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Jun 17 2015

Meditation and PTSD, A Self-Research Study PART 2 – Three Potential Challenges of Meditation for PTSD

Three challenges to meditation when healing from trauma and PTSD(continued from PART 1)

One thing I set out to do initially with this experiment on meditation and PTSD was to find out if there were any “pitfalls,” or really just difficulties or challenges, for people with PTSD who want to meditate. I specifically wondered if meditation would end up triggering dissociation or triggering a flashback.

So let’s see – what difficulties did I encounter?

Summary of Findings

Three Potential Challenges: Exhaustion, Dissociation and Flashbacks

  1. Exhaustion came about for four reasons:
    1. Meditation is hard work.
    2. Learning a new skill while already exhausted is tiring.
    3. Re-arranging brain synapses can be exhausting.
    4. Body oblivion issues.
  2. Dissociation temporarily increased for the following reasons:
    1. Amplification of difficult internal states due to attention may increase dissociation.
    2. Rearranging synapses can be disorienting and distressing and increase dissociation.
    3. Any of the many altered states caused by meditating (such as sleep, light trance) can be disorienting and increase dissociation.
    4. A vision or flashback can increase dissociation.
  3. Flashbacks or Visions are normal responses to going into altered states, but can be challenging to deal with when the happen.

*end of summary of findings*

Discussion

Exhaustion – Meditating While Dealing with PTSD Was Exhausting

In general, the process of meditating increased my level of exhaustion by 13.26 points.

Average exhaustion before mediation was 46.73 and average after was 60.

For 15 days out of 23 days, I became a lot more exhausted by meditating.

Out of all symptoms, only two symptoms increased. Exhaustion was the one that increased the most. The other symptom that increased in general was apathy by an average of 5.87 points. I wrote a number of times in my notes that I thought the increase in apathy was an effect of feeling so incredibly exhausted, however, when I look at the numbers apathy is not correlated with exhaustion. Changes in apathy are strongly correlated with changes in suicidality and negativity.

Mindfulness Meditation Was the Most Exhausting

One reason Mindfulness Meditation increased symptoms in general, rather than reducing them, is because exhaustion went up pretty significantly when I practiced mindfulness meditation. Exhaustion increased by 22.08 points on average from before to after doing mindfulness. For 8 days out of 12 days, I became a lot more exhausted by doing mindfulness meditation.

The other two kinds were not as exhausting. When I did Energetic Management, exhaustion reduced by 2.5 points and when I did Pranayama Breathing Only, exhaustion increased by 7.14 points.

I spent more time on Mindfulness Meditation – 28 minutes versus 11 on Pranayama Breathing, and Mindfulness was a lot of work…

Why Was Meditating So Exhausting?

Reason 1. Meditation is Hard Work.

Mindfulness and Loving Kindness are hard work when dealing with a lot of inner turmoil, being triggered, being thrown into strong feelings of disgust and terror. I put a ton of effort into it! So it tired me out. A lot. Take the notes from Day 4 (on this day I note an increase in exhaustion of 5, so this was one of the least exhausting days):

“Today I did Energetic Management, Mindfulness – noticing sounds and noticing reactions, not changing anything but noticing separation of sound from my reaction to sound, small amount giving empathetic awareness to self and others (empathetic awareness is a kind of loving kindness). My loving kindness is still a VERY weak skill.

“Why is it that when mental disintegration and dissociation go down, negativity, sorrow and apathy go up? Sometimes disintegration is too much, I don’t feel anything. I’m too disorganized. Once I get into the body more and my mind is more able to handle things, emotions like sorrow go up. Also, exhaustion is going up due to the effort exerted to do the meditation.”

