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1, 2, 3’s of PTSD

7/3/2017

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PTSD has three main sets of symptoms: 1) psychological, 2) behavioral, and 3) physical.  Persons with PTSD may experience some or all of these symptoms and in
varying degrees.  
  
Psychological Symptoms of PTSD

Depression
With depression, the person is no longer able to look forward to events.  They have difficulty enjoying things or getting excited about things in the future.  There is very little joy and if happiness is found, it’s in a very small amount – almost as if it is in a faraway dream.

Anxiety
The person worries excessively over things not considered a problem in the past.  These worries can begin to take over their lives and control their actions.
 
Guilt
Persons usually experience one or both of two kinds of guilt.  One is feeling guilt over their means of survival during the traumatic event and/or blaming themselves for the trauma, as if they had power to control the situation.  The other is what is referred to as “survivor’s guilt” which is feeling guilty because they survived, whereas their friends or co-workers may not have.

Avoidance/Lack of Emotion
They seem to be shutting down.  They avoid any situation that could trigger their painful and frightening symptoms/memories and avoid
situations that cause emotions to “bubble up.” They may shut down during emotional situations and withdraw into themselves, rather than communicating with a loved one or trusted friend during these
times.

Intrusive Thoughts
This is a “hallmark” symptom of post-traumatic stress disorder based on Hollywood’s stereotypical version of a flashback.  Real “flashbacks” occur by thinking or dreaming about the trauma. They are triggered by sights, sounds, smells, etc. that make the person feel like they are reliving the trauma in the present.  Most times, the
traumatic situation creeps into their thoughts without them having any control over this happening.

Hallucinations
This can be a flashback, reliving an event, and/or seeing/hearing things that are not really there. These can be very traumatizing and
challenging for a person to deal with, often one of the most frightening parts of PTSD.

Behavioral Symptoms of PTSD

Extreme Rage
The person is experiencing huge amounts of anger over “minor” things that never bothered them in the past.  “Little” things are suddenly a HUGE trigger for gigantic screaming matches over what is, in reality, no big deal.

Short Fuse
The person is going from being relaxed or only mildly irritated to “extreme rage” in a matter of seconds.  This can be described as a “blowing up” in some families.  It's like lighting a match to a tank of gasoline and it just explodes.

Isolation
The person is pulling away from everyone.  He or she is no longer able to share thoughts, feelings or emotions with those he or she loves.  They also may not want to be physically close to anyone and begin to sleep in a different part of the house, may work extended 
hours and find other ways to get distance.

Alcohol or Drug Abuse/Dependence
 The person is using alcohol or drugs (illegal or non-prescribed prescription) to mask their symptoms and cover up issues they do not want to face and that are extremely painful to face.  This is commonly called “self-medicating.”  

Always Being on Guard (Hypervigilant)
A person is on guard for a potential threat or attack.  The veteran with PTSD is constantly scanning crowds, traffic, and other areas for potential threats.  A bag in the street is seen as a potential bomb.  A person in an airport is “suspicious.”  A rape victim may be looking over his/her shoulder for an unsuspecting attack.    
 
Feeling Numb
The person is not feeling emotions normally.  They feel very little emotion, if any at all, toward the people and activities around them. 
They often seem vacant and like a hollow shell.

Memory Problems
Person is struggling to remember things.  Things are constantly being lost, past conversations are forgotten, and little details,
like phone numbers are difficult to remember.  This may lead to aggression and frustration due to the lack of recall.

Lack of Concentration
The person is unable to concentrate in one or more areas.  They may be struggling at work or at school, thus affecting their performance. 
Concentrating on their favorite hobbies may be a challenge as well.

Nightmares
They may be experiencing extremely disturbing dreams.  These may or may not be directly associated with their trauma.  They can be combined with other symptoms.  The nightmares can include sleepwalking and physical aggression while sleeping.

Unable to Fall Asleep or Stay Asleep (Insomnia)
The person is having difficulty falling asleep in the evening.  It may feel like their brain “just won’t shut off.” They lie awake for hours despite being utterly exhausted.  The person may awake from sleep to check doors and windows or to make sure family members are all present and accounted for.  They may have other “odd” logical or illogical nighttime “concerns.”

Being Easily Startled/Increased Startle Response
The veteran is easily reacting to loud noises that sound similar to 
explosions like gunfire or other “combat sounds.”  Some common noises that cause this could be a car backfiring, a balloon popping,
fireworks going off and even bubble wrap popping.  
 
Low Self-Esteem
The veteran feels they are not worth anything to society anymore.  They may feel the loss of their job in military service or be concerned about their abilities being compromised due to disabilities.  They may feel very “low” or “down in the dumps.”  Rape victims may feel damaged and unworthy of love and support and/or blame self for the crime that happened to them.    
  
Feeling Hopeless About the Future
The person feels that nothing positive lies before them any longer, as if there is no good in neither the world nor any good things in the
future.  They become lost in a sea of nothing.

Avoidance
Not wanting to see/hear anything that reminds the veteran of deployment.  The veteran avoids the news, movies, and other things that would remind them of their deployment.  They may avoid memorabilia in the house, friends who were deployed with them and they may become agitated when confronted with these things.  They may also try to avoid people who remind them of those who were in the location where they were deployed.  A rape victim
may avoid dating or social situations that remind them of their traumatic event or may avoid locations that remind them of the event. 
 
Lack of Appetite
The person may barely be eating enough to stay alive.  Their
emotions have left them with no desire for food and, at times, repulsed by the thought of having to eat.

Overeating/Gorging
The person may be “self-medicating” with food, drowning their pain by endlessly eating.  Sometimes this is combined with or alternates with lack of appetite.

