Trauma & PTSD – Part 2

Treatment Options

Treatment for Trauma and PTSD using therapy and medication can be very effective and help the individual regain a sense of control over their life.

Psychotherapy:

Several forms of therapy may be used to treat both children and adults with Trauma or PTSD.  Cognitive Therapy, Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive Behavioral Therapy are all powerful tools to alleviate PTSD symptoms.  I will discuss EMDR in further detail below.

 
Medications:
Several types of medications can improve symptoms of Trauma or PTSD. Anti-anxiety and/or antidepressant medications work amazingly well to diminish depression, anxiety, problems with sleep, concentration and other disturbing symptoms.
Which medications are best for each person depends on the specific symptoms and situation. Check with your doctor to determine which treatment is best for you.
Let’s look a little closer at EMDR below.

EMDR Overview
No one truly knows why any form of psychotherapy works neuro-biologically or in the brain.  However, we do know that when a person is very upset, their brain cannot process information as it would ordinarily. One moment becomes “frozen in time”, and remembering a trauma may feel as bad as going through  it the first time because the images, sounds, smells and feelings have not changed. Such memories have a long lasting negative effect that interferes with the way a person sees the world and the way they relate to other people and situations.
EMDR has a direct effect on the way the brain processes information. Following a successful EMDR session the person no longer relives the images, sounds and feelings when the event is brought to mind, and normal information processing is resumed. The person still remembers what happened, but it is less upsetting.
EMDR appears to be similar to what occurs naturally during dreaming or REM (rapid eye movement) sleep. Therefor, EMDR can be thought of as a physiologically-based therapy that helps a person see disturbing material in a new and less distressing way.

EMDR Process
During EMDR, the therapist works with the client to identify a specific problem as the focus of the treatment session. The client calls to mind the disturbing issues or event, what was seen, felt, herd, thought, etc. and what thoughts and beliefs are currently held about that event.
The therapist facilitates the bilateral simulation with eye movements or tappers while the client focuses on the disturbing material, and the client just notices whatever comes to mind without making any effort to control the direction or content. Each person will process information uniquely, based on personal experiences and values.
Sets of eye movements are continued until the memory becomes less disturbing and is associated with positive thoughts and beliefs about oneself; for example, “I did the best I could.” During EMDR, the client may experience difficult emotions, but by the end of the session, most people report a great reduction in the level of disturbance.

Trauma and Post Traumatic Stress Disorder (PTSD)

Definition
Trauma is an emotional response to a terrible event like an accident, rape, natural disaster or war. Immediately after the event, shock and denial are typical. Longer term reactions include unpredictable emotions, flashbacks, strained relationships and even physical symptoms like headaches or nausea. While these feelings are normal, some people have difficulty moving on with their lives.
Post-Traumatic Stress Disorder is a type of anxiety disorder that’s triggered by a traumatic event. It can develop when an individual experiences or witnesses an event that causes intense fear, happiness or horror.
Many people who are involved in traumatic events have a brief period of difficulty adjusting and coping. But with time and healthy coping methods, such traumatic reactions usually get better. In some cases, though, the symptoms can get worse or last for months or even years and completely disrupt life.
Getting treatment as soon as possible after symptoms develop may prevent Trauma or PTSD from becoming a long-term condition.

Additional Background Information
People of all ages can have Trauma or PTSD. It’s relatively common among adults, with approximately 8% of the population having PTSD at some time in their lives.  PTSD is especially common among those who have served in combat. Woman are four times more likely than men to develop PTSD. Experts believe this is because women are at increased risk of experiencing the kinds of interpersonal violence – such as sexual violence – most likely leading to PTSD.
Other kinds of traumatic events include:
 – Childhood neglect and physical abuse
 – Physical attack
 – Being threatened with a weapon
 – Natural disaters
 – Car accidents
 – Terrorist attacks
Most people who experience a traumatic event will have reactions that may include shock, anger, nervousness, fear, and even guilt. These reactions are common; and for most people, they go away over time. For a person with PTSD, however, these feelings continue and even increase, becoming so strong that they keep the person from living a normal life. People with PTSD have symptoms for longer than one month and cannot function as well as before the event occurred.

