • "I live on my own now. This is MY house/apartment. I can drive now. I have children/a spouse/a partner now. These are my car keys. This is my drivers’ license/ID."

  • “I am currently outside. That happened inside. (Or vice versa.) It was nighttime then, but it’s noon now.” Name several other environmental differences, Rooms, time, days, furniture, clothes, etc.

  • "I have a voice. Before I would have been too scared to even make a sound right now." [Then use your voice in any form to prove to yourself that it's safe to do so.]

  • "I am a strong, competent adult now; I am no longer a helpless child. I have options to ensure my own safety, and the safety of others, and I employ them."

  • Label any changes about your abuser(s): their age, location, relationship to you, if they has passed, etc.

  • Label any other major life changes: geographic locations, professions, people you know now that you didn't back then, other appearance changes, pets, etc.

  • List (or listen to) popular music, movies, entertainment you enjoy now. Remind yourself these things did not exist back then.

  • Acknowledge the positive supports you have in your life now: new pets, friends, a therapist, a partner, family members, etc.

 

 

Internal Communication

     Internal communication is a bit more specific to those with DID/OSDD, but can still be applicable to those with C-PTSD or PTSD in different ways. It is also not quite an "easy, basic skill", as was the case in the other tools offered. This is definitely more of an advanced skill, however, it is very important to include because failing to check inside has the potential to render alllll your other grounding/symptom management tools ineffective. It may come as a surprise to some, but alters in a DID/OSDD system, or even just parts of a less compartmentalized C-PTSD individual, are capable of sending flashbacks your way on purpose. It is not always with nefarious or hurtful intent. It's often with the counterintuitive desire to protect or is being used as a means of communication. This may look like handing you pieces of memory they feel are important for you to know, feel, or be reminded of, or showing you what they’ve been struggling with alone for weeks - ‘asking for help’ in the only way they know how.  When this is the case, using symptom management to make the flashback go away may just exhaust you.

     If you already have some well-established communication inside of your mind, you can certainly ask them these questions more directly. But, if you aren't there yet, or if you don't have differentiated alters at all, you can still send these thoughts back into your mind and see what bubbles up. For those who are just starting to establish communication with their system, sometimes opening that line during a flashback can be the first successful connection to come through.

   Some questions you can ask alters/your mind: (Then, open yourself up to allow the answers)

  • "Is there a reason I'm being shown this flashback right now? Is someone sending this to me?"

  • "What are you trying to communicate by making me relive these images/feelings/physical pain?"

  • "Is someone else in a flashback but came/got too close to the front of the mind? Can we do a role call and see that everyone is grounded and present?"

  • "Are you trying to make me feel as unsafe as YOU feel right now about something else happening in our life?"

  • "Do you want to scare me back into silence?" "Is this your way of reminding me we aren't supposed to talk or tell anyone?"

  • "Are you trying to incapacitate me? ...make it so that I can't go to work/go out with a friend/accomplish x task/leave the house/see x person/etc?" "Why are you afraid of me doing that?"

  • "Did something trigger you that I don't know about? Did you see/hear/feel something really familiar that I didn't notice?"

  • "Are you feeling ignored? ..like I don't care? ..like I'm not listening to you or taking your feelings into consideration? Are there other ways you could get my attention that don't include re-traumatizing me?"

  • "Are you oriented to the present? I know that it's 201_, but do you? How can we work on getting grounded together? Do you need to look through my eyes or feel in the body that we are safe and not in danger right now?"

  • "Did someone else inside order you to share this memory with me? If so, you can say so without revealing yourself to me. I want to talk to them, not you; you're not in trouble."

  • "Am I being punished for something? Can it be shared with me what I did ‘wrong’ or which rules I broke without this flashback? I can't have a conversation with you about it or make amends if I can't think straight."