Physical Symptoms of PTSD

Headaches
The person may experience anything from a minor headache to a migraine that lasts for days.  The headaches may be connected with other symptoms or appear/disappear on their own.

Rapid Heart Rate or Sweating
The person may experience profuse sweating and or “feel” or “hear” their heartbeat when they are reminded of their trauma or while they are experiencing flashback symptoms.  Some people report that they experience this symptom without it being connected to their trauma and will break out in a sweat and hyperventilate (feel short of breath) even when they are not remembering the event.  This can be incredibly distressing to them because it is out of the blue and for no apparent reason.
 
As mentioned previously, persons with PTSD may have some or all the above symptoms and they may present in varying degrees from one individual to next.  
  
If you are experiencing symptoms of PTSD, help is available.  Please see a physician and/or a mental health professional who specializes in PTSD. 



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HOW TO SET HEALTHY BOUNDARIES

7/20/2016

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Healthy boundaries create healthy relationships. Unhealthy boundaries create dysfunctional ones. By establishing clear boundaries, we define ourselves in relation to others. To do this, however, we must be able to identify and respect our needs, feelings, opinions, and rights. Otherwise our efforts would be like putting a fence around a yard without knowing the property lines.

Those of us raised in dysfunctional families have probably had little experience with healthy boundaries. Therefore, learning how to establish them must be an important goal in our personal growth. In order to achieve this, however, we must overcome low self-esteem and passivity; learn to identify and respect our rights and needs; and become skilled at assertively taking care of ourselves in relationships. This process allows our true selves to emerge, and healthy boundaries become the fences that keep us safe - something we may never have experienced in childhood.

Boundaries can be physical or emotional. Physical boundaries define who can touch us, how someone can touch us, and how physically close another may approach us. Emotional boundaries define where our feelings end and another's begins. For example, do we take responsibility for our feelings and needs, and allow others to do the same? Or do we feel overly responsible for the feelings and needs of others and neglect our own? Are we able to say "no"? Can we ask for what we need? Are we compulsive people pleasers? Do we become upset simply because others are upset around us? Do we mimic the opinions of whomever we are around? The answers to these questions help define the "property lines" of our emotional boundaries.

Together, our physical and emotional boundaries define how we interact with others, and how we allow others to interact with us. Without boundaries, others could touch us in any way they wanted, do whatever they wished with our possessions, and treat us in any way they desired. In addition, we would believe everyone else's bad behaviors are our fault, take on everyone's else's problems as our own, and feel like we have no right to any rights. In short, our lives would chaotic and out of our control.

Boundaries can be too rigid or too loose. Those whose boundaries are too rigid literally shut out everyone from their lives. They appear aloof and distant, and do not talk about feelings or show emotions. They exhibit extreme self-sufficiency, and do not ask for help. They do not allow anyone to get physically or emotionally close to them. It is as if they live in a house surrounded by an immense wall with no gates. No one is allowed in.

Those whose boundaries are too loose put their hands on strangers and let others touch them inappropriately. They may be sexually promiscuous, confuse sex and love, be driven to be in a sexual relationship, and get too close to others too fast. They may take on the feelings of others as their own, easily become emotionally overwhelmed, give too much, take too much, and be in constant need of reassurance. They may expect others to read their minds, think they can read the minds of others, say "yes" when they want to say "no," and feel responsible for the feelings of others. Those with loose boundaries often lead chaotic lives, full of drama, as if they lived in houses with no fences, gates, locks, or even doors.

Those with healthy boundaries are firm but flexible. They give support and accept it. They respect their feelings, needs, opinions, and rights, and those of others, but are clear about their separateness. They are responsible for their own happiness and allow others to be responsible for their happiness. They are assertive and respectful of the rights of others to be assertive. They are able to negotiate and compromise, have empathy for others, are able to make mistakes without damaging their self-esteem, and have an internal sense of personal identity. They respect diversity. Those with healthy boundaries are comfortable with themselves, and make others comfortable around them. They live in houses with fences and gates that allow access only to those who respect their boundaries.

Learning to set healthy boundaries can feel uncomfortable, even scary, because it may go against the grain of the survival skills we learned in childhood - particularly if our caretakers were physically, sexually, or emotionally abusive. For example, we may have learned to repress our anger or other painful emotions because we would have been attacked and blamed for expressing the very pain the abuse had caused. Thus, attempting to set healthy boundaries as an adult may initially be accompanied by anxiety, but we must learn to work through these conditioned fears, or we will never have healthy relationships. But this process of growth takes time, and our motto should always be, "Progress not perfection."

Here are some tips for setting healthy boundaries, modified from the book, Boundaries: Where You End and I Begin, by Anne Katherine

When you identify the need to set a boundary, do it clearly, preferably without anger, and in as few words as possible. Do not justify, apologize for, or rationalize the boundary you are setting. Do not argue! Just set the boundary calmly, firmly, clearly, and respectfully.

You can’t set a boundary and take care of someone else’s feelings at the same time. You are not responsible for the other person’s reaction to the boundary you are setting. You are only responsible for communicating the boundary in a respectful manner. If others get upset with you, that is their problem. If they no longer want your friendship, then you are probably better off without them. You do not need "friends" who disrespect your boundaries.

At first, you will probably feel selfish, guilty, or embarrassed when you set a boundary. Do it anyway, and tell yourself you have a right to take care of yourself. Setting boundaries takes practice and determination. Don't let anxiety or low self-esteem prevent you from taking care of yourself.

When you feel anger or resentment, or find yourself whining or complaining, you probably need to set a boundary. Listen to yourself, then determine what you need to do or say. Then communicate your boundary assertively. When you are confident you can set healthy boundaries with others, you will have less need to put up walls.

