Overcoming Trauma Is Possible – with Help

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When you see news accounts of people experiencing traumatic events, shootings, violent or sexual assaults, kidnappings, accidents, fires, drowning and more, it may seem both commonplace and far removed at the same time. The fact that the news tends to sensationalize such terrible events might numb you to the magnitude of the trauma these victims endured.

But when it happens to you, you’re stunned, frozen with fear, totally unprepared. The aftermath leaves you deeply scarred, physically, psychologically and emotionally shattered.

I know exactly how this feels. I was a victim of such trauma. Yet, I did overcome this life-altering experience with psychotherapy.

The Attack

It was a beautiful, sunny day in June when I drove into the parking space behind my best friend’s apartment building. She lived on the other side of the building, and so couldn’t see me approach. Thus, she had no idea what was about to happen. Neither did I.

Since we were going to do our hair and nails at her place before going out to a restaurant for dinner afterward, I gathered my purse and situated the bag containing shampoo, conditioner, blow dryer, curling iron, hair spray, makeup and change of clothes in the front seat. There was no one on the sidewalk and no cars nearby. As I opened the door to get out, my purse was hanging on my shoulder, my car keys in my other hand.

Suddenly, I felt something sharp pressed into the left side of my neck, and someone grabbed me roughly to pin my right arm back.

“Don’t move,” a man’s voice commanded.

I didn’t. I couldn’t. Everything seemed so surreal. Time seemed to stretch on forever as I stood petrified.

I felt my purse yanked off my shoulder and felt the sharp tip leave my neck. I sensed motion and after a few seconds realized my attacker was gone. I turned my head and saw two young males running down the sidewalk that led to another apartment building and forked to a small park.

For some reason, I started yelling at them to stop. Then, inexplicably, I took off after them. One turned, saw me, and they split. I ran after the one I thought had my purse, although I couldn’t be sure. He had a huge head start on me and I soon lost him.

The sidewalk ended on a residential street. There was a man watering his tiny patch of grass and I ran up to him and asked if he’d seen a young guy barreling by. He said he hadn’t and asked me what happened. Out of breath, just then beginning to realize how foolish my actions had been in trying to chase my attackers, I told him. He urged me to call the police.

I felt like my legs turned to Jell-O, but I slowly made my way back to my friend’s place and tearfully related what happened. She drove me to the police station and I made a report. The officers held out slim hope that the attackers would be apprehended, but said they’d be in touch if they did.

We went back to my friend’s place and had some iced lemonade. Forget the evening plans. Forget me going home to my apartment that weekend. My house keys, identification, wallet, address book with my home address in it, my checkbook with the same, my medication, all were now in the hands of my attacker.

I did call my upstairs neighbor to give him a heads-up. He promised to watch my place.

Three days later, on my return home, my neighbor met me at my door. It had been broken into and the doorjamb was destroyed. My neighbor said he heard loud banging the night before and went out on his balcony to look down. He yelled and saw two guys making off with something, although he couldn’t see what it was. He called the police.

I spent the next few nights at my mom’s house, while the landlord installed a new door and lock at my apartment. I also got a call from someone who said they’d found my purse, and wanted to know if I wanted it. I was afraid this was a scam, so I arranged for the finder to meet me at the police station with my purse. I did, and the purse was fine, although the money, my ID, checkbook and keys were gone. I offered a $20 reward, which the man gratefully accepted. I had to borrow the money from my friend to give to him.

The Nightmares and Flashbacks Begin

For months after the attack, I never slept through the night. I tossed and turned, knowing that when I did fall asleep, I’d have vivid nightmares that replayed the traumatic event over and over. In the daytime, any sudden movement put me on edge. The sound of a man’s commanding voice anywhere – on the TV, radio, in the market, at work – put me right back to the attack. I felt the knife tip, heard his insistent voice, saw the wild-eyed look in his eyes. The latter is something I remembered in the split-second when he turned to look at me on that sidewalk.

As I attended night school at university, I was also afraid to go from my car to classes. My schoolwork suffered. I had to finally drop out of school for the semester.

At work, my attention wandered. I couldn’t stay focused on the task at hand. Often, my supervisor would find me gazing off into space. I barely knew he was there, for what I was seeing was the attack happening all over again.

He suggested I go for counseling and said my company benefits would pay for it. I asked a few friends for recommendations for a psychotherapist, selected one, made an appointment, and began therapy.

The Long Road Back to Mental Health

It wasn’t easy reliving the violent episode with my therapist. Although he knew that was the reason that I started therapy, there were other items in my past that needed attention as well. We first had to establish trust. I’ll admit the thought of psychotherapy was very unnerving, but I was in a precarious state and needed help.

My therapist was a kind, gentle man. He spoke softly, whether to ease my fears or that was his regular demeanor. All I know is that I instinctively trusted him and believed he wanted the best for me.

In helping me learn how to deal with my trauma, we went over self-protective measures I put in place immediately following the attack. He also encouraged me to stay in close contact with my upstairs neighbor, my family, co-workers and friends so they knew my schedule and could tell if something was off. This gave me an added sense of security.

Working to rebuild my self-confidence and self-esteem took quite some time, and he used different approaches for that. I know I cried a lot during sessions, and a lot more at home. Still, I felt I was getting stronger every day.

I knew that I’d never again put myself in harm’s way. Before exiting a vehicle or building or wherever I went, I taught myself to be keenly aware of my surroundings. I needed to be able to quickly identify escape routes, to impress on my memory specific details of people, places and things around me – in case I needed those facts later.

While in those days, I don’t recall the words post-traumatic stress disorder or panic attack, I know now that I probably suffered from both. I was prescribed anti-anxiety medication that I took for a period of months before my therapist felt I could be weaned off them.

Did therapy help me overcome trauma? Absolutely. Was it a rapid healing process? No, it took a couple of years to undo the damage that one traumatic act of violence inflicted. Yes, I did heal. Frankly, the episode gave me an overwhelming appreciation for life and gratitude that I was able to survive what could have been another fatality statistic.

Overcoming Trauma Is Possible – with Help

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How White Denial of Racism Can Fuel Inequality

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Denial has been said to be the trademark of addiction, and it has been long identified in the field of psychology. Denial is also relevant to experiences of trauma. These include witnessing trauma, inflicting trauma, and surviving trauma. Furthermore, white denial of racial trauma is the breath of racism.

What Is Denial and Why Do People Do It?

Denial is a refusal to accept reality in order to protect oneself from a painful event, thought, or feeling. It is a common defense mechanism that gives a person time to adjust to distressing situations. For example, a person with drug or alcohol addiction will often deny that they have a problem. People indirectly dealing with the addiction, such as family or friends of the addicted person, may also deny the severity of the issue.

It is possible to deny some aspects of reality while accepting other aspects. For example, a person may acknowledge there is an issue (such as addiction) while denying the need to take action (such as quitting the drug).

Denial isn’t limited to individuals. It has also been recognized on a cultural scale. Current examples include conspiracy theorists’ claims that the Holocaust never occurred or the renunciation of global warming.

Some experts theorize that denial occurs in linear, progressive stages. These types of denial include the following:

  • Denial of fact (“That’s not true”)
  • Denial of awareness (“I had no idea”)
  • Denial of responsibility (“It’s not my fault”)
  • Denial of impact (“That wasn’t my intention”)

Denial is initially an unconscious adaptive response. It can also be one of the most primitive, meaning that while it can be very effective short-term, it is ineffective and potentially harmful in the long-term. Staying in denial interferes with change.

How Denial Can Contribute to Racism

The stigma associated with being racist often fuels white denial—the refusal to accept that racism exists. Racism can be defined as the discrimination and/or oppression inflicted upon individuals belonging to a socially constructed racial category. Racism happens at three levels:

  1. Institutional—Discrimination through laws or social norms.
  2. Individual—When one person discriminates against a minority group.
  3. Internalized­—When a marginalized person believes stereotypes about their group and/or blames themself for any discrimination they face.

Racism requires the combination of prejudice, power, access, and privilege. It has been summarized as a pathology of power marked by ignorance.

The infamous photograph of the horrific lynching of Rubin Stacy in 1935 is a striking example of white denial. The photo shows a white child in the crowd dressed in her Sunday best. She is smiling while looking at the dead body of a black man hanging in the tree.

Transforming and healing the societal trauma of racism must include healing the numbness of people who benefit from racism.The child could be considered a visual representation of how the short-term coping response of denial evolves into a long-term strategy. The photo demonstrates how racism can be embedded in the culture we grow up in (institutionalized). It also shows how our belief system and our physiology can embody racism (individualized and internalized).