   There are many ways to appeal to parts inside to get to the root of why a flashback may have been sent your way. It is also possible to send these thoughts throughout the mind even if you do not have parts or a system. Many aspects of the mind may still be operating under similar pretenses and using these symptoms as a protective defensive mechanism -- maladaptive as that may be. Appealing internally may strike a chord and enlighten you to what the real issue is. The answer may just "click" the moment you ask, even if you can't hear a direct/"audible" reply. Once that has been discovered, you will be better able to tackle things appropriately, to meet that need or fear, instead of just exhausting yourself on symptom management skills that won't work until that primary issue is resolved.

 

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     We sincerely hope these four basic, foundational tools will be able to help you find relief and distance during a flashback -- no matter what stage you're at in your healing. Once armed with more stability and a framework from which to work, you can then explore more detailed and elaborate skills with confidence!  We will absolutely be covering more of those, namely imagery, containment, modulation, and the various journaling tools that are extremely helpful in the fight against flashbacks. (We've already introduced a couple!) So, stay tuned. 

     Please don't hesitate to share some of your go-to strategies for flashbacks below and consider bookmarking this page for quicker, more direct access should you need it while you're struggling!

 

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MORE POSTS YOU MAY FIND HELPFUL:

  ✧  Grounding 101: 101 Grounding Techniques
  ✧  Distraction 101: 101 Distraction Tools
  ✧  Self-Care 101: 101 Self-Care Techniques
  ✧  Nighttime 101 and Nighttime 201Sleep Strategies for Complex PTSD
  ✧  Imagery 101Healing Pool and Healing Light
  ✧  DID MythsDispelling Common Misconceptions about Dissociative Identity Disorder
  ✧  Did You Know?: 8 Things We Should All Know about C-PTSD and DID
  ✧  Trauma and Attachment: 3-Part Series on Attachment Theory with Jade Miller
 
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Article Index  ❖

Nighttime 101: Sleep, Nightmares, Insomnia and More

 

Getting Some Rest as a Complex Trauma Survivor

  It’s no secret that survivors of trauma often have an incredibly difficult time with sleep. Whether that's due to experiencing terrible nightmares, night terrors or sleep paralysis; having a racing mind that won’t turn off; only feeling safe to sleep during the daytime; or wrestling with any of the countless complications surrounding bedtime — we know that the time of day most really look forward to can be one that fills many survivors with dread.  We have accumulated, used and witnessed the success of many different tools and strategies over the years - tools that are designed to help trauma survivors not only get to sleep, but do so safely and stay asleep peacefully.  In sharing some of them with you here, we hope it may even shift your overall approach to sleep, while ultimately leading to a much more secure and restorative rest.  As an added bonus, you can also take away that you are not alone, crazy, or making too big a fuss out of “something so simple”.  It’s not simple or you wouldn’t be struggling with it!  Hopefully we can help with that and get you some long overdue rest.

  We will tackle four main areas - Nighttime Routine, Journaling (both before bed and as a tool for nightmares), Internal Parts (for those with DID, but also still applicable to most), and Medication.  Feel free to take what you need and just leave the rest.  And please feel free to add your own experiences, struggles, and suggestions below.  You may find that someone else has the perfect solution for your biggest challenge, or that by sharing your own experience you spark a light bulb in another that brings some clarity to their lifelong battle with sleep. So, don’t be shy. Your voice is valuable.

 

Nighttime Routine

  One staple skill for just about anyone to keep in their toolbox if they're fighting with sleep, is to create a nighttime routine. Whenever you take a series of deliberate, personalized steps about 30-60 minutes before bed - and do so night after night - you send an early signal to your mind and body that you plan to sleep soon.  It learns that once you've begun step one, it’s time to start slowing down, settling your heart rate, and preparing to turn off and recharge shortly.  And, as you are likely very familiar, most (C)PTSD minds are extremely hyperaware and vigilant for any sign of distress. So any early indicators you can give your mind that you plan to disengage (while also letting it know you’re taking intentional steps to ensure it will be safe to do so) can make a dramatic difference in it following through.  ...and doing so by the time you're settled and would like to relax.