When you set boundaries, you might be tested, especially by those accustomed to controlling you, abusing you, or manipulating you. Plan on it, expect it, but be firm. Remember, your behavior must match the boundaries you are setting. You can not establish a clear boundary successfully if you send a mixed message by apologizing for doing so. Be firm, clear, and respectful.

Most people are willing to respect your boundaries, but some are not. Be prepared to be firm about your boundaries when they are not being respected. If necessary, put up a wall by ending the relationship. In extreme cases, you might have to involve the police or judicial system by sending a no-contact letter or obtaining a restraining order.

Learning to set healthy boundaries takes time.  It is a process. You will set boundaries when you are ready. It’s your growth in your own time frame, not what someone else tells you. Let your counselor or support group help you with pace and process.  Develop a support system of people who respect your right to set boundaries. Eliminate toxic persons from your life - those who want to manipulate you, abuse you, and control you.  Setting healthy boundaries allows your true self to emerge – and what an exciting journey that is. 

If you would like help in learning to establish healthy boundaries in your relationships, therapy might be right for you.

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COGNITIVE PROCESSING THERAPY (CPT) for PTSD, DEPRESSION ANXIETY

4/12/2014

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    CPT involves a structured, sequenced approach to address the unique needs of  each patient suffering from PTSD and/or DEPRESSION. Specifically, CPT is a  short-term treatment that has been shown to work in as few as 12 treatment  sessions.  Of course, treatment may be provided for longer periods depending on each individual's needs. Sessions address the following issues:  
        1. Educating patients about PTSD and explaining the nature of their symptoms
        2. Helping patients explore how traumatic events have affected their lives
        2. Learning about connections between trauma-related thoughts, feelings, and behaviors
        3. Remembering the traumatic event and experiencing the emotions associated with it 
        4. Increasing patients' ability to challenge maladaptive thoughts about the trauma
        5. Helping  patients increase their understanding of unhelpful thinking patterns and learn  new, healthier ways of thinking; and
        6. Facilitating patients' exploration of how each of 5 core themes have been affected by their traumatic experiences.

    CPT explores and helps survivors modify "stuck points" in the five major  areas of functioning that are usually affected by victimization: safety, trust,  power and control, self-esteem, and intimacy

    Why CPT? Because CPT works!
    There is strong scientific evidence that CPT  helps patients overcome PTSD and DERESSION that are associated with trauma  exposure. 
       1. Multiple randomized, controlled clinical trials have found  that CPT is better than no treatment or good comparison treatments in reducing  symptoms related to trauma.
      2.  CPT is effective in both military/veteran  and civilian populations.
      3.  Though I focus on use of CPT as an  individual treatment, there is evidence that CPT can also be delivered  effectively in a group format.
      4. CPT was developed and tested with  patients presenting with a wide range of comorbid disorders and complicated  trauma histories

    CPT is a non-threatening approach to PTSD that allows the client to  understand PTSD, their symptoms and to methodically uncover maladaptive thought  patterns.  Clients learn to apply healthier ways of thinking about their  traumatic experience and themselves.  CPT also addresses and helps clients  with issues related to safety, trust, power and control, self-esteem and  intimacy.  The treatment method provides the client with a before and after view of their  progress and provides the client with tools to use in everyday life once treatment is completed.  
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"UNDERSTANDING TRAUMA" IV ~ HOW WE FEEL DURING TRAUMA

4/7/2014

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This is Part IV of a V Part series to help survivors and loved ones better understand how the body and mind react to traumatic events.

We  don’t usually think about it, but it is possible to die of fright or to die of a  broken heart.  Every vital organ  system is closely tied in through the autonomic nervous system, with our emotional system. In fact, however, people rarely die from emotional upsets. A fundamental reason for such rarity, despite the extent of fearful circumstances that children face, is the built‐in  “safety valve” that we call “dissociation.”

Dissociation is defined as “a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the   environment.”  Dissociation helps us do more than one thing at once. We can go on autopilot and automatically complete tasks that we have previously learned well, while we are focused on something else. This increase in efficiency may help explain why we evolved the ability.

 Traumatized people make special use of this capacity. There are  different ways that people dissociate. Fainting is an extreme form of simply stopping consciousness. Psychogenic fainting is the brain’s way of saying, “I can’t handle this.”  But we can also split off memories from conscious awareness, as we have already discussed, and develop “amnesia.” Rarely, someone can develop amnesia for their entire identity and begin a separate life – a fugue state. More commonly people develop amnesia for parts of their lives or just for parts of certain overwhelming experiences.

But there is another way we can dissociate that is so common that almost everyone does it – splitting off experience from our feelings about that experience.  In its most extreme form, this is  called “emotional numbing.” So commonly do human beings cut off feelings about what happened to them while still remembering everything, that often we have to look closely at the person before we see something is wrong - they do not feel the emotions that would normally be expected under the circumstances.  In such cases, instead of seeing the emotional numbing that has occurred to the person, we will make comments about “how well Sheila is coping with her loss” or “how extraordinary it is that John never seems to get ruffled, even if someone is yelling at him.”  But Sheila and John are not necessarily“coping well”‐they  may be dissociated from their feelings and their capacity for normal emotional interaction may be consequently diminished.

