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Section 5

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In the last section, we discussed depression and its various manifestations when linked to PTSD: behavioral depression, learned helplessness, repressed anger, and loss and grief.

I have found that many clients view the expression, "Getting in touch with your feelings" disdainfully or silly.  Some have even said, "Feelings are what west coast freaks talk about in guitar circles!"  Have you found, like I, that many PTSD clients cannot differentiate between a "thought" and an "emotion" or "feeling"? 

In this section, we will examine ways for a client to better understand his or her emotions via feeling awareness, thoughts vs. feelings, and writing out the trauma.  We will examine PTSD and its relation to abuse and trauma of a robbery.

3 Ways for Clients to Better Understand Their Emotions

♦ #1 Feeling Awareness
The first issue in understanding emotional effects of trauma is feeling awareness. 

Stan was a PTSD client of mine whose alcoholic mother used to beat him regularly.  Stan once stated, "This might sound stupid coming from a 50-year-old man, but I don’t know what to say when you ask me about my feelings.  My mother used to beat me a lot, and she was always too drunk to take me to the doctor when I was sick.  How did I feel about that?  Sometimes, I can’t remember how I felt, or even if I felt at all.  I don’t even know what to call it when I do remember."

Because Stan was most likely punished for showing his emotions, his brain had learned to shut them off to the point that he could not even identify his feelings almost fifty years later. In recovering from trauma, I believe it is essential that a client understand just how their emotions are playing a role in their lives. This of course begins with feeling awareness. 

♦ Technique:  Tuning Your Emotional Antenna
To help Stan become aware of his emotions, I suggested he try the "Tuning your Emotional Antenna" exercise. 

I asked Stan to complete the following techniques to help him be more aware of his feelings throughout the day:

  1. Quiet your body - or move it.  I stated to Stan, "The most commonly prescribed methods for getting in touch with your feelings involve getting inside yourself by sitting still for a few minutes, meditating, or practicing muscle relaxation.  However, if you suffer from bouts of extreme physical tension and anxiety, sitting still or meditating can be agitating rather than soothing.  Therefore, you may choose to "quiet" your body by moving it through exercise, dance, or physical labor.
  2. Ask yourself, "What am I feeling?"  Don’t expect to know right away; Give yourself some time to discover your feelings.  Also recognize, and indeed expect, that you may be feeling more than one emotion. 

Once Stan had completed the exercise over the course of a few sessions, Stan stated, "I am starting to understand, now.  I’m more in touch with what I’m feeling throughout the day than I ever was before.  Sometimes I can say to myself I feel good, or I feel pissed off!"  As you can see, by quieting down the white noise, Stan could focus more clearly on the internal happenings of his mind.

♦ #2 Thoughts vs. Feelings
The second aspect of emotional comprehension is clarifying for the client the difference between a thought and a feeling.  I have found, probably like you, that many clients mistake thoughts for feelings.  Kara had survived an armed robbery of her apartment and had trouble differentiating between a thought and a feeling. 

When I asked her about what she felt when the burglars had held her at gunpoint, she said, "I feel like I should have gotten a deadbolt on my door."  I explained to Kara that statements that start out, "I should have…" are not feelings, but thoughts.  Think about your PTSD client.  Can they tell the difference between a thought and a feeling? 

♦ Technique:  Distinguishing Thought and Feeling
To help Kara learn to distinguish between a thought and a feeling, I suggested she try the "Distinguishing Thought and Feeling" exercise.  I asked Kara to carry around a small notebook for one week.  Every two or three hours, I told her to jot down three things on the left side of the paper:
1. The time,
Her thoughts, and
3. The feelings she was having.

On the right hand side, I asked her to indicate whether what she was experiencing was a thought or a feeling.  I also asked her to be specific about what kind of feeling she was experiencing.  Kara wrote in her notebook that at 10:00 she was angry at herself for staying up too late the night before, which she listed correctly as a feeling.  At 12:00 she stated that one of her coworkers was probably angry at her for what she said about him the day before.  This she correctly listed as a thought. 

At 3:00, she stated that she should probably try harder at work, which she correctly listed as a thought.  As you can clearly see, through her participation in this exercise, Kara could more easily understand the difference between a thought and a feeling.

♦ #3 Writing out the Trauma
In addition to feeling awareness and thoughts vs. feelings, the third step I use in PTSD feeling comprehension is remembering the trauma.  To identify the feelings and how they relate to the client’s life and their trauma, it is important for the client to recall a detailed description of the traumatic event. 

By recreating the crisis, feelings and emotions might arise in the client that can be effectively addressed.  I ask my PTSD clients to list what happened immediately before, during, and after their trauma.  I then ask him or her to write his or her description with as much detail as possible. 

For example, if they were in combat and describing a traumatic battle, I ask them to mention the temperature and terrain, the weapons or other objects they were carrying.  Then, as the description becomes more physically detailed, I ask my clients to describe their thoughts and feelings as the trauma progressed. 

I also asked them to describe what others thought or felt about what was happening.  Even if he or she could only make conjecture about the thoughts of those around them, I encourage the client to write that down as well.  This exercise is designed to allow the client the opportunity to encounter their trauma willingly and to address the emotional concerns associated with it.

In this section, we discussed ways for a client to better understand his or her emotions: feeling awareness, thoughts vs. feelings, and writing out the trauma.

In the next section, we will examine survivor guilt and other self-destructive behaviors arising from it such as: self-mutilation, substance addiction, and eating disorders.

Peer-Reviewed Journal Article References:
Beck, J. G., Reich, C. M., Woodward, M. J., Olsen, S. A., Jones, J. M., & Patton, S. C. (2015). How do negative emotions relate to dysfunctional posttrauma cognitions? An examination of interpersonal trauma survivors. Psychological Trauma: Theory, Research, Practice, and Policy, 7(1), 3–10. 

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. 

O'Connor, D. B., Branley-Bell, D., Green, J. A., Ferguson, E., O'Carroll, R. E., & O'Connor, R. C. (2020). Effects of childhood trauma, daily stress, and emotions on daily cortisol levels in individuals vulnerable to suicide. Journal of Abnormal Psychology, 129(1), 92–107. 

Tsvieli, N., & Diamond, G. M. (2018). Therapist interventions and emotional processing in attachment-based family therapy for unresolved anger. Psychotherapy, 55(3), 289–297. 

What are three ways for a client to better understand his or her emotions? To select and enter your answer go to Test.

Section 6
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