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PTSD Getting Worse

Question:

I have post traumatic stress disorder. When I get sometimes feel the least little bit anxious I start thinking that I should do away with myself. I have to really fight to not act on it. I have come a long way in my healing but I don[t want things to stay this way. It is too tiring. I also get angry very easily and say things I shouldn’t. It was never like this before in my therapy. Any thoughts.

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  • Dr. Dombeck responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
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Answer:

Conventional behaviorally-oriented therapy for PTSD aims to help the patient process through ‘undigested’ traumatic emotional material in a very measured way. You want enough discussion of the trauma to occur so that the patient is not completely avoidant of the material, but at the same time, you want to make sure that the material that is discussed never becomes so vivid that it becomes overwhelming and re-traumatizing. It’s a moving target as you might guess, and difficult to accomplish for both patient and therapist. I don’t know a thing about the sort of therapy you’re in or if it subscribes to the outline I’ve described just above. I wonder though, if the therapy work you are doing (or have done recently?) might be too overwhelming for you. It sounds like you are overwhelmed. I’d recommend making your therapist aware of your increased symptoms if you haven’t done that already, especially your suicidality. You should have a suicidality plan in place and know exactly what to do if you start feeling that you will kill yourself soon. You may want to ask your therapist about whether he or she can work on teaching you self-soothing skills for a while, rather than doing any sort of ‘dealing with the trauma memories directly’ sort of exploratory work. Also, you may want to consult with your psychiatrist to see if there are any medicines (or changes in your current medication regime) that might help you cope better and de-escalate the danger you’re feeling. Letting those around you know about your increased symptoms and suicidality might be a good idea as well. They can’t support you if they don’t know what they are dealing with. Good luck to you.

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