 We are able to cut off all our emotions but that usually happens only in extreme cases of repetitive and almost unendurable trauma. More commonly we cut‐off or diminish specific emotional responses, based on the danger the emotion may  present to continued functioning. Our emotions are intimately tied to the expression of emotion through our facial expressions, our tone of voice, our gestures, so that we easily give away what we may be consciously trying to hide. If you grow up in a violent home, where every time you express anger you get beaten, it is best that you never show anger. If you grow up in a home – or a culture – that says that little boys who cry are wimps who should be taught a “lesson,” then it is a good idea to learn to never feel sadness, therefore minimizing the danger of tears. If any sign of pleasure or laughter is met with hostility and abuse, then it is best that you never feel joy. In this way, children from destructive situations learn how not to feel, they learn to dissociate their emotions from their conscious experience and their nonverbal expression of that emotion and in doing so, they can possibly stay safer than if they show what they feel. That does not mean that the emotion actually goes away. It does not. Emotions are built‐in, part of our evolutionary, biological heritage and we cannot eliminate them, we can only transmute them. There is an abundance of evidence from various sources that unexpressed emotions may be very damaging to one’s mental and physical health.

It is certainly clear that emotional numbing is damaging to  relationships. We need all of our emotions available to us if we are to create and sustain healthy relationships with other people. If we cannot feel anger, we cannot adequately protect others and ourselves. If we cannot feel sadness, we cannot complete the work of mourning that helps us recover from losses so that we can form new attachments. If we cannot feel joy, life becomes empty and meaningless leading to an increased potential for detachment, alienation, suicide and homicide. This is yet another example of how a coping skill that is useful for survival under conditions of traumatic stress can become a serious liability over time.

As this process continues over time, we gradually may shut‐off more and more of our normal functioning. We may dampen down any emotional experience that could lead back to the traumatic memory. We may withdraw from relationships that could trigger off memories. We may curtail sensory and physical experiences that could remind us of the trauma. We may avoid engaging in any situations that could lead to remembering the trauma. At the same time, we may be compelled, completely outside of our awareness, to reenact the traumatic experience through our behavior. This increases the likelihood that instead of managing to avoid repeated trauma, we are likely to become traumatized again. As this process happens, our sense of who we are, how we fit into the world, how we relate to other people, and what the point of it all is, can become significantly limited in scope. As this occurs, we are likely to become increasingly depressed. These avoidance symptoms, along with the  intrusive symptoms, like flashbacks and nightmares, comprise two of the  interacting and escalating aspects of post‐traumatic  stress syndrome (PTSD), set in the context of a more generalized physical  hyper-arousal.  As these alternating symptoms come to dominate traumatized people’s lives, they feel more and more alienated from everything that gives our lives meaning‐themselves, other people, a sense of direction and purpose, a sense of spirituality, a sense of community. It is not surprising, then, that slow self‐destruction through addictions, or fast self‐destruction through suicide, is often the final outcome of these syndromes. For other people, rage at others comes to dominate the picture and these are the ones who  end up becoming significant threats to the well-being of others.

Children who are traumatized do not have developed coping skills, a developed sense of self, or self in relation to others. Their schemas for meaning, hope, faith, and purpose are not yet fully formed. They are in the process of developing a sense of right and wrong, of mercy balanced against justice. All of their cognitive processes, like their ability to make decisions, their problem‐solving  capacities, and learning skills are all still being acquired. As a consequence, the responses to trauma are amplified because they interfere with the processes of normal development. For many children, in fact, traumatic experience becomes the norm rather than the exception and they fail to develop a concept of what is normal or healthy. They do not learn how to think in a careful, quiet, and deliberate way. They do not learn how to have mutual, compassionate, and satisfying relationships. They do not learn how to listen carefully to the messages of their body and their senses. Their sense of self becomes determined by the experiences they have had with care taking adults and the trauma they have experienced teaches them that they are bad, worthless, a nuisance, or worse. Living in a system of contradictory and hypocritical values impairs the  development of consciousness, of a faith in justice, of a belief in the pursuit of truth. It should come as no surprise then that these children so often end up as the maladjusted troublemakers that pose so many problems for teachers, schools, other children, and ultimately all of us.

Again, the implications of this knowledge for intervention techniques and strategies are significant. We must create systems that build and reinforce the acquisition of what Goleman has termed “emotional intelligence.”   We need to recognize that many of the maladaptive symptoms that plague our social environment are the result of the individual’s attempt to manage  overwhelming emotions, effective in the short‐run, detrimental long‐term.  If we fail to protect children from overwhelming stress, then we can count on creating life‐long adjustment problems that take a toll on the individual, the family, and society as a whole.

Please come back for Part V and final part of this series.

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“UNDERSTANDING TRAUMA' III ~ HOW WE THINK DURING TRAUMA

3/27/2014

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This is Part III of a V Part series to help survivors and loved ones better understand how the body and mind react to traumatic events.  We cannot think our way out of trauma/PTSD but knowledge is power!

Our capacity to think clearly is severely impaired when we are under stress. When we perceive that we are in danger, we are physiologically geared to take action, not to ponder and deliberate. In many situations of acute danger it is better that we respond immediately without taking the time for complicated mental processing, that we respond almost reflexively to save our lives or to protect those we love. When stressed, we cannot think clearly, we cannot consider the long‐range consequences of our behavior, we cannot weigh all of the possible options before making a decision, we cannot take the time to obtain all the necessary information that goes into making good
decisions.  Our decisions tend to be based on impulse and are based on an experienced need to self‐protect.  As a consequence these decisions are inflexible, oversimplified, directed towards action and survival.  In such situations, people can demonstrate poor judgment and poor impulse control. The mind is geared towards action and often the action taken will be violent.  Many victims have long‐term problems with various aspects of thinking.  There tends to be an intolerance of mistakes, denial of personal difficulties, anger as a problem‐solving strategy, hypervigilance, and absolutistic thinking are other problematic thought patterns that have been identified by survivors of trauma, the if onlys.

In formulating intervention strategies, this means that every effort should be made to reduce stress and we need to look at the growing sources of social stress that are inflicted on individuals and families at home, in the workplace, and in the community and evaluate what kinds of buffers can be put into place that help attenuate the effects of these stressors, not add to them.