Studies on epigenetics reveal how trauma responses can be passed down through generations, not only through learning and conditioning, but also through genetics. One study shocked male mice while exposing them to the scent of a cherry blossom. The mice then showed a trauma response every time there was the scent, even without being shocked. The trauma response was also present in the mice’s children and grandchildren when they were exposed to the scent of a cherry blossom, even though they never experienced a shock. Their genes were altered.

The study suggests that a person may not have to directly experience a traumatic event to enact a trauma response. In other words, a traumatic response to a relevant trigger can occur even when a person doesn’t know what the original stimulus was. Regarding the photo, the loved ones grieving Rubin Stacy’s death could have passed down their trauma response to their descendants. Future descendants of the white child may embody her physiological response as well.

White denial, and the identified physiological response, may be relevant in the concept “the privilege of numbness”. The term refers to emotional numbness as an adverse effect of racism. This numbness may enable white individuals to ignore or perpetuate a system of racism that benefits them without feeling guilt about others’ suffering. Transforming and healing the societal trauma of racism must include healing the numbness of people who benefit from racism.

When Ignorance Is Intentional

Conscious acts of denying can also appear when people face ethical dilemmas. A study examining shopping behaviors found that if consumers were specifically told that a product was made in an unethical way, the consumers wouldn’t purchase the product. However, when consumers were given the choice to hear the backstory on the product, most people chose to not know.

Researchers asked participants to rank jeans by picking two of four categories to do so:

  1. Style
  2. Color
  3. Price
  4. Whether or not child labor was used to make the clothing

More than 85% of participants did not choose child labor as a category for their consideration. These results suggest the vast majority of participants were “willfully ignorant.” Researchers found the conscious act of denial was at least in part due to an unconscious fear of being upset by what would be discovered.

Next, researchers asked the willfully ignorant participants what they thought of consumers who chose to research a brand’s labor practices before making a purchase. The response? The willfully ignorant participants tended to degrade the ethical consumers, not just with criticism, but also with character attacks.

Why the hate? Research indicated the participants were unconsciously acting out due to their own guilty feelings. Perhaps even more concerning, a related study demonstrated that willfully ignorant consumers who degraded their ethical peers were less likely to support the social cause in the future.

Addressing Denial Through Self-Examination

Challenging denial is typically an ongoing process of self-examination and radical honesty. Denial is universal—everyone perceives events through personal bias. Therefore, confronting denial often starts at an individual level.

When challenging your own denial, remember to consider the following:

  • Realize that denial and personal bias are largely implicit and unconscious processes. Uncovering and confronting social conditioning requires ongoing effort and outside feedback. We all have blind spots.
  • Remove the blame and shame. Binary judgments of good/bad can further increase stigma. Stigma in turn can heighten defense mechanisms and trigger trauma reactions (i.e. denial).
  • Replace blame and shame with vulnerability, curiosity, and humility. Embrace feelings that allow for growth. Seek understanding. Stretch your worldview.
  • Befriend the body. Increase your awareness of your body. Understand how it reacts when you are stressed or ashamed. Learn to tell the difference between discomfort and pain.
  • Focus on holding yourself responsible and accountable. Consider if your internal and external resources are being used in accordance with your values. Action often alleviates guilt.

Sometimes confronting personal bias or past mistakes can feel emotionally overwhelming. A licensed therapist can offer confidential support without judgment. You can find a therapist here.

References:

  1. Aizenman, N. (2016). Do these jeans make me look unethical? National Public Radio. Retrieved from https://www.npr.org/sections/goatsandsoda/2016/01/07/462132196/do-these-jeans-make-me-look-unethical
  2. Aldebot, S., & de Mamani, A. G. (2009). Denial and acceptance coping styles and medication adherence in schizophrenia. The Journal of Nervous and Mental Disease, 197(8), 580–584. doi:10.1097/NMD.0b013e3181b05fbe
  3. D’Angelo, R. (2011). White fragility. The International Journal of Pedagogy, (3) Retrieved from http://libjournal.uncg.edu/ijcp/article/view/249/116
  4. Kendi, I. X. (2018). The heartbeat of racism is denial. The New York Times. Retrieved from https://www.nytimes.com/2018/01/13/opinion/sunday/heartbeat-of-racism-denial.html
  5. Lewis, T. (2013). Fearful experiences passed on in mouse families. Live Science. Retrieved from https://www.livescience.com/41717-mice-inherit-fear-scents-genes.html
  6. Lynching of Rubin Stacy in Fort Lauderdale, Florida [Photograph]. (1935) Retrieved March 2019 from https://www.alamy.com/stock-photo-lynching-of-rubin-stacy-in-fort-lauderdale-florida-49908098.html
  7. Raheem, M. A., & Hart, K. A. (2019, March). Counseling individuals of African descent. Counseling Today, 61(9). Retrieved from https://ct.counseling.org/2019/03/counseling-individuals-of-african-descent
  8. Winn, M. E. (1996). The strategic and systemic management of denial in the cognitive/behavioral treatment of sexual offenders. Sexual Abuse, 8(1), 25–36. Retrieved from https://journals.sagepub.com/doi/10.1177/107906329600800104

© Copyright 2019 GoodTherapy.org. All rights reserved. Permission to publish granted by Tahmi Perzichilli, LPCC, LADC, therapist in Minneapolis, Minnesota

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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Narcissistic Families: Growing Up in the War Zone

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When you are raised in a narcissistic family it can feel like there is no help.

Parents who are narcissistic are often self-focussed. They will relate to their children as “self-adjuncts” serving to support them and their image of themselves.

Do something that reflects well on them and you are suddenly the Golden Child. Make a mistake, ask for help or express your vulnerability, and you are on your own or worse, ridiculed.

Children in this situation learn quickly that their needs are unwelcome. Because they are raised to ignore, undermine or suppress their natural sense of who they are, they become alienated from their authentic selves. It can take a lot of work in therapy to unravel this masking process and reveal the true self.

Often this fragile and undermined true self will be associated with intense shame.

Parents who are narcissistic will normally shame a child for asking for her needs to be met, because they are considered inconvenient. Having an imperfect, needy child can bring the narcissist back in contact with their own denied vulnerability, the unfolding shame causing them to become hostile and shaming towards their child. This temporarily rids them of their shame and puts it into the child, who becomes a convenient long-term container for the parent’s unconscious projections.

This shaming process is intensely destructive for young children — the younger they are, the more damaging it will be. Narcissistic parents often don’t provide the soothing and reassurance needed by the child to cope with the overwhelming emotional states accompanying these shame experiences. A child in this situation will develop their own coping mechanisms, usually leading to the splitting off of traumatic memories around the abuse and sometimes, dissociation.

Shame is the fundamental weak spot for narcissists.

Their vulnerability around shame will make them project it onto others, including their children.

Because they are hardwired for attachment, all children will gravitate towards an attachment figure, working to maintain a relationship with parents and looking for support, soothing, nourishment and validation. But the narcissistic parent is often unable or unwilling to provide the emotional validation needed by the growing child. They will be too caught up in their own needs to be attuned to their child or to provide the sensitive responses which help children learn to understand their own emotions.

In some cases these narcissistic parents will be overwhelmed by their own history of trauma.

Being confronted by the emotional needs of a child can bring up painful, sometimes dissociated memories of their own infancy and childhood. These experiences will be more than enough to prevent them from being able to empathize with their children.

A child in this environment soon learns that their emotions are overwhelming for the parent and will unconsciously lose contact with their genuine responses and feelings, understanding that these are likely to be met with hostility.

Narcissistic families often operate in an atmosphere of enmeshment and secrecy, where there is a lack of healthy boundaries and open dialogue. Communication will be unclear, perhaps tangential. Those who ask for what they want will soon learn that this is not welcome. Emotions will not be verbalized, but will be acted out (or “behaved”) sometimes with violence or verbal abuse. At times, addictive behaviors will be used to mask the pain of underlying feelings, making the parent even less available to their children.

A narcissistic home can at times resemble a war zone, with hidden traps and exploding emotions.

The non-narcissistic parent will be desperate to avoid triggering their partner, hoping that things will be OK, but never really knowing what they will come home to.

Often the non-narcissistic parent will deny their own emotions and dependency needs, tiptoeing around the narcissist in a misguided attempt to manage the destructive anger that can tip over into violence and abuse.