PTSD Symptoms
Signs and symptoms of PTSD typically begin within three months of a traumatic event.  In a small number of cases, PTSD symptoms may not occur until years after the event.
PTSD symptoms are commonly grouped into three types: intrusive memories, avoiding and numbing and increased anxiety or emotional arousal (hyper-arousal).
Symptoms of intrusive memories may include:
 – Flashbacks or reliving the traumatic event for minutes or even days at a time.
 – Upsetting dreams about the traumatic event
Symptoms of avoidance and emotional numbing may include:
 – Trying to avoid thinking or talking about the traumatic event.
 – Feeling emotionally numb
 – Avoiding activities
 – Hopelessness about the future
 – Memory problems
 – Trouble concentrating
 – Difficulty maintaining close relationships
 – Panic attacks
 – Feeling of going crazy
Symptoms of anxiety and increased emotional arousal may include:
 – Irritability or anger
 – Overwhelming guilt or shame
 – Self-destructive behavior such as drinking too much
 – Trouble sleeping
 – Being easily startled or frightened
 – Hearing or seeing thinks that aren’t there
PTSD symptoms can come and go. Individuals may have more symptoms during times of higher stress or reminders of what that person had experienced.

Take Responsibility and Take Back Your Life

Take responsibility and take back your life

Following are 10 ideas for you to work on.
 
Feelings – Paying attention to feelings (sometimes the gut Indicates what boundary needs to be set) is a good barometer for what is right and wrong for each person.
Attitudes and Beliefs – A person’s attitudes have to do with the stance someone takes towards others and/or things. Beliefs are those ideas that people hold dear, however, some beliefs aren’t always very evident. Each person needs to take responsibility for their attitudes and beliefs. Many people with boundary problems have distorted attitudes about responsibility.
Behaviors – Behaviors have consequences. Children need consequences to be clear about the boundaries and who is in charge. Parenting with love and limits gives children a
sense of safety and produce children who have control over their own lives.

Choices – Each individual is responsible for their choices. Setting boundaries involves taking responsibility for choices.
Values – What value each person places on people and things is each person’s responsibility. One person may value something (such as money) and another person may value something else (relationships).
Limits – Individuals can’t limit other people, but they can limit their time spent with others. Limits are also important for self-control. Individuals need to say “No” to themselves from time to time.
Talents – Each individual has gifts and talents and they are important. Expressing and experiencing these gifts are important for a good sense of self.
Thoughts – Establishing boundaries in thinking involves three things:
  • Each person must own their own thoughts. Many people become chameleons and start thinking and believing like the people around them.
  • Healthy thoughts need to be expanded. Studying and learning is a life-long process.
  • Think about and clarify distorted thinking. For example, “All men are mean,” is distorted thinking.
Desires – Considering what desires are important is essential for everyone. Follow those desires, when appropriate.
Love – Giving and receiving love can be difficult for many, especially if they love a person who is emotionally unhealthy. Define love in a healthy way and seek that in life.

