POST INFIDELITY/POST ADULTERY STRESS DISORDER (PASD)
Although not included in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), therapists have recognized that many people who have experienced the betrayal of a partner, suffer from similar symptoms as those diagnosed with Post Traumatic Stress Disorder (PTSD), and equal to PTSD, they need a long time to heal.
- Feelings of fear, helplessness, and horror
- Desperation & numbness
- Resentment and grieving
- Intruding reminders that elicit a strong emotional reaction & nightmares
- Irritability, anger and rage
- Self-blame and low self-worth
- Feeling lost due to the having one’s core beliefs shattered
- Isolation & loneliness
Continuous fear and anxiety: Right after the adultery is discovered, spouses live in a phase of continuous high anxiety and hyper-vigilance intruding during rest and sleep (nightmares), and daily functioning. The high anxiety affects overall physical and mental health, including the ability to digest food causing weight loss. No partner who betrays their spouse seems to be able to disclose all they have done in a timely matter. This means that the spouse is left to try to connect the dots. The time between D-day and knowing all (that matters) can be long and torturous. There is always more…more demons to deal with.
Desperation: Often right after D-day, the spouse feels extremely desperate, followed by periods in which nothing seems real. The magnitude of the consequences of the event has not yet sunk in. Denial as well as anger, deep sadness and numbness follow each other in cycles. Often the spouse wants to have deep intimate contact with the partner coming from a desperate attempt to restore what once was. This phase might last for a while.
Resentment and grieving losses: The spouse eventually will have periods of deep insight in what future might bring and will realize that the memories of what has happened will never go away. The realization of the timelessness results in deep resentment and blame of what has been lost. There are many losses, from trust and safety to how the new reality affects self-worth and everyday performance. The resentment will likely cause a withdrawal from their partner. As trust is affected, many spouses have trouble trusting anyone which affects socialization in a negative way. Many feel that they can no longer be the person they used to be, as it feels like a dark secret has invested itself in their body and mind.
Defeat: Spouses who loved their partner and who have done their utmost to make their partner happy, feel utterly defeated. They have noticed their partner staying longer “at work”, being distracted, spending long times on their phone or other device and making excuses for their absences. They tend to have “urgent meetings”, are “overwhelmed with work demands”, and are busy during weekends, evenings and time-off. Many spouses have noticed weight loss and an increased attention to their appearance. Many partners have lost interest in any family event, the children and the home. They are totally self- absorbed. Spouses who want to trust their partners take over the entire workload. They do all that is required to attend to the children, do the housework, the shopping, the cooking and the cleaning. They offer more physical intimacy and make it possible for their partner to do “their work”. After they find out that work was not the issue, they feel utterly defeated as despite all they did, their partner continued “to entertain” a person outside the relationship.
Triggers and nightmares: Certain places, events, even movies, songs and people are a negative reminder of the traumatic event resulting in symptoms of high anxiety (heart palpitations, nausea, light-headedness, and sweating), as if experiencing the event all over. Often people try to avoid reminders of the event which is nearly impossible. Anything that is a reminder directly, or indirectly of the affair causes a chain of experiences starting with a jolt of pain in the heart and often a skipped beat, followed by a very rapid pulse. Vague thoughts of impending doom become increasingly more concrete, as a movie showing images of how their partner lied, what they said, and what they did with the individual they had sex with. The rapid thoughts and visuals lead to anger and deep grief and rage followed by self-blame for being too stupid to have prevented the affair. These visuals intrude during daytime and nighttime. At night difficulty sleeping due to intruding thoughts and visuals adds to the torture. Vivid dreams are cause to wakening with an anxiety attack. The theme in most dreams is the wish to have done something to stop the affair.
Irritability and rage: No matter how much spouses want to heal and move forward after they discover the affair, they continuously are confronted with events that act as a trigger which makes escaping the feelings of anger and rage impossible. There is no escape. Sleep is disrupted or absent. More often than not, spouses self-medicate with alcohol or drugs. Initially the alcohol suppresses the anxiety, but soon after, it causes the brain to be more open to disturbing thoughts. Many spouses are self-destructive. Many have violent and aggressive outburst. That this happens to people who were never violent in their life before the affair, shows how incredible painful the betrayal is and how it affects people.
Self-blame: Spouses blame themselves for not knowing that the affair was going on. They feel that they have someway somehow contributed to the affair and they feel that they are not good enough for their spouse. This is mitigated by the messages on some internet sites. The spouse feels “stupid” for trusting their partner. They remember the times they went through their partner’s pockets, not knowing what to look for. They remember smelling their partner’s underwear and blaming themselves for being stupid, as their partner “would never do such a thing!” Spouses often think that “if they had done such and such”, they may have prevented things from escalating. The spouse feels that their unfaithful partner hated them or felt no emotion (indifferent) and that the partner had no feelings of guilt and shame. Spouses of partners who betray them feel publicly humiliated and isolated as being the “victim” of betrayal is often kept a secret from friends and family.
