Written by Samantha Wall, LCSW
Edited by Joe DeNoon
Routines and rituals are important aspects when addressing PTSD symptoms. Trauma or traumatic events send us into a state of hyperarousal, which affects our ability to orient to the present moment, regulate our emotions, and live daily life. As Francine discussed in the last blog, rituals provide concrete ways to provide comfort and self-compassion to ourselves while we are working towards processing the trauma we have experienced. Even when we are going through active trauma, routines and rituals provide us consistency in our daily life when there may not be a routine in another aspect of life.
Being nurses, you all experience trauma in your job, but the biggest event that comes to mind that is and was a traumatic event for most of the world was the pandemic. The likelihood the pandemic was traumatic for you as a nurse is much higher than for the rest of the population. That trauma from your work must be addressed, and that is why boundaries with work are so important for you all! Boundaries provide you with specific routines for your body to transition out of work. When you notice that you are not following your routines and rituals, it can be difficult to feel grounded from day to day. This difficulty will then inevitably delay the work to process the trauma.
Francine also discussed the book “What My Bones Know” By Stephanie Foo. She created routines and rituals in her daily life as she was experiencing complex trauma. Complex trauma is defined as, “the exposure to multiple, often interrelated forms of traumatic experiences AND the difficulties that arise as a result of adapting to or surviving these experiences.” (Complex Trauma Resources). When we experience complex trauma, it is a disruption to our regulation daily. Since these traumatic experiences disrupt our daily life, our system responses are re-wired. However, when we incorporate routines and rituals in our daily life, this can then disrupt the disruption.
The question is, how do we start incorporating routines and rituals? If we change everything at once, that could also be dysregulating. Stephanie discussed how she went to therapy for 8 years before her therapist discussed the diagnosis of Complex PTSD, and then the integration of that information to her life. Stephanie did make a big disruption to her daily life by quitting her job (where her boss was a HUGE trigger), and fully prioritizing her mental health. As I was reading this, I understood her reasoning and felt it was the best decision for her. I also noticed she was still very structured and had routines throughout her time that she was not working. She went to yoga, doctor appointments, meditation classes, etc. She then discussed how her structured day was just continuing a pattern that had been present since she was young. She was trying to perfect ‘treatment’. My suggestion would be to pick out one thing you can change in your routine in a week or a month, whatever feels more doable. With routines and rituals, we want to build them slowly over time, so our system has time to adjust to new things.
A great place to start is our routine/ritual around the aspect of our life that we find the most triggering. If it is seeing our family, going to work, cooking, etc. (triggers can be anything), we want to create a routine and ritual around this trigger. Since we are focused on nursing in this blog when going to work and leaving work, having a consistent routine can help our body prepare for the triggers when we go to work, as well as recognize the triggers are over when we leave. When we first start out changing our routines, we want to be strict with how they are done and when they are done. This can be especially hard to keep up when we have a hard day and less tolerance to complete the routine, but this is when it becomes the most important to practice this skill. We create these routines and rituals for the hardest day, so it can re-regulate us.
As we are able to shift and change our rituals and routines, we also want to think about the best routine for ourselves. If going on a walk, taking five minutes to yourself, or reading is what helps, do that! Things we want to avoid are those habits that are not beneficial to our well-being. This is different for everyone, but things to avoid in our routines are drug use, drinking alcohol, binging, and restricting food/basic needs. These rituals are not going to be beneficial to our regulation, even if they seem like the easiest thing to do.
Routines and rituals can be so regulating and beneficial to our daily lives (even if we do not struggle with PTSD), but these can be essential when managing PTSD symptoms. If you feel you are struggling with PTSD symptoms, this is a helpful tool, but as always, please seek professional help as well to address and process the trauma along with implementing routines and rituals.
What My Bones Know by Stephanie Foo https://www.stephaniefoo.me/