Understanding Trauma and PTSD

What exactly is trauma? Renowned traumatologist, Robert Scaer, M.D. defines trauma as, “Any negative life event that occurs in a position of relative helplessness.” A trauma could be a one-time experience, a reoccurring event, or multiple traumas over a lifetime.

What types of events could be considered a trauma?  Most people probably think of the more obvious types of trauma, such as: exposure to violence or accidents in active military duty, physical or sexual assault, car or work accidents, or being the victim of a violent crime.  But there are many other experiences that could result in a traumatic experience.  Examples include: the loss of a child, loss of a parent figure, recurrent and persistent bullying, medical interventions, chronic or serious illness, verbal abuse, physical or emotional neglect in childhood, an animal attack, bee sting, or a natural disaster.

So what is Posttraumatic Stress Disorder (PTSD)?  PTSD occurs when an individual continues to suffer lasting effects from a traumatic experience.  These effects may include anxiety, depression, anger, difficulty sleeping, a sense of guilt or responsibility about the event, and feeling edgy.  They may develop a quick startle response, especially to trigger stimuli such as certain sounds, smells, touches, or visual exposure to certain people or places.  They may then find themselves avoiding certain people, places, or objects. The person may continue to have dreams about the trauma or experience flashbacks, sudden images or sensations that take the person back to the trauma.  It can be difficult to focus, to connect with others, and difficult to feel safe, even in your own body. It can be very disabling at times.  Not everyone who experiences a trauma will necessarily develop PTSD.

How does a traumatic experience become PTSD?  It is important to remember that above all, humans are wired for survival.  Physically and emotionally we will instinctively do what we need to do to survive.  This is where our fight or flight system comes in.  Our fight or flight system has its home in the middle of our brain, in what is called the Limbic System.  When we are faced with some type of physical or emotional danger, our fight or flight system shuts down our pre-frontal cortex.  That is the front portion of our brain, or the “thinking” part of our brain.  It is the part of our brain that helps us organize, prioritize, reason, and make decisions.  When faced with danger, time may be critical and if we spend too much time thinking, we might be dead.  So our fight or flight system takes over and makes split second decisions, acting on instinct, in order to keep us safe.  We are either going to stay and “fight”, escape the situation through “flight” or, there is actually a third response, which is a “freeze” response, meaning we do nothing but to go along with whatever is happening.  The freeze response is often misunderstood because it may appear as though a person is consenting to the event, when in fact; it is a survival strategy when fight or flight are not possible or not safe options.  When the brain becomes overwhelmed by the traumatic experience and unable to process it, the person’s body can remain trapped in the experience of the trauma.

For example, imagine that you are walking along a sidewalk while reading an email on your phone. You didn’t realize that you were so close to the end of the sidewalk.  You unexpectedly step off the curb into the street and suddenly hear a loud horn honking.  Your head jerks up toward the sound and you see a red car coming toward you.  You hear the car’s brakes squealing as it tries to stop.  You jump back onto the sidewalk just in time to avoid the car.  Your heart is pounding, you are breathing hard and you suddenly realize you are back on the curb.  For a while after the trauma, when this person hears a horn honk, brakes squealing, the sound of traffic, or sees a red car, their body may start to respond to these triggers as though it still needs to prepare for danger.  The heart beat may quicken, the breathing rate may increase, and a feeling of anxiety may set in.  Even when there are no physical triggers, the brain can be assaulted by distressing thoughts or images that are internally created.  These symptoms may last for only a few days to a month, and would not be unusual.  But when the symptoms persist, and interfere with an individual’s ability to function on a day-to-day basis we recognize this as posttraumatic stress disorder.  PTSD can be a very intense, overwhelming, and even disabling condition.

Why can’t I just get over it?  A trauma can be difficult to “get over” because your brain simply will not allow you.  Connections have been made between your sensory system and your brain that are not easily disconnected.  It is important to remember that the brain does mean well.  It is trying to keep you safe by remaining alert and attentive to perceived danger.  The problem is that the brain does not realize that the danger is no longer present.  Working with a therapist can help a person learn how to help the limbic system reset and regulate so that they are no longer activated by triggers, images, and thoughts.

For more assistance in understanding trauma and the development of PTSD, check out this YouTube video by media co-op: https://www.youtube.com/watch?v=4-tcKYx24aA

January 30, 2016

So it has been a long time since I entered a blog. Apparently this whole having a job and being a parent thing takes up a lot of time. But even though I have not been writing, I do keep thinking about the kinds of things I want to write about. I have really wanted to do a blog on the topic of fear. And the reason why I want to write about it is because I see its presence in the world every day. I see it in my clients, my children, and in myself. The fear can range from being down-right debilitating to just a nuisance. Fear can cause people to lash out and hurt others, and it can cause people to shrink away. But its presence in our world and within ourselves does impact our choices every day. Here is one small example. I take back roads to work most days, because I am more afraid of getting in an accident on the highway where more cars travel. So fear has dictated my daily route of travel.