(I specifically wrote about my exhaustion from effort on Days 4,7,10,11,13,14)

Day 12, 14, 10 and 17 exhaustion went up the most – by 80 points on day 14, 60 points on day 12, 50 points on day 10 and 45 points on day 17. Let’s see what was going on…

Well, one thing that happened was on the Day 12 and 14 I said I thought I was overheating because the AC had broken and the repairman had not come by yet to fix it. That doesn’t make that much sense though because the outside temperature was 68 and 66 degrees on those two days. I should have complained on Day 13 when it was 80 degrees with no AC but I never mentioned the heat and actually that was really the only day I would have needed the AC. (People with PTSD can have strange body temperature experiences) Let me just check into whether outdoor temperature had anything to do with exhaustion…

Note – Temperature, Bad Night and Time of Day Didn’t Affect Exhaustion Much. I checked to see if there was any correlation between the outside temperatures at the times I was doing meditation and exhaustion. Overall, there was a .22 correlation between the temperature and the amount of change in exhaustion, which means “weak positive relationship.” On Days 5-15 and 18, which was the Mindfulness Meditation portion (that increased  exhaustion the most), the correlation between the temperature and the change in level of exhaustion is .004, which means basically there was no correlation. On the days with the AC issue, 12-15, there was a -.94, a slightly negative correlation. There was also a negative correlation between the temperature and the average level of exhaustion (versus change in exhaustion), of -.34. There was also a -.34 correlation between time of day and average level of exhaustion, and .06 between time of day and change in exhaustion. “Bad night” was negatively correlated to both average exhaustion and change in exhaustion. So it looks like temperature, bad night and time of day didn’t affect exhaustion that much and it was more the activity of meditating itself.

As for Days 12, 14, 10 and 17, I complained that the act of meditating was terribly draining, and on one of the days I was overwhelmed by feelings of disgust and revulsion because of seeing a vision of a violent scene of someone being killed.

Reason 2. Learning a New Skill While Already Exhausted is Tiring.

Most of the time I was already exhausted – my average beginning level of exhaustion was 46.73 which is kind of dragging oneself around, half of the way to dead asleep. It was exhausting to do the meditation because it was a new skill to learn, when I didn’t have a lot of energy to begin with. One note I wrote: “Remember – NOW, life is like a Living Hell because of all this exhaustion and stress.”

Reason 3. Re-arranging Brain Synapses Can Be Exhausting.

Mindfulness meditation seeks to rearrange the neural pathways. Instead of Trigger –> Reaction, it is trying to change it to Trigger –> Neutral Observation –> New Reaction. In addition, you are changing your reaction to your reaction, so Reaction –> Neutral Observation –> New Reaction. Also, I was focusing on neutral sounds, registering on how I heard “sound” as just a vibration, and then moving my focus to triggering sounds and experiencing the characteristics of sound instead of the trigger, which is trying to bring about Trigger –> Perception as Just Sound –> New Reaction. All this is actually moving around brain synapses.

Notes that reflect how overwhelming and exhausting this process can be:

(Day 8 ) “I focused mindfulness on sounds the whole time. No loving kindness this time. Focused on sound:

  • direction
  • amplitude
  • pitch
  • rhythm
  • texture

“Then focused on my reaction: tension in chest and stomach, etc. Tried to convince myself that reaction is from brain not sound. Very disconcerting and disorienting to try to shift this, feel like crying. Sound is just SOUND not EVIL? I feel very hot inside now. Very sad. Lots of grief for what I’ve been through.”

In my experience, whenever I’m trying to change the wiring of my brain, it drains a lot of energy and leaves me tired out. Sometimes it’s overwhelming. It can bring up a lot of emotions.

Reason 4. Body Oblivion Issues.

Day 12 and 14 I overheated – I thought it was due to problems with the AC but the actual temperature was not hot so I was overheating for some other reason. On Day 20 I was totally freezing cold (outside temp was 62.1 F) (freezing is a fairly common occurrence ever since the accidents and I don’t know why it happens). There was one day I ate too much sugar and was shivering during the meditation due to the effects of the sugar. People with PTSD can be oblivious to things going on in the body (for example I get bruises and cuts I have no idea where they came from) but those things can still have an effect on them. Overheating, freezing and getting a huge sugar rush all were tiring.