For young children, the unpredictability and unspoken tension of a home like this can be particularly harmful. Most children who experience these environments will develop trauma responses, including the complex trauma response.

As adults, these children will often be unaware of the trauma they experienced. They will be vulnerable to depression and anxiety — and loneliness. Some will find a way to manage their unacknowledged pain through addictions. Others will be left wondering why they find it hard to relate to others — or to trust.

It is only through psychotherapy that these neglected children will come to understand themselves and eventually come to terms with the pain of their past.

Narcissistic Families: Growing Up in the War Zone

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Podcast: There’s More to Trauma than PTSD

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Most of us are familiar with post-traumatic stress disorder. PTSD (deservedly) gets a lot of attention, largely focused on soldiers returning from service. But trauma comes in many forms, and most people have experienced it in one form or another. In this episode, learn about the differences between PTSD and other forms of trauma, how to identify it, and what can be done about it.

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About Our Guest

Robert T. Muller, Ph.D., is the author of the psychotherapy book, “Trauma & the Struggle to Open Up: From Avoidance to Recovery & Growth,” which focuses on healing from trauma.

Dr. Muller trained at Harvard, was on faculty at the University of Massachusetts, and is currently at York University in Toronto. He has over 25 years in the field.

Books by Robert T. Muller

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TRAUMA SHOW TRANSCRIPT

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Narrator 1: Welcome to the Psych Central show, where each episode presents an in-depth look at issues from the field of psychology and mental health – with host Gabe Howard and co-host Vincent M. Wales.

Gabe Howard: Hello, everyone, and welcome to this week’s episode of the Psych Central Show Podcast. My name is Gabe Howard and I’m here with my fellow host Vincent M. Wales and our guest today is Dr. Robert T. Muller and he is the author of the psychotherapy book Trauma and the Struggle to Open Up: From Avoidance to Recovery and Growth, which focuses on healing from trauma. Robert welcome to the show.

Dr. Robert T. Muller: Very, very glad to be here.

Vincent M. Wales: We are glad to have you. So the word trauma is thrown around a lot these days. What do we really mean by that?

Dr. Robert T. Muller: Well, so there are different kinds of traumatic experiences but they all are based in the fact that something clear has happened to the person in the external world. Something that overwhelms their normal coping abilities and this can be a natural disaster, of course, but it can also be an event that occurs in the home. It could be something like physical or sexual abuse from a caregiver or various kinds of assault. And these are experiences that are overwhelming and most people who go through these overwhelming experiences don’t end up with post-traumatic stress disorder or various kinds of consequences. But a number of them do. and when they do and they’re left with these feelings of great distress and that’s what we refer to as trauma. The feelings that are left in the person that affect them, that affect their choices, that affect their relationships, that affect the way they engage in friendships following an overwhelming experience. And it’s hard, it’s very, very tough for people to deal with.

Gabe Howard: You know, outside of people who work in this field, the only really thing that they understand about trauma is post-traumatic stress disorder. That’s like the closest that the general public gets when you’re talking about trauma. Where does PTSD fit in? Can you kind of help people understand that?

Dr. Robert T. Muller: So the term PTSD we see in the psychiatric literature, and by PTSD we mean that the person has a disorder after a traumatic event post-traumatic stress disorder. So that means that they are continuing to suffer and by disorder we mean that their mental health is suffering and that they’re experiencing symptoms of re-experiencing the event, flashbacks. They may remember and have memory intrusions, memories of the event. And that’s very severe. They also have startle responses where they’re stressed very, very easily and by stress that can be very overwhelming stress. They also have problems with mood because they often feel depressed because of these traumatic experiences. And then finally they try to stay away from the things that remind them about whatever happened. So we see post-traumatic stress disorder in Vietnam vets, Gulf Wars vets, vets who’ve come back from Afghanistan, for sure. So we can also see these symptoms in victims of domestic violence and people who have been to experiences even who haven’t gone to war. So PTSD refers to the psychiatric language that’s used to describe the symptoms that many people have after a traumatic event. So that’s what it’s really meant by PTSD.

Gabe Howard: Thank you so much for that. And just to clarify, you can be traumatized and not develop PTSD. Is that correct?

Well you can be. Yeah. So here we get into a little bit of different words can sometimes mean similar things but when we talk about someone who is traumatized, they have all kinds of symptoms. They may not have exactly that cluster of things that I mentioned that we call PTSD but they’re going to have very similar experiences. There’s something called Complex PTSD and that’s a little bit different. Complex PTSD refers to people very often who have had traumatic events happen in childhood and in relationships. They feel betrayed by people who have who they thought were going to care for them the most. And when people have complex PTSD, very often what they have are huge problems in relationships. So, they’ve been hurt by somebody, they may feel tremendously abandoned by someone who they trusted. And then in life and in relationships, they now struggle to trust and they often really question other people. They question whether they can really trust them and they have a hard time with developing relationships because they feel scared. There are many feelings of fear that come over them. Shame, feelings of shame are common in complex PTSD. So, complex PTSD can take longer to heal than PTSD. If treatment for PTSD tends to be something more like six months to a year, treatment of complex PTSD can be two, three years, maybe even four years something like that. Pretty common. So those are some distinctions.

Vincent M. Wales: Thank you. Gabe and I are both very familiar with abandonment disorder and that sort of thing, attachment disorders. And there seems to be a very clear relation there with complex PTSD?

Dr. Robert T. Muller: For sure there is. There often is that for sure. There are feelings of abandonment very often and people with complex PTSD, and there are attachment problems. So, by attachment, that means that in times of distress they have difficulty turning to others who if you had a secure, what’s called a secure attachment, you might have an easier time turning to the people who feel, you know, should care about you. You know you might do that more easily; you might turn to them and ask for help and feel comfortable with that. But when people have what’s called an insecure attachment, and this is very common in complex PTSD, they have a great deal of difficulty turning to those people, who really you would think that they could turn to, their husbands, wives, their friends. They have a hard time turning to them because they feel very very frightened very often that people are going to just going to let them down. It’s a very very challenging disorder to treat. But it’s important for a therapist who works with people like this be what’s called trauma informed. Where they know about the effects of trauma so they can help people like this manage and find their way through their trauma.

Gabe Howard: Trauma informed care is something again, coming up more and more in mental health circles. Can you explain what trauma informed care means?

Dr. Robert T. Muller: So, there are many conditions that are related to trauma. It’s not just trauma therapists who come across people who have trauma histories. Family doctors very often will come across people who come in complaining of migraines, fibromyalgia, chronic fatigue, irritable bowel syndrome, immune system kind of disorders, stress related disorders. All of those are greatly exacerbated in people who have trauma histories. So it’s very important for family doctors. It’s very important for teachers, actually, to be trauma informed because you may see a kid in your class who appears like they have ADHD. They can’t sit still, they’re irritable, and that may also be a reaction to trauma. And I’m not saying that every person with all these disorders has a trauma history. I’m not saying that. Most of time people have migraines not because of trauma. But, if you do have a trauma history, all of those conditions can be greatly exacerbated. And so it’s very important for professionals who work interpersonally with people, family doctors, chiropractors, dentists, temporomandibular joint dysfunctions can be a symptom of trauma. Teachers, nurses, it’s very important for them to be trauma informed. For them to understand about the different manifestations of trauma. And there are many very often the immune system because of the stress of trauma the immune system has been affected. And that makes you more susceptible to a variety of different disorders. That’s why you need to be trauma informed.

Vincent M. Wales: Now for someone who has a pre-existing mental illness, whether it’s bipolar, or depression, or what have you, how are they affected by trauma? Is it any differently than someone without those issues?

Dr. Robert T. Muller: Yeah. Yeah. So trauma exacerbates other kinds of conditions. People have, let’s say, a family history of depression or family history of bipolar illness and then very traumatic thing happens to them. That can exacerbate other problems that they have. So it’s very difficult to disentangle this symptom is caused by this and this is a symptom caused by that. It’s impossible really to disentangle what’s caused by what. But what you do want to do is you want to work with people if you’re doing therapy with an individual who’s been through this. You want to work with them in a way where if somebody has bipolar illness where you get them seeing a good psychiatrist who can prescribe the right medication. But then if they have a trauma history that doesn’t mean that that’s it. That medication is all of the treatment. No. Somebody has a trauma history, they’ve got to find a way to talk about what’s happened to them. And that’s very difficult when you’ve been through trauma. It’s hard to talk about. And so good trauma informed therapies will work with a person in a measured, paced way to help them slowly feel comfortable. We’re starting to talk about what happened. And that can be very, very challenging.