  For many, this routine may start with taking nightly medications — which is a great place to start if you have any that are for sleep — that way they have time to take effect before your eyes are closing.  Perhaps there are sitcoms or online videos you like to watch that help you unwind and get into a lighter place.  If this kind of entertainment is an important part of your evening, it’s good to add those early in your routine so that you’ve had a solid 15-30 minutes without electronics before shuteye.  This isn’t only a good idea because of the way digital devices keep our minds active and can affect sleep rhythm, but they are notoooorious for sucking us in and getting us to watch one more episode, scroll a little longer, or play just one more game. ...sometimes hours longer than we intended. ;) And if you're dissociative orrrr just really really avoiding sleep? I don’t think you need me to tell you that you can fall down a hole that's not easy to get out of. ;) So, enjoy these early on and continue with the rest of your bedtime routine. Get a snack, drink some tea or something calming. Feed your pets if you have them. Wash your face. Brush your teeth. Take out your contacts. Put on your PJs. Set your clothes out or gather other items that you need for the next day.  Do all the things that you need to be ready for bed while adding in any self-care items you aren’t currently doing that you think could be helpful to you and your sleep.

  Once you’ve climbed into bed, we know that this can be the hardest part. Ease into it. Go ahead and plug in your phone, set your alarms for the next day, turn on any light music or white noise apps that you enjoy. Then instead of just closing your eyes, you’ll want to take some extra steps that are just for your mind.  Whether that’s through journaling (discussed more below!) or mental imagery, do what you can to consciously put the day - and alllll its stressors and triggers - away.  Then take some time to acknowledge to yourself where you are, the year, that you are an adult and that you are safe.  Look around and do some self-talk reminding yourself of all the ways you are secure in your home and in your room, that no one can interrupt your rest in any unsafe way.  If you have parts inside, go ahead and take time for them - making sure their needs are met and they are ready for bed as well.  (More on this below!)  Then spend a bit more time on pleasing imagery for yourself, whatever that may look like.  Safe place imagery, progressive muscle relaxation, color breathing, or just envisioning a special place you’d like to be resting your head.  Hopefully, it shouldn’t be too long before you drift.

  While we know there can be other pitfalls to sleep that we’ll discuss in a moment, establishing a routine like this that you try really hard to follow in the same order each night can do wonders for your rest. Setting that rhythm and getting your mind, neurology, and whole body in sync can be a key in helping you get the sleep you aren’t currently getting.  The more you can stick with it, the better the efficacy.  But, hey, we know that life happens, it’s okay if it gets interrupted or you forget a step or two. It’s less about absolute perfection and more about the intentionality of taking gradual steps to walk away from high-alert and into a more settled and calm you. 

Journaling

 

Journaling to Help with Sleep

  One of the best ways to ensure a good night’s sleep is to practice a coping skill called containment — and one of the most universal mediums for that is journaling.  Containment allows you to temporarily “put away” upsetting or difficult thoughts and feelings by mindfully and consciously giving them a place to go.  This way you can continue on with your day, or your rest, without those things intrusively revisiting you.

  Everyone has experienced sleep made more difficult by even mild stress throughout the day, but triggers you've encountered, worries and fears you have about the upcoming day, memories you’ve been wrestling with, and all sorts of similarly challenging material can make it a million times harder.  Taking a moment to write about some of these things gives your mind a chance to acknowledge and validate how much they are affecting you.  (And this is important because it keeps you from stuffing them, or pretending they don’t exist or faze you, which nearly always leads to them thrusting themselves back into your awareness whenever they feel like it. ...any way to not be ignored or forgotten.  That includes in your dreams.)  But, more importantly than just validating the tough stuff, journaling also gives it a place to go.  The journal gets to hold on to it, and when you shut the book, it's contained within its pages -- allowing your mind the freedom to concentrate on more pleasant, calming thoughts so you can drift to sleep faster.  Thinking of it in this way, and making the conscious effort to believe the difficult items are contained tight within your journal until you want to revisit them (whether that means the next day, in therapy, or weeks from now), you're far less likely to have your dreams disturbed by their content.  This skill is especially important if you’ve been triggered that day, are dealing with really difficult memories or therapy material, or have been having an excess of nightmares or unsettling dreams.

