Healing From Trauma | What is Complex PTSD?

If you have been reading Endo Strong for a long time, you know that I want to (eventually) attend graduate school for my Master’s in Social Work to become a licensed clinical social worker. I have a special interest in working with trauma survivors as a therapist, partly because of my personal experience with complex trauma.

I have always been anxious; a people-pleaser; over-achieving. I spent my childhood, adolescence, and early college years trying to win the approval of someone who always wanted me to be someone who I am not. Growing up with divorced parents, I spent my time split between a house where I felt safe but misunderstood, and a house where I felt fundamentally anxious and unstable. My parent has untreated mental illness and narcissistic traits that shaped me into someone who feels like she needs to be “fixed;” someone who is unworthy of love.

Thanks to my low self-esteem, I stayed in an abusive, manipulative relationship for three years and, because of my difficulties with emotional regulation, truly believed that I was the problem. In that relationship, I was sexually coerced, which I believe contributes to my experience with chronic pelvic pain. It was almost as if I sought out a flawed relationship because I did not believe myself deserving of better.

Both my mind and my body have been affected by trauma, to the point where I consider my traumatic past to be a core part of my identity. If we had “islands” of core character traits in real life, the way they do in the Pixar movie Inside Out, my Trauma Island would be an epic destination of Disney-sized proportions. That’s why I want to dedicate my life to helping people who have been through similar experiences recover from their trauma.

In particular, I have a special place in my heart for sufferers of complex post-traumatic stress disorder (C-PTSD), which in many ways describes what I went through to a T. C-PTSD develops after an ongoing traumatic experience, rather than a single traumatic event like a natural disaster or military service. Many times, C-PTSD develops from childhood experiences of abuse and instability, but it can also develop from an abusive relationship in adulthood. C-PTSD shares many characteristics with PTSD, but sufferers often do not meet the full criteria for classical PTSD.

Unlike “normal” PTSD, C-PTSD is not a formal diagnosis in the DSM-V handbook that therapists use to characterize mental illnesses. Many mental healthcare providers do not recognize it at all, which is why it is crucial that more people like me enter the field. I hope that going through complex trauma myself will offer me perspective on what it means for my patients to experience ongoing trauma. In other words, I hope I am able to one day use my traumatic experiences to help others. To me, this will be the ultimate expression of post-traumatic growth.

I won’t pretend that I can teach you how to heal a lifetime of trauma in one blog post. But what I can do is offer some understanding. Perhaps you know that you suffered a difficult childhood, but don’t understand how your present day behaviors are connected to that behavior. Or, maybe you resist thinking about your past because it affects how you think and feel in the present and as a result, you feel disconnected from your mind and body. Whatever the case, this post is for you.

This post is for the high-achieving, anxious, people-pleasing woman. She was once a little girl who didn’t get the love she deserved and now, she struggles with self-confidence and emotional regulation. Today, I’m going to do my best to teach you how to give yourself the love you were once denied by others, and how to take back the present moment from a traumatic past.

What is Trauma?

We often make the mistake of defining trauma as a single, standout event that haunts a person to this day. But while things like a natural disaster, a tour in the military, or a violent sexual assault are undoubtedly traumatic, other types of trauma exist — and can be equally as, if not more haunting. There are many types of trauma, including:

