Undoing Emotional Numbing May Be Key to Trauma Recovery

New research looks at drivers of emotional state transition in PTSD.

KEY POINTS

PTSD is characterized by difficulty regulating emotions, with rapid shifts from positive to negative states.
The sudden changes in emotions lead to distress and dysfunction with oneself and others.
Research shows that emotional numbing, a core PTSD symptom, may drive emotional instability.
Learning emotional awareness may be crucial to recovery from PTSD and, more broadly, to well-being.

People with PTSD struggle with a variety of symptoms, including re-experiencing traumatic memories via nightmares, intrusive thoughts, and unwanted repetitive patterns of behavior; depressive symptoms and cognitive clouding; difficulty with excessive reactivity and hyperarousal; sudden shifts into states of panic, fear, and rage; and, often, symptoms of avoidance, dissociation, and emotional numbing.

With PTSD, both classic PTSD after discrete traumatic experiences and complex PTSD (cPTSD) following years of trauma and distress, sudden shifts from positive to negative emotional states create terrible difficulties in terms of both personal suffering and destruction of personal and professional relationships and performance.

Losing It

Emotional dysregulation also impacts people surrounding those with PTSD. For example, research on intergenerational transmission of trauma, as from parent to child, has found that moments of disorganized emotion when parents “lose it” are an important factor in passing along trauma. What does this mean? What is the “it” that people lose during such interactions?

Parents with unresolved trauma may have a disorganized attachment style, shifting unpredictably from secure to insecure modes, from overly close to suddenly distant. In particular, intergenerational transmission of trauma may occur when parents in the throes of disorganized attachment, such as when frustrated with a child’s behavior, express their helplessness and hostility (H/H) toward the child.

This typically occurs without the child understanding what is happening or why. If that understanding isn’t there from the parents, or perhaps another adult who can mentalize with the child, the behavior interferes with the child’s development and causes or contributes to future mental health problems, substance use disorders, and personality disorders. In such states of mind, people don’t slow down and talk through what is happening with those around them.

Disruption doesn’t happen only between parents and children. It’s sadly familiar in many personal and professional relationships, and, for many, may even be normalized in the form of endemic abuse and harassment in relationships.

What Drives Sudden Emotional Transitions in PTSD?

For the above reasons, it’s important to understand what drives the sudden shifts from positive to negative emotion in people with PTSD. Identifying the drivers will allow people to gain self-control and ultimately put them on the road to recovery and life satisfaction.

To this end, Korem and colleagues (2024) in the journal JAMA Network (Journal of the American Medical Association) published the results of a study of more than 1,400 trauma-exposed individuals (they had witnessed or experienced extreme violence and death) to find out what happens when their emotional states suddenly flip.

Participants completed a set of standard ratings to determine who met the criteria for which PTSD symptoms and to what extent they were clinically significant (diagnostic of PTSD). Participants were shown 35 images depicting scenes of varying emotional intensity and valence, from neutral to extremely distressing. Their emotional responses were tracked, and researchers used sophisticated statistical techniques (hierarchical Bayesian modeling) to see which factors were associated with rapid versus more gradual, emotional transitioning.

There were two major findings: First, those with PTSD had a steeper emotional slope, meaning that emotions do indeed more drastically move from positive to negative, and back again, with PTSD. Second, and of clear significance, a singular factor emerged with rapid shifts: Emotional numbing. When people tune out from what they are feeling, they lose not only awareness but also control.

The Many Consequences of Emotional Numbing

The finding is simple and elegant, deeper, perhaps, than it seems at first glance. Several factors are important to consider. One is the basic function of being present and aware of one’s own emotions, not to mention empathetic attunement with others’ emotional states, which itself requires being self-attuned.

Anger management depends on emotional awareness as a first step, and experiencing joy also requires staying tuned in as a first step. Being tuned in is only a first step, however. We not only have to stay with our emotions but also keep track of our thoughts and, more profoundly, the meaning and significance of our experiences. Further, awareness facilitates a key skill required for good executive function, namely inhibitory control.

The ability to notice what’s happening and either put on the brakes or let things move forward—in real time—is a huge determinant of success and satisfaction. It’s worth mentioning that other conditions, including ADHD, anxiety, and depression, can add to difficulties in awareness and regulation.

Closely related to emotional numbing are dissociation and avoidance. About 14 percent of people with conventional PTSD have the dissociative subtype, in which out-of-body experiences such as depersonalization and derealization are common. Dissociation is more prominent in those with cPTSD. In extreme situations, it may coalesce into dissociative identity disorder (DID), in which individuals shift, often unpredictably, from one subpersonality (or part of the personality) to another.

Emotional numbing permits such shifts by disconnecting executive function from reflective awareness, which in turn allows more primitive threat-based systems to hijack behavior and perception. Sudden emotional transition is a hallmark of such loss of emotional regulation and sense of self.

On a broader level, emotional numbing means we don’t really know ourselves or others. Emotional numbing, as a form of avoidance, avoidance of living and experiencing, means we are cut off from one of the most essential parts of being human and relating to others. Cutting off empathy and self-awareness, leading to self-defeating behavior, emotional numbing may be not only a core symptom of PTSD but also one of the factors maintaining PTSD and preventing growth and recovery.

There is limited research on how PTSD symptoms unfold over time and on how earlier symptoms interfere with recovery and sustain PTSD into the future. But one study of civilian war survivors (Schlecter et al., 2022) found that factors overlapping with emotional numbing, including difficulty concentrating, avoidance of letting oneself get upset, and trying to remove trauma from memory were associated with propagating PTSD from one year to the next.

Practical Implications

Clinical experience and best practices often focus on restoring emotional awareness and, more generally, presence in one’s own life as a requisite for recovery from trauma. Notably, in phase-based treatments for trauma and dissociation, overcoming phobias of one’s own inner mental states is part of the first stage of recovery, along with addressing fears of intimacy, given that forming a therapeutic alliance is a key factor in therapeutic effectiveness. Future research can look at whether specifically targeting emotional numbing can enhance outcomes.

Generally, if we are not feeling our own emotions in real time or are unable to name them, we can’t catch on to how they are starting to change. By then, often it’s too late, and we’ve done something regrettable or missed out on something we’d have wanted to experience.

Feeling emotions is so important, and yet so much of the messaging we get in society and our communities tells us to ignore or downplay feelings, or even to equate not feeling with strength. While suppression is an important temporary measure when times are tough, ongoing avoidance of emotion is deeply harmful. Ultimately being adaptively emotionally aware and present is a necessary life skill.

References

Korem N, Duek O, Spiller T, Ben-Zion Z, Levy I, Harpaz-Rotem I. Emotional State Transitions in Trauma-Exposed Individuals With and Without Posttraumatic Stress Disorder. JAMA Netw Open. 2024 Apr 1;7(4):e246813. doi: 10.1001/jamanetworkopen.2024.6813. PMID: 38625701; PMCID: PMC11022112.

Schlechter, P., Hellmann, J. H., McNally, R. J., & Morina, N. (2022). The longitudinal course of posttraumatic stress disorder symptoms in war survivors: Insights from cross-lagged panel network analyses. Journal of Traumatic Stress, 1-12. https://doi.org/10.1002/jts.22795

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