Emotional numbness in PTSD & C-PTSD
One of the most damaging assumptions about someone who has experienced trauma, or has a PTSD or C-PTSD diagnosis is that they don’t seem to be upset by it. In fact, their apparent disassociation from the event – or series of incidents – could be due to a defensive reaction known as emotional numbing.
It is a way for individuals to shield themselves from the full force of their reaction (often subconscious), but it can carry a range of serious repercussions which can be damaging to their recovery and their everyday mental health and quality of life.
In fact, as we explore in this article, numbing your emotions can actually worsen your PTSD or C-PTSD – a vicious cycle.
What is emotional numbing?
The anxiety and fear that result from trauma can become ever-present when your brain has been altered and you are in a permanent state of ‘alarm’. However, some people’s brains respond to trauma by avoiding its full force, by essentially numbing the pain of the thoughts and feelings it’s experiencing. And it’s actually doing it to protect itself from further ‘damage’. When this happens, you may feel temporary relief that allows you to move on. Over time, though, this protective shield can begin to get in the way of connecting with others and getting in touch with feelings that are both positive and negative.
It links to the well-documented ‘fight, flight, freeze, fawn and flop’ responses that we have discussed before.
Your amygdala is the part of the brain that responds to stressful situations. When you experience something extremely traumatic, it can trigger a significant physical and emotional reaction to help to protect you from perceived danger. This includes shutting down – freezing – your immediate response. It allows the body and brain time to work out what the best course of survival is, emotional rationale isn’t important during survival, so it switches this part off. Ordinarily, following trauma, when the signal is sent that everything is ok again, these emotions come ‘back online’ so to speak.
When the physiological signal to calm everything down proves ineffectual, or is left ‘on’ as in the case of someone with PTSD or C-PTSD, this numbing process can continue and you shut off your reactions longer term.
An ingrained level of avoidance is not a healthy solution though. Strong emotions of any kind can start to be perceived as a threat or deeply uncomfortable, leading to an inability to respond appropriately to positive situations and relationships too.
Anyone experiencing emotional numbness following trauma can also appear detached, ‘unfeeling’ or lacking in energy to make the right responses. It may only be others that notice this ‘distance’ – but more often than not, the person themselves just feels ‘numb’ to the world and their emotions, and unfortunately this numbing covers the negative and any positive emotions too – they simply ‘can’t feel anything anymore’.
Why detachment is counterproductive in PTSD & C-PTSD
It is clear to see why emotional numbing can worsen PTSD and C-PTSD. The individual is unable to benefit from the sort of experiences that contribute to recovery, including enjoying the love and support of family and friends and finding happiness and calm in their favourite activities.
Although their natural reactions are not ‘gone’, they’re just buried, maintaining this level of detachment can be exhausting.
However, it’s important to point out that emotional numbness is not always obvious and widespread. It can be an instinctive response that happens only to certain situations and emotional stimulation.
How do I know if I’m emotionally numb?
It may be that some of this sounds familiar, or that others have commented, but the symptoms of emotional numbness are things like:
- Losing interest in positive activities you used to enjoy
- Feeling distant or detached from others
- Failing to access your feelings
- Feeling flat, both physically and emotionally
- Experiencing an inability to fully participate in life
- Having difficulty with experiencing positive feelings such as happiness
- Preferring isolation vs. being with others
- Being in denial about situations and realities
There are in fact a number of reasons why someone might be emotionally numb however, such as anxiety, BPD, grief, depression, medications, mental or emotional abuse, stress, physical abuse, and substance misuse, so it’s always best to speak to your GP about this.
Treatment for emotional numbness
The way to address this understandable response to trauma is similar to ways to overcome other PTSD or C-PTSD symptoms. ‘There are a variety of treatment options available that can help you reduce the extent to which you try to escape, disengage from, or avoid your emotions.’
Therapy and counselling can help ‘unlock’ the issues behind the reaction and start to direct you towards healthier coping strategies.
This is not the same as telling you what you should be feeling, or forcing you to deal with a lot of negative emotions at once! The therapy involved will be a gradual process, to help you alleviate the numbness in a measured and sustainable way.
- ‘Cognitive behavioural therapy (CBT) gives you the opportunity to express and understand your emotions, as well as examine the sources of those emotional responses. It addresses how certain thoughts may be contributing to your emotions. Rather than avoiding or using maladaptive coping tools (such as numbing), CBT strategies aim to empower you to shift from thoughts of powerlessness to beliefs of strength and emotional competence.