  “How long should I journal?”  “What should I write about?”  “Won’t thinking about all the hard stuff right before I lay down just make me feel WORSE?”  “I’m so tired before bed, I don’t have time for that, I just wanna sleep!”  “I have never journaled before and I’m not a writer.”

  Fear not, we’ve got some answers!  Firstly, you don’t need to have ever journaled before to be able to benefit from or be “good” at this skill.  Because the cool thing is, you don’t even need to write full sentences.  In fact, many avid journalers can even get swept away in their storytelling and get themselves worked up and fully “in it” again.  And we don’t want that before bed!  So, some useful tips include not only setting a time limit for yourself, but consider keeping it a short one.  If you want to do longer journaling (which we highly support and recommend!), you can do so any other time of the day!  We just don’t want you to do that right before bed.  Keeping it simple is just as effective and doesn’t get your neurological system all revved up and firing again when we just settled it down through your routine. Take only a short moment to write a bit about your day, some of the things that are recycling through your mind or upsetting you, and a bit on how it made you feel.  For some, this may literally just be in a bulleted list, no sentences at all.  If the material is particularly triggering, writing a full sentence about it may even take you right back there - so an effective tool around that is to just give it a headline. What would a newspaper title the full story? You’ll know what it means without needing to write any more detail. For anything else, it's possible just listing what you did or what happened that day through timestamps is appealing to you, while others care less about the events of the day so much as the emotional experiences in it. There are so many different journaling techniques (we will likely even make another post about them at some point!) but there are many ways to do this, so personalize it.  Some may work better for you than others. Don’t give up if it the first tries haven’t gone perfectly!

  (As an aside, another common objection to journaling is being afraid that someone will read it.  While we love the thought of you getting a journal that feels like a really personal, inviting place to hold all of your experiences for you — there is nothing wrong with or ‘lesser' in just writing via the Notes section of your phone.  Then it is always on your person, you can lock entries so no one can find them, and you still help your mind displace some of its recursive thoughts by putting them somewhere outside of your pretty little head.)

  Final thoughts on this!  Ultimately, the purpose of journaling right before bed is to put away the day’s worries and stressors - but, some really like to use it as more than that.  While we highly recommend following up your journaling with pleasant imagery and “good vibes” once you lay down, many incorporate that into their journaling.  They use their 'good thoughts' as a bookend to their writing so it doesn’t feel as if all the “yuck” is just left open-ended on the page. If this appeals to you, you can do so in various ways:
  Some choose to end by further describing a container they’d like to place these specific things in - such as a chest under the sea, flown away on a private airplane, a flood of emotions filling up an entire canyon that you can walk away from, images projected on to a movie screen that you can leave in the theater, a filing cabinet with an elaborate system of locks..so many possibilities.  Those struggling with the emotional side of things may like to end their journaling with 5 to 10 statements that challenge any upsetting beliefs or distorted thoughts. Statements like, “I have worth.” “I am safe and can protect myself.” “Their beliefs about me do not MAKE me those things. I know who I am.” “I am not to blame; they made that decision when I wasn’t even there.” “My needs are important. I am not too much.”.  Many like closing up with 3 positive things they like about themselves, several grounding statements, 5 wonderful things about the day, or a handful of things they are grateful for.  There are many positive, uplifting, affirmative, or calming things you could use.  Choose whatever feels right to you and what best meets your needs so that your mind is in a more peaceful and light place before you even close the book.  Then, that satisfying close of the cover, locking up all the hard stuff, will feel that much more satisfying because you’re already in a much better place before you shut the book.

 

Journaling to Help with Nightmares

  Journaling isn’t only a great tool to use before you go to sleep, it can also be incredibly useful after you’ve had a nightmare.  Some nightmares are just too stubborn and intrusive that all the coping skills in the world before sleep can’t keep them from finding you. And, returning to sleep after one can be positively dreadful, if possible even at all.  Keeping your journal nearby may be all that lends a hand when little else does.