Gabe Howard: It’s interesting. As someone who lives with bipolar disorder, I know the importance of being able to tell my medical team, whether it’s a psychiatrist, or a social worker, or a psychologist, you know, what’s going on inside my head, what my challenges are, what I need help with. It sounds like you’re saying somebody who just has a trauma background really needs to respond the same way. They have to be able to explain that to their medical team in order to get the right care.

Dr. Robert T. Muller: Well the thing with trauma is that people, a lot of professionals are not trauma informed. And so what ends up happening is that you get people going in for symptoms. So somebody with a trauma history, a typical kind of presentation. I’ll just give a name, Susan. Susan was raped let’s say in university. She experiences all kinds of difficulty in classes. She then goes and sees her doctor, gets put on an antidepressant. Is O K for a year or two on this antidepressant. And then, she starts to date again and then whoa. All these symptoms start to come back. She starts to experience confusion. She experiences other symptoms like headaches. She goes back and gets sent to a specialist. Then she says she has difficulty with her eating. Then the question of what? Does she have an eating disorder? And so what you end up with is this smorgasbord of different professionals. You know, this person specializes in depression, that person specializes in eating disorders, this sort of person specializes in migraines and whatever, trying to treat this person. And you don’t have a coherent treatment plan. And it’s because none of these professionals actually sat down and said, “Tell me a little bit about what happened in your life for the last five years. Walk me through it. What’s happened? Anything important? Tell me about it.” And if you do that with people, you can look for this. Sort of sitting down where you can say OK. Yes. Look at this. This person’s had these depression symptoms and this eating disorder seem to have really gotten a lot worse when dot dot dot. And then you could start to put the pieces of the puzzle together. And so you’re not just treating for this disorder or that disorder or the other disorder, but you develop a coherent plan to help the person find a way to start to deal with the underlying trauma that led to a variety of different responses. So that’s where it’s really important to be trauma informed.

Gabe Howard: We’ll be right back after these words from our sponsor.

Narrator 2: This episode is sponsored by BetterHelp.com, secure, convenient and affordable online counselling. All counselors are licensed, accredited professionals. Anything you share is confidential. Schedule secure video or phone sessions, plus chat and text with your therapist whenever you feel it’s needed. A month of online therapy often costs less than a single traditional face-to-face session. Go to BetterHelp.com/PsychCentral and experience seven days of free therapy to see if online counselling is right for you. BetterHelp.com/PsychCentral.

Vincent M. Wales: Welcome back. We’re here with Dr. Robert T. Muller discussing trauma. There’s a therapy relationship. What’s so important about that?

Dr. Robert T. Muller: Well it’s really, really important, the therapy relationship. And in trauma work, that’s absolutely true. It’s even true in other kinds of psychiatric or psychological problems. Research on outcomes of mental health problems and treatment strategies, what we find is, that regardless of the school of thought that the clinician uses, let’s say people go to see a cognitive behavioral therapist, or the person goes to see a psychoanalyst, or the person goes to see a Gestalt therapist, you name it. Regardless of the school of thought, the one thing that seems to run throughout therapy is the benefits of having a good, strong psychotherapy relationship. And so this means that if you’re a cognitive behavioral therapist, it might be that the person got better in part because you help them look at their underlying thoughts and how their thoughts affect their feelings and how to help them change their behaviors and they’ll improve their feelings. Maybe. Maybe that’s a piece of it. But it also is the case for research what we know is that if you do that in the context where the two of you are really working together and feel like you’re on the same page then therapy will be much more effective. So this is true for all schools of thought of therapy and psychoanalysis and everything else. And so this therapy relationship research shows is really important. So what does that mean? That therapist and client are working together, on the same page working toward similar goals. The same goals really. You have to have similarity of thought around the goals and there’s a sense of warmth. There’s a sense that the client feels that their therapist gives a darn. That they really do actually care. And that the therapist gets it. That the client has to feel that the therapist gets it and is listening and paying attention. These are really important skills. And you know, Carl Rogers in the 1950s really honed in on this. And since then we’ve come up with all kinds of therapies. And I’m not saying these other therapies are not helpful. I’m just saying that going back to basics is really important. That the skills that Rogers taught around empathy turned out to be, in fact research shows, they’re very important. This is really the case with trauma therapy. When you’ve been traumatized and you’ve been traumatized most often when people feel in relationships that they’ve been hurt, then they might work with a therapist and think my therapist doesn’t like me, or my therapist is going to abandon me. My therapist is judging me. And it’s understandable that you’d feel this way as a client. If you’ve been hurt, when your trust has been violated, you’re going to be very cautious for good reason in relationships, and you’re even going to be cautious around your relationship with your therapist. You don’t know whether your therapist is just trying to manipulate you. In all fairness, you don’t know. And so it’s very important for the therapist to be attentive to these kinds of relational issues and trauma. Are my client and I are on the same page? And that sort of thing.

Gabe Howard: Who should go to trauma therapy? I mean who is, I know that the answer might be anybody who is traumatized, but you know more specifically, like who is trauma therapy for exactly?

Dr. Robert T. Muller: So very often if you’re holding something that feels like it’s a huge burden that’s something to notice. So pay attention. Pay attention to this question. Ask yourself, am I carrying around a deep burden from years ago? Am I holding on to a secret? A secret that if other people knew, I would feel judged? I would feel that they would hate me? I would feel ashamed of those sorts of things? Am I being loyal to people who harm me? Those are all questions that you can ask yourself. I talk a little bit about this in Trauma and the Struggle to Open Up, the idea of how people, how many trauma symptoms develop, and these themes are really, really big. The themes of secrecy, feelings of betrayal, themes of loyalty to those who maybe you shouldn’t necessarily be so loyal to. But those are the kinds of questions to ask yourself. That is does the thought or some memory about something, does it make you feel sick? Does it make you feel like this feeling of I’m a bad person? You know, when I think about x y z that happened to me, I feel terrible guilt. How could I? How could I have done that? If you’re asking some questions like why me? Or if you’re asking questions of yourself like why not me? Why did X Y Z happen to my brother and not me? Those sorts of questions are very important questions that can be addressed in trauma therapy. And very often people have those questions in association with symptoms. When you know when you think about x y z that I just mentioned, maybe you feel depressed? Or maybe you feel self-loathing or disappointed in yourself? Why did I do that? Why didn’t I help my sister when such and such? When dad was, I don’t know, especially when Dad was drinking the way he was or mom was? Why didn’t I? So if you ask yourself those kinds of questions and you’re pained by it, that might be a sign that getting help, that talking to a therapist around your history is important. Because you’ve been trying to deal with this on your own for so long, and that can feel very lonely, it can feel very burdensome. And you don’t have to be alone in dealing with these things. That’s where I would think of therapy.

Vincent M. Wales: Right. We also have what we call post-traumatic growth. Is that just a fancy word for recovery or?

Dr. Robert T. Muller: Well no. No, it’s related to recovery. I mean people you hope that through trauma therapy people will get back to the way they were before you know they started really deteriorating. But it doesn’t exactly work that way. Recovery is a bit unpredictable. And what happens is as people start to talk about their problems, and start to talk about their history, they start to deal with things in a way that they never dealt with before. And so they start asking themselves questions like I mentioned. Why me? Why not me? Maybe those kinds of questions. Like what’s my place in the world after what happened to me? I thought my identity would be such and such but now I just don’t know. So when you start addressing questions like that, those kinds of questions lead to a re-evaluation of yourself. And so along with recovery, along with feeling better, along with removing, or removing and recovering from these psychiatric symptoms, that you really want to recover from, along with that comes a new understanding as you start to delve into issues from the past. And so that’s where there’s an opportunity for what’s called post-traumatic growth. That through the process of talking about and questioning and dealing with, there’s a reckoning. And that reckoning can help you grow in ways you may not have imagined. You may realize things about yourself that you hadn’t really thought of before. You know, like you may realize things like previously when I thought about such and such, I just felt guilt about what I did. But now, as I think about it now, actually, I was pretty strong the way I stood up to so and the way I did such and such. And I feel, I actually feel proud of myself for that. That may not sound like a big deal, but it can really feel like a big deal if you’ve felt ashamed of yourself for so long.

Gabe Howard: Do you do you think there’s a lot of people who are suffering from trauma who just don’t realize it? And how do we reach those people? Because you can’t exactly go ask for help if you don’t know that you are in need of help, right?

