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I always end my sessions by asking my clients, “Based on what we discussed today, what are you going to work on for homework?” At the end of a recent session with a client who has the tendency to avoid her feelings and thoughts of her past trauma, when I asked this question, she responded, “Dr. B I am going to work on feeling my feelings and making friends with them.” I could not be happier! She got it. She was trying so hard to push the feelings away that it was exhausting her. We worked on the idea of thinking of her symptoms not as something that had to be pushed away, and gotten rid of, but as a part of her that needed to be reintegrated. In his book The Body Keeps The Score: Brain, mind and body in the healing of trauma, Bessel Van Der Kolk, M.D. talks about “Befriending the Emotional Brain.” Since I am not going to go into the specific treatments for PTSD, as it can vary from person to person, I want to summarize what Van Der Kolk shares as a place for you to start in terms of beginning the journey of recovery from trauma. Dealing with Hyperarousal The vagus nerve connects the brain with many of the internal organs. Eighty percent of the fibers of the vagus nerve run from the body to the brain. This gives us the ability to influence our arousal via our breath, movements, and vocalizations. Being able to use the breathe to achieve a state of physical relaxation while visiting painful memories is required in order to recover from traumatic experiences. Taking a few deep breathes you can notice the parasympathetic nervous system damper your arousal. The more you focus on your exhale until the very end and then pause before your inhale the more you will turn on your parasympathetic nervous system. Continue to breath and notice the air moving in and out of your lungs thinking about how the oxygen nourishes and energizes the cells of your body helping you feel connected and alive. Mindfulness Self-awareness is at the center of recovery. Being able to notice our irritation or anxiety allows us to change our point of view and see other options besides our usual habitual reactions. Mindfulness allows us to see the transitory nature of our feelings and perceptions. When we tune in with focused attention to our bodily sensations we can feel the ebb and flow of our emotions and with that we can increase our ability to have control over them. The first task is focusing your mind on your sensations and noticing how the sensations are transient and shift in response to changes in body position, breathing, and thinking. Next start to label what is happening, i.e. “When I feel sad I feel a prickly knot in my stomach.” Focus on the sensation and notice how it changes when you take a deep breath and focus on the exhale, or allow yourself to cry. Being self-aware, or practicing mindfulness calms down the sympathetic nervous system so that you are less likely to be catapulted into fight or flight. Gaining the skill of observing and tolerating physical sensations is essential for safely revisiting the traumatic memories. Mindfulness decreases activity of the amygdala and thus decreases reactivity to potential triggers. Relationships Repeated research studies have shown that having a good support system is the single most powerful protection against developing PTSD. Our brains are wired to be in-tune with others. Remember those mirror neurons?? Recovery involves connecting with others. When trauma occurs within trusted relationships it can be more difficult to treat due to the fear of being re-traumatized within a relationship. This can take a toll on other relationships as the fear of getting hurt can prevent the formation of the required healing relationships. Communal Rhythms and Synchrony When we are able to play with others we feel attuned and experience a sense of connection and joy. Drum circles are a wonderful example of this feeling in tune with and connected to others. Getting in Touch The most natural way we as humans are soothed is by being hugged, touched, or rocked. Think of an infant, how we rock, and hold them in order to sooth their distress. This desire to be held and comforted in times of stress stays with us forever as a means of helping us calm. Taking Action The purpose of stress hormones are to give us strength and endurance so that we can respond and act in traumatic situations. People who take action during a traumatic situation use their stress hormones for their proper purpose and thus are less likely to develop PTSD. Feelings of helplessness and not being able to take action prevent the use of the stress hormones as they are meant to be used. This results in the stress hormones and activation that was meant to fuel coping with the stress, to be turned back against the organism. This results in the continuing of misplaced fight, flight, or freeze responses. When these responses to extreme stress get stuck, treatment moves to explore physical sensations and identifying the location and shape of how the trauma left its mark on the body. As mentioned in a previous post, Peter Levine developed Somatic Experiencing which focuses on guiding clients in gently moving in and out of feeling the imprints of the traumatic memory left on the body in a process he calls pendulation. Moving in and out of the traumatic sensations helps clients build their tolerance to such sensations. As clients become more aware and build tolerance to their trauma based sensations they are likely to recognize physical energy such as hitting, running or pushing that they wanted to do during the trauma but were unable to in order to maintain their safety. These impulses come out in subtle bodily movements. Working to fully feel and express these movements in different ways can help bring the trauma to a close. Somatic Experiencing helps the client free themselves from the trauma by feeling that it is safe to move in the present. They literally move to free that pent up energy that got stuck during the trauma. In a training on Somatic Experiencing that I completed, Peter Levine treated a man who, as an infant, was in a holocaust orphanage. Peter Levine helped the client lean into his sensations and exaggerate what his body wanted to do. He ended up making these grand movements as if he was flapping his wings flying away. Just incredibly interesting stuff. The desire of the body to escape being acted out and released years later. In Somatic experiencing when the clients can feel what it would of felt like to take effective action, it can give them a sense of control. When clients can experience what it would of been like to expel that energy and fight or flee, their bodies can begin to relax and feel at peace. So this is where I am going to end my blog series on PTSD. I hope it gave you enough information and understanding of what PTSD is, what it looks like, and how it impacts the brain and body. Like I said when I started this topic, trauma is a broad, heavy topic but one I felt compelled to address as so many people are not living fully due to their PTSD. I hope this information gives you a place to start if you or someone you love is suffering from PTSD. With great care and compassion. Until next time… Dr. B References Heck, S. (2013). Healthing and Resilience After Trauma. Home Study. heiselandassoc.com. Levine, P. (2015). Peter Levine Ph.D. on Trauma: How the body releases trauma and restores goodness. Online Training. catalog.pesi.com Van Der Kolk, B. (2014). The Body Keeps the Score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Books.