Exhaustion is Likely Only a Phase

I think the exhaustion is most likely a beginning phase. Most likely, over time, all four of the above issues can be resolved and Mindfulness Meditation could then reduce exhaustion profoundly by bringing calm, peace, relaxation and new, higher perceptions of the world and self. If a certain amount of learning were to take place, a lot of synapses made new adjustments, and the body were settled, I can imagine Mindfulness would be a positive meditation technique for my PTSD symptoms.

Dissociation – Sometimes, Meditation Increased Dissociation

I had wondered if dissociation would increase. Although overall, dissociation decreased by an average of 2.4, Dissociation increased on 8 of the 23 days; the highest increase was by 50 points. Most of the days dissociation increased, I was doing Mindfulness Meditation. Dissociation increased an average of 2.92 points when doing Mindfulness Meditation, but decreased 11.43 points with the breathing and 2.5 points with the energy work.

There were a few days in which dissociation went up during the meditation and then went down by the end, basically staying the same.

These are the changes to dissociation each day:

day                         dissociation changed    (average -2.4)

1                             20

2                             0

3                             15

4                             -45

5                             -35

6                             30

7                             50

8                             15

9                             0

10                           20

11                           -10

12                           0

13                           -25

14                           -10

15                           -10

16                           -10

17                           0

18                           10

19                           -20

20                           -10

21                           -30

22                           10

23                           -20

When reviewing my Notes I found 4 reasons for the times dissociation increased significantly. (These reasons are summarized in the beginning of the article).

Note that Dissociation Increasing is not a bad thing. I was always OK with dissociation increasing because I understood it to be a temporary experience and part of a larger, positive endeavor.

These are my descriptions of the Four Reasons from my Notes:

Reason 1. Amplification of Difficult Internal States due to Attention May Increase Dissociation.

The first reason is that just by paying attention to difficult sensations and emotions increases them which increases dissociation. I wrote about this on the following days:

Day 1 – dissociation increased by 20 points. “One variable, dissociation, went up from 50 to 70. This is OK. It’s kind of expected, because I’m inviting myself to shed the fog of numbness and to be present with everything hidden underneath. That stuff can be overwhelming and cause dissociation. I don’t mind because I know that over time, as I become more adept, even the dissociation will likely begin to reduce.”

Day 2 – “Dissociation and Mental Disorganization VERY HIGH during the meditation – like “nuts”. I couldn’t keep track of what I was doing and random images kept popping up, I was disintegrated.

“Again, dissociation increased during the meditation and then by the end decreased again, ending up where I started. Why? The nature of paying attention to the really difficult emotions.”

Day 3 – dissociation increased by 15 points. “Trigger Reactivity/Disgust – I separated experiences of disgust outside of my personal space and put empathetic awareness around them. ..Then surrounded myself by empathetic awareness. Disgust increased. Mental disintegration and dissociation increased (because of the focused attention on difficult emotions). Then went down again. Increase can be good.”

Reason 2. Rearranging Synapses Can be Disorienting and Distressing and Increase Dissociation.

Rearranging my perceptions of triggers caused a feeling of distress and increased dissociation (and mental chaos).

Day 6 – dissociation increased by 30 points “dissociation changed from 40 to 70 (plus 30) due to reorganizing perceptions leads to temporary confusion and distress; mental chaos (same) changed from 35 to 60 (plus 25) due to reorganizing perceptions leads to temporary confusion and distress”

Day 8 – dissociation increased by 15 points “Again, I experienced a huge decrease in DISGUST (Trigger Reactivity) accompanied by an increase in DISSOCIATION and HYPERAROUSAL. Basically, when re-wiring or re-associating or even just observing triggers, it can cause a lot of disorientation and even emotionality. It’s worth it though… mental chaos went up 15 – because it’s disorienting to focus on triggers; dissociation went up 15 – because it’s disorienting to focus on triggers.”

Reason 3. Any of the Many Altered States Caused by Meditating (such as Sleep, Light Trance) Can be Disorienting and Increase Dissociation.

