The Seasons of Trauma: Recognizing When Symptoms Might Flare Up

Autumn leaves falling onto a dock by a lake.A woman who has experienced a traumatic event seeks counseling when she finds that symptoms related to the trauma affect her ability to enjoy life and function normally. She meets with her therapist once per week for 9 months, and she makes tremendous progress in therapy.

As she works hard and stays committed to the process of resolving her trauma, she feels very proud of herself and receives validating feedback from her therapist, who acknowledges her hard work and progress. She then notices that with the change of seasons, some of the symptoms she tried so hard to minimize or eliminate altogether come creeping back. She notices, as the time of year associated with her trauma approaches, her symptoms worsen still.

She becomes very frustrated. She fears she will experience the same degree of trauma she did immediately after the traumatic event. She wants to just give up. “What’s the point?” she asks herself and her therapist. “I have worked so hard and here I am, going right back to the trauma!”

Why Seasonal Change Can Reawaken Trauma

This case example illustrates a very common occurrence in trauma work. Trauma symptoms may resurface or worsen at certain times of year—it is almost as if the change in seasons is a catalyst that causes a person to feel as though they are regressing. It is easy at these times to dismiss the progress that has been made in therapy and focus, instead, on the reemerging symptoms. Rather than consider this a regression in therapy, I prefer to think of it as an expected occurrence in trauma work that should be normalized and discussed.

Several factors can be at play here. First, as the time of year when the traumatic event occurred comes around again, a very powerful reminder of the trauma often occurs. The brain is triggered and begins remembering. The body also remembers and symptoms reemerge.

Another consideration is that holidays can also trigger trauma memories and symptoms, especially if loss has occurred. The loss of a loved one is one of the most common and difficult traumatic events humans can experience. Even if the loss did not occur around the holidays, holiday times often serve as reminders of loved ones who are deeply missed.

Furthermore, according to the American Psychiatric Association, 80% of people who meet criteria for a diagnosis of posttraumatic stress disorder (PTSD) also meet criteria for other mental health diagnoses. In my experience, one does not have to have an actual diagnosis of PTSD to become more susceptible to other troubling mental health symptoms after a traumatic event. Just experiencing a traumatic event can make someone more likely to experience symptoms related to anxiety, depression, and other challenges.

Certain times of the year can make symptoms worse. For example, with colder weather and less daylight during the winter months, a trauma survivor who also experiences symptoms associated with seasonal affective disorder (SAD) may encounter a worsening of both SAD and trauma symptoms. Similarly, someone prone to anxiety may find symptoms flare up during the holidays, when more cars are out on the road, malls and stores are more crowded, and financial and social pressures are mounting.

Unfortunately, many people are ashamed to talk about reoccurring or worsening symptoms, and this can cause symptoms to escalate even more, impacting well-being and functioning.

Addressing Reoccurring Trauma in Therapy

Unfortunately, many people are ashamed to talk about reoccurring or worsening symptoms, and this can cause symptoms to escalate even more, impacting well-being and functioning. Beliefs may surface that all the time and hard work one has given in moving forward from a traumatic experience has been wasted. Feelings of frustration and an urge to give up on therapy are very common during these times, as illustrated in the case example.

In addition, a fear of disappointing one’s therapist may come up, preventing some people from openly discussing new or reoccurring symptoms. Making progress in therapy is validating and rewarding, as the case example demonstrated. Returning to therapy when symptoms reoccur can bring up feelings of shame or guilt, causing one to feel as though they will somehow disappoint the therapist or that the reoccurring symptoms will suggest to the therapist they are not working hard enough.

Reemerging Trauma as an Opportunity for Healing

I find this point in trauma work is sometimes the most critical, when clients have a wonderful opportunity to make the most progress toward resolving their trauma for good. This is the time to talk to your therapist to let them know exactly what you are experiencing and how it is making you feel. A good trauma therapist will validate and normalize what you are going through and help you to confront the fear of reoccurring symptoms so that when other triggers come up, it is not so daunting to confront them. This is an opportunity to practice skills with your therapist that will reinforce that you are strong and capable of handling whatever may come up.

Going back to our case example: The therapist validated and normalized what the woman was feeling and experiencing. She reassured the woman that what she felt was very common in trauma work and presented it as an opportunity. The woman stuck with therapy, continuing to talk about her urges to give up on therapy and her feelings of disappointment as they came up. She continued working hard and trusting the therapeutic process.