Our way of remembering things, processing new memories, and accessing old memories is also dramatically changed when we are under stress.  Still, there is a growing body of evidence indicating that there are actually two different memory systems in the brain ‐ one for normal learning and remembering that is based on words and another that is largely nonverbal.  Our verbally based memory system is vulnerable to high levels of stress. Under normal conditions, the two kinds of memory function in an integrated way. Our verbal and nonverbal memories are thus usually intertwined and complexly interrelated.  What we consider our “normal” memory is based on words. From the time we are born we develop new categories of information, and all new information gets placed into an established category, like a filing cabinet in our minds. We talk in words, of course, but we also think with words.  The person we identify as “me” is the person who thinks and has language.  When we need to recall something, we go into the appropriate category and retrieve the information we need.   But under conditions of extreme stress, our memory works in a different way.

When we are overwhelmed with fear, we lose the capacity for speech, we lose the capacity to put words to our experience. Without words, the mind shifts to a mode of thinking that is characterized by visual, auditory, olfactory, and  kinesthetic images, physical sensations, and strong feelings.  This system of processing information may be adequate under conditions of serious danger.  But the powerful images, feelings, and sensations do not just “go away.” They are deeply imprinted, more strongly in fact, than normal everyday memories.  The neuroscientist Joseph LeDoux has called this “emotional memory” and has shown that this kind of memory can be difficult or impossible to erase, although we can learn to override some of our responses to it.

This “engraving” of trauma has been noted by many researchers studying various survivor groups.  Problems can arise later because the memory of the events that occurred under severe stress are not put into words and are not remembered in the normal way we remember other things.  Instead, the memories remain “frozen in time” in the form of images, body sensations like smells, touch, tastes, and even pain, and strong emotions, which leads me to flashbacks.

A flashback is a sudden intrusive re‐experiencing of a fragment of one of those traumatic, unverbalized memories.  During a flashback, people become overwhelmed with the same emotions that they felt at the time of the trauma.  Flashbacks are likely to occur when people are upset, stressed, frightened, or aroused or when triggered by any association to the traumatic event. Their minds can become flooded with the images, emotions, and physical sensations associated with the trauma once again.  But the verbal memory system may be turned off because of the arousal of fear, so they cannot articulate their experience and the nonverbal memory may be the only memory a person has of the traumatic event.

At the time of the trauma they had become trapped in “speechless terror” and their capacity for speech and memory were separated.  As a result, they developed what has become known as “amnesia” for the traumatic event – the memory is there, but there are no words attached to it so it cannot be either talked about or even thought about. Instead, the memory presents itself as some form of nonverbal behavior and sometimes as a behavioral reenactment of a previous event.  Even thinking of flashbacks as “memories” is inaccurate and misleading. When someone experiences a flashback, they do not remember the experience, they relive it.   Often the flashback is forgotten as quickly as it is happens because the two memory systems are so disconnected from each other.

Over time, as people try to limit situations that promote hyperarousal and flashbacks, limit relationships which trigger emotions, and employ behaviors designed to control emotional responses, they may become progressively numb to all emotions, and feel depressed, alienated, empty, even dead.   In this state, it takes greater and greater stimulation to feel a sense of being alive and they will often engage in all kinds of risk‐taking behaviors since that is the only time they feel “inside” themselves once again.

If we cannot remember an experience we cannot learn from it.  This is one of the most devastating aspects of prolonged stress.  The implicit functioning of the brain, life‐saving under the immediate conditions of danger, becomes life threatening when the internal fragmentation that is the normal response to overwhelming trauma, is not healed.  The picture becomes even more complicated for children who are exposed to repeated experiences of  unprotected stress.  Their bodies, brains, and minds are still developing.  We are only beginning to understand memory, traumatic memory, and how these memory systems develop and influence each other.  We do know that children who are traumatized also experience flashbacks that have no words.  For healing to occur, we know that people often need to put the experience into a narrative, give it words, and share it with themselves and others.  Words allow us to put things into a time sequence ‐ past, present, future.

Without words, the traumatic past is experienced as being in the ever present “Now.” Words allow us to put the past more safely in the past where it belongs.  Since a child’s capacity for verbalization is just developing, their ability to put their traumatic experience into words is particularly difficult. In cases of childhood terror, language functions are often compromised. Instead, children frequently act‐out their memories in behavior instead of words.  They show us what happened even when they cannot tell us.  We call this automatic behavioral reliving of trauma, “traumatic reenactment.” 

The implications of this important information about memory and trauma are extensive.  It means that environments designed to intervene in the lives of suffering people must provide an abundance of opportunities for people to talk, and talk and talk about their experiences, their past lives, their conflicts, their feelings. It means that programs that focus on nonverbal expression – a description that includes art, music, movement, and theatre programs as well as sports – are vital adjuncts to any community healing efforts and should be funded, not eliminated, in the schools.   It means that the arts can play a central role in community healing, serving as a “bridge across the black hole of trauma.”

Please pass this along to others who might benefit and visit again for Part IV of “UNDERSTANDING TRAUMA,” as we look at our emotions during trauma.

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“UNDERSTANDING TRAUMA” II ~ WHAT IS HELPLESSNESS?

3/22/2014

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This is the second of a series of posts looking at what trauma does to the minds and bodies of those involved. This information will not only benefit the many who are affected by traumatic events and/or PTSD but also the families and loved ones will better understand why their loved one is acting and reacting in the manner that they are. 

As described in Understanding Trauma I, we are born with a number of innate emotions that produce patterned and predictable responses in all of our organs, including our brain.  One is the fight‐or‐flight response which profoundly impacts, at a physiological level, our response to all stresses.  The real nature of the fight‐or‐flight response means that if we hope to help traumatized people, then we must create safe environments to help counteract the long‐term effects of chronic stress.

