There are different opinions about avoidance and they seem to fall short when it comes to the reality of living a functional life with cPTSD. So we will take a short look at the extreme statements about avoidance and explore the body work concept of capacity to create more clarity.
Avoidance
Contra
Some believe that avoidance in PTSD is like avoidance in phobia. The more we try to avoid something the more sensitive we become for it. That is why our response to a trigger gets worse the more we avoid it. Imagine running from the city noise into nature, only to get hyperaware how loud the bees are humming. Returning to the city would be overwhelming after we have sensitized ourselves for noises like this. So the mantra is: Avoid Avoidance!
Pro
Others believe that avoidance in PTSD happens for a good reason. We don’t process things when they get triggered, we just experience more stress that costs us energy and functioning. Relentlessly pushing ourselves to face what is difficult for us will only strengthen the trauma pattern of survival in our body and mind and drive the trauma deeper into our system. The mantra is: Avoid stress at all cost!
The problem with these positions is that they are both true but they are completely missing the point. There is no simple answer to the question of avoidance; we will have to assess situations ourselves and decide what is best. To be able to successfully discern what to do we need to understand capacity.
Capacity
The expression ‘capacity’ is used in trauma body work to describe the ability of our nervous system to deal with situations, to show a healthy stress response and then regulate back to our safe and social state in a natural flow. (If you haven’t already, please make yourself familiar with the polyvagal ladder, it is the foundation of what I am trying to explain).
The important thing is not to never get stressed, it is to have a flexible dynamic in our nervous system and to be able to follow the rhythm of regulation back to a calm state.
The nervous system and stress
We can imagine our nervous system like a pool full of water and stressful situations like big beach balls that the world throws into our pool. It happens all the time. When our nervous system is strong and healthy we will experience an increase in stress in our body, the nervous system gets stirred and then calms down in little waves that serve to release the stress. Thinking of the pool, they transport the beach ball to the side of the pool and out of the system. These little waves, the capacity of our nervous system to regulate after getting stressed, is what we need to pay attention to.
The traumatized nervous system
Trauma are beach balls that were thrown into our pool and they were too big to allow for the natural waves to develop to release the stress from the body. They get stuck there and end up sitting in our pool, taking up space and limiting our ability to create little waves for the new beach balls that life throws at us. That way it gets easier for more beach balls to get stuck in the pool and take up space. All that space in our nervous system that is blocked by beach balls limits how well we can cope with normal stress in life because our nervous system isn’t flexible to move like it should anymore.
When we experienced early childhood adversity, including abuse, neglect, unsafe attachment etc our pool doesn’t grow to the same size other people have, so we are not just more vulnerable to beach balls to begin with, we also can’t handle as many as other people who have more space for waves to happen (see The polyvagal theory)
When the nervous system gets stuck
We need at least some space in our pool to create little waves of regulation to manage stress in a healthy way. If we have a pool full of beach balls our nervous system gets stuck in a defensive state, it is not regulating back to safe and social anymore. We are now living in a chronic, functional flight/fight/freeze response. We end up with low capacity and, because being in a defensive state takes a lot of strength, low levels of energy. Coping with everyday life can become difficult and we have no tolerance for being present, sensing our bodies or dealing with stress.
We might not even know the rhythm of regulation of the little waves because we never had a chance to experience them. Whenever we free a little capacity and there is movement in our nervous system we get scared and try to stop it from happening, often by getting busy or using toxic coping strategies that add a new beach ball to our pool to keep things stuck like we know it.
Getting the nervous system unstuck
To get some space in our pool we either have to take out beach balls or make the pool bigger.
We need at least some waves to get a beach ball unstuck, that is why we learn specific techniques to calm ourselves during phase 1 of our trauma therapy. If we can’t regulate at all, we don’t have the capacity to manage trauma work. Therapists who move too fast, ignoring capacity, will add more beach balls to our pool by doing so.
It takes time and patience but it is possible to expand our pool over time. We do this using orientation-based mindfulness and grounding exercises. The more awareness we have for our surroundings and our body, the more we can experience safety. It is this new sense of safety that opens up space for us to experience some little waves again.
It is not comfortable to start experiencing little waves. It means feeling emotions and the physical sensations of moving through stress responses until the body regulates back to safe and social. Make sure to work on this with your therapist. For some the experience of movement within the nervous system and of regulation is so strange it could get overwhelming. That is why we only try to expand our pool in tiny steps and stop mindfulness exercises when they start to become too uncomfortable for us. There is no use in pushing here. That is not how it works.
Managing capacity
Even with beach balls stuck in our pool we can learn how to move with the little waves of regulation we get when we expand the pool slowly. We can get really good at following the process with our attention, noticing when we get stressed and what it feels like and then staying with the process so that we can also feel our nervous system calm down again. By observing the waves coming and going we can gain security with the process; we know that we will return to a calm state. Eventually we will lose our fear of dysregulation. It is not inherently bad, it is just something that happens and passes, a natural movement the nervous system goes through. Often the only thing that keeps us dysregulated is our fear of dysregulation and our evaluation that this should not be happening or needs to be stopped with force.
