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Section 15
Coping Styles with Posttraumatic Outcomes

Question 15 | Test | Table of Contents

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In the last section, we discussed the effects of triggers on PTSD clients and also various types of triggers:  anniversary triggers, current stresses, and bodily triggers.

Now that we’ve discussed the various types of triggers, we will move on to coping strategies for the client’s reaction to these triggers. 

In this section, we will present three techniques to help a PTSD client cope with their triggers:  trigger coping questionnaire, writing, and abdominal breathing exercise.  We will discuss PTSD resulting from combat and sexual abuse.

Cho, a 29 year old escaped refugee from North Korea, related her traumatic experiences while imprisoned in a communist detention center for singing a South Korean song.  Cho stated, "They beat me, bad.  Every day.  After breakfast of rice, they would beat me, because they liked to see me throw up.  I would go hungry until they fed me again the next day.  The guards raped me and told me I was a traitor.  They told me my family was dead and my husband was dead.  I did not know if they were lying.  Now when I smell rice, I want to throw up." 

As you can see, one of Cho’s strongest triggers was rice.  Her other triggers included the smell of blossoms and warmth because she was imprisoned during the warm blossoming season; the feeling of being dirty because she was not allowed to bathe while in captivity; and the sound of metal doors banging open or closed.  Throughout this section, we will relate the following techniques to Cho’s specific triggers:  rice, blossoms, feeling dirty and metal doors. 

Three Techniques to Cope with Triggers

♦ Technique #1:  Trigger Coping Questionnaire
To help Cho motivate herself to face these triggers, her therapist Marion asked her to answer the following "Trigger Coping Questionnaire" relating to her present coping strategies with the trigger of rice:

♦ Technique #2:  Writing
To help with Cho’s trigger, blossoms, Marion suggested she try writing about what the blossom means to her.  Some clients prefer to use positive self-talk in their writing about their triggers, but Cho decided on a different route.  In her culture, it was common to write poems about blossoms and the weather associated with it. 

First, Cho started out by reading some of her favorite poems to remind her of the calm and sense of beauty that blossoms once inspired.  Eventually, she began to write poems of her own about the blossoms and the purity they represented.  After a few months of writing, Cho reported that she was growing a small cherry tree in her backyard to symbolize her healthy growth.  Her reintroduction to what she had loved about blossoms in the first place helped Cho to overcome her fear of them as her trigger.

♦ Technique #3:  Abdominal Breathing Exercise
Because her triggers, feeling dirty, loud metal doors and rice, all caused Cho to feel anxious and on edge, Marion suggested Cho use a relaxation technique.  Her choice of relaxation was the "Abdominal Breathing Exercise." 

While she stood outside the restaurant, Cho also had extra support from a friend, who held her hand and said soothing things to her.  Importantly, this friend was female because Cho associated rice and males with the guards who beat her.  Some of your clients might prefer this extra support as well.  The "Abdominal Breathing" exercise is designed to decrease body tension by increasing oxygen flow to the brain.

  Here are the instructions I gave to Cho:

Five full minutes of abdominal breathing will have a pronounced effect in reducing anxiety or early signs of panic.  Other breathing exercises include the Calming Breath exercise which we discussed in section 3.
              
In this section, we presented three techniques to help a PTSD client cope with their triggers:  trigger coping questionnaire, writing, and abdominal breathing exercise.

In the next section, we will discuss techniques to help your client recall the trauma safely and accurately:  memory prompts, revisiting the scene of the trauma, talking to others, and artistic outlets.   Also, we will discuss self-forgiveness and its relation to the recall process.
Reviewed 2023

Peer-Reviewed Journal Article References:
"Advancing complex explanatory conceptualizations of daily negative and positive affect: Trigger and maintenance coping action patterns": Correction to Dunkley et al. (2014) (2014). Journal of Counseling Psychology, 61(2), 263. 

Bosmans, M. W. G., van der Knaap, L. M., & van der Velden, P. G. (2016). The predictive value of trauma-related coping self-efficacy for posttraumatic stress symptoms: Differences between treatment-seeking and non–treatment-seeking victims. Psychological Trauma: Theory, Research, Practice, and Policy, 8(2), 241–248. 

Lehmann, C., & Steele, E. (2020). Going beyond positive and negative: Clarifying relationships of specific religious coping styles with posttraumatic outcomes. Psychology of Religion and Spirituality, 12(3), 345–355.

Taylor, S., Charura, D., Williams, G., Shaw, M., Allan, J., Cohen, E., Meth, F., & O'Dwyer, L. (2020). Loss, grief, and growth: An interpretative phenomenological analysis of experiences of trauma in asylum seekers and refugees. Traumatology. Advance online publication.

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

QUESTION 15
What are three techniques that are useful in helping PTSD clients cope with their triggers? To select and enter your answer go to Test.