Through working with my clients I have realized that most of what we are dealing with, at its core, is fear. It might go something like this: pattern of self-sabotage…fear of success/fear of failure; staying at a job that someone does not like…fear of change; staying in an unhappy relationship…fear of being alone/fear of losing financial stability; not saying no to people or bending over backwards…fear of others being upset with them. These are just examples, and any of these patterns of behavior could have other underlying causes, but these are just some common fears I see.

Fear does have its place in this world. It can help keep us safe. If you fear getting poisoned, you may avoid eating an unknown berry in the woods, and all-in-all that seems like a pretty reasonable and useful fear to have. Some fears may be more debatable, in terms of the usefulness of the fear. Personally, I am afraid of sharks, so I tend to stay out of the ocean. Now some may see this fear as useful and reasonable and others may see it as problematic because it is preventing me from doing something. However, I do not feel any great loss, sadness, or dissatisfaction for not going into the ocean because I so thoroughly enjoy it from the shore. But if my fear of sharks prevented me from having an experience that I wanted to have or became disruptive in my life, I think my fear would be problematic. Now my fear of sharks is easy for me to identify and talk about. Sometimes though, our fears are quietly hanging out in the background and we are not consciously aware of their presence. An example might be having an underlying fear of abandonment, which might cause someone to keep sabotaging their relationships without any conscious awareness of the fear. That is the kind of fear that likes to hang out in the background and make mischief while we just plod along with no idea why our relationships never work out.

So as you begin to think about this whole idea of fear try this strategy:
#1: Identify the obvious fears. Sharks, heights, dogs, etc.
#2: Decide if the obvious fears prevent you from having any life experiences you want to have, or if the fears have little impact on your life.
#3: Identify any problematic patterns of behavior or places in your life where you are feeling stuck or unhappy that may be “symptoms” that some underlying fear is present.
#4: Try to follow the problem downward like a rope anchoring a boat. When you get down to the anchor at the bottom of that rope, that is where the fear lives. Name it, identify it, work toward understanding the fear.
#5: Once you are aware of the fear, start to think about the different ways that fear may be affecting your life. Not all of it may be negative. Fear can be useful at times, problematic at others.
#6: Make a conscious decision as to what you want to do with the fear now that you are aware of it. Do you want to try to shift the fear, or do you want to just live with it? What you decide, is not as important as the fact that you do decide. Make a conscious decision about the fear, rather than just being unconsciously at its mercy.
#7: If you want to do something with the fear, start to make a plan for ways that you can begin to challenge or shift your fear. You might be surprised, that once you identify the fear, it might be easy to shift. There are other times though when fear can be stubborn and you will have to decide what resources you want use to help shift it.

If you have ever wondered why your child can be a rationale…okay, somewhat rationale creature one moment, and out of control the next, this is the book for you. Daniel Siegal, M.D. and Tina Payne Bryson, Ph.D. do an amazing job of explaining what is happening in your child’s brain development and provide 12 strategies for how to work with their developing brain without going insane yourself. Most of us know that our brain has a right and left hemisphere and that each side specializes in certain functions. But they explain that our brain essentially has a bottom half and a top half as well. The bottom half of our brain is the much more primitive part of our brain that involves basic automatic body functions such as breathing, heart rate, blinking, etc.. The bottom half also holds our fight/flight/freeze system. The upper half of our brain is the part that makes us the most human. It is where we can access reasoning, logic, decision making, and organization. It is essentially the “conductor” for the rest of the brain.

From birth our brain is developing from the bottom up, which is why children are not always capable of being rationale, logical beings. Their frontal cortex is still developing. It can be so tricky to parent because they can have the capacity for reason at some moments, and none at all the next. As a parent it can be hard to make the shift with them and we may expect them to be able to be rationale and logical much of the time. This book explains that at times of high emotional arousal it is almost as though a gate closes between the bottom and top half of the brain, preventing access to logical thought. If you have ever seen your child laying in a puddle on the floor, crying hysterically because their favorite pants are in the wash you know what I am talking about. Yelling at your child or giving them consequences at that point is useless because they do not have access to the logical part of their brain to comprehend the point of the consequence. The child needs assistance from the parent to just focus on calming down so that their “thinking” brain can come back online and work out the problem rationally. Trying to force or demand the return of their logic is pretty ineffective, speaking as someone who has tried it. My reward for that is usually another 10 minutes of tantrums…from them or me is kind of debatable.