  • Acute trauma. This is the type of trauma we often call to mind when we think of post-traumatic stress disorder: a single, devastating, often violent event, like a natural disaster, car accident, war, or rape.
  • Repetitive trauma. This type of trauma occurs when a person experiences multiple traumatic events, such as receiving regular chemotherapy for cancer.
  • Complex trauma. The trauma concerned in C-PTSD, complex trauma, results from prolonged, ongoing trauma, often of an interpersonal nature and typically occuring during childhood. Examples include domestic violence and narcissistic parental abuse.
  • Developmental trauma. Early-onset exposure to trauma during infancy through early childhood — including neglect, assault, witnessing violence, or coercion — comprises developmental trauma. Developmental trauma affects a person’s attachment style due to its effect on our relationships with caregivers. This can overlap with complex trauma and/or C-PTSD.
  • Vicarious trauma. Also known as secondary trauma, vicarious trauma affects service providers like therapists and first-responders who treat patients with trauma. They absorb some of the patient’s traumatic background, integrating it into their own functioning.
  • Historical trauma. This trauma is passed down across generations, resulting from large-scale group trauma experienced by family members. This type of trauma includes ancestral genocide, slavery, and colonialism. Children of Holocaust survivors, or the great-great grandchildren of former slaves, are the examples I use to frame historical trauma.
  • Intergenerational trauma. Intergenerational trauma is also passed down across generations, but concerns patterns of coping developed in response to trauma, rather than the direct effects of a massive group trauma. For example, the child of a parent who has experienced an acute trauma may pick up on or have been taught some of that parent’s coping mechanisms, effectively absorbing the effects of their family member’s trauma.
  • Medical trauma. We don’t often think of medical treatment as traumatic in nature, but invasive, painful, or emotionally difficult hospital stays and procedures often trigger the trauma response — especially in children. While much attention is given to emergency rooms, ICUs, and operating rooms when discussing medical trauma, it’s important to acknowledge that medical trauma can occur at any level of care.

Trauma — especially acute trauma — can affect you at any stage of life, but mental healthcare providers are especially concerned with the dramatic effects that experiencing trauma during childhood can have on us as adults. A survey conducted by the Centers for Disease Control and Prevention (CDC) found that 61 percent of adults experienced at least one adverse childhood experience (ACE). ACEs are linked to chronic health conditions, mental illness, and substance abuse, but can also cause subclinical problems with emotions and relationships, in adulthood.

Adverse Childhood Experiences (ACEs) - Napa-Solano
Image Source: Kaiser Permanente

Your “ACE score,” used to identify ACEs in the CDC’s original study, is a measure of the number of ACEs you have experienced. This score comes with limitations; it only identifies ten types of ACEs, whereas I (and many trauma therapists) believe that the definition of childhood trauma is more nuanced. However, the score has been used to predict the rates of chronic disease, depression, and suicide. An ACE score above 4 is considered high. An ACE score of 4 or more is linked to a 460 percent increase in the rate of depression and a 1,200 percent increase in the rate of suicide attempts alone. 1 in 6 adults — myself included (my ACE score is 5) — have experienced at least 4 ACEs, making the somatization and integration of trauma incredibly common.

About the CDC-Kaiser ACE Study |Violence Prevention|Injury Center|CDC
Image Source: CDC

We often instinctively know when we have experienced trauma. Our bodies hold onto those traumatic memories, experiences, and feelings, and internalize them as somatic symptoms like aches, pains, migraines, and upset stomach. Sometimes, however, memories of trauma can be buried beneath layers and layers of denial, suppression, and other coping mechanisms. Working with a therapist can help you uncover suppressed trauma — and specific therapeutic techniques have been developed to help you do just that.

Signs of C-PTSD

When adults experience a traumatic event, they are more easily able to process what they have been through. That is why C-PTSD stemming from early childhood experiences is so destructive to a child’s physical and psychological well-being. Children who experience ACEs have their development disrupted by trauma. As a result, the trauma becomes deeply interwoven into the child’s identity. They integrate their experiences into their core beliefs, and often grow up feeling unworthy and unloved.

As an adult, the signs and symptoms of trauma do not simply disappear. Because they are woven so deeply into the fiber of our being, it can be impossibly challenging to unravel our beliefs surrounding ourselves and our experiences, in order to develop an identity separate from our traumatic past. According to the organization Beauty After Bruises, patients with C-PTSD often require over ten years of therapy to heal the wounds inflicted in childhood. There is a strong physical component to psychological healing as well: studies of animals and humans with PTSD show that trauma literally changes our brains, and the way the neurochemicals in our brains respond to stress.

When I first read the challenges faced by people living with C-PTSD, I instantly resonated. I knew at my core that C-PTSD was the name for the psychological and relational difficulties I’ve faced since my late adolescence. Below, I’ll recount the signs and symptoms of C-PTSD. My advice? Pay attention to the way your body feels as you read them. Your body will communicate with you through sensations, to tell you what it has to say about C-PTSD and you.