Also, some meditations were so exhausting that I fell asleep and the disorientation (from the altered state of sleep) caused dissociation to rise:

Day 7 – dissociation increased by 50 points. “dissociation went up 50 due to exhaustion and sleeping and just waking up”

Any altered state can bring new and disorienting sensations, like tingling, vibrations, etc.

Reason 4. A Vision or Flashback can Increase Dissociation.

A flashback or “vision” can occur due to inducing a light trance which is an altered state of consciousness in yourself. In my case this was not a flashback but was a “vision” because it was representative of things that happened to me rather than an exact re-experiencing as happens in a flashback. The experience was similar though; the vision was not as intense as a flashback but was still disturbing. Having visions is a normal result of meditation… with PTSD the vision could be disturbing and increase dissociation.

Day 10 – dissociation increased by 20 points. On this day I had a vision of something violent during the meditation, which had a lot of effects, among them dissociation went up.

Meditation and Flashbacks

The second pitfall I was curious about was meditation causing flashbacks. Well, as I mentioned above, on Day 10 I had a “vision” of something violent.

Flashbacks or visions can be disturbing, but they are just par for the course in terms of PTSD.

I think that when I have a flashback or vision it can actually be healing. For me, I was “ready” for this vision and the understanding it brought with it. Sure, it was disgusting and disturbing, but that’s something my mind wanted to express at that moment so I’m fine with it. It connects with some aspects of my healing process and contains a “message” for me. I am just beginning to understand that they are not as bad as actually being in a life threatening situation.

But the answer is yes, meditation induces altered states which can open up visions and flashbacks. So be prepared.

Advice for Handling these Three Challenges

  1. Understand Titration.

On Day 8 I wrote: “It’s good to go slowly. It’s very important to know how not to overdo it. Titration is a key part of Somatic Experiencing. Don’t jump in the deep end of any psychological process without first gradually learning how to swim. I think that it’s important to know how to do titration if you are trying to meditate when struggling with PTSD.

Titration is the slowing down and breaking down into parts of overwhelming experiences. Anything that comes too fast and too much, whether good or bad, causes the system to be overwhelmed. If the system is overwhelmed it can become dissociated. Whatever the experience is – in meditation it would be experiences coming from inside, such as emotions, memories, realizations or sensations – it  needs to be slowed down and broken down into pieces. The important thing to remember is to try to use the actual meditation technique itself to help slow your experience down, and to stop altogether if that’s impossible to do that for some reason.

  1. Begin with Breathing.

I would recommend to begin with any breathing meditation because it’s balancing for the body and brain, and is much less exhausting. Then after having done this for a period of time, like a few months or whatever feels right to you, try other types of meditation.

  1. Allow yourself to stop whenever you want.

Don’t hold yourself to a specific amount of time for your meditation. If you need to stop, stop.

The Biggest Challenge is to Keep Going…

The biggest challenge might be that these difficulties might become associated with the act of meditating and then the person will stop meditating due to fear.

For example, if on some level my system associates extreme exhaustion, dissociation, disorientation and  distress (like getting very hot and feeling like crying), and having visions or flashbacks with meditating, I will have part of me that becomes very resistant to meditating. Also, a lot of these distressing experiences came about exactly when I was having a major breakthrough – a turning point, insight, new way of seeing the world. These important and therapeutic experiences could easily become associated with negative experiences and then I would stop.  Part of my system would be protecting me from going there again.

I think that the way meditation calms the system in the beginning of the session is important to make these turning point moments that come up later in the session feel safe. One reason to begin with simple breathing techniques would be to get into a rhythm first, a calming rhythm of the breath, so that when either a profound realization or a distressing experience comes up, the body is already quite calm. It will hopefully ease and lessen the impact, and not set up any negative associations with meditation that would get in the way of continuing to meditate in the future.

Other impediments to continuing meditation practice are: disorganization, stress, apathy (not caring about doing it), and a long list of excuses and addictions. Like anything worthwhile, it takes some effort to overcome all these obstacles in order to make progress with the practice.

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Heidi Hanson is an artist and writer in Asheville, North Carolina currently working on an illustrated book chronicling her journey healing from Post Traumatic Stress Disorder.