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Another possible response to experiencing trauma is the person going into denial. Their bodies register the trauma, but their mind goes on as if nothing happened. Even though their mind may learn to ignore the signals from the emotional brain, the alarm messages and stress hormones do not stop firing. The continuous firing from the emotional brain and secretion of stress hormones keep the body in a state ready for action or immobilize for collapse. These physical effects on the organs go on until they ultimately result in illness.
A person with PTSD has a malfunctioning thalamus that is not filtering incoming information properly. This results in a state of constant sensory overload. To cope with this state of sensory overload, the person may attempt to shut down, which unfortunately could also lead to cutting out the experiences of pleasure and joy. Traumatized people feel unsafe in their bodies due to the chronic discomfort of their visceral distress signals. In an effort to function, they become skilled at ignoring their bodily sensations. The more people try to ignore their bodily sensations, the more apt these sensations are to take over. When an individual cannot recognize what is happening inside their bodies he or she can end up responding in extreme ways by either shutting down or panicking in response to even the slightest trigger. The cost of ignoring bodily sensations is not being able to truly recognize what is dangerous and harmful, or what is safe and nourishing. Our sense of self is housed down the midline of the brain. Severe early life trauma effects this area of the brain in a profound way. On brain scans of people with early trauma and chronic PTSD, it has been found that there is nearly no activation along the midline of the brain. What this indicates is that the person learned to shut down the brain areas that process the visceral feelings and emotions that come along with terror. In doing so, however, they also shut down the ability to feel the full range of emotions and sensations that form the foundation of self awareness. As an attempt to avoid the terrifying sensations, they also lost the ability to feel fully alive. This lack of activation down the midline of the brain could explain why many traumatized people lose their sense of purpose and direction. The core of our self-awareness is housed in the physical sensations that communicate the inner states of our body. Remembering emotional experiences from the past cause us to feel in the present the visceral sensations that were felt during the original incident. The more we are aware of our sensory body-based feelings, the more able we are to control our lives. Knowing what we feel is the first clue in figuring out why we feel that way. Our gut feelings tell us what is safe or threatening, and help us figure out what is going on around us. If you are connected to your inner sensations, you can trust them to guide and provide you a sense of control. Brain scans of traumatized people who freeze completely when revisiting their trauma show a marked decrease in activity across the whole brain, and report feeling nothing. This is referred to as depersonalization. The bottom-up approach is essential when working with someone who presents with depersonalization. The goal is to change the person’s relationship to their bodily sensations. Help them notice body sensations by tapping acupressure points or engaging them in rhythmic interactions such as passing a beach ball, drumming, or bouncing. A main challenge of treating individuals with PTSD is helping them to learn to live in the present. Self-regulation only happens when one has a good relationship with his or her body. People who have a difficult time knowing and describing their physical sensations tend to register their emotions as physical problems. They may experience being angry or sad as muscle pain or irregular bowels. Recovery from trauma requires becoming familiar with and accepting the bodily sensations. It requires developing awareness of their sensations and the ways their bodies respond to their environment. Physical self-awareness is the first step in letting go of the trauma. What I have found in working with client’s with PTSD is that there is often a sense of urgency to get rid of the troubling symptoms, to get past it, to get away from it. This instinct, however, does not jive with truly addressing the trauma and how it is impacting the body. To push it away or ignore it, as we have read, only makes it push in more or seep out, as my old supervisor would say, sideways. When working with a client I want to look at how they think about their symptoms. Do they hate their symptoms or see them as evidence of them being faulty or damaged? Are the symptoms something you can truly ignore or push away, and if so, at what cost?? We can see there are major costs physically. Over time, the ignoring of the sensations can lead to deteriorations in health. So I invite you to think differently about the sensations and how to approach them. In my next post we will talk more about this and the idea of making friends with your sensations. With great care and compassion. Until next time… -Dr. B References Heck, S. (2013). Healthing and Resilience After Trauma. Home Study. heiselandassoc.com. Levine, P. (2015). Peter Levine Ph.D. on Trauma: How the body releases trauma and restores goodness. Online Training. catalog.pesi.com Van Der Kolk, B. (2014). The Body Keeps the Score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Books. What is it like to live with PTSD? Hard.