Signs and symptoms of C-PTSD include:

  • Emotional dysregulation. Emotional regulation is one of the core skills in dialectical behavior therapy, first developed for patients with borderline personality disorder (BPD). It should come as no surprise, then, that patients with C-PTSD are frequently misdiagnosed with BPD. C-PTSD survivors, too, face difficulty with experiencing and managing their emotions. They may cope with uncomfortable emotions in unhealthy ways, whether by over- or underreacting. Many patients do not know how to adequately identify and name the emotions they are experiencing, or may suppress their emotions altogether, leading them to appear numb and disaffected.
  • Dissociation. The most extreme example of dissociation occurs in Dissociative Identity Disorder, in which patients switch between personalities, or “alters.” However, a more mild form of dissociation is often seen in PTSD and C-PTSD. Patients with C-PTSD may forget elements of their trauma; recall events in the wrong chronological order; experience intrusive thoughts, flashbacks, or nightmares of their trauma; or even experience episodes of feeling wholly disconnected from their physical bodies. Many people describe this feeling as an “out-of-body” experience, as if the patient were looking down on themselves as an observer rather than being present in the moment.
  • Relational challenges. Challenges with interpersonal relationships emerge naturally from the developmental and psychological effects of childhood trauma. Survivors of C-PTSD may be distrustful due to an inability to depend on their caregivers as children — or, alternatively, they may be too trusting. Some C-PTSD patients are over-eager to connect with others to make up for childhood neglect, leading them to seek out and stay in unhealthy relationships, even when they become abusive or dangerous. From a partner’s perspective, it can also be difficult to understand a C-PTSD survivor’s behavior. Their emotions can come across as erratic or unstable; they may seek constant reassurance, express signs of codependency, or fundamentally doubt the relationship, harboring a deep distrust of their partner. It is critical for long-term partners of patients with C-PTSD to understand their loved one’s trauma, so they can better understand from where these “irrational” behaviors (which are, in fact, completely normal within the context of the trauma response) stem.
  • Misperception of the perpetrator. C-PTSD survivors may be unable to recognize the abuse they experienced at the hands of a particular person. To those on the outside, it is completely clear that this person was abusive — yet the C-PTSD patient’s perception of that person remains untouched. Gaslighting is a common behavior used by abusers to maintain control over their victims. The abuser makes the victim out to be the crazy or irrational one, until the victim begins to doubt their own perceptions of reality. As a result, the victim’s perceptions of the abuser can also become distorted. Many abusers put on a charming front to the rest of the world, and victims can sometimes remain enchanted by this public persona. Other times, victims long for emotional validation they will never receive from their abuser, so much so that they over-compensate with their achievements in an attempt to win their abuser’s approval. Others still become transfixed with bitterness or the idea of revenge. In my experience, it’s also possible to oscillate between all three of these extremes (sometimes, even in the course of a single day).
  • System of Meanings. Our System of Meanings is the name given by trauma therapists to our core beliefs about ourselves and the world around us. People who have experienced complex trauma may learn to see the world as a cold, unjust place, in which perpetrators are never held accountable for their wrongdoings. They may doubt the motivations of others, believing that no one does anything without the expectation of something in return, or feel suspicious and distrustful of those around them. But perhaps the most harmful beliefs, and the most difficult to repair, are those that we develop about ourselves in the wake of childhood trauma. Because we were so often exposed to them, we begin to believe the criticisms of our abusers, and internalize the beliefs that we are “bad,” “lazy,” “worthless,” or “cruel.” Our self-perception becomes so distorted that we start to view ourselves as unworthy and unlovable. Many of us feel like there is something fundamentally wrong with us; that we are “broken” or need to be “fixed.” As a C-PTSD survivor, I can assure you that the only thing you need to fix about yourself, the only thing that is broken about you, is this faulty System of Meanings. Unraveling these beliefs and replacing them with better ones can take years, but it is a critical step in the process of healing from complex trauma.

How to Heal from Trauma

As humans, we aren’t necessarily born with the innate ability to be resilient. Resilience is a skill like any other, which must be developed with practice. But resilience represents only one side of healing from complex trauma: we also need to learn to honor our bodies and emotions, forgive ourself and others, and rewire our subconscious System of Meanings.