Core Beliefs: In committed relationships partners make certain assumptions about trust, respect, honesty, safety and security. The spouse of a partner who commits adultery experiences the shattering of core beliefs they thought were the basis of their relationship. Spouses who discover adultery feel that their entire relationship was based on lies and deceit. Trust has been violated, safety and security has been breached. A partner who commits adultery shows in all aspects that they do not respect their spouse, and in turn, their spouse will lose respect for them. Committing adultery does not come out of the blue. What people who betray their spouse have on-common is an intense self-centeredness. A person committing adultery places the health of their spouse in danger. They have sex outside the committed relationship. They give to a stranger what once was the most intimate and sacred interaction between them and their spouse.
Isolation: Many spouses withdraw from family and friends. They do not want everyone to know what has happened. Often they protect their spouse. An affair is not a disease such as cancer that warrants empathy or at least sympathy. As self-worth and confidence is shattered, many feel unworthy. They doubt their sanity and their intelligence. Another reason why spouses withdraw from the world is the triggers and not being able to enjoy a social event in a restaurant or hotel. Trusting others becomes a huge issue. As many spouses have experienced, disclosing an affair might lead to gossip and the experience of yet another betrayal.
Treatment Options for PASD
First and foremost, choose a therapists who gets it. Many well-meaning people in the field have preconceived ideas and opinions that are not helpful to a spouse who is desperate for empathy and understanding. As clients who experience PASD are vulnerable, a therapist has to start with listening to their story and perceive their story as their truth. Clients will not tell about all the ugliness of the affair and their destructive behaviours as a response to the unbearable pain, in fear of being discarded and judged. Clients will never open up if a therapist is not willing to hear what has been said and if not willing to assist where and when help is required. Therapists cannot make statements that places responsibility on both partners. There is one who committed adultery and regardless what has contributed to the selfish act, they are the ones who have to assume full responsibility.
Therapists use different approaches when assisting spouses who experience this type of trauma. Some approaches might be helpful, or initially helpful. If perceived as such, it probably is the right approach for the spouse regardless whether scientific evidence backs up the approach.
A series of approaches have stood the test of time. These include cognitive therapy, cognitive behavioural therapy and rational emotive behaviour therapy. What they have in common is that these are not magical approaches that offer immediate relief. These approaches require hard work and that is the reason why so many people are looking for alternatives that promise a speedier relief. Some approaches are based on CT, but have added a component that might offer some “immediate relief”. Often the “active ingredient” that offers healing on the long-term is based on the science behind CT and CBT.
First of all, think about the following:
- What do you want? Staying in the relationship or to separate? Describe your future. You do not want to hurt for the rest of your life. Focus on the positives: Who loves you, what have you achieved already?
- What is sabotaging this “better future” (reminders of the affair)? Try to systematically deal with these (see below).
Rational Emotive Behaviour Therapy (Albert Ellis) can be used in the process of healing from the most disturbing symptoms of PASD which are reminders of the past and which hurt immensely.
Albert Ellis REBT (1913-2007)
Who is Albert Ellis?
Ellis is an American therapist and the creator of Rational Emotive Behaviour Therapy (REBT), a successful form of psychotherapy that is related to Cognitive Therapy (CT) and Cognitive Behaviour Therapy (CBT). Ellis lived a long and productive life. He is known for his outspokenness and often perceived as blunt or rude.
The following sums it up nicely. In response to a question during an interview he confirmed to being a very unusual person and a kind of character. “Yes [Ellis said] compared to most therapists, and probably to the general population, because I usually tell it like it is. And I don’t give that much of a damn what people think of me for saying it. That’s unusual, since the world consists mainly of love slobs who need other people’s approval. Most people don’t live their own lives very well.” (p. 181). Ellis is not the nicest person, and there may be reasons for that. Either way, the approach has a lot to offer for those struggling with symptoms of PASD.
Rational Emotive Behaviour Therapy (REBT)
In response to an activating event (A), one can have a rational belief (B) followed by healthy consequences (C). These are healthy feelings and rational thoughts). One can also have irrational beliefs (IBs), followed by unhealthy consequences (unhealthy feelings and self-defeating thoughts). When one disputes their irrational belief (D), one will experience healthy consequences as healthy thoughts and beliefs are based on undogmatic and flexible preferences.
Helpful Acronyms from REBT:
ABCD stands for: ADVERSITY (A), BELIEFS (B), EMOTIONAL CONSEQUENCES (C),
DISPUTING IRRATIONAL BELIEFS (IBs) which is the ability to change one’s dysfunctional beliefs.
When people dispute their IBs, they change their self-defeating thinking, and experience healthy emotional consequences and feelings.
HEALTHY FEELINGS: Sorrow, sadness, regret, feeling sorry, annoyed, frustrated, concerned, and displeased versus UNHEALTHY FEELINGS: Shame, embarrassment, humiliation, desperation, defeat, and panic.