Boundary Myths and Problems Caused by Boundaries

Common Boundary Myths
Following are common boundary myths with the offsetting healthy truth about boundaries:
* Setting boundaries is selfish. (It’s healthy to set boundaries with others. It speaks to the fact that the individual is self-aware and assertive.)
* Boundaries are a sign of disobedience (Being congruent with self helps increase self-esteem.)
* Setting boundaries will cause hurt for the individual setting the boundary and for others. (Most people appreciate other people’s boundaries and respect their decisions.)
* Boundaries indicate that the person is mean or angry. (Boundaries actually decrease anger.)
* Boundaries cause feelings of guilt. (Initially, this may be true, but as individual’s learn the importance of being true to themselves, the guilt will subside.)
* Boundaries are permanent, and will burn bridges. (Boundaries can always be changed, if need be. If someone decides not to have a relationship with the boundary-setting person, it indicates their inability to respect the other.)
Problems Caused by Boundaries
Compliant people struggle with saying “No.” Being able to say, “I don’t agree,” “I don’t like that,” “It hurts,” “Stop,” “I won’t do that,” is healthy. Guilt seems to be the biggest problem for most people, so instead of speaking their truth about their real feelings, they give in to the guilt.
The following are descriptions of the type of people who struggle with boundaries:
* Avoidants. To avoid confrontation or uncomfortable situations, some people tend to avoid the situation. Avoiding doesn’t mean the problem will go away it just means they are at the mercy of the other person.
* Controllers. These people do not respect others’ boundaries. Demanding and controlling people ruin lives. Some controlling people are aggressive and/or manipulative.
* Non-responsives. These people don’t hear the needs of others which causes disconnection with other people. This may also be defined as neglect.

Boundary Definition and Examples of Boundaries

Definition
A boundary is each person’s personal property line. It defines who they are, where they end, and where others begin.  Boundaries are a way to describe a person’s sphere of responsibility. What a person is in control o- themselves.
Boundaries help people determine their property lines, keeping things out and letting things in. Boundaries are not walls, they are flexible.  Being able to let the good in is important.
Examples of Boundaries
Skin – Skin covers bones and protects the inside of bodies (letting the good in – food; letting the bad out – waste products).  Victims of physical and sexual abuse often have poor boundaries.  Their mind, body and spirit were violated.
Words – “No”…Children start saying “No” in their two’s and three’s.  Parents don’t always like it, but it’s important for them to define what is “Yes” and what is “No.”  When someone hasn’t learned to say “No,” they lose a sense of boundaries for their words.
Truth – Individuals being able to speak their truth is called a boundary.  “I believe I am loved” is a truth for many.  Each individual knowing the truth about themselves is important for healthy relationships.  Being authentic (silly, quiet, loud, Type A, shy, etc.) is an example of a personal truth.
Geographical Distance – For some, removing themselves from danger or abusive situations may be the right choice, even if it’s removing themselves from family.  Choosing healthy relationships indicates high self-esteem.
Time – Taking time off from a person or situation may be healthy to take back an out-of-control aspect of a person’s life.  Taking time to build healthy boundaries and creating new ways of relating is healthy.
Emotional Distance – This may be a temporary boundary some may choose to heal their heart, if they’ve felt unsafe or hurt/abused.  By taking some distance this can clear heads to make more conscious decisions, rather than making emotional decisions.
Other People – Support groups are very helpful in terms of learning and creating new boundaries.  Other people can help those who feel boundary-less to be strong enough, at times, to set boundaries.  Be aware that many feel guilty when we first start setting boundaries.
Consequences – Consequences enforce boundaries. They signal the seriousness and importance of boundaries. Each person decides to protect their boundaries for their own sanity and health and determine consequences if the boundary is not valued.

Boundaries – Introduction

When I am working with clients, there is often confusion around boundaries, and more specifically, a lack of knowledge on what are healthy boundaries.  This is because many of us were raised in families that did not provide healthy boundaries; we did not learn the correct skills and techniques.
Over the next several weeks, I will provide a good overview and action plan on healthy boundaries. This will include:
  • Definitions and examples of boundaries
  • Boundary myths
  • Problems caused by unhealthy boundaries
  • How to set boundaries
  • How to take responsibility and take back your life
Peg Roberts, LMFT
President & Clinical Director
“When we fail to set boundaries and hold people accountable, we feel used and mistreated. This is why we sometimes attack who they are, which is far more hurtful than addressing a behavior or a choice.”
Bren’e Brown

The Three C’s of Sending Messages

As you are working on your communication skills, remember to make your messages Clear, Concise and Complete.