The combination of these tasks represents true healing, and it’s true healing that eventually gives way to post-traumatic growth. Post-traumatic growth can be defined as the ability to channel previous trauma into a positive endeavor. Post-traumatic growth is exemplified by those whose trauma sparked a deep desire to help others heal from the same experiences. I once believed that it was impossible to serve as a mental healthcare provider with a history of mental illness and trauma, but I’ve never been happier than to be proven wrong the legions of mental health providers who were inspired to do their current work by their past experiences, in a stunning example of post-traumatic growth.

It’s important to recognize that post-traumatic growth does not happen overnight. It’s not as easy as simply deciding to channel your energy into something different. You cannot heal from trauma without acknowledging and moving forward from your past experiences. Try as we may to suppress our traumatic memories, the body remembers our history of trauma, even when the mind does not. Even the most fervent attempts to heal from trauma can be upended by our refusal to confront the past. When we avoid confronting previous trauma, we may experience somatic symptoms in the body — such as aches, pains, migraines, and gastrointestinal complaints — that cannot be explained by medicine, even when we have subjectively “moved on” from our trauma in the mind.

Avoidance, resistance, and stagnancy are not treatment plans. We can only heal from complex trauma with time, dedication, and commitment. In my opinion, it’s best to begin the process of healing from childhood trauma under the guidance of a licensed mental health professional. However, it’s equally as important to consider how we treat ourselves when we are outside the care of therapists, psychologists, or psychiatrists. Weekly therapy sessions can help you process trauma in a safe environment, but true healing also requires a steadfast commitment to practicing self-care and self-love outside the therapist’s office.

Below, I’ve provided a preliminary list of strategies and resources to help you heal from complex trauma. Treat this toolkit as a jumping-off point for personal growth, rather than an exhaustive collection. Over time, you can add to your toolbox with strategies learned in therapy and from your own personal experience.

The Complex Trauma Toolkit

The Survivor Bill of Rights. As a human being and as a survivor of complex trauma, you possess inherent rights. Prolonged abuse purposefully strips us of these rights. Our abusers systematically use techniques designed to undermine our rights and maintain control, leaving us uncertain of our worth and dignity as human beings — even after the abuse has long since ended.

Dr. Thomas V. Maguire developed the Survivor Bill of Rights for trauma victims to help you reclaim those rights, especially in respect to the therapeutic process. As a survivor of complex trauma, your rights include your personal authority, your boundaries, your integrity of communication, and your physical and emotional safety. Some of my favorite assertions in the Bill of Rights are the rights to:

  • Direct your values and recovery
  • Seek, accept, or decline help from any sources
  • Be afraid, deciding for yourself when and how to confront fear
  • Speak about and remain silent about any topic you wish, at any time
  • Ask for change when your needs are not being met
  • Hold your therapist’s undivided loyalty in respect to any abuser
  • Receive treatment that is not conditional on your “good behavior” (excepting serious crime and the endangerment of yourself or others)

Understand that while you inherently possess all of these rights, not all of them may resonate with you right now — and that’s okay. For those rights that do resonate with you, it may help you to build regular reminders of those rights into your day to prompt you to recognize your value as a human being. Repeated exposure to your rights as a survivor can help you reconstruct the damaged beliefs in your self-worth resulting from your experience with complex trauma. Try setting phone reminders of your favorite rights at regular intervals throughout the day, or writing down your favorite rights on sticky notes and posting them in places where you will see them often.

Journaling. Telling your story is an essential component of healing. The practice of Narrative Therapy tells us that there is no objective reality and that all elements of your traumatic experience are valid. Through Narrative Therapy, patients learn to construct a cohesive narrative of their trauma. By re-experiencing their trauma through storytelling, patients with a history of complex trauma learn to take back control of their narrative.

You can harness the power of Narrative Therapy on your own by exploring your traumatic memories, thoughts, and feelings in a journal. Journaling can help you better process what happened, including thoughts and memories you may not be ready to share out loud with your therapist. Commit to journaling for 15-20 minutes every day and re-experiencing different elements of your traumatic past. Start with the facts of what happened, then begin to consider deeper questions like “How has this affected my relationships?” or “What core beliefs have I internalized as a result of this experience?”

