CPTSD & The Very High Cost of Struggle & Agitation

CPTSD is Complex Post-Traumatic Stress Disorder. It's typically what one "catches" from having been traumatized in various ways over time rather than by any single "overwhelming" event. (This is an update of an article written many months ago with substantial added material on causes, conditions and treatments.) 

IME (which is plenty since hitting the wall in August of 1994, and finding my way further and further out of the maze since 2003), most of us appear to have been so deeply conditioned, in-doctrine-ated, instructed, socialized, habituated, normalized and neurally “hard-wired” into a default mode network of Martin Seligman's "learned helplessness and victim identity" since childhood that we continue to struggle with life in pretty obvious ways.

We drive ourselves mercilessly -- and mindlessly -- to solve problems in a chronic fight-flight-freeze response, which can lead over time to allostatic overload and breakdown of our immune systems. Experts on stress like Hans Selye, Joseph Wolpe, Herbert Benson, Bruce McEwen, Sonya Lupien, Robert Sapolsky, Stephen Porges and Pat Ogden have known for decades that "stressaholics" tend considerably toward greater incidence and severity of viral infections, as well as susceptibility to both elective and accidental self-harm. (See the list of books at the end here.)

In my empirical-observation-based opinion, as well as my own personal experience, the conditioned, habituated and normalized tendency to struggle leads to agitation of the autonomic nervous system in the manner described below:

Chronic amygdalar stimulation > relentless triggering of the hypothalamic-pituitary-adrenal axis > secretion of cortiocotropin releasing factor > secretion of adrenocorticotropic hormone > secretion of adrenaline > increased intensity of the general adaptation (fight / flight / freeze) response of the sympathetic branch of the autonomic nervous system > imbalanced polyvagal stimulation > rebounding levels of cortisol in the brain > allostatic loading throughout all striated muscle tissue > increased STRESS on the immune system > a continuous feedback loop between stress and the experience of AGITATION.

One of the most damaging types of struggle & agitation I see so often in a certain category of patient with CPTSD is what I will call "righteous victimhood." Believe me, I understand that "rage is a stage." And moreover, that Kubler-Ross was 100% correct in asserting that it is a stage one must go through and not around. But if one lingers there too long because they have developed an attachment to it -- even an identity with it as a primary defense mechanism, as some people definitely do -- it can become extremely costly in terms of repeated, allostatic overload. 

The cure for stressaholism is often, IME & IMO, the cure for Complex PTSD. The cognitive-behavioral therapies -- especially including Albert Ellis's Rational-Emotive Behavior Therapy and Stanley Block's Mind-Body Bridging Therapy -- and the new, mindfulness-based cognitive therapies like Jon Kabat-Zin's Mindfulness-Based Stress Reduction, Marsha Linehan's Dialectical Behavior Therapy, Peter Levine's Somatic Experiencing and Pat Ogden's polyvagal-theory-driven Sensorimotor Processing for Trauma appear to be the most effective and research-verified at this time. (All of these are easily found online.) I have developed a combination of Ellis's REBT and Ogden's SP4T; others have also developed combinations of the CBTs and MBCTs.

In my own first-hand experience, as well as experienced derived for working with and learning from many other CPTSD sufferers and mental health professionals (including all of those listed in the first paragraph of this article), the development of self-awareness via mindfulness meditation -- or Choiceless Awareness for Emotion Processing --is the foundation of this cure. 

Books on Stress and treatment thereof (in the order of publication): Joseph Wolpe's Life Without Fear: Anxiety and it's Cure, Hans Selye's Stress Without Distress, Herbert Benson's The Relaxation Response, Bruce McEwen's The End of Stress as We Know It, Robert Sapolsky's Why Zebras Don't Get Ulcers, Stephen Porges's The Pocket Guide to the Polyvagal Theory, and Pat Ogden's Trauma and the Body.

Related articles:

Stress Reduction vis Distress Tolerance & Emotion Regulation

Dis-I-dentifying with Learned Helplessness & the Victim Identity (in not-moses's reply to the original poster on that Reddit thread)

How Self-Awareness Works to Digest Emotional Pain

Threat, Stress, COVID-19 & Meditation: Useful, Useless, Or...?

A CPTSD Library

Threat, Stress, COVID-19 & Meditation: Useful, Useless, Or...?

