Complex PTSD and Psychedelics
Woven together by several threads of trauma, complex post-traumatic stress disorder (C-PTSD) can paralyze a person’s mind in places of darkness. Could psychedelic therapy present a way out?
What Is C-PTSD?
In his book, ‘The Body Keeps the Score’, the Dutch psychiatrist and researcher Bessel Van de Kolk highlights the debilitating nature of trauma:
“Traumatized people chronically feel unsafe inside their bodies: The past is alive in the form of gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside. They learn to hide from their selves.”
Psychiatrist and author Bessel Van der Kolk - whose work has contributed to understanding the nature of trauma and complex PTSD
Many people are familiar with post-traumatic stress disorder (PTSD) - a condition that can be characterized by such conditions as nightmares, flashbacks, and heightened states of anxiety associated with memories of a traumatic event. Less spoken about, but equally common and equally crippling exists a related condition called C-PTSD.
Unlike PTSD - which tends to be focused around a single event, C-PTSD manifests from a cluster of traumatic events such as ongoing domestic abuse, repeated abuse in childhood or other prolonged instances of distressing, inescapable circumstances that compound upon each other. Such earlier life hardships can have long-term impacts, including persistent feelings of low self-worth, distrust in others and separation from society and the surrounding world.
Although the term has been around since 1988, C-PTSD remains less well known and understood than other mental health disorders. Perhaps the relatively small public awareness comes from a lack of ease in distinguishing the condition, with its considerable overlap with both PTSD and borderline personality disorder (BPD). Shame and fear around situations leading to trauma also deter those with C-PTSD from sharing their experiences, keeping the condition hidden from the public eye.
Affecting an estimated 4% of the population, it is important that more attention is drawn to C-PTSD so that more people may learn to better understand and support survivors of trauma, and help to shift the status quo from that of shame, towards opportunities for growth and healing.
In the advent of a psychedelic therapy revolution, new models of understanding and treating C-PTSD appear well on the horizon.
How Might Psychedelics Help Treat C-PTSD?
People exposed to ongoing traumatic events sometimes store traumatic memories in subconscious parts of their brain - a coping mechanism by the mind to“forget” distressing experiences. However, this doesn’t stop the psychological and physical effects of trauma from occurring.
The word “psychedelic” means “mind-manifesting”, alluding to how psychedelic drugs can help reveal memories and emotions, including those stored subconsciously. As such, psychedelic therapy, which may include a combination of talk therapy and guided psychedelic experiences with a therapist, could offer a means to help people with C-PTSD “mind-manifest” and remember the subconscious memories linked to their trauma.
By surfacing these memories, and with the guidance of a therapist, psychedelic therapy could help people with C-PTSD address and better understand some of the root causes of their thoughts and behaviour, providing a clearer window for opportunities to make changes. And by increasing the capacity for change, psychedelics could aid this shift.
If you imagine thoughts and behaviours like a system of roads, people with C-PTSD often get stuck travelling down the same route. This route might be a stuck way of thinking, something like “I’m not good enough”, “the world wants me to suffer”, or “I can’t trust anybody”.
Research has shown how psychedelic drugs can increase communication between different parts of the brain. Like a driver suddenly being able to travel across hundreds of different new roads, this effect means psychedelics offer new routes and directions to think, feel and behave.
Image on right demonstrates the increased nerve communication between different areas of the brain whilst on psychedelics compared to nerve communication whilst not on psychedelics indicated by the left image
This widened scope for thought offers a chance for someone to develop more positive narratives about the self, others and the world around them, aided by the accompanying therapy and integration which goes alongside the psychedelic experience. It also provides an opportunity to re-frame memories relating to trauma, moving away from perspectives of blame and rage to something more compassionate. For example, one woman quoted following a course of psychedelic therapy using MDMA:
“The first place I saw was this maze. I went in. There was so much trauma. I had never remembered these terrible, terrible things. And before MDMA, I really did think it was my fault. I felt it in my bones that something was so wrong with me, that I deserved those things. Being on MDMA was the first time I ever felt compassion for myself. I realized that I was a child when it happened. I had no choice.”
Another woman interviewed for this blog piece also described how her experience with psilocybin enabled her to move past a place of anger, and for the first time, feel a deep sense of empathy towards her mother, who had been abusive and negligent towards her as a child. Her psychedelic experience helped her understand that her mother’s behaviours were because she, too, had been traumatized.
Could Psychedelics Be a Future C-PTSD Treatment?
As psychedelics have moved into the limelight for trauma therapy research, the scientific community has begun exploring the potentials of psychedelic therapy in C-PTSD treatment.
In a recent study, a group of scientists investigated adults who had been victims of childhood abuse. Through collecting data from various questionnaires, they compared symptoms of C-PTSD between those who had used psychedelics in an intentional therapeutic way, with those who hadn’t.
The scientists found that adults who had used psychedelics multiple times with therapeutic intent had lower scores on a DSO scale - a measure of C-PTSD core features including low self-worth, problems with regulating emotions, and difficulties in relationships. Their results also showed those who had an increased number of intentional psychedelic uses revealed decreased levels of self-shame, another common C-PTSD symptom.
These findings alone don’t conclude psychedelic therapy can treat C-PTSD. And, it’s important to consider psychedelic users had an intention to heal - a power of will that is independently transformative. Nonetheless, the study highlights how psychedelics could play a role in the healing process of C-PTSD, and with an estimated one in five adults having suffered childhood abuse, it’s promising that scientists are illuminating this area of research.
The increasing likelihood of legal and accessible MDMA therapy for PTSD, and psilocybin therapy for depression, make psychedelic therapy treatment for C-PTSD a very real possibility. However, with relatively few currently recognizing C-PTSD, and a failure by the National Institute for Health and Care Excellence (NICE) to provide any existing treatment guidelines, it’s critical that first we raise awareness, and urge a better understanding of the condition.
A final point to raise is that efforts looking to treat C-PTSD mustn’t bypass the need to address the fundamental issues that cause trauma in the first place. Psychedelic therapy offers a means to address trauma from its origins instead of simply masking its symptoms, like many of our commonplace Western medicines tend to do.
In this sense, we shouldn’t just focus on healing the suffering of trauma victims, but also on the origins, and investigating ways to prevent the oppression and suffering from occurring in the first place.
How can we move toward creating a healthier societal infrastructure based in community care and compassion, in which all the triggering and oppressive factors of poverty, stress, violence and unaddressed mental health issues that may lead to abusive behaviour are significantly reduced?