  Similarly to above, this can work as a kind of containment that your mind really needs after all that distressing content was pulled to the forefront of your mind.  Though you may be exhausted, and your handwriting illegible, scribbling down a bit of your nightmare can help you ‘get it out’ so you’re less likely to just keep thinking about it as you try to fall back to sleep. It also allows your journal to “hold it” for you and keep it away from you and your sleep.  You don’t have to write much detail or elaborate heavily, just hitting the key components that are most distressing to you is what matters most.  Just list them, give them a headline, name a few feelings or objects or people, draw something if the words are too hard....anything to get the bulk of the nightmare out on paper and out of your poor head.  For good measure, a lot of people like to fold that page of their journal over so they can’t even see it anymore.  It gets extra-contained in that folded page.  Then you can close the book up tight, set something heavy on top of it if you please, shut it tight in a drawer, and even move to the other side of the bed if you feel you need to.  …nothing is too silly if it helps you feel it can no longer reach you.  Now you're free to think about whatever pleasing scenery or place you wish to be instead, knowing it is tight and secure in its square on the page, and you’re in your safe place heading toward more pleasant sleep.

  As a bonus, jotting these nightmares down can be incredibly useful to bring to therapy.  If you have a particularly recurring dream, there are strong themes in your nightmares that may be trauma-related, or you’re having actual flashbacks in your nightmares, these notes can be extremely valuable when you’re in sessions. Having them written down the moment you woke from them, as authentically and raw as they get, can help you tackle things in much more nuanced way.  This can get you through them more quickly and more accurately, which inevitably leads to better solutions for them all-around.  Nothing could be more relieving than that.

 

 

Internal Parts (DID)

  Not all survivors with Complex PTSD have internal parts, as this is more DID-specific, but that doesn’t mean some of these ideas won’t still be helpful for all to at least consider. There are many different aspects of the whole self that can struggle with sleep, aspects of yourself that you may be unaware of or had never considered before.  For those who have DID, we know it can seem so simple or obvious that alters may be the reason your sleep is so disrupted.  But it’s also completely understandable that you might be inclined to look just about everywhere else for what may be to blame before you ever think to look inside.  "Did I have too much caffeine?" "Is this work project getting to be too much?" "Did I stay online too long?" "Maybe I shouldn’t eat that before bed anymore..?"  When there are sooo many things that can keep a person from sleeping, it never hurts to be reminded to stop and consider…hm, maybe someone inside is keeping me up.  While individual alters may be physically responsible for keeping you awake, for trauma survivors without DID, the younger aspects of yourself and traumatized parts of your mind may still need just as much attention and care.  They could very much be the source of your restlessness, too.

  For DID systems…. Parts inside might not be intentionally trying to keep your body awake, but that is actually also a possibility, too.  Checking inside to see if someone is afraid to go to bed, has a belief that you need to be more productive or don’t deserve to sleep, or actively wants to punish you for something they feel you did wrong, are all things that could be going on beneath the surface.  Looking to see if any of these types of feelings are what’s at play may lead you to some very surprising answers.  Other possibilities may be much more innocent. Like parts making a bit of a ruckus inside, but not because they wanted to keep the body awake; it was just an accidental byproduct of their distress.  Maybe a small kiddo part really wanted a you to sleep with their favorite stuffed animal or wear your fuzzy socks. Or they needed someone inside to come tuck them in or read them a story before they could rest, which left you wide awake up front.  Other parts may be having an incredibly difficult with nightmares or triggers around bedtime that you weren’t even aware of - and their nervous energy or insomnia even on the inside may be keeping you up. Some insiders may just be ungrounded or unaware that it’s 2017, and extra grounding help before bed may be all they needed to quell their terror and lead them to sleep.  Other struggles may be more challenging to overcome, though, like a part not liking that you have to share the bed with your partner if you have one.  Issues like this may require a lot of talking and compromise before you can all get some shut-eye.  A simple nighttime snack may have been the answer for someone one night, while making sure to double-check the locks on the doors may be a absolute non-negotiable every single night for someone else.  There are countless things different parts could be having a hard time with - some that may relate to sleep and others that might not at all.  But until their needs are heard and met, you will likely be left awake. 