When individuals with PTSD are stuck in survivor mode, it is difficult to tend to their relationships, or to focus on anything else. Their relationships and overall functioning suffer. Intense emotions impact the brain, gut, and heart via the pneunogastic nerve. This is why we feel strong emotions in the visceral areas of our stomach, and chest. These visceral sensations are so jarring that most people will do anything to make them stop. Individuals who experience flashbacks tend to shape their lives in a way as to avoid the flashback. The more the traumatic memory is replayed, the more the stress hormones carve those memories more deeply into the mind. When people shut down they may not feel any changes; however, when they are medically monitored, racing hearts and the presence of stress hormones are detected. This shutting down generalizes to other parts of their lives in which they would normally feel joy and connection to others. This lack of connection often leads to the feeling of shame. At the core of PTSD is that, as a result of the trauma, the person’s threat perception system has changed, and now their reactions are dictated by the past. The trauma from their past is played out in their bodies in the present, often without a conscious understanding of what is happening. A traumatized person will shape and behave in their life as if the trauma is still going on. Every new experience they have is jaded by the past. After trauma, the person experiences the world with a different nervous system. Their energy becomes focused on pushing down their inner chaos, which interferes with their ability to truly engage in life. The effort to control these internal physiological reactions can lead to further physical symptoms, including fibromyalgia, chronic fatigue, and other autoimmune diseases. When the brain’s alarm system is activated, and we know that in PTSD it is activated more readily due to the elevated stress hormones, it automatically initiates preprogrammed physical escape plans from the oldest parts of the brain. Remember how our brains form? The older parts of our brain take over when our alarm system sounds. Not unlike other animals, the nerves and chemicals that comprise our basic brain structures have a direct link to our bodies. When the old brain is activated, it takes over and partially shuts down the higher brain centers, including our conscious mind, and forces the body to run, hide, fight, or possibly freeze. We might not be fully aware of our situation until we are already on the move. If the fight, flight, freeze response is successful and we escape the threat, then we return to our equilibrium and move on. If a response is blocked, or unsuccessful, the brain keeps releasing stress chemicals and the brain’s electrical systems continue to fire. Being able to take action and protect oneself is a critical piece in whether or not the experience will leave lasting effects. Immobilization at the time of the trauma is at the root of most cases of PTSD. According to Peter Levine, the immobilization or inability to act successfully during a traumatic event leads to sensations getting stuck in the body. Levine developed a treatment approach called Somatic Experiencing. In Somatic Experiencing, the client is gently guided in moving in and out of feeling the imprints of the traumatic memory left on the body. Moving in and out of the traumatic sensations helps clients build their tolerance to such sensations, as well as start to release some of the physical impulses stuck in the body. If you look up videos of Levine his work it appears almost magic. Without many words he works with the client to feel into their sensations, move into them, and release them. A more famous case study of Levine’s was on a Marine named Ray who was blown up with two IED’s. Ray presents with a stiff posture and what appears to be Tourettes-type tics. In the video recordings of Levine’s work with Ray you can see Ray’s body physically release what is purported to be the trauma imprint impulses as he moves into his sensations. Really amazing stuff! In a sense, Levine’s work serves to close the loop that was opened during the traumatic event but was not closed at the time due to the person’s response being blocked, or immobilized. The tuning into those visceral sensations is critical. The road to recover is not necessarily learning to accept what has happened but rather to gain control over one’s internal sensations and emotions. Tuning in, naming, and identifying what is occurring in the body is the first task. Recovery from trauma can occur only when the brain structures that were turned off during the original experience are turned back on. Bringing attention to the past trauma should only occur while people are feeling grounded, safe, and calm in the present. Helping a person get rooted in the present while thinking about the past trauma presents the opportunity of recognizing that the traumatic event exists in the past. In order to do this, the frontal lobe and the limbic system need to be on and working together, otherwise the person will continue to be pulled into the past. The driving force of PTSD comes from the emotional brain, which means that it shows up in physical sensations, gut wrenching, heart-breaking physical sensations. The only way to change how we feel is by tuning-in to what is going on inside our bodies, and learning to befriend our bodily sensations. More on this later. With great care, and compassion. Until next time… Dr. B References Heck, S. (2013). Healthing and Resilience After Trauma. Home Study. heiselandassoc.com. Levine, P. (2015). Peter Levine Ph.D. on Trauma: How the body releases trauma and restores goodness. Online Training. catalog.pesi.com Van Der Kolk, B. (2014). The Body Keeps the Score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Books. As you may recall, the emotional brain communicates with the body by releasing stress hormones and other messengers that produce visceral sensations in the body. You might be wondering what are these visceral sensations? Visceral sensations are those shock waves you feel throughout your body when something fearful or threatening occurs. For instance driving in your car and the person in front of you slams on his or her brakes. Your body is rushed with these intense sensations that surge through your body rapidly in order to get you to react.