SELF-DEFEATING THOUGHTS: thoughts such as “I am insane, I am stupid, and I am an idiot” versus RATIONAL THOUGHTS: I am sad and hurt and it does not feel good. I do the best I can and I am not perfect but doing the best I can.
Epictetus, a philosopher, discovered 2,000 years ago that people evaluate certain events (i.e. they give meaning to), based on what should have been. This makes it harder to accept reality and to focus on the positives and the ultimate goal of having good and positive relationships. Epictetus said “people are disturbed not by what happens to them but by their view of them”. This does not mean that it is all in your head, it means that how you talk to yourself can either help you forward or hold you back.
MUSTURBATORY PHILOSOPHY is not helpful. It refers to thoughts like “the world and people must be fair”; “people should use their brain” (and other examples of unrealistic thinking).
UNDOGMATIC FLEXIBLE PREFERENCES are helpful and these are derived by changing irrational beliefs, and by helping a person to face acceptance of the reality.
USA refers to Unconditional Self-Acceptance and this is accepting of self, including one’s short comings. Helpful is as well to equip oneself with High Frustration Tolerance (HFT). Last, but not least, Unconditional Life Acceptance (ULA) refers simply to “shit happens”!
DEALING WITH NEGATIVE REMINDERS OF THE PAST (TRIGGERS)
- Examine (with help if needed) every single trigger*. Start with one of the least disturbing. Consciously think about it**.
- Place it in the correct timeframe (it happened in the past, it is not happening right now).
- Observe your inner dialogue as if listening in
- Alter the dialogue’s path by inserting rational thoughts
- Reframing and restructuring thoughts and overall thinking about the events lead to having more rational feelings and therefore a decrease in the engagement of self-defeating behaviours
- Repeat this as often as the trigger and disturbing thoughts reoccur. The repetition functions as a desensitization process. The restructuring of the thinking helps to claim a formerly avoided trigger back. Desensitization means that the event eventually will no longer elicit a painfully strong emotional reaction (anxiety and panic).
- After doing this emotionally intensive work, seek some non-triggering distraction.
*Note: Certain triggers might require long term avoidance as these are too painful to face. Other events or locations that are a trigger need to be subjected to a process of restructuring thought or cleansing.
**Note: Not all people hurting after they find out that their partner had an affair want to hear the details. If you are a person who tends to want to know all facts before being able to move on, you need to have your questions answered. Subjecting a spouse to guessing and fearing the worst of the worst is complete torture.
Where does the partner fit in, if still in the picture?
The one who had the affair and who wants their spouse to heal and the relationship to survive, is fully committed to do EVERYTHING and for AS LONG as it is needed. This means that they are no longer the selfish people they were. They no longer feel entitled, and have shed the arrogant attitude. They messed up, and they deeply hurt their spouse and children. They need to become someone they were not. They need to be honest, loyal and patient. No matter what their spouse says or does, they need to accept, understand and show love and kindness. They need to fully get that the process toward healing is a long one with small gains overall, but with many deep lows. They need to understand that they deeply damaged a relationship that was believed to be based on trust and respect. They need to do everything to earn some of that trust and respect back.
Without sleep people cannot function. Sleep deprivation leads to an inability to think straight. What helps a person to sleep is to have some distraction from all the work to be done in order to get out of the hole that has swallowed you up.
Movies that are trigger-free, or even better; A podcast that helps you sleep (there is an app for that), or reading a trigger-free book on your e-reader (use the night setting), can be helpful.
In order to have a restful night sleep a certain routine might help. In addition to distraction and peace before bedtime, try to add one cardio activity as well as yoga and/or meditation to your daily schedule.
Avoid the use of alcohol with the aim to fall asleep and avoid sleeping tablets and benzo diazepam type of drugs (to reduce anxiety and induce sleep). All of them have either long-term side effects, change your natural sleeping rhythms, and are addictive. Although sleep is crucial, dependence on prescription drugs and alcohol does a lot of damage. The withdrawal symptoms when stopping with benzodiazepines are severe.
Good therapists are familiar with the symptoms people struggle with when coming to terms with the ugliness of a partner’s affair. They know about self-medication, self-destructive behaviours, self-harming as well as loneliness and isolation. They will ask the right questions and are not afraid to hear the answers. They allow clients to disclose all and normalize, validate and acknowledge. They do not preach, judge or give advice. They are patient and gentle and in the first place are concerned about their client’s safety while keeping in mind that it is a brave thing to do to seek help.
In addition to sleep, eating healthy food is essential for healing. So is exercise and very helpful are yoga and meditation. The ability to relax, even if it is initially only for a short time, provides hope that life ultimately can be better, and indeed it can be, it requires determination to keep placing one foot in front of the other.
Ellis, A. (2004). Rational Emotive Behavior Therapy. It works for me. It can work for you. New York: Prometheus Books.