Make sure to take time to self-soothe throughout the process of journaling, as reliving these events can bring up challenging thoughts and feelings that may lead to physical discomfort or difficulty regulating emotions. You should always feel free to stop the exercise and redirect your attention to something else at any time. For more guidance on journaling as a strategy for healing trauma, check out this tool for Therapeutic Journaling developed by the Veterans Health Administration.

Radical acceptance. Trauma often leads us through a minefield of emotions, ranging from anger to sadness, to guilt, to fear, to shame. Many approaches to treating trauma, and especially PTSD, encourage patients to practice gradual exposure to memories associated with their trauma (usually in a therapist’s office). During the process of exposure, patients learn to also practice radical acceptance of the thoughts, feelings, and images that arise from the memory of their previous trauma. Research shows that the practice of radical acceptance decreases uncomfortable emotions related to trauma, including guilt, shame, distress, disgust, and fear.

Radical acceptance involves complete and total awareness and acceptance of what is in your mind, body, heart, and soul in the present moment. For trauma, this means accepting what happened to us, as well as accepting ourselves as we are — learning to believe that we are enough. If you’ve ever done the “don’t think about a pink elephant” experiment in a psychology class, you know that trying to resist thoughts and feelings actually strengthens them. Radical acceptance is the opposite of resistance. For traumatic memories to become less disruptive, you must allow whatever thoughts, feelings, and images that come over you to simply be, as they are, without giving into the desire to change them, the urge to ignore them, or the imposition of self-doubt.

Difficult as it may be, radical acceptance promises the closure you need to effectively move forward in life, without letting your past disrupt your present. You can use the same principles of radical acceptance, a dialectical behavior therapy (DBT) skill, to cope with intrusive memories, flashbacks, and/or nightmares related to C-PTSD. According to Marsha Linehan, the developer of DBT, radical acceptance begins with observing our thoughts, feelings, and behaviors as an objective outsider. Once you notice you have begun to question or fight the reality of what happened to you, remind yourself that your trauma is what it is and cannot be changed.

Use accepting self-talk to encourage yourself to accept what has happened. Acknowledge that what happened to you was not your fault, while still accepting the causal factors that have shaped your present reality. Then, purposefully shift your perspective by asking yourself, “How would I think, feel, and act if I could accept what happened to me and move on from my trauma?” Vividly visualize how you would behave if you were already practicing radical acceptance, and put these behaviors into practice as if this were really the case.

Somatic experiencing. Somatic experiencing is a therapeutic technique developed by Peter A. Levine, Ph.D. for releasing stored trauma in the body. Dr. Levine has famously compared the human body to a Slinky to explain our natural reaction to trauma. Traumatic events trigger our fight-or-flight response, in which the body generates tremendous amounts of energy to help us do what we must to survive. In the wild, animals release this energy by shaking their bodies from head to toe. But because this physical response is not always socially acceptable or possible to us as humans, we learn to compress this traumatic energy, like a Slinky when it is collapsed.

The problem is that holding in this level of energy requires us to expend even more energy. Our bodies respond to the high levels of energy required to suppress the trauma response by developing somatic symptoms like headaches, stomachaches, panic attacks, and more. These physical symptoms are our bodies’ way of communicating that they are burnt out and overwhelmed by the demands that trauma has placed on them. They are an expression of the thoughts and feelings our bodies harbor, due to the fact that we were unable to release them at the time of our trauma.

Dr. Levine’s theory of somatic experiencing states that we need to “discharge” the stored energy from our trauma in order to achieve physical and psychological healing. By noticing our body’s natural response to memories of trauma, we can stop trying to override the fight or flight system, and instead ride the wave of our bodily sensations to a natural resolution. When we release control of our bodily sensations and learn to become mindful observers instead, we allow ourselves to discharge stored trauma, thereby relieving physical and psychological symptoms associated with it.

Traditionally, somatic experiencing sessions are completed under the guidance of a specially trained therapist. The therapist gradually walks you through reliving your trauma, piece by piece, and observing the sensations that arise in your body as you talk about what happened. Still, you can incorporate elements of somatic experiencing into your self-care and self-soothing routines on your own as you work through trauma treatment with a mental health practitioners. Some somatic experiencing techniques and exercises to help you cope with unpleasant memories as a mindful observer include pendulation and self-hugging.