The tolerance for experiencing the process of regulation is needed for any kind of trauma work. We collaborate with our T to address specific beach balls and then let our nervous system go through the little waves to move the trauma out of our system. In trauma body work this will be a focus, but it also happens in any other successful technique, even if it is more mind-based. The body releases the energy in ripples and regulates back to safe&social. This is what happens in our nervous system when we integrate trauma. I have no love for techniques that try to bypass this natural development (More) or aim to artificially create capacity (More). In learning how to manage stress by allowing our nervous system to regulate we protect ourselves from future trauma and learn better coping skills that will serve us all our life. We need to build capacity for long-term success. Trying to get around that with the aim of processing trauma, ignoring nervous system health, will do us little good.
The concept of capacity is superior to the window of tolerance because it is more accurate when it comes to the process of regulation and doesn’t condemn dysregulation unnecessarily. The big question is not how much we can do without ever touching hyperarousal, it is how stressed we can get and still have the capacity to regulate ourselves in a natural flow. This turns out to be a lot more practical in real life.
Capacity and DID
Just like we need a certain capacity to get beach balls unstuck we need it to reduce or remove dissociative barriers. Rushing integration will not work. Don’t try to pull down dissociative barriers!! We need to slowly build up tolerance for inner connections so that we will have the capacity to integrate. The idea is to practice being together while also being able to regulate. Doing orientation and grounding exercises together as a team is priceless. Once we have built capacity co-consciousness and blending will be a lot easier and in some cases integration might happen spontaneously.
Capacity and avoidance
So what does all this mean when it comes to making decisions about avoiding stress?
We can check our inner pool to see how much capacity we have. Is there enough space in our nervous system that we could regulate ourselves when we throw a new beach ball of stress into the pool? When we manage that, the waves of regulation will let the beach ball drift to the side and out of the system again. It means that we will experience some action inside but we will be fine, the beach ball will not be added to our collection.
Apart from the condition of our pool we also need to compare the size of the new beach ball situation with our capacity. Could it possibly be too big to cope? Failing to regulate after a stressful event means that it has been too big. Actively seeking orientation, safety and regulation after stress can make avoidance unnecessary.
With DID, avoiding certain parts at certain times is functional. There is no value in forcing ourselves to reduce avoidance if we can’t handle it through regulation. There is no need to avoid if we have the capacity.
Our pool changes from day to day. Sometimes we got more sleep, there were safe and positive exchanges, we brought a trustworthy friend for co-regulation etc and we will have slightly more capacity. Some days suck and if we pay attention to it, we will know that it is not a good day to take on beach balls.
This is how we decide when to avoid and when to push through. There is no formula that would make it easier, we will have to listen to ourselves and listen to our body. Just because we can put our nervous system through a tough workout one day doesn’t mean that we can do it the next day or should be doing it every day. Befriending our weakness on days when capacity is lower is part of proper self-care. It would be folly to push ourselves beyond our capacity simply because someone said that we need to avoid avoidance. Avoidance is not the problem. Any conversation about avoidance in PTSD that ignores capacity misses the point.
So, check your pool, check the beach ball, make sure you have capacity, increase capacity over time and always keep in mind: we can’t control life. It would be best to be prepared for some unexpected beach balls and not use up all our capacity all the time. That’s the path to stability.
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How do I find a therapist who specializes in all this? How do I find such a person? I live in Montreal, Canada, it’s difficult. I need a therapist who deeply understands the content of this article, and who can guide me through healing, after 4 years of ACA and other trauma modalities have left me shattered and worse. Or maybe I’m just no longer in denial? Either way, it’s a threat to my survival. I need a therapist who can deeply understand this. How do I find one?
Mine is trained in Somatic Experiencing. That is where I learned about capacity. Find someone who knows the work of Peter Levine and maybe Kathy Kain.
I still can’t help seeing a paradox here. If someone’s nervous system is so chronically hyperaroused that they have no capacity left (the pool is full), how can they shift some balls to find a calmer baseline?
It seems like they’d need to shift some of these balls first, in order to move the system into a calmer state, but that the nervous system is too overwhelmed to be able to create the extra little ripples needed to do so. My anxious mind can’t help seeing a catch 22.
The metaphor isn’t perfect and it is difficult work. We have articles about chronic dissociation that explain what to expect. And one about increasing capacity and some about advanced emdr and fractionated abreaction. Those might help.
First, you don’t try to remove balls, you try to build additional space for the pool. Build up safety and resources that help with regulation. It makes the balls move and feels uncomfortable.
Then there are techniques to break down balls into small pieces. You might not be able to take out a whole ball but you can take out the pieces.
It can still be tricky but real life goes beyond metaphors.
Hi Pete
I’m not sure if this is what you mean by „shift some balls first,“ but for me I did have to remove myself to a safer environment before I could work on the hyperarousal. My nervous system could not move to a calmer baseline while I was still physically and emotionally unsafe. I needed to get safer before healing. It’s pretty similar to what I did in EMS: get patient out of harm’s way, and to safety before effective treatment can start. Be well.