During a traumatic experience, when the fight-or-flight response kicks in, if a person is able to master the situation of danger by successfully running away, winning the fight or getting help, the risk of long‐term physical changes are lessened. But in many situations considered to be traumatic, the victim is helpless and it is this helplessness that is such a problem for human beings. As a species, we cannot tolerate helplessness ‐ it goes against our instinct for survival.  We know from animal experiments, that helplessness can cause changes in the animals’ ability to recognize and escape from danger so that once the animal becomes accustomed to trauma, it fails to try and escape from danger. This has been called “learned helplessness.”

Apparently, there are detrimental changes in the basic neurochemistry that allows the animal to self‐motivate out of dangerous situations. Change only occurs when the experimenter actively intervenes and pulls the animal out of the cage. At first, the animal runs back in, but after sufficient trials, it finally catches on and learns how to escape from the terror once again. The animals’ behavior improves significantly, but they remain vulnerable to stress. As in human experience, animals show individual variation in their responses. Some animals are very resistant to developing “learned helplessness” and others are very vulnerable.

We know that people can learn to be helpless too, that if a person is subjected to a sufficient number of experiences teaching him or her that nothing they do will effect the outcome, people give up trying. This means that interventions designed to help people overcome traumatizing experiences must focus on mastery and empowerment while avoiding further experiences of helplessness.

The experience of overwhelming terror destabilizes our internal system of arousal ‐ the internal “volume control” dial that we normally have over all our emotions, especially fear. Usually, we respond to a stimulus based on the level of threat that the stimulus represents. People who have been traumatized lose this capacity to “modulate arousal.” They tend to stay irritable, jumpy, and on edge.  Instead of being able to adjust their “volume control,” the person is reduced to only an “on‐or‐off” switch, losing all control over the amount of arousal they experience to any stimulus, even one as unthreatening as a crying child.

Children are born with only an on‐or‐off switch. Gradually, over the course of development and with the responsive and protective care of adults, the child’s brain develops the ability to modulate the level of arousal based on the importance or relevance of the stimulus. This is part of the reason why the capacity of adults to soothe frightened children is so essential to their development. They cannot soothe themselves until they have been soothed by adults. Children who are exposed to repeated experiences of overwhelming arousal do not have the kind of safety and protection that they need for normal brain development. They may never develop normal modulation of arousal. As a result they are chronically irritable, angry, unable to manage aggression, impulsive, and anxious. Children – and the adults they become – who experience this level of anxiety will understandably do anything they can to establish some level of self‐soothing and self‐control.

Under such circumstances, people frequently turn to substances, like drugs or alcohol, or behaviors like sex or eating or even engagement in violence, all of which help them to calm down, at least temporarily. If you have never been able to really control your feelings, and you discover that alcohol gives you some sense of control over your internal states, it is only logical that you will turn to alcohol for comfort. The experience of control over helplessness will count for much more than anyone’s warnings about the long‐term consequences of alcohol abuse.

The implication of these findings for intervention strategies is that we need to understand that many of the behaviors that are socially objectionable and even destructive are also the individual’s only method of coping with overwhelming and uncontrollable emotions. If they are to stop using these coping skills, then they must be offered better substitutes, most importantly, healthy and sustaining human relationships, support groups and skilled professional counseling.  Blaming and punishment is thus counterproductive to the goals that we hope to achieve – they just tend to make things worse.   

Please pass this on to others who may benefit and please bookmark this site so you do not miss part III of “Understanding Trauma,” as we look at how we think during a traumatic event.


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“UNDERSTANDING TRAUMA” I ~ WHAT IS IT?

3/16/2014

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This is the first of a series of posts looking at what trauma does to the minds and bodies of those involved. To understand what trauma does, we have to understand what it is. This information will not only benefit the many who are affected by traumatic events and/or PTSD but also the families and loved ones will get a glimpse into why their loved one is acting and reacting in the manner that they are. 

Psychic trauma occurs when a sudden, unexpected, overwhelming intense emotional blow or a series of blows assaults the person from outside. Traumatic events are external, but they quickly become incorporated into the mind. Trauma occurs when both internal and external resources are inadequate to cope with an external threat. It is not the trauma itself that does the damage, it is how the individual’s mind and body reacts in its own unique way to the traumatic experience. Trauma occurs whenever someone fears for their life or for the lives of someone they love. A traumatic experience impacts the entire person ‐ the way we think, the way we learn, the way we remember things, the way we feel about ourselves, the way we feel about other people, and the way we make sense of the world are all profoundly altered by a traumatic experience.

 It is impossible to fully understand human behavior and the human response to
trauma without grasping key insights about the way our evolution has affected  us. The fight‐or‐flight response is a part of our mammalian heritage, and continues to profoundly impact, at a physiological level, our response to all stresses, even those caused by our sophisticated social environments. We are born with a number of innate emotions that are also part of our mammalian heritage and that produce patterned and predictable responses in all of our organs, including our brain. This means that overwhelming emotions can do damage to our bodies as well as our psyches.

As a species, we survived largely because we developed as social animals for mutual protection and this social nature of human beings is grounded in our need to attach to other human beings from cradle to grave. Children who suffer disrupted attachments may suffer from damage to all of their developmental systems, including their brains and we are particularly ill-suited to having the people we are attached to also be the people who are violating us. Our very complex brains and powerful memories distinguish us as the most intelligent of all animals, and yet it is this very intelligence that leaves us vulnerable to the effects of trauma such as flashbacks, body memories, post traumatic nightmares and behavioral reenactments.