Pendulation is a key skill in somatic experiencing, and involves shifting awareness from sensations in parts of the body that feel painful or uncomfortable, and sensations in parts of the body that feel comfortable and calm. As survivors of complex trauma, we often learn to focus on what is bad, negative, or painful, losing our ability to pendulate between states of positivity and negativity; eustress and distress. Pendulation encourages us to allow both of these sensations to be present in the mind and body at the same time. The practice of pendulation helps us better integrate our trauma by recognizing both the parts of ourself that have been affected by trauma and the parts of ourself that feel whole. You can practice pendulation by closing your eyes and honing your attention on an area of your body where you feel physical discomfort. Hold your awareness here for a few breaths, then shift your awareness to a different part of the body that feels calm and pain-free. Breathe here for a few moments, then begin to practice shifting your awareness back and forth between these two areas. Notice how it feels both to honor the unpleasant sensations in your body, the somatization of your trauma, and to acknowledge the parts of your body, of your life, that are good and whole.

When’s the last time you gave yourself a hug? The sensation of self-hugging brings us back ito our bodies, allowing us to feel more grounded. This quick practice can manage symptoms of dissociation associated with trauma, helping us step back into the present moment instead of lingering in our memories of the past. Offering a hug to yourself is the fullest expression of self-love. Even when we have trouble seeing our value as victims of trauma, we still have the simple power to give ourselves physical affection; to show our bodies love and offer ourselves healing, even when we do not feel loving towards our conscious self. Wrapping your arms around your shoulders for a few moments brings you back into your body in moments when the fight or flight response is triggered by memories, nightmares, or flashbacks of trauma. Self-hugging is also a powerful way to heal your inner child, as you are able to offer yourself the love and affection you were denied during your traumatic upbringing. A self-hug is instinctive; you don’t need to do anything special, besides close your eyes and focus on both the bodily sensations and emotions that arise from the feeling of being touched with loving kindness.

Resources for Further Reading

The Body Keeps the Score by Bessel Van Der Kolk, M.D. THE book to read if you are interested in deeply understanding trauma and its effects on the mind, body, and spirit.

The Complex PTSD Workbook by Arielle Schwartz, Ph.D. One of the only workbooks (and, in my opinion, the best) that specifically addresses complex trauma and C-PTSD.

The Gifts of Imperfection by Brene Brown. Brown is a psychological researcher who has spent 20 years studying shame, courage, vulnerability, and empathy. This book is not specific to trauma, but provides ten actionable guideposts for working through imperfection and building self-esteem that you may find helpful in your journey towards healing.

Life Events Checklist and PTSD Checklist by the National Center for PTSD. This screening checklist is meant for use by clinicians to assess a patient’s history of trauma and risk for PTSD. While you can’t self-diagnose PTSD using this tool, you may find it helpful to reflect on your previous experiences and how they affect you today.

Towards Recovery Fact Sheet by Blue Knot Foundation. Written by an Australian foundation for trauma survivors, this fact sheet lists 17 things to know about trauma recovery for survivors. It’s a great starting point for anyone contemplating recovery.

What Are Traumatic Memories? by the Sidran Institute. A public service brochure explaining the relationship between trauma and memory, and why trauma survivors may experience disruptions in memory.

Understanding Complex Trauma, Complex Reactions, and Treatment Approaches by Christine A. Courtois, Ph.D. An article thoroughly examining the differences between complex trauma and “normal” trauma, factors that render a person vulnerable to C-PTSD, and how treatment for C-PTSD should differ from that for “normal” PTSD.

8 Things We Should All Know About Complex PTSD and Dissociative Identity Disorder by Beauty After Bruises. This one is a must-read if you’re looking to understand C-PTSD and DID from a macroscopic, sociologic perspective.

Three Types of Triggers, Three Techniques for Taming by Carolyn Spring. Trauma and dissociation researcher and survivor Carolyn Spring explains three types of triggers for people with PTSD and how to cope with each of them.

13 Steps for Managing Flashbacks by Pete Walker, M.A. Some practical advice for grounding yourself in the present moment when traumatic memories resurface.

Overcoming Shame-Based Thinking by Behavioral Health Evolution. An excerpt from the book How to Change Your Thinking About Shame that can help you challenge negative core beliefs related to your trauma.