  The good news is that there are often solutions to many of these issues.  Some are quick fixes while others take a lot of work, time, therapy, and/or compromise. But there are usually answers somewhere, if given the proper time and attention.  If you don’t yet have good internal communication, learning what the issue even is may be the harder part for you.  But if you remain open to hearing from your mind, and let everyone know it's safe for them to express their needs or worries, you’ll likely hear (or at least pick up on) something you can work with.  Perhaps making sure all parts have gone to independent safe places before bed is what you will need to do nightly.  If they each have their own room, maybe child parts will need bedtime stories and snugs from maternal, comforting parts inside.  And, sometimes things on the outside are your answer to making parts happy - like special PJs, blankets, a fan being turned on, a favorite movie, or even something more serious like not sleeping in just undies.  The solutions may not always be comfortable to you, and this is where compromise and explaining your needs alongside theirs will be necessary.  But it’s a start.  And a start is often better than nothing if it’s been months since you’ve slept and you’ve tried EVERYTHING. If this is the first time you’ve gotten any insight to what’s keeping you up, it’s worth giving it your best effort. 

  It’s just too easy as we go about our lives to forget about parts inside or even those younger, traumatized parts of ourselves if we don’t have individual alters.  Tending to their needs, fears and worries - or just taking extra time on self-care and grounding for all of you before bed - can do wonders for your mind.  You’ve been through so very very much and your mind is going to wrestle with the idea of turning off for awhile, especially when it's the most vulnerable position you can be in all day.  It’s only natural that you may need to take some extra time, thought and attention toward your health, safety and comfort.  Yes, when you’re absolutely exhausted and just want to rest, this can feel like such a pain.  But I can promise you that it’s well worth it if it actually results in good, restorative sleep in contrast to the restless, angst-ridden wrestling and warring you’re currently doing.  Be kind to yourself, to your body, to young you and teenage you and adult you.  You each have your unique challenges, but you are all one, and that whole person in this singular body needs and deserves a great night’s rest each day of the year.  So, whenever you find yourself just having zero luck catching even a moment of decent sleep, or you're routinely waking up at the same time each night, we urge you to check inside.  See what might be going on for the rest of you that you’re often less aware of during the day.  Whether that is to each individual alter, or the traumatized and still-healing aspects of the singular you, give some thought to what you may need and ways you could tend to those worries or fears.  The worst that happens if you try and it’s not where the problem was?  Well, you just get a little extra self-care and comfort.  Shucks!   ;)

 

 

Medication

  Oh, medication — it seems it’s either the most vital necessity or the greatest enemy to complex trauma survivors.  And heck, both can even be true within the same person at different points in their life, orrr even at the same exact time!  When it comes to sleep, there are no ifs, ands, or buts about it — you absolutely must get it and you just cannot keep going if you aren’t getting a good amount.  For many of you, this will require medication at some point in your life, and that is one-hundred percent okay.  Whether the decision to try medication comes after you’ve tried everything else, or is something you jumped for at the first sign of trouble, there is never any shame in asking for, or needing, medication to help you sleep.  We fully support and recommend its assistance to you under the direction of a mental health professional (most preferably one who is familiar with complex trauma, but we know those are hard to find.  We’re working on that!).  That said, we know just as well as many of you know, that sometimes medication can just stop working one day, never really did in the first place, gave you awful side effects, left you with terrible nightmares, or is something parts inside (or even you alone) have intense misgivings about and can’t reliably take each night.  We want you to know that no matter where you fall on this spectrum of the medication journey, we empathize with you completely and are sorry that it has to be so difficult.  Sleep is so important and absolutely vital; we ache for anyone who, even after all their best efforts on their own terms, can't even rely on medication to be a sustainable resource.