- Acceptance and commitment therapy (ACT) is another form of behaviour therapy that is often used with PTSD, C-PTSD and other mental health issues that have emotional numbness and avoidance as symptoms. ACT uses a mindfulness-based approach to help you recognise ways in which you attempt to suppress or control emotional experiences. The goal of ACT is to help you experience your inner feelings while focusing attention on living a meaningful life.’
In addition to psychotherapy, your doctor or therapist may recommend several lifestyle modifications to help relieve some of the symptoms of emotional numbness, and hopefully, prevent more episodes from happening in the future.
While it may take a bit of trial and error, the key to the success of lifestyle modifications is to find what works best for you. Here are a few ideas you can try on your own.
- Develop a Support System: While reaching out to others may seem difficult at first, seeking social support from friends and family that you trust may help provide a safe way to express your emotions.
- Engage in Physical Activity: Staying physically active and engaging in exercises that you enjoy not only benefits your health, but it can also reduce the symptoms of depression and anxiety. Try to include some form of exercise or physical activity most days of the week.
- Get Adequate Rest: Both the quality of sleep and the amount of rest are critical to managing the symptoms of any physical, emotional, or mental health issue – although many people find this challenging due to nightmares and other PTSD or C-PTSD symptoms like hypervigilance.
- Minimise Stress: Both daily stressors and overwhelming stress are major contributors to emotional numbness. Finding ways to better manage stress is key to addressing the avoidance of emotions and feelings. Try managing your schedule, being sure to make time for activities that you enjoy. Practice deep breathing, which can help provide almost immediate relaxation. Eat a nutritious diet. It’s also important to note that while some use drugs and alcohol to cope with stress, substances can contribute to greater stress levels.
- Use Mindfulness Strategies: “Mindfulness strategies may be particularly helpful in reducing emotional numbing and increasing emotional strength and competence to manage stressful experiences,” says Dr. Mendez. Engaging in relaxation exercises, particularly body awareness exercises, says Dr. Mendez, can be very helpful for awakening sensations, feelings, and regulation of emotions.
One study puts forward a theory that “individuals with PTSD are not, in fact, ’emotionally numb’ as a result of traumatic experience. Rather, PTSD is associated with hyperresponsivity to negatively balanced emotional stimuli.” They conclude, therefore, that the best way to overcome it is by purposefully providing positive experiences.
“Patients with PTSD require more intense positive stimulation to access the full complement of appetitive or pleasant emotional behaviour.”
Also, another study into ’emotional blunting’ that reduces responsiveness to negative and positive emotions focused on its relationship to depression. In this context, the inability to engage in pleasurable stimulation is referred to as anhedonia.
Data presented to a conference called EPA 2021 Virtual, in Italy, appeared to show that certain types of antidepressants “significantly improved emotional blunting as measured by the Oxford Depression Questionnaire. After eight weeks of treatment, 50% of patients reported no blunting.”
As always, effective PTSD and C-PTSD treatment depends on the individual. The first step is always the same though – seek out help if you feel you (or someone you love) is emotionally unresponsive or numb due to trauma response.
It’s important to note, that while choosing your PTSD or C-PTSD recovery path you need to address both the symptoms and the underlying condition. NICE guidance updated in 2018 recommends the use of trauma focused psychological treatments for Post Traumatic Stress Disorder in adults, specifically the use of Eye Movement Desensitisation Reprocessing (EMDR) and trauma focused cognitive behavioural therapy (CBT).
Please remember, these aren’t meant to be medical recommendations, but they’re tactics that have worked for others and might work for you, too. Be sure to work with a professional to find the best methods for you
- Litz BT, Gray MJ. Emotional numbing in posttraumatic stress disorder: current and future research directions. Aust N Z J Psychiatry. 2002 Apr;36(2):198-204. doi: 10.1046/j.1440-1614.2002.01002.x. PMID: 11982540.
Photo by Craig Adderley
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It is possible for PTSD to be successfully treated many years after the traumatic event occurred, which means it is never too late to seek help. For some, the first step may be watchful waiting, then exploring therapeutic options such as individual or group therapy – but the main treatment options in the UK are psychological treatments such as Eye Movement Desensitisation Reprogramming (EMDR) and Cognitive Behavioural Therapy (CBT).
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