I frequently hear patients tell me that they have trouble concentrating because they find themselves thinking about what happened to them when they don’t want to be. Another complaint I hear is that a person feels that some part of them is not really in the room. For example, a patient might tell me, “I was at my daughter’s birthday party watching her blow out the candles, but maybe the flames reminded me of the house fire I just responded to [while working as an EMT, for instance], and I felt so anxious.” People also tell me about feelings that seem more intense than the situation calls for, because sometimes emotions alone evoke a sense of dread that doesn’t quite match the current moment. For instance, maybe grief over a lost pet evokes the fear and dread of treating COVID patients as an emergency doctor, when grief and dread went hand in hand for months on end. I think you get the point: Part of PTSD means having unwanted memories and feelings associated with a traumatic event. Flashbacks—when you may actually feel as though you are back at the scene, rather than remembering it—can also be part of this experience. But the “intrusive memories and flashbacks” feature of PTSD can take many forms.
Also part of this symptom category are nightmares, or distressing dreams. We all have dreams that are bizarre sometimes, and dreams related to traumatic events are often no exception. Maybe your dream just loosely resembles what happened to you, or maybe it doesn’t look like that combat scene—or that EMT call—at all. But upon closer discussion, it might be possible for us to identify that some of the feelings you experienced during the dream, or its themes (of self-blame, mistrust of others, or having no place to go), resemble what you actually went through. Night terrors, which can involve abruptly awakening in a state of intense fear without a clear memory of a dream, are different from nightmares. Although they are not themselves a diagnostic symptom of PTSD, they can sometimes occur alongside trauma-related sleep disturbances.
So, why am I telling you about all of this? Because whether or not you actually meet the criteria for PTSD, these kinds of experiences can really get in the way of functioning and feeling good. You deserve to have someone to speak about them with so that you can process those memories, thoughts, and feelings. With appropriate treatment, you may have an opportunity to become less distressed by those memories, so that they eventually feel more ordinary, or even almost “boring,” when you revisit them. It’s then that they can start to become part of your past instead of intrusive memories that come up when you don’t want them to.
So, if you feel comfortable doing so, try keeping a log on your smartphone or in a diary next to your bed about what you think or dream about, what you feel that seems disproportionate to the situation, or when you experience episodes of intense fear during sleep. Note the date and time, what you experienced (triggers or situations, feelings or thoughts, and how you coped), so that you can talk about it with your therapist. You don’t need to force yourself to revisit upsetting memories on your own. But you might find that, with support, facing these challenges makes them surmountable.
About the Author: Andrea Mazzarino, LCSW-C, PhD, is a licensed clinical social worker and trauma therapist providing individual psychotherapy and mental health counseling to adults and adolescents in Maryland, Virginia, Washington, D.C., Florida, and Minnesota. Through her private practice, Windy Creek Therapy, she specializes in PTSD, trauma recovery, anxiety, and stress-related disorders, using evidence-based approaches including EMDR therapy, cognitive behavioral therapy (CBT), and mindfulness-based interventions. She offers in-person therapy in Montgomery County, Maryland, and online therapy for clients in states where she is licensed.