Dr. Robert T. Muller: Well this is why trauma education is so important. There’s getting to be more and more education about this. I have an online therapy and mental health magazine called The Trauma & Mental Health Report where you know my students and I, we publish articles and they’re very, very straightforward articles written for general consumption. They’re not academic heavy kinds of articles. And we’re trying to teach people about what happens in trauma. We have a lot of stories. You know for example, one of my favorite stories is A Corporal Speaks: 10 Questions for a Soldier Who Served in Afghanistan. And he tells his story. This corporal who came back and happened to be a Canadian, and who served alongside Americans. And many of the stories relate actually to the American soldiers who he served with. And it’s just a really interesting story. And these stories and so we’re trying to teach about how people struggle with these things in a way that the general public can start to learn. Not just people in mental health or whatever academics who know about this stuff, but that people in the general population can start to learn about this. And I think there’s greater interest. There’s more interest lately I’ve noticed in the topic of disassociation, people who have been through trauma, many of them dissociate. So they check out. They sort of go absent at times, you know. Why do they do this? Because sometimes. emotional trauma can be so overwhelming that they lose focus and lose attention to that and start thinking about some totally different things. And that allows them to feel okay. But you know that can be very very challenging when you dissociate a lot in your everyday life. So there’s a little bit more knowledge about that in the general public. I mean I’m noticing increasingly. So I think it’s, I think it’s really about education. And I think what you guys are doing here with this podcast and other people, other mental health podcasts, are becoming much more commonplace and people are asking these questions. There’s more stuff out there. I think that I think is the way to get people to learn about this stuff.

Gabe Howard: We agree with everything you just said except other mental health podcasts. We’re completely unaware of any other podcast other than this one. Don’t search for them. No, just kidding. I just have a couple of more questions because we’re about out of time. But one is please talk about your book for a moment and where folks can find it. I’m assuming you’re going to say Amazon. And what got you interested in researching and writing about trauma in the first place? I imagine they go kind of hand-in-hand.

Dr. Robert T. Muller: Yeah, that’s for sure. So I’ll do the thing about the book. It’s called Trauma and the Struggle to Open Up: From Avoidance to Recovery and Growth. It is available on Amazon and mental health bookstores as well. So there’s a hardcopy and a Kindle as well. So. what got me interested in trauma is not a short answer, but also what originally got me interested is a little bit different than when I realized, you know years later when I worked in the field for a long time. Originally, I just thought it was you know an interesting research topic and my supervisor was interested in it in graduate school. But what I realized in my 40s, was that there was a much deeper unconscious reason, I think, that I really got drawn into it. And I also realized that much more so as I did my own psychotherapy. And that is that my parents were children during the Holocaust. And both of them actually were separated from their families, and I believe to some extent traumatized by the Holocaust to some extent. I would say that their childhoods were shaped in ways that you can never imagine. My father’s father was actually killed. My mother’s parents were not killed they were okay, but they were there. My mom was separated from them. She was only 6 years old. She was separated from her parents for months. And so it was terrifying for a 6-year-old. She had no idea where her parents were and they left her in the care of a non-Jewish woman. Again, this saved my mom’s life, but this was a terrifying experience for her. And so I grew up with stories about the Holocaust and with stories about what it was like to be a child during the Holocaust. What it means to lose your innocence as a child. What it means to lose your childhood as a child. And so those kinds of experiences I think to a very large extent shaped me. I believe that’s ultimately why I went into this. Why I went into this field and why I can connect with trauma survivors I think it’s that experience. That’s a fair answer.

Gabe Howard: Yes. Thank you so much.

Vincent M. Wales: Wow. Well thank you for sharing that story with us.

Dr. Robert T. Muller: No problem.

Vincent M. Wales: That’s really heavy. And thank you so much for being here and for informing us on trauma so that we can recognize it and deal with it when we have it.

Dr. Robert T. Muller: OK. Ok. My pleasure.

Vincent M. Wales: And remember, you can get one week of free, convenient, affordable, private online counseling anytime anywhere by visiting BetterHelp.com/PsychCentral. Thanks. We’ll see you next week.

Narrator 1: Thank you for listening to the Psych Central Show. Please rate, review, and subscribe on iTunes or wherever you found this podcast. We encourage you to share our show on social media and with friends and family. Previous episodes can be found at PsychCentral.com/show. PsychCentral.com is the internet’s oldest and largest independent mental health website. Psych Central is overseen by Dr. John Grohol, a mental health expert and one of the pioneering leaders in online mental health. Our host, Gabe Howard, is an award-winning writer and speaker who travels nationally. You can find more information on Gabe at GabeHoward.com. Our co-host, Vincent M. Wales, is a trained suicide prevention crisis counselor and author of several award-winning speculative fiction novels. You can learn more about Vincent at VincentMWales.com. If you have feedback about the show, please email [email protected].

About The Psych Central Show Podcast Hosts

Gabe Howard is an award-winning writer and speaker who lives with bipolar and anxiety disorders. He is also one of the co-hosts of the popular show, A Bipolar, a Schizophrenic, and a Podcast. As a speaker, he travels nationally and is available to make your event stand out. To work with Gabe, please visit his website, gabehoward.com.

Vincent M. Wales is a former suicide prevention counselor who lives with persistent depressive disorder. He is also the author of several award-winning novels and creator of the costumed hero, Dynamistress. Visit his websites at www.vincentmwales.com and www.dynamistress.com.

Podcast: There’s More to Trauma than PTSD

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Psychology Around the Net: April 6, 2019

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This week’s Psychology Around the Net dives into how to stop worrying about what other people think of you, ways to defeat procrastination, why pets can help boost physical and mental health (especially in older adults), and more.

Enjoy!

Stop Worrying About What Others Think of You: 7 Tips for Feeling Better: The fear of rejection is at the root of caring what someone thinks of you. Learn how to understand what “rejection” really means, use rejection (when it actually happens) as a brilliant opportunity for growth, how to embrace your individuality, and more to overcome your fear of rejection and truly stop worrying what other people think about you.

How to Defeat Procrastination with the Psychology of Emotional Intelligence: A step-by-step guide to overcoming procrastination by using the psychology of emotion regulation and emotional intelligence, with some extra tips and tricks to boot? Sign me up! (Additionally, you might want to find out how anxiety affects procrastination.)

Here’s One Big Way To Help Working Mothers Thrive: This new study tackles how to reduce a mother’s work-family conflict and employment-related guilt.

Why It’s a Problem If ‘Joker’ Connects Mental Illness to Villainy: While most portrayals of The Joker have involved a character backstory that’s mysterious, if not outright nonexistent, there are hints that this new Joker will include not only a backstory, but a backstory that includes mental illness linked to becoming a violent criminal. However, shouldn’t we pause and determine whether the story links mental illness in general with violent and criminal behavior, or whether the story features one character who has a mental illness that drove him to violent criminal behavior?

Poll: Pets Help Older Adults Cope with Health Issues, Get Active, and Connect with Others: According to a recent national poll, pets can help older adults deal with physical and mental health issues; however, for some (18 percent of participants), pets bring various strains (for example, financial burdens and problems that arise from putting a pet’s needs before your own). Which is it for you?

What We Know and Don’t Know about How Mass Trauma Affects Mental Health: Researchers are working to figure out who is at most risk of suicide and other types of self-harm after mass trauma events such as wars and political violence, natural disasters, and — especially prevalent in today’s troubled climate — mass shootings, including school shootings.

Psychology Around the Net: April 6, 2019

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How Trauma and Dissociation Disrupt Your Ability to Form Memories

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“Memories warm you up from the inside. But they also tear you apart.” Haruki Murakami

We all know from popular drama (TV shows, movies, etc.) that traumatic events are often forgotten by the sufferer. People who experience a devastating event such as a car accident, natural disaster, or terror attack often cannot remember the incident. It’s also common not to remember what took place right before or right after the incident. In a similar way, many adults who suffered child abuse have difficulty recalling large chunks of time from childhood. In these cases, problems with memory can continue into adulthood as well, particularly when faced with emotional distress.

Our brain and nervous system have evolved to do spectacular things: we can read, write, make music, and contemplate the meaning of life. But the brain’s first and foremost duty is to keep us alive. When it comes to traumatic events, the part of our brain that protects our physical and emotional well-being takes control. In this process, the parts of the brain that are responsible for higher thought processes, such as forming and retrieving memories, are suppressed.

How the Brain Forms Memories

On a regular stress-free day, memories for facts are made and stored in three steps: acquisition, consolidation, and retrieval.