Usually these stress hormones dissipate to their normal state relatively quickly. In individuals with PTSD, however, researchers have found they secrete stress hormones on a continuous basis long after the actual danger has passed. The balancing system fails and they get stuck with their fight/flight/freeze chemicals continuing to release. Further, since the stress hormones do not dissipate completely, they spike more rapidly and disproportionately in response to less stressful situations. The effects of this constant elevation of stress hormones can lead to problems with memory, attention, irritability, and sleep. It can also lead to long term health issues. This is major stuff. The effects of these stress hormones are profound. How people react to this constant release of stress hormones can go one of two ways. The first way is they become extremely jumpy, react quickly, and intensely, and over time, start avoiding a lot of situations over fear of being triggered. The other way people react is that they cut themselves off from their emotions and the visceral sensations. They ignore and push it away so much that they stop feeling emotions all together. Both avenues are devastating. I will go more into the two main ways that I have seen people react and what that looks like in my next two posts. For now, cosy up, breathe, and take care of yourself. With great care and compassion… Until next time.- Dr. B References Heck, S. (2013). Healthing and Resilience After Trauma. Home Study. heiselandassoc.com. Levine, P. (2015). Peter Levine Ph.D. on Trauma: How the body releases trauma and restores goodness. Online Training. catalog.pesi.com Van Der Kolk, B. (2014). The Body Keeps the Score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Books. Ok, so we covered how the brain forms and how it is related to PTSD in terms of our reactions, but lets now turn our attention to what exactly is happening in the brain structures during the symptoms of PTSD. Part of the picture of living with PTSD is re-experiencing the sensations and images of the trauma when you are not in a dangerous or traumatic situation. As you can imagine this is very difficult to manage, and it often leads to many disruptions in a person’s daily life.
To gain perspective on what occurs in the brains of people with PTSD researchers have performed brain scans while having a traumatized person listen to a recorded script of their traumatic experience. These brain scans show a large area of activation in the limbic region of the brain (aka the emotional brain). The intense emotions activate the lower right limbic area, and in particular, the amygdala. The amygdala’s job, as we learned in my last post, is to warn us of impending danger and to activate our stress response. Studies show that when traumatized people come in contact with images, sounds, or thoughts related to their trauma experience, their amygdala reacts with alarm even if the actual threat is no where near them in either space or time. Activation of the amygdala sets into motion a multitude of stress hormones and nerve impulses that drive up blood pressure, heart rate, and oxygen intake in preparation for fight or flight. We can see how this intense activation can be troubling and interfere with daily functioning if this is occurring in seemingly innocuous situations such as at work or your kid’s soccer game. Another finding from the brain scans of traumatized people was that there was an area in the left frontal lobe that showed a significant decrease in activation. This area of the frontal lobe is known as Broca’s area, which is one of the speech centers of the brain. When this area is cut off people have tremendous difficulty putting their thoughts and feelings into words. In traumatized people, the scans showed that their Broca’s areas went offline whenever a flashback was triggered. Even years after a trauma, people have tremendous difficulty articulating what exactly happened to them. Their bodies will re-experience the terror, rage, and helplessness along with the urge to fight or flee, but these feelings are nearly impossible to put into words. This is not to say that survivors cannot talk about the tragedy at all, eventually traumatized people come up with a story that explains their symptoms, but these stories often fail to represent the true inner experience of what they went through, or what their symptoms continue to be. When words cannot be found, images capture the experience and return to the person in the form of nightmares and flashbacks. In the brain scans, the region of the brain known as Brodmann’s area 19 was activated. Brodmann’s area 19 is located in the visual cortex and registers images when they first enter the brain. Normally, raw images registered in this area are rapidly sent to other brain areas for interpretation, and to make meaning of what has been seen. The activation of this area when participants listened to their trauma scripts once again indicates that the brain area was activated as