When the past feels like it's happening now: trauma and PTSD
A woman is in a crash on the A21. Months later the physical injuries have healed, but the sound of a horn in a car park sends her heart rate through the roof. She doesn’t think “that reminds me of the crash”. Her body reacts as though the crash is happening again. She has started avoiding driving, and her world is getting smaller.
The Oxford psychologists Anke Ehlers and David M. Clark built their model of PTSD around exactly this experience. Their idea is that PTSD persists when a trauma is processed in a way that makes it feel dangerous now rather than over. Two things drive that sense of current threat. One is the meaning attached to what happened, such as “I’m not safe anywhere” or “it was my fault”. The other is the way the memory itself is stored: fragmented, easily triggered, and missing the context that says it ended.
Cognitive therapy for PTSD works on both. We find the worst moments of the memory and connect them to what you know now, for example that you survived. We practise telling present-day triggers apart from the original event, so a horn in a car park becomes a horn in a car park. Where it helps, people sometimes revisit the place where it happened, which is often the moment the memory finally files itself as the past.
The evidence is strong. In a 2014 trial, 77% of people having weekly cognitive therapy no longer met criteria for PTSD, compared with 7% on a waiting list. Many people worry they need months of stabilisation before they can touch the trauma, but Ehlers’ group found that most people don’t.
If something that happened to you still feels like it’s happening, trauma-focused therapy is worth exploring. Read more about trauma and PTSD therapy, or get in touch.