The social nature of our species is guaranteed by an innate sense of reciprocity that can be observed even among primates. But this same sense of “fair play” leads not only to the evolution of justice systems, but also to the need for revenge. The result is that you cannot hurt anyone, most importantly children, without setting the stage for revenge that will be exacted either upon themselves, upon others, or both. Finally, we are physiologically designed to function best as an integrated whole, just like the computers that we now build. The fragmentation that accompanies traumatic experience degrades this integration and impedes maximum performance in a variety of ways. Human brains function best when they are adequately stimulated but simultaneously protected from overwhelming stress. This explains our need for order, for safety, for adequate protection.

We are animals and like other animals, we are biologically equipped to protect ourselves from harm as best we can. The basic internal protective mechanism is called the fight‐or‐flight reaction. Whenever we perceive that we are in danger, our bodies make a massive response that affects all of our organ systems. This change in every area of basic function is so dramatic that in many ways, we are not the same people when we are terrified as when we are calm.  Each episode of danger connects to every other episode of danger in our minds, so that the more danger we are exposed to, the more sensitive we are to danger. With each experience of fight‐or‐flight, our mind forms a network of connections that get triggered with every new threatening experience. If
children (or soldiers in combat) are exposed to danger repeatedly, their bodies become unusually sensitive so that even minor threats can trigger off this sequence of physical, emotional, and cognitive responses. They can do nothing to control this reaction ‐ it is a biological, built‐in response, a protective device that only goes wrong if we are exposed to too much danger and too little protection in childhood or as adults.

This may help explain why some people have developed PTSD and others have not.  Anyone who has been exposed to enough life-threatening events can develop PTSD.

Please pass  this on to others who may benefit and bookmark this site so you do not miss part II of “Understanding Trauma.”

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Child Sexual Abuse

10/1/2012

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Child sexual abuse has been reported up to 80,000 times a year,   but the number of unreported instances is far greater, because the children are  afraid to tell anyone what has happened, and the legal procedure for validating  an episode is difficult. The problem should be identified, the abuse stopped,  and the child should receive professional help. The long-term emotional and psychological damage of sexual abuse can be devastating to the  child.

Child sexual abuse can take place within the family, by a  parent, step-parent, sibling or other relative; or outside the home, for   example, by a friend, neighbor, child care person, teacher, or stranger. When sexual abuse has occurred, a child can develop a variety of distressing feelings, thoughts and behaviors.

No child is psychologically prepared to cope with repeated  sexual stimulation. Even a two or three year old, who cannot know the sexual activity is wrong, will develop problems resulting from the inability to cope  with the overstimulation.

The child of five or older who knows and cares for the abuser  becomes trapped between affection or loyalty for the person, and the sense that  the sexual activities are terribly wrong. If the child tries to break away from  the sexual relationship, the abuser may threaten the child with violence or loss  of love. When sexual abuse occurs within the family, the child may fear the  anger, jealousy or shame of other family members, or be afraid the family will  break up if the secret is told.

A child who is the victim of prolonged sexual abuse usually  develops low self-esteem, a feeling of worthlessness and an abnormal or distorted view of sex. The child may become withdrawn and mistrustful of   adults, and can become suicidal.

Some children who have been sexually abused have difficulty  relating to others except on sexual terms. Some sexually abused children become child abusers or prostitutes, or have other serious problems when they reach  adulthood.

Often there are no obvious external signs of child sexual abuse.  Some signs can only be detected on physical exam by a  physician.

 Sexually abused children may also develop the following:
•unusual interest in or avoidance of all things of a sexual
nature 
•sleep problems or nightmares 
•depression or withdrawal from friends or family 
•seductiveness 
•statements that their bodies are dirty or damaged, or fear that
there is something wrong with them in the genital area 
•refusal to go to school 
•delinquency/conduct problems 
•secretiveness 
•aspects of sexual molestation in drawings, games, fantasies 
•unusual aggressiveness, or 
•suicidal behavior 

Child sexual abusers can make the child extremely fearful of  telling, and only when a special effort has helped the child to feel safe, can  the child talk freely. If a child says that he or she has been molested, parents  should try to remain calm and reassure the child that what happened was not  their fault. Parents should seek a medical examination and psychiatric  consultation.  
 
Parents can prevent or lessen the chance of sexual abuse by: 
 •Telling children that if someone tries to touch your body and
do things that make you feel funny, say NO to that person and tell me right away 
  •Teaching children that respect does not mean blind obedience to
adults and to authority, for example, don't tell children to, Always do
everything the teacher or baby-sitter tells you to do 
  •Encouraging professional prevention programs in the local
school system 

Sexually  abused children and their families need immediate professional evaluation and  treatment. Child and adolescent psychiatrists can help abused children regain a  sense of self-esteem, cope with feelings of guilt about the abuse, and begin the  process of overcoming the trauma. Such treatment can help reduce the risk that  the child will develop serious problems as an adult. 
 
Excerpts from Your Child on Sexual Abuse
Many parents are unsure or squeamish about bringing up sexual  matters, especially with their children. Yet, there are ways of laying the  groundwork so that you can talk to your child without scaring her. Establish an  open dialogue about sexual issues early on. If you introduce the subject of sex  in a discussion of abuse, there is the danger that the idea of sex may become  automatically linked in your child’s mind with danger and  anxiety.

 If you have fostered in your child a sense of ownership   regarding her body, she will likely have an instinct about what is okay for her   body and what is not. You build on her natural sense of ownerships of her body   by letting her pick out her own clothes or wash herself in her own way. Also,   avoid pushing her to kiss or hug other adults when she clearly does not want   to.