  • Acquisition occurs through the combination of sensory experience and emotion. The amygdala processes and interprets the experience so it can become a memory.
  • The hippocampus consolidates the experience and sends the information off to the appropriate place for storage (memories are stored all over the brain).
  • It is thought that retrieval of factual memories occurs as a function of the prefrontal cortex. When we want to think of a fact, such as the definition of a word, the prefrontal cortex retrieves it and we remember.

When we are confronted with life-threatening danger, the brain behaves differently. The amygdala sends an emergency signal to the hypothalamus, which in turn activates the fight or flight response. Corticosteroids are then released into the bloodstream in order to prepare the body for action. Blood pressure, heart rate, and respiratory function all increase to provide the body and brain with extra energy and oxygen. Our alertness increases, and our body is ready to move.

When this is happening, the amygdala inhibits the activity of the prefrontal cortex. When faced with danger, this is useful, as the prefrontal cortex operates substantially slower. While it is trying to work out what is happening, our body may be harmed. The quicker, action-oriented part of the brain enables us to respond rapidly and try to avoid danger. We act fast. Later, once we are safe, we have time to think. In respect to memory, the parts of the brain involved in memory formation are shut down when faced with a traumatic experience.

The activation of the fight or flight response prevents the parts of the brain responsible for creating and retrieving memory from functioning effectively. This is why we can forget what occurred around a traumatic event. In the case of ongoing trauma, such as with childhood abuse, ongoing problems with memory and the related process can occur, leading to what is understood as dissociation.

Dissociation and Memories

At the heart of dissociation is memory disruption.At the heart of dissociation is memory disruption. During dissociation, the normally integrated functions of perception, experience, identity, and consciousness are disrupted and do not thread together to form a cohesive sense of self. People with dissociation often experience a sense that things are not real; they can feel disconnected from themselves and the world around them. Their sense of identity can shift, their memories can turn off, and the connection between past and present events can be disrupted.

In understanding the human response to trauma, it is understood that dissociation is a central defense mechanism because it provides a kind of mental escape when physical escape is not possible. This type of defense is often the only kind available for children living in abusive situations. Posttraumatic stress (PTSD) and complex posttraumatic stress (C-PTSD) often go hand in hand with dissociation. In studies investigating the impact of PTSD and memory, researchers have found that people with dissociative symptoms have a greater impairment with both working memory and long-term memory.

Long-Term Impact of Memory Impairment

To understand the long-term impact of memory impairment due to dissociation, we need to look at the context from which it arises. Dissociation occurs as a result of ongoing trauma which is associated with chronic stress. A chronically stressed brain and nervous system have difficulty learning. The hippocampus, critical for memory formation and consolidation, can become damaged from ongoing exposure to stress hormones. Researchers have found that the hippocampus actually shrinks in people who suffer from major depression. In addition to the emotional impact of chronic stress and abuse, difficulties with learning and memory can occur as well.

Implications range from difficulties with academics to reduced on-the-job learning and performance. In terms of survival, the implications are serious, as we all need the ability to prepare for, find, and keep employment. Unfortunately, once a person frees him or herself from an abusive childhood, the effects can follow into adulthood in unexpected ways. A damaged hippocampus and overactive nervous system can make life more difficult than it has to be. Over time, self-esteem and confidence can be negatively impacted as well.

Fortunately, the prognosis of dissociation can be optimistic. Researchers have found treatment with antidepressants can increase hippocampal volume. Talk therapy and other therapeutic approaches that are designed to reduce stress and increase emotional resilience may also help.

If you are experiencing trauma or dissociation, you can find a mental health professional here.

References

  1. Bedard-Gilligan, M., & Zoellner, L. A. (2012). Dissociation and memory fragmentation in post-traumatic stress disorder: An evaluation of the dissociative encoding hypothesis. Memory, 20(3), 277-299. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22348400
  2. Lanius, R. A. (2015). Trauma-related dissociation and altered states of consciousness: A call for clinical, treatment, and neuroscience research. European Journal of Psychotraumatology, 6(1), 27905. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439425
  3. Nuwer, R. (2013, August 1) Why can’t accident victims remember what happened to them? Smithsonian. Retrieved from https://www.smithsonianmag.com/smart-news/why-cant-accident-victims-remember-what-happened-to-them-21942918
  4. Özdemir, O., Özdemir, P. G., Boysan, M., & Yilmaz, E. (2015). The relationships between dissociation, attention, and memory dysfunction. Nöro Psikiyatri Arşivi, 52(1), 36-41. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5352997
  5. Phelps, E. A. (2004). Human emotion and memory: Interactions of the amygdala and hippocampal complex. Current Opinion in Neurobiology, 14(2), 198-202. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15082325
  6. Rosack, J. (2003, September 5) Antidepressants may prevent hippocampus from shrinking. Psychiatric News. Retrieved from https://psychnews.psychiatryonline.org/doi/full/10.1176/pn.38.17.0024
  7. Sapolsky, R. M. (2001). Depression, antidepressants, and the shrinking hippocampus. Proceedings of the National Academy of Sciences, 98(22), 12320-12322. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045

© Copyright 2019 GoodTherapy.org. All rights reserved. Permission to publish granted by Fabiana Franco, PhD, therapist in New York City, New York

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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To Others Who Have Experienced Trauma as Children

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Most of us have real anger and suffering living inside us. Perhaps in the past we were oppressed or mistreated, and all that pain is still right there, buried in our store consciousness. We haven’t processed and transformed our relationship with what happened to us and we sit there alone with all that anger, hatred, despair and suffering. If we were abused when were young, every time our thinking mind goes back over that event, it’s like we’re experiencing the abuse all over again.– Thich Nhat Hahn

The #MeToo movement, including Dr. Ford’s testimony on the Senate floor in 2018, was an eye-opener for many of us. Even though I personally had experienced sexual assault and figured others had too, I was not prepared for the staggering number of brave women and men who publicly came forward to share their experiences of pain and violation. I also wasn’t prepared for the amazing feeling that this movement could actually change the climate that our daughters and sons grow up in.

By the time most of us reach adulthood, we have experienced some form of trauma, ranging from heartbreak to the more intense physical, sexual, and emotional abuse. Though the actual trauma may have been experienced decades ago, often there are hidden tender and hurting spaces in its wake.

Healing is a lengthy process, even years after the event, things can happen that “trigger” a traumatic response. That is, current events in our lives that are not directly related to the trauma we experienced can evoke a reaction that is more intense than the situation at hand deserves. What happens when we are overreactive is that we are no longer in the present. However, by being aware of when we are triggered, and working on maintaining our calm and presence, we are, in fact, helping our children and ourselves.

Psychologists who study the long-reach of trauma will note that when your child enters the age that the parent was when they experienced a traumatic event, a deep part of them will relive the experience. This is beyond a simple remembering of the event — it is as if we’re actually re-experiencing the trauma. This is critical to keep in mind so that we are not blind-sided when the kids reach that age in which we experienced a significant loss or abuse.

I believe the human system is built this way so we can heal unresolved issues from our earlier wounding. It also may be a survival mechanism, in that our hypervigilance helps us protect our children by warning them of dangers in their environment. However, like most automatic survival mechanisms, these processes can take on a life of their own. That is why it’s critically important to use these uncomfortable situations as opportunities to set the course for the next generation. To harness the hidden power in these circumstances by becoming aware of when you’re triggered and before stepping into overreaction, use the trigger as a signal to get centered.

How do you know when you’re triggered? For me, all of a sudden I feel overly anxious, overly angry, or conversely, like I want to withdraw and hide. I examine whether or not a real danger is evident. In nearly every single case of being triggered, there actually is no real danger (if there is, please address it immediately and maybe even get backup help).

If there is no real danger, this is the critical moment. Breathing deeply and naming feelings “worried, scared, agitated”, can lead to healing. Yes, it’ll reduce the likelihood that you’ll act from the wounded place, but it will also help you soothe the hurting places. As if you were a loving parent to yourself, nurturing and healing the wounded places.

I’ve noticed that being kinder to myself reduces the likelihood that I’ll act out from the painful residue of the trauma. It’s an act of cultivating unconditional friendliness towards ourselves. We embrace the scared and vulnerable parts of ourselves, instead of pushing the challenging emotions away through reacting or overreacting.

When I am in a triggered phase (which when it is really bad, can last for most of a day and even span a couple days), I start my day by talking to the wounded little girl inside of me. I place a hand on my heart and on my abdomen (the Grounding Hand Posture), and I tell my younger self that I (the adult protectress) am here now. I comfort those wounded places within me with the knowledge that I am present and in charge, and that I will guide the hurt parts of myself with my mature wisdom, with strength and with kindness.