When communicating about a difficult issue:

  1. Pick an appropriate time when no one is upset, angry, hungry or tired.
  2. Use non-inflammatory language (no fighting words).
  3. Speak for yourself using I messages.
  4. Keep it brief and to the point. Do not explain or justify.
  5. Use the Five Step Invitation to problem solve:
    • Describe what your senses perceive (I see, hear, smell).
    • Express your thoughts giving the other the benefit of the doubt (I think, believe, know).
    • Share emotions (I’m (name a feeling)).
    • Disclose the want you want for yourself, for your partner or for the relationship (I want, would like)
    • State what you are doing or will do (I’m, I will)

Remember K.I.S.S. (keep it short and simple).

Speaker Listener Technique

As we move through the elements of communication and how to improve your communication one of the best tools that I have worked is, is the Speaker Listener Technique.  Following are sound rules to follow which will quickly improve your communication skills:

Rules for the Speaker

  • Speak for yourself, don’t mind read!
  • Keep statements brief. Don’t go on and on.
  • Stop to let the listener paraphrase

Rules for the Listener

  • Paraphrase what you hear.
  • Focus on the speaker’s message. Don’t rebut.

Rules for Both

  • The speaker has the floor.
  • Speaker keeps the floor while the listener paraphrases
  • Share the floor.

Anxiety

Anxiety

“I always thought I was just a worrier. I’d feel keyed up and unable to relax. At times it would come and go, and at times it would be constant. It could go on for days. I’d worry about what I was going to fix for a dinner party, or what would be a great present for somebody. I just couldn’t let something go.”
“When my problems were at their worst, I’d miss work and feel just terrible about it. Then I worried that I’d lose my job. My life was miserable until I got treatment.”
“I’d have terrible sleeping problems. There were times I’d wake up wired in the middle of the night. I had trouble concentrating, even reading the newspaper or a novel. Sometimes I’d feel a little lightheaded. My heart would race or pound. And that would make me worry more. I was always imagining things were worse than they really were. When I got a stomachache, I’d think it was an ulcer.”

Definition

People with Generalized Anxiety Disorder (GAD) go through the day filled with exaggerated worry and tension, even though there is little or nothing to provoke it. They anticipate disaster and are overly concerned about health issues, money, family problems, or difficulties at work. Sometimes just the thought of getting through the day produces anxiety.

GAD is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months. People with GAD can’t seem to get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They can’t relax, startle easily, and have difficulty concentrating. Often they have trouble falling asleep or staying asleep.

When their anxiety level is mild, people with GAD can function socially and hold down a job. Although they don’t avoid certain situations as a result of their disorder, people with GAD can have difficulty carrying out the simplest daily activities if their anxiety is severe.

GAD affects about 6.8 million American adults, including twice as many women as men.  The disorder develops gradually and can begin at any point in the life cycle, although the years of highest risk are between childhood and middle age. There is evidence that genes play a modest role in GAD.

Other anxiety disorders, depression, or substance abuse often accompany GAD, which rarely occurs alone. GAD is commonly treated with medication or cognitive-behavioral therapy, but co-occurring conditions must also be treated using the appropriate therapies.

When to Seek Medical Advice

Both adults and children with Generalized Anxiety Disorder are constantly plagued by worries.

They may feel anxious and worried about things both large and small, such as:

  • School
  • Work
  • Sports performance
  • Car repairs
  • Household chores
  • Earthquakes
  • War
  • Finances
  • Airplane flights
  • Their own and others’ health

Those with GAD may find it impossible to banish fears and worries, even when trying to relax or unwind. This anxiety can go on for months and months. They may feel as if they’ve lost control over managing it. And it may interfere with their ability to carry out daily routines.

Their worries are unlikely to simply go away on their own, and they may actually get worse over time. It’s best to seek professional help even before the anxiety becomes severe — it may be easier to treat.