Now having seen several offers of "meditations for coronavirus" online and having a) been in the practice of vipassana meditation since 1975, and b) considerable formal education and experience on such matters, may I offer the following?

Meditation may have value with regard to the desensitization of the amygdalar > hypothalamic > pituitary > adrenal axis and its direct effects upon the general adaptation syndrome or stress response. Which -- if sustained -- leads to allostatic loading and suppression of the normal functions of the body's immune system. (The very high incidence of hypertension in the measured comorbidity of COVID deaths in New York through early April is a strong indicator of allostatic loading, by the way.)

BUT the only way I know for a fact how meditation would be beneficial is if the practitioner "digested" and "discharged" any unprocessed affective energy in the neural feedback loops in the brain's limbic system. And that can only occur if the practitioner feels whatever affective sensations are dis-cover-ed via attending to his or her interoceptive experience.

I am not here to assert that guided imagery or posthypnotic suggestions are useless or futile in such circumstances. They may well be; I don't presume to know. But I do know that what I have described above and in the links that follow does produce results that -- according to published, peer-reviewed, empirical research -- are (among other things) correlated at least with reduced incidence of infection as well as reduced symptom severity.

With respect to stress reduction, one may also wish to consider the information at this link: "As One Thinks so Shall One Feel." And How One Can Change All That, and the use of introspection to monitor one's thoughts and their relationship to one's emotions... and stress response.

Resources: See Benson, McEwen, Sapolsky, Selye, and Wolpe in A CPTSD Library... and How Self-Awareness Works to Digest Emotional Pain.

How Self-Awareness Works to "Digest" Emotional Pain

Quoting Alan Watts in The Wisdom of Insecurity: A Memoir for an Age of Anxiety:

"Even in our most apparently self-conscious moments, the 'self' of which we are conscious is always some particular feeling or sensation -- of muscular tensions, of warmth or cold, of pain or irritation, of breath or of pulsing blood. There is never a sensation of what senses sensations, just as there is no meaning or possibility in the notion of smelling one's nose of kissing one's own lips.

"In times of happiness and pleasure, we are usually ready enough to be aware of the moment, and to let the experience be all. In such moments we 'forget ourselves,' and the mind makes no attempt to divide itself from itself, to be separate from experience. But with the arrival of pain, whether physical or emotional, whether actual or anticipated, the split begins...

"As soon as it becomes clear that 'I' cannot possibly escape the reality of the present, since 'I' is nothing more than what I know now, this inner turmoil must stop. No possibility remains but to be aware of the pain, fear, boredom, or grief in the same complete way that one is aware of pleasure. The human organism has the most wonderful powers of adaptation to both physical and psychological pain. But these can only come into full play when the pain is not being constantly restimulated by this inner effort to get away from it, to separate the 'I' from the feeling. The effort creates a state of tension in which the pain thrives. But when the tension ceases, the mind and body begin to absorb the pain..." (All italics mine.)

As just posted in an addition to Interoception vs. Introspection on Reddit's r/CPTSD.

But the medical explanation would be:

Douse the mid-brain with meditation >

reduce amygdalar stimulation >

reduce triggering of the hypothalamic-pituitary-adrenal axis >

reduce secretion of cortiocotropin releasing factor >

reduce secretion of adrenocorticotropic hormone >

reduce secretion of adrenaline >

reduce the intensity of the general adaptation (fight / flight / freeze) response of the sympathetic branch of the autonomic nervous system >

reduce imbalanced polyvagal stimulation >

reduce rebounding levels of cortisol in the brain >

reduce allostatic loading throughout all striated muscle tissue >

reduce STRESS on the immune system >

disempower the feedback loop between stress and the experience of AGITATION.

Nothing a $135K worth of med school with an emphasis on psychopharmacology won't teach a student who's paying attention. Or one could just read Joseph Wolpe's Life Without Fear: Anxiety and it's Cure, Hans Selye's Stress Without Distress, Herbert Benson's The Relaxation Response, and Bruce McEwen's The End of Stress as We Know It, Robert Sapolsky's Why Zebras Don't Get Ulcers, Stephen Porges's The Pocket Guide to the Polyvagal Theory, Pat Ogden's Trauma and the Body, Jiddu Krishnamurti's This Matter of Culture and Alan Watts's The Wisdom of Insecurity and Tao: The Watercourse Way.