By emotionally taking care of ourselves through tending the emotional wounds and anxieties, we are less likely to act from the painful residual trauma. And we begin to remove the fear of our own emotions, which only serves to separate us from our self and those we love.

Use your triggers as an opportunity to deepen your friendship with yourself. Call upon your courage, which you likely have in spades. You’ll be more connected to the reality of the present moment. This, in turn, will increase the likelihood that your actions will arise from the most centered part of you.

Compassionately paying attention to ourselves has added benefits — of interrupting the transmission of trauma between generations, and of drawing any lingering shameful feelings out of the darkness and into the light. These earlier challenging experiences can become our opportunity to embrace ourselves with unconditional friendliness, to change the social climate that our children grow up in, and to powerfully reclaim our truth as we stand in solidarity.

To Others Who Have Experienced Trauma as Children

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8 Reasons Why Your Depression May Not Be Getting Better

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You’ve been to four psychiatrists and tried over a dozen medication combinations. You still wake up with that dreadful knot in your stomach and wonder if you will ever feel better.

Some people enjoy a straight path to remission. They get diagnosed. They get a prescription. They feel better. Others’ road to recovery isn’t so linear. It’s full of winding bends and dead-ends. Sometimes it’s entirely blocked. By what? Here are a few impediments to treatment to consider if your symptoms aren’t improving.

1. The Wrong Care

Take it from the Goldilocks of mental health. I worked with six physicians and tried 23 medication combinations before I found the right psychiatrist who has kept me (relatively) well for the last 13 years. If you have a complex disorder like I do, you can’t afford to work with the wrong doctor. I would highly recommend that you schedule a consultation with a mood disorders center at a teaching hospital near you. The National Network of Depression Centers lists 22 Centers of Excellence located across the country. Start there.

2. The Wrong Diagnosis

According to the Johns Hopkins Depression & Anxiety Bulletin, the average patient with bipolar disorder takes approximately 10 years to receive the proper diagnosis. TEN YEARS. About 56 percent are first diagnosed incorrectly with major depressive disorder, leading to treatment with antidepressants alone, which can sometimes trigger mania.

In a study published in the Archives of General Psychiatry, only 40 percent of participants were receiving appropriate medication. It’s pretty simple: if you’re not diagnosed correctly, you won’t get the proper treatment.

3. Non-adherence to Medication

According to Kay Redfield Jamison, Ph.D., Professor of Psychiatry at Johns Hopkins University and author of An Unquiet Mind, “The major clinical problem in treating bipolar illness is not that we lack effective medications. It is that bipolar patients do not take these medications.” Approximately 40 to 45 percent of bipolar patients do not take their medications as prescribed. I’m guessing the numbers for other mood disorders are about that high. The primary reasons for non-adherence are living alone and substance abuse.

Before you make any major changes in your treatment plan, ask yourself if you are taking your meds as prescribed.

4. Underlying Medical Conditions

The physical and emotional toll of chronic illness can muddy the progress of treatment from a mood disorder. Some conditions like Parkinson’s disease or a stroke alter brain chemistry. Others like arthritis or diabetes impact sleep, appetite, and functionality. Certain conditions like hypothyroidism, low blood sugar, vitamin D deficiency, and dehydration feel like depression. To further complicate matters, some medications to treat chronic conditions interfere with psych meds.

Sometimes you need to work with an internist or primary care physician to address the underlying condition in tandem with a mental health professional.

5. Substance Abuse and Addiction

According to the National Institute on Drug Abuse (NIDA), people who are addicted to drugs are approximately twice as likely to have mood and anxiety disorders and vice versa. About 20 percent of Americans with an anxiety or mood disorder, such as depression, also have a substance abuse disorder, and about 20 percent of those with a substance abuse problem also have an anxiety or mood disorder.

The depression-addiction link is both strong and detrimental because one condition often complicates and worsens the other. Some drugs and substances interfere with the absorption of psych meds, preventing proper treatment.

6. Lack of Sleep

In a Johns Hopkins survey, 80 percent of people experiencing symptoms of depression also suffered from sleeplessness. The more severe the depression, the more likely the person will have sleep problems. The reverse is also true. Chronic insomnia creates a risk for developing depression and other mood disorders, including anxiety, and interferes with treatment. In persons with bipolar disorder, inadequate sleep can trigger a manic episode and mood cycling.

Sleep is critical to healing. When we rest, the brain forms new pathways that promote emotional resilience.

7. Unresolved Trauma

One theory of depression suggests that any major disruption early in life, like trauma, abuse, or neglect, may contribute to permanent changes in the brain. According to psychiatric geneticist James Potash, M.D., stress can trigger a cascade of steroid hormones that likely alters the hippocampus and leads to depression.

Trauma partly explains why one-third of people with depression don’t respond to antidepressants. In a study recently published in Scientific Reports, researchers uncovered three subtypes of depression. Patients with increased functional connectivity between different brain regions who had also experienced childhood trauma were categorized with a subtype of depression that was unresponsive to selective serotonin reuptake inhibitors like Zoloft and Prozac. Sometimes, then, intensive psychotherapy needs to happen alongside medical treatment in order to reach remission.

8. Lack of Support

A review of studies published in General Hospital Psychiatry assessed the link between peer support and depression and found that peer support helped reduce symptoms of depression. In another study published by Preventive Medicine, teens who had social support were significantly less likely to become depressed after experiencing work or financial stress in early adulthood than those without support. Depression was identified among conditions affected by loneliness in a paper published in the American Journal of Public Health. Persons without a support network may not heal as quickly or as completely as those with one.

8 Reasons Why Your Depression May Not Be Getting Better

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7 Ways to Help a Child Deal with Traumatic Stress

This is an interesting article I found on: www.psychcentral.com

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Life is stressful. That’s a fact. To grow and learn we must try new things. Struggling, prevailing, and tolerating failures along the way builds confidence and the deep feeling in a child that “I can do it.” But the positive aspects of struggle and stress are lost when the amount of stress becomes too great and/or sustained.

Persistent and long-lasting stress on the mind and body caused by overwhelming emotions leads to traumatic stress, a condition characterized by a nervous system in overdrive. The brain’s emotional centers lock into a state of DANGER and the body operates in fight, flight, and freeze modes.

Traumatic stress feels awful. The body tenses and succumbs to many other physiological changes leading to digestive problems and headaches, for example. Furthermore, children overwhelmed by emotions can’t engage positively in learning as curiosity in the outside world is a byproduct of a calm nervous system, not one that’s in a state of high alert.

Imagine for a moment what it feels like when you are terrified. Do you feel well? Do you feel like learning, engaging in life, socializing with others? No! When children and adults alike are terrified, we want to run away, hide, and find safety again as soon as possible so we feel better. When we are scared, we feel vulnerable and insecure. After a while, we feel hopeless, numb and even dead inside. Depression, chronic anxiety, substance abuse, isolation, and aggression, are all symptoms of traumatic stress.

So, what can be done to help a child experiencing traumatic stress? Help them to feel calmer. Here are 7 ways:

1. Be with them — connection is soothing.

John Bowlby, the father of Attachment Theory, taught us that children need to feel safe and secure to thrive. It may seem elementary, but the first aspect of creating safety for a child is being there so a connection can be established.

A child with traumatic stress is scared (even if they don’t appear so on the outside, like how a bully or aggressive child may present). Simply having someone in the room can be a comfort even when there is push-back from the child. Being alone heightens fear.

2. Be gentle so as not to inadvertently startle or jar a child.

A child suffering traumatic stress is fragile and prickly, a byproduct of a hyper-aroused nervous system. We live in a very left-brain dominant culture where we don’t talk nearly enough about emotional safety conveyed through right brain communications. Right-brained communications are the non-verbal cues we unconsciously pick up from one another. Right-brain communications include tone of voice, eye contact, and body language.

Adults should strive to speak in a gentle, calm voice with soft eyes and slow movements to avoid jarring or startling a child. Just think about how you like to be approached when you are upset.

3. Play fosters safe positive connection, and positive connection is calming.

Play feels good and healthy for all people no matter what age. According to Polyvagal theory, play stimulates the social engagement system of the vagus nerve, the body’s largest nerve, and therefore relaxes the nervous system.

Play helps a child feel better and calm down. But play involves so much more than a game. It involves connection, smiling, speaking with a cheery and playful tone of voice, and movement. All of those actions calm a child.