Symptoms

Signs & symptoms of Generalized Anxiety Disorder can vary in combination or severity.

Symptoms  may include:

  • Restlessness
  • Feeling of being keyed up or on edge
  • Feeling a lump in your throat
  • Difficulty concentrating
  • Fatigue
  • Irritability
  • Impatience
  • Being easily distracted
  • Muscle tension
  • Trouble falling or staying asleep
  • Excessive sweating
  • Shortness of breath
  • Difficulty swallowing
  • Trembling/twitching
  • Lightheaded
  • Breathlessness
  • Stomachache
  • Diarrhea
  • Headache

If an individual has GAD they may feel on edge about many or all aspects of life. For example, they may feel intense worry about their safety or that of loved ones, or have a general sense that something bad is about to happen, even when there’s no apparent danger.

GAD often begins at an early age, and the signs and symptoms may develop more slowly than in other anxiety disorders. Many people with GAD can’t recall when they last felt relaxed or at ease.

Treatments

The two main treatments for Generalized Anxiety Disorder are psychotherapy and medications, either alone or in combination.

Psychotherapy

Also known as talk therapy or counseling, psychotherapy involves receiving help from a mental health provider through a combination of talking and listening. Evidence shows that cognitive behavior therapy in particular can help improve symptoms of GAD.

Cognitive behavior therapy helps identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. It’s based on the idea that our own thoughts — not other people or situations — determine how we behave. Even if an unwanted situation doesn’t change, we can change the way we think and behave in a positive way. Generally a short-term treatment, cognitive behavior therapy emphasizes learning to develop a sense of mastery and control over thoughts and feelings.

Treatment for GAD or any mental illness is tailored to each person. No single treatment regimen works for everyone. Most treatment occurs on an outpatient basis, but some people may need care in a hospital setting.

Medication

Several different types of medications are used to relieve Generalized Anxiety Disorder symptoms:

Anti-anxiety medications. Benzodiazepines are sedatives that have the advantage of easing anxiety within 30 to 90 minutes. On the downside, they can be habit-forming if taken for more than a few weeks. For this reason, the doctor may prescribe them for only a short time to help get through a particularly rough period. The most commonly prescribed sedatives include alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium) and lorazepam (Ativan).

 These medications may cause unsteadiness, drowsiness, reduced muscle coordination and problems with balance. Higher doses and long-term use can cause memory problems.

A different type of anti-anxiety medication often prescribed for GAD is buspirone (BuSpar). While this medication typically takes several weeks to improve symptoms, it doesn’t pose a risk of dependence. A common side effect of buspirone is a brief feeling of lightheadedness shortly after taking it. Less common side effects include headaches, nausea, nervousness and insomnia.

Anti-depressants. These medications influence the activity of certain neurotransmitters that are thought to play a role in anxiety disorders. Examples of antidepressants used to treat GAD include fluoxetine (Prozac), paroxetine (Paxil), imipramine (Tofranil), venlafaxine (Effexor), escitalopram (Lexapro) and duloxetine (Cymbalta).

Coping & Support

  • Joining an anxiety support group. Here, individuals with GAD can find compassion, understanding and shared experiences.
  • Taking action. Working with a mental health provider to figure out what’s making the person anxious and address it.
  • Letting it go. Don’t dwell on past concerns. Change what can be changed and let the rest take its course. Repeat as needed.
  • Breaking the cycle. When feeling anxious, take a brisk walk or delve into a hobby to refocus the mind away from worries.
  • Self care. Get enough rest, eat a balanced diet, exercise and take time to relax. Avoid caffeine and nicotine, which can worsen anxiety. Don’t turn to alcohol or un-prescribed drugs for relief.
  • Sticking to a treatment plan. Take medications as directed. Keep therapy appointments. Consistency can help keep treatment plans on track.
  • Don’t let worries isolate them from loved ones or enjoyable activities. Touching base with others offers a healthy diversion.
  • Allow their faith in God to help through the daily activities and responsibilities.  Focus on the good things in life and be grateful for them.