if the participant was in the actual trauma scenario, even though the trauma could have occurred long ago. The scans also revealed that during flashbacks the participants brains only lit up on the right side, while the left side seemed deactivated. Do you recall the differences between the right and left side of the brain? Well, the left side of the brain is associated with rational, linguistic, logical thinking while the right is more intuitive and artistic. When the left side of the brain goes offline, it has the direct impact on one’s ability to organize experience into sequences, and to put one’s feelings and perceptions into words. As you might of guessed, Broca’s area is on the left side. When a traumatized person is reminded of their trauma, their right hemisphere brain lights up and reacts as if the traumatic event is happening in the present. The right side of the brain appears to be more connected to our emotions, and thus, gets taken over during reminders of the trauma. Getting familiar with what specific brain structures are impacted during activation of trauma symptoms helps us gain a better understanding of why individuals feel and experience what they do with PTSD. Education on how the brain reacts during PTSD can help individuals feel less confused and out of control, and in a sense normalize what they are going through. I have seen a true look of relief on my client’s faces when I can explain to them the reasons they are experiencing what they are experiencing. It helps set the stage for moving forward to calming self-love and self-acceptance. The suffering experienced with PTSD is profound. It is my hope that by sharing these tid bits of information, it may help someone who does not walk through my door to find some peace amongst the turmoil. With care and compassion… Until next time. - Dr. B References Heck, S. (2013). Healthing and Resilience After Trauma. Home Study. heiselandassoc.com. Levine, P. (2015). Peter Levine Ph.D. on Trauma: How the body releases trauma and restores goodness. Online Training. catalog.pesi.com Van Der Kolk, B. (2014). The Body Keeps the Score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Books. At least a few times a month I have a client come in and describe a situation in which they had a very strong, intense, quick reaction over which it seemed they had no control. The reason for this has to do with how our brains are formed and how we process information. I want to talk about how the brain is formed because it is relevant to PTSD and how the symptoms of PTSD manifest.
The brain is formed from the back to the front, or bottom to top depending on which way you want to think about it. Our ancient animal brain, or reptilian brain- the parts of our brain that we have in common with most other animals- is located in the brain stem just above where the spinal cord enters the skull. The reptilian brain is in charge of basic survival including eating, sleeping, and breathing. This is the part of the brain that is online and working when an infant is born. Above the reptilian brain we find the rest of the brain stem and the hypothalamus. Together these structures dictate our energy levels and regulate the heart, lungs, endocrine, and immune systems. Again our basic systems that keep us alive. Just above the the brain stem and reptilian brain is the limbic system. The limbic system houses our emotions. It helps us recognize danger, tells us what is desirable or scary, and indicates what is needed or not needed for survival. It also helps us navigate our social environments. Our limbic system is shaped based on our experiences, along with our genetics and temperament. Together the reptilian brain and the limbic system comprise the “emotional brain.” The job of the emotional brain is to look out for our well-being. It monitors and communicates by releasing hormones and other messengers that yield visceral sensations. These visceral sensations get our attention and possibly change our course. The emotional brain takes in a lot of information and assesses this information broadly. This means that it may jump to react based on generalizations versus taking in the details of a situation. The emotional brain starts us on our biological instincts to escape. These reactions are automatic and start without our conscious awareness. Sometimes we do not catch up and realize what is going on until after the threat is over. The top layer of the brain is the neocortex. This layer of the brain starts to develop rapidly around the age of 2 when the child starts to develop language. The neocortex houses our frontal lobes which allow us to integrate and give meaning to information. The more intense the visceral/sensory messages from the emotional brain, the more difficult for the rational brain to override it. As we take in information from our environment it first registers in the thalamus which is located in the limbic system (emotional brain). Messages about what is happening are then sent in two directions, down