Tips for Meditating When You Have PTSD by Sian Ferguson. Tips from a rape survivor on helping yourself feel safe during mindfulness meditation. I recommend skimming this short read before trying the meditation practice below.

20-Minute Trauma Informed Meditation Practice. Through the Insight Timer app, the BioMedical Institute of Yoga and Meditation shares a helpful trauma informed meditation practice. It is especially geared toward people with PTSD.

The Trauma-Conscious Yoga Method. This awesome YouTube channel offers free trauma-informed yoga videos to help you reconnect with your body at home.

Learning to Be More Assertive

If you or someone you love is having thoughts of ending their life, I encourage you to contact the National Suicide Prevention Hotline at 1-800-273-8255 or text HOME to 741-741 to chat with the Crisis Text Line.

Disclaimer: I am not a certified mental health professional. My advice is based solely on my experience as a psychiatric patient and my research/personal interest in mental health. Please consult a doctor or therapist for qualified treatment if you suffer from mental illness.

Those of you who follow me on Instagram know I have been taking part in an IOP, or intensive outpatient program, designed to aid in my recovery from depression and anxiety.

I’ve talked a lot about my experience with eating disorders on this blog, which I think is part of the reason my depression has become so bad this winter: I haven’t been sharing as much about this part of my life, even though blogging is a cathartic activity for me. So, I’ve decided to blog about some of the things I’ve learned (and challenges I’ve faced) as a patient in an IOP for mood disorders.

The IOP program I am in uses DBT, or dialectical behavioral therapy, which you can learn more about by clicking here. Even though DBT was originally created to treat people with borderline personality disorder, it’s now used to treat all kinds of mental health problems, including depression, anxiety, bulimia and anger management issues.

DBT teaches four main skills to help people recover from mental illness: Goal-Setting and Mindfulness, Interpersonal Effectiveness, Emotional Regulation and Distress Tolerance. Today’s topic, learning to be more assertive, is something I learned in Interpersonal Effectiveness — basically, a skill that helps you improve your relationships with others, leaving you happier and mentally healthier than before.

So, what is the key to becoming more assertive? If I had to choose one thing to work on, it would be setting healthy boundaries in my relationships with others. In this blog post, I’ll talk about how setting boundaries has helped me become more assertive and how I improved my assertive communication using the DEARMAN and GOAL FAST skills from DBT….

But first, let’s talk about why it’s important to be more assertive in the first place, and how training your assertiveness skills can make you a healthier, happier person, both mentally and in your relationships with others.

Why Assertiveness Matters

Ever been called a people-pleaser or pushover? You may have wondered why those terms are derogatory. After all, what’s wrong with wanting to make other people happy?

Truthfully, nothing is wrong with wanting to please others — except when it gets in the way of your own happiness. What’s NOT okay is lying to others about your wants and needs, or staying quiet when it’s important for you to speak up, because you’re afraid of retaliation from family or friends if you tell them what you really think.

Constantly holding in our true thoughts, feelings and desires isn’t healthy: in fact, it increases stress, depression and anxiety. Living for other people won’t make you happy, and neither will living in fear of creating a conflict. If you want to get what you want in life, you have to ask — and assertiveness is the skill that will help you make your needs heard.

If you’re not an assertive person, you’ve probably already noticed how it has made you unhappy or resentful in the past — but what about the benefits of being more assertive? In order to change, the benefits of being assertive must outweigh the costs…. and they do! Here’s how:

Benefits of Being Assertive

  • Building honest relationships with others. If you’re constantly bending to others’ whims to make them happy, you’re not showing your loved ones who you truly are. You run the risk of becoming codependent, or living your life to make another person happy.
  • Boosting your self-esteem. Constantly giving in to others’ desires, while ignoring our own, sends the message to our brains that what we want doesn’t matter. This is a negative thought I constantly use to have: “I’m not important. What I want doesn’t matter.” But you do matter — and when you start to act like it, you will also start to believe it!
  • Appearing more open to new relationships. When you are passive or aggressive (rather than assertive), you come across as distant and closed-off. However, when you’re assertive and learn to communicate more — and more effectively! — others view you as an open and honest person, which in turn makes them want to build a relationship with you more than they might otherwise.
  • Getting what you want more often. Ever wished that someone would “read your mind” and know what you wanted deep down, without you ever having to say it? This is a passive person’s favorite fantasy for a reason! When you lack the skills to be assertive, you rarely get what you want, because you never ask for it. Alternatively, when you learn to ask for what you want respectfully, rather than demanding in an aggressive style, and to come up with compromises that are pleasing to everyone, you’ll find yourself getting more of what you want far more often.