Resources

  1. Bourne, Edmund J., and Lorna Garano. Coping with Anxiety.  Oakland, CA:  New Harbinger Publications, 2003.
  2. Brantley, Jeffrey. Calming Your Anxious Mind.  Oakland, CA: New Harbinger Publications, 2003.
  3. Copeland, Mary Ellen. The Worry Control Workbook.  Oakland, CA: New Harbinger Publications, 1998.
  4. White, John. Overcoming Generalized Anxiety Disorder: Therapist Protocol and Client Manual.  Oakland, CA: New Harbinger Publications, 1999.

 

Written by:  Maureen Vogt, MA, LPC

As a Licensed Professional Counselor, Maureen has dedicated her career to working with Generalized Anxiety, OCD, panic and phobias, depression, low self-esteem, eating problems, interpersonal relationships, trauma, abuse, personality challenges, adoption  issues, and ADHD.

 

Destructive Communication Patterns

As I continue to move through my material relating to healthy communication, I felt it was important to discuss “destructive communication patterns”.   These are 6 points that are important to avoid during communications:

  1. Dishonor and Invalidation:
    • When you use negative words about your spouse’s character or use hurtful statements.
    • This may be subtle like being insensitive to your spouse’s feelings, or more directly, resulting in insults and invalidating their feelings
    • The antidote to invalidation is unconditional love and acceptance.  This does not mean that you have to agree with your spouse on the issue at hand, but it does mean that you listen to and respect their perspective.
  2. Defensiveness:
    • Defensiveness is really a way of blaming your partner.  You’re saying in effect, “the problem isn’t me, it’s you.”
    • Defensiveness escalates the conflict by blaming the other and take little (or no) responsibility for how you have contributed to the problem.
    • The key is to respond by listening and validating, which shows the other person that they are more important than proving yourself right.
  3. Escalation:
    • This is when you scream or yell and lose control of your emotions.
    • Often the person starts defending himself/herself or tries to win an argument.
    • Each negative comment increases the level of anger and frustration, and a small disagreement can blow up into a major fight.
    • The key to a strong marriage is learning to control your emotions and your words.
    • Healthy communication is when you agree to take a break but come back later when emotions have calmed down.
  4. Negative Interpretations:
    • When you become judgemental and view your spouse’s intentions or words as more negative that he or she intended it.
    • Instead of giving your spouse the benefit of the doubt, you take the negative view that may not be fair or accurate.
    • The key to battling negative interpretations is to reconsider what you think about your partner’s motives.  Ask yourself if your thinking might be overly negative.
  5. Contempt:
    • Sarcasm, cynicism, name-calling, eye-rolling, sneering, mockery, and hostile humor are forms of contempt.
    • Contempt is poisonous in a relationship because it conveys disgust.  It’s virtually impossible to resolve a problem when your partner is getting the message you’re disgusted with him or her.
    • Contempt is fueled by long-simmering negative thoughts about the partner.  You’re more likely to have such thoughts if your differences are not resolved.
    • Resolving issues in a healthy manner is important because contempt can be fueled by long-simmering thoughts about your spouse.
  6. Withdrawal and Avoidance:
    • When you pull away, shut down or leave to avoid conflict without letting the other person know you will talk later.
    • Withdrawal can be as obvious as getting up and leaving the room or as subtle as “turning off” during an argument.
    • Often the person keeps their anger internalized and expresses their anger through non verbal actions such as the cold shoulder.
    • One may withdrawal as a protection against feeling flooded.  Flooding means that your spouse’s negativity – whether in the guise of criticism or contempt or even defensiveness – is so overwhelming and so sudden, that it leaves you shell-shocked.  When a pounding heart and other physical stress reactions happen in the midst of a discussion with your mate, your ability to process information is reduced, and it is harder to pay attention and solve issues.
    • A typical reaction is to fight of flee.