to the amygdala and up to the frontal lobe. The path down to the amygdala is much faster than the path up to the frontal lobe. The job of the amygdala is to tell us if incoming information is relevant to our survival. It does this extremely fast and automatically with the help of the hippocampus which is in charge of memory and relates the new information to past experiences. This explains how we get triggered by stimuli that are similar to stimuli we have encountered before even if the current stimuli is not dangerous. Since the amygdala processes information much faster than the frontal lobe it could set into action a stress response and cause us to be on the move before we are even aware of what is happening. To sum it up, information comes in, it gets skimmed over by the emotional brain, then it is sent both down to the amygdala, and up to the neocortex… our brain wants us to survive, so the route down to the amygdala is much faster (remember our amygdala assesses for danger), if the amygdala senses danger it puts in motion a survival response. This explains the experience of reacting so quickly and intensely that you do not feel you have control over your actions. Think of walking along a trail and seeing something move out of the corner of your eye, you jump and start to move in the opposite direction before realizing it was just the wind blowing a twig. This is an example of how the message got down to the amygdala faster than it got to the neocortex where you could have determined that it was a twig versus a snake or crocodile. Having experienced trauma makes misinterpreting a situation even more likely. It can lead to, put simply, a wacky alarm system (more on this later), that can cause a person to explode or shutdown to seemingly neutral comments, movements, or facial expressions. If the incoming information is not too threatening, and the message is able to get to the frontal lobe before our amygdala sets in motion the stress response, then our frontal lobes can help us recognize the twig versus the faux snake. The executive functioning of the frontal lobe helps us observe the situation and predict what will occur based on what action we choose to take. As long as our frontal lobes are functioning properly we can most likely control our reactions. In PTSD, however, the relationship between the amygdala and frontal lobes changes- putting the amygdala on much higher alert- making it more difficult to control emotions and impulses. In a sense, PTSD disrupts the balance and ability to assess incoming information and causes the person to stay in a heightened state of detection to threat without the ability to properly assess what is going on. To be able to manage stress properly it depends on having a balance between the amygdala and frontal lobes. Having this balance can be achieved by either a top down or bottom up approach. Top down meaning using your frontal lobes to pay attention and improve your ability to monitor your body’s sensations via mindfulness and yoga. Bottom up involves resetting the autonomic nervous system through breath, movement, and touch (soothing activities). Again think of soothing an infant. Rocking, swaying, being held, and being able to calm and slow down our breathing will help bring the overactive amygdala into more balance. To sum it up and make this easier to digest. Think about how we are all animals. Our sole purpose on this earth is to survive, and multiply. These are strong biological drives. Our brains are wired to help us survive. This is the reason we may jump to react even if the situation is not dangerous, but reminds us of something dangerous we may (or may not of) encountered before. The path to reacting is much quicker than the path to assessing the situation logically, especially in PTSD. In PTSD the path to reaction is primed and ready to fire. In order to help calm down the kindling that is ready to ignite, we need to work on bringing our systems into a calmer more mindful state. With much care and compassion… Until next time. - Dr. B References Heck, S. (2013). Healthing and Resilience After Trauma. Home Study. heiselandassoc.com. Levine, P. (2015). Peter Levine Ph.D. on Trauma: How the body releases trauma and restores goodness. Online Training. catalog.pesi.com Van Der Kolk, B. (2014). The Body Keeps the Score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Books. Ok, now that you know what PTSD is (if you read my last post, if not go back and read it) you may be wondering who gets PTSD, or maybe even do I have PTSD? When traumatized individuals come into my practice seeking care, some have a sense of what they might be dealing with, but others just feel as if they are out of control and do not know what is happening. We will get more into the feeling out of control part of living with PTSD and why a person might experience that, but for today, I want to educate on the factors that contribute to some developing PTSD, while others who may have experienced a similar situation do not.