It may seem counter intuitive to initiate play with a child under stress, but if they are receptive, it gives the nervous system a chance to calm down. Even if for a little while, a moment of playfulness is good.

4. Help a child name their feelings.

Putting language on emotions helps calm down the nervous system. We can use stories, our own personal stories or ones we create, to help a child put language on their emotions. For example, a mother could share with her traumatized child, “When I was little, my mother went away for a long time. She was sick, so she had to go to where doctors could help her. Even though I understood why she went away, I was still so sad and scared. And, sometimes I even felt angry at her for not being there for me. All those feelings are so natural.”

There are many ways to help children put language on their feelings. You can show them drawings of little faces with many feelings and they can point to the ones they relate to. You can help a child name their feelings with games, drawings, and puppets.

5. Help a child express their feelings.

Emotions contain impulses that generate biological energy. This energy needs to be expressed so it doesn’t get pent-up inside. For example, if a child is in danger, their brain will trigger fear. Fear sends signals throughout the body, setting off impulses to run. But if a child is in a situation where they cannot run to safety, like being restrained by Mexican border patrolmen, all that energy gets trapped in the body and leads to symptoms of traumatic stress.

Helping a child express their emotions can be done in a variety of creative ways, such as the through art, play, stories, fantasy, puppets, or by helping the child verbally or physically express themselves. You should feel free to experiment and take your cues from the child for what works best. Cues to look for that indicate you are helping a child are expressions of relief, happiness, calm, and a desire to play and connect more. If an intervention is not helping, you’ll see a child’s face and body demonstrate more tension, sadness, anger, rigidity, and withdrawal.

6. When a child accepts it, give hugs and other physical affection.

Holding, rocking, stroking, hugging, and swaddling can help soothe a stressed nervous system. Again, take your cues from the child. If they don’t like something, don’t do it. You can tell by the way the child looks and reacts if they are responding positive or negatively. If they stiffen, it’s a protest. If they relax and soften, that’s a green light.

7. Reassure a child and help them make sense of what’s happening.

A little reassurance goes along way. Be explicit! Say things like, “You will be ok,” “This feeling is temporary,” “You are not alone,” “It’s not your fault,” and, “You don’t deserve this.”

Don’t lie to a child. Do look for truthful ways you can reassure them that they are safe now and will not be alone. Explain what has happened and what is currently happening. For example, in the case of parental separation, “Mommy and daddy are safe and soon you will see them again. Until then, we’ll be together every day and I’ll take care of you.” Reassuring a child that they didn’t do anything bad and that they matter helps because children internalize shame, a sense that they are bad or unworthy when they feel bad.

Humans are wired for connection and thrive in conditions of safety and security. When safety and security is compromised, we must do everything we can to restore a child’s sense of safety and security as fast as possible. There are many educational resources available to adults that teach how to minimize stress and foster recovery in children. The cost to our society is great when our children suffer.

7 Ways to Help a Child Deal with Traumatic Stress

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When Stress Is a Headache: The Link Between Trauma and Migraines

This is an interesting article I found on: www.goodtherapy.org

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Migraine headaches are one of the most common chronic conditions worldwide. Depending on the study, chronic migraines affect around 1 in 10 people, with twice as many sufferers being female.

Migraine headaches are disabling and cause significant loss of productivity and quality of life. Once they strike, a migraine can last anywhere between 4 and 72 hours. In addition to substantially reducing quality of life, frequent migraines can place one’s job at risk and prevent daily functioning.

Currently, the causes of migraine headaches are not well understood. Genetics are thought to play a role as well as environmental effects and changes in the way the brain interacts with the trigeminal nerve, a pain pathway.

Maladaptive Response to Stress?

It may be that migraine headaches are a result of the brain’s maladaptive response to stress. Researchers have found that when a migraine is triggered, the body’s responses (pain, increases in stress hormones, nausea, and vomiting) are in excess of what is normal. Even during migraine-free periods, a migraine sufferer’s brain is more excitable in response to stimuli.

If we understand how the brain operates on a neural level, we know that much of what is going on inside the brain is inhibitory. It is not optimal to have cascades of neurochemicals circulating through the brain. Overexcitability in the brain reduces the effectiveness of the calming mechanisms in the brain and increase pain sensitivity. What this means is the brain’s response to stimuli between attacks is heightened in an abnormal way.

We know the experience of stress is a significant factor in migraines. Work stress and home stress contribute to the likelihood of a migraine episode.

Childhood Trauma and Headaches

We know that too much stress can change the brain and its reactivity to one’s inner environment, or thoughts, and one’s outer environment, or lights, sounds, and other stimuli. Adults who were exposed to ongoing stress or trauma while growing up often have an impaired ability to calm themselves both mentally and physiologically in response to stress.

A difficult childhood is not a life sentence of heightened stress and suffering. We can take steps to alter our response to stress.

When we look at migraine sufferers as a group, we see a connection between adverse childhood experiences (ACE) and migraine headaches. Examples of ACE are domestic violence, emotional neglect, emotional abuse, and sexual abuse.

Researchers have also begun to investigate the connection between adverse childhood experiences and headaches. Individuals who suffer from migraine headaches are more than twice as likely to have experienced ACEs such as domestic violence while growing up.

How Trauma Results in Migraine: A Possible Mechanism

The connection between childhood stress and migraines is likely linked, at least in part, through the hypothalamic-pituitary-adrenal axis (HPA axis).

The HPA axis is a complex set of interactions among the pituitary gland and the adrenal glands. This hypothalamic-pituitary-adrenal axis controls and regulates bodily processes related to stress reactions. It is easily understood as the fight or flight response. When an individual senses a threat, the body reacts appropriately. Energy is taken away from the digestive and immune systems and is moved to the muscles in order to get ready to run or fight. The adrenal glands are stimulated, and heart-rate, blood pressure, and breathing rates increase. This is an energy-expending state and not optimal for growth or restorative activities.

It is well understood that repeated exposure to stress and trauma during childhood often results in an impaired ability to regulate the stress response over one’s lifetime. Childhood trauma affects the HPA axis. What this means is that over time, the HPA axis loses its ability to effectively control the stress response. During times of upset, the person has an intense reaction that lasts too long. The result is overexposure of the body and brain to high levels of the stress hormone, cortisol.

Migraines may be tied to the same neurochemical conditions associated with trauma, depression, and anxiety, with an overactive stress response (de-regulation of the HPA axis) playing a role. An investigation into certain neurochemicals in migraine sufferers found abnormal patterns of hypothalamic hormonal secretion, a condition also associated with trauma and child abuse.

What Can We Do to Help?

A difficult childhood is not a life sentence of heightened stress and suffering. We can take steps to alter our response to stress. Exercise and meditation have been shown to help calm the mind and body. These activities can begin to reverse the damage caused by an overactive HPA axis. Cognitive behavioral therapy (CBT) is also an effective tool for learning coping strategies and allows individuals to take greater control of reactions to daily life events that cause stress.

Research on migraines and childhood trauma is relatively new and is not well understood. However, if we understand that stress plays a role in migraines, taking steps to reduce stress may help reduce the frequency and duration of migraine episodes. At the very least, a reduction in stress can help us in every area of life, giving us more resilience to deal with a migraine once triggered.

If you think stress or trauma are a source of migraines for you, learning how to manage your stress response in therapy could help. Begin your search for a licensed and compassionate counselor here.

References:

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  2. Brennenstuhl, S., & Fuller‐Thomson, E. (2015). The painful legacy of childhood violence: Migraine headaches among adult survivors of adverse childhood experiences. Headache: The Journal of Head and Face Pain, 55(7), 973-983. doi: 10.1111/head.12614
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  8. Lubin, E. (2018). Migraine headache FAQs. Retrieved from https://www.emedicinehealth.com/migraine_headache_faqs/article_em.htm
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  10. Peres, M. F. P., Sanchez del Rio, M., Seabra, M. L. V., Tufik, S., Abucham, J., Cipolla-Neto, J., Silberstein, S. D., & Zukerman, E. (2001). Hypothalamic involvement in chronic migraine. Journal of Neurology, Neurosurgery, and Psychiatry, 71, 747-751. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1737637/pdf/v071p00747.pdf
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  12. Woldeamanuel, Y., & Cowan, R. (2015). Worldwide migraine epidemiology: Systematic review and meta-analysis of 302 community-based studies involving 6,216,995. Neurology, 86(16). Retrieved from http://n.neurology.org/content/86/16_Supplement/P6.100

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