  We don’t have any hard and fast answers or guidelines here, but we did want to mention its role in this battle against insomnia and nightmares.  Because, while it may not be a long-term solution, and may include some unpleasant side effects, it may still be the most welcome rescue to your desperate need for sleep.   Now, just going to your personal care physician and telling them you’re having an impossible time with sleep maaay lead to them prescribing some pretty heavy duty sleeping pills.  But, we want you to know that not only are these NOT the only options out there, they aren’t always the best option for someone with your specific needs anyway. Talking with a psychiatrist tends to lead to a much more nuanced understanding of what about sleep is so difficult for you.  And this can make all the difference in getting either a medication that just physically sedates you, one that takes down your excessive anxiety so you can fall asleep organically, or even antidepressants that can regulate your body’s natural sleep cycle so that you can turn down when you want and wake when you need.

  Another lesser-known but available option is a group of medications that target nightmares more specifically.  These are usually only prescribed by very knowledgable psychiatrists since they tend to affect blood pressure, and nightmares are not the medication’s primary focus.  However, in recent years, they have found that certain medications (such as MiniPress/Prazosin and Catapres/Clonidine), which typically lower blood pressure, have been affective in treating PTSD nightmares.  They do not always work and require very close monitoring of the person’s blood pressure since most who are taking it for PTSD reasons do not need their BP lowered. ...but that will still happen anyway.  However, it’s always helpful to know that some of these options exist out there and could potentially be viable for you.  You will need to talk thoroughly with your physicians to find what is right and safe for you, but just knowing there are various possibilities out there may lead you to the help you deserve.  “Sleeping pills” or the hardcore medications you’ve heard tons of awful things about are not your only option. In fact, they’re pretty rarely used for trauma patients (with exceptions of course).  Whether it’s through benzodiazepines, antidepressants, other psychiatric drugs with sedating side effects, blood pressure medications, or any other class of meds — there are so many ways to tailor your sleep regimen to your specific needs.  There is no one-size-fits-all when it comes to sleep, and that even includes within the same person.  What you needed, or did terribly with, as a teen may be the most unhelpful or perfect solution to you now.

  Of course, we know there will still be a subsection of you who have tried literally every concoction under the sun and there’s just no way to get relief through medicine.  We extend our sincerest sympathies and encourage you to look deep for internal reasons that insist you fight and override every combination of medicines thrown at you.  The mind is an incredibly powerful force and if it doesn’t want to sleep, it can beat even the most powerful of substances.  This could very much be the case for you, and really taking the time to explore why sleep is so forbidden, frightening, or “bad” could eventually unlock the mystery that’s been - quite literally - keeping you up at night.  And, if that doesn’t seem to be a fruitful exploration and you’re still desperate for some Zzz’s, it's never a bad idea to at least consider retrying medications you’ve tried once before.  The body, its chemistry, and your personal needs can change dramatically over time.  What you need now may be completely different than what you’ve been trying at this stage or in the past.  We know just how frustrating this can be and completely understand why you may've thrown your hands in the air already not wanting to try anymore.  But you deserve sleep. You NEED sleep.  We want to see your body and mind get that wonderfully restorative break.

  If you needed a nudge or for someone to tell you that it’s okay to try medication again - or for the first time - this is it.  We’re telling you it’s okay.  It doesn’t have to be forever, you don’t have to rely on them, and you can stop at any time.  But you deserve a chance at peace, comfort and rest.

  We truly hope that this has helped some of you in your fight against nightmares or insomnia.  If nothing else, we hope that it’s helped you think about this battle you face every night in a different way, and perhaps it will lead to some looooong, peaceful nights.  Please don’t forget to share your experiences or own personal tips an tricks with us and others below.  We have far too many possibilities to include them all here, so we know that you guys have even more!  And, nothing could be more helpful than a collection of survivors’ stories on how they beat what kept them up for so long and finally got some solid sleep!

~~~

 

If you would like to catch other informative or educational posts of ours, give these a try:
   • Grounding 101: Featuring 101 Grounding Techniques
   • Regarding the Film 'Split': Our Support for Survivors and Public Statement on the Film 
   • Surviving the Holidays with C-PTSD or Coping with Toxic/Abusive Families During the Holidays