Just because you experience a traumatic event does not necessarily mean that you will develop PTSD. Like I explained in my last post, symptoms after a traumatic event are not uncommon, but it is when the symptoms hang around longer than a month that we start to get concerned. So the question is what factors contribute to the reason that some people go on to develop PTSD while others go on unscathed? The first factor is how frequent and intense the trauma was. If the trauma was a one time occurrence and the person felt supported and able to seek out help, then the likelihood is lower for developing PTSD. If the person was repeatedly traumatized starting as a young child, then the odds for developing PTSD grow substantially. Individuals with a history of prior traumas or other comorbid disorders such as depression or anxiety are also at higher risk of developing PTSD. The type of traumatic event also influences the adjustment after the trauma. If the traumatic event was a natural disaster, then the development of PTSD is less likely than if it is a combat event or the experience of being attacked or violated by a trusted partner or family member. The manner in which a person copes is also a factor in developing PTSD. Resilience is the ability to cope with tough times and bounce back from trauma. Some things that contribute to resilience is having a strong support system, being flexible in your thinking and the way you see things, seeing the cup as half full, having problem-solving abilities, spiritual beliefs, and a sense of humor. A regular exercise routine does not hurt either as it enhances a sense of well-being. To sum it up, having healthy outlets, outlooks, and habits can help protect you against the development of PTSD. Social support, in particular, is the most powerful protector against overwhelming stress and trauma. We as humans are social creatures. We need one another to live and thrive. After a trauma if an individual does not feel they can go to others to get support and care, then it makes coping with the trauma much more difficult. After a traumatic event our physiology is on overdrive (I will go into this more in a later post) and we need people close to us to help us feel cared for, seen, and heard. In order for the physiology to calm down we need a visceral feeling of safety. Think of an infant who needs touch and holding to calm down- those needs for us do not go away as we grow. Again, we are social beings and we need others to help us feel soothed and safe. In our brains we have mirror neurons that allow us to take in another person’s movements, and emotional states so that we can be in sync with others. These mirror neurons make possible the feeling of empathy and being in tune with someone else. This feeling of being understood and supported can mean a complete world of difference to the traumatized person. To think of an example to tie this all in, when I first moved back to the area after about 13 years of living and working in other cities, there was a noticeable difference in the clients I first started to see here. When I moved back in 2015, before I opened my private practice I was doing telemedicine. I had a few clients from along the coast, north of us, and there was a subtle/understood manner in which they talked that implicated a pre and post Hurricane Sandy world. We live in an area that has a shared trauma of a natural disaster. Hurricane Sandy was devastating and it is felt in the stories that I hear from my clients and friends when they talk about life and how things changed so drastically from destruction to rebuild. Organizations such as Jetty and others that stopped everything to rebuild and bring people together are prime examples of how social support heals people after trauma. Those people who did not have access to support may not have fared as well. So like I said trauma is a broad subject that can show up in many different ways in our lives. It is important to keep in mind these factors that can help protect against more intrusive and prolonged symptoms of PTSD…. Until next time. -Dr. B References Heck, S. (2013). Healthing and Resilience After Trauma. Home Study. heiselandassoc.com. Levine, P. (2015). Peter Levine Ph.D. on Trauma: How the body releases trauma and restores goodness. Online Training. catalog.pesi.com Van Der Kolk, B. (2014). The Body Keeps the Score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Books. The next topic I am going to tackle on this blog is trauma. Now, trauma is a very broad concept with a lot to consider, and cover, so I am going to try and keep this relatively practical to give you a good understanding of what PTSD is, and some of the factors that predict its development. I will then go on to share some of the neurology around trauma and how it can affect the body and one’s life.
Bear with me, as I mentioned this is a hefty topic. One that I hesitated tackling so soon on my blog but the truth is I use this blog as a means to consolidate information for myself and my clients. Trauma, or PTSD, is one of my specialty areas, and a good portion of my clinical caseload. So, what exactly is PTSD? PTSD or Post Traumatic Stress Disorder is a disorder that can develop after a person has experienced a traumatic event. The intensity and frequency of the traumatic event(s) contributes to the likelihood of a person developing the disorder. What does PTSD look like? Symptoms of PTSD include:
Not all individuals who experience a traumatic event, or even repeated traumatic events, go on to develop PTSD. Things like a person’s risk factors and resilience determine whether or not he or she will develop PTSD. Another thing to consider is that it is common for a person to experience an Acute Stress Reaction to a traumatic event. An Acute Stress Reaction involves symptoms of anxiety, irritability, mood swings, difficulty concentrating, poor sleep, nightmares, flashbacks, avoidance of things that remind the person of the traumatic experience, and somatic symptoms such as abdominal pain and headaches. Notice anything familiar about these symptoms? They are almost the exact symptoms experienced in PTSD. The main difference is the duration of the symptoms. A person experiencing an Acute Stress Reaction may have these symptoms anywhere from one day to one month. If the symptoms persist longer than a month then the person is considered to have developed PTSD. The point here, is that it is normal for your body to develop these symptoms after a traumatic event. You’ve been through a traumatic event for goodness sakes! You cannot expect yourself to get up and have absolutely no reaction to it. Trauma, unfortunately, can sometimes be unavoidable. If you have been through a traumatic event, be gentle with yourself and remember that whatever symptoms you may be experiencing is your body’s reaction to the trauma. As I mentioned, the risk factors and resilience of a person are what will ultimately determine the development of PTSD, which, like I said, is essentially a prolonged experience of these symptoms mentioned above. I will elaborate more on the risk factors in my next post as I want to make these posts relatively short and easily digestible. For now, if you or someone you love has experienced a traumatic event be gentle with yourself or your loved one and try to avoid self-blame or self-punishment as these types of thoughts and behaviors only serve to worsen the symptoms. This would be a good time to make yourself a cup of tea, cozy up under a warm blanket and nurture yourself. With compassion and care, until next time- Dr. B References Heck, S. (2013). Healthing and Resilience After Trauma. Home Study. heiselandassoc.com. Levine, P. (2015). Peter Levine Ph.D. on Trauma: How the body releases trauma and restores goodness. Online Training. catalog.pesi.com Van Der Kolk, B. (2014). The Body Keeps the Score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Books. Ok, so if you’ve tried everything I suggested so far on improving your sleep and you still cannot sleep, we have one more thing to talk about. This next aspect of CBT-I has been found to be the most effective tool in knocking out insomnia. Basically it has to do with how much time we spend in bed.