This is how I do that with their considerable assistance. 

The Very Likely -- and Very High -- Risk of Addiction Switching

A friend's daughter recently self-published a book about a close relative's battle with severe substance abuse. For a first time at bat, it's not bad. And the pretty-much-true story there is inspiring, for sure.

But reading through it from the perspective of one in long-term recovery (36 years C&S), I was as dismayed as I (along with my hero, Dr. M) usually am to note that the topic here was not examined. Or even recognized. Because it's a situation school-trained, addiction treatment professionals run into over and over and over again. And, moreover, a situation that so often leads a recovering substance abuser back into the clutches... sometimes once and for all.

Blessedly for me after slipping right into addiction switching after getting the plug in the jug and tossing out the connections' phone numbers back in 1984, my own AS did not (quite) kill me. But it almost did. Twice.

The protagonist in Ms. Yerxa's book turns to hyper-exercise in a manner not dissimilar to one of my own new obsessions in the mid-1980s: Long-distance bicycle racing. No more or less than sex, romance, social causes and work, I went fully (and diagnosably) obsessive-compulsive with that and other forms of physical exercise, and continued to do so until I began to break both mentally and physically from the buildup of lactic acid and its dangerous conversion to sodium lactate in the brain. (Other high-incidence addiction switches I run into here and elsewhere on a regular basis include food, gambling, online gaming and Internet pornography.)

In my case, the upshots included at least two forms of toxic-stress-induced bipolar spectrum disorders. My life from 1994 to 2003 was a never-ending cycle of "manic or panic" that took me to the psych lock-up eleven times, to the ER at least that many times... and cost me a career, a marriage and $440,000.00. Let me assure you: No One who has ever been through any of that wants to continue with being bipolar for another five minutes. Complex PTSD can be plain ghastly.

And yet, among recovering substance abusers who have not been through professionally administered treatment programs -- and even for some who have -- addiction switching runs rampant. Addiction and codependency treatment expert nonpareil Pia Mellody told us way back in 1991 that sex, romance and relationship were the truly fundamental addictions underlying almost all others. And that one had to clean house with respect to those to -- as another addiction expert named Anne Hardy told me even before that -- kill the core of addiction. (Hardy and her husband, Sam, ran a recovery home for adolescents in the Palm Springs area back then, and they had no doubt whatsoever about the cause of addiction among their teenage charges.)

(Mellody and the Hardys were already aware of Bozarth's, Carnes's, DiClemente's and Khantzian's ideas in those days. See the References below.) 

I have attended Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, Pills Anonymous and Marijuana Anonymous meetings since 1984. Until very recently, I've never heard anyone in any of those almost 10,000 meetings even say the words "addiction switching." (I am pretty much the only person who shares about that topic. But I do so regularly.)

Addiction switching is treatable and preventable. Chemical abstinence is mandatory at the outset. But then, it very often comes down to addressing the pressing question, "Will the Addict Ever Stop Using SOMETHING if He or She remains Depressed, Anxious & Belief-Bound?"

For me, at least, Ms. Yerxa's book was a very useful reminder of what can happen when that question remains unanswered.

So. Proceed at your own risk. "One can do anything they want in recovery so long as they're willing -- and able -- to deal with the consequences.

Published References and Resources

Bozarth, M.: Drug addiction as a psychobiological process, in Warburton, D. (ed.): Addiction Controversies, London: Harwood Academic Publishers, 1990.

Bozarth, M.: Pleasure systems in the brain, in Warburton, D. (ed.), Pleasure: The politics and the reality, New York: John Wiley & Sons, 1994.

Carnes, P.: Don’t Call it Love: Recovery from Sexual Addiction, New York: Bantam, 1991.

DiClemente, C.: Addiction & Change: How Addictions Develop and Addicted People Recover, New York: Guilford Press, 2006.

Dodes, L.: The Heart of Addiction: A New Approach to Understanding and Managing Alcoholism and Other Addictive Behaviors, New York: Harper & Rowe, 2002.

Ekleberry, S.: Seminar on Substance Abuse and Axis II Personality Disorders, San Francisco: Arcturus (online), 2000. 

