The PTSD Workbook: Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms

362 Pages·2013·18.26 MB·English

by  Mary Beth Williams PhD LCSW CTS

“This excellent workbook, based on a rich body of research, will be helpful to anyone who has experienced
a sudden, incomprehensible event or suffered lifelong abuse. The authors have provided readers with a
clear, comprehensive explanation of trauma, accompanied by practical yet creative exercises to help them
manage their trauma symptoms. It’s also a valuable resource for clinicians as well as members of the general
public striving to understand trauma and return to everyday functioning.”
— Betty Stevens-Guille, PhD, CPsych, trauma specialist,
Edmonton, Alberta, Canada
“For those who believe that they will never feel ‘normal’ after a traumatic event, this workbook provides
many techniques that survivors can use to jump-start their recovery…an extremely important tool for
growth and strength.”
—James D. Baxendale, PhD, CTS
“The PTSD Workbook, Second Edition, is an excellent resource for those directly affected by a critical or
traumatic event, as well as for professionals working in the trauma field. Filled to the brink with concrete,
helpful tools and useful information, it will guide the reader in reducing the untoward effects of trauma.
Clinical wisdom is combined with evidence-based information in a very readable book. Having worked
with trauma and loss for over thirty years I know that this book will be an indispensable guide for the
field.”
—Atle Dyregrov, PhD, director at the Center for Crisis Psychology, Bergen, Norway
“This revised workbook is based on the latest research, but written with the same warmth and wisdom that
informs the first edition. It is a classic for those who live with severe trauma on an ongoing basis.”
—M.E. Stevens-Guille, PhD

PTSD
THE
W OR K B O OK
SECOND EDITION
Simple, Effective Techniques for
Overcoming Traumatic Stress Symptoms
Mary Beth Williams, PhD, LCSW, CTS
Soili Poijula,
PhD
New Harbinger Publications, Inc.
Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is
sold with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other professional
services. If expert assistance or counseling is needed, the services of a competent professional should be sought.
Distributed in Canada by Raincoast Books.
Elements from The Body Remembers: The Psychophysiology of Trauma Treatment by Babette Rothschild. Copyright ©
2000 by Babette Rothschild. Used by permission of W. W. Norton & Company, Inc.
“Assessing Your Self-Criticism,” “Using Self-Compassion Phrases,” and “Fostering Self-Compassion” adapted from
SELF-COMPASSION: STOP BEATING YOURSELF UP AND LEAVE INSECURITY BEHIND by Kristin Neff,
copyright © 2011, published by HarperCollins Publishers. Used by permission of author.
Copyright © 2013 by M ary Beth Williams and Soili Poijula
New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com
Cover design by Amy Shoup
Edited by Jasmine Star
Acquired by Catharine Meyers
Text design by Tracy Marie Carlson
All Rights Reserved
Library of Congress Cataloging-in-Publication Data
Williams, Mary Beth.
The PTSD workbook / Mary Beth Williams, PhD, LCSW, CTS, and Soili Poijula, PhD. -- Second
edition.
pages cm
Includes bibliographical references.
ISBN 978-1-60882-703-9 (pbk. : alk. paper) -- ISBN 978-1-60882-704-6 (pdf e-book) -- ISBN 978-
1-60882-705-3 (epub) 1. Post-traumatic stress disorder--Diagnosis--Popular works. 2. Post-
traumatic stress disorder--Treatment--Popular works. I. Poijula, Soili, 1958- II. Title. III. Title:
Post-traumatic stress disorder workbook.
RC552.P67W544 2013
616.85’21--dc23
2012047447
I would like to dedicate the book to my children, who have endured, complained about,
and survived “Mom’s papers”: Cary, Kirstin, Ryan, Seth, Nagima, Zhannah, and Bishop.
I would also like to dedicate it to my support team: Hedi Fried, Dr. Yael Danieli, Jackie
Garrick, Dr. Joe Albeck, Jan Shubert, my coauthor Soili Poijula, and especially Lasse Nurmi.
— MBW
I would like to dedicate this book to my mother Maria,
a war orphan herself, and the mother of mothers.
— SP
This book is dedicated to all the helping professionals, members of the military, law enforcement
officers, and fire, rescue, and EMT personnel who serve in spite of the challenges, danger of
compassion fatigue, and certainty of impact of the work on their own lives, including potential
loss of life. This book is also dedicated to survivors throughout the world.
— MBW and SP

Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
1 A Look at Trauma: Simple and Complex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
2 Before Doing the Work: Safety, Security, and Intention . . . . . . . . . . . . . . . . . . . . . . . . . .35
3 Identifying and Writing about What Has Happened to You . . . . . . . . . . . . . . . . . . . . . . .57
4 Helping Yourself When You Reexperience a Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
5 Coping with Trauma with Less Avoidance and Denial . . . . . . . . . . . . . . . . . . . . . . . . . . .94
6 Lessening Arousal: What to Do If You Can’t Sleep, Can’t Relax, or Are Angry
and Irritable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106
7 Stress, Trauma, and Your Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140
8 Dealing with Associated Symptoms of PTSD: Guilt, Survivor Guilt, Shame, and Loss .150
9 For Veterans Returning from War: Tools for Personal Survival . . . . . . . . . . . . . . . . . . . .174
10 Difficulty Regulating Emotion (Complex PTSD, Category 1) . . . . . . . . . . . . . . . . . . . . .192
11 Alterations in Attention or Consciousness: Dealing with Dissociation
and Traumatic Amnesia (Complex PTSD, Category 2) . . . . . . . . . . . . . . . . . . . . . . . . . .221
12 A Bit More about Somatization: How Trauma Impacts Your Body
(Complex PTSD, Category 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .227
13 How Trauma Impacts the Way You View Yourself (Complex PTSD, Category 4) . . . . . .231
14 Dealing with Your Perpetrators (Complex PTSD, Category 5) . . . . . . . . . . . . . . . . . . . .257
15 Alterations in Your Relationships with Others (Complex PTSD, Category 6) . . . . . . . .261
16 Finding Meaning (Complex PTSD Category 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .288
17 Final Thoughts and Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .303
Appendix A: Complex PTSD Questionnaire for Trauma Survivors . . . . . . . . . . . . . . . .320
The Stressors of War Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .329
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .343

Introduction
As the second edition of this workbook goes to print, the tenth anniversary of 9/11 has come and
gone. Osama bin Ladin, who claimed responsibility for the attacks, has been caught and killed.
Peacekeeping forces from the United States and other countries continue to fight in Operation
Enduring Freedom (OEF) in Afghanistan, and Operation Iraqi Freedom (OIF) has officially drawn
to a close. Security checks and rechecks at airports are now a way of life: take off your shoes and
put them in the container, take all metal out of your pockets, and hold up your arms over your
head for the X- ray version of a strip search.
In spite of preventive efforts and best practices such as Resilience Training or Comprehensive
Soldier Fitness education for those going into combat, and in spite of increased emphasis on resil-
ience and post- traumatic growth, thousands upon thousands of young men and women have been
wounded in many ways through repeated deployments, exposure to guerilla- type warfare, blasts
from improvised explosive devices (IEDs) that have led to amputations and traumatic brain inju-
ries, and other war- related traumatic events.
The U.S. Department of Veterans Affairs (formerly the Veterans Administration) is over-
whelmed with claims from veterans of past wars, particularly Vietnam veterans reaching retire-
ment age, Now that their productive work lives are winding down, these veterans are finding that
their previously effective avoidance mechanisms are no longer keeping away the memories of the
past. They also are coming face- to- face with mortality as the effects of Agent Orange, dormant for
decades, invade their bodies in the form of type 2 diabetes, prostate cancer, and many other VA-
accepted illnesses and diseases. Add to these veterans others from Desert Storm, OEF, OIF, and
other military operations, and the wait time to process an initial claim may run eighteen months
or so; if veterans dispute the rating they receive, it may take another eighteen months to two years
to get reconsideration.
In the years since the first edition of this book was published in 2002, tragedies and disasters
have continued to plague the world. The Virginia Tech shooting in 2007 was the deadliest mas-
sacre by a single perpetrator in U.S. history. The Aurora, Colorado, shooting on Friday, July 20,