Finally,  when parents treat their children’s bodies with respect, children tend to demand  that others treat their bodies in a similar manner. Children who are  consistently hit, grabbed, or physically punished at home may feel that adults  are entitled to misuse their bodies simply because they are bigger
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HEALTH BENEFITS OF LAUGHTER

4/29/2012

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Humor is infectious. When laughter is shared, it binds people together and increases happiness and intimacy. Laughter also triggers healthy physical changes in the body. Humor and laughter strengthen your immune system, boost your energy, diminish pain, and protect you from the damaging effects of stress.

Laughter is a powerful antidote to stress, pain, and conflict. Nothing works faster or more dependably to bring your mind and body back into balance than a good laugh. Humor lightens your burdens, inspires hopes, connects you to others, and keeps you grounded, focused and alert.

With so much power to heal and renew, the ability to laugh easily and frequently is a tremendous resource for surmounting problems, enhancing your relationships, and supporting both physical and emotional health.   

Laughter is good for your health:
    Laughter relaxes the whole body. A good, hearty laugh relieves physical tension and stress,     leaving your muscles relaxed for up to 45 minutes after. 
    Laughter boosts the immune system. Laughter decreases stress hormones and increases immune cells and infection-fighting antibodies, thus improving your resistance to disease. 
    Laughter triggers the release of endorphins, the body’s natural feel-good chemicals. Endorphins promote an overall sense of well-being and can even temporarily relieve pain. 
    Laughter protects the heart. Laughter improves the function of blood vessels and increases blood flow, which can help protect you against a heart attack and other cardiovascular problems.
    Laughter makes you feel good. And the good feeling that you get when you laugh remains with you even after the laughter subsides. Humor helps you keep a positive, optimistic outlook through difficult situations, disappointments, and loss. 

More than just a respite from sadness and pain, laughter gives you the courage and strength to find new sources of meaning and hope. Even in the most difficult of times, a laugh–or even simply a smile–can go a long way toward making you feel better. And laughter really is contagious—just hearing laughter primes your brain and readies you to smile and join in the fun. 

Laughter and Mental Health
Laughter dissolves distressing emotions. You can’t feel anxious, angry, or sad when you’re laughing. 
Laughter helps you relax and recharge. It reduces stress and increases energy, enabling you to stay focused and accomplish more. 
Humor shifts perspective, allowing you to see situations in a more realistic, less threatening light. A humorous perspective creates psychological distance, which can help you avoid feeling overwhelmed. 

Laughter and Relationships
Shared laughter is one of the most effective tools for keeping relationships fresh and exciting. All emotional sharing builds strong and lasting relationship bonds, but sharing laughter and play also adds joy, vitality, and resilience. And humor is a powerful and effective way to heal resentments, disagreements, and hurts. Laughter unites people during difficult times. 
Incorporating more humor and play into your daily interactions can improve the quality of your love relationships— as well as your connections with co-workers, family members, and friends. 

Using humor and laughter in relationships allows you to:
    Be more spontaneous. Humor gets you out of your head and away from your troubles. 
    Let go of defensiveness. Laughter helps you forget judgments, criticisms, and doubts. 
    Release inhibitions. Your fear of holding back and holding on are set aside. 
    Express your true feelings. Deeply felt emotions are allowed to rise to the surface.

As laughter, humor, and play become an integrated part of your life, your creativity will flourish and new discoveries for playing with friends, your children and/or grandchildren, coworkers, acquaintances, and loved ones will occur to you daily. Humor takes you to a higher place where you can view the world from a more relaxed, positive, creative, joyful, and balanced perspective.
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Avoidance ~ What is it?

4/22/2012

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What is avoidance?
Avoidance is a common reaction to trauma. It is natural to want to avoid thinking about or feeling emotions about a stressful event. But when avoidance is extreme, or when it’s the main way you cope, it can interfere with your emotional recovery and healing.

What are the different types of avoidance?
Emotional avoidance is when a person avoids thoughts or feelings about a traumatic event. For example, a rape survivor may try to force herself to think about other things whenever thoughts about the rape arise. Or, she may stop herself every time she begins to feel sadness about the rape, or focus on something else that makes her feel less sad. She may say things to herself like, "Don't go there," or "Don't think about it."

Avoiding reminders of a trauma is called behavioral avoidance. For example, a combat Veteran may stop watching the news or reading the newspaper because of coverage of the war. Someone who lived in Manhattan might move out of the city after the 9/11 terrorist attacks. Assault survivors might go out of their way to stay away from the scene of their attack.

What are the consequences of avoidance?
Growing up, you may have heard advice like, “just try not to think about it” or “don’t dwell on it.” But if you avoid thoughts and feelings of the trauma all of the time, your symptoms may get worse. Using avoidance as your main way to cope can make it harder to move on with your life.

Is all avoidance bad?
Not all avoidance is bad. It can be helpful to learn ways to focus your thoughts and feelings on things that are not related to the trauma. Distraction is a useful skill that can help you to get on with your daily life after a trauma. It can allow you to go to school or work, or buy groceries, even in the face of difficult life events. Although distraction and avoidance can be helpful in the short-term, they should not be your primary way of coping.

How can you learn to cope with difficult thoughts and feelings?
You may be afraid that if you let yourself feel difficult emotions, they might overwhelm you. You may be afraid that if you start crying, you’ll cry forever. Or you may worry that if you experience the anger inside you, you might lose control. Therapy can help you learn to deal with your thoughts and feelings about the trauma instead of being afraid of them.
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    Beth Watson, LCSW

    I am a Licensed Clinical Social Worker with a strong spiritual foundation providing counseling in the Tallahassee, Florida area.  My areas of interest include grief and loss, depression and anxiety, women's emotional health, trauma related issues such as PTSD, family substance abuse issues, domestic violence and family counseling including couples counseling, children and adolescent behavioral issues and parenting. Giving back is very rewarding with the growth and satisfaction of each client. It is my passion and my honor to serve others. 
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