Gorski, T.: Gorski-CENAPS Model of Substance Abuse Treatment, Springs Hill, FL: Gorski-CENAPS, 2001.

Hamilton, L.; Timmons, C.: Principles of Behavioral Pharmacology, Englewood Cliffs, NJ: Prentice-Hall, 1990.

Kannon, J.; et al: Narcotics Anonymous, North Hollywood, CA: Narcotics Anonymous World Service Office, 1981 through 2008 (one original and five revised editions).

Khantzian, E. J., Mack, J.F.; Schatzberg, A.F.: Heroin use as an attempt to cope: Clinical observations, in American Journal of Psychiatry, Vol. 131, 1974.

Khantzian, E. J.: The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence, in American Journal of Psychiatry, Vol. 142, 1985.

Khantzian, E.J.: The self medication hypothesis of substance use disorders: a reconsideration and recent applications, in Harvard Review of Psychiatry, Vol. 4, No. 5, Jan-Feb 1997.

Koob, G.; Le Moal, M.: Drug addiction, dysregulation of reward, and allostasis, in Neuropsychopharmacology, Vol. 24, 2001.

Koob, G.: Allostatic view of motivation: implications for psychopathology, in Motivational Factors in the Etiology of Drug Abuse, at the Nebraska Symposium on Motivation, Vol. 50, edited by Bevins, R.; Bardo, M.; Lincoln NE: University of Nebraska Press, 2004.

Koob, G., Le Moal, M.: Plasticity of reward neurocircuitry and the ‘dark side’ of drug addiction, in National Neuroscientist, Vol. 8, 2005, doi:10.1038/nn1105-1442.

Koob, G.: A Role for Brain Stress Systems in Addiction, in Neuron, Vol. 59, No. 1, July 2008.

Koob, G.: Neurobiology of Addiction, in Focus, Vol. 9, December 2011.

Mate, G.: In the Realm of Hungry Ghosts, Berkeley, CA: North Atlantic Books, 2010.

Mellody, P.: Miller, A. W.: Facing Love Addiction: Giving Yourself the Power to Change the Way You Live, San Francisco, Harper, 1992.

Prochaska, J.; Norcross, J.; DiClemente, C.: Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Live Positively Forward, New York: Harper-Collins, 1994.

Shaffer, H.; LaPlante, D., La Brie, R.; et al: Toward a Syndrome Model of Addiction: Multiple Expressions, Common Etiology; in Harvard Review of Psychiatry, Vol. 12, 2004.

Stahl, S.: Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, 2nd Ed., New York: Cambridge U. Press, 2000.

Wilson, B.: Alcoholics Anonymous, New York: AA World Services, 1939, 1955, 1976, 2004 (one original and three revised editions).

Wilson, B.: Twelve Steps & Twelve Traditions, New York: AA World Services, 1951.

Wilson, B.: The Best of Bill: Reflections on Faith, Fear, Honesty, Humility and Love, New York: A. A. Grapevine, 1986.

Why do Two Codependents get – and Stay – Involved with Each Other?

What I have seen since I went to my first CoDA meeting in 1990 is...

When two people were conditioned, in-doctrine-ated, instructed, socialized, habituated, normalized and neurally “hard-wired” to sadomasochistic tendencies well before they met -- and they are both willing to race around a mutual Karpman Drama Triangle alternately playing Rescuer, Persecutor and Victim -- they're evidently more likely to keep racing around that thing.

The "classic" codependent needs to be abused to feel seen and heard. (See Associating Abuse with Safety & Security.)

Most severe codependents do get into -- and remain in -- romantic enmeshments with other codependents, and/or with malignant narcissists who almost always play sadist to the codependent's masochist because narcissists of that type direly need someone to abuse to feel better about themselves.

AND, depending upon who's the "alpha dog" in any given relationship, codependents may be sadists in one relationship and masochists in another. ("Caca rolls downhill," after all.)

If intrigued, see also...

The Patterns & Characteristics of Codependence on the Codependents Anonymous website, and notice how a codependent can be one way with some people and the opposite with others. (It's all conditioned, instructed, socialized, habituated, and normalized polarized extremism in a flip-flop set-up that often looks about like this.)

“Narcissist as Glutton. Codependent as The Next Meal”

Resources:

Bools for the Adult Children of Narcissistic Parents

Better Books on Codependency and Related Topics