What is Assertive Communication?

In order to understand how to be assertive, we first need to understand what it means to be assertive — and in order to understand how to be assertive, you need to understand what the alternative styles of communication are.

To make this more fun, below, I’ve explained the four styles of communication — aggressive, passive, passive-aggressive and assertive — with check-boxes beside them, so you can see which communication style you most strongly identify with. Go ahead: copy and paste (or print) and play along!

Passive Communication

__ Failing to express their thoughts or feelings; opinions

__ Allowing others to infringe on their rights (deliberately or not)

__ Speaking softly and apologetically

__ Poor eye contact and slumped posture

__ Often feel anxious, depressed and/or resentful

Aggressive Communication

__ Dominating or humiliating others

__ Low emotional tolerance; high impulsivity

__ Use “you” statements

__ Interrupt frequently

__ May not listen well

__ Overbearing, intimidating and/or alienated from others

Passive-Aggressive Communication

__ Avoid confrontation; have difficulty acknowledging their anger

__ Use sarcasm and/or denial

__ Appear cooperative while doing things to deliberately annoy others

__ Use subtle sabotage to “get even”

__ Remain stuck in a position of powerlessness

Assertive Communication

__ State needs and wants clearly, appropriately and respectfully

__ Use “I” statements

__ Feel relaxed and connected to others

__ Respect others and accept their differences, without the need to control or dominate

__ Confident in themselves and prioritize their needs, wants and rights

Still unsure what type of communicator you are? Take this quiz from Amy Castro to find out!

How to Be More Assertive

So, you know where you’re starting from, and you know where you’d like to be — now what? You may not be communicating assertively now, but assertiveness is, thankfully, a skill that can be developed over time. All it takes is a little bit of practice!

Here are some exercises to try that will help you develop your assertiveness. And always remember: if your communication style is causing significant distress or problems in your life or your relationship, there’s no shame in seeking help from a qualified therapist or counselor in your area.

  1. Develop self-awareness. The first step to communicating assertively is developing self-confidence — believing that you deserve to be heard! Assessing your strengths and developing self-awareness can help. Try this Personal Strengths Inventory and/or Values Questionnaire to get a better sense of who you are and what you feel is worth standing up for (and being assertive about!).
  2. Use “I” statements. When communicating, do you focus on blaming or accusing others of what they’ve done wrong? Do you read others’ minds and put words into their mouths? These types of statements often take the form of “you” statements — i.e. “you made me do this!” or “you didn’t ask me how I felt.” Instead, shift your perspective and try phrasing statements using “I” — as in, “I felt sad when you chose work over me” or “I felt angry when you yelled at our child.” These types of statements encourage you to take ownership of your thoughts and feelings, rather than affixing blame to others.
  3. Try the “broken record” technique. One technique I learned in DBT during our interpersonal effectiveness training is to be a broken record. This is especially helpful if you’re someone who has difficulty saying no or voicing their opinions. Decide what you want to say in advance, phrase it as a simple statement — such as “I can’t take on any more work right now” — and repeat it until the person you’re speaking to gets the message. To see how this works IRL, a sample conversation can be found on this page.
  4. Notice how you respond to feedback. Feedback, whether positive or negative, can teach us a lot about ourselves and how we relate to the world — and so can how we respond to it. For example, if you’re someone who doesn’t take a compliment well, you may struggle with low self-esteem and possess a passive communication style. Or, if you’re someone who’s resistant to criticism, you may be passive-aggressive or aggressive, and may also suffer from self-doubt. Next time you receive feedback, good or bad, try filling out this Feedback Matrix worksheet from Mindtools — it will help you process your feedback in a healthier way, and determine whether your gut reaction is conducive to an assertive communication style.