Mr. Siegal and Ms. Bryson do a great job of creating relatable examples of parenting struggles. As I read the book I found myself saying, “Oh my gosh! That exact same thing has happened to me!” After validating your experience as a parent they offer reasonable strategies for how to approach these struggles. They do not make unrealistic claims like “follow these 12 strategies and you will have perfect angels.” Personally I have found that having a better understanding of what is happening in my child’s brain when they are a crying, floor puddle has eased my own tension and frustration. This ultimately leads to more opportunities for me to stay calm and parent from my best place. I have found that when I am able to use these strateiges my child calms down faster, and therefore we can work through the issue more quickly and get on with the day. This book validates that as parents we are also humans. The writers understand that you are not going to use these strategies perfectly, nor every time there is an opportunity because sometimes we are not at our best. Sometimes we get stuck because of our own mood or stressors. We have to be forgiving of ourselves as parents and keep plugging away.   This book just offers some great knowledge about the development of children and a few more tools to throw into the parenting toolbox.

Any adult who has ever experienced the discomfort of anxiety or a panic attack understands how intense and scary the experience can be.  Now imagine taking that sensation of anxiety, and squeezing it into the body of a child.   For children, the experience of anxiety can be very difficult to describe as they themselves often do not understand what is happening.  Anxiety can present itself in children in more unique ways than it does in adults which can make it more difficult for adults to recognize it for what it is.  They may develop an odd behavior such as hair twirling, sucking on their shirt, or pulling out their eyelashes.  They may suddenly develop a lot of reoccurring stomachaches, headaches, or nausea.  Sometimes we just think they are being “silly”, “ridiculous”, or “dramatic,” when in fact they may actually be experiencing anxiety.  As a parent, it can be really tough to recognize what these behaviors are.  Sometimes, even as a therapist it takes a while to sort out the meaning of a child’s behavior.

Children may experience  symptoms of anxiety similar to adults, such as feeling nervous, experiencing worrisome thoughts that cannot be controlled, restlessness, difficulty concentrating, and difficulty sleeping.  In children you may also notice a drop in grades or sudden school refusal. Children may become increasingly avoidant, shy, or withdrawn as a result of anxiety. They may also do the opposite and “act out” through temper tantrums or oppositional behaviors.  Children may become unreasonably upset about plans changing or may need frequent reassurance about what the days plans are going to be.  As with adults, some anxiety in children is normal, but if it is persistent or becomes problematic, interferring with their relationships or education, it may need more attention.

So what should you do if you think your child is dealing with anxiety?  Every situation requires something different, but here are a few good places to start.

• Validate that what your child is feeling is real, even if the thoughts are not rationale.
• Help them identify calming strategies that work for them, such as taking deep breaths, taking a bath, reading a book, getting outside, or doing something active.
• Listen to your child and ask questions to help them, and  you, better understand their fears.
• Work with their school, if necessary, to create a calm down plan if they get anxious during the school day.
• Keeping your own fears and anxiety in check is important for your child as well.  They will sense your energy.
• Simplify their life if they are feeling overwhelmed.

Anxiety.  The thing that can make your mind race, your heart pound, your chest tighten, and keep you awake at night.  It’s a delightful little beast.  Anxiety does not care who you are, as it is perfectly content invading anyone’s life.  You may have had it for as long as you can remember, or it may suddenly sideswipe you out of nowhere.   At its best, it is annoying and inconvenient, at its worst it can be paralyzing.

So what is a person supposed to do with anxiety once you have it?  There are lots of possible answers to that question.  The first thing to consider might be how intense the anxiety is.  Not all anxiety is bad, and some anxiety is normal, such as before a performance, before a test, or in a new situation.  Anxiety becomes problematic when it is affecting your ability to function.  What is the impact on your sleep?  Is it difficult to get things done at work or home because you cannot focus?  Are you feeling panicky in public places? Is it affecting your physical health?  If the intensity of the anxiety is fairly disruptive or uncomfortable you may want to seek professional help from a therapist or a medical doctor.  If it is still somewhat manageable you may want to try a few things on your own to see if improvements can be made before seeking professional help.

Some things that you can try to help manage anxiety include:

• Meditation (Guided meditations are helpful to start-check Amazon or iTunes)
• Practicing mindfulness
• Yoga
• Deep breathing
• Exercising to discharge nervous energy
• Avoiding caffeine
• Positive self-talk (Eg: “I am feeling anxious, but I know I will be okay.”  “I know I am safe.”)

Distracting yourself with activities or spending time with others can be a nice coping strategy for anxiety too.  The down side is that when it is finally time to go to bed, which requires removing distractions, the anxiety can make a fierce comeback.  So be prepared with strategies to help quiet your mind and body such as those suggested above.   At times it can even be useful to stay with your anxiety and really pay attention to it.  What is it trying to tell you?  What is the anxiety really about?  What is your true fear?  Being more aware of the anxiety can be a means of understanding the anxiety and therefore learning what is needed to manage it.