She was able to overcome her reemerging symptoms. The time of year that served as a trigger passed, and she found that when she thought of that time of year rolling around again, she was not as distressed as she expected. She felt better and more confident as she moved forward. Eventually, she did not need to see her therapist anymore, although she always knew she could return if she felt the need. And when the next trigger appeared, she handled it beautifully, which just reinforced her strength and the belief that she could continue to move forward.

Reference:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

© Copyright 2014 GoodTherapy.org. All rights reserved. Permission to publish granted by Anastasia Pollock, LCMHC, therapist in Midvale, Utah

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Claire

    Claire

    January 21st, 2014 at 10:47 AM

    What about the time of year when the trauma occurred? That could always have a negative connotation for the patient and cause him or her to feel worse or experience worse symptoms around that time.

  • Ally

    Ally

    January 21st, 2014 at 3:26 PM

    I think that what you will find is that anyone who has experienced pain like this and on this level will always have some sort of trigger that could set them off or could make them more symptomatic. It could be a song, a place, a person, anything could be that trigger. I think that a large part of recovery would be to come to recognize what those triggers are and how to manage those when they appear in life. It is not always possible to avoid them at all times, no matter how hard you try. So learning instead to deal with them when they do arise, that must be so empowering who has felt the pain of trauma and who now knows that they don’t have to allow it to rule their lives anymore.

  • paulson

    paulson

    January 22nd, 2014 at 3:39 AM

    I don’t know why those of us in therapy think that this is always supposed to be a smooth ride, that there will always only be forward progression but that we don’t alow ourselves to go back.

    Don’ we all slip and fall at times and then need help getting back up again? This is how I see things. Nothing always has only forward momentum, there will be times when we all take a few steps back. But that alone should not stop us from wanting to continue to move forward.

  • zara

    zara

    January 22nd, 2014 at 10:39 AM

    In some ways it makes me feel like I am letting my therapist down when I have these little slips, like he has worked so hard with me to get me to this place but am I somehow not feeling like I am good enough to deserve all of this so I intentionally sabotage it all?
    I know I shouldn’t feel ashamed of my feelings, they are mine after all and I own what I do and what I feel. But I don’t wish to let anyone else down either especially when he has worked so hard to help me overcome so much of this.

  • Chilli

    Chilli

    January 23rd, 2014 at 3:42 AM

    The great thing is that when you have worked on this for so long you will start to recognize the little things that could set you off… no matter what they might be, you will come to a place where you are eductaed enough about your own trigger points that you will be able to avoid some of the headaches that can come along with the recurrences. It won’t make things perfect but at least when you know what they could be or when they could happen you can at least start trying to head them off before that cause you too much upheaval.

  • Stanley

    Stanley

    January 25th, 2014 at 4:40 AM

    Why the frustration? Why the fear? If you are doing everything right otherwise then you should know that this is simply all a part of the journey

  • Ollie

    Ollie

    January 29th, 2014 at 8:58 AM

    I happen to think that when you come to the point where you know that you could start to show signs of the trauma creeping back in and hurting you, this is actually a pretty good thing. That would tell me that you are most likely becoming far more self aware and that you know better where your actual weaknesses lie. Once you know this then you begin to develop some logical defenses against this, ways to fight back to keep you strong and not so overwhelmed by those traumatic events. Once you can clearly see what the issues are and how tyou could avoid them, then I think that is showing real progress!

  • Gaynor Challingsworth

    Gaynor Challingsworth

    February 8th, 2014 at 7:23 PM

    There are times when it becomes more than seasonal. An instant downward roll of the rollercoaster not expected. There are many levels of trauma. Symptoms vary from person to person. Increase and decrease. My daughter has just left hospital. Her normal symptoms would be severe depression. This time one day she felt depressed the next she completely lost all feeling in her left side of body, like a stroke. It can take days or weeks to recover and are now in the process of rehabilitation to be able to walk again. Extreme trauma is devasting. Things can happen when least expect. I watch my 17yr old and see the struggles everyday. But have seen a girl who has strived not to give in. Working as a vet nurse, completing studies, a world at her feet, yet still finds life so lonely. As her mum its gut wrenching, but each day our motto. We will worry about what comes when and if it does.

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