This aspect of CBT-I asks that you think about how long you used to sleep before developing insomnia. Then, you think about what time you want to wake up in the morning. Remember, we want a consistent wake time, so think about what time you want to wake up on most days. If you want to wake up at 7am, and you used to sleep about 6 hours before your insomnia, then you would go to bed around 1am. This exercise of reducing the amount of time you spend in your bed makes it so that when you are in bed you are getting deeper, better quality sleep. Many research studies have found that decreasing time in bed leads to a quicker time to fall asleep, deeper sleep, and less wakening during the night. This is major stuff! So what is the catch, right? Well the catch is, it is not easy to do it. What you may find is you have a really hard time staying awake until your prescribed sleep time. I encourage you, however, try to stay awake until your sleep time. This sleep time, again, is based on the time you want to wake up minus how many hours you used to sleep regularly. What you will find is that if you can stay awake until that time you will fall asleep more quickly and into a deeper more restorative sleep. And, your insomnia will be gone! After a few nights of this, and getting more sound sleep, you can start to gradually move your bedtime back to an earlier time. If the insomnia returns, stay up later again until you are sleeping more soundly once more. So I hope you enjoyed my series on insomnia. If you have more questions about insomnia let me know in the comments! Until next time… Dr. B References Perl, J. (1993). Sleep Right in Five Nights: A clear and effective guide for conquering insomnia. New York, NY: William Morrow and Company, Inc. Danforth, M. (2018). Treating Insomnia: Evidence-based strategies to help your clients sleep. Presentation, New Jersey. I am not going to review everything I have covered in the last 7 blog posts, but I do want to elaborate on something I mentioned previously in my post on conditioned insomnia. I wrote a little bit about the importance of not trying to fall asleep. Trying to fall asleep is the one thing that will likely keep you awake if you want to fall asleep. Sleep is the one thing we do that is not rewarded by effort. Trying to fall asleep is not rewarded with sleep, but rather it often causes more fear of insomnia, physical alertness, and sleeplessness. So, how do you not try to fall asleep? Well, as discussed previously, you do something else, or you start to think differently about sleep. Some metaphors I came across in the book Sleep Right in Five Nights: A clear and effective guide for conquering insomnia by James Perl, Ph.D. suggest trying to think as if sleep is taking you over or overcoming you. Like you are a passive object just floating along. One specific imagery he suggests is picturing yourself as a surfer and positioning yourself in the wave and just letting the wave overtake or sweep you away. Or think of waiting for a friend to visit that always comes unexpectedly. Don’t think of sleep as something you can pursue or capture, but rather something that just arrives when it wants to. Be patient and calm. It is fine to practice relaxation exercises while in bed just as long as the goal of the relaxation exercise is relaxation and not sleep. You can relax, breathe, and meditate all you want, with those being the only purposes, and chances are it may help you be overtaken by sleep. My personal go to when I find myself awake at night is first scanning my body to see where I am holding tension. Most often it is right in the middle of my forehead just above my eyebrows, or my lower back. Which ever spot it is I focus on that spot and on releasing the tension. Again, I do not try to fall asleep but I just focus on releasing the tension. Before I know it I have drifted off and put my insomnia to rest. Just a quick tip that I wanted to emphasize. Until next time… Dr. B References Perl, J. (1993). Sleep Right in Five Nights: A clear and effective guide for conquering insomnia. New York, NY: William Morrow and Company, Inc. Danforth, M. (2018). Treating Insomnia: Evidence-based strategies to help your clients sleep. Presentation, New Jersey. |
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